THE Metropolitan Borough of Bethnal Green REPORT on the HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1923 BY GEOFFREY EUGENE OATES M.D., B.S. (London), M.R.C.P. (London), D.P.H. (Cambridge); Barrister-at-Law, of the Honourable Society of Gray's Inn; Lieutenant (late R.A.M.C.); Fellow of the Royal Society of Medicine; FelloW of the Royal Institute of Public Health; Fellow of the Zoological Society; Member of the Royal Sanitary Institute; and Medical Officer of Health and Administrative Tuberculosis Officer for the Metropolitan Borough of Bethnal Green. LONDON: Printed by Frowde & Co. (T.U. all Depts), 242-244, Old Kent Road, S. E. l. Town Hall, Bethnal Green, E.2. June, 1924. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, I have the honour to present to you my fourth Annual Report, which deals with the health of the Borough of Bethnal Green during the year 1923. The health of the Borough continued good as judged by previous experience, the death-rate being a low record one of 11.3 per 1,000 of population. The birth-rate also showed a decline, being 24.2 per 1,000. This may be compared with a rate of 35.6 per 1,000 in 1903. For every three children born twenty years ago only two are born now. This is a very striking social phenomenon. The infantile mortality showed also a satisfactory decrease which is commented upon in my report. As in past reports, I have to express my thanks to the members of the Council, and more particularly to members of the Public Health Committee, for the support and consideration they have accorded myself and my staff during the past year. I must also tender my thanks to the officers and employees of the Public Health Department for the support I have received from them, and to other officers of the Council's staff for the help and courtesies received. I am, Ladies and Gentlemen, Your obedient servant, GEOFFREY EUGENE OATES, Medical Officer of Health, Metropolitan Borough of Bethnal Green. PUBLIC HEALTH COMMITTEE, 1923-1924 as on 31st December, 1923. Meetings held at the TOWN HALL on the first and third Wednesdays, at 7 p.m. Councillor Mrs. R. Elsbury, Chairman. Alderman Mrs. H. Jeffcote, Vice-Chairman. Councillor C. Agombar. Councillor T. F. H. French. „ J. Alabaster. „ C. Fursse. „ A. Edwards. „ A. H. Gillison. „ S. Elsbury. „ G. H. Pettet. „ J. J. Fleming, J. P. „ J. Valentine. Ex-Officio Members of the Public Health Committee: (The Mayor and Chairmen of other Standing Committees of the Council.) His Worship The Mayor (Ald. T. J. Boyce.) COMMITTEE. CHAIRMAN. Finance Alderman J. E. A. King. Works and Stores ... Councillor J. J. Vaughan. Law and General Purposes ... „ S. Elsbury. Baths „ T. F. H. French. Electricity „ H. Buck. Valuation „ D. G. Alabaster. Public Libraries „ J. Valentine. Housing „ C. N. Murphy. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. PUBLIC HEALTH DEPARTMENT. STAFF as on 31st December, 1923. *Geoffrey Eugene Oates, M.D., B.S., M.R.C.P., London, D.P.H., Cambridge, Barrister-at-Law; Medical Officer of Health and Administrative Tuberculosis Officer. Alfred W. Stokes, F.C.S., F.I.C., Public Analyst. Sanitary Inspectors. *o§ Evan Richards, Chief Sanitary Inspector. *OF. T. Bare. *°J. H. Hewitt. *°W. Billings, Junr. *°E. J. Jenkins. *°G. I. Brighting. *°I. R. Jones. *°§A. S. Henley. °*J. o. G. Weeks. ° Certificated Sanitary Inspector. § Certificated Meat, etc. Inspector. Health Visitors. *†‡Miss G. I. Le Geyt, Superintendent Health Visitor (Member Central Midwives Board) *†Mrs. F. M. Barden. *†‡Miss E. M. Patrick. *† Miss V. D. Cornish. *†‡Mrs. A. W. Rosling. *†‡Mrs. E. L. Hann. *†‡Miss L. F. Wright. *‡Mrs. M. A. Hodgkins. *†‡Miss C. E. Love. *†‡Miss E. S. Crisp (Tuberculosis) † Certificated Nurse. ‡ Certified Midwife. Clerical Staff. ° J. Henry Lloyd, Chief Clerk. F. G. Thomas, Assistant Clerk. S. Slater, Junior Clerk. R. W. Slyheld, Assistant Clerk. ― F. J. Bryant, Shorthand Typist. H. A. Saunders, General G. E. Gould, Assistant Clerk. Assistant. *L. A. Taylor, Assistant Clerk. °W. H. Heron, General Assistant o Certificated Sanitary Inspector. 1 Leading Disinfector, 3 Disinfectors, 3 Messengers, 1 Mortuary Keeper, 1 Drainlayer and 2 Labourers (combined drainage). Maternity and Child Welfare Centre: 1 Porter, 1 Attendant, 1 Cleaner, 1 Cleaner (part time). Temporary (Part Time) Medical Officers (Maternity and Child Welfare Centres). *Mrs. K. Addison, M.B., B.S. *Miss E. F. Iredell, M.D. *Miss M. M. Basden, M.D., B.S., *Mrs. O. Langmead, M.B., B.S. F.R.C.S., L.R.C.P. *Mrs. N. D. Pinkerton, M.B., B.S., M.R.C.S., L.R.C.P., B.Sc. Clinical Tuberculosis Officers. (appointed by the Governors of the City of 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.B., B.S., London, D.P.H., Oxon. CHANGES DURING 1923. Mr. W. Rowsell, Food Inspector, resigned his appointment as from the 31st July, 1923. * The Council receives Exchequer grant towards the salaries of these officers. VITAL STATISTICS. GENERAL STATISTICS. The area of the Borough is 760 acres. At the 1921 Census there were 18,497 structurally separate dwellings in the Borough, and 27,596 families or separate occupiers lived therein. The rateable value of the Borough on the 31st December, 1923, was £578,485, and the product of a 1d. rate is estimated at £2,270. POPULATION. The population, as estimated by the Registrar- General in the middle of 1923, was 118,700. CENSUS STATISTICS. Certain further statistics arising out of the Census taken in 1921 have now been published, and an abstract is here appended : — OCCUPATIONS BY SEX OF PERSONS (AGED 12 AND OVER). Males. Females. Total population 56,766 60,472 Under 12 years of age 15,145 15,124 Aged 12 and over 41,621 45,348 Total occupied, aged 12 years and over 36,152 19,643 Total unoccupied and retired, age 12 years and over 5,469 25,705 Makers of glass and glassware 235 16 Workers in chemical processes; makers of paint, oils, etc. 176 79 Metal workers (not electro plate or precious metals) 1,754 168 Workers in precious metals and electro plate 135 14 Electrical apparatus makers and fitters and electricians 251 20 Furriers, skinners, tanners and leather dressers 303 244 Makers of leather and leather substitute goods (not boots and shoes) 210 283 Males. Females. Textile workers 166 361 Makers of textile goods, boots and shoes and articles of dress and tailors 3,267 6,914 Makers of foods, drinks and tobacco 972 914 Workers in wood and furniture 6,066 792 Printers, bookbinders and photographers 1,257 757 Makers of stationery, cardboard boxes and other workers in paper 195 1,435 Builders, bricklayers, stone and slate workers; contractors 873 5 Painters and decorators (not pottery) 501 14 727 5 Railway workers Road transport workers 3,475 13 Salesmen and shop assistants 922 615 Costermongers and hawkers 741 92 Proprietors, managers and directors of businesses 1,171 303 Domestic servants (indoor) 98 977 Charwomen, office cleaners 23 1,118 Clerks, draughtsmen (not Civil Service or Local Authority) and typists 942 991 Warehousemen, storekeepers and packers 1,573 861 10,119 2,652 Other occupied persons BIRTHPLACES OF THE POPULATION. Males. Females. England 52,484 56,234 Wales 119 142 Scotland 127 120 Ireland 108 155 Isle of Man and Channel Islands 13 4 Other British Dominions, Colonies, etc. 97 60 Foreign countries 3,441 3,413 4 6 Born at sea Birthplace not stated 373 338 Total 56,766 60,472 WORK-PLACES OF THE POPULATION. Occupied persons over 12 years of age and students over 18 years of age. Working in Bethnal Green but living elsewhere. With work-place in Bethnal Green. With work-place outside Bethnal Green. Males. Females. Females. Males. Females. Males. 11,618 3,920 10,487 6,901 20,780 10,614 MARRIAGES. The number of marriages celebrated in Bethnal Green during 1923 was 848. This is equal to a rate of 14.3 persons married, or 7.1 marriages per 1,000 total population. BIRTHS. The number of births registered in the Borough during 1923 was 2,482, and, in addition, 398 occurred outside the Borough to Bethnal Green residents in excess of those occurring in Bethnal Green to residents of other localities, making a total of 2,880 births, The birth-rate for 1923 was, therefore, 24.2 births per 1,000 population. The rates for the last eight years are as follow:— 1916 27.3 1917 22.8 1918 19.2 1919 22.4 1920 33.1 1921 25.4 1922 25.2 1923 24.2 The birth-rates in the four quarters of the year were: — First Quarter 25.1 Second „ 25.5 Third „ 24.2 Fourth „ 22.1 Of the 2,880 births, 1,459 were those of males, and 1,421 those of females. ILLEGITIMACY. Of the 2,880 births credited to this Borough, 65 were illegitimate, being 34 males and 31 females, and being 2.2 per cent. of the total number of births. STILLBIRTHS. Fifty-eight stillbirths were brought to notice, being a proportion of 2 per cent, of all births, live and dead. DEATHS. The number of deaths that were registered during the year as having taken place in the Borough was 1,275. Of these, 282 were of persons whose residence was not in Bethnal Green, 277 dying in Bethnal Green Institutions and 5 in other places in the Borough. There were also reported to the Registrar-General 340 deaths of Bethnal Green persons who died in institutions in other parts of London, and 7 who died in other parts of England and Wales. This correction gives the net number of deaths for Bethnal Green as 1,340, making an annual deathrate of 11.3 per 1,000 of population. The death-rates for the last eight years are as follow: — 1916 15.3 1917 15.8 1918 23.9 (Influenza pandemic) 1919 13.9 1920 14.6 1921 12.9 1922 15.3 1923 11.3 The death-rates in the four quarters of the year were:— First Quarter 12.5 Second „ 10.2 Third „ 10.1 Fourth „ 12.4 The death-rate for Bethnal Green, 11.3, was the same as that for the County of London. The year 1923 was the healthiest ever known, both in England and Wales and in Bethnal Green. Indeed, it may be said that the English people enjoyed an immunity from death and disease greater than has ever yet been recorded for a population of the same size, and Bethnal Green has shared in this improvement. The death-rate of 11.3 per 1,000 persons was most nearly approached in 1921, when the death-rate was 12.9. Previous to the Great War, the usual figure for the death-rate varied between 15 and 18 per 1,000. The causes of this lowered mortality were largely the comparative absence of influenza and measles until the end of the year and the consequent smaller number of cases of the respiratory diseases which commonly follow on these epidemic diseases. Whooping-cough, often a serious cause of mortality, was not very prevalent. Apart from the lowered mortality due to the causes above mentioned, it is a remarkable fact how little bad effect the prevalent unemployment and industrial depression has had on the public health and mortality. Owing to the highly developed system of public relief, few persons are seriously underfed or underclothed, and, as a consequence, the resistance of the population to disease continues to be maintained. Due credit must also be given to the high standard of health and sanitation maintained in the homes of the people by the local authorities, by the vigilance and perseverance of their health visitors, sanitary inspectors and other officers. Infantile mortality and the mortality from tuberculosis and other infectious diseases are subjects of comment in other parts of this Report. The causes of death among the population of Bethnal Green are classified in the following table: — 10 11 A provisional analysis of the CAUSES OF DEATHS at various ages during the year 1923. Deaths in various institutions in the Borough whether of residents or nonresidents. Total Institutional Deaths 1 ... ... ... 5 ... 4 5 6 6 137 8 7 52 4 5 137 35 84 16 46 2 1 ... 17 1 ... 55 18 4 116 1 773 Waterloo House (Poor Law) ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 30 3 ... ... ... ... ... ... ... ... ... 2 1 ... 6 ... ... ... 45 Bethnal Green Hospital (Poor Law) ... ... 40 2 ... 92 24 32 7 8 ... 1 ... 8 1 ... 16 10 4 58 1 ... 394 5 1 ... 4 4 74 1 1 ... ... City of London Hospital for Diseases of the Chest. 1 5 ... ... 12 6 4 8 ... ... ... ... 3 3 2 ... 11 ... ... ... ... ... 108 ... ... ... ... ... ... ... 55 ... 1 ... Mildmay Mission Hospital. ... ... 5 ... ... 2 ... 6 ... 4 ... ... ... ... ... ... 6 3 ... 7 ... 37 ... 1 2 1 ... Metropolitan Borough of Bethnal Green. ... ... ... ... ... ... ... ... ... . ... 2 3 1 2 6 6 5 2 2 5 1 42 42 1 34 2 ... ... 6 ... 390 189 Queen's Hospital for Children. ... 29 4 ... 34 Number of Deaths of residents at various ages, whether occurring within or without the Borough. 65 and upwards. 390 ... ... ... ... ... ... ... 4 ... 21 ... ... ... ... ... 10 ... ... ... 10 3 98 1 40 1 ... 116 62 13 10 1 45 and under 65 years. 340 ... ... ... ... ... 7 3 80 ... 340 ... ... ... 6 2 56 ... 2 56 56 24 19 ... ... ... 9 ... 1 1 ... 18 ... 25 and under 45 years 189 ... ... 4 3 6 ... 189 ... ... ... ... ... 5 ... 50 1 1 17 3 ... 20 10 15 1 2 1 ... ... 2 7 40 1 15 and under 25 years 70 ... ... ... ... ... ... 2 ... 1 25 1 ... 4 1 8 ... 70 ... 1 2 ... 10 1 4 ... ... 4 ... ... 4 1 1 53 ... 5 and under 15 years. ... ... ... ... ... 6 ... ... 6 3 5 ... 53 1 1 ... 3 ... 4 ... ... 3 ... ... 1 ... ... 1 6 ... 13 48 ... ... ... ... 1 ... 1 5 1 1 2 and under 5 years. 1 ... ... ... ... ... ... 3 ... 3 1 48 7 2 6 11 1 ... 3 ... 1 ... 1 and under 2 years 52 ... 10 1 3 ... ... ... ... ... ... 1 3 ... 4 ... 52 ... ... 17 1 6 ... ... ... 1 4 ... 1 ... ... ... ... 198 ... ... ... 8 2 7 1 ... 1 2 1 ... ... 1 1 9 33 1 33 ... ... ... 1 ... ... 66 4 ... 27 ... 198 Under 1 year. ... All Ages. 1340 ... ... ... 32 5 19 20 16 4 164 10 9 7 116 2 206 107 103 40 10 1 ... 38 4 7 68 39 14 273 3 1340 23 All causes Certified Uncertified 1. Enteric Fever 2. Small Pox 3. Measles 4. Scarlet Fever 5. Whooping Cough 6. Diphtheria & Croup 7. Influenza 8. Erysipelas 9. Phthisis (Pulmonary Tuberculosis) Causes of Death. 