J\c HAC 27 Borough of Hackney. REPORT on the SANITARY CONDITION of the hackney district, FOR THE YEAR 1911, 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; 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: Chas. Straker & Sons, Ltd., 5-9, Bishopsgate Avenue, E.C. 1912. INDEX. page Alcoholism 60 Anthrax Order 75 Birth Rate 12 Canal Boats Act 75 & 162 Cancer 60 Census, 1911 8&9 Cerebro-Spinal Fever 45 Chickenpox 44 Cleansing of Persons Act, 1897 105 Constitutional Diseases 59 Cowhouses, Milkshops, and Dairies 67 Customs and Inland Revenue Act 72 Death Rate 14 Deaths in Public Institutions 19 Diarrhœa 48 Diphtheria 37 Disinfection 96 Enteric Fever 38 Erysipelas 46 Estimated Population 10 Factories 89 Factory and Workshops Act, 1901 86 Glanders and Farcy Order 75 Glanders, Anthrax and Hydrophobia in Man 48 Home Work and Out-Workers 93 Housing and Town Planning Act, 1909 76 Houses Let in Lodgings 70 Ice Cream Vendors 75 Illegitimacy 13 Infant Mortality 16 Influenza 48 Marriage Rate 11 Measles 55 Meteorology 129 Mortuary 115 Notification of Births Act 12 Notifiable Diseases 35 Non-Notifiable Diseases 45 Offensive Trades 68 Ophthalmia Neonatorum 47 Plague 16 Polio-myelitis 46 Population and Density a 2 index. PACK Prosecutions under Food and Drugs Acts 127 Prosecutions under Public Health (London) Act 126 Public Health (London) Act, 1891 64 Public Health Legislation 85 Public Health (Tuberculosis) Regulations, 1908-1911 80 Puerperal Fever 46 Register of Sanitary Work 116-123 Removal of House Refuse 112 River Lea 78 Senile Mortality 19 Scarlet Fever 35 Shelter 105 Slaughter-Houses 68 Small-pox 33 & 130 Smoke Nuisances 60 Specific Causes of Death 20-34 Tuberculous Disease 59 Tuberculosis Dispensaries 139 Typhus 45 Vaccination 61 Whooping Cough 58- Workshops and Laundries 89 Zymotic Diseases 35 Tables— Articles Disinfected during 1911 97 Births 13 Bakehouses, List of 164 Causes of Infant Mortality 16 Common Lodging Houses 162 Cowsheds 163 Deaths 26-34 Death Statistics, according to Causes and Ages 24-25 Dusting Account 114 Infectious Sickness 23 Inquests 115 Population, Area and Density in Sub-Districts in Hackney 10 Requests for Removal of Dust 113 Samples of Foods and Drugs Purchased 125 Samples of Milk Analysed 124 Slaughter-Houses, List of 163 Suicides and Accidental Deaths 115 Vaccination 63 metropolitan Borough of hackney. MEDICAL OFFICER'S REPORT FOR THE YEAR 19 11 PUBLIC HEALTH DEPARTMENT. Town Hall, hackney n.e. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Gentlemen, I beg to present my Twentieth Annual Report on the Public Health of the Borough of Hackney. The year 1911 was noted for a rise in the general death-rate from 12.3 per 1,000 living in the year 1910 to 15.0 per 1,000 living. This rise in the deathrate was chiefly due to an outbreak of measles early in the year, and an excessive number of deaths from summer diarrhoea during the third quarter of the year. The infant mortality which was 119 per 1,000 births, also showed an increase upon the rate for 1910, the infant mortality for the latter year being 99 per 1,000 births. Infectious disease also showed an increase in the Borough compared with the previous year, and the death-rate from the chief zymotic diseases was 1.9 per 1,000 living as against .8 per 1,000 living during 1910. The following table shows the Density of Population, Annual Mortality from all causes and Infant Mortality in the Borough of Hackney, during the 13 years ending 1910. Year. Density. General Death Rate (per 1,000 living). Infantile Mortality Rate (per 1,000 births). 1899 67.5 17.9 165 1900 66.5 17.4 162 1901 66.7 16.6 137 1902 67.3 16.0 121 1903 67.9 14.7 127 1904 68.5 16.0 155 1905 69.1 15.0 140 1906 69.8 14.1 123 1907 70.6 14.4 116 1908 71.0 13.9 117 1909 71.3 13.7 108 1910 72.2 12.3 99 1911 67.1 15.0 119 6 The position occupied by Hackney amongst the London Boroughs may be seen from the subjoined table showing the death.rates from all causes and the death.rate of infants under 1 year of age, in the Metropolitan Boroughs and the City of London during the 52 weeks of 1911, as calculated by the Registrar.General. In spite of the increased mortality during that year the relative position of Hackney remains practically unchanged. Boroughs. Death.rate from all causes per 1,000 living (corrected). Deaths under 1 year to 1,000 births. County of London 15.8 129 Hampstead 10.9 78 Lewisham 11.8 104 Wandsworth 12.6 122 Stoke Newington 13.6 102 Woolwich 13.7 97 City of Westminstsr 14.0 103 Paddington 14.3 127 Kensington 14.7 133 Camberwell 14.8 109 Hackney 15.0 119 Fulham 15.0 12.5 Greenwich 15.0 128 Battersea 15.3 124 Lambeth 15.4 123 Islington 15.5 127 Chelsea 16.0 109 St. Marylebone 16.1 108 Hammersmith 16.2 146 St. Pancraa 16.2 112 Deptford 16.4 142 Citv of London 16.6 124 Holborn 16.9 115 Stepney 18.1 144 Bethnal Green 183 151 Bermondsey 18.9 156 Southwark 19.2 144 Poplar 19.5 157 Finsbury 20.5 156 Shoreditch 21.1 170 In reference to infant mortality, satisfactory progress has been made during the year in dealing with this problem. Details as to the measures taken are given in another part of this report. 7 The preventive measures detailed in my report of 1910, applicable to pulmonary tuberculosis, have been continued and extended during 1911. In my annual report for 1910, I stated that there were in the Borough at the end of that year 444 factories, 1,321 workshops and 3,164 outworkers. At the end of 1911 these figures had changed to 489 factories, 1,157 workshops and 3,071 outworkers. I have pleasure in stating that the officers of the department have, on the whole, carried out the duties entrusted to them to my entire satisfaction. Population and Density.—On the 3rd April, 1911, the 12th Census of the population of England and Wales was taken. This gives the population of these countries at midnight, 2nd April. In reference to the population of London the census yielded some surprises. It showed firstly, that the population of the Administrative County of London as a whole had decreased during the preceding ten years, to the extent of 13,306 persons or 0.3 per cent. of the population enumerated in 1901. Of the total number of Metropolitan Boroughs, including the City of London, the census showed that only nine had increased in population since 1901, the increase varying from 34.3 per cent. in Wandsworth to 0.2 in Greenwich. Hackney is included in the nine boroughs above referred to, but its increase of population was only l.6 per cent. of the enumerated population in 1901, whereas its increase of population during the preceding intercensal period 1891-1901 amounted to 10 per cent. of the enumerated population in 1891. The remaining boroughs and the City of London showed a decline in their populations, varying from 27 per cent. in the City of London to 0 7 per cent. in the Borough of Battersea. The following tables give further details of the census in Hackney:— 8 CENSUSES 1891, 1901, 1911. Registration Sub-districts in the Borough of Hackney; Area, Families, or Separate Occupiers, 1911; and Population 1891, 1901, 1911. Registration: Sub-districts. Area in Statute Acres. Families or Separate Occupiers. 1911. Population 1911. Increase or Decrease of Population between 1901 and 1911. Population. Increase of Population between 1891 and 1901 1891. 1901 Increase. Decrease. North Hackney 1,081 12,552 53,701 3,303 — 44,885 50,398 5,513 Central Hackney 857 12,060 53,604 3,068 — 43,124 50,536 7,412 South-West Hackney 586 13,975 58,058 — 1,863 58,097 59,921 1,824 South-East Hackney 764 12,067 57,224 — 1,031 53,500 58,255 4,755 Totals 3,288 50,654 222,587 6,371 2,894 199,606 219,110 19,504 9 CENSUS, 1911 (HACKNEY) WARDS. Urban and Rural Districts, Municipal Wards and Civil Parishes. Area in Statute Acres (Land and Inland Water.) Families of Separate Occupiers. Population. Institutions, Large Establishments, Vessels, &c., 1911. (included in Cols. 4 and 6.) 1901. 1911. 1901. 1911. Persons. Persons. Males. Females. No. Population. Cols. (1) (2J (3) (4) (5) (6) (7) (8) (9) (10) Hackney Metropolitan B. and C. P.* (11:2-5) 3,287-8 48,701 50,022 219,110 222,533 102,948 119,585 89 7,263 Wards:— Clapton Park (11:2, 3, 5) — — 9,100 - 42,451 20,160 22,294 9 2,595 Hackney (11 : 3, 4, 5) — — 6,751 - 27,776 12,981 14,795 8 485 South Hackney (11:4 & 5) — — 5,074 - 23,163 10,858 12,307 15 904 West Hackncy (11:2, 3, 4) — — 4,511 - 19,018 8,853 10,160 6 151 Homerton (11:3,5) — — 7,825 - 37,211 18,040 19,171 16 1,892 Kingsland (11:4) — — 5,831 - 23,045 10,922 12,123 6 217 Stamford Hill (11:2 & 3) — — 7,599 - 32,790 13,765 19,025 12 411 The Downs (11:2 & 3) — — 4,021 - 17,076 7,366 9,710 17 608 *By the Counties of London and Middlesex (Hackncy and Tottenham) Order, 1907, which came into operation on the 1st April, 1908, parts of Hackney Civil Parish and Metropolitan Borough were transferred to Tottenham Civil Parish and Urban District and part of Tottenham Civil Parish and Urban District was transferred to Hackney Civil Parish and Metropolitan Borough. 10 It will be seen that although there is a total increase in the population of Hackney compared with the census of 1901, this is only true with regard to two of the Registration Sub-Districts. The populations of the North and Central Sub-Districts have increased to the extent of 6,371; but on the other hand, the populations of the South-West and South-East Sub-Districts have decreased to the extent of 2,894. The nett increase for the whole Borough is therefore only 3,477. The census table further shows the number of families or separate occupiers in the Borough. These amount to 50,654, thus giving an average of 4.3 persons per family. Although the last intercensal increase of the population has been small Hackney still remains the sixth largest Borough in the Metropolis in point of population. Applying the rate of increase observed at the last census, I estimate the population of Hackney at the middle of 1911 to be 222,674 persons. This estimate gives a density of population for the whole Borough of 67.1 persons per acre, varying from 49.5 persons in the North Sub-District to 99.0 persons in the South-west Sub-District per acre. The following table shows the estimated population and density of population per acre for each of the Sub-Districts in the Borough:— Table. Showing estimated Population, Area and Density of the Registration Sub-Districts in Hackney, at middle of 1911. North. Central. Southwest. SouthEast. Total for Hackney Total for London. Estimated Population 53,783 53,681 58,012 57,198 222,674 4,522,628 Area in square acres 1,081 857 586 764 3,288 74,816 Density—persons per acre 49.5 62.6 99.0 74.8 67.1 60.4 11 *Marriages and Marriage Rates.—During 1911 there were 1,919 marriages celebrated in the Borough of Hackney. The annual marriage rate for persons married during this period is therefore 17.2 per 1,000 of the population. The following table gives the number of marriages, and the marriage rates for the Borough of Hacknev and London for the ten vears 1901-1911 Year. Borough of Hackney. London. Marriages. Marriage Rate. Marriage Rate. 1901 1,750 15.9 17.6 1902 1,668 15.0 17.8 1903 1,695 15.1 17.4 1904 1,710 15.1 17.0 1905 1,714 15.0 16.9 1906 1,770 15.4 17.1 1907 1,906 16.4 17.0 1908 1,996 17.0 15.9 1909 2,036 17.2 15.8 1910 1,700 14.3 16.0 Average 1901—1910 1,795 15.6 16.8 1911 1,919 17.2 17.8 Births.—The number of births registered in the Borough of Hackney during the year 1911 was 5,410 of which 2.800 were males and 2,610 females. The total shows a decline of 83 compared with the number of births registered in the Borough during 1910. It must be remembered that this total is the actual number of births registered in Hackney, but of these a certain number should be transferred to other districts, and there also certain births *I have here to acknowledge my indebtedness to Mr. Tom Hosgood, Superintendent Registrar, who has kindly abstracted for me the number of marriages for the year 1911. 12 in outlying districts which should properly be transferred to Hackney in order to obtain an accurate corrected birth rate for the Borough. The Registrar-General has supplied me with the number of births which should be so transferred, viz., 270 births to be transferred to other districts and 103 births transferred to Hackney. After making these corrections, the correct total of births amongst Hackney residents is 5,243. From this figure I calculate the birth rate for Hackney during 1911 to be 23.5 per 1,000 of the population. The birth rate for all London for the same period is 24 8 per 1,000 of the population. Notification of Births.—Under the provisions of the Notification of Births Act, 1907,1 received 5,353 notifications of births occurring in the Borough of Hackney. This includes notifications from medical practitioners, midwives and other persons. It also includes still births. This total is equal to 98.9 per cent. of the number registered by the Registrars of Births. Amongst the births notified were 173 still born. This is equal to 3 2 per cent, of those notified. I give here a table showing the number of notifications of birth received with other details in connection with the same:— [ (b) NOTIFICATION OF BIRTHS ACT, 1907, Notifications of Births (Live or Stillborn) received during the year, 1911. Year 1911. Medical Practitioners. Midwives. Parents and Others. Total. Live. Still. Live. Still. Live. Still. Live. Still. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Totals. 895 820 32 34 1,236 1129 52 39 573 527 8 8 2,704 2,476 92 81 13 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1911 was 371, but of these I am informed by the Registrar-General that 253 should be transferred to districts outside of Hackney, as the mothers were not Hackney residents; and that 8 births taking place in other'districts should be transferred to Hackney, Making these corrections there remain 126 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate birth-rate of 24 per 1,000 registered births. The following table gives the number of births, birth-rates, &c., for the sub-districts the Borough:— Table. Births. Registration District of Hackney. Registration Sub-District. All London, North. Central. SouthWest. SouthEast. Total No. of Births 5,410 1,012 1,332 1,622 1,444 111,738 Rate per 1,000 living 24.3 18.8 24.8 28.0 25.2 24.8 No. of Illegitimate Births 126 Rate per 1,000 Births 24.0 14 The following table shows the birthrates for tl:e Borough and its sub-districts during the years 1901 to 1911. Birth-Rate for the Borough of Hackney and its Sub-Districts for the Years 1901-1911 compared with that of London. Year. Borough of Hackney. North SubDistrict. Central SubDistrict. South-West SubDistrict. South-East SubDistrict. London. 1901 28.7 21.1 30.1 31.6 31.1 29.0 1902 28.2 21.5 28.5 30.7 31.3 28.5 1903 27.6 19.9 27.9 30.9 30.6 28.4 1904 27.2 19.5 26.5 29.9 33.5 27.9 1905 25.7 19.6 26.8 29.9 27.3 27.1 1906 25.5 19.0 25.4 28.2 28.3 26.4 1907 24.8 19.4 25.1 27.2 26.8 25.8 1908 24.3 18.6 23.0 28.7 26.0 25.2 1909 24.2 18.2 23.1 29.4 24.0 24.2 1910 23.1 17.6 22.9 26.7 24.6 23.6 Average 1901—1910 25.9 19.4 25.9 29.3 28.3 26.6 1911 24.3 18.8 248 28.0 | 25.2 24.8 Deaths.—The total number of deaths registered in the Borough during 1911 was 3,546, but of these 779 were deaths of non-residents dying in institutions in the Borough. On the other hand 443 residents of Hackney died in institutions in other districts. On making the necessary corrections by subtracting 779 from and adding 443 to the above total, we obtain the correct number of deaths amongst Hackney residents during the year 1911, namely, 3,210. This is an increase of 388 deaths upon the number which eccurred during the year 1910. The crude general death rate from all causes for the year 1911 is 14.4 per 1,000 of the population. On further correcting this for age and sex distribution by means of the factor 1.04262, 1 obtain the corrected general deathrate of 15.0 per 1,000 of the population of Hackney for the year 15 1911. The corrected general death-rate for the year 1910 was 12.3 per 1,000 of the population so that the death-rate for 1911 is 2.71 per 1,000 living higher than the rate for the previous year. The causes of this are several. During last year there was an actual increase in the number of deaths over that of the previous year to the extent of 332. These deaths were chiefly brought about by an outbreak of measles in the earlier months and an excess of diarrhoea during the third quarter of the year. It must also be mentioned that for some years the population has been over-estimated, which has helped to show the death-rate somewhat lower during the last few years prior to the census of 1911, than it would have appeared had the data been available for a more accurate estimate of population. Amongst the sub-districts the death rate was lowest in the north sub-district (11.8 per 1,000) and highest in the south-east sub-district (17.4 per 1,000). Sub-District. Population. No. of Births. Birthrate. Total Deaths. Death rate (crude.) Deaths under 1 year. Infant Mortality per 1,000 Births. North 53,783 1,012 18.8 635 11.8 92 90 Central 53,681 1,332 24.8 738 13.7 161 120 South-West 58,012 1,622 28.0 854 14.7 185 114 South-East 57,198 1,444 25.2 983 17.1 195 135 All Hackney 222,074 5,410 24.3 3,210 14.4 633 117 The corrected annual death-rate from all causes for London during 1911 is 15.8 per 1,000 living. The following shows the death rate of Hackney from all causes per 1,000, compared with London during the last decade. Year. Hackney. London. Year. Hackney. London. 1902 16.0 17.2 1907 14.4 15.35 1903 14.7 15.7 1908 13.9 14.5 1904 16.0 16.6 1909 13.2 14.0 1905 15.0 15.1 1910 12.3 13.3 1906 14.1 15.1 1911 15.0 15.8 16 Infant Mortality.—The deaths under 1 year amongst Hackney residents during the year 1911 numbered 633. This is an increase of 90 upon the number of infant deaths during the previous year. The infant mortality-rate for the year 1911 is therefore 120 per 1,000 births. This figure shows a large increase over the Infant mortality-rate for the year 1910, and is unquestionably traceable to the excessive mortality from diarrhoea and enteritis due to the excessive heat and dryness of last summer. Other causes of deaths which must be mentioned are 76 premature births, 81 attributed to the indefinite causes, atrophy, debility and marasmus, and 105 to bronchitis and pneumonia. TABLE IV.—INFANT MORTALITY. 1911. Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OF DEATH. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 10 20 30 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... 1 ... 1 Whooping Cough ... ... ... ... ... 3 2 9 10 24 Diarrhœa ... 2 2 2 6 24 38 43 27 138 Enteritis ... 2 1 2 5 10 9 6 4 34 Tuberculous Meningitis ... ... ... ... ... ... 3 4 4 11 Abdominal Tuberculosis ... ... ... ... ... 2 3 9 ... 7 Other Tuberculous Diseases ... ... ... ... ... ... ... 3 3 0 Congenital Malformations 7 1 2 ... 11 5 ... ... ... 16 Premature Birth 55 12 1 3 71 5 ... ... ... 76 Atrophy, Debility and Marasmus 11 6 8 11 36 20 12 10 3 81 Atelectasis 10 2 2 ... 14 1 1 ... ... 16 Injury at Birth 4 ... ... ... 4 ... ... ... ... 4 Erysipelas ... 1 ... ... 1 1 1 ... ... 3 Syphilis 2 1 ... ... 3 2 1 ... 1 7 Rickets ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... 1 ... ... 1 ... 3 6 2 12 Convulsions 7 4 4 ... 15 ... 3 6 1 38 Gastritis ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 1 ... 2 8 9 6 2 27 Pneumonia (all forms) 1 1 3 ... 5 13 11 22 27 78 Suffocation, overlying 3 ... ... ... 5 3 2 2 ... 12 Other Causes 6 1 1 ... 8 1 1 1 ... 11 Total 106 35 25 21 187 111 99 131 105 633 17 During the past year Mrs. C. Brown, Health Visitor, has continued her work amongst nursing mothers and their infants. During this time Mrs. Brown made 966 primary visits. If at one of these visits the Health Visitor found the infant properly fed and cared for a second visit was not usually made; but where the feeding and care of the infant was not so satisfactory one or more subsequent visits were made. Of these secondary visits Mrs. Brown made 1,022. There were in addition 881 fruitless calls made by the Health Visitor, the mother being out at the time, or having changed her address. Early in the year I arranged that the Health Visitor should be at the Town Hall one afternoon a week, for the purpose of weighing infants and advising nursing mothers generally in the care and nurture of their infants. During the year there were 32 afternoons so appropriated. The average number of mothers (with their infants) who attended on each afternoon during that time was 20. This I regard as extremely satisfactory. It is at present too early to gauge the effect of the advice so given to nursing mothers by the Health Visitor; but I may here state that whilst the deaths under one year of age amongst the 966 infants visited numbered only 44, which is equal to an infantile death-rate of 46 per 1,000, the number of deaths amongst the remainder of infants born in the Borough during the year was 589 which is equal to 137 per 1,000 births. On the whole the result of the appointment of a Health Visitor by the Borough Council is extremely satisfactory. A further proof of the success of the appointment may be gathered from Mrs. Brown's statement to me that her visits are, with very few exceptions, cordially welcomed. The following table gives information as to the feeding, &c., of infants, and home conditions found by the Health Visitor amongst the 966 infants visited :— 18 PARTICULARS RESPECTING THE FEEDING, CARE, AND ENVIRONMENT OF THE BVBIE5 VISITED, 1912. Babies Visited. Feeding. Separate Cot Provided for Baby. Use of Comforter. Home Conditions of Family. Employment of Father. Remarks. Poor. Fair. Comfortable. Boys. Girls. Breast. Artificial. Mixed. No. Yes. No. Yes. Clean. Dirty. Clean. Dirty. Clean. Dirty. In Work. Out of Work 521 482 766 67 170 897 106 325 678 302 186 323 19 169 4 *911 *61 *1nformation as to employment of father could only be obtained in 972 cases. 