HAC 8 Borough of Hackney. REPORT on the SANITARY CONDITION of THE hackney district, FOR THE YEAR 1900 by J. KING WARRY, M.D., LOND., M.R.G.P., Diplomate in Public Health; Licentiate of the Society of Apothecaries; Fellow of the Society of Medical Officers of Health; Fellow of the Royal Institute of Public Health; Member of the Sanitary Institute; Member of the Jenner Institute of Preventive Medicine; Foreign Associate Member of the Society of Hygiene of France; Medical Officer of Health for the District. London: A. T. Roberts, Son & Co., Ltd., Printers, 5, Hackney Road, N.???. 1901. INDEX. PAGE Bakehouses 88 Birth Rate 6 Canal Boats Act 39 & 73 Cancer 25 Constitutional Diseases 24 Cow Sheds, List of 87 Customs and Inland Revenue Act 39 Death Rate 7 Diphtheria 20 Enteric Fever 21 Erysipelas 23 Estimated Population 6 Factory and Workshops' Act 33 House Refuse 40 Housing of the Working Classes Act, 1890 30-31 Illegitimacy 6 Infant Mortality 7 Infant Diarrhœa 54 Infected Milk 60 Marriage Rate 6 Measles 24 Meteorology 53 Mortuary 48 Notifiable Diseases 17 Non-Notifiable Diseases 23 Plague 22 Population and Density 6 Prosecutions under Food and Drugs Act 74 Prevention of Small Pox 5/ Prosecutions under Public Health Act (London) 78 Public Health Act (London) 1891 25-28 Puerperal Fever 22 Register of Sanitary Work 50-52 Removal of House Refuse 40 River Lea 35 Senile Mortality 8 Scarlatina 20 Slaughter-Houses, List of 86 Small-pox 17 Smoke Nuisances 28 Specific Causes of Death 8 Temporary Shelter 32 Whooping Cough 24 Workshops and Laundries 70 Zymotic Diseases 8 Tables— Analysis of Lea Water 37 Births 6 Bakehouses, List of 88 Causes of Infant Mortality 8 Deaths 9-10-11 Deaths from Diarrhœa. 24 Death Statistics, according to Diseases, Ages and Localities 14 Dusting Account 44 Infectious Sickness 16 Influenza 23 Inquests 49 Population, Area and Density in Sub-Districts of Hackney 5 Requests for Removal of Dust 42 Suicides and Accidental Deaths 49 Tubercular Diseases 24 Vaccination 41 Metropolitan Borough of Hackney. MEDICAL OFFICER'S REPORT FOR THE YEAR 1900. PUBLIC HEALTH DEPARTMENT. Town Hall, Hackney, N.E. To the Mayor, Aldermen, and Councillors of the Borough of Hackney. Gentlemen, I beg to present my Report on the Health of the District of Hackney for the year 1900, and, in doing so, am pleased to state that in spite of increasing population and density, the low death-rate of previous years has been maintained. The general death-rate for the year 1900 is 17.4 per 1,000 living, against an average annual death- 4 rate of 17.9 per 1,000 for the seven years 1893 to 1899, and 18.8 per 1,000 for all London for the same year. The infant mortality was 162 per 1,000 births, against an average infant mortality of 151.2 per 1,000 births during the period 1893 to 1899, and 160 per 1,000 births for all London for the same year. The marriage rate has increased slightly during the year, and the birth-rate is also satisfactory, being 29.0 per 1,000 living, whilst that for all London is 22 6 per 1,000. Notifiable infectious disease was very low, but on the other hand whooping cough and summer diarrhoea were very prevalent. On the whole, I am of opinion that the Public Health of Hackney during the year 1900 has been most satisfactory, and shows a considerable improvement upon that for several years. In November of last year the Hackney District was created a Borough under the London Government Act, 1899, and the duties of the late Vestry were transferred to the newly-elected Borough Council. Amongst other powers and duties transferred by the above Act of Parliament from the London County Council to the Borough Council were:- (a) Power under Section 28 of the Public Health (London) Act, 1871, of registering dairymen. (b) Power to adopt Part III. of the Housing of the Working Classes Act, 1890. (c) The duty of enforcing " within the Borough the bye-laws and regulations for the time being in force with respect to dairies and milk, and with respect to slaughter-houses, knackers' yards and offensive businesses." 5 These were allocated by resolution at the first meeting of the Council to the Public Health Committee. This has, in consequence, very largely increased the work of the Public Health Department. I am pleased to put on record that, on the whole, the Sanitary Inspectors and other Officers of the Public Health Department have earnestly and ably performed the duties allotted to them during the past year. Population and Density.—During the preparation of this report the decennial Census of 1901 has been taken, and owing to the early issue of a summary of the population, I am enabled with more accuracy to calculate the population of Hackney at the middle of 1900. The rate of increase which had been maintained during the quinquennial period of 1891 to 1896 has not been maintained in Hackney since; on the contrary, it has declined very much. If the rate of the previous quinquennium had been maintained, the population would have been 225,318 at the middle of 1900, but from the recent census, I calculate it to be only 218,976, a difference of 6,342. This shows that the rate of increase or decrease of the population of a particular place during any intercensal period, when applied to a subsequent period, may give quite an erroneous result, so that such calculations must always be regarded as a very approximate estimate, especially as we recede from the year of census. With an acreage of 3,292 acres, the population gives a density of 66.5 persons per acre. The density varies from 44.6 in the North Sub-district, to 99.5 persons per acre in the South-West District. 6 Table. Showing estimated Population, Area and Density of the Registration Sub-Districts in Hackney, at middle of 1900. North. Central. South West. South East. Total for Hackney Total for London. Estimated Population 50,498 0,463 59,844 58,171 218,976 4,589,129 Area in square acres 1,132 815 601 770 3,292 74,837 Density = persons per acre 44.6 61.9 99.5 75.5 66.5 61.2 *Marriages.—The number of marriages solemnized in Hackney during 1900 was 1684. This is equivalent to a marriage rate of 15.3 per 1,000 persons living. The rate for London for the same period is 17.6 per 1,000. Births.—The births registered in the Borough of Hackney during the year 1900 numbered 6,359. This is a decline of 94 on the number registered during the previous year. The birth-rate for the Borough for last year is therefore 29.0 per 1,000 living; while that for London is 22.6 per 1,000 living. The birth-rate varies much in different parts of Hackney, being only 22.3 per 1,000 living in the North, while it is 32.6 per 1,000 in the South-East Sub-district. Table. Births. Registration District of Hackney. Registration Sub-Districti. All London North Central South West South East Total No. of Births 6,359 1,131 1,408 1,921 1,899 130,868 Rate per,1000 living No. of Illegitimate 29.0 22.3 27.9 32.1 32.6 22.6 Births 136 Rate per 1,000 Births 21.3 *Illegitimacy. -The number of illegitimate births registered in Hackney last year was 340; but of these 212 took place in the *I have here to acknowledge my indebtedness to Mr. Tom Hosgood, Superintendent Registrar, who has kindly abstracted for me the number of marriages and illegitimate births for the year 1900. 7 Rescue Homes of the Salvation Army established in Hackney, and of these only 8 were of Hackney parentage; so that the actual number of illegitimate births amongst Hackney residents was 136. These give an illegitimate birth-rate of 21.3 per 1,000 births. Such a rate does not testify very highly to the morality of Hackney. Deaths.—The deaths registered in Hackney during the year 1900 reached the total of 3,898; but of these 518 were of non-residents in the district, and in addition 291 Hackney residents died in other districts. Making the necessary corrections, I find the exact number of deaths amongst residents during the year 1900 to be 3,652, which is equivalent to an annual death-rate of 16.7 per 1,000 living. Correcting this rate for age and sex-distribution by means of the factor 1.01645, the true mortality of Hackney for the year 1900 becomes 17.4 per 1,000 living, against a rate of 171 per 1,000 living for the year 1899. The above rate for 1900 compares favourably with all London, which was 18.8 per 1,000 for the same year. It is very satisfactory to know that in spite of increasing population, especially of a class amongst whom as a rule the death-rate is high, and increasing density, the death-rate does not show any considerable rise. It also shows that the money and labour spent in Public Health administration have not been used in vain, but are being rewarded by lengthened life, and improved health of the public. Infant Mortality.—The deaths under one year of age numbered 1,035 during the year 1900. This is equivalent to a mortality of 162 per 1,000 births. The following table shews the chief causes of infant mortality during the last nine years. It will be seen that diarrhoea and tubercular diseases, with lung diseases, form a large proportion, and are all more or less preventable. The infant mortality for all London for the same period was 160 per 1,000. 8 Table .—Eleven principal causes of Infant Mortality. 1892 1893 1894 1895 1896 1897 1898 1899 1900 Measles 19 3 35 24 15 32 25 29 12 Scarlatina 4 4 2 3 6 7 4 2 2 Whooping Cough 41 68 25 29 61 36 44 22 50 Teething 21 22 18 23 19 11 17 16 6 Diarrhœa 86 103 58 141 171 151 160 165 181 Convulsions 99 127 86 104 93 72 72 70 80 Lung Diseases 152 162 133 154 137 142 131 150 136 Tubercular Diseases 66 84 53 31 57 55 61 56 73 Atrophy and Debility 174 109 144 125 101 131 136 134 128 Premature Birth 109 105 81 99 110 118 145 124 130 Accidents & Violence 28 26 31 34 27 26 34 36 30 Total 799 878 666 767 826 781 829 804 828 Other Causes 113 167 136 209 184 198 213 265 207 Total 912 1045 802 976 1010 979 1042 1069 1035 Senile Mortality.—The deaths of persons at 65 years of age and upwards numbered 822 during the year. This total is made up of 397 deaths between the ages of 65 and 75; 322 between 75 and 85; and 103 above 85 years, and is equal to a mortality of 3.7 per 1,000 living. SPECIFIC CAUSES OF DEATH. Class I. Specific Febrile or Zymotic Diseases.—The corrected number of deaths in this class during the year was 578, against 747 during the year 1899; thus shewing a decline of 169, and a zymotic death rate of 2.1 per 1,000 living. The zymotic mortality for London for the same period is 2.2 per 1,000 living. 9 TABLE OF DEATHS Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1900. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards Totals. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. Membranous Croup 1 .. 1 .. .. .. .. .. .. .. .. 2 Smallpox. Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinat'd .. .. .. .. .. .. .. .. .. .. .. .. Vaccndoubtfi .. .. .. .. .. .. .. .. .. .. .. .. Measles 12 16 0 1 .. .. .. .. .. .. .. 29 Scarlet Fever 2 8 7 1 .. .. .. .. .. .. .. 18 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 50 53 3 1 .. .. .. .. .. .. .. 107 Diphtheria 10 33 15 1 .. .. 1 .. .. .. .. 60 Simple Fever .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. 1 5 10 14 10 1 3 .. .. .. 44 Other Miasmatic Diseases .. .. .. .. .. .. .. .. .. .. .. .. English Cholera .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery 181 25 .. .. 1 2 3 2 2 2 .. 218 Ague,ReraittentFever .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. Syphilis, &c 8 .. .. .. .. 1 .. 1 .. .. .. 10 Erysipelas 3 .. .. .. .. 3 1 4 .. 1 .. 12 Pyæmia 3 2 4 1 1 3 1 1 1 .. .. 17 Puerperal Fever .. .. .. l 4 1 .. .. .. .. .. 6 Thrush Vege Parasites .. .. .. .. .. .. .. .. .. .. .. .. Worms, Hydatids .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast Milk .. .. .. .. .. .. .. .. .. .. .. .. Alcoholism .. .. .. .. 5 8 25 14 4 3 .. 59 Influenza 1 3 1 1 7 13 12 11 15 14 5 83 271 141 36 17 32 41 44 36 22 20 5 - 665 Constitutional Diseases. Rheumatic Fever .. .. .. 1 1 2 .. 1 1 .. .. 6 Rheumatism .. 2 2 1 2 1 .. 1 2 .. .. 11 Gout .. .. .. .. .. .. 1 .. 2 .. .. 3 Rickets 3 5 .. 1 .. .. .. .. .. .. .. 9 Cancer .. .. 1 3 6 21 46 50 45 14 4 190 Tabes Mesenterica 29 10 .. .. .. .. 1 .. .. .. .. 40 Tubercular Meningitis 16 24 2 3 .. .. .. .. .. .. .. 45 Phthisis 3 2 5 26 57 58 37 27 7 1 .. 223 Scrofula, Tuberculosis 25 14 4 9 8 10 6 2 1 .. .. 79 Purpura Hæmorrhagica .. .. .. .. .. .. .. .. .. .. .. .. Anæmia, Leucocytha .. 1 1 1 .. 1 .. 1 1 .. .. 6 Diabetes .. .. .. .. .. 1 2 1 5 1 .. 10 Other Constitutional Diseases .. .. .. 2 .. .. .. 1 .. .. .. 3 76 58 15 47 74 94 93 84 64 16 4 - 625 Developmental Premature Birth 130 .. .. .. .. .. .. .. .. .. .. 130 Malformations 20 2 1 .. .. .. .. .. .. .. .. 23 Old Age .. .. .. .. .. .. .. 3 37 94 65 199 150 2 1 .. .. .. .. 3 37 94 65 352 10 TABLE OF DEATHS—Continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards Totals Nervous Diseases. Inflammation of Brain or Membranes 20 18 7 3 3 2 2 1 6 4 .. 63 Apoplexy, Hemiplegia .. .. .. 1 8 6 17 33 42 30 4 141 Insanity, General Paralysis .. .. .. 1 2 6 6 5 3 1 2 26 Epilepsy .. .. .. 3 .. 1 3 2 .. .. .. 9 Convulsions 80 9 .. 1 .. .. .. .. .. .. .. 90 Laryngismus Stridulus .. 2 .. .. .. .. .. 2 .. .. .. 4 Diseases of Spinal cord .. 1 .. .. 1 1 .. .. .. 1 .. 4 Paraplegia .. .. .. .. .. .. .. .. .. 1 .. 1 Other Nervous diseases 1 .. 1 1 3 4 4 5 9 2 .. 30 101 28 8 10 17 20 32 48 60 39 6 - 368 Diseases of Circulating Organs. Peri & Endo-Carditis .. .. 2 5 2 1 1 1 .. 1 .. 13 Valvular Disease of Heart 5 1 14 20 15 21 33 56 37 23 4 229 Other diseases of heart .. .. 1 .. 1 1 2 4 3 2 2 16 Aneurism .. .. .. .. 2 .. .. .. 1 2 1 6 5 1 17 25 20 23 36 61 41 28 7 - 264 Respiratory Organs. Laryngitis .. 4 .. .. .. .. .. 1 .. .. .. 5 Croup 1 2 .. .. .. .. .. .. .. .. .. 3 Asthma .. .. .. .. 1 1 2 3 2 1 .. 10 Bronchitis 71 36 .. 2 4 7 30 54 79 61 8 352 Pneumonia 61 60 9 11 21 24 35 39 33 23 3 319 Pleurisy .. .. .. .. .. .. 1 1 1 .. .. 3 Other Respiratory Dis. 3 .. .. .. .. .. .. .. 1 .. .. 4 136 102 9 13 26 32 68 98 116 85 11 - 696 Diseases Digestive System. Dentition 6 6 .. .. .. .. .. .. .. .. .. 12 Quinsy, Sore Throat .. .. 1 .. .. .. 2 .. 1 .. .. 4 Disease of Stomach 8 3 .. 3 2 1 2 1 2 4 .. 26 „ Bowels 2 .. .. 1 .. 4 2 .. 2 1 .. 12 Enteritis 95 12 .. 2 .. 2 3 2 1 .. .. 117 Obstruction of Intestines 13 .. .. .. 2 1 3 2 3 2 .. 26 Peritonitis 3 .. 4 5 2 6 3 2 .. .. .. 25 Spleen .. .. .. .. .. .. 1 .. .. .. .. 1 Jaundice, Liver Dis. 5 .. .. 1 .. 3 1 7 3 4 1 25 132 21 5 12 6 17 17 14 12 11 1 - 248 11 TABLE OF DEATHS—Continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85 85 and upwards Totals Diseases of Urinary System. Kidney Diseases .. .. 1 1 1 1 3 5 5 .. .. 17 Nephritis 1 1 .. .. 1 2 7 7 4 2 .. 25 Bright's Disease .. .. .. .. 3 2 5 4 7 4 .. 25 Other Kidney Diseases .. .. 1 .. .. .. .. 1 .. .. .. 2 Bladder and Prostate .. .. .. .. .. 1 1 2 4 2 2 12 1 1 2 1 5 6 16 19 20 8 2 - 81 Diseases of Uterus &c Disease of Uterus .. .. .. .. .. 2 .. .. 1 .. .. 3 Abortion, Flooding .. .. .. 1 5 3 .. .. .. .. .. 9 Puerperal Convulsion .. .. .. 1 1 .. .. .. .. .. .. 2 Ovarian Dropsy .. .. .. .. .. .. 2 .. .. .. .. 2 .. .. .. 2 6 5 2 1 .. - 16 Bones and Joints, &c. Caries, Necrosis .. .. 1 1 .. .. .. .. 1 .. .. 3 Arthritis, Ostitis .. .. 1 .. .. .. .. .. .. .. .. 1 Carbuncle, Phlegmon .. .. .. .. .. .. .. .. .. .. .. 0 Other Skin Diseases 2 .. .. .. .. .. .. .. .. .. .. 2 2 .. 2 1 .. .. .. .. 1 .. .. — Violence. Accidents & Violence 30 12 7 9 10 8 11 7 11 10 .. 115 Homicide .. .. .. .. .. .. .. .... .. .. .. .. Suicide .. .. .. 2 2 8 5 1 1 .. .. 19 30 12 7 11 12 16 16 8 12 10 .. - 134 Ill-Defined Causes. Dropsy .. .. 1 .. .. .. 1 .. 1 1 2 6 Debility and Atrophy 128 4 .. 2 .. .. .. 2 1 2 .. 140 Mortification .. .. .. .. .. 2 .. 1 4 3 .. 11 Tumour .. .. 2 .. 1 2 .. 2 .. .. .. 7 Abscess 1 1 1 1 2 1 .. .. .. .. .. 8 Haemorrhage 2 .. .. l 1 1 1 1 4 2 .. 13 Sudden Deaths (doubtful) .. .. .. l .. 1 2 2 1 3 .. 10 Causes not Specified .. .. .. 1 .. .. .. .. .. .. .. 1 Lead Poisoning .. .. .. .. .. .. 1 .. .. .. .. 1 131 5 4 6 4 7 8 8 11 11 2 - 197 Totals 1035 370 106 145 202 261 332 379 397 322 103 3652 12 HACKNEY DISTRICT.—For whole District. Year. 1 Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths of public Institutions. Deaths of Nonresidents registered in District. Deaths of Residents registered b yond District. Deaths at all Ages. Number. Rate.* Number. Rate per 1,000 Births registered Number. Rate.* Number. Rate.-* 2 3 4 5 6 7 8 9 10 11 12 13 1893 239226 6910 28.8 1045 151 4570 19.1 193 528 337 4377 18.3 1894 212547 5938 28.5 781 128 3625 17.0 472 509 277 3393 15.9 1895 215620 6141 28.4 976 159 4060 18.8 574 507 270 3823 17.7 189G 213766 6422 30.0 1010 157 3649 17.0 884 423 271 3497 16.4 1897 216651 6312 29.0 979 137 3838 17.7 729 438 303 370:1 17.0 1898 2J.9540 6445 29.3 1042 161 3855 17.5 794 502 278 3631 16.4 1899 222429 6453 29.0 1069 165 4033 18.1 1142 520 294 3807 17.11 Averages for years 1893-99 219968 6374 29.0 986 151 3947 17.9 684 489 290 3747 16.9 1900 218976 6359 29.0 1035 162 3898 17.7 1114 518 291 3652 16.7 *Rates calculated per 1,000 of estimated population. Area of District in Acres (exclusive 6f area covered by water). .3234.2 Total population at all ages 199,006 Number of inhabited houses 28,684 Average number of persons per house 6.9 At Census of 1891. 13 HACKNEY DISTRICT. Names of Localities. 1. All Hackney. 2. North. 3 Central. 