BET 31 AC 4366 THE Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1926, BY J. BELL FERGUSON, m.d., m.R.c.p.. d.p.H., Medical Officer of Health 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, 1926-1927 as on 31st December, 1926. Meetings held at the TOWN HALL on the first and third Wednesdays, at 7 p.m. Councillor Mrs. R. Elsbury, Chairman. Councillor A. R. Bean, Vice-Chairman. Alderman H. E. Tate. Councillor W. Paddock. Councillor D. G. Alabaster. „ C. J. Palmer. ,, C. Bennett. „ R. E. Pearson. ,, L. Goldstein. ,, M. E. Seymour. ,, A. Harris. Ex-Officio Members of the Public Health Committee : (The Mayor and Chairmen of other Standing Committees of the Council.) His Worship the Mayor (Alderman C. W. Hovell). Committee : Chairman : Finance Councillor S. Elsbury. Works and Stores „ A. G. Clark. Law and General Purposes ,, L. Goldstein. Baths „ W. H. Bryant. Electricity „ G. E. Snelling. Valuation ,, D. G. Alabaster. Public Libraries Alderman J. E. A. King. Housing Councillor W. Paddock. Staff „ C. J. Palmer. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. Council Representatives on Joint (Tuberculosis) Dispensary Committee: The Mayor, Councillors Mrs. R. Elsbury and C. J. Palmer. 2 PUBLIC HEALTH DEPARTMENT. STAFF as on 31st December, 1926. *J. Bell Ferguson, M.D., D.P.H., Medical Officer of Health. 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. R. Jones. *°§A. S. Henley. *°J. O. G. Weeks. Health Visitors, &c. : *†‡Miss G. I. Le Geyt, Superintendent Health Visitor. *†Mrs. F. M. Barden. *†‡Miss E. M. Patrick. *†Miss V. D. Cornish. *†‡Miss M. Playle. *†Miss C. E. Love. *†‡Mrs. A. W. Rosling. *†Miss A. A. Page. *†‡Miss L. F. Wright. *†‡Miss M. B. Illingworth (temporary). *†‡Miss E. E. Taylor, Borough Midwife. *†‡Miss E. S. Crisp, Tuberculosis Health Visitor. *Miss L. F. Gavin, Clerk-Dispenser. Clerical Staff: °J. Henry Lloyd, Chief Clerk. F. G. Thomas, Clerk. F. C. Sharpe Clerk. ° R. W. Slyfield, Clerk. °§S. Slater, Clerk. *L. A. Taylor, Clerk. J. E. Pestell, Junior Clerk. S. P. Hansen, Clerk. L. Lane, General Assistant. °Certificated Sanitary Inspector. §Certificated Meat, &c., Inspector, †Certificated Nurse. ‡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 Unestablished Part Time Officers, Maternity and Child Welfare Centres. Medical Officers. *Mrs. K. Addison, M.B., B.S. *Mrs H. Andrews, M.B., B.S., M.E.C.S., L.R.C.P. *Miss M. M. Basden, M.D., B.S., F.R.C.S., L.R.C.P. *Miss A. M. Hutchison, M.D., Ch.B., M.R.C.P. *Miss E. F. Iredell, M.D. *Miss H. M. M. Mackav, M.D., B.S., M.R.C.S., M.R.C.P. *Miss D. I. Mart, M.R.C.S., L.R.C.P. Mrs. D. E. Mason, M.R.C.S., L.R.C.P. Masseuse: *Miss Y. Lawson. Dental Surgeon: *Miss J. H. M. Sutherland, L.D.S (R.C.S.). 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, *C. H. C. Toussaint, M.R.C.S., L.R.C.P. A. E. Parkes, F.I.C., Public Analyst. The Council receives Exchequer grant in respect of the salaries of these Officers. CHANGES DURING 1926. Dr. J. Aspinall Marsden's services as Acting Medical Officer of Health ceased on the 31st October, 1926, and Dr. J. Bell Ferguson, formerly Medical Officer of Health for Smethwick, took up his appointment on the 1st November, 1926. During the year Mrs. E. L. Hann resigned her appointment as Health Visitor, and her successor had not been appointed at the close of the year. Messrs. S. P. Hansen, F. C. Sharpe, and J. E. Pestell were appointed to the Clerical Staff. The Ministry of Health and London County Council sanctioned the appointment of an additional Tuberculosis Health Visitor, and the Council appointed Miss J. Butler, to this post, but she had not taken up her duties at the end of the year. During the year Mr. A. W. Stokes, F.C.S., F.I.C., resigned his post as Public Analyst after a long period of office in that capacity. Mr. A. E. Parkes, F.I.C., who is also Public Analyst for Poplar, was appointed to the vacant post. 4 Town Hall, Bethnal Green, E. 2. April, 1927. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, The health statistics for 1926 are, on the whole, comparatively satisfactory. The Death Rate was 11.6, as compared with 12.0 last year. The graph following p. 24 will show how this compares with previous years. The Birth Rate was 20.9 per thousand of the population, and compares with 21.9 last year. Comparison with previous years and a comment thereon will be found on p. 25. The Infant Death Rate, always a sensitive index to public health administration, was 71.1 per thousand births, as compared with 80.6 in 1925. This is the second lowest Infant Death Rate for Bethnal Green on record. The marked decline in the Infant Death Rate of the Borough is further commented on on p. 25. Scarlet Fever and Diphtheria continued to be prevalent, but on the whole the type of disease was fairly mild. Arising out of proposals by the Shoreditch Borough Council, meetings have taken place between representatives of the Battersea, Shoreditch and Bethnal Green Borough Councils in connection with the proposed provision of a joint convalescent home for mothers and children. A suitable site has been found, and plans and estimates are now being considered by the respective Councils and the Ministry of Health. There is a decided need for such an institution in view of the increasing demand for convalescent facilities for nursing mothers and young children. In order to attain the full benefits of the home and to facilitate the admission of mothers with families, the Council may have to consider the advisability of some scheme of home helps. The increasing recognition of the value of ultra-violet radiation in the prevention and treatment of disease, particularly in babies and young children, has thoroughly justified the provision of the lamp at the Welfare Centre. It is hoped in the near future to extend this form of treatment by the provision of additional apparatus to enable further types of case to be dealt with, including the preventive radiation of infants and a session for expectant mothers. It is worthy of note that the Council is planning the provision of a Cleansing Station at Digby Street which will provide four baths. This should prove a great boon to persons suffering from the unwelcome attentions of insect pests or afflicted with scabies. At 5 present the London County Council is doing good work in connection with school children, but no provision has so far been made for adults. Notwithstanding the considerable improvement in the sanitary condition of the Borough and the Council's efforts in connection with better housing, there still remains urgent need for the radical improvement of the housing conditions of a considerable number of residents in the Borough. A scheme to this end has recently been suggested in the Teale Street area. Numerous inspections and conversations have taken place with the London County Council and plans prepared in connection with this proposed housing scheme, and it is to be hoped that a substantial betterment in this particular district will result. I should like to conclude by thanking the staff of the Public Health Department for their co-operation and willing help during my period of office, and also the Chairman and members of the Public Health Committee for their support and interest in the work of the Department. My thanks are also due to colleagues in other Departments, from whom I have received every courtesy and assistance. I am, Ladies and Gentlemen, Your obedient servant, J. BELL FERGUSON, Medical Officer of Health. 6 GENERAL DESCRIPTION Bethnal Green is a roughly rectangular shaped district in East London, about 1¾ miles from west to east and about one mile from north to south, and 760 acres in area. It is bounded by Shoreditch and Hackney on the north, Stepney on the south and Poplar on the east. Where the original soil exists it is of gravel and sand formation. The surface is generally flat, varying from 36 to 54 feet above sea level. The principal industries carried on in the district are the making of boots, shoes and clothing, cabinet making and other branches of the furnishing trade. The main lines of the Great Eastern section of the L.N.E.R. pass through the borough. There are also three railway stations in the borough, and several others in close proximity, while various tram and motor bus routes traverse the main roads in the borough. There is a considerable daily inflow and outflow of workers, with the larger stream outward to workplaces in other parts of London. The tendency is for the borough to be increasingly used for industrial and commercial purposes and the resident population is very congested. At the 1921 census there were 18,497 structurally separate dwellings in the borough, and 27,596 families or separate occupiers lived therein. There is an excellent open space to the east of the borough in the shape of Victoria Park, and there are a few small open spaces elsewhere in the borough. The rateable value of the borough on the 31st December, 1926, was £600,414, and the product of a 1d rate is estimated at £2,375. SOCIAL WELFARE In view of their close association with questions of Public Health, I have thought it right to obtain some statistics concerning the social welfare of the 7 borough. The residents in the borough suffer to a considerable extent from unemployment and casual labour, as is evidenced by the following figures kindly supplied to me by the Clerk to the Bethnal Green Board of Guardians:— Date Total Number of Persons relieved in their own homes including wives and children Unem. Others| Persons Relieved in Institutions Persons suffering from sickness or bodily infirmity Persons suffering from mental infirmity Persons not suffering from sickness, bodily or mental infirmity on 1st Jan. 1925 3697 1246 827 748 462 1926 5462 2460 861 746 513 1927 8968 3238 814 735 470 At my suggestion the Clerk to the Guardians has also furnished me with the following note concerning the Guardians' care of children :— "With regard to the work at the Leytonstone Children's Homes, it is somewhat difficult to speak, but generally one may say that within the past two or three years the dietary has been altered so as to provide the children with food best calculated to promote their growth and general well-being, and the buildings themselves have been remodelled. In the Infants' Departments children are now admitted from 1 year of age, and in some few cases even earlier, and the most up-to-date methods are employed in their care, including the glazing of the windows with Vitaglass, which permits the sunlight to come through in its most beneficient form." I have also obtained the following statistics concerning unemployment, by the courtesy of the Managers of thelocalemploymentexchanges (Hackney, Shoreditch and Stepney), which are roughly indicative of the state of employment among Bethnal Green residents:— 8 Table showing the number of persons registered as unemployed at the end of each month of 1925 and 1926. Year and Month. Men Boys Women Girls Total 26th January, 1925 5,910 196 1,996 155 8,257 23rd February 5,773 157 1,811 81 7,822 30th March 5,573 89 1,670 83 7,415 27th April 5,363 272 1,652 152 7,439 25th May 4,936 120 1,405 64 6,525 22nd June 4,911 98 1,424 73 6,506 27th July 4,913 221 1,385 116 6,635 31st August. 5,016 195 1,197 89 6,497 28th September 4,510 110 1,081 81 5,782 26th October 4,422 148 941 82 5,593 30th November 4,388 113 1,112 100 5,713 21st December 3,868 80 1,041 53 5,042 1926 25th January 4,634 208 1,208 166 6,216 22nd February 4,407 132 960 128 5,627 29th March 4,091 62 776 49 4,978 26th April 4,024 126 744 107 5,001 31st May 4,905 152 1,304 135 6,496 28th June 4,589 119 982 69 5,759 26th July 4,669 160 919 130 5,878 30th August 4,585 165 675 99 5,524 27th September 4,336 144 707 95 5,282 25th October 4,425 139 760 113 5,437 29th November 4,696 127 1,109 152 6,084 24th December 4,429 123 1,095 108 5,755 9 Against the apparent improvement in 1926 as compared with 1925, must be set the fact that owing to the restrictions of unemployment benefit there were probably fewer registrations by unemployed persons. Even ignoring this, the figures for 1926, so far as it is possible to analyse them, suggest that at least 10 per cent of the normally employed population was unemployed during the year. The actual percentage may easily have been much higher, and the Poor Law figures given previously are probably a much truer guide to the distress in the borough. PUBLIC HEALTH EXPENDITURE. The exceedingly small cost of the local Public Health services is shown by the latest available figures for the financial year 1925-6, when the total expenditure of the Public Health Committee was £14,244, or 2s. 4½d. per head of the population, and equivalent to a rate of 6d. in the £1. The New York State Department of Health has the striking statement on its envelopes "Public Health is purchaseable. Within natural limitations any community can determine its own death rate." The results achieved by progressive public health administration in Bethnal Green, as illustrated by the graphs on p.25, show that this is largely true. Bethnal Green is handicapped in engaging in any expensive health scheme by its low rateable value, but its modest expenditure and substantial achievements compare favourably with those of many better-circumstanced districts. OTHER HEALTH SERVICES. Owing to the slow and unsystematic manner in which our health organization has been developed, there are many important health services outside the ambit of the Borough Council, which is the local 10 health authority. These may be divided into those administered by other public authorities (such as the London County Council, Metropolitan Asylums Board. Board of Guardians and London Insurance Committee), and those run by private individuals or corporations (such as general medical practitioners, midwives, nurses and voluntary hospitals). The Medical Officer of Health is dependent upon the courtesy of these agencies for any information as to their activities. A brief list of them is appended :— Medical Inspection and Treatment of School Children— This is dealt with by the London County Council. By the courtesy of Dr. F. N. Kay Menzies, School Medical Officer L.C.C. I have been furnished with the following information concerning local arrangements for the medical treatment of school children:— "The only school treatment centre in Bethnal Green is situate at the St. James the Less Dispensary, St. James's Road, Bethnal Green. At this centre special departments are arranged for the treatment of eye (refraction) cases, dental cases and for children suffering from minor ailments. "The ophthalmic surgeon attends the centre one session a week and about 440 children are treated annually. The dentist visits the centre on nine sessions a fortnight and about 1,540 children are treated each year. In the minor ailments department the doctor attends on two sessions a week and a nurse is daily in attendance. About 1,400 children are treated in this department annually. "A certain number of children in the Borough attend at the Queen's Hospital for dental treatment, and a small number attend at Moorfields Hospital for eye treatment. "Verminous school children are cleansed at the London County Council bathing centre,51a, Russia Lane, Bethnal Green. Treatment of children suffering from scabies is also given at this centre. During the year 1926, the total number of baths, cleansings, etc., given at this centre was 5,745." 