19 Senile Mortality.—The deaths which occurred in Hackney during the year at 65 years and upwards numbered 886, and of these 441 occurred between the ages of 65 and 75 years, 340 between the ages of 75 and 85 years, and 105 were at the ages of 85 years and upwards. The annual mortality rate of persons of 65 years and upwards is 4.0 per 1,000 living. Deaths in Public Institutions.—There were 1,566 deaths in public institutions in the Borough during 1911; of these 779 were residents of other districts, and the remaining 787 were residents of Hackney. The following lists give the names of the institutions within the Borough, receiving persons both from and without the Borough, and also the institutions outside the Borough receiving sick and infirm persons from the Borough, with the number of deaths of Hackney residents in each institution during the year 1911. INSTITUTIONS WITHIN THE BOROUGH RECEIVING PERSONS BOTH FROM AND WITHOUT THE BOROUGH. 46a, Amhurst Park, Private Nursing Home 3 331, Amhurst Road, Private Nursing Home 3 Brooke House, Upper Clapton Road 9 City of London Workhouse, Clifden Road 92 Downs Road Private Nursing Home 2 Eastern Fever Hospital, Homerton 247 French Hospital, Victoria Park Road 3 German Hospital, Dalston Lane 148 Goldsmith's Asylum, Holcroft Road 1 Hackney Union Infirmary, Homerton 746 Hackney Union Workhouse, Homerton 9 Metropolitan Hospital, Kingsland Road 222 St. Joseph's Hospice, Mare Street 57 St. Scho'lastica's Retreat, Kenninghall Road 2 Salvation Army Nursing Home, 29, Devonshire Road 2 Salvation Army Maternity Hospital, Mare Street 10 Salvation Army Maternity Home, 16, Rectory Road 2 Salvation Army Home, Springfield 1 18 & 20, Southwold Road, Private Nursing Home 7 1,566 20 INSTITUTIONS OUTSIDE THE DISTRICT RECEIVING SICK AND INFIRM PERSONS FROM THE DISTRICT. Banstead Asylum 11 Bethnal House Asylum 6 Bethnal Green Infirmary 3 Bethlem Royal Hospital 2 Brompton Hospital 1 Cancer Hospital, Chelsea 1 Cane Hill Asylum 3 Caterham Asylum 5 Charing Cross Hospital 4 Children's Infirmary, Carshalton 1 Children's Hospital, Great Ormond Street 10 Claybury Asylum 37 City of London Lying-in Hospital 1 Colney Hatch Asylum 15 Camberwell House Asylum 1 Darenth Asylum 2 Dartford Heath Asylum 10 East London Hospital 2 Epileptic Colony, Epsom 2 Friedenheim Hospital 2 Guy's Hospital 2 Great Northern Hospital 3 Grove Fever Hospital 1 Hackney Workhouse, Brentwood 8 Hanwell Asylum 6 Horton Asylum 3 Homœpathic Hospital 2 Home of Good Shepherd, Snoreditch 1 Hammersmith Infirmary 1 Islington Infirmary 1 Invalid Asylum. Stoke Ncwington 2 King's College Hospital 3 21 Leavesden Asylum 9 Long Grove Asylum 8 London Hospital 72 Manor Asylum 2 Middlesex Hospital 4 Mildmay Memorial Hospital 5 National Hospital, Queen's Square 2 North-Eastern Fever Hospital 16 North-Western Fever Hospital 2 Northern Fever Hospital 1 Northumberland House, Green Lanes 1 Park Fever Hospital 2 Prince of Wales' General Hospital, Tottenham 7 Poplar Workhouse 2 Queen's Hospital for Children 68 Queen Mary's Hospital 2 Royal Chest Hospital, City Road 3 Royal Free Hospital 5 Royal Waterloo Hospital 1 St. Bartholomew's Hospital 18 St. George's Hospital 1 St. Luke's House 3 St. Giles' Workhouse 1 St. Pancras Infirmary 1 Seaman's Hospital 1 South-Eastern Fever Hospital 1 Samaritan Free Hospital 1 Shoreditch Infirmary 5 21, Stamford Hill 4 Tooting Bee Asylum 21 University College Hospital 4 Victoria Park Chest Hospital 8 West Ham Infirmary 3 Westminster Hospital 1 West London Hospital 1 Miscellaneous Institutions 18 456 22 TABLE I.—HACKNEY DISTRICT. Vital Statistics of Whole District during 1911 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 221,227 5,866 5,643 25.5 3,315 14.9 530 353 721 127 3,132 14.1 1907 221,516 5,761 5,581 25.2 3,321 15.0 493 401 667 119 3,229 14.5 1908 221,805 5,673 5,103 24.3 3,195 14.4 409 430 666 123 3,126 14.1 1909 222,095 5,702 5,436 24.4 3,123 14.0 442 447 616 113 3,128 14.0 1910 222 384 5,493 5,240 23.5 2,878 12.9 506 450 543 104 2,822 12.6 1911 222,674 5,410 5,243 23.5 3,546 15.9 779 443 633 120 3,210 14.4 23 Cases of Infectious Disease Notified during the Year 1911. Notifiable Disease. Cases Notified in whole Districts. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. North. Central South-East South-West Small Pox 5 ... ... 2 1 2 ... ... ... 1 4 ... 4 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 310 6 117 141 32 20 ... ... 75 00 91 90 270 Erysipelas 358 7 14 41 49 109 84 54 40 97 154 67 88 Scarlet Fever 613 5 168 307 47 24 2 ... 102 224 159 128 552 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 48 ... 6 15 11 11 5 ... 5 15 24 4 43 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 16 ... ... ... 4 12 ... ... ... 7 7 2 6 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis Under Tuberculosis Regulations, 1908 234 ... 3 16 50 99 61 5 25 40 100 63 200 Under Tuberculosis Regulations, 1911 322 ... 1 22 72 106 58 3 55 77 90 100 63 Others 26 ... ... 2 4 17 3 ... 0 4 9 7 1 Cerebro-Spinal Meningitis 7 4 1 ... 1 1 ... ... 1 3 1 2 5 Polio Myelitis 4 2 1 1 ... ... ... ... 1 ... 1 2 2 Ophthalmia Neonatorum 19 19 ... ... ... ... ... ... 7 4 3 5 9 Chickenpox 133 11 56 60 5 1 ... ... 38 31 28 30 ... Totals 2,101 54 367 667 270 402 213 02 355 509 671 506 1,243 24 TABLE III.—HACKNEY DISTRICT. Causes of, and Ages at, Death during the Year 1911. CAUSES OF DEATH. Deaths in whole Districts at Subjoined Ages. Deaths in Public Institutions. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 8 ... ... ... ... 2 5 1 ... 11 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 145 30 42 60 13 ... ... ... ... 158 Scarlet Fever 10 ... 1 6 3 ... ... ... ... 17 Whooping-cough 52 25 13 13 1 ... ... ... ... 2 Diphtheria and Croup 21 1 5 6 8 1 ... ... ... 41 Influenza 24 ... ... ... 1... ... 4 9 16 ... Erysipelas 18 3 ... ... ... ... 2 4 9 6 Cerebro-Spinal Fever 2 ... ... 1 ... l ... ... ... ... Phthisis (Pulmonary Tuberculosis) 295 ... 1 6 14 57 135 69 13 180 Tuberculous Meningitis 42 11 11 6 12 1 ... 1 ... 14 Other Tuberculous Diseases 62 13 4 6 8 10 16 4 1 29 Rheumatic Fever 9 ... ... ... 4 3 1 ... 1 1 Cancer, Malignant Disease 217 ... ... 1 1 1 17 118 79 110 13ronchitis 244 27 5 2 4 2 7 57 140 97 Broncho-Pneumonia 157 67 33 24 6 ... 3 7 17 66 Pneumonia (all other forms) 155 11 10 5 10 "7 34 43 35 66 25 HACKNEY DISTRICT—continued. Causes of, and Ages at, Death during the Year 1911. CAUSES OF DEATH. Deaths in whole Districts at Subjoined Ages. Deaths in Public Institutions. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 66. 65 and upwards. Other Diseases of Respiratory Organs 27 ... 1 2 2 ... 5 8 9 13 Diarrhœa and Enteritis 225 172 29 6 2 1 3 4 8 88 Appendicitis and Typhlitis 22 ... ... 3 7 7 1 4 ... 10 Alcoholism. 1 ... ... ... ... ... ... 1 ... 5 Cirrhosis of Liver 24 ... ... ... 1 ... 6 12 5 10 Nephritis and Blight's Disease 66 ... ... ... 1 2 12 33 18 50 Puerperal Fever 4 ... ... ... ... 1 3 ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 7 ... ... ... ... 9 5 ... ... ... Congenital Debility and Malformation, including Premature Birth 183 177 3 2 1 ... ... ... ... 51 Violent Deaths, excluding Suicide 85 13 4 6 8 5 "s 15 26 53 Suicides 18 ... ... ... ... 3 7 6 2 11 Other Defined Diseases 754 42 10 9 24 34 112 252 271 315 Diseases ill-defined or unknown 333 41 11 3 6 2 7 21 242 165 Totals 3,210 633 183 167 137 142 393 669 886 1,569 26 TABLE OF DEATHS Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1911, AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... Not ... ... ... ... ... ... ... ... ... ... ... ... Doubtful ... ... ... ... ... ... ... ... ... ... ... ... Cowpox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ...... ... ... ... ... ... ... ... ... ... Measles (Morbilli) 30 102 13 ... ... ... ... ... ... ...... ... 145 Epidemic Rose Rash, German Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 7 3 ... ... ... ... ... ... ... ... 10 Typhus ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... 1 ... 1 3 1 ... 7 3 ... 24 Whooping Cough 25 26 1 ... ... ... ... ... ... ... ... 52 Mumps ... 1 ... ... ... ... ... ... ... ... ... 1 Diphtheria, Membranous Croup 1 11 8 1 ... ... ... ... ... ... ... 21 Cerebro Spinal Fever ... 1 ... 1 ... ... ... ... ... ... ... 2 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... 9 3 2 1 ... ... ... ... 8 Asiatic Cholera. ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Diarrhœa, Epidemic (or Zym.) Enteritis 91 20 2 ... ... ... 9 ... ... ... 1 116 27 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. Diarrhœa, Choleraic Diarrhœa 47 11 ... ... 1 1 ... 1 9 4 1 68 Dysentery ... ... ... ... 1 ... ... ... 2 ... ... 3 Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Farcy. ... ... ... ... ... ... ... ... ... ... ... Anthrax Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... 1 ... ... ... ... ... ... 1 Syphilis 7 ... ... ... ... ... 2 ... ... ... ... 9 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septicaemia, Sapraemia ... ... ... ... 1 1 ... ... ... ... ... 2 Puerperal Pyaemia ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Dolens... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... 1 ... 1 ... ... ... ... 2 Infective Endocarditis ... ... ... 1 ... 1 ... 1 ... ... ... 3 Epidemic Pneumonia, Pneumonia Fever ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 3 ... ... ... 1 1 3 1 5 3 1 18 Septicaemia (not Puerperal) ... 2 1 ... 4 2 2 2 ... ... ... 13 Pyaemia (not Puerperal) 1 ... ... ... 1 ... ... 1 ... ... ... 3 Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... 1 1 ... ... 2 Phagedaena ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... ... ... ... ... ... ... 28 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). ... 6 11 46 53 63 43 18 9 ... 1 250 "Phthisis " ... 1 3 11 8 11 5 3 2 1 ... 45 Tuberculous Meningitis 11 17 12 1 ... ... 1 ... ... ... ... 42 Tuberculous Peritonitis 2 2 1 2 1 ... ... ... ... ... ... 8 Tabes Mesenterica 5 9 ... ... ... ... ... ... ... ... ... 7 Lupus ... ... ... ... ... 1 ... ... ... ... ... 1 Tubercle of other Organs ... ... 1 9 5 3 1 1 1 ... ... 14 General Tuberculosis 6 ... ... 6 2 4 ... 2 ... ... ... 32 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... ... ... ... 1 ... ... ... 1 Opium, Morphia Habit. ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning . ... ... ... ... ... ... ... ... ... ... by Lead ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning by Phosphorus ... ... ... ... ... ... ... ... ... ... ... ... by Arsenic and other Metals ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... 4 3 1 ... ... ... ... 1 ... 9 Rheumatism of Heart. ... ... ... ... ... ...... ... ... ... ... ... ... Chronic Rheumatism ... ... ... ... ... ... 1 2 1 1 ... 5 29 TABLE 01' DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 05. 65 to 75. 75 to 85. 85 and upwards. All Ages. Rheumatic Arthritis, Rheumatic Gout ... ... ... ... 1 ... 1 ... ... ... 1 3 Gout ... ... ... ... ... ... ... ... 3 1 ... 4 Carcinoma ... ... ... 1 1 9 33 40 31 14 4 133 Sarcoma ... 1 1 ... 1 ... 9 3 1 ... ... 9 Malignant Diseases, Cancer ... ... ... ... 2 4 12 28 20 9 ... 75 Rickets 1 1 ... ... ... ... ... ... ... ... ... 2 Purpura ... ... ... ... ... ... ... ... ... ... ... ... Hremophilia, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Leucocythaemia ... 2 ... 2 2 1 6 ... 4 ... ... 17 Diabetes Mellitus ... ... 1 1 ... 3 3 4 7 3 ... 22 Premature Birth 70 1 ... ... ... ... ... ... ... ... ... 77 Congenital Defects 16 ... ... ... ... ... ... ... ... ... ... 16 Injury at Birth 4 ... ... ... ... ... ... ... ... ... ... 4 Atelectasis 16 ... ... ... ... ... ... ... ... ... ... 10 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... ... ... ... ... ... ... Debility 81 4 1 ... ... ... ... ... ... ... ... 86 Disease of Nervous System. ... ... ... ... ... ... ... ... ... ... ... 1,381 Meningitis, Inflammation of Brain 12 11 5 1 2 3 ... ... ... 1 ... 35 Softening of Brain ... ... ... ... ... ... 1 4 6 3 2 16 General Paralysis of Insane ... ... ... ... 3 6 0 1 ... ... ... 16 30 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 2 1 9 2 9 ... ... 11 Chorea ... ... 1 ... ... ... ... ... ... ... ... 1 Epilepsy ... 1 ... 1 4 1 3 ... 1 1 ... 12 Convulsions 38 5 1 ... ... ... ... ... ... ... ... 44 Laryngismus Stridulus 1 ... ... ... ... ... ... ... ... ... ... 1 Locomotor Ataxy ... ... ... ... ... ... 3 1 ... ... ... 4 Paraplegia and Disease of Cord 1 ... 1 ... 1 3 3 3 2 1 ... 15 Neuritis, Periph, PolyNeuritis ... ... ... ... ... ... ... ... ... 1 1 2 Brain Tumour (not specific) ... ... 1 2 1 1 2 3 ... ... ... 10 Nervous System, other Diseases ... 1 1 ... ... 1 1 3 7 4 ... 18 Disease of Organs of Sense. ... ... ... ... ... ... ... ... ... ... ... 185 Otitis, Mastoid Dis. ... ... 2 2 ... ... ... ... ... ... ... 4 Epistaxis, Nose Dis ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Dis. ... ... ... ... ... ... ... ... ... ... ... ... Accident 12 10 6 4 2 9 8 5 14 11 1 75 Violence Suicide ... ... ... 3 4 3 2 4 1 1 ... 18 Drowned ... ... 2 1 1 3 ... 1 ... ... ... 8 Homicide 1 ... ... ... ... ... ... 1 ... ... ... 2 Disease of Heart. ... ... ... ... ... ... ... ... ... ... ... 107 Valve Dis., Endocarditis ... 1 7 10 17 15 35 50 48 18 2 215 Pericarditis ... 1 ... ... ... 1 1 2 1 1 ... 7 31 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 ... ... ... 1 Angina Pectoris ... ... ... ... ... ... 1 2 ... 1 ... 4 Dilatation of Heart ... ... ... ... ... ... ... 2 1 ... ... 3 Fatty Degeneration of Heart ... ... ... 1 1 1 3 4 6 3 ... 19 Syncope Heart Dis. (not specified) ... 9 9 ... 1 ... 3 3 16 16 3 46 Disease of Blood Vessels. ... ... ... ... ... ... ... ... ... ... ... 295 Cerebral Haemorrhage, Emb., Throm. ... ... ... 1 2 8 19 23 34 25 3 115 Aoplexy, Hemiplegia ... 1 ... 1 1 ... 3 6 19 11 2 44 Aneurysm ... ... ... ... 2 1 5 2 1 ... ... 11 Senile Gangrene ... ... ... ... ... ... ... 1 5 3 2 11 Embolism, Thrombosis (not Cerebral) ... ... ... ... 1 ... 1 ... 1 ... ... 3 Phebitis ... ... ... ... ... ... ... ... ... ... ... ... Varicose Veins ... ... ... ... ... ... ... ... ... ... ...... ... Blood Vessels, other Diseases ... ... ... ... ... ... ... 6 2 2 ... 10 Disease of Respiratory Organs. ... ... ... ... ... ... ... ... ... ... ... 194 Laryngitis ... 9 2 ... ... ... ... ... ... ... ... 4 Membranous Laryngitis (not Diphtheritic) ... ... ... ... ... ... ... ... ... ... ... ... Croup (not Spasmod. or Membr.) ... ... ... ... ... ... ... ... ... ... ... ... Larynx. other Dis. (not specified) ... ... ... ... ... ... ... ... ... ... ... ... 32 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 Bronchitis 27 7 4 2 2 5 20 37 61 63 16 244 Lobar (Croupous) Pneumonia 1 4 2 3 3 9 5 7 3 1 ... 38 Broncho, Catarrhal, Lobular Pneumonia 67 57 6 ... 1 2 3 4 11 3 3 157 Pneumonia 10 11 8 4 7 15 17 14 20 7 4 117 Emphysema, Asthma ... ... ... ... 1 2 ... 4 4 ... ... 11 Pleurisy ... 1 ... ... 1 ... ... 2 3 ... ... 7 Fibroid Dis. of Lung ... ... ... ... ... ... ... ... ... ... ... ... Respiratory Dis.,other ... ... ... ... ... 1 1 1 1 1 ... 5 Disease of Digestive System. 583 Tonsilitis, Ouinsey ... 1 1 ... ... 1 ... ... ... ... ... 3 Mouth, Pharynx, Dis. (not specific) ... 1 ... ... ... ... ... ... ... ... ... 1 Gastric Ulcer ... ... ... ... 4 4 1 2 1 ... ... 12 Gastric Catarrh 2 1 ... ... ... ... ... ... 9 ... 1 0 Stomach, other Dis. (not Malig.) ... ... ... ... 1 ... ... 1 1 ... ... 3 Enteritis (not Epid.) 11 ... ... ... ... 1 1 ... ... ... ... 13 Gastro-Enteritis 23 4 ... 1 ... ... ... ... ... ... ... 28 Appendicitis, Perityphilitis ... 3 7 7 ... 1 4 ... ... ... ... 22 Hernia 1 ... ... ... ... 1 1 1 2 5 ... 11 Intestinal Obstruction 1 ... 1 1 ... 1 2 3 2 ... 1 12 Other Dis. of Intestines ... ... ... ... ... 1 1 ... 1 ... ... 3 Peritonitis (not Puerperal 1 ... 3 2 1 2 2 3 1 1 ... 16 33 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. Cirrhosis of Liver ... ... 1 ... ... 6 8 4 5 ... ... 24 Liver and Gall Bladder, other Diseases 1 ... ... 1 1 1 1 2 2 2 ... 11 Digest. Syst., other Diseases ... ... ... ... ... ... 1 ... ... 1 ... 2 Lymph Disease. 167 Spleen Disease ... ... ... ... ... ... ... ... ... ... ... ... Lymph System, other Diseases ... ... 1 ... ... ... ... ... ... ... ... 1 Thyroid Body Disease ... ... ... ... ... ... ... 1 ... ... ... 1 Supra Renal Capsules Disease ... ... ... ... ... ... ... ... ... ... ... ... Disease of Urin. Syst. 2 Nephritis, Acute ... ... 1 1 ... 1 1 ... ... ... ... 4 Chronic Bright's Dis., Albuminura ... ... ... 1 7 4 18 14 8 9 1 62 Calculus (not Biliary) ... ... ... ... ... ... ... ... ... ... ... ... Bladder and Prostate Dis. ... ... ... ... ... 1 ... 3 4 5 ... 13 Urin. Syst., other Dis. ... ... ... ... ... 2 ... 2 1 1 ... 6 Disease of Gener. Syst. 85 Ovarian Tumour (not Malig.) ... ... ... ... ... ... ... ... 1 ... ... 1 Other Dis. of Ovary ... ... ... ... ... ... ... ... ... ... ... ... Uterinal Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Uterus and Vagina ... ... ... ... ... ... ... ... ... ... ... ... 34 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. Disorders of Menstruation ... ... ... ... ... ... ... ... ... ... ... ... Gener. and Mam. Orgs., other Dis ... ... ... ... ... ... ... ... ... ... ... ... Accidents Childbirth. 1 Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... 1 4 ... ... ... ... ... ... 5 Placenta Prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... Other Accid. of Preg. and Childbirth ... ... ... 1 ... 1 ... ... ... ... ... 2 Joint Disease. 7 Caries, Necrosis ... 1 1 2 ... ... ... 1 ... ... ... 5 Anthritis, Periostitis ... ... ... ... ... 1 ... ... 1 1 ... 3 Other Dis. of Locom. Syst. ... ... ... ... ... ... ... ... 2 ... ... 2 Skin Disease. 10 Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... Skin Disease, other ... ... ... ... ... ... ... ... ... ... ... ... Old Age ... ... ... ... ... ... ... 2 41 96 54 193 Totals 633 350 137 142 169 224 308 361 441 340 105 3,210 Chart showing the number of cases of Scarlet Fever, Diphtheria and Enteric Fever weekly during 1911. 35 SPECIFIC INFECTIOUS OR ZYMOTIC DISEASE. During the year 1911 there were 1,541 cases of acute infectious disease compulsorily notified in the Borough; but of these 68 cases were subsequently found not to be suffering from infectious disease, thus reducing the number of genuine cases to 1,473. This total is a considerable increase upon that of 1910, the excess being 602. The attack rate in respect of the notifiable acute infectious diseases for the year 1911 is 6.6 per 1,000 persons living. In addition, I received 234 notifications of pulmonary tuberculosis under the Public Health (Tuberculosis) Regulations 1908, and 322 under the Public Health (Tuberculosis in Hospital) Regulations 1911, and 26 voluntary notifications. The deaths from the seven chief zymotic diseases during the year numbered 438. This is equal to a zymotic death-rate of 1.9 per 1,000 living persons in the Borough. A—NOTIFIABLE INFECTIOUS DISEASES (ACUTE). Small-pox.—A small outbreak of disease occurred in the Borough during the early months of last year. The total number of cases notified was 5, but of these 2 were subsequently found not to be suffering from small-pox. Full details respecting the genuine cases are given in a special report appended to this report. Early in April I received a communication from the Local Government Board stating that the Board attach much importance to a record of information as to the vaccinal condition of small-pox patients, and directing me to fill up and return a form enclosed giving the required details in connection with the three genuine cases notified. A copy of this form is given in the appendix. Scarlet Fever or Scarlatina.—The number of cases of this disease notified during the year was 613, but of these 29 were afterwards found not to be cases of scarlet fever. The genuine cases thus amounted to 584. This is an increase of 202 cases c 2 36 upon the genuine cases notified during 1910. On reference to the chart accompanying this report it will be observed that a slight rise in the incidence of scarlet fever occurred in the third week of July, the week before the summer school vacation, and again in the first week in August (the schools closed on the 26th July) falling again to a very low point during the next two weeks. During the last week of August a rise again took place, which continued at intervals to increase until the disease reached its highest point in the third week of October, after which it gradually declined, with one interval of increase until the end of the year. It will be seen that the excess of cases occurred almost immediately after the summer holidays, and justifies the presumption that school influence played a considerable part in causing an increase. The attack rate for 1911 is, therefore, 2.6 per 1,000 persons living. The number of cases of scarlet fever removed to hospital during the year was 552. This is equal to 90 per cent. of the total notified. The following table shows the distribution of scarlet fever in the respective sub-districts of the Borough:— Sub-Districts. North. Central. South-West. South-East. No. of Cases of Scarlet Fever. 102 224 128 159 Attack Rate per 1,000 living. 1.8 4.1 2.2 2.7 It will be seen from the above that scarlet fever was most prevalent in the central and south-east sub-districts, especially in the former. The deaths from this disease during the year numbered 10, which is equal to a mortality rate 16 per 1,000 attacked and .04 37 per 1,000 living. The mortality rate for London from scarlet fever during 1911 was .04 per 1,000 living. Diphtheria and Membranous Croup.