AC4366 BET29 THE Metropolitan Borough of Bethnal Green REPORT ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1924 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 Belhnal Green. LONDON: Printed by Waterlow & Sons Limited, Birchin Lane, E.C.3. Metropolitan Borough of Bethnal Green. PUBLIC HEALTH COMMITTEE, 1924-1925. as on 31st December, 1924. 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. Alderman T. J. Boyce. Councillor G. H. Pettet. Councillor T. Brooks.„ D. J. Pickering „ J. J. Fleming, J.P. „ G. E. Snelling. „ A. Harris. „ .J. Valentine. E. C. E. Lear. Ex-Officio Members of the Public Health Committee: (The Mayor and Chairmen of other Standing Committees of the Council.) His Worship The Mayor (Alderman C. W. Hovell.) COMMITTEE. CHAIRMAN. Finance Councillor J. W. Martin. Works and Stores „ E. C. E. Lear. Law and General Purposes „ D. G. Alabaster. Baths Alderman Rev. G. E. A. Whitworth. Electricity Councillor G. E. Snelling Valuation „ C. J. Palmer. Public Libraries Alderman J. E. A. King. Housing Councillor C. N. Murphy. Staff „ S. Elsbury. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. Council Representatives on Joint (Tuberculosis) Dispensary Committee: Alderman Mrs. H. Jeffcote, Alderman Rev. G. E. A. Whitworth, Councillor Mrs. R. Elsbury. 2 PUBLIC HEALTH DEPARTMENT. STAFF as on 31st December, 1924. *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. *°§Evan Richards, Chief Sanitary Inspector. *°F. T. Bare. *°J. H. Hewitt. *°W. Billings, Junr. *°E. J. Jenkins.. *°G. I. Brighting. *°I. R. Jones. *°§A. S. Henley. *°J. O. G. Weeks. 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). *†‡Miss E. E. Taylor, Temporary Midwife. *†‡Miss M. Playle, Temporary Health Visitor. Clerical Staff. ° J. Henry Lloyd, Chief Clerk. F. G. Thomas, Assistant Clerk. S. Slater, Junior Clerk. R. W. Slyfield, Assistant Clerk. F. J. Bryant, Shorthand Typist. H. A. Saunders, General Assistant. G. E. Gould, Assistant Chris. §°W. H. Heron, General Assistant. *L. A. Taylor, Assistant Clerk. * The Council receives Exchequer grant towards the salaries of these Officers. 0 Certificated Sanitary Inspector. § Certificated Meat, &c., Inspector, † Certificated Nurse. ‡ Certified Midwife. 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). 3 Temporary (Part Time) Medical Officers (Maternity and Child Welfare Centres). *Mrs. K. Addison, MB., B.S. *Miss E. F. Iredell, M.D. *Miss M. M. Basden, M.D., B.S., F.R.C.S., L.R.C.P. *Mrs. 0. Langmead, M.8., B.S. *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 Heart and Lungs). 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 1924. Miss Taylor took up her duties as Midwife on the 10th July, 1924. During the illness of members of the Permanent Health Visiting Staff, Miss M. Illingworth, Miss H. M. Stocken and Miss M. Playle acted as Temporary Health Visitors, the latter being still engaged at the end of the year. * The Council receives Exchequer grant towards the salaries of these Officers. A2 4 Town Hall, Bethnal Green, E.2. April, 1925. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, I have the honour to present to you ray fifth Annual Report, which deals with the health of the Borough of Bethnal Green during the year 1924. The health of the Borough continued good as judged by past standards, the death-rate being 12.4 per thousand of population. The infantile mortality rate was 78.0 per thousand births, this also being a striking improvement on the figures of past years. A considerable portion of this report is taken up with the subject of our Maternity and Child Welfare scheme, in view of the progress being made in its development. As in past reports. ] 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. 1 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 stall for the help and Courtesies received. I am, Ladies and Gentlemen, Your obedient servant, GEOFFREY EUGENE OATES, Medical Officer of Health. 5 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, 1924, was £578,072, and the product of a Id. rate is estimated at £2,275. POPULATION. The population, as estimated by the Registrar- General in the middle of 1924, was 119,200. MARRIAGES. The number of marriages celebrated in Bethnal Green during 1924 was 843. This is equal to a rate of 14.2 persons married, or 7.l marriages, per 1,000 total population. BIRTHS. The number of births registered in the Borough during 1924 was 2,241, and, in addition, 399 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 2,640 births. The birth-rate for 1924 was, therefore, 221 births per 1,000 population. The rates for the last nine 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 1924 22.1 6 The birth-rates in the four quarters of the year were: — First Quarter 23.7 Second „ 22.0 Third „ 21.3 Fourth „ 21.5 Of the 2,640 births, 1,314 were those of males, and 1,326 those of females. ILLEGITIMACY. Of the 2,640 births credited to this Borough, 59 were illegitimate, being 27 males and 32 females, and being 2-2 per cent, of the total number of births. STILLBIRTHS. Forty-seven stillbirths were brought to notice, being a proportion of 1-8 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 1,446. Of these, 304 were of persons whose residence was not in Bethnal Green, 301 dying in Bethnal Green Institutions and 3 in other places in the Borough. There were also reported to the Registrar-General 334 deaths of Bethnal Green persons who died in institutions in other parts of London, and 10 who died in other parts of England and Wales. 7 This correction gives the net number of deaths for Bethnal Green as 1,486, making an annual deathrate of 12.4 per 1,000 of population. The death-rates for the last nine 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 1924 12.4 The death-rates in the four quarters of the year were: — First Quarter 18.1 Second „ 10.8 Third „ 8.4 Fourth „ 12.3 The increased death-rate in the first quarter was due to the prevalence of influenza and its complications. The death-rate for Bethnal Green, 12-4, compares with 12-1 for the County of London. 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:— Metropolitan Borough of Bethnal Green. A provisional analysis of the CAUSES OF DEATHS at various ages during the year 1924. Deaths in various institutions in the Borough whether of residents or nonresidents. Number of Deaths of residents at various ages, whether occurring within or without the Borough. City of London Hospital for Diseases of the Heart and Lungs. Bethnal Green Hospital (Poor Law). Waterloo House (Poor Law). Total Institutional Deaths. 65 and upwards. Queen's Hospital for Children. Causes of Death. Under 1 year. 2 and under 5 25 and under 45 years. 45 and under 65 years. Mildmay Mission Hospital. 1 and under 2 years. 6 and under 15 years. 15 and under 25 years. All Ages. 195 44 374 120 539 45 943 1483 204 59. 54 69 163 486 74 1 ... ... ... ... 2 ... ... ... ... All causes —Certified —Uncertified 3 ... ... ... ... ... 1 1 1 3 1. Enteric Fever 11 2 1 4 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2. Small Pox ... ... ... ... ... ... 8 11 ... 24 9 1 3 ... ... 3. Measles 42 8 ... ... ... ... ... 1 5 2 1 1 ... ... ... 4. Scarlet Fever 2 ... ... ... ... 3 5 ... 3 2 ... ... 14 7 4 ... ... ... ... ... 1 5. Whooping Cough ... 1 ... ... 3 4 13 9 ... ... ... 6. Diphtheria & Croup 29 ... ... ... 11 ... 11 11 2 7 14 ... ... ... 7. Influenza 35 1 ... ... 2 2 ... ... 1 1 ... 2 ... ... ... ... 8. Erysipelas ... ... ... ... 2 9. Phthisis (Pulmonary Tuberculosis) 10 6 54 61 ... 123 2 1 4 23 48 45 134 1 12 ... 3 15 10. Tuberculous Meningitis 1 ... ... 11 2 6 2 ... ... ... ... 11. Other Tuberculous Diseases 7 4 2 13 2 1 3 1 ... ... 7 ... ... ... ... 12 56 56 1 7 10 58 1 77 12. Cancer, malignant disease 125 1 ... ... ... ... 13. Rheumatic Fever 8 5 1 1 1 2 3 1 6 ... ... ... ... ... ... 2 3 2 9 1 5 15 14. Meningitis 11 2 1 1 ... ... ... ... 153 32 201 15. Organic Heart Disease 288 6 14 13 66 189 ... 3 13 ... ... ... 16. Bronchitis 123 12 1 1 3 4 41 61 7 2 7 29 5 50 ... 5 8 21 28 32 36 14 8 69 3 130 17. Pneumonia (all forms) 177 45 30 8 18. Other diseases of respiratory organs 19 2 ... 1 10 6 1 5 6 12 ... ... ... ... ... 19. Diarrhœa and Enteritis 1 22 1 14 37 32 29 1 1 ... ... ... ... ... ... 20. Appendicitis and Typhlitis 8 2 1 1 3 1 4 1 5 ... ... ... ... ... ... 4 1 3 3 21. Cirrhosis of Liver 5 ... ... ... ... ... ... ... ... ... ... 21a. Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22. Nephritis and Bright's Disease 28 2 ... 5 9 12 2 3 8 13 ... ... ... ... ... 23. Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24. Other accidents and diseases of Pregnancy and Parturition 6 2 4 1 1 ... ... ... ... ... ... ... ... ... ... 25. Congenital Debility and Malformation, including Premature Birth 80 80 ... ... 37 2 15 2 56 ... ... ... ... ... ... 26. Violent Deaths, excluding Suicide 36 6 7 12 5 1 13 19 1 3 5 2 ... ... 2 7 ... 27. Suicide 11 2 1 2 3 ... ... ... ... ... ... ... ... 28. Other Defined 238 26 79 93 36 9 11 72 2 130 15 2 4 9 10 29. Diseases ill-defined or unknown 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1486 206 74 59 54 69 120 943 Total 163 374 487 195 44 539 45 10 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 (Poor Law) 527 Waterloo House (Poor Law) 42 Queen's Hospital 39 Chest Hospital, Victoria Park 20 Mildmay Mission Hospital 15 643 Institutions out of the Borough. London Hospital 100 Other General Hospitals 52 Maternity Hospitals 12 M.A.B. Hospitals 73 Poor Law Hospitals 17 Sanatoria 13 Mental Hospitals 49 Hostels for the Dying 4 Other Places 12 332 Total 975 From these figures it will be seen that of the 1,486 deaths during the year, 975, or 65-6 per cent, took place in institutions. VITAL STATISTICS of Bethnal Green During 1924 and Previous Years. Population Estimated to Middle of Each Year. Births. Transferable Deaths. Nett Deaths of Persons Resident in the Borough. Total Deaths Registered in the Borough. At all Ages. Under 1 year of Age. Nett. Of Nonresidents registered in the Borough. Of Residents not registered in the Borough. Year. Including combatants serving for calculating birth-rate. Civilian for calculating death-rate. Uncorrected Number. Rate per 1,000 births or infantile mortality. Number. Number. Death rate. Number. Rate. 1,761 19.2 288 129 2,225 2,331 2,473 23.9 1918 103,403 115,859 - - 1,517 13.9 2,242 2,564 22.4 1919 110,085 114,676 1,535 218 85 - - 1,626 3,346 3,855 33.1 1920 116,600 1,702 14.6 366 95 - - - 1,452 12.9 3,003 25.4 1921 118,300 2,636 1,530 300 100 - - - 25.2 15.3 1922 118,400 2,579 2,981 1,776 1,814 271 91 - - - 2,880 1,275 11.3 1923 118,700 2,482 24.2 282 340 1,340 198 68.7 - 1924 304 1,486 206 78.0 119,200 - 2,241 2,640 1,446 344 12.4 22.2 12 MATERNITY & CHILD WELFARE. NOTIFICATION OF BIRTHS ACTS. 1907 AND 1915. During the year, 2,640 live births were registered ; and of these, 2,622 were notified to the Medical Officer of Health. There were also 47 stillbirths notified. Of the 2,669 living and stillbirths notified, 1,592 were notified by midwives, 500 by maternity assistants of the London Hospital, 305 by medical practitioners, and 272 by parents and others. MATERNITY AND CHILD WELFARE CENTRES. The popularity of the Council's new Centre in Cornwall Road was maintained during the year. The extra room on the first floor was completed toward the end of the year. In connection with this improvement, the two rooms underneath the new room had additional windows built in the outside wall. As it was found that during mild weather it was neither convenient nor economical to use the central heating supplied from the Public Library, means of supplementary heating was installed in the basement of the Centre. During very cold weather this will also be useful in ensuring a proper degree of warmth throughout the Centre. Electric lighting has been provided in certain additional rooms in the basement. The auxiliary Centre at Thornton Hall, Mount Street, was in use on Monday afternoons throughout the year. The statistics of attendances at the Centres during 1924 and in previous years are as follow :- Cornwall Thornton Road. Hall. Total Attendances of Children . . 13,900 2,835 Average Attendance per Session 89.1 57.8 New Cases (Children) .. .. 1,248 280 Medical Consultations (Children) 9,729 2,053 1924. 1923. 1922. Total Attendances of Children 16,735 18,028 14,446 New Cases (Children) .. 1,528 1,989 1,623 New Cases (Mothers) .. . . 