10. Tuberculous Meningitis 11. Other Tuberculous Diseases 18. Other diseases of respiratory organs 19. Diarrhœa and Enteritis 20. Appendicitis and Typhlitis 21. Cirrhosis of Liver 21a. Alcoholism 22. Nephritis and Bright's Disease 23. Puerperal Fever 24. Other accidents and diseases of Preg- nancy & Parturition 25. Congenital Debility and Malformation, including Premature Birth 26. Violent Deaths, excluding Suicide 27. Suicide 28. Other Defined Diseases 29. Diseases ill-defined or unknown Total 12. Cancer, malignant disease 13. Rheumatic Fever 14. Meningitis 15. Organic Heart Disease 16. Bronchitis 17. Pneumonia(all forms) DEATHS IN INSTITUTIONS. The extent to which the deaths of the inhabitants of the Borough take place in institutions may be seen from the following table: — Institutions in the Borough. Bethnal Green Hospital 378 Waterloo House 43 Queen's Hospital 52 Chest Hospital, Victoria Park 16 Mildmay Mission Hospital 7 496 Institutions out of the Borough. London Hospital 125 Other General Hospitals 42 Maternity Hospitals 10 M.A.B. Hospitals 59 Poor Law Hospitals 15 Sanatoria 11 Mental Hospitals 57 Hostels for the Dying 3 Other Places 24 346 Total 842 From these figures it will be seen that of the 1,340 deaths during the year, 842, or 62.8 per cent, took place in institutions. VITAL STATISTICS of Bethnal Green During 1923 and Previous Years. Year. Including combatants serving for calculating birth-rate. Total Deaths Registered in the Borough. Nett Deaths of Persons Resident in the Borough. At all Ages. Under 1 year of age. Death rate. Rate per 1,000 births or infantile mortality. Number. Population Estimated to Middle of Each Year. Births. Transferable Deaths. Civilian for calculating death-rate. Uncorrected Number. Nett. Of Nonresidents registered in the Borough Of Residents not registered in the Borough Number. Number Rate. 1,761 129 1918 103,403 115,859 2,225 19.2 2,331 384 542 288 2.473 23.9 114,676 2,564 1919 110,085 2,242 22.4 1,535 13.9 366 412 218 85 1,517 1920 116,600 - 3,346 3,855 320 398 1,702 14.6 33.1 366 95 1,626 118,300 - 2,636 372 300 12.9 1921 3,003 25.4 295 100 1,530 1,452 269 1922 118,400 - 2,579 2,981 1,776 349 391 90 1,818 15.3 25.2 118,700 1923 - 2,482 24.2 1,275 282 340 198 68.7 1,340 11.3 2,880 MATERNITY AND CHILD WELFARE NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. During the year, 2,880 live births were registered; and of these, 2,784 were notified to the Medical Officer of Health. There were also 58 stillbirths notified. Of the 2,842 living and stillbirths notified, 1,719 were notified by midwives, 500 by maternity assistants of the London Hospital, 315 by medical practitioners, and 308 by parents and others. MATERNITY AND CHILD WELFARE CENTRES. The popularity of the Council's new Centre in Cornwall Road (which was commented upon in my last Report), has been maintained, and even increased, during 1923 to such an extent as to render urgently necessary an extension of the premises. After negotiations with the Ministry of Health, approval was given to the construction of an extra room on the first floor, and arrangements for the execution of the necessary work are now being made. The auxiliary Centre at Thornton Hall, Mount Street, was in use on Monday afternoons throughout the year. Owing to the increased attendances of mothers, it was found necessary for two medical officers to be in attendance, in place of one, commencing on the 4th June, 1923. With the co-operation of the owners of this hall, a great deal of improvement has been effected. The doctors' room has been completely partitioned off from the weighing-room, the lavatory accommodation has been improved, and there have been other minor alterations. The best use possible is now made of a hall which is really unsuited for Infant Consultations, but is the best accommodation available in the neighbourhood. Certain improvements in the equipment and management of the main Centre may be summarised (1) Green bamboo sunblinds have been provided in certain rooms, being adjusted on supports so as to provide shade without impeding ventilation. (2) Open wire baskets are being gradually substituted for wicker baskets as holders for infants' clothing. Such wire baskets are more easily cleansed after use. (3) Dried milk measures are provided and are appreciated by the mothers, many of whom now speak of so many measures per feed instead of teaspoonfuls, which, of course, are variable, according as to whether an eggspoon or large teaspoon is used. (4) A portable electric lamp on a flexible stand has been provided for use in the Maternity Clinic. (5) A large wooden shute has been erected for the delivery of cases of dried milk in the basement. The growth in the activities of the Centres is shown by the following statistics: — 1923. 1922. 1921. Total Attendances of Children 18,028 14,446 17,124 New Cases (Children) 1,989 1,623 2,073 New Cases (Mothers) 483 349 247 Medical Consultations (Children) 11,685 9,541 10,037 (Mothers) 1,055 710 487 Total Attendances for Milk Grants 15,862 8,302 10,255 The statistics of attendances at each Centre during 1923 are as follows:— Cornwall Road. Thornton Hall. Total Attendances of Children 14,820 3,208 Average Attendance per Session 96.8 66.8 New Cases (Children) 1,577 412 Medical Consultations (Children) 9,899 1,786 INFANT CONSULTATIONS. The work of Infant Consultations has continued on the same lines as heretofore, that is, the individual instruction of the mother by the doctor or health visitor. It is sometimes suggested that lectures to mothers, or something in the nature of class instruction, should be a feature of the Centre work. For many reasons it is quite impracticable to adopt such a suggestion at present. The most that can be done is to give a simple health talk to the assembled mothers occasionally, but even this is difficult, owing to shortage of staff and to the fact that not every health visitor feels able to fill a role which, simple in appearance, is a somewhat difficult one. A few observations by the Medical Officers will be of interest: — Dr. Olive Langmead writes:— "For some time past I have been making a special effort to retain breast-feeding, wholly or partially. A supply of breast-pumps is available at the Centre which I have found extremely useful in two types of case:— (1) In cases of mothers who complain that there is no breast milk: Here the breast-pump provides an undeniable proof, not only of the actual presence of milk, but of the amount which can be drawn off from each breast, and the mothers are thereby encouraged to feed at the breast: (2) In cases where there is not very much breast milk, or where there is a fair amount of milk, but the baby (for various reasons) refuses to suck, or will only partially empty the breast. Usually, the babies are partially or wholly weaned; in such a case a breastpump is lent to the mother, who draws off the breast milk and gives it to her baby, finishing when necessary with a supplementary artificial feed. By this means some babies have returned entirely to breast feeding only, and a large number have only needed supplementary feeds instead of being completely weaned." Dr. E. F. Iredell writes:— "I should like to point out how difficult it is to persuade the mothers that Infant Welfare Centres exist for healthy babies and that sick babies are provided for in other directions. We still frequently see children whose mothers have not brought them for weeks or months 'because they are going on well' —a statement which may be, but more often is not, correct." Dr. N. Pirikerton writes:— "On the whole, there is a great improvement in the regularity of feeding the babies: Most mothers are now aware that the intervals between feeds should be fairly long. They are also beginning to realise that when a baby does not seem to be satisfied with the breast, it is not necessary to wean entirely, but that supplementary feeding is the better method. In several cases it has been possible to re-establish breast feeding, even when the mother had weaned the child for over one or two weeks. The mothers show great interest in the feeding and training of their children, and a great desire to learn more. They are beginning to realise that the responsibility for rearing healthy children rests primarily with them. There is, however, still great ignorance with regard to children's teeth. In one case of a child, aged three years, when I pointed out that the child's molars were decaying, the mother said : 'I suppose you don't know these are the child's first teeth !' Some treatment for the teeth of toddlers should be provided. In very many cases it would be possible to save these important milk teeth; it is now almost impossible for the children to have proper attention anywhere, unless the mothers take the children to distant hospitals, where special treatment for young children is provided. The early decay of the teeth may be due to pappy food, the continuous eating of starchy food, and the fact that the teeth are practically never cleaned. The use of the dummy is far too prevalent; and many badly shaped jaws may be attributed to its constant use. "The babies under two years suffer very much from lack of fresh air and sunlight. This seems to be due to two causes: (1) Many parents think 'it is too cold to take a child out'; (2) Many cannot take a child out. This is because they live in buildings or tenements where there are no gardens, no balconies, and it is impossible to drag a perambulator up many flights of stairs. "Emphasis should be laid on the fact that the Centre exists mainly for advice as to the feeding of children, and for the prevention of disease. Far too many mothers attend once or twice and do not bring the child again perhaps for a year or two, until it is seriously ill, sometimes with the early stages of some infectious disease. This attitude of the mothers should be discouraged." MATERNITY CLINIC. New ante-natal cases 387 Subsequent attendances 479 Total 866 Attendances New post-natal cases 98 Subsequent attendances 90 Total 188 Attendances There were 102 sessions, the average attendance per session being 10.3. On the average, the ante-natal cases attended 2.3 times during pregnancy, and the post-natal cases had an average attendance of 2. The ante-natal cases, 387 in number, may be analysed as follows: — Number of primigravidæ 71 Full-term confinements, including 4 stillbirths 299 Premature births 3 Miscarriages 10 Not yet confined (March 25th, 1924) 94 Found not to be pregnant 46 Wassermann reaction for syphilis:— Number of blood tests 15 Number positive 2 The Medical Officer in Charge, Dr. N. Pinkerton, writes: — "There were three premature births; all of these infants are alive and doing well. There were 10 miscarriages. The miscarriages could not be accounted for except in the case of two of the patients, who were found to have a positive Wassermann re-action. Both of them are now having appropriate treatment. "Forty-six women attended to see if they were pregnant and were found not to be so, the majority of these being nursing mothers anxious to know if they should continue feeding their babies. Four cases of purulent discharge were treated regularly during pregnancy and the midwife in charge of the case warned to be especially careful. In none of these cases did the babies develop ophthalmia neonatorum. A very good result was obtained in the case of a mother who had had four still-born children. She was found to have a positive Wassermann reaction when three months pregnant, and after continuous treatment produced at her fifth pregnancy a very healthy, full term, live child. "Five cases of contracted pelvis were admitted to Hospital for their confinements; one had a premature child and two had live children by Cæsarean Section. One of these mothers had lost her first baby at birth. "A very bad case of Myocarditis was sent into Hospital at the fifth month, where she remained until the baby was born by Cæsarean Section; the mother did well. As this was her second child in fifteen months, and as she had been in extremis with the previous one, the result was pleasing. Unfortunately, both children died when a few months old. Another very bad case of Mitral Stenosis was admitted to Hospital and did well. About six other cases of heart disease were kept under close observation, and one of these was admitted to Hospital twice during the pregnancy. "During this year, many cases of slight albuminuria were seen, and eight of such cases caused some anxiety, but responded to treatment. One very bad case was seen for the first time when at term. She was extremely oedematous, the urine was solid with albumen. She was delivered by Cæsarean Section, and the child was alive and healthy. The mother died five days later of Toxæmia. It is probable that had she been seen regularly during pregnancy, she might not have developed such bad albuminuria. Two other cases were admitted to Hospital for œdema and albuminuria. One of these patients exhibited œdema at the sixth month, with a blood pressure of 125mm. At the seventh month she exhibited albuminuria in spite of a strict diet. She was admitted to hospital for her confinement, and had a very bad postpartum hæmorrhage. The other patient who developed albuminuria and who was admitted to Hospital, had a "doubtful" Wassermann re-action, just before the albuminuria developed. The Wassermann re-action is said to be positive during eclampsia. The Wassermann re-action taken sometime after the birth of the baby was negative, and the baby is an extremely fine child. A most interesting fact is that the mother, who is again pregnant, was vomiting badly at the third month, there was a cloud of albumen, and the blood pressure was 135mm. These symptoms have responded to treatment. Another interesting case was that of a mother who thought she was seven months pregnant. On examination, it was found that she had an Ovarian cyst which on removal was found to weigh 19 lbs. Another woman was found to have a small fibroid of the uterus. "There were three deaths among the mothers who attended the Clinic. One was the case of albuminuria already referred to. Another one had an ante-partum hemorrhage, and the midwife attending could not get her a bed in Hospital, and called in a doctor. However, the patient died three days later of heart failure. The third mother was not seen at the Clinic after five months, but was said to have died of "fits" after the baby was born. "The majority of the mothers had very bad teeth. The Pyorrhœa was really appalling, and it was very difficult to persuade them to have dental treatment. "There were also numerous cases of bad varicose veins." SUPPLY OF FOOD. Considerable use is made of the Council's Centres for the distribution of food to mothers and infants. Dried milks of various brands are sold, being labelled specially to the Council's directions to avoid the use of trade names.The following quantities of milk were sold: — Dried Milk 28,237 lbs. Condensed Milk ... 130 tins MILK GRANTS. The following quantities of milk were issued free to necessitous cases: — Fresh Milk 3,773¾ gals. Dried Milk lbs. Condensed Milk 868 tins together with drugs, etc.The approximate cost of the milk given in this way was £1,705 3s. 3d. The grants made numbered 5,108.These figures show a considerable increase on those for 1922, when 2,814 grants were made, at an approximate cost of £912 1s. 2d., and this was no doubt due to the prolonged unemployment and better knowledge of the Council's welfare work. Every application for a milk grant is carefully investigated. The amount usually given is 1 lb. of dried milk or 7 pints of fresh milk per week per case. HYGIENIC CLOTHING. Although restricted in scope by our limited accommodation and staff, a good deal of useful work is being done in the education of the mothers in the use of more hygienic clothing for themselves and their children, and there is a ready sale for good models of garments at the Centres. SUMMARY OF VISITS PAID BY HEALTH VISITORS. 1922. 