HAC 19 Borough of Hackney. REPORT on the SANITARY CONDITION of the hackney district, FOR THE YEAR 1903, by J. KING WARRY, M.D., LOND., M.R.C.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 Lister 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 E. 1904 INDEX. page Bakehouses 60 Birth Rate 9 Canal Boats Act 45 Cancer 38 Chickenpox 34 Constitutional Diseases 38 Cowhouses, Milkshops, and Dairies Order 43 Cow Sheds, List of 117 Customs and Inland Revenue Act 46 Death Rate 10 Diarrhœa 35 Diphtheria 29 Disinfection 72 Enteric Fever 30 Erysipelas 34 Estimated Population 7 Factory and Workshop Act, 1901 54 Home Work and Workers 57 House Refuse 83 Ice Cream Vendors 47 Illegitimacy 10 Infant Mortality 11 Infant Diarrhœa 35 Marriage Rate 8 Measles 35 Meteorology 90 Mortuary 87 Notifiable Diseases 28 Non-Notifiable Diseases 34 Offensive Trades 43 Population and Density 7 Prosecutions under Food and Drugs Act 111 Prosecutions under Public Health Act (London) 114 Public Health Act (London) 1891 41 Puerperal Fever 38 Register of Sanitary Work 88 page Removal of House Refuse 83 River Lea 51 Senile Mortality 12 Scarlatina 28 Shelter 80 Slaughter-Houses, List of 116 Small-pox 28 Smoke Nuisances 45 Specific Causes of Death 20 'Tuberculous Disease 38 Vaccination 39 Whooping Cough 38 Workshops and Laundries 54 Zymotic Diseases 28 Tables— Births 9 Bakehouses, List of Alterations 62 Causes of Infant Mortality 12 Deaths 20 Death Statistics, according to Diseases, Ages and Localities 18 Dusting Account 84 Infectious Sickness 17 Inquests 87 Population, Area and Density in Sub-Districts of Hackney 7 Requests for Removal of Dust 85 Suicides and Accidental Deaths 87 Vaccination 40 Metropolitan Borough of Hackney. MEDICAL OFFICER'S REPORT FOR THE YEAR 1903. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, N.E. To the Mayor, Aldermen and Councillors of the Borough of Hackney. Gentlemen, I beg herewith to present my Twelfth Annual Report on the Public Health of the Borough of Hackney. The year 1903 has been exceptional in several ways. The general dea,th-rate of the Borough for the year was 14.1 per 1000 living. This is the lowest mortality rate on record since the year 1889, when it was 13.6. The infant mortality was also low, being only 127 per 1000 births. The deaths from infectious disease contrasted favourably with past years, the zymotic death-rate for the Borough during 1903 being 19 per 1000 living, the average for the year 1892 to 1903 being 31 per 1000 living. The number of cases of notifiable infectious disease was 6 low compared with previous years. From a public health point of view the figures are eminently satisfactory. The cause of such favourable results is, amongst other circumstances, closely connected with the meteorological conditions which prevailed during the greater part of the year 1903. The mean temperature for the months of June, July and August, the months of high temperature, was very low being only 60.4°. The mean temperature for the months January, February and December was 42.9°, this being much higher than the average for winter months. Extremes of temperature have a prejudicial effect upon public health. Extreme heat, by facilitating the rapid putrefaction of organic matter, leads to fatal intestinal disease in the very young and the aged. Extreme cold attacks the same individuals at the extremes of life, especially if poverty is combined with these extremes, producing fatal lung disease; so that the moderate temperature of last year has had a beneficial effect upon the general health of the Borough by sparing the lives of the very young and the aged. The abnormal rainfall has also had a beneficial effect upon the public health. It is difficult to estimate even approximately the effect of excessive rainfall apart from other meteorological phenomena upon the public health; but the excessive rain, no doubt, helped to keep the mean temperature of the earth low during the summer months, and also helped to wash away from the streets, drains and sewers, organic matter which otherwise would have decomposed and prejudicially affected health. It is also probable, that the washing of the atmosphere by repeated falls of rain freed it from pathogenic organisms. Apart from atmospheric conditions the efforts of the Public Health staff have, in my opinion, contributed to the satisfactory health report for the year. The removal of nuisances prejudicial to health from occupied dwellings and their neighbourhood, the isolation of infectious cases, the removal of infectious cases to hospital, the disinfection and cleansing of infected articles and dwellings, the regular removal of house refuse, the general supervision of the schools of the Borough in their relation to infectious disease, not to mention less obvious, but still important work of the Public Health Department, have contributed to the improvement of general health of the Borough during 1903. 7 The general character of Hackney is changing every year. It is becoming every year denser, both in population and dwellings. It is also becoming more an industrial than a residential district. These changes are almost invariably associated with an increased death-rate; but although the above alterations have been taking place in Hackney during the last ten or twelve years, the usual result has not followed. The death-rate if anything, apart from weather influences, has decreased. This must be attributed to the efforts made by the Council, through its Public Health Committee, to provide the Borough with the means to carry out the provisions of the various Acts of Parliament bearing upon Public Health. Both in point of staff and equipment, for dealing with disease, the Borough of Hackney can compare very favourably with any district in Great Britain. I am pleased to state that the several Officers of the Public Health Department have, on the whole, carried out the duties allotted to them to my entire satisfaction. Population and Density.—The population of the Borough of Hackney, at the middle of the year 1903, I estimate to be 223,716 and the density 67.9 persons per acre. At the census of 1901 there were 30,419 inhabited houses in the district. This gives with the above population 7 persons per inhabited house. The population and density of the various sub-districts of the Borough are given in the following table:— Table. Showing estimated Population, Area and Density of the Registration Sub-Districts in Hackney, at middle of 1903. North. Central. South East. South West. Total for Hackney Total for London. Estimated Population 51,848 52,203 59,324 60,341 223,716 4,613,812 Area in square acres 1,132 815 770 601 3,292 74,839 Density = persons per acre 45.8 64 0 77.0 100 4 67.9 61.6 8 Overcrowding.—While on the subject of population, I think it advisable to give the result of a comparison of the amount of overcrowding in the Borough at the two censuses 1891 and 1901. The following taken from the Report of the Medical Officer to the London County Council for the year 1902 shows the amount of overcrowding existing at 1891 and 1901 census. It will be seen from this that during the last decade there has been a slight decrease in overcrowing. The percentage of decrease is not large, but it is a, hopeful sign to see that overcrowding is not increasing. Sanitary Area. Tenements with Percentage of total population in each group of tenements. Overcrowding. Percentage of Population living more than 2 in a room in tenements of less than five rooms. 1891 1901 Increase or decrease. 1891 1901 Increase or decrease. Hackney 1 Room 4.0 3.8 — 0.2 1.90 1.55 — 0.35 2 Rooms 9.6 100 + 0.4 3.69 3.11 — 0.58 3 „ 14.2 15.9 + 1.7 3.26 2.82 — 0.44 4 ,, 14.2 16.4 + 2.2 1.98 1.86 — 0.12 Total 42.0 46.1 + 4.1 10.83 9.34 — 1.49 MARRIAGES AND MARRIAGE BATE IN THE BOROUGH OF HACKNEY DURING THE DECENNIUM 1893.1993. *Marriages.—The number of marriages solemnized in the Borough of Hackney during 1903, was 1695. The annual rate of persons married in the Hackney population is therefore 15.1 per 1000. The marriage rate for London for the same period is 17.4 per 1000. The following table gives the marriage rates for Hackney and London for the 10 years ending 1902. 9 Year. Borough of Hackney. London. Marriage3. Marriage Rate. Marriage Rate. 1893 1776 14.8 17.2 1894 1592 13.2 17.0 1895 1540 14.2 17.2 1896 1694 16.3 18.0 1897 1788 16.9 18.5 1898 1755 15.9 18.8 1899 1754 15.7 18.6 1900 1684 15.3 18.0 1901 1756 15.9 17.6 1902 1668 15.0 17.8 Average 1893.1902 1700 15.3 17.8 1903 1695 151 17.4 Births.—During 1903 there were 6,180 births in the Borough of Hackney, 3,141 males and 3,039 females. This is equivalent to a birth-rate of 27.6 per 1,000 living persons for the whole Borough. This shows a decline upon the rate for 1902, which was 28.2 per 1,000 living. The birth-rate was lowest in the North Sub-District, viz. 19.9 per 1,000, and the highest in the South-West Sub-District, viz. 30.9 per 1,000 living persons. Table. Births. Registration District of Hackney. Registration Sub-Districts. All London North Central South West South East Total No. of Births 6,180 1,032 1,460 1,819 1,869 130,906 Rate per 1,000 living 27.6 19.9 27.9 30.6 30.9 28.4 No. of Illegitimate Births 102 Rate per 1,000 Births 16.5 10 *Illegitimate Births.—I find that during the past year 293 illegitimate births were registered in the Borough of Hackney. Of this number 191 took place in the Salvation Army Rescue Home, Mare Street, and were of mothers drawn from districts outside Hackney. Deducting this number from the total, there remains 102 illegitimate births to be credited to Hackney residents. This gives an illegitimate birth-rate of 16.5 per 1,000 births. BIRTH-BATE FOB THE BOROUGH OF HACKEY AND ITS SUB-DISTRICTS FOR THE YEARS 1898-1903 COMPARED WITH THAT OF LONDON. Year. Borough of Hackney. North SubDistrict. Central SubDistrict. South-East Sub-District South-West Sub District London. 1898 29.4 22.4 30.7 32.7 30.6 29.5 1899 29.0 22.0 31.3 31.1 30.5 29.4 1900 29.0 22.3 27.9 32.6 32.1 28.5 1901 28.7 21.1 30.1 31.1 31.6 29.0 1902 28.2 21.5 28.5 31.3 80.7 28.5 Average 1898—1903 28.6 21.5 29.4 31.5 31.0 28.9 1903 27.6 19.9 27.9 30.6 30.9 28.4 Deaths—The number of deaths from all causes registered in the Borough of Hackney during the year 1903 was 3,287; but of these 453 were of persons not resident in the Borough. In addition, 328 residents of Hackney died in Institutions outside the Borough. Making the needful corrections, there were 3,162 deaths of Hackney residents during the year 1903. This is equivalent to an annual death-rate of 14.1 per 1,000 living persons. Making a further correction for age and sex distribution by means of the factor 1.04264, the *I have here to acknowledge my indebtness to Mr. Tom Hosgood, Superintendent Registrar, who has kindly abstracted for me the number of marriages and illegitimate births for the year 1902. 11 corrected death-rate from all causes becomes 14.7 per 1,000 living persons. This is the lowest annual death-rate experienced in in Hackney since the year 1889, when the death-rate from all causes was 13.6 per 1,000 living. The lowest death-rate 11.4 per 1,000 was in the North sub-district, and the highest 17.2 per 1,000 in the South East sub-district. The annual death-rate from all causes for London in 1903 is 15 7 per 1.000 living. Sub-District. Population. No of Births. Birth-rate Total Deaths. Deathrate. Deaths under 1 year. Infant Mortality per 1000 Births. North 51848 1032 19.9 591 11.4 119 115 Central 52203 1460 27.9 678 12.9 167 114 South-East 59324 1819 30.6 1021 17.2 294 161 South-West 60341 1869 27.6 869 14.4 206 112 All Hackney 223716 6180 26.3 3162 14.1 786 127 The following shows the death-rates of Hackney from all causes per 1,000 compared with London daring the last decade. Year. Hackney. London. Year. Hackney. London. 1894 16.26 17.4 1899 17.9 19.6 1895 18.60 19.5 1900 17.4 18.6 1896 17.10 18.2 1901 16.6 17.1 1897 17.80 17.8 1902 16.0 17.2 1898 17.10 18.4 1903 14.1 15.7 Infantile Mortality.—The deaths of infants under one year of age, numbered 786 during 1903. This is equivalent to an infantile mortality of 127 deaths per 1,000 births. This is slightly higher than that for the previous year, which was 121 per 1,000 births. The infant mortality was lowest, 115, in the North sub-district, and highest, 161 per 1,000 births, in the South East District. 12 The following are the infantile death-rates for the Borough of Hackney compared with the rates for all London during the years 1894-1903. Year. Hackney. London. Year. Hackney. London. 1894 128 127 1899 153 166 1895 159 154 1900 158 158 1896 157 146 1901 135 148 1897 127 147 1902 121 139 1898 161 152 1903 127 131 The following table gives the chief causes of infant mortality during the years 1894 to 1903. Table.—Eleven principal causes of Infantile Mortality. 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 Measles 3 35 24 15 32 25 29 12 22 17 13 Scarlatina 4 2 3 6 7 4 2 2 — 2 1 Whooping Cough ???8 25 29 61 36 44 22 50 21 33 24 Teething 22 18 23 19 11 17 16 6 14 4 2 Diarrhœa 103 58 141 171 161 160 165 181 130 83 89 Convulsions 127 86 104 93 72 72 70 80 68 67 78 Lung Diseases 162 133 154 137 142 131 150 136 129 142 110 Tubercular Diseases 84 53 31 57 55 61 56 73 69 61 67 Atrophy and Debility 10 144 125 101 131 136 134 128 121 96 119 Premature Birth 105 81 99 110 118 145 12 130 124 131 134 Accidents and Violence 2??? 31 34 27 26 34 36 30 26 26 26 Total 878 666 767 826 781 829 804 828 724 147 662 663 Other Causes 167 136 209 184 198 213 265 207 142 123 Total 104 802 976 1010 972 1042 1069 1035 171 804 786 Senile Mortality.—The number of deaths of persons, at 65 years and upwards, during the year 1903 is 737, of which 384 were between the ages of 65 and 75 years, and 270 between 75 and 85 years, and 83 above 85 years of age. The annual death-rate of persons at 65 and upwards during 1903 is 3.2 per 1,000. 13 Deaths in Public Institutions.—There were 1,182 deaths in institutions within the Borough. Of these 729 were residents of Hackney, and 453 the residents of other districts. The following are the institutions within the Borough receiving persons both from and without the Borough, with the deaths in each during 1903. The "Nest," 10 Springfield 14 City of London Workhouse 3 Eastern Fever Hospital 169 11, Devonshire Road, S. A. Nursing Home 28 French Hospital 8 Hackney Infirmary 649 „ Workhouse 5 Metropolitan Hospital, Kingsland 160 German Hospital 125 Mare Street S.A. Maternity Home 21 The following is a list of the institutions outside the Borough receiving sick persons from Hackney, with the deaths of Hackney residents during 1903. INSTITUTIONS OUTSIDE THE DISTRICT, RECEIVING SICK AND INFIRM PERSONS FROM THE DISTRICT. Mothers' Home, Commercial Road 2 Middlesex Asylum 2 Tooting Bec. Asylum 3 L.C. Asylum, Dartford 8 Brompton Hospital 2 Horton Asylum 20 City of London Asylum 2 Licensed Victuallers' Asylum 1 Claybury Asylum 24 North Eastern Children's Hospital 29 14 St. Bartholomew's „ 18 London Hospital 49 Hanwell Asylum 7 Colney Hatch Asylum 18 N. E. Fever Hospital 23 St. Thomas' Hospital 3 St. Peters' Hospital 1 Hospital for Women, Soho 2 Northern Fever Hospital 1 Darenth Asylum 2 Middlesex Hospital 6 Royal Free Hospital 2 Royal Chest Hospital 5 London Temperance Hospital 1 Cane Hill Asylum 3 Friedenheim 1 St. Mary's Hospital 2 National Hospital 1 Banstead Asylum 9 City of London Chest 2 Hostel of God 2 Guy's Hospital 2 Children's Hospital, Gt. Ormond Street 3 Royal Home for Incurables, Horton Asylum, Epsom 1 St. Ann's House, Stoke Newington 1 Homoeopathic Hospital 1 Hoxton House Asylum 9 Bethnal House Asylum 19 Great Northern Hospital 2 City of London Lying-in Hospital 2 Cancer Hospital 1 Leavesden Asylum 4 King's College Hospital 7 Miscellaneous Institutions 23 15 Vital Statistics of Whole District during 1903 and Previous Years. HACKNEY DISTRICT. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions. Deaths of Nonresidents registered in District. Deaths of Residents registered beyond District. Deaths at all Ages. Number. Rate.;* Number. Rate per 1,000 Births registered Number. Rate.* Number. Rate.* 1 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 1896 218766 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 3703 17.0 1898 219540 6445 29.3 1042 101 3855 17.5 794 502 278 3631 16.4 1899 222429 6453 29.0 1069 165 4033 18.1 1142 520 294 3807 17.1 1900 218976 6359 29.0 1035 162 3898 17.7 1114 518 291 3652 16.7 1901 219780 6318 28.7 918 145 3634 16.5 1993 463 326 3497 15.9 1902 221730 6266 28.3 804 128 3526 15.8 1102 516 368 3378 15.3 Averages for years 1893.02 220526 6356 28.7 966 149 3869 17.5 890 492 301 3675 16.7 1903 223716 6180 26.3 802 129 3287 14.7 1182 453 328 3162 14.1 Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Area of District in Acres (exclusive of area covered by water). 3234.2 Total population at all ages 219,288 Number of inhabited houses 30,419 Average number of persons per house 7.2 At Census of 1901. 16 HACKNEY DISTRICT. Vital Statistics of separate Localities in 1903, and previous years. Names of Localities. 1. All Hackney. 2. North SubDistrict. 5. Central SubDistrict. 5. S. East SubDistrict. 4 S. West SubDistrict. 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. 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 59079 1933 1343 325 63261 1938 940 306 1899 222429 64533807 1052 50182 1116 591 129 48302 1512 770 257 59855 1864 1448 350 64090 1961 998 316 1900 218976 6359 3652 1035 50498 1131 626 125 50463 1408 732 215 58171 1899 1233 390 59844 1921 1061 305 1901 219780 6318 3497 871 50713 1072 650 120 50720 1530 839 212 58372 1818 1068 302 59975 1898 940 237 1902 221730 6266 3378 804 51269 1103 596 96 51462 1470 758 194 58850 1844 1076 304 60149 1849 948 210 Averages of Years 1893 to 1902. 220491 6368 3393 955 50438 1106 611 124 49723 1477 770 222 48865 1871 1233 334 61464 1913 977 275 1903 223716 6180 3162 786 51848 1032 591 119 52203 1460 678 167 59324 1819 1024 294 60341 1869 869 206 17 HACKNEY DISTRICT. Cases of Infectious Diseases notified during the Year 1903. 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 East W. South West. North C'ntr'l South East. South West. Under 1. 1 to 5. 5 to 15 15 to 25. 25 to 65. 65 and upw'ds Small-pox 4 1 2 1 1 1 2 1 1 2 Cholera Diphtheria 533 9 189 239 57 39 61 144 222 106 40 115 174 87 Membranous croup 13 11 2 3 8 2 1 2 1 Erysipelas 280 10 10 23 44 157 36 30 68 124 58 2 12 38 10 Scarlet fever 676 7 197 389 71 12 155 217 153 151 98 192 143 140 Typhus fever Enteric fever 272 5 88 109 70 29 94 99 50 19 71 86 43 Relapsing fever Continued fever 5 3 2 1 4 1 1 1 Puerperal fever 21 3 18 6 6 6 3 1 4 3 Plague Chicken Pox 46 2 20 22 2 3 13 27 3 1 4 Totals 1850 28 432 766 287 300 37 285 546 644 375 161 397 452 284 Isolation Hospital—Eastern Hospital, Homerton. 18 HACKNEY DISTRICT. Causes of, and Ages at, Death during Year 1903. 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 35. 65 and upwards North Hackney. Central Hackney. South-east Hackney. South-w't Hackney. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 111 13 88 9 1 .. .. 9 37 43 22 13 Scarlet fever 20 1 9 10 .. .. .. 5 3 5 7 28 Whooping-cough 66 21 37 5 .. .. .. 18 13 18 17 6 Diphtheria and membranous croup 48 3 30 13 1 1 5 8 25 10 82 Croup 1 .. 1 .. .. .. .. 1 .. .. .. .. Fever Typhus 35 1 2 17 15 •• 3 12 13 7 .. Enteric 46 Other cont'ed .. Epidemic influenza 27 1 .. .. 4 13 9 10 6 5 6 3 Cholera .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 117 89 13 2 1 6 6 11 26 51 29 28 Enteritis 23 12 2 1 2 5 1 5 9 5 4 8 Puerperal lever 3 .. .. .. 1 2 .. 2 1 .. .. 3 Erysipelas 19 1 .. .. .. 8 10 3 3 9 4 13 Other septic diseases 13 2 .. 1 1 8 1 6 3 4 .. 7 Phthisis 256 4 4 7 45 184 12 36 59 76 85 161 19 Other tubercular diseases 153 63 54 15 7 14 .. 27 60 37 29 47 Cancer, malignant disease 192 1 .. 1 1 120 69 47 50 59 36 73 Bronchitis 214 51 24 3 3 40 93 41 72 64 37 56 Pneumonia 218 58 52 5 5 60 38 36 71 50 61 48 Pleurisy 10 .. .. .. 1 7 2 1 6 2 1 3 Other diseases of Respiratory organs 21 1 3 .. .. 10 7 7 5 3 6 2 Alcoholism 60 .. .. .. .. 41 9 11 16 13 10 10 Cirrhosis of liver Venereal diseases 19 17 .. .. .. 2 .. 1 13 .. 5 13 Premature birth 134 134 .. .. .. .. .. 