468 483 349 Medical Consultations (Children) 11,782 11,685 9,541 (Mothers) 1,044 1,055 710 Total Attendances for Milk Grants 17,425 15,862 8,302 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. A few observations by the Medical Officers will be of interest: — Dr. Addison writes : — " In making a report on the year's work, certain impressions at once come into my mind. The first is one of wonder and respect at the endless industry, patience and self-denial required of, and displayed by, any poor mother who attempts to bring up a family decently. One sees the young mother with her first baby, bears and sympathises with her exhaustion, nervous and physical, in trying to keep the baby well, feed it herself, wash it and also do her house cleaning and washing. Then one sees the mother of six or seven, the baby clean and vigorous, and the others not at school brought up by turns, all well-cared for, and often well-behaved and obedient, and realises that the woman who can do all that this mother does. 14 and at the same time be cheerful and healthy, is one of those daily miracles that make the world so wonderful. These mothers are certainly the salt of the earth. " My next impression is that many mothers only bring their children to the Centre because they are ill. This, when it means a first visit at a month or so old, is not a bad thing as the mother often then becomes a regular attendant. " What is most annoying is the mother who comes once, with a breast-fed baby satisfactory in every way, and then never again until about eighteen months or two years later, when she brings a miserable, pasty, undersized child with bow legs. When reproached, she invariably says that, as to the bow legs, the lady next door, or her mother, or her grandfather (and sometimes the doctor) says ' He will grow out of it as he gets older.' Only yesterday, since I wrote this, .Mrs. T brought up, for his first visit only, George, now aged twenty-one months, a miserable object who, at his first visit, in August, 1923, was a fine, healthy baby, 10 lbs. at birth. Asked about Alfred, who made one attendance only after his first in infancy, she says he is attending hospital, ' where they have put him in irons for rickets ' " The nurses do everything possible to get the mothers to attend. Every day I have several mothers who come as the direct result of judicious visiting, but one longs for some means of enforcing a visit to the Centre at least once in two months. However, in spite of this sort of mother, I have no doubt that rickets is very much on the decline compared with what it was about nine years ago, when I first visited Bethnal Green. " I think that on the whole the Bethnal Green baby probably suffers more from want of fresh air than from anything else. The homes are small and the mothers so busy, they really can hardly manage to get out with the children. Time after time, with children of two years or so, I have advised extra hours of fresh air for Joss of appetite and persuaded the mother (rather unbelieving) to give it a trial, and time after time a tremendous improvement has been the result. " I think the rich woman's child gets its greatest advantage over poor children, not so much from food or clothing, or warmth, as from having a nurse to take it out for two hours in the morning and afternoon, and from its regular midday sleep. This also, one is gradually introducing, I hope, to Bethnal Green. 15 Dr. Iredell writes :— " The babies on the whole flourish much better than could have been expected considering their environment. " Even London babies need to spend most of their lives out of doors, and a great difficulty arises in regard to babies living in large blocks of flats such as some so-called ' model dwellings.' One finds that on the whole the babies living in them tend to suffer from lack of fresh air. When the flat is upstairs, the mother of a young family is not often able to take the children out, nor dare she trust the baby to have its sleep outside. When there is a pram which has to be kept upstairs it may be that the children cannot go out unless both the father and mother are able to assist in the starting of the expedition, and often days may pass with the little ones confined to the flat." Dr. N. Pinkerton writes : — " The medical work at the Infant Welfare Clinic falls under two heads :— (a) The actual inspection of each child, and (b) Advising the mother as to the health and general management of the child. " When the child is first seen it is stripped, and any defects, acquired or congenital, are noted and pointed out to the mother. Its full history is obtained and methods of feeding enquired into; the mother is advised as to the general treatment of the child; any faulty methods of feeding or upbringing are pointed out and explained, and the mother is urged to attend regularly. "in the case of very delicate babies it is advisable that they should be seen by the doctor at least once a week ; in some exceptional cases, they have attended twice a week until the baby has 'turned the corner.' "It is most gratifying to realise how much most mothers appreciate the advice as to the feeding and upbringing of their children. The young mother feels she needs advice and help, and the mother of many children realizes from her own past experience the value of what is told her. "The teaching given lays special stress on the importance of fresh air and sunlight, and the provision of a separate bed, the regularity of feeding, loose, properly fitting clothing, proper cleanliness, especially of the nose by keeping it clear, and keeping the mouth closed; the use of purgatives is deprecated. 16 " The diet in cases of children over one year is fully discussed. Early training in good habits and in the avoidance of bad ones such as use of a dummy and thumb sucking, prolonged bottle and breast feeding, sniffing, mouth breathing, &c., are of great importance, and if the mother attends regularly most of these points can be dealt with as occasion arises. " Where there is any disturbance in health, or where any physical defect is found, the mother is advised, but only if the illness is of the mildest and capable of being nursed at home is treatment given, as it is attempted to keep the general atmosphere of the Centre associated with healthy children and education of the mother. If the disturbance of health is grave, the mother is advised to seek advice from the proper source, e.g., family doctor, Dispensary or Hospital. "My general impression has been that during the year there has been an increased number of cases of mild rickets, but there were about three or four cases of very severe rickets. All these cases occurred among children who had not attended the Centre for many months, and who were seldom taken out. "I feel sure, however, that the general standard of hygiene is improving. Many babies do not have separate cots, but when this is recommended most mothers manage to provide one. "The children, especially the babies, are kept indoors far too much, but I think this is due to the difficulty of getting them out. If balconies could be provided, the mothers would perhaps make use of them. The difficulty of keeping perambulators is also a serious handicap. "Adequate rest, especially for children over one year, is not always provided ; it is almost impossible when the whole family live in one room. "There is a great improvement in the standard of clothing. Far fewer stiff binders are seen, and not very many flannel ones. "It is a great pity that more mothers cannot make their own baby clothes ; the ready-made usually consist of flannelette and cotton, whereas the home-made one is always made of flannel, or is knitted. " The teaching by the mother of regular habits during the first year has also greatly increased, but the use of the ever popular dummy is still very prevalent. It is curious how the mother believes it doesn't matter so long as the doctor doesn't see it. The badly shaped, under-developed jaws of the dummy-sucker are very common, but mothers are often persuaded to discontinue the use of this harmful practice. 17 " Most of the mistakes in feeding are due to over-feeding. I think the toddler suffers more than the baby from this. Far too many sweets are eaten, and too much bread and carbohydrate food generally. It is always my custom to advise the mother as far as possible as to the relative food values of different foods, and to explain to her how, if she saves the money spent on sweets or broken biscuits, she could buy " real " butter, fruit, vegetables and eggs, which have a greater food value for the child. Dripping is always recommended in preference to margarine. "In discussing the diet of the child with the mother, the importance of good teeth is emphasized ; the mother is advised to give a little raw fruit (to children over one year) after each meal, and recommended to clean the teeth every night. "In the feeding of infants, breast-feeding is urged and, in many cases, is re-established after some one or two weeks has elapsed after hurriedly weaning the baby. When the mother is unable to feed the baby, supplementary feeding, usually with a Dried Mill-:, is advised. My own experience is that a Dried Milk, properly used, is quite as satisfactory in every way as boiled Cows' Milk." MATERNITY CLINIC. This is open every Wednesday and Thursday morning. Particulars of attendances :— Total. Expectant Mothers—first visits .. .. 350) 835 „ „ subsequent visits .. 485) Mothers recently confined—first visits 118) 211 „ „ „ subsequent visits 93 The number of sessions was 102, and the average attendance per session was 10.2. On the average the expectant mothers attended 2.4 times, and recently confined mothers 1.8 times. During the earlier part of the year, the attendances fell somewhat, but increased rapidly towards the end of the year. 18 Attendances have been affected by the fact that a number of expectant mothers, who used to be sent by the Salvation Army Midwives, now attend the out-patient department of the Mothers' Hospital, Clapton, and the ante-natal work of the London Hospital is extending. The expectant mothers, 350 in number, may be grouped as follows : — Number of primigravidsæ .. 43 Number of multigravidæ 307 Pull-term confinements, including 3 stillbirths 248 Premature births 3 Caesarian section 1 Miscarriages 13 Not yet confined (March 28th, 1925) 76 Left Borough, result unknown . . 9 Wassermann reaction for syphilis : —- Number of blood-tests 9 Number of positive 3 The Medical Officer in Charge, Dr. N. Pinkrton, writes: — " One hundred and twenty-five women attended to see if they were pregnant, and 50 were found not to be so. "Of the 13 miscarriages which occurred amongst expectant mothers in attendance, four only had come to see if they were pregnant, two were suffering from cervical polypi, and three attended when a miscarriage was inevitable, one of these latter having a leaking ectopic gestation which was successfully operated upon. "Of the three stillborn births, one was macerated, one was a brow presentation, and one was born in a hospital and no reason for its death was known to us. "No mother died of childbirth, but three mothers in attendance died of other conditions. 19 "Three bad cases of albuminuria and several mild ones Were treated, with good results. "Three severe cases of heart-disease were treated and the mothers did well. " The three patients with a positive Wassermann reaction were all referred for special treatment and produced healthy children. One of these had previously borne a macerated foetus, another had had three premature dead babies. One mother who had had four miscarriages previously, bore a definitely diseased baby, although her own Wassermann reaction had been twice negative. 