4. S. West. 5. S. East. Year. Population estimated to middle of each Year. Births registered. Deaths all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths of all Ages. Deaths under 1 year. Population estimated to middle of each Year- Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all Ages. Deaths under 1 year. 1898 219540 6445 3631 1013 49528 1110 594 150 47672 1464 754 232 63261 1938 940 306 59079 1933 1334 325 1899 222429 6453 3807 1052 50182 1116 591 129 48302 1512 770 257 64090 1961 998 316 59855 1864 1448 350 Averages Years 1898 to 1899. 220984 6449 3719 1034 49855 1113 592 139 47987 1488 762 244 63675 1949 969 311 59467 1898 1391 337 1900 218976 6359 3652 1035 50498 1131 626 125 50463 1408 732 215 59844 1921 1061 305 58171 1899 1233 390 14 HACKNEY DISTRICT. Causes of, and Ages at, Death during Year 1900. Causes of Death. Deaths in whole District at subjoined ages. Deaths in Localities (at all Ages ) Deaths in Public Institutions. All Ages. Under 1 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. North Hackney. South-east Hackney. South-w't Hackney. Central Hackney. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 29 12 16 .. 1 .. .. 6 9 9 5 7 Scarlet fever 18 2 8 7 I .. .. 2 7 1 8 24 Whooping-cough 107 50 53 3 l .. .. 15 41 26 25 4 Diphtheria and membranous croup 62 11 33 16 1 1 .. 16 21 16 9 196 Croup 3 1 2 .. .. .. .. .. 1 1 1 •• Fever Typhus Enteric 44 .. 1 5 10 28 .. 5 7 18 14 64 Other cont'ed Epidemic influenza 83 1 3 1 I 43 34 28 18 24. 13 8 Cholera .. .. .. .. .. .. .. .. .. • • • • •• Plague .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 218 181 25 .. .. 8 4 15 111 47 45 21 Enteritis 117 95 12 .. 2 7 1 19 40 23 35 13 Puerperal fever 6 .. .. .. 1 5 .. 2 1 1 2 .. Erysipelas 12 3 .. .. .. 8 1 2 7 3 .. 5 Other septic diseases 17 3 2 4 1 6 1 3 7 4 3 6 Phthisis 223 3 2 6 25 179 8 35 63 71 54 95 15 Other tubercular diseases 164 71 47 7 11 27 1 25 56 48 35 1 Cancer, malignant disease 199 .. .. 1 3 123 63 55 45 61 29 51 Bronchitis 352 71 36 2 95 148 52 114 117 69 60 Pneumonia 319 61 60 9 11 119 159 44 121 85 69 51 Pleuisy 3 .. ... .. .. 2 1 .. 2 1 .. 1 Other diseases of Respiratory organs 22 4 4 .. .. 9 5 3 7 8 4 4 Alcoholism 59 .. .. .. 52 7 5 26 18 10 20 Cirrhosis of liver Venereal diseases 10 8 .. .. .. 2 1 4 5 .. 1 Premature birth 130 130 .. .. .. .. .. 19 31 51 29 1 Diseases and accidents of parturition 11 .. .. .. 2 9 .. 3 4 .. 4 2 Heart diseases 264 5 1 17 25 140 76 59 81 83 41 73 Accidents 115 30 12 7 9 36 21 20 34 31 30 60 Suicides 19 .. .. 2 16 1 8 2 8 1 1 All other causes 1055 293 5 23 36 259 291 184 373 301 197 305 All causes 3652 1035 370 106 145 1174 822 626 1233 1061 732 1114 HACKNEY DISTRICT. Cases of Infectious Diseases notified during the Year 1900. Notifiable Diseases. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages.—Years. 1 2 3 4 1 2 3 4 North C'ntr'l H. South West. South East North C'ntr'l H. South West. South East. Under 1. 1 to 5. 5 to 15 15 to 25. 25 to 65. 65 and upw'ds Small-pox 12 3 2 3 4 7 5 7 5 Cholera Diphtheria 603 13 224 255 61 50 90 133 195 185 46 86 155 125 Membranous croup 7 1 5 1 3 1 3 1 1 Erysipelas 230 12 11 20 42 128 17 33 43 51 103 3 1 8 21 Scarlet fever 678 8 191 364 94 21 114 215 141 208 62 131 99 162 Typhus fever 1 1 1 Enteric fever 219 14 53 66 84 2 35 55 54 75 19 36 38 58 Relapsing fever Continued fever 4 1 2 1 2 2 1 Puerperal fever 15 4 11 4 5 4 2 Plague Totals 1769 34 448 696 273 299 19 278 462 446 583 130 262 200 373 16 1900 Chart Showing rise and fall weekly in Cases of Scarlet Fever, Diphtheria and Typhoid Fever, reported during 1900. Note, Scarlets Fever Diphtheria Typhoid Fever 17 A.—NOTIFIABLE DISEASES. Small-pox.—During the year 1,900 there were 16 cases of fever notified as small-pox, but of these four were ultimately diagnosed as chicken-pox. The following is a list of the notified cases: — Cases of Small-pox reported during the year 1900. Date. Address. Name. Age. Date of Removal 11 January 52, Churchill Road Prank Wi. 30 10 Jan. „ ,, ,, Alice Wi. 30 ,, „ ,, ,, Bert Wi. ly 9m ,, „ ,, ,, Frank Wi. 10 ,, „ ,, ,, Arthur Wi. 7 ,, „ 21, Bentham Road George We. 16 ,, „ ,, ,, Robert We. 4 11 „ ,, ,, Florrie We. 21 ,, 20 January 52, Churchill Road Jessie S. ly 9m 19 Jan. 25 „ ,, ,, Lily S. 29 24 Jan. 30 „ 5, Daubeney Road Arthur P. 4 30 Jan.* 17 March 7, Hassett Road Sarah L. 22 16 Mar. „ ,, ,, Charles L. 25 17 Mar. 20 April 4, Ballance Road Ernest B. 3 19 April* 12 June 12, Woolpack Place Lucy T. 6 11 June* 28 July 233, Cassland Road James S. 22 27 July* Cases marked * returned home as not suffering from small-pox. In the above list those cases marked with an asterisk were really not cases of small-pox: the remainder were connected together and had their origin in a common source of infection. This outbreak of small-pox at first threatened to assume serious proportions, but happily, by careful enquiry and vigilance, it was speedily controlled and brought to an end. The circumstances of the outbreak were these: On the 10th of January of 1900, I received information from the Bethnal Green Public Health Department that a case of small-pox had occurred in that district, and that the mother of the patient had stated that her child had been to a party on Christmas and Boxing Day, at 21, Bentham Road, South Hackney, and that amongst the children present was a child, A.Wi., who had " spots on his body." 13 This child was said by the mother to be suffering- from chicken-pox on the authority of her medical attendant, who had also advised her the child could, without danger, attend the party. I immediately visited 21, Bentham Road, and saw Mrs. We., who corroborated the statement as to having a party at her house on the days stated, and of the child A.Wi., being present with spots on his body. She further stated that nine children lived in the house with herself and her husband; that one of her sons was at that time ill with influenza. I examined him and found the disease to be small-pox. (This boy was immediately removed to hospital). She further informed me that the following persons were at the abovementioned party:— Mr. and Mrs. We. and nine children living at 21, Bentham Road; A married daughter of above and husband with two children from Mile End; Mr. and Mrs. Wi. and three children from 52, Churchill Boad, Hackney; E. Wi., brother of above, and a young "woman from Essex Street, Kingsland; F. B.. from Page Street, Westminster; N. II., from Grandsden Avenue, Hackney. This makes a total of 24 persons who had been exposed to infection in this house, eight rooms, from the morning of Christmas Day until the end of Boxing Day. I also visited the Wi. family at 52, Churchill Boad, and found the father, mother and two children with the small-pox eruption on them, well marked, and the boy Arthur, who was said to have had chicken-pox, marked with scars and a few crusts of eruption of undoubted small-pox. The whole family were immediately sent off to hospital. 19 I subsequently visited all those persons residing in Hackney who had been exposed to infection, and kept them under observation; those residing in other districts were kept under observation by the Medical Officers of Health of their respective districts, whom I had informed of the circumstances, and of their addresses. Later, others were found to be suffering from the disease, and in the early stages were removed to hospital. Infected rooms, clothing, bedding, &c., were disinfected, and advantage was taken to advise all persons who had been exposed to infection to be vaccinated or re-vaccinated. All efforts to trace the source of infection beyond the boy Arthur Wi. were fruitless. The manner in which Charles L. became infected deserves some record. It appears that F. Wi, of 52, Churchill Road, was employed at a boot factory in leather cutting. During the early days of his illness, and while the eruption was appearing, it appears he continued at work. On leaving work, all his work tools were taken to his home, except a leaden weight and cutting knife, which were put on one side until his return. The tools taken home and the workroom were disinfected, and the board on which he cut the leather was planed, and the shavings destroyed. During the absence of P. Wi., another workman, Charles L., was taken on as cutter, who took F. Wi's place at the bench, using the same board as he used. F. Wi. returned to work on the 7th February, taking his place at the bench next to Charles L. On re-commencing work, he took out the leaden weight and knife which had been put aside, and not used by anyone during his illness, and used them at his work. Charles L. at the same time participating in the use of these tools. About a fortnight after F. Wi. returned to work, Charles L. fell ill with small-pox, the eruption which was modified, appearing on the 1st of March. Unfortunately this was diagnosed by the patient's medical attendant as chicken-pox, the result being that the patient's wife was attacked with a more severe form of the disease. They were both removed to hospital, and made a good recovery in due course. The interesting feature about Charles L's illness, is that he almost certainly contracted the disease from F. Wi., and through the medium 20 of the leaden weight and knife which had not been disinfected. I do not think F. Wi. conveyed the infection on his clothes or person, for he had quite recovered from the disease before his return, and his clothes had been steamed during his illness, moreover, no other person in the shop developed the disease, although another workman worked at his left hand side, quite as near as Charles L. on his right hand, but the difference was that the former did not use Wi's. tools but Charles L. did. In connection with this outbreak, I was instructed by the Public Health Committee to prepare a leaflet for distribution on the subject of vaccination. A copy of this leaflet will be found in the appendix. Scarlatina.—During the year 1900 there were 678 cases of this disease notified in Hackney, but of these 13 were returned from the fever hospital as not suffering from any infectious disease, thus reducing the total to 665, against 986 cases notified during the previous year. This shows an attack rate of 2.9 per 1,000 living. The deaths numbered 18, which gives a death-rate of 2.65 per centum attacked, and .08 per 1,000 of the population. This disease has declined very much of late years in Hackney, and I believe that speedy removal to hospital and isolation have had much to do with this. Of the total notified during the year 454 cases were removed to hospital—nearly 67 per cent. Knowing the infectious character of scarlatina, it is only reasonable to suppose that the early removal to hospital of the above proportion of cases must have assisted largely in diminishing its prevalence. The chart, accompanying this report, shows the progress of disease week by week throughout the year. It will be seen that the disease fluctuated considerably during the year, but was at the highest point of prevalence during the months of June and October, and at its lowest early in the month of September. Diphtheria and Membranous Croup.—During the year, 603 cases of diphtheria and 7 of membranous croup were notified, but of these 17 cases of diphtheria were returned from the fever hospital as 21 not suffering from any infectious disease, so the total of diphtheria and membranous croup is 593. The corresponding total for 1899 was 664; so that like scarlatina, though not to the same extent, this disease was less prevalent during last year, the attack-rate being 2.6 per 1,000 living. The deaths numbered 62, which is equivalent to a mortality-rate of 10 03 per cent. attacked, and .27 per 1,000 of the population. The number removed to hospital was 414, being equal to 678 per cent. of the cases notified. The accompanying chart shows the disease to have been at its highest point during the months of July and November, and lowest during the month of June. During the year 1900, I represented to the Public Health Committee that it was desirable to obtain a bacteriological examination of material from the throats of patients in doubtful cases of diphtheria and membranous croup, and also of blood in doubtful cases of enteric or typhoid fever, in order to secure early diagnosis for the purpose of isolation or removal to hospital. I was instructed to make whatever arrangements I thought necessary. To this end, I arranged with the superintendent of the Jenner Institute for a supply of tubes, swabes, &c., and for the bacteriological examination of material from cases of diphtheria and enteric fever at a cost of 2s. 6d. per examination. I further informed the medical practitioners of Hackney by letter of the measures taken, and that the local authority were prepared to supply them with apparatus, and have these examinations made free of cost. These arrangements were made in the month of October, and since then six samples of diphtheria material, and one sample of blood from enteric fever patients have been examined. Anti-toxin serum was supplied to medical practitioners to the number of 24 bottles during the year. Enteric ok Typhoid Fever.—This disease was less prevalent during 1900 than during 1899, the number of cases notified during these years respectively, being 219 and 254—a decrease of 35 upon the year 1899. Of the above total for 1900, no less than 151 were removed to hospital, but of the latter 8 were returned as not being cases of infectious disease, so that the total of real cases of typhoid 22 notified was 211. This gives an attack-rate of .9 per 1,000 persons living. The deaths numbered 43, which shows a mortality of 20 0 percent. attacked, and .19 per 1,000 of the population. The disease prevailed above the average during the first three months of the year, and much more so during the months of August, September, and November. Thirteen cases of this disease appear to have been introduced into Hackney from outlying districts. Typhus.—No case of typhus fever was notified in Hackney during 1900. Continued Fever.—Four cases of fever were notified under this name during the year, one of which was removed to hospital. Pcerperal Fever.—Fifteen cases of puerperal fever were notified during 1900, of which six died. All cases of puerperal fever are enquited into, with a view to ascertain, and if possible remove their cause; at the same time every precaution is taken to prevent infection. In this connection I interview all nurses and midwives who have attended the cases notified and instruct them as to the precautions to be taken against the conveyance of infection. Cholera.—No case of this disease occurred in Hackney during 1900. Plague.—This disease was made notifiable by an order of the Local Government Board, dated September 19th, 1900. In addition to making the disease notifiable, the order imposes upon the Medical Officer of Health the duty of reporting to the Local Government Board any case of plague, either notified to him or brought to his knowledge within the district of which he is Medical Officer of Health. The local authority are also required by this Order to inform all legally qualified medical practitioners in the district of their duties in regard to the notification of this disease. 23 Immediately after the receipt of this Order, I was instructed by the Public Health Committee to inform the medical practitioners of the district of the disease having been made notifiable, and remind them of their duties in respect of the same. Happily the disease' did not make its appearance in the district during the year. Erysipelas.—No less than 230 cases of erysipelas were notified during the year, of which 33 were removed to some general hospital. The deaths numbered 12, giving a mortality-rate of 5 2 per cent. of those attacked. B.—NON-NOTIFIABLE DISEASES. Influenza.—The year 1900 was marked by an outbreak of this disease which led to the death of 83 persons in Hackney, which is equivalent to a death-rate of .36 per 1,000 living persons. The disease was not confined to any particular part of the district, but was fairly general. Most of the deaths occurred at the middle and advanced ages of life, and the seasonal distribution was as below:— Deaths from Influenza during the years 1891 to 1900. Year. Jan Feb. Mar. Apl. May June July Aug. Sep. Oct. Nov. Dec. 1891 0 0 0 2 86 39 6 3 2 1 1 1 1892 77 29 6 3 1 1 1 0 0 0 0 1 1893 3 A 11 10 4 4 3 1 1 1 7 37 1894 18 5 2 4 1 3 0 0 1 1 1 3 1895 2 91 9 3 1 0 0 2 2 3 5 1896 1 4 2 3 2 1 0 1 0 1 3 4 1897 1 1 6 5 9 3 0 0 1 2 2 7 1898 11 16 7 5 4 3 2 2 2 1 1 1 1899 3 9 35 11 6 3 1 1 0 5 3 10 1900 48 18 4 2 2 1 1 0 1 1 3 2 Diarrhoea.—During the year there were 218 deaths from this cause, 181 being under one year ; in addition there were 117 deaths from enteritis and gastro-enteritis. due probably to the same causes as those registered under the term diarrhœa. Of these latter, 95 were under one year old. These facts are tabulated below. Owing to the prevalence of diarrhœa and enteritis during the third quarter 24 of 1900, a leaflet (see appendix) was distributed widely through the district, with a view to the education of the public in the measures to be attended to in order to prevent this scourge to infants. Deaths at all ages during the year from Deaths under one year. In the third quarter, all ages. In the third quarter, und'rone ye'r Diarrhœa 218 181 198 176 Enteritis and Gastroenteritis 117 95 68 55 Measles.