BET 23 THE Metropolitan Borough of Bethnal Green, REPORT ON THE HEALTH OF THE BOROUGH DURING THE YEAR 1920. BY GEOFFREY EUGENE OATES, M.D., 8.5., (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: Primed by Vail & Co. (T.U.) 170 Farringdon Road, E.C.I. 1921. Town HALL, BETHNAL GREEN, E.2. June, 1921. 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 my second Annual Report, which deals with the Health of the Borough of Bethnal Green for the year 1920. The year has been one of steady progress in health matters, and a determined and partly successful effort has been made to cope with the arrears of work arising out of the long period of the War. This has necessitated some increase in staff, generously and wisely provided by yourselves, and the formation of a Housing Section within the Public Health Department. There has been great activity in dealing with housing questions throughout the year, and if the results of such activity are disappointing it is not due to any lack of foresight and enthusiasm on the part of yourselves, or lack of zeal on the part of your officers. However, although there are no new houses or cleared slum areas in evidence so far, it must not be forgotten that there has been in progress throughout the year a large amount of repair and improvement of individual houses resulting from the work of the sanitary inspectors. In the following report I have only touched on housing questions so far as they concern myself as a Health Officer, and have not attempted to deal with the important question of re-housing, with which your Town Clerk and Borough Surveyor are more concerned. Owing to the need for economy this Report] is much abridged, and much information of minor importance as well as some statistical summaries have been omitted. I should like to take this opportunity of thanking the Members of the Council, and more particularly the Public Health and Housing Committees, for the support and consideration they have accorded myself and my staff during the past year. 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 COMMITTER, 1920-1921 Meetings held at the TOWN HALL on the first and third Wednesdays, at 7 p.m. Councillor F. W. Wright, Chairman. Councillor C. N. Murphy, Vice-Chairman. The Mayor (Councillor J. J. Vaughan) Alderman T. J. Boyce, Alderman J. J. Fleming, J.P. Alderman Mrs. H. .Jeffccte. Councillor W. H. Bryant. Councillor A. H. Gillison. H. Fitt. „ E. C. E. Lear. „ Miss James, J.P. „ Rev. G. E. A. Whitworth, „ W. A. Warden. 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. W. Hovell. Baths T. F. H. French. Electricity J. J. Cunningham. Valuation J. Valentine. Public Libraries W. Windsor. 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' as on December 31st, 1920. Geoffrey Eugene Oates, M.D., M.R.C.P. London, D.P.H. Cambridge, Barrister-at-Law, Medical Officer of Health and Administrative Tuberculosis Officer. John Foot, Chief Sanitary Inspector and Housing Superintendent. Alfred W. Stokes, F.C.S., F.I.C., Public Analyst. Evan Richards, Deputy Chief Sanitary Inspector. Sanitary Inspectors. E. Ainley. E. J. Jenkins. F. T. Bare. J. R. Jones. W. Billings, Junr. Miss A. F. Murphy. G. I. Brighting. W. Rowsell. A. S. Henley. J. 0. G. Weeks. J. H. Hewitt. Health Visitors. Miss C. R. Brown, Superintendent. Miss V. D. Cornish. E. M. Squier. Mrs. E. L. Hann. „ E M. Patrick. Miss L. F. Wright. Mrs. M. A. Hodgkins. Mrs. F. M. Barden. Miss E. S. Crisp (Tuberculosis). Mrs. A. W. Rosling. J. Henry Lloyd, Chief Clerk. (Vacancy) Senior Assistant Cleric. F. G. Thomas, Assistant Clerk. F. J. Bryant, Shorthand Typist. R. W. Slyfield, Assistant Clerk. G. E. Gould. S. Slater, Junior Clerk. H. A. Saunders, General Assistant. W. H. Heron, „ „ TEMPORARY STAFF. Mrs. M. Radford, Medical Officer (Maternity and Child Welfare Centre). Mrs. K. Addison, Mrs. E. F. Iredell, Mrs. O. Langmead. Mrs. J. P. Smyth, W. F. Mayo, Sanitary Inspector. S. H. Taylor, L. A. Taylor, Assistant Clerk. J. Godwin, Assistant Clerk (Housing). Miss C. Lane, „ „ (Housing). Miss E. Packman, (Maternity and Child Welfare). Clinical Tuberculosis Officers (appointed by the Governors of the City o£ London Hospital for Diseases of the Chest). Senior, H. Tylford Howell, M.R.C.S. L.R.C.P. London. Junior, F. W. Hamilton, M.8., B.S. London, D.P.H. Oxon. Also Fuel Overseer. Also Assistant Fuel Overseer PUBLIC HEALTH DEPARTMENT. STAFF. CHANGES IN 1920. Sanitary Inspectors. Mr. E. J. Jenkins and Miss A. F. Murphy were appointed as Sanitary Inspectors, and took up their duties on the 3rd May, 1920. Clerical Staff. Mr. E. Q. Bilham, Chief Clerk, resigned on the 20th May, 1920. Mr. J. Henry Lloyd, formerly Chief Clerk in the Public Health Department, Hounslow, was appointed Senior Assistant Clerk, and subsequently, upon the resignation of Mr. Bilham, was appointed Chief Clerk. Mr. H. W. Fendrill, Assistant Clerk, resigned on the 5th June, 1920. Messrs. F. J. Bryant and G. E. Gould have been appointed as Shorthand Typist and Assistant Clerk respectively. Health Visitors. Miss E. M. Squxer, Miss E. M. Patrick, Mrs. E. L. Hann, and Miss L. F. Wright, formerly employed at the voluntary Maternity and Child Welfare Centres taken over by the Council on the 1st April, 1920, together with Miss V. D. Cornish, formerly employed in a temporary capacity, were all appointed as Health Visitors. Vital Statistics of Bethnal Green during 1920 and Previous Years. Population estimated to Middle of each year. 2 Births. Total Deaths. Registered in the District. Nett Deaths belonging to the District. Transferable Deaths. Under 1 Year of Age. At all Ages. Number. 6 Uncorrected Number. 3 Nett. Rate. 7 Year. 1 Of Nonresidents registered in the District 8 Of Residents not registered in the District. 9 Rate per 1 000 Nett Births. 11 Number. 4 Rate. 5 Number. 10 Number. 12 Rate. 13 434 127,662 3,786 29.6 2,113 16.5 1914 3,609 368 519 137.0 2,047 16.0 3,514 27.5 17.9 502 120,207 2,152 1915 3,314 441 415 118.0 2,091 17.4 115,552 3,171 3,438 1,784 15.5 445 27.4 1916 425 365 106.0 1,764 15.3 2,710 425 107,362 2,409 22.6 1,665 15.5 1917 435 299 110.3 1,675 15.6 103,403 1,761 2,220 19.2 2,331 22.5 1918 384 542 289 130.2 2,488 24.1 110,085 2,564 1,517 2,242 22.4 13.8 1919 366 412 218 80 1,563 14.2 114,471 3,346 3,857 33.7 1,626 14.2 320 1920 365 94.6 1,715 398 15.0 Deaths Registered during 1920 in Bethnal Green Classified by Age and Cause. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "Non- Residents " in Institutions in the District. Under 1 year. 5 and under 15 years. 25 and under 45 years 45 and under 65 years. 65 and upwards Causes of Death. 1 and under 2 years. 2 and under 5 years 15 and under 25 years All Ages. 2 3 4 5 6 7 11 1 9 8 10 All causes Certified Uncertified 91 .. 70 .. 225 86 .. .. .. 947 .. 1715 .. 365 .. 407 91 .. 380 .. 1. Enteric Fever 1 2 .. .. .. 1 .. .. .. 2. Small-pox .. .. .. .. .. .. .. .. .. .. 3. Measles 62 14 31 17 .. .. 45 4. Scarlet Fever 12 .. .. .. .. .. 2 4 4 1 1 .. 5. Whooping Cough 55 29 12 .. 12 14 .. 34 .. .. .. .. 6. Diphtheria and Croup 36 4 7 13 11 .. 1 3 .. .. 7. Influenza 62 3 2 5 3 7 20 19 3 32 8. Erysipelas 6 2 1 .. 1 2 4 9. Pulmonary Tuberculosis 173 .. .. .. .. 1 3 29 70 58 12 115 .. 10. Tuberculous Meningitis 13 2 1 8 2 .. .. .. .. 15 11. Other Tuberculous Diseases 11 1 3 3 3 .. 1 .. 7 .. 12. Cancer, malignant disease 119 .. 2 .. 17 69 31 61 .. 6 .. 1 2 .. 4 13. Rheumatic Fever .. .. 2 1 .. 16 14. Meningitis (not tuberculous) 10 2 2 2 1 .. 1 1 1 16. Organic Heart Disease 201 1 .. 7 7 27 56 103 127 .. 16. Bronchitis 162 32 4 1 .. .. 10 45 70 65 17. Pneumonia (all forms) 177 69 16 6 7 14 28 15 93 22 24 .. 16. Other diseases of respiratory organs 5 1 .. .. 11 7 15 .. 19. Diarrhœa and Enteritis 51 45 3 2 .. .. .. 1 59 .. 20. Appendicitis and Typhlitis 8 2 1 3 1 1 .. 4 .. .. 21. Cirrhosis of Liver 2 .. 2 .. 1 .. .. .. .. .. 3 14 10 17 22. Nephritis and Bright's Disease 32 .. .. 1 4 .. 23. Puerperal Fever 3 .. .. 1 2 .. .. 1 .. .. 24. Other accidents and diseases of Pregnancy and Parturition 7 .. .. .. 7 .. .. 3 25. Congenital Debility and Malformation, including Premature Birth .. .. 94 .. .. .. .. .. 59 94 .. .. 26. Violent Deaths, excluding Suicide 46 7 2 2 11 .. 8 9 7 14 27. Suicide 21 2 5 11 3 1 .. .. .. .. 33 78 115 152 28. Other Defined Diseases 318 55 3 1 12 21 29. Diseases ill-defined or unknown 2 .. .. 1 1 .. .. .. .. .. 1715 365 91 70 86 407 380 947 91 Totals 225 8 POPULATION. The population of this Borough for the middle of 1920 is estimated by the Registrar-General at 114,471. The figure obtained at the last Census in 1911 was 128,183. MARRIAGES. The number of marriages celebrated in Bethnal Green during 1920 was 1,124. This is equal to a rate of 19 6 persons married per 1,000 total population. BIRTHS. The number of births registered in the Borough during 1920 was 3,346, and in addition 511 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 3,857 births. The birth rate for 1920 was therefore 33.7 births per 1,000 of population. This compares with: 1914 29.6 1915 27.5 1916 27.4 1917 22.6 1918 19.2 1919 22.4 The birth rates in the four quarters of the year were:— First quarter 41.8 Second „ 34.4 Third „ 30.6 Fourth „ 27.6 9 ILLEGITIMACY. Of the 3,857 births credited to this Borough, 89 were illegitimate, or 2.3 per cent, of the total. DEATHS. The number of deaths that were registered during the year as having taken place in the Borough was 1,626. Of these, 320 were of persons whose residence was not in Bethnal Green, 315 dying in Bethnal Green institutions, and 5 in other places in the Borough. There were also reported to the Registrar- General 398 deaths of Bethnal Green persons who died in institutions in other parts of London, and 11 who died in other parts of England and Wales. This correction gives the net number of civil deaths for Bethnal Green as 1,715, making an annual death rate of 14 9 per 1,000 of civil population. Death rates of previous years are:— 1914 16.0 1915 17.4 1916 15.3 1917 15.6 1918 24.1 (influenza pandemic) 1919 14.2 There were no uncertified deaths during the year. Cases of Notifiable Diseases Notified during the Year 1920 in Bethnal Green. Number of Cases Notified. All Ages. At Ages—Years. Disease. Under 1. 5 and under 15 years 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards 1 and under 5 years. 1 Small Pox .. 1 .. .. .. .. .. .. Cholera (C) Plague (P) - .. .. .. .. .. .. Diphtheria (including Membranous Croup) 580 13 174 326 50 15 1 1 Erysipelas 133 9 7 17 18 30 37 15 259 60 22 .. Scarlet Fever 1070 6 723 .. Typhus Fever - .. .. .. .. .. .. .. Enteric Fever 5 .. .. .. 2 3 .. .. Relapsing Fever (R) Continued Fever (C) - .. .. .. .. .. .. .. Puerperal Fever 10 .. .. .. 3 7 .. .. Cerebro-spinal Fever 7 3 4 .. .. .. .. .. Acute Poliomyelitis 3 1 1 1 .. .. .. .. Acute Encephalitis Lethargica 6 .. .. 4 .. 2 .. .. Ophthalmia Neonatorum 29 29 .. .. .. .. .. Acute Polio-encephalitis .. 1 .. .. 1 .. .. .. .. Dysentery 1 .. .. .. .. 1 .. .. Malaria 42 .. .. .. 7 31 4 .. Acute Primary Pneumonia 105 5 36 29 10 17 7 1 Acute Influenzal Pneumonia 66 .. 11 12 9 23 8 3 Pulmonary Tuberculosis 270 .. .. 27 52 107 77 7 Other forms of Tuberculosis 65 .. 8 36 7 12 2 .. 