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 23,385 lbs. Condensed Milk 159 tins PROVISION OF MILK FOR NECESSITOUS MOTHERS AND CHILDREN. Milk is given in the following cases : — (a) Expectant mothers during the last three months of pregnancy. (b) Nursing mothers. (c) Children up to three years, also in exceptional cases children between three and five years of age. The quantity of milk authorised does not exceed one pint per day except in the case of children between 3 months and 18 months where a special medical certificate is furnished, and in which case as much 20 as 1½ pints per day may be authorised. One pound of dried milk is considered to be the equivalent of 7 pints of fresh milk. Applications are made by mothers at the Maternity and Child Welfare Centre, Cornwall Road, either on Tuesday or Friday morning at 10 o'clock, when the Superintendent Health Visitor and an assistant are in attendance to obtain the necessary particulars in each case. As far as necessary and practicable, the particulars given are verified by writing to employers and by reference to the Board of Guardians. A scale of income is appended which is used for the purpose of determining whether applicants are to be regarded as necessitous, and as to whether milk shall be supplied free or at half price. Before any case is recommended to the Committee, the Medical Officer of Health must be satisfied that the supply is necessary on grounds of health. A special medical certificate is also required in the case of children between 3 months and 18 months where more than 1 pint per day is required or where any milk is required for children between 3 and 5 years of age. The existence and duration of pregnancy must be verified by the signature of a doctor or midwife. Applications for grants are considered in detail by a rota of members of a Sub-Committee of the Public Health Committee (which is the statutory Committee under the Maternity and Child Welfare Act, 1918). A member on the rota attends at the Town Hall every Wednesday. The grants authorised by the rota member are subsequently confirmed by the Sub-Committee and reported to the full Public Health Committee. In case of emergency the Superintendent Health Visitor is authorised to issue milk for one week pending the submission of the case to the rota member. 21 Grants, after authorisation by the rota member, are normally for a period of four weeks calculated to a Saturday, and are renewable, subject to further application and approval by the Committee, every four weeks. Grants take two forms : — (a) Fresh milk—supplied by order on the nearest milkman on the Council's list. (b) Dried milk —supplied at the Welfare Centre, Cornwall Road. The necessary orders and cards of authority are prepared in the Public Health Department on Thursday, and are issued at the Centre on the following morning. In the case of fresh milk, the official order together with an invoice is handed to the mother to take to the milkman, who subsequently furnishes his account to the Council on the invoice, which must contain the mother's signature for the milk. In the case of dried milk, the authority to issue the specified quantity is sent to the Centre on a card on which the mother gives a receipt each week. Complete records are kept in the Public Health office from weekly returns furnished from the Centre, of the stocks and issues of the various brands of dried milk supplied. Mothers, in addition to milk grants, are also allowed free any medicines which may be prescribed for them or their children attending the Centre by one of the Centre Medical Officers, and a card for this purpose is also issued at the time the milk grant is made. During the year the following quantities of milk were issued to necessitous mothers :— Fresh Milk 3,144 gals. Dried Milk 21,417 lbs. Condensed Milk 452 tins together with drugs, &c. The approximate cost of milk given in this way was £1,738. 22 INCOME SCALE. Limits of Income per head of family after deducting rent: Number in family. For supply of Milk Free. For supply of Milk at Half-price. d. d. s. s. 1 15 0 17 6 2 12 6 15 0 13 6 3 10 0 4 8 0 12 0 5 7 6 10 0 6 7 0 9 0 7 6 6 8 0 8 6 0 7 6 9 5 6 7 6 10 5 0 6 0 11 5 0 6 0 12 5 0 6 0 In assessing the income, no regard is had to wages derived from Council temporary relief works. 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. 23 SUMMARY OF VISITS PAID BY HEALTH VISITORS. 1923. 1924. Births (first visits) 2,918 2,650 Births (re-visits) 20,507 16,628 1,435 Visits to mothers 1,577 Ophthalmia Neonatorum 149 223 Puerperal Fever 21 48 Measles 1,110 1,029 242 Special Matters 450 Futile Visits 2,377 2,847 Milk Grant Enquiries 1,141 828 Total visits paid 26,398 29,782 Of the 20,507 re-visits, 235 were to children under 1, and 20,272 to children between 1 and 5. NUESING ASSISTANCE. Up to the limits permissible by law, a very complete scheme of home nursing is now in operation. Such nursing is carried out by the mediation of a voluntary organisation, the Shoreditch and Bethnal Green Nursing Association. For each visit a charge of tenpence is made to the Council by the Association. As regards children under the age of five years, the Ministry of Health have sanctioned expenditure on the nursing of all sick cases, but grant is only paid by the Ministry in respect of certain specified conditions, e.g., Measles, Whooping Cough, Diarrhoea, Ophthalmia Neonatorum and Poliomyelitis, which come within the Council's Maternity and Child Welfare Scheme. 24 During the year 338 children under the age of 5 were nursed, a total of 2,680 visits being made at a cost of £111 13s. 4d. Of this expenditure £42 lis. Bd. was expenditure under the Maternity and Child Welfare Scheme. Thirty-eight mothers received 569 visits for nursing in connection with conditions incidental to childbearing, the cost being £23 14s. 2d. Forty-one adults and children over 5 received 353 visits for nursing at a cost of £14 14s. 2d. 25 Nursing Assistance 1924. Under Public Health Acts. Under Maternity and Child Welfare Scheme. Disease. Under 1 year. 1-5 years. Children under 5. Mothers. Others. Cases Visits Cases Visits Cases Visits Visits Cases Cases Visits Ophthalmia Neonatorum 18 468 ... ... Discharging Eyes ... ... ... ... ... ... 45 395 37 319 ... ... ... ... ... ... Measles 4 44 13 112 2 ... ... ... 21 Whooping Cough 1 3 ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other pre-and post-natal conditions 38 569 ... ... ... ... ... Conjunctivitis ... ... ... 1 10 ... ... ... ... ... ... ... ... Blepharitis 1 3 ... ... ... ... ... ... ... ... Ophthalmia 2 24 ... ... ... ... ... ... ... Corneal Ulcer ... ... ... 2 20 ... ... Injuries to Eye ... ... ... ... ... 1 13 ... ... ... ... ... ... ... Otorrhœa 4 40 ... ... ... ... ... ... ... ... Otitis 2 20 ... ... ... ... ... ... ... ... Mastoid ... ... 1 3 ... ... ... ... ... ... Tonsils and Adenoids 78 252 ... ... Septic Throat ... ... ... ... ... ... 2 16 ... ... ... ... ... ... ... ... Influenza 15 133 ... ... 1 9 Bronchitis ... ... ... ... 4 21 ... ... Pneumonia ... ... ... ... ... ... 31 279 22 183 ... ... ... ... ... ... Phthisis 2 16 ... ... ... ... ... Constipation ... ... ... 1 3 ... Intestinal Obstruction ... ... ... ... ... ... ... 4 16 ... ... ... ... ... ... ... ... Threadworms 49 387 ... ... ... ... ... ... ... Rectal Prolapse ... 1 15 ... Vaginitis ... ... ... ... ... ... ... 1 10 ... Septic Umbilicus ... ... ... ... ... ... ... 1 9 ... ... ... ... ... ... ... ... Burns and Scalds 2 20 ... ... ... ... ... ... Sepsis ... 7 ... 1 ... Abscess ... ... ... ... ... ... 4 ... 30 ... ... ... ... ... ... ... ... Impetigo 1 8 ... ... ... ... ... ... ... ... Pyrexia 25 124 ... ... ... ... ... ... ... ... 1658 Totals 67 907 38 569 353 14 115 257 41 13 cases were in hand at the beginning of the year. 15 cases were in hand at the end of the year. A total of 3,602 visits were paid to 417 cases at a cost of £150 Is. 8d. 26 MASSAGE. During the year an arrangement was come to with the Bethnal Green branch of the British Red Cross Society for the services of trained masseuses at the Centre. Commencing on 16th September, two masseuses were in attendance on two or three afternoons a week. The number of sessions held was 44, the number of children who received massage was 82 and they made 463 attendances. The children were referred to the massage room by the doctors attending the consultations, and a record was kept of the condition of each child at the beginning of the treatment and during its course. The results obtained were extremely encouraging, but in view of the fact that only a few children had completed their course of treatment at the end of the year, any comment must be reserved for the next Annual Report. Every endeavour was made to teach the mothers to carry out simple massage at home in order to supplement the attendance at the Centre, which had to be perforce restricted to once or twice a week. The conditions for which the children were referred were : — Rickets 24 Muscular Atony 42 Constipation 12 Other conditions 4 MIDWIFERY SERVICE. During the year a midwife was appointed, the office being a temporary one. Miss E. E. Taylor, the lady appointed, took up her duties on 10th July During the remainder of the year she conducted 24 confinements at the homes of mothers, and at the end of the year, she had 35 expectant mothers on her books. The small number of confinements conducted 27 is, of course, explained by the midwife being new to the Borough. By the end of the year it was evident that the new service was likely to be both popular and useful. I do not consider it would be profitable to analyse the 24 deliveries, the number being too small to warrant any conclusions. The work of the midwife, including the above 24 cases, will be described and fully commented on in my Annual Report for 1925. CONVALESCENT TREATMENT. During the year 3 mothers were sent to the London Mothers' Convalescent Home, Sunningdale, Berkshire, and 5 mothers to the " George Whitlaw " Convalescent Cottage, Amerden, near Taplow. Each mother was sent away for two weeks. In 4 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 20 children were sent to that Council's Home at St. Leonard's-on-Sea, Sussex, 7 for a period of four weeks, 1 for five weeks, 6 for six weeks, 6 for eight weeks, 1 for nine weeks, 1 for eleven weeks, 1 for twelve weeks, and 1 for sixteen weeks. The prolonged periods in certain cases were due to an outbreak of chicken-pox in the Home. Owing to the need for alternative accommodation, arrangements were made for children to be admitted to the Marjorie Lumley Holiday Home, Maidenhead, and the Children's Convalescent Home, Beaconsfield. Three children were sent to the Marjorie Lumley Home for four weeks in each case. In 12 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 children. 28 INFANTILE MORTALITY. Two hundred and six 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 78.0 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 1924 78.0 So far as can be ascertained, 202 of the deaths were those of legitimate infants and 4 those of illegitimate infants. Accordingly, we have the following figures for Infantile Mortality : — Infantile Mortality (legitimate) 78.2 do. do. (illegitimate) 67.8 do. do. (all infants) 78.0 Of the 206 deaths, 53 were due to prematurity. The deaths from diarrhceal diseases were 29 in number, a very low figure and much on a level with last year's figure of 34. There were 57 deaths from bronchitis and pneumonia, as compared with 42 last year. This, however, is a relatively satisfactory figure in comparison with the experience of former years (1923, 83 deaths), and was mainly due to the small prevalence of whooping cough and measles which are so often followed by fatal chest trouble in infants. The Infantile Mortality figure of 78-0 per 1,000 births is the second lowest on record for Bethnal Green, the previous record having been 68-7 last year. In 1903, 22 years ago, the figure was 141. 29 Infantile Mortality in Bethnal Green, in 1924. 4 weeks & under 3 months. 3 months & under 6 months. 6 months & under 9 months. 9 months & under 12 months. Under 1 week. 3-4 weeks. Total under 4 weeks. Total Deaths under 1 year. Rate per 1000 births. 2-3 weeks. Cause of Death. All causes— 205 17 83 Certified 48 10 7 34 33 31 25 77.63 Uncertified ... 1 .37 ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... 1 1 37 ... ... ... ... ... ... Measles ... ... 2 6 8 3.03 ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 1 2 2 2 ... 7 2.65 ... ... ... ... 3 Diphtheria and Croup 1 1 1 1.14 ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis (30) ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis (31) ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 1 1 .37 ... ... ... ... ... ... ... ... Meningitis (not Tuberculous (61) 1 1 2 .75 ... ... ... ... ... ... ... Convulsions (71) 1 1 2 ... ... ... .75 ... ... ... ... Laryngitis (87B) ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 1 2 1 4 2 3 12 4.55 ... Pneumonia (all forms) (91 & 92) 3 4 8 9 6 17 5 45 17.05 1 Diarrhœa (104 B, E & F) ... ... 2 2 6 1 1 1 1 2.27 Enteritis (104 A, C, D & G) ... ... 