AC4366 BET 33 the Metropolitan Borough of Bethnal Green Report ON THE HEALTH OF THE BOROUGH OF BETHNAL GREEN DURING THE YEAR 1928, BY F. LEONARD KEITH, m.d., d.p.h . l.d.s. Medical Officer of Health and Administrative Tuberculosis Officer for the Metropolitan Borough of Bethnal Green. LONDON: Printed by Freame Manning & Co., Ltd., 12a, Lee High Road, Lewisham, S.E. 13. Metropolitan Borough of Bethnal Green. PUBLIC HEALTH COMMITTEE, 1928-1929 as on 31st December, 1928. Meetings held at the TOWN HALL on the first and third Wednesdays, at 5.30 p.m. *Councillor C. Bennett, Chairman. *Councillor Mrs. A. E. Davy, Vice-Chairman. Alderman C. Fursse. Councillor W. H. Jones. *Councillor Miss L. D„ Benoly. ,, R. Larkins. ,, S. Brown. * ,, Mrs. K. E. Rawles, ,, R. Cohen. M.B.E. * „ Miss M. E. E. James, „ A. J. Sharman. J.P. „ T. P. Spring. Ex-Officio Members of the Public Health Committee : (The Mayor and Chairmen of other Standing Committees of the Council.) *His Worship the Mayor (Councillor W. C. Chandler, J.P.). Committee : Finance Works and Stores Law and General Purposes Baths Electricity Valuation Public Libraries Housing Staff Chairman : Councillor M. R. Seymour. „ G. Bayley, J.P. „ T. Brooks. „ G. Edmonds, J.P. „ R. E. Pearson, J.P., L.C.C. Alderman W. Rawles, J.P. Councillor Miss M. E. E. James, J.P. „ Miss L. D. Benoly. „ W. C. Chandler, J.P. The Public Health Committee is also the Statutory Committee to which all matters relating to Maternity and Child Welfare stand referred. * Members of Sub-Committees for Maternity and Child Welfare and Tuberculosis. Council Representatives on Joint (Tuberculosis) Dispensary Committee : Councillors C. Bennett, Miss L. D. Benoly, and Mrs. A. E. Davy. 2 PUBLIC HEALTH DEPARTMENT. STAFF as on 31 si December. 1928. F. Leonard Keith. M.D., D.P.H., L.D.S., Medical Officer of Health. Sanitary Inspectors: *§Evan Richards, Chief Sanitary Inspector. *F. T. Bare, *§A. S. Henley, Food * G. I. Brighting, District *J. O. G. Weeks, Inspectors. * §G. E. Gould, sanitary *W. Billings, Junr., *§W. H. Heron, inspectors. Housing Inspector. *J. H. Hewitt, * E.J. Jenkins *I. R. Jones, Workshop Inspector. Health Visitors, & c.: *†‡Miss G. I. Le Geyt, Superintendent Health Visitor. *†‡Miss E. M. Patrick, Assistant Superintendent. *†Mrs. F. M. Barden. *†‡Miss A. A. Page. *†Miss V. D. Cornish. *†‡dMiss M. Playle. *†‡°Miss D. L. Fraquet. *†Mrs. A. W. Rosling. *†‡Miss C. E. Love. *†‡dMiss L. F. Wright. *†‡Miss E. E. Taylor, Borough Midwife. *Miss L. F. Gavin, Ph.C., Clerk-Dispenser. *†‡Miss E. S. Crisp, *†‡Miss J. Butler} Tuberculosis Health Visitors. Clerical Staff: °J. Henry Lloyd, F.S.S., 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. d Health Visitors Diploma. *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 Storekeeper, 1 Attendant, 1 Caretaker, 2 Cleaners (part time). Personal Cleansing Station : 1 Woman Attendant (part time). 3 Unestablished Part Time Officers. Maternity and Child Welfare Centres. Medical Officers. *Mrs. K. Addison, M.B., B.S. *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. Mackay, M.D., B.S., M.R.C.S., M.R.C.P. *Miss D. I. Mart, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. *Mrs. D. E. Mason, M.R.C.S., L.R.C.P. *Miss O. G. Potter, M.R.C.S., L.R.C.P., M.B., B.S. *Miss R. C. Townshend, M.R.C.S., L.R.C.P., M.B., B.S., D.P.H. Orthopædic Surgeon: *J. B. Barnett, F.R.C.S., L.R.C.P. Dental Surgeon: *Miss J. H. M. Sutherland, L.D.S. (R.C.S.). Masseuse: *Miss Y. Lawson, C.S.M.M.G. 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, W. J. Dowling, B.A., M.D. A. E. Parkes, F.I.C., F.C.S., Public Analyst. *The Council receives Exchequer grant in respect of the salaries of these Officers. 4 Public Health Department, Town Hall, Bethnal Gre.en, E.2. 1 st May, 1929. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Bethnal Green. Ladies and Gentlemen, It is customary, in endeavouring to assess the health of a District, to take into account certain statistics, amongst others, the birth and death rates. The birth rate for 1928, the lowest ever recorded in the Borough, was 19.0 per 1,000 of the population, contrasted with 19.9 in 1927—a further example of the steady fall which we have experienced now for some years past. The general death rate at all ages and from all causes was 11.7 which compares with the figure 11.3 per 1,000 of the population in 1927. Of the special death rates, the infant mortality figure, calculated as the number of children dying under 1 year per 1,000 births, is frequently regarded as a sensitive index of the health of a District. Too much importance cannot be attached to yearly fluctuations in this figure, for, where comparatively small numbers form the basis of calculation, the possible margin of error is proportionally large. It is, however, worth noting that there has been an increase of 30 per cent. in the number of infant deaths over the figures, for 1927. This suggests the necessity for ever being on the outlook for any factors inimical to child life. While we thus have from the birth and death returns a good deal of information of the two extremes of life, we have very little definite knowledge of the amount or the nature of the diseases which periodically incapacitate so many of the population, diseases which, while not necessarily leading to a fatal termination, are responsible for grievous suffering to the individual and result in great loss to the national prosperity. In the absence of any accurate information of the qualitative nature of these incapacitating diseases, we have to rely upon the incidence of certain notifiable infectious diseases as a criterion. During 1928, the commoner infectious diseases compared favourably, both in incidence and type, with those in past years, while the decrease in the number and the severity of the cases of diphtheria was very satisfactory. 5 As opposed to the experience in 1927, small-pox manifested itself in the Borough in the autumn of 1928 and the spring of 1929. All the cases, many of which originated in the same households, were of a very mild type. Upon a sanitary environment and a pure food supply, health largely depends. It is most satisfactory to point to the volume of work being undertaken by the Housing and the District Sanitary Inspectors in the maintenance of property in the. Borough. Much of this property is old and worn out, and moderately habitable conditions can be maintained only at the price of eternal vigilance on the part of these Officers. No fewer than 29,000 nuisances were discovered and remedied at 7,204 premises during the year—an excellent record ! The counterpart to a sanitary domestic environment is a sanitary workshop environment. In a highly industrialized district like Bethnal Green, conditions unfavourable to health would soon arise were adequate supervision not exercised. The fact that 4,905 inspections were made, and 2,000 defects found, and remedied, is sufficient testimony to the high efficiency attained by the Workshops Inspector. Food inspection comprises diverse duties. Supervision over the place of manufacture, inspection for unsound food, and. " sampling " of food and drugs—all most important duties—are carried out by the Food Inspectors with a degree of thoroughness worthy of the highest praise, and, in its results, warrants the assertion that Bethnal Green boasts a food supply of as high a standard as is possible under existing legislation. This report purports to be a faithful statement of the year's work. The recording of that work, the compilation of the necessary statistics, the correlation of the work of the outdoor staff, duties punctiliously carried out by the clerical staff, under the very capable direction of the Chief Clerk, enable me to say that the Public Health work of this Borough is based on a sure foundation. It only remains for me, in relinquishing my appointment as Medical Officer of Health, to express my thanks to the Committee for their collective and individual support, to express my appreciation for the loyal and unswerving devotion of the Public Health Department, and to thank my colleagues in other Departments for their ever-ready co-operation and assistance. F. LEONARD KEITH, 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, 1928, was £602,207, and the product of a 1d. rate is estimated at £2.835. SOCIAL WELFARE. In view of their close association with questions of public health, I have endeavoured to obtain statistics concerning the social welfare of the residents in the borough. Unfortunately, however, no very relevant 7 and reliable figures appear to be available. The borough is not a unit for unemployment insurance purposes, and consequently there are no very reliable statistics as to the actual prevalence of unemployment among its residents. The statistics as to Poor Law Relief, while they relate exactly to the area of the Borough, do not necessarily measure the actual amount of unemployment or poverty, as many persons may refrain from applying for relief or be refused relief. The following statistics, therefore, are submitted only as a general indication of the prevalence of social misfortune in the Borough. Ministry of Labour. Estimated number of residents in Bethnal Green on registers of employment exchanges at Shoreditch, Stepney, Hackney and Stratford on 15-11-28 : — Percentage of estimated No. No. of Insured Persons. Men 2,519 8.6 Women 528 3.4 Juveniles 96 2.0 3,143 6.4 Bethnal Green Board of Guardians. Position on 1st January, 1929. Total number of persons relieved in their own homes, including wives and children :— Unemployed 4,392 Others 3,132 Persons relieved in institutions : — Persons suffering from sickness or bodily infirmity 894 Persons suffering from mental infirmity 724 Other persons 533 8 Another view of the need which exists may be gained from the Guardians' expenditure on outdoor relief for the year ended the 30th September, 1928, which was £212,650 (including £121,341 on relief of unemployment). The low wage standards prevailing among the inhabitants of the Borough are indicated by an investigation made of the financial circumstances of mothers attending the Welfare Centre for the first time during a fortnight in January, 1929, which revealed the fact that among the 74 mothers 32 (or 43.2 per cent.) were so poor that they would have been entitled to a free milk grant under the Council's scale ; 16 (or 21.6 per cent.) would have been entitled to a half-price milk grant ; Of the remaining 26 (or 35.1 per cent.), nineteen were the wives of workmen earning from 40s. Od. to 70s. Od. per week, and seven were the wives of small shopkeepers. If the present "living wage" for a family of five be taken as approximately £4 0s. Od. per week, it is clear that the great majority of the residents are far below this standard. These facts need to be borne in mind in considering the facts as to vital statistics, etc., given later in this report. PUBLIC HEALTH EXPENDITURE. The exceedingly small cost of the local Public Health services is shown by the latest available figures for the financial year 1927-8, when the nett expenditure of the Public Health Committee was £15,911, or 2s. 8d. per head of the population, and equivalent to a rate of 5.6d. in the £1. The New York State Department of Health has a striking statement on its envelopes : "Public Health is purchasable. Within natural limitations any community can 9 determine its own death rate." The results achieved by progressive public health administration in Bethnal Green, as illustrated by this and previous Annual Reports, show that the assertion 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 bettercircumstanced districts. THE HEALTH SERVICES IN THE BOROUGH. 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 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 : — GENERAL MEDICAL PRACTITIONERS. There are 45 general medical practitioners with consulting rooms in the Borough. Our relations are of a friendly nature. 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, Nichols Square, E.2. An account of the Council's arrangements with the Association for nursing services will be found in the Maternity and Child Welfare Section of this report. 10 MID WIVES. There are two private midwives living in the Borough, and about six others who reside outside and are known to practice frequently within the Borough. The Council also employs a midwife, who resides in the borough : an account of her work is given in the Maternity and Child Welfare Section. HOSPITALS. Public. Board of Guardians : Bethnal Green Hospital, Cambridge Road. I am indebted to Dr. R. D. O'Leary, the Medical Superintendent, for the following statistics concerning the work of the Bethnal Green Hospital for the year ended the 30th September, 1928 : — No. of Admissions 6,734 Casualties treated 2,678 Children Admitted : Under 3 years 1,257 Operations performed 885 3—16 years 1,559 Out-patients' Attendances 6,399 Other. The Officers of the hospitals have furnished me with the following statistics concerning their work last year— Beds No. of new Outpatients Outpatients Attendances No. of Inpatients Average duration Inpatient treatment (days) Queen's Hospital for Children, Hackney Road 134 32,708 131,708 1,814 25 Mildmay Mission Hospital, Austin Street 56 15,113 52,301 1,150 15 City of London Hospital for Diseases of the Heart and Lungs, Victoria Park 185 7,034 27,658 1,070 41 The London Hospital, Whitechapel Road, although situated outside the Borough, is also largely used by residents. 11 DISPENSARIES, &c. The following Dispensaries exist in the Borough, and I have been furnished with the following statistics concerning last year's work. No. of Out-Patients' Out-Patients. Attendances. Queen Adelaide's Dispensary, Pollard Row 3,037 7,938 Medical Mission, St. James-the-Less, St. James's Road No information received. Medical Mission, Annie Macpherson Home of Industry, Cambridge Road 2,604 15,623 CLINICS. For Children Under Five. The Council has a Welfare Centre in Cornwall Road (also a Branch Centre at Thornton Hall, Mount Street) at which a variety of work, including Infant Consultations, Orthopaedic Clinic, Dental Clinic, Light Clinic, etc., is carried on. This work is commented on in the Maternity and Child Welfare Section of this Report. For School Children. These are conducted 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, 12 " The ophthalmic surgeon attends the centre one session a week, and about 440 children are treated annually. The dentist visits the centre on eleven sessions a fortnight, and the schools on one session a fortnight for inspection. About 1,760 children are treated each year. In the minor ailments department the doctor attends on five sessions a fortnight, and a nurse is daily in attendance. About 2,000 children are treated in this department annually. " Many children in the Borough attend hospitals and centres in neighbouring boroughs, here given in order of frequency: London Hospital, Queen's Hospital, Whitechapel School Treatment Centre, Moorfields Hospital, and Old Ford, Shoreditch, and Almeric Paget School Treatment Centres." DAY NURSERIES. There are two Day Nurseries in the Borough, both belonging to voluntary committees : — (i) Bethnal Green Day Nursery, Somerford Street. (ii) Pro Patria Day Nursery, Bishops Road. Some Bethnal Green children also attend a nursery situated in Shoreditch, attached to St. Saviour's Priory, Great Cambridge Street. ORPHANS. There is a branch of the National Children's Home and Orphanage situated in Bonner Road. MATERNITY. Public. The Borough Council has a Maternity Clinic, Cornwall Road, at which a variety of work for maternal welfare is carried on (see the section of this report dealing with Maternity and Child Welfare). Board of Guardians: Maternity wards in Bethnal Green Hospital. Dr. R. D. O'Leary informs me that 205 maternity cases were dealt with in the year ended the 30th September, 1928. 13 Other. 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, are largely used by residents of the Borough. MEDICAL TREATMENT OF PERSONS INSURED UNDER THE NATIONAL (HEALTH) INSURANCE ACTS. Arrangements are made by the London Insurance Committee. I understand that 90 medical practitioners are on the medical panel for the Borough, 37 of whom have consulting rooms in the Borough. AMBULANCES. Infectious Diseases. In addition to their use for the removal of patients to M.A.B. Hospitals, the M.A.B. Ambulances are available, upon payment, for the removal of cases of infectious disease to other places. A medical certificate as to the nature of the disease must be handed to the Ambulance Driver. The charge for the hire of an ambulance to a place within the metropolitan area, including, when the patient is over twelve years of age, the services of a male attendant, is 10s., which must be paid to the Driver, who will give an official receipt. The services of a Nurse will also be supplied, if desired, at an additional charge of 5s. Application should be made from 9 a.m. to 10 p.m. to the M.A.B. Head Office (Telephone: City 7200) ; from 10 p.m. to 9 a.m., to the Eastern Ambulance Station, Brooksby Walk, Homerton, E.9. (Telephone: City 7200.) 14 Non-Infectious Diseases. M.A.B. Ambulances are also available for the conveyance of medical, surgical and mental cases on the above-mentioned terms. The L.C.C. Ambulance Service is available for the conveyance at any hour of the day or night of persons suffering from accident or sudden illness in the street or any public place, to hospitals, infirmaries or their own homes. This ambulance service is also available for the transport of women urgently expecting confinement, who have letters of admission to certain hospitals, including the London, City of London Maternity, Jewish Maternity, and Mothers' Hospitals, between 11 p.m. and 8 a.m. The ambulance can be summoned by telephone by merely asking for "AMBULANCE." No charge is made. A doctor, nurse or female friend must accompany the patient to hospital. TUBERCULOSIS DISPENSARY. This is situated at the City of London Hospital for Diseases of the Heart and Lungs, Victoria Park, and its work is fully discussed in the Tuberculosis Section of this report. VENEREAL DISEASE. This is dealt with by the L.C.C. The nearest treatment centres are at the London Hospital, Whitechapel Road, and the Metropolitan Hospital, Kingsland Road. PERSONAL CLEANSING STATIONS. For Adults. The Council has established a Personal Cleansing Station at the Depot, Digby Street. 15 For School Children. At the Bathing Centre, 5a, Russia Lane, controlled by the L.C.C., about 5,700 baths were given to some 5,000 children for the removal of verminous conditions, and about 330 baths to 114 children for the treatment of scabies and impetigo. 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-.— For S.W. Bethnal Green-.— H. J. Hardwick, Miss M. Peters, 106, Bishops Road. 347, Bethnal Green Road. 