HAC 21 Borough of Backney. REPORT on the SANITARY CONDITION of the hackney district, FOR THE YEAR 1905, 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 Royal 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. C. Fowler, Printer, 28, Tenter Street, Moorfields, E.C., and High Street, Shoreditch, E.C. 1906. C No. 255—A.C.F.. T. 305—9/7/06. INDEX. PAGE Alcoholism 47 Bakehouses 69 Birth Bate 7 Canal Boats Act 63 Cancer 47 Chickenpox 44 Constitutional Diseases 46 Cowhouses, Milkshops, and Dairies Order 56 Cowsheds, List of 131 Customs and Inland Revenue Act 63 Death Bate 9 Deaths in Public Institutions 13 Diarrhœa 44 Diphtheria 33 & 116 Disinfection 79 Enteric Fever 34 & 120 Erysipelas 43 Estimated Population 6 Factory and Workshop Act, 1901 68 Health Visitors 103 Home Work and Workers 74 House Refuse 92 Housing of the Working Classes Act 63 Ice Cream Vendors 67 Illegitimacy 9 Infant Mortality 10 Influenza 44 Marriage Rate. 6 Measles 45 Meteorology 102 Mortuary 96 Notifiable Diseases 30 ii INDEX. PAGE Non-Notifiable Diseases 44 Offensive Trades 56 Plague 43 Population and Density 6 Prosecutions under Pood and Drugs Act 128 Prosecutions under Public Health (London) Act 124 Public Health Act (London) 1891 51 Puerperal Fever 43 Register of Sanitary Work 98 Removal of House Refuse 92 River Lea 67 Senile Mortality 13 Scarlatina 30 & 112 Shelter 88 Slaughter-Houses, List of 132 Small-pox 30 Smoke Nuisances 58 Specific Causes of Death 19 Tuberculous Disease 46 Typhus 43 Vaccination 49 Whooping Cough 45 Workshops and Laundries 70 Zymotic Diseases 30 Tables— Births 8 Bakehouses, List of 133 Causes of Infant Mortality 11 Deaths 21 Death Statistics, according to Diseases, Ages and Localities 11 Dusting Account 93 Infectious Sickness 13 Inquests 97 Population, Area and Density in Sub-Districts of Hackney 6 Requests for Removal of Dust 96 Samples of Milk Analysed 127 Suicides and Accidental Deaths 97 Vaccination 50 Metropolitan Borough of Hackney. MEDICAL OFFICER'S REPORT. FOR THE YEAR 1905. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, N.E. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Gentlemen, I beg herewith to present my Fourteenth Annual Report on the Public Health of the Borough of Hackney. The year 1905 has been a very satisfactory one on the whole from a public health point of view compared with previous years. Infectious disease was less prevalent last year in the Borough than during the previous year, the total number of cases notified being 1,866, compared with 2,426 during 1904. The general mortality rate shows a considerable diminution compared with the year 1904, the rate for 1905 being 15.01 per 1,000 living persons. The death rate from infectious disease was also low, being 0.37 per 1,000 persons living. With the diminution in the general mortality there was also, I am pleased to report, a proportional diminution in the infantile mortality, this being 140 per 1,000 births against 155 per 1,000 births during 1904. I do not expect, however, the infant mortality will much improve until some more serious endeavours are made by public authorities to bring home to mothers the importance of the proper feeding of infants during the first 12 months of life. The increase of artificial feeding at the expense of maternal feeding 6 is no doubt responsible for the large amount of the infant mortality of the district. During the year a beginning was made in endeavouring to impart instruction in the feeding of infants by forwarding to the mother of each child born in the Borough a printed leaflet on this subject. I am pleased to add that the several officers of the Public Health Department have during the past year, 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 end of June, 1905, I estimate to be 227,630 persons, and the density to be 69.1 persons per square acre of the Borough. The following table gives the population and density of each sub-district. Table Showing estimated Population, Area and Density of the Registration Sub-Districts in Hackney, at middle of 1905. North. Central. SouthWest. SouthEast. Total for Hackney Total for London. Estimated Population 52,972 53,686 60,276 60,696 227,630 4,684,794 Area in square acres 1,082 857 764 586 3,289 74,839 Density = persons per acre 48.9 62.6 78.9 103.9 69.1 62.4 Marriages and Marriage Rate.—During the year 1905 there were 1714 marriages solemnized in the Borough of Hackney. The annual rate of persons married per 1,000 of the population during that period is, therefore, 15.0 per 1,000. The marriage rate for London during the same year is 16.9 persons married per 1,000 of * I have here to acknowledge my indebtedness to Mr. Tom Hosgood, Superintendent Registrar, who has kindly abstracted for me the number of marriages and illegitimate births for the year 1905. 7 the estimated population. The following table shows the marriages nd marriage rates for the Borough of Hackney and London for the 10 years 1896-1905. Year. Borough of Hackney. London. Marriages. Marriage Rate. Marriage Rate. 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 1903 1695 15.1 17.4 1904 1710 15.1 17.0 Average 1895—1904 1704 15.5 17.8 1905 1714 15.0 16.9 Births.—During the year 1905 there were 5,873 births registered in the Borough of Hackney; 3,041 males, and 2,832 females. This shows a decline upon the number registered during the previous year of 275 births. The birth rate for the year 1905 is 25.7 per 1,000 living persons. Below is given the number of births and birth rate in the separate sub-districts of the Borough. The birth rate for London during the same period is 27.1 per 1,000 living. 8 Table. Births. Registration District of Hackney. Registration Sub-District. All London. North. Central. SouthEast. Southwest. Total No. of Births 5,873 1,030 1,442 1,646 1,755 162,620 Rate per 1,000 living 25.7 19.6 26.8 27.3 29.9 27.1 No. of Illegitimate Births 93 4,684 Hate per 1,000 Births 15.8 37.0 The following table shows the birth rates for the Borough and and its sub-districts during the years 1898-1905. BIRTH-RATE FOB THE BOROUGH OF HACKNEY AND ITS SUB-DISTRICTS FOR THE YEARS 1898-1905 COMPARED WITH THAT OF LONDON. Year. Borough of Hackney. North SubDistrict. Central SubDistrict. South-East SubDistrict. South-West SubDistrict. 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 25.8 1991 28.7 21.1 30.1 31.1 31.6 29.0 1902 28.2 21.5 28.5 31.8 30.7 28.5 1903 27.6 19.9 27.9 30.6 30.9 28.4 1904 27.2 19.5 26.5 33.5 29.9 27.9 Average 1898—1905 28.3 21.1 28.6 31.5 30.6 28.5 1905 25.7 19.6 26.8 27.3 29.9 27.1 9 *Illegitimate Birth Rate.—The number of illegitimate births registered in the Borough of Hackney during 1905 was 321. Of this number, 241 took place in the Salvation Army Rescue Home, Mare Street, but 228 of these were of mothers drawn from places outside of Hackney. Deducting these from the total illegitimate births registered, there remain 93 illegitimate births to be credited to Hackney residents. This gives an illegitimate birth rate of 15.8 per 1,000 births. Deaths.—The deaths registered in the Borough of Hackney numbered 3,397, but of these deaths there were 465 of persons belonging to districts outside of Hackney, but dying in Hackney institutions. On the other hand, there were 367 deaths of Hackney residents dying in institutions outside the Borough. Making the needful corrections, the correct number of deaths to be credited to the Borough of Hackney is 3,299. This gives a mortality of 14.4 per 1,000 living persons. This rate requires a further correction for age and sex distribution, which is made by means of the factor 1.04262. Applying this factor to the above rate we obtain a rate of 15.01 per 1,000 living as the corrected death rate for the Borough of Hackney for the year 1905. This rate is lower than that for 1904, the mortality rate for that year being 16.05 per 1,000 living, The lowest death rate is in the North Sub-District (11.7 per 1,000), and the highest in the South-East Sub-District (16.6 per 1,000). The annual death rate from all causes for London in 1905 is 15.1 per 1,000 living. Sub-District. Populalation. No. of Births. Birthrate. Total Deaths. Deaths rate. Deaths under 1 year. Infant Mortality per 1000 Births. North 52,972 1,030 19.6 620 11.7 95 92 Central 53,686 1,442 26.8 778 14.5 211 147 South-East 60,276 1,646 27.3 1,005 16.6 296 180 South-West 60,696 1,755 29.9 896 14.7 220 125 All Hackney 227,630 5,873 25.7 3,299 15.01 822 140 10 The following shows the death rates of Hackney from all causes per 1,000, compared with London, during the last decade:— Year. Hackney. London. Year. Hackney. London. 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 14.7 15.7 1899 17.9 19.6 1904 16.05 16.6 1900 17.4 18.6 1905 15.01 15.1 Infant Mortality.—The deaths of infants under one year of age in the Borough of Hackney numbered 822 during 1905. This is equivalent to an infantile mortality of 140 per 1,000 births. This rate is lower than that for 1904, the infantile mortality for the latter year being 155 per 1,000 births. This decrease last year in the infant mortality is no doubt connected with the diminished prevalence of infectious disease in the Borough, as well as more moderate temperature during the summer and early winter months. The following are the infantile death rates for the Borough of Hackney, compared with the rates for all London during the years 1894-1905:— Year. Hackney. London. Year. Hackney. London. 1895 159 154 1901 135 148 1896 157 146 1902 121 132 1897 127 147 1903 127 131 1898 161 152 1904 155 146 1899 153 166 1905 140 129 1900 158 158 The following table gives the causes of deaths of infants under one year old:— 11 Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 Year. Common Infectious Diseases— Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. .. 1 .. .. .. 1 .. 1 .. .. 1 9 7 20 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 .. 3 Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Whooping Cough .. .. .. 1 1 1 .. 1 2 1 1 2 7 5 3 3 27 Diarrhœal Diseases— Diarrhœa, all forms .. .. 1 1 2 18 23 11 15 15 20 11 29 16 15 9 184 Enteritis (not Tuberculous) 1 .. .. 2 3 .. 4 1 4 1 8 .. 8 1 2 .. 32 Gastritis, Gastrointestinal Catarrh .. .. 2 .. 2 .. .. 1 .. 1 .. 1 .. .. .. .. 5 Wasting Diseases— Premature Birth 67 4 2 3 76 4 1 .. .. .. .. .. .. .. .. .. 81 Congenital Defects 23 5 1 2 31 3 1 .. 1 1 .. .. .. 1 .. .. 38 Injury at Birth 7 .. 1 .. 8 .. .. .. .. .. .. .. .. .. .. .. 8 Want of Breast-milk .. .. .. .. .. 2 2 .. .. .. .. .. .. .. .. .. 4 Atrophy, Debility, Marasmus 20 12 5 3 40 29 11 8 2 .. 1 .. 1 .. .. .. 92 12 Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-12 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 Year. Tuberculous Diseases— Tuberculous Meningitis .. .. .. .. .. 1 .. 2 .. .. 1 2 .. .. 3 3 12 Tuberculous Peritonitis:Tabes Mesenterica .. .. .. .. .. 2 2 .. .. .. 1 .. 1 .. .. 1 7 Other Tuberculous Diseases .. .. .. .. .. 2 1 .. 2 4 2 2 4 2 2 4 25 Erysipelas .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Syphilis .. 1 .. .. 1 4 .. .. .. .. .. .. 1 .. .. .. 6 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 3 Meningitis (not Tuberculous) 1 1 .. .. 2 .. 3 3 1 1 3 4 2 4 2 1 26 Convulsions 17 2 5 4 28 11 5 6 .. 3 3 2 3 2 1 1 65 Bronchitis 1 .. 2 2 5 11 7 5 6 4 2 4 6 6 3 7 66 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Pneumonia .. .. 1 2 3 5 5 6 2 4 10 2 10 6 2 5 60 Suffocation, overlaying .. 1 1 1 3 2 3 1 2 3 .. .. .. .. .. .. 14 Other Causes 6 5 3 3 17 4 3 2 3 2 1 2 1 2 2 3 42 All Causes 144 31 24 24 223 100 71 47 41 40 54 34 73 47 47 46 823 13 Senile Mortality.—The deaths at 65 years and upwards in the Borough during 1905 numbered 780, and of these 397 were between the ages of 65 and 75 years; 286 between the ages of 75 and 85 years, and 97 were at 85 years and upwards. The annual mortality rate of persons at 65 years and upwards is 3.4 per 1,000 persons living. Deaths in Public Institutions.—There were 1,268 deaths in public institutions in the Borough during 1905. Of these 465 were residents of other districts, and the remainder, 803, were residents of Hackney. The following gives the institutions within the Borough receiving persons both from the Borough, and also persons from without, with the number of deaths in each institution during the year 1905. INSTITUTIONS WITHIN THE BOROUGH RECEIVING PERSONS BOTH FROM AND WITHOUT THE BOROUGH. Brooke House, Upper Clapton 5 The " Nest," 10, Springfield 1 City of London Workhouse 5 Eastern Fever Hospital 155 11, Devonshire Road—S.A. Nursing Home 21 French Hospital 5 Hackney Infirmary 699 „ Workhouse 16 Metropolitan Hospital, Kingsland 182 German Hospital 119 Mare Street S.A. Maternity Home 20 Home for Aged Jews, 23, Well Street 13 St. Joseph's Hospice Cambridge Lodge Villas 27 1,268 14 INSTITUTIONS OUTSIDE THE DISTRICT, RECEIVING SICK AND INFIRM PERSONS FROM THE DISTRICT. Manor Asylum, Epsom 1 Tooting Bee Asylum 4 L.C. Asylum, Dartford 10 Darenth Asylum 4 Horton Asylum, Epsom 6 Whitechapel Infirmary 4 Claybury Asylum 13 North-Eastern Children's Hospital 55 St. Bartholomew's Hospital 32 London Hospital 52 Hanwell Asylum 4 Colney Hatch Asylum 20 N.E. Fever Hospital 14 St. Thomas's Hospital 1 Hospital for Women, Soho 1 Northern Fever Hospital, Winchmore Hill 1 Middlesex Hospital 2 Royal Free Hospital 2 Royal Chest Hospital, City Road 4 Cane Hill Asylum 4 Friedenheim Hospital 1 St. Mary's Hospital 1 National Hospital, Queen's Square 1 Banstead Asylum 10 City of London Chest Hospital 6 Guy's Hospital 3 Children's Hospital, Great Ormond Street 15 St. Ann's House, Stoke Newington 1 15 Homoeopathic Hospital 1 Holborn Infirmary 4 Bethnal House Asylum 8 Long Reach Hospital 2 City of London Lying-in Hospital 1 H.M. Hospital, Stepney 1 Leavesden Asylum 6 Gore Farm Hospital 1 Islington Infirmary 2 Strand Workhouse, Edmonton 1 Mildmay Hospital 1 Bethnal Green Infirmary 3 Mile End Infirmary 1 Middlesex County Asylum, Wandsworth 1 British Hospital for Incurables 1 Ilford Asylum 6 East London Hospital 1 Charing Cross Hospital 5 L.C. Asylum, Norwood 4 Shoreditch Infirmary 7 Caterham Asylum 1 Asylum, Friern Barnet 2 Poplar Workhouse 1 N.W. Hospital, Hampstead 1 Jubilee Hospital, Brompton 1 Mount Vernon Hospital, Hampstead 1 Heart Hospital, Soho Square 1 Miscellaneous Institutions 27 364 16 HACKNEY DISTRICT. Vital Statistics of Whole District during 1905 and Previous Years. 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. Death 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 1895 215620 6141 28.7 976 159 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 161 3855 17.5 794 502 278 3631 16.4 1899 222429 6453 29.0 1069 165 4033 18.1 1142 520 294 3807 17.1 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 1903 463 326 3497 15.9 1902 221730 6266 28.3 804 128 3526 15.8 1102 516 368 3378 15.3 1903 223716 6180 26.3 802 129 3287 14.7 1182 453 328 3162 141 1904 225663 6148 27.2 953 155 3537 15.6 1238 436 372 3473 15.4 Averages for years 1895.1904. 220287 6304 28.5 958 149 3731 16.9 1066 477 310 3562 16.2 1905 227630 5873 25.8 822 139 3397 14.9 1255 465 367 3299 14.4 * 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). 3,251 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. 17 HACKNEY DISTRICT. Vital Statistics of Separate Localities in 1905 and Previous Years. Names of Localities. 1. All Hackney 2. North SubDistrict. 3. Central SubDistrict. 4. S. East SubDistrict. 5. 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 6453 3807 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 1903 223716 6180 3162 786 51848 1032 591 119 52203 1460 770 167 59324 1819 1024 294 60341 1869 869 206 1904 225663 6148 3473 953 52404 1026 671 141 52945 1404 740 202 59801 1904 1078 328 60513 1814 984 282 Averages of years 1898-1904 221690 6309 3514 930 50920 1084 617 125 50538 1464 766 211 59064 1868 1181 327 61167 1892 962 266 1905 227630 5873 3299 822 52972 1030 620 95 53686 1442 778 211 60276 1646 1005 296 60696 1755 896 220 b 18 HACKNEY DISTRICT. Cases of Infectious Disease Notified during the Year 1905. Notifiable Disease. 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. Central (H.) South-East (W.) South-West. North. Central (H.) South-East (W.) -West Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox 4 .. .. .. .. 4 .. .. 2 .. 2 .. 2 .. 2 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 372 5 152 157 35 23 .. 58 101 136 77 37 81 117 65 Membranous Croup .. 12 .. 7 5 .. .. .. 1 3 5 3 .. 2 3 2 Erysipelas 286 9 10 19 38 171 39 40 53 137 56 6 9 42 15 Scarlet Fever 1081 14 326 629 78 34 .. 131 307 378 265 97 289 344 243 Typhus Fever 1 .. .. .. .. 1 .. .. 1 .. .. .. 1 .. .. Eriteric Fever 165 .. 7 42 42 74 .. 23 53 57 32 15 38 47 32 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. Puerperal Fever 8 .. .. .. 2 6 .. 2 4 2 .. .. 3 1 .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1930 28 502 852 196 313 39 255 524 716 435 155 425 554 359 Isolation Hospital—Eastern Hospital, Homerton. 19 HACKNEY DISTRICT. Causes of, and Ages at, Death during Year 1905. Causes of Death. Deaths in whole District at Subjoined Ages. Deaths in Localities (at all Ages). Deaths in Public Institutions. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. North Sub-district. Central Sub-District. South-East Sub-District. South-West Sub-District. Small-pox 2 .. .. .. .. 2 .. .. .. .. 2 .. Measles 74 18 52 4 .. .. .. 8 17 27 22 29 Scarlet Fever 18 3 13 2 .. .. .. 2 3 10 3 47 Whooping-cough 64 27 35 2 .. .. .. 7 12 25 20 4 Diphtheria and Membranous Croup 26 1 21 4 .. .. .. 4 7 9 6 61 Croup 1 .. 1 .. .. .. .. 1 .. .. .. .. Fever Typhus 26 .. .. 3 7 16 .. 2 10 6 8 32 Enteric Other continued Epidemic Influenza 28 1 .. 1 2 15 9 5 9 7 7 .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 233 185 30 1 1 7 9 19 70 94 50 38 Enteritis 44 32 4 .. .. 4 4 7 7 10 20 30 Puerperal Fever 2 .. .. .. 1 1 .. 1 .. 1 .. 2 Erysipelas 10 2 1 .. .. 4 3 1 3 2 4 6 Other Septic Diseases 19 3 4 .. 2 8 2 1 8 5 5 29 Phthisis (Pulmonary Tuberculosis) 256 3 6 8 34 192 13 47 61 65 83 142 Other Tubercular Diseases 135 42 50 17 7 16 3 27 34 41 33 43 B 2 20 HACKNEY DISTRICT—continued. Causes of, and Ages at Death during Year 1905. Causes of Death. Deaths in whole District at Subjoined Ages. Deaths in Localities (at all Ages). Deaths in Public Institutions. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. North Sub-District. Central Sub-District. South-East Sub-District. South-West Sub-District. Cancer, malignant disease 203 1 1 .. 3 126 72 50 42 54 57 75 Bronchitis 327 66 34 5 1 78 143 60 80 96 91 114 Pneumonia 247 60 45 11 12 87 32 39 68 76 64 66 Pleurisy 12 .. .. .. .. 8 4 3 1 2 6 4 Other Diseases of Respiratory Organs 26 1 2 1 .. 16 6 5 8 8 5 4 Alcoholism—Cirrhosis of Liver 41 .. 1 .. 1 33 6 9 8 10 14 22 Venereal Diseases 15 14 .. .. .. 1 .. 1 .. 5 9 .. Premature Birth 81 81 .. .. .. .. .. 13 23 20 25 10 Diseases and Accidents of Parturition 8 .. .. .. .. 8 .. 1 3 3 1 .. Heart Diseases 284 6 6 10 15 147 100 70 65 73 76 92 Accidents 99 20 17 7 5 29 21 4 29 33 33 67 Suicides 26 .. .. .. 2 23 1 12 4 10 .. 4 All other causes 992 256 38 36 35 275 352 221 206 313 252 347 All causes 3299 822 361 112 128 1096 780 620 778 1005 896 1268 21 TABLE OF DEATHS Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1904. 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 .. .. .. .. 2 .. .. .. .. .. .. 2 Not „ .. .. .. .. .. .. .. .. .. .. .. .. Doubtful .. .. .. .. .. .. .. .. .. .. .. .. Cowpox. Effects of vaccination .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles (Morbilli) 18 52 4 .. .. .. .. .. .. .. .. 74 Epidemic Rose Rash, German Measles 1 .. .. .. .. .. .. .. .. .. .. 1 Scarlet Fever 3 13 2 .. .. .. .. .. .. .. .. 18 Typhus .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. lnfluenza 1 .. 1 2 3 3 6 3 5 1 3 28 Shooping Cough 27 35 2 .. .. .. .. .. .. .. .. 64 Mumps .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria, Membranous Croup 1 21 4 .. .. .. .. .. .. .. .. 26 Cerebro Spinal Fever .. .. .. .. .. .. .. .. .. .. .. Simple Continued Fever .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. 3 7 5 9 1 1 .. .. .. 26 Asiatic Cholera .. .. .. .. .. .. .. .. .. .. .. Epidemic Diarrhœa, Epidemic (or Zym.) Enteritis 102 15 1 .. .. .. 1 .. .. 2 .. 121 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 Age Diarrhœa, Choleraic Diarrhœa 82 14 .. .. .. 1 1 3 4 2 .. 107 Dysentery 1 1 .. 1 .. .. 1 .. 1 .. .. 5 Malarial Fever .. .. .. .. .. .. .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. Glanders, Farcy .. .. .. .. .. .. .. .. .. .. .. .. Anthrax Splenic Fever .. .. .. .. .. .. .. .. .. .. .. .. Tetanus 1 .. 1 .. .. .. .. .. .. .. .. 2 Syphilis 14 .. .. .. .. 1 .. .. .. .. .. 15 Gonorrhœa, Stricture of Urethra .. .. .. .. .. .. .. .. .. .. .. Puerperal Septicæmia, Sapræmia .. .. .. .. .. 2 .. .. .. .. .. 2 Puerperal Pyæmia .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Phlegmasia Dolens .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. 1 .. 1 .. .. .. .. .. 2 Infective Endocarditis .. .. .. 2 .. .. .. .. .. .. .. 2 Epidemic Pneumonia, Pneumonia Fever .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 2 1 .. .. .. .. 2 2 3 .. .. 10 Septicæmia (not Puerperal 3 3 .. 1 2 2 .. 1 1 .. .. 13 Pyæmia (not Puerperal .. 