—There were 316 cases of diphtheria and membranous croup notified during 1911, but of these 32 were afterwards found not to be genuine diphtheritic cases, thus reducing the genuine cases of this disease occurring in the Borough to 284. This is an increase of 129 upon the number which occurred in the Borough during 1910. The chart shows the disease to have been prevalent all the year, the incidence, however, being low, except during the months of October and December, when there were increases in the numbers notified, but the disease again declined during the last three weeks of the year. There were 276 cases of diphtheria and membranous croup removed to hospital during 1911. This is equal 87 per cent. of the total notified. The following table shows the distribution of the cases of this disease in the different sub-districts of the Borough during 1911:— Sub-Districts. North. Central. South-West. South-East. No. of Cases of Diphtheria and Membranous Croup. 75 60 90 91 Total attack rate per 1,000. 1.3 1.1 1.5 1.6 From the above it will be noted that this disease was most prevalent in the south-west and south-east sub-districts and least prevalent in the central sub-district. The deaths from diphtheria and membranous croup during the year numbered 21. This is equivalent to a death rate of 7.6 per cent. attacked and .09 per 1,000 living. The death rate from diphtheria for London during the same period is .14 per 1,000 living. 38 During the year 248 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically examined, 91 of which gave positive and 152 negative results, and 5 were returned as doubtful. Diphtheria Anti-Toxin. In accordance with the Anti-toxin Order of 1910, a supply of diphtheria anti-toxin has been provided during 1911, and issued as required to medical practitioners applying for it in cases of diphtheria amongst the poorer inhabitants of the district. The toxin has been used both for curative as well as prophylactic purposes. There were 36 bottles of anti-toxin of 2,000 units each supplied during the year to medical practitioners, of these 19 bottles were for curative treatment and 17 for prophylaxis. Typhoid or Enteric Fever.—There were 48 cases of enteric fever notified during the year 1911, but of these 9 were afterwards found not to be suffering from this disease, so the genuine cases of typhoid fever numbered 39. This is a decrease of 19 over the number of genuine cases notified during 1910. The attack rate is therefore .17 per 1,000 living. Of the 48 cases notified, 43 were removed to hospital. This is equal to 89 per cent. of the total notified. It will be seen from the chart that most of the cases occurred during the months of August, September and October, the seasonal months for this disease, but the bulk of the earlier cases were in the months of April and May. The table below gives the distribution of the cases in the subdistricts of the Borough. Sub-Districts. North. Central. South-West. South-East. No. of Cases of Typhoid. 5 15 4 24 Attack Kate per 1,000 living. .09 .26 .07 .42 From this table it appears that enteric fever was most prevalent in the central and south-east sub-districts. 39 With respect to the sources of infection of these cases of enteric fever, I may say in the first place, that four cases I am of opinion may be traced to infection in places outside of the Borough whilst on a visit. The particulars of these cases are as follows:— 1. E. B. Age 32. M. Returned from Margate on August 12th, having been there two weeks on a visit. He began to feel ill two or three days after his return from Margate. This case was notified on the 26th September. 2. W. M. Age.9. M. Returned from Holly Bourne, Hampshire, on August 27th, where he had been staying a month on a visit. He first fell ill on September 1st. The case was notified September 2nd. 3. A. F. R. Age 4. M. Returned from Ramsgate on September 3rd, where he had been on a visit for three weeks. He began to feel ill on September 1st. This case was notified on September 18th. 4. I. S. Age 50. M. This patient was a visitor at Westcliffe for four days from the 25th July. He first fell ill on August 22nd and was notified on the 31st August. Besides the above cases, there were two groups of cases which occurred in the Borough during last autumn. Apart from the first case occurring in each group, these cases, in my opinion, were due entirely to personal infection, or, as it is sometimes called, contact infection. Group I.—This is a series of five cases occurring in succession in a family of ten persons, consisting of father, mother and eight children. The father is a labourer, but his wife attended to the family at home, supplementing the family income by taking in washing for one family. The housing accommodation consisted of three rooms, viz., a kitchen and two bedrooms. The first case of enteric fever to occur in the family was Mrs. C. E.H., the mother, and she attributed her illness to washing 10 some foul smelling linen. No evidence was forthcoming that the linen was specifically infected. Enquiries as to the usual causes of infection yielded negative results. The beginning of her illness was stated to be on March 10th. A medical practitioner was called in on March 13th and on March 22nd she was notified to be suffering from enteric fever and was removed the same day to hospital. Disinfection of the infected room, clothing and bedding was forthwith carried out. It will be observed that this undoubted case of enteric fever was twelve days at home, a centre of infection amongst her family. She was nursed during this time by her eldest daughter (age 19 years) who also kept house for the remainder of the family, and after the removal of her mother to hospital had charge of the domestic concerns of the family. R. H., age 5 years, was the next case to occur. She was a daughter of the above. She is said to have been feeling poorly when her mother was removed to hospital. A medical practitioner was not called in to see her until April 6th. On the 10th of the same month the case was notified as enteric fever and was removed to hospital the same day. Disinfection was again carried out. The next case to fall ill was W. H. H., aged 3 years, brother of the last, on May 4th. On the 8th of May the medical attendant was called in, who diagnosed the illness as enteric fever. The patient was forthwith removed to hospital. Disinfection was again carried out. The next case in the family was I. A. H., aged 7 years. another daughter. She fiist fell ill on April 14th, a medical attendant being called in on April 18th who diagnosed the case as enteric fever on April 22nd. The case was removed to hospital on the same date. This case, it will be observed, remained at home 12 days after the onset of illness. Disinfection was carried out the third time. The next and last case in the family was L. G. H., aged 18 months, the baby of the family and sister to the last case. 41 This case was first seen by one medical practitioner on the 22nd April who treated the infant for diarrhoea until the 29th April She was subsequently seen by another practitioner who notifed the case as enteric fever on May 12th. The diagnosis of this case was based on the examination of the infant's blood by means of Widal's test—a positive reaction resulting. This case had apparently recovered when the test was applied, but the history of a prolonged attack of diarrhoea together with history of the other cases in the family raised more than a suspicion that baby's attack was something more than infantile diarrhoea. The following gives in table form chief facts above recorded:— Initials of Name. Age. Sex. Date of Onset of Illness. Date of Notification. Date of Removal to Hospital. Remarks. C. E. H.. 42 F Mar. 10th Mar. 22nd Mar. 22nd The usual causes negative. Attributed by patient to washing some dirtv linen. R. H. 5 F Unwell since previous case. Apl. 10th Apl. 10th Contact infection. I. A. H. 7 F Apl. 14 th Apl. 22nd Apl. 22nd ,, ,, W. H. H. 3 M May 4 th May 8th May 8th ,, ,, L. G. H. 18 mths. F Apl. 20th May 15 th This case was nursed at home She had an attack of diarrhoea from April 22nd to April 29th. The diagnosis of enteric fever was subsequently confirmed by a positive Widal's reaction being obtained on examination of the patient's blood. 42 Group II.—This second group of cas s concern two families. The first case was that of a Mrs. A. C., age 32, living with her husband and four children in a tenement of three rooms at 20, S-Street. This patient is said to have fallen ill on about April 7th last year. She was removed to the infirmary on the 10th and was notified as suffering from enteric fever on April 20th. Enquiries as to the usual sources of infection proved fruitless. After the removal of this patient to the infirmary one of her children, Christopher, aged 10 years, fell ill. His illness began on April 15th but a medical attendant was not called in until the 25th of that month. The patient was then recognised as suffering from enteric fever and removed to the infirmary. All the time since the removal of the mother, this boy has been with his grandmother at 27, W- Road, during the daytime. It further appears that on the removal of Mrs. C. to the infirmary, a Mrs. M., a lodger at 217, W-Road, removed some soiled linen belonging to Mrs. C. of S- Street (the first case) to her lodgings and washed the same with some of her own linen. There is a history of Mrs. M. suffering from diarrhoea a few days after the washing of the soiled linen. She was attended by a local medical practitioner for about ten days. On April 26th, the day after the removal of Christopher C., the son of Mrs. M., a boy of 11 years, fell ill, but a medical attendant was not called in until May 5th. On the 6th of that month he was notified as suffering from enteric fever and removed to hospital. It may be here mentioned that Mrs. M. occupied, with her husband and six children, two rooms, with the use of a washhouse, &c., common to the other tenants, at 217, W- Road, so that the presence of a person suffering from enteric fever, amongst a family so circumstanced, has every opportunity of infecting the whole family. On April 5th the medical attendant's attention was also drawn to Grace, age 7 years, sister of the last case. She remained under observation and treatment at the house until the 9th when she was pronounced to be suffering from enteric fever, and was removed to hospital on that date. 43 On April 8th two sisters of the last case, viz., Alice, age10 years and Ivy age 12 years, fell ill. They were attended and treated at home by a medical practitioner until May 20th when they were notified to be suffering from enteric fever, and removed tohospital. Again, on May 24th, George, another brother of the former cases, age 8 years, fell ill, the medical attendant being called in on the 27th. George was notified as suffering from enteric fever on the 29th of that month and removed to hospital. This was the last case of the group. The following gives in table form the chief facts above recorded. Initials of Name. Age. Sex. Date of Onset of Illness. Date of Notification. Date of Removal to Hospital. Remarks. A. C. 32 F Apl. 7 th Apl. 20th Apl. 10th This was the first case in the group to occur. C. C. 10 M Apl. 15th Apl. 25th Apl. 25th Son of above. A. W. M. 11 M Apl. 26th May 6th May 6th C. C., above, had associated with this case daily for nearly a fortnight. G. E.M. 7 F May 6th May 9th May 9 th Sister of last case, A. W. M. A. M. 10 F May 8th May 13 th May 20th Sister of above. I. M. 2 F May 8th May 13 th May 20th Sister of above. G. H. M. 8 M May 24th May 29th May 29th Brother of above. To the above must be added Mrs. M., who suffered, as stated above, for several days from diarrhoea and was medically treated for the same. Although her illness was not diagnosed as enteric fever, I am of opinion, in the light of the large number of cases occurring amongst her children, that she too suffered from this 44 disease. The incident is complicated by the doubt as to whether Christopher C. introduced the infection amongst the members of the M. family at 217, W— Road or Mrs. M., by her own illness, caused by the soiled linen of Mrs. C. which she brought home to 217, W-Road to be washed. However, whether introduced by the boy Christopher, who, it may be noted, associated with the children of Mrs. M. at 217, W-Road during a period when he must have been capable of conveying infection, or by Mrs. M.; the disease attacked all the children of the family in rotation with the exception of one child. My object in giving details of these groups of cases of enteric fever is to emphasize the importance of recognising personal or contact infection as a considerable factor in the spread of this disease, especially in the homes of the poor. In the more exciting chase after infection by food, especially fish of various kinds, and "carriers," the more commonplace mode of transmission by personal or contact infection is apt to be thrust into the background. I am of opinion that a considerable decrease in this disease might be anticipated, if this mode of infection is always borne in mind, both by medical practitioners and by the public ; especially if the former were to make freer and earlier use of the Agglutination test for enteric fever, when called in to attend obscure cases of feverish conditions. The deaths from enteric fever in the Borough last year numbered 8. This is equal to an annual mortality of 20'5 per cent, attacked, and .036 per 1,000 living. During 1911 specimens of blood from 21 persons suspected to be suffering from enteric fever were submitted to Widal's test. Of these 7 gave a positive and 14 a negative reaction. The mortality for all London for the same period is .03 per 1,000 living. Chicken-pox.—During the month of March of last year, whilst small-pox was prevalent in the East End of London, the London County Council thought it desirable to make chicken-pox a notifiable disease for a limited period. 45 At a meeting of the London County Council held on the 14th of March, 1911, it made the order in the following terms :— "The London County Council hereby Resolves and Orders, as a case of emergency, that, having regard to the recent outbreak of Small-pox and to the fact that mild forms of this disease are liable to be mistaken for Chicken-pox, Sections 55, 68 and 70 of the Public Health (London) Act, 1891, with respect to the notification and prevention of infectious disease shall apply, in the Administrative County of London, for a period of three calender months from and including 22nd March, 1911, to the disease known as Chicken-pox." During the three months in question, 133 cases of chicken-pox were notified. The outbreak of small-pox having ceased at the expiration of the above period, it was not thought necessary to renew the Order relating to chicken-pox. No death during the year was registered as due to chicken-pox. Cerebro Spinal Meningitis.—At a meeting of the London County Council, held on the 7th February, 1911, the Order making this a notifiable disease was renewed for a further period of 12 months, in the following terms:— "The London County Council hereby Resolves and Orders that Section 55 of the Public Health (London) Act, 1891, with respect to the notification of infectious disease shall apply, in the Administrative County of London, for a further period of 12 calender months, from and including 13th March, 1911, to the disease known as Cerebro Spinal Fever (Epidemic Cerebro Spinal Meningitis)." During the year 1911 there were 7 cases of this disease notified, and there were 2 deaths registered. Typhus.—No case of this disease was notified in the Borough during the past year. Continued Fever.—No case of continued fever was notified in the Borough during the year. 46 Puerperal Fever.—There were 16 cases of puerperal fever notified during 1911, of which 6 were removed to the infirmary. The deaths from this disease numbered 4. The attack rate for the year was 3 0 per 1,000 births, and the death rate .74 per 1,000 births. Plague.— No case of plague was notified in the Borough of Hackney during last year. Erysipelas.—There were 358 cases of Erysipelas notified during 1911. This is equivalent to an attack rate of 1.6 per 1,000 living. Of the 358 cases notified, 88 were removed to hospital. There were 18 deaths from this disease during the year, which gives a mortality rate of 5 per cent. attacked, and .08 per 1,000 living. The following table shows the distribution of the disease in the sub-districts of the Borough:— Sub-Districts. North. Central. South-West. South-East. No. of Cases of Erysipelas. 40 97 67 154 Rate per 1,000 living. .74 1.8 1.1 2.7 Polio-myelitis or Polio-encephalitis.—This disease was added to the list of notifiable diseases by the London County Council, with the approval of the Local Government Board, at a meeting held on the 25th July, 1911. The Order made is in the following terms:— "The London County Council hereby Resolves and Orders that Section 55 of the Public Health (London) Act, 1891, with respect to the notification of infectious disease shall apply in the Admininistrative County of London up to and including the 12th day of March, 1912, to the disease known as Acute Polio-myelitis or Acute Polio-encephalitis. The Order came into operation on the 1st September, 1911. 47 During the last four months of last year four cases of this disease were notified, but no death was registered. Ophthalmia Neonatorum.—At a meeting of the London County Council on November 8th, 1910, it made an Order making the above a notifiable disease in the County of London. The Order was as follows: "The London County Council hereby Resolves and Orders that Section 55 of the Public Health (London) Act, 1391, with respect to the notification of infectious disease shall apply, in the Administrative County of London, to the disease known as Ophthalmia Neonatorum." This Order was approved by the Local Government Board and came into operation as from and including March 13th, 1911. From this date up to the end of the year 19 cases of ophthalmia neonatorum were notified. All the cases not under medical treatment or in hospital were immediately visited by the Health Visitor, Mrs. C. Brown, who urged the necessity of medical treatment. The cases were kept under observation until recovery. Six other cases of inflammation of the eyes in infants were brought to my notice by the medical inspectors of the London County Council. These cases, too, were visited by the health visitor, and the parents where necessary, persuaded to obtain medical help for their infants. The danger of this disease of the eyes in infants and the measures which should be adopted to prevent permanent blindness, are brought to the notice of parents by the following warning, contained in the leaflet " On the care of Infants," a copy of which is sent to every mother in the Borough on the birth of a child. I.—Inflammation in the Eyes of the New Born Child. This is a very dangerous and infectious disease. It is the cause of 36 per cent. of the total blindness of children. But it is quite preventable by observing the following few simple rules:— At birth the infant's eyes should be carefully washed by the nurse or midwife. Each day during the next week, the 48 infant's eyes should be carefully examined, and if the eyelids show any redness or swelling, or if there is any discharge from the eyes, a doctor should be immediately sent for, and his instructions carefully followed. In the meantime the affected eye or eyes of the infant should be gently washed, plain cold water and soft rag or cotton wool being used for this purpose. The rag or wool must not be used more than once and must then be burnt. The same piece of rag or wool must not be used for both eyes. Care must also be taken by the nurse, midwife, or other person attending to the infant, not to allow any discharge to get into her own eyes, because this discharge is extremely infectious. No instance of permanent damage to the eyes has resulted in any of the cases notified, nor in any of those cases of inflammation of the eyes reported by the medical inspectors of the London County Council. Glanders, Anthrax and Hydrophobia in Man.—No case of these diseases occurred in Hackney during the year amongst human beings. B.—Non-notifiable Infectious Diseases. Influenza.—During the year 24 deaths were registered as due to this disease. This is a decline of 10 on the number registered during 1910. The death-rate from influenza for 1911 is therefore .11 per 1,000 living, and that for all London .11 per 1,000 living. Diarrhoea.—This was the cause of 184 deaths, of which 169 were amongst persons under 5 years of age. This is an increase of 138 deaths from this cause over the number registered during 1910. There were also 41 deaths ascribed to enteritis, of which 38 were amongst children under 5 years of age. The annual mortality rate for 1911 from diarrhoea is 8.2 per 1,000 living. 49 The distribution of this disease in the Borough may be seen from the following table:— Sub-Districts. North. Central. South-West. South-East. No. of Deaths from Diarrhœa. 