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. F. Harris White, Dr. F. Arthur, 130, Roman Road. 395, Bethnal Green Road. The Vaccination Officer is:— P. Ivess, Guardians' Offices, Bishops Road, E.2. CERTIFYING SURGEON: FACTORIES AND WORKSHOPS. The local Certifying Surgeon under the Factory and Workshops Act is:— Dr. J. Bate, 1, Old Ford Road. 16 HEALTH EXHIBITION. From the 17th to the 20th September, 1928, a Health Exhibition, organized by officers of the Public Health Department, was held at the Town Hall, while lectures and cinematograph films were given at the Public Library at the same time. Having regard to the limitations of space and the fact that this was the first Health Exhibition held in the Borough, it was very successful. It is estimated that 2,000 school children and 3,000 adults visited the Exhibition during the four days, apart from those who attended the lectures and saw the films at the Library. 17 VITAL STATISTICS. For a clear understanding of the problems with which the Public Health Service has to deal, and to measure its achievements, one needs, among other things, full knowledge of the diseases and deaths which occur among the population concerned. Unfortunately our information concerning these things is extremely, limited. The chief source of information the Medical Officer of Health has as to sickness in the Borough is comprised in the notifications of certain infectious diseases -quite a small part of the total illness which exists. A limited amount of information as to illness amongst the young children in the Borough is also available through the Maternity and Child Welfare records, and some particulars of some illnesses among school children. As regards the incidence in the Borough of the commoner forms of illness, such as rheumatism, heart disease, respiratory disease, cancer, etc., the Medical Officer of Health has no definite information, apart from such deductions as may be drawn from the death returns. Much valuable information has recently been obtained for the country as a whole with regard to illnesses among insured persons, and this has been found very suggestive as to the direction in which special research and special effort is required. It would be very helpful if steps were taken to make such information available in each local administrative area. More information is available concerning deaths. By arrangement with the local registrars, the Public Health Department is furnished weekly with particulars of the deaths which have been registered in the Borough, while the Registrar - General periodically supplies particulars of deaths of Bethnal Green residents who have died in other parts of the country. The mortality statistics thus obtained provide very useful material in indicating both the progress 18 which has been made and the problems which still remain to be dealt with. There have been great improvements in the methods of death certification during recent years, but there is room for considerable improvement yet before the death returns can be regarded as a thoroughly satisfactory index of the health of the people. The statement of the cause of death is very defective in many instances, and vague and probably inaccurate descriptions are frequently met with. In many cases I believe it is the practice of the Registrar-General to communicate with the Doctor concerned with a view to getting fuller or more definite information as to the cause of death, and it would be a great advantage to the Medical Officers of Health if this additional and more accurate information were also furnished to them at the time. Even greater efficiency would probably be achieved in death registration if its local administration were made an integral part of the Public Health Service. A striking illustration of the foregoing remarks is given by the death which was certified during the year as "Heart failure, P.M." I do not know what action, if any, was taken by the Registrar-General with regard to this case, but feeling that any local classification would be reduced to absurdity by such certification, I wrote to the medical practitioner concerned. From his reply it appeared that the actual causes of death were syphilis, heart disease and bronchitis. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. BIRTHS. Males Females TOTAL Birth Rate Legitimate 1,077 1,001 Illegitimate 39 20 2137 19.0 19 DEATHS. Males Females TOTAL Death Rate 695 622 1,317 11.7 MATERNAL MORTALITY. Number of Women dying in, or in consequence of, childbirth : — From Sepsis 3 From other causes INFANT MORTALITY. Deaths of infants under one year of age per 1,000 births :— Legitimate 70.7 Illegitimate 186.4 Deaths from Measles (all ages) 44 „ „ Whooping Cough (all ages) 12 ,, „ Diarrhœa (under two years of age) 33 POPULATION. The Registrar-General estimates the population of the Borough at the middle of 1928 to have been 112,200. This is a substantial reduction on the figures given for recent years: 117,900 in 1927, and 119,600 in 1926. I I have not the means to confirm or criticize the estimate, in calculating which, no doubt, regard has been had to the new and fuller register of electors and to the effect of the movement of the population to the newer housing accommodation in Greater London. It is possible, of course, if some general factor has been adopted, that the actual incidence of migration from Bethnal Green may be somewhat exaggerated. As, however, I have no specific evidence in the matter, the estimate of the Registrar-General has been accepted as the basis for the calculation of the vital statistics in this report. 20 MARRIAGES. The number of marriages registered in Bethnal Green during 1928 was 964. This is equal to a rate of 17.8 persons marrying per 1,000 of the popu'laion. BIRTHS. The number of births registered in the Borough during 1928 was 1,570, and in addition 567 occurred outside the Borough to Bethnal Green residents in excess of those occurring in Bethnal Green to l'esidents of other localities, making a total of 2,137 births. The birth-rate for 1928 was, therefore, 19.0 births per 1,000 population, the lowest ever recorded in the Borough. The provisional birth-rate for London is given as 15.9, and for England and Wales as 16.7. Of the 2,137 births. 1,116 were those of males, and 1,021 those of females. ILLEGITIMACY. Of the 2,137 births credited to this Borough, 59 were illegitimate, being 39 males and 20 females, and being 2.7 per cent. of the total number of births. STILLBIRTHS. Fifty-eight stillbirths were brought to notice, being a proportion of 2.65 per cent. of all births, alive or dead. This subject is dealt with in a special note in the maternity and child welfare section of this report. DEATHS. The number of deaths registered during the year as having taken place in the Borough was 1,323. 21 Of these, 268 were of persons whose residence was not in Bethnal Green, dying in Bethnal Green Institutions or in other places in the Borough. There were also reported to me 262 deaths of Bethnal Green persons who died in institutions in other parts of London or in other parts of England and Wales. The foregoing figures gve the net number of deaths for Bethnal Green as 1,317, making an annual deathrate of 11.7 per 1,000 of population. The death-rate for Bethnal Green, 11.7 compares with 11.6 for the County of London and 11.7 for England and Wales as a whole. 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 as classified by the Registrar-General, are given in the accompanying table. 22 23 CAUSES OF DEATH at different periods of life in the Metropolitan Borough of Bethnal Green, 1928. Cause of Death. All Ages Number of Deaths of residents at various ages, whether occurring within or without the Borough 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 under 75 years 75 and upwards All causes M F 695 106 27 24 17 32 72 206 130 81 622 52 18 14 21 32 68 151 125 141 1. Enteric Fever M f ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Smallpox M F ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Measles M F 31 8 14 8 1 ... ... ... ... ... 13 3 4 5 1 ... ... ... ... ... 4. Scarlet Fever M F 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 5. Whooping Cough M F 4 3 1 ... ... ... ... ... ... ... 8 4 3 1 ... ... ... ... ... ... 6. Diphtheria M F 3 1 ... 1 ... 1 ... ... ... ... 6 2 1 2 1 ... ... ... ... ... 7. Influenza M F 9 ... ... ... ... ... 1 6 1 1 5 ... ... ... ... 1 1 ... 2 1 8. Encephalitis Lethargica M F 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Meningococcal Meningitis M F ... ... ... ... ... ... ... ... ... ... 3 2 ... ... ... 1 ... ... ... ... 10. Tuberculosis of the respiratory M system F 61 1 ... ... 2 11 20 25 2 ... 44 ... ... ... 2 17 18 6 1 ... 11. Other Tuberculous Diseases M F 8 ... 2 3 2 ... ... 1 ... ... 10 ... ... 2 5 3 ... ... ... ... 12. Cancer, malignant disease M F 79 ... ... 1 ... 1 3 43 27 4 80 ... ... ... 1 ... 9 38 20 12 13. Rheumatic Fever M F 3 ... ... ... 1 1 1 ... ... ... 3 ... ... ... 1 1 1 ... ... 14. Diabetes M F 4 ... ... ... ... ... ... 2 2 ... 9 ... ... ... ... ... ... 1 7 1 15. Cerebral Hæmorrhage M F 12 ... ... ... ... ... ... 2 7 3 24 ... ... ... ... ... ... 9 8 7 16. Heart Disease M F 143 ... ... ... 1 2 12 44 49 35 173 ... ... ... 1 6 16 41 37 72 17. Arterio-Sclerosis M F 23 ... ... ... ... ... ... 8 7 8 23 ... ... ... ... ... ... 3 8 12 18. Bronchitis M F 36 3 ... ... 1 ... 2 11 10 9 32 ... ... ... ... ... ... 9 8 15 19. Pneumonia (all forms) M F 78 24 7 5 2 3 7 19 6 5 39 9 4 3 2 1 4 5 6 5 20. Other respiratory diseases M F 6 ... ... ... ... ... ... 2 3 1 6 ... ... 1 ... 1 1 ... 3 ... 21. Ulcer of Stomach or M Duodenum F 13 ... ... ... ... ... 5 7 1 ... 1 ... ... ... ... ... 1 ... ... ... 22. Diarrhœa M F 21 19 ... 2 ... ... ... ... ... ... 14 12 2 ... ... ... ... ... ... ... 23. Appendicitis and Typhlitis M F 5 ... ... 1 ... 2 1 1 ... ... 1 ... ... ... ... ... ... 1 ... ... 24. Cirrhosis of Liver M F 3 ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 25. Acute and Chronic Nephritis M F 8 ... ... ... ... ... 3 3 1 1 26 ... ... ... ... ... 1 15 10 ... 26. Puerperal Sepsis M F ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 ... ... ... 27. Other accidents and diseases of M Pregnancy and Parturition F ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28. Congenital Debility and Mai- M formation, Premature Birth F 33 30 ... 1 1 ... 1 ... ... ... 14 13 ... ... ... ... ... 1 ... ... 29. Suicide M F 7 ... ... ... ... 1 1 3 1 1 4 ... ... ... ... ... 3 1 ... ... 30. Other Deaths from Violence M F 21 1 i 1 5 2 6 2 3 17 1 1 ... 3 ... ... 4 4 4 31. Other Defined Diseases M F 81 16 2 1 4 5 12 20 11 10 62 5 2 ... 4 1 11 16 11 12 32. Causes Ill-defined or unknown M F 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 24 CANCER. One hundred and fifty-three (R.G. 159) deaths, or over l/10th of the total, were certified as due to some form of cancer. The following is a provisional analysis of these cases:— Mouth, etc 7 (Esophagus (6), pharynx (1), pylorus (1), stomach (36), liver (8), gall bladder (5) 57 Colon (16), rectum (14) 30 Uterus, etc. 19 Breast 7 Larynx, bronchus and lungs 13 Pancreas 7 Bladder, kidneys 6 Other 7 Recent investigation has shown that many forms of cancer are more amenable to early surgical treatment than has hitherto been appreciated. This particularly applies to cancer of the breast, and it is important that any woman with a suspicious swelling in this region, even if painless, should seek skilled advice at the earliest possible moment so that the undoubted benefit of early surgical treatment may be secured. VITAL STATISTICS of Bethnal Green During 1928 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 Rate Number Death rate Number Rate per 1,000 births or infantile mortality 1923 118,700 2,482 2,880 24 2 1,275 282 347 1,340 11.3 198 687 1924 119,200 2,241 2,640 221 1,446 304 344 1,486 124 206 78.0 1225 119,800 2,199 2,630 21.9 1,400 270 307 1,437 120 212 80.6 1926 119,600 1,993 2,501 209 1,363 271 301 1,393 11.6 178 711 1927 117,900 1,782 2,353 199 1,303 264 293 1,339 11.3 136 57.7 1928 112 200 1,570 2,137 19.0 1,323 268 262 1,317 . 11.7 158 73 9 25 26 PUBLIC MORTUARY. (Church Row, Bethnal Green, E.2.) During the year 137 bodies were received at the Mortuary, i.e.: — On Coroner's order 105 On Sanitary Inspector's order 7 From the Police 6 At the request of relatives 19 Exact particulars are only available as to the 69 bodies on which coroner's inquests were held. On 28 of these bodies post-mortem examinations were made. There were also 38 post-mortem examinations made in cases in which there was no inquest. Mortuary Statistics. Places from which bodies were brought to the Mortuary. Removed by the Police from streets, etc. 4 Removed from Bethnal Green Hospital 38 „ ,, Queen's Hosjpital ... 5 „ „ Mildmay Mission Hospital 1 „ „ Private houses etc 21 Total 69 Inquest cases classified according to age: — Number under 1 year 13 ,, over 1 year and under 5 years 2 „ „ 5 years „ „ 10 „ 3 „ 10 „ „ ,/ 20 „ 3 „ 20 „ „ „ 30 „ 1 „ 30 „ „ „ 40 „ 7 „ 40 „ „ „ 50 „ 4 „ 50 „ „ „ 60 „ 9 „ 60 „ „ „ 70 „ 7 „ 70 „ „ „ 80 „ 12 „ 80 _8 Total 69 27 Causes of death in inquest cases:— Natural causes 17 Misadventure: Operative shock 3 Accidental: Asphyxia 2 ; burns and scalds 1; tetanus 1; falls 18; run over 5 . 27 Open Verdict: Asphyxia in bed 3; ruptured bladder 1 ; want of attention at birth 3 ; no cause 1 8 Suicide 14 Total 69 28 MATERNITY & CHILD WELFARE. The development of Public Health administration has heen strikingly shown in the variety of activities now carried on under the general description of Maternity and Child Welfare work. From concern with purely environmental conditions, the Public Health service has found it necessary more and more to deal with the individual, and the newer forms of work relate to the most important and intimate phases of individual well-being. At the beginning of the year certain new branches of work came into operation and the Council has now one of the most comprehensive Maternity and Child Welfare services in London, as indeed is well needed having regard to the housing conditions and the economic position of the residents in the Borough. The main features of the work consist in (a) in the visitation of mothers and children in their homes by a staff of ten Health Visitors, and (6) in the giving of advice to mothers and children by a staff of part-time lady doctors, assisted by Health Visitors, etc., at the Welfare Centres. The Council's principal Maternity and Child Welfare Centre is a well-equipped building, at which, in addition to the usual clinics for general advice with regard to maternal and child welfare, there are also the following special branches of work Special Clinic for Delicate Children, Light Treat— ment, Dental Treatment, Orthopaedic Clinic, Massage. A Children's Consultation Clinic is also conducted on hired premises at Thornton Hall every week. The Council employs a trained Midwife, who conducts confinements in the district, also provides the services of Home Helps to relieve women of domestic work during confinement. A sterile maternity outfit is obtainable free, at half-price, or at cost price, accord— ing to the financial circumstances of the family. Mothers recovering from confinement and ailing children are sent away for convalescent treatment. In-patient 29 treatment is provided by arrangement with the Queen's Hospital, for children with enlarged tonsils, adenoids or mastoid disease. Nursing assistance in a variety of illnesses is also provided through the agency of the District Nursing Association. NOTIFICATION OF BIRTHS ACTS, 1907 AND 1915. During the year, 1,570 live births were registered in the Borough ; and of these 1,548 were notified to the Medical Officer of Health. There were also 35 stillbirths notified. Of the 1,583 living and stillbirths notified, 986 were notified by midwives, 363 by maternity assistants of the London Hospital, 186 by medical practitioners, and 48 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 580 live babies and 23 stillbirths being received in this way. WORK OF HEALTH VISITORS. The following table gives some account of the outdoor work of the Health Visitors so far as this can be expressed in statistics : — Visits. 28 Re-visits. Babies (under 1 year) 2,100 11,104 Children (1—2 years) 15 3,488 11,621 „ (2—3 years) 6 3,044 „ (3—4 years) 2 2,557 ,, (4—5 years) 5 2,532 Mothers (Ante-natal) 699 350 „ (Post-natal) 22 29 Stillbirths 38 43 Infant Deaths 57 25 Maternal Deaths 4 — Puerperal Fever (41) and Pyrexia (20) 27 34 Ophthalmia Neonatorum 36 75 Acute Poliomyelitis 2 2 30  Visits. 'Re-visits. Other Notifiable Diseases 13 25 Diarrhoea and Enteritis 27 15 Measles (4,477) and German Measles (33) 2,279 2,231 4,510 Whooping Cough 42 40 Other Non-notifiable Diseases 17 13 Milk Grants 72 1,100 Convalescent Treatment 23 41 Other matters 89 13b Futile Visits 378 1,983 Total Visits 5,953 28,867 Grand Total 34,820 MATERNITY AND CHILD WELFARE CENTRES. The popularity of the Council's Centre in Cornwall Road was maintained during the year. There were 150 sessions for infant consultations and 115 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 1928 and in previous years are as follow : — 1928. Cornwall Tkorntpn Road. Hall. Babies (0—1): First attendances 1,146 207 Subsequent „ 9,536 l',829 Children (1—5): First „ 145 38 Subsequent ,, 5,173 1,299 Total „ 16,000 3,373 31 Cornwall Thornton Road. Hall. Average attendance per Session 106.6 71.7 Medical Consultations 10,094 2,458 The statistics with regard to the attendances at the Maternity Clinic are given in detail later. 1928. 1927. 1926. 1925. Total Attendances of Children 19,373 18,223 15,992 15,713 New Cases (Children) 1,536 1,553 1,530 1,567 New Cases (Mothers) 759 600 515 527 Medical Consultations— Children 12,552 12,283 11,189 10,995 Mothers 1,726 1,390 1,172 1,200 Total Attendances for Milk Grants 18,131 17,287 13,844 13,931 32 Babies' Ailments. Prevention of Summer Diarrhoea. Health Exhibition. Lessons learned from Health Week. INFANT CONSULTATIONS. The work of Infant Consultations has continued on the same lines as heretofore, that is, the individual instruction of the mother by the doctor or health visitor. A few observations by one of the Medical Officers will be of interest :— " I have now been in attendance at the Friday Clinic at Cornwall Road long enough to begin to see some results. There are several sturdy children who first came to the Clinic as puny babies who had been steadily going downhill, and a number of mothers who had difficulty with a first child and are bringing up a second successfully with very little help. Other interesting cases are those mothers who have been induced by the Health Visitors, after weeks of persuasion, to come up. They are suspicious of help and intolerant of advice at first, but most of them return again and again, and many of them become the Centre's most devoted adherents. " It is a great help to know that the Health Visitors will at once follow up any case of difficulty or illness, and to be able to refer the mothers and children to specialist clinics for further treatment." Olive Potter. MATERNITY CLINIC. This is open every Wednesday and Thursday morning, and there is also a special post-natal session on the afternoon of the third Monday every month. Particulars of attendances : — Total. Expectant Mothers—First visits ... 