1 .. 1 .. .. .. 1 .. .. .. 3 Phlegmon, Carbuncle (not Anthrax) .. .. .. .. .. 1 1 .. 1 .. .. 3 Phagedæna .. .. .. .. .. .. .. .. .. .. .. .. Other Septic Diseases .. .. .. .. .. .. .. .. .. .. .. 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 Tuberculous Phthisis (Pulm Tuberculosis) 1 3 7 21 44 40 22 13 10 1 .. 162 "Phthisis" 2 3 1 13 31 17 19 6 1 1 .. 94 Tuberculous Meningitis 12 28 10 3 .. .. .. .. .. .. .. 53 Tuberculous Peritonitis 5 3 .. .. 1 .. .. 1 .. 1 .. 11 Tabes Mesenterica 2 5 2 .. .. .. .. .. .. .. .. 9 Lupus .. .. .. .. .. .. .. .. .. .. .. .. Tubercle of other Organs 1 .. .. 1 .. 3 .. .. 1 .. .. 6 General Tuberculosis 20 14 5 3 5 3 .. 3 1 .. .. 54 Scrofula 2 .. .. .. .. .. .. .. .. .. .. 2 Parasitic Diseases .. .. .. .. .. .. .. .. .. .. .. Starvation .. .. .. .. .. .. .. .. .. .. .. Scurvy .. .. .. .. .. .. .. .. .. .. .. .. Alcoholism, Delirium Tremens .. .. .. .. .. 3 3 1 1 .. .. 8 Opium, Morphia Habit .. .. .. .. .. .. .. .. .. .. .. .. Ptomaine Poisoning .. .. .. .. .. .. .. .. .. .. .. .. Industrial by Lead .. .. .. .. .. 1 .. 1 .. .. .. 2 by Phosphorus .. .. .. .. .. .. .. .. .. .. .. Poisoning by Arsenic and other Metals .. .. .. .. .. .. .. .. .. .. .. .. Rheumatic Fever, Acute Rheumatism .. 2 1 1 .. .. 2 1 .. .. .. 7 Rheumatism of Heart .. .. .. .. .. .. .. .. .. .. .. Chronic Rheumatism .. .. .. .. .. .. 1 1 1 .. 1 4 24 TABLE OP 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, Rheumatic Arthritis, Rheumatic Gout .. .. .. .. .. .. 1 2 .. 2 .. 5 Gout .. .. .. .. .. .. .. .. 2 1 .. 3 Carcinoma .. .. .. .. 2 12 14 33 28 12 .. 101 Sarcoma .. 1 .. 2 1 1 3 .. .. .. 1 9 Malignant Diseases, Cancer 1 .. .. 1 1 8 25 26 23 7 1 93 Rickets 3 1 .. .. .. .. .. .. .. .. .. 4 Purpura .. .. .. .. .. .. .. .. .. .. .. .. Hæmophilia, Hæmorrhagic Diathesis .. .. .. .. .. .. .. .. .. .. .. .. Anæmia, Leucocythæmia .. .. .. .. 1 .. 1 .. 2 .. .. 4 Diabetes Mellitus .. .. .. 3 1 .. 3 10 4 .. 1 22 Premature Birth 81 .. .. .. .. .. .. .. .. .. .. 81 Congenital Defects 28 .. .. .. .. .. .. .. .. .. .. 28 Injury at Birth 8 .. .. .. .. .. .. .. .. .. .. 8 Atelectasis 11 .. .. .. .. .. .. .. .. .. .. 11 Want of Breast Milk 5 .. .. .. .. .. .. .. .. .. .. 5 Teething .. .. .. .. .. .. .. .. .. .. .. .. Debility 92 1 .. .. .. .. .. .. .. .. .. 93 1403 Disease of Nervous System. Meningitis, Inflammation of Brain 26 18 16 1 1 2 2 5 .. 1 .. 72 Softening of Brain .. .. .. .. 1 1 1 7 4 7 2 23 General Paralysis of Insane .. .. .. 1 1 5 4 5 1 2 .. 19 25 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. Insanity (not Puerperal) .. .. .. .. .. 1 3 2 2 4 .. 12 Chorea .. .. .. 1 .. .. .. .. .. .. .. 1 Epilepsy .. .. 4 1 1 5 3 .. .. .. .. 14 Convulsions 65 10 1 .. .. .. .. .. .. .. .. 76 Laryngismus Stridulus 1 1 .. .. .. .. .. .. .. .. .. 2 Locomotor Ataxy .. .. .. .. .. .. 2 1 2 .. .. 5 Paraplegia and Disease of Cord .. .. .. 2 .. .. 1 2 1 1 .. 7 Neuritis, Periph, Poly-Neuritis .. .. .. .. 1 1 1 .. .. .. .. 3 Brain Tumour (not specific) 1 .. 2 1 2 1 1 2 .. 1 .. 11 Nervous System, other Diseases .. .. .. .. .. .. 1 .. .. .. .. 1 246 Disease of Organs of Sense. Otitis, Mastoid Dis. .. .. .. 1 1 .. .. .. .. .. .. 2 Epistaxis, Nose Dis. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia, Eye Dis. .. .. .. .. .. .. .. .. .. .. .. .. Accident 20 17 7 5 6 8 8 7 10 8 3 99 Violence Suicide .. .. .. 2 4 7 7 5 1 .. .. 26 Drowned 1 .. 2 2 3 1 1 3 .. .. .. 13 Murder .. .. .. .. .. .. .. .. .. .. .. .. 140 Disease of Heart. Valve Dis., Endocarditis 1 4 7 14 8 20 43 32 40 19 2 190 Pericarditis .. 1 2 .. 1 .. .. 2 .. .. .. 6 2-6 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. Hypertrophy of Heart .. .. .. 1 .. .. .. .. 2 2 .. 5 Angino Pectoris .. .. .. .. .. .. 1 1 1 .. 1 4 Dilatation of Heart .. .. 1 .. 1 1 4 10 9 2 1 29 Fatty Degeneration of Heart .. .. .. .. 1 1 4 13 5 4 .. 28 Syncope Heart Dis. (not specified) 5 1 .. .. .. 1 1 2 4 5 3 22 284 Disease of Blood Vessels. Cerebral Haemorrhage, Smb., Throm. 1 .. 1 2 5 3 14 17 24 14 .. 81 Apoplexy, Hemiplegia .. .. .. .. 1 •• 4 17 11 13 4 50 Aneurysm .. .. .. .. 2 .. •• 7 2 .. .. 11 Senile Gangrene .. .. .. .. .. .. 1 1 4 6 2 14 Embolism, Thrombosis (not Cerebral) .. .. .. .. 2 .. .. .. .. .. .. 2 Phlebitis .. .. .. .. .. .. .. .. 1 1 .. 2 Varicose Veins .. .. .. .. .. .. .. .. .. .. .. • • Blood Vessels, other Diseases .. 1 .. 1 .. 1 .. 1 2 4 .. 10 170 Disease of Respiratory Organs. Laryngitis 1 2 1 .. .. .. .. 1 .. .. .. 5 Membranous Laryngitis (not Diphtheritic) .. .. .. .. .. .. .. .. .. .. .. .. Croup (not Spasmod. or Membr.) .. 1 .. .. .. .. .. .. .. .. .. 1 Larynx, other Dis. (not specified) .. .. .. .. .. .. .. .. .. .. .. .. 27 TABLE OP 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. Bronchitis 66 34 51 1 .. 5 25 48 83 52 8 327 Lobar (Cropus-Pneumonia) .. .. 1 1 3 2 2 2 1 .. .. 12 Broncho, Catarrhal, Lobular, Pneumonia 29 22 4 1 .. 2 3 6 3 2 2 74 Pneumonia 31 23 6 10 11 16 21 19 17 5 2 161 Emphysema, Asthma .. .. .. .. .. 2 1 4 4 .. .. 11 Pleurisy .. .. .. .. 3 .. 1 4 3 •• 1 12 Fibroid Dis. of Lung .. .. .. .. .. .. 1 .. .. 1 .. 2 Respiratory Dis., other .. .. .. .. 1 3 2 1 1 .. .. 8 613 Disease op Digestive System. Tonsilitis, Quinsev .. .. .. .. .. .. .. .. .. .. .. .. Mouth, Pharynx, Dis. (not specific) .. 1 .. .. .. .. .. .. .. .. 1 .. Gastric Ulcer .. .. .. 5 2 2 .. 3 2 .. .. 14 Gastric Catarrh 2 .. 2 .. .. .. 1 1 2 .. .. 8 Stomach, other Dis. (not Malig.) 4 1 .. .. .. .. .. .. 3 .. .. 8 Enteritis (not Epid.) 15 2 .. .. .. 1 1 2 1 1 1 24 Gastro-Enteritis 17 2 .. .. .. .. .. .. .. .. 1 20 Appendicitis, Perityphlitis . . 1 1 4 2 5 .. 1 .. .. .. 14 Hernia .. .. .. .. .. .. .. 2 1 .. .. 3 Intestinal Obstruction .. 1 .. .. 1 .. .. 4 3 .. .. 9 Other Dis. of Intestines .. .. .. .. .. .. .. .. .. .. .. .. Peritoritis (not Puerperal 1 .. .. 2 2 2 .. 4 2 .. .. 13 28 TABLE OP 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. Cirrhosis of Liver .. 1 .. 1 .. 3 12 11 3 2 .. 33 Liver and Gall Bladder, other Diseases 1 .. .. .. 2 1 3 1 .. 1 1 10 Digest. Syst., other Diseases .. .. .. .. .. .. .. 1 .. .. .. 1 159 Lymph Disease. Spleen Disease .. .. .. .. .. .. .. .. .. .. .. .. Lymph System, other Diseases .. .. .. .. .. .. 2 .. .. .. .. 2 Thyroid Body Disease .. .. .. .. .. .. .. .. .. .. .. .. Supra Renal Capsules Disease .. .. .. .. .. .. .. .. 1 .. .. 1 3 Disease of Ukin. Syst. Nephritis Acute .. .. 1 2 3 .. 1 .. 2 .. .. 9 Chronic Bright's Dis., Albuminura .. .. .. 1 3 5 7 15 12 4 .. 47 Calculus (not Biliary) .. .. .. .. .. .. .. 1 .. .. .. 1 Bladder & Prostate Dis. .. .. .. .. .. .. 2 3 2 .. .. 7 Urin. Syst., other Dis. .. .. .. .. .. .. 3 2 1 .. .. 6 70 Disease of Gener. Syst. Ovarian Tumour (not Malig.) .. .. .. .. 1 1 .. 1 .. .. .. 3 Other Dis. of Ovary .. .. .. .. .. .. 1 .. .. .. .. 1 Uterinal Tumour (not Malig.) .. .. .. .. .. .. .. .. .. .. .. .. Other Dis. of Uterus and Vagina .. .. .. .. .. .. .. .. .. .. .. .. 29 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. Disorders of Menstruation .. .. .. .. .. .. .. .. .. .. .. Gener. and Mam. Orgs., other Dis. .. .. .. .. .. .. .. .. .. .. .. 4 Accidents Childbirth. Abortion, Miscarriage .. .. .. .. .. .. .. .. .. .. .. Puerperal Mania .. .. .. .. .. .. .. .. .. .. .. Puerperal Convulsions .. .. .. .. .. .. .. .. .. .. .. Placenta Prævia, Flooding .. .. .. .. 3 2 .. .. .. .. .. 5 Other Accid. of Pregnan8y and Childbirth .. .. .. .. 3 .. .. .. .. .. .. 3 8 Joint Disease. Caries, Necrosis .. .. 2 1 .. .. .. 1 .. .. .. 4 Arthritis, Periostitis .. .. 2 1 .. .. .. .. .. .. .. 3 Other Dis. of Locom. Syst. .. .. .. .. .. .. .. .. .. .. .. 7 Skin Disease. Ulcer, Bedsore .. .. .. .. .. .. .. .. .. .. .. Eczema .. .. .. .. .. .. .. .. .. .. .. Pemphigus 4 .. .. .. .. .. .. .. .. .. .. 4 4 Skin Disease, other .. .. .. .. .. .. .. .. .. .. .. Old Age .. .. .. .. .. .. .. 4 35 94 55 188 188 Totals 822 361 112 128 181 219 303 393 397 286 97 3299 30 SPECIFIC INFECTIONS OR ZYMOTIC DISEASE. During the year 1905 there were 1,930 cases of notifiable infectious disease certified, but of these cases 64 were subsequently found not to be genuine, thus reducing the total to 1,866. This shows a considerable decline upon the numbers notified during 1904, the notifications for this latter year having been 2,375, the decline above noted amounting to 519. The attack rate for the year 1905 is, therefore, 8.2 per 1,000 persons living. The deaths from notifiable infectious disease numbered 84. This is equal to a mortality rate of .37 per 1,000 persons living. A.—NOTIFIABLE INFECTIOUS DISEASE. Smallpox.—There were 4 cases of smallpox notified in the Borough during 1905, and of these two died, neither of whom tad been vaccinated. Scarlet Fever.—During the year under consideration there were 1,081 cases of scarlet fever notified in the district, but of these 24 were afterwards found not to be suffering from the disease, thus reducing the genuine cases of scarlet fever for the year 1905 to 1,057. This is an increase of 208 upon the number notified during 1904. The attack rate for the year is, therefore, 4.6 per 1,000 living persons. The incidence of the disease upon the Borough remained fairly low from January to the end of July. At this point a rise set in which continued to increase until the second week of November, when 42 cases were notified in that week. This rate was maintained for about four weeks when a rapid decline set in, which continued to the last week but one in the year, after which indications of a rise again appeared. These movements in the incidence of scarlet fever may be followed by consulting the annexed chart. The total number of scarlet fever cases removed to hospital during the year was 973, which amounts to 90 per cent. of the total notified. 31 The following table shows the distribution of the disease in the respective sub-districts of the Borough. Sub-districts. North. Central. South-East. South-West. No. of Cases of Scarlet Fever. 131 307 378 265 Attack rate per 1,000. 2.4 5.7 6.2 4.3 It will be seen from this table that the disease was most prevalent in the Central and South-East Sub-Districts. The deaths from scarlet fever during the year numbered 18 which is equivalent to a mortality of 17 per 1,000 attacked and .08 per 1,000 living persons. The mortality rate for London for the same period is .12 per 1,000 living. During the year a Report was presented to the Metropolitan Asylums Board by their Medical Investigator, Dr. A. G. R. Cameron, on the subject of cases of Scarlet Fever and Diphtheria caused by infection from persons returning home from hospital after being treated for these diseases. The Report was submitted to the Board's Medical Superintendents for their observations, and I give below their recommendations. Recommendations of the Board's Medical Superintendents— Scarlet Fever. As a result of our examination of the facts brought forward by Dr. Cameron, and such other sources of information as are known to us, we recommend— 1. That as far as practicable every patient, as soon as he is in a fit condition, and without regard to age or sex, be transferred from the Acute to the Convalescent Hospitals. 2. That a discharge ward for Scarlet Fever be established at each hospital, into which the patient could be admitted and bathed not later than the day before discharge. 32 3. As we are of opinion that harm resulted from the abrupt transition from hospital to home conditions undergone by patients immediately on discharge, we recommend that every endeavour should be made to prepare patients for this change, especially by providing facilities for their being in the open air. At some of the hospitals this will involve the erection of verandahs or other form of shelter. 4. That the following notice be printed and a copy sent with the notice of discharge to the parent or guardian of every discharged Scarlet Fever patient:— "Although every endeavour is made to send out patients free from infection, it is advisable, as an additional precaution, that they should, as far as possible, be kept away from other children, including attendance at school, for the first three weeks after their return home. They should certainly not sleep in the same bed, and, if possible, not in the same room with children who have not had the disease. "It is also advisable that articles used by the patients, such as cups, plates, spoons, handkerchiefs, towels and toys, should, during this period, be kept distinct from those used by other children. "The above precautions are specially important in the case of those patients suffering from discharge from either nose or ears." 5. That at one hospital, say the South-Eastern, now in course of rebuilding, two or more wards be divided by glass partitions into separate rooms, and that Scarlet Fever patients be treated therein on the system of complete isolation during the whole period of detention, so far as that may be found practicable, and that the effect of this procedure on the occurrence of "return cases" should be carefully observed. 6. That similar rooms be erected at two other Acute Hospitals in which Scarlet Fever patients may be isolated for at least three weeks after admission. The patients being afterwards drafted into convalescent wards, the complicated and uncomplicated cases being kept separate. The structural arrangements of the 33 rooms mentioned in this and the preceding recommendations to be carefully considered by the Medical Superintendents. 7. That inquiry into the subject of "return cases" should be continued, on lines to be suggested by the Medical Superintendents. 8. That arrangements be made to notify each "return case" to the superintendent of the hospital from which the infecting patient was discharged. The adoption of certain of the above recommendations would necessitate an increased number of staff, and would also diminish the accommodation available for the direct admission of cases. We consider that both these changes are justified by the prospect of reaching a higher standard of efficiency in the purpose for which the hospitals are primarily intended, viz., the protection of the public from infection. Recommendations of the Board's Medical Superintendent's— Diphtheria. Prom the evidence collected by Dr. Cameron, we see that "return cases" are less common after Diphtheria than after Scarlet Fever; and that a larger proportion of the alleged cases were doubtful or proved coincidences. Further, a larger proportion of the Diphtheria "return cases" must be classed (provisionally, at any rate) as non-preventible ; since no abnormal condition was detected in the supposed infectious cases. We are not prepared to recommend at present any special systems of isolation even experimentally. The question whether a bacteriological examination before discharge gives any additional security should be further investigated. Diphtheria and Membranous Croup.—During the year 1905 there were 372 cases of diphtheria and 12 cases of membranous croup notified in the Borough of Hackney. Of these 22 cases of diphtheria and 1 case of membranous croup were found not to be suffering from this disease, thus leaving 261 genuine cases of 34 diphtheritic disease during the year. This is equivalent to an attack rate of 1.5 per 1,000 living persons. This shows a considerable decline in the prevalence of this disease upon that during 1904, the attack rate for this latter year being 2.4 per 1,000 living persons. The incidence of the disease continued low during the whole of the year, as may be seen in the accompanying chart. The following shows the distribution of diphtheritic disease in the various sub-districts of the Borough during 1905:— Sub-districts. North. Central. South-East. South-West. No. of Cases of Diphtheria. 58 101 136 77 Do. do., Membranous Croup. 1 3 5 3 Total attack rate per 1000. 11 1.9 2.3 1.8 It will be seen from this table that diphtheritic disease was most prevalent during 1905 in the south-east sub-district, and least in the north sub-district. Of the cases notified, 307 were removed, to hospital, which is equal to 78 per cent. of the total. The deaths from diphtheria and membranous croup number 26, which is equivalent to a mortality rate of 9.9 per cent, attacked, and .11 per 1,000 living persons. The mortality rate for London is .12 per 1,000 living persons. During the year 93 swabbings from the throats of persons suspected to be suffering from diphtheria were bacteriologically examined, with the result that 42 gave positive results and 51 negative. Typhoid or Enteric Fever.—During the year 165 cases of this disease were notified in the district, but of these 16 cases were subsequently found not to be cases of enteric fever, thus leaving 149 35 genuine cases notified during the year. This gives an attack rate of .65 per 1,000. This rate is lower than that during 1904, the number of cases notified during this latter year having been 175, and the attack rate .77 per 1,000. The disease was prevalent in Hackney during the whole year, but at no time did the incidence reach a higher point than 9 cases in one week, this level being reached twice, in the last week of September and the third week of November. The following table gives the distribution of the cases in the sub-districts of the Borough. Sub-districts. North. Central. South-East. South-West. No. of Cases of Typhoid. 22 48 50 29 Attack rate per 1,000 living. .43 .94 .80 .47 Of the number notified 132 were removed to hospital, which is equivalent to 80 per cent, of the total. The number of deaths from enteric fever equalled 26, which is equivalent to a mortality rate of 15.7 per cent, attacked, and .11 per 1,000 living persons. The mortality rate of enteric fever for London for the same period is .05 per 1,000 living. During the year 30 specimens of blood from patients suspected to be suffering from enteric or typhoid fever were examined; of these 16 gave the reaction known as "Widal's." In the remainder the examination gave negative results. In my Annual Eeport for the year 1902 I commented upon the undesirableness of enteric fever patients being nursed at home unless C 36 exceptional accommodation with skilled nursing were available, owing to the danger of secondary cases arising from personal infection. During the year 1905 a rather large number of instances arose in the Borough, illustrating in a striking way the danger of personal infection in the way suggested. I give below, arranged in groups, details of the secondary cases which have arisen from personal infection. Group 1.—Sidney and Cyril S., aged respectively 7 and 5 years, of 42a, B. Road, fell ill on or about the 27th December, 1904, and were treated at home. On January 7th, 1905, they were notified as suffering from enteric fever. Sidney was removed to hospital on January 11th, but Cyril was kept at home and nursed by his mother. About the 20th January, Reginald, aged 2½ years, fell ill, and he was notified by the doctor in attendance as suffering from enteric fever on January 25th. He, too, was retained at home with Cyril and nursed by his mother. On or about the 3rd of March, Mrs. S., mother and nurse to the above, fell ill with what was notified on the 9th March as enteric fever. She was removed to hospital on the same day. This family consisted of Mr. and Mrs. S. and five children. The sick children were isolated in a room by themselves. The accommodation for the whole family consisted of four rooms and a scullery. The source of Cyril and Sidney's illness was not ascertained ; but that of Reginald and Mrs. S. appear to be due to direct infection from Cyril, who was nursed at home. I may add here that the children were retained at home on a certificate from the attending medical practitioner. On inspection no insanitary condition was found except that the house required cleaning. Group 2.—Sidney B., aged 13 years, residing at 23, H. Street, was taken ill on or about the 16th June, 1905. He was notified as suffering from enteric fever on the 22nd June, and removed to the Fever Hospital on the same day. Elizabeth B., aged 12 years, sister of above, fell ill on or about the 11th July of the same year, and was notified as suffering from 37 enteric fever on the 19th July, on which date she was removed to the Fever Hospital. George B., aged 19 years, brother of above, fell ill on about the 23rd July. He was notified as suffering from enteric fever on the 27th July, and was removed to the Fever Hospital on the same day. These three persons lived with their parents at the above address, in a tenement consisting of two rooms only. George and Sidney slept in the same bed. Elizabeth slept in the same bed with a lodger's child, who is stated to have suffered from diarrhoea earlier. The exact date could not be ascertained. The circumstances of the family were those of the casual labouring class. On inspection of the premises no nuisance was discovered. Group 3.