11 Medical Treatment of Persons Insured under the National (Health) Insurance Acts— Arrangements made by the London Insurance Committee. Maternity— Public.— For the Borough Council's activities, see the section of this report dealing with Maternity and Child Welfare. Board of Guardians: Maternity wards in Bethnal Green Hospital. Hospitals— Public.—Board of Guardians: Bethnal Green Hospital, Cambridge Road. Private.— The maternity services connected with the London Hospital, City of London Maternity Hospital, Salvation Army Midwives and Royal London Maternity Charity. Although these institutions are situated or directed from outside the Borough, they are largely used by residents of the Borough. Private.— Queen's Hospital for Children, Hackney Road; Mildmay Mission Hospital, Austin Street; City of London Hospital for Diseases of the Heart and Lungs, Victoria Park; Queen Adelaide's Dispensary, Pollard Row; Medical Mission, St. James the Less. The London Hospital, Whitechapel Road, although situated outside the Borough is largely used by residents. Vaccination— The Vaccination Acts are administered by the Board of Guardians. The Public Vaccinators are :— For N.E. Bethnal Green : For S.W. Bethnal Green : Dr. P. Harris White, Dr. F. Arthur, 130, Roman Road. 395, Bethnal Green Road. Registration of Births, Deaths and Marriages— The Clerk to the Board of Guardians acts as Superintendent Registrar, the District Registrars being :— For N.E. Bethnal Green : H. J. Hardwick, 108, Bishop's Road. For S.W. Bethnal Green: Miss M. Peters, 347, Bethnal Green Road. 12 General Medical Practitioners— There are forty-three general medical practitioners with consulting rooms in the Borough. Thirty-four of them are on the London Insurance Committee's panel. Nurses— The Shoreditch and Bethnal Green District Nursing Association has its headquarters just outside the Borough, but undertakes a great deal of Nursing in the Borough. Address: 80, Nichol's Square, E. 2. Midwives— There are five private midwives known to practice in the Borough, of whom two actually live in the Borough. 13 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, 1926, was £600,414, and the product of a 1d. rate is estimated at £2,375. POPULATION. The population, as estimated by the RegistrarGeneral in the middle of 1926, was 119,600. MARRIAGES. The number of marriages celebrated in Bethnal Green during 1926 was 925. This is equal to a rate of 15.4 persons married, or 7.7 marriages, per 1,000 total population. BIRTHS. The number of births registered in the Borough during 1926 was 1,993, and, in addition, 508 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 2,501 births. The birth-rate for 1926 was, therefore, 20.9 births per 1,000 population. 14 The course of the birth-rate during the past 30 years is shown in the graph inset, following page 24. Of the 2,501 births, 1,260 were those of males, and 1,241 those of females. ILLEGITIMACY. Of the 2,501 births credited to this Borough, 54 were illegitimate, being 22 males and 32 females, and being 2.1 per cent. of the total number of births. STILLBIRTHS. Forty stillbirths were brought to notice, being a proportion of 1.9 per cent. of all births, live and dead. DEATHS. The number of deaths registered during the year as having taken place in the Borough was 1,363. Of these, 271 were of persons whose residence was not in Bethnal Green, 264 dying in Bethnal Green Institutions and 7 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 or in other parts of England and Wales. This correction gives the net number of deaths for Bethnal Green as 1,393, making an annual deathrate of 11.6 per 1,000 of population. The death-rates in the four quarters of the year were :— First Quarter 13.9 Second „ 11.1 Third „ 8.3 Fourth „ 13.2 15 The death-rate for Bethnal Green, 11.6, is the same as that for the County of London and for England and Wales as a whole. The course of the death-rate during the last 30 years is shown in the graph inset, following page 24. 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 tables which appear on pages 16 and 17. 16 17 Metropolitan Borough of Bethnal Green. A provisional analysis of the CAUSES OF DEATH at various ages during the year 1926. 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 Langs Bethnal Green Hospital (Poor Law) Waterloo House (Poor Law) Total Institutional Deaths  All causes—Certified 1393 178 56 34 48 71 164 359 483 142 49 84 471 120 866 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1. Enteric Fever 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 2. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3. Measles 37 14 13 8 1 1 .. .. .. 2 .. .. 16 .. 18 4. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5. Whooping Cough 2 .. .. 2 .. .. .. .. .. 1 .. .. 1 .. 2 6. Diphtheria & Croup 21 .. 1 8 1 1 1 .. .. .. .. .. .. 2 .. 2 7. Influenza 12 .. .. .. .. .. 3 4 5 .. 2 .. .. .. 2 8. Erysipelas 3 .. .. .. .. .. 2 .. 1 .. .. .. 2 .. 2 9. Phthisis (Pulmonary Tuberculosis) 121 2 .. .. 4 22 46 39 8 7 .. 25 43 .. 75 10. Tuberculous Meningitis 8 .. 2 2 2 2 .. .. .. 7 2 1 1 .. 11 11. Other Tuberculous Diseases 12 3 .. .. 3 3 .. 2 1 2 2 1 3 .. 8 12. Cancer, malignant disease 141 .. .. .. .. 2 16 63 60 1 4 7 65 2 79 13. Rheumatic Fever 12 .. .. .. 1 3 4 1 3 1 1 5 3 1 11 14. Meningitis 4 2 1 .. 1 .. .. .. .. 9 3 .. .. .. 12 15. Organic Heart Disease 186 2 .. .. 4 6 20 42 112 2 .. 7 72 65 146 16. Bronchitis 164 10 3 1 .. 2 6 50 92 3 1 9 65 21 99 17. Pneumonia (all forms) 122 25 23 8 1 4 11 19 31 18 10 4 39 4 75 18. Other diseases of respiratory organs 23 2 .. 1 .. .. 4 9 7 3 .. 1 9 .. 13 19. Diarrhoea and Enteritis 41 34 7 .. .. .. .. .. .. 28 4 .. 27 .. 59 20. Appendicitis and Typhlitis 4 .. .. .. 2 .. .. .. 1 5 .. .. 2.. 7 21. Cirrhosis of Liver 6 .. .. .. .. .. 1 3 2 .. .. .. .. .. .. 21a. Alcoholism.. 2 .. .. .. .. .. .. 1 1 .. .. .. .. 1 1 22. Nephritis and Bright's Disease 23 .. .. 1 .. 2 5 10 5 3 .. 5 2 1 11 23. Puerperal Fever 2 .. .. .. .. .. 2 .. .. .. .. .. 1 .. 1 24. Other accidents and diseases of Pregnancy and Parturition 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 25. Congenital Debility and Malformation, including Premature Birth 68 68 .. .. .. .. .. .. .. 22 5 .. 17 .. 44 26. Violent Deaths, excluding Suicide 31 2 1 1 2 8 5 5 7 2 3 .. 13 .. 18 27. Suicide 20 .. .. .. .. 1 4 11 4 .. .. .. 3 .. 3 28. Other Defined Diseases 325 13 5 2 16 14 33 99 143 26 12 19 84 25 166 29. Diseases ill-defined or unknown 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Total 1393 178 56 34 48 71 164 359 483 142 49 84 471 120 866 18 Some of the causes of death seem to call for special comment, and the accompanying graphs have been prepared to show the death rates from these diseases during the past ten years. CANCER. One hundred and forty-one deaths, or nearly l/10th of the total, were certified as due to some form of cancer. The curve of the disease during the past ten years shows that, as in other towns, there has been a slight increase in mortality as compared with 1917, but apparently less in Bethnal Green than has been experienced in some towns. Part of this increase is probably due to more accurate diagnoses. Nevertheless, the figures throughout the country generally are somewhat disquieting. Yarious committees have been appointed by the Ministry of Health to investigate cancer, and during the year reports on the aims and results of operative treatment have been presented. It would appear from these reports that many forms of cancer are more amenable to early surgical treatment than was appreciated. This particularly applies to cancer of the breast, and it is important that any woman with a suspicious swelling in this region should seek skilled advice at the earliest possible moment so that the undoubted benefit of early surgical treatment may be secured. It is to be remembered that in the majority of these cases the initial swelling is quite painless. In addition, radiology has made advances by the use of powerful x-rays (Erlangen Therapy) in the treatment of the deeper-seated growths. Educational efforts should be continued amongst the public, pointing out the necessity for early diagnosis and early operation. RHEUMATIC DISEASES The group of rheumatic diseases is of great importance to the community. It is estimated that in England and Wales 30,000 deaths are due annually 19 20 to these diseases. In 1924 the Ministry of Health investigated the incidence of these diseases amongst the insured population, and disclosed the fact that nearly 1/6th of the industrial invalidity in the country was due to "Rheumatism." In July, 1926, the Science Committee of the British Medical Association published a report on "Rheumatic Heart Disease in Children." These inquiries revealed the close association of rheumatism with poor, damp dwellings and the importance of early detection of rheumatic infection in the child and the need for proper care and rest. In a certain proportion of cases connection of diseased tonsils with rheumatic infection was confirmed. Further research is required, but the indications clearly point to the desirability of more effective measures to ascertain the presence of rheumatic infection in the child at the earliest possible moment, and to secure adequate rest and supervision for children found to be affected. By this means the number of children who would otherwise develop into chronic cardiac invalids may be reduced. Our Health Visitors are instructed to keep a watchful eye on the toddlers they visit, or see at the Welfare Centres, for signs of repeated sore throat, slight chorea (St. Vitus' Dance), "growing pains," joint pains and manifestations of nervousness often accompanied by pallor. These children are noted and kept under close supervision and the mothers advised to give them additional rest. In the past such children have been allowed to drift into heart disease, and a great field of preventive work offers itself for carefully-considered measures, which will widen out as our knowledge of this infection is increased by research. It must be remembered that for every patient who dies of rheumatism large numbers are seriously damaged and suffer from chronic inefficiency and ill-health. In the meantime, attention to housing, dampness in dwellings, by securing as much sunlight as possible, decent wages and early detection and careful treatment of the infected children are the lines to follow up. 21 22 TUBERCULOSIS. The accompanying graphs suggest an association between the prevalence of respiratory diseases and tuberculosis. The death rate from tuberculosis in the Borough shows the same satisfactory fall as that experienced throughout the country, and is now exactly half what it was twenty years ago. While this condition of things is satisfactory, and probably due in part to anti-tuberculosis measures, it must be remembered that the tuberculosis death rate had been falling steadily before these measures were adopted, and a considerable portion of the improvement must be attributed to the generally improved standard of life in the population. 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) 487 Waterloo House (Poor Law) 90 Queen's Hospital 30 City of London Hospital, Vic toria Park.. 9 Mildmay Mission Hospital 18 - 634 23 Institutions out of the Borough. London Hospital 90 Other General Hospitals 56 M.A.B. Hospitals 43 Mental Hospitals 57 Other Institutions 43 - 289 Total 923 From these figures it will be seen that of the 1,393 deaths during the year, 923, or 66 per cent, took place in institutions. 24 VITAL STATISTICS of Bethnai, Green During 1926 and Previous 5 Years. Year Births Transferable Deaths Net Deaths of Persons Resident in the Borough Population Estimated to Middle of Each Year Uncorrected Number Net 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 Birth Hate Number Death rate Number Rate per 1,000 births Or infantile mortality 1921 118,300 2,636 3,003 25.4 1,452 - - 1,530 12.J 300 100 1923 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 21.9 1,400 270 307 1,437 12.0 212 80 .6 1926 119,600 1,993 2,501 20.9 1,363 271 301 1,393 11.6 178 71.1 BETHNAL GREEN: A THIRTY YEARS PUBLIC HEALTH RETROSPECT. 25 A THIRTY YEARS RETROSPECT The accompanying graphs show the fairly steady fall in the birth rate and in the death rates which have taken place in the last 30 years in the Borough. The reduction in the general and infant death rates is particularly striking, both having been halved in the period. It is not possible to attribute this result entirely to any one factor, but undoubtedly a great part has been played by the systematic improvement of the housing and sanitary conditions in the Borough. More recently, the adoption of specific schemes for maternity and child welfare has accelerated the saving of the children. Apart from the disturbance of the Great War, the birth rate has shown an extraordinarily steady decline during the whole period. Whether the slight acceleration of this decline during the past three years be due to an increasing adoption of birth control methods, cannot be said. Having regard to the economic and housing conditions of the people in Bethnal Green, a reduction in the birth rate can only be regarded as a fortunate circumstance. 26 27 MATERNITY & CHILD WELFARE NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. During the year, 1,994 live births were registered in the Borough; and of these, 1,971 were notified to the Medical Officer of Health. There were also 40 stillbirths notified. Of the 2,011 living and stillbirths notified, 1,252 were notified by midwives, 447 by maternity assistants of the London Hospital, 221 by medical practitioners, and 91 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 485 live babies and 12 stillbirths being received in this way. SUMMARY OF VISITS PAID BY HEALTH VISITORS. 1923. 1924. 1925. 1926. Births (first visits) 2,918 2,650 2,645 2,520 Births (re-visits) 16,628 20,507 23,640 23,147 Visits to mothers 1,577 1,435 1,443 1,730 Ophthalmia Neonatorum 149 223 190 238 Puerperal Fever 48 21 46 47 Measles 1,110 1,029 699 1,552 Special Matters 450 242 436 656 Futile Visits 2,377 2,847 2,290 2,448 Milk Grant Enquiries 1,141 828 1,069 1,138 Total visits paid 26,398 29,782 32,458 33,476 Of the 23,147 re-visits, 7,695 were to children under 1, and 15,452 to children between 1 and 5. 28 MATERNITY AND CHILD WELFARE CENTRES. The popularity of the Council's Centre in Cornwall Road was maintained during the year. There were 147 sessions for infant consultations and 101 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 47 Infant Consultation Sessions at this Centre. The statistics of attendances at the Centres during 1926 and in previous years are as follow:— Cornwall Road. Thornton Hall. Total Attendances of Children. 