526 ), „ „ —Subsequent visits ... 874 f ' Mothers recently confined—First visits ... 233 „ „ „ —Subsequent visits 110 ( 33 The number of sessions was 115, and the average attendance per session was 15.1. One hundred of the mothers who attended for pre— natal care also attended the Maternity Clinic after their confinement, and 28 of these mothers were sent away to a convalescent home. The 526 women who attended for the first time may be grouped as follows : — Gravid Primiparse 79 —Multiparse 388 467 No evidence at first attendance 11 Sterile 5 Not pregnant 43 526 In the case of the 467 gravid women, the following were the periods of gestation :— 3 were in the 1st month. 65 „ „ „ 2nd „ 55 ,, „ „ 3rd „ 44 „ „ „ 4th „ 62 „ „ „ 5th „ 98 „ „ „ 6th 91 „ „ „ 7th „ 42 „ „ „ 8th „ 7 ,, ), yj 9th An analysis of these cases shows :— Full-term confinements 305 Premature births 2 Caesarian section 1 Miscarriage (18); Stillbirths (5) 23 Not yet confined 136 The confinements took place: — 241 at home, and 67 in institutions. 54 Wasserman reaction for syphilis: — Number of blood tests 3 Positive 2 Number of films 11 Positive . — The following features of the work of the Clinic are also of interest:— (i) The large proportion of women attending in the early months of pregnancy. This is a striking testimony to the successful working of the Clinic and the confidence it inspires in the mothers. (ii) Many women, believing themselves pregnant, by attending the Clinic learn that although not pregnant they are suffering from conditions frequently coincident with the menopause such as fibroids, cysts, etc. (iii) Of the mothers who attended the Maternity Clinic during the year, 159 have attended the Infant Consultations with their children. Fourteen of the mothers engaged a Home Help from the Council's panel, and 73 of them obtained one of the Council's maternity outfits. The results of the 127 cases brought forward from 1927 were as follows:— Full-time confinements 122 Miscarriage (2); Stillbirths (nil) 2 Not pregnant 3 Of the 122 who were confined, in 89 cases this took place at home, and in 33 cases in an institution. Dr. R. C. Townshend reports on the work of the Maternity Clinc, as follows: — I am glad to be able to report that there has been a further increase in the average attendance during the year. There is nothing outstanding to report with regard to the results of the cases. With regard to the Caesiarian Section, this operation was performed for the second time on the same patient, with a satisfactory result. With regard to the miscarriages, all occurred in multiparae, and, with four exceptions, there was a history of the patient's having « 35 been attended by a doctor or being admitted to hospital. The four exceptions occurred in the early pregnancies of multigravidae. The two premature births occurred in first pregnancies, and both survived. One case occurred in hospital, as a result of induction of labour for pelvic contraction. With regard to the five stillbirths : two were about six and a half months premature and attended the Clinic complaining of haemorrhage at their first visit, and of these, one had a positive Wassermann and had been recommended to hospital treatment during her previous confinement, which terminated successfully ; the other patient was edentulous and poorly nourished. One case was due to post-maturity and occurred in hospital. One case appeared to be due to a recent attack of influenza, and the remaining patient gave a history of fright. The three Wassermann test cases were all referred to hospital. One was negative and two positive, and in each case the pregnancy terminated in a full-term healthy child. The five sterility cases were all referred to hospital for further investigation. The following interesting conditions occurred amongst the cases attending the Ante-Natal Clinic : Albuminuria ; haematuria ; heart disease ; pelvic contraction ; ovarian cyst ; fibroids of the uterus ; toxic erythema of pregnancy. All cases of albuminuria were treated by diet and terminated by successful pregnancies. With regard to the other conditions, the patients were either treated at the Clinic or referred to private doctors or hospitals for further advice. The Post-Natal Clinic, which was started in December, 1927, was held from 2—4 p.m., on the third Monday of each month throughout the year 1928. The Clinic has been fairly well attended, though handicapped by being held at such long intervals and on irregular dates. The result is that in some cases the patients are unable to wait so long for treatment and have therefore to be referred to the AnteNatal Clinic, with consequent overcrowding, and I feel that a fortnightly session would be more satisfactory and ultimately result in a larger attendance. The following interesting conditions occurred amongst patients attending the Post-Natal Clinic : — Uterine prolapse ; perineal rupture ; vaginal discharge ; breast abscess ; pulmonary tuberculosis. A number of patients also attended after stillbirth or miscarriage. 36 In conclusion, I should again like to thank the Lady Superintendent and the Health Visitors in attendance at the Clinic, together with the Dispenser, for their cordial help and untiring work throughout the year. Ruth C. Townshend. BOROUGH MIDWIFERY SERVICE. Of the Borough Midwife's 24 bookings carried forward to 1928, 2 were cancelled, Avhile during 1928 146 bookings were received, of which 5 were subsequently cancelled. During the year 131 mothers were attended, 82 by the Borough Midwife, plus one case in which a doctor was engaged, and 46 by private midwives acting as deputy for the Borough Midwife, while 2 patients were removed to hospital in labour. Of the 128 mothers delivered, 11 were primiparse and 117 multiparae. There were 32 expectant mothers on the books at the end of the year. The Borough Midwife paid 1,336 visits in connection Avith her practice and 8 other visits. She also conducts a regular weekly session for ante-natal care of her patients, and assists in the work of the Welfare Centre. In addition to the Borough Midwife's visits, visits were also paid during her absence on leave by her deputies. It is gratifying to record that 44 of the mothers delivered by the Borough Midwife during the year had been previously attended by her, 7 of them on two previous occasions, and 1 on three occasions. OBSTETRICAL CONSULTANTS. The Council has a panel of five Obstetric Consultants, who may be called in by any general practitioner in any midwifery case which presents difficulty or abnormality. Three consultations took place during the year. HOME HELPS. This new service came into operation during the year. Like the provision of maternity outfits, it will 37 require time and greater advertisement to develop. At the end of the year there were 4 Home Helps on the panel, and they had been engaged by 14 mothera(, in 12 cases the mother paying a contribution for the services rendered. MATERNITY OUTFITS. As foreshadowed in last year's annual report, the Council has arranged, with the sanction of the Ministry of Health, to provide a sterile accouchement outfit for the use of expectant mothers. The scheme was only in operation during part of the year, and has not yet become generally known in the borough. Outfits were issued as follows:—Free 45; Half-price 13; Cost price 14; Total 72. 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 If pints per day may be authorised. In April, 1928, specially packed cartons of dried milk, containing the uniform equivalent of 7 pints of fluid milk, were substituted for the previous 1 - lb. packets, which were equivalent to various quantities (according to brand), less than 7 pints. A full account of the procedure in dealing with applications for milk grants was given in the annual report for 1924. 38 There were 99 sessions for dealing with applications for milk grants, and parents made 18,131 attendances at the Welfare Centre in connection with this subject. During the year the following quantities of milk were issued to necessitous mothers:— Grade A (Tuberculin Tested) Milk 10,451 galls. Dried Milk 18,547 pkts. Condensed Milk 245 tins together with drugs, etc. The approximate cost of milk given in this way was £2,769. While it does not admit of statistical measurement, there can be little doubt that the Council's provision of milk for necessitous mothers and children has been an important contributing factor to the improved standard of child life in the borough. The milk provides much needed increased resistance to the debilitating effects of over-crowding, noise and dirt, deficiency of sunlight and air, and the other concomitants of poverty in a congested urban area. Its value in better health far outweighs its modest cost in cash. SUPPLY OP DRIED MILKS, Etc. In connection with the work of the Council's Centres dried milks of various brands, labelled specially to the Council's directions to avoid the use of trade names, are sold to the mothers :— Dried Milk 15,842 pkts. Condensed Milk 97 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. 39 SPECIAL CLINIC FOR DELICATE CHILDREN. Since 1925, a Special Consultation Clinic for Delicate Children has been in operation at the Centre, conducted by Dr. Helen M. M. Mackay, M.D., M.R.C.P. Medical Officers at the Infant Consultations observing children whose conditions require special investigation, or on whom they desire a second opinion, refer such children to the Special Clinic. An important feature of the Clinic is artificial light treatment by means of a quartz mercury vapour lamp. Below are given the figures for cases and attendance:— New cases 100 Subsequent attendances 621 Consultations 627 Light treatments 766 No. of sessions 48 Average attendance per session 15 ARTIFICIAL LIGHT TREATMENT. The subject of phototherapy has been one round which, of late, much controversy has centred. There are those who would deny that, except in certain specified conditions, notably rickets, there is any demonstrable proof of actual physical benefits accruing to the recipient of Artificial Light Treatment as administered by the Ultra Violet lamp, and further, they allege, that the same benefit can be obtained by other and less costly means as, for example, the administration of cod liver oil and regulation of the food intake. Upon the other hand there is much subjective evidence of an improvement in general well-being, noted in the form of better appetite, sounder sleep, increased energy—in short, an increased joy in life. Although such subjective evidence is necessarily suspect, tinged as it often is with an unwarrantable optimism and faith, its volume is such as to merit careful consideration. It 40 invites the question whether we are justified, in the absence of scientific proof of the efficacy of light treatment, in making provision for its use at our Welfare Centres. Unquestionably, I think, its provision is justified. With the bulk of our children in Bethnal Green living under the insanitary conditions associated with an intense urbanisation and, for whom a properly balanced dietary is not available, it would appear only reasonable to give them the benefit of the doubt. The administration of artificial light must, however, be carefully regulated. Opinion is conflicting upon its optimum dosage, and its physiological effects; that there is danger in its unskilled and injudicious exhibition cannot be gainsaid. It is, in short, unsuitable for indiscriminate use by the general public. But, under the conditions it is administered at the Borough Council's Welfare Centre, where the dose is adjusted under medical supervision, there appears every reason why we should continue to make available this form of treatment pending such time as a balanced opinion and judgment upon all the facts available can be expressed. PROPHYLACTIC LIGHT CLINIC. There are now two ultra-violet ray lamps (one suspension type and one of the standard type), thus enabling light treatment to be given as a prophylactic measure for expectant and nursing mothers and children as well as the children previously treated in connection with Dr. Mackay's clinic. Treatment is also given to children from the Bethnal Green Day Nursery, Somerford Street. I append some extracts from the report of Dr. D. I. Mart, who conducts the Prophylactic. Light Clinic:— I have to report that the year's results of the Prophylactic Ultra-Violet Light Clinic have been very encouraging. Our attendance numbers have grown steadily. 41 Looking back over the year, I would generalize by saying that while ultra-violet light has definitely curative properties, such as for rickets, chilblains and shingles, its best benefit to Bethnal Green is in preventing illness. It has an extraordinary tonic effect, both mental and physical. The dust in Bethnal Green air fobs the natural sunlight of its health - giving rays. Our Clinic makes up the loss. Artificial sunlight is at the present day a fundamental need of nearly every person in the Borough. As a result of sunlight starvation, mothers become depressed and debilitated, and for the same reason our children fail to grow properly, becoming rickety, and suffer from bronchitis. In these debilitated states they are an easy prey to every kind of infectious disease and many other illnesses. Our' mothers, too, say that ultra-violet has helped to cure their nervous depression, and lias made them feel stronger and healthier. Cases of failing breast milk through general ill-health have so improved that they have maintained breast feeding throughout the whole nine months without recourse to any artificial substitute. We have still much to do in getting more mothers to come for treatment, and we still have to teach the lesson that to have healthy children we must first have healthy mothers. My best thanks are due to the Health Visitors, whose excellent co-operation has enabled us to overcome the initial difficulties and trials in organizing the work. In addition to cases arising directly through the Infant Consultations, we have lately had cases, referred to us from the hospitals, i.e., London and Great Ormond Street, from our own Orthopaedic Clinic and from the local Bethnal Green doctors. The new cases for the year 1928 show the following types of patients to have received marked benefit from treatment : — Children : Anaemia ; Malnutrition ; Orthopaedic Defects from Rickets, Paralysis, etc. ; ill-defined conditions classified as "Debility" and some local conditions such as Blepharitis, Enlarged Cervical Glands. Women : Both Expectant and Nursing Mothers—for Debility ; Nervous Manifestations ; Failure of Breast Milk. 42 LIGHT TREATMENT. The following statistics give some idea of the light treatments given to mothers and children arising from both the Special Clinic for Delicate Children and the Prophylactic Light Clinic: — Treatment Sessions:—202 (4 per week). Treatments:— Children ... 384 (including 189 new cases). Nursing Mothers 315 (including 44 new cases). 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 year's work was as follows:— Thirteen Ordinary Sessions and eleven Gas Sessions have been held during the year on alternate Thursday mornings. Cases brought forward from 1927 14 New cases—Mothers 53 Children 75 Subsequent attendances—Mothers 58 Children 74 Total attendances 260 Average attendance per session 11 Forty-seven mothers and 52 children were recommended by the doctors at the Centre, and 12 mothers and 20 children by the Health Visitors, etc. Treatment has comprised the following :— Mothers. Children. Extractions 28 53 Fillings 8 24 Dressings 6 2 Silver nitrate — 14 Scalings and polishing 14 2 Referred to Hospitals 16 Ten expectant mothers attended the Clinic as patients, 43 The extractions were as follow :— Temporary 154, Permanent 107 ; Total 261. There were 73 extractions under a general anaesthetic at the gas sessions (41 children, 32 mothers). The fillings consisted of :— Temporary 55, Permanent 18 ; Total 73. Miss Sutherland's comments on the work are as follow: Increased interest in the Dental Clinic is shown by the larger number of patients who have attended, both mothers and children ; and an advance has been made in the treatment of very young children. Several under the age of two years were brought to the Clinic bv mothers anxious for them to have treatment in the early stages of caries. Much educational and conservative work has been done with these very young patients. The introduction of gas sessions at the beginning of the year has been of great benefit, many cases being treated that would otherwise have had to go elsewhere. With increased facilities for extractions of unsavable teeth, a demand for artificial dentures will arise. The co-operation of the Clinic Doctors and the Health Visitors has added greatly to the value of the work of the Dental Clinic. Janet H. M. Sutherland. ORTHOPAEDIC TREATMENT. During the year, the new arrangement for orthopaedic treatment came into operation. The Orthopaedic Surgeon attends the Clinic onoe a month, while an Orthopaedic Sister attends once a week to carry out any prescribed treatment. Children found to require instruments or in-patient treatment are provided accordingly. Dr. J. B. Barnett, the Orthopaedic Surgeon, reports as follows: — During the past year twelve sessions were held by the Orthopaedic Surgeon, and 45 by the Sister; 116 children received treatment from the Surgeon, and 461 from the Sister ; making in all a total of 57 sessions and 577 treatments—a very satisfactory record for a first year's work, 44 The congenital cases included Equino Varus, 4 ; Dislocated Hips, 2 ; Deformity of Toes, 1 ; Multiple Deformities, 1 ; Spastic Diplegia, 1. The acquired conditions were as follows :—Genu Varus, 56 ; Genu Varum, 23 ; Flat Feet, 7 ; Rickets, 10 ; Anterior Poliomyelitis, 4 ; Habit Deformity, 1 ; Funnel Chest, 1 : Ganglion below Ext. Malleolus, 1 ; Upper and Lower Motor Nerve Lesion, 1. It is interesting to note that of these patients 13 have been discharged as cured. As regards the treatments given, 66 patients received massage and remedial exercises ; seven, Faradism ; 54, ultra-violet radiation ; 74 splints have been issued,; 1 plaster case, and two patients were X-rayed at the London Branch of the Royal National Orthopaedic Hospital, in Great Portland Street. Two patients, sufiering from Outward Curvature of the Tibia, have been admitted to the Royal National Orthopaedic Hospital, at Stanmore. Both were successfully treated by operation ; one has already been discharged and the other is well on the way to recovery. The Bethnal Green Clinic is fast reaching a stage when grave defects are infrequently seen. Cases are now carefully treated before deformity has had time to set in, to the great advantage of all concerned. The co-operation of other branches of the Public Health services with the Orthopaedic Clinic is most admirable, and contributes in no small degree to the efficient working of the latter. MASSAGE. Massage had been given by a trained Masseuse for several years prior to the establishment of the Orthopaedic Clinic. Upon this taking place, and in accordance with the request of the Ministry of Health, the massage arrangements were made part of the scheme of orthopaedic treatment. During the year there were 290 sessions for massage; 77 new cases were treated, and there were 1,594 treatments, 45 ENLARGED TONSILS, ADENOIDS AND MASTOID DISEASE. In accordance with the new arrangements with the Queen's Hospital, 9 young children had operations for enlarged tonsils as in-patients upon the recommendation of the Medical Officers of the Welfare Centres. CONVALESCENT TREATMENT. During the year 13 mothers were sent to the London Mothers' Convalescent Home, Sunningdale, Berkshire, and 14 mothers to the "George Whitlaw" Convalescent Cottage, Amerden, near Taplow. Each mother was sent away for two weeks. In 20 of the cases the husband contributed to the cost of the convalescence. With regard to children, the arrangement made with the Hertfordshire County Council in 1922 was continued, and 46 children were sent to that Council's Home at St. Leonard's-on-Sea, Sussex, 4 for one week, 35 for the normal period of four weeks_, 1 for five weeksl, 6 for six weeks. Children were also sent to the Marjorie Lumley Holiday Home, Maidenhead (8), and the Toddlers' Convalescent Home, Arkley (5), for periods varying from 2 to 8 weeks. In 28 cases the parents contributed to the cost of the convalescence. The satisfactory character of the arrangements made for the well-being and comfort of the mothers may be judged from the following sample appreciatory letter: — " I wish to thank you and show you how grateful I am for my two weeks at the George Whitlaw Convalescent Home. Though it is four weeks since I have come home, I really must thank you and let you know how much good it has done me. " I was on the verge of a bad breakdown. But for the two weeks I really don't know what I should have done. My health and babies have greatly improved. 