—Amelia and Elizabeth H., aged 10 and 6 years respectively, of 11, M. Road, are said to have fallen ill on or about the same date, viz., 23rd September. They were notified as suffering from enteric fever on the same day, and removed to the Fever Hospital on 25th September. Enquiries led to the information that three weeks before these fell ill another child of the family, Alice May H., age 2½ years, fell ill with diarrhoea and sickness. This child attended the out-patient's department of the Infirmary, where she was treated. The child's illness is said to have lasted 15 or 16 days. This family consisted of father, mother, and four children. They occupied a tenement of four rooms. The father was a typecaster, working at his trade in the City. The defects found on inspection were defective gutters, kitchen ceiling dirty, manhole cover in back yard imperfectly sealed. Group 4.—Mary H., aged 44 years, married, 5, W. Road, fell ill about the 7th October, 1905, and was notified on the 17th October as suffering from enteric fever. She was removed on the same date to the fever hospital. Daisy H., aged 7 years, daughter of the above, fell ill about 18th October, was notified as suffering from enteric fever on the 19th October, and was removed to the Fever Hospital on the next day. Daisy is said to have slept with her mother in the same bed prior to her removal to hospital. C 2 38 This family, consisting of father, mother and five children, occupied a tenement of two rooms. The father at this time was out of employment. The only insanitary condition found on inspection here was dirty rooms. Group 5.—Alice W., aged 4 years, and Daisy W., aged 10 years, of 78, C. Road, fell ill about the same time, October 8th. They were notified as suffering from enteric fever on the 16th October, and removed to hospital on the same day. Daisy C. and William C., aged respectively 7 and 9 years, of the same address, fell ill, the former on about the 1st October, the latter about the oth October, and were both notified as suffering from enteric fever on the 10th October. They were removed to hospital on the same date. These children were members of another family in the same house, on the upper floor. Walter W., aged 7 years, fell ill with diarrhoea and sickness on or about the 18th September, and was nursed at home by his mother. He kept his bed about three weeks, and his recovery afterwards was very slow. The illness of the other members of the family, in the meantime, aroused suspicions that Walter's illness was probably enteric fever. He was consequently notified as suffering from enteric fever on the 21st October, although acute symptoms had left him, and was removed to the Fever Hospital on the same date. (His retention at hospital confirmed this suspicion.) During the illness of Walter the children on the next floor (the C.'s) had free access, as well as his own brothers and sisters, to the room where he was ill; and Mrs. C., mother of Daisy and William C., assisted alternately with Mrs. W. in nursing Walter, especially at night, when his condition was at its worst. The family of the W.'s consisted of father, mother and four children, the father being a porter. They occupied four rooms, two in the basement and two on the first floor. The C. family consisted of father and mother and two children, occupying two rooms on the second floor. The father's occupation was that of a labourer. The only insanitary condition found on inspection was dirty rooms and bedding. 39 Group 6.—Clara F., aged 15 years, of 70, F. P. Eoad, fell ill on about the 11th October, 1905, and was notified on the 21st October to be suffering from enteric fever, and removed on the same date to the Fever Hospital. Florence E., aged 35 years, of the same address, fell ill about the 8th November, and was notified as suffering from enteric fever on 17th November. She was retained at home and,nursed by her mother. Clara F. was nursed before removal to hospital (about two weeks in bed) alternately by her grandmother and Florence E. She is said to have suffered badly from diarrhoea during the last week before removal to hospital. No insanitary condition was noted on inspection of these premises. Group 7.—Florence C., aged 23 years, of 126, D. Road, fell ill on or about the 26th September, and was notified by the medical attendant as suffering from diphtheria on the 10th October, and was removed to hospital on the same day. This diagnosis was found by the Asylums Board's Medical Officer to be incorrect, and he notified the case as one of enteric fever. Later enquiries revealed the fact that a brother of the patient, Thomas C., aged 20 years, and residing at the same address, was ill at home, and kept to his bed from October 3rd to October 13th. He suffered from sickness and diarrhoea during this time, and his temperature at one time was 103°. He gradually recovered, but was very weak for some time after. (His mother and a sister, Louisa, attended upon him during his illness.) Another sister of the patient, Josephine, aged 13 years, was also ill at home during this period, being treated by a local practitioner from October 19th to 21st, but was sent away to a sister, with whom she remained three days; but this sister, being unable to keep her longer, sent her to another married sister, with whom she remained. This sister states the child was very weak when she arrived, and thinks she did suffer from diarrhoea a short time before she came to her. On the 6th November, Louisa C., another sister of above and living at 126, D. Road, fell ill and was notified as suffering from enteric fever on the 14th November, being removed to hospital on the same day. 40 This family consists of father, mother, and four children, three of whom were adults. The family occupied four rooms in a sevenroomed house in D. Street. No nuisance could be discovered on the premises when inspected. Group 8.—Arthur E., age 26 years, of 371, W. Road, fell ill on or about the 25th August, 1905, and was removed to the London Hospital. He was notified as suffering from typhoid fever on the 31st August. On or about the 23rd October, Mary E., wife of above, age 27 years, is said to have fallen ill. She was notified as suffering from enteric fever on the 7th November, and was removed the same day to the London Hospital. The above occupied, with their two children, a tenement of three rooms at the above address. The four remaining rooms in the same house were tenanted by another family, consisting of three adult3 and one child. On the 11th November one of these adults named Robert N., age 17 years, is said to have fallen ill, and was notified as suffering from typhoid fever on the same day and removed to hospital on 14th November. Both families in this house belonged to the hawker class, and carried on business on stalls near to each other. It is certain that living in the same house and carrying on the same class of business there was intimacy between the two families. Robert N., I am of opinion, received infection from Mary E., in what particular way I am unable to say; but from what one knows of the habits of families of this class aggregated together in one house it is not surprising that infection is conveyed from family to family. Mary E., I am of opinion, was infected by her husband possibly while on a visit to her husband in the hospital. The only insanitary condition found was dirtiness of the premises. Group 9.—Nellie J., age 24 years, of 33, C. Road, is said to have fallen ill on or about the 10th October, 1905, and was notified as 41 suffering from enteric fever on the 27th October. She was treated and nursed at home. On or about the 5th December, Maggie J., age 10 years, stepdaughter of the above, fell ill and was notified as suffering from enteric fever on the 17th December. She was removed to hospital on that day. The housing accommodation for this family consisted of five rooms in an eight-roomed house. The only defects found in this house was an untrapped sink. Group 10.—Alice T., aged 4 years, of 15, E. Place, fell ill with sickness, pains in the head and stomach, and became an outpatient at the North-Eastern Children's Hospital on the 24th July, and continued attending there until 31st July, when she was admitted an in-patient, where she remained until she had recovered. By permission of the Resident Medical Officer I extract the following notes from the clinical reports of this case:—"14th August, temp. 103° last night; 18th August, temp. 100°, tongue coated, spleen palpable; a few doubtful-looking spots on abdomen; heart and chest clear. The bacteriological report on the examination of the blood for the Widal reaction is as follows:—"18th August—Bacilli sluggish to start with, and grew more sluggish, but there was no definite clumping. Result negative." Owing, no doubt, to the rather negative result of the above examination, this case was never notified as one of enteric fever; but in the light of the subsequent cases which occurred, the physician in attendance on the case was of opinion that the case was undoubtedly one of enteric fever. Albert Thompson, age 9 years, brother of above, fell ill about 17th August, with pains in the head and stomach; was admitted into North-Eastern Children's Hospital on the 21st August, and was notified as suffering from enteric fever on the 23rd August. He was detained in the hospital until the 20th October. 42 Fred T., age 1½ years, brother of above, is said to have fallen ill oil the 26th September, and to have been admitted into the NorthEastern Children's Hospital, and notified as suffering from enteric fever. Eliza T., age 12 years, sister of above, is said to have fallen ill about the 21st September, was admitted into the North-Eastern Children's Hospital on 25th September, and notified as suffering from enteric fever on the 26th September. Emily T., age 43 years, mother of above children, is said to have fallen ill on or about the 19th September, but there are evidences that she was ill at home a considerable time before this date. She was, however, removed to the Infirmary, Homerton, on the 26th September, and was notified as suffering from enteric fever on the 27th September. Her condition got worse, and she died oil the 25th October. Henry T., age 17 years, son of above, is stated to have fallen ill on or about the 25th September, was notified as suffering from enteric fever on the 1st October, on which date he was removed to the North-Eastern Fever Hospital. William T., age 43 years, father to the last patient, is stated to have fallen ill about the 24th September, but there appears to be no doubt that he had been ailing some time before this. He was notified as suffering from enteric fever on the 5th October, and was removed to the Eastern Fever Hospital on the same date. Annie T., age 7 years, another daughter, was removed to the Hackney Infirmary on the 5th October, and was notified from that Institution as suffering from enteric fever on the 21st October. In addition to the above, another daughter, Emily, age 22 years, fell ill about 15th September, and was admitted into the Metropolitan Hospital, Kingsland, on the 29th September, where she remained until 30th November, when she was discharged to a Convalescent Home. This case escaped notification, but medical opinion at the Metropolitan Hospital regarded it as an undoubted case of enteric fever. 43 Circumstances of the family: Mr. and Mrs. T. occupied, with their seven children, three rooms in a five-roomed house in E Place. Mr. T. was a journeyman cabinet-maker, his wife being engaged at home in attending to the family. The rooms occupied were two on the ground floor, and one on the first floor, the other rooms in the house being occupied by another family, consisting of father, mother and one child. No member of this family was affected. At the beginning of this outbreak the house was examined for sanitary defects, the drains being tested more than once, but none was found; but towards the end of the outbreak it was found that they were defective and were reconstructed. I am of opinion that this defect did not lead to the spread of the disease through the family, but personal infection was responsible for its spread. In the investigation of all these cases of enteric fever, close enquiry was made as to whether the ordinary causes for the spread of enteric fever were operative, but with negative result. Typhus.—One case of this disease was notified in the Borough during 1905, and this case occurred in the Central sub-district. Continued Fever.—Under this head one case of fever was certified in the Borough during 1905. Puerperal Fever.—There were eight cases of puerperal fever notified in Hackney during 1905, of which four were removed to hospital. The deaths numbered 2, which is equivalent to a mortality rate of 25 per cent, attacked. The attack rate is 1.3 per 1,000 births, and the mortality .34 per 1,000 births. Plague.—No case of plague occurred in Hackney during the year 1905. Erysipelas.—There were 286 cases of erysipelas notified in the Borough of Hackney during 1905, which is equivalent to an attack rate of 1.2 per 1,000 living persons. Of this number 72 were removed to hospital, which is equal to 25 per cent. of the total notified. 44 Below is given the distribution of the disease in the several sub-districts of the Borough. Sub-districts. North. Central. South-East. South-West. No. of Cases of Erysipelas. 40 53 137 56 Rate per 1,000 living. .75 .98 2.2 .92 The deaths from erysipelas amounted to 10 during 1905. This is equal to a mortality rate of 3.5 per cent. attacked, and .04 per 1,000 living persons. B. NON-NOTIFIABLE INFECTIOUS DISEASE. Influenza.—During the year in question 28 deaths were recorded in the Borough of Hackney from this cause. This is a slight increase over the number recorded during the year 1904. The mortality rate for 1905 is .12 per 1,000 living persons; that for London during the same period is .15 per 1,000 living persons. Chicken-Pox.—No death from this cause was recorded in the Borough during the year 1905. Diarrhœa.—There were 233 deaths from diarrhoea in the Borough during 1905. In addition there were 44 deaths registered as due to enteritis. The following table gives the distribution of deaths from diarrhoea in the different sub-districts:— Sub-districts. North. Central. South-East. South-West. No. of Deaths from Diarrhœa. 19 70 94 50 Death-rate per 1,000 living. .35 1.3 1.5 .8 45 The mortality rate for the whole district from this disease is 1-02 per 1,000 living persons. The mortality rate for London for the same period is .72 per 1,000 living persons. Measles.—This disease was rather more prevalent during 1905 than during the previous year, the deaths in 1905 being 74, with a mortality rate of .32 per 1,000 living, against 66 deaths, with a mortality rate of .26 per 1,000 living in 1904. The following table gives the distribution of the deaths in the different sub-districts:— Sub-districts. North. Central. South-East. South-West. No. of Deaths from Measles. 8 17 27 22 Mortality rate per 1000 living. .15 .31 .44 .36 The mortality rate for the whole of London is .37 per 1,000 living persons. During the year information was received from the headmasters of elementary schools in the Borough of 1232 cases of measles. Whooping Cough.—The deaths from whooping cough in the Borough of Hackney during last year numbered 64. This is a very slight decline upon the number registered during 1904, the number for this latter year being 66. The mortality rate for 1905 is .28 per 1,000 living; that for all London during the same period being .32 per 1,000 living persons. The deaths were distributed in the Borough in the following proportions:— 46 Sub-distriota. North. Central. South-East. South-West. No. of Deaths from Whooping Cough. 7 12 25 20 Mortality rate per 1000 living. .13 .22 .41 .32 During the year information was received from the headmasters of elementary schools in the Borough of the existence of 376 cases of whooping cough. CONSTITUTIONAL DISEASES. Tuberculous Disease.—During 1905 there were 389 deaths in the Borough due to tuberculous disease. They are grouped under the following heads:— Tuberculous Phthisis 162 Phthisis 94 General Tuberculosis 54 Tuberculous Meningitis 53 „ Peritonitis 11 Tabes Mesenterica 9 Tubercle of other organs 8 391 This is equal to a mortality rate of 1.7 per 1,000 living. The deaths were distributed in the different sub-districts in the following proportion:— Sub-districts. North. Central. South-East. South-West. No. of Deaths from Tuberculous Disease. 74 95 106 116 Mortality rate per 1,000 living. 1.4 1.7 1.7 1.9 47 Cancer.—The number of deaths from this cause recorded in the Borough of Hackney during 1905 was 203. This is equal to a mortality rate of .90 per 1,000 persons living. The deaths were distributed in the sub-districts in the following proportions:— Sub-districts. North. Central. South-East. South-West. No. of Deaths from Cancerous Disease. 50 42 54 57 Mortality rate per 1,000 living. .94 .78 .89 .93 Below is given a table showing the number of deaths and death rates in this Borough during the ten years ending 1905:— Years. 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 Borough of Hackney. Deaths from Cancer. 138 164 199 200 190 182 190 192 182 203 Death rate per 1,000. .64 .75 .90 .87 .86 .82 .85 .85 .80 .90 London. Death rate per 1,000. .86 .88 .92 .95 .95 .93 .99 .87 .99 1.00 The death rate from this disease for all London during 1905 was 1.00 per 1,000 living. ALCOHOLISM. During 1905 there were 8 deaths registered as due to acute and chronic alcoholism. In addition there were 33 deaths registered from cirrhosis of tha liver, a disease which in most cases is caused by the excessive indulgence in alcohol. 48 Towards the end of the year the Borough Council caused a placard pointing out the dangers of excessive alcoholic drinking to be published in the district. The following is a copy of the placard METROPOLITAN BOROUGH OF HACKNEY. PHYSICAL DETERIORATION AND ALCOHOLISM. The Report of the Committee presented to Parliament by command of His Majesty states that the abuse of Alcoholic Stimulants is a most potent and deadly agent of Physical Deterioration. Some of the highest medical authorities are of opinion that alcoholic persons are specially liable to Syphilis, Tuberculosis, and all inflammatory diseases. Evidence was placed before the Committee showing that the effects of physical training on young men are to convince them that in abstinence is to be sought the source of muscular vigour and dexterity. The Lunacy statistics show a large and increasing number of admissions of both sexes which are due to drink. The following facts are published in order to carry out the recommendations of the Committee, and to bring home to men and women the fatal effects of the abuse of alcohol on physical efficiency. 1. Alcoholism is a chronic poisoning, resulting from the habitual use of Alcohol (whether as spirits, wine or beer), which may never go as far as drunkenness. 2. It is a mistake to say that those doing hard work require lants. As a fact no one in health requires alcohol as either food or tonic. 3. Alcohol is really a narcotic, dulling the nerves like laudanum or opium, but is more dangerous than either in that often its first effect is to weaken a man's self control while his passions are excited; hence the number of crimes which occur under its influence. 4. Spirits, when taken in excess, rapidly produce alcoholism ; but milder alcoholic drinks, as beer, and even cider, drunk repeatedly every day, may produce after a time alcoholic poisoning with equal certainty. 49 5. The habit of excessive drinking leads to the ruin of families, the neglect of social duties, distaste for work, and is the source of much misery, theft and crime. It leads also to the hospital, for alcohol produces the most various and the most fatal diseases, including Paralysis, Insanity and Diseases of the Stomach and Liver. It also paves the way to Consumption, and frequenters of public houses furnish a large proportion of the victims of this disease. It complicates and aggravates all acute diseases. Typhoid Fever, Pneumonia and Erysipelas are often rapidly fatal in the subject of alcoholism. 6. The sins of alcoholic parents are visited on the children ; if these survive infancy, they are threatened with Idiocy or Epilepsy, and many are carried away by Tuberculosis, Meningitis or Phthisis. (Consumption). 