12,861 3,131 Average Attendance per Session 87.5 66.6 New Cases (Children) 1,254 276 Medical Consultations (Children) 8,896 2,293 1926. 1925. 1924. 1923. 1922. Total Attendances for of Children 15,992 15,713 16,735 18,028 14,446 New Cases (Children) 1,530 1,567 1,528 1,989 1,623 New Cases (Mothers) 515 527 468 483 349 Medical Consultations— (Children) 11,189 10,995 11,782 11,685 9,541 (Mothers) 1,172 1,200 1,044 1,055 710 Total Attendances for Milk Grants 13,844 13,931 17,425 15,862 8,302 29 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 some of the Medical Officers will be of interest:— I am struck at the Bethnal Green Clinic, as I am at my other clinics and at Great Ormond Street, with the rarity of cases of congenital syphilis and of rickets—at least of rickets of any extreme degree. I have often heard Dr. Frew, whose first assistant I am at Great Ormond Street, comment on these two facts, which I myself proved to be true. There are all sorts of mothers attend the Clinic, some for what they can get, but I always find the work is well worth doing for the sake of those who really come for advice and try to follow it out. A. M. Hutchison. One of the most important functions of an Infant Welfare Centre is to superintend and advise as to the feeding of babies. It is very gratifying to notice what a large proportion of the mothers attending this Centre are able and anxious to feed their babies in the natural and best way—on the breast. Where this is not possible I usually recommend one of the excellent dried milks—which in most cases prove very successful. However pure and fresh the milk is when delivered, we have to remember that many of our mothers live, and have to carry on all their domestic activities, in cramped and crowded houses. It is almost impossible for them to keep the milk, which is perhaps delivered in a satisfactory condition, free from all contamination for the rest of the day, and milk which is not clean may be a virulent poison. E. F. Iredell. 30 One of the questions I have been asking myself in the course of work at the Centre this winter has been : How much could the incidence of colds and bronchitis be diminished? I think bronchitis must be largely preventable and should not be so prevalent as it is in Bethnal Green. In trying to educate the mothers as to the value of fresh air indoors as well as out, one comes up at once against the housing shortage. In a limited space which has to serve for cooking and all household duties as well as living room, the air must get too moist and overheated. A baby or an older child spends its time in this atmosphere and is then taken out into a very different temperature. This is probably quite a frequent cause of bronchitis, though by no means the only one. Many babies are not taken out enough, and it is very difficult for a busy mother to find time to go out. In these cases I always suggest letting the baby sleep or lie by a widely opened window. The outdoor clothes can be put on first in cold weather. Clothes are gradually becoming more sensible. Many children still suffer from having too many layers of flannelette and calico. Knitted clothes of a good wool that does not shrink are expensive to buy. Good wools are sold at cost price at the Centre, but a mother with more than one child does not have much spare time for knitting. The fashions for babies change slowly, but the superiority of knitted woollies over the heavy and cumbersome garments they so often wear is becoming more realised. In my experience, mothers are still far too frightened of suiting the costume to the weather. On a hot summer day many children perspire under numerous garments for fear they should catch cold if the number is lessened. There is still a fair amount of rickets, though I can only remember seeing one really serious case this year, in which the epiphyses were much enlarged and the tibiae badly bent. I believe the prevention of rickets is very important. D. E. Mason. 31 MATERNITY CLINIC. This is open every Wednesday and Thursday morning. Particulars of attendances:— Total. Expectant Mothers—first visits 396 l003 „ ,, subsequent visits 607 Mothers recently confined—first visits 119 177 ,, ,, „ subsequent visits 58 The number of sessions was 101, and the average attendance per session was 11.7. Forty-three of the mothers who attended for pre-natal care also attended the Maternity Clinic after their confinement, and 13 of these mothers were pent away to a Convalescent Home. The expectant mothers, 396 in number, may be grouped as follows:— Number of primigravidæ 69 Number of multigravidæ 327 Full-term confinements, including 3 stillbirths 186 Premature births 2 Caesarian section 2 Miscarriages (14) and Stillbirths (4) 18 Not pregnant 56 Sterile 2 Not yet confined 120 Left Borough, result unknown 10 Wassermann reaction for syphilis:— Number of blood-tests 4 Number of positive 2 32 The 194 confinements took place, 162 at home and 32 in institutions. The following features of the work of the Clinic are also of interest:— No less than 73 mothers came to enquire whether they were pregnant. Of the mothers who attended the Maternity Clinic, up to 31st January, 1927, 128 have attended the Infant Consultations with their children. The results of the 108 cases brought forward from 1925 were as follows:— Full-time confinements 93 Miscarriage (1) Stillbirths (2) 3 Not pregnant 9 Left district (result unknown) 3 Of the 95 who were confined, in 72 cases this took place at home and in 23 cases in an institution. Seventy of these mothers attended the Infant Welfare Centre with their babies. The Medical Officer in charge of the Maternity Clinic reports on the year's work as follows:— I am glad to be able to report that the Ante-Natal Clinic has maintained a satisfactory average attendance during the year. Although the actual figures are not higher than last year, it should be remembered that there have been four sessions less owing to the closing of the Centre for re-decoration. A survey of the figures shows that the appointments for reattendances have been better kept, and there has been a marked appreciation by those who re-attended of the health talks given by members of the staff, and of the model baby clothing. I must mention in particular the efficient help of the Lady Superintendent and Health Visitors who have been in attendance at Clinics throughout the year, and the particularly happy atmosphere that has been created. The Borough midwife has made a practice of attending with her own cases as frequently as her duties permit, and it is a pity that the local midwives do not more frequently avail themselves of this same opportunity. There is nothing outstanding to report with regard to the results of the cases except perhaps for the comparatively large number (73) who attended to enquire if they were pregnant. The majority of these were referred from the Infant Welfare Centres on account of debility or with a view to the continuation of breast feeding. 33 The mothers who had Caesarian section performed are both well and and their babies, together with the two premature ones, are progressing satisfactorily. With regard to the miscarriages, in all but 4 there was a history of a doctor having been in attendance or admission to an Institution. The 4 exceptions occurred early in the pregnancies of multiparæ varying from six to seventeen gravida. Several of these cases have re-attended at the Clinic. All four stillbirths occurred in Institutions, having been referred from the Clinic. Three of these were exceptionally difficult labours, and the fourth had been attending Hospital throughout her pregnancy on account of specific trouble. It is unfortunate that mothers do not take more advantage of the help given by the Borough Council for convalescent treatment, but this can be explained in the majority of cases by their inability to leave their families. Helen Andrews. 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. In the early part of the year, Grade A (Tuberculin Tested) Milk was substituted for ordinary milk. A full account of the procedure in dealing with applications for milk grants was given in the annual report for 1924. 34 During the year the following quantities of milk were issued to necessitous mothers:— Ordinary Fresh Milk 226 galls. Grade A (Tuberculin Tested) Milk 3,835 „ Dried Milk 16,146 lbs. Condensed Milk 751 tins together with drugs, etc. The approximate cost of milk given in this way was £1,704. SUPPLY OF DRIED MILKS, Etc. Considerable use is made of the Council's Centres for the sale to mothers and infants of dried milks of various brands, labelled specially to the Council's directions to avoid the use of trade names. The following quantities of milk were sold Dried Milk 15,198 lbs. Condensed Milk 102 tins 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. SPECIAL CLINIC FOR DELICATE CHILDREN. In June, 1925, 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 35 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. Dr. Mackay reports as follows:— The "special clinic for delicate children" has been held weekly during 1926, and has been attended by cases of various types. Infants and young children making poor general progress have predominated, but the Infant Welfare Medical Officers have also referred cases of rickets, anaemia, chronic intestinal indigestion, recurrent bronchitis, restless sleep, bed wetting, and other nervous complaints and diseases, as well as children convalescent from various acute illnesses. Children requiring greater facilities for investigation or treatment I have transferred to the Queen's Hospital for Children, but the great majority have been treated at the Centre alone. During the winter and spring months particularly, the mercury vapour quartz lamp installed about 18 months ago has proved a valuable adjunct to treatment, and many children with flabby muscles and poor muscular strength and activity have been greatly benefitted by the massage given before or during the light exposure. The mothers have, as at other light clinics, frequently commented on such changes in their children as quieter sleep, better appetite, increased activity, and greater general contentment subsequent to starting light treatment. During the summer months, when children were more out of doors and in the sunshine, comparatively few artificial light treatments were given. The following figures give the main facts concerning attendances at the clinic during the year 1926:— New cases 162 Subsequent attendances at Clinic 1,256 Consultations 1,115 Cases treated with artificial light, or light and massage 57 36 Number of attendances for light treatment— Mondays 855 2,066 Wednesdays 648 Fridays 563 Lamp in use (hours) 287 Number of Doctors' sessions 45 Average attendance per session 34 Children sent to convalescent homes 13 My thanks are due to the Staff of the Cornwall Road Infant Welfare Centre for the constant co-operation and help they have given me. H. M. M. Mackay, M.D., M.R.C.P. MASSAGE. The number of massage sessions held was 244, the number of children who received massage was 142 (including 98 new cases) and they made 1,730 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:— Poor Muscular development 91 Rickets 23 Knock-knee (5) Bowed legs (9) 14 Talipes (2) Flat feet (1) 3 Constipation 4 Poliomyelitis 3 Encephalitis Lethargica 1 General debility after illness 3 37 DENTAL CLINIC. The Dental Clinic established in September, 1925, and conducted by Miss J. H. M. Sutherland, L.D.S. (R.C.S.), has continued with two sessions per month ever since. The main purpose of the clinic is educational and the prevention of dental disease. It is, therefore, a natural and integral part of the work of the Welfare Centre in raising the standard of maternal and child health. Miss Sutherland reports on the year's work as follows:— Twenty-four Sessions have been held during the year on the second and fourth Thursday mornings of the month. Total attendances 187 New cases—Mothers 57 Children 62 Subsequent attendances—Mothers 42 Children 26 Average attendance per session 7.79 Sixty-three patients were recommended by the doctors at the Centre and elsewhere and 18 by the Health Visitors in the district. Treatment has comprised the following :— Extractions 165 Fillings 121 Other operations 78 Advice as to home treatment 11 Referred to London Hospital 3 Twenty-one expectant mothers attended the Clinic as patients. Attendances at the Clinic have improved and become more steady though the irregularity of sessions, especially when there are five Thursdays in a month, is certainly a drawback in making re-appointments. There has been an increased attendance of very young children under two years, which is a hopeful sign, and much good may be done by a periodic inspection at regular intervals, when slight treatment may be carried out. A great deal has yet to be done in educating the parents to understand the immense importance of healthy milk teeth on 38 the general health of the child. In this respect, of course, the doctors have helped much by referring children under their care to the Dental Clinic. On the whole the mothers are now more willing than at first to have treatment carried out for their children, once the facts of the ease have been carefully explained to them. The mothers themselves after friendly talks with them are becoming increasingly willing to venture to have their own teeth attended to. The accommodation and equipment at the Centre are excellent; there is plenty of work to be done in the Borough. I feel that a regular weekly session would ensure a larger and more steady attendance of patients, who find it difficult to remember the present irregular dates, constantly lose their appointment cards, often turning up on a Thursday when there is no session. Janet H. M. Sutherland. BOROUGH MIDWIFERY SERVICE Of the Borough Midwife's 35 bookings carried forward to 1926, 2 were cancelled, while during 1926 120 bookings were received, of which 10 were subsequently cancelled. During the year 114 mothers were delivered, 83 by the Borough Midwife, 19 by one of the Health Visitors while acting as Deputy Borough Midwife, 11 by various private midwives acting as deputy for the Borough Midwife, while in one case the mother was admitted to hospital while in labour. Of the 114 mothers delivered, 17 were primiparæ and 97 multipara. There were 31 expectant mothers on the books at the end of the year. The Borough Midwife paid 1,122 visits in connection with her practice. She also attended 61 Infant Consultation Sessions, 73 Maternity Clinic Sessions and 45 Midwifery Booking Sessions. The services of the Borough Midwife are appreciated in the Borough, as will be seen from the fact that although she started only in July, 1925, 18 of the mothers delivered in 1926 had been previously attended by her. 39 CONVALESCENT TREATMENT. During the year 4 mothers were sent to the London Mothers' Convalescent Home, Sunningdale, Berkshire, 1 mother to the Evelyn Convalescent Cottage, Wargrave, Berkshire, and 10 mothers to the "George Whitlaw" Convalescent Cottage, Amerden, near Taplow. Each mother was sent away for two weeks. In 8 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 38 children were sent to that Council's Home at St. Leonard's-on-Sea, Sussex, 1 for a period of two weeks, 28 for four weeks, 3 for five weeks, 2 for six weeks, and 4 for eight weeks. Children were also sent to the Marjorie Lumley Holiday Home, Maidenhead (1), the John Madocks Babies Home, Basing (1), and the Toddlers' Convalescent Home, Arkley (1) for periods varying from 3 to 10 weeks. In 25 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, Diarrhœa, Ophthalmia Neonatorum and Poliomyelitis, which come within the Council's Maternity and Child Welfare Scheme. 