22 37 47 28 9 Diseases and accidents of parturition 11 .. .. .. 1 10 .. 2 2 4 3 .. Heart diseases 254 2 2 9 18 122 101 52 70 77 55 89 Accidents 82 24 13 4 2 24 15 10 29 21 22 44 Suicides 23 .. .. .. 1 19 3 7 4 6 6 7 All other causes 1042 285 40 25 34 297 361 213 335 295 199 383 All causes 3162 786 373 112 146 1008 737 591 1024 869 678 1182 20 TABLE OF DEATHS Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1903. 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 All Ages. Smallpox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. Not „ .. .. .. .. .. .. .. .. .. .. .. .. Doubtful .. .. .. .. .. .. .. .. .. .. .. .. Cow-p x. Effects of Vaccination .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. 1 .. .. .. .. .. .. .. .. 1 Measles (Morbilli) 13 88 9 1 .. .. .. .. .. .. .. 111 Epidemic Rose Rash, German Measles .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 9 10 .. .. .. .. .. .. .. .. 20 Typhus .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. Influenza 1 .. • • 4 2 1 5 5 2 6 1 27 Whooping Cough 24 37 5 .. .. .. .. .. .. .. .. 66 Mumps .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, Membranous Croup 3 30 13 1 .. .. 1 .. .. .. .. 43 Cerebro Spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. 1 2 17 10 4 1 .. .. .. .. 35 Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Diarrhœa, Epidemic (or Zym.) Enteritis 65 10 .. .. .. .. .. .. 2 .. .. 77 Diarrhœa, Choleraic Diarrhœa 2??? 3 2 1 .. .. .. 4 2 2 2 40 Dysentery 1 .. .. .. .. .. 2 .. .. .. .. 3 Malarial Fever .. .. .. .. .. .. .. .. .. .. .. .. 21 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 05. 65 to 75. 75 to 85. 85 and upwards All Ages. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. Glanders, Farcy .. .. .. .. .. .. .. .. .. .. .. .. Anthrax Splenic Fever .. .. .. .. .. .. 1 .. .. .. .. 1 Tetanus 1 1 .. .. .. .. .. .. .. .. .. 2 Syphilis 17 .. .. .. .. .. 1 1 .. .. .. 19 Gonorrhoea, Stricture of Urethra .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Septicæmia, Sapræmia .. .. .. 1 1 1 .. .. .. .. .. 3 Puerperal Pyæmia .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Phlegmasia Dolens .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. Infective Endocarditis .. .. 2 3 2 1 .. .. .. .. .. 8 Epidemic Pneumonia, Pneumonia Fever .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 1 .. .. .. 2 2 3 1 6 4 .. 19 Septicaemia (not Puerperal) 2 .. .. .. 1 .. 4 1 1 .. .. 9 Pyæmia (not Puerperal) .. .. 1 1 .. 1 1 .. .. .. .. 4 Phlegmon, Carbuncle (not Anthrax) .. .. .. .. .. .. .. .. .. 2 .. 2 Phagedæna .. .. .. .. .. .. .. .. .. .. .. .. Other Septic Diseases .. .. .. .. .. .. .. .. .. .. .. .. Tuberculous Phthisis (Pulm Tuberculosis) 2 3 5 24 32 28 23 11 6 .. .. 134 "Phthisis" 2 1 2 21 34 27 17 12 6 .. .. 122 Tuberculous Meningitis 19 24 7 1 .. .. .. .. .. .. .. 51 Tubereulo'sPeritonitis 1 2 1 1 .. .. .. 1 .. .. .. 6 Tabes Mesenterica 9 1 1 .. .. .. .. .. .. .. .. 11 22 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 All Ages. Lupus .. .. .. .. .. .. .. .. .. .. .. .. Tubercle of other Organs 4 1 .. .. .. 1 1 1 .. .. .. 8 General Tuberculosis 30 26 6 5 6 2 2 .. .. .. .. 77 Scrofula .. .. .. .. .. .. .. .. .. .. .. .. Parasitic Diseases .. .. .. .. .. .. .. .. .. .. .. .. Starvation .. .. .. .. .. .. .. .. .. .. .. .. Scruvy .. .. .. .. .. .. .. .. .. .. .. .. Alcoholism, Delirium Tremens .. .. .. .. 2 3 3 2 1 .. .. 11 Opium, Morphia Habit .. .. .. .. .. .. .. .. .. .. .. .. Ptomaine Poisoning .. .. .. .. .. .. .. .. .. .. .. .. Indu'tri'l by Lead .. .. .. .. .. .. .. .. .. .. .. .. by Phosphorus .. .. .. .. .. .. .. .. .. .. .. .. Pois'ning by Ars'nic & oth'r Metals .. .. .. .. .. .. .. .. .. .. .. .. Rheumatic Fever, Acute Rheumatism .. .. 3 .. 2 1 .. .. 1 1 .. 8 Rheumatism of Heart .. .. .. .. .. .. .. .. .. .. .. .. Chronic Rheumatism .. .. .. .. .. .. .. .. 1 1 .. 2 Rheumatic Arthritis, Rheumatic Gout .. .. .. .. .. .. .. .. .. 1 .. 1 Gout .. .. .. .. .. .. 1 3 2 .. .. 6 Carcino'ma .. .. .. .. 2 13 20 32 21 13 .. 101 Sarcoma 1 .. 1 1 .. 1 1 1 2 1 .. 9 Malignant Diseases, Cancer .. .. .. .. 2 8 19 21 27 3 2 82 Rickets 3 3 1 .. .. .. .. .. .. .. .. 7 Purpura .. .. .. .. .. .. .. .. .. .. .. .. Haemophilia,Hæmorrhagic Diathesis .. .. .. .. .. .. .. .. .. .. .. .. 23 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 All Ages. Anæmia, Leucocythæmia .. .. 1 2 1 1 2 2 .. .. .. 9 Diabetes Mellitus .. .. .. 2 2 2 1 6 4 .. .. 17 Premature Birth 134 .. .. .. .. .. .. .. .. .. .. 134 Congenital Defects 19 .. .. .. .. .. .. .. .. .. .. 19 Injury at Birth 7 .. .. .. .. .. .. .. .. .. .. 7 Atelectasis 10 1 .. .. .. .. .. .. .. .. .. 11 Want of Breast Milk .. .. .. .. .. .. .. .. .. .. .. .. Teething 2 1 .. .. .. .. .. .. .. .. .. 3 Debility 119 2 1 .. .. .. .. .. .. .. 122—1453 Disease of Nervous System. Meningitis, Inflammation of Brain 18 11 1 3 3 2 1 1 .. .. .. 40 Softening of Brain .. .. .. .. 1 1 1 6 4 6 .. 19 General Paralysis of Insane .. .. .. 1 1 5 10 3 .. .. .. 20 Insanity (notPuerp'r'l) .. .. .. .. .. 2 .. 1 .. 2 .. 5 Chorea .. .. .. .. .. .. .. .. .. .. .. .. Epilepsy .. .. 2 3 3 1 1 1 .. .. .. 11 Convulsions 78 9 .. 1 1 .. .. .. .. .. .. 89 LaryngismuaStridulus .. 1 .. .. .. .. .. .. .. .. .. 1 Locomotor Ataxy .. .. .. .. .. .. 1 .. .. .. .. 1 Paraplegia and Disease of Cord .. .. .. .. 1 3 2 2 4 .. .. 12 Neuritis, Periph, Poly-Neuritis .. .. .. .. 1 1 2 .. .. .. .. 4 Brain Tumour, (not specific) .. .. .. 1 2 .. 2 .. .. .. .. 5 Nervous System, other Diseases 1 .. .. 1 .. 1 3 3 6 6 .. 21— 228 24 TABLE OF DEATHS—Continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 3. 33 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Dis. of Org. of Sense. Otitis, Mastoid Dis .. 1 .. .. .. .. .. .. .. .. .. 1 Epistaxis, Nose Dis. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia, Eye Dis. .. .. .. .. .. .. .. .. .. .. .. .. Accident 24 13 4 2 5 5 7 7 7 4 4 82 Violence Suicide .. .. .. 1 1 6 9 3 1 2 .. 23 Drowned .. .. .. 2 .. 2 1 .. 1 .. .. 6 Murder 2 .. .. .. .. .. .. .. .. .. .. 2—114 Disease of Heart. Valve Dis., Endocarditis 1 2 9 13 20 17 19 40 47 26 3 197 Pericarditis .. .. .. 3 .. 2 .. .. 1 .. .. 6 Hypertrophy of Heart .. .. .. .. .. 1 1 1 2 .. .. 5 Angina Pectoris .. .. .. .. .. .. .. .. 1 1 .. 2 Dilatation of Heart .. .. .. .. 1 .. .. 3 1 .. .. 5 Fatty Degeneration of Heart .. .. .. .. 1 2 5 3 12 .. .. 23 Syncope Heart Dis. (not specified) 1 .. .. 2 1 2 2 1 4 2 1 16— 254 Dis. of Blood Vessels. Cerebral Hæmorrhage, Emb., Throm 1 .. 1 1 3 9 15 24 24 11 2 91 Apoplexy, Hemiplegia .. .. .. .. .. 1 7 9 15 9 .. 41 Aneurysm .. .. .. .. 1 3 2 5 2 .. .. 13 Senile Gangrene .. .. .. .. .. .. .. 1 3 1 .. 5 Embolism, Thrombosis (not Cerebral) .. 1 .. .. .. 1 .. .. .. .. .. 2 Phlebitis .. .. .. 2 .. .. .. .. .. .. .. 2 Varicose Veins .. .. .. 1 .. .. .. .. .. .. .. 1 Blood Vessels, other Diseases .. .. .. .. .. 1 .. .. .. 2 .. 3-158 25 TABLE OF DEATHS—Continued. AGES Under 1 year. 1 to 5. 5 to 5. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Dis. of Resp. Org. Laryngitis 1 2 .. .. .. .. .. .. 1 • • .. 4 Membranous Laryngitis (not Diptheritic) .. .. .. .. .. .. .. .. .. .. .. .. Croup (not Spasmod. or Membr.) .. 1 .. .. .. .. .. .. .. .. .. 1 Larnyx, other Dis. (not Specified) .. .. .. .. .. .. .. .. .. .. .. .. Bronchitis 51 24 3 3 1 5 11 23 53 32 8 214 Lobar, CropusPneumonia 1 1 .. .. 2 4 1 1 2 2 .. 14 Broncho, Catarrhal, Lobular, Pneumonia 43 34 1 1 2 2 4 2 8 2 1 100 Pneumonia 14 17 4 4 8 9 12 13 16 6 1 104 Emphysema, Asthma .. .. .. .. 1 .. 3 4 1 2 .. 11 Pleurisy .. .. .. 1 1 1 3 2 1 1 .. 10 Fibroid Dis. of Lung .. .. .. .. 1 .. .. 1 2 .. .. 4 Respiratory Dis., other .. .. .. .. .. .. .. .. .. 1 .. 1— 463 Dis. of Digest. Stst. Tonsilitis, Quinsey .. 1 .. .. .. .. .. .. .. .. .. 1 Mouth, Pharnyx, Dis. (not specific) 1 1 .. .. .. .. .. .. 1 .. .. 3 Gastric Ulcer 1 .. .. .. .. 1 2 3 1 .. .. 8 Gastric Catarrh 7 2 1 .. .. 1 .. .. 2 .. .. 13 Stomach, other Dis. (not Malig.) 2 .. .. .. 1 .. .. 3 .. 1 .. 7 Enteritis (not Epid.) 5 1 .. 2 .. 1 3 .. 1 13 Gastro-Enteritis 7 1 1 .. .. .. 1 .. .. .. .. 10 Appendicitis, Perityphlitis .. .. 5 4 .. .. 2 1 .. .. .. 12 Hernia .. .. .. .. .. 1 .. 1 2 .. 1 5 Intestinal Obstruction 2 2 1 1 3 1 .. 1 3 4 .. 18 26 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 All Ages. Other Dis. of Intestines .. 1 .. .. 1 .. 1 .. 1 .. .. 4 Peritonitis (not Puerperal) .. 1 1 .. 1 3 7 1 1 1 .. 16 Cirrhosis of Liver .. .. .. .. .. 10 12 9 7 1 .. 39 Liver and GallBladder other Diseases 1 .. .. 1 2 .. 4 3 4 1 1 17 Digest.Syst.,otherDis. .. .. .. .. .. .. 1 .. .. .. 1 2— 168 Lymph Disease. Spleen Disease .. .. .. .. .. .. .. .. 1 .. .. 1 Lymph System, other Diseases .. .. .. .. .. .. .. 1 .. .. .. 1 Thyroid Body Disease .. .. .. .. 1 .. 1 .. 1 .. .. 3 Supra Renal Capsules Disease .. .. .. .. .. 1 .. .. .. .. .. 1— 6 Dis. or Urin. Syst. Nephritis Acute 3 .. 1 1 1 3 .. 3 .. .. .. 12 Chronic Bright's Dis., Albuminura .. 1 1 2 .. 12 16 12 11 9 1 65 Calculus (not Biliary) .. .. .. .. .. .. 2 1 .. .. .. 3 Bladder&Prostate Lis. .. .. .. .. 1 .. 2 1 1 1 .. 6 Urin. Syst., other Dis. .. .. 1 .. .. .. 1 .. 2 1 1 6— 92 Dis. of Gener. Syst. Ovarian Tumour (not Malig.) .. .. .. .. .. .. 1 .. .. .. .. 1 Other Dis. of Ovary .. .. .. .. .. .. 1 .. .. .. .. 1 Uterinal Tumour (not Malig.) .. .. .. .. 1 1 .. .. .. .. .. 2 Other Dis. of Uterus and Vagina .. .. .. .. .. .. .. .. .. .. .. .. Disorders of Menstruation .. .. .. .. .. .. .. .. .. .. .. .. Gener. and Mam. Orgs., other Dis. .. .. .. .. .. .. .. .. .. .. .. ..-4 27 TABLE OF DEATHS—Continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 5 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Accidents Childbi'th Abortion, Miscarriage •• •• •• •• •• •• •• •• •• •• •• •• Puerperal •• •• •• •• •• •• •• •• •• •• •• •• Puerperal Couvulsions •• •• •• 1 •• 1 •• •• •• •• •• 2 Placenta Prsævia, Flooding •• •• •• •• 4 •• •• •• •• •• •• 4 Other Accid. of Pregnancy & Childbirth •• •• •• •• 2 3 •• •• •• •• •• 5— 11 Joint Disease. Caries, Necrosis 1 •• 1 2 •• •• 2 2 1 •• •• 9 Arthritis, Periostitis 1 •• •• •• •• •• •• 1 1 •• •• 3 Other Dis. of Locom, Sys •• 1 •• •• •• •• •• •• 1 1 •• 3— 15 Skin Disease. Ulcer, Bedsore •• •• •• •• •• •• •• •• •• •• •• •• Eczema 1 •• •• •• •• •• •• •• •• •• •• 1 Pemphigus 3 •• •• •• •• •• •• •• •• •• •• 3 Skin Disease, other •• •• •• •• •• •• •• •• •• •• •• Old Age •• •• •• •• •• •• •• 2 40 97 53 192— 196 Totals 786 373 112 146 181 225 293 309 384 270 83 3162 28 SPECIFIC INFECTIOUS OR ZYMOTIC DISEASE. The deaths from the chief specific disease, both notifiable and nonnotifiable, numbered 419, which is equivalent to a zymotic mortality of 1.9 per 1000 living, that for London for the same period being 1.7 per 1000 living, A. NOTIFIABLE INFECTIOUS DISEASE. Small-Pox.—During 1903 there were only four cases of this disease notified in the Borough, one of which was subsequently found not to be small-pox. Scarlet Fever.—The number of cases of Scarlet Fever notified in Hackney during 1903 was 676, but of these 40 were subsequently determined by the Medical Superintendents of the hospitals to which the patients were removed, not to be suffering from this disease. This makes the total number of genuine cases notified during the year 636, which is equivalent to an attack rate of 2.8 per 1,000 living persons. This shows an improvement upon the year 1902, when the cases notified numbered 869, and the attack rate was nearly 4 per 1,000 living. Of the 676 cases notified, 573 were removed to hospital. This is equal to 87.7 per cent. of the total. The chart given with this report shows this disease to have been prevalent during the whole year, the fluctuations in the incidence not being very marked. The following table also shows that the disease was pretty evenly distributed over the Borough, being, perhaps a little more marked in the central than in the remaining sub-districts. The following gives the number of genuine cases of scarlet fever notified in each sub-district with the attack rates per 1000 living persons. Sub-districts. North. Central. South-East. South-West. No. of Cases of Scarlet Fever. 153 196 144 143 Attack rate, per 1,000. 2.9 3.7 2.4 2.3 1903. Cases of Scarlet Fever, Diphtheria and Enteric Fever notified weekly. 29 The deaths from scarlet fever numbered 20 during the year. This is equivalent of 3.1 per cent. of those attacked, and .08 per 1,000 persons living. The number of cases of scarlet fever notified in the whole of London during 1903 was 12,531, and the death-rate was .08 per 1,000 living. Diphtheria and Membranous Croup.—During the year 1903 there were notified 533 cases of Diphtheria and 13 Membranous Croup in the Borough. Of these, 40 cases were afterwards, at the fever hospitals, found not to be cases of Diphtheria and 2 not to be Membranous Croup. The total number of genuine cases is, therefore, 507 Diphtheria and 11 Membranous Croup. The attack rate for diphtheritic disease for 1903 is 2.3 per 1,000 living persons. The following gives the numbers and rate of incidence of this disease in the different sub-districts. Sub-distriots. North. Central. South-East. South-West. No. of cases of Diphtheria. 60 138 209 100 Ditto ditto, Membranous Croup. 3 6 2 Total attack rate per 1000. 1.15 2.7 3.6 1.6 Of the total notifications, 420. were removed to hospital. This is equivalent to a percentage of 76.9. Diphtheria has been prevalent in the Borough the whole year, more so in the first half of the year than the latter half, and it has been more prevalent in the central and south-east parts of the Borough than elsewhere; but it has not been so prevalent as during 1902. The number of cases notified during that year was 673. The deaths from this disease numbered, during 1903, no less than 48, which is equivalent to a death-rate of 9.3 per cent. of persons attacked, and .21 per 1,000 persons living. 30 During the year 19 swabbings from the throats of persons suspected of suffering from Diphtheria were bacteriologically examined at the Lister Institute. Of these the Klebs-Loeffler bacillus was isolated in 7 cases, the results in the remainder being negative. Antitoxin serum was sold to medical practitioners to the number of 12 bottles during the year. The number of cases of Diphtheria and Membranous croup notified in the whole of London during 1903 was 7738, and the death-rate was "16 per 1,000 living. Typhoid or Enteric Fever.—During 1903, the incidence of this disease on the Borough was exceptionally high. The number of cases notified was 272, but of this number 25 were found subsequently not to be suffering from this disease, thus leaving the total of genuine cases of typhoid at 247. This is the largest number of cases notified in any one year since 1895 when 256 cases were notified. The attack rate is therefore equal to 1.1 per 1,000 living persons. The following table shows the number of genuine cases notified and the attack rate per 1,000 in each sub-district. Sub-Districts. North. Central. South-2aat. South-West. No. of cases of Typhoid 25 87 93 42 Attack-rate per 1,000 living .47 1.6 1.5 •69 It will be further seen that the greatest incidence of the disease was in the Central and North-East Sub-Districts. Of the total notified 219 were removed to hospital. This is equal to 88 per cent. The deaths from this disease during the year numbered 35 which is equivalent to a mortality of 141 per 1,000 attacked and .15 per 1,000 living persons. The number of cases of typhoid or enteric fever notified in the whole of London during 1903 was 2339, and the death-rate equalled .08 per 1000. 81 During the early part of the year until the end of the month of May, typhoid fever had been very low, but in the first week in June the notifications began to rise until in the third week 14 cases were notified. In the subsequent weeks, cases were not so prevalent. But in the first week in August another rise in the notifications took place, which reached in the last three weeks of August 15, 16, 16, the total in the three weeks being 47. After this the notifications diminished gradually to the end of the year, the decline being checked only by one rise in the first week in October. This last rise I have not been able to assign to any particular medium of infection, but the excess from the second week in June to the last week in August has formed a subject of a special report to the Public Health Committee of the Borough. This report will be found in the appendix. The Public Health Committee submitted the following report on this subject to the Borough Council. "Your Committee have received a report from the Medical Officer of Health for the Borough on an excess of enteric fever which occurred in the Borough during the months of June, July and August of this year, a period when the prevalence of this disease is usually below the average. The result of his investigations goes to show that the excess of enteric fever cases during the period in question was due to the consumption of sewage polluted watercress. It also appears that, judging from the investigations made in this Borough, a large part of the watercress supplied to the Metropolis is sewage polluted." "From the condition of things revealed by this report, your Committee are of opinion—" 1. "That the Local Government Board should be asked to make an enquiry as the sources of the watercrcss supplied to the Metropolis in relation to the possibility of this article causing disease." 2. "That copies of the report of the Medical Officer of Health should be forwarded to all the Metropolitan Borough 32 Councils and the London County Council, and that they be asked to support the applications made by the Borough of Hackney to the Local Government Board." 3. "That a copy of the report be sent to the County Borough of West Ham and their attention drawn to the manner in which watercress is grown in that Borough, and that they be requested to adopt such measures as may be necessary to ensure that such watercress shall be free from pollution." "Your Committee recommend accordingly." "(Report above referred to printed and circulated amongst the members)." This report was adopted by the Borough Council with the recommendations of the Public Health Committee, and the Local Government Board, the London County Council, the Metropolitan Borough Councils, and the County Borough of West Ham were communicated with in the terms of the report. I may here state the result of these communications. Of the 27 Metropolitan Boroughs beside Hackney 23 have replied, stating that they had resolved to support the application of the Borough Council. West Ham, and the other Boroughs have simply acknowledged the receipt of the communication. The Public Health Committee of the London County Council, in mediately on receipt of the communication, considered the report and reported thereon to the Council on the 8th of December, 1903 recommending:— "That enquiries be made by the Medical Officer of Health with regard to the condition of watercress beds in the County of London, and that he be instructed to extend his enquiries to sources outside the County from which watercress is supplied to London if it is found practicable to do so after a preliminary investigation." 33 The reply of the Local Government Board to the request for an enquiry may be gathered from the following extract from a letter received on this subject on December 19th, 1903. "In reply to the request of the Borough Council that this Board should cause an enquiry to be made as to the sources of the watercress supplied in the Metropolis in relation to the causation of disease, I am to state that the Board learn that the London County Council have had Dr. Warry's report under consideration, and have instructed their Medical Officer of Health to institute an enquiry into the subject." "In the circumstances it does not appear to be necessary for the Board to take any action with regard to it at the present time." Until the report of the County Medical Officer of Health is presented, nothing further can he done except to watch the incidence of typhoid in relation to the consumption of watercress. Typhus.—There was no case of this disease notified in the Borough during 1903. Continued Fever.