7. In short, alcoholism is a most terrible enemy to personal health, to family happiness, and to national prosperity. By Order of the Borough Council, TOM HOSGOOD, Mayor. Town Hall, Hackney, N.E. J. KING WARRY, M.D., D.P.H., 28th September, 1905. Medical Officer of Health. VACCINATION. Below is given a summary of the Vaccination Officers' returns for the half year ending June 30th, 1905. From this it will be seen that there were 2,988 births registered during that half year, and of these 1,799 were successfully vaccinated. Of the remainder, certificates of conscientious objection were received in respect of 25, no less than 280 died unvaccinated, the vaccination was postponed in respect of 58, and 673 removed either to other districts or to unknown places, and 146 are entered as not being accounted for. After deducting the 280 deaths from the total births, the successful vaccinations equalled 66 4 per cent. of the remaining births. This is an improvement upon the proportion vaccinated during the first half year of 1904— the proportion during this latter period being 64 per cent. 50 Return made on the 8th February, 1906, by the Vaccination Officers of the Hackney Union, respecting the Vaccination of Children whose Births were registered in their Districts from 1st January to 30th June, 190S, inclusive. Registration Subdistricts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets " as registered from 1st Jan. to 30th June, 1905. Number of these Births duly entered by 31st January, 1906, in cols. 1, II, IV and V of the " Vaccination Register" (Birth List Sheets), viz.:— No. of these Births which on 31st Jan., 1906, remained unentered in the "Vaccination Register" on account (as shown by Report Hook) of No. of these Births remaining on 31st January, 1906, 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 calendar year 1905. Col. I. Column II. Col. IV. Col. V. Postponement by Medical Certificate. Removal to Districts, the Vaccination Officer of which had been duly apprized. Removal to places unknown or which cannot be reached and cases not having been found. "Successfully Vaccinated." "Insusceptible of Vaccination." "Had Small-pox." Number in respect of whom Certificates of Conscientious Objection have been "Dead. Unvaccinated." 1 2 3 4 5 6 7 8 9 10 North Hackney 510 359 5 .. 8 23 18 4 65 28 22 Central Hackney 740 452 1 .. 7 69 5 3 167 36 47 South-East Hackney 840 419 1 .. 4 98 29 21 209 59 South-West Hackney 898 569 .. .. 6 90 6 37 167 23 Total 2988 1799 7 .. 25 280 58 65 608 146 69 Total for the period of 1904 (1st Jan. to 30th June) 3081 1762 9 .. 36 349 41 87 517 280 89 51 PUBLIC HEALTH (LONDON) ACT, 1905. (a) Complaints of Nuisances.—During the year 1905 there were 2,107 complaints received. On investigation a small percentage only was found to be unreal, but almost the whole were proved to be real. These were investigated and dealt with by the various district inspectors. (b) Infectious Disease.—There were 1,930 dwellings inspected during 1905, owing to notifiable infectious disease occurring therein. The nuisances discovered, although they may have had no relation to the disease notified, were immediately brought to the notice of the persons responsible for their abatement by means of a notice. (c) House to House Inspections.—The number of inspections made under this head during the year was 954, the largest number being made in the following localities, viz: London Fields, 219; Hackney Wick, 120; South Hackney, 103; and in the High Hill Ferry district, 158. These inspections are independent of inspections made in consequence of complaints of nuisance or the occurrence of infectious disease. The nuisances found on inspection were in the majority of instances abated on the service of an Intimation Notice; 342 required the service of a Statutory Notice, and 22 the issue of a summons to appear before a Court of Summary Jurisdiction, to secure the abatement of the nuisances found. The result of the prosecutions is given in the appendix to this report. During the past year house to house inspections have been continued in the Homerton and London Fields Districts. So important is this kind of inspection regarded by the Public Health Committee that the Borough Council, on the Committee's recommendation, appointed the officers temporarily engaged on this work, permanently for such work. The following details refer to the house to house inspections made during the year by these inspectors. d 52 Details of house to house inspections made in the London Fields District during the year 1905 by Inspector Walter C. Vobe:— No. of houses inspected 219 Re-inspections made 2,190 No. of Intimation notices served 225 „ Statutory „ 22 Final notices served 13 Nuisances. Found. Abated. In hand. Outstanding. House or part in a dirty condition 91 77 7 7 House or part in a damp condition 41 37 2 2 House or part in a dilapidated condition 17 15 2 0 Inlet to surface drain improperly trapped 2 2 0 0 W.C. so foul as to be a nuisance 43 43 0 0 W.C. with a deficient supply of water 25 24 0 1 W.C. improperly constructed 5 5 0 0 W.C. so defective as to be a nuisance 12 12 0 0 W.C. stopped 5 5 0 0 Insufficient external light and ventilation to w.c. 15 10 5 0 Soil pipe unventilated 4 4 0 0 Yard paving defective 37 31 6 0 Yard dirty 4 4 0 0 Gully improperly placed within the house 10 10 0 0 Sink waste connected directly with drain 4 4 0 0 Sink waste untrapped 36 31 2 3 Sink waste defeclive 4 4 0 0 53 Nuisances. Found. Abated. In hand. Outstanding. Lavatory waste untrapped 1 1 0 0 Water cistern defective 1 1 0 0 No dust bin or dilapidated dust bin 61 58 0 3 Drain choked 3 3 0 0 Drain unventilated 2 2 0 0 Rain-water pipe connected direct to drain 7 5 0 2 Rain-water pipe defective 10 10 0 0 House without a proper water supply 3 3 0 0 Roof defective 30 30 0 0 Guttering defective 11 11 0 0 Area dirty 5 5 0 0 Wash-house paving defective 3 3 0 0 Animals kept as to be a nuisance 5 5 0 0 House or part overcrowded 42 42 0 0 Underground rooms let contrary to the Act 1 1 0 0 Insufficient ventilation under the ground or basement floor 76 75 1 0 Vent shaft not a safe outlet for foul air 5 5 0 0 Foul urinals 1 1 0 0 Urinals improperly constructed 1 1 0 0 Beer cellar defectively paved and drained 1 1 0 0 Defective drains 65 55 9 1 Foul sinks in scullery 4 0 0 4 No draw tap on main 5 5 0 0 d 2 54 Details of house to house inspections made in the Homerton District during the year 1905 by Inspector W. Peveret:— Houses inspected 385 Houses re-inspected 4,018 Intimation notices served 314 Houses where nuisances found 273 Statutory Notices served 34 Nuisances. Found. Abated. In hand. Outstanding. House or part of house in dirty condition 135 132 3 0 House or part of house in damp condition 8 8 0 0 W.C. so foul as to be a nuisance 5 5 0 0 W.C. without water supply 2 2 0 0 W.C. with dificient supply of water 24 22 2 0 W.C. improperly constructed 18 18 0 0 W.C. so defective as to be a nuisance 20 20 0 0 W.C. placed in an improper position 1 1 0 0 Insufficient external vent to water closet 6 6 0 0 Soil-pipe defective 2 2 0 0 Soil-pipe unventilated 2 2 0 0 Yard paving defective 117 112 5 0 Yard dirty 2 2 0 0 Gully trap improperly placed within house 20 18 2 0 Sink waste directly connected with drain 23 23 0 0 Sink waste untrapped 192 180 0 12 Sink waste defective 18 18 0 0 Waste pipe of bath untrapped 1 1 0 0 Dust bin or ashpit defective 93 92 0 1 55 Nuisances. Found. Abated In hand. Outstanding. Drain defective 108 101 1 6 Drain choked or stopped 5 5 0 0 Rain-water pipe in direct communication with the drain 21 21 0 0 Rain-water pipe defective 44 44 0 0 Roof defective 34 33 1 0 Guttering defective 39 39 0 0 Area improperly paved 5 5 0 0 Paving of wash-house defective 17 17 0 0 An animal kept in such a manner as to be a nuisance 5 5 0 0 House or part of house overcrowded 12 12 0 0 Insufficient ventilation under floor 117 114 0 3 Ventshaft defective 3 3 0 0 Ventshaft unsafe outlet 6 0 0 6 Various 47 46 1 0 No. of houses in which nuisances existed 273 250 8 15 Articles Seized and Surrendered as Unfit for Food.— During 1905 the following articles were seized by or surrendered to the Inspectors as being unfit for food, viz., 1 ton, 1 cwt., 18 lbs. fish; 10 cwt. fruit and vegetables; 13 cwt., 3 qrs., 4 lbs. meat. In addition, 3 boxes of fish and 16 boxes and one basket of tomatoes were surrendered. All of these articles, after examination, were destroyed by fire. There were two prosecutions during 1905 in regard to unsound food. During the examination of a consignment of pig's heads on the premises of a local brawn manufacturer, it was found by the meat Inspector that several of the heads were affected with tuberculosis. These were seized and submitted to a Magistrate, who 56 condemned and ordered their destruction. A prosecution was ordered by the Public Health Committee against the consignors, a firm in Wiltshire. The defendants were fined 20s. and 2 guineas costs. A second seizure was made of tuberculous pigs' heads in connection with a subsequent consignment of heads to the same local firm; but the case, after hearing by a magistrate, was dismissed. DAIRIES, COWSHEDS AND MILKSHOPS. Cowhouses.—There are 23 licensed cow-keepers in the Borough, with 33 cowsheds. This is the same number as during the year 1904. The Inspector reports that he made 309 visits to these premises, and with one exception found them all in a fairly clean condition. On the 6th July the Public Health Committee visited the cowhouses of the Borough. In three cases only had the Committee occasion for complaint. In one cowhouse the milk was improperly stored; the yard was dirty in a second instance, and in another there was an excessive accumulation of manure. Dairies and Milkshops.—During the year 1905 there were 91 milk-places removed from the register and 33 added, thus leaving a total of 362 milk-places in the Borough. The number on the register at the end of 1904 was 420. The Inspector reports that he made 1,120 visits to these premises during the year, served five notices for discovered defects, and supervised repairs in eight dairies. One summons was issued for dirty utensils. The defendant was ordered to pay 2s. costs only. Offensive Trades.—There is now only one such trade in the Borough, that is a tripe boiler. The Inspector made 18 visits to these premises during the year, but on every occasion he reports that he found the bye-laws carefully observed. Slaughter houses.—There are now 36 licensed slaughter-houses in the Borough, one having been removed from the register during 57 the year. The number on the register at the end of 1904 was 37. The Inspector made 366 inspections and served two notices for slight defects observed during these visits. The notices were complied with immediately. On the 6th of July, the Public Heath Committee visited the slaughter-houses of the Borough. These were all found in a satisfactory condition with the exception of one slaughter-house, where the paving was defective. The following statement gives particulars as to the milk-places, cowsheds, slaughter-houses, and offensive trades in the Borough. Number of Places. Number of Inspections, 1905. Number of Notices, 1905. Number of Prosecutions. Premises. On Register at end of 1904. Added in 1905. Removed in 1905. On Register at end of 1905. Milk premises 420 33 91 362 1120 5 1 Cowsheds 33 — — 33 309 — — Slaughter-houses 27 — 1 26 366 2 — Other offensive trade premises 1 — 1 18 — — During the visits to the slaughter-houses the Inspector reports that he examined the carcases of 219 oxen, 2,273 sheep, 2 calves, 16 sheep and 1 goat. The following were found diseased and were surrendered as unfit for human food. Oxen. 1 carcase with internal organs affected with Tuberculosis. 1 fore-quarter, lungs and heart ,, ,, 4 livers „ Distomata. 1 ,, „ Abscess. 1 „ and skirt ,, ,, Part of flank ,, Inflammation. 1 kidney 58 Sheep. 5 livers and lungs affected with Parasitic cysts. 4 ,, „ Distomata. 2 „ „ Parasitic cysts. Parts of 4 carcases „ Bruising. Ribs of 1 carcase „ Inflammation. Preserved Provision Factories.—There are eight wholesale provision factories in the Borough. The Inspector made 63 surprise visits to these premises during the year. During these visits he found and seized 6 pigs' heads affected with tuberculosis. These cases with resulting proceedings are referred to above. Smoke Nuisances.—During the year 1905 the Smoke Inspector made 1,660 observations of chimney shafts of factories, workshops, &c., in the Borough. These observations lasted from half-an-hour upwards. The intimation notices served numbered 42, and the statutory notices one during the same period. Water Supply, Sec. 48 (2) Public Health (London) Act, 1891. Under this section 37 certificates of proper and sufficient supply of water were issued under this section to owners of either new houses or houses rebuilt. The certificates include 292 houses and tenements. Bye-laws as to houses let in Lodgings.—At the end of 1904 there were 463 houses registered as houses let in lodgings in the Borough, 226 being in Hackney Wick and 237 in London Fields During 1905 there were 75 of these houses which ceased to be occupied by members of more than one family, thus reducing the total registered houses let in lodgings in the Borough to 388. During the year 1905, there were 122 of these inspected, 10 of which were found to be overcrowded, the remainder were more or less dirty and required cleaning. The overcrowding was abated and the cleaning done on the service of notices. 59 FACTORY AND WORKSHOP LEGISLATION. During 1905 the Secretary of State issued the following Home Work Order, extending Sections 107 and 110 to further classes of work. Statutory Rules and Orders, 1905. No. 939. FACTORY AND WORKSHOP. Home Work. The Home Work Order of 15th August, 1905. In pursuance of the powers conferred on me by Section 107 108 and 110 of the Factory and Workshop Act, 1901, I hereby make the following Order:— 1. Section 107 (relating to lists of out-workers) and Section 108 (relating to employment in unwholesome premises) shall apply to the following classes of work:— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto; The making, ornamenting, mending, and finishing of lace and of lace curtains and nets; Cabinet and furniture making and upholstery work ; The making of electro-plate ; The making of files; Fur-pulling; The making of iron and steel cables and chains; The making of iron and steel anchors and grapnels: The making of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds; The making of locks, latches, and keys; The making of covers for, and the covering, finishing, altering or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto ; 60 The making of paper bags and of paper boxes; Brushmaking; and The making of stuffed toys. II. Section 110 (relating to the prohibition of home work in places where there is infectious disease) shall apply to the following classes of work:— The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto (as in the said section specified) ; The making, ornamenting, mending, and finishing of lace and of lace curtains and nets ; Upholstery work; Fur-pulling ; The making of covers for, and the covering, finishing, altering or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto; The making of paper bags and of paper boxes; Brushmaking; and The making of stuffed toys. 2. The lists of out-workers required to be kept by Section 107 and the copies thereof shall be kept and made in the form and manner, and with the particulars shown in the Schedule hereto. 3. This Order may be referred to as the Home Work Order of the 15th August, 1905. 4. The Home Work Orders of the 11th December, 1901, and of the 14th July, 1902, are hereby revoked. A. Akers-Douglas, One of His Majesty's Principal Secretaries of State. Home Office, Whitehall, 15th August, 1905. 61 Schedule. List of Out-workers. A correct list of out-workers employed in the following classes of work— (a) The making, cleaning, washing, altering, ornamenting, ing, and repairing of wearing apparel and any work incidental thereto. (b) the making, ornamenting, mending, and finishing of lace and of lace curtains and nets ; (c) cabinet and furniture making and upholstery work; (d) the making of electro-plate ; (e) the making of files ; (f) fur-pulling; (g) the making of iron and steel cables and chains; (h) the making of iron and steel anchors and grapnels; (i) the making of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds; (j) the making of locks, latches, and keys ; (k) the making of covers for, and the covering, finishing, altering, or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto; (l) the making of paper bags and of paper boxes; (m) brushmaking; and (n) the making of stuffed toys ; must be kept in the form and with the particulars specified below in the factory or workshop or place from which the work is given out, 62 and must be open to inspection by H.M. Inspectors and the officers of the local authority ; and a copy of the list signed and dated and corrected up to that date must be forwarded to the local authority of the district on or before the first day of February and the first day of August in each year. In order that the list may be correct, the name of any person newly taken into employment should be immediately entered, and the name of any person ceasing to be employed should be immediately struck out. Factory, Workshop, or Place from which the work is given out Full Postal Address Business Name of occupier_____________________ List of Persons directly employed by (a) in the business of, but outside the above Factory, Workshop, or Place, in the classes of work specified above. (a) Give name of employer. (6) Say whether the occupier or a contractor employed by the occupier. Name in full. Whether employe 1 as Workman (W) or Contractor (C). Place of Employment, i.e. place where the work is actually done. Address. [No entry need be made in this column if the entry in column (3) is a sufficient address.] (1.) (2.) (3.) (4.) 63 CUSTOMS AND INLAND REVENUE ACT, 1890. During the year 1905 applications were made to me by seven owners of tenement property for certificates that their tenements were so constructed "as to afford suitable accommodation for each of the families or persons dwelling therein, and that due provision is made for their sanitary requirements," for the purpose of obtaining a remission from the Inhabited House Duty. The seven applications included 397 tenements. These I inspected, and granted the required certificates after the execution of any required alteration. CANAL BOATS ACT, 1877-1894. The Canal-Boats' Inspector of the Borough reports that during the year 1905 he made 115 visits to the waterways in the district and inspected 71 boats. He found on these boats 139 men, 4 women and 3 children. The only infringement of the Canal Boats Acts and Regulations was the absence of proper marking of one boat. The boats were found in good structural repair and in a clean condition. Only one notice was served, that being for the above nonmarking of a boat. HOUSING OF THE WORKING CLASSES ACTS, 1890-1903. In the month of February I made the following representation under Part II. of the Housing of the Working Classes Act, 1890. Town Hall, Hackney, N.E. 2nd February, 1905. To the Public Health Committee, Gentlemen, I beg to report to you, in pursuance of Section 32 of the Housing of the Working Classes Act, 1900, that on the 10th day of January last, I inspected the dwelling houses situate at and known as 64 1—16, Tranby Place, Homerton, within your district, and of which Henry Bainton, 17, May Road, The Green, Twickenham, is the owner. I found such dwelling houses to be in the state hereinafter set forth, which in my opinion are so dangerous or injurious to health that the said houses are unfit for human habitation. In my opinion the said dwelling houses are not capable of being made fit for human habitation, and are in such a state that the occupation thereof should be immediately discontinued. State of Dwelling Houses. 1. Badly and closely arranged in a narrow court, causing want of light, air, and ventilation. 2. Insufficient through ventilation. 3. Damp walls. 4. Insufficient sanitary conveniences. 5. Insufficient water supply. 6. Defective drains. 7. Generally decayed. I have the honour to be, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., Medical Officer of Health. The Public Heath Committee after the consideration of this representation resolved that legal proceeding should be taken to close these dwellings. Summonses were issued against the owners, which were heard at the North London Police Court on the 5th of April. The magistrate after hearing evidence on behalf of the Borough Council, adjourned the summonses sine die, to enable the defendants, who pleaded that they could effect such improvements in the dwellings as would render them fit for occupation, to submit to the Public Health Committee a specification of their proposals. 65 The following is a summary of these proposals:— Roofs.—Repair roofs, gutters and parapet walls, and render them waterproof. Walls.—Re-point the whole of the walls with Portland cement and sand, and repair and make good all cement plinths. Damp Course.—Lay in a proper damp course above the foalings where necessary, consisting of two courses of slates laid with break joints in Portland cement and sand. Ventilation under Floors.—Remove existing floors and excavate ground where necessary to a depth of two feet below floor line, and cover where necessary the whole surface with 6 inches of Portland cement concrete. Properly relay floors, and provide air bricks to the spaces below the floors. Ventilation of Dwelling Rooms.—Cut openings in the ceilings and roofs of upper rooms, and provide dormer windows capable of opening. Cut openings in the walls and fix Tobin fresh-air inlets. Water Supply.—Provide stoneware sinks in each ground floor room, with trapped lead sink waste from each, to discharge into gullies in the open. Supply draw tap and connections from the main to each house. Drains.