23 45 59 57 Death Rate per 1,000 living. .42 .84 1.2 1.0 About the middle of August a circular letter was received from the Local Government Board calling the attention of the Hackney Borough Council to the excessive child mortality then prevalent, and suggesting lines along which action should be taken with a view to minimising the excess, and stating that, "The Board will be glad if the Medical Officer of Health, in his annual report dealing with the current year, will set out the course of action adopted in the district to prevent diarrhoea and child mortality generally, in the special circumstances of the present year." The following quoted from the circular letter, are the suggestions of the Board:— "Firstly, it is important that exact advice should be given as to the feeding and management of children, and more generally as to preventing the exposure of their food to contamination from decomposing organic matter. The distribution of clearly worded leaflets is useful in this connection, but even more important are personal visits and the offer of practical advice to the mothers of babies born within the last twelve months. Exact and simple instructions are most likely to be followed if given during a period of special danger. In districts and towns in which the Notification of Births Act has been adopted, the records obtained under that Act will give valuable information in selecting the house to which visits are now most urgently required." D 50 "Secondly, the full value of the personal instructions indicated above cannot be realised unless vigorous efforts are made to prevent the accumulation in or in the vicinity of the house of decomposing animal and vegetable matter. It is not necessary to do more than mention the importance of efficient scavenging, or frequent and, if practicable, daily removal of house and stable refuse, of domestic cleanliness, and of keeping all food properly protected. The Council may consider it advisable during the next few weeks to divert the sanitary inspectors from less urgent work, and to instruct them to make rapid visits with a view to securing efficient sanitation, especially in and about the houses of the working classes." "Thirdly, it is important that the Council should promptly ascertain in which parts of their district diarrhoea is especially prevalent, and should devote close attention to street and court scavenging and to the removal of stable and domestic refuse in these areas. Without waiting for the weekly death returns, efforts should be made to obtain information of cases of diarrhoea from Health Visitors and others who make domestic visits; and to impress upon parents the importance and immediate treatment of infantile diarrhoea. Apart from the medical notification of cases of epidemic diarrhoea in children, the visits of Health Visitors can be utilised for impressing upon parents the seriousness of diarrhoea amongst young children and the desirability of information being given to the Medical Officer of Health should a case of diarrhoea occur.'' This letter was received during the summer recess of the Council, but it was immediately handed to me to take such action in accordance with the suggestions of the Local Government Board as I was authorised to take, and I beg herewith, in compliance with the special desire of the Local Government Board, "to set out the course of action taken in the district to prevent diarrhoea and child mortality generally in the special circumstances "of the past summer. 51 1st—With respect to the first suggestion of the Board, as to giving advice to parents as to the feeding and management of children, and preventing the exposure of their food to comtamination, I am glad to state that for several years past advice of this nature has been systematically given. During 1911 a leaflet on the "Care of Infants" was sent to the mother of every infant whose birth was notified to me. This leaflet is reproduced in the appendix to this report. About the middle of June an additional leaflet, on the "Prevention of Infantile or Summer Diarrhoea," was sent with the above to the mother of every infant whose birth was notified. This leaflet is also reproduced in the appendix. The despatch of this latter leaflet was not discontinued until the end of the month of September, when the seasonal excess of diarrhoea had practically ceased. It will be remembered that a health visitor was appointed in November, 1910, for the purpose of visiting nursing mothers and giving them instruction in the care and feeding of infants. Reference is made elsewhere in this report to her work during the year; but I can here state that her energies were solely confined to this work, and to localities which I knew from their poverty and density of population most needed such guidance. Mrs. Brown, the Health Visitor, received instructions from me to work on the lines of the leaflet referred to. 2nd—With respect to preventing the accumulation of decomposing vegetable or animal matter in the neighbourhood of dwelling houses, I have to state that the system of house refuse removal adopted in the Borough is a weekly one. Very complete arrangements are made to ensure that the dustmen call at every occupied house in the Borough at least once a week. Blocks of flats and many other places are visited twice and some even three times a week. This is the normal arrangement. During the hot months of last summer, the two dust inspectors were instructed to give special attention to the regular collection of house refuse, and to D2 52 deal immediately with every complaint of nuisance from accumulations in the crowded parts of the Borough. The dustmen are supplied with a deodorant powder to apply to dustbins which, when emptied, have an offensive smell. Instructions were given to the dustmen to report all cases where portable dustbins are wanting or are dilapidated at occupied dwellings. With regard to the removal of stable refuse from mews, stables, &c., in the Borough, this is required to be removed twice a week by the following public notice, issued by the Borough Council in the year 1893 and renewed in 1905:— HACKNEY METROPOLITAN BOROUGH COUNCIL. Removal of Manure or other Refuse Matter from Stables, Cowhouses, &c. Notice is hereby given that pursuant to Section 36 (2) of the Public Health (London) Act, 1S91, the Hackney Metropolitan Borough Council, acting as the Sanitary Authority for the Borough of Hackney, require the removal of Manure or other Refuse Matter from Stables, Cowhouses, and other Premises at least twice in each week. In order to meet cases where difficulty is experienced in removing Manure or other Refuse Matter periodically, as above mentioned, the Council are prepared to remove such Manure or other Refuse on payment by the owner for such removal, at a rate per load to be agreed, upon application being made to the Public Health Department at the Town Hall, Hackney, for that purpose. By Order, W. A. WILLIAMS, Town Hall, Hackney, N.E., Town Clerk. November, 1905. Public Health (London) Act, 1891,—Sec. 36 (2). "Notice may be given by a Sanitary Authority (by public announcement in the district or otherwise) requiring the periodical Removal of Manure or other Refuse Matter from Stables, Cowhouses, or other premises: and where any such notice has been 53 given, if any person to whom the Manure or other Refuse Matter belongs fails to comply with the notice, he shall be liable without further notice to a fine not exceeding Twenty Shillings for each day during which such non-compliance continues." The districts sanitary inspectors were instructed to give special attention to the poorer class districts, especially with regard to the presence of accumulation of filth or refuse in the yards of dwellings or in streets, and the accumulation of dung in stables, &c., and to deal immediately with such nuisances as provided by the Public Health (London) Act, 1891. 3rd—The Health Visitor was instructed where cases of infant diarrhoea was brought to her notice to advise the parents to obtain medical advice and treatment and in case of poverty to apply to the relieving officer. Outline of Suggested Scheme for Dealing more completely with Summer Diarrhoea and Enteritis. The difficulty in dealing with infant diarrhoea and enteritis is that local authorities only know of its prevalence usually when the deaths from this disease increase; and these do not as a rule increase at the beginning of an epidemic, not until in fact the disease is well established. It would, I am of opinion, be of immense advantage to have knowledge of all cases occurring, and especially of the first cases in any outbreak or the first cases in any family. In order that this information may be obtained some form of notification will be necessary. This notification may be restricted to the three months of the year, July, August, September. It should be obligatory on medical practitioners consulted by parents, and parents or others in charge of infants and young children. Mere notification of cases without other action, would only be useful to show the localities where the disease is most prevalent and the extent of its prevalence and would not exercise any control over the spread of the disease—the main thing to be 54 aimed at—so that this measure must be regarded as introductory to supplementary measures. These should in my opinion consist of the following:— (1) The temporary appointment of two or more qualified assistants to the present Health Visitor. These should be retained for the three months during which the disease is prevalent. Their duties would be to visit the home of each case to ascertain if the patient is under proper medical treatment ; to ascertain if the case is so treated at home as to prevent the sick child from infecting other healthy persons; to ascertain the home condition as to whether there is any suspicious cause operating to cause the disease. On this report, if necessary, inspection would be sent to make a thorough inspection of the dwelling and its environment. Proper advice on feeding and the care of infants and young children would also be given. (2) Arrangements should be made with local hospitals and dispensaries to treat such cases as cannot afford to call in a private practitioner. Arrangements should also be made with hospitals including the Infirmary and Metropolitan Asylums Board to receive such cases as, from poverty and inadequate accommodation, cannot with safety be treated at home. (3) Suspension of the ordinary procedure by which it is necessary for the relieving officer to make enquiries before medical relief can be afforded. This suggestion is made to enable medical advice and treatment to come to the patient without unnecessary delay. (4) If necessary the redrafting of the conditions of the Dusting and Slopping Contracts so as to enable the local authority to call for a more frequent removal of house refuse and street refuse (if necessary confining these revised conditions to specified areas). The present rule is for house refuse to be removed at least once a week from occupied houses ; and refuse from streets to be removed in certain streets once and in others twice or more times in the week. 55 During the prevalence of summer diarrhoea there should be no hindrance placed in the way of local authorities to remove house or street refuse as frequent'y as the circumstances of the moment required. Of course the simplest, although, perhaps, somewhat more expensive plan would be for the local authority to employ its own men with its own plant. I am of opinion that if these suggestions were adopted in the Borough of Hackney infantile or summer diarrhoea would soon come under control with a considerable diminution in its mortality. Measles.—During the early months of last year measles became very prevalent in London, the Borough of Hackney suffering in proportion. The outbreak realy began in December of 1910 in Hackney, 7 deaths occurring during that month. These increased until the maximum was reached in the months of March and April after which the deaths, and with them the prevalence of the disease, diminished until July, when the outbreak m?y be said to have ceased. The following shows the number of deaths during the months of the year 1911. Number of Deaths from Measles during the months of the year 1911. Months. Jan. Feb. March. April. May. June. Total. Deaths 11 20 49 32 22 8 ) 145 Months. July. Aug. Sept. Oct. Nov. Dec. Deaths 2 1 0 0 0 0 Of these 145 deaths no less than 132 occurred amongst children under 5 years of age, and 30 under 1 year of age. The above total shows an increase of 83 deaths over the number of deaths from this disease registered during 1910. The mortality rate for 1911 is -65 per 1,000, and that for London '57 per 1.000 living. 56 The following table gives the distribution of the deaths from this disease in the different sub-districts of the Borough :— Sub-Districts. North. Central. South-West. South-East. No. of Deaths from Measles. 18 38 36 53 Mortality Rate per 1,000 living. 33 7 62 92 In the month of April, when the prevalence of the disease was at its height, a memorandum was received from the Local Government Board on the measures which should be adopted to check the spread of this disease. In order to give Medical Officers of Health early information of cases of measles, it was stated that during the emergency in question school attendance officers would give speedy information to the Medical Officers of Health of all cases of illness coming under their notice. The memorandum further adds that the information thus obtained would require following up, that arrangements should be made for making a proper diagnosis of cases of measles, and for securing that cases are property isolated, and for urging on the parents the need for obtaining medical aid where such aid is required. It was also stated that the Metropolitan Asylums Board had agreed to receive cases of measles on the recommendation of the Medical Officers of Health, preference being given to those cases most needing hospital treatment. The Board also reminded the Borough Council that they have power to provide temporary hospitals, and if the accommodation of the Metropolitan Asylums Board became exhausted, it might be necessary to use this power. Finally, the Board pointed out that for dealing with the outbreak and properly following up the information acquired, it is 57 essential that the Medical Officer of Health should be provided with an adequate staff, and expressing the hope that the Council would at on:e appoint any additional assistants (medical and other) that might be required. With regard to the arrangement that school attendance officers should give speedy information of cases of illness to the Medical Officers of Health, I can certainly say with regard to this Borough that this arrangement was carried out very perfunctorily. The bulk of the notices from the head-masters and mistresses have always been received on the Saturday morning. It appears as if they were saved up during the week and despatched on the Friday afternoon. In support of this view, I give here a table showing the number of notices received from the whole of the schools in Hackney each day of the week during the months of March, April and May of last year.—the period when the epidemic reached its height and began to decline. Number of notices of illness amongst scholars received from head-masters and mistresses of schools under the London County Council during the months of March, April and May, 1911:— DAY OF WEEK. MARCH. APRIL. MAY. Week Ending Week Ending Week Ending Mar. nth Mar. 18th Mar. 25 th Ap. 1st Ap. 8th Ap. ]5th Ap. 22nd Ap. 29th May 6th Mav 13th May 20th May 27th June 3rd Monday — 1 21 2 — — — — — 5 — 1 1 Tuesday 83 21 35 34 37 5 — 8 19 5 14 12 2 Wednesday 28 40 36 22 17 6 — 16 7 5 2 7 10 Thursday 41 21 18 48 3 6 — 8 11 4 1 8 7 Friday 25 16 21 29 15 g.f. — 11 3 2 13 4 1 Saturday 248 192 105 80 40 2 — 63 29 18 88 41 41 58 The total number of cases of measles notified from the schools during the year was 2,626. The action taken in these cases was to send to the person in charge of the patient a leaflet (see appendix) on the "Prevention of Measles," together with a letter asking to be informed when the child had recovered or had been removed to hospital in order that the premises, &c., might be disinfected. A printed and stamped form of reply was enclosed. Many cases, especially those in most need from their condition and circumstances, were removed to the Asylums Board's Hospitals. On receiving notice of removal disinfection was immediately carried out. There were 234 cases of measles removed to the Metropolitan Asylums Board's Hospitals during the year. Whooping Cough.—I received information of 374 cases of whooping cough in the Borough during 1911 from the head-masters and mistresses of the elementary schools in the Borough. There were 52 deaths from this disease registered during the year. This is equal to a mortality rate of .23 per 1,000 living. The death-rate for all London for the same period was "23 per 1,000 living. The number of cases of whooping cough removed to hospital during the year was 31. The distribution of the disease in the sub-districts of the Borough is given in the following table :— Sub-Districts. North. Central. South-West. South-East. No. of Deaths from Whooping Cough. 4 13 13 22 Mortality Rate per 1,000 living. 07 24 22 4 59 CONSTITUTION DISEASES. Tuberculosis.—During the year 1911 there were 26 cases of pulmonary phthisis voluntarily notified by [medical practitioners practising in Hackney. This is a decline of 20 upon the number voluntarily notified during 1910. There were, however, 234 cases notified under the Public Health (Tuberculosis) Regulations, 1908, and 322 cases notifed under the Public Health (Tuberculosis Hospitals) 1911. Bacteriological examination of sputa from 132 cases was made during the same period. In 22 of these examinations, the specific organism of the disease was discovered; in 110cases, the result of examination was negative. The number of deaths from tuberculous disease occurring in Hackney during 1911 was 399, which are classified as follows:— Tuberculous Phthisis 250 Phthisis 45 General Tuberculosis 32 Tuberculous Meningitis 42 „ Peritonitis 8 Tabes Mesenterica 7 Tubercle of other Organs 15 399 This number of deaths gives an annual mortality of nearly 1.7 per 1,000 living. The deaths are distributed in the sub-districts of the Borough, as follows:— Sub-districts. North. Central. South-West. South-East. No. of Deaths from Tuberculous Disease. 60 98 102 133 Mortality rate per 1,000 living. 1.2 1.8 1.7 2.3 60 Cancer.—To the different varieties of malignant disease were attributed 217 deaths during 1911. This shows a decrease of 5 deaths upon the number registered during 1910. The annual death-rate from cancer for the former year is .97 per 1,000 persons living. The deaths are distributed in the sub-districts in the following proportions:— Sub-districts. North. Central. South-West. South-East. No. of Deaths from Cancerous Disease. 61 44 53 56 Mortality rate per 1,000 living. 1.2 0.8 09 09 Below is given a table showing the number of deaths and death rates in this Borough during the ten years ending 1910:— Years. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Borough of Hackney Deaths from Cancer. 190 192 182 203 175 198 225 214 222 217 Death rate per 1,000. .85 .85 .80 .90 .75 .91 .96 .91 .93 .97 London. Death rate per 1,000. .99 .87 .99 1.00 1.05 1.03 1.06 .96 .94 1.05 The death-rate from cancer for all London for the year 1911 is 105 per 1,000 persons living. ALCOHOLISM. During the year under consideration there was only 1 death registered as due to acute alcoholic poisoning, but there were 61 24 deaths due to cirrhosis of the liver, a condition regarded as a rule to be due to excessive indulgence in alcohol, extending over lengthy periods. VACCINATION. Appended is a summary of the proceedings under the Vaccination Acts, during the year 1911. It will be seen from this that the practice of vaccination is declining. The number of birth certificates received during last year was 5,413 and the number of vaccination certificates received during the same period 2,571. This latter is equal to 47.4 per cent. of the births, leaving over 52 per cent. of infants unvaccinated. This is the highest percentage of infants escaping vaccination recorded for some years. The following table shows the fluctuations in the proportion of infants unvaccinated to births and also the growth in the number of certificates and declarations of conscientious objection received by the vaccination officers from and including the year 1898, the first year during which certificates of conscientious objection were received, up to date. Year. No. of Certificates of Births Received. No. of Certificates of Vaccination Received. Percentage of Infants Escaping Vaccination. No. of Certificates and Declarations of Conscientious Objection Received. 1898 6,350 2,286 64% 64 1899 6,450 3,019 53% 61 1900 6,423 2,903 55% 64 1901 6,351 2,998 53% 61 1902 6,274 3,926 48% 51 1903 6,190 3,943 36% 81 1904 6,190 3,733 40% 74 1905 5,881 3,618 39% 69 1906 5,888 3,072 48% 91 1907 5,812 3,247 44% 228 1908 5,676 3,135 45% 636 1909 5,608 2,877 49% 954 1910 5,498 2,862 48% 1,329 1911 5,413 2,571 52 % 1,475 62 From this table it may be seen that when conscientious objectors had to apply to two justices or a magistrate, and satisfy them that they conscientiously believed that vaccination would be prejudicial to the health of their children, the number of certificates remained fairly constant; but in the year 1907, when a statutory declaration before a Commissioner of Oaths or other persons authorised to receive a statutory declaration, was sufficient to exempt a child from vaccination, the number of exemptions from vaccination began to increase, so that from 91 in the year 1906, the number had increased to 1,475 in a space of five years. Unless some check takes places in the rate at which these certificates are granted, it will not be many years ere the bulk of the infant population will be growing up totally unprotected against small-pox. To those who know what small-pox is, such a contingency will cause great anxiety. Once small-pox gets a footing amongst a child population so unprotected, it will spread with such rapidity that no system of notification, isolation, &c., will have the slightest chance of stopping its progress, until it has spent its force for want of material. We see every few years the same phenomenon exhibited in the case of measles and other infectious diseases. The most serious factor about this condition of things is the universal apathy shown by the legislature and administrative bodies both central and local. It is not that these bodies are not well advised, indeed, the most competent advice in the Kingdom is at their disposal, but it is generally ignored. If such advice were not enough, there is the practice of other civilized nations standing out clearly both as an example and a warning. 