Ac4366 Bet 30 THE Metropolitan Borough of Bethnal Green Report - ON THE \ HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1925, BY J. ASPINALL MARSDEN M.R.C.S. (Eng.); L.S.A. (Lond.); L.S.Sc., etc.; Licent. in Sanitary Science (Health Diploma) Univer. Durham; Ex M.O.H.; Major R.A.M.C.; Specialist Health Officer, North Mid. Area (6 counties); D.A. Director of Hygiene, South-West Area; Fellow Iioyal Institute of Public Health; Fellow Soc. Med. Officers of Health; President Hx. Medical Society, etc.; Acting M.O.H. and Administrative Tuberculosis Officer for the Metropolitan Borough of Bethnal Green. LONDON: Printed by A. Chris. Fowler, 6, New Union Street, Moorfields, E.C. 2 Metropolitan Borough of Bethnal Green. PUBLIC HEALTH COMMITTEE, 1925-1926 as on 31st December, 1925. Meetings held at the TOWN HALL on the first and third Wednesdays, at 7 p.m. Councillor Mrs. B. Elsbury, Chairman. Councillor A. E. Bean, Vice-Chairman. Alderman T. F. H. French. Councillor C. L. Coomber. „ H. E. Tate. „ L. Goldstein. Councillor H. Adams. ,, G. H. Pettet. „ W. H. Bryant. „ W. Shadforth. ,, G. Buckmaster. ,, G. E. Snelling. Ex-Officio Members of the Public Health Committee : (The Mayor and Chairman of other Standing Committees of the Council.) His Worship the Mayor (Alderman C. W. Hovell). Committee : Chairman : Finance Councillor S. Elsbury. Works and Stores ,, A. H. Gillison. Law and General Purposes ,, C. J. Palmer. Baths Alderman H. E. Tate. Electricity Councillor J. J. Vaughan. Valuation „ D. G. Alabaster. Public Libraries Alderman J. E. A. King. Housing Councillor W. Paddock. Staff ,, J. J. W. Bradley. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. Council Eepresentatives on Joint (Tuberculosis) Dispensary Committee : Councillors Mrs. E. Elsbury, A. E. Bean, and J. J. W. Bradley. 2 PUBLIC HEALTH DEPARTMENT. STAFF as on 31st December, 1925. *J. Aspinall Marsden, Acting Medical Officer of Health. Alfred W. Stokes, F.C.S., F.I.C., Public Analyst. Sanitary Inspectors : *°§Evan Richards, Chief Sanitary Inspector. *°F. T. Bare. *°§W. H. Heron. *°W. Billings, Junr. *°J. H. Hewitt. *°G. I. Brighting. *°E. J. Jenkins. *°§G. E. Gould. *°I. B. Jones. *°§A. S. Henley. *°J. O. G. Weeks. Health Visitors, &c. : * Miss G. I. Le Geyt, Superintendent Health Visitor. *†Mrs. F. M. Barden. *†‡Miss A. A. Page. Miss V. D. Cornish. *†‡Miss E. M. Patrick. *†‡Mrs. E. L. Hann. *†‡Miss M. Playle. *†‡JMiss C. E. Love. *†‡ Mrs. A. W. Rosling. *†‡Miss L. F. Wright. *†‡Miss E. E. Taylor, Midwife. *†‡Miss E. S. Crisp, Tuberculosis. *Miss L. F. Gavin, Clerk-Dispenser. Clerical Staff: °J. Henry Lloyd, Chief Clerk *F. G. Thomas, Assistant Clerk. ° S. Slater, Assistant Clerk. °B. W. Slyfield, Assistant Clerk. H. A. Saunders, General Assistant. *L. A. Taylor, Assistant Clerk. (3 vacancies). ° Certificated Sanitary Inspector. § Certificated Meat, &c., Inspector. †Certificated Nurse. I Certified Midwife. * The Council receives Exchequer grant towards the salaries of these Officers. 1 Leading Disinfector, 3 Disinfectors, 2 Messengers, 1 Mortuary Keeper, 1 Drainlayer and 2 Labourers (combined drainage). Maternity and Child Welfare Centre: 1 Porter, 1 Attendant, 1 Cleaner, 2 Cleaners (part time). 3 Temporary (Part Time) Medical Officers (Maternity and Child Welfare Centres). *Mrs. K. Addison, M.B., B.S. *Miss E. F. Iredell, M.D. *Miss M. M. Basden, M.D., B.8., *Mrs. N. D. Pinkerton, M.B.,B.S., F.R.C.S., L.E.C.P. 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. * The Council receives Exchequer grant towards the salaries of these Officers. CHANGES DURING 1925. Dr. G. E. Oates resigned his appointment as Medical Officer of Health for the Borough as from the 30th September, 1925, upon his appointment to a similar office in the Borough of Paddington. Dr. J. Aspinall Marsden was appointed Acting Medical Officer of Health from the 1st October, 1925, pending the appointment of a permanent officer. During the year Mrs. M. A. Hodgkins, Health Visitor, retired on superannuation. Miss M. Playle (Health Visitor) and Miss E. E. Taylor (Midwife) were added to the permanent staff, while Miss A. A. Page, formerly Health Visitor at Willesden, was appointed to the additional post as Health Visitor sanctioned by the Ministry of Health; Messrs. G. E. Gould and W. H. Heron, formerly on the clerical staff, were appointed Sanitary Inspectors; Mr. F. J. Bryant resigned his appointment as clerk upon obtaining an appointment as sanitary inspector in another borough ; Miss L. F. Gavin was appointed to the new post of Clerk-Dispenser at the Welfare Centre, and took up her duties on the 11th May. 4 Town Hall, Bethnal Green, E. 2. May, 1926. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, Dr. G. E. Oates having ceased to function as Medical Officer of Health for the Metropolitan Borough of Bethnal Green on October 1st, when he became Medical Officer of Health for the Borough of Paddington, it becomes my duty, as your Acting Medical Officer of Health, to present to you the Annual Report for the year 1925. The health of the Borough continued good, and in view of the existing overcrowding and unemployment, the death rate of 12 0 per thousand of the population is highly satisfactory. I beg 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 the staff during the past year. I must also tender my thanks to the officers and employees of the Public Health Department for the support I have received from them, and to other officers of the Council's staff for the help and courtesies received. Especially do I desire to acknowledge with gratitude the very able assistance I have received from the Chief Sanitary Inspector (Mr. Evan Richards) and the Chief Clerk (Mr. J. H. Lloyd), two highly competent and reliable officers. I am, Ladies and Gentlemen, Your obedient servant, J. ASPINALL MARSDEN, Acting Medical Officer of Health. 5 GENERAL SANITARY REVIEW Upon taking charge of the health of Bethnal Green as Acting Medical Officer of Health, various public health problems arrested my attention, and, writing at the close of eight months' service the sanitaryhistory of the year 1925 for this Borough, I feel glad to have already witnessed the solution of some of these and I look forward to the near future for the answer to others. In a review of this nature the following points suggest themselves for consideration :— Tuberculosis.—This subject is particularly sad to my mind, for it is very disappointing indeed to realize what small progress has been made towards stamping out this disease. It is the only infectious disease in which, practically speaking, no isolation is attempted, and consequently failure to check it is quite naturally anticipated. The only way to cure a disease is to ascertain the cause of it in the first place and to act upon this knowledge, but in this devastating infectious disease we do nothing of the kind ! Bovine Tuberculosis, the principal form of this disease in children, and which produces innumerable deaths in children under two years of age, is beyond all question due to drinking milk containing Tubercle Bacilli— then why is such milk permitted by law to be sold ? The draft Regulations of 1926 prohibit imported milk to be sold if it contains Tubercle Bacilli—but why is such prohibition restricted to imported milk ? Would it not be much cheaper and better to make the sale illegal rather than building large orthopœdic and other hospitals for the treatment of poor suffering cripples whose illness is entirely due to drinking tuberculous milk ? Again, what shall it profit the nation to send phthisis patients to sanatoria and when they are almost cured send them to the Relieving Officers, whose 6 acquaintance they resent naturally, for special nourishment, and to their poverty-stricken and horribly overcrowded homes to again endure the identical conditions which gave rise to their illness, and to extend infection to their wife and family, sleeping in the same room, and often in the same bed, for, alas, there is no escape for them from these disgraceful conditions ! The fault is not their's—upon whose shoulders should it be laid ? The halls of my memory contain no pictures so sad ! It is regretted that the County Council Boarding-out Scheme for Children has so far been a failure in this area; for the want of the "human" element, I think. A mother naturally wishes to see the Foster-mother who is going to have the care of her child, but this is not the case. She also wants to visit the child now and then, but this is discouraged. Though willing to send her child to a Home or Institution for a few weeks, she entertains fears that the child may be taken away from her ! The prevention of this " preventable" disease is not so impossible as is too often inferred, and those with experience know it to be a very curable disease, but not in the " slums ! " The cardinal preventive points are:—untainted milk and meat, disinfection, and care of sputum, " spit " notices, open-air treatment and good food. After adequate sanatorium treatment, open-air conditions should be continued in the country on the American " Shacks" principle. Work, when possible, should be performed in the open air, and if in a town at open-air factories, e.g., Holborn, open-air " hostels" being provided at nights. Any serious attempt to prevent tuberculosis will, of course, have to include the provision of comfortable institutions, preferably not poor law, to which incurable cases can be sent from over-crowded homes to save the other members of the family. TheBorough of Bethnal Green does not as yet possess the much to be desired power of compulsory removal; and, in any case, the accommodation available is utterly inadequate. Maternity and Child Welfare Scheme—This most useful institution is very well managed and highly 7 appreciated. The following requirements were noted and have already been carried out:— The building required renovating, as also did Thornton Hall. Printed diet sheets were required for the feeding of infants. Lockers for Health Visitors' clothes and some additional " files " for records were wanted. Additional heating apparatus, with electric radiators to preserve a satisfactory temperature for children and especially for those undergoing " Sunlight " treatment was urgently needed. The pram roof required repairing to prevent rain falling upon the prams. In view of the thousands of persons visiting the rooms, the " Centre" needs an additional inlet (or outlet) to obviate overcrowding and as an emergency " fire outlet." Application for this has been made to the Minister of Health. The staff of lady doctors have always rendered the most valuable assistance in the discharge of their onerous duties. It is felt that more cases could be provided for the Dental Clinic and that an additional clinic should be held at Thornton Hall, as the attendances are good, and many prams are wheeled from this part of the district to the Centre. This is at present the only clinic outside the Centre. The massage clinic at Cornwall Road is doing good work, but I think the addition of electric apparatus would greatly increase its value. The prenatal advice so ably given has proved of incalculable value, and the gift by the Council of the book entitled " Advice to Mothers," prepared by the National League for Health, Maternity and Child Welfare, to every expectant mother in the Borough is very highly appreciated indeed, for it is full of the most valuable information. 8 Full particulars of all cripples under five years of age are now kept on a " card system," so that they can readily be inspected at frequent intervals and each child's progress noted. A special record will in future be kept of all children who die under two years of age, and the Health Visitor concerned has an interview with the Medical Officer of Health with regard to each case. The question of " Home Helps" for the assistance of mothers after confinement has been considered, but the question is one beset with much difficulty and no solution has so far been arrived at. It is hoped that in the coming year Baby Week will be observed. Milk.—This question has engaged much attention, and all free grants of milk will in future be of Grade A (Tuberculin Tested), for " Pasteurized" Milk is regarded at best as very dirty milk, full of dead germs, and which by re-heating (as is often the case) to preserve it is rendered practically valueless. The popularity of the former grade of pure milk will be ensured by propaganda work in the form of lectures with film views and the distribution of pamphlets on Grade A (Tuberculin Tested) Milk. At the Centre this grade of pure milk will be distributed, for it is unthinkable that these children should run any risk of acquiring tuberculosis. No form of dried milk will be used in which vitamins have been destroyed by high temperature. " Occasional " milk is a source of danger, for its origin is not always clear. Labels on packets of dried milk will in future contain a list of vegetable and fruit juices containing vitamins, and the definite statement that these are "fundamentally necessary for the child's health and growth." At present, the mothers think that fruit juice, etc., is just for the child's bowels and neglect to provide it and premonitory symptoms of shortage of vitamins are observed, including probably irritability. 9 Day Nurseries.