2394 66 27 Total 494 1183 218 270 136 11 SMALL-POX. In May a child of 15 months who had been vaccinated was notified as having Small-pox. Further investigation, however, showed that the case was really one of severe Chicken-pox, and the child was admitted to Bethnal Green Hospital. It was fortunate that the case proved not to be Small-pox, as it occurred in a densely populated block of flats. Owing to the effective protection afforded by vaccination, Small-pox in a vaccinated child of 15 months is very unlikely to occur, and such cases invariably prove to be Chicken-pox. During the year 12 individuals who had been in contact with Small-pox were reported to me and kept under close observation for the period of a fortnight, within which the disease might develop. None of these persons contracted the disease. Ten of them were soldiers from a vessel on which a case of Smallpox had occurred. One person had recently arrived from an infected port in Spain, and the remaining person had visited by mischance a hospital ward in which a case of Small-pox was shortly afterwards detected. TYPHOID FEVER. Five cases were notified. In no case was it possible to ascertain the source of infection. Two deaths from the disease occurred. TYPHUS FEVER. One man who had been in contact with a case on board a steamship was kept under observation. 12 DIPHTHERIA. There were 580 cases of Diphtheria notified during the year. Of these there were 13 cases under the ace of 1 year, 174 between the ages of 1 and 5 years, 326 between the ages of 5 and 15 years, 50 between the ages of 15 and 25 years, 15 cases between the ages of 25 and 45 years, 1 case between the ages of 45 and 65 years, and 1 case over the age of 65 years. Of the 580 cases, 566 were removed to an Isolation Hospital. In 24 instances the Hospital authorities reported the diagnosis to be incorrect. Thirty-six deaths from this disease occurred during the year, 34 of which took place at hospitals. Comparison with previous years is as follows: — 1915 39 deaths 1916 26 1917 19 1918 26 1919 58 A little 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 a delay of some hours, or even a day or two. The delay did not at any time equal that experienced in 1919. SCARLET FEVER. There were 1,070 cases of Scarlet Fever notified during the year. 13 Of these, there were 6 cases under the age of 1 year, 259 cases between the ages of 1 and 5 years, 723 cases between the ages of 5 and 15 years, 60 cases between the ages of 15 and 25 years, and 22 cases between the ages of 25 and 45 years. Of the 1,070 cases, 1,042 were removed to an Isolation Hospital. In the earlier part of the year there was but little Scarlet Fever about, but the disease became very prevalent in the autumn and winter. Twelve deaths occurred from Scarlet Fever during the year, all of which number took place at hospitals. Comparison with previous years is as follows:— 1915 11 deaths 1916 5 „ 1917 3 1918 9 „ 1919 4 „ As in the case of Diphtheria, some difficulty was experienced in obtaining the prompt removal of cases notified during the last few months of the year. MALARIA. During the year 42 cases were notified. In all cases the patient was found to be an ex-Service man and had contracted his infection overseas. CHOLERA, RELAPSING- FEVER, PLAGUE, TRENCH FEVER, ANTHRAX, GLANDERS, HYDROPHOBIA. No cases of these diseases were notified to me during the year. 14 ACUTE ENCEPHALITIS LETHARGIC A. Six cases of this disease were notified, of which two cases died. Two of the cases recovered completely, and the other two cases recovered with some impairment of mental condition. CEREBRO-SPINAL FEVER, Seven cases of this disease were notified, with a fatal issue in each case. ACUTE POLIO-MYELITIS AND POLIOENCEPHALITIS. Three cases of Acute Polio-myelitis and one case of Acute Polio-encephalitis were notified. DYSENTERY. One case of this disease was notified. The patient, a young married woman, was removed to hospital, where she died. ACUTE PRIMARY PNEUMONIA AND ACUTE INFLUENZAL PNEUMONIA. One hundred and five cases of Acute Primary Pneumonia and 66 cases of Acute Influenzal Pneumonia were notified during the year. The great majority of the patients were removed either to the Bethnal Green Hospital or the London Hospital. In pursuance of the powers given by the Regulations rendering the diseases notifiable, nursing assist- 15 ance for some of the cases treated at home was provided at the expense of the Thorough Council by the Shoreditch and Bethnal Green District Nursing Association. (See the table on page 28.) VERMINOUS CONDITIONS. 351 children reported to me from the Elementary Schools as being infested with body-lice were visited. In every case advice as to treatment of the clothing and bedding was given and disinfestation was offered. However, in only 3 cases was advantage taken of the offer of such disinfestation. Twenty-one men suffering from body-lice were cleansed at the Disinfecting Station and their clothing disinfested. SCABIES OR ITCH. 187 children suffering from this disease were visited after being excluded from the Elementary Schools. In only 17 instances was disinfestation of the clothing and bedding permitted. PUERPERAL FEVER. Ten cases of this disease were notified, and in three cases death resulted. Six of the cases were reported from the London Hospital or the Bethnal Green Hospital. These cases were, generally speaking, patients who had undergone prolonged or difficult labour in their homes previous to removal to the institution, and the infective condition resulting was 16 closely correlated with this fact and in no way connected with the treatment the patient received at the institution. There can be no doubt that an appreciable number of slight cases of puerperal infection escape notification owing to the doctor in attendance not considering the case to be severe enough to be classed as " Puerperal Fever." In my opinion, any rise of temperature or septic discharge from the uterus following on child-birth should be notified as Puerperal Fever unless cause can be shown to the contrary. It is time the medical profession enlarged the scope of the term " Puerperal Fever," and ceased to restrict it to those cases which are complicated by septicaemia and which consequently ofter have a fatal issue. It is to be regretted that the Legislature while requiring the notification of Puerperal Fever has not seen fit to define the condition. Seven women died during the year from accidents and disease incidental to pregnancy and parturition. With the London Hospital and Bethnal Green Hospital close at hand the Borough is well equipped for dealing with the emergencies of child-birth. None the less a number of women die every year from the incidents of child-bearing, while considerable numbers are permanently injured in health. This is the more to be regretted since these deaths are almost all preventible, if the mother had only had proper advice during pregnancy when things were apparently going on well. One of the important functions of Maternity 17 Clinics, such as have been set up by the Borough Council and by the London Hospital, is the prevention of these lamentable deaths in child-bed by the detection of abnormal conditions beforehand and in time to exercise preventive measures. OPHTHALMIA NEONATORUM. Twenty-nine cases of purulent eye discharge in the newly-born were notified to me, 27 by Doctors and 2 by a Midwife. This disease is of special interest as a cause of blindness, but in only one case did complete blindness result, in the right eye. In one case it was found impossible to trace the issue of the case, and the remaining 27 cases are apparently without impairment of vision. Whilst one must regret the continued prevalence of a disease which is easily prevented, the results as regards the preservation of vision are quite satisfactory. Cases in the Borough if severe are almost always removed to a hospital for treatment. Homenursing is provided by the Shoreditch and Home- Green Nursing Association, the Borough Council paying a part of the cost of such nursing. During the year 18 cases of eye-discharge in babies were nursed and a total of 614 visits were paid. 18 INFANTILE MORTALITY. 365 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 94 6 per 1,000 births. Comparison with previous years is as follows: — 1914 137.0 1915 118.0 1916 106.0 1917 110.3 1918 130.2 1919 85.0 Of the 365 deaths, 58 were due to Prematurity and 45 were due to Diarrhoea and Enteritis. Only 14 deaths were certified as being due to Measles, although some of the 101 deaths ascribed to Bronchitis or Pneumonia were probably secondary to Measles. So far as can be ascertained, 358 of the deaths were those of legitimate infants and 7 those of illegitimate infants. Accordingly we have the following figures for infantile mortality:— Infantile mortality (legitimate) 95 Infantile mortality (illegitimate) 79 Infantile mortality (all infants) 94.6 It is unusual for the illegitimate infantile mortality to be lower than the legitimate infantile mortality. 19 Infantile Mortality in Bethnal Green in 1920. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks Total under 4 weeks. 4 week & 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— 76 6 112 48 365 Certified 76 17 13 76 53 ... Uncertified ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... 2 2 ... ... ... ... ... Measles 7 ... ... ... 1 2 4 14 ... ... ... ... ... Scarlet fever ... ... ... ... ... ... 10 ... Whooping Cough ... ... 3 8 8 29 ... ... ... Diphtheria and Croup ... ... ... 1 2 1 4 ... ... ... Erysipelas ... ... ... 1 ... 2 ... ... ... ... ... Tuberculous Meningitis ... ... 2 2 ... ... ... ... ... Abdominal Tuberculosis ... ... 1 ... 1 ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... 2 ... 2 ... ... ... 1 ... 1 6 1 2 Convulsions 3 1 ... 9 ... ... Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis 4 1 5 11 9 5 2 32 ... ... Pneumonia (all forms) 3 1 1 5 14 22 14 14 69 ... ... ... 1 2 2 ... Diarrhœa ... ... 5 ... 15 3 Enteritis 2 ... 2 10 10 40 ... ... Gastritis ... ... ... 1 ... 1 ... ... ... ... Syphilis 1 1 ... 2 1 3 1 ... 7 ... Rickets ... ... ... ... ... ... ... ... Suffocation, overlying ... ... 2 ... 1 1 4 1 ... 7 ... ... ... Injury at birth 3 3 ... ... 3 ... ... ... ... Atelectasis 13 1 ... 14 1 ... 15 ... ... ... Congenital Malformations 6 1 1 1 9 4 3 1 1 18 Premature birth 43 5 2 1 51 6 1 58 ... ... Atrophy, Debility and Marasmus 1 4 1 2 7 3 1 ... 15 ... Other Causes 5 3 1 ... 9 7 6 3 5 30 Totals 76 17 13 6 112 76 76 53 48 365 Nett Births registered during the year legitimate 3766 illegitimate 89 Nett Deaths registered during the calendar year of legitimate infants 358 (illegitimate infants 7 20 NOTIFICATION OF BIRTHS ACTS, 1907 & 1915. During the year 3,678 births were notified, 3,595 being live births and 83 still-births. Of the total 2,099 were notified by mid-wives, and 1,490 by parents and doctors. MATERNITY AND CHILD WELFARE CENTRES. During the year 14,429 attendances of infants were recorded at the Centres. 1,645 new cases were brought to the Centres during the year, and 99 expectant mothers seen for the first time. The Medical Officers in charge saw 7,865 of the infants, and held 535 ante-natal and other consultations with expectant and nursing mothers. 