40 Nursing Assistance 1926. 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 12 222 .. .. .. .. .. .. .. .. 222 Discharging Eyes 61 884 .. .. .. .. 19 295 .. .. 1179 Measles 3 33 19 386 .. .. .. .. 6 71 490 Whooping Cough 1 16 1 13 .. .. .. .. .. .. 29 Puerperal Fever and Pyrexia .. .. .. .. 4 51 .. .. .. .. 51 Other pre-natal and postnatal conditions .. .. .. .. 34 358 .. .. .. .. 358 Abscess or Cyst of Eye .. .. .. .. •• 2 20 .. .. 20 Otorrhœa, Abcess of Ear .. .. .. .. .. .. 7 75 .. .. 75 Polypus, Nasal Catarrh .. .. .. .. .. .. 2 12 .. .. 12 Tonsils and Adenoids .. .. .. .. .. .. 146 514 .. .. 514 Rheumatism .. .. .. .. .. .. 2 20 .. .. 20 Influenza .. .. .. .. .. .. .. .. 12 97 97 Bronchitis .. .. .. .. .. .. 7 52 .. .. 52 Pneumonia .. .. .. .. .. .. 23 182 16 148 330 Empyema .. .. .. .. .. .. 1 4 .. .. 4 Tuberculosis .. .. .. .. .. .. 1 10 .. .. 10 Intestinal Conditions .. .. .. .. .. .. 9 60 .. .. 60 Threadworms .. .. .. .. .. .. 68 579 .. .. 579 Umbilical Hernia .. .. .. .. .. .. 1 8 .. .. 8 Septic Umbilicus .. .. .. .. .. .. 2 13 .. .. 13 Stomatitis .. .. .. .. .. .. 3 26 •• .. 26 Burns and Scalds .. .. .. .. .. .. 2 15 .. .. 15 Pyrexia .. .. .. .. .. .. 2 10 .. .. 10 Abscess .. .. .. .. .. .. .. .. 3 60 60 Talipes .. .. .. .. .. .. 1 20 .. .. 20 Impetigo .. .. .. .. .. .. 3 22 .. .. 22 Eczema .. .. .. .. .. .. 1 7 .. .. 7 Septic Arm, Blisters, Foot .. .. .. .. .. .. 3 26 .. .. 26 Dislocated Hip .. .. .. .. .. .. 2 16 .. .. 16 Enlarged Glands .. .. .. .. .. .. 1 10 .. .. 10 Prematurity 1 8 .. .. .. .. 1 10 .. .. 18 Circumcision .. .. .. .. .. .. 3 28 .. .. 28 Vaginal Discharge .. .. .. .. .. .. 1 8 .. .. 8 Totals 78 1163 20 399 38 409 313 2052 37 376 4389 12 cases were in hand at the beginning of the year. 8 cases were in hand at the end of the year. A total of 4,389 visits were paid to 486 cases at a cost of £182 17s. 6d. 41 During the year 411 children under the age of 5 were nursed, a total of 3,604 visits being made at a cost of £150 3s. 4d. Of this expenditure, £65 1s. 8d. was expenditure under the Maternity and Child Welfare Scheme. Thirty-eight mothers received 409 visits for nursing in connection with conditions incidental to child-bearing, the cost being £17 0s. 10d. Thirty-seven adults and children over 5 received 376 visits for nursing at a cost of £15 13s. 4d. INFANTILE MORTALITY. One hundred and seventy-eight deaths of Bethnal Green infants under one year of age took place during the year. This is equal to a rate of infantile mortality of 71.1 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, 168 of the deaths were those of legitimate infants and 10 those of illegitimate infants. Accordingly, we have the following figures for Infantile Mortality:— Infantile Mortality (legitimate) 68.6 do. do. (illegitimate) 185.1 do. do. (all infants) 71.1 42 The only noteworthy comparisons with the previous years' figures are the reduction in mortality from Diarrhoeal diseases (34, as compared with 56) and an increase in mortality from the Developmental diseases (66 as compared with 49). While it is satisfactory to record the steady reduction in the infant death rate which has been shown in recent years, it is necessary to remember how much has got to be done before we can claim that the new born child has every prospect of a long and healthy life which our civilisation, rightly directed, could afford. The heavy mortality from the Developmental diseases (Premature Births, etc.) which takes place in the first few weeks, points to the need for more care for the mother. The substantial mortality from Respiratory diseases and the Diarrhœal group must be partly attributed to bad housing conditions, as well as poverty, which are preventable and should be prevented. 43 The Infantile Mortality figure of 71.1 per 1,000 births is the second lowest on record for Bethnal Green, the previous record having been 68.7 in 1923. Infantile Mortality in Bethnal Green in 1926. 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 Small-pox .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 5 9 14 5.6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup 1 1 .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis (30) .. .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis (31) .. .. .. .. .. .. .. 2 1 3 1.2 Other Tuberculous Diseases .. .. .. .. .. .. 1 1 .. 2 .8 Meningitis (not Tuberculous) (61) .. .. .. .. .. .. 2 .. .. 2 .8 Convulsions (71) 1 .. .. 1 2 1 .. .. .. 3 1.2 Laryngitis (87B) .. .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. 2 .. 3 3 4 .. .. 10 4.0 Pneumonia (all forms) (91 & 92) 1 1 .. .. 2 3 7 9 5 26 10.4 Diarrhœa (104 B, E & f) .. .. .. .. .. 2 5 1 .. 8 3.2 Enteritis (104 A, C, D & G) .. 1 1 .. 2 6 10 3 5 26 10.4 Gastritis (103A) .. .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. Rickets (36A) .. .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 1 .. .. .. 1 .. .. .. .. 1 .4 Injury at birth (152C) .. .. .. .. .. .. .. .. .. .. .. Atelectasis (152B) 3 1 .. .. 4 .. .. .. .. 4 1.6 Congenital Malformations (150) 3 .. 1 .. 4 2 .. 2 .. 8 3.2 Premature Birth (151A) 27 3 3 3 36 1 .. .. .. 37 14.7 Atrophy, Debility and Marasmus (151B) 3 .. 1 2 6 8 5 1 1 21 8.4 Other Causes 1 .. 1 1 3 1 2 3 4 13 5.4 Totals 41 6 9 7 63 27 36 27 25 178 71.1 Net Births in the year legitimate 2447 illegitimate 54 Net Deaths in the year legitimate infants 168 illegitimate infants 10 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. 44 PUERPERAL FEVER. Eight cases of this complication of childbirth were reported during the year. Four of the patients were treated in the Eastern Hospital, two in the London Hospital, one in Bethnal Green Hospital, and the remaining case was nursed at home. There were two deaths from the disease. On the 1st October new regulations came into force, making Puerperal Pyrexia notifiable. Up to the end of the year 9 cases were notified under this designation. Two of these cases were treated in the City of London Maternity Hospital, one in the Mothers' Hospital, Clapton, one in the Bethnal Green Hospital and the remainder at home. OPHTHALMIA NEONATORUM. Fifty cases of purulent eye-discharge in the new-born were notified, all by doctors. In every case the condition was cured without any apparent impairment of vision. Twelve cases received nursing attention at home from the Shoreditch and Bethnal Green District Nursing Association, the Borough Council paying part of the cost: 222 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 scrutinized, the object being the prevention of any risk of blindness resulting. In addition to the foregoing formal notifications of Ophthalmia Neonatorum, 47 reports were received from Medical Officers of the London County Council concerning new born babies suffering from inflammation of the eyes. These cases were also visited by the Health Visitors. 45 NOTIFIABLE DISEASES, Etc. Diphtheria. There were 646 cases of diphtheria notified during the year. Of these, there were 13 cases under the age of 1 year, 234 between the ages of 1 and 5 years, 340 between the ages of 5 and 15 years, 41 between the ages of 15 and 25 years, 16 between the ages of 25 and 45 years, and 2 between the ages of 45 and 65 years. Of the 646 cases, all were removed to an isolation hospital except 4. These cases were treated at home, proper facilities being available for isolation and treatment. Twenty-one deaths from this disease occurred during the year, equivalent to a case mortality of 3.2 per cent, or a general death rate of 0.17 per 1,000 of the population. Comparison with previous years is as follows:— Cases Deaths Death rate per 1,000 pop. 1917 340 19 0.17 1918 337 26 0.25 1919 552 58 0.53 1920 580 36 0.31 1921 565 34 0.28 1922 539 34 0.28 1923 489 20 017 1924 566 29 0.24 1925 493 19 016 These figures are illustrated by the death rate graph following page 2. Of the 21 deaths, 9 were of children 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 46 234 cases occurring during this period of life, it will be seen that 3.8 per cent died. At the epoch 5-15 years the mortality was 3.2 per cent. of those attacked. Anti-diphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor; 48,000 units were supplied during the year. Scarlet Fever. There were 469 cases of scarlet fever notified during the year. Of these, there were 8 cases under the age of 1 year, 167 cases between the ages of 1 and 5 years, 259 cases between the ages of 5 and 15 years, 26 cases between the ages of 15 and 25 years, and 9 cases between the ages of 25 and 45 years. Of the 469 cases, 461 were removed to an isolation hospital. No deaths were certified from scarlet fever during the year. Comparison with previous years is as follows:— Cases Deaths 1918 298 9 1919 393 4 1920 1070 12 1921 996 10 1922 356 6 1923 316 5 1924 426 5 1925 333 4 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 final diagnosis of all cases should be reported to the Medical Officer of Health concerned, 47 on the discharge of the patient. I have good reason to believe that in a substantial number of cases the diagnosis is changed at the hospital. Typhoid Fever. There were 14 cases notified during the year. One patient died from the disease. Continued Fever. One case was notified under this description. Small-pox. No case of Small-pox occurred in the Borough during the year. The last serious outbreak of Small-pox in the Borough took place in 1904, when 118 cases were notified. Since then, sporadic cases have occurred, as follows:— 1905 3 1915 1 1922 1 1906 6 1918 2 1923 1 1911 3 1919 1 1925 11 The small outbreak in 1925 suffices to remind us of the continued danger of this serious disease. Erysipelas. There were 80 cases notified and 3 deaths. Malaria. No case was notified. Dysentery. There were no cases reported. Acute Polio-Myelitis and Acute PolioEncephalitis. Two cases of Acute Polio-Myelitis and one of Acute Polio-Encephalitis were notified. 48 Acute Encephalitis Lethakgica. 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 ninety-three cases of acute primary pneumonia and 33 cases of acute influenzal pneumonia were notified during the year. In Bethnal Green we are fortunate in having the services of the District Nursing Association for the care of these patients, and in the existence in or near the Borough of several hospitals where the more severe cases may be treated. Pneumonia should be regarded as an infectious disease, and the public should appreciate the risk of its spreading by carriers, both convalescents and attendants upon patients. It is usually most prevalent in the early spring and late winter. Dust, cold, damp, lack of sunshine, overcrowding, smoky atmosphere, and indiscriminate spitting in public places, all undoubtedly influence the pneumonia rate. At present, the only forms of pneumonia which are notifiable are those specified in this heading, but it would greatly facilitate the study of pneumonia infections if all forms, such as Broncho Pneumonia, were made notifiable, and if the type of the disease were given on the notification. Special supervision is desirable in the case of children who have recovered from Broncho Pneumonia following Whooping Cough or Measles, and this would be rendered possible by a wider notification of Pneumonia. 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. 49 Cases of Notifiable Diseases Notified During the Year 1926 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 .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 646 13 231 340 41 16 2 .. Erysipelas 80 2 4 7 9 20 26 .. Scarlet Fever 469 8 167 259 26 9 .. .. Typhus Fever .. .. .. .. .. .. .. .. Enteric Fever 14 4 4 3 2 .. .. Puerperal Fever 8 .. .. .. 2 6 .. .. Cerebro-spinal Fever 4 3 1 .. .. .. .. .. Acute Poliomyelitis 2 1 1 .. .. .. .. .. Acute Encephalitis Lethargica 6 .. 1 2 2 .. .. .. Ophthalmia Neonatorum 50 50 .. .. .. .. .. .. Acute Polio-encephalitis 1 .. 1 .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. Malaria .. .. .. .. .. .. .. .. Acute Primary Pneumonia 193 15 54 40 20 27 26 11 Acute Influenzal Pneumonia 33 1 3 .. 8 16 3 2 Pulmonary Tuberculosis 154 .. 3 7 43 43 51 7 Other forms of Tuberculosis 57 .. 10 22 11 9 3 2 Cholera, Plague, Relapsing Fever .. .. .. .. .. .. .. .. Continued Fever 1 .. .. .. 1 .. .. .. Anthrax .. .. .. .. .. .. .. .. Hydrophobia, Glanders .. .. .. .. .. .. .. .. Total 1727 93 483 681 168 155 112 35 50 DISINFECTION SERVICE. During the year, 1,638 rooms and 20,895 articles were disinfected for various reasons, liquid Formalin in the form of a spray being used for the purpose of disinfecting rooms. Both the Belsize motor vans used for conveying articles for disinfection showed signs of being the worse for wear during the year. One was overhauled and reconditioned, and it was decided to sell the other and purchase a new Morris van in its place. The table appended gives full details of the rooms, bedding and clothing disinfected. 51 Rooms, Bedding and Clothing Disinfected dueing the Year ending 31st December, 1926. 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 25 54 .. .. .. .. 12 2 .. 2 8 5 108 1684 February 13 50 .. .. .. .. 11 2 2 1 11 2 92 1505 March 21 62 .. .. .. .. 12 1 5 2 18 5 126 1600 April 24 28 .. 4 .. .. 17 2 1 .. 25 1 104 1094 May 29 22 .. .. .. .. 8 .. .. 2 33 2 97 936 June 34 41 .. .. .. .. 17 1 2 .. 59 4 158 1417 July 41 27 .. .. .. .. 13 1 2 .. 27 8 119 1337 August 42 76 .. 1 .. .. 13 .. 1 2 45 180 1370 September 80 89 .. 3 .. .. 4 .. .. .. 41 1 218 1677 October 70 65 .. .. .. .. 11 3 .. .. 9 1 159 1989 November 57 67 .. .. .. .. 21 .. 1 .. 3 6 155 4777 December 31 47 .. 2 2 .. 21 .. .. 4 10 5 122 1509 Totals 467 628 .. 