—Five cases of fever were notified under this name during the year, one being in Central Hackney and four in the South-East Sub-districts. Two were removed to Hospital. There was no death recorded under this head during 1903. Puerperal Fever.—There was 21 cases of puerperal fever notified in the Borough during 1903. The deaths numbered nine which is equivalent to a mortality of 43 per cent of the cases notified. The attack rate is 3.4 per 1000 births and mortality 1.4 per 1000 births. Plague.—No case of plague occurred in the Borough of Hackney during 1903. 34 Erysipelas.—There were 280 cases of this disease notified in the Borough during 1903, which is equivalent to an attack rate of 1.2 per 1000 living. Of the total, 62 were removed either to the Infirmary or some general hospital. This is equal to a percentage of 22. Below is given a table showing the distribution of the disease in the Borough with the attack rate. Sub-districts. North. Central. South-East. South-West. No. of Cases of Erysipelas. 30 68 124 58 Bate per 1000 living. .57 1.3 2.1 .96 The deaths from erysipelas numbered 19 during the year. This is equal to a mortality of 68 per 1000 cases and .09 per 1000 persons living. B.—NON-NOTIFIABLE DISEASES. Influenza.—There were 27 deaths from this cause in the Borough during the year 1903. Of these, 18 were between the ages of 45 and 85. The mortality rate for the year is .12 per 1,000 living. The death-rate for London from the same cause is .13 per 1,000. Chicken-pox.—This disease was made notifiable in the Borough during the prevalence of small-pox. When this latter disease ceased to be prevalent chicken-pox was withdrawn from the list of notifiable infectious diseases. Up till and including the 7th of January, 1903, chicken-pox was notifiable, during this short period 46 cases were notified. After this date information of cases was afforded by Head Masters of Board Schools of scholars excluded from school owing to their suffering from this disease or coming from homes where cases of chicken-pox were said to exist. Of these I received 249 notices. 35 One death from chicken-pox is said to have occurred in the Borough during 1903. Diarrhœa.—This disease caused 117 deaths in Hackney during 1903, no less than 89 occurring under the age of one year. The annual mortality rate from this disease is therefore .39 per 1,000, that for all London being .64 per 1,000. In addition there were eight deaths from enteritis. Measles.—There were 111 deaths from measles in the Borough durng 1903. This is an increase upon the number of deaths during 1902, and is equal to a death-rate of .49 per 1,000 living. The deathrate from this cause during 1902, was .33 per 1,000, The deathrate for London for 1903 is .45 per 1,000. In order to obtain, if possible, some control over the spread of this disease the London County Council, early in the year 1903, passed an Order applying certain sections of the Public Health (London) Act, 1891, to this disease. The following is a copy of the Order as issued by the Council:— LONDON COUNTY COUNCIL. Measles. NOTICE IS HEREBY GIVEN that the London County Council, at a Meeting held on the 20th day of January, 1903, made the following Order:— The London County Council do hereby Resolve and Order that Sections 60, 61, 62, 63, 64, 65, 68, 69, 70, 72, 73 and 74 of the Public Health (London) Act, 1891, with respect to dangerous infectious diseases, shall apply to the administrative County of London, from and including 1st April, 1903, to the disease known as MEASLES. The Order has been duly approved by the Local Government Board. The following is a brief summary of the sections above referred to:— 36 Section 60 gives power to Sanitary Anthorities to require the cleansing and disinfection of infected houses or parts of houses and the disinfection or destruction of infected articles, and requires them to pay compensation for articles destroyed or for unnecessary damage caused by disinfection, and to provide free of charge temporary accommodation for the shelter of persons during the disinfection of their dwellings. Section 61 enables Sanitary Authorities to require infected bedding, clothing, or other articles to be delivered up to them for disinfection or destruction, and provides that they shall pay compensation for any unnecessary damage or for any articles destroyed. Any person failing to comply with a notice by the Sanitary Authority under this Section is liable to a fine not exceeding Ten Pounds. Section 62 prohibits persons from knowingly casting, or causing or permitting to be cast, infectious rubbish into ashpits without previous disinfection. Any person infringing the provisions of this Section is liable to a fine not exceeding Five Pounds, and to a further fine of Forty Shillings for every day during which the offence continues after notice of such provision has been served on the master of the house by the Sanitary Authority, which shall on his request provide for the removal and disinfection or destruction of the aforesaid rubbish. Section 63 prohibits persons, under a penalty not exceeding Twenty Pounds, from knowingly letting houses or parts of houses in which infected person have been lodging until such premises have been disinfected and until all infected articles therein have been disinfected or destroyed. For the purposes of this Section the keoper of an inn shall be deemed to let for hire part of a house to any person admitted as a guest into such inn. Section 64 provides that any person letting, or showing for the purpose of letting, a house or part of a house who knowingly makes a false statement as to a case of infectious disease being, or having within six weeks previously been therein, shall be liable to a fine not exceeding Twenty Pounds or to a month's imprisonment with or without hard labour. Section 65 provides for a penalty not exceeding Ten Pounds on persons ceasing to occupy infected houses or parts of houses without disinfection or notice of the previous existence of the disease to the owner or master of the house or part of the house or knowingly making a false answer to questions on the subject. 37 Section 68 prohibits, under a penalty not exceeding Five Pounds, the exposure of infected persons and articles without proper precautions against spreading disease. Section 69 prohibits, under a penalty not exceeding Ten Pounds, infected persons from carrying on any occupation in such a manner as to be likely to spread disease. Section 70 prohibits the conveyance of infected persons in public conveyances. The person responsible for such an offence is liable to a fine not exceeding Ten Pounds, and the driver of the conveyance is further liable to a fine not exceeding Five Pounds if, after conveying any such person, he fail to give notice to the Sanitary Authority and to have the conveyance disinfected. Section 72 prohibits, under a penalty not exceeding Five Pounds, the retention for more than forty-eight hours in a dwelling-room, sleepingroom and work-room, of the body of any person who has died of any infectious disease, unless such body is retained with the sanction in writing of a doctor. Section 73 requires, that in certain cases, the body of a person who has died in Hospital of an infectious disease shall be removed only for burial. Any person wilfully offending against this Section is liable to a fine not ex ceeding Ten Pounds. Section 74 prohibits, without previous notice to the owner or driver, the use of a public conveyance for carrying the body of a person who has died of an infectious disease, and requires the disinfection of the conveyance if so used. Any person offending against this Section is liable to a fine not exceeding Five Pounds, and to a further fine not exceeding Forty Shillings for every day during which the offence continues. G. L. GOMME, Clerk to the Council. Spring Gardens, S.W. 16th March, 1903. It is too early to estimate the effect of this Order upon the prevalence or the fatality of the disease. Of course, it has had an educational effect, not sufficiently strong enough perhaps to be measurable, but still sufficient in my opinion to have had some beneficial results. 38 Our only sources of information of cases of measles, in the absence of notifications, is the local Registrars returns of deaths, and the information from Head Masters of Board Schools, the latter of course comprising the larger number of cases. Prom these two sources we have received information from the 1st April to 1st December, 1903, of 1,623 cases of measles in the Borough. Whooping Cough.—There was a decline in the number of deaths from this cause during the year 1903 compared with the previous year. The deaths during 1903 numbered 66 but during 1902 they numbered 87, the death-rate for these years being respectively .29 and .39 per 1,000 living. Of the 66 deaths during last year, 61 were under 5 years of age. The death-rate for London for the same period was .35 per 1,000. Notices of the existence of cases of whooping cough in the homes of children attending the Board Schools of the Borough were received from Head Masters to the number of 188. CONSTITUTIONAL DISEASES. Tuberculous Disease.—During the year under review there were 409 deaths from this cause. The following are the heads under which the deaths were arranged:— Tuberculous Phthisis 134 Phthisis 122 General Tuberculosis 77 Tuberculous Meningitis 51 ,, Peritonitis 6 Tabes Mesenterica 11 Tubercle of other organs 409 The annual death-rate from tuberculous disease in the Borough is 1.8 per 1,000 living, the London mortality for phthisis is 16 per 1,000 living. Cancer.—There were 192 deaths from this cause in the Borough during 1903. This gives an annual death-rate of .85 per 1,000. 39 Below is given a table showing the number ot deaths from cancerous disease in the Borough during the 10 years ending 1903, with the annual death-rates compared with London. Years. 1893 1894 1895 1896 1897 189- 1899 1900 1901 1902 1903 Borough of Hackney. Deaths from Cancer. 160 157 153 138 164 199 200 190 182 190 192 Death-rate per 1000. .60 .70 .70 .64 .75 .90 .87 .86 .82 .85 .85 1 London. Death-rate per 1000. .80 .79 .83 .86 .88 .92 .95 .95 .93 .99 .87 VACCINATION. Below is given a copy of the latest return rendered by the Vaccination Officers respecting the vaccination of children in the Borough of Hackney. The return relates to the half year ending 30th June, 1903, The total number of births registered during this period was 3,143, those successfully vaccinated 1927, which is in the proportion of 61 per cent. of the total births. This is a further improvement upon the percentage of successful vaccinations for 1902. The proportion for the latter year was 54 per cent. If we deduct the successfully vaccinated and the deaths from the total births we see there are 928 infants during the half year which escaped vaccination, over 29 per cent. of the total births. The proportion of 29 per cent. of unvaccinated infants in the population is a standing danger. It must ultimately lead to another outbreak of small-pox unless some measures are adopted to secure a more complete vaccination of the infant and adult population. The number of certificates of conscientious objection received during the half-year in respect of those infants born during that period was 43. 40 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, 1902. 2 Number of these births duly entered by 31st January, 1903, in cols. I., II., IV. and V. of the " Vaccination Register" (Birth List Sheets) viz:— No. of these births which on 31st January, 1903, remained unentered in the "Vaccination Register " on account (as shown by Report Book) of No. of these births remaining on 31st January, 1903,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. Number of certificates of conscientious objections actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the half year ending 30th June, 1903. Col. I. "Successfully Vac'in'ted." 3 Column II. Col. IV. Number in respect of whom Certificates of conscientious objection have been received. 6 Col. V, Dead. Unvaccinated." 7 Postponement by Medical Certificate. 8 Removal to Districts, the Vaccination Officer of which has been duly apprized. 9 Removal to places unknown or which cannot be reached and cases not having been found. 10 "Insusceptible of Vac'in'ion." 4 "Had Small-pox." 5 North Hackney 535 343 5 — 10 35 21 — 79 42 29 Central Hackney 741 511 1 — 17 56 8 15 97 36 — South-East Hackney 930 462 1 — 9 101 22 15 150 170 65 South-West Hackney 937 611 2 — 7 96 6 70 109 36 — Total 3143 1927 9 — 43 288 57 100 435 284 94 Total for the period) of 1902 (1st Jan.V to 30th June). ) 3110 1698 11 — 17 308 78 74 387 557 57 41 PUBLIC HEALTH (LONDON) ACT, 1901. (a) Complain4ts.—During 1903 there were 2,826 complaints of nuisances received at the Public Health Department. These were all investigated by the respective Inspectors of the districts where the nuisances were said to exist. Notices of abatement were served where necessary. (b) House-to-House Inspection.—The number of these inspections made during 1903 was 493. These were made by the district Inspectors, as the pressure of infectious disease and complaints diminished. Naturally, the bulk of these inspections were made in the denser populated parts of the Borough, viz.: Homerton, Hackney Wick, and London Fields. Almost the whole of the nuisances found during the above inspections, viz., 2,778 were abated by means of an intimation notice only, 255 required the service of Statutory Notices and 14 legal proceedings for their abatement. The re-inspections made during the abatement of nuisances found reached the high figure of 30, 435. (c) Infectious Disease.—The number of houses inspected after infectious disease during the year numbered 2,369. The inspector in each case reported as to sufficiency of isolation at home, from which I was able to decide as to the desirableness of removal to hospital or not. The Inspector also examined the premises including the usual drain testing, to see if anything existed on the premises ealling for abatement under the provisions of the Public Health (London) Act, 1901. The number of rooms fumigated was 2,253, and those stripped of wall paper and cleansed 622, the number of articles taken to the 42 disinfecting station for steaming 16,949, and the persons sheltered at Millfields, while their homes were being disinfected, numbered 148. The disinfectants issued to applicants from the Public Health Department were 6,986 bags of sanitas powder of about one pound weight each, and 719 bottles of carbolic acid. The quantity of carbolic acid in each bottle was four ounces. The bottles were of the proper colour and marked "poison." The following quantities of disinfectants were also issued to the Surveyor's department during the year : Tons. cwt. qrs. lbs. Sanitas powder 2 11 — — Carbolic powder 7 4 — — Kuna pine blocks 2 10 — — Kuna pine (40 gallons) Carbolic acid (208 gallons) The cost to the Borough for disinfectants during 1903, was £255 11s. 8d.; the quantities of the several disinfectants ordered for the Public Health Department, being sanitas powder 15 tons, carbolic powder 8 tons, carbolic acid 200 gallons, Kuna pine blocks 50 cwt., Kuna pine liquid 60 gallons, kreasol 10 gallons, sulphur 1 ton. One remark further may be made on the subject of disinfectants, and that is, that by instruction of the Public Health Committee the dustmen, during the summer months, apply some deoderising powders to the dustbins after emptying them. This is very much appreciated by the public. Articles Seized Unfit for Food.—The following [articles were seized as unfit for food during 1903: viz., 19¾ cwt. fish, 20¾ cwt. fruit and vegetables, 9¼ cwt. meat. In addition to the above 2 trunks of plaice, 1 trunk whiting, 2 boxes of kipper herrings, 43 and 4 sacks of potatoes were certified as unfit for food and destroyed on the application of the owners of these articles. These certificates enable the owners to obtain the cost of the articles from the wholesale dealers. One prosecution took place during the year for exposing bad meat for sale, or meat intended for sale. The defendant was convicted and fined £5 and 2s. costs. DAIRIES, COWSHEDS AND MILKSHOPS ORDER. Cow-houses.—The licensed cow-houses in the Borough number 24, and the cowsheds 37. To these 290 visits of inspection were made during the year. The Inspector reports that on 5 occasions he has had to complain of excessive accumulation of manure on the premises, and on three of want of cleanliness of the premises during the year. He further adds, on the whole the general condition, considering the bad construction of the majority of the sheds, is fairly good. Dairies and Milkshops.—There are 118 dairies and 228 milkshops in the Borough. To these the Inspector made 1,025 visits during the year. On 13 of these occasions he found the measures or utensils on the premises were not properly clean. This is a very small proportion, and shows, according to the Inspector, an improved standard of cleanliness upon the previous year. In 41 dairies it was necessary to serve notices for repairs and limewashing. These notices were satfsfactorily complied with. During the year 32 milksellers were removed from, and 30 added to the register. Two contraventions of the Dairies, Cowsheds, and Milkshops Order were reported by the Inspector. Offnsive Trades.—We have only three registered premises included under this heading, viz.—a tallow melter, gut scraper and a tripe boiler. The Inspector paid 38 visits during the year to these premises. 44 Slaughter Houses.—There are 29 slaughter houses in the Borough. During 1903 the Inspector made 348 inspections of these premises. His visits were mainly on slaughtering days. During these visits the Inspector examined the carcases of 1,363 sheep, 10 calves, 144 oxen or heifers, and 6 pigs. He found the following parts diseased and had them destroyed as unfit for food: Oxen. 1 liver and skirt affected with Abscess 9 livers ,, Distomatosis 1 pair lungs ,, Tuberculosis 1 fore quarter lungs ,, ,, Liver and head ,, ,, Sheep. 2 livers affected with Distomatosis 1 ,, ,, Abscess 1 heart and lungs affected with Inflammation 1 heart, liver and lungs ,, Melanosis 2 livers ,, Parasitic cysts 1 liver and lungs ,, ,, Whole carcase and organs ,, Peritonitis and pleurisy „ ,, Pneumonia and dying when slaughtered. The periodical cleansing of the cowhouses and slaughter-houses was supervised by this Inspector. The Public Health Committee made an inspection of the cowhouses and slaughter-houses of the Borough on the 26th September, 1903. The general condition of both cow-houses and slaughter-houses was very satisfactory, the only nuisances found being the following:— Cow-house—Premises dirty, and large accumulation of manure. Slaughter-house.—Bell trap in yard. 45 TABLE. premises. NUMBER OF PLACES. Number of Inspections 1903. Number of Notices 1903. Number of Prosecutions. On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Milk premises 348 30 32 346 1025 1 Nil Cowsheds 37 .. .. 37 290 2 Nil Slaughter-houses 29 .. .. 29 348 1 Nil Other offensive trade premises 3 .. •• 3 38 •• Nil Smoke Nuisances.—During 1903, observations, lasting in duration from a half to one hour, to the number of 1,134 were made by the smoke Inspector. Intimations and statutory notices were served in 52 cases, and 4 summonses were applied for during the year. The following are the results : Two summonses heard, fines and costs amounting to £7 4s. being imposed; 1 case was adjourned sine die, and 1 dismissed with £2 2s. costs against the Council. Sec. 48 (2) Public Health (London) Act. Forty-two certificates of proper and sufficient water supply under the above section of the Public Health (London) Act, 1891, have been granted to the owners of new or rebuilt houses. These certificates refer to 143 houses, Byb-laws as to Houses let in Lodgings.