5,255 applications for the supply of milk and food on the ground of necessitous circumstances were dealt with during the year. There were three Voluntary Centres working at the commencement of the year; at 49, Green Street, 26, Preston Street, and at the King Edward Institution, Albert Street, Spitalfields. These were taken over by the Council on 1st April, 1920, as going concerns, together with the staff. The Centre at 49, Green Street consists of a house on lease and is well equipped and conveniently situated. It is open three times a week for consultations and at other times it is used as a Centre for dealing with necessitous cases, and as an office for the Health Visitors. The Centre at 26, Preston Street is also well equipped and consists of a disused public-house, 21 rented on lease. It is open for consultations twice a week. The Centre at King Edward Institution was only in use for two afternoons a week, and on November 30th, owing to its inconvenient position outside the Borough, its activities were transferred to the St. Andrews Institute, St. Andrews Street, certain rooms being rented from the St. Andrews Parish Council on two afternoons of each week. Acknowledgment must be made of the valuable gift to the Borough Council made by the Voluntary Committee in charge of the three transferred Centres. It is not possible to give figures for the attendances at each Centre throughout the year. The Centre at 499 —505, Hackney Road, which had been working for some years was closed at Christmas 1920, owing to the premises being required by the landlord. This Centre was replaced by a Centre opened at Thornton Hall, Mount Street, on two afternoons a week. The furniture and equipment at the Hackney Road Centre are stored for the time being. SUPPLY OF FOOD. Considerable use was made of the Council's Centres for the distribution of food to mothers and infants. The following food was sold at cost price:— Dried Milk 11,350 lbs. Condensed Milk 217 tins. 22 The following amount was distributed free to necessitous cases:— Fresh Milk 1,359½ ga15. Dried Milk 9,358 lbs. Condensed Milk 1,133 tins. together with drugs, etc. The approximate cost of the milk given to necessitous cases was £1,319 14s. 1d. Each necessitous case was carefully investigated before assistance was given, and the usual amount given was 2 lbs. of dried milk or pints of fresh milk per week to each case. SUMMARY OF VISITS PAID BY HEALTH VISITORS. Births (first visits) 3,732 (re-visits) 6,433 Visits to Mothers 1,468 Ophthalmia Neonatorum 152 Puerperal Fever 16 Measles 1,422 School Complaints 752 Special Matters 958 Futile Visits 1,232 Tuberculosis 2,956 Total visits paid 19,121 During the year an important alteration in the hours of duty of the Health Visitors was put into effect. Previously they were on duty from 9 a.m. to 12 noon on Saturdays. In place of this they now work for 3 hours on certain evenings in the week. It 23 is found that in many homes an evening visit is much appreciated especially when the parents are out at work during the day. It is occasionally useful to be able to have a talk to the father of the family, who is, of course, not generally at home in the day time. A further advantage is that the Health Visitors get an intermission of two whole days in their duties every week. It may be added that one of them attends on Saturday in rotation to attend to any urgent matters. HOSTEL FOR UNMARRIED MOTHERS AND THEIR INFANTS. This Hostel at 4, The Terrace, Old Ford Road, is under the control of the London Diocesan Council for Rescue and Preventive Work, and provides for about six mothers with their infants. lam informed that a grant of £131 19s. 9d. was made to this institution during 1920 by the Ministry of Health. BACTERIOLOGICAL EXAMINATIONS. The following examinations were carried out by the Clinical Research Association and the Royal Institute of Public Health:— Throat Swabs —Submitted for examination 391 Diphtheria bacilli present in 81 Sputum —Specimens submitted for examination 88 Tubercle bacilli present in 19 Blood-serum—Specimens examined 5 4 of these gave a negative Widal result to Typhoid Fever. Faeces—2 specimens submitted. 24 In addition to the above, 4 samples of milk were examined bacteriologically. 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 173 deaths from Pulmonary Tuberculosis, 13 deaths from Tuberculous Meningitis, and 11 deaths from other Tuberculous diseases. SOLDIERS AND SAILORS SUFFERING FROM TUBERCULOSIS. 186 ex-Service men were under observation during the year. There were 19 deaths amongst these, and 7 removed from the Borough. 330 visits were paid to these men by the Tuberculosis Health Visitor. WORK OF TUBERCULOSIS HEALTH VISITOR. This Officer paid 2,956 visits to cases. During the year 60 sputum flasks were distributed to patients. 50 sputum tins with 1,500 cardboard refills were distributed to patients for use indoors. 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. Under 5 5 to 10 10 to 15 0 to 1 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 45 to 55 65 and upwards. 1 to 5 35 to 45 55 to 65 243 ... ... 1 ... 1 Tuberculosis of Lungs— ... ... 15 3 174 Male 7 9 15 29 36 35 25 69 Female ... 3 6 8 14 20 22 13 4 4 94 27 121 ... ... ... ... 1 ... Tuberculosis (other parts) ... 5 9 4 1 2 2 3 2 ... ... 28 7 35 ... 2 2 2 Male 6 36 Female ... 3 9 7 4 ... 4 3 ... ... ... 30 6 36 2 1 ... 3 (1) These are all new cases to Bethnal Green, but have sometimes been already notified in other Districts. 26 No. of Notifications on Form C. Poor Law Institutions. Sanatoria. Pulmonary Tuberculosis— Male 8 120 Female 2 41 Non-Pulmonary Tuberculosis— Male 5 5 Female 2 8 No. of Notifications on Form D. Poor Law Institutions. Sanatoria Pulmonary Tuberculosis— Male 61 45 Female 18 20 Non-Pulmonary Tuberculosis — Male 2 5 Female 6 1 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. A full report on the work of the Dispensary by Dr. H. T. Howell, Clinical Tuberculosis Officer, appears in the appendix to this report, on page 73. 27 NURSING ASSISTANCE. Up to the limits permissible by law, a very complete scheme of home nursing is now in operation. Such nursing is carried out by the mediation of a voluntary organisation, the Shoreditch and Bethnal Green Nursing Association. For each visit a charge of tenpence is made to the Council by the Association. As regards children under the age of five years, the Ministry of Health have sanctioned expenditure on the nursing of all sick cases, but grant is only paid by the Ministry in respect of certain specified conditions, i.e., Measles, Whooping Cough, Diarrhoea, Ophthalmia Neonatorum and Poliomyelitis, which come within the Council's Maternity and Child Welfare Scheme. During the year 211 children under the age of 5 were nursed, a total of 3,224 visits being made at a cost of £134 6s. 8d. Of this expenditure £58 4s. 2d. was expenditure under the Maternity and Child Welfare Scheme. Fifteen mothers received 154 visits for nursing in connection with conditions incidental to child-bearing, the cost being £6 8s. 4d. Fifty-four adults and children over 5 received 694 visits for nursing at a cost of £28 18s. 4d. 28 Nursing Assistance 1920. Under Maternity and Child Welfare Scheme. Under Public Health Acts. Disease. 1-5 years. Children under 5 Under 1 year. Mothers. Others. Ophthalmia Neonatorum 18 604 ... ... ... ... ... 4 41 57 ... 662 ... ... ... ... Measles ... 8 67 ... Pneumonia ... ... ... ... ... ... 53 731 30 483 Whooping Cough ... 2 56 ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... ... Other post-natal conditions ... ... 15 154 ... ... ... ... ... ... ... ... ... ... Diarrhœa ... 3 34 ... ... ... ... ... ... ... Other diseases:- ... ... ... Thread worms ... 8 59 ... ... ... ... ... ... Stomatitis ... ... ... 1 8 ... ... ... Spinal disease ... ... ... ... ... ... 1 35 ... ... Hæmorrhage ... ... ... ... ... 1 4 ... ... ... Impetigo ... 3 35 ... ... ... ... ... ... ... ... ... 1 Constipation ... ... ... ... 1 ... ... Abscess ... ... ... ... ... 10 125 ... ... ... Scalds ... ... ... ... ... 3 126 ... ... ... Influenza ... ... ... 3 15 16 144 ... ... ... Bronchitis ... 146 ... ... ... ... ... 18 ... ... Pyrexia ... ... ... ... ... ... 3 14 ... ... Tubercular Glands ... ... ... ... ... ... 1 7 ... ... Otorrhœa ... ... ... ... ... ... 2 20 ... ... Circumcision ... ... 2 24 ... ... ... ... 251 ... ... Blepharitis ... ... ... ... ... ... 3 ... ... Ulcerated mouth ... ... ... ... ... ... 1 6 ... ... Convulsions ... ... ... 1 2 ... ... ... ... ... ... ... 5 42 Marasmus ... ... ... ... ... ... ... 18 ... Septic Rash ... ... ... ... 1 9 ... .. Nasal Catarrh ... ... ... ... ... 1 ... ... ... Hernia ... ... ... ... ... 1 15 ... ... ... Injuries ... 1 54 ... ... ... ... ... ... ... ... ... 1 47 Ulcers ... ... ... ... 3 ... ... Excision of tonsils ... ... ... ... ... 1 ... ... ... Conjunctivitis ... ... ... ... 1 30 ... ... ... ... 1827 54 Totals. 15 154 22 645 62 752 127 694 10 cases were in hand at the beginning of the year. 9 cases were in hand at the end of the year. A total of 4,072 visits were paid to 280 cases at a cost of £169 13s. 4d, 29 MILKSHOPS AND DAIRIES. Thirty three applications for registration under the Dairies, Cowsheds and Milkshops Orders were considered during 1920, and were acceded to.* 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 1919 190 Deduct number of purveyors removed from register during 1920 5 Add number of new purveyors added to register by resolution of the Public Health Committee during 1920 9 Number of purveyors of milk at retail milkshops on register at end of 1920 194 During the year 690 inspections of milkshops were made by the Inspectors, and 91 notices were served under the Public Health (London) Act, 1891. Legal Proceedings.—One prosecution was undertaken under the Dairies, Cowsheds and Milkshops Orders of 1885 and 1886. COWHOUSES. There were at the end of 1920 twelve licensed cowhouses in the Borough, as in previous years. 59 inspections were made during the year. This includes changes of occupiers in premises previously registered, 30 LIST OF LICENSED COWHOUSES. 63, Bishop's Road. —(No. of cows —Shed No. I—B1 —8 cows, Shed No. 2—6 cows.) 42, Cheshire Street.—(6 cows.) 23, Ezra Street.—(6 cows.) 38, Fellbrigg Street.—(No. of cows —Shed No. I—B cows, Shed No. 2—S cows.) 104, Gibraltar Walk.—(18 cows.) 34b, Green Street.—(45 cows.) 1, Hamilton Road.—(13 cows.) 55, Kerbela Street. —(No. of c£ws—Shed No. 1 J8 co.ws, Shed No. 2—2 cows.) 2, Lisbon Street.—(19 cows.) 64, Squirries Street.—(14 cows.) 38, Three Colts Lane.—(23 cows.) 6, Warley Street. —(10 cows.) ICE CREAM PREMISES. 205 visits were paid to these premises by the district inspectors during 1920. No legal proceedings were taken in respect of the manufacture and sale of ice cream. FRIED FISH AND FISH-CURING PREMISES. At the end of 1920 there were 50 fried fish vendors' premises in the Borough, at two of which curing was also carried on. There were 25 fish curers' premises, including these two. 488 visits were made by the Food Inspector to these premises. 31 UNSOUND FOOD. 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. Twelve seizures of unsound food have been made during 1920, as follow:— Seizures. Description of Article. Weight. Date. Prosecution and Result. Fined £50. Costs £3 3s. 19/5/20 Liquid Egg 21 lbs. Margarine 24 „ Condensed Milk 5 tins ?/7/20 70 lbs. P.H. Committee decided not to prosecute. Cherries Roe (fish) 22/7/20 28 „ Fined £1. Costs £2 2s, 16/9/20 Pears 32 „ „ 15s. 28/9/20 30 „ „ 15s. „ 75 29/9/20 £2. „ 30/9/20 Conger Eel 8 „ Summons not served; correct address could not be obtained. 3/11/20 278 in number Owner absconded before his name and address could be obtained. Eggs 4/11/20 Pears 108 lbs. Fined £1 9/11/20 Condensed Milk 11 tins „ 10s. 8/12/20 124 in number Eggs „ £2. 28/12/20 „ £7. Costs £3 3s. Meat 102 lbs On 80 occasions during the year the following articles of unsound food have been surrendered by the owners to the Food Inspector, and destroyed as trade refuse. 32 Articles Surrendered. Description of Article. Weight. Fish 17 cwt. 67 lbs. 11 „ 109 „ Meat 4 tons 13 cwts. 9 lbs. Fruit (Excluding 129 tins of pears, 2 bundles of Tangerines and 1,000 tins of pineapple*) 14,163 in number. Eggs Others Articles 1 cwt. 88 lbs. and 100 quarters of damaged Wheat and 24 tins of Condensed Milk. * The weight of which was not ascertained. SLAUGHTER HOUSES. There were three licensed slaughter houses in the Borough at the end of 1920, situated at — 294, Bethnal Green Road, 354, Bethnal Green Road, 278, Hackney Road. Fourteen visits were made to Slaughter Houses by the Food Inspector during the Year. SALE OF FOOD AND DRUGS ACTS. 714 samples were taken and examined. 