10 3 2 160 12 14 13 289 40 1638 20895 No. of articles destroyed by request 295 Articles disinfected in Formalin Chamber, such as boots, boxes, books, etc. (included in 20,895 above) 5,090 52 Verminous Conditions. Two hundred and nineteen 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. In 23 cases advantage was taken of the offer. During the year 20 men infested with body-lice had baths at the Disinfecting Station and 186 articles of their clothing were disinfested at the same time. Rooms were disinfested of bugs in 266 cases. Scabies or Itch. Forty children suffering from this disease were visited after being excluded from the Elementary Schools. In 13 instances disinfestation of the clothing and bedding was accepted, 120 articles being disinfested. Thirteen rooms were also fumigated after scabies, by request. Cleansing Station. During the year attention was drawn to the need for a Cleansing Station to assist residents affected with vermin, Scabies and similar conditions. A scheme to provide accommodation for the purpose at the Disinfecting Station was under consideration at the end of the year. BACTERIOLOGICAL EXAMINATIONS. BACTERIOLOGICAL EXAMINATIONS. The following examinations were carried out by the Royal Institute of Public Health:Throat and Nasal Swabs—submitted for examination 858 Diphtheria bacilli present in 110 Sputum—specimens submitted for examination 178 Tubercle bacilli present in 19 Blood-serum—specimens examined 5 Widal reaction positive in 2 53 TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year are set out in the table appended hereto, from which it will be seen that 211 new cases of Tuberculosis were notified under the Public Health (Tuberculosis) Regulations. In addition, there were 21 cases which came to my knowledge other than by notification, 13 of these being after death, making a total of 232 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. The number of cases remaining on the Register at the 31st December, 1926, was 1,337. The details are given in the table on page 55. During the year there were 121 deaths from Pulmonary Tuberculosis, 8 deaths from Tuberculous Meningitis, and 12 deaths from other tuberculous diseases. The number of deaths from Tuberculosis of all kinds during the past few years is as follows:— Pulmonary Non-Pulmonary Total 1919 185 31 216 1920 173 24 197 1921 158 26 184 1922 194 25 219 1923 164 19 183 1924 134 18 152 1925 121 21 142 54 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 1926. Age of Patient Tuberculosis of the Lungs Other Tuberculosis. Male Female Total Male Female Total Primary Notifications. 0—1 year. .. .. .. .. .. .. 1—5 years. 2 1 3 3 7 10 5—10 „ 2 2 4 4 3 7 10—15 „ 1 2 3 5 5 10 15—20 „ 6 13 19 4 3 7 20—25 „ 12 12 24 3 1 4 25—35 „ 9 15 24 2 2 4 35—45 „ 13 6 19 2 3 5 45—55 „ 26 10 36 2 1 3 55—65 „ 11 4 15 •• .. .. 65 years and over 5 2 7 1 1 2 Total 87 67 154 26 26 52 Cases re-notified 32 33 65 .. 6 6 Total Notifications on Form A 119 100 219 26 32 58 Primary Notifications by School Medical Officers. 0—5 years .. .. .. .. .. .. 5—10 „ .. .. .. 2 2 4 10—15 „ .. .. .. .. 1 1 Cases re-notified .. .. .. 3 .. 3 Total Notifications on Form B .. •• .. 5 3 8 55 No. of Notifications on Forms C. & D. Poor Law Institutions Sanatoria c d c d Pulmonary Tuberculosis— Male 25 15 83 67 Female 16 4 35 31 Non-Pulmonary Tuberculosis— Male 2 1 12 8 Female 3 2 15 13 C—upon admission D—upon discharge Public Health (Tuberculosis) Regulations, 1924. Pulmonary Non-Pulmonary Total Males Females Males Females Number of cases on the Tuberculosis Register 31/12/25 583 391 195 164 1333 Number of cases notified under the Public Health (Tuberculosis) Regulations, 1912, during the year 1926 89 65 27 30 211 Other eases added to the Tuberculosis Register during 1926 4 5 1 1 11 676 461 223 195 1555 Number of cases removed from Tuberculosis Register during 1926. (For details see separate statement) 103 78 18 19 218 Cases remaining on Tuberculosis Register 31/12/26 573 383 205 176 1337 56 Details of Cases removed from Tuberculosis Register during the year 1926. Pulmonary non-Pulmonary Total Males Females Males Females Deaths 79 55 8 8 150 Patients removed from Borough — — — — 56 Cases removed from Register as “Cured” - — — — 12 Total cases removed from Register — — — — 218 EX-SOLDIERS AND SAILORS SUFFERING FROM TUBERCULOSIS One hundred and fifty-eight ex-Service men were under observation during the year. There were 14 deaths amongst these, and 9 removed from the Borough. Three hundred and nine visits were paid to these men by the Tuberculosis Health Visitor. WORK OF TUBERCULOSIS HEALTH VISITOR. This officer paid 3,184 visits to cases. Towards the end of the year, acting on the recommendation of my predecessor, the Council appointed a second Tuberculosis Health Visitor. TUBERCULOSIS SUB-COMMITTEE. The Public Health Committee also set up a Tuberculosis Sub-Committee to undertake certain duties previously performed by an interim Tuberculosis Care Committee established by the L.C.C. SUPPLY OF SPUTUM OUTFITS. During the year 17 sputum flasks were distributed to patients. Forty-two sputum tins, with 2,732 cardboard refills, were distributed to patients for use indoors. 57 GRANTS OF EXTRA NOURISHMENT. The arrangements with regard to grants of extra nourishment to tuberculous patients were fully reported in the Annual Report for 1921, and were continued during 1926. Since 21st February, 1926, Grade A (Tuberculin Tested) Milk has been given instead of ordinary milk. During the year 211 grants of milk and eggs were made to 95 patients at an estimated, cost of £217. Nineteen patients were 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 96. JOINT DISPENSARY COMMITTEE. The Joint Dispensary Committee (which was set up under the agreement between the Borough Council and the Governors of the City of London Hospital for Diseases of the Heart and Lungs, and consists of four representatives of the Hospital Governors, three representatives of Bethnal Green and three of Hackney), has met regularly during the year. DENTAL TREATMENT FOR TUBERCULOSIS PATIENTS. During 1926, 7 dispensary patients received dental treatment at the City of London Hospital for Diseases of the Heart and Lungs. There were 5 attendances for extractions, all under gas. In addition there were 5 other attendances for advice and treatment. 58 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 23 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, having 18 refills between them. ARTIFICIAL LIGHT TREATMENT. During the year arrrangements were made, with the approval of the Ministry of Health and London County Council, for the provision of Artificial Light Treatment for Tuberculosis patients, chiefly nonpulmonary cases, at the City of London Hospital for Diseases of the Heart and Lungs, from the 1st April. Up to the end of the year, 6 patients had received 160 treatments under these arrangements. 59 PROTECTION OF FOOD SUPPLY Public Health activities for the protection of the food supply take three forms: (i) Supervision of premises where food is prepared or sold to ensure cleanliness; (ii) Examining food as to its soundness; and (iii) Sampling food to ascertain its composition and quality. Milkshops, cowsheds, bakehouses, butchers' shops, fish shops, slaughterhouses and other food premises are inspected fairly frequently, and any unsatisfactory conditions found are at once dealt with. The vigilance of the staff in detecting the sale of unsound food will be shown by the figures on pages 72 and 73, while the results of action taken under the Sale of Food and Drugs Acts immediately follow. 60 SALE OF FOOD AND DRUGS ACTS. Seven hundred and twenty-seven samples were taken; 704 of these proved to be "genuine," and 23, or 3.1%, adulterated The details are given in the following table:— SUMMARY OF ANALYST'S REPORTS. Article Samples taken formally Samples taken informally Total number of Samples taken No. taken Genuine Adulterated No. taken Genuine Adulterated Milk 337 327 10 3 3 .. 340 Butter 144 142 2 18 18 .. 162 Margarine 15 15 .. 6 6 .. 21 Lard 11 11 .. 6 6 .. 17 Dripping 3 3 .. 7 7 .. 10 Shredded Suet 1 .. 1 .. .. .. 1 Cream 6 3 3 1 1 .. 7 Cream (Preserved) 9 9 .. .. .. .. 9 Condensed Milk 10 10 .. 2 2 .. 12 Dried Milk .. .. .. 3 3 .. 3 Jam 40 39 1 .. .. .. 40 Coffee 10 10 .. .. .. .. 10 Cocoa 4 4 .. .. .. .. 4 Vinegar 39 38 1 1 .. 1 40 Camphorated Oil 7 5 2 .. .. .. 7 Glycerine 1 1 .. .. .. .. 1 Aspirin Tablets & Powders 2 2 .. .. .. .. 2 Carbonate of Soda .. .. .. 1 1 .. 1 Flour 7 7 .. 6 6 .. 13 Bread .. .. .. 1 1 .. 1 Pastries 7 7 .. .. .. .. 7 Custard Powder 1 1 .. .. .. .. 1 Moist Sugar 2 2 .. .. .. .. 2 Honey ] 1 .. .. .. .. 1 Treacle 1 1 .. .. .. .. 1 Golden Syrup 1 .. 1 .. .. .. 1 Salmon and Shrimp Paste 1 1 .. .. .. .. 1 Herrings in Tin .. .. .. 1 1 .. 1 Ham and Tongue Paste 1 1 .. .. .. .. 1 Potted Meat .. .. .. 1 1 .. 1 Apples .. .. .. 2 2 .. 2 Fish Frying Oil 4 4 .. .. .. .. 1 Tomato Sauce .. .. .. 1 1 .. 1 Ices Mixture 1 .. 1 .. .. .. 1 Vermicelli .. .. .. 1 1 .. 1 Totals 666 644 22 61 60 1 727 61 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 (6) Previous Convictions (if any) (c) Other Remarks Milk 126 6½% added water Costs £2 2s. .. Camphorated Oil 188 11% less than proper amount of camphor Costs £1 1s. (c) Summons taken against wholesaler for giving false warranty. Fined £3 Costs £7 7s. Do. 210 8½% Do. Costs £2 2s. Cream 268 0.35% boric acid .. (c) Conviction in respect of cream not bearing a declaratory label. Butter 279 2/10% water beyond legal limit .. (c) No legal action taken Cream 315 0.35% boric acid .. (c) Conviction in respect of cream not bearing a declaratory label. Milk 333 2½% added water .. (c) No legal action taken Do. 352 3.5% added water .. (c) Do. Cream 376 0.12% boric acid .. (c) Conviction in respect of cream not bearing a declaratory label. Milk 413 3.5% added water .. (c) No legal action taken Ices Mixture 478 0.06% boric acid .. (c) Do. Milk 485 4.7% added water Costs £2 2s. (6) Previous conviction, 26/6/23. Vinegar 524 12.5% added water Fined £8 Costs £2 2s. .. Blackberry Jam 530 20% apple pulp Fined £5 Costs £3 3s. .. 62 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 (6) Previous Convictions (if any) (c) Other Remarks Milk 580 93% less than proper amount of fat .. (c) Summons not served; Vendor gave incorrect address. Do. 625 5.8% added water Dismissed. Warranty proved. .. Do. 626 3.5% Do. .. (c) Vendor cautioned Golden Syrup 647 75% syrup other than cane or beet syrup Fined £5 Costs £2 2s. .. Milk 651 4.7% added water Fined £3. Costs £2 2s. (c) Conviction also for being unregistered Butter 657 1.6% excess of water and 2.2% of free fatty acids Costs 21s. .. Shredded Suet 659 17% rice starch Costs 21s. .. Milk 663 7% added water Costs £3 3s. .. 63 ACTION TAKEN WITH REGARD TO OFFENCES OTHER THAN ADULTERATION. Articles No. of Sample Offence Result of Prosecution or Remarks Margarine 221 Exposing for sale unlabelled parcel of margarine Fined 10s. Cream 268 (a) Depositing for sale preserved cream in receptacle not bearing declaratory label Fined £1 Costs 10s. (b) Delivering to purchaser preserved cream in receptacle not bearing declaratory label Fined £1 Costs 10s. Do. 315 (b) Delivering to purchaser preserved cream in receptacle not bearing declaratory label Fined £15 Costs £3 3s. Do. 376 (b) Delivering to purchaser preserved cream in receptacle not bearing declaratory label Costs £5 5s. Do. 451 Depositing for sale preserved cream in receptacle not bearing declaratory label Costs £1 11s. 6d. Milk 580 Selling milk from vehicle and receptacle neither of which was inscribed with name and address of vendor Summons not served. Vendor's address unknown Do. 580 Selling separated milk from churn not marked "separated milk" in large and legible type Do. Do. 580 Carrying on trade of dairyman without being registered by the sanitary authority Do. Margarine 605 Exposing for sale unlabelled parcel of margarine Vendor cautioned Milk 651 Carrying on trade of dairyman without being registered by the sanitary authority Fined 20s. Costs 21s. Margarine 653 Selling margarine by retail in plain wrapper and from unlabelled bulk Vendor cautioned Do. 660 Exposing for sale unlabelled parcel of margarine Fined £2 Costs 21s. 64 SAMPLES TAKEN INFORMALLY. Sixty-one samples were taken informally during the year, one of which was found to be adulterated, as follows:— Sample 540.—Vinegar. Found to contain 12 per cent added water. The genuine samples were:— Butter 18; Dripping 7; Margarine 6; Lard 6; Flour 6; Milk 3; Condensed Milk 2; Cream 1; Dried Milk 3; Apples 2; Tomato Sauce 1; Tinned Herrings 1; Bread 1; Carbonate of Soda 1; Vermicelli 1; Potted Meat 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 thirty-seven formal samples and 3 informal samples of milk were taken, and in no case was the presence of a preservative reported. Nine samples of preserved cream were taken, all of which proved to be genuine, but in 1 case the receptacle containing the cream was not labelled in accordance with the Regulations. Of 6 samples of cream which were taken, 3 were found to contain boric acid to the extent of 0.12 per cent., 0.35 per cent and 0.35 per cent respectively, the receptacles in which they were 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 contain 7 per cent added water, certain samples of milk were, at the request of the owner, taken direct from the cows at the shed. Upon analysis, these samples were found to be genuine. 65 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Ten formal samples and two informal samples of condensed milk were taken under these Regulations, all of which proved to be genuine. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. Three informal samples of dried milk were taken during the year, each of which complied with the Regulations. BACTERIOLOGICAL EXAMINATIONS OF FOOD. During the year, more attention has been paid to the possible presence of harmful bacteria in milk and other foods. Several samples of ice cream bought from stalls in the Borough were found to contain pathogenic bacilli to a serious extent, and it was decided to take proceedings in one case under the unsound food section of the Public Health (London) Act. Upon the summons being heard, the case was dismissed upon payment by the defendant of £5 5s. costs, the magistrate being of opinion that the sample in question should have been divided (on the analogy of the Sale of Food and Drugs Act) to give the defendant the opportunity for a private analysis. Samples of other foods were submitted to bacteriological analysis as follows: Milk, 7—6 being found to be unsatisfactory. Grade A Milk, 2—found to be satisfactory. Grade A (Tuberculin Tested Milk) 8—5 being found unsatisfactory. Condensed Milk, 1—found to contain streptococci, etc. Ice Cream, 20—the bulk of them being found unsatisfactory. Butter, 2—found to be unsatisfactory. 66 FOOD PREMISES. Milkshops and Dairies. Twenty-nine* applications for registration were considered during 1926, one of them being from a firm outside the Borough, proposing to sell bottled milk from their carts in the Borough. 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 milk- shops on register at end of 1925 245 Deduct number of purveyors removed from register during 1926 5 Add number of new purveyors added to register by resolution of the Public Health Committee during 1926 4 Number of purveyors of milk at retail milk- shops on register at end of 1926 244 During the year 809 inspections of milkshops were made by the Inspectors, and 83 notices were served under the Public Health (London) Act, 1891. No legal proceedings were found to be necessary. A copy of the Milk and Dairies Order, 1926, has been furnished to each Dairyman in the Borough, and his attention has been drawn to the requirements of the Order. Milk (Special Designations) Order, 1923. Two purveyors in the Borough were licensed for the sale of "certified milk" and "Grade A (Tuberculin Tested) Milk," and eight for the sale of "Grade A (Tuberculin Tested) Milk" only, while supplementary licenses, one to sell "certified milk" in the *This includes changes of occupier in premises previously on the register. 