—During 1903, there were 135 houses let in lodgings inspected, 20 in the London Fields District, and 135 in Hackney Wick. The chief defects noted and remedied were dirty rooms, passages, yard paving and dust-bins, CANAL BOATS ACTS, 1877-1894. The Inspector to whom the inspection of canal boats passing through this district is entrusted, and who, I may add, gives one day a week to this work, reports that he made 75 visits during the year 46 to the waterways, and inspected 96 boats. He found that 92 of these conformed to the acts and regulations, but that infringements were observed in four instances. The following are details of these infringements. Certificate did not identify owner 1 No certificate on board 1 Boat not marked 1 Boat required painting 1 No water vessel on board 1 These infringements were remedied on service of notices. The Inspector reports that these boats were occupied by men only. CUSTOMS AND INLAND REVENUE ACT, 1900. During the past year 19 applications were male by owners of tenement properties for certificates to secure exemption from Inhabited House Duty. The number of tenements comprised in these applications was 228. Certificates were granted in each case after any necessary works had been executed. HOUSING OF THE WORKING CLASSES ACTS. Towards the end of 1903 my attention was drawn to an insanitary group of houses situated off Well Street and known as Priory Place. I inspected this property and found some of the cottages very old, damp and dilapidated, and reported respecting them to the Public Health Committee in the following terms. To the Chairman and Members of the Public Health Committee, being the Sanitary Authority for the District of Hackney. Gentlemen, I beg to report to you, in pursuance of Section 32 of the Housing of the Working Classes Act, 1890, that on the 4th day of November last I inspected the dwelling houses situate 47 at, and known as Nos. 21, 22, 23 and 24, Priory Place, Well Street, within your district, also on 10th November last, N03. 14 and 15, Priory Place, Well Street, and of which Mrs. Taylor, 41, Queen's Road, Walthamstow, is the owner. I found such dwelling houses to be in a state, which, in my opinion, is so dangerous and injurious to health, that the said houses are unfit for human habitation. State of Dwelling Houses. 1. The walls are damp, the floors are below the ground level, and there is no through ventilation beneath the same. 2. There is insufficient through ventilation. 3. The water supply is insufficient, and the houses are generally decayed and dilapidated. I have the honour to be, Gentlemen, Your obedient Servant, J. KING WARRY M.D., etc., Medical Officer of Health. The Committee ordered notices to be served upon the owner to make the premises fit for habitation, and in default of so doing, that proceedings be taken against the owner to prohibit the use of the premises for human occupation. As it was really impossible to put these cottages in suitable condition without re-building, the owner preferred to close the same. Five of the six cottages are now closed, and the tenant of the sixth cottnge is under notice to quit. ICE-CREAM VENDORS. During 1903 a register was made of the ice-cream vendors in the district. As a result of enquiries we find there are 83 sellers of this article, 73 of them selling ice-creams in connection with pastry and sweets, and 10 only being barrow vendors. Besides these we found 48 6 vendors carrying on their trade in this Borough, but living in neighbouring boroughs. Notices were sent on notifying these cases to the Medical Officer of Health of the Borough concerned. At the time of writing the whole of the ice-cream premises are undergoing inspection. RIVER LEA. During the year 1903 the River Lea gained in some measure from the abnormal atmospheric conditions which prevailed during the summer of that year. The low temperature of the summer months, in spite of the large quantity of sewage matter poured into its backwaters, reduced putrefaction to a low point. The excessive and constant rainfall acted in the same beneficent way by constant flushing of the river branches. The total result has been an almost complete absence during the summer months of 1903. of any complaints of nuisance from the river. In my last year's Report I stated that a drainage scheme for the Lea Valley was under consideration. The matter now remains at a standstill, and will, no doubt, remain so, until hot and dry weather cause the river to resume its old offensive state. FLOODS IN THE CLAPTON PARK DISTRICT. The year 1903 was remarkable for its rain-fall. During this year no less than 36-84 inches of rain fell in the London area. While this on the whole appears to have had a beneficial effect upon public health, it has not been without some disadvantages. On the 13th June the fall of rain was so great that in certain parts of the Borough the sewers were surcharged and in one district where basements existed, sewage was forced back through gulleys in the basement areas flooding the living rooms on that level. The following is a list of houses so affected : No. 256, Millficlds Road—2ft. of water in cellar. Nos. 241 to 295, and 306 to 322, Glyn Road—Water under floors, through air bricks and over door sills. 49 Nos. 52 and 54, Overbury Street—Over 1ft. of water in back yard. Nos. 234 to 244, 248 to 252, 219 to 227, 233 to 235, Rushmore Road—Water under floors through air bricks and over door sills. Nos. 1, 6, 11 to 31, 47 to 55, 10 to 14, 18 to 50, Oswald Street— Water under floors through air bricks in front. Nos. 10, 12, 14, 16, 17a, 19a, 21a, 23a, 25a, 29a, 27, 23, 25, 17,15, Maclaren Street—Water under floors through air bricks and over door sills, Notices were served upon the owners to abate the nuisance. The Borough Council also sent help to remove the sewage-polluted soil beneath the floors of the rooms flooded. The amount expended by the Council in the relief work was £166 6s. 5d. In addition to calling upon the owners of the affected premises to abate the immediate nuisance and rendering them assistance as above stated, the Public Health Committee presented the following report to the Borough Couucil on the subject. "The attention of your Committee has been called by the Medical Officer of Health to the recurring flooding of houses in Maclaren and other streets, Clapton Park, caused by the insufficient capacity of the London County Council's sewer draining that district." "The Medical Officer of Health reports that the floodings, which have occurred not more, on an average, than once a year in the past, have since June last recurred no less than seven times. After each flood steps have been taken to remove the sewage, etc., from these premises, to prevent injury to the health of the inmates of the houses affected, but these efforts have not been successful. He has expressed the opinion that the recurring floods are prejudically affecting the health of the inmates of these premises, and under these circumstances they are unfit for habitation, and advises that legal steps should be taken to obtain closing orders for these houses." 50 "The attention of the London County Council has been called from time to time to the necessity of adopting some measures to prevent these disastrous floodings, but without result." "Your Committee therefore recommend that a communication be forwarded to the London County Council, again calling attention to the matter, and urging that body to at once deal with this important question, and undertake such work as they may be advised is necessary to prevent their sewers becoming surcharged and overflowing during the periods of heavy rainfall." "All which is respectfully submitted." EDWIN REYNOLDS, Chairman. The London County Council were communicated with in the terms of the above report, and a remedy suggested which I made in my Annual Report for the year 1897, reporting upon similar floodings of basements in the lower part of the Clapton Park district. I there made the following statement. "The remedy, of course, is an engineering one, which can only be applied by the London County Council. The time is opportune for drawing their attention to this matter, because they are considering a scheme for the relief of Hackney Wick, and some modification of this scheme to relieve Clapton Park might now be made more easily than at a later period; and I would most strongly urge that their attention should be called to this area, and be asked tc improve, if possible, its sewage arrangements to prevent the recurrence of similar floods to that noted above." I am given to understand that some scheme is now being formulated to remedy the floods in this district. In a report of the main drainage Committee of the London County Council presented on the 4th February, 1904, recommending measures for the prevention of future floodings, occurs the following paragraph:— 51 EXTENSION OF HACKNEY WICK RELIEF SEWER. "The north-eastern part of Hackney, including Upper and Lower "Clapton, is at present drained by means of the northern high level "sewer and the Marsh sewer, but as the latter sewer is in a very "defective state and incapable of efficiently disposing of the storm "water from the district draining into it, it is proposed that the "Hackney Wick relief sewer should be extended northwards from "its present termination near Gainsborough Road. The Engineer "estimates that the cost of carrying out this extension will amount "to about £70,000." It will be seen from the above that the London County Council have at last taken in hand the problem of preventing the flooding of basements in Clapton Park. (I may here add that I reported fully on this matter in 1897 and urged that immediate steps should be taken to provide a remedy.) OVERFLOW OF RIVER LEA. Another result of the excessive rain of last year was the overflow of the River Lea. This occurred several times last year; but the most disastrous occurred on the night of the 18th June, when the river overflowed its banks and inundated the surrounding districts, invading the houses on the west side of the river, the water reaching half way across the North Mills Fields. The marshes on the east side of the river was also entirely covered by water. The following are particulars of the houses flooded in the Lea Bridge and Upper Clapton districts The ground floors of the following list of houses were entirely covered by water to the various depths, and the occupiers compelled to retreat to the upper rooms. 5 Middlesex Wharf Depth of water 1ft. 6in. 6 „ „ „ 7 „ „ „ 8 „ „ „ 9 „ „ „ 52 10 Middlesex Wharf Depth of water 2ft. 0in. 11 „ „ „ 12 „ „ „ 13 „ „ „ 14 „ „ „ 15 „ „ „ 16 „ „ „ 17 „ „ „ 18 „ „ „ 19 „ „ „ 21 „ Depth of water 1ft. 0in. 22 „ „ „ 23 „ „ „ "Jolly Anglers" Public House Depth of water 2ft. 0in. "Water entered the above houses about 12 o'clock midnight. Hammond's Cottages West—Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10— Water entered houses about 12 o'clock midnight, and rose to about 2ft. 0in. Hammond's Cottages East—Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Hammond's Villas—Nos. 1 and 2. Pleasant Place—Nos. 1, 2, 3, 4, 5. Dock Side—Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. "King's Head" Public-house. Megg's Boat House. Upper Clapton District— Retreat Cottages—Nos. 1, 2, 3, 4, 5, 6, 7, 8—Water entered houses between 11 and 12 p.m., and rose to a height of 12 in. Willow Cottages—Nos. 1, 2, 3, 4, 5, 6, 7. Laburnham Cottages—Nos. la, 1, 2, 3, 4, 5, 6, 7, 8, 9,10,11,12. June 17th—The water has increased in depth by 2in., and is apparently still rising. 53 In my Annual Report for the year 1897, I dealt at length with this subject of the overflow of the River Lea, and remarked inter alia respecting the cause of the flooding: "Considering the whole of these circumstances it is probable that the embanking of the Hackney Marshes by the London County Council was instrumental, to some extent, in bringing about the flooding of the houses on the west bank of the river referred to above, but, I am of opinion that the other works referred to, and carried out by the East London Water Company and the Lea Valley Drainage Commissioners were also to a similar extent responsible." "It is obvious that the waters of a river, which during heavy rains is accustomed to overflow its banks, and flood low lying lands, will, if the banks are raised, rise considerably during such times and probably overflow other parts, if the water cannot get away fast enough by the natural channel of the river." "Endeavours are being made to reclaim from the river such of the low lying lands as are capable of being utilised. This is especially the case in our district. We may then confidently anticipate that the flooding of the houses named above which hitherto has been a rare event, will become more frequent; and the object of recording this event is to consider what, if any, remedy can be applied to prevent the recurrence of floods to the detriment of inhabited houses in this district." "It is clear that the reclaiming of low lying land near the river, and its utilisation cannot be stopped; so the problem to be solved is how to allow) storm waters to pass rapidly enough away to prevent the flooding of inhabited houses on the river banks." 54 "The first suggestion is to raise that part of the river bank adjacent to the dwellings; or, if this is not practicable, to construct some channel of relief to be used during the times of flood; but the remedy is really an engineering work, and properly, should be proposed by such an expert." "As to who should undertake this work, I would suggest that the Lea Drainage Commissioners, who have already done similar work in other parts of the Lea, and apparently with good results, should be re-appointed, under a new Act of Parliament, if necessary, to carry out the work of preventing floods from the Lea in this district." These remarks are as applicable now as in the year 1897. Some measures should be adopted to prevent these disastrous floods. Perhaps the newly constituted Lea Conservancy Board have power to deal with this matter. FACTORY AND WORKSHOPS ACT, 1901. In my last year's report I gave the total number of workshops on the register. Recently I have had the register carefully revised, and find that a large number of the workshops have ceased to be used as workshops, and a few more have been added to the register. The figures now available are fairly accurate. Workshops.—The number of workshops registered in the Borough in which articles of wearing apparel are manufactured is 623, and where other articles are manufactured 290, a total of 913. The following is a list of these two classes of workshops with the occupations carried on therein:— 55 ANALYSIS OF OCCUPATIONS CARRIED ON IN THE REGISTERED WORKSHOPS OF HACKNEY. (a) Wearing Apparel. Occupations. No. of Workshops. Occupations. No. of Workshops. Boot and Shoe Mauufacturer 111 Shirt Makers 8 Baby Linen 3 Fur Trimming 1 Fall Net Chenilling 1 Mantle Makers 59 Blouse Makers 35 Tailoring 11 Millinery 13 Garabaldi Makers 1 Embroidery 1 Artificial Flower Makers 5 Collars 3 Boot Machinists 52 Pianafores 4 Dressmakers 129 Skirts 10 Underclothing 19 Trimmings 2 Fancy bows on shoes 4 Costumers 2 Furriers 27 Beading 3 Infants' Millinery 10 Waterproofs 2 Tie Making 79 Gloves 1 Stay Makers 4 Belts 1 Waistcoat Makers 11 Children's Costumes 11 Dressing and Tea Gowns 6 623 Hat Manufacturer 3 (B) Other Occupations. Occupations. No. of Workshops. Occupations. No. of Workshops. Cabinet Making 51 Pianofortes 11 Trunk and Bag Makers 2 Upholsterers' Trimming 3 Box Makers 9 Doll Manufactures and Dressers 6 Upholsters 3 Toy Makers 2 Fancy Leather 4 Rubber Manufacturer 1 Laundries 118 Confectioners 16 Miscellaneous 57 Skin Dressers 1 Bookbinders 2 290 Brushes 4 Of the workshops and places where wearing apparel is manufactured or altered, there are 523 where females alone are employed, 91 where males and females are employed, 29 where males alone are employed. In addition to the above there are 77 domestic workshops employing females alone. In the workshops and places of other occupations females alone are employed in 132, males alone in 104 and both sexes in 54. Of both classes of workshops and places (a and b) 635 employ females alone, 133 males alone and 145 both sexes, and 77 domestic workshops employ females alone. During the year the following notices and complaints were received from the Factory Inspector. NOTICES AND COMPLAINTS RECEIVED FROM H.M. INSPECTORS OF FACTORIES DURING 1903. Complaints—Factory 1 „ Workshops 26 Notices—Factories 5 ,, Workshops 87 During the year Miss Teebay made 135 first visits to workshops where females were employed and 1,440 visits of reinspection. During these visits nuisances were found on 312 of these premises, 212 being dealt with by Miss Teebay, and the remainder by the male Inspectors. In three instances the nuisances were not abated without instituting proceedings at the police court. The following list of work was done under the supervision of Miss Teebay: Workrooms cleansed128 Workrooms, the ventilation of which was improved 36 Abatement of overcrowding in workrooms 17 Defective condition of wc's, yards, guttering, rainwater pipes, floors, roofs and dust bins remedied 84 57 The male Inspectors inspected 58 workshops where males were employed and dealt with 72 other workshops reported by Miss Teebay, as requiring attention. Any nuisances found were] abated by the service of the usual notices. HOME-WORK AND HOMEWORKERS. The following is the total number of outworkers on the register. Total outworkers on the register 1736 (a) Outworkers whose addresses were obtained locally from employers 828. (b) Outworkers whose addresses were forwarded by other local authorities, 908. The following analysis shows the trades followed by the outworkers comprised under (a)— Trade. No. of Outworkers. Trade. No. of Outworkers. Boots and Shoes 362 Skirts and Mantles 137 Ties 41 Blouses 57 Millinery 52 Underclothing 39 Fur Trade 12 Trimming 1 Tailoring 5 Collars 6 Pinafores 1 Shirts 54 Upholsterer's Trimmings 4 Baby linen 10 Gloves 2 Net Chenilling 2 Shoe Bows 34 Corsets 3 Costumes 6 828 58 The following analysis shows the trades followed by the outworkers, comprised under (b). Skirts and Mantles 38 Collars 9 Box Manufacturers 3 Furriers 13 Drapers 12 Boot Manufacturers 144 Pinafores 9 Blouses 82 Children's Costumes 12 Dry Cleaners 3 Outfitters 36 Shirts 24 Ties 147 Baby Linen 5 Underclothing 45 Artificial Flowers 8 Clothiers 67 Hats and Bonnets 10 Dressing Gowns 6 Millinery 36 Tailoring 79 Trimmings 27 Waistcoats 5 Slippers 5 Miscellaneous 19 Trade not stated 64 908 The local authorities from which we have received names and addresses of outworkers during the last year are the following:— City of London 265 Bermondsey 2 Finsbury 288 Chelsea 2 Islington 89 Hampstead 4 Shoreditch 38 Paddington 4 Bethnal Green 80 Southwark 4 Poplar 17 St. Pancras 4 Marylebone 8 Tottenham 21 Leyton 15 Woolwich 1 Camberwell 2 Walthamstow 2 Stoke Newington 31 Hull 1 Stepney 28 Manchester 1 Holborn 1 908 59 On examination of the lists of outworkers supplied to the local authority by the employers we found the names and addresses of 845 who were residing in other districts. These were sent on to their respective local authorities. The following is a list of such local authorities with the number of outworkers whose names and addresses were forwarded. LIST OF OUTWORKERS FORWARDED TO OTHER BOROUGHS DURING 1903. Bethnal Green 236 West Ham 22 Stepney 50 Finsbury 8 Tottenham 51 Walthamstow 54 Camberwell 28 Islington 87 Lewisham 1 Deptford 8 Uxbridge 1 Southwark 9 St. Pancras 3 Edmonton 8 Bermondsey 6 East Ham 1 Leytonstone 9 Croynon 1 Wood Green 1 Hampstead 2 Greenwich 2 Willesden 2 Woolwich 1 Southgate 1 Shoreditch 139 Poplar 49 Leyton 17 Stoke Newington 32 Wandsworth 4 Hornsey 6 Hammersmith 1 Lambeth 5 845 With respect to the inspection of outworkers premises, Miss Teebay was able during the year, in addition to her work of workshop inspections, to deal with 139 outworkers premises. Of these 11 were found dirty, 4 dilapidated, 5 had defective roofs, 7 had defective w.c's., 3 defective dust-bins and 3 improperly paved yards. I stated in my annual report for 1903 that in order to ensure the inspection of outworkers premises it would be necessary for the Borough Council to employ another female Inspector. The attention 60 of the Borough Council was drawn to this point by the London County Council during 1903, but without result. Immediately after the election of the new Council in November, 1903, the question was again brought before the Public Health Committee which forthwith recommended to the Borough Council the appointment of an additional female Inspector. This recommendation was approved of by the Council. The officer has now been elected and will soon begin her duties of inspection of outworkers premises. Bakehouses.