—During the year 29 deaths were registered in the district from this cause, against 116 in 1899. The mortality is therefore .13 per 1,000 living. Whooping Cough.—The deaths from whooping cough during 1900 numbered 107, against 47 during the previous year. This is equivalent to a mortality of .48 per 1,000 living persons. Class II. Constitutional Diseases.—The most important diseases in this class are tuberculous diseases and cancer. The following shews the deaths from the former disease in Hackney during the years 1894 to 1900 Number of deaths in Hackney during the years 1894-1900, inclusive, from Tubercular Diseases. 1894 1895 1896 1897 1898 1899 1900 Tabes Mesenterica 35 62 35 34 37 25 45 Tubercular Meningitis 40 43 35 41 53 42 45 Phthisis 278 292 294 299 308 313 223 Scrofula and Tuberculosis 52 62 44 63 85 96 79 Totals 405 459 408 434 483 476 492 25 The deaths registered during the last year from this cause was 492, which are equal to an annual death rate of 2.2 per 1,000 living. Cancer.—This disease was responsible for no less than 190 deaths during the past year. This is equal to a death rate of .86 per 1,000. Class III. Developmental.—The deaths under this head numbered 352, and included 130 due to premature birth. The mortality for the whole class is l.6 per 1,000. Class IV. Local Diseases.—The total deaths in this class numbered 1,679, and is equal to an annual mortality of 7.6per 1,000 living. Class V. Violence.—There were 134 deaths during the year due to violence, and of these 19 were suicides. The death-rate for violence is .6 per 1,000 living. Class VI. Ill-Defined Causes.—No less than 197 deaths were attributed to indefinite causes. PUBLIC HEALTH (LONDON) ACT, 1891. Nuisances.—The number of nuisances abated during the year amounted to 3,966; of these 3,732 were abated by the service of intimation or statutory notices, and 234 were only abated after the initiation of legal proceedings. The character of the nuisances varied very much, some of them requiring only trifling repairs, others involving large expenditures of labour and money on the part of the owners for their abatement. In proportion to the extent of the measures adopted to effectually abate a nuisance, so is the time and attention of the inspector drawn upon. As examples of extremes, I mention the removal of some 26 offensive deposit, or the choking of a gulley, and the reconstruction of a combined system of drainage for four or five houses. The former probably is abated after one visit of the inspector, the latter requiring visits at intervals during two or three weeks. In proof of this, I may state that no less than 36,101 visits of re-inspection were made during the year, which work out at an average of about nine visits to each nuisance abated. House-to House Inspection.—In addition to the inspections made on complaint, and in houses where infectious disease has occurred, considerable progress has been made during the year in what is known as house-to-house inspections. This has been rendered possible by the diminution of notifiable infectious disease in the district during the year. Nearly 1,000 houses were so visited by the inspectors, and notices served for the abatement of any nuisance found on the premises. Infectious Disease.—The number of inspections made after infectious disease was less than one-half those requiring inspection during 1899—the number in 1900 not reaching higher than 1694, whereas, the year before, it totalled 4,246. The drains of each house visited were tested, and any nuisance found abated. The rooms fumigated numbered 1659, in addition 529 of these were stripped of their wall paper and cleansed. The articles disinfected by super-heated steam numbered 10,038, and those destroyed by request of the owners 51. The disinfectants distributed to persons applying at the Town Hall for such, were 7,952 bags of sanitas powder, and 1,182 bottles of carbolic acid. For list of articles disinfected, etc., see appendix. Accommodation for persons during the disinfection of their homes was paid for by the local authority on two occasions. These do not represent the whole of those who were deprived of their homes for one or more nights, but those only who made application to the Public Health Department for the means to provide accommodation. 27 Articles Seized Unfit for Food.—Amongst these were 5 cwts. of fish, 6¼ cwts. of fruit and vegetables, and 25f cwts. of meat. There were in addition 270 tins of preserved food, and 2 cwts. of miscellaneous articles. Cow-houses and Slaughter-houses.—Following their usual custom, the Public Health Committee inspected these (29 cow-houses and 35 slaughter-houses) in the month of September, and found them on the whole in a very fair condition. Up till November of 1900, these have been for inspection and control under the supervision of the London County Council, but by the London Government Act which came into operation in that month, they were transferred to the Borough Council. The following defects were found :— Cow-sheds dirty ... ... ... ... 14 Storage cistern dirty 1 Accumulations of manure 2 Pen and utensils dirty 1 Slaughter-houses dirty 1 No receptacles for manure 1 20 Bake-houses.—These are inspected twice a year by the inspectors with a view to the abatement of any nuisance present, and to ensure proper cleansing of the premises. In the month of May, the committee made their annual visit to the bake-houses with the following result:— Number of bake houses inspected 122 ,, in a satisfactory condition 99 ,, requiring lime-washing 12 ,, requiring small repairs 11 28 Smoke Nuisances.—During the year 1,479 observations were made by the Smoke Inspector, and 41 intimations and statutory notices were served for the abatement of this nuisance. The general results of the service of the notices has been to cause a more general use of anthracite coal in the furnaces of factories, and the adoption of proper smoke-consuming apparatus. PUBLIC HEALTH (LONDON) ACT, 1891, PROPOSED AMENDMENT. My experience of the last few years shows that there is need for some amendment of the Public Health Act, which will enable local authorities to deal more promptly with recalcitrant owners of property in respect to the cleansing of rooms, especially those occupied by the working and lower classes. To the credit of the majority of property owners most of the cleansing is done on the service of a notice by the local authority ; but there is a certain class of owners who will not do such work unless by a Magistrates' Order. At present in order to obtain a Magistrates' Order to cleanse the walls and ceilings of an occupied room, it is necessary to take it as a general nuisance under Sec. 2 of the Public Health (London) Act as a nuisance, or dangerous, or injurious to health. It is extremely difficult to prove that a dirty ceiling or wall is dangerous or injurious to health in any special sense. Certainly cleanliness of dwelling, as well as personal, is essential to good health, and when they are so dirty that they give rise to a stuffy or unwholesome smell, they tend to lower the vitality of the inmates. But the local authority should have the power of dealing with this before it reaches the condition to injuriously affect the health of the occupants in a similar way to that in which factories, or workshops, or bakehouses are periodically cleansed. The following extracts show that the law is adequate to deal with the cleansing of these:— 29 FACTORY AND WORKSHOP ACT, 1878. Special provisions for Health in certain Factories and Workshops. Sec. 33. For the purpose of securing the observance of the requirements of this Act as to cleanliness in every factory and workshop, all the inside walls of the rooms of a factory or workshop, and all the ceilings or tops of such rooms (whether such walls, ceilings, or tops be plastered or not) and all the passages and staircases of a factory or workshop, if they have not been painted with oil or varnished once at least within seven years, shall be limewashed once at least within every fourteen months, to date from the period when last limewashed ; and if they have been so painted or varnished shall be washed with hot water and soap once at least within every fourteen months, to date from the period when last washed. Sec. 34. (a) Where a bakehouse is situate in any city, town, or place containing, according to the last published Census for the time being, a population of more than five thousand persons, all the inside walls of the rooms of such bakehouse, and all the ceilings or tops of such rooms whether such walls, ceilings, or tops be plastered or not, and all the passages and staircases of such bakehouse, shall either be painted with oil, or varnished, or be limewashed, or be partly painted, or varnishedand partly limewashed ; where painted with oil or varnished there shall be three coats of paint or varnish, and the paint or varnish shall be renewed once at least in every seven years, and shall be washed with hot water and soap once at least in every six months; where limewashed the limewashing shall be renewed once at least in every six months. PUBLIC HEALTH (LONDON) ACT, 1891. Sec. 25. (1) Where on the certificate of a Medical Officer of Health or Sanitary Inspector, it appears to any sanitary authority that the limewashing, cleansing, or purifying of any workshop (other than a bakehouse), or of any part thereof, is necessary for the health of the persons employed therein, the sanitary authority shall serve notice in writing on the owner or occupier of the workshop to limewash, cleanse, or purify the workshop or part, as the case requires, within the time specified in the notice, and if the person on whom notice is so served fails to comply therewith, he shall be liable to a fine not exceeding five pounds, and to a further fine not exceeding ten shillings for every day during which he continues to make default after conviction; and the sanitary authority may, if they think fit, cause the workshop or part to be limewashed, cleansed, or purified, and may recover in a summary manner the expenses incurred by them in so doing from the person on whom the notice was served. 30 Tenements, houses registered under the bye-laws for houses let in lodgings are also required to be cleansed thoroughly once a year by the landlord. Now this provision of annual cleaning should be applied to every house occupied by the working classes, if not, these houses ought to at least be put on as high a sanitary level as workshops under the Public Health Act (London), 1901, that is that the cleansing of any room should be compulsory on the certificate of a Medical Officer of Health. See (Sec. 25. (1.) above, as in workshops.) If this amendment of the law could be effected, the work of the local authority in dealing with dirty rooms would be much simplified and made more effectual. HOUSING OF THE WORKING CLASSES ACT, 1890. Part I. Early in the year I made a representation in accordance with sec. 5. of the above Act to the London County Council respecting an area in the London Fields district. The following is a copy of the representation : — HOUSING OF THE WORKING CLASSES ACT, 1890. London ( ). Improvement Area. To the London County Council. I, J. King Warry, M.D., of No. 39, Filey Avenue, Clapton Common, in the County of London, Medical Officer of Health of the Parish of Hackney, in the said County, Do hereby, with reference to a certain area within the Parish of Hackney, which is delineated and coloured red on the plan hereunto annexed and signed by me, make an Official Representation within the meaning of the Housing of the Working Classes Act, 1890, to the effect following—that is to say :— 1.—That the houses, courts, or alleys, within the said area are unfit for human habitation ; and 2.—That the narrowness, closeness, and bad arrangement, or the bad streets and houses or groups of houses within such area, or the want of light,, air, ventilation, or proper convenitnces, or any other sanitary defects, or one or more of such causes, are dangerous or injurious to the health of the inhabitants of either of the buildings in the said area. 31 3.—That the evils connected with such houses, courts, or alleys, and the sanitary defects of such area cannot be effectually remedied otherwise than by an Improvement Scheme for the re-arrangement and re-construction of the streets and houses with such area, or of some of such streets or houses. Dated this First day of May, One Thousand Nine Hundred. This area is bounded on the south by Duncan Road, on the east by Sheep Lane, on the north by a line at the rear of the buildings forming this side of Duncan Square, and on the west by a line at the back of the premises forming the eastern side of the Broadway. The total number of premises concerned is 71. The decision of the London County Council is not yet known. Part II. During the early part of 1900 my attention was drawn to the condition of the houses in Tyssen Flace, Tyssen Passage, and Tyssen Street, Dalston Lane. The total number of houses was 36. These I found upon inspection to be in such a state as to be, in my opinion, unfit for habitation. The conditions existing upon the premises from which I formed this opinion were as follows :— 1.—The whole of the houses in a generally dilapidated and dirty condition. 2.—The walls of ground-floor rooms damp. 3.—No through ventilation beneath the ground-floor. 4.—The exterior walls so defective as to allow the rain to percolate to the interior. I accordingly made a representation to the local authority on each house to the above effect. These representations were considered by the Public Health Committee, and it was resolved that legal proceedings should be instituted for the closure of these houses. This was done, and on the 11th of May the magistrates sitting on that date at the North London Police Court made orders for their closure. Since that date the houses have been demolished to make room for the erection of a factory. 32 TEMPORARY SHELTER.—PUBLIC HEALTH (LONDON) ACT, 1891. CLEANSING OF PERSONS ACT, 1897. The question of providing a shelter for persons deprived of their homes while they are undergoing disinfection, advanced a stage further during this year. In the month of July, 1900, the Local Government Board was asked by the local authority of Hackney to give their consent to a loan being raised for the erection of a shelter, a new disinfecting station and a caretaker's lodge. Before giving consent, a local enquiry was held at the Hackney Town Hall, July 26th, by one of the Board's Medical Inspectors, when evidence for the need of the accommodation was submitted to him, together with plans of the proposed buildings and their estimated cost. In the course of a few weeks the consent of the Board was given ; tenders for the work were immediately obtained, and the erection of the buildings begun. At the time of writing this report they are nearly completed. The shelter consists of four entirely separated and furnished tenements of two rooms, with w.c. and bathroom to each. The disinfecting station is of good size, the chamber receiving the infected goods completely cut off from the chamber receiving the disinfected articles. It is provided with two Alliot & Paton's improved Washington Lyons high pressure steam disinfectors. In connection with the noninfected chamber is a small laundry, fitted with a washing machine, a hydro (both to be worked by means of an electric motor), troughs, &c., and an ironing room fitted with electric heated irons ; also a drying room. It was thought desirable to include in this block shelter for the vans used in the transport of articles to and from the station, a two-stalled stable and loose box for the horses employed. It is intended to provide the disinfecting station with steam from the boilers of the dust destructor ; but to provide against the contingency of a failure on the part of the destructor, an upright boiler has been provided in connection with the disinfecting apparatus. 