63 Summary of Proceedings under the Vaccination Acts, 1867 to 1898 during the year 1911. Registration Sub-District. No. of Cases in Birth Lists received during Month. No. of Certificates of Vaccination received. No. of Certificates of Postponement owing to No. of Certificates under Section 2 of Vaccination Act, 1898, and No. of Statutory Declarations under Section 1 of the Vaccination Act, 1907. No. of Certificates of Insusceptibility or of having had Smallpox. No. of Cases No. of Entries in Lists sent to Public Vaccinator Health of Child. Condition of House. Prevalence of Infectious Disease. Parents Removed out of District. Otherwise not found. North 1,015 588 107 — — 283 4 22 44 303 Central " 1,335 553 36 — — 422 2 28 92 539 South-East 1,446 590 141 — 8 425 3 37 135 591 South-West 1,617 843 42 — — 345 3 228 100 611 Total 5,413 2,571 326 - 8 1,475 12 315 371 2,044 64 PUBLIC HEALTH (LONDON) ACT, 1891. (а) Complaints of Nuisances.—During the year 1911 there were 1,998 complaints of nuisance received by the Public Health Department. These were investigated by the sanitary inspectors of the Borough. Notices, where necessary, were served for the remedy of any defect or nuisance upon the person or persons responsible under the provisions of the above Act. About 17 per cent. of the complaints were anonymous, but these received the same consideration as other complaints. (b) Infectious Disease.—The number of houses inspected during the year after infectious disease was 2,278. This is a great increase on the number inspected during 1910. The increase is due to inspections made after notifications of pulmonary tuberculosis. Any sanitary defects found were dealt with under the provisions of the above Act. (c) House-to-House Inspections.—These are in addition to those inspections made under (a) and (b). The number of house to house inspections made by the inspectors during 1911 was 2,197. This is 157 less that those inspected during the previous year, but this is due to the fact that the two inspectors especially engaged in this work had to devote a portion of their time during the year to inspection under the Housing, Town Planning, &c., Act, 1909. These will be referred to later. The nuisances found during house to-house inspections were dealt with in the same manner as those found under the headings (a) and (b). Nuisances or defects found on inspection were remedied in most cases on the service of intimation notices alone. The total number of such notices served during the year was 4,768. The number of statutory notices served was 228, and legal proceedings had to he initiated in 7 cases. 65 The following details relate to house to house inspections made by the special inspectors engaged for this work. House-to-House Inspections, 1911.—No. 7 District. Inspector—W. C. Vobe. Number of premises inspected 237 Number of premises on which nuisances were found 166 Intimation notices served 167 Statutory notices served 7 Found. Abated. In hand Outstanding. The house or part in a dirty condition 57 50 5 2 „ damp „ 12 9 2 1 „ dilapidated,, 45 39 4 2 dangerous „ 10 9 1 — „ verminous ,, 12 10 2 — The w.c. so foul as to be a nuisance 3 3 — — without a water supply 3 3 — — „ with a deficient supply of water 6 5 1 - „ so defective as to be a nuisance 2 2 — — „ choked 5 5 — — The yard paving defective 7 5 2 — The sink waste defective 2 2 — — Bath waste untrapped 4 4 — — „ choked 2 2 — — No dustbin or dilapidated dustbin 7 7 — — Defective drains 8 8 — — The drain choked 3 3 — — The rainwater pipe defective 8 5 2 1 The main roof defective 30 26 2 2 The guttering defective 13 11 1 1 The scullery or w.c. roof defective 19 17 — 4 The scullery paving defective 3 2 — 1 Animals improperly kept 2 2 - - e 66 Found. Abated. In hand. Outstanding. The house or part overcrowded 3 3 — — No ventilation or insufficient tion beneath ground floor 5 5 — — Ventilation shaft defective 2 2 — — Storage cistern dirty. 2 2 — - Clearing eye to drain defective 2 2 — — Burst water pipes 2 2 - - Accumulations of refuse 3 3 - - Smoke nuisances 3 2 - 1 Bedroom with insufficient external ventilation 1 1 - - The yard dirty 7 5 1 1 House-to-House Inspections, 1911—Homerton District. Inspector—Jas. W. Hall. Number of premises inspected 186 Number of premises on which nuisances were found 157 Intimation notices served 168 Statutory notices served 17 Found. Abated. In hand. standin;. The house or part in a dirty or verminous condition 1ll 89 10 12 Ditto in a damp condition 28 17 9 2 Ditto in a dilapidated condition 73 55 9 9 Surface drain improperly trapped 2 — — 2 Water closet in a defective condition 22 18 2 2 Ditto without water supply 4 3 1 — Ditto with deficient water supply 14 13 1 — Ditto stopped 1 1 — — Ditto without external ventilation 2 1 1 — Drain ventilation pipe defective 5 4 — 1 Yard paving defective 20 14 5 1 Yard dirty 2 2 — — 67  Found. Abated. In hand Outstanding. Gully trap within premises 8 2 5 1 Sink wastes untrapped 22 13 7 2 Ditto defective 11 11 — — Bath waste untrapped 1 1 — — Accumulation of refuse 3 1 — 2 Dustbins required 15 14 1 — Dustbins defective 30 21 5 4 Drains defective 59 39 11 9 Drains choked 11 9 2 — Rainwater pipe directly connected to drain 1 1 Ditto defective 18 15 — 3 House without a proper water supply 4 4 — — Roof defective 50 35 9 6 Guttering defective 31 29 1 — Area paving defective 5 4 — 1 Washhouse paving defective 14 12 1 1 Improper manure receptacle 2 1 1 — Animals improperly kept 13 12 1 — Rooms overcrowded. 19 19 — — Floor space insufficiently ventilated 32 19 8 5 Sundry defects 8 7 1 — Articles of Food Seized or Surrendered as Unfit for Food.— During the year 1911 the following articles of food were seized by the inspectors or surrendered as being unfit for food, viz., 12 cwt. 4 qrs. fish; 4 cwt. 1 qr. 2 lbs. meat; 19 cwt. fruit and vegetables ; 3 cwt. 1 qr. tinned foods. DAIRIES, COWHOUSES AND MILKSHOPS. (a) Cowhouses.—The licensed cowkeepers in the Borough have again decreased in number during the past year. At the end of 1911 they numbered 15 only with 20 cowsheds. This is a reduction of 4 licenses and 6 sheds on the previous year. Inspector Bobbitt e 2 68 reports that he made 255 visits to these cowsheds during the year. He served three intimation notices for repairs and cleansing, which were immediately complied with. On September 23rd the Public Health Committee made their annual visit to the cowhouses in the Borough. These were found to be in a satisfactory condition both as to repair and cleanliness with the exception of 3, one of which was dirty and dilapidated and 2 which required lime whiting. The needed cleansing and repairs were executed on the service of notices. (b) Dairies and Milkshops.—During the past year 54 milk premises were removed from the register and 14 new milk premises added, thus making the total on the register at the end of last year 311. The proprietors of milk premises were changed in 66 instances. Amongst the milk premises removed from the register were 21, the proprietors of which ceased to sell milk rather than make the necessary alterations required by the Public Health Committee to render the premises "suitable for the sale of milk therein" under the London County Council (General Powers) Act, 1908, Section 5 (1). Inspector Bobbitt reports that he made 1,490 visits of inspection to these premises during the year, and discovered dirty utensils in 20 instances. He also served 14 notices for cleansing and repairs which were immediately complied with. Offensive Trades.—The only offensive trade in the Borough, viz., that of tripe boiler, was visited by inspector 13 times during the year. He reports that on these occasions he always found the premises in a clean condition. Slaughter-houses.—The number of licensed slaughter-houses in the Borough at the end of 1911 remained the same as at theendo: the previous year, viz., 21. Inspector Bobbitt reports that he made 319 visits of inspection to these during the year, and had occasion to serve three intimation notices for repairs, which notices were immediately complied with. During his visits to the slaughterhouses, Inspector Bobbitt inspected the carcases and organs of 69 1,726 sheep and lambs, 227 oxen and 25 pigs, and found the following organs diseased, and had them destroyed, viz.:— 3 ox livers affected with abscess. 9 ox livers affected with distomatosis. 6 ox livers affected with distomatosis. 8 sheep livers and lungs affected with parasitic cysts. 2 sheep livers affected with parasitic cysts. On September 23rd the Public Health Committee made their annual visit to the slaughter-houses of the Borough. These were all found in a satisfactory condition. The following statement refers to the milk places, cowsheds, slaughter-houses and offensive trades in the Borough :— Premises. Number of Places. Number of Inspections, 1911. Number of Notices, 1911. Number of Prosecutions. On Register at end of 1910. Added in 1911. Removed in 1911. On Register at end of 1911. Milk premises 351 14 54 311 1,490 14 — Cowsheds 26 — 6 20 255 3 — Slaughter-houses 21 — — 21 319 3 — Other offensive trade premises l — - 1 13 — — Preserved Provision Factories.—There were eight of these in the Borough at the end of 1911. Inspector Bobbitt reports that he made 58 visits of inspection to these premises during the year. All the meat examined on these occasions was found to be sound and free from disease. Smoke Nuisances.—The Smoke Inspector made 777 observations of chimneys of factories, workshops and other places in the Borough during the year. These observations lasted from half an hour upwards. Intimation notices in connection with this nuisance were served to the number of 49. 70 Water Supply.—Under Section 48 (2) of the Public Health (London) Act, 1891, there were 27 certificates of proper and sufficient water supply issued to owners of new or rebuilt dwelling-houses in the Borough. These certificates refer to 55 houses. By-laws for Houses Let in Lodgings.—During the year the following houses were registered by the Public Health Committee as houses let in lodgings. 11, 15, 17, 19, 21, 23, WWestgate Street. 36, Chatham Place. The former houses included 29 tenements and the latter 9 tenements. The total number of houses on the register at the end of 1911, including the above, was 501. All of the occupied houses registered as let in lodgings were inspected during 1911. The following sets out in detail the result of the inspections made, etc.:— HOUSES LET IN LODGINGS. 1911. No. 7 District. No. of premises on register end of 1911 243 No. of premises inspected 232 No. of premises on which nuisances found 152 abated 152 Intimation notices served152 Statutory notices served 1 Found. Abated. The house or part in a dirty condition 135 135 damp „ 9 „ „ dilapidated condition 61 61 dangerous „ 18 18 „ „ verminous „ 22 22 The w.c. so foul as to be a nuisance 4 4 „ without a water supply 4 4 „ with a deficient supply of water 9 9 71 Found. Abated. The w.c. so defective as to be a nuisance 10 10 „ choked 4 4 The yard paving defective 11 11 dirty 15 15 The sink waste defective 4 4 No dustbin or dilapidated dustbin 20 20 The drain choked 2 2 The rain water pipe defective 7 7 The roof defective 46 46 The gutter defective 19 19 Scullery or w.c. roof defective 22 22 The house or part overcrowded 7 7 Insufficient ventilation beneath the ground floor .. 4 4 Smoke nuisances 3 3 Scullery paving defective 4 4 Animals improperly kept 2 2 No. 11. District. No. of premises on register end of 1911 ... 226 No. of premises inspected ... 161 No. of premises on which nuisances found ... 60 abated ... 60 Intimation notices served ... 60 Found. Abated The house or part in dirty condition 55 55 „ „ dilapidated condition 15 15 The w.c. foul 14 14 without water supply 4 4 „ defective 15 15 „ improperly placed 2 2 so defective as to be a nuisance 4 4 stopped 3 3 The soil pipe unventilated 5 5 ,, yard dirty 12 12 72 Found. Abated The water cistern foul 4 4 „ sink waste pipe connected 7 7 No dustbin 20 20 The drain foul 9 9 „ choked 5 5 The rain water pipe defective 23 23 „ house without water supply 4 4 „ roof defective 19 19 „ gutters „ 15 15 „ washhouse paving defective 15 15 Animals improperly kept 4 4 House overcrowded 16 J6 No ventilation under ground floor 3 3 CUSTOMS AND INLAND REVENUE ACT, 1890. During the year 1911 a very large number of applications were made to me to inspect and certify premises let out in tenements under the provisions of the above Act, in order to obtain exemption from Inhabited House Duty. The following is a list of the premises which I inspected and for which I gave certificates, after necessary alterations, repairs and cleansing had been completed:— No. of Premises. Tenements. 65, Dalston Lane 5 Sylvester House, Sylvester Road 80 11 to 85, Egerton Road 76 11a to 85a, Egerton Road 95 to 109, Ravensdale Road 16 8 95a to 109a, Ravensdale Road 4, 4a, 5, 5a, 6, 6a, 16, 16a, Freemont Street i & 1a, Hilsea Street 2 73 No. of Premises. Tenements. 1 to 12, Stamford Mansions, Stamford Grove East, Old Hill Street 12 1 to 4, Abney Gardens, High Street, Stoke Newington 4 1 to 20, Great Eastern Buildings, Reading Lane 20 1 to 32, Stamford Hill Mansions, Stamford Hill 32 Carlton Mansions, Holmleigh Road, Stamford Hill 24 94 to 100 (even numbers), Morning Lane 16 1 to 2, Rivaz Place 8 6, 7 & 8, Woodbine Terrace 24 Ashford House, St. Thomas' Place, Well Street 4 102 to 122, Morning Lane 44 7, Buckingham Road 6 37a, Stamford Road 3 22a & 22b, Englefield Road 6 1 to 80, Graham Mansions 80 7 to 30 Rowhill Mansions 24 1 to 24, Kinnoull Mansions 24 1 to 24, Clarence Gardens 24 65 to 71, Holmleigh Road, Stamford Hill 7 114 to 136, and 113 to 135, Holmleigh Road 24 Carlton Mansions 16 1 to 32, St. John's Mansions 32 1 to 10, Clapton Square Mansions 10 1 to 32, Cavendish Mansions 32 35a, 35b. 35c, 35d, Halidon Street 4 41 & 43, Lesbia Road 4 50, Bodney Road 2 1, 1a, 3, 3a, 5, 5a, 7, 7a, 9, 9a, Leagrave Street 10 11, 11a, 13, 13a, 15, 15a, 17, 17a, Leagrave Street 8 5a, 55b, 55c, 55d, 55e, 55f, Southwold Road 6 57a, 57b, 57c, 57d, 57e, 57f, Southwold Road 6 18, 20, 22, 24, Homerton Row 12 1 to 12, Oswald Mansions 12 74 No. of Premises. Tenements. 1 to 21, Northumberland Mansions 21 60, Kenninghall Road 4 2 to 25, Seal Street 49 1 to 21, April Street 42 1 to 8, Perch Street 16 96 , 98, 100, Lower Clapton Road 6 1 to 10, Hornsey Buildings 10 1 to 12, Rushmore Road 12 1 to 24, Lion Flats, Mandeville Street 24 1 to 8, College Mansions 8 1 to 9, Belsham Street, Morning Lane 20 13 to 23, Belsham Street 24 25 to 31, Belsham Street 14 4 to 14, Belsham Street 24 40, 42, 44, Stockmar Road, Morning Lane 12 77, 79, 81, 83, 85, 87 & 91, Pedro Street 14 11 & 11a, Hilsea Street 2 13 & 13a, Hilsea Street 2 15 & 15a, Hilsea Street 31 & 31a, Hilsea Street 2 33 & 33a, Hilsea Street 2 221 to 239, Cassland Road 19 16 to 48, Rushmore Road 51 26, Chatham Place 3 2 to 18 Margaret Street 9 49 to 81, Windus Road 17 23 & 25, Well Street (Common Lodging House) 1 14, 16, 18, 20, 22, Reading Lane 19 1,156 75 CANAL BOATS ACTS, 1877-1894. The Canal Boats Inspector reports that he made 69 visits to the waterways in the Borough during 1911, and inspected 27 boats during that period. No infringements of the Canal Boats Acts or Regulations were observed on these visits. A copy of the Canal Boats Inspector will be found in the appendix to this report. ICE CREAM VENDORS. At the end of 1911 there were 175 ice cream vendors in the Borough, an increase of 16 on the number present at the end of 1910. The number of inspections of these premises made during the year was 193. Defects were found in 21 of these premises, which were remedied on the service of intimation notices. GLANDERS AND FARCY ORDER, 1907. I received 2 notifications from the Veterinary Inspectors of the London County Council of glanders in animals in the Borough during 1911 under the above order. In each case, I had the premises inspected and made enquiries respecting the health of the stablemen, &c., but in no case did it appear that the disease had been conveyed to human beings. DISEASES OF ANIMALS ACTS—ANTHRAX ORDER OF 1910. During the year I received one notification of the existence of anthrax on premises in the Borough HOUSING OF THE WORKING CLASSES ACTS, 1890-1903. No representation was made nor action taken under the above Acts during the year 1911. 76 HOUSING, TOWN PLANNING, ETC., ACT, 1909. In accordance with a resolution passed by the Public Health Committee and approved of by the Borough Council, I submitted to the Committee during the year 1911 the undermentioned lists of houses which in my opinion should be inspected under Section 17 of the above Act, viz.:— Jan. 5th, 1911. Nos. 1 to 16, Helmsley Place (consecutive numbers). „ 7 to 18, Helmsley Street (consecutive numbers). „ 1 to 79, Nisbet Street (odd numbers). „ 2 to 72, Nisbet Street (even numbers). March 16th, 1911. Nos. 1 to 77, Chalgrove Road (odd numbers). „ 2 to 110, Chalgrove Road (even numbers). March 30th, 1911. Nos. 1 to 21, Marian Street (odd numbers). „ 2 to 32, Marian Street (even numbers). „ 11 to 23, Woolpack Place (odd numbers). „ 10 to 16, Woolpack Place (even numbers). „ 1 to 21, Ribston Street (odd numbers). „ 2 to 4, Ribston Street (even numbers). „ 14 to 20, Ribston Street (even numbers). „ 1 to 11, Hockley Street (consecutive numbers). „ 13 to 18, Hockley Street (consecutive numbers). „ 18 to 29, Hockley Street (consecutive numbers). These premises were duly inspected by Sanitary Inspectors Vobe and Hall under my supervision and notices were served as provided by the Act for any defects found. The following table gives information respecting the inspection of the above dwelling-houses as required by Article V. of the Regulations made under Section 17 (1) of the Housing Town Planning, etc., Act, 1909. 77 General character of defects found to exist in dwellings inspected during 1911, under Section 17, Housing and Town Planning Act, 1909. No. of premises where the conditions were found to be satisfactory or otherwise under the following heads:— Helmsley Place. Helmsley Street. Chalgrove Road. Nisbet Street. Marian Street. Hockley Street. Ribstone Street. Woolpack Place. Satisfactory. Unsatissactory. Satisfactory. Unsatisfactory. 1. The arrangements for preventing the contamination of the water supply 113 – 144 3 2. Closet accommodation 113 – 147 – 3. Drainage 109 4 111 36 4. The condition of the dwelling-house in regard to light, the free circulation of air, dampness and cleanliness 13 100 16 131 5. The paving, drainage and sanitary condition of any yard or out-houses belonging to or occupied with the dwelling-house 93 20 113 34 6. The arrangements for the deposit of refuse and ashes 98 15 90 57 7. The existence of any room which would, in pursuance or sub-section (3) of Section 17 of the Act of 1909, be a dwelling-house so dangerous or injurious to health as to be unfit for human habitation 113 – 147 – 8. Any defects in other matters which may tend to render the dwellinghouse dangerous or injurious to the health of the inhabitants 42 71 57 90 73 THE RIVER LEA. Owing to the hot weather experienced during last summer, combined with an exceptionally small rainfall, the river Lea, which it will be remembered, receives the effluents from the sewage farm and the Leyton sewage works, became very offensive. As a result a letter was received from the Local Government Board early in July enclosing copy of a communication from the tenant of the White Hart Hotel, Temple Mills, complaining of a nuisance from the River Lea alongside his premises, and asking for the observations of the Borough Council upon the subject. I immediately had a sample of the Lea water taken from the Lead Mill Stream as it flows past the White Hart Hotel, and submitted to the public analyst. The following is a copy of his certificate of analysis. I also made an inspection of that part of the river complained of, and found its condition so foul as to justify the complaint which had been made. I reported to the Public Health Committee the result of my inspection and in consequence the Town Clerk was instructed to forward the following letter to the Local Government Board in answer to their communication of the 30th June. Certificate of Analysis. Sample of water received from the Hackney Borough Council on 4th July, 1911. Sample mark—Taken from Bridge, White Hart, Temple Mills, 3rd July, 1911. Seal . Weight On analysis the sample yielded— Total solid residue 48.8 grains per gallon. Organic in solution 16.2 „ Suspended matter .5 „ Chlorine 5.6 „ As NaCl 9.2 „ Free Ammonia 10.64 „ 79 Organic Ammonia .9800 grains per gallon. Oxygen required by organic matter .4240 „ Nitrates Absent. Nitrites „ Sulphuretted hydrogen „ This sample when received was foul in odour and the chemical and physical results indicate heavy sewage pollution. On keeping, the odour became less offensive. (Signed) LEO. TAYLOR, F.I.C., &c. 11th July, 1911. [Copy.] Metropolitan Borough of Hackney. Town Hall, Hackney, N.E. 17th July, 1911. W. A. Williams, Town Clerk and Solicitor. Sir, I am directed by the Hackney Borough Council to acknowledge the receipt of your letter of the 30th June last forwarding copy of a letter addressed to the Board by Mr. G. H. Riches of the White Hart Hotel, Hackney Marshes, complaining of a nuisance arising from the river alongside his premises. In reply, I beg to inform you that the complaint has been investigated by the Medical Officer of Health to the Borough, and he reports that the Lead Mill Stream which is complained of, receives the combined effluents from the Walthamstow Sewage Farm and the Leyton Sewage Works, and in consequence of the diminished flow of the stream and the recent high atmospheric temperature, rapid decomposition of the sewage effluents takes place, giving rise to foul effluvia. A sample of water has been taken from the Lead Mill Stream near the White Hart Hotel and submitted to the Borough Public Analyst for analysis. A copy of his report is enclosed. 