46 " I wish, on behalf of my husband and myself, to thank Miss Whitlaw and the Matron and staff for the kindness to me and the baby. The goodness of the two ladies is really beyond my thanks. " Wishing the two ladies health and strength to carry on the wonderful work—" NURSING ASSISTANCE. A scheme of home nursing has been in operation for some years by arrangement with a voluntary organisation, the Shoreditch and Bethnal Green Nursing Association. For each visit a charge of tenpenoe is made to the Council by the Association. As regards children under the age of five years, the Ministry of Health have sanctioned expenditure on the nursing of all sick cases, but grant is only paid by the Ministry in respect of certain specified conditions, e.g., Measles, Whooping Cough, Diarrhoea, Ophthalmia Neonatorum and Poliomyelitis, which come within the Council's Maternity and Child Welfare Scheme. 47 Nursing Assistance, 1928. 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 3 93 ... ... ... ... ... ... ... ... 93 Discharging Eyes 30 530 ... ... ... ... 20 358 ... ... 888 Measles 3 21 17 147 ... ... ... ... 8 84 262 Whooping Cough ... ... 1 5 ... ... ... ... ... ... 5 Diarrhoea ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever and ... ... ... ... ... ... ... ... ... ... rexia ... ... ... ... 3 51 ... ... ... ... 51 Other pre natal and ... ... ... ... ... ... ... ... ... ... ... natal conditions ... ... ... ... 40 506 ... ... ... ... 506 Corneal Ulcer ... ... ... ... ... ... 2 20 ... ... 20 Conjunctivitis ... ... ... ... ... ... 1 10 ... ... 10 Excision of Eye ... ... ... ... ... ... 1 10 ... ... 10 Otorrhcea, Abscess of Ear ... ... ... ... ... ... 5 38 ... 6 38 Tonsils and Adenoids ... ... ... ... ... ... ... 79 271 ... ... 277 Influenza ... ... ... ... ... ... 1 5 3 18 23 Bronchitis ... ... ... ... ... ... 5 44 ... ... 44 Pneumonia ... ... ... ... ... ... 21 208 18 141 349 Tuberculosis ... ... ... ... ... ... 1 10 ,,, ... 10 Intestinal Conditions ... ... ... ... ... ... 7 30 ... ... 30 Threadworms ... ... ... ... ... ... 50 411 ... ... 411 Septic Umbilicus ... 21 ... ... ... ... ... ... ... ... 21 Stomatitis ... ... ... ... ... ... 2 13 ... ... 13 Burns and Scalds ... ... ... ... ... ... 4 35 ... ... 35 Abscess ... ... ... ... ... ... 2 16 ... ... 16 Pemphigus ... 40 ... ... ... ... ... ... ... ... 40 Impetigo ... ... ... ... ... ... 9 86 ... ... 86 Eczema ... ... ... ... ... ... 1 10 ... ... 10 Septic Throat ... ... ... ... ... ... 1 10 ... ... 10 Circumcision ... ... ... ... ... ... 5 38 ... ... 38 Totals 41 705 18 152 43 557 217 1623 30 249 3286 4 cases were in band at the beginning of the year. 16 cases were in hand at the end of the year. A total of 3,286 visits was paid to 349 cases at a cost of £132 15s. Od. 48 During the year 276 children under the age of 5 were nursed, a total of 2,480 visits being made, but owing to the restricted character of the Government grant for nursing assistance, only 857 of these visits ranked for grant. Forty-three mothers received 557 visits for nursing in connection with conditions incidental to child-bearing, grant being payable in respect of this expenditure. INFANTILE MORTALITY. One hundred and fifty - eight deaths of Bethnal Green infants under one year of age are reported by the Registrar-General as having taken place during the year. This is equal to a rate of infantile mortality of 73.9 per 1,000 births. The infant death rate for London was 67 and for England and Wales as a whole 65. 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 1926 71.1 1927 57.7 The Registrar-General reports that 147 of the deaths were those of legitimate infants and 11 those of illegitimate infants. Accordingly we have the following figures for Infantile Mortality:— Infantile Mortality (legitimate) 70.7 do. do. (illegitimate) 186.4 do. do. (all infants) 73.9 49 These figures show a disquieting increase on those for the past 2 or 3 years. Deaths from Measles, Pneumonia, Diarrhoea and Premature Birth all were higher than in the previous year. As I indicate elsewhere in this report, the housing and other social circumstances in Bethnal Green are not favourable to child life, and I am afraid that so long as these are allowed to remain, we must expect to have setbacks in our progress towards better health. Infantile Mortality in Bethnal Green in 1928. Causes 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 1,000 Births Measles ... ... ... ... ... ... 2 1 8 11 5. Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 3 3 1 ... 7 3. Diphtheria and Croup ... ... ... ... ... ... 1 1 1 3 1. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 1 0.5 Meningitis (not Tuberculosis) ... ... ... ... ... ... 2 3 ... 5 23 Convulsions ... ... ... 1 1 ... 1 ... ... 2 0. Bronchitis ... ... ... ... ... 1 ... ... 1 2 0'9 Pneumonia (all forms) ... ... 1 1 5 7 4 9 7 32 15'0 Diarrhoea and Enteritis ... ... 1 ... 1 4 15 7 5 32 15'0 Syphilis ... ... 1 ... 1 ... ... ... ... 1 0. Rickets ... ... ... ... ... ... ... 1 1 2 0'9 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 2 ... ... ... 4 ... ... ... ... 4 1.9 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 1.9 Congenital Malformations ... 2 ... 1 ... 7 ... ... ... ... 7 3.2 Premature Birth 23 ... i 2 '26 2 1 ... ... 29 13.6 Atrophy, Debility and Marasmus ... ... ... ... ... 1 1 ... ... 2 0.9 Other Causes 4 ... ... ... 4 1 4 2 3 14 6.5 Totals 36 6 5 6 53 19 34 26 26 158 73.9 Net Births in legitimate 2078 the year illegitimate 59- Net Deaths in the year legitimate infants 147 illegitimate infants 11 50 PUERPERAL FEVER AND PUERPERAL PYREXIA. Twelve cases of Puerperal Fever were reported during the year, but in one case the diagnosis was not confirmed. Three of the patients were treated in the North Western Hospital, two in the London Hospital, two in the City of London Maternity Hospital, one in St. Bartholomew's Hospital, and four in Bethnal Green Hospital. There were two deaths from the disease. Ten cases were also notified as Puerperal Pyrexia, but in one case the diagnosis was not confirmed. Three of the patients were treated in the North Western Hospital, three in the Mothers' Hospital, Clapton, one in the Elizabeth Garrett Anderson Hospital, one in the City of London Maternity Hospital, and the remaining two cases at home. Three mothers had nursing assistance in respect of Puerperal Fever and Puerperal Pyrexia. OPHTHALMIA NEONATORUM. Thirty notifications of Ophthalmia Neonatorum were received during the year, eighteen of these notifications coming from public medical officers either of the Borough Council, Board of Guardians or London County Council. One case was removed to and treated in the St. Margaret's Hospital, while six other cases received out-patient treatment at hospitals. The remaining cases were treated at home. Three cases received nursing attention at home from the Shoreditch and Bethnal Green District Nursing Association, the Borough Council paying part of the cost: 93 visits being paid by the nurses of the Association. In every case the condition was cured without any apparent impairment of vision. 61 Very special attention is given to this serious ailment. Every case is very carefully watched by the Health Visitor until the condition clears up, and her reports most thoroughly scrutinized, the object being the prevention of any risk of blindness resulting. The Health Visitors paid 111 visits to cases. In addition to the foregoing formal notifications of Ophthalmia Neonatorum, 42 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. The district nurses treated 30 cases of discharging eyes in young infants, paying 530 visits for the purpose. STILLBIRTHS. Inquiry was made into 56 stillbirths reported during the year, and some information relating to 48 of them was obtained. In ten cases the mother was reported to have been engaged in industrial employment during pregnancy. The health of the mothers was reported on as follows:—Good 23; Fair 9; Bad 15; and the following complications of pregnancy were noted: Albuminuria 3; Rheumatism and Heart Disease 2; Gastritis 2; Cough 2; Venereal Disease 1; Hernia 1; Varicose Veins 1. The period of gestation was normal in 24 cases, but was only seven to eight months in ten cases and eight to nine months in nine cases, while one case was given as hyper-normal (42 weeks). Labour varied greatly in duration, being less than six hours in ten cases, six to twelve hours in eleven cases, twelve to eighteen hours in six cases, eighteen to twenty-four hours in two cases, twenty-four hours in two cases, and in 34, 36, and 48 hours there was one case each, while there were two cases with a labour given as long as four days, and four cases were simply marked as "long." 62 There was a record of one previous stillbirth in two cases, and of four previous stillbirths in one case, while there was one case of a previous miscarriage, one of three previous miscarriages, and one of four previous miscarriages. The possible causes of stillbirths do not admit of very clear tabulation, but include the following assignments, with or without other complication:— Small pelvis (2); Large child (1) 3 Abnormal delivery 11 Falls during pregnancy 5 Ante-partum haemorrhage 4 Placenta prævia 2 Fright (3); Domestic worries (2) 5 Induced delivery, following albuminuria (inc. 1 cæsarian section) 2 Information of a positive Wassermann reaction was obtained in one case. A glaring sidelight upon the housing conditions of the people is afforded by the statistics as to accommodation in 45 of these cases: — Persons per room. 0—1 1—2 2—3 3—4 4—5 5 and over. 2 21 16 3 2 1 In the last case referred to there were six persons in a single room. The prospects of a satisfactory live birth, to say nothing of the child's after life, in such conditions can surely be appreciated by the most limited imagination. Seven mothers are shown as having attended the Council's Maternity Clinic, and eight other mothers attended hospital ante-natal clinics. Six of the mothers attended the Council's Post-Natal Clinic after the confinement. The foregoing facts emphasise the desirability of making better known to expectant mothers the facilities open to them for getting sound advice as to their condition, and as to the precautions which need to be taken to ensure the safe birth of a live and healthy child. 53 INFANTILE DIARRHŒA. During the year 21 cases of Infantile Diarrhoea were investigated by the Health Visitors at the homes of children following notice of these cases given by the medical officers at the Welfare Centre. The enquiries gave the following results:— Wards. South—5; West—1; North—5; East—10. Where the children were not already under medical care, the mothers were advised as to simple precautions to be taken, and a leaflet of advice was left at the home. Each case was kept under observation until it cleared up. One case was fatal. Only three of the children affected were breast-fed; twelve of the children were over 9 months of age. The figure with regard to the use of the dummy is more satisfactory than last year's, five children being found with this dangerous so-called "comforter." Food cupboards of some kind were found in 20 cases. In all but five cases the dust-bin was found covered. The most disquieting feature resulting from the investigation of these cases was the revelation of the overcrowded conditions under which these children lived. In only nine cases were the families above the low housing standard of two persons per room; in four cases there were two persons; in four further cases three persons; in three cases four persons; and in one case the equivalent of 4.5 persons per room. Coupled with the actual overcrowding of the persons per room should also be considered the congestion of the persons on the site. I find that in 18 cases in which the information is given, the floors on which the families lived were as follow:—Basement 1; Ground 4; First 6; Second 4; Third 2; Fourth 1. The distance of the family from the ground floor complicates both the prompt removal of refuse and the obtaining of outdoor exercise. Tenement building life 54 has also the drawbacks indicated in the following sample reports by Health Visitors:-— " The large dustbins outside the buildings, used in common by all the other tenants, were uncovered, and the contents swarming with flies. Lids of dustbins are rather high and heavy to lift." (Eeferring to sanitary fittings). "All in working order, but used by six families and frequently in a dirty state." The Health Visitors' reports concerning the standard of domestic hygiene they found reflects great credit on the mothers living under the conditions just described, 14 being reported as good (many specially distinguished as "very clean," etc.), 3 as fair, and only 3 as "bad." Several talks to mothers on diarrhoea, its prevention and treatment, were given by the Superintendent Health Visitor at the Welfare Centre. MATERNITY AND CHILD WELFARE DEVELOPMENTS. Most of the developments of the Council's Maternity and Child Welfare Scheme, concerning which I reported in 1927, have been carried into effect. There were, however, certain other matters which while they could not then be dealt with should be borne in mind as possible suitable subjects for the future extension of the work. No considerable extension of activity is possible within the limits of the present accommodation and staff, which are already adequately occupied. If sufficient and suitable accommodation were available in the Western portion of the Borough, it could undoubtedly be utilized with advantage as a Child Welfare Centre in place of Thornton Hall, as well as being used as a Breast - feeding Clinic, and possibly also as a Day Nursery. The chief difficulty is securing such accommodation. 55 NOTIFIABLE DISEASES, Etc. Diphtheria. There were 385 cases of diphtheria notified during the year. The age grouping of the eases is given in the accompanying table. All the cases were removed to an isolation hospital except 2. These cases were treated at home, proper facilities being available for isolation and treatment. Nine deaths from this disease occurred during the year, equivalent to a case mortality of 2.3 per cent., or general death rate of 0.07 per 1,000 of the population. In view of the considerable discussion during recent years of the incidence and mortality of Diphtheria, in connection with proposals for the adoption of the Schick test and immunisation by means of toxin-anti-toxin, the following figures are given as to the experience of the Borough:— Notifications 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 0.17 1924 566 29 0.24 1925 493 19 0.16 1926 646 21 0.17 1927 476 16 0.13 1928 385 9 0.07 It should be noted that the figures headed "Notifications" do not accurately represent the number of cases, as no doubt they include a proportion of cases 56 mistakenly diagnosed as clinical Diphtheria, undue reliance being placed upon a positive bacteriological report as a basis for notification. Anti - diphtheritic serum is stocked at the Town Hall and supplied free on the order of a doctor; 28,000 units were supplied during the year. Scarlet Fever. There were 623 cases of scarlet fever notified during the year, 621 of the patients being removed to an isolation hospital. The relative mildness of the disease in recent years indirectly leads to the spread of the disease, through many "missed" cases of an ambulatory type living amongst the general population. No use has been made in the Borough, so far as I am aware, either of the Dick test for the purpose of diagnosis or of serum for immunisation or therapeutic purposes. Two deaths were returned by the Registrar-General as due to scarlet fever during the year, equal to a case mortality of 0.3 per cent., and a death rate of 0.017 per 1,000 population. Comparison with previous years is as follows:— Notifications Deaths Death Rate 1918 298 9 .09 1919 393 4 .04 1920 1070 12 .10 1921 996 10 .08 1922 356 6 .05 1923 316 5 .04 1924 426 5 .04 1925 333 4 .03 1926 469 — — 1927 610 4 .03 1928 623 2 .02 57 Hospital Treatment and Diagnosis. Almost all (99 per cent.) the cases of Diphtheria and Scarlet Fever were removed in a remarkably prompt manner to M.A.B. Hospitals. I share the opinion expressed by my predecessor, that it is desirable that the final diagnosis of all cases should be reported to the Medical Officer of Health concerned, on the discharge of the patient. There is good reason for thinking that in a substantial number of cases an altered diagnosis is arrived at at the hospital. Smallpox. Four cases of Smallpox occurred in the Borough during the year, while many cases occurred in other London Boroughs with contacts in Bethnal Green. The last serious outbreak of Smallpox 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 Other Notifiable Diseases. Particulars of the number of notifications of various diseases and the age grouping of the patients will be found in the accompanying table. In addition to the usual routine enquiries and protective measures, special enquiries have been made in a number of cases of Encephalitis Lethargica, etc., on behalf of the London County Council. 