—Reconstruct the drainage, disconnecting from the sewer, and providing adequate ventilation. Provide a separate w.c. for each tenement. Thoroughly cleanse the walls and ceilings of the rooms of all the tenements. Repair paving where necessary, and limewash the walls of court where necessary. In executing the above works it was necessary to demolish one of the cottages. This provided more air space about the remaining cottages. 66 The proposals were accepted, as likely to remove the insanitary conditions complained of, and render the dwellings fit for occupation. The works were completed, and the cottages reoccupied in the month of July, 1905. On the 15th June, 1905, I made the following representation respecting seven two-roomed cottages situated in a narrow court, known as Queen's Court. HOUSING OF THE WORKING CLASSES ACT, 1890. PART II. Nos. 1, 2, 3, 4, 5, 6 and 7, Queen's Court. The Medical Officer of Health presented his report, as follows:— 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 30th day of May last I inspected the dwelling-houses situate at and known as Nos. 1, 2, 3, 4, 5, 6 and 7, Queen's Court, Well Street. I found such dwelling-houses to be in the state hereinafter set forth, which, in my opinion, is so dangerous or injurious to health that the said houses are unfit for human habitation. State of Dwelling Houses. No. 1 Queen's Court. 1. No through ventilation. 2. Insufficient and improper water supply. 3. Improper w.c. accommodation. 4. Insufficient ventilation of rooms. 5. Damp wall. 6. Defective paving. 67 Nos. 2, 3, 4, 5, and 6, Queen's Court. 1. No through ventilation. 2. Insufficient and improper water supply. 3. Insufficient and improper w.c. accommodation. 4. Insufficient ventilation of rooms. 5. Defective yard paving. No. 7, Queen's Court. 1. No through ventilation. 2. Insufficient and improper water supply. 3. Insufficient and improper w.c. accommodation. 4. Insufficient light and ventilation of the rooms. 5. Circulation of air impeded by presence of insanitary w.c.'s. 6. Defective paving. I have the honour to be, Gentlemen, Your obedient servant, J. KING WARRY, M.D., Medical Officer of Health. The Committee received the representation and gave instructions for summonses to be issued to close the same. Whilst the summonses were pending negotiations were opened by the owners to render the property fit for habitation. At the time of writing the negotiations have not been completed. ICE CREAM VENDORS. During the year 1905 there were 23 inspections of premises where ice creams were prepared. Necessary cleansing, &c., was done on the service of intimation notices only. THE RIVER LEA. The condition of this river as it passes through the Borough remains in its usual filthy condition, causing a nuisance during the hot summer months of the year to persons frequenting the large open space adjoining it, as also to persons living in its vicinity. e 68 Factories, Workshops, Laundries, Workplaces and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 29 3 .. Workshops (including Workshop Laundries) 2,158 320 .. Workplaces 3 .. Homeworkers' Premises 1,365 283 1 Total 3,555 605 1 2.—DEFECTS FOUND. Particulars. Number of defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 310 252 .. .. Want of Ventilation 18 20 .. .. Overcrowding 18 14 .. .. Want of drainage of floors 6 3 .. .. Other nuisances 469 254 .. 1 Sanitary accommodations:— Insufficient 2 1 .. .. Unsuitable or defective 163 76 .. .. Not separate for sexes 6 2 .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (SS. 97 to 100) .. .. .. .. Failure as regard lists of outworkers) (S. 107) Feb., 175 Feb., none Aug., 183 .. .. Aug., 2 Giving out work to be done in premises which are— Unwholesome (S.108) .. .. .. .. Infected (S. 110) .. .. .. .. Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S. 109) .. .. .. .. Other offences .. .. .. .. Total .. .. .. .. 69 3.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 70 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Notified by H.M. Inspector 60 Reports (of action taken) sent to H.M. Inspectors 8 Other •• Underground Bakehouses (S. 101):— Certificates granted during the year •• In use at the end of the year 49 Homework:— Number of Lists. Outworkers Lists of Outworkers (S. 107):— Lists received 447 3366 Addresses of Outworkers forwarded to other Authorities 1,619 received from other Authorities 2,138 Homework in unwholesome or infected premises:— Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (S. 106) •• •• Cases of infectious disease notified in homeworkers' premises •• •• Orders prohibiting homework in infected premises (S. 110) •• •• Workshops on the Register (S. 131) at the end of 1905 1,000 Important classes of workshops, such as workshop bakehouses, may be enumerated here. Total number of workshops on Register •• E 2 70 Factories.—During the year 29 factories were inspected; of these 11 were factory laundries, and the remainder factories where articles of clothing, furniture, &c., are manufactured, and where female young persons are employed. In 8 factories nuisances were found in connection with the sanitary accommodation, viz., in 3 insufficient light and ventilation; in 3 defective flush of water; in 2 separate sanitary conveniences were not provided, though both sexes were employed; and in 1 factory no sanitary conveniences were provided. Factories. Nuisances. Found. Abated by Workshop Inspector. Abated by District Inspector. Total. Insufficient sanitary conveniences 1 1 •• 1 Unsuitable or defective ,, 6 3 3 6 Not separate for sexes ,, 2 2 2 Workshops.—The number of workshops registered in the Borough at the end of December, 1905, in which articles of wearing apparel are manufactured is 748, and where other articles are manufactured 252, a total of 1,000, a decrease of 38 upon the number registered at the end of 1904. The cause of this decrease is due to a revision of the workshop register. During this revision it was found that 38 employers had either moved from the Borough or ceased to carry on their business. The following is a list of these two classes of workshops with the occupations carried on therein:— 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 Shirt Makers 8 turer 111 Baby Linen 6 Fur Trimming 2 Blouse Makers 44 71 Occupations. No. of Workshops. Occupations. No. of Workshops Mantle Makers 59 Millinery 26 Tailoring 18 Collars 4 Artificial Flower Makers 7 Pinafores 4 Boot Machinists 63 Skirts 13 Dressmakers 138 Trimmings 1 Underclothing 27 Costumers 3 Fancy Bows on Shoes 10 Beading 3 Furriers 44 Waterproofs 2 Infants' Millinery 10 Gloves 2 Tie Making 75 Belts 14 Stay Makers 5 Overalls 4 Vest Makers 15 Children's Costumes 16 748 Dressing and Tea Gowns 12 Hat Manufacturer 3 (b) Other Occupations. Occupations. No. of Workshops. Occupations. No. of Workshops Cabinet Making 32 Pianofortes 9 Trunk and Bag Makers 2 Upholsterers' Trimming 4 Box Makers 9 Doll Manufacturers and Dressers 5 Upholsters 4 Toy Makers 9 Fancy Leather 5 Rubber Manufacturer 1 Laundries 114 Confectioners 14 Miscellaneous 53 Skin Dressers 1 252 Bookbinders 2 Brushes 4 72 With respect to workshops where wearing apparel alone is manufactured or altered, in 539, females alone are employed; in 112 both males and females are employed. There are also 60 domestic workshops registered in the Borough; in 45 of these females alone are employed, and in 15, males and females, and in the remainder, males alone. In workshops and places of other occupations, females alone are employed in 158, and males and females in 61. Thus in both classes (a and b) of workshops and workplaces, females alone are employed in 697, and both males and females in 173. During the year the following notices and complaints were received from H.M. Inspectors of Factories:— Complaints—Factories 2 ,, Workshops 8 Notices—Factories 0 „ Workshops 50 During the year Miss Teebay, the Workshop Inspector, made 2,161 inspections of workshops and places where females are employed. In connection with these visits she served 320 notices for the abatement of the nuisances found. The following table gives further particulars relating to the workshops in the Borough:— 73 NUISANCES IN WORKSHOPS, 1905. Outstanding at end of 1904. Pound in 1905. Outstanding at end of 1905. Abated in 1905. By Inspector of Workshops. By District Inspector. Total. Want of Cleanliness 44 192 49 172 15 187 Want of Ventilation 9 18 7 20 .. 20 Overcrowding .. 17 4 13 .. 13 Want of Drainage of Floors 5 6 2 3 6 9 Other Nuisances .. 209 39 115 55 70 Insufficient Sanitary Accommodation 2 1 2 .. 1 1 Unsuitable or defective Sanitary Accommodation 8 66 14 83 27 60 No separate Sanitary Accommodation for sexes .. 4 2 2 .. 2 74 Outworkers.—The number of registered outworkers employed in the borough at the end of 1905 was 3,366, against 2,472 at the end of 1905. There was thus 894 additional outworkers added to the register during the past year. The following analysis shows the trades followed by these outworkers:— No. of Trade. Outworkers. Boots and Shoes 871 Ties 282 Millinery 196 Fur Trade 98 Tailoring 120 Pinafores 57 Gloves 2 Shoe Bows 90 Children's Costumes 17 Waistcoats 23 Artificial Florist 24 Belts 56 Clothiers and Outfitters 62 Boxes 9 Upholsterers Trimmings 10 Beading 20 Tea Gowns 19 No. of Trade. Outworkers. Skirts and Mantles 419 Blouses 224 Underclothing 153 Trimming 19 Collars and Bibs 13 Shirts 137 Baby linen 10 Net chenilling 14 Corsets 6 Overalls 3 Vests 12 Miscellaneous 28 Trade not stated 372 3,366 The local authorities from which we have received names and addresses of outworkers during the last year are the following:— City of London 891 Finsbury 634 Islington 200 Hampstead 3 Paddington 5 Southwark 13 75 Shoreditch 99 Bethnal Green 127 Poplar 36 Westminster 7 Croydon 1 Camberwell 2 Stoke Newington 40 Stepney 40 Hornsey 2 Deptford 1 Bermondsey 3 Chelsea 5 St. Pancras 3 Tottenham 10 Wandsworth 4 Walthamstow 6 West Ham 2 Kensington 1 Hove 2 Bromley 2,138 On examination of the list of outworkers sent in by employers in this Borough during 1905, we found 1619 whose addresses were in other districts. The names and addresses of these were forwarded to their respective local authorities, as given in the following list:— Bethnal Green 416 Stepney 123 Tottenham 100 Camberwell 48 Hford 2 St. Pancras 4 Bermondsey 8 Leytonstone 6 Wood Green 9 Richmond 2 Woolwich 1 Shoreditch 247 Southwark 12 Edmonton 7 East Ham 9 Croydon 1 Hampstead 3 Willesden 4 New Southgate 3 Poplar 139 Stoke Newington 82 Hornsey 2 Lambeth 8 Westminster 1 76 Leyton 54 Ingatestone 1 Hammersmith 3 Manchester 1 St. Albans 2 Ealing 2 Brentford 2 Paddington 3 West Ham 33 Finsbury 9 Walthamstow 109 Islington 140 Deptford 9 Fulham 1 Battersea 1 Cricklewood 2 City of London 1 Highgate 1 Hendon 2 Finchley 2 Greenwich 2 Woodford 1 Chiswick 1 1,619 During the past year, Miss Newton, the inspector entrusted with the inspection of home workers' premises, made 2,929 visits. Amongst these she found 45 domestic workshops; 90 workshops; 93 where only male outworkers were employed; and in 1336 visits, the address was either incorrect or the home worker had left the premises or ceased to take in home work. Thus nearly half this officer's time was wasted. It appears to me that if employers of outworkers were to regularly correct their lists better results still would be obtained by the inspector. Miss Newton made 1365 inspections of home workers' premises during 1905, and found 453 nuisances, for the abatement of which 283 notices were served, and one prosecution was initialed. The character of the nuisances and other details are given in annexed table. NUISANCES IN OUTWORKERS' PREMISES, 1905. Outstanding at end of 1904. Found in 1905. Outstanding at end of 1905. Abated in 1905:— By Inspector of Outworkers. By District Inspector. Total. Want of Cleanliness 29 118 35 80 32 112 Want of Ventilation 1 .. 1 .. .. .. Overcrowding .. 1 .. l .. 1 Number of Premises on which other Nuisances found 10 244 24 139 91 230 Sanitary Accommodation Defective 6 83 6 40 43 83 77 78 The class of individuals who receive home work appears to be very changeable in their habits and place of residence, for of 183 outworkers' premises visited a second time at an interval of about twelve months from the first visit, it was found that only 85 were still outworkers in the same premises, 98 having ceased to have home work (either permanently or temporarily), or had moved their residence, and a few had started workshops. Of 735 workrooms in the Borough visited by Miss Newton only 130 were found to be confined to work alone. They were used as set out below:— Workroom, bedroom and kitchen 118 „ and kitchen 418 ,, and bedroom 69 „ alone 130 Total 736 79 DISINFECTION. (a) Rooms.—During the year 1905 there were 2,354 rooms fumigated and 792 rooms cleansed by the staff of the Public Health Department. The corresponding figures for 1904 were 2,269 rooms fumigated and 644 rooms cleansed. The disinfection and cleansing done each month of the year is set out in the following table. This table includes the disinfection and cleansing after both notifiable and non-notifiable infectious disease:— Number of Rooms Fumigated and Cleansed each Month during 1905. Month. Rooms Fumigated. Rooms Cleansed. Remarks. January 201 48 The method of fumigation is by burning sulphur. After fumigation the rooms to be cleansed are stripped of their wall-paper and cleansed with a solution of carbolic. The ceilings are afterwards whitened. February 155 51 March 258 51 April 214 47 May 212 69 June 196 61 July 208 69 August 139 62 September 183 79 October 194 83 November 208 99 December 186 73 Total 2,354 792 80 (6) Articles of Clothing and Furniture.—The number of articles under this head disinfected at the Millfields Road Station was 16,242. This disinfection is accomplished by means of saturated steam. The number of articles thus dealt with was rather less than during the previous year. In addition to these there were 241 articles destroyed on request from the owners. These are set out in the following table :— Articles Destroyed. Beds 40 Quilts 6 Bolsters 4 Mattrasses 18 Pillows 16 Palliasses 16 Blankets 6 Sundry Articles 120 Carpets 3 Cushions 12 Total 241 Articles Disinfected During the Year 1905. Description of Articles, January February March April May June July August September October November December Total HOUSE LINEN. Beds (feather, flock, wool) 77 86 88 94 96 107 113 81 121 133 149 125 1270 Bed Vallance.. 4 6 3 1 .. .. .. 4 3 2 6 1 30 ,, Covers 9 15 16 17 11 12 7 5 6 9 15 9 131 „ Furniture .. .. 4 .. .. .. .. .. .. .. .. .. 4 Blankets 166 161 159 142 139 125 140 93 147 197 303 196 1968 Bolsters 73 66 57 69 71 66 79 81 86 83 107 88 926 Box Covers .. 1 .. .. .. .. .. .. .. .. .. .. 1 Carpets; 3 2 2 .. 2 .. 1 1 9 2 .. 2 24 Chair Bed Cushions 5 24 11 16 8 33 18 30 10 35 44 22 256 Coverlets .. .. 18 .. .. .. .. .. 1 .. .. .. 19 Cushions 21 18 5 11 22 8 18 4 7 8 12 19 153 Glass Cloths .. 1 2 .. .. .. .. .. .. .. .. .. 3 Hearth Rugs 8 1 .. .. .. .. .. .. .. 8 4 2 23 Mattresses (Horse-hair, Wool, Straw, or Spring) 76 73 70 61 69 52 64 68 70 63 84 59 809 81 Articles Disinfected During the Year 1908—continued. Description of Articles. January February March April May June July August September October November December Total Mats .. 1 .. .. .. .. .. .. .. .. 1 1 3 Matting .. .. .. .. .. .. .. 6 .. .. .. .. 6 Palliasses 7 13 22 4 6 4 4 4 .. 4 .. 7 77 Pillows 211 190 171 191 205 217 229 188 240 238 336 221 2637 Pillow and Bolster Cases 11 6 13 8 7 7 6 13 14 7 3 3 98 Quilts 90 90 120 87 90 79 74 67 102 123 173 126 1221 Round Towels .. 9 .. .. 8 .. 4 .. .. .. .. 1 22 Rugs 4 .. 4 7 9 11 3 4 4 7 8 4 65 Sheets 111 97 106 77 68 83 106 78 115 130 171 117 1259 Sofa Squabs .. .. 6 .. 1 1 .. .. .. .. .. 1 9 Table Cloths 2 3 5 .. 2 3 3 1 1 3 7 3 33 Toilet Covers.. .. 3 4 1 4 .. 2 5 .. 1 2 .. 22 Towels 17 10 12 5 13 6 3 1 7 13 5 10 102 Window Blinds .. .. .. .. 2 .. .. .. .. .. .. .. 2 Window Curtains .. 15 4 17 5 9 4 6 3 6 8 17 3 97 11270 82 Articles Disinfected During the Year 1905—continued. Description of Articles. January February March April May June July August September October November December Total MEN'S. Caps 4 2 7 8 1 3 .. .. 9 3 5 2 44 Coats 6 6 8 12 10 7 5 5 4 13 12 1 89 Collars 2 2 7 .. .. 1 .. .. 7 7 .. 6 32 Drawers .. 2 10 2 5 3 1 .. .. 3 7 .. 33 Flannels 6 11 2 .. .. .. .. .. .. 2 3 .. 24 „ Vests 12 .. .. 6 11 11 8 5 25 19 20 10 127 Hats .. .. 5 .. .. .. .. .. .. .. .. .. 5 Neck Ties 2 1 .. 2 2 3 .. .. 1 2 3 .. 16 Night Shirts 9 7 10 S 4 6 6 14 2 14 15 10 102 Shirts 13 16 8 6 8 7 11 1 14 26 16 10 136 Socks 12 10 7 7 7 6 13 .. 9 14 18 23 126 Suits of Clothes .. .. .. .. .. .. .. .. 3 .. .. 1 4 Trousers 1 4 2 13 7 3 5 3 7 3 3 .. 51 83 Articles Disinfected During the Year 1905—continued. Description of Articles. January February March April May June July August September October November Deoember Total Ulsters .. 1 2 .. .. .. 1 2 .. 1 .. .. 7 Waistcoats 8 4 3 6 5 5 11 3 14 9 8 7 83 879 WOMEN'S Aprons 7 2 4 2 3 3 8 1 1 11 4 1 47 Caps 1 3 4 7 1 10 5 1 6 6 6 50 Chemises 9 9 11 15 12 8 8 11 18 19 30 4 154 Cloaks 2 .. 1 1 2 1 5 .. .. 7 5 25 49 Collars 4 4 10 2 3 .. .. 4 4 4 2 2 39 Corsets 6 7 13 2 2 5 8 7 3 11 6 16 86 Cuffs 6 4 .. 1 2 .. .. .. .. 5 5 .. 23 Drawers 14 12 12 6 3 4 9 2 17 20 16 12 127 Dresses 2 1 8 2 1 2 1 1 1 5 24 Dress Bands .. .. 2 .. 3 .. 1 .. 3 1 1 .. 11 Dressing Gowns .. 6 8 3 3 7 2 .. 2 3 7 7 48 F 2 Flannel Petticoats .. .. l 3 .. .. .. .. .. .. .. 1 5 ,, Vests 18 26 28 6 1 16 17 6 16 34 39 23 236 Jackets 3 10 5 11 11 2 3 1 3 6 9 4 68 Night Dresses 21 19 26 27 17 22 22 8 29 29 46 31 297 Petticoats 38 22 22 25 14 11 18 2 25 33 26 26 262 Petticoat Bodices 8 12 12 7 4 3 .. 4 2 6 4 9 71 Sashes .. .. 19 .. 1 2 2 .. .. .. 2 .. 26 Shawls 23 14 17 13 8 15 12 10 12 26 30 29 209 Skirts 13 5 11 8 5 8 6 .. 9 11 10 14 100 Stockings 28 18 26 16 10 10 21 5 28 28 16 20 226 2158 CHILDREN'S. Boys' Knickers 12 5 3 3 8 4 4 2 17 15 6 10 89 ,, Jackets.. 11 4 4 9 12 10 11 6 25 20 11 20 143 ,, Suits .. .. .. .. .. .. 4 .. .. 1 .. .. 5 Feeders .. .. .. .. 1 .. .. .. .. .. .. 2 3 F rocks 22 1C 33 24 2 5 8 4 17 15 16 11 167 Pelisses .. .. .. .. 5 .. 1 .. 3 .. .. 4 13 Pinafores 9 7 20 5 4 2 3 2 3 4 10 7 76 496 85 Articles Disinfected During the Year 1905—continued. Description of Articles. January February March April May June July August September October November December Total OTHER ARTICLES. Boots 2 1 .. 7 .. .. 2 .. .. .. 2 .. 14 Handkerchiefs 25 13 13 8 13 7 7 6 23 25 37 9 186 Shoes .. .. .. 2 2 12 1 .. .. .. .. .. 4 .. 2 23 Slippers .. 6 .. .. 2 .. .. .. 2 2 .. 6 18 SUNDRIES 68 50 276 258 58 61 69 30 71 82 94 81 1198 1439 1339 1218 1587 1335 1119 1091 1198 882 1379 1618 2004 1472 Total 16242 86 Summary of persons lodged and maintained at the Council's Shelter, in Millfields-road, Clapton, N.E., during the year ended 31st December, 1905. Month. No. of Persons admitted. Cost of Maintenance. Average period of Stay. Diseases. Men. Women. Children. Total. £ s. d. January 3 3 4 10 1 5 0 2 days. 2 Cases of Scarlet Fever. 1 Case Diphtheria. February .. .. .. .. .. .. .. .. .. March 3 5 12 20 9 0 0 7.2 days. 2 Cases Small-pox. 2 ,, Diphtheria. 1 Case Scarlet Fever. April 1 1 2 4 10 0 2 „ 1 ,, Enteric. 4 Cases Scarlet Fever. May 5 6 8 19 2 7 6 2 „ 1 Case Diphtheria. June .. 1 2 3 .. 7 6 2 „ 1 „ „ July 1 2 6 9 1 2 6 2 „ 1 „ „ 2 Cases Scarlet Fever. August a 2 .. 4 .. 10 0 2 ,, 2 „ „ September l 2 4 7 .. 17 6 2 „ 2 „ „ October 3 4 4 11 1 7 6 2 „ 3 „ „ 1 ,, Diphtheria. November I 1 .. 2 .. 5 0 2 ,, 1 ,, Scarlet Fever. December I 2 1 4 10 0 2 „ 1 „ 1 ,, Diphtheria. 21 29 43 93 18 2 6 2.4 days. 87 88 THE SHELTER. During the year 1905 there were admitted to the shelter 93 persons, 21 of which were men, 29 women arid 43 children, while their homes were being disinfected and cleansed. This is a slightly less number than those admitted during 1904. The cost of maintenance for the year was £18 2s. 6d., and the average period of stay in the shelter was 2.4 days. The table on page 85 gives further particulars concerning these contacts. Conveyance to and from the Shelter. — The following are particulars of expenses incurred for the conveyance of persons to and from the shelter during the year 1905:— Vehicle Hired. Cost of Hiring. No. of Families. No. of Persons. Disease. Omnibus 7/- 2 8 Smallpox. Cab 10/- 1 4 Typhoid Fever. Cab 10/- 1 3 Diphtheria. CLEANSING OF PERSONS ACT, 1897 During the year 1905 the facilities provided under the above Act by the Borough Council were to a much greater extent made use of. The total number of persons bathed and cleansed during that year was 241. The number during the previous year was 9. The satisfactory result during last year was no doubt the result of sending a copy of the following notice to all the hospitals and infirmaries in the district, to the medical practitioners and head masters of schools, making more public the fact that facilities existed for the cleansing of persons affected with parasitic disease. 