8.71 ... 9 9 3 2 23 ... ... ... ... Gastritis (103A) ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 1 1 2 .75 ... ... ... ... ... ... Rickets (36A) ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... Injury at birth (152C) 2 2 2 .75 ... ... ... ... ... ... ... Atelectasis (152B) 3 3 1.14 3 2 ... ... ... ... ... ... ... Congenital Malformations (150) 3 1 6 1 1 1 9 3.41 ... ... 20.08 Premature Birth (151A) 36 6 2 4 47 5 1 53 ... ... Atrophy, Debility and Marasmus (151B) ... 2 1 1 4 4 4 3 15 5.68 ... ... 4.55 Other Causes 5 1 1 7 2 2 1 12 ... Totals 49 34 33 25 206 78.0 17 10 7 83 31 Nett Births in the year legitimate 2581 Nett Deaths in the year legitimate infants 202. illegitimate 59 illegitimate infants 4 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. I I 1-2 weeks. 30 PUERPERAL FEVER. Six cases of this complication of childbirth were reported during the year. Two of the patients were removed to the London Hospital, two to Bethnal Green Hospital, one to the Mothers' Hospital, Lower Clapton Road, one to the Jewish Maternity Home, Underwood Street, Stepney, and one to a Metropolitan Asylums Board Institution. There were no deaths from the disease. OPHTHALMIA NEONATORUM. Forty-three cases of purulent eye-discharge in the new-born were notified, all by doctors. In every case the condition was cured without any apparent impairment of vision. Eighteen cases received nursing attention at home from the Shoreditch and Bethnal Green District Nursing Association, the Borough Council paying part of the cost: 468 visits were paid by nurses of the Association. 31 NOTIFIABLE DISEASES, Etc. Diphtheria. There were 566 cases of diphtheria notified during the year. Of these, there were 16 cases under the age of 1 year, 252 "between the ages of 1 and 5 years, 236 between the ages of 5 and 15 years, 41 between the ages of 15 and 25 years, 19 between the ages of 25 and 45 years, and 2 between the ages of 45 and 65 years. Of the 566 cases, all were removed to an isolation hospital except 3. In 2 of these cases there was a doubt as to the correctness of the diagnosis. The remaining case was treated at home, proper facilities being available for isolation and treatment. Twenty-nine 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 „ 1924 29 „ Of the 29 deaths, 17 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 252 cases occurring during this period of life, it will be seen that 6.7 per cent. died. At the epoch 5.15 years the mortality was only 3.9 per cent, of those attacked. Antidiphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor. 64,000 units were supplied during the war. 32 Scarlet Fever. There were 426 cases of scarlet fever notified during the year. Of these, there were 4 cases under the age of 1 year, 184 cases between the ages of 1 and 5 years, 209 cases between the ages of 5 and 15 years, 24 cases between the ages of 15 and 25 years, and 5 cases between the ages of 25 and 45 years. Of the 426 cases, 422 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 „ 1924 5 „ Small-pox. No case of this disease was notified. Typhoid Fever. There were 90 cases notified during the year, the great majority occurring during an outbreak in the autumn. Eleven deaths occurred. A special report on this outbreak has already been issued. Continued Fever. Seventeen cases were notified under this description, but in 12 cases the diagnosis was subsequently altered to that of Typhoid Fever. Further information is contained in the special report referred to above. 33 Erysipelas. There were 77 cases notified and 2 deaths. Malaria. During the year 5 cases were notified. The patients were found to be ex-Service men who had contracted the infection overseas. Acute Polio-Myelitis and Acute PolioEncephalitis. No case of either disease was notified. Dysentery. There were no cases reported. Acute Encephalitis Lethargica. There were 26 cases reported. There was an undue prevalence of this disease uniformly spread over the Borough. Cerebro-Spinal Fever. Three cases of this disease were notified. Acute Primary Pneumonia and Acute Influenzal Pneumonia. Two hundred and sixty cases of acute primary pneumonia and 76 cases of acute influenzal pneumonia were notified during the year. The increased prevalence of pneumonia was due to the presence of influenza in the first quarter of 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 1924 in Bethnal Green. Number of Cases Notified. Under 1 year. 15 and under 25 years. 25 and under 45 years. Disease. 1 and under 5 years. 5 and under 15 years. 45 and under 65 years. All Ages. 65 and upwards. Small Pox ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 566 16 252 236 41 19 2 ... 77 3 5 5 7 20 28 9 Erysipelas 209 24 Scarlet Fever 426 4 184 5 ... ... Typhus Fever ... ... ... ... ... ... ... ... Enteric Fever 90 12 31 24 17 6 ... ... 6 Puerperal Fever ... ... 1 5 3 ... ... ... Cerebro-spinal Fever 2 1 ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... Acute Encephalitis Lethargica 26 3 7 7 4 ... 5 ... ... Ophthalmia Neonatorum 43 43 ... ... ... ... ... Acute Polio-encephalitis ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... Malaria 5 1 4 ... Acute Primary Pneumonia ... ... ... ... 260 12 89 41 30 44 32 12 18 13 Acute Influenzal Pneumonia 76 1 3 18 18 5 Pulmonary Tuberculosis 202 1 7 10 42 79 55 8 Other forms of Tuberculosis 2 52 18 16 9 5 2 ... Cholera, Plague, Relapsing Fever ... ... ... ... ... ... ... ... Continued Fever, Trench Fever 17 4 3 4 3 2 1 ... Anthrax ... ... ... ... ... ... ... ... Hydrophobia, Glanders ... ... ... ... ... ... ... ... 84 592 562 201 226 35 149 Total 1849 35 Verminous Conditions. One hundred and four 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 two cases was advantage taken of such offer, 11 articles being so disinfested. During the year one man infested with body-lice had baths at the Disinfecting Station and his clothing was disinfested. Rooms were disinfested of bugs in 277 cases. Scabies or Itch. Twenty-six children suffering from this disease were visited after being excluded from the Elementary Schools. In only 3 instances was disinfestation of the clothing and bedding permitted, 50 articles being disinfested. Three 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 584 Diphtheria bacilli present in 70 Sputum—specimens submitted for examination 166 Tubercle bacilli present in 27 Blood-serum—specimens examined 58 Widal reaction positive in 18 Specimens of urine and faeces examined 7 Blood-culture 1 c 2 36 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 134 deaths from pulmonary tuberculosis, 11 deaths from tuberculous meningitis, and 7 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 1924 152 The number of deaths from this disease showed a substantial decline, and is probably a genuine indication of the progress made in combating this disease. 37 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 1924. Tuberculosis of the Lungs. Other Tuberculosis. Age of Patient. Male. Total. Female. Male. Female. Total. Primary Notifications. 1 1 0—1 year. 1 1 ... ... 1-5 years. 2 3 5 7 8 15 5-10 „ 2 2 4 3 2 5 10—15 „ 4 2 6 6 5 11 15—20 „ 6 13 19 4 1 5 20—25 „ 13 10 23 1 3 4 25—35 „ 19 23 42 1 2 3 35-45 „ 24 13 37 2 2 ... 45—55 „ 28 10 38 1 1 2 55—65 „ 11 6 17 ... ... ... 65 years and over 6 2 8 ... ... ... 116 200 22 Total 84 26 48 Cases re-notified 50 28 78 9 1 10 166 Total Notifications on Form A 112 278 35 23 58 Primary Notifications by School Medical Officers. 0—5 years 1 1 ... ... ... ... 5-10 „ 1 1 2 2 2 ... 10—15 „ ... 1 1 ... ... ... Cases re-notified ... ... ... ... ... ... Total Notifications on Form B 1 1 2 4 4 ... . 38 No. of Notifications on Forms C. & D. Poor Law Institutions. Sanatoria. C C D D Pulmonary Tuberculosis— Male 26 27 104 84 Female 25 15 47 27 Non-Pulmonary Tuberculosis — 8 Male 3 3 7 Female 4 3 11 14 C —upon admission. D —upon discharge. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1921. During the year the names of 224 patients were removed from the Tuberculosis Register as follows : — Deaths 181 Removals 43 Of the 43 patients who removed from the Borough, it was possible in 24 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. Four 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 six ex-Service men were under observation during the year. There were 22 deaths amongst these, and 7 removed from the Borough. Four hundred and twenty-eight visits were paid to these men by the Tuberculosis Health Visitor. 39 WORK OF TUBERCULOSIS HEALTH VISITOR. This officer paid 3,310 visits to cases. SUPPLY OF SPUTUM OUTFITS. During the year 55 sputum flasks were distributed to patients. Forty-eight sputum tins, with 2,042 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 1924. During the year 283 grants were made at an estimated cost of £160. One hundred and thirty-nine patients were dealt with, 29 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 77. DENTAL TREATMENT FOR TUBERCULOSIS PATIENTS. By arrangement with the City of London Hospital for Diseases of the Heart and Lungs, the revised scheme for the dental treatment of Tuberculosis Dispensary patients found to require such treatment came into operation on the Ist July, 1923. In accordance with this scheme, patients are dealt with in the Dental Department of the Hospital at an agreed charge of 6s. 8d. per attendance. During 1924, 16 40 patients received dental treatment. There were 11 attendances for extractions, 10 being under gas. Other attendances for treatment were: examinations 3; fittings and alterations for dentures, 15. 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 2 patients were so treated, making 57 attendances for treatment. The Council's arrangements for the provision of pneumothorax refills at the Brompton Hospital were not used during the year. JOINT DISPENSARY COMMITTEE. On 13th November an agreement between the Borough Council and the Governors of the City of London Hospital for Diseases of the Heart and Lungs came into operation, which effected some changes in the management of the Tuberculosis Dispensary. Whilst in future the Governors of the Hospital will remain responsible for the provision and staffing of the Dispensary, a Joint Dispensary Committee is formed, composed of four representatives of the Governors, three representatives of Bethnal Green and three of Hackney. The powers and duties of the Joint Dispensary Committee, under the direction and control of the Governors, shall include the following matters : — (a) To manage the Dispensary for and on behalf of the Committee. (b) From time to time to consider and report to the Committee on all matters appertaining to the administration of the Dispensary, including (i) the salary and conditions of service of 41 the Tuberculosis Officer and other officers and servants so far as their duties relate to the Dispensary; (ii) the staffing of the Dispensary (iii) any special expenditure on drugs, stationery and other matters requisite for the Dispensary; (iv) general arrangements for dispensary service, times of opening, patients' grievances and other administrative matters. (c) To appoint and dismiss the Tuberculosis Officers and all other officers and servants employed exclusively at the Dispensary. The appointments to be such and on such terms as shall have been previously approved by the Committee. Provided that in the appointment of a Tuberculosis Officer the Joint Dispensary Committee shall have due regard to the opinion and advice of the Honorary Medical Staff of the Hospital. The new arrangement should have the effect of bringing the Council into closer touch with the working of the Dispensary than has hitherto obtained. 42 PROTECTION OF FOOD SUPPLY. SALE OF FOOD AND DRUGS ACTS. Seven hundred and fifty-three samples were taken ; 709 of these proved to be " genuine," and 44 or 5-8 per cent, adulterated. The details are given in the following table :— SUMMARY OF ANALYST'S REPORTS. Samples taken formally. Samples taken informally. Total Number of Samples taken. Adulterated. No. taken. Adulterated. No. taken. Article. Genuine. Genuine. Milk 315 297 18 5 4 1 320 Butter 123 122 1 3 1 2 126 Margarine 37 36 1 ... ... ... 37 Lard 16 16 ... ... ... 16 ... 2 2 ... ... ... ... 2 Cheese Cream Cheese 1 ... 1 ... ... ... 1 Cream 8 5 3 ... ... 8 ... Condensed Milk 7 7 ... ... ... 7 ... Dried Milk 4 ... 1 1 ... 5 4 Jam 72 69 3 ... 72 ... ... Coffee 10 10 10 ... ... ... ... Cocoa ... 