—Two of these exist within the Borough and one just outside it. They all receive grants in aid from the Ministry of Health. About 100 children in all attend them daily whilst their mothers are at work. They are disinfected, washed and fed, and all seem happy at play, which is often in the open air. The one in Somerford Street exists in a building which is unworthy of it—yet the place is very popular, and it deserves a milk grant. INFECTIOUS DISEASE. The continued prevalence of Diphtheria and Scarlet Fever in London is a matter of much concern to those in sanitary charge. In Bethnal Green there were 493 cases of diphtheria as against 566 in the previous year, and 333 cases of scarlet fever as against 426. The number of cases was fairly equally distributed throughout the year, but, as is usual, I think, more cases occurred following the school summer holidays than at any other period of the year. This Borough did not compare unfavourably with some other areas and the number of cases was less than in 1924, yet this is more than should be the case and this comment applies throughout most parts of London. It cannot, in fact, be regarded otherwise than as a terrible reflection on the sanitary efficiency of London, and I am of opinion that it imperatively demands a commission of inquiry with a view to ascertaining more precisely the causation of such outbreaks and why they are so prolonged. I desire here to enter a very earnest protest against the admission or retention for treatment of any case of infectious disease in any general hospital in this or any other Borough. For example, a case of typhoid fever in a children's hospital would be especially dangerous from the point of view of the spread of infection. It is a remarkable fact that in most cases no relationship whatever can be found to exist with other cases, and this is a very unusual experience and one that has not been observed in other large towns which have their 10 trams, buses, schools, mills, " carriers," etc., etc., which no doubt at times may contribute to the causation. One great difference between London and most other cities is the condition of the uncovered ashbins and dust carts, to which I refer in another part of the report, and I will only add here that infection will necessarily take place if these so-called sanitary dustbins or uncovered dust carts contain infectious material, which may be expected if they come from infected houses. In this connection, I may remark that the public entertain the idea that infectious disease may be derived from sitting as out-patients for some time near such cases, and I am inclined to agree with their views and have urged the authorities to have a preliminary survey of cases with sore throats, rashes, etc., and I was glad to observe at a large hospital here posters inviting such cases to report at once. Before me are replies received from various Metropolitan Boroughs with regard to procedure in connection with diphtheria, but as they differ materially on the value of taking swabs, examining contacts and testing for virulency, it is thought that a memorandum from the Ministry of Health would be welcome. As a test to prove whether bacilli found in "contacts" is virulent or avirulent in the type is so expensive, it is thought that the County Council or Ministry of Health would do a great service by establishing an institution where this investigation could be made more economically. The possibility of conferring immunity to diphtheria by toxin-antotixin injections is now an accepted fact. By the Schick test it is quite possible to ascertain which among any group of persons are susceptible or immune to diphtheria. The reaction in 95 per cent, of the subjects can be read accurately within 24 hours. The former can then receive at the practitioner's hands the necessary doses of toxin-antitoxin mixture, rendering them immune to the disease. In short, we nowadays have a definite means of controlling diphtheria: if the public only knew and acted up to this, diphtheria would be a disease of the past. 11 The "Dick" test for scarlet fever almost certainly promises to have a field of prophylaxis by immunization analogous to that of the " Schick " test in cases of diphtheria—in fact, it is used and has been found quite successful at some of the fever hospitals to protect the staff. Vermin.—Bugs, fleas and lice are, I think, as prevalent in this and some other Metropolitan Boroughs as ever they were, and recent knowledge proves that they are the origin of much illness, and in the past have been responsible for our largest pandemics. The people themselves are strangely inactive regarding them, because their constant presence with these has produced apathy, and Science has not, in their experience, provided a reliable destructor for them. It is pitiable to see these people wasting their energy and money on quite useless powders and solutions. Three recent discoveries, viz., "Sodium Silicofluoride," used as a spray in a 1 per cent, solution (Report from Department of Insecticides, Rothamsted), "Budge" (used as a preventive in many ships), and "Exterpest" are now being put to the test by the Sanitary Inspectors. Such as are found to be efficacious will be distributed with inexpensive sprays by the Inspectors to the houses concerned, for use by the inmates. In time this will, in all probability, prove of immense service. The present methods of disinfection will, of course, be continued, and pamphlets of instruction distributed. The public buys carbolic soap and other disinfecting material, chiefly from grocery shops and stores, but it is all a waste of money, because it contains by law (1908) less than 3 per cent, of carbolic acid or its homologues, and so is quite useless. If it exceeds 3 per cent, it must be labelled "poison"—hence the public are deceived, for they think they are using a disinfectant and there can be no danger, for people do 12 not poison themselves by eating soap! This is a rather serious matter, I think, as a public health officer, that such a universal agent amongst the poor people for disinfecting and cleansing their rooms should be deprived of its value by this reduction to 3 per cent, strength. For the treatment of "Scabies" the Danish method (Kathiolan) will in future be employed as the necessity for fumigation is dispensed with, and its efficacy is assured. As we have no "cleansing station" the treatment of school children at the County Council cleansing station is very prejudiced, for it is of little avail if the parents and other persons above or below school age at home are infested. There is in the Borough one bath only for verminous persons, which in view of the number of lodgers—Salvation Army Rests, etc.—is absurd. This matter is now in the hands of the Borough Engineer, on the Public Health Committee's instructions. Rats.—There are probably more rats in this and other Metropolitan Boroughs than there were when they caused the " Great Plague," but we now know that they can cause other diseases besides Plague, and we know, too, that the Brown Rat is not immune to Plague, as was thought. The sewers contain many of these pests, and when drains are defective they gain an entry into the houses and the inmates hasten to the Town Hall, but the remedy while it precludes the subsequent entry of the rats, does not exterminate them ! Sulphur fumigation by a "Clayton Apparatus" works havoc amongst these pests where used. A proper organized scheme and plan of campaign is being prepared, and will be in charge of the Sanitary Inspectors, and special attention will be given to the subject in Rat Week. 13 Flies.—The fly peril demands more exact preventive treatment, for the deadly effects of these pests are not adequately appreciated by the general public, and yet the prevention of fly breeding would undoubtedly imply a heavy fall in the death rate. Sanitary Supervision.—The Sanitary Department here is the most active in my experience, but in this and other Metropolitan Boroughs the sanitary bins and dust-carts are a serious menace to public health; why they should remain for hours at the mercy of children and tramps, uncovered and over-flowing in front of the houses in the streets, is not understood. In future, in this Borough, covers will be provided for the bins, those containing any infectious material will be dealt with separately by isolation and disinfectant powder; a time table drawn out, showing the probable time of removal, and the present carts amended so that the canvas curtains (made from the cover) can be drawn down from the central pole, as parts of the cart are filled, to prevent the dust from blowing about. At present, throughout London, this terrible nuisance is possibly the source of very much of the paper and dust, and probably of much infectious disease. Epidemics of "sore throats" (follicular tonsillitis) are not uncommon in the Army, and it is not difficult to understand that dust from these bins and carts containing Diphtheria or Scarlet Fever may produce these diseases. It is difficult to understand why the public tolerate this horrible nuisance. The best type of dust cart has small wheels and so needs no ladder, the sanitary bins being readily emptied directly into the low body of the cart. Barbers' Shops.—A systematic inspection of these will in future be made. Antiseptic measures are very necessary, I am sure, if we are to prevent the far too prevalent baldness. In almost all the saloons, after the head has been scrupulously cleansed, it appears to be the custom to apply a brush that has just been used 14 on other customers. All brushes, etc., should be disinfected by formalin immediately after use. Public Swimming Baths.—The existing baths and wash-house are, of course, well patronised, but they quite fail to deal with the population of this Borough, and this has resulted in the projected scheme of public swimming baths and wash-houses, which are urgently required. A neighbouring Borough Council have just given up their system for another one, so I do earnestly advise the Council to be sure they are obtaining the best type of installation. A report on the subject of the purification of swimming-bath water has been prepared (1st May, 1926) by me after a very careful and complete investi-HOUSING OF THE WORKING CLASSES IN BETHNAL GREEN. In regard to this subject, it may in the first instance be unequivocally asserted that the Pneumococcus (Pneumonia) and the Tubercle Bacillus (Tuberculosis), two of the most deadly enemies of mankind, exert their evil influence in inverse ratio to the decency with which the people are housed. Overcrowding due to shortage of houses, is indeed most distressing and serious, and the difficulty is enhanced by the large number of dilapidated, sunless and damp houses. Devitalized air, absence of sunlight and cleanliness, dampness, deficiency in sleeping and sanitary accommodation, are constantly met with in these houses and result in impaired health, rampant disease and not infrequently immorality. Slum properties are common and situated in narrow streets, courts and alleys. In the East ward, the density of population per acre was about 198 (excluding park 15 land), against 60 per acre for the County of London. Some very serious cases of overcrowding come under observation from time to time, and what can be done ? Herewith are a few :— (1) One room with a total capacity of 1,368 cubic feet. Furniture : one double bed, one single bed, table, wash-stand, several chairs. Food is kept and cooked in this room. Water has to be carried up several flights of stairs. The family consists of father, mother and six children, all of school age or under (two of them since admitted to an institution). The room is very dirty. The father is nearly always out of work and the general condition of the household and family is past describing. (4) One room about 8 ft. 6 ins. long by 8 ft. 6 ins. wide by 8 ft. high. Furniture : One single bed, one cot, two chairs, one small table. In this room all food is kept and cooking done by fire and gas ring. Water is carried up from a tap a few flights of stairs down. The family living in this dwelling consists of father, mother (recently confined) and two small children. A dog expecting puppies lives under the bed. Child aged about 3 years is sitting in the cot all day, wedged between the wall and the bed; it has no desire to do anything else, also would not have room to run about if it wanted to. Child aged about 16 months sitting at the foot of the bed all day (and, no doubt, this is where it has to sleep, there being no other suitable space), also has no idea of running about; its only joy in life is trying to catch the bugs as they wander about the wall, but the vermin is more energetic than the child and therefore always gets away. 16 The newly-born babe developed ophthalmia during the first few days of its life, and has since died. The mother, during her lying-in period, used to do the necessary washing on a chair beside her bed and hang the things out of the small window to dry. This she could do by kneeling up on the bed. When the midwife was attending she had to sit on the bed whilst bathing the baby, as there was not room to place a chair for her as well as one for the bowl. (5) Accommodation: One small back room, 9 ft. 6 ins. by 8 ft. 6 ins. by 9ft. Family : Husband, wife, three children. Wife confined 11th February, 1926. Midwife called 5 a.m. Husband and two children had to remain on stairs or sit in unfurnished room at back of passage, with no fire, until allowed to re-enter the room at 12 noon. (17) Two rooms. Three adults and four children, 17, 15, 10, 6. These are tenement houses, the stairs being very dark and usually badly ventilated. The mother, who is tuberculous, occupies a room about 15 ft. by 12 ft. and sleeps in one bed with her husband, while there are also two other children sleeping in this room in separate beds (one bed occupied by children aged 10 and 6 years). The other room, which is a living room as well as a bedroom for three persons is about 13 ft. by 8 ft. 6 ins. This is occupied by the grandmother and girls of 17 and 15 years old. The home is clean and ventilated. (22) The first floor front room is occupied by a mother and four children (girls, 21 and 12 years; boys, 19 and 17 years.) The room is overcrowded and indecently occupied. Cubic capacity of room : 1,173 cubic feet. 17 Cubic capacity required: 2,000 cubic feet. It is stated that owing to the bad conditions existing the husband is compelled to sleep away from the above house. If, to this state of affairs be added unemployment, poverty, fleas, bugs, lice and rats—all carriers of disease—then it is obvious that we are liable any time to Smallpox, Typhus Fever, Cerebro-spinal Fever, Encephalitis Lethargica, Poliomyelitis, Relapsing Fever, Epidemic Diarrhoea, or even Plague. Such houses breed disease, but they also breed resentment to those responsible, and after visiting the scheduled areas, I can quite understand this. Time does not permit me to say more here, than to stress the fact that this condition of affairs undoubtedly implies absolute negation of all social, religious, moral and temperance considerations ! ! Public health administration, admirable as it is in the circumstances, offers an ironical comment on our present-day civilisation. We condemn a large proportion of the population to live in overcrowded houses in congested areas, ill provided with means of cleanliness and domestic conveniences, with a smokeladen atmosphere which obstructs such sunlight as may be available. These conditions inevitably favour the development and spread of Tuberculosis and other infectious diseases, as well as that general enfeeblement of health, which results from breathing vitiated air and from the absence of proper facilities for personal and domestic cleanliness and comfort. We thereupon find it necessary to establish Clinics, Sanatoria, etc., to deal with the consequences of our social neglect. How much more intelligent and humane it would be by better housing and more sensible methods of heating and lighting to prevent much of our present ill health. 