67 Borough from premises in Hackney and another to sell "Grade A (Tuberculin Tested) Milk" in the Borough from premises in Poplar, were also granted during the year. Samples of Grade A and Grade A (Tuberculin Tested) Milk, were taken upon delivery at two local institutions, with unsatisfactory results in 5 cases. The attention of the Ministry of Health and other authorities concerned was drawn to the matter. Cowhouses. There were at the end of 1926 eleven licensed cowhouses in the Borough, as in previous years; 40 inspections were made during the year. The premises are as follows:— 63, Bishop's Road.—Shed No. 1—8 cows, Shed No. 2—6 cows.) 42, Cheshire Street.—(6 cows.) 23, Ezra Street.—(6 cows.) 38, Fellbrigg Street.—Shed No. 1—8 cows, Shed No. 2—8 cows.) 104, Gibraltar Walk.—(18 cows.) 34b, Green Street.—(45 cows.) 1, Hamilton Road.—(14 cows.) 55, Kerbela Street.—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.) Not used as cowsheds in 1926. A copy of the Milk and Dairies Order, 1926, has been furnished to each cowkeeper in the Borough and his attention has been drawn to the requirements of the Order. Representations have also been made to the London County Council, as the licensing authority 68 for cowhouses, concerning the unsatisfactory character of certain of these premises, which are of such old construction and so situated as to be difficult of alteration to comply with modern standards. The eleven cowhouses in Bethnal Green have accommodation for a maximum of 195 cows. It appears to me, however, that the keeping of cows in a large city ought to be prohibited—certainly in a congested district like Bethnal Green. The cows are cooped up for many months (in one case for a continuous period of sixteen months) in dark, ill-ventilated and ill-constructed cowsheds, where often their only means of exercise is alternating between getting up and lying down. In many of these premises the cowshed, dung receptacles, milk cooler, water supply, w.c. and stores of litter and foodstuffs, are all so crowded together that the production of a safe milk supply is an utter impossibility. When it is remembered that Nature intended the cow to roam in meadows, with free access to sunlight and fresh air, which are vitally important factors in the production of wholesome milk, it will be seen that the present state of things is fundamentally wrong. I understand that there are about 500 cowhouses in the County of London. It is clear, however, that the only satisfactory milk supply for a vast city like London must be derived from the surrounding country, and it should be possible, with a little enterprise and adjustment, for the existing cowkeepers to restrict themselves to the distribution of a safe, bottled milk produced by cows living in natural and healthy conditions. Ice Cream Premises. There were 164 ice cream premises recorded at the end of the year, and 367 visits were paid to them by the district inspectors. As mentioned on page 65, samples of ice cream were purchased for bacteriological analysis during the year, and legal proceedings were taken in one case. 69 Fried Fish and Fish-Curing Premises. At the end of 1926 there were 51 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. Two hundred and seven visits were made by the Food Inspector to these premises, and 17 notices were served for insanitary conditions. Workshop Bakehouses. In the County of London, the Metropolitan Borough Councils are responsible for enforcing proper sanitary conditions in all bakehouses, whether wholesale or retail, which are workshops, that is, without mechanical power. There are, in Bethnal Green, 57 workshop bakehouses, 17 of which are underground: 186 visits were made to them during the year, resulting in the serving of 37 sanitary notices. Factory Bakehouses. There are in Bethnal Green 20 factory bakehouses, 7 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. Fifty-seven inspections were made during the year, and arising out of these visits, 2 notices were served. 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. 70 Other Premises used for the Preparation or Sale of Food. There were 182 such premises on the register, the majority being restaurant-kitchens. Five hundred and eighty-three inspections were made during the year, and arising out of such inspections 90 Notices to remedy faults or insanitary conditions were issued. SLAUGHTERHOUSES. There were 3 licensed slaughterhouses in the Borough at the end of 1926, situated at:— 294, Bethnal Green Road. 354, Bethnal Green Road. 27 8, Hackney Road. Visits were made to slaughterhouses by the Food Inspector twice weekly during the year. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. During the year 1926, 175 visits were made to the slaughterhouses for the purpose of inspecting animals and their carcases after slaughter. Two of the slaughterhouses are used regularly every week, and it must be said that all three butchers kill prime cattle, sheep and pigs, therefore the amount of disease found is comparatively small and confined usually to the organs only. The following is a list of animals killed:— Bullocks 101 Heifers 1 Calves 23 Sheep 414 Lambs 192 Pigs 293 Total 1,024 71 The following carcases or offal were condemned and destroyed for reasons shown:— Bullocks' Livers 17 Distomatosis do. 2 Abscess do. 4 Cirrhosis Bullocks' Pluck 1 Abscess do. Lungs 2 Pneumonia do. do. 1 Parasitic Cyst Heifers' Pluck 1 Tubercular Sheep's Livers 1 Abscess do. do. 1 Parasitic Cyst do. do. 1 Distomatosis do. Lungs 4 Abscess Lambs' Livers 3 Abscess Pigs' Carcases 2 Tubercular do. Heads 13 Tubercular do. Livers 8 Unsaleable do. Pluck 2 Tubercular do. Lungs 2 Abscess I am pleased to record the fact that during the year it was necessary to prosecute only one street meat trader for non-compliance with the regulations with regard to covering the stall for the protection of the meat from dirt, etc. This man was an old offender and the penalty imposed on this occasion was £4. SLAUGHTERERS OF POULTRY. There are 8 slaughterhouses for poultry in use, all of them situated in the West ward of the Borough: 63 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. 72 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. In addition to the special inspections of slaughterhouses and other premises where food is prepared or sold, the Food Inspectors keep stalls and market places under regular supervision, particularly during the week-end. The District Sanitary Inspectors also keep general observation in the course of their duties. Eight seizures of unsound food were made by the staff during 1926, as follows:— Seizures. Date Description Number or Weight cution and Result 1st March Pears 35 Fine £15. Costs £5 5s. 2nd March Peas 90 lbs. Fine £6. Costs £5 5s. 17 th May Walnuts 14 lbs. Fine £3. Costs £2 2s. 17th July Pears, Oranges, 8 lbs. Manager Fined £5. Costs £1 1s. Plums, Lemons, Apples Owner—Costs £1 1s. 16th Aug. Bananas 38 Fine £10. Costs £3 3s. 27th Sept. Butter 1 lb. Fine £1. Costs £2 2s. 27th Sept. Do. 3¼ lbs. Fine £4. Costs £1 1s. on each of two summonses. 24th Nov. Meat Paste 91 tins Fine £1—Retailer. Two Wholesalers fined £10 and £2 respectively, with costs £3 3s. and £2 2s. On 40 occasions during the year unsound food, comprising the following articles, was surrendered by the owners and destroyed as trade refuse:— 73 Articles Surrendered. Description of Article. Weight. Tons. Cwts. lbs. Fish — 7 19 Meat — 8 49 Fruit — 13 36 Vegetables 12 2 84 Rabbits — 1 58 Other Articles - - 19 also 4 boxes winkles 1 barrel crabs 19 gallons shrimps 1 box herrings 1 barrel pears 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. 74 GENERAL SANITARY ADMINISTRATION. SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding for the 52 weeks ended 1st January, 1927. Nature of Visit Inspector— G. . Brighting. J. H. Hewitt. G. E. Gould. F. T. Bare. W. H. Heron. I. R. Jones. A. S. Henley. J. G. Weeks. W. Billings. E. J. Jenkins. Totals. District .. A B C D E F Food Food H.to H. W'shps Infectious Disease .. 210 210 257 125 312 287 .. .. 37 7 1445 Complaints .. 1289 735 633 902 824 685 .. .. 60 149 5227 House to House Inspections .. .. 22 139 .. 65 20 .. .. 768 .. 1014 Milkshop Inspections .. 61 68 157 160 141 64 .. .. 1 .. 652 Other Pood Premises .. 44 107 167 150 62 85 515 .. 8 .. 1138 Factory and Workshop Inspections .. .. .. .. 14 .. 31 .. .. 6 2200 2251 Outworkers' Home Inspections .. 406 360 161 79 190 283 .. .. 1 .. 1481 Tenement House Inspections .. 38 2 149 151 29 50 .. .. 2 .. 421 New Buildings Inspections .. .. .. 26 .. .. 36 .. .. 3 4 69 Combined Drainage Inspections .. .. 166 233 .. 59 293 .. .. 205 1 957 Smoke Nuisances Premises under Observation .. 3 3 7 3 .. 1 .. .. 1 1 19 Other Inspections or Special Work 447 602 782 272 1102 924 155 2 304 116 4706 Re-Inspections .. 3851 3520 3120 4602 3079 3082 65 .. 3304 2907 27530 Total Visits for the Year .. 6299 5795 5831 6458 5863 5841 735 2 4700 5385 46909 Unsound Food Seizures or Surrenders .. .. .. .. .. .. .. 17 29 5 .. 51 Samples of Food, etc., taken .. .. .. .. .. .. .. 39 681 .. 13 736 Police Court Attendances .. .. 2 3 3 3 1 4 72 23 17 128 Premises where Nuisances Abated .. 1117 1087 987 1279 1098 1276 50 .. 569 965 8428 Premises where Matters Outstanding .. 67 44 76 72 95 69 .. .. 100 70 593 75 The increase in the inspectorial staff is reflected in the substantial increase in the number of inspections made during the year. Mr. Billings' allocation for house to house inspection has resulted in 1014 houses being dealt with in this way, as compared with 440 in the previous year. There have also been large increases in the numbers of inspections of milkshops and other food premises, factories, workshops and outworkers' homes. One of the practical results of the increased sanitary inspection of the district, particularly from house to house, is shown in the following table: SANITARY DEFECTS DISCOVERED DURING 1926. Period Dirty Rooms Defective Drains Defective and Dirty W.C.'s. Defective Water Supply Other Matters Total 4 wks. ending 30th Jan. 592 54 188 140 1522 2496 4 „ „ 27th Feb. 643 45 228 89 1452 2457 5 „ „ 3rd Apl. 1172 84 390 78 1587 3311 4 „ „ 1st May 890 56 297 83 1390 2716 4 „ „ 29th May 613 48 243 58 1268 2230 5 „ „ 3rd July 787 66 325 51 1553 2782 4 „ „ 31st July 568 8 209 64 1663 2512 4 „ ,, 28th Aug. 492 6 187 57 1743 2486 5 ,, „ 2nd Oct. 937 59 338 57 2230 3621 4 „ „ 30th Oct. 532 50 253 40 1519 2394 4 „ „ 27th Nov. 633 60 275 58 2187 3213 5 „ „ 1st Jan. 468 52 246 49 1742 2557 Totals 8327 588 3179 824 19856 32774 The number of dirty rooms discovered (and of course subsequently dealt with) has increased from 5947 in 1925 to 8327 last year. The increased outdoor sanitary work is reflected in the greater volume of associated clerical work which has also been recorded. During the year 6,712 Preliminary Notices were served requiring the remedying of Nuisances. 5,323 Statutory Notices were served. Formal letters giving 76 notice of legal proceedings were sent in 1,085 cases. These figures compare with 4705, 4737 and 569, respectively, in 1925. During the year nuisances at 8,394 premises were abated. TENEMENT HOUSES The number of houses remaining on the register as being let in lodgings or occupied by members of more than one family was 170; 933 visits of inspection were made to these houses, and arising out of such visits 283 notices were served. During the year, new By-laws with regard to tenement houses came into operation, although many important clauses do not operate until six months after the Rent Restrictions Acts have ceased to be in force. The new By-laws apply to a great many houses in Bethnal Green, and should lead to a considerable improvement in the sanitary condition and comfort of these houses. RENT AND MORTGAGE INTEREST RESTRICTIONS ACTS, 1920 & 1923 During the year one application for a certificate as to the state of repair of a house was received, and it was granted. CUSTOMS AND INLAND REVENUE ACTS. Provision was contained in the Customs and Inland Revenue Act, 1890, amended in 1891 and 1903, for the exemption from inhabited house duty of dwellings below 7s. 6d. in weekly rent, certified by the Medical Officer of Health to be so constructed as to provide suitable accommodation for the families occupying them. Owing to the lapse of time and altered level of rentals, little use is now made of this provision and no application for a certificate was received during the year. 77 WATER SUPPLY TO NEW HOUSES. During the year 49 new houses were certified as having a proper and sufficient water supply. SMOKE NUISANCE. During the year, 22 formal observations of smoke shafts were made, but no nuisances were observed of such a character as to cause notices to be served. The Public Health (Smoke Abatement) Act, 1926, which will come into force on the 1st July, 1927, makes some slight alterations in the law with regard to smoke nuisances. An important change is that an emission of smoke need not be black in order to be deemed a nuisance, the definition of smoke is made to include soot, ash, grit, etc., and the maximum penalties for offences are substantially increased. The value of the Act is, however, somewhat discounted by a provision that any person charged may plead that he has used the best practicable means for preventing the nuisance having regard to the cost and to local conditions and circumstances. The Act maintains the exemption of private dwelling houses from the law with regard to smoke nuisances. This matter is of considerable public health importance. Few things contribute so greatly to the polluted state of the atmosphere and to the reduction of vital sun rays reaching us as the emission of coal smoke into the air. This applies just as much to the private dwelling house as to the factory. It is to be hoped that gas and electricity will increasingly take the place of the wasteful and polluting coal fires, although those who are attached to the old open grate can obtain appliances burning smokeless coke which are quite economical and clean. Bethnal Green, in particular, needs the maximum amount of clean air and available sunlight for the health of its population, children and adults alike, as some counter influence to the congested housing conditions which prevail. 