607 of these proved to be " genuine," and 47, or 6.6 per cent., adulterated. The details are given in the following table:- 33 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. 341 8 Milk 328 13 22 14 363 Vinegar 65 58 7 6 2 73 8 58 1 13 4 72 Butter 59 9 3 2 1 42 Jam 39 36 3 Margarine 19 19 .. 2 2 .. 21 Flour 14 14 .. .. .. .. 14 14 .. .. Coffee 14 .. .. 14 Cocoa 12 12 .. .. .. .. 12 11 Lard 11 .. .. .. .. 11 Marmalade 10 10 .. .. .. 10 .. 7 Pepper 7 .. 2 2 .. 9 8 Mustard 8 .. .. .. .. 8 Condensed Milk 2 .. 2 4 4 .. 6 Camphorated Oil 2 1 1 4 1 3 6 5 5 .. .. Olive Oil .. .. 5 Oatmeal 1 .. 3 3 1 .. 4 4 Chocolates .. .. .. 4 .. 4 Sago 4 4 .. .. .. .. 4 Cotton-seed Oil 4 4 .. .. .. .. 4 Ground Ginger 4 4 .. .. .. .. 4 2 1 1 Strong Tincture of Iodine 3 .. 1 4 Calomel Ointment 3 3 .. .. .. .. 3 Sweetmeat .. .. .. 3 3 3 .. Dripping 2 2 .. .. .. .. 2 2 2 Sugar .. .. .. .. 2 Treacle 2 2 .. .. .. .. 2 Custard Powder .. .. 2 2 2 .. .. Scones .. .. 1 1 .. 1 .. .. Rice 1 1 .. .. .. 1 Concentrated Tea, Sugar and Milk .. .. .. 1 .. 1 1 Concentrated Coffee, Sugar and Milk .. .. 1 1 .. .. 1 Tea Tablets .. .. .. 1 1 .. 1 Cornflour 1 1 .. 1 .. .. .. Cheese .. .. 1 1 .. 1 .. Crushed Linseed 1 1 .. .. .. 1 .. 1 Herbal Mixture 1 1 .. .. .. .. Pork Sausage .. .. 1 1 .. 1 .. Totals. 636 608 28 78 59 19 714 Prosecutions were instituted in respect of 22 of the 28 formal samples which were reported to be adulterated. Full details are set forth in the following table: — Administrative Action regarding Samples not reported to be genuine. If any legal proceedings were instituted under the Sale of Food and Drugs Acts, state result, showing fines and costs separately. 4 If any legal proceedings were taken under Acts other than Sale of Food & Drugs Acts, state the result, showing fines and costs separately. 5 If no legal proceedings were instituted, state briefly the course adopted in regard to each sample 6 Identification Number given to the sample. 2 Remarks on any point of special interest. 8 Information, if any, as to previous convictions. 7 Result of Analysis. 3 Name of Article. 1 .. Vinegar No. 4 Contained 23 per cent. of added water. Vendor paid £1 1s. costs. .. .. .. 34 .. .. Contained 25 per cent. of added water. Vendor paid £1 1s. costs. .. .. do. 8 .. .. .. Milk „ 32 Found to be 10 per cent. deficient in fat. Vendor fined £2 Costs £1 1s. .. 45 .. Contained 9 per cent of added water. Vendor fined £3 3s. Costs £3 3s. .. .. .. do. .. .. .. Contained 8 per cent of added water. Withdrawn by informant. See column 8 It was proved that this sample was from the same churn as sample No. 45 for which a conviction was obtained the same day. do. „ 47 505 Found to be 100 per cent margarine. Vendor paid costs, £2 2s. .. .. Butter 6th December, 1917. Vendor was fined £2 in respect of adulterated vinegar. .. 16th July, 1907. Vendor fined £2 for selling butter 16 per cent. deficient in fat Found to be 18 per cent. deficient in fat. „ 522 .. .. Vendor fined £15. Costs, £5 Milk .. 35 5th December, 1912. Fined £1, costs £1 35., for selling milk containing 10 per cent. of added water. 6th April, 1916. Fined £1, costs £1 1s., for selling milk 5 per cent. deficient in fat. 15th June, 1916. Committed for trial at Central Criminal Court on charge of conspiracy in connection with a false warranty. Bound over in sum of £50, and ordered to pay £30 towards cost of prosecution. Administrative Action regarding Samples not reported to be genuine.—Continued. If any legal proceedings were instituted under the Sale of Food and Drugs Acts, state result, showing fines and costs separately. 4 If any legal proceedings were taken under Acts other than Sale of Food & Drugs Acts, state the result, showing fines and costs separately. 5 If no legal proceedings were instituted, state briefly the course adopted in regard to each sample. 6 Identification Number given to the sample. 2 Remarks on any point of special interest. 8 Information, if any, as to previous convictions. 7 Result of Analysis. 3 Name of Article 1 .. .. Vendor cautioned by order of Public Health Committee. .. .. Vinegar No. 97 Contained 5 per cent. of added water. 36 Contained 5 per cent. of added water. Vendor fined £2 Costs, £1 1s. .. .. .. .. Milk 119 .. .. .. do. 120 Found to be 13 per cent. deficient in fat. Vendor fined £2 Costs, £1 1s. .. .. Contained 10 per cent. of added water. Vendor fined £2 Costs, £1 1s. .. .. .. do. 121 do. .. „ 122 Found to be 14 per cent. deficient in fat. Vendor fined £2. Costs, £1 1s. .. .. .. .. do. „ 180 Found to be 13 per cent. deficient in fat. Dismissed. .. 30th September, 1915. Vendor fined £10, costs £1 1s., for refusal to serve Inspector. Warranty proved. 1st July, 1918. Fined £10, costs £2 2s., for selling milk 10 per cent. deficient in fat. Contained 10 per cent. of apple pulp. Plum Jam „ 530 Dismissed. .. .. .. Warranty proved. 37 .. Raspberry Jam 309 Contained 40 per cent. of apple pulp. Dismissed .. .. Nature of article demanded not proved to satisfaction of Magistrate. Vinegar .. 339 Contained 19 per cent. of added water. Vendor paid costs, £1 1s. .. .. .. Administrative Action regarding Samples not reported to be genuine.—Continued. If any legal proceedings were instituted under the Sale of Food and Drugs Acts, state result, showing fines and costs separately. 4 If any legal proceedings were taken under Acts other than Sale of Food & Drugs Acts, state the result, showing fines and costs separately. 5 If no legal proceedings were instituted. state briefly the course adopted in regard to each sample. 6 Indentification Number given to the sample. 2 Remarks on any point of special interest. 8 Information, if any, as to previous convictions 7 Result of Analysis. 3 Name of Article. 1 Milk No. 369 Found to be 16 per cent. deficient in fat. Vendor fined £15. Costs, £5 .. .. 16th March, 1916. Vendor fined 18s., costs £1 1s , for selling milk 32 per cent deficient in fat .. 38 5th September, 1917. Fined £10, costs £2 2s., for obstructing Inspector in the course of his duties. 14th March, 1918. Fined £18, costs £2, for selling milk 12 per cent. deficient in fat. .. .. .. .. Milk 394 Contained 5 per cent. of added water. No prosecution in view of warning notice to purchaser exhibited in shop. Raspberry Jam „ 461 Contained 50 per cent. apple pulp. .. .. .. .. No action taken in consequence of nature of article demanded being in doubt. Milk „ 488 .. .. .. Contained 8½ per cent. of added water. Vendor fined £40. Costs £10. 15 April, 1920. Vendor fined £2, costs £1 1s., on each of four summonses for selling milk deficient in fat. do Found to be 16 per cent deficient in fat. .. .. .. 513 Vendor fined £1. Costs, £1 1s. .. „ 538 .. 39 Vinegar Contained 15 per cent. of added water. Vendor fined £1. Costs, £1 1s. .. .. .. do. „ 548 Contained 10 per cent. of added water. Vendor fined £2. Costs, £2 2s. .. .. .. 8th May, 1913. Vendor fined 10s., costs 12s. 6d., for selling glycerine containing 35 per cent. sugar. 4th August, 1913. Fined 5s., costs 12s. 6d., for selling vinegar 55 per cent. deficient in acetic acid. .. do. 567 Contained 17 per cent. of added water. Vendor fined £5 Costs, £2 2s. .. .. .. Administrative Action regarding Samples not reported to be genuine.—Continued. Name of Article. 1 Identification Number given to the sample. 2 Result of Analysis. 3 If any legal proceedings were instituted under the Sale of Food and Drugs Acts, state result, showing fines and costs separately. 4 If any legal proceedings were taken under Acts other than Sale of Food & Drugs Acts, state the result, showing fines and costs separately. 5 If no legal proceedings were institututed, state briefly the course adopted in regard to each sample. 6 Information, if any, as to previous convictions. 7 Remarks on any point of special interest. 8 No. 577 Contained 94 per cent. less than the proper amount of fat. (Proved to be a sample of machine skimmed milk.) No prosecution in respect of adulteration, but vendor summoned for selling unlabelled machine skimmed milk. (See offences other than adulteration.) Condensed Milk .. .. .. .. 40 Found to be 26 per cent. deficient in camphor. Vendor fined £5. Costs, £2. .. .. „ 539 Camphorated Oil .. .. No prosecution in respect of adulteration, but vendor summoned for selling unlabelled machine skimmed milk. (See offences other than adulteration.) .. Condensed Milk 603 Found to contain 91 per cent. less than the proper amount of fat, and to be in a decomposed condition. (Proved to be a sample of machine skimmed milk.) .. .. .. „ 616 .. 41 Strong tincture of Iodine Vendor paid costs, £2 2s. .. .. Contained 75 per cent. less than the amount of Iodine prescribed by the British Pharmacopœia. .. 42 SAMPLES TAKEN INFORMALLY. Of the 21 samples of milk taken informally, 7 were found to be adulterated. The results of the analyses were:— Sample No. 37 7½ per cent, of added water. „ 153 6 „ „ 104 10 „ 152 13 „ deficient in fat. „ 15 13 „ „ „ 360 23 „ „ 472 24 Thirteen informal samples of butter were taken, 4 of which were adulterated as follows:— Sample No. 585 80 per cent. of foreign fat. „ 586 80 „ 150 67 „ margarine 582 100 „ Out of 8 informal samples of vinegar, 2 were found to be adulterated, containing:— Sample No. 19 39 per cent, of added water. „ 103 17½ „ „ Of the four informal samples of camphorated oil, 3 were found to be adulterated as follows:— Sample No. 576 69½ per cent. deficient in camphor. „ 606 61½ „ „ 636 47 „ „ Of the 3 informal samples of jam taken, 2 were found to be genuine and 1 to be adulterated with 30 per cent, of apple pulp. One informal sample of strong Tincture of Iodine was found to be 75 per cent, deficient in Iodine. 43 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 & 1917. The following is a report of the work done under the Regulations during the year ended the 31st December, 1920. 363 samples of milk were taken, and in no case was a preservative reported to be present. No samples of cream were taken. No contraventions of the Regulations were discovered. "APPEAL TO COW" SAMPLES. No samples of milk were taken direct from the cow during 1920, there being no requests received for such action. 44 OFFENCES OTHER THAN ADULTERATION. No. of Sample Result of Prosecution. Article. Offence. Milk 33 Selling milk from a can on which name and address of vendor was not conspicuously inscribed. Fined £1, costs £1 1s. Margarine 26 Selling margarine by retail in plain wrapper Fined £3. Milk 329 Selling milk from a vehicle on which name and address of vendor was not conspicuously inscribed. Fined 10s., costs 10s. „ 377 Obstructing Inspector in the course of his duties. Fined £20, costs £5 5s. Margarine 539 (1) Exposing for sale by retail an unlabelled parcel. Fined 10s., costs 10s. (2) Selling margarine by retail in plain wrapper. Fined 10s., costs 10s. „ 544 Exposing for sale by retail an unlabelled parcel. Ordered to pay costs 20s. Condensed Milk 577 Selling condensed skimmed milk without a label thereon stating "Machineskimmed milk" or "Skimmed Milk" Fined £5. 