18 It may be said that for the solution of this problem economic difficulties have to be met with. With this aspect of the matter I am not concerned, save to point out as a practical consideration that the loss of productive capacity due to ill-health and the expense of maintaining institutions which would be unnecessary in a healthy community amount in the aggregate to an enormous sum which might well counterbalance the expenditure on decent housing for the people, whatever this expenditure may be. Any medical officer faced with the conditions to be found in Bethnal Green must record his conviction as to the urgent necessity for proper housing in the Borough. The indelible picture of dying Tuberculosis patients in small and very overcrowded rooms, sleeping in the same bed with their children and so of necessity infecting these also, will haunt my mind for the rest of my life. 19 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, 1925, was £579,972, and the product of a Id. rate is estimated at £2,285. POPULATION. The population, as estimated by the RegistrarGeneral in the middle of 1925, was 119,800. MARRIAGES. The number of marriages celebrated in Bethnal Green during 1925 was 945. This is equal to a rate of 15.8 persons married, or 7.9 marriages, per 1,000 total population. BIRTHS. The number of births registered in the Borough during 1925 was 2,199, and, in addition, 431 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 2,630 births. The birth-rate for 1925 was, therefore, 21.9 births per 1,000 population. The rates for the last ten years are as follows:— 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 1925 21.9 20 The birth-rates in the four quarters of the year were :— First Quarter 21.1 Second „ 24.8 Third „ 22.0 Fourth „ 19.7 Of the 2,630 births, 1,354 were those of males, and 1,276 those of females. ILLEGITIMACY. Of the 2,630 births credited to this Borough, 47 were illegitimate, being 26 males and 21 females, and being 1.8 per cent. of the total number of births. STILLBIRTHS. Fifty-eight stillbirths were brought to notice, being a proportion of 2.2 per cent. of all births, live and dead. DEATHS. The number of deaths that were registered during the year as having taken place in the Borough was 1,400. Of these, 270 were of persons whose residence was not in Bethnal Green, 265 dying in Bethnal Green Institutions and 5 in other places in the Borough. There were also reported to the Registrar-General 301 deaths of Bethnal Green persons who died in institutions in other parts of London, and 6 who died in other parts of England and Wales. This correction gives the net number of deaths for Bethnal Green as 1,437, making an annual deathrate of 12.0 per 1,000 of population. 21 The death-rates for the last ten 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 1925 12.0 The death-rates in the four quarters of the year were:— First Quarter 13.2 Second „ 11.0 Third „ 10.0 Fourth „ 13.8 The death-rate for Bethnal Green, 12.0, compares with 11.7 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 :— 22 23 Metropolitan Borough of Bethnal Green. A provisional analysis of the CAUSES OF DEATH at various ages during the year 1925. Causes of Death Number of Deaths of residents at various ages, whether occurring within or without the Borough Deaths in various institutions in the Borough whether residents or non-residents All Ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Queen's Hospital for Children Mildmay Mission Hospital City of London Hospital for Diseases of the Heart and Lungs Bethnal Green Hospital (Poor Law) Waterloo House (Poor Law) Total Institutional Deaths ALL causes- Certified 1437 212 60 50 46 62 129 424 454 179 38 92 508 70 887 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1. Enteric Fever 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 2. Small Pox 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 3. Measles 12 2 9 1 .. .. .. .. .. .. .. .. 6 .. 6 4. Scarlet Fever 4 .. .. 3 1 .. .. .. .. .. .. .. .. .. .. 5. Whooping Cough 61 30 20 10 l .. .. .. .. 3 .. .. 17 .. 20 6. Diphtheria & Croup 19 2 2 9 6 .. .. .. .. .. .. .. 1 .. 1 7. Influenza 20 .. .. .. 1 1 2 10 6 .. .. .. 3 6 9 8. Erysipelas 3 .. .. .. .. .. 2 1 .. .. .. .. 3 .. 3 9. Phthisis (Pulmonary Tuberculosis) 121 .. 1 .. 3 22 41 46 8 3 .. 33 47 .. 83 10. Tuberculous Meningitis 14 3 3 7 1 .. .. .. .. 16 1 1 4 .. 22 11. Other Tuberculosis Diseases 7 1 .. 2 .. 1 .. 3 .. 5 .. 1 1 .. 7 12. Cancer, malignant disease 145 .. .. 1 .. .. 18 71 55 2 3 3 58 .. 66 13. Rheumatic Fever 7 .. .. .. 3 1 .. 3 .. 2 1 1 1 .. 5 14 Meningitis 10 3 .. 3 2 2 .. .. .. 12 1 .. .. .. 13 15. Organic Heart Disease 224 .. .. .. 7 11 12 77 117 2 l 15 91 29 138 16 Bronchitis 156 7 2 .. .. 11 6 64 75 2 1 4 60 10 77 17. Pneumonia (all forms) 125 39 15 10 3 2 8 29 19 36 7 4 37 2 86 18. Other diseases of respiratory organs 12 .. .. .. .. 2 2 5 5 .. .. 4 2 .. 6 19. Diarrhoea and Enteritis 61 55 5 .. .. .. .. .. .. 33 4 .. 39 .. 76 20. Appendicitis and Typhlitis 6 .. .. .. 2 1 1 .. 2 2 1 .. 1 .. 4 21. Cirrhosis of Liver 6 .. .. .. .. .. .. 5 1 .. .. .. 3 .. 3 21a. Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 22. Nephritis and Bright's Disease. 25 .. .. .. .. .. 4 13 8 1 1 6 8 .. 16 23. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 24. Other accidents and diseases of Pregnancy and Parturition 6 .. .. .. .. 2 4 .. .. .. .. .. 2 .. 2 25. Congenital Debility and Malformation, including Premature Birth 56 54 1 .. 1 .. .. .. .. 23 1 .. 20 3 47 26. Violent Deaths, excluding Suicide 31 4 1 1 6 6 3 6 4 2 2 .. 6 .. 10 27. Suicide 19 .. .. .. .. .. 6 8 5 .. 1 .. 3 .. 4 28. Other Defined Diseases 284 11 1 3 9 9 20 82 149 35 13 20 94 20 182 29. Diseases ill-defined or unknown 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. 1 Total 1437 212 60 50 46 62 129 424 454 179 38 92 508 70 887 24 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) 477 Waterloo House (Poor Law) 52 Queen's Hospital 39 City of London Hospital, Victoria Park 16 Mildmay Mission Hospital 16 600 Institutions out of the Borough. London Hospital 82 Other General Hospitals 70 Maternity Hospitals 5 M.A.B. Hospitals 58 Poor Law Hospitals 16 Sanatoria 14 Mental Hospitals 53 Hostels for the Dying 3 Other Places 19 320 Total 920 Prom these figures it will be seen that of the 1,437 deaths during the year, 920, or 64.0 per cent. took place in institutions. "VITAL STATISTICS of Bethnal Green During 1925 and Previous Years. Yeah Population Estimated to Middle of Each Year Births Transferable Deaths Nett Deaths of Persons Resident in the Borough Uncorrected Number Nett Total Deaths Registered in the Borough Of Nonresidents registered in the Borough Of Residents not registered in the Borough At all Ages Under 1 year of Age Number Rate Number Death rate Number Rate per 1,000 births or infantile mortality 1920 116,600 3,346 3,855 33.1 1,626 — — 1,702 14.6 366 95 1921 118,300 2,636 3,003 25.4 1,452 —— — 1,530 12.9 300 100 1922 118,400 2,579 2,981 25.2 1,776 — — 1,814 15.3 271 91 1923 118,700 2,482 2,880 24.2 1,275 282 340 1,340 11.3 198 68.7 1924 119,200 2,241 2,640 22.1 1,446 304 344 1,486 12.4 206 78.0 1925 119,800 2,199 2,630 22.1 1,400 270 307 1,437 12.1 212 80.6 25 26 MATERNITY & CHILD WELFARE. NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. During the year, 2,199 live births were registered in the Borough ; and of these, 2,194 were notified to the Medical Officer of Health. There were also 49 stillbirths notified. Of the 2,243 living and stillbirths notified, 1,362 were notified by midwives, 510 by maternity assistants of the London Hospital, 273 by medical practitioners, and 98 by parents and others. Through the courtesy of neighbouring Medical Officers of Health I also received copies of notifications of births of Bethnal Green babies which took place outside the Borough ; information as to 385 live babies and 9 stillbirths being received in this way. SUMMARY OF VISITS PAID BY HEALTH VISITORS. 1923. 1924. 1925. Births (first visits) 2,918 2,650 2,645 Births (re-visits) 16,628 20,507 23,640 Visits to mothers 1,577 1,435 1,443 Ophthalmia Neonatorum 149 223 190 Puerperal Fever 48 21 46 Measles 1,110 1,029 699 Special Matters 450 242 436 Futile Visits 2,377 2,847 2,290 Milk Grant Enquiries 1,141 828 1,069 Total visits paid 26,398 29,782 32,458 Of the 23,640 re-visits, 7,682 were to children under 1, and 15,958 to children between 1 and 5. 27 MATERNITY AND CHILD WELFARE CENTRES. The popularity of the Council's new Centre in Cornwall Road was maintained during the year. There were 153 sessions for infant consultations and 105 sessions in connection with the Maternity Clinic. Other work carried on at the Centre in connection with the Special Clinic for Delicate Children, massage, milk grants, etc., will be found under these separate headings. The auxiliary Centre at Thornton Hall, Mount Street, was in use on Monday afternoons throughout the year. There were 48 Infant Consultation Sessions at this Centre. The statistics of attendances at the Centres during 1925 and in previous years are as follow:— Cornwall Thornton Road. Hall. Total Attendances of Children 12,831 2,882 Average Attendance per Session 83.8 60.0 New Cases (Children) 1,270 297 Medical Consultations (Children) 8,853 2,142 1925. 1924. 1923. 1922. Total Attendances of Children 15,713 16,735 18,028 14,446 New Cases (Children) 1,567 1,528 1,989 1,623 New Cases (Mothers) 527 468 483 349 Medical Consultations— (Children) 10,995 11,782 11,685 9,541 (Mothers) 1,200 1,044 1,055 710 Total Attendances for Milk Grants 13,931 17,425 15,862 8,302 28 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 one of the Medical Officers will be of interest:— Dr. E. F. Iredell writes:— " There has been quite a considerable attendance of small children under five years, and it appears as though to some extent the ex-baby is the Cinderella of the family. Many causes—chiefly, perhaps, the inevitable limitations of one woman—mother though she be—combine to bring this about. One cause, however, is the idea, too widely spread, that after 1½ to 2 years a child does not require a midday rest. In consequence of this, the little three-year-old is put to bed at about 6.30 p.m. too exhausted in mind and body to settle down to rest quickly. The mother then perhaps thinks that if put to bed later he would go to sleep more quickly, and acts upon this. The result is that the child's hours of rest are seriously curtailed and one of the cheapest essentials of life is stinted with disastrous results." E. F. Iredell. MATERNITY CLINIC. This is open every Wednesday and Thursday morning. Particulars of attendances :— Total. Expectant Mothers—first visits 401 1014 ,, ,, subsequent visits 613 Mothers recently confined—first visits 126 205 „ „ „ subsequent visits 79 The number of sessions was 105, and the average attendance per session was 11.6. On the average the expectant mothers attended 2.5 times, and recently confined mothers 1.6 times. 29 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, 401 in number, may be grouped as follows :— Number of primigravidse 79 Number of multigravidæ 322 Full-term confinements, including 3 stillbirths 212 Premature births 3 Caesarian section 1 Miscarriages (15) and Stillbirths (7) 22 Not pregnant 46 Sterile (1), Mother died (1) 2 Not yet confined (22nd March, 1926) 108 Left Borough, result unknown 7 Wassermann reaction for syphilis :— Number of blood-tests 7 Number of positive 2 The 215 confinements took place, 173 at home and 42 in institutions. The following features of the work of the Clinic are also of interest:— No less than 128 mothers came to enquire whether they were pregnant. Of the mothers who attended the Clinic before their confinement 49 also attended after the confinement, while 130 of the mothers have attended the infant consultations with their children. 30 The results of the 110 cases brought forward from 1924 were as follow :— Full-time confinements 99 Premature (1) Stillbirths (3) 4 Not pregnant 6 Left district (result unknown) 1 Of the 103 who were confined, in 80 cases this took place at home and in 23 cases in an institution. The Clinic has been able to show improvement both in numbers and that valuable adjunct, subsequent attendances at the Clinic made by appointment. A new and satisfactory feature in the work has been the possibility of co-ordinating ante-natal care of those who booked with the Borough Midwife. This has also enabled home visiting of these cases to be done on a more friendly and interesting footing than could be obtained by such visits for any other reason. It is satisfactory to report that of the premature births two of the babies are progressing well and in both instances the mothers have kept closely in touch with the Infant Chnics, and the same can be said of the child delivered by Caesarian Section. Of the miscarriages, two cases attended the Post-natal Clinic at the Welfare, and in 10 cases there is a record of medical attendance at the time. In the remaining five cases the miscarriage took place under or at the third month. There has been considerable increase in the sales of wool for home knitting among the mothers, and a noticeable improvement in the more modern type of baby clothing they are using for children under a year. 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 16,218 lbs. Condensed Milk 55 tins 31 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 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. A full account of the procedure in dealing with applications for milk grants was given in last year's report. During the year the following quantities of milk were issued to necessitous mothers :— Fresh Milk 2,289 gals. Dried Milk 16,643 lbs. Condensed Milk 446 tins together with drugs, etc. The approximate cost of milk given in this way was £1,373. 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. 32 SPECIAL CLINIC FOR DELICATE CHILDREN. In June a Special Clinic for Delicate Children was opened at the Cornwall Road Centre. The main feature of the Clinic is artificial light treatment by means of a quartz mercury vapour lamp. The Medical Officer in charge is Dr. H. M. M. Mackay, M.D., M.R.C.P., who has had considerable experience in artificial light therapy. Dr. Mackay has instructed certain of the Health Visitors in the routine use of the lamp and the necessary precautions to be taken, and light treatment is given three times a week. Four patients are usually treated at a time. The cost of the treatment itself is extraordinarily low, the lamp being estimated to consume one unit per hour, which, at the present cost of electric current, is 2d. per hour for the first 60 and thereafter ½d. per hour. The Clinic had not been running sufficiently long by the end of the year to afford full and reliable data as to results, but very complete records are being kept and it is hoped that a comprehensive report will be available in respect of 1926. Meantime, it may be said that one obvious value of the Clinic is to make good to some extent the deficiency of natural sunlight from which the town child suffers, especially in congested districts and in winter. There is, moreover, evidence that the treatment has been of value in many cases of rickets, etc. Dr. Mackay reports as follows :— " This Clinic has now been working for about a year, and for most of that time a mercury vapour quartz lamp has been in use for those children for whom it is require'd. The children attending the Clinic include cases of rickets, anaemia, and persistent catarrhal infections, as well as many who are flabby, backward or whose general progress is poor. Nearly all the cases are transferred from other clinics by their respective Medical Officers. Light treatment and massage are given three days weekly during the morning—but no case is ordered such treatment until a full clinical history has been obtained and a physical examination has been made, and the mother has received advice concerning any defects of feeding or hygiene which it appears within her power to rectify. 