89 METROPOLITAN BOROUGH OF HACKNEY. NOTICE. " The Hackney Borough Council have provided baths and disinfecting chambers for the cleansing and purifying of the bodies and clothing of persons infested with vermin or parasites. No charge is made for the use of these facilities, and applicants will be treated with every consideration on application to the Caretaker at the Disinfecting Station, Millfields Road, Lower Clapton, N.E. (adjoining the Hackney Electricity Works) between the hours of 9 a.m. and 5 p.m." "J. King Wakby, M.D., " Medical Officer of Health. " Public Health Department, " Town Hall, Hackney, N.E. " April, 1905." In the month of September I introduced the provision of sulphur baths for cases of scabies. The result in this respect has been very gratifying. The following table gives particulars of the number, &c., of persons who were bathed and cleansed for parasitic disease at the disinfecting station during the year:— Month January February March April May June July August September October November December Totals. Receiving Hot Baths. Men 2 1 2 3 2 26 31 56 38 14 11 12 198 Women •• 1 1 1 1 . 1 1 •• •• •• •• •• 6 Children •• 3 3 3 •• 2 •• 5 1 •• •• 17 Receiving Sulphur Baths. Men •• •• •• •• •• •• •• •• •• •• •• •• •• Women •• •• •• •• •• •• •• •• 2 1 •• •• 3 Children •• •• •• •• •• •• •• •• 12 3 1 1 17 90 91 The following table shows the expenditure in detail incurred in connection with the disinfecting station, including that relating to the shelter:— EXPENDITURE AT DISINFECTING STATION FOR YEAR ENDED 31st DECEMBER, 1905. Shelters. £ s. d. £ s. d. Wages—Female caretaker ... 58 10 0 Subsistence allowance 18 2 6 Maintenance—Repairs, etc. Electricity Supply 6 19 6 Water 4 8 10 Electric fittings 1 5 1 Coals 2 10 3 Stores, etc. 3 15 10 Hire of Ambulance for conveyance of contacts 1 7 0 20 6 6 96 19 0 Disinfecting Station. £ s. d. £ s. d. Wages 335 14 9 Electricity Supply 13 18 11 Water 8 17 9 Horse— Fodder 43 8 7 Shoeing and Clipping Horse 3 16 8 Repairs to Harness 0 10 0 Hire of Horse 13 17 6 Veterinary attendance on Horse 7 15 6 69 8 3 Repairs— To Station 9 7 4 To Boiler 17 14 0 To Laundry 2 1 4 To Lodge 3 12 0 To Disinfecting Van 3 16 0 36 10 8 92 Expenditure at Disinfecting Station—continued. £ s. d. £ s d. Lubricating Oil 1 14 6 Boiler Fluid 5 0 0 Fence Materials 13 2 10 Electric fittings 2 10 3 Coals— Steam 34 15 2 Kitchen (lodge) 5 0 6 39 15 8 Stores, firewood, etc. 7 11 8 £534 15 3 REMOVAL OF HOUSE REFUSE. During the year 1905 there were 37,953 tons, 5 cwts., 3 qrs., of house refuse collected from dwellings in the Borough and destroyed by burning at the destructor works. The total cost for this removal was £8,010 0s. 5d. The house refuse is collected from dwellings by contract—that of the North Division being collected by Mr. Walker at the rate of 4s. Id. per ton, and that of the South Division by Messrs. Abbott at the rate of 4s. 4d. per ton. In the North Division 17,056 tons, 19 cwts., 14 lbs. were collected* at a total cost of £3,482 9s. 5d.; in the South Division 20,896 tons, 6 cwts., 2 qrs., 14 lbs. at a total cost of £4,527 11s. 0d. The total amount of house refuse collected during the whole year in the two divisions of the Borough shows an increase upon the total collected during 1904 of a little over 75 tons, at an increased cost of £29 1s. 9d. The cost of the destruction of the house refuse, including the cost of disposal of the residue and clinker, &c., has been estimated by the Electrical Engineer to the Borough at 3s. 6½d. per ton; 37,953 tons, 5 cwts., 3 qrs. at this rate amounts to a total of £6,720 18s. 2½d. The total cost then for the collection and disposal of house refuse in the Borough, is for the North Division at 7s. 7½d. per ton, £6,502 19s. 7½d., and that for the South Division at 7s. 10½d. per ton is £8,227 19s. Od. For the whole Borough then the total cost for the collection and disposal of house refuse is £14,730 18s. 7½d. DUSTING ACCOUNT, 1905. Month. Northern Division. Southern Division. Totals. Weight. Cost. Weight. Cost. Weight. Cost. January tns. 1697 cts. 0 qrs. 0 lbs. 0 £ 346 s. 9 d. 5 tns. 2025 cts. 3 qrs. 1 lbs. 21 £ 438 s. 15 d. 9 tns. 3722 cts. 3 qrs. 1 lbs. 21 £ 785 s. 5 d. 2 February 1622 0 0 0 331 3 2 1970 15 0 7 427 0 0 3592 15 0 7 758 3 2 March 1491 0 0 0 304 8 3 1793 16 3 7 388 13 4 3284 16 3 7 693 1 7 April 1507 0 0 0 307 13 7 1823 5 1 14 395 0 10 3330 5 1 14 702 14 5 May .. 1511 0 0 0 308 9 11 1820 16 2 14 394 10 3 3331 16 2 14 703 0 2 June 1329 0 0 0 271 6 9 1634 10 1 21 354 2 11 2963 10 1 21 625 9 8 July .. 1241 0 0 0 253 7 5 1572 1 3 7 340 12 5 2813 1 3 7 593 19 10 August 1084 0 0 0 221 6 4 1440 15 3 7 312 3 6 2524 15 3 7 533 9 10 September 1148 10 3 7 234 10 0 1441 4 0 14 312 5 3 2589 14 3 21 546 15 3 October 1358 16 2 7 277 8 6 1669 18 1 14 361 16 4 3028 14 .3 21 639 4 10 November 1588 2 0 7 324 4 10 1906 18 1 7 413 3 4 3495 0 1 14 737 8 2 December 1479 9 2 21 302 19 3 1797 0 1 21 389 7 1 3276 10 0 14 691 8 4 Totals .. 17056 19 0 14 3482 9 5 20896 6 2 14 4527 11 0 37953 5 3 0 8010 0 5 @ 7s. 7½d. = @ 7s. 10½d. = Cost of Destruction £6,720 18 2½ £6,502 19s. 7½d. £8,227 19s. 0d. £14,730 18 7½ 93 94 The following is a table showing the total cost for the collection and disposal of house refuse during the last ten years:— Year. Cost. Remarks. £ s. d. The borough destructor was opened for the destruction of house refuse in May, 1901. The year April, 1900 to March, 1901 was the last year during which the refuse was removed and disposed of by contractors at a rate per load. 1905 14,729 8 11½ 1904 14,703 3 9 1903 13,569 3 1 1902 13,964 19 2 1901 18,284 9 0 1900 18,579 15 4 1899 16,901 9 4 1898 15,952 6 4 1897 15,195 7 1 1896 13,630 7 7 It will be seen from the above that the Borough has been an immense gainer by changing the system of disposal from contract disposal to destruction by fire. The gain has been a double one. Offensive refuse instead of being dumped in places which eventually may become building sites, where it might be prejudical to health, has been immediately robbed by the agency of fire of its prejudicial properties, and reduced to one-third its bulk. This change has also been effected at a greatly reduced cost, and corresponding saving to the ratepayers. The extent to which the cost for the removal and disposal of house refuse has been reduced during the last four years, may be obtained by taking the average annual cost for this work during these four years, and contrasting it with the annual average cost for the last four years during which the house refuse was removed and disposed of by contractors. The average annual cost for the last four years (1902 to 1905) amounts to £11,241; the average annual cost during the last four years of contractors' work (1898 to 1901) amounted to £17,429; therefore it will be seen that there has been an annual saving to the Borough during the years 1902 to 1905 of £3,188, and a total saving for the four years of £12,752. This must be regarded in all respects as very satisfactory. The saving thus brought about however has taken place in the cost of collection only. The cost of disposal under the contract 95 system, did not amount to more than 1s. 6d. per ton; under the system of destruction by fire, the cost is 3s. 6½d. per ton ; so that really there is a great increase in the cost of disposal. A compensating advantage which must be attached to the more modern system of dust disposal is that of being more sanitary. Distributing the total cost for the removal and destruction of house refuse during the year 1905 over the whole population of the Borough, it amounts to 1s. 3½d. per head. I give below the usual table showing the number of "refusals" and "no answers" given to the dustmen's weekly call. Week ending, Refusals. No answers. Week ending. Refusals. No answers. Jan. 7th 4739 428 July 1st 5891 663 14th 4913 437 8th 6716 617 „ 21st 5019 401 15th 6348 597 28th 4617 375 ,, 22nd 6509 586 Feb. 4th 4588 674 29th 5914 614 11th 5195 581 Aug. 5th 6110 657 18th 6034 498 12th 6217 593 25th 7420 486 19th 5834 571 Mar. 4th 6852 514 26th 5709 619 11th 6913 573 Sept. 2nd 6031 623 18th 7142 585 9th 6174 584 ,, 25th 5691 563 16th 5795 567 April 1st 6174 514 23rd 6213 601 „ 8th 6390 521 30th 6319 609 „ 15th 6402 567 Oct. 7 th 5215 599 „ 22nd 5847 619 14th 5331 613 „ 29th 6113 656 21st 5098 574 May 6th 6748 685 28th 6107 581 „ 13th 5987 593 Nov. 4th 5981 565 „ 20th 6215 615 11th 6032 547 „ 27th 6193 671 18th 5895 614 June 3rd 6217 538 25th 6317 594 „ 10th 7185 579 Dec. 2nd 5219 497 „ 17th 6912 582 9th 5671 548 ,, 24 th 6411 609 16th 5480 571 23rd 5612 518 30th 5344 384 I give below a table showing the number of requests received for the removal of house refuse from dwelling-houses during the ten 96 years ending December, 1905. This shows a further improvement during last year. List of the requests for the removal of Dust received during the ten years, ending December 31st, 1905. 1896 1897 1898 1899 1900 1901 1902 1903 1904 1905 Jan. 37 21 22 26 50 13 31 28 28 12 Feb. 17 20 6 7 7 4 6 11 3 5 March 30 10 6 3 9 9 20 23 10 6 April 46 8 19 37 22 18 20 63 21 10 May 22 11 3 21 11 12 11 43 11 10 June 39 12 11 22 20 18 12 45 18 16 July 18 17 11 43 37 27 119 47 19 16 August 12 9 6 14 8 12 53 12 10 8 Sept. 24 6 8 2 18 17 17 25 6 9 Oct. 21 8 3 10 8 7 15 13 14 6 Nov. 14 9 4 6 2 8 16 10 5 6 Dec. 17 7 15 18 13 13 35 11 10 4 Totals 297 143 114 220 205 158 355 331 155 108 THE MORTUARY. The following tables give the number of bodies deposited in the mortuary during the year, also the number of inquests held there, with the causes of deaths, &c. Number of bodies deposited in mortuary 433 1. To await inquests—(a) Infectious 2 (b) Non-Infectious 402 2. To await burial 29 Number of post-mortems made 157 97 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 121 105 Accidental death 78 52 Suicide 21 6 Open verdict 11 5 Manslaughter 2 Homicide .. 1 Totala 234 168 Table showing nature of above Suicidal and Accidental Deaths in the Borough of Hackney during the Year ended 1905. Suicides. Accidental Deaths. Nature of Suicide. No. Nature of Accidental Death. No. Poisoning 5 Poisoning 1 Cut throat 3 Fall 44 Drowning 16 Suffocated 41 Fall 2 Shock from burns 25 Shooting 1 Drowning 8 Run over 6 Shock from scalds 3 Fracture of skull 2 Suffocated in bed 14 Others 26 Total 27 Total 130 98 REGISTER OP SANITARY WORK, 1905. Mr. Ellis, Stamford Hill. Mr. Harvey West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South Hackney. Mare St. tadSoutta Hackney. Mr. Haben, Homerton, E. Mr. Mansell, Homerton, N. Mr. Kemp, Homerton, S. Mr. Wbite, Clapton, N.E. Mr. Peverett, Special. Mr. Vobe, Special. Mr. Bobbit, Special. Miss Teebay, Special. Miss Newton, Special. Totals. Mr. High. Mr. Sbep'd. Mr. Punter. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. No. 10. No.11. No. 12. Inspections— Made on complaint 135 167 153 143 325 283 206 119 182 62 123 73 43 86 .. 7 .. 2107 Workshops .. 10 1 .. .. 6 6 .. 2 14 .. .. 1 .. .. 249 .. 288 House to house .. .. 35 19 68 41 80 103 60 120 51 158 219 .. .. .. 954 Houses after infectious disease 70 95 90 207 135 155 200 129 224 173 138 57 72 32 .. .. .. 1777 Premises re-inspected 2367 2634 2386 2747 2109 2810 2629 2669 2835 1816 3470 1721 922 3276 .. 1936 630 36957 Fishmongers' and poulterers' yards .. .. .. .. 3 .. .. .. 10 2 1 .. 1 .. .. .. .. 17 Slaughterhouses .. .. .. .. .. .. .. .. .. .. .. .. .. .. 366 .. .. 366 Cowhouses (premises), dairies and milkshops .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1429 .. .. 1429 Miscellaneous inspections .. .. 6 .. .. .. .. 2 .. .. 10 .. .. .. 52 .. .. 70 Greengrocers' yards .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 2 Schools .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. 4 Bakehouses 4 20 3 44 18 43 43 .. 16 21 5 26 .. .. .. .. .. 243 Urinals 5 5 15 2 15 30 7 8 10 52 13 4 1 2 .. .. .. 169 Canal boats .. .. .. .. .. .. .. .. .. .. .. 74 .. .. .. .. .. 74 Animals improperly kept 2 6 .. .. .. .. 1 3 5 .. 7 .. .. 7 .. .. .. 31 Laundries .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 5 .. 7 Offensive trades .. .. .. .. .. .. .. .. .. .. 4 .. .. .. 18 .. .. 22 Outworkers' premises .. .. 1 .. .. .. 10 11 .. 12 6 .. 1 .. .. .. 2299 2340 New buildings .. .. 24 .. 27 .. 5 .. 36 10 .. .. 20 .. .. .. .. 122 Special inspections 9 129 46 32 15 24 37 19 89 3 11 3 14 5 .. .. .. 436 Houses let in lodgings .. .. .. .. .. .. .. .. .. .. 119 .. .. .. .. .. .. 119 Mews and stables 2 8 .. .. .. 2 .. 2 .. 4 3 .. 3 .. .. .. .. 24 G 99 100 101 REGISTER OF SANITARY WORK, 1905—Continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South Hackney. Mare St. and South Hackney. Mr. Haben, Homerton. E. Mr. Mansell, Homerton, N. Mr. Kemp, Homerton, S. Mr. White, Clapton, M.E. Mr. Peverett, Special. Mr. Vobe, Special. Mr. Bobbit, Special. Miss Teebay. Special. Miss Newton, Special. Totals. Mr. High. Mr. Sbep'd. Mr. Punter. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. No. 10. No. 11. No. 12. Inspections—continued. Places where food prepared for sale .. 7 .. .. .. 3 .. 3 .. 3 5 3 2 .. 81 .. .. 107 Other workplaces .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ice cream premises .. 10 .. .. .. .. .. .. .. .. 11 2 .. .. .. .. 23 Intimation notices served 134 177 154 263 204 303 323 247 269 173 228 98 110 348 7 241 186 3465 Peremptory or final notices served 30 .. 29 30 .. 25 22 35 31 .. 27 .. .. 18 .. 51 44 342 Statutory notices served 29 26 5 33 18 14 40 23 22 13 25 2 .. 22 .. 7 10 289 Proceedings before magistrates or justices under the Public Health Act. .. 4 .. 9 3 1 .. .. .. .. .. .. .. .. 2 2 1 22 Nuisances abated 143 198 171 261 213 304 131 244 255 210 227 112 114 340 .. 317 229 3469 Seized and Condemned as Unfit for Human Food— Fish .. .. .. 6 cwt. .. .. 3 cwt. cwt. lbs. 1 18 .. .. 7 cwt. .. 1 cwt. 2½wts ½ cwt. .. .. tns. cwts. lbs. 1 1 18 Fruit and vegetables .. .. .. 3 cwt. .. .. 5 cwt. 14 lbs. ½ cwt. .. ½ cwt. 14 1bs. .. ½ cwt. 36 lbs. .. .. 10 cwts. 8 lbs. Meat .. .. .. .. .. .. .. .. .. .. 60 lbs. .. .. .. 13¼ cwts. .. .. cwts. qrs. lbs. 13 3 4 Tinned Foods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other articles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Open spaces cleared 2 .. .. .. .. .. .. .. .. .. 1 3 .. .. .. .. .. 6 Special reports to Medical Officer of Health 3 6 39 6 .. .. 37 2 8 .. 5 .. 1 .. 9 .. .. 116 Food Adulteration— Samples collected for analysis 73 72 .. 66 61 72 72 72 72 66 72 72 60 60 71 .. .. 961 Proceedings taken before magistrates 11 1 .. 2 5 2 4 3 3 2 9 2 3 2 1 .. .. 50 102 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 1905. 1905. Temperature. Relative Humidity. Amount of Cloud. Rain. Means. Extremes. Amount, No. of Days. 9a.m. Min. Max. Range Mean. Min. Max. o o o o o o o % in. January 39.5 35.5 44.5 9.0 40.0 22.9 54.5 84 5.8 1.ll 6 February. 43.0 40.0 48.0 8.0 44.0 33.0 53.0 81 6.3 .67 11 March 47.0 41.2 51.9 10.7 46.6 32.8 59.6 78 7.5 2.77 21 April 49.1 42.8 53.7 10.9 48.2 34 .0 62.8 74 8.1 1.58 19 May 56.6 47 .0 63.1 16.1 55.1 37.7 80.7 66 4.8 .69 7 June 61.5 54.8 67.4 12.6 61.1 47.4 77.7 77 7.0 4.50 15 July 66.9 60.6 74.0 13.4 67.3 53.7 80.9 71 51 .88 7 August 62.2 56.4 68.0 11.6 62.2 50.5 73.8 73 6.3 2.17 14 September 57.8 53.3 62.2 8.9 57.7 45.6 72.9 81 7.3 1.76 12 October 47.5 42.2 52.1 9.9 47.2 33.8 59.4 80 6.0 .93 12 November 43.8 40.0 47.7 7.7 43.8 30.7 55.0 88 7.3 2.70 17 December 42.5 39.7 45.6 5.9 42.7 31.6 57.0 88 7.8 .56 8 Year 51.5 46.1 56.5 10.4 51.3 22.9 80.9 78.4 6.6 20.32 149 I remain, Gentlemen, Yours faithfully, J. KING.WARRY, M.D., D.P.H., May 10th, 1906. Medical Officer of Health. 103 APPENDIX. MEMORANDUM ON HEALTH VISITORS. By J. KING WARRY, M.D., Medical Officer of Health. In preparing this memorandum, it is necessary before entering upon any explanation of the duties, &c., of health visitors, to make some reference to the present position of public health, and to the progress made in London during the last half century; and this is especially necessary, as such a resume will show in great measure the lines along which public health progress has taken place, and the special measures which have contributed to that result. It will, at the same time, indicate the lines along which no progress has been made, but, on the contrary, where retrogression is proceeding, and consequently will show the direction in which public health efforts should be pressed or guided if the progress of the past is to be maintained. Some idea of the change above referred to may be gleaned from the following table of statistics prepared from figures supplied by Dr. Tatham to the Royal Commission on Physical Degeneration:— Periods. London. Infantile mortality per 1,000 births. Birth rate per 1,000 population. Death rate per 1000, population. 1851-1860 33.6 23.7 155 1861-1870 35.4 24.4 162 1871-1880 35.4 22.5 158 1881-1890 33.2 20.5 152 1891-1900 30.2 19.6 160 This table shows the general death rates, the infantile mortality, and the birth rates during the five decennia ending 1900. It will be 104 seen that the general mortality has fallen during this period from 23.7 per 1,000 to 19.6 per 1,000 of the population—a diminution in the general mortality of 41 per 1,000 persons. That is to say, the annual deaths in London during the last decade of the nineteenth century were four less for every thousand inhabitants than fifty years before, i.e., on the present population of London there is an annual saving of lives amounting to 18,179. This does not represent the whole improvement from a Public Health point of view enjoyed by the present population of London over that of 1851. It is calculated that for every fatal illness there are at least three eases of recoverable sickness. There is, therefore, a diminution of sickness corresponding to 54,537 cases per annum. But while the general mortality in the periods mentioned has declined to the extent of 41 per 1,000, this is not so in the special case of the death rate under one year of age—the infant mortality. Reference to the above table will show that not only has the infantile mortality not declined, but that during the decade 1891 to 1900 it shows an increase upon the rate for the decade 1851 to 1860 to the extent of 5 per 1,000. This means that five more infants died annually during the last decade per 1,000 infants born, i.e., taking the number of births in London during the year 1901, which was 131,278, as an annual average, the increase of 5 per 1,000 on the infant mortality means 656 deaths annually more than if the rate of 1851 had been maintained. It may here be added that the same phenomena are exhibited by mortality statistics relating to Hackney for the same periods. The different behaviour of the general mortality rate, and the infant mortality rate, the former continuously falling, and the latter rising, naturally provokes the enquiry why, coincident with a declining general death rate, there should be a rising infant death rate. Now, there is perfect agreement among hygienists of all classes, that the chief cause of the reduction in the general death rate, and the sick.rate, witnessed in London and in the country generally during the last half century, is the direct result of the public health 105 measures adopted and applied by local and other authorities during that period. Such as the improvement of drainage and water supplies; the improved system of removal and disposal of house refuse; the improved sanitary condition of dwellings and their neighbourhood; the notification and isolation of infectious diseases, Ac., in addition to other improvements provided for in the various Public Health Acts passed during the period in question. While these measures have profoundly affected, in a beneficial manner, the general mortality and the sick rate, they appear to bave had very little or no effect for good upon the infant mortality, and the reason for this is not difficult to discover. It may safely be said that the health of the community at large, especially that of adults, depends upon many factors, some of which have been beneficially influenced by Public Health legislation; but the health of the infant population depends chiefly upon home and maternal influences, i.e., upon the mode of feeding, clothing, &c., which Public Health legislation has only slightly touched. The general mortality reacts most quickly to sanitary measures of a municipal character, the infant mortality to domestic hygiene, and this, in my opinion, is the explanation of the different behaviour of the general death rate and the infantile death rate during the last half century. The fact is that personal and domestic hygiene, and in this I include all that relates to the proper care of infants, has been neglected in the past; it may be said in this respect we are very little better on the whole than a quarter of a century ago. With the exception, perhaps, of a nebulous idea that when an individual is known to be suffering from an infectious disease, such person should be separated from those who are healthy, the public, especially in crowded localities, may be said to possess no ideas on domestic hygiene, with the result that the community at large still suffer from an unnecessarily and preventably high infant death and sick rate. It appears, therefore, as if the time has arrived when those to whom the Public Health has been entrusted, as well as those interested in its maintenance and improvement, should make some effort, outside 106 the ordinary way, by dealing with the iiome and home influence, especially as they relate to infants and infant life, in order to reduce the high mortality prevalent at the present time amongst the infants in the crowded part of our Borough. The question may now be asked, is the reduction of the infant mortality within the region of practical and reasonable preventive efforts? Before replying to this question, I think it will be advisable to examine the causes of death under 1 year of age. During 1904 there were 953 deaths of infants in Hackney under 1 year old. Of this number 798 were due to the following chief causes :— On a careful consideration of the above causes, it will be generally agreed that a large number of the deaths above classified is preventible. For instance, the diarrhoea and enteritis of infants are closely associated with errors in feeding; the bronchitis and pneumonia with want of knowledge to deal with minor catarrhal affections and the infectious diseases. The deaths entered under the head of debility are also probably closely connected with errors in diet and with neglect; the premature births to indiscretions of mothers during the antenatal period; the accidents, of which the majority are cases of overlaying, with carelessness and want of thought, and so on. From these considerations, I am of opinion that a reduction of the infant mortality is within the reach of practical and reasonable preventive efforts. There appears, therefore, to be a sphere at present almost untouched and Causes of death of infants under 1 year—1904. Whooping cough 40 Diarrhoea and enteritis 231 Bronchitis and pneumonia 131 Tubercular disease 138 Debility 116 Meningitis 26 Convulsions 60 Accidents 27 Premature birth and congenital defects 138 107 unapproached—the home sphere—where conditions arise and flourish to the prejudice of the inmates of such dwellings, and consequently to the community at large. These conditions arise through want of knowledge, thoughtlessness, and ingrained prejudice. Of such the following are examples:— 1. Want of personal and domestic cleanliness. 