603 Selling condensed skimmed milk without a label thereon stating "Machineskimmed milk" or "Skimmed Milk." Fined £2. „ „ 45 The case of obstruction noted above (Milk No. 377) deserves special mention. The defendant was a, notorious offender, having been convicted of adulteration on six previous occasions. In the last two prosecutions fines of £20 and £30 respectively were imposed. The defendant had been observed on this occasion to be carrying out manipulations with various cans on his barrow in the intervals between serving customers. He was then accosted by an Inspector who took a formal sample of milk from one of his cans. It was observed that the defendant, on becoming aware of the approach of the Inspector, hastily filled up this can from the churn. This sample was subsequently reported upon as being " genuine" milk. The Inspector then asked for half-a-pint of milk from a milk can hanging on the handle of the barrow. The defendant made no reply but lifted the lid and the can was found to be empty. Another can on the barrow was then indicated and the defendant was asked what the contents were. He stated that the can was empty. On being pressed in the matter he deliberately lifted the lid and spilled the contents over the barrow. The Inspector was only able to conserve a small amount of milk, not large enough for formal division. On analysis this informal, sample was found to contain 48 per cent, of added water. Other cans on the barrow were then examined and four - of them were found to contain altogether 6 quarts of water. A sample of milk from the churn was found to be " genuine." The procedure of the defendant apparently was to keep cans of water on his barrow and add genuine milk to such water according to the " gullibility " of the purchaser. He evidently calculated that he would get off more lightly on an obstruction prosecution than on a prosecution for extreme adulteration, 46 47 GENERAL SANITARY ADMINISTRATION. Work of Sanitary Inspectors. Total Number of Inspections and Particulars of Cases in Hand for the Year ended 25th December, 1920. Infectious Cases. Complaints. House to House Inspections Trade Inspections. Re-Inspections. Milkshop Inspections. Factory and Workshop Inspections. Outworkers' Home Inspections. Tenement House Inspections. New Buildings Inspections. Ice Cream Shop Inspections. Combined Drainage Inspections. Smoke Nuisances. Premises under Observation. Other inspections or work of Special Character. Number of Calls. Unsound Food Seizures. Samples of Food and Drugs taken. Police Court Attendances. Nuisances Abated. Total Visits for the Year. Inspector. Number of Cases in Hand. 803 .. 87 471 34 .. 31 .. 2974 1 275 119 .. .. 899 63 5321 G. I. Brighting. 56 3 470 .. 606 .. 3163 53 175 259 11 .. 31 400 J. H. Hewitt. .. .. 110 .. .. .. 946 56 5205 397 .. 172 623 1 3724 51 2 48 .. 4 25 .. 85 318 2 19 1064 72 5370 W. Billings. 314 7 .. 38 113 65 .. 4512 175 627 .. 29 .. .. 146 .. 3 4 1009 41 5987 F. Bare. 97 185 .. 628 .. 2036 71 1 6 13 29 .. 95 3470 E. J. Jenkins. 40 266 .. 4 50 269 6 680 .. .. 68 696 .. 3103 28 224 18 23 12 17 145 7 .. 5150 1176 I. R. Jones. 310 .. 37 537 .. .. .. 898 4 .. .. .. .. .. .. 140 53 .. .. 2 35 E. Richards. 22 .. 818 1 .. .. 1165 .. .. .. .. .. .. .. .. 54 47 1395 .. .. 230 1 W. Rowsell. .. 9 .. .. .. .. .. .. .. .. .. .. 701 .. .. J. G. Weeks. .. .. 99 .. .. .. .. 1 .. 31 .. 783 .. .. 1856 .. .. .. .. .. .. 449 9 3147 694 Miss A. F. Murphy. 1 404 72 .. .. .. 1 .. 178 24 486 .. .. .. .. .. .. .. 71 .. W. E. Galvin (Voluntary Inspector working "E" District from 22-5-20 to 24-7 20). .. 1 4 .. .. .. 1950 3445 22 1166 20537 458 2226 2230 245 25 162 145 14 1970 12 771 211 6234 36637 2042 359 48 Total number of Sanitary Defects discovered during 1920. Dirty Premises. Defective and Dirty W.C.'s. Defective Water. Supply. Smoke Nuisances Month. Defective Drains. Other Matters. Total. Jan. 316 223 72 - 622 1268 35 Feb. - 680 273 193 37 34 1217 - Mar. 341 650 40 225 40 1296 - April 220 335 47 159 27 788 - 508 May 359 63 211 39 1180 June 610 2 848 79 396 69 2004 July 311 942 - 83 130 118 1584 265 - 706 Aug. 128 52 103 1254 2 447 753 Sept. 63 232 59 1556 Oct. 446 - 1474 116 176 164 2376 Nov. 419 - 1309 98 152 131 2109 124 468 1380 2232 Dec. 108 152 - 821 2349 1008 10207 18864 4475 Totals 4 During the year 3,726 Preliminary Notices were served requiring the remedying of a Nuisance. 5,769 Statutory Notices were served. 49 RATS AND MICE (DESTRUCTION) ACT, 1919. This Act came into force on January Ist, 1920, and the Medical Officer of Health was appointed the Officer for administrative purposes. It was not found necessary to appoint any special Officer for rat destruction, owing to the rat problem being of minor importance in Bethnal Green as compared with some other localities. A good deal of advice was given to persons who complained of rats and a few informal notices were served on persons whose premises were found to harbour rats, or not to be rat-proof. 211 tins of ratpoison were also distributed. SMOKE PREVENTION. During the year 74 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. Three visits were paid to these premises. No legal proceedings were taken during the year. RAG FLOCK ACT, 1911. Nine samples were taken under this Act during 1920. One prosecution was instituted (see page 81). 50 DISINFECTION SERVICE. During the year, 1,852 rooms were disinfected for various reasons, one-and-a-quarter tons of sulphur candles and 25 gallons of Creocide being used for this purpose. It is proposed in future to use liquid Formalin in the form of a spray for disinfection. The table appended gives full details of the rooms, bedding and clothing disinfected. There were also:— Articles destroyed 57 Articles disinfected in Formalin Chamber 650 Books from Borough Library disinfected 344 Rooms in schools disinfected 2 Hospital Wards disinfected 15 MOTOR DISINFECTING VANS. During the year, the hand-drawn trucks previously used for conveying bedding and clothing to and from the Disinfecting Station were replaced by two motor vans purchased from the Belsize Motor Co., Ltd. Rooms, Bedding and Clothing disinfected during the Year ending 31st December, 1920. Month. Scarlet Fever. Diphtheria. Pulmonary Tuberculosis Enteric and Typhoid. Verminous Rooms. Cancer. Erysipelas. Chicken Pox. Scabies. Measles. Influenza. Pneumonia. By Request. Total No. of Rooms Total No. of Articles. 33 63 7 2 1 1 6 2 .. .. 1 116 2493 January .. .. 14 15 .. .. 1 6 3 .. .. .. 121 1976 February 33 48 1 51 6 8 11 2 2 .. 6 6 .. 4 137 2303 March 41 .. .. 13 .. .. .. 3 4 .. .. 1 120 1777 April 46 39 14 34 19 1 .. .. .. 1 3 2084 .. .. .. 116 May 46 12 .. 29 .. .. .. 1 .. .. 1 131 1522 June 65 34 11 .. 7 .. 3 .. .. .. 120 July 69 .. .. .. 2051 37 4 .. August .. 5 .. .. .. .. .. .. .. 1 142 2134 75 47 14 September 3 .. 2 2 191 115 57 .. .. .. .. 1 1 2459 10 .. 5 .. .. .. October 2 .. .. 3 225 4090 162 45 8 .. .. 2 1 1 .. 1 273 November 213 48 7 .. .. .. .. 4330 160 2232 .. 2 2 .. 2 1 .. .. .. 2 December 101 38 12 I 999 541 121 3 102 7 6 3 28 15 2 6 19 1852 29,451 52 DISTRIBUTION OF DISINFECTANTS. Thirty-nine casks of Sanitas powder, made up into 2,730 packets, were distributed. 1,900 pint bottles of Sanitas Fluid and 5,037 pint tins of Izal Fluid were also distributed. The foregoing quantities of disinfectants are excessive in my opinion, in so far as they are principally used as deodorants, that is, for removing smells. Such smells usually arise from lack of cleanliness and want of attention given to foul traps and gullies. It is doubtful whether the distribution of disinfectants without supervision leads in any way to the prevention of infectious disease, and possibly harm may result if persons are led thereby to place reliance on such substances, and not pay sufficient attention to personal hygiene and cleanliness. Steps are now being taken to restrict the issue of disinfectants to within reasonable limits. SHELTER FOR CONTACTS, 3, ST. JAMES ROAD. Fortunately but little use had to be made of the Shelter during the year. Three families were accommodated for very short periods, in no case exceeding 24 hours. CUSTOMS AND INLAND REVENUE ACTS. Applications for Exemption from Inhabited House Duty. No applications for certificates under these Acts were received during the year 1920. 53 PUBLIC MORTUARY STATISTICS 1920. Bodies removed to Mortuary:— On Coroner's order 116 By Police 12 By Sanitary Inspector's order 1 At request of relatives 35 Total 164 Number of Inquests held 127 Number of post-mortem examinations made 92 Particulars of Bodies on which Inquests were held:— Bodies removed by Police from Canal 3 Bodies removed by Police from Street, etc. 7 Bodies removed by Police from Great Eastern Railway 1 Bodies received from Bethnal Green Hospital 14 Bodies received from Queen's Hospital 6 Bodies received from Mildmay Mission Hospital 2 Bodies received from Private Houses, etc. 94 Total 127 54 Inquest cases according to age period:— No. under 1 year 30 „ over 1 year and under 5 years 12 „ „ 5 „ „ 10 „ 5 „ „ 10 „ „ 20 „ 5 „ „ 20 „ „ 30 „ 4 „ „ 30 „ „ 40 „ 6 „ „ 40 „ „ 50 „ 12 „ „ 50 „ „ 60 „ 19 „ „ 60 „ „ 70 „ 16 „ „ 70 „ „ 80 „ 13 „ „ 80 and over 5 Total 127 Causes of Death in Inquest cases: — Natural causes 81 Accidental—Choked by a piece of meat 1 „ Burns 2 „ Drowning 4 „ Falls 6 „ Gas Poisoning 1 „ Run over by Motor Lorry 2 „ Scalds 3 „ Suffocation whilst in Bed 7 55 Misadventure—Death whilst under Chloroform 1 Suicide—Drowning 2 „ Fall from window 1 „ Gas Poisoning 3 Hanging 4 „ Poisoning 1 „ Revolver Shot 1 „ Run over by a train 1 Alcoholic excess 1 Manslaughter 1 Wilful Murder 1 Diphtheria 2 Measles 1 Total 127 Bodies received under the Public Health (London) Act: — Cerebro-Spinal Fever 1 Diphtheria 3 Scarlet Fever 1 5 Total 56 FACTORY AND WORKSHOP ACT. Inspection of Factories, Workshops and Workplaces Including Inspections made by Sanitary Inspectors. Number of Written Notices. Premises. Inspections. Prosecutions. Factories (Including Factory Laundries) 142 20 .. Workshops (Including Workshop Laundries) 3,916 851 6 13 1 Workplace s (Other than Outworkers' premises included in Part 3 of this Report) .. Total 4,071 872 6 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:— 365 Want of Cleanliness 361 .. .. Want of Ventilation 24 .. 24 .. Overcrowding 2 2 .. .. Want of drainage of floors 2 2 .. .. Other nuisances 1,047 1,042 .. 5 insufficient 22 20 .. 1 Sanitary accommodation 345 .. unsuitable or defective 345 .. 15 not separate for sexes 13 .. .. 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) .. 48 2 48 Other offences 13 .. .. 13 (Excluding offences relating to outwork which are included in Part 3 of this Report) .. Total 1,883 1,870 8 HOME WORK. Outwork in Infected premises, Sections 109,110 Outwork in unwholesome premises, Section 108. OUTWORKERS LISTS, SECTION 107. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made, (s. 110). Prosecutions (s. 109, 110). Lists received from Employers. Failing to keep or permit inspection of lists. Failing to send lists. Sending once in the year Addresses of Outworkers. Nature of Work. Sending twice in the year. Received from other Councils. Forwarded to other Councils. Outworkers. Outworkers. Lists. Contractors Workmen. Lists Contractors Workmen. 143 44 58 .. 21 1447 797 .. .. 246 209 .. .. 8 Wearing Apparel— Making, etc. 1393 .. 2 .. Curtains and Furniture hangings 17 7 .. 1 .. 6 .. .. .. .. 4 .. .. .. .. .. Furniture and upholstery .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 13 .. .. .. Fur-pulling 2 14 .. .. 1 .. .. .. .. .. .. .. .. .. .. 6 16 .. 4 1 Umbrellas, etc. .. .. 74 .. .. 11 .. .. .. .. 17 .. .. Artificial Flowers 2 .. 43 .. .. .. 36 1 .. .. 5 4 .. .. .. .. Paper, etc., Boxes, Paper Bags 1 293 .. 164 149 32 856 1 307 15 1 .. .. .. .. .. .. 5 497 1 1 111 5 Brush-making .. .. 348 .. .. 35 31 .. .. .. 1 .. Stuffed Toys 2 24 .. .. 1 16 1 .. 1 .. .. .. .. .. .. .. Basket-making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cosques, Christmas Crackers, Christmas Stockings, etc. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 3 Textile Weaving Total .. .. 2 23 .. .. .. 6 1 1 .. 7 5 .. .. .. .. .. .. 196 44 .. 1975 84 1 .. 477 414 2886 11 24 1491 .. .. .. .. 