58 Consultations with Medical Practitioners. In several instances in which the diagnosis was in doubt, I was asked by the medical practitioners concerned to see the cases in consultation. Statistics and notes with regard to Puerperal Fever, Ophthalmia Neonatorum, Infantile Diarrhoea, and Home Nursing will be found in the section relating to Maternity and Child Welfare. 59 Cases of Notifiable Diseases Notified during 1928. Disease Number of Cases Notified Reported by RegistrarGeneral. Total Under 1 year 1 and under 2 years 2 and under 3 years 3 and under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards Removed to Hospital Smallpox 4 4 ... ... ... ... ... ... ... 1 2 1 ... ... 4 Enteric Fever 7 7 1 1 ... ... ... 1 ... 1 ... 3 ... ... 7 Diphtheria (inc. Memb. Croup) 384 385 21 25 24 46 37 127 59 20 15 10 1 ... 383 Scarlet Fever 628 623 11 30 45 58 64 277 72 35 20 8 3 ... 621 Puerperal Fever 11 12 ... ... ... ... ... ... ... ... 3 9 ... ... 12 Puerperal Pyrexia 11 10 ... ... ... ... ... ... ... ... 3 7 ... ... 8 Ophthalmia Neonatorum ... 30 30 ... ... ... ... ... ... ... ... ... ... ... 1 Erysipelas 94 94 2 2 1 1 3 7 8 3 6 24 32 5 57 Cerebro spinal Fever ... 3 3 ... ... ... ... ... ... ... ... ... ... ... 3 Acute Poliomyelitis ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 Acute Encephalitis Lethargica ... 6 ... ... 1 ... ... 2 1 ... ... 1 1 ... 5 Acute Polio-encephalitis ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 Acute Primary Pneumonia ... 196 15 20 8 12 15 30 13 13 5 36 19 10 92 Acute Influenzal Pneumonia ... 35 ... ... 1 ... ... ... 1 4 6 15 6 2 21 Dysentry ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... Malaria ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... Continued Fever ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Typhus Fever, Cholera, Plague, Relapsing Fever ... Nil ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Hydrophobia, Glanders ... Nil ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... 177 ... 1 1 ... ... 6 5 19 31 70 38 6 • Other forms of Tuberculosis ... 43 ... 1 3 3 1 13 4 7 3 6 2 ... • Total 1631 83 81 84 120 120 463 164 103 94 193 103 23 1217 * See particulars as to Sanatorium Treatment in Tuberculosis section. 60 Non-Notifiable Diseases. During the year 2,184 cases of Measles came to my knowledge from the following sources:— Schools 1,243 M.A.B. Hospitals 99 Other Hospitals 264 Medical Practitioners 62 Health Visitors 491 Others 25 2,184 All cases were visited, either by the special Measles Health Visitor or the District Sanitary Inspector or the Health Visitor, according to the age of the patient. Three hundred and thirty patients were removed to M.A.B. Hospitals, and in twenty-eight cases nursing assistance was provided by the Council. Forty cases proved to be not measles. The Temporary Measles Health Visitor appointed at the end of 1927 was employed until 31st March, 1928, when the epidemic had abated. Her services were of great value in securing some kind of administrative control over the spread and prompt treatment of the disease. Information as to primary cases under school age was passed on to the L.C.C., to enable that authority to check the spread of infection in the schools, and similar information was sent to Sunday Schools. I also received information as to 418 cases of Chicken Pox, mainly from the Head Teachers of Elementary Schools in the Borough. These cases were visited by the District Sanitary Inspectors. Thirteen cases of Whooping Cough occurring in children under school age came to my knowledge through reports from the M.A.B. (12) and a Health Visitor (1), and these children were visited by the Health Visitors. 61 A number of other children were also visited by the Inspectors for conditions reported by the Head Teachers, and suggestive of one of the notifiable diseases. DISINFECTION SERVICE. During the year, 1,658 rooms and 24,136 articles were disinfected for various reasons, liquid Formalin in the form of a spray being used for the purpose of disinfecting rooms. One Belsize and one Morris motor van are used for conveying articles for disinfection. The table appended gives full details of the rooms, bedding and clothing disinfected. Disease No. of Rooms Disinfected Scarlet Fever 610 Diphtheria 359 Smallpox 29 Enteric Fever 6 Puerperal Fever 4 Erysipelas 4 Pneumonia 1 Pulmonary Tuberculosis 94 Measles 14 Cancer 17 Scabies 21 Verminous conditions 473 Other conditions 26 1,658 No. of articles disinfected, 24,136 (including 2,000 articles such as boots, etc., disinfected in Formalin Chamber). No. of articles destroyed by request, 186. Library books disinfected, 666. 62 INSECT PESTS. During the year the scheme for the destruction of vermin in the Borough has been in operation. A small stock of spraying machines is kept for issue on loan, with a quantity of insecticide, to residents desirous of following up and completing the disinfection of their rooms. The sprayers were lent on 127 occasions during the year. The newly-opened Personal Cleansing Station (referred to below) now provides facilities for personal treatment. An attractively printed leaflet on the subject of Insect Pests has also been prepared. Verminous Conditions. Eighty-five children were reported from the L.C.C. Cleansing Station as being infested with vermin. In every case advice as to the treatment of the clothing and bedding was given and disinfestation by steam was offered. In 13 cases advantage was taken of the offer. Rooms were disinfested of vermin in 473 cases. Scabies or Itch. Forty-five children suffering from this disease were visited after being excluded from the Elementary Schools. In 12 instances disinfestation of the clothing and bedding was accepted. In addition, 10 cases of Scabies were reported by the London Hospital, and in 7 of these cases the bedding was disinfected. Twentyone rooms were also fumigated after Scabies. Personal Cleansing Station. The Personal Cleansing Station opened in September, 1927, is gradually becoming better known to the public as part of the Council's considered scheme for 63 the destruction of insect pests. The baths are available for women on Wednesdays, when a woman attendant is engaged, the other days being allocated to men. During the year 242 men and 4 women had baths and their clothing disinfected for vermin, and 90 men, 11 women and 13 young children had treatment with sulphur ointment, in addition to baths and disinfection for Scabies. DISTRIBUTION OF DISINFECTANTS. During the year 11,323 pints of disinfectant fluid were distributed to applicants at the Town Hall. At the end of the year, in pursuance of a circular from the Ministry of Health, arrangements were made for the issue of disinfectant in poison bottles only. 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. The shelter was used on two occasions for a total period of four nights during the year. BACTERIOLOGICAL EXAMINATIONS. The Council's bacteriological work is carried out by the Clinical Research Association. The following specimens were examined during the year:— Throat and Nasal Swabs—submitted for examination 1,034 Diphtheria bacilli present in 108 Sputum—specimens submitted for examination 174 Tubercle bacilli present in 19 Blood-serum—specimens examined 6 Widal reaction positive in 1 One specimen of faeces and eleven specimens of uterine material were also examined. 61 TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year are set out in the tables appended hereto, from which it will be seen that 220 new cases of Tuberculosis were notified under the Public Health (Tuberculosis) Regulations. In addition, there were 29 cases which came to my knowledge other than by notification, 19 of these being after death, making a total of 249 cases. Since the introduction of the Regulations which deal with the quarterly revision of the Tuberculosis Register, it has been 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, 1928, was 1,326. The details are given in the table on pages 65-68. During the year the Registrar-General reported 105 deaths from Pulmonary Tuberculosis, and 18 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 1926 121 20 141 1927 115 17 132 1928 105 18 123 The notifications received during the year will be seem from the following tables:— 65 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications on Forms A & B received during the year 1928. Age of Patient Tuberculosis of the Lungs Other Tuberculosis Male Female Total Male Female Total Primary Notifications. 0—1 year ... ... ... ... ... ... 1—5 years. 1 1 2 4 4 8 5—10 „ 2 4 6 4 8 12 10—15 „ 2 3 5 1 2 3 15—20 „ 7 12 19 4 3 7 20—25 „ 10 21 31 1 2 3 25—35 „ 19 12 31 3 2 5 35—45 „ 26 13 39 1 ... 1 45—55 „ 22 6 28 ... 2 2 55—65 „ 9 1 10 ... ... ... 65 years and over 4 2 6 ... ... ... Total 102 75 177 18 23 41 Cases re-notified 38 26 64 2 2 4 Total Notifications on Form A 140 101 241 20 25 45 Primary Notifications by School Medical Officers 0—5 years ... ... ... ... ... ... 5—10 „ ... ... ... 1 ... 1 10—15 „ ... ... ... ... 1 1 Cases re-notified ... ... ... 1 ... 1 Total Notifications on Form B ... ... ... 2 1 3 66 Patients added to the Register otherwise than by notification. Pulmonary Non-Pulmonary 0—1 years 1 — 1—5 " 1 8 5—10 " — 1 10—15 " — — 15—20 " 2 — 20—25 " — — 25—35 " 11 — 35—45 " 1 — 45—55 " — — 55—65 " 1 1 65 years and over 2 — 19 10 Notification is fairly satisfactory on the whole, but delay is sometimes experienced in the receipt of notifications of admissions to and discharges from sanatoria. There were 19 deaths certified from Tuberculosis in which the deceased person had not previously been notified. Enquiry of the certifying practitioner in each case elicited the following explanations:— Due to oversight or pressure of work 3 Previous notification assumed or alleged 6 Bacteriological evidence only received at death 4 Diagnosis based on post-mortem examination 4 Certified by Coroner 1 No reply (doctor removed from district) 1 A number of these cases were Tuberculous Meningitis. Late notification, probably due to delay in seeking medical treatment, is shown by the following figures:— Notified practically at time of death 6 „ within 1 month „ „ 17 „ „ 3 months „ „ 15 „ „ 6 „ „ „ 11 67 No. of Notifications on Forms C. & D. Poor Law Institutions Sanatoria c D c D Pulmonary Tuberculosis— Male 25 21 75 61 Female 19 14 48 37 Non-Pulmonary Tuberculosis— Male ... ... 16 13 Female 1 ... 10 11 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 31/12/27 537 370 220 174 1301 Number of cases notified under the Public Health (Tuberculosis) Regulations, 1912, during the year 1928 102 75 19 24 220 Other cases added to the Tuberculosis register during 1928 6 6 1 1 14 645 451 240 199 1535 Number of cases removed from Tuberculosis Register during 1928. (For details see separate statement) 98 67 24 20 209 Cases remaining on Tuberculosis Register 31/12/28 547 384 216 179 1326 68 Details of Cases removed from Tuberculosis Register during the Year 1928. Deaths 134 Patients removed from Borough 65 Cases removed from Register as "Cured" 6 Diagnosis not confirmed" 4 Total 209 WORK OF TUBERCULOSIS HEALTH VISITORS. The two Tuberculosis Health Visitors paid 4,682 visits of enquiry and advice with regard to the welfare of tuberculous patients in the Borough. In the course of their work they endeavour to persuade such patients to adopt such hygienic manner of life as is practicable by separate sleeping accommodation, safe collection and disposal of sputum, etc. They also make economic enquiries on behalf of the L.C.C. in connection with sanatorium treatment, etc. TUBERCULOSIS SUB-COMMITTEE. The Tuberculosis Sub-Committee of the Public Health Committee has functioned during the year as the local care committee, dealing with such matters as grants of extra nourishment, assessments for sanatorium treatment on behalf of the London County Council, provision of bedsteads and bedding on loan to necessitous patients, etc. 69 SUPPLY OF SPUTUM OUTFITS. During the year 33 sputum flasks were distributed to patients. Twenty-two sputum tins, with 1,546 cardboard refills, were distributed to patients for use indoors. OPEN-AIR SLEEPING SHELTER. The Council's Open-Air Sleeping Shelter has been in use by one patient during the year. Unfortunately,, owing to the limited space available in the yards and gardens attached to the houses in the Borough, very little extension of use can be made of this valuable adjunct to treatment. SANATORIUM TREATMENT. During the year 171 patients were recommended to the London County Council for Sanatorium Treatment, and 146 of them were sent away for such treatment, while 10 children were admitted to open-air schools, and one adult patient to the Preston Hall Colony. I am not acquainted with the reasons for the non-acceptance of the other cases. GRANTS OF EXTRA NOURISHMENT. The arrangements with regard to grants of extra nourishment to necessitous tuberculous patients were fully reported in the Annual Report for 1921, and were continued during 1928. Since 21st February, 1926, Grade A (Tuberculin Tested) Milk has been given instead of ordinary milk. During the year 225 grants of milk and eggs were made to 94 patients at an estimated cost of £236. Fourteen patients were receiving nourishment at the end of the year. 70 TUBERCULOSIS DISPENSARY. A full report on the work of the Dispensary, by Dr. H. T. Howell, the Clinical Tuberculosis Officer, together with a copy of the new Annual Return to the Ministry of Health appeal's in the appendix to this report on page 106. 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 1928, 10 dispensary patients received dental treatment at the City of London Hospital for Diseases of the Heart and Lungs, and made 14 attendances therefor. Three patients were also assisted in the provision of artificial dentures. FINSEN LIGHT TREATMENT FOR LUPUS. PNEUMOTHORAX REFILLS. Since 1921, the Council has paid for the Finsen Light treatment of cases of Lupus at the London Hospital. During the year 3 patients were so treated, making 79 attendances for treatment. 71 Under the Council's arrangements for the provision of pneumothorax refills, 1 patient had 23 refills at the Brompton Hospital and 7 patients received this form of treatment at the City of London Hospital, having 68 refills between them. ARTIFICIAL LIGHT TREATMENT. The arrangements made last year for the provision of Artificial Light Treatment for Tuberculosis patients, chiefly non-pulmonary cases, at the City of London Hospital for Diseases of the Heart and Lungs were continued. During 1928, 3 patients had received 59 treatments under these arrangements. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. During the year, there came under observation a newly-notified case of Tuberculosis in the person of the wife of a dairyman. In view, however, of the facts that there was no proof that the patient was in an actively infectious state or that she took any regular part in the business, it was deemed sufficient to caution her verbally in the matter. 72 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 page 87, while the results of acton taken under the Food and Drugs Acts immediately follow. The regulations restricting the use of preservatives in food have placed important new duties upon the Council which require special skill and care for their efficient discharge. 73 FOOD AND DRUGS ACTS. Seven hundred and thirty - three samples were taken; 663 of these proved to be "ganuine" and 68, or 9.3 per cent, 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 301 277 24 5 4 1 306 Butter 85 73 12 14 12 2 99 Margarine 4 4 ... ... ... ... 4 Card 6 6 ... 3 3 ... 9 Cream 12 11 1 9 7 2 21 Condensed Milk 4 4 ... 5 5 ... 9 Dried Milk 3 3 ... ... ... ... 3 Jam 36 34 2 5 5 ... 41 Golden Syrup 2 2 ... ... ... ... 2 Honey 1 1 ... ... ... ... 1 Coffee 3 3 ... ... ... ... 3 Cocoa 4 4 ... 5 5 ... 9 Tea ... 2 2 ... 2 Lime Juice ... ... 5 5 ... 5 Lemon Juice ... ... ... 4 4 ... 4 Orange Squash ... ... ... 2 2 ... 2 Wine ... ... ... 3 3 ... 3 Whisky 4 4 ... ... ... ... 4 Gin 3 3 ... ... ... ... 3 Rum 2 2 ... ... ... ... 2 Olive Oil 2 2 ... ... ... ... 2 Camphorated Oil ... ... 2 2 ... 2 Aspirin Tablets 1 1 ... 5 4 1 6 Vinegar 27 21 6 2 2 ... 29 Mustard 1 1 ... 2 2 ... 3 Pepper 1 1 ... 6 6 ... 7 Sauce ... ... ... 2 2 ... 2 Flour ... ... ... 19 19 ... 19 Pearl Barley 29 23 6 19 15 4 48 Rice ... ... ... 6 6 ... 6 Tapioca ... ... ... 7 7 ... 7 Semolina ... ... ... 2 2 ... 2 Cornflour ... ... ... 1 1 ... 1 Arrowroot ... ... ... 2 2 ... 2 Rolled Oats ... ... ... 4 4 ... 4 Sago ... ... ... 2 2 ... 2 Bread ... ... ... 6 6 ... 6 Bread & Butter ... ... ... 1 1 ... 1 Puff Paste ... ... ... 1 1 ... 1 74 SUMMARY OF ANALYST'S REPORTS—continued. Article Samples taken formally Samples taken informal) Total number of Samples taken No. taken Genuine Adulterated No. taken Genuine Adulterated Sugar 1 1 ... 5 5 ... 6 Sweets 11 9 2 7 7 ... 18 Dried Fruit l 1 ... ... ... ... 1 Table Jelly 1 1 ... 2 2 ... 3 Pork & Beans 1 ... 1 4 1 3 5 Prawns ... ... ... 1 1 ... 1 Fish Paste 1 1 ... ... ... ... 1 Canned Peas 1 1 ... 1 1 ... 2 Meat Pieces ... ... ... 4 3 1 4 Sausages 1 1 ... ... ... ... 1 Ice Cream Powder ... ... ... 1 1 ... 1 Mincemeat 1 1 ... 5 5 ... 6 Totals 550 496 54 181 167 14 731 The Public Analyst has furnished me with the following summary of his work for the Council during 1928:— During the year 1928, 731 samples were examined under the Sale of Food and Drugs Acts. Eleven of the samples were taken by officials of neighbouring boroughs, the remainder by our own Inspectors. Sixty-eight of the samples were found to be adulterated, or 9.3 per cent. of the whole. In addition, 51 samples were of inferior quality, or doubtful purity. Of the 731 samples, 181 were purchased informally, and of these 14 were adulterated and 6 were of inferior quality. The adulteration for the previous five years was as follows :— Year. No. of Samples Examined. Percentage of Adulterated. 1927 728 9.2 1926 721 3.3 1925 745 3.9 1924 754 6.1 1923 736 5.6 Average 737 5.6 75 The average adulteration for the London Boroughs in 1927 was at the rate of 3.9 per cent., and for the whole of England and Wales 5.5 per cent. The number of samples examined was in the ratio of 6.2 per 1,000 of the population, as compared with an average of 8.8 per 1,000 for the London Boroughs, and 3.3 per 1,000 for the whole of England and Wales during 1927. The milk samples generally were of good quality, but during the year it was necessary to sample a herd of cows at the time of milking. Twelve samples were taken from individual cows, and of these samples in 6 cases the amount of fat failed to reach the legal limit. Other samples examined during the year were:— Fourteen rag flocks, of which one sample failed to reach the necessary standard of cleanliness. Three samples of creosote oil for the Surveyor's Department. Three samples of milk powder for the Public Health Department. Albert E. Parkes. 