33 " The progress of the children has on the whole been satisfactory, but it is impossible at present to formulate any statistics of results. I aim at seeing all children every one or two weeks, and the attendances have, I think, been good. Full records are kept of all cases. I have received wholehearted co-operation from the Lady Superintendent and Health Visitors, and without their constant help it would have been impossible to achieve the very good results obtained in many cases." 29th May, 1926. MASSAGE. The arrangement made in 1924 with the Bethnal Green branch of the British Red Cross Society for the services of trained masseuses at the Centre came to an end at the beginning of 1925, when the Council made direct arrangements with two of the masseuses. The masseuses were in attendance on two or three afternoons a week. The number of sessions held was 173, the number of children who received massage was 111 and they made 1,548 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. 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 25 Muscular Atony 71 Constipation 2 Paralysis 3 Old Fractures 1 Talipes 3 Knock-knee 5 Muscular weakness after Enceph. Lethargica 1 B 34 BOROUGH MIDWIFERY SERVICE. During the year, the appointment of the Borough Midwife was made permanent. Of the 35 bookings carried forward to 1925, 8 were cancelled, while during 1925 159 bookings were received, of which 13 were subsequently cancelled. Of the net bookings for the year (173) 138 mothers were delivered during the year, 109 by the Borough Midwife, 3 by doctors who were engaged with the Borough Midwife, and 26 by various midwives acting as deputy for the Borough Midwife. Of the 138 mothers delivered, 8 were primiparæ and 130 multipara. There were 35 expectant mothers on the books at the end of the year. The Borough Midwife paid 1,020 visits in connection with her practice and 87 visits in connection with the Maternity Clinic. She also attended 36 Infant Consultation sessions, 77 Maternity Clinic sessions, and 43 Midwifery Booking sessions. The Borough Midwife is popular with all her patients and her retention is thoroughly justifiable, if alone for the high standard of her work and the large number of poor persons who are temporarily " down and out" and who decline poor law benefit as long as possible. LONDON HOSPITAL MATERNITY CHARITY. The decision of the London Hospital to send out a trained Nurse with the Student in every case is a great and very necessary move in the right direction and will prove a source of great comfort and relief to the poor mothers of Bethnal Green. It is to be earnestly hoped that this example will be followed by other similar hospitals in London if it is not already the practice. CONVALESCENT TREATMENT. During the year 4 mothers were sent to the London Mothers' Convalescent Home, Sunningdale, Berkshire, 1 mother each to the Evelyn Convalescent 35 Cottage, Wargrave, Berkshire, and to the National League for Health's Mothers' Hostel, Buckhurst Hill and 7 mothers to the " George Whitlaw " Convalescent Cottage, Amerden, near Taplow. Each mother was sent away for two weeks. In 10 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 29 children were sent to that Council's Home at St. Leonard's-on-Sea, Sussex, 19 for a period of four weeks, 3 for five weeks, 5 for six weeks, 1 for seven weeks, and 1 for eight weeks. Children were also sent to the Marjorie Lumley Holiday Home, Maidenhead (3), the John Madocks Babies Home, Basing (2), and the Toddlers' Convalescent Home, Arkley (2) for periods varying from 3 to 8 weeks. In 24 cases the parents contributed to the cost of the convalescence. General satisfaction has been expressed by mothers regarding the treatment at the Homes, and at the benefits derived therefrom, particularly in the case of children. NURSING ASSISTANCE. Up to the limits permissible by law, a very complete scheme of home nursing is now in operation. Such nursing is carried out by the mediation of a voluntary organisation, the Shoreditch and Bethnal Green Nursing Association. For each visit a charge of tenpence is made to the Council by the Association. As regards children under the age of five years, the Ministry of Health have sanctioned expenditure on the nursing of all sick cases, but grant is only paid by the Ministry in respect of certain specified conditions, e.g., Measles, Whooping Cough, Diarrhoea, Ophthalmia Neonatorum and Poliomyelitis, which come within the Council's Maternity and Child Welfare Scheme. 36 Nursing Assistance 1925. Disease Under Maternity and Child Welfare Scheme Under Public Health Acts Total Visits Under one year ONE to FIVE years Mothers Children under five Others Cases Visits Cases Visits Cases Visits Cases Visits Cases Visits Ophthalmia Neonatorum 10 205 .. .. .. .. .. .. .. 205 Discharging Eyes 63 615 .. .. .. .. 15 149 .. .. 764 Measles .. .. 13 121 .. .. .. 1 9 130 Whooping Cough 2 23 3 36 .. .. .. 1 13 72 Puerperal Fever .. .. .. .. .. .. .. .. .. .. Other pre-natal and postnatal conditions .. .. .. .. 50 594 .. .. .. 594 Conjunctivitis .. .. .. .. .. .. 1 24 .. .. 24 Corneal Ulcers .. .. . .. .. .. 2 20 .. .. 20 Otorrhœa .. .. .. .. .. .. 3 25 1 ..6 31 Nasal Catarrh .. .. .. .. .. .. 1 10 .. .. 10 Tonsils and Adenoids .. .. .. .. .. .. 130 490 .. .. 490 Septic Throat .. .. .. .. .. .. 1 10 .. .. 10 Influenza .. .. .. .. .. .. .. 5 43 43 Bronchitis .. .. .. .. .. .. 8 84 1 10 94 Pneumonia .. .. .. .. .. .. 12 117 17 134 251 Tuberculosis .. .. .. .. .. .. 1 6 .. .. 6 Intestinal .. .. .. .. .. .. 4 21 .. .. 21 Threadworms .. .. .. .. .. .. 63 523 .. .. 523 Imperf. Anus .. .. .. .. .. .. 1 10 .. .. 10 Septic Umbilicus .. .. .. .. .. .. 2 17 .. .. 17 Phimosis .. .. .. .. .. .. 4 23 .. 23 Burns .. .. .. .. .. .. 3 30 .. .. 30 Pyrexia .. .. .. .. .. .. 6 25 .. .. 25 Abscess .. .. .. .. .. .. 1 6 .. .. 6 Impetigo .. .. .. .. .. .. 1 10 .. .. 10 Eczema .. .. .. .. .. .. 2 20 .. .. 20 Supervision .. .. .. .. .. .. 1 10 .. .. 10 Totals 75 843 16 157 50 594 262 1630 26 215 3439 15 cases were in hand at the beginning of the year. 12 cases were in hand at the end of the year. A total of 3,439 visits were paid to 429 cases at a cost of £144 4s. 6d. During the year 353 children under the age of 5 were nursed, a total of 2,630 visits being made at a cost of £109 lis. 8d. Of this expenditure £43 2s. 6d. was expenditure under the Maternity and Child Welfare Scheme. 37 Fifty mothers received 594 visits for nursing in connection with conditions incidental to child-bearing the cost being £24 15s. 0d. Twenty-six adults and children over 5 received 215 visits for nursing at a cost of £8 19s. 2d. INFANTILE MORTALITY. Two hundred and twelve 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 80.6 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 1925 80.6 So far as can be ascertained, 206 of the deaths were those of legitimate infants and 6 those of illegitimate infants. Accordingly, we have the following figures for Infantile Mortality :— Infantile Mortality (legitimate) 75.8 do. do. (illegitimate) 127.6 do. do. (all infants) 80.6 Of the 212 deaths, 30 were due to prematurity. The deaths from diarrhœal diseases were 55 in number, a considerable increase on last year's figure of 29. There were 46 deaths from bronchitis and pneumonia, as compared with 57 last year. 38 The Infantile Mortality figure of 80.6 per 1,000 births is the third lowest on record for Bethnal Green, the previous records having been 68.7 in 1923 and 78.0 in 1924. In 1903, 23 years ago, the figure was 141. Infantile Mortality in Bethnal Green in 1925. Cause of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks & under 3 months 3 months & under 6 months 6 months & under 9 months 9 months & under 12 months Total Deaths under 1 year Rate per 1000 Births All causes— 212 80.6 Certified 33 8 8 6 55 38 47 41 31 .. .... .. .. .. .. ... .. .. .. .. .. .... .. .. .. .. .. .. .. .. .4 Chicken-pox .. .... .. .. .. .. .. .. 1 1 Measles .. .... .. .. .. .. .. 2 .. 2 .. .. .. .. .. .. .. 30 11. 4 Whooping Cough .. .. .. 1 1 3 9 10 7 Diphtheria and Croup .. .. .. .. .. 1 1 .. .. 2 .8 .. .. .. .. .. .. .. .. .. .. 1.1 Tuberculous Meningitis (30) .. .. .. .. .. .. .. .. 3 3 Abdominal Tuberculosis (31) .. .. .. .. .. .. .. .. 1 .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 •4 1.1 Meningitis (not Tuberculous (61) .. .. .. .. .. 1 1 1 .. 3 Convulsions (71) .. .. .. .. .. .. .. 1 .. 1 .4 Laryngitis (87B) .. .. .. .. .. .. .. .. .. .. 2.7 Bronchitis .. .. 1 1 2 2 1 1 1 7 Pneumonia (all forms) (91 &92) .. 1 2 1 4 9 7 9 10 39 14.8 Diarrhoea (104 B. E & F) .. .. .. .. .. .. 1 .. .. 1 .4 Enteritis (104 A, C, D & G) .. 1 .. .. 1 14 20 12 7 54 20.5 Gastritis (103a) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .4 Suffocation, overlying.. .. .. .. .. .. .. 1 .. .. 1 .4 Injury at birth (152C) 1 .. .. .. 1 .. .. .. .. 1 6 2.2 1.5 11.4 Atelectasis (152B) 5 1 .. .. 6 .. .. .. .. Congenital Malformations (150) 1 .. .. .. 1 2 .. 1 .. 4 Premature Birth (151A) 19 5 3 2 29 1 .. .. .. 30 Atrophy, Debility and 15 5.7 Marasmus (151B) 3 .. 2 1 6 4 4 1 .. Other Causes 4 .. .. .. 4 1 2 3 1 11 4.2 Totals 33 8 8 6 55 38 47 41 31 212 80.6| Nett Births in J legitimate 2583 Nett Deaths in legitimate infants 206 the year illegitimate 47 the year illegitimate infants 6 Note.—The numbers given in brackets after certain causes of death indicate the numbers of the corresponding headings in the detailed International List of Causes of Death, 1909. 39 PUERPERAL FEVER. Eight cases of this complication of childbirth were reported during the year. Two of the patients were removed to the London Hospital, three to Bethnal Green Hospital, and the remaining three cases nursed at home. There were no deaths from the disease. OPHTHALMIA NEONATORUM. Thirty-eight cases of purulent eye-discharge in the new-born were notified, all by doctors. In every case the condition was cured without any apparent impair ment of vision. Ten cases received nursing attention at home from the Shoreditch and Bethnal Green District Nursing Association, the Borough Council paying part of the cost: 205 visits were paid by nurses of the Association. Very special attention is given to this serious ailment. Every case is very carefully watched by the Health Visitor and her reports most thoroughly scru tinized, the object being the prevention of any risk of blindness resulting. 40 NOTIFIABLE DISEASES, Etc. Diphtheria. There were 493 cases of diphtheria notified during the year. Of these, there were 13 cases under the age of 1 year, 201 between the ages of 1 and 5 years, 207 between the ages of 5 and 15 years, 46 between the ages of 15 and 25 years, 25 between the ages of 25 and 45 years, and 1 between the ages of 45 and 65 years. Of the 493 cases, all were removed to an isolation hospital except 3. These cases were treated at home, proper facilities being available for isolation and treatment. Nineteen 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 19 deaths, 2 were those of children under 1 year of age and 11 over 1 year 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 201 cases occurring during this period of life, it will be seen that 5.5 per cent. died. At the epoch 5-15 years the mortality was only 2.9 per cent. of those attacked. Antidiphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor; 36,000 units were supplied during the year. 41 Scarlet Fever. There were 333 cases of scarlet fever notified during the year. Of these, there were 8 cases under the age of 1 year, 159 cases between the ages of 1 and 5 years, 143 cases between the ages of 5 and 15 years, 19 cases between the ages of 15 and 25 years, and 3 cases between the ages of 25 and 45 years, and 1 case between the ages of 45 and 65 years. Of the 333 cases, 329 were removed to an isolation hospital. Four 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 ,, Hospital Treatment and Diagnosis. Almost all (99 per cent.) the cases of Diphtheria and Scarlet Fever were removed and in a remarkably prompt manner to M.A.B. Hospitals, but it appears to me a matter of importance, if for statistical reasons only, that the diagnosis of all cases should be given to the Medical Officer of Health concerned, on the discharge of the patient. I have good reason to believe from facts before me that in not less than 25 per cent. of the cases the diagnosis is changed at the hospital. Typhoid Fever. There were 12 cases notified during the year. One patient died from the disease. 42 Continued Fever. Four cases were notified under this description. Small-pox. A group of cases (11 in all) of Small-pox were notified in April and May, the first of these being a man aged 31 years. The only possible source of infection was that the man, who was a shipping clerk, had handled samples of foreign rags at his place of business. His wife and three children were subsequently notified but one child was speedily returned home with a definite diagnosis that he was not suffering from small-pox and the wife and other two children detained only for a short period and then discharged without any pronouncement as to whether they were suffering from the disease or not. This group of cases was followed by one in the person of one of the Council's disinfectors who probably contracted the disease from handling bedding, etc., at the home of the other cases. The next case was one notified in the person of a child aged 5 years, but on admission to hospital was found not to be suffering from small-pox and accordingly returned home. A very severe case of a hæmorrhagic type next occurred in the person of a charwoman aged 57 years. The patient died the morning following her admission to hospital. Despite very extensive enquiries no trace could be found of any possible source of infection. Another case of mistaken diagnosis occurred in the person of a baby aged 7 months, the child being discharged from hospital very shortly after admission. Two other cases were notified in the persons of a man and wife who resided next door to the fatal case above mentioned. If these people did suffer from the disease, the obvious source of infection was the case next door, the husband first contracting the disease 43 and then transmitting it to his wife. In view of the fact, however, that they were only detained in hospital three weeks, if the diagnosis were correct, they only suffered from mild attacks of the disease. With the exception of the cases of children notified and subsequently found not to be suffering from small-pox, all the patients had been vaccinated, though in several instances this had not been performed since infancy. Erysipelas. There were 93 cases notified and 3 deaths. Malaria. During the year 7 cases were notified. The patients were found to be ex-Service men who had contracted the infection overseas. Acute Polio-Myelitis and Acute PolioEncephalitis. One case of Acute Polio-Myelitis was notified. Dysentery. There were no cases reported. Acute Encephalitis Lethargica. There were 6 cases reported. Cerebro-Spinal Fever. Four cases of this disease were notified. Acute Primary Pneumonia and Acute Influenzal Pneumonia. One hundred and sixty-eight cases of acute primary pneumonia and 42 cases of acute influenzal pneumonia were notified during the year. Statistics and notes with regard to Puerperal Fever, Ophthalmia Neonatorum and Home Nursing will be found in the section relating to Maternity and Child Welfare. 