78 RATS AND MICE (DESTRUCTION) ACT, 1919. No formal notices were served under the Act during the year, but an abstract of the requirements of the Act was posted in the Borough. A number of complaints as to rat infestation have been investigated and dealt with and occupiers of premises have been advised in the matter. Poor occupiers have been assisted by the supply of rat poison, 52 tins being issued in this way. The investigation of rat complaints has in many cases led to the discovery and repair of defective drains. During the early part of November the Clayton Disinfecting apparatus, jointly owned by the Works and the Public Health Committees, was brought into use, and the Borough Engineer informs me that the sewers in the following streets were thoroughly cleared of rats during this period:— Barnsley Street Brady Street Buckhurst Street Coate Street Code Street Coventry Street Cross Street Cudworth Street Darling Row Fleet Street Hill Garner Street Lisbon Street New Church Street Old Bethnal Green Road Pedley Street School Place Scott Street Somerford Street Tapp Street Teale Street Teesdale Street Tent Street Warner Place Weaver Street 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 in 10 offences under these by-laws, and fines and costs were imposed upon the offenders to a total amount of £30 1s. 79 OFFENSIVE TRADES. During the year, one offensive trade, that of a Fur-skin Dresser, was carried on at 74, Florida Street. Two inspections were made at these premises. Poultry slaughtering, an offensive trade also, is dealt with elsewhere in this report. RAG-FLOCK ACT, 1911. Thirteen formal samples of rag-flock were taken during the year, and in 4 cases the amount of chlorine present found to be in excess of the limit fixed by the Regulations. Prosecutions took place in each case, and although in 3 instances the summonses were dismissed, each of the defendants was required to pay £2 2s. costs. The decisions in these cases undoubtedly arose from the difficulties of the defendants in obtaining coal supplies, owing to the Mining Dispute. RAG AND BONE DEALERS. Twenty-two persons or firms are known to be carrying on this business in the Borough. During the year 34 visits of inspection were made, and 3 sanitary notices were served. Proceedings were taken in four cases of contravention of the bye-laws. HAIRDRESSERS. During the year a list of the Hairdressers in the Borough was compiled, with a view to these businesses being kept under Public Health observation. Seventyfour premises were placed on the register, and 130 visits were made to them. CINEMAS. Having regard to the possibility of their acting as media of infection, visits of inspection were paid to the Cinemas in the Borough, and in 3 cases samples 80 of air were taken. Two of these samples revealed the presence of 12.4 and 14.8 parts per 10,000 of carbondioxide, respectively, both being above the permissible limit of 10 parts per 10,000. 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 707 such systems in the Borough, draining approximately 3,290 houses and premises. The staff engaged on this work consists of a drainlayer and two labourers, with additional help as required. During the year nine systems were reconstructed, taking 41 houses. DRAINAGE WORK. Legal proceedings were taken during the year in respect of various offences in connection with drainage work, as follows:— Constructing w.c. without notice, 3; constructing w.c. in contravention of by-laws, 2; constructing drain without giving notice, 1; constructing drain in such manner as to be nuisance, 1; and making connection to sewer without submitting plans, 1. The proceedings were successful in 6 cases, in the other 2 the summonses were withdrawn for technical reasons upon payment by the defendant of £1 1s. costs on each summons. 81 PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 129 bodies were received at the Mortuary, i.e.— On Coroner's order 88 From the Police 7 At the request of relatives 34 Exact particulars are only available as to the 93 bodies on which coroner's inquests were held. On 57 of these bodies post-mortem examinations were male. Mortuary Statistics. Places from which bodies were brought to the Mortuary. Removed by the Police from the canal and Victoria Park Lake 4 Removed by the Police from streets, etc. 3 Removed from Bethnal Green Hospital 25 „ „ Queen's Hospital 10 „ „ Mildmay Mission Hospital. 3 „ „ Victoria Park Hospital 1 „ „ Private houses, etc. 47 Total 93 82 Inquest cases classified according to age:— Number under 1 year 18 „ over 1 year and under 5 years 3 „ „ 5 years „ „ 10„ 2 „ „10„ „ „ 20 „ 3 „ „ 20 „ „ ,, 30 ,, 2 „ „ 30 ,, „ ,, 40 ,, 6 „ „ 40 ,, ,, ,, 50 ,, 17 „ „ 50 ,, ,, ,, 60 ,, 11 „ „ 60 „ „ „ 70 „ 18 „ „ 70 ,, ,, ,, 80 ,, 11 ,, ,, 80 2 Total 93 Causes of death in inquest cases:— Natural causes 45 Misadventure: death under an anaesthetic 6 Accidental: Burns or Scalds 2; Suffocation 5; Falls 6; Run over 8; Tetanus 1 22 Chronic Alcoholism 1 Suicide 19 Total 93 DISTRIBUTION OF DISINFECTANTS. During the year 11,324 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. 83 HOUSING. Housing Statistics for 1926. 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) 7,429 (2) Number of dwelling-houses which were inspected recorded under the Housing Consolidated Regulations, 1925 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 3 of the Housing Act, 1925:— (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. 84 (b) Proceedings under Public Health Acts:— (1) Notices served requiring defects to be remedied:— Intimations 6,712 Statutory Notices 5,323 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners (nuisances abated) 8,394 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11, 14, 15 and 18 of the Housing Act, 1925:— (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling houses in respect of which Closing Orders were determined, the 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. 85 FACTORIES, WORKSHOPS, OUTWORKERS, Etc. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 605 130 3 Workshops (Including Workshop Laundries) 4167 1231 13 Workplaces (Other than Outworkers' Premises) 105 26 .. Total 4877 1387 16 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 580 560 .. 5 Want of ventilation 6 4 .. .. Overcrowding 3 4 .. .. Want of drainage of floors 2 2 .. 1 Other nuisances 1087 1034 .. 29 Sanitary accommodation— insufficient 24 23 .. .. unsuitable or defective 775 742 .. 15 not separate for sexes 10 10 .. .. Offences under tht Factory and Workshop Acts:— .. .. .. .. Illegal occupation of underground bakehouses (s. 101) .. .. .. .. Other offences (Excluding offences relating to out work). .. .. .. .. Total 2487 2388 •• 50 86 Registered Workshops. Workshop on the Register (s. 131) at the end of the year. Number Workshops 1752 Workshop Bakehouses 57 Total Number of Workshops on Register 1809 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) 20 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 119 Reports (of action taken) sent to H.M. Inspector. 119 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 24 87 HOME WORKERS. Of the 3,685 workmen and contractors whose names appeared on the lists received, 2,578 resided within the Borough. The latter figure is approximately double the number of individual workers, as in the majority of cases the same people are notified in February and in August. The number of visits paid to Home Workers' dwellings was 2,265. The number of premises found to be in an insanitary condition was 408, or 47 per cent of the 860 premises inspected. Notices were served in 315 cases, 81 premises being already under notice arising from other visits, and a verbal intimation only being given in the remaining 12 cases. Difficulty is occasionally experienced in getting employers promptly and accurately to send in copies of their list of outworkers, but it was not found necessary in the course of the year to prosecute on this account. 88 HOME WORK. Nature of Work OUTWORKERS' LISTS, SECTION 107 Outwork in unwholesome premises,Section 108 Outwork in Infected premises, Sections 109,110 Lists received from Employers Addresses of Outworkers Notices served on Occupiers as to keeping or sending lists Prosecutions Instances Notices served Prosecutions Instances Orders made (s. 110) Prosecutions (s. 109, 110) Sending twice in the year Sending once in the year Failing to keep or permit inspection of lists Failing to send lists Lists Outworkers Lists Outworkers Received from other Councils Forwarded to other Councils Contractors Workmen Contractors Workmen Wearing appeal- Making, etc. 134 26 1114 5 .. 24 1339 704 99 .. .. 212 238 4 .. .. .. Curtains, Furniture hang- ings and Trimmings 10 .. 82 .. .. .. 22 37 6 .. .. 11 13 .. .. .. .. Fur-pulling and feathers .. .. .. .. .. .. 17 .. 2 .. .. 2 4 .. .. .. .. Umbrellas, etc. 2 .. 7 .. .. .. 77 .. 2 .. .. 12 15 1 .. .. .. Artificial Flowers .. .. .. .. .. .. 19 .. .. .. .. 5 4 .. .. .. .. Paper, etc., Boxes, Paper Bags 38 1 452 2 .. 7 135 150 25 .. .. 137 165 2 3 .. .. Brush-making 6 .. 298 .. .. .. 19 216 3 .. .. 21 24 .. .. .. .. Draught Board making .. .. .. 1 .. 1 .. .. 1 .. .. .. .. .. .. .. .. Cosaques, Christmas Crackers, Christmas .. .. .. .. .. .. 22 .. .. .. .. 5 7 .. .. .. .. Textile Weaving 2 .. 21 .. .. .. .. .. 2 .. .. 2 3 .. .. .. .. Toys .. .. .. .. .. .. 2 .. .. .. .. 1 1 .. .. .. .. Total 192 27 1974 8 .. 32 1652 1107 140 .. .. 408 474 7 3 .. .. 89 LEGAL PROCEEDINGS, 1926. In addition to the 54 cases, of which details are given on the following pages, proceedings were taken in 64 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:— Cases Costs in each Case 56 £0 10 6 1 £1 1 0 1 £2 2 0 1 £3 3 0 5 Nil 90 91 SUMMARY OK LEGAL PROCEEDINGS, 1926. (Other than under the Sale of Food and Drugs Acts, for which sec pp. 61 and 63). Date of Hearing Offence Inspector Result and Remarks 12th January Exposing for sale, intended for human food, about 7½lbs. Pears unfit for human food Billings Ordered to pay 23s. costs 21st January Non-compliance with Statutory Notice requiring abatement of nuisance Bare Defendant ordered to do work in 28 days and pay 10s. 6d. costs 21st January Do. do. Do. Do. do. 21st January Do. do. Do. Do. do. 21st January Do. do. Do. Do. do. 28th January Do. do. Heron Defendant ordered to do work in 7 days and pay £3 3s. costs. 4th February Do. do. Jenkins Defendant ordered to do work in 7 days and pay £2 2s. costs. 4th February Do. do. Do. Do. do. 25th February Failure to comply with By-law re Rag and Bone Dealers Richards Fined £2, costs £'2 25th February Constructing W.C. without having given notice Jenkins Costs £1 3s. 25th February Constructing W.C. in contravention of By-laws Jenkins Fined £2 25th February Constructing drain to a W.C. without having given notice Do. Costs £1 3s. 25th February Making addition to sewer without having submilted plans, sections, etc. Do. Do. 11th March Repairing W.C. in contravention of Sec. 42 Heron Fined 5s., costs £1 1s. 11th March Fitting new pan and trap without giving notice Do. Do. 16th March Exposing, intended for human food, for sale 35 Unsound Pears, unfit for human food Billings Fined £15, costs £5 5s., or 6 weeks' imprisonment 16th March Exposing for sale about 90lbs. Unsound Green Peas Do. Fined £6, costs £5 5s. 20th April Wilfully obstructing and assaulting inspector in course of his duty Do. Obstruction:- Fined 20s., costs 21s. Assault:— Bound over in sum of £15 for 12 months. Costs 2s. Defendant went to prison. 1st June Exposing for sale, intended for human food, 14 lbs. Unsound Walnuts, unfit for human food Do. Fined £3, costs £2 2s. 8th June Failing to comply with the requirements of the Public Health (Meat) Regulations, 1924 Henley Fined £4, or 11 days 11th June Conveying offensive matter through London, per H. Monk, during prohibited hours Weeks Costs 21s. llth June Do. Per H. Vango Do. Fined £2, costs £2 2s. 11th June Conveying offensive matter through London, per H. Monk, in vessels not suitably covered Do. Costs 21s. 92 93 SUMMARY OF LEGAL PROCEEDINGS, 1926—continued. Date of Hearing Offence Inspector Result and Remarks 11th June Conveying offensive matter through London, per H. Vango, in vessels uot suitably covered Weeks Costs 21s. 22nd July Non-compliance with Statutory Notice requiring abatement of Nuisance Jenkins Costs 21s. Nuisance Order 2 months 31st August Exposing for sale by her servant, intended for human food, about 8 lbs. of Fruit, unfit for human food Billings Costs 21s. 31st August Exposing for sale, intended for human food, about 8 lbs. of Fruit, unfit for human consumption Do. Fined £5. Costs 21s. 31st August Conveying through London, during prohibited hours, offensive matter Do. Fined 40s. Costs 21s. 31st August Conveying through London, offensive matter in unsuitable receptacles Do. Do. do. 31st August Removing from 107, Bethnal Green Road, offensive matter during prohibited hours Richards Fined 20s. Costs 10s. 6d. 31st August Conveying through London, offensive matter in unsuitable receptacles Do. Fined 30s. Costs 10s. 6d. 16th September Non-compliance with Statutory Notice requiring abatement of Nuisance Jenkins Defendant ordered to do work in 14 days and pay costs 42s. 16th September Do. do. Hewitt Do. do. 28th September Exposing for sale quantity of food unfit for human consumption Billings Fined .£10. Costs £3 3s. 28th September Conveying offensive matter through London during prohibited hours Billings Fined £5. Costs £3 3s. 28th September Conveying offensive matter in uncovered and unsuitable receptacles Do. Fined £5. Costs £2 2s. 6th October Selling Ice Cream, intended for human food, which was unfit for human food Weeks Dismissed. Costs paid by defend ant, £5 5s. 5th October Depositing for sale, intended for human food, Ice Cream which was unfit for human food Do. 5th October Fixing W.C. pan and trap without giving notice Hewitt Withdrawn, Costs £1 1s. 5th October Repairing drain in such a manner as to cause a nuisance Do. Do. do. 5th October Possessing Rag Flock containing 75 parts of excess Chlorine Jenkins Costs £2 2s. 5th October Failing to comply with Bye-law No 4 (a) respecting business of Hag and Bone Dealer Richards Fined £2 26th October Unlawfully failing to comply with Bye-law 4 (a) in respect of business of Rag and Bone Dealer. On 24/9/26. 10 Fined 10s. 26th October Do. do. On 27/9/2C. Do. Fined 10s. 27th October Exposing for sale, intended for human food, 1 lb. Butter, unfit for human food Weeks Fined £1. Costs £2 2s. 94 SUMMARY OF LEGAL PROCEEDINGS, 1926—continued. Date of Hearing Offence Inspector Result and Remarks 27th October Depositing for sale, intended for human food, 1 lb. of Butter, unfit for human food Weeks Withdrawn. (Conviction on above.) 