76 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES. Name of Article and Identification Number of Sample Result of Analysis Result of Legal Proceedings (a) Action taken other than legal proceedings (b) Previous Convictions (if any) (c) Other Remarks Jam 24 15% foreign fruit pulp Fined £20 Costs £10 10s. Vinegar 26 30 parts per million of sulphur dioxide ... (c) No legal action taken Vinegar 46 50 parts per million of sulphur dioxide Dismissed (c) Proceedings taken against wholesaler. Costs £5 5s. Vinegar 47 15 parts per million of sulphur dioxide ... (c) No legal action taken Pearl Barley 96 45 parts per million of sulphur dioxide Dismissed. Warranty proved ... Pearl Barley 97 20 parts per million of Sulphur dioxide Do. ... Pearl Barley 98 Do. Withdrawn Costs £3 3s. ... Pearl Barley 100 Do. Dismissed. Warranty proved ... Acid Tablets 105 0.25% talc ... (a) Vendor cautioned Butter 107 1.1% excess water Costs £1 3s. Milk 111 4% deficient in fat ... (a) Vendor cautioned Butter 123 0.5% excess water ... (c) No legal action taken Butter 152 0.05% boric acid ... (c) Do. 77 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES—continued. Name of Article and Identification Number of Sample Result of Analysis Result of I.egal Proceedings (a) Action taken other than legal proceedings (6) Previous Convictions (if any) (c) Other Remarks Pork and Beans 154 Contained not more than 0.9% meat Dismissed. Warranty proved ... Milk 184 3.3% deficient in fat (c) No legal action taken Milk 194 5.8% added water Costs £3 3s. ... Milk 224 3.3% deficient in fat ... (c) No legal action taken Pearl Barley 226 180 parts per million of sulphur dioxide Costs £1 Is. ... Pearl Barley 230 50 parts per million of sulphur dioxide Fined £2 (c) Proceedings also taken against alleged wholesaler. Summons dismissed Milk 232 3.3% deficient in fat ... (c) No legal action taken Butter 237 5 grains per lb. of boric acid Withdrawn (c) Conviction obtained against wholesaler. See sample 275 Jam 247 10% foreign fruit pulp Costs £2 2s. ... Aspirin tablets 259 2% talc. ... (c) No legal action taken Butter 275 2 grains per lb. of boric acid Fined £2 Costs £5 5s. ... Milk 297 10% deficient in fat Costs £3 3s. ... Milk 336 10% deficient in fat Do. ... Milk 351 5% deficient in fat Do. ... 78 ADMINISTRATIVE ACTION TAKEN WITH RESPECT TO ADULTERATED SAMPLES—continued. Name of Article and Identification number of Sample Result of Analysis Result of Legal Proceedings (a) Action taken other than legal proceedings (b) Previous Convictions (if any) (c) Other Remarks Butter 380 0.1% boric acid ... (c) Proceedings taken on sample 397 Cream 388 5% deficient in fat Costs £3 3s. ... Butter 389 0.2% excess water ... (c) No legal action taken Butter 393 0.3% excess water ... Do. Butter 397 0.1% boric acid Costs £2 2s. ... Milk 400 4.7% added water ... (a) Vendor cautioned Milk 401 Do. Costs £4 4s. (c) Third portion sent to Government Analyst who reported 2% added water Milk 402 Do. ... (c) proceedings on sample 401 Vinegar 420 4.0% deficient in acetic acid ... (c) no legal action taken Milk 440 8 2% added water Fined £20 Costs £3 3s. (c) Warranty Pleaded Butter 454 1.5 grains per lb. of boric acid ... (c) No legal action taken Milk 475 3.3% deficient in fat ... Do. Vinegar 579 2.9% deficient in acetic acid Fined £10 Costs £2 2s ... Butter 580 0 .4% excess water ... (c) No legal action taken Crystal Mints 621 0 .2%french chalk ... (a) Vendor cautioned Milk 656 233% deficient in fat Costs £5 5s. ... Butter 17 2.8 grains per lb. of boric acid ... (c)No legal action taken In addition, 10 samples taken direct from cows, 4 from one cowkeeper and 6 from another, were found to be adulterated, in the sense of being below standard. 79 ACTION TAKEN WITH REGARD TO OFFENCES OTHER THAN ADULTERATION. Article No. of Sample Offence Result of Prosecution or Remarks Margarine 150 Exposing for sale unlabelled parcel of margarine Fined £3 Costs £2 SAMPLES TAKEN INFORMALLY. One hundred and eighty-one samples were taken informally during the year, fourteen of which were found to be adulterated, as follows:— Articles No. of Sample Offence Milk 15 33% deficient in fat Pearl Barley 27 Found to contain 20 parts per million of sulphur dioxide Pearl Barley 28 „ „ 30 „ „ „ „ Pearl Barley 29 „ „ 70 „ „ „ „ Pearl Barley 31 „ „ 50 „ „ „ „ Pork & Beans 119 Found to be deficient in meat Pork & Beans 159 „ „ „ „ Pork & Beans 160 „ „ „ „ Butter 267 Found to contain 0.1% excess water Aspirin tablets 305 „ „ 6% talc. Cream 378 Found to be 10% deficient in fat Cream 396 „ „ 5% „ „ Meat 439 Found to contain 20 parts per million of sulphur dioxide Butter 447 „ „ 0.9% excess water The genuine samples were :— Flour 19; Pearl Barley 15; Butter 12; Cream 7; Sweets 7; Tapioca 7 Bread 6; Rice 6; Pepper 6; Condensed milk 5; Jam 5; Sugar 5; Cocoa 5; Lime Juice 5; Mincemeat 5; Milk 4; Aspirin tablets 4; Lemon Juice 4; Rolled Oats 4; Lard 3; Meat pieces 3; Wine 3; Vinegar 2; Tea 2; Mustard 2; Table elly 2; Sauce 2; Semolina 2; Orange squash 2; Arrowroot 2; Camphorated il 2; Sago 2; Pork & Beans 1; Prawns 1; Puff paste 1; Bread & Butter 1; anned peas 1; Cornflour 1; Ice cream Powder 1. 80 PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 to 1927. Eighteen formal and six informal samples taken under these Regulations were found to contain preservatives, as follow:— Pearl Barley 180 parts per million of sulphur dioxide „ 70 „ „ „ „ „ „ 50 „ „ „ „ „ „ 50 „ „ „ „ „ „ 45 „ „ „ „ „ „ 30 „ „ „ „ „ „ 20 „ „ „ „ „ „ 20 „ „ „ „ „ „ 20 „ „ „ „ „ „ 20 „ „ „ „ „ Vinegar 50 „ „ „ „ „ „ 30 „ „ „ „ „ „ 15 „ „ „ „ „ „ 33 „ „ „ „ „ Meat 20 „ „ „ „ „ Butter 7 grains of boric acid per pound „ 7 „ „ „ „ „ 5 „ „ „ „ „ 2.8 „ „ „ „ „ 2 „ „ „ „ „ 1.5 „ „ „ „ „ 0.05 „ „ „ „ Jam 3 „ „ „ „ „ 2.5 „ „ „ „ 81 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. The following is a report of the work done under these Regulations: — Three hundred and one formal samples and 5 informal samples of milk were taken, and in no case was the presence of a preservative reported. No samples of preserved cream were taken. Of 21 samples of cream which were taken, 2 were found to be 5 per cent, deficient in fat in each case, and one was 10 per cent, below the guaranteed limit of fat stated on the receptacle. "APPEAL TO COW" SAMPLES. Arising out of a prosecution in respect of a sample of milk which was found to be 10 per cent, deficient in fat, 12 samples were taken direct from the cows at the shed at the request of the owner. Upon analysis, 6 of the samples failed to reach the legal standard of fat. In addition, 8 samples were taken at the request of a neighbouring borough direct from cows in anoher cowkeeper's sheds : 4 of these proved to be below the standard. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Four formal samples and five informal samples of condensed milk were taken under these Regulations, all of which proved to be genuine. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. Three samples of dried milk were taken during the year, each of which complied with the Regulations. 82 BACTERIOLOGICAL EXAMINATIONS OF FOOD. During the year 11 bacteriological examinations of milk were made, as follows: — Ordinary 6, four being found to have a high bacterial count and to contain B. coli. Grade A, 1; Grade A (Tuberculin Tested), 4.— All found to be in conformity with Regulations. FOOD PREMISES. Milkshops and Dairies. Forty-two* applications for registration were considered during 1928. The figures in regard to registration of Milkshops are set out below: — Number of purveyor's of milk on register at end of 1928 253 Deduct number of purveyors removed from register during 1928 40 Add number of new purveyors added to register by resolution of the Public Health Committee during 1928 42 Number of purveyor's of milk on register at end of 1928 255 During the year 835 inspections of milkshops were made by the Inspectors, and 97 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. * This includes changes of occupier in premises previously on the register. 83 Milk (Special Designations) Order, 1923. One dairyman was licensed to sell "Certified'," "Grade A (Tuberculin Tested)," and "Pasteurised" milks, one to sell "Certified" and "Grade A (Tuberculin Tested)," eleven for the sale of Grade A (Tuberculin Tested)" milk, and one for the sale of "Pasteurised" milk, while supplementary licences, one to sell "Certified" milk in the Borough from premises in Hackney and others to sell "Grade A (Tuberculin Tested)" and "Pasteurised" milk in the Borough from premises in Poplar, were also granted during the year. Four samples of "Grade A (Tuberculin Tested)" and one sample of "Grade A" milk were taken upon delivery at local institutions, with satisfactory results in each case. Cowhouses . There were at the end of 1928, eleven licensed cowhouses in the Borough. Fifty-eight inspections were made during the year, one notice was served. 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). A copy of the Milk and Dairies Order, 1926, has been furnished to each cowkeeper in the Borough, and 84 his attention was drawn to the requirements of the Order at the time it came into operation. Representations have been made on several occasions to the London County Council, as the licensing authority 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. Ice Cream Premises. There were 160 ice cream premises recorded at the end of the year, and 310 visits were paid to them by the district inspectors: 37 notices were served. Fried Fish and Fish-Curing Premises. At the end of 1928 there were 44 fried fish vendors' premises in the Borough, at one of which curing was also carried on. There were 20 fish curers' premises, including this one. One hundred and ninety-nine visits were made by the Food Inspectors to these premises, and 8 notices were served for insanitary conditions. Workshop Bakehouses. There are, in Bethnal Green, 48 workshop bakehouses, 17 of which are underground: 175 visits were made to them during the year, resulting in the serving of 19 sanitary notices. Factory Bakehouses. There are in Bethnal Green 22 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. Eighty inspections were made during the year, and two notices were served. 85 Wholesale Dealers in Margarine. The following premises are registered as being occupied by wholesale dealers in margarine:— 136, 352, 374 and 420, Bethnal Green Road, 153 and 200, Brick Lane, 231, Cambridge Road, 19, 182, 199, 209, 211, Green Street, 282, 324a and 489, Hackney Road and 43a, Old Ford Road. Other Premises used for the Preparation or Sale of Food . There were 193 such premises on the register, the majority being restaurant-kitchens. Five hundred and seventy-seven inspections were made during the year, and arising out of such inspections 72 notices to remedy faults or insanitary conditions were issued. SLAUGHTERHOUSES. There were two licensed slaughterhouses in the Borough at the end of 1928, situated at:— 294, Bethnal Green Road. 354, Bethnal Green Road. Visits were made to slaughterhouses by the Food Inspector twice weekly during the year. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. During the year 1928, visits were made to the slaughterhouses for the purpose of inspecting animals before slaughter and their carcases and offal afteaslaughter. Both slaughterhouses were used regularly during the year. On the whole, the cattle, sheep, pigs, 86 etc., killed were of good quality, only one animal being seized as unfit for food. No prosecution followed this seizure, the Meat Inspector's attention having been called to the condition of the animal, which died during the night. The following is a list of animals killed:— Bullocks 49 Calves 14 Sheep 354 Lambs 214 Pigs 529 Total 1,160 The Meat Inspector comments that the reduction in the number of bullocks slaughtered was no doubt due to the high prices ruling during the early summer. He also reports that the animals slaughtered were of good quality and that the amount of offal which it was found necessary to condemn and destroy was considerably less than in previous years. The following carcases or offal were condemned and destroyed for reasons shown: — Bullocks' Livers 10 Distomatosis. do 1 Tubercular. Bullocks' Pluck 1 Tubercular. do. Lungs 1 Cysts. do. do. 2 Abscess. Sheep's Liver 1 Cysts. do. Lungs 1 Unsaleable. do. do. 1 Abscess. Pigs' Heads 4 Tubercular. do. Pluck 1 Tubercular. SLAUGHTERERS OF POULTRY. There are 8 slaughterhouses for poultry in use, all of them situated in the West ward of the Borough: 87 80 visits were paid to them during the year. There are also 5 premises on which poultry are kept prior to slaughter, and to which the by-laws would apply. Premises on which slaughtering of poultry is carried on:— 147, 151, 159 and 267, Brick Lane, 107, Bethnal Green Road, 80, Virginia Road, 71, Church Street and 36, Hare Street. UNSOUND FOOD. 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 weekend. The District Sanitary Inspectors also keep general observation in the course of their duties. On 24 occasions during the year, unsound food, comprising the following articles was surrendered by the owners and destroyed as trade refuse: — Description of Article. Weight. Tons. Cwts. lbs. Fish — — 30 Meat and Poultry — — 74½ Fruit 1 — 54½ Vegetables 12 10 — Also 1000 Eggs 132 Table Jellies 68 pkts. Ice Cream Powder 16 boxes Oranges 50 tins Fruit 20 boxes Tomatoes 1 bag Mussels 41 Lobsters 2 bags Whelks 8 tins Herrings and Tomatoes 4 boxes Skate 1 trunk Whiting 8¾ lbs. Chocolate Cocoanut Cream 88 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 Expiry Laws Continuance Act, 1927. Imported meat and eggs are required to be labelled as such. No contravention of the Order was reported during the year. , 89 GENERAL SANITARY ADMINISTRATION. The statistics of sanitary work appear very dull reading unless lit up with understanding and imagination. To anyone not knowing the conditions of life in Bethnal Green, the fact that 843 premises were inspected house-to-house (i.e., in detail), and that 4,932 others were inspected because of some particular cause for complaint might seem to have little significance. Yet, these inspections serve to illustrate how necessary is the constant vigilance of the sanitary inspecting staff in order that the recurring dilapidations associated with old property may be promptly and effectually dealt with. Allusion is made later to the more general aspect of the housing question. Here I need only comment on the practical public health value of the day-to-day work of the sanitary staff in the prompt removal of defects in w.c.'s, sinks and gullies, the cleansing of dirty rooms, the remedying of dampness, etc., the provision of proper dustbins. Each individual item may be of limited importance, but in their totality these matters represent a considerable prvention of possible dangers to health. The development of new branches of public health activity in no way minimizes the fundamental importance of sound environmental conditions. The increased power over our environment which greater knowledge now gives us, makes the sanitary supervision of dwellings, streets, etc., more important, rather than less. 90 SANITARY SUPERVISION OF THE BOROUGH. A Summary of Inspections and Visits, with Matters Outstanding for the 52 weeks ended 29th December, 1928. Nature of Visit Inspector— G. Brighting J. H. Hewitt G. E. Gould F. T. Bare W. H. Heron I. R. Jones W. Billings e. J. Jenkins A. S. Henley J. G. Weeks Totals District A B C D E F H to H W'shps Food Food Infectious Diseases 416 337 294 189 420 419 36 6 ... 2 2119 Complaints 864 661 862 760 810 660 66 241 8 ... 4932 House to House Inspections 17 66 76 37 ... ... 647 ... ... ... 843 Milkshop Inspections 67 80 135 162 109 86 ... ... ... ... 639 Other Food Premises 53 92 116 159 76 73 ... ... 574 5 1148 Factory and Workshop Inspections 2 4 2 ... 4 55 1 1750 ... ... 1818 Outworkers' Home Inspections 359 372 147 85 113 162 ... ... ... ... 1238 Tenement House Inspections 19 15 102 83 33 28 ... 20 ... ... 300 New Buildings Inspections 1 ... 54 ... 19 62 1 21 ... ... 158 Combined Drainage Inspections 478 339 427 ... 378 376 272 232 ... ... 2502 Smoke Nuisances Premises under observation 1 2 8 4 ... ... 2 ... ... ... 17 Slaughterhouse Inspections ... ... ... ... ... ... ... ... 183 69 252 Other Inspections or Special Work 403 269 687 294 839 818 368 332 55 24 4089 Re-Inspections 3342 3316 2979 4139 2674 2647 4454 2617 44 9 26221 Total Visits for the Year 6022 5553 5889 5912 5475 5386 5847 5219 864 109 46276 Unsound Food Seizures or Surrenders ... ... ... 1 ... ... ... ... 11 12 24 Samples of Food, etc., taken ... ... ... ... ... ... ... ... 67 676 743 Samples of Rag Flock taken ... ... ... ... ... ... ... 14 ... ... 14 Police Court Attendances 1 5 3 3 6 ... 18 7 9 60 112 Premises where Nuisances abated 897 934 818 1022 989 1090 610 965 31 ... 7356 Premises where Matters Outstanding 52 48 79 67 87 85 100 70 ... ... 588 91 The following sanitary defects were discovered during 1928: — Dirty rooms 8,719 Defective drains 999 Defective w.c.'s 2,725 Defective water supply... 886 Defective paving 847 Defective gutters and rainwater pipes 978 Defective roofs 2,160 Dampness 955 Defective dustbins 1,156 Smoke nuisances 4 Other defects 10,242 Total 29,671 The work of the outdoor staff is reflected in the volume of clerical work associated with sanitary administration. During the year 6,268 Preliminary Notices were served requiring the remedying of Nuisances. 4,622 Statutory Notices were served. It is estimated that approximately 5,000 letters on sanitary matters were typed, including 1,068 formal letters giving notice of legal proceedings. The legal proceedings which were necessary to enforce the Notices served are reported on in the appendix to this report. At the beginning of the year there were 560 premises with nuisances outstanding. During the year, nuisances at 7,204 premises were abated and 588 premises with nuisances outstanding were carried forward to 1929. TENEMENT HOUSES. The number of houses on the register as being let in lodgings or occupied by members of more than one 92 family was 170; 1,090 visits of inspection were made to these houses, and arising out of such visits 366 notices were served. New By-laws with regard to tenement houses are now in 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, as and when these houses are duly registered, should lead to a considerable improvement in their sanitary condition and in the comfort of their inhabitants. 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. 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 levels of rentals, little use is now made of this provision and no application for a certificate was received during the year. WATER SUPPLY TO NEW HOUSES. During the year 44 new houses were certified as having a proper and sufficient water supply. 