44 Cases of Notifiable Diseases Notified During the Year 1925 in Bethnal Green. Disease Number of Cases Notified All Ages Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Small Pox 11 1 2 2 .. 2 4 .. Diphtheria (including Membranous Croup) 493 13 201 207 46 25 1 .. Erysipelas 93 2 3 11 17 22 25 13 Scarlet Fever 333 8 159 143 19 3 1 .. Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 12 .. .. 4 6 2 .. .. Puerperal Fever 8 .. .. .. .. 8 .. .. Cerebro-spinal Fever 4 3 .. 1 .. .. .. .. Acute Poliomyelitis 1 .. 1 .. .. .. .. .. Acute Encephalitis Lethargica 6 .. .. 2 2 1 1 .. Ophthalmia Neonatorum 38 38 .. .. .. .. .. .. Acute Polio-encephalitis .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. Malaria 7 .. .. .. 1 5 1 .. Acute Primary Pneumonia 168 4 37 30 24 32 28 13 Acute Influenzal Pneumonia 42 6 3 .. 9 9 12 3 Pulmonary Tuberculosis 189 .. 4 6 51 69 57 2 Other forms of Tuberculosis 54 1 17 22 11 1 2 .. Cholera, Plague, Relapsing Fever .. .. .. .. .. .. .. .. Continued Fever 4 .. .. .. 2 1 1 .. Anthrax .. .. .. .. .. .. .. .. Hydrophobia, Glanders .. .. .. .. .. .. .. .. *Chicken Pox 145 9 67 67 2 .. .. .. Total 1608 85 494 495 190 180 133 31 *Notifiable for 2 months from July 45 Verminous Conditions. Seventy-five children were reported from the L.C.C. Cleansing Station as being infested with vermin. 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 seven men infested with body-lice had 19 baths between them at the Disinfecting Station and 317 articles of their clothing were disinfested at the same time. Rooms were disinfested of bugs in 250 cases. Scabies or Itch. Twenty-nine children suffering from this disease were visited after being excluded from the Elementary Schools. In only 8 instances was disinfestation of the clothing and bedding permitted, 77 articles being disinfested. Nine rooms were also fumigated after scabies, by request. BACTERIOLOGICAL EXAMINATIONS. The following examinations were carried out by the Royal Institute of Public Health :— Throat and Nasal Swabs—submitted for examination 860 Diphtheria bacilli present in 111 Sputum—specimens submitted for examination 200 Tubercle bacilli present in 19 Blood-serum—specimens examined 6 Widal reaction positive in 1 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, 46 from which it will be seen that 243 new cases of Tuberculosis were notified under the Public Health (Tuberculosis) Regulations. In addition, there were 22 cases which came to my knowledge other than by notification, making a total of 265 cases. In view of the introduction of new Regulations which deal with the quarterly revision of the Tuberculosis Register, it is now possible to estimate with a greater degree of accuracy the prevalence of this disease in the Borough. A thorough revision of the Tuberculosis Register has taken place in accordance with suggestions contained in a circular letter received from the Ministry of Health, in consequence of which the names of 989 patients have been removed from the Register. The number of cases remaining on the Register at the 31st December, 1925, was 1,333. The details are given in the table on page 47. During the year there were 121 deaths from Pulmonary Tuberculosis, 14 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 1925 142 47 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. Age of Patient Tuberculosis of the Lungs Other Tuberculosis. Male Female Total Male Female Total Primary Notifications. .. .. .. 0—1 year. .. .. .. 1 .. 1 1—5 years. 3 1 4 12 5 17 5—10 „ .. 1 1 8 6 14 10—15 „ .. 5 5 4 3 7 15-20 „ 14 16 30 4 2 6 20—25 „ 8 13 21 2 3 5 25—35 „ 17 16 33 1 .. 1 35—45 „ 21 15 36 .. .. .. 45—55 „ 29 13 42 1 1 2 55—65 „ 10 5 15 .. .. .. 65 years and over .. 2 2 .. .. .. Total 102 87 189 33 20 53 Cases re-notified 59 45 104 5 6 11 Total Notifications on Form A 161 132 293 38 26 64 Primary Notifications by School Medical Officers. 0—5 years .. .. .. .. .. .. 5—10 „ .. .. .. .. 1 1 10—15 „ .. .. .. .. .. .. Cases re-notified 1 .. 1 1 2 3 Total Notifications on Form B 1 .. 1 1 3 4 48 No. of Notifications on Poems C. & D. Poor Law Institutions Sanatoria C D c D Pulmonary Tuberculosis— Male 8 2 97 67 Female 9 7 50 38 Non-Pulmonary Tuberculosis— Male 3 2 8 7 Female 4 — 9 7 C—upon admission D—upon discharge Public Health (Tuberculosis) Regulations, 1924. Pulmonary Non-Pulmonary Total Males Females Males Females Number of case3 on the Tuberculosis Register 31/12/24 906 567 323 278 2074 Number of cases notified under the Public Health (Tuberculosis) Regulations, 1912, during the year 1925 100 86 34 23 243 Other cases added to the Tuberculosis Register during 1925 3 1 — 1 5 1009 654 357 302 2322 Number of cases removed from Tuberculosis Register during 1925. (For details see separate statement) 426 263 162 138 989 Cases remaining on Tuberculosis Register 31/12/25 583 391 195 164 1333 49 Details of Cases removed from Tuberculosis Register during the year 1925. Pulmonary non-pulmonary Total Males Females Males Females Deaths 87 53 10 7 157 Patients removed from Borough 34 24 2 4 64 Patients who have been lost trace of for several years 65 33 17 16 131 Patients notified as inmates of Workhouse or Common Lodging Houses, lost trace of 21 – – – 21 Patients notified as "homeless," presumed now to have left district 6 – – – 6 Romoved from Register with consent of notifying practitioner 45 43 4 1 93 Negative cases removed from Register, the notifying practitioner having left district 19 16 2 2 39 Cases removed from Register as " Cured " 149 94 127 108 478 Total ' cases removed from Register 426 263 162 138 989 EX-SOLDIERS AND SAILORS SUFFERING FROM TUBERCULOSIS Two hundred ex-Service men were under observation during the year. There were 24 deaths amongst these, 12 removed from the Borough, and 16 were removed from the Register as "cured." Three hundred and ninety-three visits were paid to these men by the Tuberculosis Health Visitor. WORK OF TUBERCULOSIS HEALTH VISITOR. This officer paid 3,562 visits to cases. I am of opinion that for the adequate performance of these duties more than one officer is required. 50 SUPPLY OF SPUTUM OUTFITS. During the year 42 sputum flasks were distributed to patients. Forty sputum tins, with 2,483 cardboard refills, were distributed to patients for use indoors. "PRECAUTIONS AGAINST CONSUMPTION." A pamphlet with up-to-date advice under the above mentioned title was issued at the end of the year and has proved useful to patients. 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 1925. During the year 278 grants were made at an estimated cost of £183. One hundred and twenty patients were dealt with, 23 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 92. DENTAL TREATMENT FOR TUBERCULOSIS PATIENTS. By arrangement with the City of London Hospital for Diseases of the Heart and Lungs, a revised scheme for the dental treatment of Tuberculosis Dispensary patients found to require such treatment came into operation on the 1st 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 1925, 26 patients received dental treatment. There were 20 attendances for extractions, 19 being under gas. In addition there were 31 other attendances, which included 7 for the taking of " impressions," 10 for preparation, 7 for advice and 2 for alterations to dentures. 51 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 68 attendances for treatment. The Council's arrangements for the provision of pneumothorax refills at the Brompton Hospital were not used during the year, but 2 patients received this form of treatment at the City of London Hospital. JOINT DISPENSARY COMMITTEE. On 13th November, 1924, 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. The Joint Dispensary Committee, which was set up under this agreement and consists of four representatives of the Hospital Governors, three representatives of Bethnal Green and three of Hackney, has met regularly during the year. 52 PROTECTION OF FOOD SUPPLY. This branch of Public Health work is undoubtedly of great importance, necessitating not only regular inspection of the street markets, but constant supervision of premises where food is prepared in its various stages for human consumption, as well as the taking of samples to check adulteration. Recent legislation has done much to ensure a cleaner supply of meat being sold to the public. Similar regulations are, however, very urgently necessary in regard to articles of food other than meat. One can only imagine the terrible condition of dates and sweetmeats, at ordinary times sticky substances, yet in the highest summer temperatures, these commodities may be exposed for sale, unprotected from the dust, dirt and flies common to any market place, and sold to the unsuspecting purchaser with their full share of the proverbial peck of dirt. One spot in particular in the Borough, a railway arch, where foodstuffs are daily exposed for sale, remains to be dealt with in a drastic manner. On a wet muggy day, fruit, fish and confectionery can be seen displayed on the coster barrows in an atmosphere reeking with smoke and steam, proceeding from the railway engines passing under the roadway, and such foods are also subject to the splashing of mud and filth from vehicular and pedestrian traffic, passing through Brick Lane. Such a state of things is utterly contrary to the best interests of the public. The other side of food inspection, that of the detection of adulterated food, is of equal importance, and successful working of the various food and drugs acts requires tact, persistence and patience on the part of the staff. Recent cases which have reached a successful issue, reveal these essentials. 53 In the cases of "Richardson," Hanstater," and " Arnold," dealing with condensed milk, it was necessary to trace the milk from the date of its being brought into England, up to the sale by retail to the public. The result of these cases revealed an undoubted flaw in the Act, upon which I comment elsewhere. The case of " Rose" (milk vendor) shows the necessity of perseverance. This man misled the Inspector by giving two false names when sampled, a sample of milk was taken from him and it was not till eighteen months later that he was arrested, he having in the meantime travelled from London to Norwich, from Norwich to Hampshire and back again to London. The decrease in the percentage of adulterated samples as compared with that of a few years ago, may perhaps be due to the heavier penalties inflicted upon transgressors and the constant watching of fraudulent traders has undoubtedly had good results. 54 SALE OF FOOD AND DRUGS ACTS. Seven hundred and forty-two samples were taken; 710 of these proved to be "genuine," and 32 or 4.3% adulterated The details are given in the following table:— SUMMARY OF ANALYST'S REPORTS. Article Samples taken formally Samples taken informally No. taken Genuine Adulterated No. taken Genuine Adulterated Total number of Samples taken Milk 354 338 16 1 .. 1 355 Butter 131 129 2 4 4 .. 135 Margarine 25 25 .. .. .. .. 25 Lard 14 14 .. .. .. .. 14 Dripping 9 9 .. .. .. .. 9 Cheese 6 6 .. .. .. .. 6 Cream 2 1 1 .. .. .. 2 Cream (Preserved) 3 3 .. .. .. .. 3 Condensed Milk 4 3 1 1 .. 1 5 Dried Milk 2 2 .. 2 2 .. 4 Jam 69 66 3 2 2 .. 71 Coffee 9 9 .. .. .. .. 9 Cocoa 14 14 .. 2 2 .. 16 Tea 1 1 .. .. .. .. 1 Vinegar 38 36 2 .. .. .. 38 Mustard 3 3 .. .. .. .. 3 Pepper 3 3 .. .. .. .. 3 Camphorated Oil 7 7 .. .. .. .. 7 Olive Oil 2 2 .. .. .. .. 2 Cod Liver Oil and Malt 1 1 .. .. .. .. 1 Aspirin Tablets 1 1 .. .. .. .. 1 Formaldehyde Solution .. .. .. 1 1 .. 1 Boracic Ointment 3 3 .. 2 1 1 5 Basilicon Ointment ] 1 .. .. .. .. 1 Sassafras Pomade 2 2 .. .. .. .. 2 Zinc Ointment 2 2 .. .. .. .. 2 Glycerine 1 1 .. .. .. .. 1 Compound Liquorice 1 1 .. .. .. .. 1 Flour 6 6 .. .. .. .. 6 Cake 1 1 .. .. .. .. 1 Sponge Cake 2 2 .. .. .. .. 2 Chocolate 1 1 .. .. .. .. 1 Sweets .. .. .. 1 1 .. 1 Sausage .. .. .. 1 1 .. 1 Brawn 1 1 .. .. .. .. 1 Loganberries 1 1 .. .. .. .. 1 Apples 4 1 3 .. .. .. 4 Lemonade .. .. .. 1 .. 1 1 Totals 724 696 28 18 14 4 742 55 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample Result of Analysis Result of Legal Proceedings (a) Action taken other than legal proceedings (b) Previous Convictions (if any) (c) Other Remarks Milk 54 5% less than the proper amount of fat Fined £100. Costs £5 5s. (b) Convictions by Stoke Newington and Hackney Borough Councils (c) Defendant went to prison for 3 months in default Butter 74 Contained 80% of foreign fat Fined £10. Costs £6 6s. (c) Appeal dismissed with full costs to Council and Wholesalers Milk 77 3% less than the proper amount of fat (c) No legal action taken Do. 100 8% Do. Summons withdrawn on payment of costs £2 2s. .. Condensed Milk 145 4% Do. Dismissed on point of law. Prosecution unable to prove "Wilful Act" .. Plum Jam 197 80% of apple pulp Dismissed owing to conflicting evidence .. Milk 198 15% less than the appropriate amount of fat Fined £2. Costs £2 2s. .. Raspberry Jam 238 40% of apple pulp Fined 7s. 6d. .. Cream 306 0.24% of boric acid .. (c) No legal action taken Milk 370 7% less than the proper amount of fat Fined 40s. Costs 21s. .. Strawberry Jam 391 20% of apple pulp .. (c) No action taken in view of notice on jar 56 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES—continued. Name of Article and Identification Number of Sample Result of Analysis Result of Legal Proceedings (a) Action taken other than legal proceedings (b) Previous Convictions (if any) (c) Other Remarks Milk 417 5% less than the proper amount of fat Fined 20s. Costs 21s. .. Do. 419 2½ % of added water .. (c) Vendor cautioned Do. 444 10% less than the proper amount of fat Costs 21s. .. Do. 520 17% of added water Fined £10. Costs £5 5s. for selling to prejudice of purchaser. Summons in respect "adding water" dismissed. .. Do. 584 18% less than the proper amount of fat Case dismissed .. Do. 585 5% Do. Costs £2 2s. (c) Same Vendor as Sample 100 Do. 620 5% Do. .. (c) Sample taken from cow Do. 634 4½% of added water .. (c) Do. Do. 635 5½% Do. .. (c) Do. Do. 637 7% less than the proper amount of fat .. (c) Do. Vinegar 644 24% of added water Costs £1 1s. .. Butter 653 78% of foreign fat .. (c) Conviction in respect of Margarine exposed for sale in unlabelled parcel 57 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES—continued. Name of Article and Identification Number of Sample Result of Analysis Result of Legal Proceedings (a) Action taken other than legal proceedings (b) Previous Convictions (if any) (c) Other Remarks Vinegar 685 11½ % of added water Fined £5. Costs £2 2s. .. Milk 727 6% Do. .. (c) Summons not served. Vendors address unknown Apples 2 1/160 grain Per lb. of arsenic .. (c) No action taken Do. 3 1/325 Do. .. (c) Do. Do. 4 1/300 Do. .. (c) Do. SAMPLES TAKEN INFORMALLY. Eighteen samples were taken informally during the year, four of which were found to be adulterated, as follows Sample 117.—Full Cream Condensed Milk. Found to contain 4 per cent. less than the proper amount of butter fat. Sample 280.—Lemonade. This contained at the bottom of the bottle a comparatively large quantity of flocculent matter. The microscope showed this to consist of the ordinary dust and fluffy material present on the floors of most living and manufacturing rooms. It was mainly vegetable fibres of flax, etc., with a little fungus and bacteria. It would be difficult to state the amount, but it was certainly not a desirable or healthy contamination, though probably accidental. 