1923. . . „ . . . • Births (first visits) 3,027 2,918 Births (re-visits) 11,836 16,628 Visits to mothers 1,775 1.577 Ophthalmia Neonatorum 234 149 Puerperal Fever 25 48 Measles 1,326 1,110 School Complaints 421 167 Special Matters 236 283 Futile Visits 2,196 2,377 Tuberculosis 3,358 3,069 Milk Investigations 928 1,141 Total visits paid 25,362 29,467 It will be seen that the economy of health visitors' time effected by the use of the new centre has enabled them to make many more re-visits to babies at home. NURSING ASSISTANCE. Up to the limits permissible by law, a very conplete 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, e.g., Measles, Whooping Cough, Diarrhœa, Ophthalmia Neonatorum and Poliomyelitis, which come within the Council's Maternity and Child Welfare Scheme. During the year 213 children under the age of 5 were nursed, a total of 2,095 visits being made at a cost of £87 5s. 10d. Of this expenditure £22 3s. 4d. was expenditure under the Maternity and Child Welfare Scheme. Forty-nine mothers received 613 visits for nursing in connection with conditions incidental to childbearing, the cost being £25 10s. 10d. Thirty adults and children over 5 received 246 visits for nursing at a cost of £10 5s. Nursing Assistance 1923. Disease. Under Maternity and Child Welfare Scheme. Under Public Health Acts. Under 1 year. 1-5 years. Mothers Children under 5. Others. Ophthalmia Neonatorum Measles Visits Revisits Visits Revisits Visits Revisits Vis its Revisits Visits 338 ... ... 14 ... ... ... 1 8 16 186 Whooping Cough ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... Other pre- and post-natal conditions ... ... ... ... ... ... ... 49 ... 613 Discharging Eyes 74 689 ... Conjunctivitis 4 38 ... ... Corneal Ulcer 3 37 ... Septic Eye 1 6 ... 2 16 Injuries to Eye ... 13 Otorrhœa ... ... ... ... ... 128 ... Tonsils and Adenoids ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... Tracheotomy 1 10 ... Catarrh ... ... 1 10 ... ... ... ... ... Influenza 3 ... ... ... ... ... ... ... Bronchitis 4 36 ... ... ... ... ... ... ... 15 27 ... Pneumonia ... ... ... ... ... ... 126 Constipation ... ... ... ... ... ... 2 8 Intestinal Obstruction 17 ... ... ... ... ... ... 4 Threadworms ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 228 Hernia 1 8 Rectal Prolapse 1 10 ... ... 1 10 Phimosis Vaginitis ... ... ... ... ... ... 1 8 Dislocated Hip 1 10 ... ... ... ... ... ... ... Abscess 5 45 ... ... Adenitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 7 Cellulitis ... ... ... ... ... 2 20 ... Eczema 1 10 ... Impetigo 2 18 ... ... ... 6 50 ... Pyrexia 1 6 ... Hæmorrhage ... ... ... ... ... 9 Prematurity ... ... ... ... ... ... 1 ... 613 Totals 15 346 16 186 49 182 30 1563 8 cases were in hand at the beginning of the year. 13 cases were in hand at the end of the year. A total of 2954 visits were paid to 292 cases at a cost of £123 1s. 8d. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... CONVALESCENT TREATMENT. Owing to the transfer of the Catherine Gladstone Convalescent Home at Mitcham to the London Hospital, at the beginning of 1923, the Council had to make other arrangements for the convalescent treatment of nursing mothers. During the year two mothers were sent to the Evelyn Convalescent Home, Upper Wargrave, Berkshire, and four mothers to the London Mothers' Convalescent Home, Sunningdale, Berkshire. Each mother was sent away for two weeks. In three of the cases the husband contributed to the cost of convalescence. With regard to children, the arrangement made with the Hertfordshire County Council in 1922 was continued and 30 children were sent to that Council's Home at St. Leonards-on-Sea, Sussex, 16 for a period of four weeks, 8 for six weeks, and 6 for eight weeks. In 24 cases the parents contributed to the cost of the convalescence. General satisfaction has been expressed by mothers regarding the treatment at the Homes, and at the benefits derived therefrom, particularly in the case of the children. INFANTILE MORTALITY. One hundred and ninety-eight 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 68.7 per 1,000 births. Comparison with previous years is as follows:— 1916 106.0 1917 112.0 1918 129.0 1919 85.0 1920 95.0 1921 98.2 1922 90.2 1923 68.7 So far as can be ascertained, 192 of the deaths were those of legitimate infants and 6 those of illegitimate infants. Accordingly, we have the following figures for Infantile Mortality:— Infantile Mortality (legitimate) 68.2 do. do (illegitimate) 92.3 do. do. (all infants) 68.7 Of the 198 deaths, 34 were due to prematurity. This is a substantial decrease on the figures for 1921 and 1922, which were 47 and 54 respectively. Some of the credit for this important reduction may be awarded to the Ante-natal Clinics provided by the Council and by the various organisations dealing with maternity in the Borough. At the Council Maternity Clinic alone, 387 expectant mothers attended. It would be unwise, however, to attach undue importance to the work of Ante-natal Clinics in this matter without further experience. The deaths from diarrhœae diseases were 34 in number, a very low figure and much on a level with last year's figure of 25. There were 42 deaths from bronchitis and pneumonia, as compared with 83 last year. This, again, is a very satisfactory reduction, mainly due to the slight prevalence of whooping cough and measles which are so often followed by fatal chest trouble in infants. The Infantile Mortality figure of 68.7 per 1,000 births is a record one for Bethnal Green, the previous record having been 85 in the year 1919. In 1903, 20 years ago, the figure was 141. The reduction in the mortality of infants is a matter on which the Council may well congratulate itself, as it is largely due to municipal work. It is also a source of personal gratification to the staff engaged in Infant Welfare work. If the infantile mortality were to-day what it was twenty years ago, 405 babies would have died during the year, instead of 198. In other words, 207 infants in Bethnal Green are alive today because they had the good fortune to be born in 1923 under an enlightened Council and Ministry of Health. But there is not only the saving in lite to record; there is the improvement in health and physique of the modern infant which will be reflected in its after life. The new generation now being reared in our midst will undoubtedly be bigger, handsomer, more intelligent and healthier than the present generation, better citizens and workers as well, and that in spite of the bad environment in which so many of them will be condemned to spend their lives. PUERPERAL FEVER. Seventeen cases of this complication of childbirth were reported during the year. Eight of the patients were removed to the London Hospital, three to Bethnal Green Hospital, two to the Mothers' Hospital, Lower Clapton Road, and three to the Metropolitan Asylums Board Institutions. There were five deaths from the disease. OPHTHALMIA NEONATORUM. Twenty-three cases of purulent eye-discharge in the new-born were notified, one by a midwife, and the remainder by doctors. In every case the condition was cured without any apparent impairment of vision. Fourteen cases received pursing attention at home from the Shoreditch and Bethnal Green District Nursing Association, the Borough Council paying part of the cost: 338 visits were paid by nurses of the Association. Infantile Mortality in Bethnal Green, in 1923. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months 9 months & under 12 months. Total Deaths under 1 year. All causes— Certified 52 ... ... ... ... ... ... ... 7 I 6 I I 71 I' [ 32 I 41 ... I I 28 \ 198 I I 6 I 26 ... ... Uncertified ... ... ... ... ... ... Small-Pox ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... Measles ... ... 1 1 2 4 8 Scarlet Fever ... ... 1 1 2 ... ... ... ... ... ... 1 ... 4 2 Whooping Cough ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup ... ... ... ... ... 1 Erysipelas ... ... ... ... ... 1 ... ... 1 ... Tuberculous Meningitis (30 ... ... ... ... ... ... ... ... Abdominal Tuberculosis (31) ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... 2 ... 2 ... Meningitis (not Tuberculous) (61) ... ... ... ... ... 1 ... 1 ... ... Convulsions (71) 1 ... ... 1 1 ... 1 3 ... ... Laryngitis (87B) ... ... ... ... ... ... ... ... ... ... 1 1 6 1 1 ... 9 Bronchitis ... ... ... Pneumonia (all forms) (91 & 92) Diarrhœa (104 B, E & F) ... ... ... ... 1 2 1 5 6 6 7 33 1 9 1 ... 6 3 1 11 1 3 23 Enteritis (104 A, C, D & G) 1 ... 11 4 4 ... ... 1 Gastritis (103A) ... ... ... ... ... ... 1 ... ... Syphilis 1 1 ... ... ... ... ... ... ... ... Rickets (36A) 1 1 ... ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... ... ... ... ... 7 Injury at birth (152 C) 6 1 ... ... 7 ... ... ... ... 6 ... ... ... ... Atelectasis (152B) 5 ... ... 1 6 Congenital Malformations(150) Premature birth (151A) 7 1 1 ... 9 1 3 ... 13 ... 28 2 2 1 33 1 ... ... 34 ... Atrophy, Debility and Marasmus (151B) ... ... 3 18 1 ... 1 8 5 1 1 2 7 3 1 14 Other Causes 5 ... ... 2 41 28 198 Totals 52 6 7 71 32 26 6 Nett Births in the year legitimate 2815 illegitimate 65 Nett Deaths in the year legitimate infants 192 illegitimate infants 6 Note. The numbers given in brackets after certain causes of death indicate the numbers of the corresponding headings in the detailed International List of Causes of Death, 1909. 1 7 NOTIFIABLE DISEASES, Etc. Diphtheria There were 489 cases of diphtheria notified during the year. Of these, there were 16 cases under the age of 1 year, 184 between the ages of 1 and 5 years, 227 between the ages of 5 and 15 years, 44 between the ages of 15 and 25 years, 15 between the ages of 25 and 45 years, 2 between the ages of 45 and 65 years, and 1 over 65 years of age. Of the 489 cases, all were removed to an isolation hospital except 2 who were treated at home, and 1 in which the diagnosis was only made at the time of death. Twenty deaths from this disease occurred during the year. Comparison with previous years is as follows :— 1918 26 deaths 1919 58 „ 1920 36 „ 1921 34 „ 1922 34 „ 1923 20 „ Of the 20 deaths, 11 were those of children over 1 year of age and under 5. The second, third, fourth, and fifth years of life comprise the epoch when the young child is most susceptible to diphtheria, and a heavy toll of life is taken. Of the 184 cases occurring during this period of life, it will be seen that 6.0 per cent. died. At the epoch 5-15 years the mortality was only 2.6 per cent, of those attacked. Several cases of diphtheria having occurred in the staff of an Institution in the Borough, suggestions were made to all Institutions having the care of children that the staffs should be immunised to diphtheria by modern methods. lam pleased to state that steps are actively being taken in this direction. Antidiphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor. 56,000 units were supplied during the year. Scarlet Fever. There were 316 cases of scarlet fever notified during the year. Of these, there were 7 cases under the age of 1 year, 137 cases between the ages of 1 and 5 years, 153 cases between the ages of 5 and 15 years, 16 cases between the ages of 15 and 25 years, and 3 cases between the ages of 25 and 45 years. Of the 316 cases, 314 were removed to an isolation hospital. Five deaths occurred from scarlet fever during the year, all of which took place at hospitals. Comparison with previous years is as follows : — 1918 ... ... 9 deaths 1919 ... ... 4 „ 1920 ... ... 12 „ 1921 ... ... 10 „ 1922 ... ... 6 „ 1923 ... ... 5 „ Small-pox. One case of this disease was notified in the person of a child aged 7 years. On examination at the Isolation Hospital, however, the child was found not to be suffering from small-pox and was discharged home the same day. Typhoid Fever. There were 6 cases notified, but one of them was apparently not typhoid fever. In no case was the source of infection ascertained. There were no deaths. Erysipelas. There were 79 cases notified and 4 deaths. Malaria. During the year 1 case was notified. The patient was found to be an ex-Service man who had contracted the infection overseas. Acute Polio-Myelitis and Acute Polio- Encephalitis. Three cases of acute polio-myelitis and 1 case of acute polio-encephalitis were notified. Dysentery. There were no cases reported. Acute Encephalitis Lethargicia. There were 4 cases reported. They appear to have been of the usual type, and in no case could any source of infection be traced. Cerebro-Spinal Fever. One case of this disease was notified. Anthrax. One case of this disease was reported, a child aged 3 years. He recovered. Acute Primary Pneumonia and Acute Influenzal Pneumonia. One hundred and sixty-three cases of acute primary pneumonia and 27 cases of acute influenzal pneumonia were notified during the year. Statistics and notes with regard to Puerperal Fever, Ophthalmia Neonatorum and Home Nursing will be found in the section relating to Maternity and Child Welfare. Cases of Notifiable Diseases Notified During the Year 1923 in Bethnal Green. Disease Number of Cases Notified. All Ages. Under 1 year. 1 and under 5 years 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Small Pox 1 ... ... ... 1 ... ... ... Diphtheria (including Membranous Croup) 489 16 184 227 44 15 2 1 Erysipelas 79 3 7 12 5 21 22 9 Scarlet Fever 316 7 137 153 16 3 ... ... ... Typhus Fever ... ... ... ... ... ... ... Enteric Fever 6 3 ... ... 3 ... ... ... Puerperal Fever 17 3 14 ... ... ... ... ... Cerebro-spinal Fever 1 1 ... ... ... ... ... ... Acute Poliomyelitis 3 ... 1 1 ... 1 ... ... Acute Encephalitis Lethargica 4 ... 1 ... 2 1 ... ... Ophthalmia Neonatorum 23 23 ... ... ... ... ... ... Acute Polio-encephalitis 1 ... 1 ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... 1 Malaria 1 ... ... ... ... ... ... 28 Acute Primary Pneumonia 163 6 45 41 20 17 6 27 Acute Influenzal Pneumonia ... 1 ... 4 10 7 5 Pulmonary Tuberculosis 263 10 16 42 90 79 26 ... 60 1 12 29 11 5 2 Other forms of Tuberculosis ... ... Cholera, Plague, Relapsing Fever ... ... ... ... ... ... ... ... Continued Fever, Trench Fever 1 ... ... ... ... ... ... 1 Anthrax ... 1 ... ... ... ... ... Hydrophobia, Glanders ... ... ... ... ... ... ... ... Total 1455 57 399 484 148 190 130 47 Verminous Conditions. One hundred and ninety-eight children reported from the Elementary Schools as being infested with body-lice were visited. In every case advice as to the treatment of the clothing and bedding was given and disinfestation by steam was offered. However, in only three cases was advantage taken of such offer, 23 articles being so disinfested. During the year 23 men infested with body-lice were cleansed at the Disinfecting Station and their clothing disinfested. Scabies or Itch. Fifty-eight children suffering from this disease were visited after being excluded from the Elementary Schools. In only 6 instances was disinfestation of the clothing and bedding permitted, 44 articles being disinfested. Nine rooms were also fumigated after scabies, by request. BACTERIOLOGICAL EXAMINATIONS. The following examinations were carried out by the Royal Institute of Public Health :— Throat Swabs—submitted for examination ... 