—The Public Health Committee of the Borough considered early in the year the principles which should guide them in granting certificates of suitability for underground bakehouses under Sec. 101 (2) Factory and Workshop Act, 1901, and finally approved of the following which I recommend in my report on that subjected February, 1903. FACTORY AND WORKSHOP ACT, 1901. Conditions to be observed in underground bakehouses in the Borough of Hackney in order to be certified by the local authority as suitable. (a) Construction.—No underground bakehouse shall be less than 7 ft. 6 in. in height, measured from the floor to the ceiling, nor have a cubic capacity less than 1,000 cubic feet. The walls and floor must be constructed of hard material impervious to damp. The ceiling must be even, impermeable to damp and dust. (b) Light.—The bakehouse should be well lighted by windows opening directly into the outer air or into well lighted areas so that an official copy of the abstract of the Factory Act may be read all the year in all parts of the bakehouse between the hours of 11 a.m. and 3 p.m. 61 (c) Ventilation.—This should be sufficient, and the air supplied should be drawn directly from the outer air in such a way as to exclude street dust or dirt. (d) All other respects.—1. There should be suitable and safe means of access to the bakehouse. 2. The store for flour should be separate from the bakehouse and properly ventilated and lighted. 3. Troughs should not be fixed, but movable and provided with castors or rollers. Of course all other statutory requirements must be observed. The conditions must be observed to the satisfaction of the Medical Officer of Health. During the year 1903 many of the bakers of the district set about altering their underground bakehouses to comply with the above standard of suitability. There are 69 underground bakehouses in the Borough of Hackney, and at the time of writing the Public Health Committee has granted certificates of suitability to 54 of these. In one or two cases the Committee allowed the use of the underground bakehouses without certifying the same for periods of one to three years, at the end of which periods the owners undertook to give up the use of the underground bakehouses and provide above-ground bakehouses. I may here add that 7 underground bakehouses have been closed during 1903. There still remains a few underground bakehouses where the alterations, necessary to obtain a certificate of suitability, are now proceeding. 62 The 53 above-ground bakehouses were inspected during 1903, and any defects found were remedied on service of notice by the local authority. The following is a list of the underground bakehouses for which certificates of suitability have been granted, together with a list of the improvements made in these bakehouses. LIST OF WORK CARRIED OUT AT THE SEVERAL UNDERGROUND BAKEHOUSES IN THE BOROUGH OF HACKNEY UNDER THE PROVISIONS OF THE FACTORY AND WORKSHOP ACT, 1901 (SECTION 101). 117, Lower Clapton Road.—Wall scraped, stopped and painted; light and ventilation improved by the construction of a skylight; cleaning and glazing; troughs fitted with wheels. 71, Lower Clapton Road.—Walla rendered and distempered; existing windows cleaned and painted ; ledge over oven Bloped; floor repaired and levelled; troughs fitted with wheels. 26, Downs Road.—Walls scraped, rendered and painted; windows—skylight provided over bakehouse and window between store and bakehouse; trough fitted with wheels. 50, London Road.—Wall scraped, rendered and painted; floor lowered 18in. and paved; new ceiling provided; door, window and solid wall provided between bakehouse and store ; troughs fitted with wheels. 393, Mare Street.—Walls scraped, rendered and painted; floor lowered and re-paved; ceiling cleansed and painted; front of oven faced with glazed brick; windows provided on 63 aide of bakehouse; ventilation improved; area in front covered with pavement light and cleansed; trough fitted with wheels. 134, Sandringham Road.—Walls scraped, rendered and painted; wood floor removed and concreted floor provided; slope and prism light provided over oven; window provided between bakehouse and store; ventilation improved; cleansing to store and passage; trough fitted with wheels. 240, Dalston Lane.—Walls scraped, rendered and painted ; slope and window provided over oven; drain inlet in store altered; floor lowered and repaved; door between bakehouse and store provided; door to coal cellar provided; troughs fitted with wheels. 144, High Street, Kingsland.—Walls and ceiling rendered and whitened; new concrete and cement floor; new door to coal cellar; trough fitted with wheels; new prism foot light in pavement; new stall-board lights made to open for ventilation; one new glazed sash at rear of bakehouse for light and ventilation; store room separated from bakehouse, with partition partially glazed; walls and ceiling rendered; new concrete and cement floor; new glazed skylight at rear. 128, Stoke Newington Eoad.—Walls and ceilings rendered and whitened; new concrete and cement floor in place of old wood floor; new prism light on pavement in place of old light; new stall-board lights made to open for ventilation; door to coal celiar; troughs fitted with wheels; store room separated from bakehouse with partition partially glazed; walls and ceiling rendered; new wood floor over stone slabs; improved light and ventilation; woodwork painted. 64 58, High Street, Stoke Newington.— The ovens removed from front and built under yard at rear; new glazed lantern light at rear made to open for ventilation; walls and ceiling rendered and whitened; woodwork painted; troughs fitted with wheels; new coal cellar formed with door; new glazed sash in passage wall for light; floor repaired; store room separated from bakehouse and placed in front where the old oven was formerly placed; new partially glazed partition; walls and ceiling rendered and whitened; new concrete and cement floor; new stall-board light made to open for ventilation; improved light from pavement light with glazed tiles; all woodwork painted. 176, High Street, Stoke Newington.—Walls rendered and whitened; new ceiling provided; trough fitted with wheels; floor repaired; improved light, with panes of glass let into floor ; store-room cleansed and whitened. 239, Amhurst Eoad.—Walls and ceiling rendered and whitened; improved light and ventilation with new lantern light at rear; troughs fitted with wheels; new store cupboard erected in flour store. 33, Rectory Road.—Walls and ceiling rendered and whitened; lantern light (old) repaired and painted; door to coal cellar refitted; store room—a portion of shop floor removed, and new glazed stall-board lights made to open for ventilation, also two small iron ventilators fixed in same. 74, Oldhill Street.—Light and ventilation improved; troughs put on castors. 8, Cazenove Road.—Light and ventilation improved ; walls and ceiling rendered and whitened ; floor concreted ; troughs put on castors. 65 74, Fountayne Road.—Light and ventilation improved; bakehouse partitioned off from flour store; walls and ceilings rendered and whitened; floor concreted; troughs put on castors. 142, Victoria Park Road.—Ceiling lathed and plastered; walls rendered with sand and cement; light and ventilation improved; oven front renewed with glazed bricks; alteration to coal cellar; troughs put on castors; flour store formed separate from bakehouse; store walls rendered with sand, and cement, and ceiling painted. 106, Gore Road.—Ceiling lathed and plastered, walls rendered with sand and cement; light and ventilation improved under stall-board; alteration to coal cellar; new flour shed built in yard, stairs repaired. 79, Lauriston Road.—Walls rendered with sand and cement; floor lowered and concreted; oven front renewed with glazed bricks; light and ventilation improved; troughs put on castors; new flour store built. 13, Loddiges Road.—Ceiling lathed and plastered; walls rendered with sand and cement; light and ventilation improved under stall-board; floor lowered and concreted; alteration to coal shed; troughs put on castors; flour store repainted; ceiling repainted; windows fitted to separate store from bakehouse. 34, Church Road, Homerton.—Twelve inches of soil excavated over floor service to obtain the necessary height of storey ; floor relaid with nine inches of concrete, and trowelled off with granite chips; walls properly prepared and plastered with Keen's cement trowelled to a fair surface; ceiling painted three coats in oil; stallboard of shop front altered and fitted with new fanlight for lighting, and properly hung for ventilation purposes; 66 glass door and frame fitted to opening from bakehouse leading to store-room; store-room floor repaired; half glass door fitted to the store in rear; small area, white, tiled. 68, Lansdowne Road.—Walls rendered in sand and cement and whitewashed, and the portion round ovens rebuilt with glazed bricks; floor lowered and concreted; lighting and ventilation increased and improved; new hot water apparatus fixed; ceiling brought to an even surface and whitewashed, all woodwork painted with three coats of oil colour; flour store reconstructed, lighted and ventilated; castors fixed on troughs. 81, Wilton Road.—Walls round ovens rebuilt with glazed bricks; the other walls painted down with oil color; floor lowered and concreted; lighting and ventilation increased and improved; new hot water apparatus fixed; castors fixed on troughs; all woodwork painted with oil colour. 178, Dalston Lane.—Walls rendered and whitewashed; floor lowered and concreted; lighting and ventilation increased and improved; new hot water apparatus fixed; castors fixed on troughs; ceiling whitewashed; all woodwork painted. 25, West Side, London Fields.—Glazed bricks and tiles fixed round oven; the other walls rendered and whitewashed; floor repaired; lighting and ventilation increased and improved; woodwork renewed and painted; new hot water apparatus fixed; floor of flour store concreted; castors fixed on troughs; ceiling brought to an even surface and whitewashed. 69, High Street, Kingsland.—Walls round ovens rebuilt with glazed bricks; floor of front bakehouse lowered and repaved ; new hot water tanks fixed in each bakehouse; 67 lighting and ventilation improved in front bakehouse; castors fixed on troughs; walls and ceilings whitewashed; and woodwork painted. 88, High Street, Kingsland.—Floor lowered and concreted; lighting and ventilation increased and improved; walls rendered and whitewashed; ceiling painted; castors fixed on troughs; walls, floor and ceiling of flour store renewed ; all woodwork painted. 107, High Street, Kingsland.—Walls rendered and whitewashed; lighting and ventilation increased and improved; castors fixed on troughs; all woodwork painted; ceiling whitewashed; new hot water apparatus fixed; roof of flour store repaired. 103c, Dalston Lane.—Floor lowered and concreted; new ceiling; walls rendered and whitened; lighting and ventilation increased and improved; woodwork painted down ; new flour store built; castors fixed on troughs. 28, John Campbell Road.—Floor lowered and concreted; walls and ceiling renewed and whitened; lighting and ventilation increased and improved; woodwork painted down; castors fixed on troughs; close fitting cover provided to cistern" walls of flour store rendered and whitened. 70, Broadway, London Fields.—New plaster ceiling put up in bakehouse; walls rendered to a smooth surface; new flour store formed, and walls rendered; improved light and ventilation ; troughs put on castors ; new hot water apparatus fixed; stairs enclosed with woodwork ; all woodwork repainted. 26, West Street.—Ceilings of bakehouse and flour store renewed; walls rendered to a smooth surface; light and ventilation improved; oven front reinstated with glazed 68 bricks; troughs put on castors, and woodwork repainted; new stone steps provided; new cement floor to bakehouse; new hot water apparatus; new coal cellar formed. 27, Morning Lane.—Ceiling of bakehouse, and all woodwork re painted; walls rendered to a smooth surface; light and ventilation improved; troughs put on castors; ceiling repaired in flour store and walls whitened; close fitting cover to boiler; new door to coal cellar. 77, Frampton Park Road.—Ceiling of bakehouse repaired and whitened; bakehouse enlarged by removal of partition walls rendered to a smooth surface; floor repaired where necessary; oven front reinstated with glazed bricks; light and ventilation improved; all woodwork repainted; troughs put on castors; close fitting cover to boiler; new cement floor to flour store. 101, Mare Street.—Ceiling of bakehouses repaired and whitened; bakehouse walls rendered and whitened; floor repaired where necessary; light and ventilation improved; flour store cleansed and whitened; all woodwork re-painted; troughs put on castors. 200, Lower Clapton Road.—Flour Store—Portion of bakehouse divided off by a brick partition to form flour store; lighting improved; window in stall-board removed and replaced by a new iron framed light 4 ft. 2 in. x 1 ft. 10 in.; wall plastered and rendered smooth with granolithic plaster, and lime whitened; ceiling cleansed and lime whitened; passage leading to yard and w.c. shut off by partition with glass panelled door with vent grating over outer door; front of oven rendered with white glazed bricks; troughs put on castors. 18, Upper Clapton Eoad.—Lighting improved by fixing three new casement lights in stall-board, and the three casements made to open; new light fixed in wall of flour 69 store; lath and plaster partition at foot of stairs in bakehouse removed and doors fixed at entry to bakehouse and lobby; walls plastered and rendered impervious, and limewhitened; ceiling repaired and lime-whitened; troughs put on castors; ceiling and walls of flour store cleansed and lime-whitened. 550, Kingsland Eoad.—Walls and ceiling rendered and painted; troughs put on castors. 174, Southgate Road.—Walls and ceiling rendered and whitened; lighting and ventilation improved; cement floor re-laid; coal cupboard properly parted off from bakehouse; troughs put on castors. 322, Kingsland Road.—Walls and ceiling rendered and whitened; floor lowered one foot and cemented; lighting and ventilation improved; flour store parted off from bakehouse; coal cupboard parted off from bakehouse; troughs put on castors. 48, De Beauvoir Road.—Walls and ceiling rendered and whitened; flour store parted off from bakehouse, and lighting of same improved; coal store parted off from bakehouse; troughs put on castors. 106, Hertford Road.—Walls and ceiling rendered and whitened; floor of bakehouse lowered one foot and cemented; gully in flour store removed to outside of premises; lighting and ventilation improved; coal store parted off from bakehouse ; troughs put on castors. 72. Dalston Lane.—Walls and ceiling rendered and whitened; floor lowered one foot; troughs put on castors; lighting and ventilation improved. 207, Queen's Road.—Walls and ceiling rendered and whitened; flour store parted off from bakehouse and ventilated; 70 lighting and ventilation improved; troughs put on castors ; door provided to coal cellar. 131, High Street, Homerton.—Walls of bakehouse rendered and painted; floor lowered and made good; increased light obtained from stall-board and glazed tiles to walls of area; ventilation improved by window in partition between bakehouse and flour store; troughs placed on castors; door fitted to coal cellar. 167, High Street Homerton.—Walls of bakehouse rendered and painted; fibrous slabs fixed to ceiling of bakehouse; floor lowered and concreted; flour store separated from bakehouse by a partition; troughs placed on castors. 215, Glyn Road.—Walls and ceiling rendered and distempered; floor concreted, height—7 ft. 6 in., obtained by excavation; doors provided between store and bakehouse; ventilation obtained from under the stall-boards ; castors put on troughs. 36, Chatsworth Road.—Ceiling and walls distempered and rendered; windows renovated generally; paving renewed; door to coal cellar provided; ovens faced with glazed bricks. 19, Chatsworth Road.—Ceiling distempered ; walls distempered and rendered; door provided between store and bakehouse. 138, Chatsworth Road.—Lighting improved by fixing extra casement in flank wall with pavement light (casement 2 ft. 3 in. x 2 ft. 9 in.); panels in door at rear removed, and one glass panel fixed in each door; ventilation improved; casements (three) in stall-board; fanlight over door and doors made to open; walls plastered and ceiling lime whitened; walls painted. 71 182, Chatsworth Road.—Additional light fixed in flour store; ventilation improved; three casements made to open in stall-hoard; flour store formed by dividing off back portion of bakehouse; glass panelled partition fixed; floor of bakehouse excavated and lowered to height 7 ft. 6 in. Space under show-board of shop matchboarded; walls and ceiling plastered and lime-whitened. 94, Chatsworth Road.—Ventilation improved; the two casements in stall-board, and fanlight over door made to open; walls and front of oven plastered and painted; ceiling lime-whitened; all woodwork painted; flour stored in separate room at side of bakehouse; troughs on castors. 52, Mandeville Street.—Ventilation as before, with exception of air-shafts over oven made 6 in. square; match board portion of ceiling removed, and lath and plaster substituted; walls plastered and lime-whitened. 186, Well Street.—Walls rendered and ceiling whitened; castors put on troughs; improved light to store. 