80 Many representations have been made by the Hackney Sanitary Authority from time to time respecting this nuisance both to the local authorities in fault and to the Local Government Board and the Lee Conservancy Board, but as yet without any permanent result. The Hackney Borough Council are advised by their Medical Officer of Health that until the effluents in question are entirely diverted from the river the nuisance will be constantly recurring when the atmospheric and other conditions are favourable. I am to add that the Borough Council have again communicated with the Walthamstow and Leyton Sanitary Authorities and the Lee Conservancy Board informing them of the nuisance complained of and requesting them to take the earliest steps to prevent its recurrence. I am, Sir, Your obedient servant, (Signed) W. A. WILLIAMS, The Secretary, Town Clerk. Local Government Board, Whitehall, S.W. 1. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1908. 2. PUBLIC HEALTH (TUBERCULOSIS IN HOSPITALS) LATIONS, 1911. 3. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1911. On the 1st May, 1911, the Public Health (Tuberculosis in Hospitals) Regulations, 1911, came into force. These regulations supplemented and extended the regulations applying to tuberculosis made in the year 1908, and have for their objects the notification by medical officers of hospitals of all cases of pulmonary tuberculosis upon whom such medical officers are in attendance at the hospital. The medical officers of hospitals are required to send such notifications to the medical officer of health of the district in which the hospital is situate. If the patient's residence is not situate in 81 the same district as the hospital, the medical officer of health will forward the certificate to the medical officer of the area in which it is situate. The fee to be paid to the medical officer of hospitals is 1s. each notification. On the 15th November a third set of regulations—the Public Health (Tuberculosis) Regulations, 1911—were issued, but these did not come into force until the 1st January, 1912. These regulations still further supplements the two former sets of regulations already in force and completes the system of notification for tuberculosis. These regulations require every "medical practitioner attending on or called in to visit any person, within 48 hours after first becoming aware that such person is suffering from pulmonary tuberculosis" to notify the same to the medical officer of health for the area within which the residence of the patient is situate. Also every medical practitioner who is a school medical inspector is required within 48 hours of having inspected children attending a public elementary school to notify all cases of pulmonary tuberculosis of which he became aware during the course of his inspection to the medical officer of health for the area within which the school is situate. The fee to be paid to the medical practitioner for each notification is 2s. 6d., but no fee is payable to the school medical officer. The following extract from these regulations show the special powers given to local authorities to enable them to deal with pulmonary tuberculosis:— Special Powers of Councils. Article IX.—(1) For the purposes of these Regulations and of the Poor Law Regulations and of the Hospital Regulations a Council, on the advice of their Medical Officer of Health, may supply all such medical or other assistance, and all such facilities and articles as may reasonably be required for the detection of Pulmonary Tuberculosis, and for preventing the spread of infection and for removing conditions F 82 favourable to infection, and for that purpose may appoint such officers, do such acts and make such arrangements as may be necessary. Provided that nothing in this sub-division shall be deemed to authorise a Council to take any of the measures herein mentioned at any Poor Law Institution or any Hospital. (2) A Council, on the advice of their Medical Officer of Health, may provide and publish or distribute in the form of placards, handbills, or leaflets, suitable summaries of information and instruction respecting Pulmonary Tuberculosis, and the precautions to be taken against the spread of infection from that disease. 1. Public Health (Tuberculosis) Regulations 1908. During 1911 there were 562 notifications received by me under these regulations. Of these, 139 were duplications of cases notified to me during 1909 and 1910, and 189 were duplicates of cases notified for the first time during the year. The remaining 234 had the age and sex distribution as follows:— Ages and Sex of Notified Cases of Tuberculosis. Ages- Under 15 years. 15 to 25 years. 25 to 35 years. 35 to 45 years. 45 years and upwards. Totals. Males 7 32 28 38 43 148 Females 12 18 17 16 23 86 Totals 19 50 45 54 66 234 Further, 20 of the above cases were notified from the workhouse and 1 from the casual ward and 7 from the City of London Workhouse, Clifden Road. Of the cases notified, 84 died during the year, 72 in the infirmary and 12 at their homes. 83 2. Public Health (Tuberculosis in Hospitals) Regulations, 1911. Under these regulations 464 notifications were received by me during the last 8 months of the year, the. period during which the regulations were in force. Of this total 57 had been previously notified under the Poor Law Regulations and 85 were duplicates of notifications received during the 8 months mentioned. The remaining 322 primary cases had their age and sex distributed as follows:— Age and Sex of Cases Notified from Hospitals. Ages- Under 15 years. 15 to 25 years. 25 to 35 years. 35 to 45 years. 45 years and upwards. Totals. Males 11 40 40 40 39 170 Females 12 32 66 20 22 152 Totals 23 72 106 60 61 322 Further, 28 of these cases died during the year, 5 in hospitals and 23 at private addresses. Enquiries were made during the year in relation to each case notified under the " Poor Law Regulations " and the " Hospitals Regulations" as to the following circumstances : occupation; housing accommodation; sleeping arrangements; precautions refpecting expectoration; use of separate eating and drinking utensils; ventilation. Where any of the above were found to be such as to promote the danger of infection, steps were taken as far as legally possible to alter them. Measures taken during the year.—In general, these were the same as those specified in my Report for the year 1909, except that during last year on my recommendation the Public Health Committee resolved to supply sputum flasks to those tuberculous patients in the Borough needing them. The number of flasks as supplied gratuitously during 1911 was 20. The following table sets out in detail the Sanatorium and Hospital Accommodation provided by the Hackney Board of Guardians for Poor Law Cases of Pulmonary Tuberculosis. f 2 84 PHTHISIS: SANATORIUM AND HOSPITAL ACCOMMODATION. Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are patients selected ? Are patients under the care of a resident Medical Officer ? What charge, if any, is made for the use of Beds? Do the Sanitary Authority use — (1) their Isolation Hospital, or (2) their Small-pox Hospital, for cases of Phthisis ? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium: If so, how many, and in what Sanatorium ? Do the Sanitary Authority provide portable openair Shelters or Tents? (a) Early cases The Guardians of the Hackney Union. Mr. P. Harold Jones, Sanatoria at Sandgate. *9 By grant of Indoor relief by Guardians and subsequent classification by Medical Officer. Yes. None to destitute persons. Liable relatives pay according to ability. (1) No. No. No. (2) No. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *20 By grant of Indoor relief by Guardians and subsequent classfication by Medical Officer. No. Under Visiting Medical Officer. None to destitute persons. Liable relatives pay according to ability. No. No. No. (b) Intermediate cases. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *30 By grant of Indoor relief by Guardians and subsequent classification by Medical Officer. Yes. None to destitute persons. Liable relatives pay according to ability. No. No. No. (c) Advanced cases. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *48 By grant of Indoor relief by Guardians and subsequent classification by Medical Officer. Yes. None to destitute persons. Liable relatives pay according to ability. No. No. No. Total Infirmary Sandgate 120 Allotte d as required. I * These numbers are for the 1st March. 1912. and the approximate number of total Phthisis beds in the Hackney Union Infirmary is 120. 85 PUBLIC HEALTH LEGISLATION. During the year 1911, the following important Acts were passed:— National Insurance Act, 1911. An Act to provide for Insurance against Loss of Health and for the Prevention and Cure of Sickness and for Insurance against Unemployment and for purposes incidental thereto. Rag Flock Act, 1911. An Act to prohibit the sale and use for the purpose of the manufacture of certain articles of unclean Flock manufactured from Rags. 86 THE FACTORIES AND WORKSHOP ACT, 1901. Factories, Workshops and Workplaces. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 28 1 ... Workshops (Including Workshop Laundries) 2,058 238 ... Workplaces (Other than Outworkers' premises included in Part 3 of this Report) ... ... ... Total 2,086 239 ... 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 120 135 ... ... Want of ventilation 42 47 ... ... Overcrowding 13 14 ... ... Want of drainage of floors 1 2 ... ... Other nuisances 96 81 ... ... Sanitary accommodation— Insufficient 1 2 ... ... Unsuitable or defective 62 60 ... ... Not separate for sexes 1 1 ... ... Offences under the Factory and Workshop Act:— . Illegal occupation of underground bakehouses (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) ... ... ... ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report). ... ... ... ... Total 336 342 ... ... * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 87 3.—home work. Nature of Work. Outworkers' Lists, Section 107. Outworker in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on i Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices Served. Prosecutions. Instances. Orders Made (Section 110). Prosecutions (Sections 109,110). Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors Workmen. Wearing Apparel— (1) Making, &c 334 33 3,328 52 ... 375 355 ... 1 ... ... ... ... ... ... (2) Cleaning and Washing 2 ... 4 ... ... ... 1 ... ... ... ... ... ... ... ... Household Linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets 2 ... 6 1 ... 5 3 ... ... ... ... ... ... ... ... Curtains, furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 6 ... 61 ... ... ... 3 ... ... ... ... ... ... ... ... Electro-plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... File Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and Brass Articles ... ... ... ... ... ... ... ... ... Fur Pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. 2 8 1 ... 9 2 ... ... ... ... ... ... ... ... Artificial Flowers 6 ... 21 5 ... 233 10 ... ... ... ... ... ... ... ... Nets, other than Wire Nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks . 2 ... 4 ... ... ... 1 ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes 24 ... 492 ... ... ... 14 ... ... ... ... ... ... ... ... Brush Making 24 ... 603 ... ... ... 16 ... ... ... ... ... ... ... ... Pea Picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather Sorting 2 ... 6 ... ... ... 2 ... ... ... ... ... ... ... ... Cardings, &c., of Buttons, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys 2 ... 42 ... ... ... 2 ... ... ... ... ... ... ... ... Basket Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 406 33 4,575 59 ... 622 409 ... 1 ... ... ... ... ... ... 88 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of year. Number. Important classes of workshops, such as workshop bakehouses may be enumerated here. Total number of Workshops on Register 1,069 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act, (S. 133) 60 Action taken in matters referred by H.M. Inspector as remedi- able under the Public Health Acts,butnotundertheFactory and Workshop Act (S. 5) Notified by H.M. Inspector 31 Reports (of action taken) sent to H.M. Inspector ... 31 Other Underground Bakehouses (S. 101):— Certificates granted during the year In use at the end of the year 52 89 Factories.—During the year 28 factories were inspected by the officers of the Public Health Department; six being factory laundries, and twenty-two factories in which articles of clothing &c., were made and altered. In four factories the sanitary accommodation was defective or unsuitable. Nuisance. Found. Abated by Workshop Inspector. Abated by District Inspector. Outstanding Total. Unsuitable or Defective w.c.'s 4 3 1 — 4 Insufficient „ - — — — — Not separate for the sexes. - — - - — Workshops.—The number of workshops registered in Hackney at the end of 1911 was 1,069, an increase of 30 over the number registered at the end of 1910. Of this total 823 were workshops in which females were employed. Of these latter, 607 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, &c., 174 in which other articles were manufactured, and 42 were domestic workshops. Amongst the workshops manufacturing wearing apparel there were 4C3 employing female labour alone, and 144 employing both male and female labour. In workshops of other occupations there were 111 employing females alone and 63 employing both males and females. Of the domestic workshops, females were employed in 28 alone, and both males and females in 14. Thus in the total number of workshops registered in the Borough 602 employed female labour alone, 221 both male and female labour, and 246 male labour alone. During the year notices and complaints were received from H.M. Inspectors of Factories as follows :— Complaints Factories 2 ,, Workshops 31 Notices „ 166 90 ANALYSIS OF OCCUPATIONS CARRIED ON IN THE REGISTERED WORKSHOPS OF HACKNEY. (a) Wearing Apparel. Occupations. No. of Workshops. Occupations. No. of Workshops. Artificial Flower Makers 8 Hats ... 6 Baby Linen 2 Infants' Millinery .7 Beading 1 Mantles ... 53 Belts 7 Millinery ... 45 Blouses 42 Needlework 1 Boot and Shoe Manufacturers 77 Pinafores ...4 Shirts ... 5 Boot Machinists 113 Skirts ... 11 Children's Costumes 15 Stays 7 Clerical Robes 1 Tailoring ... 53 Clothing 5 Ties ... 40 Collars 2 Trimmings ... 5 Dressmakers 109 Underclothing 19 Dressing and Tea Gowns 8 Vests ... 16 Fancy Bows on Shoes 6 Waterproofs 4 Fall Net Chenilling 1 — Furriers 53 727 Gloves 1 — (b) Other Occupations. Bakers and Confectioners 27 Rubber Goods 5 Baskets 4 Toy Makers 1 Box Makers 14 Trunk and Bag Makers 5 Brush Makers 8 Umbrellas 2 Cabinet Makers 47 Upholsterers 9 Doll Manufacturers and Dressers 4 Upholsterers' Trimmings 4 Miscellaneous 85 Fancy Leather Goods 15 - Laundries 98 342 Pianoforte Makers 14 —- During 1911, Miss Teebay, the Workshop Inspector, made 2,058 inspections and re-inspections of factories and workshops where females are employed. In connection with thess inspections, 238 intimation and statutory notices were served for the abatement of the nuisances found. The following table gives further details relating to the inspection of workshops in the Borough:— 91 NUISANCES IN WORKSHOPS, 1911. Outstanding at end of 1910. Found in 1911. Outstanding at end of 1911. Abated in 1911. By Inspector of Workshops. By District Inspector. Total. Want of Cleanliness 35 123 20 135 3 138 Want of Ventilation 14 42 9 47 ... 47 Overcrowding 2 13 1 14 ... 14 Want of Drainage of Floors 7 1 6 2 ... 9 Other Nuisances 50 115 65 81 20 100 Insufficient Sanitary Accommodation 9 1 1 2 ... 2 Unsuitable or defective Sanitary Accommodation 49 79 49 60 19 79 No separate Sanitary Accommodation for sexes 4 2 4 1 1 2 92 Outworkers—The number of outworkers on the register at the end of 1911 was 3,071, against 3,174 at the end of 1910. There were thus 103 outworkers removed from the register during the past year. The following analysis shows the trades followed by these outworkers: — Trade. No. of Outworkers. Trade. No. of Outworkers.. Artificial Florist 46 Lace Trimmed Goods 8 Baby Linen 25 Millinery 180 Beading 5 Net Chenilling 9 Belts 99 Overalls 3 Blouses 182 Pinafores 11 Boots and Shoes 748 Shirts 61 Boxes 250 Shoe Bows 22 Braces 2 Skirts and Mantles 318 Brushes 168 Tailoring 228 Children's Costumes 4 Ties 276 Collars and Bibs 17 Trimming 30 Corsets 3 Umbrellas 28 Cleaning 3 Underclothing 119 Clothiers and Outfitters 84 Upholsterer's Trimmings 14 Dolls 8 Vests 11 Dressing and Tea Gown 13 Waistcoats 6 Fancy Goods 11 Waterproofs 2 Fur Trade 62 Feather sorting 7 —- Hats 8 3,071 The local authorities from which I have received names and addresses of outworkers during the last year are the following: Battersea 6 Paddington 5 Bethnal Green 402 Poplar 104 Camberwell 10 St. Marylebone 52 Chelsea 8 St. Pancras 2 City of London 1,442 Shoreditch 208 East Ham 2 Southgate 5 Finsbury 636 Southwark 18 Fulham 1 Stepney 99 Hampstead 9 Stoke Newington 77 Holborn 8 Tottenham 17 Hornsey 2 Walthamstow 25 Ilford 3 Wandsworth 1 11 Islington 300 West Ham Kensington 14 Westminster 12 Lambeth 2 Willesden 1 Leyton 25 3,507 93 On examination of the lists of outworkers sent in by employers in this Borough during 1911, I found 2,477 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:— Acton 1 Amersham 3 Bermondsey 8 Bethnal Green 691 Brentford 2 Camberwell 37 Chingford 1 Chiswick 6 City of London 2 Croydon 2 Deptford 2 East Ham 12 Edmonton 9 Enfield 5 Erith 1 Finsbury 22 Great Missenden 1 Greenwich 1 Hammersmith 1 Holborn 2 Hornsey 8 Ilford 10 Islington 245 Kensington 1 Lambeth 8 Lewisham 3 Leyton 103 Manchester 1 Poplar 217 St. Pancras 9 Shoreditch 349 Southwark 8 Stepney 238 Stoke Newington 133 Teddington 1 Tottenham 103 Walton-on-Thames 1 Walthamstow 182 Wandsworth 4 Welling 1 Westminster 3 West Ham 32 Woodford 2 Wood Green 4 Woolwich 2 2,477 During the year 1911 Miss Portlock (the Inspector appointed for the inspection of outworkers' premises) made 1,171 inspections and 682 re-inspections. She also made 877 visits without inspection, the outworkers either having moved or being deceased (464), or having given up homework (117), or being out at the time of 94 visit (140), or owing to a wrong address being given (91), or the premises being workshops (19), or male workers only being employed (46). During her visits Miss Portlock discovered 720 sanitary defects. For the abatement of these she served 414 intimation notices and 38 final notices. Of the 1,171 premises inspected, in 62 only was a room set apart entirely for work. In the remainder work was carried on in rooms used for other purposes, as set out below:- Workroom, bedroom and kitchen 73 „ „ and living room 42 „ and kitchen 771 „ „ bedroom 132 „ „ parlour 76 „ „ scullery 12 „ „ bath room 2 „ „ landing 1 Workroom only 62 Total 1,171 95 The following table gives details of the nuisances found and their abatement:— NUISANCES IN OUTWORKERS' PREMISES, 1911. Outstanding at end of 1910. Found in 1911. Outstanding at end of 1911. Abated in 1911:— By Inspector of Outworkers. By District Inspector. Total. Want of Cleanliness 52 280 68 263 1 264 Want of Ventilation 3 18 5 16 ... 16 Overcrowding ... 8 2 6 ... 6 Number of Premises on which other Nuisances found 53 297 45 289 16 305 Sanitary Accommodation Defective 22 177 15 109 13 122 96 DISINFECTION. (a) Rooms.—During the year 1911 there were 2,810 rooms fumigated and 783 rooms cleansed in Hackney by the staff of the Public Health Department. In these totals are included the disinfections not only after cases of the notifiable infectious diseases but also disinfection after phthisis, measles, and whooping cough. The number of rooms fumigated and cleansed each month is set out in the following table:— Number of Rooms Fumigated and Cleansed each Month during 1911. Month. Rooms Fumigated. Rooms Cleansed. Remarks. January 195 60 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 acid. The ceilings are afterwards whitened. February 220 52 March 360 56 April 342 44 May 213 51 June 192 45 July 158 48 August 141 68 September 232 71 October 339 102 November 240 103 December 178 83 Total 2,810 783 (b) Articles of Clothing and Furniture.—The number of articles under this head disinfected last year was 17,626. This is an increase of 5,814 over the number disinfected during 1910. This increase is due not only to an increase of infectious disease in the Borough but also to an increase in the number of articles disinfected from homes where consumption existed, and from verminous premises. 97 Articles Disinfected during the Year 1911. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. HOUSE LINEN. Beds (feather, flock, wool) 1ll 143 244 209 150 133 113 115 189 199 152 137 1,895 Bed Vallance 9 ... ... ... ... ... ... ... ... ... ... ... 9 „ Covers 18 ... ... ... ... ... ... ... ... ... 8 9 35 „ Furniture ... ... ... 32 22 16 5 14 18 22 52 48 229 Blankets 137 106 242 203 141 90 76 56 112 217 187 247 1,814 Bolsters 86 98 134 115 91 58 67 69 115 136 128 135 1,232 Box Covers ... ... ... ... ... ... ... ... ... ... ... ... ... Carpets 25 10 1 16 9 ... ... ... ... ... 1 ... 62 Chair Bed Cushions ... 43 74 46 16 32 7 11 26 23 23 15 316 Coverlets ... ... ... ... ... ... ... ... ... ... ... ... ... Cushions 30 25 24 27 25 11 7 2 15 24 16 11 217 Glass Cloths ... ... ... ... ... ... ... ... ... ... ... ... ... Hearth Rugs 6 4 ... 2 14 5 2 6 ... ... 9 3 51 Mattresses (Horse-hair, Wool, Straw or Spring 70 62 100 124 77 45 53 43 70 131 110 95 980 G 96 DISINFECTION. (a) Rooms.