423 Diphtheria bacilli present in ... ... 62 Sputum—specimens submitted for examination 191 Tubercle bacilli present in ... ... 30 Blood-serum—specimens examined ... ... 2 TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year is set out in the table appended hereto. Owing to the fact that a case of tuberculosis may be notified in several boroughs or districts, the number of notification certificates received is only a very imperfect guide to the amount of tuberculosis in the Borough. There is also the consideration that notification is more strictly enforced in some districts than in others. The only exact means known at present of judging the prevalence of tuberculosis is by the deaths recorded from the disease. There were 164 deaths from pulmonary tuberculosis, 10 deaths from tuberculous meningitis, and 9 deaths from other tuberculous diseases. The number of deaths from tuberculosis of all kinds during the past few years is as follows : — 1919 ... ... 216 1920 ... ... 197 1921 ... ... 184 1922 ... ... 219 1923 ... ... 183 The notifications received during the year will be seen from the following tables : — Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications on Forms A & B received during the Year 1923. Age of patient. Tuberculosis of the Lungs Other Tuberculosis. Male. Total. Male. Female. Female Total. .. — .. .. .. 1 1 Primary Notifications. 0—1 year 6 1—5 years 6 10 6 4 12 6 5-10 „ 7 9 3 3 16 5 6 5 10—15 „ 8 3 11 10 18 1 15—20 „ 2 8 3 20—25 „ 13 24 3 5 11 8 .. 25—35 „ 21 37 3 16 3 2 32 53 .. 2 35—45 „ 21 38 55 1 .. 45—55 „ 17 1 1 24 1 15 .. 9 55-65 „ 13 26 .. .. 13 65 years and over .. Total 156 105 261 28 30 58 69 116 5 7 Cases re-notified 47 12 377 37 Total Notifications on Form A 225 152 33 70 .. Primary Notifications by School Medical Officers. .. .. .. .. .. 0 —5 years 1 .. 1 1 1 2 5-10 „ 1 .. 1 .. .. .. 10—15 „ 1 2 1 .. 1 Cases re-notified 3 Total Notifications on Form B 1 3 5 2 3 2 No. of Notifications on Forms C. & D. Poor Law Institutions. Sanatoria. D C D C Pulmonary Tuberculosis— 46 32 102 69 Male 40 45 18 39 Female 11 6 6 10 Non-Pulmonary Tuberculosis— Male 2 4 6 21 Female C = upon admission. D = upon discharge. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1921. During the year the names of 222 patients were removed from the Tuberculosis Register as follows : — Deaths ... ... 170 Removals ... ... 52 Of the 52 patients who removed from the Borough, it was possible in 16 instances to obtain the new address of the patient, and these cases were duly transferred to the Medical Officer of Health of the district to which the patient had removed. Eight cases were added to the register of patients who were reported by other Councils to have removed into this Borough. EX-SOLDIERS AND SAILORS SUFFERING FROM TUBERCULOSIS. Two hundred and fourteen ex-Service men were under observation during the year. There were 9 deaths amongst these, and 5 removed from the Borough. Four hundred and ten visits were paid to these men by the Tuberculosis Health Visitor. WORK OF TUBERCULOSIS HEALTH VISITOR. This officer paid 3,069 visits to cases. SUPPLY OF SPUTUM OUTFITS. During the year 57 sputum flasks were distributed to patients. Forty-two sputum tins, with 1,498 cardboard refills, were distributed to patients for use indoors. GRANTS OF EXTRA NOURISHMENT. The arrangements with regard to grants of extra nourishment to tuberculous patients were fully reported in my Annual report for 1921, and were continued, without material change, during 1923. During the year 270 grants were made at an estimated cost of £196. One hundred and thirtythree patients were dealt with, 18 of whom were still receiving nourishment at the end of the year. TUBERCULOSIS DISPENSARY. A full report on the work of the Dispensary, by Dr. H. T. Howell, the Clinical Tuberculosis Officer, appears in the appendix to this report on page 74. DENTAL TREATMENT FOR TUBERCULOSIS PATIENTS. By arrangement with the City of London Hospital for Diseases of the Heart and Lungs, a scheme for the dental treatment of Tuberculosis Dispensary patients found to require such treatment came into operation in July, 1922. In accordance with this scheme, special dental sessions were held once a fortnight at an inclusive annual charge covering the services vices of dental surgeon, anaesthetist, etc. It was found, however, that the number of cases requiring and willing to undergo treatment was not sufficient to justify the continuance of this arrangement, which was replaced on the Ist July, 1923, by a revised scheme under which patients were dealt with in the Dental Department of the Hospital at an agreed charge of 6s. 8d. per attendance. This has proved satisfactory, and is much more economical than the original scheme. During 1923, 33 patients received dental treatment. There were 36 attendances for extractions, 34 being under gas. Other attendances for treatment were : examinations 8; fillings 3; scalings 6; fittings and alterations for dentures 50. FINSEN LIGHT TREATMENT FOR LUPUS. PNEUMOTHORAX REFILLS. Since 1921, the Council has paid for the Finsen Light treatment of cases of Lupus at the London Hospital. During the year, 3 patients were so treated, making 71 attendances for treatment. One patient was also provided with pneumothorax refills at the Brompton Hospital on 5 occasions during the year. PROTECTION OF FOOD SUPPLY SALE OF FOOD AND DRUGS ACTS. Seven hundred and thirty-seven samples were taken; 681 of these proved to be "genuine," and 56 or 7.6 per cent, adulterated. The details are given in the following table :— SUMMARY OF ANALYST'S REPORTS. Samples taken formally Samples taken informally Milk Sterilised Milk Separated Milk Skimmed Milk Butter Margarine Dripping Lard Cheese Cream Cheese Cream Preserved Cream Condensed Milk Cond. Milk(mach. skimmed). Jam. Coffee Cocoa Vinegar Malt Vinegar Camphorated Oil Olive Oil Parrish's Chemical Food Raisin Wine Ginger Wine Orange Wine Lemonade Egyptian Cotton Seed Oil Mustard Pepper Flour Rice Chocolate Sardine, &c. Paste Mincemeat Compounded Medicines Maderia Cake No. taken. 355 1 2 2 99 37 1 21 1 2 4 2 6 3 49 7 8 39 2 ... 5 2 2 1 ... 1 ... 4 9 11 4 6 1 10 17 1 ... Genuine. 340 1 ... ... ... ... 2 ... ... ... ... 2 ... ... 97 34 1 ... ... ... ... 21 ... ... ... ... 1 ... 2 ... ... ... ... 1 3 ... ... ... 2 ... ... ... 5 1 3 ... ... ... ... 49 ... ... ... ... 7 ... ... ... ... 8 ... ... ... 36 3 ... ... 2 ... ... ... 5 ... 2 ... ... ... 2 ... ... ... ... 1 1 ... ... 4 ... ... ... 9 ... ... 11 ... ... ... ... 4 ... 6 1 ... ... ... ... 10 ... ... ... ... 15 ... ... ... 2 1 ... Total Number of Samples taken. 360 1 2 2 109 37 1 21 2 2 4 2 7 3 49 7 8 39 2 5 2 2 2 1 1 1 1 4 9 11 4 6 1 10 17 1 1 Adulterated. No taken Genuine. Adulterated. Article. 3 2 15 5 ... ... 2 10 8 2 3 ... ... ... 1 1 ... ... 1 ... 1 ... ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Flaked Beef Suet ... ... ... 1 1 ... 15 737 Totals 715 666 49 22 7 Prosecutions were instituted in respect of 22 of the 49 formal samples which were reported to be adulterated, and in 11 cases the vendor was cautioned in writing; in the remaining cases the adulteration was insufficient for proceedings. Full details are set forth in the following table :- ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Milk 67 Do. 70 Do. 71 Do. 74 Do. 118 Do. 124 Do. 145 Contained 1 1/3 per cent water beyond per legal limit of 16 per cent. Contained 5½ per cent. less than proper amount of fat. Found to be 10 per cent, deficient in fat. Found to be 4 per cent, deficient in fat. Contained 2½ per cent. excess of water. Found to be 12 per cent, deficient in fat. Contained 8½ per cent added water. Found to be 11 per cent, deficient in fat. Dismissed. Warranty proved. ... ... - Dismissed. Defendant proved milk was sold as given by cow. Costs £2 2s. (against each of two partners). Dismissed. Defendant proved milk was sold us given by cow. - (c) No action taken in view of result of analyses of samples taken direct from cow and having regard to position of law. (c) Sample taken from cow. Do. Do - - - Result of Analysis. Result of Legal Proceedings. (a) Action taken other than legal proceedings. (b) Previous Convictions (if any). (c) Other Remarks. Margarine 6 Name of Article and Identification Number of Sample. ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Milk 155 Compounded Medicine. 180 Do. 181 Do. 182 Do. 183 Do. 184 Do. 185 Do. 186 Result of Analysis. Pound to be 6 per cent. deficient in fat. Contained 29.75 grains per oz bicarbonate of soda instead of 30 as prescribed. Contained 2.2 grains quinine sulphate per oz instead of 2 as prescribed. Contained 29.87 grains bicarbonate of soda per oz instead of 30 as prescribed. Contained 29.4 grains potassic bromide per oz instead of 30 as prescribed. Contained 27.56 grains bicarbonate of soda per oz instead of 30 as prescribed. Contained 19.8 grains sodic salicylate per oz instead of 20 as prescribed. Contained 29.87 grains bicarbonate of soda per oz instead of 30 i as prescribed. Result of Legal Proceedings Dismissed. Defendant proved milk sold as given by cow. - - - - - - - (a) Action taken other than legal proceedings. (b) Previous Convictions (if any). (c) Other Remarks. - - - - - (a) Cautioned. - - Name of Article and Identification Number of Sample. ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample. Result of Analysis. Result of Legal Proceedings. (a) Action taken other than legal proceedings. (b) Previous Convictions (if any). (c) Other Remarks. Contained 6.8 grains salicylate of soda per ½ oz. instead of 10 as prescribed. (6) 30.12.20: Selling strong tincture of iodine 75 per cent, deficient in iodine. Costs £2 2s. Compounded Medicine. 506 W.R. Fined £3, costs £3 3s Costs £3 3s. Do. 508 W.R. Contained 12.5 grains salicylate of soda per ½ oz. instead of 10 as prescribed. - - - Do. 509 W.R. Contained 32 grains potassic bromide per oz. instead of 30 as prescribed. - - Contained 1.92 grains quinine sulphate per oz. instead of 2 as prescribed. Do. 510 W.R. - - Do. 511 W.R. Contained 29.4 grains bicarbonate of soda per oz. instead of 30 as prescribed. - - Contained 4 per cent. added water. Milk 202 Fined £5, costs £2 2s. Condensed Milk. 228 Contained one thirtieth usual amount of fat. (b) 6.2.23: Exposing unsound sound condensed milk for sale. Fined 8s., costs £2 2s. Contained 48 per cent. less than proper amount of sodic salicylate. (c) See also proceedings as to labelling. Compounded Medicine. 235 - (a) Cautioned. ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample. Compounded Medicine. 521 Do. 522 Margarine 247 Milk 251 Cream 259 Butter 260 Vinegar 285 Milk 304 Do. 305 Do. 523 W.R. Result of Analysis. Contained 5 per cent, less than the proper amounts of sodic salicylate and sodic bicarbonate. Contained 15 per cent, less than the proper amount of salicylate of soda. Contained 2 per cent water beyond legal limit. Contained 8 per cent. less than proper amount of fat. Contained .074 per cent. boric acid. Contained 79 per cent. foreign fat. Contained 16½ per cent. added water. Costs 2s. Contained 18 per cent, less than proper amount of fat. Contained 12 per cent. less than proper amount of fat. Contained 12 per cent. added water. Result of Legal Proceedings. - - Costs £1 1s. Dismissed. Defendant proved milk sold as given by cow. - Fined £20, costs £2 2s. Costs £2 2s. (summons withdrawn). Pined £1, costs £2 2s. Fined £10, costs £2 2s. (a) Action taken other than legal proceedings. (b) Previous Convictions (if any). (c) Other Remarks. - - (c) See also proceedings as to labelling. - (c) Proceedings in respect of labelling. (c) See also proceedings as to labelling. - - - (c) 2 summons under Milk and Dairies (Amdt.) Act, 1922 withdrawn. ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample. Result of Legal Proceedings. (a) Action taken other than legal proceedings. (6) Previous Convictions (if any). (c) Other Remarks. Result of Analysis. Cream 312 Contained .3 per cent. boric acid. - (c) Proceedings in respect of labelling. Fined £4 - Vinegar 1 E.R. Contained 15 per cent. added water. Cream 388 ... Contained .23 per cent. of boric acid. (c) Proceedings in respect of labelling. .. Margarine 421 Contained 1 per cent of water beyond legal limit of 16 per cent. (a) Cautioned. Malt Vinegar 470 - (a) Cautioned Consisted of wood vinegar containing 4.2 per cent. of acetic acid but no malt. Fined £7, costs £3 3s - Vinegar 478 Contained 60 per cent. added water. - Milk 496 (a) Cautioned. Contained 10 per cent. less than proper amount of fat. - Malt Vinegar 499 (a) Cautioned Consisted of wood vinegar containing 4 per cent. of acetic acid but no malt. Raisin Wine 636 - Contained 6 grains salicylic acid per pint. (a) Cautioned. Orange Wine 638 - Contained 2.5 grains salicylic acid per pint. (a) Cautioned. ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample. Result of Analysis. Result of Legal Proceedings. (a) Action taken other than legal proceedings. (b) Previous Convictions (if any) (c) Other Remarks. Contained 4 grains of salicylic acid per pint. - (a) Cautioned. Ginger Wine 640 - Contained 92 per cent. margarine. Butter 37 A.H. (c) Proceedings in respect of labelling (in 1924). - Contained 6 grains salicylic acid per pint. Raisin Wine 646 (a) Cautioned. - Contained 6 per cent. added water. Milk 654 (c) Case heard in 1924. Costs £2 2s. Contained .12 per cent. of boric acid. - Madeira Cake. 48 A.H. (a) Cautioned. SAMPLES TAKEN INFORMALLY. Five samples of milk were taken informally, 2 of which were found to be adulterated. One was 15 per cent, deficient in fat and the other contained 35 per cent, of added water. Ten informal samples of butter were taken, 2 of which were adulterated as follows : — Sample 244 J.G.W. Found to contain 79 per cent. foreign fat. 237 J.G.W. Found to contain 78 per cent, foreign fat. The 2 informal samples of Parrish's Chemical Food both proved to be genuine. A sample of condensed milk was found to contain only one-twenty-fifth of the proper amount of fat, one of lemonade to contain three-tenths of a grain of Carbolic Acid per pint, and one of Flaked Beef Suet to be 14 per cent, rice and wheat flour. In addition to the above, the following samples taken informally proved to be genuine : — Cheese ... ... ... 