58 Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Workshops 1601 Workshop Bakehouses 85 Total Number of Workshops on Register 1686 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— 6 Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H.M. Inspector 244 Reports (of action taken) sent to H.M. Inspector. 244 Underground Bakehouses (s. 101) in use at the end of the year 22 59 HOME WORKERS. Of the 4,929 workmen and contractors whose names appeared on the lists sent in by employers, 3,438 resided within the Borough. In 1919 the number was practically the same, being 3,490. This figure, 3,438 is approximately double the number of individual workers as in the majority of cases the same people are notified in February and in August. The number of visits paid to Home Workers' dwellings by Miss Murphy, the Sanitary Inspector detailed for this work, was 3,153. The number of premises found to be in an insanitary condition was 477, or 27 per cent, of the premises inspected. Notices were served in 414 cases, the other 63 premises being already under notice arising from other visits. Overcrowding was found to be a common defect, but it was not found possible under the prevailing circumstances to effect much improvement in this condition by the threat of legal action. A few cases of infectious disease have occurred in outworkers homes, but no action was necessary as no homework was on the premises at the time, a circumstange explained by the extensive unemployment which was prevalent. 60 HOUSING. On the recommendation of the Public Health Committee, the Council on February 5th, 1920, approved of the formation of a special staff for housing work, under the general supervision of the Medical Officer of Health. The following officers were appointed and commenced their duties on April 12th, 1920. Chief Sanitary Inspector J. Foot.—Housing Superintendent. Sanitary Inspectors A. S. Henley, E. Ainley.— Housing Inspectors. Sanitary Inspectors S. H. Taylor (left December 28th, 1920), W. F. Mayo.—Housing Inspectors (temporary). Mr. W. H. Heron.—General Assistant. Mr. J. Godwin and Miss C. Lane.—Clerks (temporary). Of the above Messrs. Taylor, Mayo, Godwin, and Miss Lane were temporary officers specially engaged for the purpose. No. 20, Patriot Square, a house adjoining the Town Hall was furnished and equipped as an office. The officers of the Housing Section were for most of the year engaged in a survey of the various unhealthy areas of the Borough, having in view the wish and intention of the Council to undertake a number of very urgently necessary clearance schemes. Before the end of the year it became evident that insuperable obstacles, financial and otherwise, stood in the way of 61 these intentions. The activities of the Housing Officers were thereupon diverted to work of a remedial nature. During the year and apart from the numerous inspections made by the District Sanitary Inspectors, the special Housing staff made a detailed inspection (including measurements) of 1,354 houses. Arising out of these visits of inspection, 651 notices' were served on owners to effect repairs. A large amount of remedial work arising out of the inspections recorded above remained to be done at the end of the year, and was then in hand. As to general housing conditions of the Borough there remains but little to add to what was said in last year's Annual Report. There is practically nothing to show for the year's work so far as the reconstruction of unhealthy areas is concerned. Furthermore no new houses have been erected. But as in previous years the efforts of the Sanitary Inspectors, supported when necessary by legal notices authorised by the Public Health Committee, have been the means of effecting a very large amount of useful and necessary work in improving individual houses. UNHEALTHY AREAS. The following is a summary of work carried out during the year on various unhealthy areas: — (1) Brady Street Area. This area need not be described as it has been fully dealt with in previous Annual Reports. The area was the subject of an Improvement Scheme 62 propounded by the London County Council during the year, and on June Ist, a Public Local Enquiry was held on this Scheme. The decision of the Ministry of Health on the Scheme is not yet forthcoming. (2) Green Street Area. This area comprises the following streets: — Globe Road Alias Road, (East Side). Lansdell Place, Baker Street, Portman Place Bonwell Street, (North Side), Butler Street, Knottisford Street, Tuscan Street, Bullards Place, Warley Street, Walter Street, Morpeth Street, Prospect Terrace, Usk Street, Braemar Street, Smart Street Moss Street, Preston Street, Surat Street, Green Street (Part of South Side), Davis Place, Violet Row, Digby Walk, Bucks Court. Digby Street, On February 20th, 1920, this area of 27 acres was represented to the London County Council as an unhealthy area, but so far no improvement scheme has resulted. It consists of about 923 houses, a large number of which are scheduled for demolition by the London County Council for the purpose of building a new school. 63 During the year a house-to-house inspection of the East portion of this area was carried out. The portion inspected, about 12 acres in extent, is bounded on the North Side by Green Street, on the South Side by the Great Eastern Railway, on the East Side by Palmers Road, and the West by the East Side of Warley Street. It consists of 432 houses of various sizes, including shop properties occupied as residences. Some 40 of the houses were unfit for human habitation, 316 required such extensive repair as to necessitate their being temporarily closed during such repair, 71 were in need of minor repairs, and the remaining 5 were in fair condition. The population of the area inspected was 3,228. (3) Cranbrook Street Area. This area of about 13 acres was on February 20th, 1920, represented to the London County Council as being an unhealthy area, but no improvement scheme has yet resulted. It comprises the following streets:— Havelock Place, Bonner Street (East Side), Mace Street, Green Street (North Side) (Part of), Ames Street, Hersee Place, Sidney Street, Tagg Street, Norton Street, Old Ford Road (South Side) (Part of), Type Street, Harold Street, Cranbrook Street, Alma Road (South Side). Cranbrook Road. 64 The area comprises 452 houses with a population of 3,504. A house-to-house inspection was carried out during the year. Some 27 of the houses were unfit for human habitation, 190 houses were unfit but capable of improvement if closed for thorough repair, 224 were in need of minor repairs, and the remainder were in fair condition. (4) Collingwood Street Area. This area of 6 acres, 286 houses and 1,716 population was on February 20th, 1920, represented to the London County Council as being an unhealthy area, but so far no improvement scheme has resulted. It comprises the following streets:— Collingwood Street (East Side) (Part of), Buckhurst Street (Both Sides (Part of), Fellbrigg Street, Venice Street, Somerford Street (South Side) (Part of, School Place, Coventry Street (Both Sides) (Part of), Octagon Street, Northampton Street. (5) Pott Street Area. This area of 6 acres, 239 houses and population 1,434, was on February 20th, 1920, represented to the London County Council as being an unhealthy area, but so far no improvement scheme has resulted. It is congested with worn-out houses and narrow and badly arranged streets. 65 It comprises the following streets: — Fox Street, Pott Street, Bethnal Green Koad (Part of South Side), Coventry Street (Roth Sides) (Part of), Archer Street, Lucas Street, Gales Gardens, Parliament Place, Birkbeck Street (Part of both sides) Abingdon Street, Parliament Street, Glass Street. (6) Pedley Street Area. This area of 4 acres, 174 houses and population 1,044, was on February 20th, 1920, represented to the London County Council as being an unhealthy area, but so far no improvement scheme has resulted. A house-to-house inspection was carried out during the year. Some 46 houses were found unfit for human habitation, 65 houses unfit but capable of being made fit if closed for thorough repair, and most of the remaining required minor repairs. There are three Courts in the area, comprising 28 houses, which with two exceptions have only two rooms each. The streets of the area are narrow and the residents are mostly Russian Poles by origin. There is much over-crowding on this area, and in 45 cases this was such as to be a legal nuisance. 66 The area comprises the following streets: — Pedley Street (South Side), Code Street (East Side), Whites Court, Collyers Court, Butlers Buildings, Eckersley Street, New Church Street, Buxton Street (Part of Nortii Side), Fleet Street Hill, Bratley Street. Weaver Street (North & West Side), (7) Teale Street Area. This area, of about 4 acres, comprises 137 houses and a population of 822. A house-to-house inspection was carried out during the year. 36 houses were found to be unfit for human habitation, 93 were unfit but capable of being made fit if closed for thorough repair, and the remaining required minor repairs. This area is eminently suitable for an improvement scheme since there is a fair quantity of land available in the form of large gardens and waste land. It was formally reported to the Borough Council as being an unhealthy area suitable for a reconstruction scheme, and is now under the consideration of the Housing Committee. It comprises the following streets:— Spencer Passage (North Side), Pritchards Road (Part of West Side), Gillman Street, Teale Street (Part of South Side), Queen Caroline Gardens, Garner Street (East Side), Dinmont Street. Coate Street (Part of North Side), 67 (8) Diss Street Area. This area of about 2 acres, comprises 69 houses and a population of 420. A house-to-house inspection was carried out during the year. Some 26 houses were found to be unfit for human habitation, and 41 houses were unfit but capable of being made fit if closed for thorough repair. This area was formally reported to the Borough Council as being an unhealthy area suitable for a reconstruction scheme. The Western portion of the area has been partly cleared for some time, and the Council considered that this portion was suitable for immediate treatment. In consequence a Reconstruction Scheme was prepared and submitted to the Ministry. A Public Local Enquiry into the Scheme was held on June 18th, 1920. As the approval of the Ministry is not yet forthcoming and the Scheme is likely to take a different form from that first put forth, I do not propose to take up any further space on this matter at present. The whole area comprises the following streets: Arline Street (Part) Stamp Place (Parti, Smiths Buildings, Chapel Street, Strouts Place (part). Diss Street (part). Pelter Street. (9) Kirkwall Place Area. This area of about seven-tenths of an acre, comprises 29 houses with a population of 159. A large proportion of the houses are unfit for human habitation, and they are as a whole hemmed in and obstructive to neighbouring dwellings. This area was formally reported to the Borough Council as being an unhealthy area suitable for a reconstruction scheme. 