2. Prejudice against ventilation. 3. Erroneous ideas as to the danger of certain infectious diseases, e.g., measles and whooping cough, with consequent neglect, exposure, and improper treatment. 4. Ignorance of the more elementary principles of nursing. 5. Ignorance as to the feeding and care of infants and children at older ages. 6. Want of knowledge of the home treatment of tuberculosis. Others could be added, but the above are sufficient to show that if the injury to health arising from the above want of knowledge and prejudice is to be diminished, there is need for a new class of public health workers. There is need for individuals who will, by means of a sympathetic manner and tact, gain the confidence of mothers, and instruct them in the elementary principles of hygiene in relation to the home and in the care of infants and young children—in personal and domestic hygiene. The health visitor is such a one. The appointment of health visitors is not a recent idea. Manchester adopted the idea 37 years ago, and the public of that city has benefited greatly by its adoption. Other towns have appointed health visitors, with satisfactory results; and the Borough of Kensington has recently appointed one or more of such officers. The appointment of health visitors to work in the Borough of Hackney would, I am convinced, in course of time have an appreciable effect in directing the attention of mothers to the necessity and advantage of ruling their homes by the laws of health, and so diminish the infant mortality. 108 This memorandum would be incomplete without some reference to the qualifications and duties of health visitors. The qualifications of health visitors should, in my opinion, include the following:— Qualifications of Health Visitors. 1. Candidates for the office of health visitor should possess a sanitary inspector's certificate approved of by the Local Government Board. 2. Should produce evidence of having had some training as a general nurse. 3. Should be competent to advise as to the feeding and care of infants. Duties of Health Visitors. 1. To visit the homes of the poor and ascertain whether there are any insanitary conditions present, and report the same to the Medical Officer of Health. The following points should be noted:— (a) The presence or complaint of bad smells or vermin. (b) The presence or not of overcrowding. (c) The sufficiency or otherwise of ventilation. (d) The cleanliness and state of repair of the rooms, passages, back yards, sinks, gullies, dust.bins, and sanitary conveniences. (e) Whether the house refuse is regularly removed. The health visitor should be prepared to point out the prejudicial effect of insanitary conditions upon the health, especially on that of children. 2. To enquire whether there is any illness in the house, and its character. If there is illness from— (a) A non.infectious disease, the visitor should advise where necessary as to the nursing of the patient, and generally how to prepare food, and administer the various remedies ordered. 109 (6) An infectious disease, the visitor should point out the necessity for isolation in order to prevent the spread of the disease ; the removal to hospital if it is a notifiable disease ; the exclusion of children of the same family from school, and, on recovery, the disinfection or destruction of any articles likely to be infective; and generally, to urge the adoption of all recognised hygienic measures to prevent the spread of infectious disease, or to diminish their fatality. If a case of consumption exists in the house visited, the visitor should advise the patient as to the steps which should be taken in the interests of the sufferer and other persons in the house. Special attention should be given to the ventilation of the room occupied by the sick person, the importance of sleeping alone, and the scalding of cups, &c., after being used by the patient, and the proper treatment of the sputa. The occasional disinfection of the patient's room, bedding and clothes, should be advised and offered. During the summer and autumn months, the visitor must be prepared to warn, on every suitable occasion, against those things which promote infant diarrhoea, such as:— (a) Foul smells from drains, sinks, want of cleanliness of gullies, &c., or from decaying refuse. (b) The contamination of food by its storage in unsuitable, unventilated, and ill.smelling places. (c) Stale or decaying food, especially meat, fruit, vegetables, and milk. This last is most important in connection with the feeding of infants. 3. To advise parents, and other responsible persons, on the proper feeding and care of infants. The visitor should enquire whether the infant is fed artificially, or by the mother. If the former, and the mother is healthy, she should point out the immense superiority of maternal to artificial feeding. If hand feeding must be adopted, the visitor should advise the mother 110 how best to feed by hand. Special attention should be given to the following points:— (а) Milk.—This should be sterilized on arrival, and placed in a scrupulously clean and covered receptacle, and kept in a cool place until required for use. (б) The quantity and times for each meal. (c) Quality.—The proper dilution, &c., of milk according to age. (d) Patent Food should only be used under medical advice. (e) The kind of feeding bottle, and its treatment. The visitor should advise as to the clothing and cleanliness of infants. The sleeping arrangements for the infant should be enquired into, and the parents should be warned against allowing it to sleep in the same bed with themselves, and advised to have a separate sleeping place for the child. 4. It would be the duty of the visitor to point out, unobtrusively on every appropriate occasion, the importance of domestic and personal cleanliness, sobriety and thrift. The above is an indication of the lines along which, in my opinion, the health visitor should work, but it is not intended to be a complete schedule of her duties. The health visitor, on her visits, would be provided with leaflets of instructions suitable for different circumstances. Generally, the health visitor would be instructed in her duties, and supervised in her work by the medical Officer of Health. During the preliminary and general discussion by the Public Health Committee on the subject of health visitors, the question was incidentally raised as to whether it would not be possible to have the work above outlined done by voluntary lady visitors, and thus save the Borough the expense of appointing special officers. I was instructed generally to make inquiries whether it would be possible to get ladies, suitably trained, to volunteer their services for this work. Mrs. Farquharson, of 135, The Common, Clapton, to whom 111 I applied for information on this point, expressed the opinion that while voluntary lady workers for social work wei'e not wanting, yet this work would probably require more previous training than one can reasonably expect in volunteers, and the control over such workers must necessarily be less complete than if they were paid workers of the Borough. These are, of course, the objections to volunteer workers. The qualifications required in a health visitor are not such as one could expect in a volunteer, unless the work was taken up for a short time for the purpose of ultimately qualifying for health visitor. Again, the voluntary worker could not well be criticised as to the time and results of her visits, and the time given to such work would only be part time. It may be said that the control over the worker, and the supervision of her work, would be much less complete than in the case of the paid worker, and the hours of work would also be less. If the introduction of health visitors is to be successful, it will depend to a large extent upon the first visitor appointed. Untrained voluntary workers would probably misrepresent the object the Borough had in view, and irreparable harm might be done to the cause. I am of opinion that, in order to ensure success in the object in view, it is necessary that the workers shall be properly qualified and also properly paid. In conclusion, I should like to express my personal view that there is ample room, and great need, for one or more health visitors in certain parts of Hackney, and that if the Borough Council appointed such officers, the results would, in my opinion, fully justify and repay the cost involved in their appointment. Public Health Department, Town Hall, Hackney, 6th April, 1905. 112 HACKNEY BOROUGH COUNCIL. PREVENTION OF SCARLET FEVER OR SCARLATINA. Scarlet fever or scarlatina is a dangerous infectious disease, attacking mostly children under ten years of age, but adults are not exempt from the disease. Males and females are equally liable to be attacked. Epidemics occur at all seasons of the year. In Hackney during the year 1903 there were 636 cases of scarlet fever, amongst which 20 died. This is a little over 3 per cent, of the persons attacked. The fatality is not very great compared with some other familiar fevers; but although recovery occurs in the vast majority of cases, the disease leaves in many of the children who have suffered from it serious constitutional damage. In some cases chronic kidney disease is a result of the fever; in others, heart disease; in a third, disease of the ear, which may end in total deafness; in others, the glands of the neck are enlarged. This does not complete the list of the effects of this disease, but the above is sufficient to show that in scarlet fever or scarlatina we have a most serious disease, and that it is the duty of the public to prevent as far as possible its spread. The disease may spread from a person ill with or recovering from the disease to a healthy person, or even from a person suffering from what appears to be only a sore throat, but which in reality is a mild form of scarlet fever. Cows' milk has been in some outbreaks the medium by which the disease has been conveyed, the milk becoming infected by persons engaged in milking or in the manipulation of milk whilst suffering from the disease in a mild form. Infected articles of bedding, clothes, toys, cups, etc., may spread the disease. Infection may also be conveyed by persons who have been in contact .with patients, although they may not be suffering themselves. 113 Symptoms.—In this disease the period between exposure to infection and the appearance of the first symptoms (the incubation period) varies from two to seven days. The earliest symptom in children affected with this disease is usually that of vomiting, but in very young children it may begin with convulsions. Fever also sets in and rises very rapidly. The skin becomes dry and hot and the face flushed. On the second day a rash appears on the body, consisting at first of a number of red points. It appears first on the neck and chest, and then spreads rapidly in most cases over the entire skin, but in some it occurs only in patches. The rash lasts two or three days and then fades away. The throat becomes at the same time more or less affected, varying in different cases from a slight redness to intense inflammation. With the disappearance of the rash the fever falls and other symptoms improve. Some days after the patient appears to have recovered from the fever a characteristic symptom appears, that is the superficial layer of the skin begins to peel off, or, as it is termed, " desquamate." This process lasts from ten to twenty days, and the peeling may affect the whole body. In some mild cases the early fever and rash are so slight that they are not noticed, and the parents only begin to suspect scarlet fever when the skin begins to peel. The above description refers to an uncomplicated case of scarlet fever, but the disease may be complicated by more serious symptoms, as indicated above. The infection of the patient lasts from the appearance of the earliest symptoms until the peeling, or desquamation, of the skin has ceased. It is considered that the period of sore throat and fever and the early stage of peeling is more infectious than the later stage, but it is safer at present to regard infection as lasting up to the end of peeling, or until all discharges from the nose or ears have ceased. From this account it will be seen that the preventive measures are similar to those of other fevers affecting children. 114 MEASURES TO BE ADOPTED TO PREVENT THE SPREAD OF SCARLET FEVER AND SCARLATINA. 1. Any child who is suffering from the above symptoms of scarlet fever or scarlatina should be removed to a fever hospital, or isolated by removal to a room apart from the remainder of the household, and from which all unnecessary clothing, hangings, etc., have been removed. A sheet moistened with a solution of carbolic acid should be hung over the door to the room. 2. The washable clothing and bedding and the towels should be placed in a receptacle containing a solution of carbolic acid (two tablespoonfuls to a pint of water) before removal from the sick room; cups, saucers, spoons, etc., should be scalded before being used by others. No food taken out of the sick room should be consumed by others. 3. Persons attending upon the sick child should wear a washable overall in the sick room, changing the same and washing their hands and face before leaving and associating with others. 4. When peeling of the skin begins, the patient should be rubbed every other day with sweet oil or vaseline, in order to prevent the scales of the desquamating skin being diffused into the atmosphere. A warm bath must be taken occasionally to remove the oil and scales entangled therein. 5. After recovery or death, the room, bedding, clothes, etc., used by the patient should be well disinfected before being used, and this will be done free of charge on application being made to the Public Health Department either by the medical attendant or person in charge of the patient. 6. No child suffering from scarlet fever, scarlatina, or any form of sore throat should be allowed to go to school or to any other public institution; nor should any child recovering from the same, until all peeling of the skin, and all discharges from the nose and ears have ceased, and all sore throat has disappeared, and not until after the thorough disinfection of the patient's clothes and home. 115 7. No child should be allowed to go to school or any other public institution from a bouse in which there is a case of scarlet fever, or scarlatina, until the complete recovery of the patient and the disinfection of the house, etc. 8. No child should be allowed to attend school who has been exposed to the infection of scarlet fever, or scarlatina, until seven days after exposure, and not even then if there are signs of the disease having been contracted. J. King Warry, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Hackney, N.E. June, 1905. 116 HACKNEY BOROUGH COUNCIL. PREVENTION OF DIPHTHERIA AND MEMBRANOUS CROUP. Diphtheria is an extremely dangerous infectious disease, attacking mostly children between the ages of two and fifteen years, and girls more than boys. Adults are also frequently affected. The disease is most prevalent in the autumn months, but cases occur in London all the year through. In the year 1903 there were 518 cases in Hackney, with 48 deaths, giving a death rate of over 9 per cent. From these figures it may be seen how very serious this disease is. Yet it is to a great extent preventable. Diphtheria is one of those diseases caused by the presence and action of a microbe in the body of those suffering from the disease. The microbe attacks chiefly the throat and the lining membrane of the passages leading from it, such as the nose and windpipe. The action of the microbe is to form a greyish white skin over the surface it attacks, but at the same time a very powerful poison is produced which is absorbed into the system; and it is the absorption of this poison that gives rise to the constitutional or general symptoms. The greatest number of deaths occurs between the ages of two years and five years, so that the later in life the disease is caught the more likely recovery will follow. The disease is also more likely to attack children with enlarged tonsils or an unhealthy condition of the throat and mouth. The disease spreads from person to person, i.e., from one suffering or recovering from the disease, or from persons who have apparently only had a simple tonsilitis, or sore throat, or discharge from the nose (in reality these latter have been mild and unrecognised cases of diphtheria). Certain domestic animals (cats, Note.—Membranous croup is a variety of diphtheria, being diphtheria of the upper part of the windpipe. 117 pigeons, fowls) suffer from a similar affection, and by some it is thought that such animals may convey it to human beings. Cows' milk has been the medium in certain epidemics. Articles, such as clothing, bedding., cups, toys, &c., may convey the disease. A healthy person who has come in contact with a diphtheria patient may convey the disease to a third person without suffering himself. Defective sanitary conditions are credited with the power to cause the disease, but these conditions act in the way of lowering the tone of the body, and by setting up a low form of sore throat, which provides a favourable soil for the growth of the microbe of this disease. Symptoms.— It may be from two to seven days after being infected before the first symptoms arise. This period is called the "incubation period. "The disease usually begins with feverishness accompanied by chilliness and aching pains in the back and neck Redness then appears at the back of the throat, and the child may complain of slight difficulty in swallowing. Greyish spots then appear on the tonsils and the neighbouring parts of the throat, which spread, and, in severe cases, may completely cover the back of the throat with a skin or membrane. If this skin extends into the windpipe difficulty in breathing may be experienced, which in certain cases may lead to suffocation. If it extends into the nose bleeding may occur from that organ. The fever may rise very high and lead to a fatal result. Many serious complications may occur during the course of the disease, such as bronchitis, inflammation of the lungs or kidneys; but the most serious complication is paralysis, which is said to occur in about 15 per cent, of the cases attacked. The paraylsis may attack the throat, causing the child to speak through the nose, as it were, and leading to a difficulty in swallowing liquids (in such case the liquid will often be passed back through the nose), or the muscles of the eyes, leading to squinting, or some muscles of the limbs may be affected ; but the most serious form of paralysis is when the heart or the muscles of the chest employed in breathing are affected. This form of 118 paralysis leads in many cases to a fatal issue. Any particular case may follow one or other course, lasting many weeks, or the membrane may gradually disappear, the fever, &c., diminishing, and the patient soon recovering. The fatality varies in different epidemics; but a very mild case in one person may cause a most serious case in another. Prom consideration of the above facts it must be apparent how desirable it is to prevent the disease spreading from one person to another. MEASURES TO BE ADOPTED TO PREVENT THE SPREAD OF DIPHTHERIA AND MEMBRANOUS CROUP. 