3 3 3 ... ... ... Vinegar 66 59 7 ... ... 66 ... Mustard 4 4 ... ... 4 ... ... Pepper 5 5 ... 5 ... ... ... Compounded Medicine 14 14 ... 14 ... ... ... Camphorated Oil 10 9 1 ... ... 10 ... Olive Oil 2 2 ... 2 ... ... ... Castor Oil 3 3 3 ... ... ... ... Eucalyptus Oil 1 1 1 ... ... ... ... Liquorice Powder 1 1 ... ... ... 1 ... Boracic Powder 1 1 ... 1 ... ... ... Crushed Linseed 3 3 ... 3 ... ... ... Flour 5 5 ... 5 ... ... ... Bread 5 5 ... ... ... 5 ... Sponge Cake 14 10 4 ... ... 14 ... Mincemeat 1 1 1 ... ... ... ... Salmon and Anchovy Paste 2 2 2 ... ... ... ... Tinned Peas 2 2 ... 2 ... ... ... Tinned Beans 1 ... 1 1 ... ... ... Sausages 1 1 1 ... ... Chocolate ... ... 2 2 2 2 ... 4 ... Walnuts ... ... 1 ... 1 1 ... 12 4 753 737 697 40 16 Totals 43 Prosecutions were instituted in respect of 22 of the 40 formal samples which were reported to be adulterated, and in 9 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. Name of Article and Identification Number of Sample. (a) Action taken other than legal proceedings. (b) Previous Convictions (if any). (c) Other Remarks. Result of Analysis. Result of Legal Proceedings. ... Milk 41 Contained 1 per cent. added water. ... Do. 70 Found to bo 8 per cent. deficient in fat. Dismissed. Warranty proved. ... Do. 71 Do. ... (c) Summons only taken in respect of first sample. ... Sponge Cakes 83 Contained .05 per cent. boric acid. ... ... Do. 94 Contained .11 per cent. boric acid. ... Milk 114 Found to be 9 per cent. deficient in fat. Dismissed. Warranty defence. ... Do. 123 Contained 2 per cent. added water. ... ... Do. 143 Found to be 6 per cent. deficient in fat. Dismissed. (c) Vendor proved milk sold as given by cow. Sponge Cakes 146 Contained .15 per cent. boric acid. ... (a) Vendor cautioned. Milk 147 Contained trace of annatto colouring matter. Adjourned sine die. ... Do. Do. 156 Dismissed. ... Do. Do. Do. 157 ... 44 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample. (a) Action taken other than legal proceedings. (b) Previous Convictions (if any). (c) Other Remarks. Result of Analysis. Result of Legal Proceedings. ... ... Milk 159 Contained 4 per cent. added water. Do. 206 Found to be 85 per cent. deficient in fat. Defendant failed to appear. (c) Summons also in respect of absence of name and address from receptacle. ... Fined 10s. 6d. Vinegar 215 Contained 10 per cent. added water. Do. 217 ... Contained 5 per cent. added water. Costs 10s. 6d. Bound over not to repeat offence. ... Milk 240 Found to be 11 per cent. deficient in fat. Costs 21s. Costs 5s. Vinegar 247 Contained 7 per cent. added water. ... Cream Cheese 261 Withdrawn on payment of costs, £2 2s., and undertaking by vendor not to use term Cream Cheese for similar article. Found to be 70 per cent. deficient in fat. ... (a) Result of analysis communicated to vendor. Sponge Cake 268 Contained 6 grains boric acid per pound. Costa 21s. Raspberry & Gooseberry Jam. Contained 7 per cent. apple pulp. ... 270 Tinned Beans 309 ... Contained .03 per cent. sulphate of copper. (a) Result of analysis communicated to vendor. Fined 5s. Milk 312 Contained 4 per cent. added water. ... Vinegar 335 Contained 3 per cent. added water. (a) Result of analysis communicated to vendor. ... Contained .12 per cent. boric acid. (c) Proceedings in respect of labelling. Cream 347 ... (a) Result of analysis communicated to vendor. Do. 349 Contained .26 per cent. boric acid. ... 45 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample. (a) Action taken other than legal proceedings. (b) Previous Convictions (if any). (c) Other Remarks. Result of Analysis. Result of Legal Proceedings. Raspberry Jam. 352 Cream 371 Milk 393 Do. 402 Do. 430 Milk 461 Do. 477 Vinegar 483 Do. 537 Do. 555 Butter 579 Margarine 582 Camphorated Oil. 604 Strawberry Jam. 703 Contained 10 per cent. apple pulp. Contained 0.39 per cent. boric acid. Found to be 8 per cent. deficient in fat. Found to be 9 per cent. deficient in fat. Found to bo 30 per cent. deficient in fat. Found to bo 16 per cent. deficient in fat. Contained 4½ per cent. added water. Contained 19 per cent. added water. Contained 5¾ per cent. added water. Contained 5.0 per cent. added water. Contained 0.75 per cent. water beyond legal limit of 16 per cent. Contained 1 per cent. water beyond legal limit of 16 per cent. Found to be 4 per cent. deficient in camphor according to B.P. standard. Contained 10 per cent. apple pulp. ... ... Dismissed. Warranty defence. Withdrawn. Defendant paid £2 2s. costs. Fined 40s. No costs. Fined £5. Costs £2 2s. (2 summonses) adjourned sine die. Costs £2 2s. awarded to Council. Costs £1 1s. ... (2 summonses) Costs £2 2s. ... ... ... (Summons heard 15/1/25.) Fined 10s. (a) Result of analysis communicated to vendor. (a) Result of analysis communicated to. vendor. ... ... ... ... ... ... (a) Vendor cautioned. ... (c) Adulteration too small for proceedings. Do. (a) Vendor cautioned. ... 46 SAMPLES TAKEN INFORMALLY Five samples of milk were taken informally, one of which was found to be adulterated, containing 3 per cent, of added water. Three informal samples of butter were taken, one of which had 90 per cent, of foreign fat, and one .75 per cent, of water in excess of the legal limit of 16 per cent. Three informal samples of cocoa and two of chocolate were examined, together with one of dried milk and one of sausages. 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, 1924 : — Three hundred and fifteen 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 percentages being .12, .26 and .39. Four 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 2 cases the cream was delivered to the purchaser in a receptacle which did not bear a proper declaratory label. One of these vendors was prosecuted for the absence of a declaratory label (see page 49), and also 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. 47 "APPEAL TO COW" SAMPLES. No samples of milk were taken direct from the cow in 1924, there being no requests for such action. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. During the year 7 samples of condensed milk were taken, all of which were found to comply with the requirements of the regulations. THE PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. These Regulations came into operation on 1st May, 1924. "Dried Milk" is therein described as "milk, partly skimmed milk, or skimmed milk, which has been concentrated to the form of powder or solid by the removal of water." Article 4 requires dried milk to be sold in a tin or other receptacle labelled in the manner prescribed by the Regulations, and provides that it must contain not less than the following percentages of milk fat, namely:— (i) In the case of milk described as "dried full cream milk," not less than 26 per cent. (ii) In the case of milk described as " dried threequarter cream milk," not less than 20 per cent. (iii) In the case of milk described as "dried half cream milk," not less than 14 per cent. ; and (iv) In the case of milk described as "dried quarter cream milk," not less than 8 per cent. 48 The labels prescribed are to indicate clearly that (i) is " Dried Full Cream Milk," and must state what is the equivalent of the contents in milk ; and that (ii) —(iv) are " Dried Partly Skimmed Milk (¾, ½ or¼ Cream)."These latter labels must also state that the contents of the tin" Should not be used for babies except on medical advice," and must indicate what is the equivalent of the contents in pints of ¾,½ or ¼ cream milk. In the case of skimmed milk, that is to say, dried milk containing less than 8 per cent, of milk fat, the label must state that the contents are "Dried MachineSkimmed Milk (or Dried Skimmed Milk)" ; are " Unfit for babies,'' and must indicate what is the equivalent of the contents in pints of skimmed milk. For the purpose of these Rules the terms " Milk," " | cream milk," "cream milk," and" cream milk " mean milk containing not less than the following percentages of milk fat and milk solids, that is to say :— Milk Solids Milk Fat. (including fat). Milk 3.6 12.4 ¾ cream milk 2.7 11.6 ½ cream milk .. 1.8 10.8 ¼ cream milk 0.9 9.9 and "Skimmed Milk" means milk which contains not less than 9 per cent, of milk solids other than milk fat. 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, 5 samples of Dried Milk were taken, all of which complied with the Regulations. Very little dried milk is sold in the Borough, except at the Welfare Centre. 49 ACTION TAKEN WITH REGARD TO OFFENCES OTHER THAN ADULTERATION. No. of Sample. Result of Prosecution or Remarks. Article. Offence. Margarine 11 Exposing for sale unlabelled parcel of margarine. Costs £1 1s. Do. 62 Do. - Do. 135 Do. Vendor cautioned. Do. 151 Do. Costs £1 1s. Do. 205 Do. Vendor cautioned. Milk 206 Failing to have name and address conspicuously inscribed on milk receptacle. Defendant failed to appear. Margarine 216 Exposing for sale unlabelled parcel of margarine. Fined 5s. Do. 229 (a) Do. ... (b) Selling margarine by retail in plain wrapper. Fined 7s. Do. 231 Exposing for sale unlabelled parcel of margarine. Fined 20s. Do. 241 (a) Do. Fined 5s. (b) Selling margarine by retail in plain wrapper. Do. Fined 7s. 6d. Do. 248 Costs 2s. 6d. Do. Exposing for sale unlabelled parcel of margarine. Fined 40s. 336 Cream 347 No declaratory label as to presence of boric acid on receptacles. Fined £20. Costs, £10 10s. (a) in which deposited. (b) in which delivered to purchaser. - Do. 349 No declaratory label as to presence of boric acid on receptacle in which delivered to purchaser. D 50 ACTION TAKEN WITH REGARD TO OFFENCES. OTHER THAN ADULTERATION— continued Article. No. of Sample. Offence. Result of Prosecution or Remarks. Margarine (a) Exposing for sale unlabelled parcel of margarine. Bound over in sum of 20s. not to repeat offence. 369 (b) Selling margarine by retail in plain wrapper. Do. 431 Exposing for sale unlabelled parcel of margarine. Fined 1s. Costs £2 2s. Do. 523 (a) Exposing for sale unlabelled parcel of margarine. Fined 5s. (b) Selling margarine by retail in plain wrapper. Fined 7s. 6d. Do. 532 Exposing for sale unlabelled parcel of margarine. Fined 10s. Do. 556 Do. Selling margarine by retail in plain wrapper. Costs 23s. Do. 576 Cautioned. Do. 582 Exposing for sale unlabelled parcel of margarine. Fined 10s. Walnuts 596 Treated with sulphite. Unfit for food. Informal. Cocoa x Contained small amount of fungus. Informal. Refusing to sell, for purpose of analysis, sample of butter. Costs £3 3s. - - Obstructing and impeding inspector in course of his duties (2 summonses). Costs £5 5s. - - - - 51 FOOD PREMISES. Milkshops and Dairies. Forty-four applications for registration under the Dairies, Cowsheds and Milkshops Orders were considered during 1924. Five of these applications were refused, and the remainder granted. 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 1923 234 Deduct number of purveyors removed from register during 1924 6 Add number of new purveyors added to register by resolution of the Public Health Committee during 1924 11 Number of purveyors of milk at retail milkshops on register at end of 1924 239 During the year 657 inspections of milkshops were made by the Inspectors, and 104 notices were served under the Public Health (London) Act, 1891. No legal proceedings were found to be necessary. Milk Special Designations Order, 1923. One purveyor in the Borough was licensed for the sale of certified milk, while one supplementary licence to sell certified milk in the Borough from premises in Hackney was also granted during the year. Cowhouses. There were at the end of 1924 twelve licensed cowhouses in the Borough, as in previous years ; 51 inspections were made during the year. * This includes changes of occupier in premises previously on the register. D 2 52 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 —B cows.) 104, Gibraltar Walk.—(lB cows.) 34b, Green Street.—(45 cows.) 1, Hamilton Road.—(l3 cows.) 55, Kerbela Street. — (No. of cows —Shed No. 1-18 cows, Shed No. 2 —2 cows.) 2, Lisbon Street.—(l9 cows.) 64, Squirries Street.—(l4 cows.) 38, Three Colts Lane.—(23 cows.) 6, Warley Street.—(10 cows.) The drains of the cowhouses at 34b, Green Street, and 6, Warley Street, were relaid during the year. During the autumn, and in consequence of an outbreak of Typhoid Fever, the Public Health Committee gave directions for a poster to be issued throughout the Borough advising residents to boil all milk before drinking it. Ice Cream Premises. There were 182 ice cream premises recorded at the end of the year, and 365 visits were paid to them by the district inspectors. Proceedings were taken against one occupier under the L.C.C. (General Powers) Act, 1902, and a fine and costs amounting to £3 Is. Od. were awarded. 