72 DISINFECTION. During the year 1903 there were 2253 rooms fumigated and 622 cleansed by the officers of the Public Health Department after infectious disease. The number done each month may be seen from the following table. Number of rooms fumigated and cleansed each month during 1903. Month. Rooms Fumigated Rooms Cleansed. Remarks. January 210 60 The method of fumigation is by burning sulphur. After fumigation, the rooms to be cleansed are strip ped of their wall paper and cleansed with solution of carbolic. The ceilings are afterwards whitened. February 150 38 March 122 46 April 182 37 May 302 66 June 280 60 July 180 57 August 105 55 September 156 49 October 164 60 November 178 55 December 164 39 Total 2,253 622 73 It may be of interest to give here an account of the cost to the Borough of this fumigation and cleansing. For fumigation two men are employed whose total wages amount in the year to £175 2s. 3d. The material, such as sulphur, etc., and apparatus etc., £18 4s., the total cost being £193 6s. 3d. which works out at a little over 1s. 8d. per room for fumigation. The number of rooms cleansed after infectious disease during the year amounted to 622, the wages of cleansers and materials to £327 9s. 3d. This amounts to a cost of a little over 10s. 6d. per room cleansed. This appears to be a high price for cleaning a room; but the advantage of having a direct control over the cleansing more than makes up for any slight excess in the cost. The articles disinfected at Millfields station during 1903 numbered 16,949. The details are given in the table below. With respect to the cost of this disinfection, which, by the way, is effected by means of high pressure steam, I find the total amount expended during 1903 for this purpose was £496 15s. 7d. This includes the wages of four men, the keep of a horse, repairs to station and machinery, coals and stores. This amounts to about 4½d. per article. This is not a large amount considering that the most of the articles are of large size. In addition to the disinfection of these articles, many infected household things as well as clothings were destroyed at the request of the owners. The following is a list of such articles:— Beds 30 Mattresses 24 Bolsters 12 Pillows 16 Palliasses 14 Sheets 8 Blankets 12 Quilts 4 Cushions 14 Articles of Clothing 06 Miscellaneous 51 Total 251 74 Articles Disinfected during the Year 1903. Description of Articles. January February March April May June July August September October November December Total. HOUSE LINEN. Beds (feather, flock, wool) 100 90 83 103 123 108 98 123 117 123 93 95 1256 Bed Vallance 6 1 5 1 2 1 11 3 6 36 „ Covers 24 7 11 18 7 7 10 6 2 3 13 108 „ Furniture 8 3 11 Blankets 302 149 167 166 219 149 128 149 163 139 155 172 2058 Bolsters 101 61 66 75 91 92 77 98 86 96 88 74 1005 Box Covers 1 1 Carpets 1 2 9 2 7 7 2 2 6 2 2 4 46 Chair Bed Cushions 25 26 26 45 34 18 22 22 35 40 30 39 362 Coverlets 1 1 Cushions 30 13 8 9 21 9 16 11 12 9 7 5 150 Curtain Tassels and Cords 3 4 7 Glass Cloths 4 4 75 Hearth Bugs 1 1 3 2 4 3 3 1 5 23 Mattresses, (Horse-hair Woo], Straw, or Spring 100 40 56 59 116 77 70 55 68 81 67 61 850 Mats 1 1 3 1 1 2 9 Matting 3 3 Palliasses 26 11 4 4 2 16 2 1 6 2 6 80 Pillows 247 176 198 208 365 227 242 278 219 256 227 238 2881 Pillow and Bolster Cases 1 7 4 i 1 8 S 1 9 4 7 6 55 Quilts 94 72 83 79 104 91 84 87 95 98 87 101 1078 Round Towels 1 1 Rugs 7 4 9 9 12 7 2 2 7 3 2 6 70 Sheets 102 74 79 84 106 89 95 114 109 108 98 97 1155 Sofa Squabs 2 1 3 Table Cloths 7 2 4 2 3 2 4 5 3 32 Toilet Covers 2 3 1 1 1 2 6 1 2 19 Towels 14 21 7 10 8 14 9 20 18 9 11 141 Window Blinds 1 1 Window Curtains 4 2 10 17 20 10 8 6 4 8 6 95 11542 76 Description of Articles. January February March April May June July August September October November December Total. MEN'S. Caps 7 6 6 3 12 58 1 4 6 6 1 110 Coats 15 25 10 11 32 7 3 11 9 6 13 10 152 Collars 2 1 74 3 3 1 83 Drawers 1 4 1 1 8 3 3 5 3 3 1 33 Flannels 3 2 1 6 „ Vests 8 9 6 5 23 9 5 21 19 7 9 3 124 Hats 1 1 Neck Ties 1 2 4 5 2 1 1 2 2 3 2 25 Night Shirts 3 5 2 6 9 4 a 4 5 3 43 Shirts 8 18 11 6 33 24 12 17 15 13 13 10 180 Socks 11 15 6 19 7 6 14 20 8 4 12 7 129 Suits of Clothes 3 3 Trousers 11 6 6 3 23 3 4 13 4 3 4 80 Ulsters 1 1 Waistcoats 9 10 8 5 30 2 3 9 8 5 7 1 97 10G7 77 WOMEN'S. Aprons 1 6 3 1 4 19 1 2 9 9 2 15 72 Caps 6 4 5 6 2 4 2 1 4 3 10 47 Chemises 17 11 12 7 17 13 19 23 12 16 14 15 179 Cloaks 1 3 1 1 8 3 3 20 Collars 1 1 1 5 8 Corsets 6 5 10 6 9 2 14 10 7 7 6 11 93 Cuffs 2 3 2 7 Drawers 13 12 7 8 13 5 12 7 5 5 9 24 120 Dresses 8 4 6 1 3 2 2 1 6 33 Dress Bands 1 1 2 Dressing Gowns 4 4 3 2 9 4 4 6 2 7 1 6 52 Flannel Petticoats 4 8 4 1 » 17 „ Vests 18 6 19 9 16 10 10 3 10 13 4 19 137 Jackets 12 11 9 6 19 13 8 13 3 11 12 6 123 Night Dresses 32 17 28 17 24 22 32 19 22 38 22 47 320 Petticoats 35 19 26 25 28 10 28 25 16 28 31 33 304 Petticoat Bodices 19 6 7 5 20 22 9 11 18 10 12 14 153 78 Articles Disinfected during the Year 1903—continued. Description of Articles. January February March April May June July August September October November December Total. WOMEN'S—continued. Sashes 1 3 1 5 Shawls 26 15 26 11 28 15 12 11 19 16 9 20 208 Skirts 15 10 7 15 17 11 8 9 15 11 21 143 Stockings 33 20 15 16 59 11 26 10 20 26 20 31 287 2330 CHILDREN'S. Boys' Knickers 9 10 5 8 2 4 5 7 4 8 6 68 „ Jackets 4 13 8 3 8 2 5 5 7 5 8 15 83 „ Suits 4 1 2 1 3 2 1 14 Feeders 1 1 Frocks 14 13 9 9 5 10 9 10 10 9 57 165 Pelisses 1 1 1 3 Pinafores 8 9 7 2 1 4 2 2 8 3 8 58 OTHER ARTICLES. 2 2 6 8 6 4 2 3 • 33 Handkerchiefs 13 10 11 4 12 21 13 21 18 9 8 21 161 Shoes 1 8 16 5 2 2 2 36 Slippers 2 1 4 4 2 12 2 2 29 SUNDRIES. 101 124 98 126 156 111 150 85 07 94 76 138 1359 2010 Totals 1701 1205 1240 1216 19.0 1476 1323 1375 1341 1385 1252 1515 16949 79 80 SHELTER. The table on Page 82 gives particulars as to the number of persons lodged at the Millfields Road Shelter while their homes were being disinfected and cleansed. The total number received during the year 1903 was 148. This shows clearly I think that the Shelter meets a want. I am of opinion that the need for such a Shelter will grow stronger as the population gets denser in the Borough. The cost of maintenance of the persons received is very small, being only £18 12s. 3d. during the year. I may here add that in addition to the maintenance each person received is provided with a hot bath. During the time the Shelter has been open, I have heard nothing from those who have been housed, in the way of complaint or reproach ; but many expressions of gratitude to the Council for providing such a necessary institution. I give here for the information of tbe Members of the Council an account of the Expenditure incurred at the Shelters and disinfecting Station during the year, 1903. EXPENDITURE AT DISINFECTING STATION FOR YEAR ENDED 31st DECEMBER, 1903. Shelters. £ s. d. £ s. d. £ s. d. Wages—Female Caretaker 52 0 0 Subsistence Allowance 17 4 0 Maintenance—Repairs, etc. Electricity Supply 6 2 0 Water 7 11 9 Rubber Sheets 0 19 0 Coals 1 18 2 Stores, &c. 4 2 0 20 12 11 89 16 11 81 Disinfecting Station. £ s. d. £ s. d. £ s. d. Wages 308 12 10 Electricity Supply 12 4 0 Water 15 3 6 Horse— Fodder 28 7 9 Shoeing 3 16 6 Collar 1 8 6 33 12 Disinfecting Van— Repairs 14 15 0 Holland Covers 6 9 0 Hire 6 10 0 97 14 0 Plumbing and other Repairs 27 3 4 Renewal of Fire Bars— Disinfections 2 15 0 £ s. d. Renewal of Rubber Rings 8 10 0 Lubricating Oil 0 18 3 New Doors to Laundry— Material and Carpenter's Wages 5 16 6 Furniture — Committee Room, Caretaker's Lodge 12 14 9 Coals—Steam 29 8 4 Kitchen (Lodge) 3 17 4 33 5 8 Stores, Firewood, etc. 8 5 0 496 15 7 £586 12 6 82 Summary of Persona Lodged and Maintained at Council's Shelter, in Millfields Road, Clapton, N.E., during the year ended 31st December, 1903. Month. No. of Persons admitted. (All causes.) Cost of Maintenance. Average period of Stay. Diseases. No.of Persons Admitted for bath only. Men. Women. Children Total. £ s. d. January 2 1 3 6 15 0 2.0 days. 1 Caee of Scarlet Fever 1 February 2 2 2 6 13 9 1.8 „ 2 Cases „ 1 Case „ March 1 1 3 6 16 0 2.8 „ 1 Case of Diphtheria 1 „ „ April 3 2 11 16 2 0 0 2.0 „ 2 Cases of Scarlet Fever 2 3 „ „ May 5 7 18 30 3 15 0 2.0 „ 4 „ Diphtheria 3 „ „ Juno 2 5 6 13 1 12 6 2.0 „ 2 „ Scarlet Fever 1 Case „ July 3 3 8 14 1 15 0 2.0 „ 2 Cases of Diphtheria 7 2 „ Enteric August 3 4 5 12 1 10 0 2.0 „ 2 „ Scarlet Fever 1 5 ,, Diphtheria September 4 8 5 17 2 2 6 2.0 „ 2 ,, Enteric 5 „ Scarlet Fever October 5 7 10 22 2 15 0 2.0 „ 1 Case of Enteric November December 1 2 4 7 17 6 2.0 „ 1 ,, Diphtheria 1 „ Scarlet Fever Totals 31 42 75 148 18 12 3 2 05 „ 11 83 REMOVAL OP HOUSE REFUSE. Below is given the account for the removal of House Refuse from dwellings in Hackney to the Municipal Destructor Works, from the 25th December, 1902, to the 25th December, 1903. Up till the 31st March, 1903, the house refuse was removed by F. Shellard, contractor, at an average price of 3s. 6d. per ton. The total quantity removed during this period was 10,513 tons at the price of £1,848 3s. 9d. From this date to the end of the year, the house refuse was removed by other contractors, the northern division by Mr. Walker, at 4s. Id. per ton ; the southern division by Messrs. Abbott at 4s. 4d. per ton. The quantity removed during this period by these contractors wa3 28,127 tons, at a total cost of £5,917 6s. 10d. Further details are given below. During the first three months of the year, while Mr. Shellard was contracting for the removal of the house refuse, the Council paid this contractor, in addition to the average 3s. 6d. per ton, £576 for the wages of the dustmen, formerly employed by the Council, transferred to him. The total expenditure for the removal of the 38,640 tons was £8,341 10s. 7d., which amounts to nearly 4s. 4d. per ton. £ s. d. Prices January to March—North Division 0 3 3 per ton. South Division 0 3 9 ,, March to December—Northern Division 0 4 1 ,, Southern Division 0 4 1 „ Cost of Destruction at 2s. 8£d. perton 5,227 12 6 Dustman's Wages—Jan., Feb., and March, 1903 576 0 3 Sanitary Labour 1,379 6 2 84 DUSTING ACCOUNT, 1903. MONTH. Northern Division Southern Division Totals. Tons. Cost. Tons. Cost. Tons. Cost. £ s. d. £ s. d. £ s. d. January 1713 278 7 3 1937 363 3 9 3650 641 11 0 February 1703 276 14 9 1971 369 11 3 3674 646 6 0 March 1504 244 8 0 1685 315 18 9 3189 560 6 9 April 1581 310 8 7 1922 406 14 5 3503 717 3 0 May 1477 301 11 1 1829 396 8 8 3306 697 19 9 June 1412 288 5 8 1804 390 18 10 3216 679 4 6 July 1216 248 5 4 1591 344 18 3 2807 593 3 7 August 1174 239 13 10 1525 330 10 10 2699 570 4 8 September 1241 253 7 5 1611 349 4 3 2852 602 11 8 October 1245 254 3 9 1576 341 10 8 2821 595 14 5 November 1535 313 7 11 1901 412 0 3 3436 725 8 2 December. 1580 322 11 8 1907 413 5 5 3487 735 17 1 Totals 17381 £3331 5 3 21259 £4434 5 4 38640 £7765 10 7 Here the house refuse is destroyed by burning, the heat developed during its combustion being used for the generation of steam, which is used in the generation of electricity for public and private lighting. The above is the account for the removal only of house refuse from dwellings to the destructor. The cost of destruction of the house refuse during 1903 has been calculated by the Borough Electric Engineers at 2s. 8½d. per ton, which for 38,640 tons gives a total cost for destruction of £5,227 85 12s. 6d. This sum, added to that for the removal of house refuse, gives a total cost of £13,569 3s. 1d. for the removal and disposal of house refuse in the Borough of Hackney during the year 1903. At the census of 1901 there were 30,419 inhabited houses in the Borough. Dividing the above sum by the latter numbers we get the sum of 8s. l1d. per inhabited house as the total cost for the removal and disposal of house refuse for the year 1903. Below is given a table, showing the number of requests for the removal of house refuse received during each month of the last ten years. It will be seen that the largest number of requests were received during the months of April and May. This I account for in the fact that the present contractors began the removal of house refuse in the month of April, and did not get into a good system until some time after commencing their contract. This phenomenon is always observed at the change of contractors. Table. A List of the requests for the removal of Dust received during the ten years, ending December 31st, 1903. 1894 1895 18'J6 1897 1898 1899 1900 1901 1902 1903 Jan. 136 89 37 21 22 26 50 13 31 28 Feb. 48 41 17 20 6 7 7 4 6 11 Mar. 85 53 30 15 6 3 9 9 20 23 Apr. 97 66 46 8 19 37 22 18 20 63 May 55 73 22 11 3 21 11 12 11 43 June 72 46 39 12 11 22 20 18 12 45 July 63 31 18 17 11 43 37 27 119 47 Aug. 56 23 12 9 6 14 8 12 53 12 Sept. 58 38 24 6 8 2 18 17 17 25 Oct. 73 27 21 8 3 10 8 7 15 13 Nov. 94 39 14 9 4 6 2 8 16 10 Dec. 46 26 17 7 15 18 13 13 35 11 Totals 893 552 297 143 114 220 205 158 355 331 86 I give here the usual table of refusals and no answers of occupiers to the application of dustmen to remove the house refuse. Table. Dust refusals and no answers for the year 1903. Week ending Refusals. No Answers Week ending Refusals. No Answers January 3rd 3,052 218 August 1st 7,294 968 „ 10th 6,437 1,243 „ 8th 6,876 1,005 „ 17th 5,856 1,172 „ 15th 6,673 973 „ 24th 5,713 1,219 „ 22nd 6,055 962 „ 31st 6,211 986 „ 29th 7,114 987 February 7th 5,909 1,043 Sept. 5th „ 12th 7,206 976 „ 14th 7,241 1,127 7,113 914 „ 21st 6,472 1,039 „ 19th 6,947 982 ,, 28th 6,319 1,114 „ 26th 7,218 897 March 7th 6,749 1,261 October 3rd 7,633 1028 „ 14th 6,581 1,384 „ 10th 6,971 913 ,, 21st 7,114 1,022 „ 17th 7,052 943 „ 28th 6,218 1,107 „ 24th 6,219 978 April 4th 6,733 1,035 „ 31st 6,772 914 ,, 11th 6,295 994 Nov. 7th 6,317 1,005 „ 18th 5,987 987 „ 14th 6,526 962 „ 25th 6,119 1,056 „ 21st 7,305 928 May 2nd 6,343 1,021 „ 28th 6,815 937 „ 9th 7,019 1,713 Dec. 5th 6,223 981 „ 16th 6,609 1,629 „ 12th 6,498 926 „ 23rd 6,317 1,219 „ 19th 5,217 917 ,, 30th 6,241 1,011 „ 26th 5,046 845 June 6th 6,513 1,113 ,, 31st 3,816 572 „ 13th 6,585 1,002 „ 20th 6,702 995 „ 27th 7,119 1,019 July 4th 6,027 1,019 „ 11th 6,149 1,007 18th 6,213 983 „ 25th 7,316 971 87 THE MORTUARY. The following tables give the number of bodies desposited 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 404 (a) Infectious 10 1. To await inquests (J) noninfectious 379 2. To await burial 15 Number of post-mortems made 134 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 107 125 Accidental Death 49 51 Suicide 22 8 Open Verdict 9 1 Murder 1 1 Stillborn 2 8 Totals 190 189 Table showing nature of above Suicidal and Accidental Deaths in the Hackney District during the Year ended 1903. SUICIDES. ACCIDENTAL DEATHS. NATURE OF SUICIDE. No. nature of accidental death. No. Poisoning 6 3 Cut Throat 3 Fall 31 Drowning 12 Suffocated 4 Hanging 4 Shock from Burns 10 Shooting 2 Drowing 1 Jumped in front of Train 2 Run over 4 „ from Window 1 1 11 Suffocated in Bed 21 Others 14 Total 30 Total 100 88 REGISTER OP SANITARY WORK, 1903. SANITARY DISTRICTS. Mr. Ellis Stamford Hill Mr. Harvey, West Hackney Mr. Legg, Hackney Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South Hackney. Mr. Haben, Homerton, E. Mr. Minsell, Homerton, N. Mr. Kemp, Homerton, S. Mr. White, Clapton, N.E. Mr. Bobbitt, Special Miss Teebay, Special. s. Mr. High. Mr. Shep'd 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 131 234 236 167 381 267 295 224 253 356 113 154 15 2826 Workshops 3 24 4 3 23 1 135 193 House to House 23 70 69 76 107 40 75 33 493 Houses after Infectious) Diseases 133 112 192 250 159 242 312 234 250 274 125 86 2369 Premises re-inspected 1944 2121 2739 1377 1949 2334 2905 2738 2579 2869 3133 2507 1440 30435 Fishmongers' and Poulterers' Yards 2 1 6 12 1 22 Slaughterhouses 9 348 357 Cow houses (Premises) 290 297 Dairies and Milk shops 7 1025 1025 Miscellaneous Inspections 102 82 115 120 4 84 52 39 105 67 2 108 830 Greengrocers' Yards 4 12 9 25 Schools 1 10 2 13 Bakehouses 16 40 34 12 16 47 29 22 18 22 3 259 Urinals 12 15 12 12 11 14 11 95 44 226 Canal Boats 96 96 Animals improperly kept 3 2 3 6 1 15 Statutory Notices served 8 31 14 40 28 11 34 6 27 14 17 17 8 255 Intimation Notices served 140 248 234 135 292 248 424 323 377 303 203 152 160 3245 Peremptory or Final Notices served 30 19 11 22 61 34 40 41 24 282 Laundries 1 9 1 10 89 Offensive Trades Outworkers 38 139 177 ProceedingsbeforeMagistrate or Justices under the Public Health Acts 1 1 2 3 2 1 1 3 14 Nuisances abated 139 206 280 168 330 241 182 283 379 324 201 136 178 3047 Seized and Condemned as Unfit for Human Food— Fish 1 cwt. 5¾ cwt. 3½ cwt. ¾ cwt. 3 cwt. 4 cwt. ½ cwt. 1¼ cwt. 19¾ cwt. Fruit and Vegetables ½ cwt. ½ cwt. ¼ cwt. ½ cwt. ½ cwt. ¼ cwt. ½ cwt. 9 cwt. ¾ cwt. ½ cwt. 7 cwt. 20¼ cwt. Meat ½ cwt. 1 cwt. ½ cwt. ¼ cwt. 9¼ cwt. Tin Foods Other Articles Open Spaces cleared 1 1 2 3 7 Special Reports to Medical Officer of Health 3 49 4 9 6 10 8 89 Food Adulteration— Samples collected for Analysis 54 54 36 54 54 54 60 60 54 60 60 600 Proceedings taken before Magistrates 6 5 5 5 5 3 10 5 4 2 3 53 90 ABSTRACT OF CLIMATOLOGICAL OBSERVATIONS. The following table, for which I am indebted to W. Marriott, Esq., 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 1903. 1903. Temperature. Relative Humidity Amount of Cloud. Rain. Means. Extremes. Amount. No. of Day .9 a.m. Min. Max. Range Mean. Min. Max. o o o O o o o %: in. JANUARY 41.5 38.5 45.9 7.4 42.2 24.8 54.4 87 6.7 2.34 17 FEBRUARY 45.9 42.2 0.6 8.4 46.4 33.3 68.0 80 8.0 •72 10 MARCH 47.7 42.0 53.1 11.1 47.6 34.4 68.3 76 6.9 2.21 20 APRIL 46.5 39.4 51.7 12.3 45.5 30.4 59.3 73 7.2 2.25 12 MAY 56.3 47.8 62.5 14.7 55.2 40.6 78.0 69 6.5 2.54 16 JUNE 59.0 50.3 64.4 14.1 57.3 42.9 82.5 71 6.3 6.23 11 JULY 63.0 56.4 69.4 13.0 62.9 48.7 83.4 70 6.4 4.62 1 AUGUST 61.7 54.4 67.6 13.2 61.0 49.2 76.9 72 6.2 4.42 19 SEPTEMBER 60.0 53.2 65.1 11.9 59.2 43.2 82.7 78 5.9 2.85 13 OCTOBER 54.4 49.8 58.2 8.4 54.0 40.2 66.0 83 7.0 5.54 26 NOVEMBER 45.7 42.0 501 8.1 46.0 32.5 55.9 84 8.1 1.89 13 DECEMBER 40.4 37.2 43.2 6.0 40.2 28.7 52.5 86 8.4 1.23 10 YEAR.. 51.8 46.1 56.8 10.7 51.5 24.8 83.4 77.4 7.0 36.84 180 91 APPENDIX. METROPOLITAN BOROUGH OF HACKNEY. REPORT ON AN OUTBREAK OF ENTERIC FEVER ASSOCIATED WITH THE CONSUMPTION OF SEWAGE-POLLUTED WATERCRESS. To the Members of the Public Health Committee. Gentlemen, During the month of June of this year the incidence of enteric fever, in the Borough of Hackney, presented very peculiar and unusual characters. Under ordinary circumstances enteric fever is at its lowest point during this month, and the seasonal prevalence of this disease does not usually set in until about the month of August; but this year the seasonal rise appeared to begin in the month of June; and, in addition, the cases notified were for some weeks mostly localised within a circle of one-third mile radius. These circumstances led me to think that some special agent wa, responsible for the unusual prevalence of this disease in the Borough which required special investigation. I have now to report the result of my investigations. Incidence of Enteric Fever.—From the beginning of this year until the second week in June, enteric fever had been very low, the average number of cases notified per week being only 1.6. During only one week, that ending 31st January, did the total cases notified reach the number of six; but from the second week of June the cases notified during each week were as set out in the following table:— 92 Table showing cases of enteric fever notified in the Borough of Hackney during the 13 weeks ending August 29th, 1903. Date week ending June 6th. Jure 13th. June 20th. Jure 27th. July 4th. July 11th. July 18th. July 25th. Aug. 1st. Aug. 8th. Aug. 15 th. Aug. 22nd. Aug. 29th. No. of Cases .. 2 6 14 8 7 4 6 3 11 7 15 1G 16 The following Chart I shows graphically the number of cases of enteric fever notified in the Borough from the beginning of the year up to the week ending August 29th. For comparison with the above, I give here Chart II showing the average number of cases of enteric fever notified weekly during the ten years 1892 to 1901. It will be seen from this that the rises indicated in the chart 1903 are quite abnormal:— Localisation of the Disease.—It will be seen from chart I. that the outbreak took the form of two waves or outbursts; the first extending from the second week in June to the week ending the 25th of July, and the second from the first week in August to the week ending the 29th of August; both of these outbursts showing a different localisation. These outbursts may be distinguished for the purposes of this report, the first by the letter A, the second by the letter B. Outburst A, which consisted of 48 notified cases extending over a period of eight weeks, were almost all located within an area represented by a circle of one-third mile radius, the centre of the circle being situated in the Clarence Road, opposite Pembury Grove. Outburst B, which consisted of 62 notified cases extending over a period of nine weeks, were scattered over a larger area, but were mostly located within a space represented by a circle of half-mile radius, whose centre was situated near Orchard Street, adjoining Well Street. A large number of these cases invaded area A. CHART I 1903. CHART II, 1892 TO 1901. 93 Age and Sex Distribution.— The 110 notified cases of enteric fever were distributed in 95 households. During A period 48 cases occurred in 45 households, and during B period 62 cases in 57 households. The age and sex distribution of the cases are given in the following table:— Table showing age and sex distribution. Age Period. 0-5 5-10 10-15 15 20 20-25 25 35 35-45 45-55 55 and wants Totals. A Period. Sex. M 2 2 2 5 5 8 1 0 0 25 F 0 3 3 7 5 4 1 0 0 23 B Period. M 1 2 8 6 5 8 3 1 0 34 F 0 4 4 6 6 5 1 1 1 28 Total Period. M & F 3 11 17 24 21 25 6 2 1 110 Cause of the Outbreak.—In endeavouring to find out the cause of this unusual outbreak of enteric fever in the Borough, it is necessary to examine in detail the known media by which this disease is usually spread, and to see if either of these was operating in causing the outbreak in question. The commonest media for the spread of enteric fever are 1, water; 2, milk; 3, shell-fish; 4, ice-creams; 5, fried-fish; 6, sanitary defects; and in addition a suspected cause,. 7, watercress, Water Supply.