2nd November Exposing for sale, intended for human food, about 3¼lbs. Butter, unfit for human food Do. Fined £4. costs £1 1s. 2nd November Depositing for sale, intended for human food, 3¼lbs. Butter, unfit for human food Do. Do. do. 2nd November Possessing Rag Flock containing 26 parts of excess Chlorine Jenkins Dismissed on payment of £2 2s. costs 2nd November Possessing Rag Flock containing 26 parts of excess Chlorine Do. Defendants summoned their wholesaler. Summons dismissed on ment of Costs, £2 2s. 2nd November Possessing Rag Flock containing 19 parts of excess Chlorine Do. Dismissed on payment of £2 2s. costs 21st December Depositing for sale, intended for human food, 91 tins of Potted Meat, unfit for human food Weeks Fined 20s. 21st December Selling certain tins of potted meat, intended for human food, unfit for human food Do. One defendant fined £10. Costs £3 3s. One defendant fined £2. Costs £2 2s. 30th December Non-compliance with Statutory Notice requiring abatement of Nuisance Jenkins Defendant ordered to do work in 7 days and pay costs £2 2s. 95 LARCENY ACT 1916, SEC. 32(1). Date of Hearing Offence Result and Remarks 26th March, 1926 (a) Obtaining goods by false pretences. Milk Grants — Glaxo, value £1 12s. Found guilty. Bound over in sum of £5 to come up for judgment if called upon within 12 months, and ordered to pay back within a fortnight the value of goods obtained by false pretences (b) Aiding and abetting wife in obtaining goods by false pretences (c) Attempting to obtain goods by false pretences. Milk Grants—Glaxo, value 1s. 3d. 96 TUBERCULOSIS DISPENSARY REPORT FOR THE YEAR 1926. By H. Tylford Howell, M.R.C.S., Eng., L.R.C.P., Lond., Clinical Tuberculosis Officer. For six years there had been no change in the personnel of the Dispensary, but last year we lost the services of two valuable members of the staff. Nurse Hill died after a prolonged illness, while Dr. Hamilton obtained the post of Senior Tuberculosis Officer to the Borough of Fulham. They were extremely popular and capable officers and gave of their best, and will be greatly missed both by the patients and their colleagues. Dr. G. H. C. Toussaint, late House Physician at the Brompton Hospital and Assistant Tuberculosis Officer for the Borough of Bermondsey, was appointed Assistant Tuberculosis Officer, and took up his duties in October. Miss H. Turner, late Tuberculosis Nurse to the Borough of Fulham and Sister at the Royal National Hospital for Consumption, Ventnor, was appointed in the place of Nurse Hill, from January 1, 1927. There has been no radical change in the routine of the Dispensary, and the sessions have remained the same. Patients are seen on Monday, Wednesday, Thursday, Friday, and Saturday mornings from 10 to 12 o'clock; Wednesday evenings from 5.30 to 7 o'clock; and on Thursday evenings from 7.30 to 9 o'clock. Saturday mornings are reserved mainly for school children and such adults as find it difficult to attend at other times, while the evening sessions are intended for patients who are at work during the day. The accommodation of the department in respect of offices, laboratory, and other facilities is very satisfactory, while the two consulting-rooms are most convenient. The fact that two dressing-rooms are attached to each consulting-room not only enables the medical officers to get through their work more rapidly, but adds considerably to the comfort of the patients and also ensures privacy, as even on busy days it is never necessary for a patient, unless of the same family, to undress in the presence of others. It also enables men and women to be seen in their turn in the order of their arrival at the Dispensary and so reduces the period of waiting to a minimum, while it obviates the necessity of separate sessions for different sexes. The practice of the two medical officers consulting one another on most new cases and afterwards discussing the special features and points of difficulty is being continued. This procedure, although not generally adopted, is, I am convinced, a sound one, and beneficial not only to the patient but also to the medical officer, as it adds to the keenness of the latter and broadens his views, while the patient obtains the benefit of a double opinion. Moreover, should occasion arise for one tuberculosis officer to take over entire charge of the department for a time, it is possible for him to do so without the patients suffering in any way, as he is acquainted with every case. We continue to utilize in every way the resources of the special departments of the Hospital. This arrangement enables us to investigate a ease thoroughly on the spot without loss of time, while in addition we have the advantage of a personal interview with the consultant concerned. 97 Formerly, the X-ray department was open on two days a week only, but the hospital authorities have now appointed a wholetime Radiographer, resulting in a further saving of time, as patients may now be X-rayed during any session. As stated in last year's report, artificial sunlight was being given a trial for the first time. The hospital has a carbon arc-lamp installation and we are able to refer patients for treatment. While most cases show improvement, the results, on the whole, are not quite so remarkable as we were led to expect, but nevertheless I think we are justified in continuing the experiment. The treatment has been almost entirely limited to notified cases of glandular enlargement in children, and as in the majority of instances this entails daily attendance at the hospital, the numbers are necessarily small, as it is often extremely difficult for the mothers to give up so much of their time. The success which has attended the treatment of children at the open-air school is being fully recognized, and the L.C.C. are opening an additional school in the East End of London. Stormont House School, on Hackney Downs, is maintaining its popularity and is always full. The children have done extremely well, and from an average roll of 87, 21 were discharged as fit for work, while 6 were enabled to return to the ordinary elementary school. It has been the custom for some years to send all the children who wished it to the seaside for a fortnight during the summer. This year, however, I was informed that this was not possible, so an appeal was made to the L.C.C. to consider the question of sending a few of our most necessitous cases. I am pleased to say the Council responded to this appeal, and seven of the children were sent to the seaside, not for the usual fortnight only, but for periods varying from two to four months. The experiment was so successful that I am hopeful it will be repeated next summer. The various charitable organizations in the district continue to assist in many ways. The Invalid Children's Aid Association in particular is most helpful, and has sent quite a number of our debilitated children to convalescent homes either at the seaside or in the country. The Charity Organization and the United Services Fund have also assisted in supplying surgical instruments, dentures, clothing, etc., and in the provision of accommodation for children while their mothers are receiving treatment in sanatorium. The arrangement generally of institutional treatment, which is in the hands of the L.C.C., has been a little easier during the year, 171 of our cases being admitted to Hospital or Sanatorium. The period of waiting is shorter and the number of cases which have failed to gain admittance is less. The problem of the advanced case, however, is still with us. There is insufficient accommodation for this class of patient, and the responsible authorities do not appear seriously to consider him. Occasionally he may be offered a bed in an institution some considerable distance from his home, and as his state of health necessitates frequent visits from his family he naturally refuses, but more frequently he is referred to the local Infirmary which he again declines. The result is that the patient is left to die at home, not before, however, he has probably infected other members of the household with whom he has shared a bedroom or maybe a bed. I make no apology for labouring the subject year by year, as only by persistent reference to the question can one hope to obtain this most urgently needed institution—a local home for advanced cases. The provision of suitable work for patients on their return from sanotorium is still one of our greatest problems. As mentioned in last year's report the scheme introduced by the Ministry of Health in which the employment exchanges were asked to facilitate the provision of suitable 98 employment for tubercular men has completely failed. I would again like to advocate the desirability of the adoption of local workshops, subsidized by the State or Local Authority, where men could work at suitable occupations under direct medical supervision and obtain a living wage. The only "real objection to such a scheme appears to be the question of expense, but surely it would be less costly to the State than continuous unemployment, and certainly better for the patients. The scheme for the supply of extra nourishment adopted by the Boroughs in 1921 still operates. The number receiving benefit is necessarily small, as the expenditure sanctioned must not excced £2 per 1,000 of the population. The additional diet given takes the form of milk and eggs, and undoubtedly it has considerably helped those patients who, on leaving sanatorium, are unable to provide suitable nourishment for themselves pending their return to work. I continue to act as Honorary Consultant to the Bethnal Green Hospital, visiting the institution once weekly. I see all doubtful cases and am thus enabled to reduce the number of notifications and consequently save the unnecessary visiting and examination of contacts. In September 1925 the Ministry of Health issued a Memorandum as to the Annual Returns to be furnished by the Chief Administrative Tuberculosis Officers of Local Authorities, and as to the records kept bv Tuberculosis Officers. The memorandum states that, for the purpose of ascertaining the extent and estimating the value of the work done under the approved schemes of Local Authorities for the treatment of Tuberculosis, and of obtaining a uniform presentation of the facts for the country as a whole, it is necessary that more complete and systematic information should be furnished to the Ministry than has hitherto been sought from Local Authorities. Returns in the form of tables are therefore required, and from the 1st January, 1926, Tuberculosis Officers were requested to keep such records as may be necessary to furnish such reports. The completion of these forms has meant a considerable increase in our clerical work. Some idea of its extent may be conceived if I mention that one table requires in summary form the condition of all patients whose case records are in the possession of the Dispensary at the end of the year, arranged according to the years in which the patient first came under Public Medical treatment for Tuberculosis, together with their original classification. While no doubt some useful information may be gleaned from these reports, they contain a great deal of which the usefulness is doubtful. As an instance of the latter I would mention that even the negative cases have to be classified into Adults, male and female, and Children, male and female. The tables, moreover, are so ambiguous and difficult of interpretation that the figures in many instances are liable to be misleading. I submit at the end of the report a statistical summary of the work of the Dispensary for 1926. The figures in some instances have been considerably affected by the recent memorandum. The drop in the number of contacts I think can be entirely accounted for in this way. Previously it was our custom to regard any patient who had been living with a definite case of tuberculosis, irrespective of the origin of his attendance at the Dispensary, as a contact. It is now laid down that only those cases which attend the department as the result of the Tuberculosis Scheme should be so regarded. Cases sent by doctors and patients who attend voluntarily are not to be entered as contacts, notwithstanding the fact that they may at the moment be living with an infectious case of Pulmonary Tuberculosis. Prior to 1926 a case was not discharged from the register, even if no evidence of tuberculosis was found, so that if he attended the department again after a lapse of several years he retained his old number and was 99 entered as a re-attendance and not as a new case. Under the new scheme should a non-tuberculous case make a further attendance during the year he is not to be entered as a new case, but if he attends the following year he is to be entered as such. This I think accounts for the increase in the number of new cases; on the other hand tubercular cases attending the Dispensary for the first time, but who have previously received public medical treatment in another Borough, are not to be recorded as new cases. Acting on instructions from the Ministry of Health a further attempt has been made to reduce the number of patients attending the Dispensary for treatment. All panel patients, with the exception of those requiring special treatment, are sent to the panel doctor, while school children who only require periodic observation are referred to the School Medical Officer. The number receiving dental treatment is small, but 1 would point out that attendance at this department is limited to those over school age. I have previously referred to the difficulty of persuading patients, especially adults, of the necessity for dental treatment unless they are actually suffering pain. Moreover, they usually prefer to attend a dentist they know, although once having attended the department there is no difficulty in persuading them to attend a second time. Contrary to what one would expect, children on the other hand do not appear to have the same fear of the dentist, and the parent's sanction is seldom refused; they are, of course, referred to the school treatment centre. The most important function of the Dispensary is as a consulting centre, and it would appear, from the steady rise in the number of patients sent to the department by the local practitioners, that it continues to increase its usefulness in this direction. In conclusion I would like to thank the Medical Officers of Health, the Hospital Physicians and Surgeons, the Resident Medical Officer, and the Hospital Secretary for their valuable help and advice, and the Dispensary staff for their efficient work and loyal support. (Signed) H. TYLFORD HOWELL. 28th February, 1927. 100 BOROUGH OF BETHNAL GREEN 1. The Totals of New Cases Males 384 Females 344 Total 728 2. The Sources of the New Cases Total Tuberculous Medical Officer of Health 218 40 Local Practitioners 248 60 Contact cases (per M.O.H.) 208 5 War Pensions Committee 8 2 London County Council 22 6 Victoria Park Hospital 7 7 Other sources 17 10 3. The Diagnosis op the New Cases Diagnosis Adults Children under 15 Total Males Females Males Females Pulmonary Tuberculosis 56 39 2 2 99 Non-pulmonary Tuberculosis 7 9 8 7 31 Non-tuberculous 144 199 110 114 567 Doubtful 17 12 — 2 31 Total 224 259 120 125 728 101 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 3 Non-pulmonary Tuberculosis 2 Non-tuberculous 195 Doubtful 8 Total 208 5. Sputum Examinations. Tubercle Bacilli present 151 Tubercle Bacilli absent 621 Total 772 6. Other Figures. Total number of attendances 4,027 Systematic examinations at the Dispensary 2,265 Number of patients sent to hospital or sanatorium by the L.C.C 82 Number of letters written 1,606 Number of visits to patients at their homes 153 Number of patients referred to:— X-ray Department 76 Dental Department 9 Sunlight 8 Other Departments 29