1 Egyptian Cotton Seed Oil 1 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, 1923 :— Three hundred and fifty-five formal samples and 5 informal samples of milk were taken, and in no case was the presence of a preservative reported. Four formal samples of cream were taken, in 3 of which boric acid was found to be present, the per- centages being .074, .23 and .3. Two formal samples of Preserved Cream were also taken and were found genuine. No informal samples of cream were taken. With regard to the formal samples, in 3 cases the cream was delivered to the purchaser in a receptacle which did not bear a proper declaratory label. These vendors were prosecuted for the absence of a declaratory label (see page 49), and in one case the vendor was also prosecuted for depositing for sale cream which was not labelled in accordance with the Regulations. In no case was the percentage of boric acid found to be in excess of the permissible amount. " APPEAL TO COW " SAMPLES. Eight samples of milk were taken direct from the cow in 1923. Seven of these samples were taken at the request of the vendor of sample 67 following the analysis of this sample, which was found to be 5½ per cent. deficient in fat; 4 of them (including a mixed per sample) were found to be genuine, while 2 were deficient in fat (4 per cent, and 10 per cent.) and one contained 2½ per cent, excess of water. A mixed sample from several cows taken from another milk vendor keeping her own cows was found to be genuine. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS. 1923. These Regulations came into force on the Ist November, 1923. " Condensed Milk " is therein described as milk or skimmed milk which has been concentrated by the removal of part of its water, whether with or without the addition of sugar, and includes the article commonly known as "evaporated milk," but does not include the articles commonly known as "dried milk" or "milk powder." "Skimmed milk" includes separated or machine-skimmed milk. The Regulations prohibit the sale of condensed milk unless it (1) is contained in a tin or other receptacle labelled in the prescribed manner, and (2) contains not less than the following percentages of milk fat and milk solids :— Description of Condensed Milk. Percentage of Milk Fat. Percentage of all Milk Solids including Fat. Full cream, sweetened or unsweetened ... 9.0 31.0 Skimmed sweetened ... — 26.0 Skimmed unsweetened... — 20.0 An important point in the matter of the prescribed scribed labelling is the fact that the labels on the Condensed Machine-Skimmed Milk (or Condensed Skimmed Milk) must include the statement that the contents of the tins are " Unfit for Babies." The Borough Council has appointed the Medical Officer of Health and all the Sanitary Inspectors as Officers for the purpose of enforcing the Regulations. During the year 6 samples of condensed milk were submitted for analysis. Five samples were genuine and complied with the requirements of the Regulations. One sample, although sold as condensed milk was found to be almost entirely free of milk-fat. Legal proceedings were instituted both for the sale to the prejudice of the purchaser and for the improper labelling of the tin and fines of £5 and £2 with costs £2 2s. Od. and £1 1s. Od. for the respective offences were awarded. ACTION TAKEN WITH REGARD TO OFFENCES OTHER THAN ADULTERATION. Article. No. of Sample. Offence. Result of Prosecution cution or remarks. 1 (i.) Withdrawn. Margarine (i.) Exposing for sale unlabelled parcel of margarine. (ii.) Selling margarine by retail in plain wrapper. (ii.) Fined £1. 14 Cautioned. Failing to have name and address inscribed on vehicle and receptacle. Milk (i.) Withdrawn. 18 Margarine Offences (i) and (ii.) as above 136 Offence (i.) as above (ii.) Fined £1. Cautioned. Do. Offence (ii.) as above 141 Do. Do. Do. Offence (i.) as above Do. 160 169 Do. Do. Do. 228 Exposing for sale machine-skimmed condensed milk not properly labelled. Condensed Milk. Fined £i. Costs £1 1s. (See also proceedings as to adulteration.) 247 Offence (i.) as above Margarine Costs £1 1s. (See also proceedings as to adulteration.) Selling preserved cream in unlabeled receptacle. Costs £3. Cream 259 260 Offences (i) and (ii.) as above (i.) Fined £5. Costs £1 1s. Butter 312 (a) Depositing preserved cream for sale in unlabelled receptacle. (ii.) Costa 2s. Cream (i.) Fine £1. (ii.) Fine £1. (b) Selling preserved cream in unlabelled receptacle. 323 Cautioned. Offence (i.) as above Margarine 335 Do. Do. Do. 359 Do. Do. Do. Cream Selling preserved cream in unlabelled receptacle. Fined £3. 388 ACTION TAKEN WITH REGARD TO OFFENCES OTHER THAN ADULTERATION—continued. Article. No. of Sample. Offence. Result of Prosecution or remarks. 507 (i.) Exposing for sale unlabelled parcel of margarine. Cautioned. Margarine Do. 509 Do. Do. 511 Do. Do. Do. Do. Do. 544 Fined 10s. (ii.) Selling margarine by retail in plain wrapper. Do. 554 Cautioned. 572 Offences (i) and (ii.) as above Do. Withdrawn. Fined 5s. Do. 37 A.H. Offence (i.) as above Case heard in 1924. Fined £2. Selling milk from receptacle not con- spicuously inscribed with vendor's name and address. 15.2.23. Fined 10s. No sample taken. No sample taken. Selling milk from vehicle and re ceptacle neither conspicuously inscribed, etc. 15.2.23. Fined 10s. FOOD PREMISES. Milkshops and Dairies. Forty-six applications for registration under the Dairies, Cowsheds and Milkshops Orders were considered during 1923, 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 1922 ... 216 Deduct number of purveyors removed from register during 1923 7 Add number of new purveyors added to register by resolution of the Public Health Committee during 1923 ... 25 Number of purveyors of milk at retail milkshops on register at end of 1923 ... 234 Number of applications for registration refused ... ... ... ... ... 0 During the year 751 inspections of milkshops were made by the Inspectors, and 107 notices were served under the Public Health (London) Act, 1891. No legal proceedings were found to be necessary. Milk Special Designations Order, 1923. One supplementary licence to sell certified milk in the Borough from premises in Hackney was granted during the year. Cowhouses. There were at the end of 1923 twelve licensed cowhouses in the Borough, as in previous years; 54 inspections were made during the year. *This includes changes of occupier in premises previously on the register. List of Licensed Cowhouses. 63, Bishop's Road.—(No. of cows—Shed No. 1—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. 1 — 8 cows, Shed No. 2 —8 cows.) 104, Gibraltar Walk. —(18 cows.) 34b, Green Street.—(45 cows.) 1, Hamilton Road. —(13 cows.) 55, Kerbela Street. —(No. of cows—Shed No. 1 — 18 cows, Shed No. 2 —2 cows.) 2, Libson Street. —(19 cows.) 64, Squirries Street.—( 14 cows.) 38, Three Colts Lane.—(23 cows.) 6, Warley Street. —(10 cows.) Ice Cream Premises. Three hundred and fifty-six visits were paid to these premises by the district inspectors during 1923. Proceedings were taken against one occupier under Section 8 of the L.C.C. (General Powers) Act, 1908, and 'a fine and costs amounting to £3 15s. Od. were awarded. Fried Fish and Fish-Curing Premises. At the end of 1923 there were 51 fried fish vendors' premises in the Borough, at three of which curing was also carried on. There were 28 fish curers' premises, including these three. Four hundred and three visits were made by the Food Inspector to these premises, and 24 notices were served for insanitary conditions. Workshop Bakehouses. In the County of London, the Metropolitan Borough Councils are responsible for enforcing proper sanitary conditions in all bakehouses, whether whole- sale or retail, which are workshops, that is, without mechanical power. There are, in Bethnal Green, 62 workshop bakehouses, 20 of which are underground. One occupier was prosecuted for keeping his bakehouse in an insanitary condition on two occasions, and was fined £5 with £2 2s. Od. costs on each summons. Two other occupiers were prosecuted for occupying uncertified underground bakehouses, and in each case 10s. 6d. costs were awarded to the Council. Factory Bakehouses. There are in Bethnal Green 16 factory bakehouse 5 of which are underground. In every case the mechanism used, which causes the bakehouses to be a factory, is a dough-mixer. Generally speaking, the factory bakehouses are kept clean and in a sanitary condition. Eighty-six inspections were made during the year, and arising out of these visits, 2 notices were served on occupiers calling attention to lack of cleanliness. Wholesale Dealers in Margarine. The following premises are registered as being occupied by wholesale dealers in margarine : — 136, 352, 374 and 420, Bethnal Green Road, 153 and 200, Brick Lane, 231, Cambridge Road, 19, 182, 199, 209, 211, Green Street, 282, 324 a and 489, Hackney Road and 43a, Old Ford Road. Other Premises used for the Preparation or Sale of Food. There were 205 such premises on the register, the majority being restaurant-kitchens. 755 inspections were made during the year, and arising out of such inspections 81 Notices to remedy faults or insanitary conditions were issued. SLAUGHTERHOUSES. There were 3 licensed slaughterhouses in the Borough at the end of 1923, situated at: — 294, Bethnal Green Road. 354, Bethnal Green Road. 278, Hackney Road. Twenty-three visits were made to slaughterhouses by the Food Inspector during the year. On the 7th December, 1923, a new by-law came into force regulating the method of slaughter of cattle. In future all animals must be effectually stunned with a mechanically operated instrument before being slaughtered. Licensed Jewish slaughterers are, however, exempt from the scope of this by-law. SLAUGHTERERS OF POULTRY. The business of a Slaughterer of Poultry having been declared an offensive trade in the County of London, by-laws regulating the conduct of such business and the structure of premises on which such business is carried on came into force on the 22nd December, 1923. At the end of the year there were found to be 10 slaughterhouses in use, all of them situated in the west ward of the Borough. There were also 5 premises on which poultry were kept prior to slaughter, and to which the by-laws would apply. These slaughterhouses have previously been kept under close observation and much improvement in the conduct of them has been brought about. The new by-laws will in time effect further improvement and minimise what is a source of trouble and offence to neighbours. Certain important points may be mentioned in the application of the structural requirements. The slaughter of poultry within public view is prohibited. This will in some cases entail the building of a wall to screen the slaughterhouse from the inmates of an adjoining dwelling house, and such wall must be of brick, stone or concrete. Similarly, the requirement that a water-closet must not open into or ventilate into a slaughterhouse will in many cases necessitate the removal of such water-closet or the building of a wall, for it is obvious that the open side of a slaughterhouse should be removed some six feet from a watercloset to prevent any effluvium from blowing into the slaughterhouse, unless such effluvium is intercepted by a wall. In one case a dwelling-room was found to be directly communicating with a slaughterhouse. After a period of two years' grace, the inner surface of doors, walls and woodwork are to be rendered up to a height of six feet with cement or other impervious material. It will, I think, be found difficult for the occupiers of many of the slaughterhouses to comply with the structural requirements of the by-laws and with the London Building Act as well, and this must result in the closing of certain premises for the purpose of poultry slaughtering. Premises on which slaughtering of poultry is carried on :— 147, 151, 159 and 267, Brick Lane, 107, Bethnal Green Road, 49 and 80, Virginia Road, 71, Church Street, 36, Hare Street and 92, Columbia Road. Premises on which poultry are kept prior to slaughter :— 254, Brick Lane, 86, Sclater Street, 9 and 58, Collingwood Street and 14, Bacon Street. UNSOUND FOOD. The Food Inspector has kept under regular inspection food exposed or deposited for sale in slaughterhouses, shops (especially butchers', cooked meat and fishmongers' shops), stalls and market places. Four seizures of unsound food have been made during 1923 as follows:— Seizures. Description of Article. Weight. Prosecution and Result. Date. Condensed Milk 31 tins. 8/1/23 Fined 8s. Costs £2 2s. Meat 140 lbs. 24/6/23 Summons not served: Vendor absconded. Tinned Fish Kippers 11/7/23 58 tins. 3 prs. Fined £10 Costs nil. Fruit 11/7/23 84 lbs. Fined £2. Costs nil. On 68 occasions during the year unsound food, comprising the following articles, was surrendered by the owners and destroyed as trade refuse : — Articles Surrendered Description of Article. Weight. Tons. Cwts. lbs. Fish - 13 85 Meat - 6 68 Fruit 1 2 63 Other Articles - 1 50 Condensed Milk 269 tins Tinned Fish 740 tins Tinned Fruit 584 tins Tinned Vegetables 80 tins Tinned Meat ... ... 12 tins Eggs 4,000 Rabbits ... ... ... 318 Shellfish 1 bag Jam 106 jars FOOD POISONING. No instance of food poisoning was brought to my notice during the year. SALE OF FOOD ORDER, 1921. Part iii. of this Order was continued in force during the year under the Expiring Laws Continuance Act, 1923. Imported meat and eggs are required to be labelled as such. No contravention of the Order was reported during the year. SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding for The Year ended 29th December, 1923. Complaints. House to House Inspections Milkshop Inspections. Other Food Premises. Re-Inspections. Factory and Workshop Inspections. Outworkers Home Inspections. Tenement House Inspections. New Buildings Inspections. Combined Drainage Inspections. District. Infectious Cases. Smote 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. Matters Outstanding. Total Visits for the Year. Inspector. 694 120 107 87 3360 89 556 37 .. 48 191 A 208 143 1 1 768 58 5641 G. I. Brighting 1 .. 154 80 2900 98 458 449 12 149 36 276 12 4993 B 26 42 313 .. 917 49 .. .. 517 85 177 155 196 J H. Hewitt 129 100 3677 116 1143 73 156 63 88 .. .. 28 5653 C 194 .. 702 73 .. 1 W. Billings 149 4309 178 121 54 102 3 92 .. 2 973 96 6044 D 160 100 121 F. Bare 736 89 117 43 214 19 33 329 .. .. 231 3491 2 331 4 1109 65 5871 E 115 .. E. J. Jenkins 613 7 56 44 237 173 362 2966 103 204 .. 4 975 F 194 57 356 .. .. 73 5372 28 1298 .. 1 .. 17 I. R. Jones .. 1120 51 .. .. .. 2730 1 214 69* 1 .. .. 375 26 77 .. .. A. S. Henley 796 47 .. .. .. .. .. .. .. .. 26 4 20 .. 1084 138 .. W. Rowsell .. 10 41 .. .. .. 658 .. .. .. .. 59 1 .. .. .. 4 .. 51† J. G. Weeks 6 3765 425 545 1609 1882 1715 362 606 1064 21941 561 4 6281 414 754 115 37,439 Totals 1592 1366 * Includes 17 Samples of Rag Flock. + Other than under Sale of Food & Drugs Acts, etc. It will be noted that there has been a reduction in the number of inspections of food premises, and of premises coming under the Factory and Workshop Act. This is mainly attributable to the reduction of the staff by one officer in the latter half of the year. More time was also taken up with drainage work than in the preceding year. SANITARY DEFECTS DISCOVERED DURING 1923 Month. Dirty Premises. Defective Drains. 59 Defective and Dirty W.C.'s. 176 Other Matters. Total. Defective Water Supply 107 Jan. 318 1351 2011 Feb. 297 48 153 93 1176 1767 Mar. 213 51 121 96 1648 1167 April 187 1082 1186 43 104 78 1494 May 219 57 143 84 1689 1545 June 204 4 3 192 97 1009 July 153 27 109 65 1007 1361 Aug. 179 39 136 63 1109 1526 Sept. 168 35 102 79 1243 1627 187 39 125 83 1407 1841 Oct. Nov. 196 41 127 69 1279 1712 Dec. 109 21 67 73 1124 1394 2430 503 Totals 987 14140 19615 1555 During the year 4,700 Preliminary Notices were served requiring the remedying of Nuisances. 