—Epidemics of enteric fever have been more frequently traced to an infected water supply than to any other 94 cause ; so that the relation of the outbreak to the water supplyjof the Borough of Hackney must be very closely examined before concluding that it has not been concerned in spreading the disease. The Borough of Hackney is supplied with water for domestic use by two water companies, viz.: the New River Company, and the East London Water Company. The former Company supplies that part of Hackney west of a line drawn zigzag from the junction of Albion Road and Queen's Road, on the south, to the junction of Dalston Lane with the Amhurst Road. From this point it follows the line of the G.E.R. northwards to Stamford Hill Station. The East London Water Company supplies the remainder of Hackney to the east of this line and in addition, this Company supplies amongst other places, the following London Boroughs:—Bethnal Green, nearly all Stepney, Poplar, and North Woolwich. With respect to the New River Company, no further reference need be made to this Company, because only one or two cases of enteric fever have occurred in the area supplied by this Water Company during the period under review. The East London Water Company derives its water from three sources. 1, The River Thames; 2, the River Lea; 3, Deep wells i the chalk. 1. The Thames water, which amounts to about 8,000,000 gallons per diem, is drawn from the river at Sunbury, there filtered and conveyed by a three feet main to the Finsbury Park covered reservoir, where it mixes with Lea Water and gravitates to Hackney, where it is distributed to about one-third of the district. 2. The intake for the Lea water is at Chingford Mill, whence it flows in an open conduit to the large reservoirs at Tottenham and Walthamstow. These are connected by an open channel with the filter beds at Lea Bridge, of which there are 25, and of these 23 are constantly filtering water. The filtered water passes into a large culvert, from whence it is pumped directly into the large mains of 95 the district and to the Finsbury Park reservoir. With respect to these mains, they are so arranged that there are no dead ends, but are connected in such a way by by-passes as to secure a complete circulation of water throughout the district. 3. The deep well water, which is a very small proportion of the whole, is pumped into the open channels and reservoirs, which convey it to the filter beds at Lea Bridge, where after Alteration it is pumped into the district mixed with the Lea water. The question may now be asked: Has the water supply to the Borough had any influence in causing the outbreak of enteric fever ? The evidence in favour of a negative reply to this question is the following:— 1. Most of the cases of enteric fever have occurred in that part of Hackney supplied by the mixed water from the Thames and the River Lea; but while the bulk of the cases have occurred in this area, they are grouped close together within a circle of f mile diameter, thus affecting only about 1/3 of the area in Hackney supplied by the mixed water, the other 2/3 being almost free from cases of enteric fever. Moreover, if we look at the other Boroughs supplied by mixed water, we find that they have not been notably affected by enteric fever cases. The other parts of the district supplied by Lea water or deep well water have not been visited with cases of enteric fever to raise a suspicion that a water-borne epidemic of enteric fever was in progress. 2. The progress of the outbreak is altogether unlike the progress of a water-borne epidemic. This latter has a characteristic course. Its onset is more abrupt, and there is a quick and steady rise in the notifications. The notifications increase until the source of infection is removed. At no time during the outbreak in question did the notifications in any week rise above 15, the numbers varying from day to day. The outbreak had more the appearance of infection by means of some article of food other than water. 96 3. If the infection were due to infected water supply, as the water is in general circulation, we should expect a general infection of the water, and cases would not be grouped in practically one area as has been the case, but more scattered over the district corresponding with the area of the particular supply; but, as we have seen above, the localization of the notified eases does not correspond with any particular area of water supply. Milk.—In investigating the relation that this article cf food may have borne to the spread of this disease, I found on enquiries that 32 invaded households used condensed milk only, and the remainder of the invaded households were supplied by 37 different dairymen, getting their milk from various sources only one of which supplied six households, the remainder supplying each a smaller number, and in addition in a few households only sterilised milk was consumed. These facts are sufficient to exclude milk as a medium for the conveyance of this infection on this occasion. Shell Fish.—The different forms of Shell Fish have been at various times instrumental in the conveyance of enteric fever, and it is necessary to consider whether they have been operative in causing the outbreak under review. During the A period there was only one household where it was admitted that shell fish had been eaten within the limits cf the incubation period of the disease. During the B period, in nine households only had shell fish been consumed during the three weeks prior to the onset of the disease, and the fish were purchased at six different places, four of which were out of the Borough. The fish consisted of the four varieties, viz.:—Oysters, mussels, cockles and periwinkles. From these facts it will be immediately seen that, shell fish has played a very insignificant part, if any, in the causation of the late outbreak of enteric fever in the Borough. Ice Creams.—Many epidemics have been traced to the consumption of this article of food, but its influence in the recent outbreak may be seen from the following facts. During the A period ice 97 creams were eaten by four only of the invaded households, and the ice creams were obtained from four different shops at great distances from each other. During the B period eleven households consumed ice creams which were obtained from eight different sources, three of which were outside the Borough. It will thus be seen that the hypothesis that ice creams have had any connection with the epidemic must be abondoned. Fried Fish.—An epidemic of enteric fever has been traced by Dr. Hamer of the London County Council to this article of diet, it would therefore not be out of place to consider what relation this article of diet may have had to the outbreak in question. By fried fish is meant the fish prepared in the common fried fish shops. I am of opinion that the conveyance of infection by this means must be a very rare event, but the possibility of its occurrence must be thought of in any investigations relating to the spread of enteric fever in large towns. During the A period, seven households admitted the consumption of fried fish during three weeks prior to the onset of the illness, and the fish was obtained from five different sources. During the B period, fried fish was consumed in twenty-nine households, but the fish was obtained from fifteen different sources. In face of these facts, it cannot be maintained for a moment that the slightest suspicion attaches to this food as a medium for the conveyance of enteric fever. Drainage and Sanitary Defects.— Inspections were carefully made in every house in which a case of enteric fever had occurred, but no wide-spread insanitary condition was found to exist competent to call forth an outburst of enteric fever such as that under enquiry. To go into details, it was found that out of 132 houses sanitary defects were observed in 32 of them, the remainder being. 98 free from such conditions. Prom this I conclude that sanitary defects have not had any casual connection with the outbreak in question. Watercress.— Early in the outbreak, while engaged in making enquiries respecting the possible relation of any of the above media to the spread of the disease, I was struck by the large number of watercress eaters amongst the patients affected, and this was especially marked during the A outburst. This led me to think that probably watercress may have been the agent by which the infection had been conveyed. What at first was mere suspicion acquired greater certainty as cases multiplied, until at last I was convinced that I had to deal with an outbreak of enteric fever largely due to the consumption of specifically infected watercress. The evidence upon which this hypothesis is based is the following — a. Statistics.— During the A period of the outbreak, 48 cases of enteric fever were notified. Of these, I could obtain no information as regards the food-stuffs eaten in three cases; but of the remaining 45 cases, definite information was forthcoming in regard to foods consumed. I found that out of these 45 cases, no less than 29 patients had partaken of watercress, in most cases more than once, during the three weeks prior to the onset of the illness. This is equivalent to 64.4 per cent. of the cases inquired into. During the B period there were 62 genuine cases of enteric fever notified. Of these, I could obtain fairly reliable information respecting food in 58 cases. Out of this number, 28 certainly partook of watercress during the three weeks prior to the onset of the disease. This is equivalent to 48.2 per cent. of those attacked. If the two periods are taken together, the watercress consuming cases numbered 57 out of a total of 103 cases, which is equivalent to 55.3 per cent. of the total. The following Table sets out these facts :— 99  Duration. No. of Cases of Enteric Fever notified. No. of Cases where definite information respecting food was obtained. No. of Watercress Cases. Percentage of Cases presumably infected by Watercress. Remarks. 1st Period June 6 to July 25. 48 45 29 64.1 2nd Period July 26 to Aug. 29 62 58 28 48.2 Total Period June 6 to Aug. 29 110 103 57 55.3 In order to fully estimate the value of the above evidence, it is necessary to obtain some idea of the proportion of the public in Hackney who are watercress eaters. To this end, I had enquiries made at 124 houses in those parts of the Borough invaded by enteric fever, and ascertained that the inmates of 34 only were watercress eaters. This figure includes not only the regular consumers of this vegetable, but also the occasional consumers, the remainder not eating watercress. Thus the watercress eaters may be taken at 27.5 per cent. and non-watercress eaters at 72.5 per cent. of the population; but the incidence of enteric fever on watercress eaters compared with non-watercress eaters during this epidemic was as the figures 64:36. Therefore it will be seen by an easy calculation that watercress eaters suffered 4.6 times more than non-watercress eaters during the A period, more than twice as much during the B period, and over three times as much during the whole epidemic. There is no essential reason why watercress eaters should be selected, except for the reason that this article of food was specifically infected. b. Source of Watercress.— Enquiries as to where the watercress had been purchased led to the following facts. The outburst of the A period led me to believe that the watercress must have been 100 purchased in the neighbourhood; and on close inquiry I found that most of the watercress had been purchased, in 21 instances, from hawkers in Clarence Road, and in eight instances from a shop in the same street. The source was not known in two instances. The watercress was purchased in two cases from a shop in the Lower Clapton Road, and in one the vegetable was obtained from various places. Of the B period, watercress was obtained from the stalls of hawkers in 20 cases, in 3 cases from various sources, in 2 cases the source was not known and in the remaining three cases from different shops in the neighbourhood. The following Table gives a summary of the above facts relating to the place of purchase of the watercress. Where purchased. Prom street hawkers. Source not known. From various places. From shops in the neighbourhood. REMARKS. No. of Cases. 41 4 4 8 It is improbable that in the four instances in which the source is not known, and also in those from various sources, the watercress was also purchased from street hawkers. c. Bacteriology.—During the progress of the epidemic, and when my suspicions that watercress was concerned in the spread of enteric fever, were strengthened by additional evidence, I had samples of watercress, exposed for sale in Clarence Road, taken and conveyed to the Lister Institute of Preventive Medicine, for bacteriological examination. These samples were reported upon by Dr. Macfadyen, whose report is included in the subjoined Table. Later when the second rise of enteric fever set in, I obtained authority from the Public Health Committee to have further samples of watercress sold in Hackney examined. Samples were taken on August 31st, September 2nd and September 8tb. The details concerning these sampler and the results of examination are to be found in the following Table. Table showing results of bacteriological examination of samples of watercress sold in the Borough of Hackney. 101 Date of Purchase Letter of Sample. Where purchased and Vendor. Source of Watercress. Bacteriological Report on Sample submitted. July 2nd A Clarence Road, Mr. W., Costermonger Spitalfields Markets, from Hampshire The three samples of watercress have been submitted to a careful bacteriological examination, and a special search has been made for organisms indicative of sewage contamination. The results have been that positive organisms of the colon or intestinal type have been detected and isolated from each of the three samples in question. There can be little doubt that the watercress was sewage polluted. „ B Clarence Road, Mr. G., Costermonger „ „ G Clarence Road, Man with Basket Gomshall, Surrey Aug.3lst D 50, Morning Lane These nine samples have been submitted to bacteriological examination with special reference to the presence of sewage organisms. Oraganisms of the intestinal type were found in every case. All the samples are obviously polluted. At least 50 Bac. Coli were present in every cubic centimeter of sample E. „ F Mrs. S., stall in Chatsworth Road Covent Garden „ G Mrs. W., stall in Chatsworth Road Kingsland Road, from grower named Cole „ H Mrs. J., stall in Chatsworth Road West Ham „ I Mrs. D., stall in Well Street „ „ J G. F., stall m Well Street Woman outside Spitalfields Market Sept.2nd K West Ham watercres3 beds West Ham „ L „ „ „ E „ „ Water Sept. 8th M W. P., Templar Road Gomshall, Surrey These samples of watercress have been submitted to a careful bacteriological examination with reference to the presence of sewage organisms. These organisms have been found in each sample, and it is obvious therefore that all these samples of watercress have been contaminated with sewage. „ N D. C., itinerant lad with basket West Ham „ 0 A. P., Well Street Delivered by man, unknown address „ P W. H., Morning Lane West Ham „ Q J. B., Digby Road Spitalfields Market „ R G. B., Arthur Street, S.S. Crooked Billet Yard, Shoreditch 102 From the foregoing Table it will be seen:— 1. That seventeen samples of watercress and one sample of water have been examined bacteriologically. 2. That all these samples were found to be polluted with organisms from the human intestine, and that the sample of water contained 50 of such organisms, i.e., bacilli coli, to each cubic centimeter (a cubic centimeter is equal to about 22 drops). 3. That six samples of watercress and the sample of water came from watercress beds situate in West Ham: four samples were said to come from Gomshall, in Surrey; three from Spitalfields Market; one from Covent Garden Market; one from Crooked Billet Yard, Shoreditch ; two from unknown sources. 4. That while these samples were taken from distant parts of Hackney, they all have this common feature, that of sewage pollution. My suspicion being directed to the West Ham beds as being chiefly concerned in the unusual incidence of enteric fever, I made a visit to this place, and found that the beds are situate in West Ham, adjoining the south-east border of the Hackney Borough. There are 25 beds, each about 20ft. wide by 60ft. in length. The beds are fed by water from an adjoining ditch, into which water is pumped as required. This water is pumped from a sump hole about 6ft. deep adjacent to the Channelsea branch of the river Lea. This branch is one of the most polluted branches of the badly polluted river Lea ; so that practically the West Ham beds are fed by almost undiluted sewage. The sample of water E was taken as it flowed from the aforementioned ditch on the watercress beds. With respect to the conditions under which the remaining samples of watercress have been grown, I should judge, from the fact that the bacteriological analysis of these gives results differing in no way from those of West Ham, that they are cultivated under conditions similar to the latter, although I have not been able to confirm this by a visit to the several places where they were grown. 103 The above evidence from which I infer that the outbreak has been caused largely by the consumption of sewage polluted water may be summarised in the following manner:— 1. The excess of enteric fever corresponds with the season for watercress, viz., June to September. 2. The excess of cases of enteric fever was amongst watercress eaters, viz., 55 per cent, for the whole period. 3. Watercress eaters suffered more than three times as much as non-watercress eaters. 4. Samples of watercress, taken from the places where infected persons market, were found on examination, to be sewage polluted. 5. A large proportion of the polluted samples were found to be cultivated in beds fed by almost undiluted sewage. These facts furnish material for serious reflection. In the first place they show that the bulk, if not the whole, of the watercress sold in Hackney is cultivated under such pollutted conditions as to be liable at any time to be specifically pollufed, and to give rise to outbreaks of enteric fever. If so many samples of watercress sold in Hackney are in a polluted condition, is it not probable that watercress sold in other boroughs of London is similarly polluted? If the information of the source of samples given in tha table, page 7, is correct, and I have no reason to question it, the bulk of the watercress supplied to the Metropolis is in a similar condition to the samples examined. It may be asked, if all the sources of supply are so polluted, why is not the infection wider and more severe. My reply to this is that although every watercress bed may be fed with sewage, this sewage may only be specifically infected in one or two cases; and it may be, that a high degree of specific pollution is necessary, before it shows itself in the form of an epidemic. It has already been noted that the season for the growth and sale of watercress is during the summer months of June to September. This same period may, with the exception of September, be regarded 104 as the months of the lowest incidence of enteric fever ; so that at this time sewage contains the minimum of specific material, i.e., the organisms of enteric fever. Sewage may during this time, or until the specific material has been reinforced by the seasonal increase of enteric fever, pollute watercress without producing anything more than slight intestinal disorder; but when the specific material is increased to a certain quantity, then enteric fever may be produced. This increase of material may begin as a result of the seasonal increase of enteric fever, or at an earlier date due to such a phenomenon as excessive rain which has washed into the watercourses morbific matter, or diminished the purifying effect of sewage farms and raised the disease-producing effect of their effluents, which are used in many cases for the growth of watercress. The harm-producing possibilities of sewage-grown watercress are very far reaching, but I will not dwell upon them here. I will conclude by repeating my conviction that the late outbreak of enteric fever in the Borough of Hackney has been??? largely caused by specifically infected watercress. The conditions revealed to me by my enquiry convince me that (1). An extended enquiry should be made as to the conditions under which watercress supplied to the Metropolis is cultivated. (2). Representations should be made by the Borough Council to the County Borough of West Ham, pointing out the conditions under which watercress is cultivated in that Borough; and asking them to take such steps as may be needful to ensure in future that watercress grown in that Borough shall be free from pollution. My thanks are due to Dr. Shirley Murphy, Chief Medical Officer to the London County Council, for kind criticism, and to Dr. Goodall, Superintendent of Eastern Hospital, for making enquiries amongst his patients. I remain, Gentlemen, Yours faithfully, J. KING WARRY, M.D., M.R.C.P., &c., Medical Officer of Health. Town Hall, Hackney, November, 1903. 