58 Sample 529.—Milk. Found to contain 18 per cent. of added water. Sample 535.—Boracic Ointment. Found to contain 37 per cent, less than the amount prescribed by the B. P. for boracic acid. The genuine samples were :— Butter 4 Cocoa 2 Jam 2 Dried Milk 2 Sweets 1 Breakfast Sausage 1 Boracic Ointment 1 Formaldehyde Solution 1 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. The following is a report of the work done under these Regulations :— Three hundred and fifty-four formal samples and one informal sample of milk were taken, and in no case was the presence of a preservative reported. Three samples of preserved cream were taken, all of which proved to be genuine, and in each case the receptacle containing the cream was labelled in accordance with the Regulations. Of two samples of cream which were taken, one was found to contain 0.24 per cent. of boric acid, the receptacle in which it was delivered to the purchaser being unlabelled. "APPEAL TO COW" SAMPLES. Arising out of a prosecution in respect of a sample of milk which was found to be 18 per cent. deficient in fat, certain samples of milk were, at the request of the owner, taken direct from the cows at the shed. 59 The results of the analyses of these samples were as follows :— 1. Genuine. 2. Found to contain 5 per cent. less than the proper amount of fat. 3. Genuine. 4. Found to contain 4½ per cent. extraneous water. 5. Found to contain 5½ per cent. extraneous water. 6. Genuine. 7. Found to contain 7 per cent. less than the proper amount of fat. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Four formal samples and one informal sample of condensed milk were taken under these Regulations. Three of the formal samples were found to be genuine, the other containing 4 per cent. less than the proper amount of fat. Summonses were issued against the retailer, wholesalers and importer in respect of this latter sample. A technical legal point was raised at the hearing of the case : that it was not sufficient to prove carelessness in the commission of an offence under the Regulations but that " wilful " default must be proved. After hearing the case argued by counsel, the magistrate said that while he thought the Council was quite right to have taken the proceedings he had owing to the weakness of the law, to dismiss the summons, but in the circumstances he did not grant any costs to the defendants. As the point at issue affects a number of food regulations made under the same Act (Public Health Act, 1896) the facts of the case were reported to the Metropolitan Boroughs Standing Joint Committee with a view to representations being made to the Ministry of Health for the necessary amendment of the Act. 60 The informal sample was found to contain 4 per cent. less than the proper amount of butter fat. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. Four samples of dried milk (two formal and two informal) were taken during the year, each of which complied with the Regulations. 61 ACTION TAKEN WITH REGARD TO OFFENCES OTHER THAN ADULTERATION. Articles No. of Sample Offence Result of Prosecution or Remarks Butter (Found to be Margarine) 74 (a) Exposing for sale unlabelled parcel of margarine Costs 2s. (b) Selling margarine by retail in plain wrapper Costs 2s. Margarine 161 Exposing for sale unlabelled parcel of margarine Vendor cautioned Do. 167 Selling margarine by retail in plain wrapper Pined 10s. Costs 21s. Do. 178 Exposing for sale unlabelled parcel of margarine Vendor cautioned Do. 209 Do. Do. Do. 221 (a) Exposing for sale unlabelled parcel of margarine (a) Pined 7s. 6d. Costs 23s. (b) Selling margarine by retail in plain wrapper (b) Pined 7s. 6d. Cream 306 No declaratory label on receptacle as to presence of boric acid No action taken Margarine 371 Exposing for sale unlabelled parcel of margarine Pined 10s. Do. 379 Selling margarine by retail in plain wrapper Pined 10s. Costs 21s. Do. 394 (a) Exposing for sale unlabelled parcel of margarine (a) Costs 23s. (b) Selling margarine by retail in plain wrapper (b) Costs 2s. Do. 403 Exposing for sale unlabelled parcel of margarine Costs 23s. Do. 410 Do. Vendor cautioned Do. 561 Do. Pined 7s. 6d. - - Selling milk from vehicle and can, neither of which was inscribed with name and address of vendor Manager and servant both bound over in the sum of 40s. not to repeat offence 62 ACTION TAKEN WITH REGARD TO OFFENCES OTHER THAN ADULTERATION—continued. Articles No. of Sample Offence Result of Prosecution or Remarks Butter (found to be Margarine) 653 Exposing for sale an unlabelled parcel of margarine Fined 9s. Costs 21s. Milk 727 Selling milk from vehicle and receptacle, neither of which was inscribed with name and address of vendor. Summons not served. Vendors address unknown FOOD PREMISES. Milkshops and Dairies. Forty-one* applications for registration under the Dairies, Cowsheds and Milkshops Orders were considered during 1925. None of these applications were refused. 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 1924 239 Deduct number of purveyors removed from register during 1925 8 Add number of new purveyors added to register by resolution of the Public Health Committee during 1925 14 Number of purveyors of milk at retail milkshops on register at end of 1925 245 During the year 725 inspections of milkshops were made by the Inspectors, and 147 notices were served under the Public Health (London) Act, 1891. No legal proceedings were found to be necessary. * This includes changes of occupier in premises previously on the register. 63 Milk Special Designations Order, 1923. One purveyor in the Borough was licensed for the sale of "certified milk," and "Grade A (T.T.) Milk" and one for the sale of "Grade A (T.T.) Milk" only, while supplementary licenses one to sell" certified milk" in the Borough from premises in Hackney and another to sell "Grade A (T.T.) Milk" in the Borough from premises in Poplar were also granted during the year. T.T.—Tuberculin Tested. Cowhouses. There were at the end of 1925 twelve licensed cowhouses in the Borough, as in previous years ; 119 inspections were made during the year. List of Licensed Cowhouses. 63, Bishop's Road.—(No. of cows—Shed No. 1—8 cows, Shed No. 2—6 cows.) 42, Cheshire Street.—(6 cows.) 23, Ezra Street.—(6 cows.) 38, Fellbrigg Street.—(No. of cows—Shed No. 1— 8 cows, Shed No. 2—8 cows.) 104, Gibraltar Walk.—(18 cows.) 34b, Green Street.—(45 cows.) 1, Hamilton Road.—(13 cows.) 55, Kerbela Street.—(No. of cows—Shed No. 1— 18 cows, Shed No. 2—2 cows.) 2, Lisbon Street.—(19 cows.) 64, Squirries Street.—(14 cows.) 38, Three Colts Lane.—(23 cows.) 6, Warley Street.—(10 cows.) 64 Ice Cream Premises. There were 194 ice cream premises recorded at the end of the year, and 243 visits were paid to them by the district inspectors. Cowsheds. Some of the cowsheds in the Borough are of such old construction and so situated as to be difficult of alteration to comply with modern standards. I am of opinion that the licensing authority (the L.C.C.) should be asked to consider the discontinuance of some of them. The production of milk under hygienic conditions is a matter of such vital importance to the community that no cowsheds should be tolerated which do not comply with such standards. Fried Fish and Fish-Curing Premises. At the end of 1925 there were 52 fried fish vendors' premises in the Borough, at three of which curing was also carried on. There were 23 fish curers' premises, including these three. Ninety-two visits were made by the Food Inspector to these premises, and 4 notices were served for insanitary conditions. Speaking generally, these businesses are well conducted and little exception can be taken to the quality of either fish or potatoes. When illness does occur it is generally due to the use of cotton-seed oil, which may soon become rancid. With regard to this borough it should be stated that samples of this oil taken from the frying tank have proved, upon analysis, to be in good condition. 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, 57 workshop bakehouses, 18 of which are underground: 181 visits were made to them during the year. 65 Factory Bakehouses. There are in Bethnal Green 19 factory bakehouses, 6 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. Twenty-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, 324a and 489, Hackney Road and 43a, Old Ford Road. Other Premises used for the Preparation or Sale of Food. There were 204 such premises on the register, the majority being restaurant-kitchens. Three hundred and seventy inspections were made during the year, and arising out of such inspections 56 Notices to remedy faults or insanitary conditions were issued. SLAUGHTERHOUSES. There were 3 licensed slaughterhouses in the Borough at the end of 1925, situated at:— 294, Bethnal Green Road. 354, Bethnal Green Road. 278, Hackney Road. Visits were made to slaughterhouses by the Food Inspector twice weekly during the year. c 66 SLAUGHTERERS OF POULTRY. There are 8 slaughterhouses for poultry in use, all of them situated in the west ward of the Borough: 77 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, 80, Virginia Road, 71, Church Street and 36, Hare 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. PUBLIC HEALTH MEAT REGULATIONS, 1924. These regulations came into force on the 1st April, 1925. Prior to this date the working of the regulations had been fully explained to the local meat traders, both at a meeting at the Town Hall, called by their local association in February, and individually to many meat traders, each of whom was furnished with a copy of the regulations by Mr. Henley, Inspector of Meat and other Foods, who has been charged with the administration of the regulations. This preparatory explanation has proved beneficial, because in the main the regulations have worked smoothly. It has been necessary to take proceedings against a few meat stall keepers for repeated breaches of the regulations, principally for failure to provide proper covering at the back of the stall and to have the name and address of the stall keeper inscribed on the stall. 67 These proceedings involved 19 summonses, all of which were successful, fines and costs amounting to a total of £23 18s. being imposed. In one case, the presiding magistrate being doubtful whether a basket from which a trader was selling meat came within the regulations adjourned the case to enable the Council to obtain further legal opinion in the matter. At the adjourned hearing of the case the Defendant was discharged under the Probation of Offenders Act, which is tantamount to a conviction. The regulations have involved a considerable amount of additional slaughterhouse supervision and inspection of carcases. During the nine months they have been in operation Mr. Inspector Henley reports that he has inspected the following carcases, with their offal:— Bullocks 79 Calves 5 Sheep 273 Lambs 212 Pigs 558 Total 1,127 The following parts of carcases or offal, were condemned and destroyed for various reasons:— Forequarters of Beef 2 Bullocks Livers 34 „ Lungs 5 Sheep's Livers 6 „ Lungs 1 Pigs Heads 9 „ Pluck 1 „ Livers 15 68 Thirteen seizures of unsound food were made during 1925, as follows:— Seizures. Date Description Weight Prosecution and Result 22nd Jan. Chocolates 64 lbs. Fine 13/-. Costs £7 7s. Wholesaler summoned but summons dismissed. 20th May Pears 4½ lbs. Fine 7/6 30th June Cherries 14 lbs. Costs 2/- 2nd July Do. 10½ lbs. Fine £1. Costs 21/- 13th Aug. Do. 6 lbs. 17th July Do. 27 lbs. Fine £20. Costs £5 5s. 24th July Chicken 3½ lbs. P.H.C. decided not to prosecute. 11th Aug. Plums and Greengages 14 lbs. Fine £1 1st Sept. 8½ lbs. 13th Aug. Pears 2½ lbs. Fine 15/- 16th Sept. Plums 3 lbs. Costs 2/- 23rd Sept. Pears 5¾ lbs. Fine 10/- 8th Dec. Do. 7½ lbs. Costs 23/- On 45 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. Tins. Fish - 17 19 — Meat - 4 22 — Fruit - 1 36 — Vegetables - - — — Rabbits - 5 99 — Other Articles 1 7 56 1 Condensed Milk — — — 10 Tinned Meat — — — — „ Fish — — — — „ Fruit — — — — Eggs — — — 82 — also 2 sheep's plucks. 2 „ heads 8 boxes Kippers 1 bag Whelks 69 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. 70 71 SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding for the 52 weeks ended 2nd January, 1926. District Infectious Disease Complaints House to House Inspections Milkshop Inspections Other Food Premises Factory and Workshop Inspections Outworkers Home Inspections Tenement House Inspections New Buildings Inspections Combined Drainage Inspections Smoke Nuisances Premises under Observation Other Inspections I or Special Work Number of Calls Re-Inspections Total Visits for the Year Unsound Food Seizures Samples of Food and Drugs taken Police Court Attendances Nuisances Abated Matters Outstanding Inspector A 219 1054 206 36 52 58 382 .. .. .. 1 111 154 4023 6296 .. .. 3 1075 52 G. I. Brighting. B 151 742 26 53 71 146 278 16 .. 107 .. 529 335 3333 5787 .. .. .. 1032 59 J. H. Hewitt. C 163 508 103 70 82 182 125 79 85 590 3 147 264 3225 5626 8 .. 22 1122 82 W. Billings. D 131 825 22 147 99 459 73 84 .. .. 8 186 149 4718 6901 .. .. 5 1294 126 F. T. Bare. E 275 777 57 107 98 151 202 17 50 11 4 416 218 3833 6216 .. .. 8 1363 70 R. J. Jenkins. F 253 576 26 57 29 155 67 17 89 258 .. 245 410 2900 5082 .. .. 3 1105 71 I. R. Jones. .. 7 .. .. 401 .. .. .. .. .. .. 144 6 21 579 1 15 16 27 .. A. S. Henley. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. 3 3 716 78 .. .. J. G. Weeks. Totals 1192 4489 440 470 832 1151 1127 213 224 966 16 1778 1539 22053 36490 12 731 135 7018 360 72 There was little variation in the work of the inspectors during the year beyond a substantial reduction in the number of visits required in infectious disease cases and an almost corresponding increase in the number of combined drainage visits. At the end of the year two additional inspectors were appointed, but they did not enter fully upon their duties until 1926. SANITARY DEFECTS DISCOVERED DURING 1925. Period Dirty Rooms Defective Drains Defective and Dirty W.C.'s. Defective Water Supply Other Matters Total 4 wks. ending 31st Jan. 439 56 223 113 1106 1937 4 ,, ,, 28th Feb. 371 44 145 54 907 1521 4 „ „ 31st Mar. 493 45 207 54 1234 2033 5 „ „ 2nd May 484 53 179 91 1252 2059 4 „ „ 30th May 507 37 243 42 1297 2126 5 „ „ 4th July 836 32 215 50 993 2126 4 „ „ 1st Aug. 484 44 136 102 1133 1899 4 „ „ 29th Aug. 473 34 181 62 1167 1917 5 „ „ 3rd Oct. 491 35 163 57 1236 1982 4 „ „ 31st Oct. 427 29 153 79 1153 1841 4 „ „ 28th Nov. 437 42 138 64 1187 1868 5 „ „ 2nd Jan. 505 59 137 131 1367 2199 Totals 5947 510 2120 899 14032 23508 During the year 4,705 Preliminary Notices were served requiring the remedying of Nuisances. 4,737 Statutory Notices were served. Formal letters giving notice of legal proceedings were sent in 569 cases. During the year nuisances at 6,969 premises were abated. 73 Rooms, Bedding and Clothing Disinfected during the Year ending 31st December, 1925. Month Number of Rooms Total No. of Articles Scarlet Fever Dipththeria Smallpox Enteric Fever Erysipelas Pneumonia Pulmonary Tuberculosis Measles Cancer Scabies Verminous Conditions Other Conditions Total No. of Rooms January 23 80 .. 