33 Tbe opportunity was also seized to erect bath-room accommodation and apparatus, in accordance with the Cleansing of Persons Act, 1897, for the cleansing of persons and their clothes infested with vermin. This accommodation consists of a bathroom for males and one for females, properly furnished with apparatus for the disinfection of the infected clothing. With this station and shelter, I have no hesitation in stating that Hackney will be the most completely equipped district in London for dealing with infectious and contagious disease. Annexed are the plans and a perspective view of the building and site, which have been prepared by the Architects, Gordon & Gunton, Fiusbury House, E.C. FACTORY AND WORKSHOPS ACTS 1878—1895. The following is a list of the additional workshops registered during the year. The total number was 52 ; of these 15 were workshops in which males were employed, and 37 where females were employed. The former were inspected by the male Sanitary Inspectors, the latter by Miss Teebay. Any nuisances found were all satisfactorily abated. The total number of workshops now on the register is 1626, all of which have been inspected at intervals; but it is obvious that these cannot be periodically inspected with the staff at my disposal without the neglect of other important work No. of Workshops registered during the year 1900 52 ,, ,, inspected on notice by Factory Inspector 50 „ ,, ,, by instruction of Medical Officer of Health 2 Result of Inspections :—(a) Workshops overcrowded 10 (b) Improper W.C. Accommodation 2 (c) No separate conveniences for sexes 1 (i) Other nuisances 81 Miss Teebay in addition to the inspections above credited to her has made a large number of visits of inspection and re-inspections B 31 during the year, and caused the abatement of many nuisances in workshops where women are employed. The details of Miss Teebay's work are given in her report set out in the appendix. At the beginning of the year, I instructed Miss Teebay to devote a certain portion of her time (one day per week) to the inspection of " outworkers' " homes, which arrangement has been continued up to the present. The following report which was presented to the Public Health Committee in July shows the progress made in this class of work and some of the difficulties encountered. To the Public Health Committee, Hackney Vestry. Gentlemen, After the organization of the work by the Medical Officer of Health, I began the systematic inspection of outworkers on March 14th of this year. Since that date I have paid 1G9 visits to addresses furnished me by employers of this class of worker. A small proportion of these visits were futile. For, in the first place, outworkers appear to be a very migratory section of the population, and in many cases were found to have left the addresses given to me, although I endeavour to allow as little time as possible to elapse between the obtaining of the address and the inspection of the premises and, in the second place, many employers fail to keep their lists of outworkers accurate and up-to-date, and do not insist upon a change of residence being notified to them. On several occasions persons asked for have never been heard of at the address furnished, or are reported to have left some considerable time previously. This carelessness on the part of employers will, I hope, gradually disappear as they more clearly understand the obligations imposed upon them by the Factory and Workshops Acts in the matter of outworkers—obligations of which in the past they appear to have had a most elementary idea, or no idea at all. In the future, however, ignorance cannot be pleaded as an excuse for non-compliance v. ith the regulations, as a copy of the Medical Officer's letter to employers, drawing attention to their responsibilities, has been, or will be, forwarded to every factory and workshop coming within the Order of the Secretary of State. The outworkers I have visited have been employed in the following trades:— The manufacture of boots and shoes—skirts and blouses—underclothing—mantle —millinery—ties—gloves and trimmings. In three cases outworkers refused to admit me to their rooms. 35 Nuisances were found to exist on 63 premises. These were dealt with by the sanitary inspectors of the various districts in which the houses were situated. During the last six months the names of nine outworkers resident in this district have been Bent to us from Islington, four from Poplar, and four from Marylebone. I am, Gentlemen, Your obedient Servant, ALICE TEEBAY. THE RIVER LEA. The river Lea has not improved in any way during the past year in regard to its foulness and its ability to give rise to offensive smells. This condition was well marked during the hot months of last summer. The following analyses of the river water sampled at certain points in Hackney witness to its polluted state. During the year a noteworthy event occurred in the intr duction of a Bill into Parliament for the reconstitution of the Lea Conservancy Board. In connection with this the local authority of Hackney was heard before a Select Committee, which had been appointed to consider the constitution of the new Board, in favour of obtaining a direct representation on the reconstituted Board. The old Lea Conservancy Board consisted of thirteen members, the new Board as determined by Act of Parliament will consist of fifteen members. The following is a table showing the constitution of the old and the reconstituted Lea Conservancy Boards. It will be seen from the latter that the action of the Hackney local authority, in pleading their case before the Select Committee for direct representation on the new Board, was to obtain for Hackney a partial representation on the Board. It forms one of three local authorities which return one member to the Board. The new Board does not come into office until April, 1901, so that it can hardly be expected that anything radical will be done to remedy the existing insanitary conditions of the River Lea in Hackney during this year, but it would be advisable for the Hackney Borough Council to bring their case at an early date before the new Board. 36 Table contrasting the Constitution of the Lea Conservancy Board of 1868 with that of 1900. constituted 1868. re-constituted 1900. Five members elected by landowners as defined in the Act of 1868 ; A ppointed members— One by the Bedfordshire County Councll; One member elected by owners of barges used on the River Lea; One by the Hertfordshire County Councll; One member elected by the heads of the local authorities mentioned in the Fourth Schedule to the Act of 1868 ; as follows : — One by the Essex County Councll; One by the Middlesex County Councll; The Chairman of the Local Board of Health of the respective dis tricts following: — Two by the London County Council ; Luton, Bishop Stortford, Ware, Cheshunt, Waltham Holy Cross, Tottenham, West Ham, Enfield, Edmonton. One by the Corporation of London ; One by the Corporation of West Ham; One by the New River Company; One by the East London Waterworks Comyany. Two members appointed by the Governor and Company of the New River brought from Chadwell and Am well to London (commonly called and in this Act referred to as " The New River Company "); Elect d members— One by the local authorities in Hertfordshire mentioned in the first part of the schedule to this Act; Two members appointed by the East London Waterworks Company ; One by the local authorities in Essex mentioned in the second part of the said schedule; One member appointed by the Mayor, Aldermen and Commons of the City of London in common council assembled ; One by the local authorities in Middlesex mentioned in the third part of the said schedule ; One member appointed by the London County Council as successors of the Metropolitan Board of Works. One by the local authorities mentioned in the fourth part of the said schedule ; as follows :— The Hackney Vestry, The Limehouse Board of Works, The Poplar Board of Works. One by the barge owners. 37 Analysis of River Lea Water, made during the year 1900, by Leo Taylor, F.I.C., Public Analyst. Date. Where taken. Total solid residue Saline Ammonia. Organic Ammonia. Chlorine. Nitrates. Nitrites. Sulphuretted Hydroge Suspend'd matter. Remarks. July 11 Culvert of Leyton and Walthamstow Sewage. 142.8 grains per gallon. 2.8 grains per gallon. .896 grains per gallon. 7.8 grains per gallon. Exc'sive Slight. Ab'nd'nt The sample was very foul, and contained a large quantity of suspended matter. It may be fairly described as muddy sewage water. July 11 White Hart Temple Mills. 43.40 4.2 2.66 7.2 Exc'sive Slight. Ab'nd'nt 369.0 grains per gallon. This is really a sample of river mud, as the suspended matter settles down directly the sample is allowed to stand. Exceedingly foul and giving off very offensive odours. 38 FLOODING OF HOUSES ON THE BANKS OF THE RIVER LEA. In the month of February, 1900, the river Lea again overflowed its banks, and flooded not only the low-lying land adjacent, but the lower rooms of many houses near certain parts of the river, both to the detriment of the property and danger to health of their inmates. Thefollowing is a list of the inhabited houses flooded:— Lea Bridge. Nos. 3 to 19, Middlesex Wharf. ,, 20 to 23, ,, „ The " Jolly Anglers' " public-house. Nos. 1 to 12, Mayston's Cottages (east side). ,, 1 to 12, ,, ,, (west side). ,, 1 to 9, Lower Dock side. ,, 1 to 12, ,, ,, ,, ,, 1 to 5, Hammond Cottages. ,, 1 to 2, ,, Villas. " King's Head " public-house. High Hill Ferry. Nos. 1 to 9, Retreat Place. " Anchor and Hope " public-house. Spring Lane. Nos. 1 to 9, Willow Cottages. ,, 1 to 11, Laburnham Cottages. The water entered the houses on Sunday afternoon, the 18th February, about 5 p.m., and rose to a height of from 18 inches to two feet, subsiding during the following night about 12 o'clock. The inmates during this time had to retreat to the upper rooms, and could only leave their homes either by wading through the water, or by the help of boats. The water remained for a considerable time under the floors of many of the houses, especially those near the Lea Bridge, causing the walls and floors to remain damp a very long time, and so endangering the health of their inmates. 39 The water overflowed both banks of the river, a part of the North Millfield, and also the marshes on the eastern side. The river overflowed in a similar manner in the spring of the year 1897, flooding the same houses, and causing the same damage and danger to health. I then pointed out that the overflow of the river would recur, and render the houses in this locality unfit for habitation. The actual cause of the flood is not quite known, but it is believed the raising of the level of the adjacent marsh lands has helped to cause their more frequent recurrence. I reported these circumstances to the Public Health Committee, and expressed the opinion that the cause of these recurring floods was complex, and required a searching enquiry to elucidate them, and that probably the London County Council if approached would undertake such an enquiry with a view to enforcing such measures as would prevent the occurrence of future floods. I believe an investigation was made by the Council, but as yet without any practical result. It is quite certain that if future flood cannot be prevented, the houses bordering the river will have to be closed; for I have no hesitation in stating that dwellings subject to casual flooding are unfit for habitation. CANAL BOATS ACTS, 1877—1894. The Inspector appointed to examine the canal boats on the waterways through Hackney reports that he inspected 93 boats during the year. Of these 83 were found to conform to the regulations, but in eight instances infringements were observed. The latter are as follows :— Certificate did not indentify owner 3 cases. Marking of boat defective or absent 2 cases. Certificate absent 3 cases. In addition to these, one cabin was not sufficiently ventilated, and in six others the cabins required painting. CUSTOMS AND INLAND REVENUE ACT, 1900. During the year I granted three certificates to the same number of owners under the provisions of this Act. The total number of tenements covered by these certificates was 54. 40 VACCINATION. Below is given a copy of the returns made by the Vaccination Officers of the Hackney Union, respecting Vaccination from 1st of January to 30th June, 1900. This shows that the proportion of successful vaccinations made during the first half year of 1900 was slightly less than those made during the same period of 1899 : but on the other hand the number not vaccinated and unaccounted for during the former period was less than those of the latter period, the percentages being respectively 23 and 29. While this is an improvement upon the period prior to the passing of the last Vaccination Act, it is not at all satisfactory. It will be noted that the number of conscientious objectors who obtained certificates during the 1st half year of 1900 was 30, an increase of 4 only on those during the same period of the previous year. The role of " conscientious objector" does not appear to be popular. REMOVAL OF HOUSE REFUSE. The house refuse removed by the local authority from occupied houses in Hackney during the year 1900 amounted to 61,164 loads, at a total cost of £18,579 15s. 4d.; against 57,990 loads, at a cost of £16,901 9s. 4d. for the year 1899. The above figures show a cost of 1/7½ per head of population (estimated) for the year 1900, and 1/6½ per head for the year 1899. The removal of house refuse is a heavy charge upon the rates, but a most necessary one ; and it is to be hoped that the disposal of the refuse by the destructor now in course of erection will effect a considerable reduction in this charge. The amount paid to the local authority for the removal and disposal of trade refuse during the year was £125 10s. 2d. Return made on the 8th February, 1901, by the Vaccination Officers of the Hackney Union, respecting the Vaccination of Children whose Births were registered in their Districts from 1st January to 30th June, 1900, inclusive. REGISTRATION SUBDISTRICTS COMPRISED IN THE VACCINATION OFFICER'S DISTRICT. Number of Births returned in the " Birth List Sheets" as registered from 1st Jan. to 30th June, 1900. Number of these births duly entered by 31st January, 1901, in cols. I., II., IV. and V. of the " Vaccination Register " (Birth List Sheets) viz :— No. of these births which on 31st January, 1901, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of No. of these births remaining on 31st January, 1901, neither duly entered in the Vaccination Register (cols. 3, 4, 5,6 and 7 of this Return), nor temporarily accounted for in the " Report Book " (cols. 8, 9 and 10 of this Return. Col. I. " Successfully Vac'in'ted." Column II. Col. IV. Number in respect of whom Certificates of conscientious objection have been received. Col. V. Dead. Unvaccinated." Postponement by Medical Certificate. Removal to Districts, the Vaccina tion Officer of which has been duly apprized. Removal to places unknown or which cannotle reached and cases not having been found. " Insusceptible of Vac'in'ion." " Had Small-pox.' 1 2 3 4 5 6 7 8 9 10 North Hackney 599 271 4 — 13 53 27 5 83 143 Central Hackney 732 318 — — 4 76 6 5 126 197 South-East H'ckney 1005 265 — — 8 163 4 5 241 319 South West H'ckney 978 498 — — 5 128 1 40 174 132 Total 3314 1352 4 - 30 420 38 55 624 791 Total for the period of 1899 (1st Jan. to 30th June) 3380 1392 22 — 26 391 54 114 386 995 42 The following table shows the number of requests received for the removal of house refuse during 1900, compared with those of previous years. The average is about four per week, an extremely small proportion considering that over 30,000 houses are visited each week by the dustmen. Table XI. A List of the requests for the removal of Dust received during the seven years, ending December 31st, 1900. 1891 1895 1896 1897 1898 1899 1900 January 136 89 37 21 22 26 50 February 48 41 17 20 6 7 7 March 85 53 30 15 6 13 9 April 97 66 46 8 19 37 22 May 55 73 22 11 3 21 11 Tune 72 46 39 12 11 22 20 July 63 31 18 17 11 43 37 August 56 23 12 9 6 14 8 September 58 38 24 6 8 2 18 October 73 27 21 8 3 10 8 November 94 39 14 9 4 6 2 December 46 26 17 7 15 18 13 Totals.. 893 552 297 143 114 220 205 The refusals of householders to allow the dust to be taken away numbered on an average about the same as during previous years. There is no doubt that such refusals are an offence under the Public Health (London) Act, 1891. It is probable that a few judiciously selected prosecutions would reduce the proportions of refusals considerably. DISPOSAL OF HOUSE REFUSE. In my annual report for the year 1895, I recommended the late Vestry to dispose of their house refuse by means of destruction by fire. In the following year the then Sanitary Committee presented to the Vestry a report recommending :— (a)—That the Vestry do undertake the work of collection and disposal of house refuse in the parish. 43 {b)—That the system of disposal of the house refuse by dust destructor be adopted. (c)—If recommendations (a) and (b) be adopted, the Sanitary Committee be instructed to submit to the Vestry a scheme for the collection and disposal of house refuse. The recommendations (a) and (b) were ultimately adopted, but (c) was adjourned. Nothing further beyond discussion was definitely settled on this subject until 1899, when the Vestry finally decided to work their electric lighting order in conjunction with a dust destructor, thus utilizing the heat arising from the combustion of the house refuse of the district in the raising of steam. Whatever may be said about the local authority working their own electric lighting order, nothing but unqualified approval must be given to the resolution to destroy by heat the house refuse of the district. The matter, however, has progressed so far that a dust destructor is now in course of erection in connection with works to supply electricity for lighting and power purposes to the district. It is intended that the destructor shall consist of 12 cells fitted with Babcock and Willcox tubular boilers for steam raising purposes, and it is estimated that these cells will be capable of cremating 160 tons of refuse per day without forcing. It is also arranged that special means shall be provided for dealing with bulky articles, such as dead animals, condemned meat, infected bedding, etc. It is believed that by disposing of the house refuse in the way indicated a saving will not only be effected in the cost of disposal, but, owing to the calorific value of house refuse, there will be a proportional saving in the cost of fuel for steam-raising for electric lighting, etc. The advantages of the cremation of house refuse from a health point of view are so apparent as to need no further reference. 