53 Fried Fish and Fish-Curing Premises. At the end of 1924 there were 54 fried fish vendor' premises in the Borough, at three of which curing was also carried on. There were 25 fish curers' premises, including these three. Three hundred and eleven visits were made by the Food Inspector to these premises, and 13 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 wholesale or retail, which are workshops, that is, without mechanical power. There are, in Bethnal Green, 60 workshop bakehouses, 19 of which are underground: 186 visits were made to them during the year. Factory Bakehouses. There are in Bethnal Green 17 factory bakehouses, 5 of which are underground. In every case the mechanism used, which causes the bakehouse to be a factory, is a dough-mixer. Generally speaking, the factory bakehouses are kept clean and in a sanitary condition. Seventy-six inspections were made during the year, and arising out of these visits, one notice was served on an occupier 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. 54 Other Premises used for the Preparation or Sale of Food. There were 206 such premises on the register, the majority being restaurant-kitchens. Six hundred and thirty-three inspections were made during the year, and arising out of such inspections 48 Notices to remedy faults or insanitary conditions were issued. SLAUGHTERHOUSES. There were 3 licensed slaughterhouses in the Borough at the end of 1924, situated at: — 294, Bethnal Green Road. 354, Bethnal Green Road. 278, Hackney Road. Seventeen visits were made to slaughterhouses by the Food Inspector during the year. SLAUGHTERERS OF POULTRY. There are 10 slaughterhouses for poultry in use, all of them situated in the west ward of the Borough: 59 visits were paid to them during the year. There are also 5 premises on which poultry are kept prior to slaughter, and to which the by-laws would apply. 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. 55 Eight seizures of unsound food were made during 1924 as follows : — Seizures. Date. Description of Article. Weight. Prosecution and Result. 12th Jan. Salmon 50 tins Wholesaler prosecuted : fined £10. Costs £5 5s. 5th May Pears 7 lbs. Fined £1. Costs £1 1s. 11th Aug. Do. 5 lbs. Fined £5. Costs £1 1s. Do. 28 lbs. Fined £6. 15th Sept. Costs £1 1s. 1st Oct. Do. 4¾ lbs. Fined 10s. Costs £1 1s. 2nd Nov. Rabbits 14 lbs. Fined £4. Costs £2 2s. 20th Nov. Eggs 58 Fined £10. Costs £5 5s. Chocolate 16th Dec. 176 bars Fined £2. Costs £1 1s. On 65 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 - 4 59 Meat - 4 75 Fruit 1 18 41 Vegetables 7 - 27 Rabbits - 6 48 Other Articles - - 45 Condensed Milk 613 tins Eggs 449 Tinned Fish and Fruit 686 tins 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. 56 57 SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding for the Year ended 29th December, 1924. Factory and Workshop Inspections. Outworkers' Home Inspections. Combined Drainage Inspections. Tenement House Inspections. Smoke Nuisances. Premises under Observation. Other Inspections or work of Special Character. Number of Calls. Infectious Cases. House to House Inspections. Re-Inspections. New Buildings Inspections. Unsound Food Seizures. Samples of Food and Drugs taken. Police Court Attendances. Nuisances Abated. Matters Outstanding. Total Visits for the Year. Complaints. Milkshop Inspections. Other Food Premises. District. Inspector. A 307 33 4041 8 6159 917 70 51 56 368 4 38 182 3 804 52 ... 84 ... ... G. I. Brighting. 219 46 116 B 682 13 3376 189 309 18 31 86 ... 278 263 ... 10 1053 57 5626 J. H. Hewitt. ... 209 100 C 553 90 90 3551 184 145 115 143 363 6 183 4 190 25 1150 81 W. Billings. ... 5922 143 154 13 1222 D 207 797 11 4613 482 99 76 9 151 147 106 ... ... ... 6889 F. T. Bare. ... E 287 732 136 67 79 3897 164 199 60 29 41 2 336 8 75 311 ... 1539 ... 6340 E. J. Jenkins. 289 56 46 330 F 691 14 49 3266 144 161 23 79 513 ... ... ... 2 1285 97 5661 I. R. Jones. 815 2 ... 8 ... ... 278 2 1 ... ... ... ... 3 1 14 3 110 ... 1109 A. S. Henley. ... ... ... ... ... ... ... ... ... 3 739 92 ... ... ... ... ... ... J. G. Weeks. ... ... 1518 23022 1219 1283 574 1462 Totals 4380 334 428 1371 296 283 25 1511 8 753 156 7163 37706 468 58 There was a substantial increase in the number of visits arising from cases of infectious disease and from complaints as to insanitary conditions : also in attendances at the police court in connection with legal proceedings. The time thus taken up accounts for the reduction in the number of inspections of workshops, outworkers' homes and food premises. Notwithstanding, however, that the staff is one short as compared with the first half of last year, the total number of inspections has been maintained at approximately the same level. An interesting experiment in sanitary propaganda during the year was the issue of a poster at the instance of the Public Health Committee inviting residents to report insanitary conditions to the M.O.H. with a view to their prompt remedy. The poster was well distributed throughout the Borough and elicited some additional complaints beyond those normally received, but on the whole the experiment rather confirmed the impression that the means for securing the removal of insanitary conditions are already pretty generally known. SANITARY DEFECTS DISCOVERED DURING 1924. Defective and Dirty. W.C.'s. Defective Water Supply. Dirty Premises. Defective Drains. Other Matters. Month. Total. January 169 53 91 87 1214 1664 February 157 41 83 92 1309 1682 March 45 93 89 1287 1655 141 April 183 51 112 98 1543 1987 May 141 43 104 89 1233 1610 129 39 91 76 1184 1519 June 151 43 117 92 1472 1875 July August ... 107 32 91 73 1028 1331 September 141 37 106 65 1102 1451 137 44 112 73 1081 1447 October 131 82 1124 1543 November 159 47 December 165 51 142 83 1164 1605 Totals 1780 526 1273 999 14791 19369 During the year 4,992 Preliminary Notices were served requiring the remedying of Nuisances. 4,872 Statutory Notices were served. Rooms, Bedding and Clothing Disinfected during the Year ending 31st December, 1924. Number of Rooms. Total No. of Articles. Scarlet Fever. Diphtheria. Pulmonary Tuberculosis. Verminous Conditions. Measles. Month. Cancer. Scabies. Enteric Fever. Erysipelas. Pneumonia. Other Conditions. Total No. of Rooms. Smallpox. January ... ... 19 51 16 2 1 5 3 97 1576 ... ... ... February 31 35 13 ... 6 1 1 87 1629 ... ... ... ... ... ... March 25 32 21 4 ... 1 4 2 2 91 1434 ... ... April ... 27 34 19 ... 14 1 ... 1 1 97 1526 ... ... ... May 30 53 7 ... 52 ... ... ... 3 5 150 1552 ... ... June 34 ... 1381 55 15 53 2 2 4 165 ... ... ... ... ... July 45 39 13 ... 60 2 2 1 162 1908 ... ... ... August 43 37 15 ... 29 ... ... 1 125 2252 ... ... ... ... ... September 58 44 10 ... 29 1 2 ... 2 146 1612 ... ... October 66 69 21 ... 12 3 ... 55 ... 7 233 2704 ... ... ... November 33 47 13 10 14 1 ... 2 120 1945 ... ... ... ... December 43 62 9 9 1 ... ... 5 ... ... 1 130 1842 Totals 454 558 172 280 7 3 14 80 2 8 25 1603 21361 ... No. of articles destroyed by request ... ... ... ... 139 Articles disinfected in Formalin Chamber, such as boots, boxes, books, etc. (included in 21,361 above) 1,200 59 DISINFECTION SERVICE. During the year, 1,603 rooms and 21,361 articles were disinfected for various reasons, liquid Formalin in the form of a spray being used for the purpose of disinfecting rooms. The table appended gives full details of the rooms, bedding and clothing disinfected. PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 139 bodies were received at the Mortuary, i.e. — On Coroner's order 102 From the Police 9 At the request of relatives 28 Exact particulars are only available as to the 108 bodies on which coroner's inquests were held. On 47 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 4 „ „ „ „ „ streetS, etc. 3 41 Removed from Bethnal Green Hospital „ „ Queen's Hospital 15 „ „ Mildmay Mission Hosp. 2 Victoria Park Hospital. 1 „ „ Private houses, etc. 42 Total 108 Inquest cases classified according to age: — Number under 1 year 9 „ over 1 year and under 5 years 15 „ 5 years „ „ 10 „ 3 „ 10 „ „ „ 20 „ 4 „ 20 „ „ „ 30 „ 1 „ 30 „ „ „ 40 „ 3 „ 40 „ „ „ 50 „ 13 „ 50 „ „ „ 60 „ 11 „ 60 „ „ „ 70 „ 25 „ 70 „ „ „ 80 „ 17 „ 80 7 Total 108 Causes of death in inquest cases:— Natural causes 62 Misadventure : death under an anæsthetic 4 Accidental: Burns 4, Drowning 1, Falls 10, Run over 12 27 Open Verdict 3 Manslaughter 1 Wilful murder 1 Suicide 10 Total 108 DISTRIBUTION OF DISINFECTANTS. During the year 14,541 pints 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, 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. Special attention is given to the storing of refuse from restaurants and food premises, a covered receptacle being required in every case to prevent the access of rats. 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 55 new houses were certified as having a proper and sufficient water supply. SMOKE PREVENTION. During the year 25 formal observations of smoke shafts were made, and 9 complaints were received as to smoke nuisances. In 3 cases black smoke was observed in such quantity as to be a nuisance, and 3 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. OFFENSIVE MATTER. During the summer months, the inspectors keep special observation to see that offensive matter is not conveyed through the streets during hours prohibited by the by-laws. Legal proceedings were necessary against one offender against these by-laws, and the firm in question was fined £5, with costs £2 2s. OFFENSIVE TRADES. During the year, one offensive trade, that of a Fur-skin Dresser, was established anew, by order of the London County Council, at 74, Florida Street. Eight inspections were made at these premises. Poultry slaughtering, an offensive trade also, is dealt with elsewhere in this report. RAG-FLOCK ACT, 1911. Five formal samples of rag-flock were taken during the year, and in no case was the amount of chlorine present found to be in excess of the limit fixed by the Regulations. RAG AND BONE DEALERS. Twenty persons or firms are known to be carrying on this business in the Borough. On 26th September, 1924, the by-laws came into full force as regards structural requirements as well as the conduct of the business. In nearly every instance structural alterations have had to be made. During the year, 46 visits of inspection were made. 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 691 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 seven systems were reconstructed, taking 21 houses. DRAINAGE WORK. Legal proceedings were taken during the year in respect of one case of failure to deposit plans of drainage and in one case of omission to give notice of intention to fit a new w.c. pan and trap, with the results that a fine of 20s. and costs, £3 3s., were imposed on the former summons, and costs, 21s., were obtained on the latter. DRAINAGE BY-LAWS. Amending by-laws made by the London County Council were approved by the Minister of Health on 2nd January, 1924, and after that date the following proviso to by-law 11 in the Drainage By-laws, that is to say : — " Provided that in any case where it shall be necessary to construct such soil pipe within such building he shall construct such soil pipe in drawn lead with proper wiped plumbers' joints and so as to be easily accessible," was repealed and the following proviso substituted therefor : — " Provided that in any case where it shall be necessary to construct such soil pipe within such building and he shall construct such soil pipe of cast iron, he shall cause such pipe to be coated on both the inside and the outside with Dr. Angus Smith's solution or with some other equally suitable material as a preservation against corrosion." and the following proviso to by-law 17 in the Drainage By-laws, that is to say :— " Provided that in any case where it shall be necessary to construct such ventilating pipe within a building he shall construct such ventilating pipe in drawn lead," was repealed and the following proviso substituted therefor:— " Provided that in any case where it shall be necessary to construct such ventilating pipe within a building and he shall construct such ventilating pipe of cast iron, he shall cause such pipe to be coated on the inside with Dr. Angus Smith's solution or with some other equally suitable material as a preservation against corrosion." E HOUSING. HOUSING STATISTICS FOR 1924. Number of new houses erected during the year : — (a) Total. 