1 .. .. 12 .. 4 2 5 3 130 1783 February 13 44 .. 2 .. 2 18 .. 2 1 1 22 105 1546 March 17 46 .. 4 .. .. 2 .. 5 1 3 3 81 1688 April 9 33 4 .. 4 .. 18 .. 5 .. 10 3 86 1603 May 22 32 14 .. .. 1 14 .. .. 3 53 1 140 1980 June 39 31 2 .. .. .. 18 .. .. .. 34 2 126 2345 July 42 27 10 .. .. .. 11 .. 3 .. 37 3 133 2640 August 42 48 .. 1 .. 1 11 .. 1 .. 54 1 159 1522 September 49 37 .. 5 4 .. 17 2 1 1 28 .. 144 1944 October 45 61 .. .. 4 1 8 1 1 .. 19 .. 140 1818 November 21 55 .. .. .. 3 20 3 1 .. 5 2 110 1903 December 25 39 .. .. .. 1 17 1 .. 1 2 3 89 1400 Totals 347 533 30 13 12 9 166 7 23 9 250 43 1443 22172 No. of articles destroyed (a) by request 337; (b) arising out of case of Small-pox 690 Articles disinfected in Formalin Chamber, such as boots, boxes, books, etc. (included in 22,172 above) 1144 74 DISINFECTION SERVICE. During the year, 1,443 rooms and 22,172 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 130 bodies were received at the Mortuary, i.e.— On Coroner's order 91 From the Police 8 By Sanitary Inspector's order 2 At the request of relatives 29 Exact particulars are only available as to the 100 bodies on which coroner's inquests were held. On 63 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 2 „ „ „ „ ,, streets, etc. 6 Removed from Bethnal Green Hospital 19 „ „ Queen's Hospital 12 „ „ Mildmay Mission Hospl. 4 „ „ Victoria Park Hospital 1 „ „ Private houses, etc. 56 Total 100 75 Inquest cases classified according to age:— Number under 1 year 16 „ over 1 year and under 5 years 8 5 years „ „ 10 „ 5 „ „10 ,, ,, ,, 20 „ 5 „ „ „ 20 ,, ,, ,, 30 ,, 5 „ „ „ 30 ,, ,, ,, 40 ,, 4 „ „ „40 ,, ,, ,, 50 ,, 8 „ „ 50 „ „ „ 60 „ 17 „ „60 „ „ „ 70 „ 10 „ „ 70 „ „ „ 80 „ 20 „ „ 80 2 Total 100 Causes of death in inquest cases Natural causes 54 Misadventure : death under an anaesthetic 3 Accidental: Burns or Scalds 4, Drowning 2, Falls 9, Poisoning 1, Run over 5, Tetanus 1, Septic Meningitis 1 23 Open Verdict 4 Self neglect 2 Suicide 14 Total 100 DISTRIBUTION OF DISINFECTANTS. During the year 14,027 pints of disinfectant fluid were distributed to applicants. 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. 76 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 53 new houses were certified as having a proper and sufficient water supply. SMOKE PREVENTION. During the year 16 formal observations of smoke shafts were made, 6 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 ; in one case proceedings were instituted, defendants being fined £2 and costs £3 3s. 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. 77 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 two offenders against these by-laws, and the defendants in question were fined 10s. and 5s. respectively. OFFENSIVE TRADES. During the year, one offensive trade, that of a Fur-skin Dresser, was carried on at 74, Florida Street. Twelve 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 2 cases the amount of chlorine present found to be in excess of the limit fixed by the Regulations. Prosecutions took place in each case, the defendants being fined £5 and ordered to pay £4 4s. costs, respectively. RAG AND BONE DEALERS. Twenty-three persons or firms are known to be carrying on this business in the Borough. During the year 39 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 698 such systems in the Borough, draining approximately 3,250 houses and premises. 78 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 39 houses. DRAINAGE WORK. Legal proceedings were taken during the year in respect of 2 cases of omission to give notice of intention to fit a new w.c. pan and trap, with the results that a fine of £3 and costs, £2 2s., were imposed in the one case, and costs, 21s., were obtained in the other. 79 HOUSING. Housing Statistics for 1925. Number of new houses erected during the year:— (а) Total. 48 (tenements). (b) As part of a municipal housing scheme : London County Council scheme : Pellew House 48 „ 1. Unfit dwelling-houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health Acts) 6,121 (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) 1 (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. 80 (b) Proceedings under Public Health Acts:— (1) Notices served requiring defects to be remedied Intimations 4,705 Statutory Notices 4,737 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners (nuisances abated) 7,018 (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 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 (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 Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. TENEMENT HOUSES. The number of houses registered as being let in lodgings or occupied by members of more than one family was 207 ; 661 visits of inspection were made to these houses, and arising out of such visits, 260 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. 81 FACTORIES, WORKSHOPS, OUTWORKERS, ETC. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 194 34 Workshops (Including Workshop Laundries) 2174 646 7 Workplaces (Other than Outworkers' Premises) 22 5 Total 2390 685 7 Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts:— Want of cleanliness 302 268 .. 5 Want of ventilation 8 8 .. .. Overcrowding 4 4 .. .. Want of drainage of floors 2 2 .. .. Other nuisances 444 412 .. 14 Sanitary accommodation— insufficient 12 12 .. .. unsuitable or defective 137 128 .. 6 not separate for sexes 7 7 .. .. Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouses (s. 101) .. .. .. .. Breach of special sanitary requirementsforbakehouses(ss.97 to l00) 42 41 .. 1 Other offences (Excluding offences relating to out work). 30 27 .. .. Total 958 909 26 82 Registered Workshops. Workshop on the Register (s. 131) at the end of the year. Number Workshops 1814 Workshop Bakehouses 57 Total Number of Workshops on Register 1871 Other Matters. Class Number Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 9 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 105 Reports (of action taken) sent to H.M. Inspector. 105 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 24 83 HOME WORKERS. Of the 3,800 workmen and contractors whose names appeared on the lists received, 2,532 resided within the Borough. This figure, 2,532, 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 1,127. The number of premises found to be in an insanitary condition was 242, or 36 per cent, of the 659 premises inspected. Notices were served in 205 cases, 30 premises being already under notice arising from other visits, and a verbal intimation only being given in the remaining 7 cases. Difficulty is occasionally experienced in getting employers promptly and accurately to send in copies of their list of outworkers, and it was found necessary in the course of the year to prosecute one employer on this account, when £2 2s. costs were awarded to the Council. HOME WORK. OUTWORKERS LIST, SECTION 107 Outwork in unwholesome premises,Section 108 Outwork in Infected premises, Sections 109,110 Nature of Work Lists received from Employers Addresses of Outworkers Notices served on Occupiers j as to keeping or sending lists Prosecutions Instances Notices served Prosecutions Instances Orders made (s. 110) Prosecutions (s. 109, 110) Failing to keep or permit inspection of lists Failing to send lists Sending twice in the year Sending once in the year Outworkers Lists Outworkers Received from other Councils 1 Forwarded to ! other Councils Lists Contractors Work men Contractors Workmen Wearing ApparelMaking, etc. 140 565 4 32 1319 648 104 .. 1 123 148 7 .. .. .. Curtains, Furniture hangings and Trimmings 4 .. 24 2 .. 19 28 41 9 .. .. 9 14 .. .. .. .. Fur-pulling and feathers .. .. .. .. .. .. 22 .. 2 .. .. .. .. .. .. .. .. Umbrellas, etc. 2 .. 2 .. .. .. 79 .. 2 .. .. 12 15 .. .. .. .. Artificial Flowers .. .. .. .. .. .. 25 .. .. .. .. 4 3 .. .. .. .. Paper, etc., Boxes, Paper Bags 36 .. 253 .. .. .. 149 164 23 .. .. 75 84 3 .. .. .. Brush-making 6 .. 152 .. .. .. 22 243 3 .. .. 14 14 .. .. .. .. Draught Board making 2 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Crackers, Christmas Stockings, etc. .. .. .. 1 .. 1 17 .. .. .. .. 2 2 .. .. .. .. Textile Weaving 2 .. 6 .. .. .. .. .. 2 .. .. 2 3 .. .. .. .. Toys .. .. .. 1 .. 1 1 .. 2 .. .. 1 2 .. .. .. .. Total 192 .. 2044 8 .. 53 1662 1096 148 .. 1 242 285 10 .. .. .. 84 85 LEGAL PROCEEDINGS, 1925. In addition to the following 65 cases, proceedings were taken in 66 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:— Gases Costs in each Case 64 £0 10 6 2 £1 1 0 SUMMARY OF LEGAL PROCEEDINGS, 1925. (Other than under the Sale of Food and Drugs Acts, for which see pp. 55 and 61). Date of Hearing Offence Inspector Result and Remarks 1st January Repairing W.C. in such manner as to be a nuisance Billings Fined £2 1st January Omitting to give written notice of intention to fit W.C. pan and trap Do Fined £3, with costs £2 2s. 13th January Exposing for sale, intended for human food, 32 bars of Chocolate, unfit for human food Weeks Conviction on Summons below 13th January Depositing for sale, intended for human food, 144 bars of Chocolate, unfit for human food Do. Fined £2, with costs £1 1s. 12th February Failing to comply with Notice to abate Smoke Nuisance Bare Fined £2, with costs £3 3s. 17th March Non-compliance with Notice requiring abatement of nuisance arising from absence of proper water supply Jones Summons dismissed 19th March Non-compliance with Statutory Notice requiring abatement of nuisance Do Defendant ordered to do work in 14 days and pay costs £1 1s. 19th March Do. do. Do Do. do. 86 19th March Non-compliance with Statutory Notice requiring abatement of nuisance ' Billings Defendant ordered to do work in 14 days and pay costs £ 1 1s. 6th April Depositing for sale, intended for human food about 10 lbs. Chocolate, unfit for human food Weeks Fined 13s. and costs £7 7s. 6th April Exposing for sale, intended for human food about 54 lbs. Chocolate, unfit for human food Do. Summons withdrawn, see above 6th April Selling to retailer, Chocolate unfit for human food, and at that time liable to seizure and condemnation Do Summons issued against wholesaler by direction of stipendiary Magis- trate. Dismissed. 16th April Causing to be conveyed by road through London, during prohibited hours, offensive fish offal Jenkins Fined £2, with costs £2 2s. 16th April Causing to be conveyed by road through London in uncovered vessels, offensive fish offal Do Fined £2 4th June Exposing for sale, intended for human food about 4 ½lbs. Pears, unfit for human food Billings Fined 7s. 6d. 5th June Wilfully neglecting to keep name and address legibly inscribed on meat stall Henley Fined £3 5th June Wilfully neglecting suitably to screen back and sides of meat stall to prevent mud, &c., being blown or splashed from ground on to meat Do Fined £3 18th June Non-compliance with Statutory Notice requiring abatement of Nuisance Bare Defendant ordered to do work in 21 days and pay costs 21s. 18th June D°. do. Do Do. do. 8th June Do. do Do Do. do. 87 SUMMARY OF LEGAL PROCEEDINGS, 1925—continued. Date of Hearing Offence Inspector Result and Remarks 30th June Wilfully obstructing Inspector in course of his duty Billings Fined 10s. with costs £2 2s. 30th June Conveying through London, offensive matter in unsuitable receptacle, thereby causing nuisance Bare and Billings Fined 10s. 19th June Failing to comply with Bye-laws as to Rag and Bone Dealers Richards Fined 20s. 19th June Do. do. Do. Fined 7s. 6d. 2nd July Causing to be conveyed by road through London, during prohibited hours, offensive matter Jenkins .. Fined 5s. 2nd July Causing to be conveyed by road through London, offensive matter in unsuitable receptacle, thereby causing nuisance Do Fined 5s. 2nd July Failing to comply with Bye-laws as to Rag and Bone Dealers Richards Fined £2 7th July Wilfully neglecting suitably to screen back and sides of meat stall, to prevent mud, &c., being blown or splashed on to meat Henley Fined £1 with costs £2 2s. 7th July Do. do. Do Fined 2s. 6d. with costs 10s. 6d. 7th July Do. do. Do Do. do. 7th July Do. do. Do Fined 10s. with costs 10s. 6d. 88 7th July Wilfully neglecting suitably to screen back and sides of meat stall, to prevent mud, &c., being blown or splashed on to meat Henley Fined 10s. with costs 10s. 6d. 17th July Do. do. Do Fined 10s. 17th July Do. do. Do Do. 7th July Wilfully neglecting to have name and address legibly inscribed on meat stall Do Fined 2s. 6d. with costs 10s. 6d. 7th July Do. do. Do Do. do. 7th July Do. do. Do Fined 10s. with costs 10s. 6d. 7th July Do. do. Do Do. do. 17th July Wilfully neglecting to keep meat bones in properly covered receptacles, apart from meat for sale Do Fined 10s. 17th July Exposing for sale, intended for human food, about 14 lbs. of Cherries, unfit for human food Weeks Costs 2s. 30th July Non-compliance with Statutory Notice requiring abatement of Nuisance Jones Defendant ordered to do work in 28 days and pay costs £2 2s. 1st September Exposing for sale, intended for human food, about 10$ lbs. of Cherries, unfit for human food Billings Fined 20s. with costs 21s. 22nd September Failing to comply with Bye-Laws as to Rag and Bone Dealers Richards Fined 20s. with costs 21s. 22nd September Occupying part of premises, where food is prepared for sale and where refuse is allowed to accumulate and due cleanliness not observed Billings Fined 10s. with costs 21s. 89 SUMMARY OF LEGAL PROCEEDINGS, 1925—continued. Date of Hearing Offence Inspector Result and Remarks 22nd September Exposing for retail sale, intended for human food, about 2½ lbs. Pears, unfit for human food Billings Fined 15s. 29th September Exposing for retail sale, intended for human food, about 14 lbs. Plums and Greengages, unfit for human food Do Fined 20s. 29th September 7½ lbs. Do. do. Do Dismissed 29th September Selling for human food, about 1 lb. Plums and Greengages, unfit for human food Do Dismissed (Under Probation of Offenders Act) 1st October Exposing for sale, intended for human food, about 27 lbs. Cherries, unfit for human food Henley Fined £20 and costs £5 5s. 8th October Exposing for sale, intended for human food, 3 lbs. Plums, unfit for human food Billing Cost 2s. 8th October Non-compliance with Statutory Notice requiring abatement of Nuisance Brighting Defendant ordered to do work in 14 days and pay costs £2 2s. 15th October Failing to furnish Council with list of Homeworkers Jenkins Costs £2 2s. 27th October Exposing for sale, intended for human food, 5 ¾lbs. Pears, unfit for human food Billings Fined 10s. 12th November Non-compliance with Statutory Notice requiring abatement of Nuisance Bare Fined £2, costs £2 2s. 90 12th November Non-compliance with Statutory Notice requiring abatement bf Nuisance Jenkins Defendant ordered to do work in 7 days and pay costs £2 2s. 10th December Omitting to give written Notice of intention to fit W.C. pan and trap Do Costs 21s. 10th December Fixing W.C. pan and trap of pattern in contravention of L.C.C. Bye-Laws Do Do. 15th December Failing to comply with the requirements of the Public Health (Meat) Regulations, 1924 Henley Costs 2s. 15th December Do. do. Do Fined 19s. with costs £1 1s. 15th December Do. do. Do Fined 9s. with costs £1 Is. 15th December Do. do. Do Do. do. 15th December Do. do. Do Do. do. 31st December Do. do. Do Dismissed under Probation of Offenders Act 29th December Being in possession of Rag flock not in compliance with the Rag Flock Act, 1911 Do Costs £4 4s. 22nd December Do. do. Do Fined £5 91 92 TUBERCULOSIS DISPENSARY REPORT FOR THE YEAR 1925. By H. Tylford Howell, M.R.C.S., Eng., L.R.C.P., LoncL, Clinical Tuberculosis Officer. In order to present a coherent statement of the activities of the Dispensary during the past year it is necessary to recapitulate briefly what has been said in previous reports with reference to the routine adopted. The personnel of the department has for the fifth successive year remained unchanged, while patients are still seen as previously, in the mornings on Mondays, Wednesdays, Thursdays, Fridays, and Saturdays from 10 to 12 o'clock, and in the evenings from 5.30 to 7 on Wednesdays, and from 7.30 to 9 on Thursdays. We continue to occupy the same rooms as hitherto, i.e., two consulting-rooms, each with two dressing-rooms and a dark room for throat examinations attached with a common waiting-room. This arrangement is very satisfactory, since the patients are interviewed in large, well-ventilated consulting-rooms, and warm dressing-room accommodation is provided for them, while it permits of frequent consultations between the medical officers without undue loss of time. In addition, we retain the same rooms for clerical and laboratory work. The suitability of the accommodation provided is only one of many points in favour of the affiliation of Tuberculosis Dispensaries to Hospitals. In view of recent criticisms of such affiliation other advantages of a close connection with a modern and up-to-date hospital may be summarised briefly as follows : 1. The facilities afforded for personal consultation with the members of the out-patient staff of the Hospital on difficult cases. 