44 DUSTING ACCOUNT, 1900. MONTH. Northern Division Southern Division Totals. Loads. Cost. Loads. Cost. Loads. Cost. 1900 £ s. d. £ s. d. £ s. d. January 2357 660 11 2 2894 735 11 2 5451 1395 2 4 February 2339 604 4 10 2767 703 5 7 5106 1307 10 5 March 2248 580 14 3 2634 669 9 6 4882 1250 4 2 April 2488 642 14 8 2782 707 1 10 5270 1349 16 6 May 2493 644 0 6 21826 718 5 6 5319 1362 6 0 June 2343 605 5 6 2634 669 9 6 4977 1274 15 0 July 2401 620 5 2 2694 684 14 6 5095 1304 19 8 August 2282 589 10 4 2752 699 9 4 5034 1288 19 8 September 2146 554 7 8 2580 655 15 0 4726 1210 2 8 October 2284 590 0 8 2748 698 9 0 5032 1288 9 8 November 2333 6C2 13 10 2794 710 2 10 5127 1312 16 8 December 2370 612 5 0 2775 705 6 3 5145 1317 11 3 28284 £7306 14 0 32880 £8357 0 0 61164 £15663 14 0 Less Fines £13 0 0 Totals 28284 £7293 14 0 32880 £8357 0 0 61164 £15663 14 0 Dustmen's Wages £2,916 1 4 Sanitary Labour £961 12 4 Prices per load .. Northern Division, 5s. 2d. Southern Divison, 5s. 1d. 45 Table XII. Dust refusals and no answers for the year 1900. Week ending Refusals. No Answers. Week ending Refusals. No Answers January tith 8,613 1,698 July 14th 7,876 1,712 13th 9,843 1.514 ,, 21st 9,289 1,518 20th 9,716 1,723 28th 8,926 1,627 27th 8,695 1,817 August 4th 9.715 1,701 February 3rd 9,583 1,678 „ 11th 9,846 1,641 10th 10,614 1,826 ,, 18th 8,873 1,619 17th 9,871 1,564 25th 9,765 1,722 „ 24th 9,618 1,672 Sept. 1st .. 9,847 1,569 March 3rd 8,743 1.921 8th 9,581 1,493 „ 10th 8,471 1,811 15th 8,963 1,682 „ 17th 9,357 1,649 „ 22nd 9.372 1,608 24th 8,519 1,763 29th 9,586 1,735 31st 9,687 1,946 October 6th 9,768 1,487 April 7th 9,318 1,712 13th 9,413 1.572 14th 8.914 1,628 20th 8,972 1,590 „ 21st 9,187 1,473 „ 27th 9,814 1,614 28th 8,359 1,693 Nov. 3rd 9,911 1,534 May 5th 9.872 1,765 10th 8,976 1,612 12th 8,410 1,514 17th 8,215 1,517 „ 19th 8,653 1,569 24th 8,761 1,619 26th 8,115 1,618 Dec. 1st 7,814 1,472 June 2nd 8,642 1,376 „ 8th 9,843 1,537 „ 9th 9,213 1,218 15th 8,762 1,125 16th 3,428 1,615 ,, 22nd 9,181 1,364 23rd 8,735 1,427 29th 9,374 1,731 „ 30th 9,681 1,563 July 7th 9,430 1,647 Total 560,242 83,601 THE REMOVAL OF HOUSE REFUSE FROM TENEMENT DWELLINGS OR FLATS. During the last few years a gradual change has been creeping over the social life of Londoners. The "home" occupied by one family has given place to the "flat," a unit of a group of families as closely lodged together as the ingenuity of architect and builder can bring them. The closer aggregation of these families demands therefore more vigilance in keeping their surroundings free from harmful influences ; but the structural arrangement of the block has introduced certain difficulties in safe-guarding their health. 46 The particular difficulty I have met with in Hackney is connected with the disposal of the house refuse in connection with these buildings. The blocks of flats in the district contain from two to five floors. The arrangements for the deposit of the house refuse until removed by the local authority differ. (a) In a few blocks portable dust-bins are provided for each tenement to hold the week's refuse which is kept either on the landing near the door of the tenement or inside the scullery. (b) In others a shoot is formed in the walls of the blocks, with doors opening into the passages at the level of each floor, to receive the house refuse from the tenements at that level. At the foot of the shoot is a chamber near the doors of the tenements on the ground floor. Into this the refuse falls and remains until removed by the local dustmen. (c) Another arrangement, worse than the last, is somewhat similar with the exception that the opening to the shoot is in each kitchen. In some the openings are closed by a simple wooden shutter sliding in grooves, in others an iron drum, one-third of which is open, is arranged horizontally, and is worked by a lever. When the lever is depressed the drum is ready to receive the refuse, and by elevating the lever the drum revolves, throws the dust into the shoot, and is then supposed to cut off all effluvia from the shoot; but as a matter of fact on testing it is found they are not air-tight, and it can easily be demonstrated in all that the shoot ventilates into the living room. The common chamber or dust-bin to each shoot is usually in these cases at the rear of the block, where it is emptied once a week. It is obvious that neither of these arrangements is satisfactory. In the first case, the presence of foul smelling dust-bins close to the doors of living rooms and in passages alive with children is clearly bad. The same remark applies to the arrangement of shoots with doors opening on the landing. Practically the shoots are ventilated into the passages, and this is especially the fact when the chamber receiv- 47 ing the dust from the shoot is at the foot of the staircase. It is almost unnecessary to state that these chambers are very offensive at times. But the most objectionable are those shoots with shutters or other openings into the living rooms. The tenants complain that an evil smell proceeds from them even when closed; that dust is forced into the room when the shoot is used by tenants on an upper floor; that when used by themselves the dust is blown back into the room, and it is consequently extremely difficult to keep the room clean. It would not have been difficult when these blocks were designed to have devised some means by which these difficulties could have been avoided, but now it would involve much labour and expense to make any satisfactory alterations. It is an axiom of sanitation that house refuse should be removed from the neighbourhood of occupied dwellings at the earliest possible date, and if this is true of the house with its attached open space or garden, how much more so is it true of a block accommodating some of them several hundreds of persons? It is contrary to all sound principles of sanitation that garbage should be kept at the doors or under the stairs of occupied houses, or that dust shoots should ventilate into the passages or living rooms of the same. Even if a daily collection were established it would not remove the objections to the above. The shoots must be abandoned, but our difficulty is to find a place free from objection for the portable bin. It must either be kept in one of the rooms of the tenement itself, or on the staircase or outside at the back of the block. The last is so inconvenient to tenants that they will not adopt it, and of the two former expedients it is difficult to say which is the less objectionable. My object in discussing this is to show how easily such difficulties could be avoided if architects were to give a little of the thought expended on decorations to the convenience and sanitation of dwellings. I am also not without hope that the London County Council will endeavour to obtain such alterations in the Building Acts as will effectually remedy the above condition of things. 48 MILK AND SORE THROAT DISEASE. During the early part of the year 1900 an outbreak of septic sore throat disease occurred in the district of Hackney, which upon investigation I could only ascribe to the malevolent qualities of a special milk supply. The full report is given in the appendix. The experience derived from this and a previous epidemic, where a milk supply was implicated in the spread of infectious disease, convinces me that very little progress will be made in the elucidation of the relationship of milk to epidemic disease, until the local dealers are compelled to supply to the local authorities a correct list of the dealers and farmers from whom their milk is obtained, so as to enable the Medical Officer of Health to proceed, immediately any milk supply is suspected of spreading disease, to the source of the milk. If Medical Officers of Health had this information, suspicious milk supplies could be stopped at a much earlier date than at present; samples of the suspected milk could also be taken and examined while the infecting agent was still present in the milk, and thus probably lead to the discovery of the pathogenic organism causing the disease. THE MORTUARY. The following tables give the number of bodies deposited in the mortuary during the year, also the number of inquests held there, with the causes of deaths etc. Number of bodies deposited in mortuary 414 (a) To await inquests 396 (b) Upon request of relatives, to await burial 18 Number of post-mortems made 141 49 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 129 107 Accidental Death 81 42 Suicide 13 4 Open Verdict 12 2 Manslaughter 2 Murder 1 Stillborn 2 I Totals 237 159 Table showing nature of above Suicidal and Accidental Deaths in the Hackney District during the Year ended 1899. SUICIDES. ACCIDENTAL DEATHS. nature of suicide. No. nature of accidental death. No. Poisoning 5 Fracture of Leg 2 Cut Throat 1 Poisoning 2 Drowning 7 Fall 34 Hanging 2 Suffocated 2 Strangulation 1 Shock from Burns 18 Fall from window 1 Shot 1 Drowning 6 Run over 7 Shock from Scalds 4 Fracture of Bibs 2 Pressure of Crowd 1 Fracture of Skull 15 Wound on Finger 1 Suffocated in Bed 25 Fracture of Spine 3 Total 17 Total 123 50 REGISTER OF SANITARY WORK, 1900. SANITARY DISTRICTS. Mr. Wood Stamford Hill Mr. Harvey, West Hackney Mr. Legg, Hackney Mr. Morley, Clapton Mr. Body, Kingsland. Mare Street and South Hackney. Mr. Babbitt, Homerton. E. Mr. Mansell, Homerton, N. Mr. Ellis, Homerton, S. Mr. White, Clapton, N.E. Mr. Sheppard, Special. Miss Tecbay, Special. Totals. Mr. High, Mr. Kemp Mr. Punter No. 1 No. 2 No.3 No. 4 No. 5 No. 6 No7. No. 8 No. 9 No. 10 No. 11 No. 12 Inspections— Made on Complaint 271 323 206 244 347 212 245 108 169 179 96 133 24 18 2635 Workshops 2 13 5 7 9 14 10 5 15 3 1 134 218 House to House 68 24 43 46 75 11 171 95 19 308 22 115 997 Houses after Infectious) Diseases 108 130 87 181 147 218 117 126 231 167 94 50 38 1694 Premises re-inspected 2057 2G50 2602 2681 2060 2706 2908 2652 2947 2911 2275 1762 3196 1906 36101 Fishmongers' and Poultorers' Yards 2 2 1 3 6 1 15 Slaughterhouses 9 16 11 36 Cow houses (Premises) ,, (Sheds) 8 2 2 24 30 66 Miscellaneous Inspections 327 96 159 200 100 7 10 181 20 26 24 12 1162 Greengrocers' Yards 2 5 2 11 6 3 3 32 Schools 1 2 3 4 1 11 Bakehouses 8 11 13 15 15 27 22 11 9 40 16 190 Uinals 6 13 17 3 30 27 44 12 11 18 1 2 184 Canal Boats 95 95 Animals improperly kept 6 6 3 4 6 10 35 Statutory Notices served 30 78 41 70 83 20 4 6 56 20 8 49 81 13 559 Intimation Notices served 240 353 236 304 223 310 252 323 295 298 407 159 132 236 3758 Peremptory or Final Notices served 50 21 25 33 20 51 105 44 40 100 10 30 44 475 Laundries 5 2 4 2 4 6 1 5 29 51 Outworkers Proceedings before Magistrate or Justices under the Public Health Acts 11 55 30 2 17 50 1 16 23 18 12 345 345 234 Nuisances abated 307 345 293 315 340 302 262 332 336 284 337 139 116 258 3966 Seized and Condemned as Unfit foe Human Food— Fish 1 cwt. 2 cwt. 2¼ cwt. 5 cwt. Fruit and Vegetables ¼ cwt. 1 stone 4 cwt. ½ cwt. ¼ cwt. ¾ cwt. ½ cwt. ¼ cwt. 2 cwt. 1¼ cwt. 1 stone 6¼ cwt. Meat ½ cwt. ¼ cwt. ¼ cwt. 3½ cwt. ¼ cwt. 21 cwt. 25¾ cwt. Tin Foods 450 120 570 Other Articles 2 cwt. 2 cwt. Open Spaces cleared 3 1 2 3 4 2 15 Special Reports to Medical Officer of Health 6 21 49 5 10 9 4 6 6 3 66 1 186 Food Adulteration— Samples collected for Analysis 54 48 40 47 54 50 50 58 48 53 48 50 600 Proceedings taken before Magistrates 4 8 7 5 4 10 4 15 8 6 6 8 85 52 REGISTER OF SANITARY WORK, 1900. Public Health Department. Letters, etc., sent out 4200 Circulars, Notices, etc. 10992 Committee Notices sent out 966 Copies of Summonses and Orders made out 1246 Houses from which Bedding, etc., was removed to be disinfected by the Vestry's apparatus 1269 Articles disinfected by the Vestry's apparatus— Beds 1138 Mattresses 569 Palliasses 20 Bolsters 847 Pillows 2241 Blankets 1768 Sheets 180 Carpets, Rugs, etc. 711 Quilts 469 Other Articles 2095 Rooms fumigated 1659 Houses cleansed after Infectious Diseases 529 Disinfectants supplied to the poor (bottles) 1182 Do. do. (bags) 7952 Infectious Patients removed to Hospital 1053 Cautionary Notices to Schools re Infectious Sickness 1512 Certificates of Disinfection issued to Schools, etc. 1477 Accumulations of Dust specially removed 147 Articles destroyed by request— Beds 21 Mattresses 10 Bolsters 3 Pillows 4 Palliasses 8 Cushions 13 Articles of Clothing 3 Miscellaneous 5 53 METEOROLOGY. The following table, for which I am indebted to Mr. Marriott, Secretary to the Royal Meteorological Society, is an abstract of the Climatological Observations made at St. Luke's, Old Street, E.C., for the year 1900. ABSTRACT OF CLIMATOLOGICAL OBSERVATIONS. 1900. Temperature. Relative Humidity. Amount of Cloud. Rain. Means. Extremes. Amount. No. of Days 9 a.m. Min. Max. Range Mean. Min. Max. JANUARY ˚ 411 ˚ 37.3 ˚ 45.5 ˚ 8.2 ˚ 41.4 ˚ 29.8 ˚ 53.4 % 87 8.9 in. 2.70 22 FEBRUARY 39.2 35.5 43.6 8.1 39.6 23.3 56.2 83 8.1 3.77 19 MARCH 40.0 35.6 45.2 9.6 40.4 28.3 56.2 78 7.3 .84 7 APRIL 49.4 42.0 56.5 14.5 49.2 30.8 75.0 73 5.7 .79 15 MAY 53.8 47.1 60.5 13.4 53.8 37.4 71.0 67 7.1 1.05 12 JUNE 61.6 53.8 69.0 15.2 61.4 47.1 86.2 70 7.3 1.94 12 JULY 68.8 59.9 76.8 16.9 68.4 49.3 90.9 61 4.9 1.37 5 AUGUST 63.4 56.4 69.7 13.3 63.0 51.3 81.2 68 6.3 2.47 16 SEPTEMB'R 60.4 52.9 67.7 14.8 60.3 47.2 78.7 72 4.9 .59 8 OCTOBER 52.9 46.7 57.9 11.2 52.3 39.0 73.1 79 4.4 1.62 16 NOVEMBER 47.2 43.7 50.9 7.2 47.3 32.4 60.8 86 8.0 1.63 17 DECEMBER 46.3 42.7 50.3 7.6 46.5 31.8 56.4 88 8.5 2.39 19 YEAR 52.0 46.1 57.8 11.7 52.0 23.3 90.9 76 6.8 21.16 168 I remain, Yours faithfully, J. KING WARRY, M.D., M.R.C.P., D.P.H., &c., Medical Officer of Health. Report of the Medical Officer of Health received, and ordered to be printed and circulated in the usual manner. WALTER HORNCASTLE, May, 1901. Mayor. 54 APPENDIX. PREVENTION OF INFANTILE OR SUMMER DIARRHŒA. Infantile Diarrhœa is a very serious and fatal form of illness occurring during the hot months of the year (July, August, September), and affecting chiefly infants under one year old. During the third quarter of the year 1899 there were 314 deaths from this cause in Hackney—250 being infants under one year old. The disease is more common in towns than in rural districts. Many circumstances, of which the following are the chief, favour its prevalence, most of these being preventable. Circumstances Favouring the Prevalence of Infantile Diarrhœa. (a) Heat and dryness of the atmosphere. Where a hot summer is combined with a small rainfall, summer diarrhoea is at its maximum. Whereas on the contrary a cool wet summer brings this disease to its lowest point. (b) Density of population and dwellings with over-crowding. These conditions either singly or combined are invariably found associated with a high diarrhœal death rate. (c) Darkness and dirtiness of dwellings. These are other ditions which promote a high mortality from summer diarrhoea. (d) Want of ventilation through and about the dwellings. The want of ventilation gives rise to a " fusty" smell, which is most unhealthy and is productive of an increase in summer diarrhœa. (e) Offensive smells, in or about the home, front decomposing organic matter, animal or vegetable (such as frequently arise from foul dust-bins, drains, w.c.'s, yards, &c.), favour the disease. 55 (f) Polluted drinking water. Diarrhœal disease has frequently been traced to this cause. (g) Stale or tainted food, especially meat, fish, fruit, and milk. Food stored in ill-ventilated cupboards, or exposed to foul smells, very soon decomposes; and if so taken, will undoubtedly cause diarrhceal disease. This is especially the case with milk, the staple diet of infants. These are, as above pointed out, the chief sufferers from this complai t. Heat, or dryness of the atmosphere alone, it is believed, will not cause summer diarrhoea; but a combination of these with one or more of the other conditions will undoubtedly bring about a prevalence of this diesase. From a consideration of the above conditions favourable to the spread of summer diarrhoea it will be readily seen what measures should be adopted in order to bring about a decrease in its prevalence. Measures to be Adopted to Prevent the Spraed of Infantile Diarrhœa. 1. Offensive smells, or any defects in the water-closets or drainage of the house should be at once reported to the Public Health Department. 2. House refuse must not be allowed to accumulate on the premises until it becomes a nuisance, but should be removed at frequent intervals. This will be done every week by the Vestry's dustmen, who are instructed to call once a week at every inhabited house in the parish, Any neglect to make the weekly visit should be at once reported to the Public Health Department. Householders should recognise their own responsibility in this matter by always allowing the dust to be removed when called for. If possible, all vegetable refuse should be burned providing it can be done without creating a nuisance. Dustbins ought to be kept clean and in thorough repair. 3. Where there is constant dampness of the soil near the dwelling, or of its walls, it should be reported to the Public Health Department. 56 4. Ventilation must be thoroughly attended to, and as much fresh air as possible allowed to circulate through the dwelling. Overcrowding must be avoided. 