1. Any child or adult suffering from the symptoms of diphtheria or membranous croup should be isolated by removal to a room apart from the remainder of the household, from which all unnecessary clothings, hangings, carpets, &c., have been removed. If the disease is only suspected from the presence of sore throat and fever the same isolation should be practised. A sheet moistened with a solution of carbolic acid should be hung over the door to the room. 2. As the discharges from the nose or mouth may convey the disease, these should be received on pieces of soft rag and immediately burned. 3. The washable clothing and bedding and the towels before removal from the sick room should be placed in a receptacle containing a solution of carbolic acid (two tablespoonfuls to one pint of water), cups, saucers, spoons, &c., should be scalded before being used by others. No food taken out of the sick room should be consumed by others. 4. Persons attending upon the sick person should wear a washable overall in the sick room, changing the same and washing their hands before leaving and associating with others. 119 5. After recovery or death, the room, bedding, clothes, &c. used by the patient should be well disinfected before being again used, and this will be done free of charge on application being made to the Public Health Department, either by the medical attendant or person in charge of the patient. 6. No child suffering from diphtheria, membranous croup, or any form of sore throat should be allowed to go to school or to any other public institution, nor should any child recovering from the above until the throat has been pronounced to be free from the microbe causing the disease, and until after the thorough disinfection of the patient's clothes and home. 7. No child should be allowed to go to school or any other public institution from a house in which there is a case of diphtheria or membranous croup, until the complete recovery of the patient and the disinfection of the house, &c. 8. No child should be allowed to attend school who has been exposed to the infection of diphtheria until seven days after exposure, and not even then if there are signs of the disease having been contracted. 9. No cat should be allowed in a room where a patient suffering from this disease is nursed, nor should children be allowed to fondle such animals, especially during prevalence of diphtheria, or if the animal appears to be ailing. J. King Warry, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall Hackney, N.E. June, 1905. 120 HACKNEY BOROUGH COUNCIL. PREVENTION OF TYPHOID OR ENTERIC FEVER. Typhoid or enteric fever is a dangerous infectious disease, attacking all classes and both sexes, but chiefly adults during the most active portion of life (from 15 to 40 years). The disease may occur at any time of the year, but it is most common during the late summer and autumn months. The fatality varies in different epidemics, but it is always high. In Hackney, during the year 1903, there were 247 cases of this disease, of which 35 died, thus giving a death rate of over 14 per cent. A disease with such a high death rate must always be regarded as extremely dangerous. Typhoid is one of those diseases which is due to the presence and action of a microbe, the bacillus typhosus, in the system. This microbe has been found in nearly all the tissues of the body, but especially in the excretions of those suffering from the disease; and it is the excretions which are the sole cause of spreading the disease through the community. The disease may spread—(1) By contagion from persons ill with the disease to nurses or others attending upon or coming into close relation with them; sometimes by direct transmission through the air, but chiefly by infected or soiled bed or body linen or clothes. (2) By infected water. Many serious epidemics of enteric fever have occurred by drinking water polluted by the excretions from persons suffering from this disease. A notable instance, within the memory of most persons, is the Maidstone outbreak of 1897. (3) By effluvia from drains or sewers which have been infected by typhoid excretions. (4) By infected food. The foods which can with reliance be regarded as active media in spreading the disease are (a) milk. This may be brought about by washing the milk cans with polluted water, or even adulterating milk with such water; (b) oysters and other shell.fish fattened in waters to which sewage has 121 access are liable to become infected and capable of spreading this disease. Many such epidemics have been described; (c) other kinds of fish have been known to convey the disease when insufficiently cooked; (d) watercress, &c. Vegetables, such as watercress, which are eaten raw, are capable of spreading the disease if grown in sewage.polluted soil and not sufficiently cleansed before consumption. If the above facts in connection with enteric fever are borne in mind by the public, it would be possible to bring about a great reduction in the prevalence and consequent mortality from the disease; and such a result is so much more to be desired, because this disease incapacitates and carries off persons in the most active and remunerative time of life, a time when life's energy and responsibilities are greatest. Symptons.—During the early days of the disease, called the "incubation period," which, by the way, may last from one to three weeks, the patient has a feeling of weakness and inability for exertion. Then other symptoms, sometimes preceded by chills or shiverings, set in, such as headache, more or less constant, loss of appetite, diarrhoea, pain in the abdomen and fever, which last rises gradually day by day until it reaches a certain point. About a week after the definite advent of fever a peculiar rash, consisting of small rose.coloured spots appear on the abdomen, then on the back and on other parts of the body. As the symptons get worse the patient loses flesh and becomes slightly deaf. Numerous complications may arise during the course of the disease which may lead to a fatal issue, or the intensity of the fever alone may bring about the same result. At the end of about three weeks in an uncomplicated case of typhoid the fever begins as a rule to diminish, and the general condition of the patient to improve. At this time and for some weeks after there is great danger of a relapse setting in with the return of the earlier symptoms, and a prolongation of the course of the disease. The period during which infection of the patient lasts is from the commencement of the disease until convalescence has been established a fortnight. 122 MEASURES TO BE ADOPTED TO PREVENT THE SPREAD OF TYPHOID OR ENTERIC FEVER. 1. During prevalence of typhoid or enteric fever regard should be paid to the various causes above enumerated capable of spreading the disease. Water and milk should be boiled before use. Shell.fish for raw consumption should either be avoided or the source known to be free from pollution. Other fish should be thoroughly cooked before consumption. Watercress and similar vegetables eaten raw should previously be most thoroughly washed or avoided. 2. No disease requires more careful and skilled nursing and attention than typhoid or enteric fever. The untrained nurse is likely not only to bring disaster to the patient, but also to spread the disease to herself and others, so that, unless ample accommodation and skilled nurses are provided, with medical attendance, it is wise in the interests of all to have the patient removed to a fever hospital, where his chances of recovery will be much improved. 3. If a case is treated at home, the patient should take to his bed at the earliest possible date, and should be kept in a well.ventilated room, free from draughts, apart from the rest of the family, preferably at the top of the house, from which all unnecessary clothings, hangings, carpets, &c., have been removed. A sheet moistened with a solution of carbolic acid should be hung over the door to the room. 4. All excretions from the patient should be received in a suitable pan in which is placed a sufficient quantity of strong solution of carbolic acid (four tablespoonfuls to a pint of water). 5. All washable clothing, bedding and towels should, before removal from the sick room be placed in a receptacle containing a solution of carbolic acid (two tablespoonfuls to one pint of water). Cups, saucers, spoons, &c., should be scalded before being used by others. No food taken out of the sick room should be consumed by others. 123 6. Persons attending upon the sick person should wear a washable overall in the sick room, changing the same and washing their hands and face before leaving the sick room and associating with others. 7. No child should attend school or any similar institution from a family where a member suffering from typhoid fever is nursed at home, until the patient has completely recovered and the home, &c., has been satisfactorily disinfected. 8. After recovery or death, the room, bedding, clothes, &c., used by the patient should be well disinfected before being used again, and this will be done free of charge on application to the Public Health Department, either by the medical attendant or person in charge of a case of typhoid or enteric fever. J. King Warry, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Hackney, N.E. June, 1905. 124 Record of Prosecutions under the Public Health (London) Act, 1891, during the year 1905- Address. Complaint. Magistrate's Decision- PeDalty. Costs. 50, Rushmore-road Pig's head sold to MessrsFuller & Son, of this address, unfit for food of man- Fined s. d. s. d. 20 0 42 0 29, Fortescue-avenue Milk utensil in an unclean condition- do. 5 0 2 0 16, Foulden-road Defective drains outlet Order to do work in 21 days. 2 0 371, Victoria-park-rd. Dirty rooms, S.W.P. untrapped, dilapidated W.C. Withdrawn (work done). 70, Brooksby's-walk Defective paving to washhouse. do. 50, Rushmore-road 3 Pigs' heads sold to Messrs- Fuller & Son, of this address, unfit for food of man. Dismissed 139, Culford-road Defective drains Withdrawn (work in hand). 87, Kyverdale-road do. do. 63, Elderfield-road Insufficient supply of water to lower W.C. and pan foul, waste pipes from sink on G.F, and in scullery foul and untrapped, B.W. untrapped, soil and waste pipes defective. Withdrawn (work done). 16, Loddiges-road Defective drains Dismissed, £2 2s. costs against council. 1, Tranby-plaoe Unfit for human habitation and not reasonably capable of being made fit. Adjourned sine die 2, do. do. do. do. do. 125 Address. Complaint. Magistrate's Decision. Penalty. Costs. 4, Tranby.place Unfit for human habitation and not reasonably capable of being made fit. Adjourned sine die s. d. s. d. 5, do do. do. 6, do. do. do. 7, do do. do. 8, do do. do. 9, do do. do. 10, do do. do. 11, do do. do. 12, do do. do. 13, do do. do. 14, do do. do. 15, do do. do. 16, do do. do. 154, Glenarm-road House dirty, S. W.P. un. trapped and defective, drains defective. Withdrawn (work done). 126, do. No through vent to space under basement floor, scullery S.W.P. un. trapped, drains defective. do. 54, Lower Clapton.rd. Defective drains in wash. house. Dismissed. 16, Prince Edward.rd. Walls and ceilings of washhouse and W.C. dirty and dilapidated. Withdrawn (work done). 18, do. do. do. 20, do. Walls and ceilings of house dirty and dilapidated. do. 22, do. do. do. 243, Well.street (outside). Vegetable refuse thrown on thoroughfare. fined 5 0 2 0 126 Address. Complaint. Magistrate's Decision. Penalty. Costs. 1, Cadogan-terrace Did fail forthwith to notify M.O.H. that James Maniger was suffering from diphtheria. Withdrawn by order of Public Health Committee. s d. s. d. 128, Glenarm-road Defective drain Withdrawn (work done). 102, Millfields-road Milk utensil in an unclean condition. Conviction 2 0 153, Amhurst-road Neglect to supply Hackney Sanitary Authority list of outworkers to 1st August, 1905. Withdrawn (no outworkers employed). 46, Well-street do. Conviction 2 0 71, Maury-road Defective drain Order to abate nuisance in 28 days. 25, Rectory-road do. Dismissed, £3 3s. costs against Council. 70, Do Beauvoir-road Foul S.W.P., three foul gulleys in garden taking the drainage of adjoining premises. Withdrawn (work done). 81, Hertford-road Defective drain do. 55, Ridley-road R.W.P. and roof defective, D.B. defective and improper. Order to do work in 14 days. 174, Dalston-lane Defective drain, S.P. defective and unventilated, R.W.P. connected direct to drains. Withdrawn (work done). 111, Brooke-road Defective drain Order to do work in 28 days. 181, Rushmore-road do. do. £1 10 0 £2 12 0 127 HACKNEY BOROUGH COUNCIL. SALE OP POOD AND DRUGS ACT, 1879-1899. RETURN OF SAMPLES OF MILK ANALYSED For the Twelve Months ended 31st December 1904, showing the percentage of samples found "Genuine" and "Adulterated." SAMPLES. Percentage of Samples found. No. examined. No. found genuine. No. adulterated below 6% in which no action was taken. No. adulterated above 6% in which action was taken. Adulterated. Genuine. Above 6% Below 6% 407 293 3 to 4% 27 6 to 7% 4 6.01 17.69 73.21 4 „ 5% 38 7 „ 8% 8 5 „ 6% 7 8 ,, 9% 3 9 „ 10% 2 10 ,. 11% 3 11 „ 12% 4 12 „ 13% 1 13 „ 14% 2 14 „ 15% 1 15 „ 16% 2 16 „ 17% 1 18 „ 19% 1 20 ,, 21% 1 27 ,, 28% 1 28 ,, 29% 1 34 ,, 35% 1 37 „ 38% 1 407 298 72 37 901 17.69 73.21 Public Health Department, Town Hall, Hackney, N.E., 23rd March, 1905. J. KING WARRY, M.D., Medical Officer of Health. 128 Prosecutions under the Sale of Food and Drugs Acts and Margarine Acts during the Year, 1905. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fine. Costs. 18 Margarine Exposed for sale unlabelled Fined £ s. d. £ s. d. 0 5 0 0 12 6 No name and address on vehicle Fined 0 5 0 0 2 0 No name and address on vehicle Fined 0 5 0 0 2 0 No name and address on vehicle Fined 0 5 0 0 2 0 107 Milk 7.2% added water Fined 0 15 0 0 12 0 169 Milk 7.9% added water Withdrawn by order of the Public Health Committee 186 Milk 15.4% added water Fined 6 0 0 0 12 6 186 Milk 23% fat abstracted Fined 195 Milk 11.3% fat abstracted Dismissed— Warranty proved 209 Milk 7.3% added water Withdrawn by order of the Public Health Committee 252 Butter 93% foreign fat Withdrawn by order of the Public Health Committee •• 0 12 6 252 Margarine Served in plain wrapper Withdrawn by order of the Public Health Committee •• 0 2 0 256 Butter 91% foreign fat Fined 5 0 0 0 12 6 256 Margarine Served in plain wrapper Conviction •• 0 2 0 273 Milk 15% fat abstracted Fined 5 0 0 0 12 6 129 No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fined. Costs. 274 Milk 16.7% fat abstracted Fined £ s. d. £ s. d. 5 0 0 0 12 6 328 Milk 21.7% fat abstracted Withdrawn by order of the Public Health Committee .. 0 12 6 369 Milk 6% added water Fined 1 0 0 0 12 6 No name or address on vehicle Withdrawn—seller not employed by defendant No name or address on vehicle Withdrawn—seller not employed by defendant 391 Milk 7.5% added water Fined 0 8 0 0 12 6 395 Milk 22% fat abstracted Withdrawn by order of the Public Health Committee .. 0 12 6 426 Milk 10% fat abstracted Fined 2 0 0 0 12 6 430 Milk 14% fat abstracted Fined 2 0 0 0 12 6 459 Butter 95% foreign fat Fined 2 0 0 0 12 6 459 Margarine Served in plain wrapper Conviction .. 0 2 0 461 Butter 92% foreign fat Fined 4 0 0 0 12 6 461 Margarine Served in plain wrapper Fined 0 10 0 0 2 0 462 Butter 76% foreign fat Fined 2 0 0 0 12 6 462 Margarine 16% excess of butter fat Withdrawn 465 Milk 9.3% added water Fined 1 0 0 0 12 6 513 Olive Oil 100% cotton seed oil Withdrawn— Notice to purchaser 558 Butter 100% foreign fat Fined 10 0 0 0 12 6 130 No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fined. Costs. 558 Margarine Served in plain wrapper Conviotion £ s. d. £ s. d. .. 0 2 0 Milk Refusing to sell Fined 1 0 0 0 2 0 601 Milk 6% added water Fined 1 0 0 0 12 6 637 Milk 18.4% fat abstracted Dismissed—Notice to purchaser 640 Milk 6.9% added water Fined 0 10 0 0 12 6 656 Milk 27.5% added water Fined 1 0 0 0 12 6 692 Milk 6.3% added water Dismissed— Warranty proved 754 Milk 11.7% fat abstracted Fined 2 0 0 0 12 6 773 Milk 13.3% added water Fined 0 7 6 0 12 6 812 Butter 5% excess of water Conviction .. 0 12 6 817 Butter 6% excess of water Fined 1 0 0 0 12 6 818 Butter 2.6% excess of water Withdrawn on payment of .. 0 12 6 842 Butter 2.8% excess of water Withdrawn on payment of .. 0 12 6 863 Margarine Exposed for sale unlabelled Fined 0 10 0 0 12 6 919 Milk 3.6% added water Withdrawn— Reserve sample broken 945 Milk 7.3% added water Fined 2 0 0 0 12 6 950 Milk 8% fat abstracted Fined 1 0 0 0 12 6 956 Milk 10.24% added water Fined 5 0 0 0 12 6 63 0 6 20 5 6 131 LIST OF LICENSED COW SHEDS In the Hackney District, October, 1905. Name. Address No. of Sheds. Jones, Mary 46, Brooksby's Walk, Homerton 1 Jenkins, John 2, Buckingham Road, Kingsland 2 Lloyd, Daniel 72, Church Road, Homerton 1 Wright, Wm. and Jno. 84, Clifden Road, Clapton Park 2 Francis, John 67, Downham Road, Kingsland 1 Evans, Rees 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 Rumbal, T. E. 83, Upper Clapton Road 4 Pocock, B. 46a, Leswin Road, Stoke Newington 1 Warner, J. C. 23, Mare Street 1 Lewis, J. 6, Palace Road, Hackney 1 Lewis, D. J. 257, Queen's Road, Dalston 1 Williams, T. R. 79, Shacklewell Lane, Hackney 1 Welford, R. W. Sigdon Road, Hackney 1 Welford, R. W. Spring Hill, Clapton 2 Stapleton, A. E. & J. G. Stoke Newington Common 5 Briggs, J. J. 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 35 I 132 LIST OF LICENSED SLAUGHTER HOUSES In the Hackney District, October, 1905. Name. Address. Friday, Richard 235, Amhurst Road Raymond, George 186, Cassland Road Hussey, A. J. 37, Church Road, Homerton Wood, Hy. Peter 90, Frampton Park Road 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 Joyce, John 531, Kingsland Road Fish, Arthur 222 Lower Clapton Road Witherden, C. A. 133, Lower Clapton Road Tyler, A. J. 80, Mare Street Teat, Thos., & Sturch, Fredk. 177, Mare Street Frost, Fredk. 200, Queen's Road, Dalston Hill, A. G. 211, Queen's Road, Dalston Hammer, William 103, Rendlesham Road Ebbels, 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 Spallacy, Frank 258, Wick Road Browning J. West Side, London Fields 133 LIST OF BAKE HOUSES, 1905. Name. Address. No. 1 District. Hall, J. . 77, Upper Clapton Road Buddin, J. . 87, Reighton Road {Vincent, A. . 74, Old Hill Street Gibson, B. T. . 9, Northwold Road ‡Austin, W. H. . 74, Fountayne Road Rees, . 8, Cazenove 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 ‡Rasey, H. 40, Shacklewell Lane ‡Karsch, J. 237, Amhurst Road Rung, P. 55, Shacklewell Lane 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 12 134 No. 4 District. Carpenter, A. 13, Median Road ‡Lunken, J. 52, Mandeville Street Saur, H. 258, Rushmore Road Mankertz, L. 182, Chatsworth Road Gerber, P. 138, Euhl, J. G. 94, ‡Lunken, H. 71, ‡Maloney, J. 36, ‡Woods, E. 19, ‡Heinlen, L. 219, Glyn Road Benson, C. 326, No. 5 & 6 District. Shedden, W. 121, Richmond Road Liebsch, H. 49, Greenwood Road ‡Spenner, A. 81, Wilton Road ‡Goodwin, J. 178, Dalston Lane ‡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 ‡Birkett, T. 25, West-side, London Fields ‡Grainger, J. 550, Kingsland Road Norman, A. 513, Best, C. 376, Paine, —. 89, Tottenham Road ‡Claridge, G. 329, Kingsland Road ‡Henkelmann, H. 174, Southgate Road Allardyee, S. W. 98, Lerner, J. 40, Downham Road ‡Calton, A. 48, De Beauvoir Road Stein, H. 24, Tottenham Road 135 ‡Pay, E. T. 106, Hertford Road ‡Roessle, W. 88, High Street, Kingsland ‡Willicombe, F. 28, John Campbell Road ‡Howe, —. 103c, Dalston Lane ‡Pipe, J. R. 69, High Street, Kingsland ‡Grainger, J. 1, Balls Pond Road Janke, Bros. 107, High Street, Kingsland No. 7 District. ‡Payne, A. 54, Broadway, London Fields May, H. 70, ,, ,, Bushell, F. 10, ,, ,, Stumm, K. 26, West Street Byron, S. T. 139, Mare Street Reihs, J. A. 6, Well Street ‡Reitz, C. 183, Mare Street ‡Wragg, A. H. 27, Morning Lane ‡Zahn, A. H. 77, Frampton Park Road ‡Eley, J. 101, Mare Street Gallowitz 77, Meek 52, Sheep Lane No. 8 District. ‡Cannon, G. D. 13, Loddiges Road ‡Skaer, P. 76, Well Street Martin, J. 105, ‡Mustard, Mrs. E. C. 79, Lauriston Road ‡Holzapfel, C. 142, Victoria Park Road ‡Slade, C. 106, Gore Road No. 9 District. Grimwood, T. 39, High Street, Homerton Grimwood, T. 59, ,, ,, ‡Gibbons, G. 131, Bradford, G. 162, Jessup, H. 167, 136 Jumper, J. T. 18, Brooksby's Walk Hertz, J. 14, The Grove, Homerton Hermann, G. O. 3, Churchill Boad No. 10 District. Werner, A. & L. 220, Wick Road Harris, J. 184, Cassland Road Hassell, Thos. 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 Holman, A. S. 154, Well Street ‡Stark, W. 186, Fey, F. 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 Lunken 276, Wic-k Road Dance, Mrs. A. 315, Brake, G. 2, Victoria Road James, G. 3, Montague Buildings Ingram, E. 41, Osborne Road Attwater, I. J. 13, Gainsboro' Cottages Davis, S. 71, Felstead Street. No. 12 District. ‡Collis & Co. 2, Beecholme Terrace ‡Mason, F. 200, Lower Clapton Road ‡ Underground Bake-houses.