68 (10) Manchester Buildings Area. This area of about ¼ acre comprises 17 houses with a population of 105. It consists of a court off Menotti Street together with a few houses in Menotti Street. Nine of the houses are unfit for human habitation, and the remainder would require to be vacated if they were to be thoroughly repaired. The houses in Manchester Buildings are built in a hollow, being about 2 feet 9 inches below the pavement level of Menotti Street and are closed in on all sides. This area was formally reported to the Borough Council as being an unhealthy area suitable for a reconstruction scheme. (11) Hemming Street Area. This area of about nine-tenths of an acre, comprises 29 houses with a population of 116. Eleven of these houses have been for some time past closed and unoccupied, owing to their structural defects. Three others are unfit for human habitation and only one of the remaining houses can be said to be in good repair. This area was formally reported to the Borough Council as being an unhealthy area suitable for a reconstruction scheme. The area comprises the following streets: — Hemming Street, Nos. 2 to 24 (even) and No. 2a. Ann's Place, no houses. Waterloo Terrace, Nos. 1 to 12 consecutive. Selby Street, Nos. 2 to 8 (even) and stables and yard adjoining No. 8. 69 (12) Sale Street Area. This area of about seven-eighths acres comprises 37 houses with a population of 265. Some 15 of the houses are unfit for human habitation, and the remainder require repairing. The houses in Crossland Square and Hague Place are situated in a hollow, being from 2 feet 3 inches to 3 feet 3 inches below the level of the pavement of Sale Street, and they are hemmed in by surrounding dwellings. This area was formally represented to the Borough Council as being an unhealthy area and suitable for a reconstruction scheme. The area comprises the following lands and streets: — Mape Street, Nos. 4 to 18 (even). Sale Street, Nos. 2 to 10 (even) with land adjoining to Hague Place. Crossland Square, Hague Place, Hague Street, Nos. 17 to 29 (odd). Derbyshire Street, Nos. 50 and 52. Nos. 1, 2, 3, and 4, BAKER'S COURT. These four houses, crowded together in a narrow cul-de-sac were the subject of Closing Orders in 1918. In 1920 the question of demolition arose, and Demolition Orders were made by the Council on May 20th. These orders were confirmed on appeal. 70 HOUSING CONDITIONS. Statistics for Year ending 31st December, 1920. 1.- GENERAL. (1) Estimated population 114,471 (2) General death-rate 14.9 (3) Death-rate from Tuberculosis 1.72 (4) Infantile mortality 94.6 (5) Number of tenements of all classes (separate occupiers) 27,755 (6) Number of working-class dwelling-houses — (7) Number of new working-class houses erected a few 2.—UNFIX DWELLING-HOUSES. I.—Inspection (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9,246 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 1,354 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 231 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation figures not available. 71 II.—Remedy of Defects without Service of formal Notices Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers figures not available. III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, etc. Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit — (a) by owners (b) by Local Authority in default of owners nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5,769 (2) Number of dwelling-houses in which defects were remedied — (a) by owners figures not available. (b) Local Authority in default of owners nil 72 C. Proceedings under sections 17 and 18 of the [Housing, Town Planning, etc. Act, 1909. (1) Number of representations made with a view to the making of Closing Orders nil (2) Number of dwelling-houses in respect of which Closing Orders were made nil (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit nil (4) Number of dwelling-houses in respect of which Demolition Orders were made 4 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders nil 3.—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890: — (1) Name of area see above, (2) Acreage „ (3) Number of working-class houses in area „ (4) Number of working-class persons to be displaced „ 4. —Number of houses not complying with the building bye-laws erected with consent of Local Authority under section 25 of the Housing, Town Planning, etc. Act, 1919 nil 5. —Staff engaged on housing work, with, briefly, the duties of each officer see above 73 APPENDIX. Bethnal Green Tuberculosis Dispensary. ABSTRACT OF REPORT FOR THE YEAR 1920, By H. Tylford Howell, M.R.C.S. Eng., L.R.C.P. Lond., Clinical Tuberculosis Officer. During the year several changes have taken place in the working arrangements of the Dispensary. In January the post of Tuberculosis Officer to Bethnal Green became vacant by the resignation of Dr. Hebert, who had done most valuable work both for the Hospital and the Dispensary for more than four years. Following his departure it was decided to place the direction of the work for both the Boroughs of Hackney and Bethnal Green under one Senior Tuberculosis Officer, and to appoint a Junior Officer to assist him. I was appointed to the senior post, while Dr. J. R. MacNeill, late Resident Medical Officer at Victoria Park Hospital, was selected as junior. Dr. MacNeill left in November, and was succeeded by Dr. F. W. Hamilton, of the Royal Chest Hospital, City Road, where he had acted as Resident Medical Officer, and later as Senior Assistant Tuberculosis Officer. This amalgamation of the two boroughs has proved to be quite satisfactory in practice. Previously it often happened that in a particular session the cases from one borough greatly predominated, thus throwing perhaps about four-fifths of the work 011 the particular officer concerned. This is now remedied, as the work can be more evenly distributed between the two officers, and it is thus possible to give more individual attention to each case. Seven sessions are still held each week, but it was found necessary during the year to make some alteration. Previously it was our custom to see patients 011 three evenings and four mornings each week. It was found that the number of attendances did not justify three evening sessions, while the morning sessions were becoming unwieldy. With the sanction of the borough authorities it was decided to cancel an evening session and to replace it by a morning one. An alteration was also made ill the evening hours. Previously patients were admitted any time between 7.30 and 9 o'clock, so that it often happened 011 an otherwise slack evening that several new cases would appear at only a few minutes before the hour for closing. This would mean that our work would not be completed till after 10 p.m., whereas if the patients 74 had arrived early, as they easily could have done, we might have finished at the normal hour. This difficulty has been overcome by limiting the time of attendance for new cases from 7.30 to 8.30 p.m. It has been found that no hardship has resulted from this restriction, and the new arrangement works quite satisfactorily. Saturday morning is reserved for school children, so that they shall not lose time from school, and those adults who find it impossible to attend at other times. The department, as in previous years, had the use of two consultingrooms, to each of which are attached two dressing-rooms, and in addition a dark room for examination of throat cases. Each patient, whether new case or old, is seen in order of his appearance at the Hospital, so that rarely one is kept waiting longer than a few minutes, and practically never for more than half an hour. The Nurse first records the temperature, weight, etc., and then sends the patients singly into the consulting-room, where the Medical Officer takes the history and makes the neccssary examination. Interesting, doubtful, or difficult cases are seen by both the Senior and Junior Medical Officers. This practice adds considerably to the interest in the work. It sometimes happens that a further opinion is necessary, in which case the patient is sent to one of the Physicians in charge of out-patients. As a personal interview is usually of more value than a written opinion we endeavour to see the out-patient Physician concerned and talk over the case with him. livery use is made of the special departments of the Hospital in the diagnosis of difficult cases. A large number of cases have been referred to the X-ray department, while cases of surgical tuberculosis are referred to the Surgeon for an opinion, many of them later being admitted to Hospital for treatment. While the Surgeon in charge of the throat department and the Dentist are only too pleased to give an opinion on any particular case, we have 110 authority to send them cases for treatment. They have very kindly undertaken this in special cases, but the arrangement is not satisfactory. The subject was reported to the Dispensary Committee, and the Borough Councils consulted, with the result that every effort is now being made to deal with the matter. With regard to disposal of patients, this has been conducted 011 the same lines as heretofore. An endeavour is made 011 the first attendance to make a definite diagnosis. This having been done, it then remains to decide 011 the most appropriate form of treatment applicable to the case. Patients with signs of early disease are usually transferred to a sanatorium, while those in advanced and hopeless condition are sent to a special hospital suitable for those in this stage of the disease. 75 The intermediate class of case, comprising those who are too advanced for sanatorium, or cases of high fever, haemoptysis, etc., in which the prognosis is doubtful, though not necessarily hopeless, is recommended for admission to Hospital for observation and treatment, and later sent to sanatorium if suitable. It often happens that it is impossible to make a definite diagnosis on the first attendance. If these cases are in the least suspicious, they are advised to attend the Dispensary at regular intervals until the diagnosis is cleared up. Should they fail to put in an appearance they are written for, or the Visiting Nurse is asked to look them up. Cases in which the above forms of treatment are contra-indicated, usually of the advanced type, or those who refuse admission to institutions, receive domiciliary treatment under the care of their own doctor, but are still under the supervision of the Tuberculosis Officer. The class of case treated at the Dispensary itself includes those of doubtful diagnosis, patients awaiting admission to sanatorium or hospital, and uninsured cases who cannot afford a private doctor. No specific form of treatment has been used, such as vaccines or serums, while our best results appear to have followed the use of creosote in increasing doses. Quite a large proportion of the positive cases received institutional treatment during the year. On the whole, the length of time the patients are kept on the waiting list has not been unduly long, but there is still great difficulty in securing admission to Hospital for those suffering from advanced disease except in the case of ex-service men. There has been no improvement as regards the question of securing suitable employment for patients who are not fit to resume their ordinary occupation. We have a large number attending the department who, though not well enough to do full-time heavy work, would benefit by some light, suitable employment; the absence of any official body to help the men in obtaining this is a great handicap. The after-care of tuberculous patients remains in the hands of the Borough Care Committee, of which the Tuberculosis Officer is a member. We are indebted to various charitable societies, including the Invalid Children's Aid Association, the Jewish Board of Guardians, and the Charity Organization Society, who have been of great assistance in providing convalescent treatment for necessitous cases. Tuberculous children can receive institutional treatment through the L.C.C., but those who have not been definitely diagnosed as such, but who are in a state of ill-health and may be