5. (a) All food should be stored in well-ventilated and lighted cupboards, away from any foul or offensive smells. Cupboards under stairs or in cellars should not be used for this purpose. (b) No tainted or stale food should be eaten. This especially applies to stale or unripe fruit, stale vegetables, fish or milk. All milk received on the premises should be boiled immediately. (c) Parents who artificially feed their infants on milk ought to see that it is quite fresh, and also give particular attention to the condition of the feeding bottles, cups, &c., used for this purpose. These should be scalded in every case before use. 6. Yards and fore courts should be kept thoroughly clean and free from deposits of offensive material. 7. All sinks, drains, and yard gullies should be well flushed with water daily. 8. Cisterns supplying drinking water ought to be frequently cleaned out, and where such cisterns supply water closets, the fact should be reported to the Public Health Department at the Town Hall. 9. Personal and domestic cleanliness must receive the first care. 10. Attention should also be paid to the general health, all excesses either of eating or drinking being avoided. By Order of the Public Health Committee, J. KING WARRY, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Hackney, N.E., July, 1900. 57 PREVENTION OP SMALL-POX. Small-pox is a very dangerous infectious fever. It attacks indiscriminately both sexes and all ages. The deaths in different epidemics have varied from 2 or 3 to 40 per 100 attacked. But the greatest mortality has been amongst unvaccinated persons. It has been recorded that out of 10,000 cases of small-pox received into the Homerton Fever Hospital, more than 43 out of every 100 unvaccinated persons died of the disease, but less than two out of every 100 thoroughly vaccinated persons. After the introduction of vaccination, small-pox greatly decreased in prevalence and mortality; but as the practice of vaccination has of late years declined in Hackney (probably from want of knowledge and carelessness), and as there are evidences of a revival of small-pox, it is thought desirable by means of this leaflet to call the attention of the Public to the measures which ought to be adopted, in order to prevent the spread of this loathsome disease. Small-pox is extremely infectious, the contagion residing in the matter and crusts of the eruption. It spreads by contact with persons suffering from the disease, from infected clothing, etc., and even by persons who, although free from it themselves, have been in contact with some one suffering from the disease. The infection is also believed to be conveyed through the air from centres where cases of small-pox are treated, such as small-pox hospitals. Sym???toms.—The symptoms of this disease begin to appear about twelve days after the contagion has entered the body. The patient becomes feverish, with severe headache, and generally has a pain across the loins, with vomiting. These symptoms continue for some days. On the third day of the illness, the peculiar rash of small-pox makes its appearance, usually first and more profusely on he face, and a few hours later on the trunk and the arms. The rash consists at first of a number of reddish pimples, which gradually enlarge and change into small bladders or vesicles, about the size of a split pea. At first the contents are watery, but, later on, gradually change to matter. A peculiar feature of the vesicles is that they mostly have 58 a depression in their centre, but this disappears as the rash gets older Each vesicle is also usually surrounded by an inflamed border. About the eighth or ninth day of the illness the vesicles begin to dry up, and are converted into scabs, which fall off about the sixteenth day of the illness, leaving in most cases a series of pock marks on different parts of the body. The patient is infectious from the beginning of the illness until all scabs have disappeared from the body. Measures to be Adopted in Order to Prevent the Spread of Small-pox. Vaccination.—This is a means of the first importance, both during and between epidemic periods. The value of it may be measured from the following quotations from the report of the Royal Commission on small-pox. The Commissioners report:— (1) That it (Vaccination) diminishes the liability to be attacked by the disease. (2) That it modifies the character of the disease and renders it (a) less fatal, and (b) of a milder and less severe type. Every child should be vaccinated not later than six months after birth, if its health permits; and in order to obtain a continuance of the protection afforded by this operation should be revaccinated about the age of 11 or 12 years The degree of protection may be estimated from the character of the vaccination marks. On this point the Royal Commissioners report: ''We think it may fairly be concluded that where the vaccine matter is inserted in three or four places, it is more effectual than when introduced into one or two places only—and that if the vaccination marks are of an area of half a square inch, they indicate a better state of protection than if their area be at all considerably below this." During the Prevalence of Small-pox:— (1) Immediately a person is suspected to be suffering from smallpox he should be strictly isolated until medical opinion has decided the nature of the complaint. 59 (2) Every case decided to be small-pox should be removed to the Small Pox Hospital. This will be done on application to the Public Health Department, Town Hall. (3) All persons who have been exposed to infection should, as far as possible, be kept from associating with other persons for at least 14 days after the last exposure. (4) Children residing in a house from which a case of small-pox has been removed to hospital should be kept home from school and from associating with other children for the same period. (5) After the removal of a case of small-pox to hospital, the rooms occupied by the patient, with all clothes, bedding, furniture, &c., should be thoroughly disinfected, and the walls of the room stripped and cleansed. This will be done by the Public Health Department on application being made. (6) Every person in a house in which a case of small-pox occurs (except those who have been vaccinated recently) should be immediately re-vaccinated. (7) Immediately any suspicious symptom shows itself in any person who has been exposed to infection, a medical practitioner should be consulted in order to ascertain the nature of the illness, with a view to its early removal should the case be found to be small-pox. This is very important, because small-pox patients are not so infectious before the rash becomes pustular, as during the development of the vesicles and scabbing; so that if a case is removed directly the symptoms point to small-pox, there is less likelihood of the disease spreading in that house. Note.—Everyone is entitled to be vaccinated at home by the Public Vaccinator free of expense. By order of the Public Health Committee, J. KING WARRY, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Hackney, N.E. April, 1900. 60 REPORT ON A RECENT OUTBREAK OF SEPTIC SORETHROAT DISEASE APPARENTLY CAUSED BY INFECTED MILK. To the Chairman and Members of the Public Health Committee. Gentlemen, I beg to report that my attention was called, on the 26th of April, by a medical practitioner of North Hackney, to the prevalence of sore-throat disease of a septic character in his practice, which appeared to be associated with a particular milk supply. In order to ascertain the proportions of this outbreak, and whether the association with milk supply was general, I immediately sent a circular letter to each medical practitioner in Hackney asking whether (a) he had recently met in his practice with any cases of sore-throat illness, acccompanied by much enlargement of the glands of the neck and considerable weakness, and, if so, whether (b) the milk supply to the patients was from a common source. At the same time I visited the dairy supplying the suspected milk, and there ascertained that nearly all the milk supplied by this dairy was obtained from seven different country dealers. In addition a few cows were kept by the dairyman. I took samples of the country milk and sent them for examination to the director of the Jenner Institute. The dairyman's cows were subsequently examined by a veterinary surgeon, who found them to be in good health. For the purposes of this report I shall in future refer to this milk supply under the symbol X. In addition to these investigations I instructed several of the Sanitary Inspectors to make a house-to-house enquiry in certain areas where I thought the suspected milk was supplied. Before giving in detail the result of these investigations I have to state that both from the replies to my circular and by personal enquiries amongst the medical practitioners of the district, I ascertained that there was a prevalence of sore-throat illness of a 61 septic character, confined principally to North Hackney. As near as I could ascertain, the disease was prevalent during nearly the whole of April, and the first week in May. The following analysis of the symptoms met with in 10 cases occurring in the practice of Dr. H. S. Powell, of Upper Clapton, to whom I am indebted for the same, clearly shows the exceptional character and course of the affection. Symptoms.—(a) In every case there was tonsilitis (not follicular). (b) In two cases there was as well superficial ulceration of the tonsil. (c) In every case there was considerable swelling of the cervical lymphatic glands, more marked on the one side than the other—in two cases the swelling was very great. (d) In one case the lymphadenitis proceeded to suppuration. (e) In every case the temperature was raised, in a few cases it was 105° F., and there were rigors. In all the cases the ten perature persisted after the tonsilitis had disappeared, lasting in nearly all for at least a fortnight. (f) The temperature assumed the remittent type, and there was in every case profuse sweating at nights. (g) There was great prostration in most cases, and considerable cachexia in all. (h) In one case acute septicaemia supervened, followed by acute septic pneumonia and death. (i) In two cases in the same family, acute nephritis with haematuria came on about a week after the onset of symptoms. (j) In one case the child had an attack of purpura haemorrhagica. (k) In all cases convalescence was protracted. In addition to the above there was a marked tendency for multiple cases to occur in families, also while no age or sex was exempt, a very large number of the sufferers were children; these features helped to direct suspicion to the milk. During my enquiries I learned that in some of the families where sore throat existed the milk supplied to the household was boiled before use. I was informed by the medical attendants that generally, where this had taken place, the sore throat disease had been of a milder form. Of course, the degree of sterilization of milk which is sought for by boiling, depends both upon the temperature to which 62 the milk is raised, and the time during which it is exposed to the high temperature. On this subject I cannot do better than quote the following extract from a paper contributed by Dr. Macfadyen to the Transactions of the British Institute of Public Health, which sums up our present knowledge with regard to the sterilization of milk:— "Whilst the Pasteurising process weeds out the non-sporing lactic bacteria from milk, a temperature of 100° c. for one hour is necessary to destroy the butyric acid organisms, and even when this has been accomplished the milk cannot be called sterile. There still remain the spores of organisms belonging to the group of the hay bacilli which are able to resist a temperature of 100° c. for three to six hours. A sterilization of milk to be absolute would consequently require six hours heating at boiling point, or at an exposure for a shorter period to steam under pressure by means of the autoclave. These very resistant forms produce little visible change in the milk, but its taste becomes bitter and pungent. Certain members of this group have marked toxic properties, causing fatal diarrhoea in young dogs and cats. It is well known, domestic sterilization of milk is very unreliable, the temperature not often being raked to the boiling point, and the period of exposure to this being very variable. Under these circumstances, domestic boiling of milk, while useful, cannot be regarded as an absolute safeguard against the transmission of disease by this means. I have now to give in detail the result of my investigations under the following heads:— 1. Bacteriological examination of milk samples. 2. Replies of Medical Practitioners to circular letter. 3. House-to-house enquiry in special areas. 1. The following is the report of the director of the Jenner Institute, to whom the suspected milk samples were submitted for examination. 63 Jenner Institute of Preventive Medicine. Chelsea Gardens, Grosvenor Road, S.W., May 11th, 1900. Dr. J. King Warry, Town Hall, Hackney. Dear Sir, I beg to inform you that we have now completed the examination of the nine samples of milk (labelled 1-7 and S x x x x 1 and 2) which you forwarded to this Institute on 26th and 28th April for bacteriological examination in connexion with an epidemic of sore throat in your district. I have to report that we have been unable to obtain any definite results from our examination of the milks. In the single case in which we had an opportunity of examining the membrane from the throat (marked X) micrococci only were isolated I may point out that a diagnosis is most difficult in dealing with such cases, as unfortunately, we still know so little regarding the morbid agents to which such outbreaks are undoubtedly due, and which may readily find access to the body through food channels. We have a parallel instance in the case of scarlet fever, the dissemination of which has at times been traced back to a tainted milk supply by strong circumstantial evidence, although the living agent of the disease is still unknown. Regretting that we have been unable to throw light on the matter, I am, Dear Sir, Yours truly, (Signed) ALLAN MACFADYEN, Director. This report does not require much comment. It does not help in the elucidation of the enquiry. It proves nothing; it disproves nothing: and further, our want of knowledge as to the active agent of septic sore throat disease, the small amount of milk operated upon, the method of taking the sample, the probability that the infective agent has ceased to be in the milk at the time the samples were taken, are all factors which may prevent a positive result; and it has for some time past been acknowledged upon substantial evidence that milk has been the means of conveying the organisms of the specific infectious fevers, e.g., scarlet fever, typhoid fever, and tuberculosis, 64 owing to its being an admirable nutrient medium for micro-organisms; there is. therefore, no improbability in assuming that organisms capable of causing a septic form of sore-throat, and as yet not isolated, may similarly find in it a suitable medium for growth and activity. 2. To my circular letter I received 67 replies, which may be classified under the following heads:— (a) Replies where cases such as described had occurred in the writers' practices and giving the source of the milk supply. Of these I received 19. (b) Replies where no cases such as described had occurred in the writers' practices. Of these I received 43. (c) Indefinite replies. Too ambiguous to be classified under either of above heads. Of these I received 5. The five replies under (c) need no comment, and with respect to the 43 replies under (b) I have to remark that they all came from medical practitioners with only one or two exceptions practising in the southern half of Hackney—roughly, south of a line beginning at the junction of the Farleigh Road with Stoke Newington Road on the west, and continued along the Downs Roads and the Millfields Road to the Eastern boundary of the parish. As the practice of medical men is generally in their immediate neighbourhood, the legitimate inference from these 43 replies is that the disease was not prevalent to any appreciable extent south of the line described. The 19 replies under (a) give account of no less than 151 cases of sore throat illness in 88 households, all occurring, with very few exceptions, in Upper Clapton and Stamford Hill. Of these totals, 138 cases occurred in 75 households, all of which were supplied with milk by X, the remaining 13 cases occurring in 13 households supplied with milk by seven other dealers. That is to say, over 85 per cent. of the households in which sore throat illness occurred were supplied with milk by X, and less than 15 per cent. by other dealers. One or two remarkable instances have occurred in distant parts of the parish, in households supplied by X but where his milk was not expected to be supplied. 