4,263 Statutory Notices were served. DISINFECTION SERVICE. During the year, 1,354 rooms and 18,771 articles were disinfected for various reasons, liquid Formalin in the form of a spray being used for the purpose of disinfecting rooms. During the year one of the Washington-Lyons disinfecting machines was fitted with a recording gauge which automatically records the number of charges, the time occupied and the steam pressure and temperature attained. The table appended gives full details of the rooms, bedding and clothing disinfected. Rooms, Bedding and Clothing disinfected during the Year ending 31st December, 1923 Mouth. January February March April May June July August September October November December Totals Number of Rooms. Scarlet Fever. Diphtheria. Total No. of Articles. Pulmonary Tuberculosis. Small pox. Verminous Conditions Cancer. Scabies. Measles Enteric Fever. Pneumonia. Polioencephalitis Anthrax. Other Conditions. Total No. of Rooms. Erysipe- las. 21 27 60 .. 1 .. .. .. .. .. .. .. 109 1412 .. .. 34 1 2 .. .. .. 3 .. 1 90 1549 21 26 2 .. 105 1711 29 15 1 .. 4 .. .. 1 .. 3 .. 4 48 .. 1 4 86 1460 19 30 28 .. 1 .. .. 1 .. .. 4 .. 118 15 28 19 5 .. 3 .. .. 1193 .. .. 1 47 .. 104 1560 12 5 23 .. 1 .. 3 29 .. 29 2 .. .. .. .. 131 1303 20 17 59 4 1 1 3 .. .. .. 2 .. 24 10 3 2 117 1316 13 1 1 .. 33 2 .. .. .. .. 52 1734 43 49 .. .. .. .. 128 21 .. 1 1 1 4 8 .. 38 56 13 5 2 .. .. 2 1915 10 .. 4 1 132 1 .. 1882 13 3 .. 47 44 .. 4 1 .. .. 119 .. .. .. 7 47 .. 115 1736 32 16 2 .. 10 2 2 2 .. .. 2 .. 325 482 208 1 226 22 9 26 6 6 18 1 3 21 1354 18771 No. of articles destroyed by request .. .. 257 Articles disinfected in Formalin Chamber, such as boots, boxes, books, etc. 1,300* Rooms in Schools disinfected .. ..8 * Inciuded in 18,771 above. PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 150 bodies were received at the Mortuary, i.e._ On Coroner's order ... ... 111 From the Police ... ... 9 From London Hospital .... ... 3 At the request of relatives ... ... 27 Exact particulars are only available as to the 124 bodies on which coroner's inquests were held. On 68 of these bodies post-mortem examinations were made. MORTUARY STATISTICS. Places from which bodies were brought to the Mortuary. Removed by the Police from the canal 3 streets, etc. 5 Removed from Bethnal Green Hospital 35 „ „ Queen's Hospital 11 „ „ Mildmay Mission Hosp. 4 Private houses, etc. 66 Total 124 Inquest cases classified according to age:— Number under 1 year 22 „ over 1 year and under 5 years 9 5 years „ „ 10 „ 7 7 „ 10 „ „ „ 20 „ 6 „ 20 „ „ „ 30 „ 6 „ 30 „ „ „ 40 „ 9 „ 40 „ „ „ 50 „ 13 „ 50 „ „ „ 60 „ 16 „ 60 „ „ „ 70 „ 16 „ 70 „ „ „ 80 „ 15 „ „ 80 5 Total 124 Causes of death in inquest cases:— Natural causes 73 Self neglect 1 Misadventure: death under an anæsthetic 2 Accidental 30 Open Verdict 5 Wilful murder 1 Suicide 12 Total 124 DISTRIBUTION OF DISINFECTANTS. During the year 12,327 pint bottles of disinfectant fluid were distributed to applicants. Owing to the fact that the fluid is largely used as a deodorant, for rinsing down sink-wastes and gullies, and for washing yards, it is given out in a diluted form, which explains the apparently large amount issued. SHELTER FOR CONTACTS (3, St. James Road). These premises, consisting of a nine-room house, were purchased freehold by the Council during the year. They are occupied by a caretaker and are available, as required by statute, for the accommodation of contacts of infectious disease during the disinfection of premises. No use of the shelter was made during the year. RATS AND MICE (DESTRUCTION) ACT, 1919. During the year much advice was given to persons needing it and a few informal notices were served on persons whose premises were found to harbour rats. In one instance an occupier of a restaurant allowed food refuse to accumulate in his yard and also stored there a number of packing cases, barrels, tins, etc.; in this way affording an ideal breeding place for rats, which were a plague to the neighbourhood. A Statutory Notice was served without result and on legal proceedings being taken a fine of £5 with £3 3s. Od. costs was imposed. During the year special attention was given to the storing of refuse from restaurants and food premises, a covered re- ceptacle being required in every case to prevent the access of rats. The "Works and Stores Committee of the Council who supply dust-bins to purchasers, agreed that the type of dust-bin to be supplied in future should be a covered one in accordance with the requirements of the by-laws. It should not be forgotten that rats cannot live without food, and that they can obtain a certain amount of food from dustbins which are commonly left uncovered. It is to be hoped that the sanitary inspectors may in time educate the public to realise the importance of preventing access of rats and mice to waste food in dust-bins. Another important means of rat control is the detection of defective drains which allow the egress of rats from the sewers. With the aid of our powerful smoke machine it has been possible to establish the connection of numerous rat runs with defective drains, such a discovery being followed by the repair of the defective drain. In connection with rebuilding operations in the Borough special attention has been given to the sealing of disused drains at the junction of sewer and drain. Unless this is done systematically a blind drain results which affords a nesting place for breeding rats. CUSTOMS AND INLAND REVENUE ACTS. No applications for certificates for exemption from Inhabited House Duty were received during the year. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920 and 1923. During the year one application for a certificate as to the state of repair of a house was received, and it was granted. WATER SUPPLY TO NEW HOUSES. During the year 108 new houses were certified as having a proper and sufficient water supply. SMOKE PREVENTION. During the year 6 formal observations of smoke shafts were made, but in no case was black smoke observed in such quantity as to be a nuisance. No Notices were served. The law as it stands at present does not prohibit the emission of black smoke from private dwelling-houses; manufacturing premises, therefore, mainly come under control. RAG-AND-BONE DEALERS. By-laws made by the London County Council under Section 9 of the London County Council (General Powers) Act, 1908, for regulating this class of business came into force on the 26th September, 1923, but as regards structural requirements twelve months' grace is to be allowed. The term " rag-andbone dealer " is defined as meaning any person selling or buying for the purpose of resale or otherwise dealing in rags (other than tailors' or dressmakers' cuttings), bones, rabbit-skins, fat, or other like articles. Twenty-three persons or firms were found to be carrying on such a business in the Borough. In nearly all cases extensive structural alterations will be necessary in order to comply with the requirements of the Bylaws.During the year 62 visits of inspection were paid by the officers concerned. OFFENSIVE TRADES. During the year under review there was no offen- sive trade carried on in the Borough, with the exception of poultry-slaughtering, which is dealt with in another part of this Report. RAG-FLOCK ACT, 1911. Five formal samples of rag-flock were taken during the year, and in one case the amount of chlorine present was found to be in excess of the limit fixed by the Regulations. In this case, however, the Analyst reported that the material was not flock manufactured from rags. Ten samples of ordinary cotton-waste were examined and found to contain an excess of chlorine, as well as certain microbes of excremental origin. As such cotton-waste is extensively used for upholstering work in the Borough, and appears to be very dusty and possibly deleterious to the operatives concerned, the Council thought it desirable to make representations to the Ministry of Health that the inclusion of cotton-waste within the provisions of the Rag-Flock Act, 1911, should be considered. UNDERGROUND ROOMS. The standard to which underground rooms must conform, if separately occupied, is prescribed in the Public Health (London) Act, 1891. In the latter part of the year a special enquiry was made, at the request of the London County Council, into the question of these rooms, and the following information was elicited : — Number of basements used for dwelling purposes 560 Do. do. with ceilings below street level 7 Number of basements with ceilings at street level 157 Do. do. with ceilings above street level 396 Those in which the width of the area in street does not exceed 3 feet 334 Those in which the width of the area in street is between 3 feet and 4 feet ... ... 226 A few cases of illegal occupation of underground rooms as separate dwellings were brought to notice, but in the present circumstances it was not considered possible to deal with these other than by means of a warning letter to the occupier and landlord. In the case of a fresh illegal letting, legal proceedings will then be justified. COMBINED DRAINAGE SYSTEMS. The reconstruction and maintenance of such combinations of drains of houses and premises as are found to be sewers by law defined and are not under highways is carried out by the Public Health Department. There are 684 such systems in the Borough, draining approximately 3,200 houses and premises. The staff engaged on this work consists of a drainlayer and two labourers, with additional help as required. During the year five systems were reconstructed. HOUSING. Housing Statistics for 1923. Number of new houses erected during the year: — (a) Total. 161 (tenements). (b) As part of a municipal housing scheme: Borough Council schemes: Bethnal Green Estate 102 „ Vaughan Estate 14 L.C.C. scheme: Collingwood Estate 45 „ 1. Unfit dwelling-houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health Acts) 5,254 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 Nil. (3) Number of dwelling-houses found and reported to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 Nil. 2. 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 Nil. 3. 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 Nil. (2) Number of dwelling-houses which were rendered fit Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. (B) Proceedings under Public Health Acts: — (1) Notices served requiring defects to be remedied Intimations 4,700 Statutory Notices 4,263 (2) Number of dwelling-houses in which defects were remedied: — (a) By owners (nuisances abated) 6,281 (b) By Local Authority in default of owners Nil. (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 2 (2) Number of dwelling-houses in respect of which Closing Orders were made 3 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 4 (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. TENEMENT HOUSES. The number of houses registered as being let in lodgings or occupied by members of more than one family was 209; 746 visits of inspection were made to these houses, and arising out of such visits, 292 Notices were served. The present By-laws do not apply when the landlord himself resides on the premises or where the rent of the tenement is above a certain figure. This explains the limited number of tenement houses which are now on the register and subject to the By-laws. Revised By-laws are now in preparation, and will be applicable to a large number of tenements which are at present excluded from the operation of the By-laws. FACTORIES, WORKSHOPS, OUTWORKERS, Etc Inspection of Factories, Workshops and Workplaces. Premises. Number of Written Notices. Prosecutions. Inspections. Factories (Including Factory Laundries) 332 46 - 8 Workshops (Including Workshop Laundries) 2663 512 Workplaces (Other than Outworkers' Premises) 17 1 - Total 3012 559 8 Defects found in Factories, Workshops and Workplaces Particulars. Nuisances under the Public Health Acts:— Number of Defects. Number of Prosecutions. Remedied. Referred to H.M Inspotr. Found. - 6 Want of cleanliness 217 203 43 Want of ventilation 39 - - 6 6 - - Overcrowding Want of drainage of floors - - - - Other nuisances 621 576 - - insufficient unsuitable or defective not separate for sexes 18 11 - 1 Sanitary accommodation 127 - 139 1 6 6 - - Offences under the Factory and Workshop Acts:— - - - - Illegal occupation of underground bakehouses (s. 101) 1 1 - 1 Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 81 81 - 2 Other offences 59 51 - - (Excluding offences relating to out work) Total 1191 1101 - 11 Registered Workshops. Workshop on the Register (s. 131) at the end of the year. Number. Workshops 1686 Workshop Bakehouses 62 Total Number of Workshops on Register 1748 Other Matters Class. Number. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 16 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 Reports (of action taken) sent to H.M. Inspector. 45 45 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 25 HOME WORKERS. Of the 3,927 workmen and contractors whose names appeared on the lists received, 2,740 resided within the Borough. In 1922 the number was larger, being 2,870. This figure, 2,740, 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 was 2,593. The number of premises found to be in an insanitary condition was 448, or 26 per cent. of the 1,715 premises inspected. Notices were served in 392 cases, the other 56 premises being already under notice arising from other visits. HOME WORK OUTWORKERS LISTS, SECTION 107. Outwork in unwholesome premises, Section 108 Outwork in Infected premises, Sections 109, 110 Instances. Notices served. Prosecutions. Instances. Prosecutions (s. 109, 110) Lists received from Employers. Addresses of Outworkers. Notices served oil Occupiers as to keeping or sending lists. Prosecutions Sending twice in the year. Sending once in the year Orders made, (s 110). Failing to send lists. Nature of Work. Failing to keep or permit inspection of lists. Lists . 135 Outworkers Lists. Outworkers. Received from other Councils Forwarded to other Councils. Contractors Workmen Contractors Workmen Wearing Apparel— Making, etc. 31 1046 6 ... 1440 I 596 16 I 82 223 ... ... 239 ... 7 ... ... Curtains, Furniture hangings and Trimmings 1 10 10 183 8 39 ... 1 ... 101 ... 28 21 ... ... ... ... ... ... 21 3 2 Fur-pulling and feathers 2 ... 3 ... ... 5 3 1 44 ... ... ... ... Umbrellas, etc 4 ... 8 ... ... ... 4 ... 14 10 ... ... ... ... ... ... Artificial Flowers 1 2 ... ... 22 2 1 8 5 ... ... ... ... ... ... ... ... Paper, etc.. Boxes, Paper Bags 31 188 139 25 388 1 96 6 80 4 ... ... ... ... ... ... ... Brush-making 6 437 ... 11 346 4 49 3 ... ... ... ... ... 57 ... ... ... ... Draught Board making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosques, Christmas Crackers, Christmas Stockings, etc. ... 16 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Textile Weaving 2 18 ... 