105 TO THE PUBLIC HEALTH COMMITTEE, HACKNEY BOROUGH COUNCIL. Gentlemen,— I have the honour to present to you my Annual Report for the year ending 31st December, 1903. Workshops.—During the year I paid 135 first visits to workshops and 1,440 visits of re-inspection. Of these, 15 visits were prompted by complaints to the Medical Officer of Health from H.M. Factory Inspectors and other persons. In accordance with Section 133 of the Factory and "Workshops Act, 1901, 42 workshops were notified to H.M. Factory Inspectors for the district, as well as seven Domestic Workshops. I found nuisances existing on 312 premises; 240 of these nuisances I dealt with myself, and can report the abatement of 178. The remaining 72 were handed over by the Medical Officer of Health to the District Sanitary Inspectors to be dealt with by them. I have served 160 Intimations of Nuisances, 24 Final Notices, 8 Statutory Notices, and applied for 3 Summonses. In the course of the abatement of the nuisances I dealt with, 128 workrooms were cleansed; ventilation was improved in 36 workrooms; and overcrowding done away with in 17. While general nuisances relating to defective conditions of w.c.'s, yards, guttering, rainwater pipes, floors, roofs and dust bins were abated in 84 cases. Ventilation I find a most difficult matter to cope with. The benefits of fresh air are not understood, and therefore not valued by the majority of the workers with whom I come in contact. A large number of the workshop occupiers in this district are small employers of labour who carry on their business in the rooms of an ordinary dwelling house. As a rule the only means of ventilation found—the chimney flue and the windows—are useless as ventilators 106 from the fact that no fire is burning in the grate, or that the chimney is "made up" to prevent draughts, for which reason the windows also are hermetically sealed. The chilling effect of a cold current of air from an open window upon the thinly-clad and ill-nourished bodies of many of the workers can be readily understood—hence the difficulty of securing adequat eventilation in workshops during the winter months. One can only point out the advantages of fresh air, insist upon the "stuffing" being taken from the chimney, advise the continual use of a fire and the adoption of some simple and inexpensive way of admitting the fresh air without draught. In a good many workrooms during the last two winters Hinckes-Bird's method has been adopted, and works well as long has the block of wood is allowed to remain in position; but when it is removed, it is mislaid and seldom replaced until the Inspector's next visit. We have now on the register 857 workshops, including 157 laundries, and containing 1,254 workrooms in which women and female young persons are employed. Workroom cards showing the number of persons permitted in each room have been distributed to 182 workrooms. Outworkers.—During the year I have inspected 139 Outworkers Premises. I found 11 of these premises dirty, 4 delapidated, 5 with defective roofs, 3 with damp walls, 7 with defective w.c's., 3 with defective dust bins, and 3 improperly paved yards. I am, Gentlemen, Your obedient Servant, ALICE TEEBAY. 107 ANNUAL REPORT OF CANAL BOATS INSPECTOR FOR 1903. To the Public Health Committee, Hackney Borough Council. Gentlemen,—I beg to submit my Annual Report upon the Canal Boats inspected under the Canal Boats' Acts and Regulations 1877 and 1884. The boats chiefly met with in this district are the "wide " barges, occupied by men only, and, with few exceptions, they were found to be in good structural repair, and were kept in clean condition. No women or children were found living on the boats inspected. The barge traffic on the River Lea has been greatly interfered with by th numerous floods which have occurred during the year. The details are as follows:— Visits to Waterways 75 Number of Boats inspected 96 Number of Boats conforming to Acts, &c. 92 „ „ infringing „ 4 Certificates examined 93 Boats inspected (Captain absent—Certificates not seen) 1 „ (not used as dwellings) 2 Number of Notices issued 4 „ „ complied with 4 Number of persons registered for—Adults 285 Children 2 287 „ „ living on boats so registered 140 Legal proceedings taken 0 Details of Infringements. Certificate did not identify owner 1 No certificates on board 1 Marking of boat 1 Overcrowding of sexes 0 Separation of sexes 0 Cleanliness 0 Ventilation 0 Painting 1 Provision of water vessel 1 Removal of Bilge water Notification of Infectious disease 0 Rufusal of admittance 0 I beg to remain, Gentlemen, Your obedient Servant, GEORGE WHITE, Sanitary Inspector and Inspector under the Canal Boats' Acts. 108 Town Hall, Hackney, February, 1904. To the Medical Officer of Health. Sir,— I beg to submit my report for the year 1903, together with a summary of my inspections. Cow Houses.—There are 24 licensed cow keepers in the Borough with 37 sheds. To these I paid 290 visits and found on 3 occasions repairs of a small nature were necessary, which were at once attended to. On 5 occasions I have found accumulations of manure and have had to find fault with the general cleanliness of one cowkeeper on 3 occasions. On the whole the general condition, considering the bad construction of the majority of the sheds, is fairly good. Dairies and Milkshops.—To these I paid 1,025 visits throughout the year, and in 13 cases I found that the measures or utensils had not been properly cleansed. This shows a great improvement on my last report, and I find that now the milksellers are periodi cally visited they are more careful in their habits. In 41 dairies repairs and limewhiting were carried out under my direction, and 95 new milksellers have been placed on the register, some of whom had not previously been registered, but whom I found selling milk and were ignorant of the regulations requiring registration. I have also reported 2 contraventions of the Dairies, Cow Sheds and Milkshops Order. Offensive Trades.—Thirty-eight visits have been paid to the 3 offensive trades established in the Borough, and which comprise a Tallow Melter, Gut Scraper and Tripe Boiler, all of which I found carried on strictly in accordance with the bye-laws. The last named has a retail shop attached where a large quantity of livers, milts, hearts, kidneys, etc., etc. (called in the trade "Offal") are sold, and od my visits I have always examined what was on the premises, and have twice found diseased livers exposed for sale. 109 Slaughter Houses.—These now Dumber 29, and to these I have paid 348 visits always on slaughtering days. Periodical limewhiting, as required by the bye-laws, has been duly carried out, and I had to caution a slaughterman on one occasion for allowing blood to enter the drain. During the course of my visits I have examined the carcases of 144 oxen and heifers, 1,363 sheep, 10 calves, and 6 pigs. The following organs and parts I found diseased and had destroyed as unfit for human food:— OXEN. 1 liver and skirt 6 livers 1 pair lungs 1 fore quarter, lungs, liver and head affected with Abscess. ,, ,, Distomatosis. „ ,, Tuberculosis. ,, „ Ditto. SHEEP. 21vers 1 liver 1 heart and lungs 1 liver, heart and lungs 2 livers 1 liver and lungs Whole carcase and organs Whole carcase and organs affected with Distomatosis. „ ,, Abscess. ,, ,, Inflammation. „ ,, Melanosis. ,, ,, Parasitic Cysts. „ ,, Ditto. „ ,, Pleurisy & Peritonitis. ,, ,, Pneumonia and in a dying condition when bled Special Inspections and Unsound Food.—On your instructions I have made special enquiries and inspections on 50 occasions into various matters connected with the sale of food and complaints of various kinds, in addition to which I have always been on the watch when passing through the market thoroughfares in different parts of 110 the Borough for anything exposed for sale that may be unsound. The following articles have been destroyed as unfit for human food:— 1 Trunk of Skate. ½ bushel of Apples. 5 dozen Bananas. ½ bushel of Oranges. 2 dozen Bananas. 38 Babbits. 2 pounds Beef Liver (diseased). 7 Babbits. 14 Lemons and 18 Oranges. 4 sacks Potatoes. 1 sheep and all organs affected with Pneumonia. 1 Babbit. 2 barrels Apples. 16 pounds ,, 1 hand of Pork and 23 Babbits. The tradesman on whose premises the last named was seized was prosecuted and fined £5 and 2/- costs. I am, Sir, Yours obediently, ARTHUR J. BOBBITT. 111 Table. Prosecutions under the Food and Drugs Acts and Margarine Acts during the year 1903. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fined. Costs. Remarks. 1 Milk 39% devoid of fat Withdrawn. 3rd sample broken. £ s. d. £ s. d. 2 Milk 10% devoid of fat Withdrawn. 3rd sample broken. 4 Milk. 8% devoid of fat Withdrawn. 3rd sample broken. 5 Milk 8% added water Withdrawn. 3rd sample broken. 31 Butter 93% foreign fat Fined 5 0 12 6 36 Butter 93% foreign fat Fined 1 0 12 6 39 Milk 12% devoid of fat Fined 30 0 0 15 6 61 Milk G-8% added water Fined 12 6 68 Milk 32% devoid of fat 16% added water Fined 1 0 0 14 6 89 Demerara Sugar. Served with best sugar crystals coloured Fined 1 0 0 1 1 0 110 Milk 8% devoid of fat Fined 1 0 0 12 6 123 Olive Oil Served with Hydrocarbon or Mineral Oil Fined 10 0 12 6 144 Margarine Exposed for sale unlabeled Fined 1 0 0 12 6 160 Milk 6.7% added water Fined 1 0 0 12 6 151 Milk 16% added water Fined 5 0 12 6 161 Milk 52% devoid of fat Fined 5 0 12 6 162 Milk 10% devoid of fat Fined 2 6 12 6 164 Milk 9% added water Fined 1 0 0 12 6 165 Milk 8% added water Fined 1 0 0 12 6 167 Milk 9 8% added water Fined 5 0 0 12 6 172 Milk 35% added water Fined 3 0 12 6 183 Milk 7% added water Fined 10 0 12 6 186 Milk 8% added water Fined 10 0 12 6 200 Milk 13% devoid of fat Fined 1 0 0 12 6 112 No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fined. Costs. Remarks s. d. s. d. 203 Milk 7% added water Fined 1 0 0 o 12 6 208 Milk 9.4% devoid of fat .. Fined 1 0 0 0 12 6 215 Margarine Cheese Exposed for sale unlabeled Fined 0 10 0 0 12 6 217 Margarine Cheese Exposed for sale unlabeled Fined 0 10 0 0 12 6 225 Milk 9% devoid of fat Fined 0 10 0 0 12 6 234 Milk 22% devoid of fat Fined 1 0 0 0 12 6 236 Milk 11-4% added water Fined 0 5 0 0 12 6 266 Margarine Cheese Served in plain wrapper Fined 0 1 0 0 12 6 282 Gin 13% excess of water Fined 10 0 0 0 12 6 284 Margarine Served in plain wrapper Fined 10 0 0 0 12 6 296 Dripping 8% water Fined 0 4 0 0 12 6 297 Dripping 15% cotton seed oil Summons not served 298 Dripping 12% water Fined 0 5 0 0 12 6 300 Dripping 4 6% water Fined 0 3 0 0 12 6 307 Dripping 20% cotton seed oil 20% water Fined 1 0 0 0 12 6 327 Milk 16% added water Fined 0 10 0 0 14 6 328 Milk 8.9% added water Fined 0 2 6 0 12 6 329 Milk 73.4% devoid of fat.. Fined 0 10 0 0 12 6 334 Mustard 20% starch Fined 1 0 0 0 12 6 342 Butter 92% foreign fat Fined 2 0 0 0 12 6 365 Cocoa 25% added starch Fined 1 13 6 377 Coffee 80% chicory Fined 1 0 0 1 13 6 392 Milk 25% added water Fined 2 0 0 1 13 6 420 Milk 7% added water Fined 0 5 0 0 12 6 434 Milk 8% added water Fined 0 5 0 0 12 6 113 No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fined. Costs. Remarks. £ s. d. £ 8. d. 435 Milk 10% added water Fined 0 10 0 0 12 6 452 Butter 100% foreign fat Fined 5 0 0 0 12 6 470 Milk 7% dded water Withdrawn Insufficient service. 552 Dripping 4.2% water Withdrawn. Warranty Proven. 552 Dripping 4.2% water Fined 0 1 0 0 12 6 576 Rum 13.4% excess of water Withdrawn by order of Public Health Committee on payment of Costs. 0 12 6 592 Milk 6.6% added water Fined 0 12 6 85 3 0 34 11 0 114 Table. Record of Prosecutions under the Public Health (London) Act, 1901, during the year 1903. Address. Complaint. Magistrates' Decision. Penalties Costs. £ s. d. s. d. 275, Amhurst Road Defective drains Order to do the work in 14 days 3 0 72, Lower Clapton Road Bad meat Fined 5 0 0 2 0 93, Lenthall Road Defective drains Order to do the work in 14 days 23 0 112, Stamford Hill Did fail to notify forthwith a case of typhoid fever at 104, Cazenove Road Fined 2 0 0 45 0 104, Cazenove Road Did not notify to Medical Officer of Health as to case of typhoid fever in house Fined 0 5 0 2 0 181, High Street, Homerton Defective drains Withdrawn (owner undertaking to abate nuisance) 27, Ridley Road Leaky roof. Floor dilapidated. Ceiling and walls of laundry dirty Order to do the work in 14 days 23 0 181, High Street, Homerton Reconstructing a drain without an intercepting trap Fined 1 0 0 42 0 Chatsworth Road Accumulation of refuse on highway Fined 0 3 0 2 0 5, St. Mark's Terrace, Down's Park Road Defective soilpipe, &c. Order to do the work in 14 days 2 0 9, Benthal Road Defective drains Order to do the work in 7 days 4 0 Lampblack Works, Gainsboro Road Offensive trade Fined 2 0 0 2 0 115 Address. Complaint. Magistrates' Decision. Penalties Costs. £ s d. s. d. Orrock's Glass Works, Wallis Road Smoke nuisance Fined 5 0 0 2 0 49, Mare Street Did neglect to supply to the Hackney Sanitary Authority list of outworkers by 1st Aug., 1903 Withdrawn 2 0 57, Well Street Do. Withdrawn 2 U 12, Tower Street Recovery of 8s. 7d for removal of trade refuse Order to pay debt 6 6 Atlas Works, Hackney Wick Smoke Nuisance Dismissed, £2 2s. costs against Council Dust Wharf, Hertford Road Offensive effluvia caused by burning house refuse Adjourned, Sine die 15 8 0 8 6 116 LIST OF LICENSED SLAUGHTER-HOUSES In the Hackney District, October, 1903. Name. Address. Friday, E. W. 285, Amhurst Eoad Raymond, E. 186, Cassland Road Hussey, A. J. 37, Church Road, Homerton Wood, Hy. Peter 90, Frampton Park Road Bell F. 5, High Street, Homerton Wragg, W. J. 57, Holly Street Roberts, F. 49, High Street, Kingsland Gooch, H. 71, High Street, Kingsland Powell J. 418, Kingsland Road Woollven, W. H. 73, Upper Clapton Road Goodwin, H. J. 78, Stamford Hill Friday, Richard & Son 113/5, Dalston Lane Joyce, J. 531, Kingsland Road Fish, Arthur 222, Lower Clapton Road Witherden, C. A. 133, Lower Clapton Road Tyler, A. 80, Mare Street Teat, Thos. & Sturch, Fredk. 177, Mare Street Frost F. & Trenholme, W. 200, Queen's Road, Dalston Miall E. D. 211, Queen's Road, Dalston Hammer, William 103, Rendlesham Road Ebbells, E. 94, Southgate Road Row, Fredk. Wm. 130, High Street, Stoke Newington Young, C. J. 220, Stoke Newington Road Stoneman, P. 3, Terrace Road Clarke, C. 150, Upper Clapton Road Tyler, Robert 92, Well Street Austin W. E. 51, Wilton Road Baker, W. J 258, Wick Road Browning, J 129, Richmond Road 117 LIST OF LICENSED COW-SHEDS In the Hackney District, October, 1903. Name. Address. No. of Shed. Jones, Mary 46, Brooksby's Walk, Homerton 1 Jenkins, J. 2, Buckingham Road, Kingsland 2 Lloyd, D. 72, Church Road, Homerton 1 Jones, D. R. 84, Clifden Road, Clapton Park 2 Francis, John 67, Downham Road, Kingsland 1 Thomas, Evan 11, Downham Road, Kingsland 1 Evans, Morgan 6, Florfield Road, Hackney 1 Larter, George William, trading as J. T. Larter 2, Gloster Road, South Hackney 2 Snewin, W. H. 47, Old Hill Street, Upper Clapton 1 Rumball, T. E. 83, Upper Clapton Road 4 Bates, T. & W, 46a, Leswin Road, Stoke Newington 1 Cashford, W. G. Jerusalem. Square, Mare Street, Hackney 4 Warner, J. C. 23, Mare Street 1 Lewis, J. 5, Palace Road, Hackney 1 Lewis, D. J. 257, Queen's Road, Dalston 1 Williams, T. 79, Shacklewell Lane, Hackney 1 Welford, R. W. Sigdon Road, Hackney 1 Welford, R. W. Spring Hill, Clapton 2 Stapleton, A. Stoke Newington Common 5 Briggs, Bros. 180, Victoria Park Road 1 Thomas, David 3, Warburton Road, Hackney 1 Brace, A. E. 133, Well Street, South Hackney 1 Jones, John 271, Wick Road, Homerton 2 Emerton & Sons, Ltd. 37, Wilton Road 1 Total Cow Sheds 39 118 LIST OF BAKE-HOUSES, 1903. Name. Address. No. 1 District. Hall J. 77, Upper Clapton Road Buddin, J. 87, Reighton Road ‡Vincent, A. 74, Old Hill Street Williamsons Ltd. Chapel Road Gibson, R. T. 9, Northwold Road ‡ Austin, W. H. 74, Fountayne Road No. 2 District. Guthrie, J. & Sons 176, High Street, Stoke Newington Pile, W. 114, High Street, Stoke Newington ‡Newell & Co. 33, Rectory Road Allardyce, S. W. 62, Evering Road Burch, Mrs. H. 9, Maury Road Willsmer, C. 8, Stellman Street ‡Guscott, J. 128, Stoke Newington Road ‡Hickling, Mrs. S. 40, Shacklewell Lane ‡Karseh, J. 239, Amhurst Road Rung, 55, Shacklewell Lane Grodzinsky, H. 58, High Street, Stoke Newington No. 3 District ‡Silver, S. 134, Sandringham Road ‡Martin, J. 50, London Road ‡Gibbons, G. 26, Downs Road Reis, W. C. 215, Lower Clapton Road ‡Parish, W. 117, Lower Clapton Road ‡Prestage, T. H. 71, Lower Clapton Road Cowley, Mrs. J. 9, Clarence Road ‡Newell & Co. 393, Mare Street Gentry, W. R. 38, Amhurst Road Seward, R. 240, Dalston Lane 119 No. 4 District. Carpenter, A. 13, Median Road ‡Lunken, J. 52, Mandeville Street Saur, H. 198, Rushmore Road Mankertz, L. 182, Chatsworth Road Gerber, P. 138 ,, Ruhl, J. G. 94 „ ‡Lunken, H. 71 ,, ‡Maloney, J. 36 „ ‡Woods, E. 19 „ ‡Heinlen, L. 219, Glyn Road No. 5 & 6 District. Shedden W. 121, Richmond Road Berry, Mrs. A. 49 „ ‡Spenner, A. 81, Wilton Road ‡Goodwin, J. 178, Dalston Lane ‡Kitchiner, J. W. 83 , ‡Hohl, J. 72 Shedden, W.64, Richmond Road Mules, J. 20 & 22, Forest Road ‡Rowe, J. 207, Queen's Road ‡Spenner, H. 68, Lansdowne Road ‡Birket, T. 25, West-side, London Fields ‡Granger, J. 550, Kingsland Road Norman, A. 513 ,, Best, O. 376 ,, ‡Claridge, G. 329 Kingsland Road ‡Henkelmann, H. 174 Southgate Road Allardyce, S. W. 98 ,, Moir and Judd 40, Downham Road ‡Calton, A. 48 De Beavoir Roa Stein, H. 24, Tottenham Road ‡Pay, E. T. 106, Hertford Road ‡Roessle, W. 88, High Street, Kingsland 120 ‡Willicombe, F. 28, John Campbell Road ‡Ring, P. 103c, Dalston Lane ‡Pipe, J. R. 69, High Street, Kingsland ‡Granger, J. 1, Balls Pond Road No. 7 District. ‡Payne, A. 54, Broadway, London Fields May, H. 70 Bushell, F. 10 „ „ Stumm, K. 26, West Street Byron, S. T. 139Mare Street Reihs, J. A. 6, Well Street ‡Rsitz, C. 183 Mare Street Harvey, A. 231 „ ‡Wragg, A. H. 27 Morning Lane ‡Zahn, A. H. 77, Frampton Park Road ‡Eley, J. 101, Mare Street Gallowitz 77 ,, No. 8 District. ‡Cannon, G. D. 13 Loddiges road ‡Skaer, P. 76, Well Street Martin, J. 105 ., ‡Mustard, Mrs. B. C. 79, Lauriston Road ‡Holzapfel, C. 142, Victoria Park Road ‡Slade, C. 106, Gore Road No. 9 District. Grimwood, T. 32, High Street, Homerton Grimwood, T. 59 „ „ ‡Gibbons, G. 131 „ Bradford, G. 162 High Street, Homerton ‡Jessup, H. 167 „ „ Juniper, J. T. 18, Rrooksby's Walk Herz, J. 14, The Grove, Homerton Shrimpton, J. R. 3, Churchill Road 121 No. 10 District. Werner, A. & L. 220, Wick Road Harris, J. 184, Cassland Road Kybert, H. J. 16, Gloucester road Weber, A. F. 92, Wick Road ‡Gunner, G. 34, Church Road, Homerton Hohloch, C. 12, Berger Road Weber, G. 50, Kenton Road Pates, F. W. 154, Well Street ‡Stark, W. 186 ,, Fey, J. 233 ,, Morse, G. 27, Elsdale Street L. C. Bread Co. 144, Morning Lane Howard, T. 142, Well Street No. 11 District. Selzer, H. 89, Sidney Road Kehrein, J. 276, Wick Road Dance, Mrs. A. 315, „ Brake, G. 2, Victoria Road James, G. 3, Montague Buildings Ingram, J. A. 41, Osborne Road Attwell, T. J. 13, Gainsboro' road Davis, S. 71, Felstead Street No. 12 District. ‡Collis & Co. 2, Beecholme Terrace ‡Mason, F. 200, Lower Clapton Road ‡Underground Bakehouses.