6 (tenements). (b) As part of a municipal housing scheme : Borougli Council schemes : Vaughan Estate 6 1. Unfit dwelling-houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health Acts) 6,232 (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 (representations) 4 (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 - 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, &c., 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 4,992 Statutory Notices 4,872 (2) Number of dwelling-houses in which defects were remedied :— (a) By owners (nuisances abated) 7,163 (b) By Local Authority in default of owners Nil. (c) Proceedings under sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909: — (1) Number of representations made with a view to the making of Closing Orders 4 (2) Number of dwelling-houses in respect of which Closing Orders were made 4 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made 1 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 TENEMENT HOUSES. The number of houses registered as being let in lodgings or occupied by members of more than one family was 207 ; 786 visits of inspection were made to these houses, and arising out of such visits, 262 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. E 2 FACTORIES, WORKSHOPS, OUTWORKERS, Etc. Inspection of Factories, Workshops and Workplaces. Number of Premises. Written Notices. Inspections. Prosecutions. ... 178 25 Factories (Including Factory Laundries) Workshops (Including Workshop Laundries) 2254 616 9 Workplaces (Other than Outworkers' Premises) 24 5 ... Total 2456 646 9 Defects found in Factories, Workshops and Workplaces. Number of Defects. Number of Prosecutions. Particulars. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 277 252 ... 2 Want of ventilation 76 68 ... 2 Overcrowding 2 2 ... ... Want of drainage of floors ... ... ... ... Other nuisances 602 561 ... 8 Sanitary accommodation— insufficient 14 11 ... ... unsuitable or defective ... 226 198 ... 4 not separate for sexes 5 5 ... ... Offences under the Factory and Workshop Acts: — Illegal occupation of underground bakehouses (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) ... 33 33 ... Other offences 66 59 ... 4 (Excluding offences relating to out work). Total 1301 1189 ... 20 Registered Workshops. Workshop on the Register (s. 131) at the end of the year. Number. Workshops 1741 Workshops Bakehouses 60 Total Number of Workshops on Register 1801 Other Matters. Number. Class. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 18 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 134 Reports (of action taken) sent to H.M. Inspector. 134 Underground Bakehouses (s.101) in use at the end of the year (including factories) 24 HOME WORKERS. Of the 4,000 workmen and contractors whose names appeared on the lists received, 2,755 resided within the Borough. This figure, 2,755, 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 1,813. The number of premises found to be in an insanitary condition was 263, or 20 per cent, of the 1,283 premises inspected. Notices were served in 241 cases, the other 22 premises being already under notice arising from other visits. Difficulty is occasionally experienced in getting employers promptly and accurately to send in copies of their fist of outworkers, and it was found necessary in the course of the year to prosecute two employers on this account. In one case, being a second offence, a fine of £2 with £2 2s. costs was imposed, while in the other case the employer was fined 10s. The latter employer was also fined 10s. for failing to keep a proper list of outworkers at his premises. 6 HOME WORK. Outwork in unwholesome premises, Section 108 Outwork in Infected promises, Sections 109, 110 OUTWORKERS LIST, SECTION 107. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Prosecutions (s. 109, 110). Lists received from Employers. Orders made (s. 110). Addresses of Outworkers. Failing to send lists. Instances. Failing to keep or permit inspection of lists. Nature of Work. Sending twice in the year. Sending once in the year. Prosecutions. Notices served. Received from other Councils. Forwarded to other Councils. Instances. Outworkers. Outworkers. Lists. Lists. Contractors Workmen Contractors Workmen Wearing Apparel — Making, etc. 676 7 134 30 1049 7 ... 19 1376 99 1 1 104 96 ... ... ... Curtains, Furniture hangings and Trimmings... 12 214 13 128 11 ... 1 36 34 ... ... ... ... ... ... ... ... Fur-pulling and feathers Umbrellas, etc. 2 2 ... ... ... 26 2 2 ... 6 5 ... ... ... ... ... ... 2 8 60 ... 2 13 12 1 ... ... ... ... ... ... ... ... ... Artificial Flowers 23 5 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, etc., Boxes, Paper Bags 169 36 478 3 22 166 20 ... ... 51 46 ... 4 ... ... ... ... Brush-making 6 398 30 270 4 42 38 ... ... ... ... ... ... ... ... ... ... Draught Board making 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosques, Christmas Crackers, Christmas Stockings. etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Textile Weaving 18 4 2 ... ... ... ... 5 ... 2 ... ... 4 ... ... ... ... Toys ... ... ... ... ... ... 25 ... ... ... ... 2 2 ... ... ... ... Total 194 30 2167 11 ... 42 1724 1245 140 1 2 263 241 12 ... ... ... APPENDIX A. SUMMARY OF LEGAL PROCEEDINGS, 1924. (Other than under the Sale of Food and Drugs Acts, for which see pp. 43 and 49.) Date of Hearing. Offence. Inspector. Result and Remarks. Failing to take steps to prevent premises, 327, Whitechapel Road, being infested by rats, after being served with requisite Notice. 15th January Billings Fined £5, with costs £3 3s. 12th February Exposing for sale, intended for human food, 16 tins Salmon, unfit for human food. Henley Bound over in sum of £2. 12th February Depositing for sale, intended for human food, 34 tins Salmon, unfit for human food. Henley Do. do. (Proceedings taken against the wholesaler.) 12th February Causing 34 tins Salmon, unfit for human food, to be deposited for sale, for food of man. Henley Do. do. 12th February Causing 16 tins Salmon, unfit for human food, to be exposed for sale, for food of man. Henley Do. do. 12th February Selling to retailer, 50 tins Salmon, unfit for human food, for purpose of sale intended for human food. Henley Fined £10, with costs £5 5s. 28th February Failing to deposit with Sanitary Authority, drainage plans. Billings Fined £1, with costs £3 3s. 20th March Omitting to give written notice of intention to fit W.C. pan and trap. Billings Costs awarded Council, £1 1s. 27th March Failing to provide Council with List of Outworkers. Jenkins Fined £2, with costs £2 2s. 27th March Do. Do. do. Fined 10s. 27th March Failing to keep on premises prescribed form of particulars of all Outworkers employed. Do. Fined 10s. 27th March Non-compliance with Statutory Notice requiring abatement of nuisance. Jones Defendant ordered to do work in 14 days, and pay costs, £2 2s. 11th April Making default with Nuisance Order granted by Magistrate on 1/11/23. Billings Fined £5. 24th April Non-compliance with Statutory Notice requiring abatement of nuisance. Bare Adjourned sine die. 15th May Do. do. Billings Defendant ordered to do work in 14 days, and pay £2 2s. costs. 27th May Exposing for sale, intended for human food, about 7 lbs. Pears, unfit for human food. Do Fined £1, with costs £1 1s. 27th May Non compliance with Statutory Notice requiring abatement of Nuisance. Bare Defendant ordered to do work in 7 days, and pay costs, £1 1s. 27th May Do. do. Do Do. do. 29th May Do. do. Jenkins Defendant ordered to do work in 14 days, and pay £2 2s. costs. 29th May Do. do. Do Do do. 73 Date of Hearing. Offence. Inspector. Result and Remarks. 8th July Causing to be removed through London, during prohibited hours, by road, putrid fat and bones. ... Fined £5, with costs £2 2s. 15th July Exposing Ice-cream to contamination at place of manufacture. Fined £2, with costs £1 1s. Do 29th July Making further default with Nuisance Order granted by Magistrate on 1/11/23. Fined £10. Do 14th August Non-compliance with Statutory Notice requiring abatement of Nuisance. Jenkins Defendant ordered to do work in 7 days, and pay costs £2 2s. 14th August Do. do. Do. Do. do. Defendant ordered to do work in 14 days, and pay costs, £2 2s. 21st August Do. do. Bare Fined £10. Making further default with Nuisance Order granted by Magistrate on 1/11/23. 29th September Billings 7th October Exposing for sale, intended for human food, about 5 lbs. Pears, unfit for human food. Do. Fined £5, with costs £1 1s. 7th October Exposing for sale, intended for human food, about 28 lbs. Pears, unfit for human food. Do. Fined £5, with costs £1 1s. 21st October Exposing for sale, intended for human food, about 4¾ lbs. Pears, unfit for human food. Do. Fined 10s., with costs £1 1s. 6th November Non-compliance with Statutory Notice requiring abatement of Nuisance. Bare Defendant ordered to do work in 14 days, and pay costs, £2 2s. 6th November Do. do. Do. Do. do. 20th November Do. do. Jenkins Defendant ordered to do work in 7 days, and pay costs, £2 2s. 25th November Depositing for sale, intended for human food, about 9 lbs. Rabbit pieces, unfit for human food. Weeks Fined £2, with costs £1 1s. 25th November Exposing for sale, intended for human food, 2 Rabbits, unfit for human food. Do. Fined £2, with costs £1 1s. 11th December Making default with Nuisance Order granted by Magistrate on 21/8/24. Bare Fined £10, with costs £5 5s. 18th December Non-compliance with Statutory Notice requiring abatement of Nuisance. Brighting Defendant ordered to do work in 21 days, and pay costs, £1 1s. 18th December Do. do. Do. Do. do. 18th December Do. do. Billings Defendant ordered to do work in 21 days, and pay costs, £2 2s. 18th December Exposing for sale, intended for human food, 58 Eggs, unfit for human food. Weeks Fined £10, with costs £5 5s. In addition to the foregoing 40 cases, proceedings were taken in 105 cases for non-compliance with Statutory Notices served requiring 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 : — Costs in each Case. Cases. 103 £0 10 6 1 1 1 0 1 .. .. ..2 2 0 APPENDIX B. Bethnal Green Tuberculosis Dispensary. REPORT FOR THE YEAR 1924, By H. TYLFORD HOWEĹL, M.R.C.S., Eng., L.R.C.P., Lond., Clinical Tuberculosis Officer. For the fourth year in succession I am pleased to report that there has been no change in the personnel of the Dispensary, and the department is fortunate in having retained the services of Dr. F. W. Hamilton, the Junior Tuberculosis Officer, the Nurse and the Clerk. There has been no radical change in routine, and the sessions have remained the same. Patients are seen on Monday, Wednesday, Thursday, Friday, and Saturday mornings from 10 to 12 o'clock, Wednesday evenings from 5.30 to 7 o'clock, and Thursday evenings from 7.30 to 9 o'clock. Saturday mornings are mainly for school children and such adults as find it difficult to attend at other times, while the evening sessions are reserved for patients who are at work during the day. Patients may present themselves during any part of the session, and are seen in order of their arrival, so that the period of waiting is reduced to a minimum. The accommodation of the department is still adequate in every respect, and compares very favourably with that of other dispensaries. We have at our disposal waiting-rooms, two consulting-rooms, with two dressing-rooms and a dark-room for the examination of throat cases attached to each. There is also a laboratory, while two rooms are set apart for the clerical work. The Tuberculosis Officers continue to make use of the special departments of the Hospital. This arrangement enables us to investigate thoroughly a case on the spot, while in addition we have the advantage of a personal interview with the consultant concerned. The fact that 42 cases were referred to the X-ray department and 32 to the dentist, in addition to those referred to the out-patient physicians and the surgeons, shows that we appreciate the usefulness of such an arrangement. The number of cases referred to the dentist is small, but this is due to the fact that it is extremely difficult to persuade patients that the