65 The above replies alone when analysed showed that sore throat illness had occurred amongst the customers of X in undue proportions compared with other vendors, and can only be attributed to some infective properties in the milk supplied, except upon the hypothesis that X supplied 85 per cent. of the households in the area from which these replies were received; but this I shall show later on is a very much higher percentage of households than that actually supplied by X. Before proceeding with the next head of my enquiry, I have to state my desire not to exaggerate the incident of sore throat illness amongst X's customers. I applied to him for a list of them, or what would have sufficed, the total houses supplied by him in certain streets; at the same time I asked for the addresses of the vendors supplying him with milk, but to these requests X informed me verbally, that he had consulted others in the milk trade and had been advised not to give me any more information as to his business, than he was legally compelled to give. The information I asked for he was not legally compelled to give, but I regret he did not see his way to assist me. 3. House to house enquiries in special areas. In making enquiries under this head, I had to take all forms of sore throat illness into account, including what is generally known as mumps, and the last was important because several medical practitioners stated that in some respects the special throat illness resembled mumps. This part of my enquiry I divide into two—(1) Area "A." (2) Area "B." The particular streets in these areas which I chose for my enquiries were such as I thought would give reliable results. Method.—Enquiry was made by an Inspector from house to house in each of these localities as to (a) whether there was or had been recently any illness in the house; (b) the character of the illness; (c) the prevalence or not of foul odours: and (d) the milk supply of the families. Where answers were obtained, certain corrections had to 66 be made. For instance, I excluded in my number the households where condensed milk only was used, also those where two vendors supplied one family. It is obvious that the inclusion of either of these would be liable to give unreliable results. The following are the results of enquiry in (1) AREA "A." Streets and Number of Houses visited. Number of Houses supplied with Milk by X. Number of Houses supplied with Milk by other vendors. Percentage Households affected with Sore Throat, Streets. Number of Houses. Number supplied. Number of Sore Throat Households. Number supplied. N umber of Sore Throat Households Amongst X Households. Amongst other Households. Dunsmure Road 61 11 4 50 1 36.3 2.0 Glaserton Road 25 4 — 21 1 0.0 4.8 Wilderton Road 22 2 1 20 50.0 0.0 Linthorpe Road 60 7 2 53 1 28.5 1.9 Totals 168 24 7 144 3 29.1 2.0 (2) AREA "B." Streets and Number of Houses visited. Number of Houses supplied with Milk by X. Number of Houses supplied with Milk by other Vendors. Percentage Households affected with Sore Throat. Streets. Number of Houses. Number supplied Number of Sore Throat Households. Number supplied. Number of Sore Throat Households. Amongst X Households. Amongst other Households. Landfield Street 25 15 3 10 — 20.0 0.0 Millington Street 17 30 1 4 — 7.6 0.0 Ottoway Street 20 10 2 10 — 20.0 0.0 Stellman Street 13 4 — 9 — 0.0 0.0 Totals 75 42 6 33 — 14.2 0.0 In the first place, I must remark that these tables show a very heavy incidence of sore throat illness in the households supplied by 67 Mr. X., and it may look heavier than it really deserves, for the reason that possibly prior to and during my enquiries certain households changed their milk supply, and the name given to the Inspector would be the one then supplying the house. While this may apply to some extent to area "A," I do not think it applies to area "B." The enquiries were made here before those in the other locality, and the occupants of the houses were of a class not to readily take alarm, or to recognise the ability of milk to cause illness. But making every allowance, these tables show an undue incidence of throat illness upon the customers of X over the customers of other dealers. Table "A" shows in the first place that the percentage of households supplied by X in that area falls very far short of 85 per cent. of the total, being a little over 14 per cent., and even if allowance is made for considerable losses of customers the incidence of disease would be out of all proportion to his supplies. Further, area "A" shows that while the incidence of throat illness is 29 per cent: amongst X's customers, it is only 2 per cent. amongst all the remaining dealers. In area " B " the respective percentages of throat illness are X's 14.2, others 0.0. The percentages of sore-throat illness in these tables are calculated on the basis of the total number of households supplied by X, and other Vendors in special areas ; and these percentages show that in the two areas selected, and they may, I think, be taken as fairly representative, sore-throat disease has fallen with special severity on X's customers. Viewing the whole of the evidence at my disposal, I am forced to the conclusion that X's common supply, and the presence of sore-throat disease of a septic kind are related together in the way of cause and effect. Conclusions.—From a consideration of the whole of the circumstances, I arrive at the following conclusions:— (i) That sore throat disease of a septic character has recently existed almost exclusively in the northern part of Hackney. 68 (2) That this disease differed greatly from ordinary catarrhal sore throat or follicular tonsilitis, being of a septic character, and suggestive of being caused by some article of diet. (3) That nearly all the cases of sore throat in question brought to my knowledge bad occurred in the households supplied by a particular milk vendor. (4) That this milk supply was "X's." (5) The inference I draw from the above conclusions is that in some way the milk supplied by "X" was the cause of the septic sore throat disease. How milk could obtain septic properties I am unable to offer any suggestion, but those familiar with dairy operations in country districts are well aware how easily milk might be infected with septic matter before consignment to London. During the progress of my enquiries, I found here and there some doubt had been expressed as to milk being the cause of the throat illness, and a tendency to attribute it to other causes. The following have been advanced against the infected milk explanation:— (1) It has been stated that sore throat illness prevails all over London, and, therefore it cannot be due to an infected milk supply. In reply to this, I have to state, that my enquiries prove, that the special form of disease under enquiry did not even extend over the whole of Hackney, but was confined to its Northern portion, and I have failed to get any proof of the statement that it prevails in any other part of London. (2) It has been suggested the disease was due to influenza. From those medical practitioners who have had the most cases to treat, I am informed that the disease bears noresemblance to influenza, or any of its complications. 69 (3) The suggestion has been made that sewage effluvia has been the cause of the disease; that North Hackney being on higher ground, the sewers in that part of Hackney are more liable to do harm than those on lower ground. There is not a tittle of evidence available in support of this view. The Walthamstow sewage farm has been requisitioned as a cause of the disease, but there is no evidence that persons suffered more in those parts of Hackney nearer Walthamstow than those at a greater distance. The Walthamstow sewage farm may have a great deal to answer for, but, amongst its misdeeds, the throat disease of North Hackney cannot be counted. It has also been hinted that defective house drainage has been the cause; but I have had an examination made of the drains of each house where I have found throat illness existed, and after excluding those houses with defects from my calculations, I find practically the same heavy incidence of throat illness on X's customers, as compared with those of other dealers. But all of these alternative suggestions ignore the fact that the disease is mostly confined to the customers of one dairyman, and unless something were supplied by that individual, with the quality of producing disease, the idea of disease selecting for its operation the customers of one man, to the exclusion of others, is absurd. I have to tender my best thanks to all those practitioners who kindly replied to my circular letter, and especially to those of Upper Clapton and Stamford Hill, without whose co-operation it would have been impossible for me to have satisfactorily investigated this outbreak. I remain, Gentlemen, Yours faithfully, J. KING-WARRY, M.D., M.R.C.P, &c., Medical Officer of Health. Town Hall, Hackney, June 7th, 1900. 70 REPORT OP INSPECTOR OF WORKSHOPS, LAUNDRIES &c., FOR THE YEAR 1900. To the Public Health Committee, Hackney Borough Council. Gentlemen, I have the honour to present to you my annual report for the year ended 31st December, 1900. Workshops and Laundries.—At the end of 1900 we had on the register 890 workshops (including laundries which number 164) containing 1,281 workrooms. These numbers are slightly smaller than at the end of 1899, owing I think to two causes. 1st—The situation of several workshops in streets surrendered to other Local Authorities in November last, in consequence of the readjustment of the boundries of the parish; and as far as I have been able to ascertain at present, the number surrendered was in excess of the number of workshops coming under our jurisdiction from the same cause. 2nd.—The fact that I have devoted one day a week to the inspection of premises occupied by outworkers, and have therefore had less time to bestow upon the finding out and visiting of workshops not already under inspection to take the place of those that in the usual course of events have to be crossed off the register as unoccupied. During the year I have paid 139 first visits to workshops and laundries, and 1,906 visits of re-inspection. In only one case have I been refused admission to a workshop. I reported the matter to the Medical Officer of Health, who at once wrote to the occupier of the workshop, so that when I called a second time I was permitted to inspect the premises without obstruction. I found nuisances existing on 426 premises—306 of these nuisances I dealt with myself, and can report the abatement of 258; the remaining 120 were handed over by the Medical Officer to the district Sanitary Inspector to deal with, as 71 their abatement involved structural alterations or repairs. In 18 instances visits to workshops and laundries were prompted by complaints to the Public Health Department, laid generally either by H.M. Inspector of Factories or some anonymous person. We have notified to the Home Office Authorities the existence of 46 workshops subject to the regulations of the Factory and Workshops Acts, as well as to those of the Public Health (London) Act, which had not previously been visited by any inspector. Workroom cards showing the number of persons permitted in each room have been distributed to 220 workrooms. Outworkers.—I began the systematic inspection of outworkers' premises in March, 1900. Lists of names and addresses of persons employed as such are required from the occupiers of factories and workshops who employ them, as also from occupiers of places from which any work of making wearing apparel is given out. I have registered all outworkers resident in this Borough whose names have been acquired since March, and have now 630 on the register. Of these 345 have been visited. In two cases upon my first visit, I was refused admission by outworkers to their houses, but was admitted a short time subsequently upon calling a second time, With the above figures to go upon, and after a nine months' trial, I have come to the conclusion that with the large number of workshops to be supervised' half the number of outworkers premises registered is as large a proportion as I shall be able to inspect. I found nuisances existing on 113 premises occupied by outworkers. All these nuisances were handed over by the Medical Officer to the Sanitary Inspectors of the different districts to be dealt with. Copies of a notice drafted by the Medical Officer have been sent to all employers of outworkers. This notice draws attention to those sections of the Factory and Workshop Acts, 1891 and 1895, which prescribe the duties of occupiers of factories and workshops, and of any places from which any work of making wearing apparel for sale is given out, as to the keeping of lists of persons employed by them outside the factory, workshop, or place, if so required by the Secretary of State by an Order made in 72 ance with Section 65 of the principal Act, and also to the fact that every such list shall be open to inspection by any Inspector under the principal Act, or by any officer of a Sanitary Authority. A larger number of names of outworkers living in this district, but working for employers in other parts have been forwarded to us by various Local Authorities this year. Of any work being now done in the inspection of outworkers premises we may, I think, justJy consider ourselves the pioneers, for until Hackney led the way, I cannot learn that any initiative was taken in the matter. By desire of the Medical Officer I drew up a Special Report re Outworkers in July last. Including inspections of 12 W.C.'s connected with the Ladies' Waiting Rooms at various railway stations in the district, the total number of visits paid by me in the discharge of my duties during 1900 was 2,402. I am, Gentlemen, Your obedient Servant, ALICE TEEBAY. 73 REPORT OF CANAL BOATS INSPECTOR. To the Council of the Metropolitan Borough of Hackney. Gentlemen,—I beg to submit my Report upon the Canal Boats inspected under the Canal Boats Acts and Regulations, 1877 and 1884, from 1st January to December 31st, 1900, viz.:— Number of Boats inspected 93 „ „ re-inspected 2 — 95 „ „ conforming to Acts and Regulations 85 „ „ infringing Acts and Regulations 8 Certificates examined 88 Boats examined, certificates not seen (captain absent) 5 Adults. Children. Number of persons registered for 287 3 „ „ living on boats so registered 157 3 Males 153 Females 4 Children 3 Number of Notices issued 8 „ „ complied with 4 „ „ outstanding 4 Legal proceedings taken 0 Details showing number of Infringements of Acts, etc. Certificate did not identify owner 3 Without requisite double bulkhead 0 Refusal of admittance 0 No proper water vessel 0 Removal of bilge water 0 Dilapidation 0 Ventilation 1 Cleanliness 0 Marking 2 Registration 0 Absence of certificate 3 Overcrowding 0 Separatioa of sexes 0 Infectious diseases 0 Painting of Cabin 6 I beg to remain, Gentlemen, Your obedient Servant, GEORGE WHITE, Sanitary Inspector and Inspector under the Canal Boats Acts. Town Hall, Hackney, N.E., 2nd January, 1901. 74 Table. Prosecutions under the Food and Drugs Acts and Margarine Acts during the year 1900. No. of Sample. Article. Adulteration or Offence. Result of Legal Proc edings. Fined. Costs. Remarks. £ s. d. £ s. d. 5 Butter 14% foreign fat Fined 1 0 0 12 6 8 Milk 6% added water Fined 5 0 Towards costs 11 Milk 6% added water Fined 5 0 Towards costs 16 Milk 16% added water Fined 1 0 0 12 6 44 Milk 7% added water Fined 2 6 12 6 45 Milk 8% added water Fined 5 0 12 6 68 Butter 80% foreign fat Fined 2 0 0 12 6 73 Butter 90% foreign fat Dismissed, wrong person summoned 83 Butter 8% foreign fat Fined 10 0 12 6 88 Butter 88% foreign fat Fined 2 0 0 12 6 95 Milk 10% added water Fined 2 0 0 12 6 101 Milk 7% added water Fined 10 0 12 6 106 Milk 11% added water Fined 1 0 0 12 6 114 Butter 91% foreign fat Fined 5 0 0 12 6 75 Butter 84% foreign fat Fined 1 0 0 12 6 121 Cocoa 70% added starch and sugar Fined 1 0 12 6 132 Butter 94% foreign fat Fined 2 10 0 12 6 133 Butter 95% foreign fat Fined 5 0 12 6 136 Milk 15% added water Fined 1 0 0 12 6 138 Milk 7% added water Fined 10 9 12 6 140 Milk 8% added water Dismissed 154 Milk 78% added water Fined 10 0 12 6 166 Milk 65% fat abstracted Fined 2 0 0 12 6 168 Milk 59% foreign fat Fined 1 0 0 12 6 75 No. of Sample. Article. Adulteration or Offence. Result of Legal Proeeetlings. Fined. Costs. Remarks. £ s. d. £ s. d. 174 Butter 45% foreign fat Fined 3 0 0 0 12 6 186 Milk 18% added water Fined 2 0 0 0 12 6 193 Milk 8% added water Fined 0 15 0 0 12 6 207 Sweet Spirits of Nitre 77% deficient of its active principle, ethyl nitrite Fined 0 5 0 0 12 6 211 Sweet Spirits of Nitre 34% deficient of its active principle, ethyl nitrite Fined 0 12 6 216 Butter 91% foreign fat Fined 0 7 6 0 12 6 225 Butter 8??? % foreign fat Fined 5 0 0 0 12 6 233 Butter 14% foreign fat Fined 1 0 0 0 12 6 236 Malt Vinegar Acid obtained from wood Fined 0 10 0 0 12 6 298 Malt Vinegar Acid obtained from wood Withdrawn 0 10 6 245 Coffee 70% Chicory Fined 2 0 0 0 12 6 246 Cocoa 68% added starch & sugar Fined 2 0 0 0 12 6 261 Milk 20% devoid of fat Dismissed, warranty proved 273 Malt Vinegar Acid from wood Fined 0 2 6 0 12 6 302 Butter 94% foreign fat Fined 3 0 0 0 12 6 310 Butter 92% foreign fat Fined 6 0 0 0 12 6 311 Butter 71% foreign fat Fined 0 2 6 0 12 6 313 Butter 92% foreign fat Fined 1 10 0 0 12 6 319 Milk 12% fat abstracted Dismissed i 35 Camphorated oil 63% deficient of camphor Adjourned sine die 336 Camphor ated oil 38% deficient of camphor Adjourned sine die 76 No. of Sample. Article. Adulteration or Offence. Result of Leffal Proceedings. Fined. Costs. Remarks. £ s. d. £ s. d. 337 Camphorated oil 8% deficient of camphor Adiourned sine die 341 Camphorated oil 24% deficient of camphor Fined l 0 0 343 Milk 11% added water Fined l 0 0 12 6 345 Milk 12% added water Fined 10 0 12 6 346 Milk 16% added water Fined 15 0 12 6 347 Milk 10% added water Fined 10 0 12 6 359 Milk 16% fat abstracted Dismissed 360 Milk 25% added water Fined 6 0 0 362 Milk 10% added water Fined 1 0 0 366 Milk 8% added water Withdrawn warranty proved 369 Coffee 60% Chicory Fined 2 0 0 12 6 371 Coffee 70% chicory Fined 2 0 0 12 6 375 Butter 44% foreign fat Fined 1 0 0 1 1 0 376 Butter 87% foreign fat Fined 1 0 0 1 1 0 377 Butter 10% foreign fat Fined 10 0 12 6 395 Milk 8% added water Fined 10 0 12 6 395 Milk 10% added water Fined 1 0 0 12 6 406 No name on barrow Fined 1 0 0 391 Milk 7% added water Dismissed warranty proved 414 Butter 73% foreign fat Fined 5 0 0 424 Butter 8% foreign fat Withdrawn on payment of costs 12 6 413 Butter 95% foreign fat Fined 10 0 0 409 Butter 93% foreign fat Fined 2 0 0 77 No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fined. Costs. Remarks. 