predisposed to the disease, are unprovided for. It is in this class of case that such good work is (ione 76 by the Invalid Children's Aid Association, the Hackney branch especially being responsible for the convalescence of a large number of our cases. The Tuberculosis Officers have continued to act as Medical Referees for the Local Pensions Committees on tuberculous or doubtful cases, and a considerable number have been referred to the department for an opinion by Pensions Medical Boards. This has entailed a good deal of additional work, but it has kept us in close touch with all discharged men of both services. The statistical tables showing the work done are given below. A comparison with last year's tables will show that there was a slight increase in the total number of new cases. From Table 2 it will be seen that there has been a marked increase in the number of contacts from Bethnal Green. The majority of the contacts examined consists of children, as there appears to be great difficulty in persuading adults to attend for the purpose of examination. The total number of patients sent by local practitioners has remained high, and it is satisfactory to see that they continue to make use of the department as. a consulting centre for cases suspected of having tuberculosis. Our relationship with the neighbouring doctors has always been of the most cordial nature. I was asked recently by the local branch of the British Medical Association to read a paper on the diagnosis of early Pulmonary Tuberculosis, and as we take every opportunity of meeting the General Practitioners, either individually or collectively, 1 was most pleased to do this. The general work of the Dispensary has increased considerably in amount, as instanced by the increase in the total number of attendances to 5,056, the number of letters written to 1,480, and the number of systematic examinations to 1,670. With regard to the number of attendances, attention was drawn to this in a recent survey of the dispensary treatment of tuberculosis in London made by the Ministry of Health. It was pointed out that " the provision of routine treatment as distinct from consultative work has at some dispensaries been developed to an undesirable extent," and that " treatment at dispensaries should as a rule be limited to patients whose continued treatment requires special knowledge or technical skill, or to those who are unable to obtain other adequate medical attendance. Patients who require treatment which can consistently with the best interests of the patient be properly undertaken by a general practi- 77 tioner of ordinary professional skill and competence, and who are either insured persons or can afford to pay for medical attendance, should not be encouraged to attend the dispensary for routine treatment." Personally, I am inclined to agree with those who hold the view that all cases of tuberculosis, excepting patients who are receiving institutional treatment or who are too ill to attend, should be treated at the Dispensary, as it is impossible properly to supervise a case receiving treatment elsewhere. If a patient is being treated at the department he will generally attend quite regularly, but great difficulty is experienced in getting a patient to attend, say, at intervals of two or three months for the purpose of supervision only, the result being that the Tuberculosis Officer loses touch with him. In conclusion I should like to thank the Dispensary Committees, the Medical Officer of Health, the Hospital Physicians, and the Hospital Secretary for their help and advice, and also the Dispensers, the Clerk, the Nurse, and the Porter, all of whom have done their work very efficiently. (Signed) H. TYLFORD HOWELL. 1st February, 1921. 78 STATISTICAL TABLES. 1. The Totals of New Cases. Males 411 Females 342 Total 753 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 142 43 Local Practitioners 146 61 35 17 London War Pensions Committee Contact Cases 283 7 London Insurance Committee 34 20 London County Council 43 16 Victoria Park Hospital 41 34 Other sources 14 4 "No card" 15 0 3. The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Children under 16 Males Females Males Females 31 20 5 24 173 Pulmonary Tuberculosis 93 8 1 19 1 0 29 Non-pulmonary Tuberculosis 87 56 280 6 71 500 Non-tuberculous 21 8 2 Doubtful 14 6 51 333 14 101 753 Total 209 96 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 5 Non-pulmonary Tuberculosis 2 Non-tuberculous 265 Doubtful 11 Total 283 5. Sputum Examinations of Insured and Uninsured Patients. Insured. Uninsured. Total. Tubercle Bacilli present 65 12 77 283 116 399 Tubercle Bacilli absent 6. Other Figures. Insured. Uninsured. Total number of attendances 2,809 2,247 873 Systematic examinations at the above 797 1,480 Number of letters written Number of visits to patients at their homes 39 14 Number of patients sent to hospital or sanatorium 137 6 Number of patients referred to: — X-ray Department 55 22 Other Departments 27 17 January 22nd Non-compliance with statutory notice requiring abatement of nuisance. Hewitt. Order to do work in seven days. Costs £2 2s. awarded. Costs £2 2s. January 29th Failing to give notice of intention to fit a new pan and trap to a water-closet. Ba r e. February 5th Non-compliance with statutory notice requiring abatement of nuisance. Billings. Order to do work in seven days. Costs 21s. awarded, do. do. February 5th do. do. Billings. Billings. Fined £5. Costs £3 3s. February 12th Removing offensive fish-refuse at other than the prescribed hours. do. do. do. do. February 12th Billings. February 12th Failing to adopt precautions for the prevention of effluvium in removing offensive fish-refuse. Billings. Withdrawn. Conviction on alternative summons. January 22nd Fined £4. Costs £3 3s. Using bread otherwise than for human food contrary to the Cereals (Restriction) Order, 1919. Rowsell. January 22nd Fined £7. Costs £3 3s. do. do. Rowsell. Legal Proceedings.—Continued. Offence. Date of hearing. Inspector. Result and remarks. 1920 January 29th Selling red herrings at excess price contrary to the Fish (Prices) Order, 1919. Aiding and abetting in the same offence. Rowsell. Fined 10s. Costs 10s. January 29th Rowsell. do. do. January 29th Selling eels at excess price contrary to the Fish (Prices) Order, 1919. Rowsell. Fined £20. Costs £5 5s. January 29th Failing to keep posted a notice showing the maximum prices of fish contrary to the Fish (Prices) Order, 1919. Rowsell. Withdrawn. Conviction on preceding summons. January 14th Selling milk at excess price contrary to the Milk (Winter Prices) Order, 1919. Weeks. Costs £3 3s. awarded 08 January 14th Weeks. Aiding and abetting preceding offence Fined £5. February 12th Selling rice at excess price contrary to the Rice (Retail Prices) Order, 1918. Weeks. Fined £5. Costs £2 2s. awarded. February 11th Selling a piece of fowl at excess price contrary to the Poultry and Game (Prices) Order, 1918. Saunders. Fined £2. Costs £2 2s. awarded. February 12th February 12th Using bread otherwise than for human food. Aiding and abetting preceding offence. Rowsell. Rowsell. Fined £5. Costs £3 3s. awarded. Dismissed. February 19th Rowsell. Selling by retail milk at excess price. Costs £2 2s. awarded. February 19th Aiding and abetting preceding offence. Rowsell. Fined £3. February 26th Selling fowl at excess price. Weeks. Fined £2. Costs £2 2s. awarded. February 26th Using bread otherwise than for human food. Rowsell. Fined £3. Costs £3 3s. awarded. February 26th Exposing for sale imported meat unlabelled as such. Rowsell. Fined £1. Costs £1 1s. awarded. Costs £1 1s. awarded. March 4th Selling sugar otherwise than for the purpose for which obtained. Rowsell. March 4th Failing to keep posted a list of Outworkers in Workshop. (Factory and Workshop Act, 1901, sect. 107.) Billings. Fined 10s. Costs 10s. awarded. March 4th Failing to send to the Council a list of Outworkers. (Factory and Workshop Act, 1901, sect. 107) Billings. do. do. April 22nd Non-compliance with statutory notice requiring abatement of nuisance. Billings. Costs 28s. awarded. April 15th Having in possession rag flock containing 270 pans of Chlorine in 100,000 parts of flock. (Rag Flock Act, 1911.) Fined £5. Costs £5. Hewitt. Fined £1. Costs £4 4s April 8th Carrying for sale bread not an even number of pounds, contrary to the Bread Order, 1918. Weeks. Fined 20s. 18 May 13th Using as a sleeping place a room in which food intended for sale was stored, contrary to the L.C.C. (General Powers) Act, 1908, sect. 8. Billings. Fined £50. Costs £5 5s. May 13th Charging excess price for bullock's liver, contrary to the Edible Offal (Maximum Prices) Orders, 1918 and 1919. Rowsell. Fined 20s. Costs 42s. May 6th Supplying sugar to a person other than a registered customer, contrary to the Rationing Order, 1918. Weeks Fined £3. Costs 42s June 17th Removing offensive matters through the streets during prohibited hours, contrary to the Bye-laws prescribing such hours. Billings. Fined £5. Costs 42s. June 10th Charging excess price for home-killed bullocks' milt, contrary to the Edible Offal (Maximum Prices) Order, 1918. Rowsell. Rowsell. Costs 42s. June 24th 28 Using a bakehouse unfit for use or occupation on sanitary grounds, contrary to the Factory and Workshop Act, 1901, sect. 98. Dr. Oates. Fined 40s. Costs 21s. June 24th do. do. Dr. Oates Fined 40s. Costs 21s. June 24th Depositing for purpose of preparation for sale certain unsound liquid eggs, margarine and condensed milk Dr. Oates. Fined £50. Costs £3 3s. July 1st Bakehouse unfit for use or occupation on sanitary grounds. (Factory and Workshop Act, 1901, sect. 98.) Dr. Oates. Fined 20s. Costs 21s. August 12th Removing in unsuitable vessels during prohibited hours certain offensive matters. Billings. Fined 40s. Costs 42s. August 12th do. do. Billings. Fined 40s. Costs 42s. August 12th Exposing for sale about 20 lbs. fish and roes unfit for food. Rowsell. Fined 20s. Costs 42s. July 1st Using as a sleeping-place a room in which certain sugar and sultanas were deposited for the purpose of preparation for sale. Dr. Oates. Fined 10s. Costs 21s. Non-compliance with statutory notice requiring abatement of a nuisance. Hewitt. Order made to do the work in 14 days. Costs £2 2s. August 5th September 9th September 16th Hewitt. do. do. Order made to do the work in 28 days. Hewitt. do. do. Order made to do the work in 21 days. Costs £2 2s. Fined 15s. October 21st Exposing for sale 30 lbs. of pears unsound and unfit for the food of man Rowsell. October 21st Exposing for sale 32 lbs. of pears unsound and unfit for the food of man. Rowsell. Fined 15s. October 28th Rowsell. Exposing for sale 75 lbs. of pears unsound and unfit for the food of man. Fined 40s. November 17th Non-compliance with statutory notice requiring abatement of a nuisance. Hewitt. Closing Order made by the Magistrate. Bare. December 2nd do. do. Order made to do the work in 14 days. Costs £2 2s. 83 December 16th Exposing for sale 11 tins of condensed milk unfit for the food of man Rowsell. Conviction. Costs 10s. (Convicted on another summons under Sale of Food and Drugs Acts.) December 30th Fined 20s. Exposing for sale 108 lbs. of pears unfit for the food of man. Rowsell. Various Non-compliance with statutory notice requiring abatement of a nuisance. Various. All summonses withdrawn on payment of 4s. costs in each case, the works having been done. Various - 112 summonses. do. 5s. do. do. do. Various. 11 summonses. do. do. - do. 6s. do. Various 1 summons. do. do. Various. do. 10s. 6d. do. 7 summonses. do. do. - Summonses against occupiers withdrawn. Proceedings taken against owners. August 12th 3 summonses. do. do.