—During the year 1911 there were 2,810 rooms fumigated and 783 rooms cleansed in Hackney by the staff of the Public Health Department. In these totals are included the disinfections not only after cases of the notifiable infectious diseases but also disinfection after phthisis, measles, and whooping cough. The number of rooms fumigated and cleansed each month is set out in the following table:— Number of Rooms Fumigated and Cleansed each Month during 1911. Month. Room's Fumigated. Rooms Cleansed. Remarks. January 195 60 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 acid. The ceilings are afterwards whitened. February 220 52 March 360 56 April 342 44 May 213 51 June 192 45 July 158 48 August 141 68 September 232 71 October 339 102 November 240 103 December 178 83 Total 2,810 783 (b) Articles of Clothing and Furniture.—The number of articles under this head disinfected last year was 17,626. This is an increase of 5,814 over the number disinfected during 1910. This increase is due not only to an increase of infectious disease in the Borough but also to an increase in the number of articles disinfected from homes where consumption existed, and from verminous premises. 97 Articles Disinfected during the Year 1911. Description of Articles. January. February. March. April. May. June. July. August. September October. November December. Total. HOUSE LINEN. Beds (feather, flock, wool) 111 143 244 209 150 133 113 115 189 199 152 137 1,895 Bed Vallance 9 ... ... ... ... ... ... ... ... ... ... ... 9 „ Covers 18 ... ... ... ... ... ... ... ... ... 8 9 35 „ Furniture ... ... ... 32 22 16 5 14 18 22 52 48 229 Blankets 137 106 242 203 141 90 76 56 112 217 187 247 1,814 Bolsters 86 98 134 115 91 58 67 69 115 136 128 135 1,232 Box Covers ... ... ... ... ... ... ... ... ... ... ... ... ... Carpets 25 10 1 16 9 ... ... ... ... ... 1 ... 62 Chair Bed Cushions ... 43 74 46 16 32 7 11 26 23 23 15 316 Coverlets ... ... ... ... ... ... ... ... ... ... ... ... ... Cushions 30 25 24 27 25 11 7 2 15 24 16 11 217 Glass Cloths ... ... ... ... ... ... ... ... ... ... ... ... ... Hearth Rugs 6 4 ... 2 14 5 2 6 ... ... 9 3 51 Mattresses (Horse-hair, Wool, Straw or Spring) 70 62 100 124 77 45 53 43 70 131 110 95 980 G 98 Articles Disinfected during the Year 1911 — continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. Mats ... ... ... 4 ... ... ... ... ... ... ... 16 20 Matting ... ... ... ... ... ... ... ... ... ... ... ... ... Palliases 11 2 35 8 18 6 4 14 66 49 17 12 242 Pillows 267 231 409 370 251 205 184 209 298 373 360 286 3,443 Pillow and Bolster Cases ... 4 ... ... ... ... ... ... ... ... ... ... 4 Quilts 90 120 180 151 122 80 68 56 98 156 130 152 1,409 Round Towels ... ... ... ... ... ... ... 1 ... ... ... ... 1 Rugs 10 4 5 16 ... 2 2 29 5 ... 16 7 96 Sheets 102 92 151 107 127 89 95 47 126 170 156 154 1,416 Sofa Squabs ... ... ... ... ... ... ... ... ... ... ... ... ... Table Cloths ... 1 1 ... 9 1 ... 3 ... 5 2 22 Toilet Covers ... ... ... ... 13 ... 1 ... ... ... ... ... 14 Towels 8 12 14 11 17 4 5 8 1 18 23 9 130 Window Blinds ... ... ... ... ... ... ... ... ... ... ... ... ... Window Curtains 5 8 9 7 18 4 2 4 6 5 16 18 102 13,739 99 Articles Disinfected during the Year 1911— continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. MEN'S. Caps ... ... 1 ... ... ... ... ... ... ... ... ... 1 Coats 7 24 30 14 25 14 9 2 13 16 19 14 187 Collars ... ... ... ... ... ... 12 ... ... ... ... 12 Drawers 12 12 5 7 ... 2 ... 15 ... 25 10 5 100 Flannels ... ... ... ... ... 3 4 ... ... ... ... ... 7 Flannel Vests 13 4 13 9 2 6 7 12 23 6 27 122 Hats ... ... ... ... ... ... ... ... ... ... ... ... ... Neck Ties ... 2 ... ... ... ... ... ... ... ... ... ... 2 Night shirts 1 7 1 9 13 ... 4 8 6 4 4 9 66 Shirts 15 11 11 7 7 11 4 7 4 25 9 14 125 Socks 10 6 11 10 9 ... 10 2 12 22 14 2 108 Suits of Clothes ... ... 3 ... ... ... ... ... 3 9 ... ... 15 Trousers 2 4 3 8 12 7 8 5 5 10 12 76 G 2 100 Articles Disinfected during the Year 1911 — continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. Ulsters ... ... 2 3 ... ... ... ... ... ... ... ... 5 916 Waistcoats 13 3 3 5 9 6 5 7 1 16 11 11 90 WOMEN'S. ... ... ... ... ... ... ... ... ... ... ... ... ... Aprons 3 ... ... ... 2 ... ... ... ... 4 8 17 Caps 2 5 ... ... ... ... ... ... ... ... ... 4 11 Chemises 17 8 23 17 25 14 16 9 14 43 29 26 241 Cloaks ... ... 1 ... ... ... ... ... ... ... ... ... 1 Collars ... ... ... ... ... ... ... ... ... ... ... ... ... Corsets 7 1 6 10 7 ... 3 1 9 21 12 16 93 Cuffs ... ... ... ... ... ... ... ... ... ... ... ... ... Drawers 20 10 5 4 11 6 4 ... 6 21 12 16 115 Dresses ... ... ... ... 1 ... ... 2 ... ... 6 ... 9 Dress Bands ... ... ... ... ... ... ... ... ... ... 12 ... 12 Dressing Gowns 1 2 1 17 10 4 9 6 ... 10 1 4 65 101 Articles Disinfected during the Year 1911.-continued. Description of Articles. January. February. March. April. May. June. July. August. September October. November December. Total. Flannel Petticoats 4 ... ... 8 ... ... 1 ... ... ... ... ... 13 „ Vests 5 9 25 1 10 11 5 l4 7 25 26 24 162 Jackets 7 1 ... 5 1 1 ... ... 21 15 36 5 92 Night Dresses 23 7 6 7 28 9 7 7 14 6 16 23 153 Petticoats 25 9 12 12 10 12 2 8 9 28 28 14 169 Petticoat Bodices 1 3 7 ... ... ... ... 2 ... ... ... ... 13 Sashes ... ... ... ... ... ... ... ... ... ... ... ... ... Shawls 12 15 1 13 5 20 4 ... 6 16 13 15 120 Skirts 4 7 4 5 8 4 1 8 18 9 8 9 85 Stockings 16 10 8 6 4 4 8 2 12 36 36 14 156 1,527 CHILDREN'S. Boys' Knickers 17 6 4 8 4 3 ... 1 6 13 17 16 95 „ Jackets 7 5 16 10 6 8 5 5 8 21 21 19 131 „ Suits ... ... ... ... ... 1 ... ... ... ... ... ... 1 102 Articles Disinfected during the Year 1911—continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. Feeders ... ... ... • • • ... ... ... ... ... ... ... ... ... Frocks 13 ... ... 6 7 1 5 4 8 17 11 4 76 Pelisses ... ... ... ... ... ... 8 ... 1 ... ... ... 9 Pinafores 9 1 ... ... ... 1 1 ... 10 7 4 21 54 366 OTHER ARTICLES. Boots ... ... ... ... ... ... ... ... 2 ... ... ... 2 Handkerchiefs 7 12 8 3 23 C 11 3 1 24 30 22 150 Shoes ... ... ... ... ... ... ... ... ... ... ... ... ... Slippers ... ... ... ... ... ... ... ... ... ... ... 4 4 SUNDRIES 139 74 119 43 75 28 20 56 68 97 101 102 922 1,078 1,403 1,223 1,952 1,695 1,437 960 852 877 1,424 2,082 1,917 1,804 Total 17,626 103 In addition to these there were 193 articles destroyed on request from the owners. These are set out in the following table:— Articles Destroyed. Beds 50 Mattresses 26 Bolsters 8 Overlays 1 Blankets 2 Pillows 23 Curtains 2 Palliasses 30 Cushions 10 Sheets 2 Hats 24 Sundry Articles 15 Total 193 (c) Public Library Books.—During the past year, 272 books were disinfected from homes in which infectious diseases had occurred. Of the total, there were 245 books which had been borrowed from the Hackney Borough Library and 27 from other Libraries. Books Disinfected, 1911. Number of Books Disinfected. Month. From Hackney Public Library. From other Libraries. Totals. January 28 ... 28 February 14 3 17 March 15 3 18 April 25 2 27 May 6 ... 6 June 8 2 10 July 16 2 18 August 15 1 16 September 9 ... 9 October 35 4 39 November 39 4 43 December 35 6 41 Total 245 27 272 104 Summary of persons lodged and maintained at the Council's Shelter in Millfields Road, Clapton, N.E., during the year ended 31st December, 1911. Month. No. of Persons Admitted. Cost of Maintenance. Average period of Stay. Diseases. Men. Women. Children. Total. £ s. d. January ... ... ... ... Days. ... February ... 2 2 4 0 6 0 1 1 case of Phthisis March 1 1 1 3 0 7 6 2 1 case of Measles April 2 2 ... 4 0 10 0 2 2 cases of Measles. May 1 2 3 6 0 14 0 2 2 cases of Measles. June ... ... ... ... ... ... July 3 1 1 5 0 8 9 1.5 1 case of Measles. 1 case of Scarlet Fever. August ... ... ... ... ... ... September ... 1 ... 1 0 1 6 1 1 case of Whooping Cough. October 1 1 ... 2 0 2 6 1 1 case of Erysipelas. November 2 3 2 7 0 9 0 1 1 case of Typhoid Fever. 1 cases of Scarlet Fever. 1 case of Diphtheria. December 1 1 1 3 0 3 9 1 1 case of Scarlet Fever. 1 case of Typhoid Fever. 11 14 10 35 3 3 0 1.4 105 THE SHELTER. During 1911, there were 35 persons admitted to the Shelter whilst their homes were being disinfected. This total consisted of 11 men, 14 women and 10 children. This is an increase of one person admitted during 1910. The cost of maintenance of the 35 persons thus admitted was £3 3s. Od. The average duration of stay in the shelter was 1.4 days. The table on page 104 gives further particulars relating to these contacts. No expenses were incurred during the year in the conveyance of persons to and from the shelter. CLEANSING OF PERSONS ACT, 1897. The facilities provided by the Hackney Borough Council under the above Act for the cleansing of verminous persons, were taken advantage of during the past year by 721 persons, who presented themselves at the station for cleansing. The following shows the number of baths given to persons affected with vermin since the baths were first provided:— Year. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 No. of Baths 3 11 9 241 330 457 724 667 568 721 Of the total 721 baths given, 67 were sulphur baths for scabies and 654 for pediculi. Amongst the number presenting themselves for baths, the great majority were children from the public elementary schools. These numbered 544, an increase of 192 on the number cleansed during 1910. 106 These numbered 544, an increase of 192 on the number cleansed during 1910. Schools. No. Cleansed. Schools. No. Cleansed. Hot Baths. Sulphur Baths. Hot Baths. Sulphur Baths. Ballance Road, R.C. 1 1 Brought forward 301 36 Benthal Road 7 ... Mayfield Road Berkshire Road 28 12 (Holy Trinity) 9 ... Berger Road 40 15 Mandeville Street 82 1 Daubeney Road 51 2 Morning Lane 22 ... Detmold Road 24 ... Northwold Road 1 ... Eleanor Road 1 2 Orchard Street 8 ... Gainsboro' Road 22 ... Percy Road 3 ... Gayhurst Road 3 ... Rushmore Road 6 ... Glyn Road 31 ... Sigdon Road 6 ... Hackney Parochial 5 1 Sidney Road 36 5 Hindle Street 19 ... St. John's, R.C. 8 ... Homerton Row 60 2 St. Michael's 2 ... London Fields 6 1 Tottenham Road 3 ... Millfields Road 3 Carried forward 301 36 Totals 487 42 Schools outside Borough sending Children. Brought forward 5 ... Chisenhale Road,Old Ford 3 ... Princess May Road 1 ... Mowlem Street 3 ... Church Street 2 ... Pritchards Road 3 ... Carried forward 5 ... Total 12 ... Sent by Doctor 13 107 The following table gives particulars of the number, etc., 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 15 13 17 8 15 29 13 22 22 ... ... ... 154 Women ... ... 1 ... ... ... ... ... ... ... ... ... 1 Children 8 16 23 3 13 19 11 ... 14 125 137 130 499 654 Receiving Sulphur Baths. Men 1 ... ... 1 2 1 1 1 ... ... ... ... 7 Women ... ... ... ... ... 1 1 3 ... ... ... ... 5 Children 4 13 6 3 1 1 14 5 8 ... ... ... 55 67 108 The following 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, 1911. Shelters. £ s. d. £ s. d. Wages—Female Caretaker 50 0 1 Subsistence allowance 3 3 0 Maintenance, Repairs, etc. Electricity supply 6 3 3 Water 4 12 0 Electric Fittings 1 4 7 Coals 3 5 1 Stores, etc 4 8 5 Matron's Uniform 0 19 8 Repairs 9 8 4 Fireguard 0 10 6 30 11 10 83 14 10 Disinfecting Station. Wages 383 17 3 Electricity Supply 12 6 6 Water 9 2 0 Hire of Horse 76 0 0 Repairs— To Caretaker's House 18 6 8 To Station 6 17 6 To Boiler 23 5 5 Engine Fitters (Wages) 40 4 1 Laundryman ,, 5 1 4 93 15 0 Compensation—Damage to Clothes 0 2 6 Formalin Lamp 1 0 0 Electric Fittings 2 9 3 Tank 6 0 0 Boiler Powder, Engine Oil, Gauge Charts, &c. 7 3 4 Coal— Steam 47 10 2 Kitchen (lodge) 6 10 2 54 0 4 Stores, Firewood, etc. 8 16 1 Attendant's Wages—Baths for Verminous Children 8 11 0 Towels Brushes, etc. 4 12 7 Potassium Sulphide 0 7 6 13 11 1 £668 4 2 109 Cleansing Verminous or Filthy Children attending Public Elementary Schools. By Section 122 of the Children Act, 1908, the local education authority have power to cleanse any children attending a public elementary school whose clothes or persons are verminous or filthy, and, may also by the same Section, require any Sanitary Authority within their district, who have provided premises or appliances, to allow them to use such premises and appliances for the above purposes. The Hackney Borough Council having provided premises and appliances under the Cleansing of Persons Act, 1897, the London County Council, being the local educational authority, applied to the Hackney Borough Council in July last for the loan of their cleansing station, &c., for the cleansing of elementary school children. The application was agreed to, subject to the following terms:— 1. The Borough Council will reserve their said cleansing station at Millfields Road aforesaid hereinafter referred to as the cleansing station on Monday, Wednesday and Friday in every week from the date hereof between the hours of nine o'clock in the morning and four o'clock in the afternoon for the exclusive use of children who may be sent to the cleansing station by the Council in pursuance of this Agreement. 2. The Borough Council will on the days and between the hours aforesaid properly cleanse to the reasonable satisfaction of the Council at the cleansing station the persons and clothing of children infested with vermin or in a foul or filthy condition who may be sent to the cleansing station by the Council for the purpose of such cleansing provided that such children are in attendance at public elementary schools and that the Borough Council shall not be required to cleanse more than ten children in any one day or thirty children in any one week. 110 3. The Borough Council will provide sufficient and competent assistants for the purpose of effecting the cleansing of children under this Agreement the cleansing of girls to be effected by women only. 4. The cleansing station shall during the continuance of this Agreement be kept entirely separate from any premises used by the Borough Council for the isolation of suspected cases of infectious disease contacts. 5. The Council will pay to the Borough Council in respect of each child cleansed under this Agreement the sum of two shillings, such payment of two shillings in respect of each child to cover any number of attendances by such child at the cleansing station for the purpose of such cleansing within the period of one calendar month from the date upon which the child is first cleansed there and to be irrespective of the number of baths required before the child can reasonably be regarded as cleansed. 6. The Borough Council will render quarterly accounts to the Council in respect of the payments to be made by the Council under this Agreement, and for the purpose of verifying the amounts payable by the Council will produce for the inspection of the Council's Officers such vouchers, books, and other documents as may reasonably be required. 7.—The Agreement shall remain in force for one year from the date hereof. Provided always that if the parties hereto shall so agree by Memorandum in writing under the hands of the Clerk of the Council and the Town Clerk of the Borough Council, the Agreement may be renewed upon the terms stated in such Memorandum. In order to assure proper cleansing of the children, the Public Health Committee authorised me to engage a suitable woman for the special purpose of cleansing the children, sent to the station, under the supervision of the nurse appointed by the London County Council, who is always present during the cleansing. 111 The work of cleansing under the Agreement commenced on August 1st last year. Up to the end of December 391 children had been cleansed at the Borough station, and their clothes thoroughly disinfected. Amongst these children 14 had to be cleansed a second time, no doubt due to re-infection. The schools attended by the children cleansed are given on page 106 of this report. London County Council (General Powers) Act 1904. Under part IV. of this Act a Sanitary Authority on the Certificate of their Medical Officer of Health may cleanse or purify or destroy at their own expense, any articles in any house in their district which are in such a filth}', dangerous or unwholesome condition that health is affected or endangered thereby, or to prevent risk of, or to check infectious disease. A Sanitary Authority may also on the certificate of their Medical Officer of Health, that any house in their district is infested with vermin, serve a notice on the owner or occupier of such house requiring him within a specified time to cleanse the house; if necessary stripping the paper from the walls, and to take such other necessary steps to destroy and remove all vermin. The sanitary authority, in default of the owner or occupier, may do the work required by the notice, and recover the reasonable expenses from the person in default. In connection with the scheme of cleansing verminous children, the London County Council at the time of cleansing any particular child asks the sanitary authority to deal with the homes, that is, to cause an inspection of the home to be made, and if it or the articles contained therein are either verminous or filthy, to deal with them in accordance with Part IV., Sec. 19 and 20 of the above Act. During the year 1911 my attention was drawn by the Medical Officer (Education) to 450 homes in the Borough from which 112 children were attending school in a verminous condition. I had all these inspected, with the following result:— No. of Homes Inspected. No. of Homes where Rooms alone were found Verminous. No. of Homes where Bedding or Clothes and Rooms were found Verminous. No. of Homes not Verminous. 450 93 52 295 Amongst the 145 verminous homes there were 52 where bedding and clothes were found to be infected as well as the walls of the rooms. The bedding and clothing were taken in these instances to the disinfecting station and steamed. The verminous rooms were fumigated and, where necessary, notices were served upon the owners to cleanse and strip the rooms to free them from vermin. REMOVAL OF HOUSE REFUSE. The total quantity of house refuse removed from occupied houses in the Borough to the Destructor by the Council's contractors during the year 1911, amounted to 39,024 tons 3 cwts. 3 qrs. and 21 lbs. From the North Division 18,043 tons 1 cwt. 2 qrs. and 7 lbs., and from the South Division 20,981 tons 1 cwt. 3 qrs. and 14 lbs. were removed at the rate of 4s. 5d. per ton, and a total cost of £8,561 14s. 11d. The quantity of house refuse removed during 1911 shows a decrease upon that removed during 1910 to the extent of 457 tons. This no doubt was due to the summer weather experienced last year. The above total cost for the removal of house refuse is therefore £157 1s. 11d. less than that for the year 1910. The cost of disposal of the house refuse removed to the destructor during 1911, which includes the destruction of the refuse by fire and the disposal of the clinker arising from the refuse, together with tins and other non-combustible material, has been estimated by the Borough Electrical Engineer at the rate of 36.25d. per ton, the total cost of destruction being £6,010 17s. 3d. This total is £139 15s. 3d. more than that for the year 1910. The total cost both for removal and destruction of the house refuse of the Borough during 1911 is, therefore, £14,572 12s. 2d., being £17 6s. 8d. less than the total expenditure during 1910. Distributing the above total cost over the estimated population of the Borough, it amounts to nearly 1s. 3¾d. per head. 113 I give below a table showing the number of "refusals" and "no answers " given to the dustman at their weekly calls. DUST REFUSALS AND NO ANSWERS FOR THE YEAR 1911. Week ending Refusals. No Answers. Week ending Refusals. No Answers. Jan. 7th 3,954 416 July 1st 3,952 416 „ 14th 4,337 520 „ 8th 4,106 409 „ 21st 4,481 438 „ 15th 4,372 472 „ 28th 4,735 462 „ 22nd 5,001 398 Feb. 4th 3,846 543 „ 29th 4,311 435 „ 11th 4,562 427 Aug. 5th 4,509 416 „ 18th 3,983 471 „ 12th 4,481 482 „ 25 th 4,431 508 „ 19th 3,995 503 Mar. 4th 4,365 491 „ 26 th 3,857 478 „ 11th 4,721 488 Sept. 2nd 4,111 466 „ 18th 3,966 421 „ 9th 4,538 471 „ 25th 4,159 436 „ 16th 3,916 508 April 1st 4,161 427 „ 23rd 4,219 483 „ 8th 4,638 441 „ 30th 4,315 475 „ 15th 4,550 519 Oct. 7th 3,864 462 „ 22nd 5,102 543 „ 14 th 4,137 486 „ 29th 4,791 461 „ 21st 4,312 476 May 6th 4,683 430 „ 28th 4,529 447 „ 13th 3,958 329 Nov. 4th 4,408 469 „ 20th 4,274 385 „ 11th 4,635 422 „ 27th 4,519 417 „ 18th 3,958 398 June 3rd 4,407 462 „ 25th 4,170 487 „ 10th 5,102 476 Dec. 2nd 4,317 445 „ 17th 4,825 481 „ 9th 3,872 503 „ 24th 4,716 397 16th 3,927 468 „ 2.3rd 4,009 472 30th 4,124 413 The following table shows the number of requests for the removal of house refuse during the ten years ending 1911:— List of the requests for the removal of Dust during the ten years ending December, 1911. 