93 SMOKE NUISANCE. During the year, 4 formal observations of smoke shafts were made, and 2 notices were served in respect of nuisances. The Public Health (Smoke Abatement) Act, 1926, which came into force on the 1st July, 1927, made some slight alterations in the law with regard to smoke nuisances, and provided for the making of by - laws which, when framed and in operation, may lead to some improvement in this matter. The real difficulty, however, is the continued use of untreated coal for domestic and industrial uses alike. RATS AND MICE (DESTRUCTION) ACT, 1919. No formal notices were served under the Act during the year. 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, 146 tins of treated biscuits and 86 bottles of Squill 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 sewers in certain streets were thoroughly cleared of rats. STORAGE AND COLLECTION OF HOUSE REFUSE. Steps have been taken during the past year or two to secure the substitution of proper covered dustbins in place of the open dustpails which were formerly in common use in the Borough. I regret that in some of 94 the tenement buildings in the Borough the unsatisfactory dustshoot method of depositing and storing refuse is in operation—a method which inevitably leads to nuisances in hot weather or where much organic refuse is thrown away. A cognate matter of great public health interest is the method of collection and disposal of refuse, to which 1 am glad to note the Ministry of Health is now devoting special attention. 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 one offence under these by-laws, and a fine and costs were imposed upon the offender to a total amount of £8 3s. Od. 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. Fourteen formal samples of rag-flock were taken during the year, and in one case the amount of chlorine present was found to be in excess of the limit fixed by the Regulations. Prosecution took place, and although the summons was withdrawn, the defendant was required to pay £1 1s. Od. costs. 95 RAG AND BONE DEALERS. Sixteen persons or firms are known to be carrying on this business in the Borough. During the year 29 visits of inspection were made, and sanitary notices were served. Proceedings were taken in one case of contravention of the by-laws, and the offender was fined £5 with £3 3s. Od. costs. HAIRDRESSERS. Seventy - seven hairdressers' premises were on the register, 135 visits were made to them, and 24 Notices were served. i 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 720 such systems in the Borough, draining approximately 3,360 houses and premises. The staff engaged on this work consists of a drainlayer and two labourers, with additional help as required. During the year six systems were reconstructed taking 22 houses. DRAINAGE WORK. Legal proceedings were taken during the year in respect of various offences in connection with drainage work, as follows: — Repairing or constructing w.c. or drain without giving notice, 2; constructing drain without depositing plans, 1 ; repairing or constructing w.c. or drain in such manner as to be a nuisance, 2. 96 The proceedings were successful in every case, fines and costs to a total of £10 11s. 0d. being imposed on the offenders. HOUSING. The only material change in the housing situation in the Borough since I reported last year is the decision of the London County Council to deal with the Teale Street area. Housing Statistics for 1928. Number of new houses erected during the year:— Total 45 (tenements) Codrington House (London County Council,). 1. Unfit dwelling-houses. Inspection— (1) Total number of dwelling-houses inspected for housing defects (under Public Health Acts) 7,051 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 843 (3) Number of dwelling-houses found and reported to be in a state so dangerous or injurious to} See previous rehealth as to be unfit for human habitation} ports with re- gard to the (4) Number of dwelling-houses (exclusive of those} general housreferred to under the previous sub-heading)} ing situation in found not to be in all respects reasonably fit }the borough. 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. 97 (b) Proceedings under Public Health Acts:— (1) Notices served requiring defects to be remedied:— Intimations 6,268 Statutory Notices 4,621 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners (nuisances abated) 7,204 (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. 98 FACTORIES, WORKSHOPS, OUTWORKERS, &c. Inspection of Factories, Workshops and Workplaces. Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 708 115 ... Workshops (Including Workshop Laundries) 4039 1095 10 Workplaces (Other than Outworkers' Premises) 158 40 1 Total 4905 1250 12 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 420 452 1 Want of Ventilation 11 10 • * * ... Overcrowding 4 4 ... ... Want of drainage of floors ... ... ... ... Other Nuisances 847 830 ... 11 Sanitary occommodation— insufficient 19 22 ... 1 unsuitable or defective 688 706 ... 8 not separate for sexes . 11 11 ... ... Offences under the Factory and Workshop Acts .— ... ... ... ... Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other offences (Excluding offences relating to out work). ... ... ... ... Total 2000 2035 21 99 Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number Workshops 1624 Workshop Bakehouses 48 Total Number of Workshops on Register 1672 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) 31 Action taken in matters referred by H.M. Inspector asremediable under the Public Health Acts, but not under the Factory and Workshops Acts (s. 5, 1901). ) Notified by H.M. Inspector 109 Reports (of action taken) sent to H. M. Inspector. 109 Underground Bakehouses (s. 101) in use at the end of the year (including factories) 23 100 HOME WORKERS. Of the 3,586 workmen and contractors whose names appeared on the lists received, 2,475 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 1,904. The number of premises found to be in an insanitary condition was 320, or 43 per cent, of the 740 premises inspected. Notices were served in 257 cases, 53 premises being already under notice arising from other visits, and a verbal intimation only being given in the remaining 10 cases. Difficulty is still experienced in getting some employers promptly and accurately to send in copies of their list of outworkers, but no legal proceedings were taken in the matter during the year. 101 HOME WORK. Nature of Work OUTWORKERS' LISTS, SECTION 107 Outworkers 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 Apparel— Making, etc. 126 87 1053 5 1 27 1348 755 95 ... ... 180 229 12 6 ... ... Curtains, Furniture hangings and Trimmings 8 ... 75 1 ... 1 23 38 8 ... ... 10 16 ... ... ... ... Fur-pulling and feathers ... ... ... ... ... ... 16 1 ... ... ... ... ... ... ... ... ... Umbrellas, etc. 2 ... 8 ... ... ... 66 2 2 ... ... 13 16 ... ... ... ... Artificial Flowers ... ... ... ... ... ... 25 ... ... ... ... 6 6 ... ... ... ... Paper, etc., Boxes, Paper Bags 24 ... 326 6 ... 25 142 109 29 ... ... 88 110 4 ... ... ... Brush-making 6 ... 268 ... ... ... 26 205 1 ... ... 16 16 ... ... ... ... Draught Board Making ... ... ... 1 ... 1 ... ... 2 ... ... ... ... ... ... ... ... Cosaques, Christmas Crackers, Christmas Stockings, etc. ... ... ... ... ... ... 17 1 ... ... ... 2 3 ... ... ... ... Textile Weaving 2 ... 20 ... ... ... ... ... 2 ... ... 2 4 ... ... ... ... Toys ... ... ... 1 ... 31 ... ... 2 ... ... 3 4 ... ... ... ... Total 168 87 1750 14 1 85 1663 1111 141 ... ... 320 404 16 6 ... ... 102 APPENDIX I. LEGAL PROCEEDINGS, 1928. In addition to the prosecutions for offences under the Food and Drugs Acts reported on pages 76—79. proceedings were taken in 123 cases for non-compliance with Statutory Notices served under the Public Health (London) Act, 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 121 £0 10 6 2 £1 1 0 Particulars of 27 other prosecutions for various offences under Public Health Statutes are given in the following list:— 103 SUMMARY OF LEGAL PROCEEDINGS, 1928. (Other than under the Sale of Food and Drugs Acts, for which see pp. 76 to 79). Date of Hearing. Offence. Inspector Result 24th January Milk and Dairies Order, 1926. Filling bottle with milk otherwise than on registered premises Weeks Fined £3. Costs £2 2s. 23rd February Public Health (London) Act, 1891: Bye-laws. Unlawfully executing work in connection with W.C. without giving written notice to Sanitary Authority Jenkins Fined £1. Costs £1 1s. 23rd February Public Health (London) Act, 1891. So repairing W.C. as to cause same to be a nuisance and injurious and dangerous to health Jenkins Fined £1. Costs £1 1s. 17th April Public Health (Meat) Regulations, 1924. Wilfully failing to have meat stall suitably screened to prevent mud, filth, etc., being splashed or blown upon stall Henley Fined £1. Costs £2 2s. 19th April Public Health (London) Act, 1891. Failing to comply with Notice re nuisance at 15, Holly Bush Gardens Gould Nuisance Order (7 days). Costs £2 2s. 31st May Rag Flock Act, 1911. Possessing Rag Flock containing 20 parts of chlorine in excess of maximum amount Jenkins Summons withdrawn on payment of costs £1 1s. 104 105 SUMMARY OF LEGAL PROCEEDINGS, 1928—continued. Date of Hearing. Offence. Inspector Result 31st May Public Health (London) Act, 1891: Bye-laws. Unlawfully executing drainage work without having given notice in writing to Sanitary Authority Jenkins Fined £2 31st May Public Health (London) Act, 1891. Repairing W.C. in such a manner as to cause a nuisance Jenkins Costs £2 2s. 7th June L.C.C. (General Powers) Act, 1908: Rag and Bone Bye-laws. Unlawfully storing rags in an open yard Richards Fined £5. Costs £3 3s. 7th June Public Health (London) Act, 1891. Failing to comply with notice re nuisance at 3, Anglesea Street Bare Nuisance Order (7 days). Costs £2 2s. 28th June Public Health (London) Act, 1891. Failing to comply with notices re nuisances at 66, Wellington Row and 50, Teesdale Street Heron Two Summonses. Nuisance Orders (14 days). Costs £2 2s. each case 10th July Milk and Dairies (Consolidation) Act, 1915. Selling milk from vehicle and receptacle on neither of which was his name and address conspicuously inscribed Weeks Fined £1 31st July Public Health (London) Act, 1891: Bye-laws Causing to be removed and carried by servant during prohibited hours certain offensive or noxious matter Weeks Fined £5. Costs £3 3s. 31st July Milk and Dairies Order, 1926. Filling a bottle with milk other than on registered premises Weeks Fined £1. Costs £2 2s. 9th August Public Health (London) Act, 1891. Failing to comply with notice re nuisance at 122, Toyes Buildings Heron Nuisance Order (14 days). Costs £2 2s. 4th September Milk and Dairies Order, 1926. Filling a bottle with milk other than on registered premises Weeks Fined 10s. 4th September Do. do. Weeks Costs 10s. 6d. 4th September Do. do. Weeks Fined 15s. Costs £1 1s. 4th September Do. do. Weeks Fined 5s. 25th September Do. do. Weeks Fined £1 2nd October Public Health (London) Act, 1891. Establishing anew business of poultry slaughterer without sanction of L.C.C. Henley Fined £1. Costs £3 3s. 11th October Metropolis Management Act, 1855: Bye-laws. Carrying out drainage work without having deposited plans, etc. Hewitt Fined 5s. Costs £2 2s. 8th November Public Health (London) Act, 1891. Failing to comply with notices re nuisances at 64, Wellington Row and 1, Delta Street Heron Two summonses. Nuisance Order (7 days). Costs £2 2s. each case 18th December Milk and Dairies Order, 1926. Filling a bottle with milk otherwise than on registered premises Weeks Two Summonses. Fined £1 10s. Costs £1 10s. in each case 106 APPENDIX II. TUBERCULOSIS DISPENSARY. REPORT FOR THE YEAR 1928. By H. Tylford Howell, M.R.C.S., Eng., L.R.C.P., Lond., Clinical Tuberculosis Officer. There has been no change in the personnel of the department during the year. Dr. W. J. Dowling, the Assistant Tuberculosis Officer, who had been given five months' leave of absence after a breakdown in health, returned to duty in June, and I am pleased to report that there has been no relapse. No radical change in the routine of the Dispensary has been introduced, and the sessions have remained the same. Patients are seen on Monday, Wednesday, Thursday, Friday, and Saturday mornings from ten to twelve o'clock; Wednesday evenings from 5.30 to 7 p.m.; and on Thursday evenings from 7.30 to 9 p.m. Saturday mornings are reserved, as far as possible, for school children, while the evening sessions are intended for patients who are at work during the day, and such mothers as find it difficult to attend at other times. Advantage has been taken of recent structural alterations to the Hospital to secure a small room, vacated by the Cardiological Department, for use as a laboratory. The former laboratory has been converted into an office for the Dispensary Clerk, and it is expected that the convenience of having the Clerk on the same floor as the rest of the staff will materially add to the smooth working of the department. There has been no change in the remaining accommodation of the department, which is in every way adequate. In addition to offices for the Tuberculosis Officers and Clerk we have at our disposal patients' waitingrooms, two large consulting-rooms, each with two dressing-rooms, and a dark-room for throat examinations attached. The generous dressing-room accommodation provided enables us to work systematically, and to pay due regard to privacy and consideration of patients' personal feelings. The practice of the two Medical Officers consulting one another on doubtful cases is being continued, while full use is made of the facilities afforded for personal consultation on difficult cases with the Hospital Physicians and Surgeons. The close association with the Hospital Staff I believe to be of inestimable value. It not only enables us to discuss individual cases, but the daily contact with physicians and surgeons treating general diseases in addition to Tuberculosis is of an obvious stimulant value to Tuberculosis Officers, who from the nature of their work might not unnaturally be inclined to develop rather a restricted clinical vision. We continue to utilize in every way the resources of the special departments of the Hospital, cases being frequently referred to the Laryngologist, 107 the Radiologist, the Dentist, and the Pathologist. This arrangement enables us to make a complete investigation of a case with the least possible loss of time. The number of cases referred to the Radiologist may tend to increase, as the London County Council has now removed its restriction that three sputum tests should be made in all cases before the help of X-rays is sought. The opening of the new X-ray department of the Hospital affords us increased facilities, and patients may now be X-rayed during the session. Previously, in order to view our X-ray films, we had to go to the X-ray department, as we had no viewing-cabinet of our own. This arrangement was unsatisfactory both to us and to the Radiographer, who was often busy with other cases, but has been remedied by the provision of a most efficient viewing-cabinet for our own use, which has already proved a great convenience. The various charitable organizations in the district continue to support us in many ways. The Invalid Children's Aid Association, in particular, is most helpful, and has sent a large number of our debilitated children to convalescent homes either at the seaside or in the country. The Charity Organization Society and the United Services Fund have assisted in supplying surgical instruments, dentures, clothing, etc., and have frequently found accommodation for children while their mothers are receiving sanatorium treatment. These children are usually boarded out with private families or sent to some residential school, so that their education is interfered with as little as possible. One hundred and eighty-two cases were admitted through the L.C.C. to Hospital or sanatorium during the year. The period between the date of recommendation and that of the patient's admission is shorter, and fewer cases than formerly are refused admission. There is still, however, insufficient accommodation for the advanced case, and in view of the prospective change in Poor Law administration it is doubtful if anything will be done in this direction at present. It is to be hoped, however, that among the many reforms contemplated this most urgently needed institution—a local home for advanced cases—will not be lost sight of. In the Borough of Hackney the problem of the advanced case is to a large extent solved, as the Borough Council accepts responsibility for those cases refused by the L.C.C. and will arrange for their admission to Hospital, and, moreover, when the home conditions of a patient are such that he is a danger to others, will, in view of its powers under their special act, compulsorily remove him. The L.C.C. scheme for the boarding-out of children of advanced cases whose home conditions are unsatisfactory is still in operation, but only rarely are we successful in persuading parents to surrender their children to strangers in a home which they have never seen and which they are discouraged from visiting. The problem of securing suitable employment for patients on their discharge from sanatorium is still an acute one. Unless the original work and conditions are definitely unsuitable and objectionable it is found from experience that it is better for a man to return to his former occupation in which he has probably already attained proficiency. Patients who are able to do so entail little worry, as they usually return to posts under their former employers, but the chief cause of anxiety is the man who must seek 108 a new kind of work, or who is fit for only a few hours' work a day. It is often found quite impossible to get employment for this class of case. The unhappy position of the labour market renders this problem even more acute than it otherwise would be, as few employers are prepared to take back a hand whose working capacity is seriously damaged, and to afford him facilities for carrying on at a lower productive level. Isolated attempts have been made to solve the problem, but with little success. One of the most recent in London was the opening, under the aegis of the Ministry of Health and the London County Council, of a wood-bundling factory in Holborn. Unless some drastic change is made I am afraid the scheme is doomed to failure, as patients find it impossible to earn a living wage. A man is naturally unwilling to work a whole week for an average wage of £1, out of which he has to pay fares and buy his dinners—knowing that he would be better off financially by staying at home and drawing the dole. As reported last year, the subject was considered by the London County Council and the National Association for the Prevention of Tuberculosis., and the Ministry of Health was approached with a view to the institution of a thorough inquiry into the matter. It was hoped that something would be done, but nothing tangible has yet resulted. In