431 Milk 12% devoid of fat Dismissed £ s. d. £ s. d. 449 Milk 27% devoid of fat Withdrawn on payment of costs l 13 6 445 Butter 42% foreign fat Fined 5 0 0 12 6 463 Butter 92% foreign fat Dismissed £l 1 0 costs agnst. Council 464 Butter 100% foreign fat Fined 10 0 12 6 472 Milk 7% added water Fined 5 0 12 6 478 Butter 12% foreign fat Fined 5 0 12 6 482 Butter 27% foreign fat Fined 1 0 0 12 6 490 Butter 75% foreign fat Fined 2 0 0 12 6 492 Butter 8% foreign fat Withdrawn 495 Butter 29% foreign fat Dismissed £6 6 0 costs agnst. Council 501 Milk 10% added water Fined 5 0 0 12 6 520 Coffee 79% chicory Fined 3 0 2 0 521 Cocoa 62% added starch and sugar Fined 2 0 568 Milk 7% added water Dismissed warranty proved 574 Milk 6% added water Fined 10 0 12 6 575 Milk 7% added water Fined 10 0 12 6 102 14 0 39 7 6 78 Table. Record of Prosecutions under the Public Health (London) Act, durinp the year 1900. Address. Complaint. Magistrates' Decision. Penalties. Costs. £ s. d. s. d. Rope Ground, Crozier Terrace Penalty summons Dismissed 96, Shrubland Grove Defective brick drain Dismissed 26, London Road Defective yard paving Withdrawn, work done 113, Rendlesham Road Penalty summons Fined 4 0 0 2 0 5, Detmold Road Dirty ceilings and walls Dismissed, £2 2s. costs against Vestry 171, Mt. Pleasant Lane Defective drains Order to do the work in 28 days 2 0 High St., Homerton Accumulation of refuse on roadway Fined 5 0 High St., Homerton Accumulation of refuse on roadway Fined 5 0 Well Street Accumulation of refuse on roadway Fined 2 6 117, 119,121, 123,125. 127, 129 and 131, King Edward Road Defective drains Order to do the work in 7 days 16 0 5, Castle Street Defective drains Withdrawn, work done 5, Amhurst Road Rooms dirty Dismissed. £2 2s. costs against Vestry 121, Amhurst Road Smells from drains Withdrawn, work done 41, High Street, Kingsland Defective drains Withdrawn, work done 106, Northwold Road Defective and unventilated soil 1 ipe Order to do the work in 7 days 2 0 70 Address. Complaint. Magistbates' Decision. Penalties. Costs. £ s. d. s. d. 7, Templar Road W.C. pan foul, rooms dirty Withdrawn, work done 3 0 9, Templar Road W.C. pan foul, rooms dirty Withdrawn, work done 3 0 11, Templar Road House dirty,leaky roof Withdrawn, work done 3 0 2, Mabley Street Yard paving defective Order to do the work in 7 days 6 0 11,Tenement,Block B, Elizabeth Buildings Walls and ceilings dirty Order to do the work in 14 days 6 0 5, Ockenden Road Defective drains Order to do the work in 14 days 3 0 Broadway, London Fields Accumulation of refuse on roadway Fined 5 0 2 0 Broadway, London Fields Accumulation of refuse on roadway Withdrawn Barge "Arthur" (owner) Carrying offensive refuse during prohibited hours Dismissed, £2 2s. costs against Vestry Barge "Arthur" (master) Carrying offensive refuse during prohibited hours Dismissed, £2 2s. costs against Vestry Barge "Arthur" (master) Carrying offensive refuse uncovered Dismissed, £2 2s. costs against Vestry Barge "Arthur" (owner) Carrying offensive refuse uncovered Dismissed, £2 2s. costs against Vestry 154, Mare Street Penalty summons Fined 2 0 0 2 0 30, Foulden Road Penalty summons Withdrawn, work done 106, North wold Road Penalty summons Fined 10 10 0 2 0 429, Kingsland Road Penalty summons Fined 5 0 0 2 0 Tranby Place Refitting w.c. without giving notice to Clerk of Sanitary Authority Fined 5 0 2 0 80 Address. Complaint. Magistrates' Decision Penalties Costs. £ s. d. s. d. 117, 119, 121,123,125, 127, 129, & 131, King Edward Road Penalty summons Withdrawn, work done 1, 2, 3, 4, 5, 6, 7, Winslade Road Defective drains Adjourned, sinedie 8, Winslade Road Defective drains Order to do work in 28 days 63 0 26, Richmond Road Defective drains Withdrawn, work done 30, Crozier Terrace Choked drains Withdrawn, work done 30, Tottenham Road Dirty walls, &c. Withdrawn, work done 32, Tottenham Road Defective roof and walls dirty Withdrawn, work done 108, Tottenham Road Defective yard paving Withdrawn, work done 102, Tottenham Road Defective roof, back addition Withdrawn, work done 17, John's Road Defective drains Order to do work in 14 days 6 0 5, Farleigh Road W.C. foul and improper, no water supply to pan Withdrawn, work done 3, Sidney Road Refittingw.c. without giving notice to Clerk of Sanitary Authority Fined 0 5 0 2 0 High Street, Kingsland Accumulation of refuse on roadway Fined 0 5 0 2 0 High Street, land Accumulation of refuse on roadway Fined 0 1 0 2 0 High Street, Kingsland Accumulation of refuse on roadway Dismissed 81 Address. Complaint. Magistrates' Decision. Penalties Costs. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, Tyssen Street The whole of the houses dirty & dilapidated, ground floor rooms damp, no vent, under ground floors, and external walls so defective as to allow rain to percolate through into interior Order to close the houses within 6 weeks 63 0 1, 2, 3, 4, 5, 6, 7, 8, Tyssen Passage The whole of the houses dirty & dilapidated, ground floor rooms damp, no vent, under ground floors, and external walls so defective as to allow rain to percolate throughinto interior Order to close the houses within 6 weeks 24 0 1, 2, 3, 4, 5, 6, 7, 8, Tyssen Place The whole of the houses dirty & dilapidated, ground floor rooms damp, no vent under ground floors, and external walls so defective as to allow rain to percolate through into interior Order to close the houses within 6 weeks 24 0 1, 3, 7, Lesbia Road Defective drains Withdrawn, work done 94, Stoke Newington Road Roof defective and inlets to drains inside house Withdrawn, work done 102, Pritchard Road Defective drains Withdrawn, work done 12, Link Street W.C. foul, rain water pipe defective Withdrawn, work done D 82 Address. Complaint. Magistrates' Decision. Penalties. Costs. £ s. d. s. d. Wilton Mews (6) Defective paving and drainage Withdrawn, work done 5, Rock Road Rooms dirty Withdrawn, work done 25, 27, 29, 31, 33, Norcott Road Defective drains Withdrawn, work done 28, John Campbell Road Dirty bakehouse Withdrawn, work done 113, Rendlesham Road Penalty summons Withdrawn, work done 21, 23, 25, Carlton Road Defective drains Withdrawn, work done 200, Lower Clapton Road Defective drains Order to do work in 14 days 202, Lower Clapton Road Defective drains Dismissed Passage side of 200, Lower Clapton Road Defective drains Dismissed 65, Powerscroft Road Drinking water cistern improperly placed Order to do work in 7 days 2 0 22, Darville Road Defective drains Withdrawn, work done 32, Darville Road Yard wet, &c. Order to do work in 14 days 2 0 25, Sydner Road W.C. wet and no water supply to same Order to do work in 14 days 2 0 7, John's Road 50, 52, 54, Jenner Road Defective drains Defective drains Order to do work in 14 days Withdrawn, work done 4 0 22, 24, 26, 28, Benyon Road Defective drains Withdrawn, work done 98, Culford Road Defective drains Dismissed, £1 1s. costs against Vestry 5, Powerscroft Road Defective drains Dismissed 83 Address. Complaint. Magistrates' Dkcision. Penalties Costs. £ s. d. s. d. Chatsworth Road Accumulation of refuse on roadway Fined 3 0 2 0 66, 66a, 68, 70, 72, 74, 76, 78, 80, 82, and 84, Dalston Lane Yard improperly paved & drained Order to do work in 28 days 45 0 261, Queen's Road Yard improperly paved & drained Order to do work in 28 days 2 0 263, Queen's Road Yard improperly paved & drained Order to do work in 28 days 2 0 Rear of 261, Queen's Road Yard improperly paved A drained Order to do work in 28 days 2 0 112, Lansdowne Road Leaky roof and walls of landing dirty Dismissed 60 and 62, Farleigh Road Defective gutters Withdrawn, work done 2, Link Street Yard paving defective Withdrawn, work done 35, Tottenham Road Defective drains Withdrawn, work done 34, Tottenham Road Defective drains Withdrawn, work done 44, Buckingham Road Defective drains Withdrawn, work done 4, Link Street Yard paving defective Order to do the work in 14 days 4 0 527, Kingsland Road Defective drains Withdrawn, work done 5. Powerscroft Road.. Defective drains Order to do the work in 14 days 27 0 62, 64, 66, 70, 72, 74, Mt. Pleasant Lane Defective drains Withdrawn, work done 6 and 8, Link Street w.c. pan foul, house dirty Order to do the work in 14 days 8 0 10, 12, 14, Link Street Yard paving defective Withdrawn, work done 51, Roding Road Foul and improper pan in w.c. Withdrawn, work done 84 Address. Complaint. Magistrates' Decision. Penalties Costs. £ s. d. s. d. 157, 159, 161, Evering Road Defective drains Order to do the work in 14 days 6 0 163, Evering Road Defective drains Withdrawn, work done 35, Clapton Square Yard paving defective Withdrawn, work done 29, Clapton Square Roof, ceiling and walls defective Withdrawn, work done 39, Sigdon Road Yard unpaved Withdrawn, work done 40, Amhurst Road Defective drains Order to do the work in 21 days 25 0 25, Sydner Road Penalty summons Withdrawn, work done 5, Myrtle Street Passage ceiling dirty Withdrawn, work done Kenmure Yard No receptacle for manure Order to do the work in 6 weeks 2 0 213, Glyn Road Yard paving defective Order to do the work in 28 days 6, Stamford Road Defective drains Order to do the work in 14 days 58 0 164, Kingaland Road Defective drains Withdrawn, work done 10, Middleton Road Defective drains Withdrawn, work done 80, Durrington Road Letting newlyerected house without obtaining certificate fromSanitaryAuthority re water supply Fined 0 10 0 2 0 3, Urswiek Road Refitting w.c. without giving notice to Sanitary Authority Fined 0 5 0 2 0 6, High Street,Homerton House dirty Withdrawn, work done 85 Address. Complaint. Magistrate's Decision. Penalties. Costs. £ s. d. £ s. d. Well Street Accumulation of refuse on highway Fined 0 5 0 0 2 0 Well Street Accumulation of refuse on highway Fined 0 5 0 0 2 0 Well Street Accumulation of refuse on highway Fined 0 5 0 0 2 0 London Fields Accumulation of refuse on highway Fined 0 5 0 0 2 0 London Fields Accumulation of refuse on highway Fined 0 5 0 0 2 0 Kingsland Road Accumulation of refuse on highway Fined 0 5 0 0 2 0 Kingsland Road Accumulation of refuse on highway Fined 0 5 0 0 2 0 Kingsland Road Accumulation of refuse on roadway Fined 0 5 0 0 2 0 Kingaland Road Accumulation of refuse on roadway Fined 0 5 0 0 2 0 Kingsland Road Accumulation of refuse on roadway Fined 0 1 0 0 2 0 Kingsland Road Kingsland Road Accumulation of refuse on roadway Accumulation of refuse on roadway Fined Fined 0 0 1 1 0 0 0 0 2 2 0 0 5, 6, 7, 8, 9, 10, Retreat Cottages 41, 43, 45, 47, 49, Bayston Rod Defective drains Defective drains Order to do the work in 6 weeks Order to do the work in 6 weeks 0 0 12 10 0 0 26 19 6 23 18 0 LIST OF LICENSED SLAUGHTEE-HOUSES. In the Hackney District, Octobbu, 1900. Name. Friday, E. Raymond, E. Hussey, A. J. Wood, Hy. Peter Longthorne, J. W. Wragg, W. J. Roberts, F. Gooch, H. Scott, G. Woollven, W. H. Barclay, E. J. Friday, Richard Joyce, J. Fish, T. Witherden, C. A. Tyler, A. Maples, Mrs. Annie Teat, Thos. & Sturch, Fredk. Harris, Samuel. Lockie, J. J. Miall E. D. Hammer, William Ebbells, E. Row, Fredk. Wm. Howard, Wm. Thos. Young, C. J. Address. 285, Amhurst Road 186, Cassland Road 37, Church Road, Homerton 90, Frampton Park Road 5, High Street, Homerton 57, Holly Street 49, High Street, Kingsland 71, High Street, Kingsland 418, Kingsland Road High Road, Upper Clapton 78, Stamford Hill 113/5, Dalston Lane 531, Kingsland Road Lea Bridge Corner, Clapton 133, Lower Clapton Road 80, Mare Street 142, Mare Street 177, Mare Street 296, Mare Street 200, Queen's Road, Dalston 211, Queen's Road, Dalston 103, Rendlesham Road 94, Southgate Road 130, High Street, Stoke Newington 85, Balls Pond Road 220, Stoke Newington Road 87 Stoneman, P. Clark, C. Tyler, W. Hawes, John Friday, R. G. Baker, W, J. Browning, J. 3, Terrace Road Aberdeen House, Upper Clapton 92, Well Street 169, Well Street 51, Wilton Road 258, Wick Road West Side, London Fields LIST OF LICENSED COW-SHEDS in the Hackney District, October, 1900. Name. Address. No. of Sheds. Jones, Mary Jenkins, J. Evans, D. M. Jones, D. R. Francis, John Evans, Thomas Evans, Morgan Larter, George William, trading as J. T. Larter Snewin, W. H. Rumball, T. E. Bates, T. & W. Cashford, W. G. Warner, J. C. Bush, J. Lewis, J. Faulkner Williams, T. R. Welford & Co. 46, Brooksby's Walk, Homerton 1 2, Buckingham Road, Kingsland 2 72, Church Road. Homerton 1 84, Clifden Road, Clapton Park 2 67, Downham Road, Kingsland 1 11, Downham Road, Kingsland 1 6, Florfield Road, Hackney 1 2, Gloster Road, South Hackney 2 47, Old Hill Street, Upper Clapton 1 Upper Clapton Road 4 46a, Leswin Road, Stoke Newington 1 Jerusalem Square, Mare Street, Hackney 4 23, Mare Street 1 Marsh Gate, Homerton 1 6, Palace Road, Hackney 4 257, Queen's Road, Dalston 1 79, Shacklewell Lane, Hackney 1 Sigdon Road, Hackney 1 88 Welford, R. W. Spring Hill, Clapton 2 Stapleton, A. Stoke Newington Common 5 Briggs, J. 180, Victoria Park Road 1 Thomas, David 3, Warburton Road, Hackney 1 Brace, E. A. 133, Well Street, South Hackney 1 Jones, John 271, Wick Road, Homerton 2 Total Cow Sheds 39 LIST OF BAKE-HOUSES, 1900. Name. Address. No. 1 District. Lidstone, J. 77, Upper Clapton Road Budden, J. 126, Northwold Road Vincent, A. Clapton Common Hurstleigh, W. S. 11, St. Andrew's Pavement Williamsons Ltd. Chapel Road Reis, W. E. 8, Cazenove Road Gibson, R. 9, Northwold Road Austin, W. H. 74, Fountayne Road Schutz, J. Northwold Road. No. 2 District. Guthrie, J. & Sons 176, High Street, Stoke Newington Tanner, Miss E. 24, Sanford Lane Pile, W. 114, High Street, Stoke Newington Curran, H. J. 33, Rectory Road Allardyce, S. W. 62, Evering Road Burch, Mrs. H. 9, Maury Koad Willsmer, C. 8, Stellman Street Guscott, J. 128, Stoke Newington Road Hickling, Mrs. S. 40, Shacklewell Lane Karsch, J. 239, Amhurst Road Rung, 73, Shacklewell Lane No. 3 District Clarke, Mrs. L. L. 134, Sandringham Road Hull, W. E. 50, London Road Brion, A. 26, Downs Road 89 Reis, W. C. 215, Lower Clapton Road Parish, W. 117, Lower Clapton Road Prestage, T. H. 71, Lower Clapton Road Tanner, J. 5, Lower Clapton Road Cowley. J. 9, Clarence Road Newell & Co. 393, Mare Street Hall, J. 370, Mare Street Thrift, A. 38, Amhurst Road Seward, R. 240, Dalston Lane No. 4 District. Carpenter, A. 13, Median Road Rest, O. 2, Beecholme Terrace Mason, F. 200, Lower Clapton Roid Newcombe, E. 3a, Glyn Road Lunken, J. 52, Mandeville Street Saur, H. 198, Rushmore Road Mankertz, L. 182, Chatsworth Road Gerber, P 138 „ Gibson 136 ,, Ruhl, J. G. 94 Lunken, H. 71 „ Maloney, J. 36 „ Woods, E. 19 „ Heinlen, L. 219, Glyn Road No. 5 & 6 District. Waters, R. J. 121, Richmond Road Berry, Mrs. A. 49 „ Ibell, W. 81, Wilton Road Goodwin, J. 178, Dalston Lane Kitchiner, J. W. 83 „ Hannerman, L. 72 „ Shedden, W. 64, Richmond Road Mules, J. 20 & 22, Forest Road Shedden, Mrs. S. F. 11, Holly Street 90 Ellson, W. W. 207, Queen's Road Spencer, H. 68, Lansdowne Road Birkekt, T 25, West-side, London Fields Granger, J. 550, Kingsland Road Norman, A. 513 „ Best, O. 376 Claridge, G. 329 „ Kurtz, W. C. 174 „ Allardyce, S. W. 98 „ Enerby, A. 40, Downham Road Pope, Mrs. E. 54b „ Stein, H. 24, Tottenham Road Pay, E. T 106, Hertford Road Roessle, W. 88, High Street, Kingsland Mann, W. 28, John Campbell Road Ring, P. 103a, Dalston Lane Major, J. 89, Tottenham Road Aerated Beverage Co., Ltd. 107, High Street, Kingsland No. 7 District. Payne, A. 54, Broadway, London Fields May, H. 70 „ „ „ Bushell, F. 10 „ „ „ Stumm, K. 26, West Street Byron, S. T. 139, Mare Street Grantham, R. W. 6, Well Street Reitz, U. 183, Mare Street Harvey, A. 231 „ Hudson, T. 297 „ Lunken, H. 27, Morning Lane Lauf, M. 77, Frampton Park Road Eley, J. 101, Mare Street Kutcher, A. 77, „ No. 8 District. Krauss, J. A. 13, Loddiges Road Skaer, P. 76, Well Street Weissgerber, P. 105 „ Bland, A. T. 127 „ 91 Mustard, Mrs. E. C. Holzapfel, C. Hatheriil, J. Grimwood, T. Grimwood, T. Gibbon, G. Bradford, G. Jessup, H. Wells, J. Herz, J. Sprimpton Hatheriil, J. Hiam, J. S. Harris, J. Maul, E. Beck, Mrs. S. Gunner, G. Bruton, J. Weber, G. Pates, F. W. Stark, W. Fey, J. Morse, G. Carton, H. Tilbury, W. Selzer, H. Kehrein, J. Dance, Mrs. A. Broke, G. James, G. Baden, E. Johnson, E. H. Davis, S. 79, Lauriston Road 42, Victoria Park Road 105, Lauriston Road No. 9 District. 39, High Street Homerton 59 131 „ 162 167 18, Brooksbv's Walk 14, The Grove, Homerton 3, Churchill Road 17, Bridge Street No. 10 District. 220, Wick Road 184, Cassland Road 16, Gloucester Road 92, Wick Road 34, Church Road, Homerton 12, Berger Road 50, Kenton Road 154, Well Street 126 „ 233 „ 27, Elsdale Street 144, Morning Lane 142, Well Street No. 11 District. 89, Sidney Road 276, Wick Road 315 „ 2, Victoria Road 3, Montague Buildings 41, Osborne Road 13, Gainsboro' Road 71, Felstead Street