2 1 1 ... ... ... ... ... ... ... ... ... ... Toys 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 191 ... 1781 131 448 ... Total 31 8 30 1187 ... ... 2085 ... 392 ... 17 APPENDIX. Bethnal Green Tuberculosis Dispensary. REPORT FOR THE YEAR 1923. By H. Tylford Howell, M.K.C.S., Eng., L.R.C.P., Loud., Clinical Tuberculosis Officer. During the past year there has been no radical change in the conduct of the work of this Dispensary. The space allotted at the Hospital to our department has remained unaltered and has once more proved quite satisfactory. Office accommodation is adequate, patients' waiting-rooms are satisfactory, while the consulting-rooms are in every way excellent. The fact that two dressing-rooms are attached to each consulting-room not only adds considerably to the comfort of the patients, but it also enables the Medical Officers to get through their work more rapidly—a factor of great importance on busy days. It also enables men and women to be seen in their turn as they arrive, and does not necessitate the setting apart of special times for the attendance of the different sexes. I have always held the view that as frequent re-examination of patients as possible is one of the most important aspects of our work, and without the generous amount of accommodation available this would have to be considerably cut down. Another very great advantage on which I have laid stress is the possibility of consultations between the two Medical Officers, for which there is always a spare room available. Every new case is seen separately by myself and my colleague, and afterwards a discussion on its special features takes place—a procedure that is also adopted at subsequent re-examinations if a definite diagnosis has not been made, or if any special symptoms, signs, or complications should arise. By this means both Medical Officers are personally acquainted with practically every one who attends the department, and it is possible, if occasion should arise, for one of us to take over entire clinical charge without the patients suffering in any way. The hours of session have remained the same as in the previous year. In 1922 an alteration was made, the time of the evening session on Wednesday being changed from 7.30 to 5.30 p.m., which as events have proved has been abundantly justified. It has enabled people who work in the vicinity of the Hospital or who pass it on their way home but who live at a considerable distance, especially in the Borough of Hackney, to visit us while returning from work, and has saved them loss of time and also an additional journey back late in the evening. For the third year in succession the personnel of the department has continued unchanged. In any branch of medical work the spirit of team work is highly desirable, but in units engaged in the anti-tuberculosis campaign which presents so many and diverse phases—clinical, pathological, and sociological—all demanding special attention, it becomes an urgent necessity if proper co-ordination of the different branches is to be successfully accomplished.In this connection it may be permissible to digress for one moment and point out the distinction which exists between the work of a Hospital outpatient department and that of a Tuberculosis Dispensary. It might be thought that during an actual session the difference would be slight, but this is very far indeed from being the case, as can be shown by a reference to the additional considerations that have to be taken into account by the Tuberculosis Officer while he is engaged in examining and interviewing a new case. In ordinary circumstances a medical man's duties are in the main limited to making a diagnosis and prescribing suitable treatment, but he who is engaged in tuberculosis work under the present scheme has constantly to keep the following in his mind in addition : (1) In taking out the history of the adult male cases he must ascertain whether or not they have been in the army; if so, the dates of their enlistment and discharge, the reason for their discharge, the illnesses from which they may have suffered in the service, their previous health, the exact duration of symptoms, whether or not they are in receipt of a pension for any disability, for a knowledge of these points may be necessary in order to give an opinion on questions subsequently submitted by the Ministry of Pensions; (2) The conditions of the man's occupation must be investigated if he is tubercular, and if his work is deemed unsuitable the Tuberculosis Officer must communicate with the local Labour Exchange, and in the case of ex-service-men, with the local Pensions Committee also; (3) A list of examinations for the day has to be made out and names entered therein; (4) The patient must be informed of the date of his next attendance and a record of the appointment entered in a special diary kept for the purpose, in order that he may be communicated with if he should fail to appear; (5) Advice must be given with regard to the collection of samples of sputum for examination; (6) Arrangements must be made for those who need dental treatment and their names entered in a register; (7) A positive case must be urged to send up his family as contacts for examination; (8) If the case is that of a child, special information must be obtained for the filling up of a report required by the London County Council to be sent to the school Medical Officer; (9) The question of whether the patient needs additional diet or not, and if so, whether he comes within the regulations of the scheme provided by the Borough for that purpose, must be investigated; (10) The question of institutional treatment, of reference back to the Insurance Practitioner, of the amount of supervision required, etc., must be discussed. It must be remembered that each of these points must be kept in mind and decided by the Tuberculosis Officer during the session itself, though the actual filling up of the multitudinous forms and reports at present in vogue is done afterwards. This may serve as an illustration of the complicated nature of the work of the Tuberculosis Officers, and it will be realised how essential for efficiency it is that the staff, both medical and clerical, should have worked together as long as possible, and that there should be a period of unbroken continuity of office. Though there have been practically no variations in the work as far as our own arrangements in the Dispensary itself are concerned, yet we are only one unit in a scheme, and necessarily alterations in rules and regulations by bodies responsible for co-ordinating the work of the scheme affect us. Thus the provision of institutional treatment is in the hands of the London County Council. In the absence of facilities for such treatment locally it is inevitable that this matter should be dealt with by some central body, and it is equally unavoidable that a certain amount of delay should be incurred in the admission of patients when a large number recommended from all the Metropolitan Boroughs have to be taken in rotation. In the spring and summer of the year it cannot be said that these arrangements were satisfactory to us, for not only was the waiting period sufficiently long for the whole aspect of the case to be changed in certain instances, but a considerable proportion of our people were unable to secure admission at all, in spite of the fact that we endeavoured as far as possible to recommend only those who were suffering from tuberculosis in its earlier stages, or those in whom it was probable that a period of institutional treatment might result in at least temporary improvement. During the latter period of the year the difficulty has not been nearly so great, but it must be remembered that at such a season the prospect of going away is not so alluring to the average patient. It is always possible to secure a bed for a pensioner, and it is to be feared that other men, many of them ex-soldiers, have suffered as a result. The system of "preferential treatment" entails that such a pensioner, no matter how unlikely he is to derive any permanent benefit therefrom, and no matter how undeserving he is on grounds of war record or length of service, takes preference over, and often excludes from institutional treatment, a man who might be likely to do well, and who in many cases has a long and honourable army record. Thus from the sentimental as well as from the utilitarian point of view the system is in my opinion unsound. As I have had to state in my previous reports, for all cases of advanced disease except pensioners there is very little provision, and their ultimate fate is still in the vast majority of cases the Infirmary, especially in the case of female patients. In spite of these criticisms, I would like to say that on the whole sanatorium and hospital treatment has for many proved a great boon. Closely allied with the institutional treatment of tuberculosis is the work carried out by the charitable societies, such as the Invalid Children's Aid Association, Charity Organisation Society, Soldiers' and Sailors' Families' Association, and the Jewish Board of Guardians, to all of which I should like to offer my sincere thanks for much valued and kindly help. It would be impossible for anyone to work for any length of time in the poorer districts of London without appreciating to the full the wonderful work done by the Invalid Children's Aid Association, in spite of the very regrettable fact that their financial resources are so extremely slender. The local branch of the association in Bethnal Green has given us the utmost assistance in dealing with children of the so-called pre-tuberculous type, and often with those definitely tuberculous but suffering from the disease in a localised and noninfectious state. Through their efforts a considerable number of children have been sent away to the sea or country, invariably with satisfactory results. Another means which we have at our disposal for dealing with tubercular children is the open-air school at Stormont House. This school, which is situated on Hackney Downs, was opened in 1919, and admits both pulmonary and non-pulmonary cases of tuberculosis of either sex, the ages ranging from eight to sixteen years. The average number on the roll was 86, with an average attendance of 74. With an occasional exception, all the children come from the neighbouring boroughs of Hackney, Bethnal Green, and Stoke Newington. The classes are held in the open air, special shelters being provided for the purpose in the grounds. Although ample accommodation during bad weather is available for the children in the permanent building, it has rarely been found necessary to make use of this even in the winter. Hot midday meals are provided at a nominal fee, and in the case of necessitous children no charge is made. Records of the temperature, weight, etc., are kept, and the Medical Officer visits the sthool every week and makes frequent examinations, and directly supervises the exercise and rest of each child. The results are very encouraging, as illustrated by the improvement in signs and symptoms, the fall of temperature, increase in weight, and the happier mental outlook of the children. During the year 13 children were discharged as fit for work, while 12 had so improved as to permit of their transfer to an ordinary elementary school. It may also be mentioned that the system recently inaugurated for coordination between the Tuberculosis Officers and School Medical Officers in the supervision of children who are contacts or who are unsatisfactory from the point of view of general health, but not definitely tubercular, is now in full working order in both boroughs. It will be remembered that I gave details of this procedure in my last report, and it will suffice if I draw attention to its main provisions. The Tuberculosis Officer reports on a special form provided for the purpose to the School Medical Officer as to the condition of all child contacts whom he encounters in his work, and also on all "unsatisfactory" children whether contacts or not. These children are definitely classified in one of two divisions, and are weighed and examined by the school medical authorities at varying intervals according to the class to which they belong. Certain of these cases are also kept under supervision at the Dispensary. It cannot be said that as a result of this system any fresh cases of tuberculosis have been brought to light that would otherwise have escaped notice, but probably the child of poor general physique and health receives more systematic and frequent examination. I should like also to draw attention to two recent innovations in the work to which I referred briefly in my report for the year 10*22, namely, the arrangements for the dental treatment of tuberculous patients and the scheme for granting additional nourishment. It is always a difficult matter to convince patients, especially if they suffer no pain from their teeth, of the necessity for availing themselves of the services of the dentist, and it is to be feared that a mere perusal of the figures may be disappointing. Every endeavour is made to secure that patients who are about to enter hospital or sanatorium shall have their mouths thoroughly overhauled and treated, and the resulting advantages are pointed out to them, but at times our best efforts in this direction are unavailing. Also the school dental service has often proved so efficient that it is by no means unusual to see apparently perfectly healthy teeth in young adults in the present day, while it is not thought advisable to refer for dental treatment patients with advanced tuberculosis unless they are actually suffering pain. Moreover, the Ministry of Pensions in most cases undertakes this duty in regard to pensioners. These considerations will show that though on paper the figures may not appear very impressive, yet the work done in this connection has been of great benefit, and no patient in need of treatment has ever been refused it. The same arrangements are in the main in force except that it has been found possible for the cases to be seen by the Hospital Dentist during his ordinary sessions. The provision of extra diet by the Borough in necessitous cases has continued throughout the year. Only a comparatively small sum has been available for this purpose, but it has been, I think, a thoroughly satisfactory investment. We have kept within the limits laid down by the Minister of Health in his circular on the subject as far as possible, but we have often felt that there are many other deserving cases to whom we should like to extend it. The (act that it is limited to so few cannot, however, be taken as an argument against its utility—rather the reverse—and it would indeed be a pity if for any reason it were dropped. We have continued to act as medical referees for the Ministry of Pensions. This work is necessarily of a somewhat thankless and uncongenial nature. It differs from ordinary medical practice in that the doctor has not only to consider the interests of the patients, but he has also to endeavour to see that the State is not defrauded. Under such circumstances, it is inevitable that occasional unpleasantness should arise, while the time occupied in such duties is considerably greater than would be the case in dealing with a similar number of patients of the non-pensioner class, and the number of forms and reports to be completed is considerable. However, it is difficult to see how else the work could be carried out, and the fact that the men are under an obligation to attend at regular intervals secures an amount of supervision over them which might otherwise be impossible. The actual treatment of pensioners, other than institutional, is still conducted by Insurance Practitioners in the main. As is well known, the Ministry of Health holds strongly that as little treatment as possible should be given in the Dispensary, and almost all insured patients, whether ex-service men or not, are now referred back to their panel doctors. In spite of that fact, there remains a considerable residue comprised of uninsured adults and children whom we treat systematically. Neither myself nor my colleague, Dr. Hamilton, as a result of our observations when resident officers in institutions, has been favourably impressed with the various methods of vaccine or serum treatment used in Pulmonary Tuberculosis, and we have in the main relied on the usual non-specific reme dies; but in the summer of the past year we felt compelled to give a trial to Professor Dreyer's "defatted antigen," both because of the good results claimed for it, and also because several patients who had read of it in the lay press were extremely anxious to receive a course. We decided to limit its use to certain classes of cases which came under one of the headings tabulated below, and it was also explained to every one that the method was only in the experimental stage and that we could not from personal experience guarantee results. 