my opinion, the only solution of the problem is the adoption of local workshops subsidized by the State or the 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 expense, but it is doubtful if this would be more costly to the State than continuous unemployment. The Tuberculosis Care Committee have for years recognized the problem of the employment of the tubercular patient, but their efforts to solve it have been hampered by lack of funds. The Hackney and Stoke Newington Care Committee now propose to start a handicraft class, and its object and scope can perhaps best be explained by giving the Chairman's own words taken from his letter of appeal for funds: "It is difficult, perhaps, for healthy people engaged in active work to appreciate the lot of those who have lost both health and occupation. We want to save these patients from brooding over their condition by giving them interesting work to occupy their thoughts. "There are light handicrafts, such as leather-work, pewter-work, basketwork, bead-work, knitting, etc., that are well suited for men and women in this state. "The articles made will be sold for the benefit of the class, with a certain percentage paid to the workers; or a patient may buy what he makes at cost price, plus a small percentage for class funds. Orders may be taken by any patient, who may sell what he or she makes under these conditions. "It is proposed to hold sessions once or twice a week, and patients will be admitted only on the recommendation of the Tuberculosis Officer. "It is hoped that after a time the class will be self-supporting." We continue to send a large number of tuberculous children to Stormont House School. This school, which is admirably situated on Hackney Downs, was opened in 1919, and admits both pulmonary and non-pulmonary cases of tuberculosis of either sex, the ages ranging from 6 to 16 years; and there are now 88 children on the roll, with an average attendance of 70. At present all the children come from the Boroughs of Hackney, Bethnal Green, and Stoke Newington; and are recommended for admission either from the Metropolitan Hospital or the Victoria Park Hospital Tuberculosis 109 Dispensaries. The classes are held in the open air in special shelters provided in the grounds, but ample indoor accommodation is available in bad weather. Hot mid-day meals are provided at a nominal fee, while in the case of necessitous children no charge is made. The Dispensary Nurse visits the school daily and keeps records of temperatures and weights, etc., while she also supervises the cleanliness of the children, arranging for weekly hot baths for those requiring them. The Tuberculosis Officer visits the school weekly, making frequent examinations of the children, and supervises the rest and exercise of each individual child. All the children have done well and the school maintains its popularity in the district, being always full. During the year 11 children were discharged as fit for work, and 9 had improved to such an extent as to justify their transfer to the; ordinary elementary school. Formerly it was the custom of the L.C.C. to send all the children from the school desiring it to the seaside for two weeks during the summer. During the past year, however, the Council were unable to do this, so the Invalid Children's Aid Association, who can always be relied upon to help in cases of emergency, came to our rescue and arranged for varying periods of convalescence for those children urgently needing it. For those patients whose financial circumstances and clinical condition warrant it, we are still empowered under the Borough scheme to recommend grants for additional diet. This diet takes the form of milk and eggs, and is particularly useful to those patients who, on leaving sanatorium, are unable to provide suitable nourishment for themselves pending their return to work. The number receiving such benefit is necessarily small, as the expenditure sanctioned must not exceed £2 per 1,000 of the population. As stated in last year's report, the results of treatment by artificial sunlight were not so encouraging as we had been led to expect. One or two of our patients may have improved slightly under treatment, but the majority showed no obvious benefit. The treatment has been almost entirely limited to 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 difficult for mothers to give up so much of their time for the purpose of accompanying their children. It is generally recognized that the best results are obtained in Lupus, certain skin conditions, rickets, superficial lesions, and surgical Tuberculosis, etc., and as the numbers of such cases we are called upon to treat are few, our experience must be regarded as restricted; but it suffices to show that ultra-violet light cannot be regarded as a "specific" for every type of disease, and that it must be used with discretion. The scheme inaugurated by the L.C.C. in 1922 for the purpose of reducing the number of children attending the Tuberculosis Dispensaries is still in operation. All non-tubercular contacts, and other children whose health is regarded as unsatisfactory, are referred to the School Medical Department for observation. The Tuberculosis Officer sends a special report on each case to the School Medical Officer, who arranges for periodic examination, weighing, etc. Should the School Medical Officer later suspect Tuberculosis in any of these children the case is immediately referred back 110 to the Tuberculosis Officer for an opinion. As no treatment is carried out at the school the scheme has no doubt failed in its main object—the reduction of the numbers of children attending the Dispensary, since the children return to the department when the parents think that treatment is necessary. Neither can it be said that as a result of this scheme any fresh cases of Tuberculosis have been brought to light that would have otherwise escaped notice, but probably the child of poor general physique and health receives more systematic supervision. It has always been my pleasant duty to comment on the happy relationship that exists between the General Practitioners in the district and the Tuberculosis Officers. Our relationship could not be more cordial, and there is a mutual appreciation of respective difficulties with an entire absence of petty annoyances or misunderstandings. I submit at the end of the report a statistical summary of the work of the Dispensary for the year. It is not to be expected that these figures will show any striking variation from year to year, as it would appear that the work of the department has now reached a stage at which it is likely to remain for some time. Thus the total number of new cases for both boroughs is practically the same as in the preceding year. In these circumstances, it is not proposed to enter into any detailed examination of the figures. 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 Dispiensary Staff for their efficient work and loyal support. (Signed) H. TYLFORD HOWELL. 8th March, 1929. 111 BOROUGH OF BETHNAL GREEN. The Totals of New Cases. Males 381 Females 383 764 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 259 62 Local Practitioners 205 56 Contact cases (per M.O.H.) 244 4 War Pensions Committee 1 — London County Council 28 3 Victoria Park Hospital 12 11 Other sources 15 3 3. The Diagnosis of the New Cases. Diagnosis. Adults. Children under 15. Total. Males. Females. Males. Females. Pulmonary Tuberculosis 61 48 – 4 113 Non-pulmonary Tuberculosis 7 5 8 6 26 Non-tuberculous 139 193 151 113 596 Doubtful 15 13 – 1 29 Total 222 259 159 124 764 112 4. The Diagnosis of Contact Cases. Pulmonary Tuberculosis 3 Non-pulmonary Tuberculosis 1 Non-tuberculous 234 Doubtful 6 Total 244 5. Sputum Examinations. Tubercle Bacilli present 127 Tubercle Bacilli absent 530 Total 627 6. Other Figures. Total number of attendances 3,682 Systematic examinations at the Dispensary 2,180 Number of patients sent to hospital or sanatorium by the L.C.C. 80 Number of letters written 1,277 Number to visits to patients at their homes 143 Number of attendances at:— X-Ray Department 106 Dental Department 20 Sunlight 246 Other Departments 38 113 TUBERCULOSIS SCHEME OF THE BETHNAL GREEN METROPOLITAN BOROUGH COUNCIL. Return showing the work of the Dispensary during the year 1928. Diagnosis. Pulmonary Nonpulmonary Total Adults Children Adults Children Adults Children A.—New cases examined during the year (excluding contacts): M. F. M. F. M. F. M. F. M. F. M. F. (a) Definitely tuberculous 55 43 • • • 3 7 4 7 4 62 47 7 7 (b) Doubtfully tuberculous • • • • • • • • • • • • • • • • • • • • • • • • 21 14 4 4 (c) Non-tuberculous • • • • • • • • • • • • • • • • • • • • • • • • 98 119 73 56 B.—Contacts examined during the year:— (a) Definitely tuberculous • • • 2 • • • • • • ... ... • • • 1 • • • 2 • • • 1 (b) Doubtfully tuberculous • • • • • • • • • • • • • • • • • • • • • • • • 4 8 • • • 1 (c) Non-tuberculous • • • • • • • • • • • • • • • • • • • • • • • • 34 67 74 53 C.—Cases written off the Dispensary Register as (a) Cured • • • • • • • • • • • • • • • • • • 1 ... ... ... 1 • • • (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) • • • • • • • • • • • • • • • • • • • • • • • • 146 198 151 113 D.—Number of Persons on Dispensary Register on Dec. 31st: (a) Diagnosis completed 249 168 12 15 45 29 67 53 294 197 79 68 (b) Diagnosis not completed • • • • • • ... • • • • • • • • • • • • • • • • • • 1 ... ... 1. Number of Persons on sary Register on Jan. 1st 605 2. Number of patients ferred from other areas and of "lost sight of cases" returned 15 3. Number of patients ferred to other areas and cases "lost sight of" 61 4. Died during the year 63 5. Number of observation cases under A (a) and B (b) above in which period of observation exceeded 2 months 14 6. Number of attendances at the Dispensary (including contacts) 3682 7. Number of attendances of non- pulmonary cases at Orthopaedic Out-stations for treatment or supervision 8. Number of attendances at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light treatment 138 (b) Other special forms of treatment 91 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 11 10. Number of consultations with Medical Practitioners:— (a) At Homes of Applicants 20 (b) Otherwise 270 11. Number of other visits by Tuberculosis Officers to Homes 143 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary Purposes 2341 13. Number of (a) Specimens of sputum, &c., examined 627 (b) X-ray examinations made in connection with Dispensary work 106 14. Number of Insured Persons on Dispensary Register on the 31st December 298 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 190 16. Number of Reports received during the year in respect of Insured Persons:— (а) Form G.P. 17 6 (b) Form G.P. 36 79 No cases written off Register in a previous year as "cured" have again been entered on the Register during 1928, and included under Heads A (a) or A (b). 25th February. 1929. H. T. Howell, Clinical Tuberculosis Officer. 114 115 TUBERCULOSIS SCHEME OF THE BETHNAL GREEN METROPOLITAN BOROUGH COUNCIL. (a) PULMONARY TUBERCULOSIS.—Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1928, arranged according to the years in which patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates Previous to 1926 1926 1927 1928 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 J Group 3 Total (Class T.B plus) Alive All classes from Oct., 1917 to 31st Dec . 1928 Discharged as cured 27 Adults M. F. Children M. F. Disease arrested Adults M. 3 3 2 ... 5 F. 2 ... ... ... ... Children M. F. Alive Diesases not arrested Adults M. 58 25 34 19 78 6 6 8 *5 19 4 2 10 6 18 13 4 14 13 31 F. 41 15 16 8 39 6 *5 5 4 14 *4 5 8 4 17 11 11 9 8 28 Children M. 5 ... ... ... ... 1 ... ... ... ... 4 1 ... ... 1 ... ... ... ... ... F. 7 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 3 ... 1 1 2 Condition not ascertained during the year 8 3 4 2 9 1 1 1 ... 2 1 ... 1 ... 1 ... ... ... ... ... Lost Sight of or otherwise Removed from Dispensary Register All Classes 406 3 3 3 1 7 1 5 3 ... 8 4 ... 1 2 3 All Classes from Oct., 1917 to 31st Dec., 1928 Adults M. 4 3 8 11 22 1 1 4 *7 12 3 ... ... 7 7 F. 2 1 2 13 16 5 1 2 3 6 1 ... 1 3 4 Dead 730 dren M. 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... F. ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Total 124 46 56 29 131 25 19 27 35 81 22 15 28 20 63 35 15 26 34 75 * One inward transfer in each group. 116 117 (b) NON-PULMONARY TUBERCULOSIS.-Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1928, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates Previous to 1926 1926 1927 1928 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Alive All Classes from Oct., 1917 to31st Dec., 1928 Discharged as cured 39 Adults M. F. Children M. F. Disease arrested Adults M. 2 ... ... ... 2 F. 1 ... ... ... 1 Children M. 2 ... ... 1 3 F. 1 ... ... 2 3 Alive Disease not arrested Adults M. 11 ... 6 3 20 3 ... 1 2 6 2 ... 1 1 4 3 ... 1 3 7 F. 4 2 2 3 11 2 1 1 2 6 2 ... 1 1 4 1 1 2 1 5 Chiddren M. 8 2 ... 31 41 3 1 ... 4 8 ... ... ... 1 1 3 1 ... *3 7 F. 7 1 2 17 27 3 ... ... 3 6 3 ... 2 1 6 ... ... 1 *3 4 Transferred to Pulmonary Condition not ascertained during the year 7 1 3 6 17 2 ... ... 1 3 1 ... ... 1 2 Lost sight of or otherwise Removed from Dispensary Register All Classes 124 ... ... 1 2 3 ... 1 ... ... 1 ... ... ... 2 2 All Classes from Oct., 1917 to 31st Dec., 1928 Dead 12 Adults M. ... ... F. 1 1 Children M F. Totals 43 6 13 63 125 13 2 3 15 33 8 1 4 5 18 7 2 4 12 25 * One inward transfer in each group. 25th February, 1929. (Signed) H. T. HOWELL, Clinical Tuberculosis Officer 118 APPENDIX III. VITAL STATISTICS For the Quarter ended 30th March, 1929. DEATHS. During this period, the number of deaths recorded as belonging to Bethnal Green was 628, which is equivalent to an average annual death rate of 21.3 per 1,000 of the population, and compares with an average annual death rate of 14.9 for the corresponding quarters in the five previous years. The General Death Rate for the County of London for the quarter was 23.9. The principal causes of death during the quarter were as follows:— Enteric Fever 1 Measles 1 Whooping Cough 12 Influenza 55 Meningococal Meningitis 2 Tuberculosis of Respiratory System 41 Cancer 36 Rheumatic Fever 6 Diabetes 3 Cerebral Haemorrhage, &c. 14 Heart Disease 164 Arterio Sclerosis 7 Bronchitis 72 Pneumonia 111 Other Respiratory Diseases 9 Ulcer of the Stomach, &c. 1 Diarrhœa 4 Appendicitis 1 Cirrhosis of Liver 2 Nephritis 14 Congen. Debility and Premature Birth 9 Suicide 6 Other Deaths from Violence 6 Other Defined Diseases 51 POPULATION. The death rate is calculated on a population of 117,900, this being the Registrar-General's estimate of the population of the Borough in the middle of the year 1927. BIRTHS. The number of births registered during the period under review was 396, which is equivalent to an average annual birth rate of 13.4 per 1,000 of the population, and compares with 17.4, the average for the corresponding quarters in the five previous years. The birth rate for the County of London for the quarter was 17.1. 119 DEATHS OF INFANTS. The number of deaths of infants under the age of one year was 41, the infant mortality rate being 103 per 1,000 births. This compares with an average infant mortality rate of 102 for the corresponding quarters in the five previous years. The rate for the County of London was 100. SMALLPOX. During March, 1929, ten cases of smallpox were notified. They were all, fortunately, of the mild type. HOUSING. I report that I submitted a representation to the Council in respect of the Digby Street Area, embracing certain houses in Digby Street and Digby Walk, on the 27th March, 1929. 120 INDEX. PAGE Ambulances 13-14 Bacteriological Examinations (medical) 63 do. do. (food) 82 Bakehouses 84 Births 4, 20, 29, 118 Cancer 24 Certifying Surgeon: Factories and Workshops 15 Chicken Pox 60 Cleansing Stations: Personal 14-15, 62 Clinics 11-12 Clothing, Hygienic 38 Combined Drainage Systems 95 Condensed Milk Regulations 81 Convalescent Treatment 45-46 Cowhouses 83-84 Customs & Inland Revenue Acts 92 Day Nurseries 12 Deaths 4, 20-23, 118 Delicate Children: Clinic for 39 Dental Clinic (M. & C.W.) 42-43 Dental Treatment of Tuberculous Patients 70 Diphtheria 55-56-57 Disinfectants: Distribution of 63 Disinfection 61 Dispensaries 11, 14, 70 Drainage Work 95 Dried Milk, &c. 38 Dried Milk Regulations 81 Enlarged Tonsils, Adenoids and Mastoid Disease 45 Expenditure on Public Health Work 8-9 Extra Nourishment 69 Factories and Workshops 98 do. do. Certifying Surgeon 15 Finsen Light Treatment 70 Fish Curing and Fried Fish 84 FOOD 72-88 Food and Drugs Acts 73 Fried Fish and Fish Curing 84 General Description of District 6 GENERAL SANITARY ADMINISTRATION 89-101 121 PAGE Hairdressers 95 Health Exhibition 16 HEALTH SERVICES 2-88 Health Visitors 29-30 do. do. Tuberculosis 68 Home Helps 36-37 Home Workers 100-101 Hospitals 10 Hospital Treatment of Infectious Disease 57 House Refuse 93-94 HOUSING 96-97, 119 Hygienic Clothing 38 Ice Cream 84 Infant Consultations 32 Infantile Diarrhœa 53-54 Infantile Mortality 48-49, 119 INFECTIOUS DISEASE 55-71 Insect Pests 62 Insurance Acts, National Health 13 INTRODUCTION 4-5 Itch (Scabies) 62 Joint Dispensary Committee (Tuberculosis) 70 LEGAL PROCEEDINGS: Food 76-79 Other 102-105 Light Treatment 39-42, 70, 71 Margarine 85 Marriages 20 Massage 44 MATERNITY AND CHILD WELFARE 28-54 Maternity Clinic 32-36 Maternity Institutions 12-13 Maternity Outfits 37 Measles 60 Meat Regulations 85-86 Medical Practitioners 9 Midwifery: Borough Midwifery Service 36 Midwives 10 Milk and Cream Regulations 81 Milk for necessitous mothers and children 37-38 Milkshops and Dairies 82 Milk (Special Designations) Order 83 Mortuary 26 NOTIFIABLE DISEASES 55-71 122 PAGE Notification of Births 29 Nurseries, Day 12 Nurses and Nursing Assistance 9, 46-48 Obstetrical Consultants 36 Offensive Matter 94 do. Trades 94 Open-Air Sleeping Shelter 69 Ophthalmia Neonatorum 50-51 Orphans 12 Orthopaedic Treatment 43-44 Outworkers 100-101 Personal Cleansing Stations 14-15, 62 Pneumo-Thorax Refills 71 Population 19, 118 Poultry Slaughterers 86-87 PUBLIC HEALTH COMMITTEE 1 Public Health Expenditure 8-9 Puerperal Fever and Puerperal Pyrexia 50 Rag and Bone Dealers 95 Rag Flock Act 94 Rats and Mice 93 Registration of Births, Deaths and Marriages 15 Rent Restrictions Acts 92 Sanatorium Treatment 69 Sanitary Inspectors, work of 89-91 Scabies (Itch) 62 Scarlet Fever 56-57 Shelter for Contacts 63 do. Open-Air Sleeping 69 Slaughterhouses 85, 86 Smallpox 57, 119 Smoke Nuisance 93 Social Welfare 6-8 Special Clinic for Delicate Children 39 Sputum Outfits 69 Staff 2-3 STATISTICS AND SOCIAL CONDITIONS 6-27, 118-119 Stillbirths 20, 51-52 Talks to Mothers 31 Tenement Houses 91 Tonsils, Adenoids and Mastoid Disease 45 TUBERCULOSIS 64-71, 106-117 Unsound Food 87 Vaccination 15 Venereal Disease 14 Verminous Conditions 62 VITAL STATISTICS 17-27, 118-119 Water Supply 92 Welfare Centres 30-36 Whooping Cough 60 R7/67