2. The power to refer cases to experts on the spot for special examinations, e.g., to the Surgeon, the Laryngologist, the Radiologist, the Dentist, and the Pathologist, the latter of whom is always kind enough to carry out elaborate investigations which cannot be undertaken in our own laboratory. 3. The close association with the resident staff of the Hospital, whose help has been invaluable, not only in providing immediate in-patient treatment in emergency, but also in giving us opportunities of keeping in touch with the latest methods of treatment and diagnosis as they are brought into practice. I gratefully acknowledge the facilities offered for this intimate collaboration, which I believe to be of inestimable benefit to us in our work. 4 The mere fact that a dispensary is established at a hospital which has gained a high repute over many years not only tends to give that Dispensary a prest ge that it might otherwise lack in the earlier stages of its existence, but also engenders confidence among a population which has come to estimate at its correct worth the value of hospital treatment. 93 During the year, with one exception, we have not made use of any new or specific forms of treatment in our own work here. We have carefully followed up such treatments as described in the medical Press, and have also had the advantage of discussing them with members of the Hospital staff who have been able to test them under conditions which entail no risk to the patient, but which cannot be fulfilled satisfactorily except when patients are under the strictest and most expert observation in a residential institution. Under these circumstances the only new therapeutic measure which we have adopted has been that of artificial sunlight. The Hospital has a carbon arc lamp installation suitable for all forms of ultra-violet radiation, and arrangements have been made with the Hospital authorities whereby we are enabled to refer cases to the department concerned. It is not easy to arrive at a correct estimate of the value of such treatment, but we have made a very careful selection of cases, and no ill-effects appear to have ensued. Glandular cases have predominated, and the results in bulk would indicate a certain measure of improvement, though this has been variable in different individuals, but two cases of advanced surgical disease in children in which the outlook was very bad seem to have derived considerable benefit. We hope to continue our observations during the ensuing year, and, as experience accumulates, to make further reference to this subject in a future report. So far the application of this treatment has been perforce mainly limited to children, since it entails a considerable amount of time which adults of the type likely to benefit cannot afford. In other respects, too, attention has of recent years become more and more concentrated on the question of tuberculosis in childhood, and it is now possible to review briefly measures which have come into more permanent use in this direction. Possibly the most valuable of these is the introduction of open-air schools, which have now passed the experimental stage and have become so firmly established that additional schools are being opened. We are fortunate in this district in having had such a school for the last six years. Situated on Hackney Downs, it is within reasonable travelling distance for the three boroughs it serves—namely, Hackney, Bethnal Green, and Stoke Newington. The school has accommodation for 75 children, which appears to be sufficient for the area, as, although it is always full, the waiting-list is never a long one. The progress of the children has been maintained during the year, 13 being discharged as fit for work, while 12 were considered as fit to attend an elementary school, and were accordingly transferred. As previously, I cannot pass this aspect of my report without a reference to the very great assistance which we have received from the branches of the Invalid Children's Aid Association in Hackney and Bethnal Green. They have once more been kind enough to provide for convalescence at the seaside or in the country for many of our children who, debilitated in themselves or recovering from acute diseases, are still further endangered as regards the liability to tubercular infection 94 by living in unhealthy surroundings. The Hospital authorities have also been good enough to send a number of such cases to their convalescent home at Saunderton, and I should like to acknowledge gratefully the help of the Resident Medical Officer and the Lady Almoner in this connection. The system introduced by the London County Council in 1922 under which the Tuberculosis Officer sends a special report to the School Medical Officer on all contact cases of school age, or on any other children examined at the Dispensary whose health for any reason is found to be unsatisfactory, has been continued throughout the year. Opinion as to its utility must vary since it has been productive of no startling results, but at least it ensures a continuity of observation of such cases that would otherwise be impossible. A further scheme has been introduced during the year by the London County Council for removing from their homes, and for boarding out elsewhere, children living in the houses of tubercular patients. This is carried out by the co-operation of the Invalid Children's Aid Association, the London County Council, and the Tuberculosis Officers. A similar scheme has achieved considerable success in France, but apparently in no other country. The difficulties in the way arise mainly from the fact that it is hard to persuade parents to surrender their children to strangers in a home which they have never seen and which they are necessarily discouraged from visiting. Moreover, it is obvious that it would be a more reasonable and economical method of securing the same end, i.e., freedom from exposure to infection, to remove the patient who is the source of that infection, especially when he has become so ill that his chances of recovery are remote. Nevertheless, such children as have been sent away and have already returned have in the majority of cases made great improvement in health. This question is intimately bound up with that of institutional treatment n general. During 1925, 206 of our cases were treated in London County Council institutions. Previously expressed criticisms still hold good—namely, the prolonged period of waiting and the difficulty of securing accommodation for all, except war pensioners, who are suffering from advanced disease. The recent opening of an institution for such cases at Grove Park, which will take in over 320 persons of both sexes, will, it is hoped, bring some relief. Last year, as heretofore, the great majority of deaths from tuberculosis of inhabitants of Hackney and Bethnal Green occurred in the local infirmaries or in the homes of the patients. There is a point in connection with institutional treatment which is a source of much anxiety: the provision of work for those who have left sanatorium or hospital, and who have made such progress as would justify one in recommending them to attempt light work under good surroundings. The unhappy position of the labour market at the present time renders this problem even more acute than it would otherwise be, and few employers are prepared to take back a hand whose working capacity is seriously damaged, and to afford him facilities for carrying on at a lower productive level. This is a serious handicap, for in many instances, unless the work and conditions are definitely unsuitable and objectionable, it is best for the worker to return to that employment in which he has already attained proficiency, and which therefore entails less wear and tear and anxiety for him. In 1923 an effort was made by the Ministry of Health, in conjunction 95 with the Ministry of Labour, to arrange for the local employment bureaux to secure work under favourable conditions for suitable persons on the recommendation of the Tuberculosis Officer, but it has proved a complete failure. The Tuberculosis Care Committees have also made strenuous efforts in this direction with occasional success, but they too are greatly handicapped by the present economic position, and by their own lack of funds. Recently, however, there has been opened in Holborn the Spero Leather Factory, under the aegis of the Ministry of Health and the London County Council, and to this a few of our patients have secured admission. Before being taken on, the majority of the men receive training in the fancy leather trade at King George V Sanatorium at Godalming, and on commencing their work at the factory have already attained a considerable degree of proficiency. They are, moreover, specially chosen from the point of view of character and temperament, and carry out their duties under carefully arranged conditions. The scheme appears to hold out prospects of success, though the question of the provision of an adequate wage is a difficult one. I have suggested previously that local workshops conducted on similar lines would provide the most ready solution of the problem, and the above experiment would appear to justify an extension of the scheme. The Tuberculosis Officers are still engaged in the capacity of Medical Referees for the Ministry of Pensions. This work is diminishing somewhat, but it is still arduous and exacting, and entails an amount of attention out of proportion to the number of cases seen. For certain patients whose financial circumstances and clinical condition warrant it, the Boroughs' scheme for the provision of additional nourishment has proved a great boon. While an expenditure of only £2 per 1,000 population is permitted, yet by a careful selection of cases I think the maximum obtainable b3nefit has been conferred, and the grant has invariably been received with grateful appreciation, and in my experience never abused. A perusal of the statistical tables appended below will show that the Dispensary maintains its position as a consulting centre in the boroughs. It is not to be expected that these figures would show any striking variation as compared with those of recent years, and it would appear that the work of the department has found a point of equilibrium at which it is likely to remain for some time. Thus the new cases in Hackney are slightly fewer than they were in 1924, but this has been offset by a corresponding increase in Bethnal Green, so that the total for the year for both boroughs is practically unchanged. Under the circumstances I do not propose to enter into a detailed examination of the figures presented, but I would like to draw attention to one branch of the work which I consider to be of the highest importance, namely, the frequent and complete systematic examinations made of patients attending the Dispensary. It will be seen that these amount to 5,145, while the total number of attendances for the year has been 10,066, i.e., rather more than one examination per two attendances. The value of this in gauging the progress made, the indications as to fitness, or otherwise for work, and the necessity for the alteration of treatment from time to time, will be readily appreciated. 96 It has always been my pleasant duty to comment on the friendly relationship which exists between ourselves and the private practitioners in the district. Many of the latter we have met in consultation, and by this means is secured a mutual understanding of repsective difficulties and a basis of good will for the future. In conclusion, I should like to thank the Dispensary Committees, the Medical Officers of Health, the Hospital Physicians and Surgeons, the Resident Medical Officer, and the Hospital Secretary, for their help and advice, and also the Dispensers, the Clerk, the Nurse, and the Porter, for the thorough and efficient manner in which they have carried out their duties. (Signed) H. TYLFORD HOWELL. 24th February, 1926. 97 BOROUGH OF BET FINAL GREEN 1. The Totals of New Cases Males 344 Females 344 Total 688 2. The Sources of the New Cases Medical Officer of Health Total Tuberculous 121 60 Local Practitioners—Primary 202 207 40 Contact 6 1 1 Contact cases (per M.O.H.) 295 14 War Pensions Committee 11 5 London County Council 22 7 Victoria Park Hospital 23 21 Other sources 9 7 3. The Diagnosis of the New Cases Diagnosis Insured Uninsured Males Females Children under 15 Males Females Total Pulmonary Tuberculosis 52 32 4 15 19 122 Non-pulmonary Tuberculosis 5 3 18 3 4 33 Non-tuberculous 109 81 205 31 68 494 Doubtful 15 9 7 3 5 39 Total 181 125 234 52 96 688 g 98 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 10 Non-pulmonary Tuberculosis 5 Non-tuberculous 268 Doubtful 17 Total 300 5. Sputum Examinations. Tubercle Bacilli present 134 Tubercle Bacilli absent 546 Total 680 6. Other Figures. Total number of attendances Insured Uninsured 1,786 2,708 Systematic examinations at the Dispensary 2,478 Number of patients sent to hospital or sanatorium by the L.C.C. 89 19 Number ot letters written.. 1,770 Number of visits to patients at their homes Number of patients referred to:— 158 X-ray Department 7 Dental Department 25 Other Departments 47