1. Those whose condition was obviously deteriorating and who were urgently clamorous to be given a trial. 2. Those who showed a good resistance but in whom the disease was extensive and in whom with careful dosage at least no harm would probably ensue. 3. Surgical cases. The number selected was small, some being treated in their own homes, and every effort was made to secure ample observation on the day following the administration of the injection, and a full day's rest was insisted upon. The vaccine was prepared by Dr. S. Roodhouse Gloyne, Pathologist to the Hospital, who also very kindly gave us the benefit of his experience in dosage, of which we gladly availed ourselves. It would not be appropriate in this place to give details of results, but they can be summarised by saying that though at times there appeared to be temporary periods of improvement, these were not sustained and did not differ from those which frequently occur during the progress of any prolonged chronic disease even if untreated. While on the subject of treatment, it may not be out of place to mention that in the latter end of the year the Minister of Health issued a circular con- taining details of a new method of procedure for co-ordinating the work of the Insurance Practitioners and Tuberculosis Officers. Criticism of it is somewhat disarmed by the statement of the Minister that in order to secure its success the cordial co-operation of Tuberculosis Officers and Insurance Practitioners is necessary, but a brief reference to some of its main features will serve to show that it will at least very considerably increase the amount of clerical work, already heavy, which devolves on the staff of the Tuberculosis Dispensary and on the Insurance Practitioner. Briefly put, it is required that the Insurance Practitioner shall forward a report on the condition of every insured patient under his care to the Tuberculosis Officer every three months, the Tuberculosis Officer being responsible for sending him a request for such reports, while there is a further form wherein the Tuberculosis Officer must acknowledge the receipt of the same; these alone will entail a new card index system in the Tuberculosis Dispensary. As regards new cases, the Insurance Practitioner is to report on a prescribed form any case which he has diagnosed as tubercular, filling up details of age, occupation, sex, etc., of the patient, the history of the illness, his clinical findings, and his recommendation for treatment. A reply to this must be sent by the Tuberculosis Officers on an appropriate form, giving the details of his clinical examination and his recommendations as to further disposal. It is also to be noted that even if the Tuberculosis Officer and Insurance Practitioner have seen a case together in consultation, the Insurance Practitioner must send in the form aforementioned to the Tuberculosis Officer, who then sends back his reply, even though it may have been verbally communicated beforehand. There are also introduced forms for Insurance Practitioners to be used if they so desire when sending up a doubtful case for an opinion, and forms for the Tuberculosis Officer to send informing the Insurance Practitioner of his decision to alter a patient's form of treatment, e.g., from domiciliary to institutional, to terminate treatment, etc. In all, eight new forms have been introduced, and it is argued that this innovation will exclude the possibility of any doubt as to who is responsible for the treatment of a patient at any paticular time. In former years, as again this year, it has been my pleasant duty to comment in my annual report on the courteous and cordial treatment which we have received from local practitioners, and it has been found in practice that successful co-ordination of the work as far as the patients' interests are concerned lias been obtained by relying on informal letter writing, telephonic communications, and personal meetings. Therefore it would appear that the main benefit to be derived from the new method of procedure will be that more systematic records will be available. It is very much to be hoped that it will not result in a more official and less personal relationship between ourselves and our medical colleagues in the two boroughs. During the year the Medical Practitioners of Bethnal Green have asked my colleague and myself to address them on matters of clinical and administrative interest, and it has been a very great pleasure to us both to accept their kind invitations and to acknowledge their hospitable treatment on these occasions. Towards the end of the year, as a result of negotiations carried out at the instance of the London County Council, I was appointed honorary consultant to the Bethnal Green Hospital, and have already entered upon these duties, visiting the hospital one afternoon a week. I submit at the end of this report a statistical summary of the work done at the Dispensary during the year 1923. A comparison with the corresponding figures for 1922 will show a considerable increase under nearly all headings. Thus the number of new cases has risen from 685 to 851. On investigation of the table giving the source of these cases it will be seen that the increase is entirely due to the greater number sent to the department by the local practitioners for consultation and to those referred by the Medical Officer of Health for examination as contacts. I think one might justifiably infer from these figures that the practitioner continues to regard the department favourably, and finds it of use in the investigation of his cases. The total number of positive contacts was 36, representing a percentage of 6.8. The fact that we have again made full use of the facilities for referring cases to the various departments of the Hospital for special opinions is seen by reference to the figures in the last table. In conclusion, I should like to thank the Dispensary Committee, the Medical Officer of Health, the Hospital Physicians and Surgeons, the Resident Medical Officer, 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. 6th March, 1924. STATISTICAL TABLES 1. The Totals of New Cases. Males 420 Females 431 Total 851 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 116 53 Local Practitioners—Primary 171 Contact 12 183 50 4 Contact cases (per M.O.H.) 494 32 War Pensions Committee 16 7 London County Council 18 12 Victoria Park Hospital 17 16 Other sources 7 4 3. The Diagnosis of the New Cases. Uninsured. Total Diagnosis. Insured Males Females Children under 15 Males Females 63 21 2 21 20 127 Pulmonary Tuberculosis Non-pulmonary Tuberculosis 35 2 6 51 2 6 Non-tuberculous 111 38 124 648 84 291 Doubtful 25 8 8 6 3 0 851 184 334 64 150 Total 119 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 20 Non-pulmonary Tuberculosis 16 Non-tuberculous 463 Doubtful 7 Total 506 5. Sputum Examinations, of Insured and Uninsured Patients. Insured. Uninsured Total. Tubercle Bacilli present 29 146 117 467 Tubercle Bacilli absent 143 610 6. Other Figures. Insured. Uninsured Total number of attendances 1,986 2,946 Systematic examinations at the above 1,3746 1,364 Number of patients sent to hospital or sanatorium by the LCC 78 23 Number of letters written 1,787 Number of visits to patients at their homes 200 Number of patients referred to: — X-ray Department 66 Dental Departmenet 70 26 Other Departments Defendant ordered to do work and pay costs, 21/-. Do. do. Defendant ordered to do work and pay costs 21/-. Defendant ordered to do work and nay costs 10/6. Result and Remarks. Do. do. Do. do. Do. do. Do. do. Do. do. Costs 21/-. (Works done.) Fined 8/-, with costs £2 2s. Do. do. Do. do. Do. do. Fined 10/-, with costs £1 1s. D o. do. Fined £5, with costs £2 2s. Fined 10/-, with costs 21/-. Do. do. D o. do. Do. do. SUMMARY OF LEGAL PROCEEDINGS, 1923 (Other than under the Sale of Food and Drugs Acts, for which see pp. 40 —45 and 49—50.) Costs 21/- (work done). Closing order rescinded. Costs 10/6. Jones Do. Bare Do. Do. Hewitt Jenkins Weeks Hewitt Do. Jones Hewitt Bare Billings Hewitt Do Do. Do. Do. Do. Do. Inspectors. Billings Do. - Non-compliance with Statutory Notice requiring abatement of Nuisance. Occupying Bakehouse contrary to Act (premises not being in use as such, and certified as suitable, at time Act came into force). (Proceedings against owner.) Making default with Nuisance Order granted, by Magistrate on 16th November, 1922. Exposing for sale, 31 tins Condensed Milk, unfit for human food. Making default with Nuisance Order granted by Magistrate on 2nd November, 1922. Non-compliance with Statutory Notice requiring abatement of Nuisance. Making default with Nuisance Order granted by Magistrate on 1st February, 1923. Making further default with Nuisance Order granted by Magistrate on 2nd November, 1922. P roceedings by Owner of Premises, against Council, requiring latter to show cause why Closing Order dated 12th April, 1917, should not be rescinded, the premises having been put into proper state by Owner. Keeping Bakehouse in dirty condition ( on 9th May,1923). Do. do. (Proceedings against manager.) Do. do. Do. do. Do. do. Do. do. Do. do. Do. do. Do . do. Do. do. Do. do. Do. do. Do. do. Do. do. Do. (on 10th May, 1923). Offence. Date of Hearing. 11th Jany. 1st Feby. 1st Feby. 1st Feby. 1st Feby. 15th Feby. 15th Feby. 1st Feby. 1st Feby. 6th Feby. 15th Feby. 15th Feby. 15th Feby. 22nd Feby. 22nd Feby. 22nd Feby. 29th March 19th April 5th June 19th April 19th April 19th April 17th May 5th June Summons withdrawn. Defendant died on 24.8.23.) Closing Order made. Costs 4/- to Council. Defendant ordered to do work in 14 days, and pay 10/6 costs. These four premises taken over by L.C.C. prior to hearing of summonses. Summons withdrawn on costs 21/- being awarded to Council. Summons withdrawn on payment of 23/- costs. (Fined on another summons.) Fined £1. Costs 23/- (see above). Summons withdrawn on payment of 23/- costs. (Fined on another summons.) Defendant failed to appear in Court: Whereabouts unknown. Warrant issued. Fined £1. Costs 23/- (see above). Do. do. Do. do. Result and Remarks. Closing Order rescinded. Fined £5. Costs £2 2s. Fined £2. Costs £2 2s. Fined £1. Costs £1. SUMMARY OF LEGAL PROCEEDINGS, 1923—continued. Costs £3 3s. Fined £10. Fined £2. Billings Hewitt Billings Jenkins Do. Do. Do. Do. Do. Henley Do. Do. Billings Do. Weeks Inspector. Do. Do. Do. Do. - - Non-compliance with Statutory Notice requiring abatement of Nuisance. Failing to give notice to Sanitary Authority of intention to execute drainage works. Ditto additional premises Causing to be conveyed through London, offen- sive matter during prohibited hours. Occupying premises in which food deposited and prepared for sale, and in which due, cleanliness not observed and refuse allowed to accumulate. Unlawfully fixing W.C. pan and trap in such manner as to be a nuisance or injurious or dangerous to health. Failing to give notice to Sanitary Authority of intention to execute drainage works. Fixing W.C. pan and trap in a manner contrary to bye-laws. Non-compliance with Statutory Notice requiring abatement of Nuisance at workshop. Causing to be conveyed through London, offensive matter during prohibited hours. Proceedings by Owner of premises against Council requiring latter to show cause why Closing Order, dated 15th April, 1918, should not be rescinded, the premises having been put into proper state by Owner. Depositing for sale, intended for food of man, about 140 lbs. unsound Meat, unfit for food of man. Depositing for sale, intended for food of man, Tinned Foods, Condensed Milk and Kippers, unsound and unfit for food of man. Exposing for sale, intended for food of man, about 84 lbs. Cherries, unsound and unfit for food of man. Do. do. Do. do. Do. do. Do. do. Do. do. Do. do. Do. do. Offence. 6th Nov. 30th August 9th Oct. 1st Nov. 6th Nov. 6th Nov. 2nd August 3rd Angust 3rd August 9th Oct. 1st Nov. 6th Nov. 6th Nov. 6th Nov. 6th Nov. 6th Nov. 31st July 2nd August 14th June 31st July 31st July Date of Hearing. SUMMARY OF LEGAL PROCEEDINGS, 1923—continued. Date of Hearing. Offence. Inspector. Result and Remarks. 11th Dec. Occupying premises in which food deposited for sale and in which due cleanliness not observed and refuse allowed to accumulate (on 19.11.23). Billings Fined 5/-. Costs 10/-. 11th Dec. Do. Ditto (22.11.23) Do. do. Do. 11th Dec. Ditto (23.11.23) Do. do. 11th Dec. Do. Ditto (24.11.23) Do. do. 11th Dec. Do. Ditto (26.11.23) Do. Do 20th Dec. Non-compliance with Statutory Notice requiring abatement of Nuisance. Jenkins Summons withdrawn on costs £2 2s. being awarded to Council. In addition to the foregoing, proceedings were taken in 57 other cases for non-compliance with Statutory Notices served requiring the abatement of nuisances. In all these cases, the summonses were withdrawn upon the specified works being done and costs being paid to the Council, as follows : — Cases. Costs in each Case. 1 .. .. .. .. ... .. 4/0 50.. ... ... ... ... ... 10/6 6 21/0