extraction of septic teeth is desirable unless they actually cause pain. The Hospital Almoner arranges for dentures when necessary, either through the Charity Organisation Society or some other body, the patients themselves contributing to the cost according to their means. This scheme appears to be satisfactory, and in every case dentures have been provided when recommended by the dentist. The various charitable organisations in the district continue to help us in many ways. The Invalid Children's Aid Association, of which Committee both Tuberculosis Officers are members, has sent quite a large number of our so-called pre-tuberculous children to convalescent homes either at the seaside or in the country. The Charity Organisation Society have helped with dentures, surgical instruments and clothing, and have frequently found suitable accommodation for the children while their mothers are receiving institutional treatment. The .Soldiers' and Sailors' Families' Association also provides accommodation for children during the absence of the mother, and gives monetary help in the case of ex-soldiers who are not in receipt of a pension. The Victoria Park Hospital has also sent quite a number of our children to their convalescent home at Saunderton, where they have all been very happy, and have done extremely weß. Apart from institutional and dispensary treatment another method at our disposal for the treatment of children is the Stormont House Open Air School, situated on Hackney Downs. In this case, however, the child must be a notified case of tuberculosis, either pulmonary or non-pulmonary. Both sexes are admitted, and the ages range from 7 to 16. The school was opened in 1919, and there are now 87 children on the roll, with an average attendance of 74. During the year 28 children were admitted, 15 were discharged as fit for work, and 8 had improved to such an extent as to justify their transfer to the ordinary elementary school. The school is always full, and there is a short waiting list. Formerly cases were admitted from other boroughs, but at present all the children come from Hackney, Bethnal Green, and Stoke Newington, and are recommended for admission either from the Metropolitan Hospital or the Victoria Park Hospital Dispensaries. The classes are held in the open air, special shelters being provided in the grounds for this purpose. Ample indoor accommodation is available in bad weather, but it has rarely been found necessary to make use of this, even in midwinter, except during dense fogs. Hot midday meals are provided at a nominal fee, while in the case of necessitous children no charge is made. Records of weight, temperature, etc., are kept by the nurse, who visits the school daily, while the Medical Officer makes frequent examinations of the children, and supervises the exercise and rest of each child. The children soon get acclimatised to the open-air conditions and are perfectly happy, while the benefit to their health is most marked. The scheme introduced by the London County Council in 1922 for reducing the number of children attending the Tuberculosis Dispensaries is being carried out. All contacts who are probably non-tuberculous, or who after a period of observation at the dispensary are found to be such, and the children whose general health is not satisfactory, are transferred to the school medical department. The Tuberculosis Officer sends a special report on each case to the School Medical Officer, who arranges for periodical examinations, weighing, etc. Should the School Medical Officer later suspect tuberculosis in any of these children, the case is immediately referred back to the dispensary for an opinion. The School Medical Officer and the Tuberculosis Officer also meet once a year to discuss these cases and decide whether further observation of each case is necessary, and, if so, whether this should continue at the school, or the child be referred back to the dispensary for a period. One hundred and two cases were admitted through the London County Council to hospital or sanatorium during the year. The period between the date of recommendation and that of the patient's admission is still longer than is desirable, but not so great as formerly. While it is usually possible to obtain institutional treatment for the early case, it is seldom one can do this for the moderately advanced or advanced patient, except in the case of the pensioner. It is only in a few instances that we can persuade those suffering from advanced disease to enter the infirmary, with the result that they remain at home, possibly sharing the same bedroom as other members of the family, and perhaps ultimately infecting them. Until more attention is paid to the advanced case, and more congenial and better-situated homes within easy distance of their friends are provided for them, little progress will be made towards the eradication of tuberculosis. In this connection lam pleased to learn that one of the charitable societies is considering the question of providing a local institution for such cases, and it is hoped that something may be done in the near future. The question of obtaining suitable employment for patients discharged from residential institutions after a course of treatment has always been a difficult one. The Ministry of Health, after consultation with the Ministry of Pensions and the Ministry of Labour, issued a circular in December, 1923, indicating a line of procedure to be adopted in order to facilitate the provision of suitable occupations for tuberculous men. Among other things the Tuberculosis Officer is asked to communicate with the local employment exchange, giving information as to the kind of occupation desirable in each case. Up to the present we have not found the results of this scheme to be very encouraging. This opinion is evidently general, as the London County Council has now issued a circular suggesting further alterations in procedure. It is pointed out that the objection to the employment of tuberculous persons is " the fear of infection, and the reluctance to engage a 1 hand' that may not be capable of an average day's work, or may have to be off work frequently." To meet the former objection the Tuberculosis Officer is asked to give to each patient seeking work a certificate which should indicate that the holder, if his sputum is free from tubercle bacilli, and if he has shown no signs or symptoms for five years except such as are compatible with a completely healed lesion, need no longer be regarded as suffering from tuberculosis, and in other cases which cannot be considered free from infection, a certificate to the effect that he is no danger to others if employed under certain conditions specified in the document. It is extremely doubtful if these certificates will help in any way to relieve the situation, as the number of patients seeking employment who have remained free from signs and symptoms for five years is very small, as in all probability the majority have obtained work before this, while the certificate of " no danger to others " which the employment exchange is bound to present to the employer may alarm rather than reassure. It would appear that the only solution of the problem of unemployment among tuberculous persons is the adoption of local workshops, subsidised by the State, where they could work at suitable occupations under direct medical supervision, and where they could obtain a living wage, even if unable to do a full day's work. The present moment, when the call for economy is so insistent, may be rather an inopportune time for such a plan, but it is possible that eventually the scheme would be practically self-supporting, and it would certainly be less costly for the State and better for the patient than continuous unemployment. The scheme for the supply of extra nourishment to patients suffering from tuberculosis, adopted by the boroughs in 1921, is still in operation. The expendi. ture sanctioned must not exceed £2 per 1,000 of the population, so that the sum available is rather limited. The additional diet given takes the form of milk and eggs, and there is no doubt that it has been of great value to those patients who, after leaving sanatorium, are unable to obtain suitable nourishment for themselves pending their return to work. As pointed out in last year's report, I was appointed Honorary Consultant to the Bethnal Green Hospital in the latter part of 1923. I have visited the Hospital one afternoon a week during the year, and have found the work most interesting. Everything has worked exceedingly smoothly, and I have received every courtesy from the Medical Staff, who freely adopt any suggestions I make. As was mentioned in last year's report, a trial was given to Dreyer's Vaccine in the treatment of some of our cases. This has now been abandoned, as we felt that the results obtained did not justify us in continuing with it further. We still rely very largely on the usual non-specific remedies, but in view of the successful results claimed for the " artificial sunlight" treatment of tuberculous glands and the fact that the Victoria Park Hospital had recently installed the necessary apparatus, I unofficially approached the hospital authorities with a view to their treating some of the dispensary cases. This they kindly consented to do, but it is early at present to form any independent opinion as to the success or otherwise of the treatment. The statistical tables given below give particulars of the work of the department for the year. The number of new cases is definitely smaller, but it will be seen that the decrease is entirely accounted for by the falling off of contacts. To a considerable extent this decrease is due to a diminution in the number of primary notifications, which in its turn is partly the result of the increasing tendency on the part of the practitioner to send patients to the dispensary for an opinion before notifying. Also, in the case of Bethnal Green, no patients are now notified from Bethnal Green Hospital until they have been seen by the Tuberculosis Officer. It is always difficult to limit the number of patients who wish to receive treatment at the dispensary, but it will be seen by the slight fall in attendances that an attempt has been made in this direction. Insured patients are sent to their panel doctors, while school children who only require periodic observation are referred to the School Medical Department. Our relation with the local practitioners is still of the most cordial nature, and I think we might infer from the increase in the number of cases sent by them that the department continues to serve a useful purpose as a consulting centre. The ligures given below are not a true indication of the number of patients referred to the department by the local practitioners, as old cases previously recorded as non-tubercular are frequently sent for re-investigation after a lapse of time often amounting to several years, and such cases are not shown in the statistical summary. In conclusion, I should like to thank 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 Dispensary Staff for their efficient work and loyal support. (Signed) H. TYLFORD HOWELL. 16th February, 1925. F STATISTICAL TABLES. 1.The Total of New Cases. Males 295 Females 354 649 Total 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 102 51 Local Practitioners—Primary 211 Contact 8 45 219 7 Contact cases (per M.O.H.) 273 11 War Pensions Committee 14 6 17 London County Council 7 Victoria Park Hospital 11 10 Other sources 13 8 3.The Diagnosis of the New Cases. Insured. Uninsured. Diagnosis. Males. Total. Children under 15. Males. Females. Females. Pulmonary Tuberculosis 21 43 17 1 25 107 Non-pulmonary Tuberculosis 24 7 1 3 3 38 Non-tuberculous 94 83 193 22 79 471 Doubtful 8 4 12 1 8 33 Total 152 105 230 47 115 649 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 14 Non-pulmonary Tuberculosis 6 Non-tuberculous 253 Doubtful 8 Total 281 5. Sputum Examinations. Tubercle Bacilli present 136 Tubercle Bacilli absent 570 Total 706 6.Other Figures. Insured. Uninsured. Total number of attendances 1,771 2,677 Systematic examinations at the above 2,233 Number of patients sent to hospital or sanatorium by the L.C.C. 84 18 Number of letters written 1,681 Number of visits to patients at their homes 155 Number of patients referred to:— X-ray Department 42 Dental Department 32 Other Departments 14