1902 1903 1904 1905 1905 1907 1908 1909 1910 1911 Jan 31 28 28 12 14 12 6 4 4 1 Feb. 6 11 3 5 5 5 6 5 6 5 March 20 23 10 6 6 10 4 4 8 10 April 20 63 21 10 14 9 3 4 9 10 May 11 43 11 10 7 6 11 11 5 13 June 12 45 18 16 13 11 11 10 3 14 July 119 47 19 16 16 7 6 10 0 20 August 53 12 10 8 3 9 5 9 6 12 Sept. 17 25 6 9 8 6 5 4 1 19 Oct. 15 13 14 6 1 2 5 1 3 7 Nov. 16 10 5 6 4 5 3 2 3 7 Dec. 35 11 10 4 7 7 2 6 4 12 Totals 355 331 155 108 98 89 89 70 52 136 H 114 DUSTING ACCOUNT, 1911. Month, Northern Division. Southern Division. Totals. Weight. Cost. Weight. Cost. Weight. Cost. tons cts. qrs lbs. £ s. d. tons cts. qrs. lbs. £ s. d. tons cts. qrs lbs. £ s. d. January 1,754 4 0 7 387 7 9 2,016 4 2 7 445 5 0 3,770 8 2 14 832 12 9 February 1,773 1 0 21 391 11 0 2,046 2 2 21 451 17 0 3,819 3 3 14 843 8 0 March 1,991 11 0 14 439 16 0 2,273 16 3 14 502 0 9 4,265 8 0 0 941 18 9 April 1,411 16 1 14 308 16 9 1,586 1 3 14 346 19 2 2,997 18 1 0 655 15 11 May 1,605 17 3 7 351 15 11 1,846 1 0 21 403 16 6 3,451 19 0 0 755 12 5 June 1,314 10 1 21 287 11 0 1,521 1 0 14 332 14 7 2,835 11 2 7 620 5 7 July 1,270 10 3 0 277 18 7 1,522 1 3 14 332 19 2 2,792 12 2 14 610 17 9 August 1,105 7 1 14 241 16 0 1,363 1 0 0 298 3 4 2,468 8 1 14 539 19 4 September 1,112 16 0 14 243 8 6 1,376 11 2 14 301 2 6 2,489 7 3 0 544 11 0 October 1,379 3 3 0 301 13 11 1,627 0 0 7 355 18 5 3,006 3 3 7 657 12 4 November 1,701 9 1 0 372 3 10 1,938 10 1 7 424 1 0 3,639 19 2 7 796 4 10 December 1,622 13 1 7 354 19 1 1,864 8 2 21 407 17 2 3,487 2 0 0 762 16 3 Totals 18,043 1 2 7 3,958 18 4 20,981 1 3 14 4,602 16 7 39,024 3 1 21 8,561 14 11 Cost of Destruction £2,779 0 1 £3,231 17 2 £6,010 17 3 115 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 death, etc. Number of bodies deposited in Mortuary 446 1. To await inquests—(a) Infectious 1 (b) Non-Infectious 418 2. To await burial 27 Number of post-mortems made 149 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 145 135 Accidental death 51 45 Suicide 27 8 Open Verdict 5 ... Manslaughter ... ... Murder 2 ... Misadventure 1 ... Totals 231 188 Table showing nature of above Suicidal and Accidental Deaths in the Borough of Hackney during the year ended 1911. Suicides. Accidental Deaths. Nature of Suicide. No. Nature of Accidental Death. No. Poisoning 16 Shock from fall 29 Cut throat 3 Suffocated 5 Drowning 9 Shock from burns 17 Fall from window 1 Drowning 4 Hanging 2 Run over 12 Run over 1 Shock from scalds 2 Mooting 3 Fracture of skull 5 Hanging 1 Suffocated in bed 12 Wound of tongue 1 Poisoning 3 Others 5 Total 35 Total 96 H 2 116 117 REGISTER OF SANITARY WORK, 1911. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South Hackney Mr. Haben, Homerton, E. Mr. Peverett, Homerton, N. Mr. Kemp, Homerton, S. Mr. White, Clapton, N.E. Mr. Hall, Special. Mr. Vobe, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. Totals. Mr. High. Mr. Sheppard. 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— (a) On complaint 163 151 144 185 222 213 229 130 162 142 68 70 17 89 ... 10 3 1,998 No. of premises on which defects were discovered 112 137 90 126 203 142 81 107 102 102 31 36 14 56 ... 259 446 2,050 (b) House to House— No. of houses inspected 125 89 20 141 162 245 161 210 54 253 129 182 186 237 ... ... ... 2,197 No. of houses in which defects were discovered 21 59 15 100 70 88 93 156 41 130 68 71 157 166 ... ... ... 1,235 No. of Notices served 21 59 15 106 70 88 93 156 41 139 68 71 168 167 ... ... ... 1,262 (c) Houses after Infectious Dis. No. of houses inspected 175 155 142 261 215 212 250 132 276 255 133 96 28 9 ... ... ... 2,279 No. of houses in which defects were discovered 42 93 18 95 86 47 51 30 92 90 37 5 12 3 ... ... ... 701 Premises re-inspected 1,869 2,429 2,379 2,180 1,551 2,034 2,364 2,617 2,370 2,813 2,962 1,222 2,818 2,458 ... 858 682 33,606 (d) Miscellaneous— Fishmongers and Poulterers yards ... 2 ... 3 4 2 ... ... 9 4 15 4 ... ... ... ... ... 43 Slaughterhouses ... ... ... ... 8 ... ... ... ... ... ... ... ... 8 319 ... ... 335 Cowhouses (premises), Dairies and Milkshops ... ... 3 ... 6 ... ... ... ... ... ... ... ... 6 1,745 ... ... 1,760 Greengrocers' yards ... 2 2 2 ... 1 1 ... ... 1 14 ... ... ... ... ... ... 23 Schools ... 1 2 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 5 Factories and workshops 7 35 ... 6 39 19 95 9 19 40 ... 2 1 ... 1 ... 1,118 ... 1,390 Housing, Town Planning, &c Act, 1909— No. of houses inspected ... ... ... ... ... ... ... ... ... ... ... ... 147 113 ... ... ... 260 No. of houses in which defects were found ... ... ... ... ... ... ... ... ... ... ... ... 144 100 ... ... ... 244 No. of houses in which defects were remedied ... ... ... ... ... ... ... ... ... ... ... ... 137 69 ... ... ... 206 118 119 REGISTER OF SANITARY WORK, 1911continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street South Hackney Mr. Haben, Homerton, E. Mr. Peverett, Homerton, N. Mr. Kemp, Homerton, S. Mr. White, Clapton, N.E. Mr. Hall, Special. Mr. Vobe, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. Totals. Mr. High. Mr. Sheppard. 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. Bakehouses— No. on Register at end 1910 7 11 10 11 16 10 10 6 7 14 8 2 ... ... ... ... ... 112 „ „ „1911 8 12 10 10 16 9 10 6 7 13 8 2 ... ... ... ... ... 111 „ above ground 6 7 4 4 8 1 4 1 5 11 8 ... ... ... ... ... 59 No. underground 2 5 6 6 8 8 6 5 2 2 ... 2 ... ... ... ... ... 52 „ of Inspections, 1911 15 25 24 27 45 34 10 27 18 34 15 4 ... ... ... ... 278 „ of Notices, 1911 3 8 4 ... ... ... ... 3 1 6 3 ... ... ... ... ... ... 28 „ of Prosecutions, 1911 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Urinals 14 13 14 6 19 13 19 10 9 19 25 6 ... ... ... ... ... 167 Canal boats ... ... ... ... ... ... ... ... ... ... ... 27 ... ... ... ... ... 27 Visits to waterways ... ... ... ... ... ... ... ... ... ... ... 69 ... ... ... ... ... 69 Animals improperly kept ... 9 ... 2 2 ... ... 1 6 4. 13 ... 13 4 ... ... 35 89 Laundries ... 2 4 ... ... ... ... ... ... ... ... ... ... ... ... 100 ... 106 Offensive trades ... 1 2 ... ... ... ... ... ... ... ... ... ... ... 13 ... ... 16 Outworkers' premises ... 7 20 4 ... 22 ... ... 2 13 ... 2 ... ... ... ... 1,171 1,241 New buildings 15 .... ... ... 2 40 6 ... 4 ... ... 4 ... ... ... ... ... 71 Special Inspections 10 140 51 266 17 18 82 9 217 96 134 4 234 301 204 ... ... 1,783 Houses Let in Lodgings— No. on Register at end 1910 ... ... ... ... ... ... ... ... ... 1 226 ... ... 237 ... ... ... 464 „ „ „ 1911 ... ... ... ... ... ... ... ... ... 1 226 ... ... 243 ... ... ... 470 „ of Inspections, 1911 ... ... ... ... ... ... ... ... ... ... 1 151 ... ... 232 ... ... ... 384 „ of Notices, 1911 ... ... ... ... ... ... ... ... ... 1 60 ... ... 152 ... ... ... 213 „ of Prosecutions, 1911 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Lodging Houses— No. on Register at end of 1910 ... ... ... ... ... ... 4 ... 1 ... ... ... ... ... ... ... ... 5 „ „ „ 1911 ... ... ... ... ... 1 4 ... 1 ... ... ... ... ... ... ... ... 6 120 121 REGISTER OF SANITARY WORK, 1911.—continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South Hackney. Mr. Haben, Homerton, E. Mr. Peverett, Homerton, N. Mr. Kemp, Homerton, S. Mr. White. Clapton, N.E. Mr. Hall, Special. Mr. Vobe, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. Totals. Mr. High. Mr. Sheppard. 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. Mews and Stables 2 7 4 ... ... 2 ... ... ... 9 7 ... ... ... ... ... ... 31 Floodings ... ... ... ... ... ... 9 ... ... ... ... ... ... ... ... ... ... 2 Tenement Houses— No. provided with additional water supply during 1911 ... 5 ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 8 Overcrowding— No. of dwelling rooms overcrowded ... 11 ... 11 2 3 4 4 6 11 27 9 19 10 ... ... 8 118 No. remedied ... 11 11 2 3 4 4 6 11 27 9 19 10 ... ... 6 116 „ of Prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Insanitary Houses— No. closed under Public Health (London) Act, 1891 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. closed under Housing of Working Classes Act, 1890 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of verminous premises cleansed ... 25 4 50 2 8 7 13 15 70 13 14 108 50 ... ... 69 448 Underground Rooms— Illegal occupation dealt with ... ... ... ... ... ... ... ... ... ... ... ... 9 ... ... ... ... 2 No. of rooms closed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Places where Food prepared for Sale— No. on Register at end 1910 ... 14 ... ... 10 ... ... 6 11 15 7 ... ... ... ... ... ... 63 „ of Inspections, 1911 ... 15 ... ... 21 ... ... 6 11 34 7 ... ... ... ... ... ... 94 „ of Notices ... 7 ... ... ... ... ... 2 1 14 2 5 ... ... ... ... ... 31 Other workplaces ... 1 ... ... ... ... ... ... 4 5 ... ... ... ... ... ... ... 10 Miscellaneous Inspections 30 23 53 ... 23 18 29 ... 31 148 31 4 ... ... 204 ... ... 594 Ice Cream Premises— No. on Register at end 1910 12 18 24 15 5 13 11 11 14 19 9 8 ... ... ... ... ... 159 „ „ „ 1911 16 17 30 16 9 15 13 11 13 18 9 8 ... ... ... ... ... 175 „ of Inspections 1 18 40 16 14 15 13 13 15 19 21 8 ... ... ... ... ... 193 122 123 REGISTER OF SANITARY WORK, 1911 .—continued. Mr. Ellis, Stamford Hill Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South -Hackney Mr. Haben, Homerton, E. Mr. Peverett, Homerton, N. Mr. Kemp, Homerton, S. Mr. White, Clapton, N.E. Mr. Hall, Special. Mr. Vobe, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. Totals, Mr. High. Mr. Sheppard 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. Ice Cream Premises— No. of Notices ... 2 4 ... ... 1 ... 2 1 6 5 ... ... ... ... ... ... 21 „ „ Prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total number of Intimation Notices served 224 279 169 386 245 288 241 398 297 403 382 172 289 378 17 186 414 4,768 Peremptory or Final Notices served 50 ... 13 25 53 ... 17 43 33 38 23 ... 27 17 ... 39 38 416 Statutory Notices served 6 32 6 24 18 21 11 13 11 31 2 10 18 11 ... 14 228 Proceedings before Magistrates or Justices under the Public Health Act 1 ... ... ... ... 3 ... 1 ... ... ... ... ... 2 ... ... ... 7 Nuisances abated 101 271 136 346 223 275 _ 218 378 238 341 338 126 290 361 273 445 4,450 Seized and Condemned as Unfit for Human Food— Fish ... ... ... cwt. qr. ... ... cwt qr. Cwt qr. ... ... cwt. qr. ... cwt qr. ... cwt. qr. ... ... cwt. qr. lb 0 1 4 0 0 1 2 1 2 1 3 3 12 3 0 Fruit and Vegetables ... ... ... 8 1 ... ... 2 1 ... ... ... 0 1 ... ... ... 8 1 ... ... 19 0 0 Meat ... ... ... ... ... ... ... ... ... ... ... ... 2 lbs. ... 4 1 ... ... 4 1 2 Tinned Foods ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 3 1 0 Other Articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Open spaces cleared 2 ... 2 ... ... ... ... ... 2 ... ... 3 ... ... ... ... ... 9 Special Reports to Medical Officer of Health 4 29 20 13 1 2 26 ... 5 4 3 ... 16 4 23 ... ... 150 Food Adulteration— Samples collected for analysis 66 66 ... 66 72 72 72 72 66 66 66 66 60 66 66 ... ... 942 Proceedings taken before Magistrates 1 3 ... 3 2 1 3 4 2 1 2 3 ... 2 1 ... ... 28 124 RETURN OF SAMPLES OF MILK ANALYSED. For the Year 1911, showing the percentage of Samples found "Genuine " and " Adulterated." SAMPLES. Percentage of Samples found. No. examined. No. found genuine. No. adulterated in which no action was taken. No. adulterated in which action was taken. Adulterated. Genuine. No proceedings. Proceedings taken. 516 447 3 to 4% 43 5 to 6% 1 10.47 2.9 4 „ 5% 5 6 „ 7% 1 5 „ 6% 5 7 „ 8% 2 10 „ 11% 1 8 „ 9% 2 9 „ 10% 1 10 „ 11% 1 11 „ 12% 1 12 and above 6 516 447 54 15 10.47 2.9 86.63 125 SAMPLES PURCHASED DURING 1911. Articles Purchased. Number Purchased. Number Adulterated. Number where proceedings taken. Number of Samples Adulterated with percentage of Adulteration. Milk 516 69 15 See samples of Milk analysed (next page). Butter 322 16 8 86% foreign fat. 3 83% „ 1 82% „ 1 80% „ 1 68% „ 1 50% „ 1 13% „ 1 7% excess of water 3 2% „ 1 1% „ 3 Olive Oil 15 Cocoa 12 Lard 12 Camphorated Oil 9 1 15.9% deficient in camphor. Coffee 6 Pepper 6 Mustard 6 Cheese 6 Arrowroot 6 Paregoric 6 Cream 5 Margarine 3 1 Served in plain wrapper. 2.84 excess of water. Whisky 3 1 Gin 3 Dripping 3 Liquorice Powder... 3 942 87 24 126 Record of Prosecutions under the Public Health (London) Act, 1891, during the year 1911. Address. Complaint. Magistrate's Decision. Penalty. Costs. f. s d. f. s. d. 20, North Street Reconstruct drains without having deposited plans Withdrawn (plans submitted; Do. Fixed ventilation pipe not in accordance with the L.C.C. by-laws Withdrawn on payment of (defective work replaced) 1 5 0 38, Balcorne Street Defective drains Withdrawn (work done) 183, Graham Road Defective drain, defective ventilating shaft Order to abate in 21 days 0 5 0 9, Castle Street Defective drain Withdrawn (work done) 16, Ivydene Road. Do. Dismissed (held to be a sewer) 156, Osbaldeston Road Do. Order to abate in 28 days Total 1 10 0 Record of Prosecutions under the Factory and Workshop Act, 1901, during the year 1911. Address. Complaint. Magistrate's Decision. Penalty. Costs. £ s. d £ s. d. 32, Lavender Grove Fail to send list of Out-workers to 1st August, 1911. Withdrawn (Defendant deceased.) ... 127 Prosecutions under the Sale of Food and Drugs Acts during the year 1911. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fine. Costs. £ s. d. £ s. d. 18N Margarine Served in plain wrapper Withdrawn by order of Public Health Committee. 0 12 0 72R Butter 78% foreign fat Fined 2 0 0 0 17 6 „ Margarine 12% excess of butter fat. Withdrawn. (See other summons) 54T Butter 7.2% excess of water Fined 2 0 0 0 2 0 „ MilkBlended Butter Improper wrapper Withdrawn. (See other summons) 76V Milk 5.65% added water Fined 0 10 0 0 15 6 77V Milk 8 24% added water Fined 1 0 0 0 15 6 1W Milk 14.33% fat abstracted Fined 2 0 0 0 12 6 61w Butter 83.6% foreign fat Fined 5 0 0 1 18 6 Margarine Served in plain wrapper Withdrawn. (See other summons) 69w Milk 19.897 added water Withdrawn. (Defendant deceased) 70w Milk 9.29 added water Fined 1 0 0 0 15 6 6x Milk 16.12% added water Fined 2 0 0 0 15 6 10.x Milk 12.94% added water Fined 15 0 0 1 1 0 11x Milk 10.24% added water Fined 10 0 0 0 12 6 65x Milk 7.65% added water Withdrawn— (warranty proved) 66x Milk 11.18% added water Fined 0 15 6 0 15 6 76x Butter 86.8% foreign fat Fined 1 0 0 0 17 6 Carried forward. 42 5 6 10 11 6 128 Prosecutions under the Sale of Food and Drugs Acts—continued. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fine. Costs. £ s. d £ s. d. Brought forward 42 5 6 10 11 6 76x Margarine Served in plain wrapper Withdrawn. (See other summons) ... ... 30z Butter 13.77% foreign fat Withdrawn by order of Public Health Committee ... 0 12 6 34z Milk 7.42% added water Withdrawn— (warranty proved) ... ... 50z Milk 12.12% added water Withdrawn— (warranty proved) ... ... 58z Milk 8.24% added water Fined 3 0 0 0 2 0 44A Butter 7.5% excess of water Fined 1 0 0 1 3 0 48A Butter 68.7% foreign fat Fined 6 0 0 1 3 0 72A Milk 14.123% added water Withdrawn— (warranty proved) ... 3B Milk 6.71% added water Fined 1 10 o 1 3 48B Butter 50% foreign fat Fined 2 0 0 1 3 „ Margarine Served in plain wrapper Withdrawn. (See other summons) 55 15 6 15 18 0 129 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 1911. 1911. Temperature. Relative Humidity. Amount of Cloud. Rain. Means. Extremes. Amount No. of Days. 9 a.m. Min. Max. Range Mean. Min. Max. ° ° ° ° ° ° ° ° in. ] January 39.6 367 43.0 6.3 39.9 30.2 51.3 86 9.6 1.25 13 February 41.4 37.8 46.5 8.7 42.2 25.2 55.1 79 9.7 1.28 14 March 41.9 384 48.1 9.7 43.3 33.4 58.9 83 8.0 1.59 17 April 46.7 41.6 54.2 12.6 47.9 27.6 66.2 72 8.5 1.50 11 May 57.2 50.2 66.2 16.0 58.2 42.4 78.6 70 6.2 2.21 11 June 61.3 54.3 67.9 13.6 61.1 44.3 81.0 70 6.6 2.40 11 July 68.0 59.8 77.4 17.6 08.6 51.2 89.1 60 4.8 0.63 5 August 67.4 61.0 76.9 15.9 69.0 54.9 93.0 70 5.8 0.89 7 September 61.0 54.4 69.9 15.5 62.2 45.2 88.2 69 5.7 1.44 11 October 51.1 46.6 56.9 10.3 51.8 35.1 63.1 84 7.9 2.99 14 November 45.5 41.3 49.8 8.5 45.6 31.3 59.0 82 8.0 3.30 19 December 45.8 42.0 49.7 7.7 45.9 33.0 54.0 87 8.1 4.11 23 Year 52.2 47.0 58.9 11.9 53.0 25.2 93.0 76.0 7.4 23.62 156 I remain, Gentlemen, Yours faithfully, J. KING-WARRY, m.d., d.p.h., June, 1912. Medical Officer of Health. 130 APPENDIX. SPECIAL REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE RECENT OUTBREAK OF SMALLPOX IN THE BOROUGH OF HACKNEY. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Gentlemen, In accordance with the request of the Local Government Board I beg herewith to submit a report upon the cases of smallpox which have recently occurred in the Borough of Hackney. These cases were only three in number, but their interest centres not so much in their number as in their possible relation to the larger and more serious outbreak in the Borough of Stepney. The following are particulars relating to each case:— Case 1.—Mrs. L., 39, Berkshire Road, Hackney Wick, age 33 years, married and has six children, four of whom reside with her at this address, the other two live with their aunt at 100, Chapman Road. Four of these children go to school, and one, age 14 years, works at Clarnico's, Hackney Wick ; the remaining child is an infant in arms. Mrs. L.'s husband is a carman in casual employment The family occupy three rooms in the house, the other rooms being occupied by another family, consisting of a man and his wife with four children. Mrs. L. was vaccinated in infancy and again about the age of 10 years. She was notified as suffering from smallpox on the 25th February, and was removed to hospital on that date. Case 2.—Mrs. B., age 43 years, 101, Chapman Road, married and has three children. Her husband works at Clarnico's, Hackney Wick. One son is a tinsmith and works in the City, the other two children go to school in the neighbourhood. The family occupy three rooms in this house, one other room is occupied by a married couple with no family, and two rooms at the top of the house are occupied by a family consisting of a man and his wife and four 131 children. Mrs. B. was vaccinated in infancy. She was notified as suffering from smallpox on the 27th February, and was removed to hospital on that day. Case 3.—Arthur B., son of the last case, age 20 years, single, a tinsmith, and living with his parents at 101, Chapman Road. He was vaccinated in infancy. He was notified on the 27th February, and was removed to hospital on that day. History of the Cases. Mrs. L. (Case 1) fell ill on the 22nd February, the characteristic rash appearing on the 24th February. On the 25th she was seen by Dr. Turtle, who notified her on that date as suffering from smallpox, and she was immediately removed to hospital. On enquiry I learnt that Mrs. L. had been discharged from Whipp's Cross Infirmary on the 11th February, where she had been under treatment for two weeks. She had, prior to admission to that institution, lived at Leyton, and whilst she was in the Infirmary her family had moved into Hackney to 39, Berkshire Road. The same evening after the removal of Mrs. L., I visited 39, Berkshire Road, and saw all the occupants. These all appeared in good health. I was informed that Mrs. L. had a sister living at 101, Chapman Road, and another sister at 100, Chapman Road, this latter having charge of two of her children. On enquiry of Mrs. L.'s sister at 101, Chapman Road, on February 27th, whom I found in good health, I was informed that a Mrs. B., occupying another part of this house, was ill. I requested permission to see her. This was granted, and she informed me she had seen her doctor that morning at his surgery as she was feeling ill, and he had sent her home, advising her to go to bed, as she was suffering from a severe cold, which would turn to pneumonia if the did not follow his advice. I found she was really suffering from mallpox, it being probably the first day of the characteristic eruption of that disease. I notified the case (Case 2), and had her immediately removed to hospital. Whilst pursuing these enquiries I 2 132 I was informed that a son of Mrs. B., named Arthur, had been home from work for some weeks, suffering, it was said, from blood poisoning and eczema. He had gone again to work that morning. I could not learn the name nor the address of the firm he was working with, so called again in the evening, when he had returned from wort I found he had really been suffering from smallpox, and had not yet recovered, there being still dried-up crusts of the vesicles scattered over his face and body. I notified him (Case 3) as suffering from smallpox, and had him removed to hospital. The history of this case was as follows:— On the 1st February he felt unwell, havin; pains in the head and back with fits of shivering, and went to the Cripplegate Dispensary in the City, where he was told he had influenza, and was sent home with some medicine. He took tolls bed, but did not improve ; so on the 5th, as an eruption had in in meantime appeared on his body, he called in a local practitioner, who informed him he was suffering from blood poisoning and eczema He was visited several times at his home by this doctor and treated up till the 25th February, when he visited the surgery and was informed by the doctor's locum tenens that he might go to work on the following Monday, February 27th. Enquiry of Arthur B. revealed the fact that a young woman (R. F.), living in Shoreditch, had visited him several times during his illness. I communicated this fact and her address to the Medical Officer of Health to that Borough, who informed me at a later date that she had contracted smallpox, and had been removed to hospital, This was not the end of the mischief, for the sister of this young woman was also subsequently removed to hospital suffering from the same disease. Action taken to Prevent the Spread of Infection. 1. Vaccination and Re-vaccination of Contacts.—Notices were sent to the Vaccination Officer and Public Vaccinator on February 27th, informing them of the cases of smallpox, and asking steps to be taken with a view to the inmates of the infected houses 133 being vaccinated or re-vaccinated. I am informed that the Public Vaccinator called at 39, Berkshire Road and at 100 and 101, Chapman Road on the 28th, and offered vaccination and re-vaccination to all of the inmates. In response to this offer the following vaccinations took place, viz.:— Primary Vaccinations (28th February)— E. M. L., 100, Chapman Road. F. E. L., 39, Berkshire Road. J. L., 39, Berkshire Road. Re-vaccination (Vaccinated in Infancy)— E. B., 101, Chapman Road. L. R. L., 39, Berkshire Road. The Public Vaccinator made a house-to-house visitation of the infected area and offered vaccination and re-vaccination to 180 persons, "the bulk of whom," he states, "refused altogether to have vaccination." He further adds, "out of this number I vaccinated primarily 12 and re-vaccinated 3." 2. Quarantine, (a) School Children.—On the same date notices were sent to the Head Teacher of the schools attended by the children from the infected homes in order that they should be Excluded from school. Other children in the same schools, who ivere even remotely thought to have been in contact with these children, were also excluded. The parents of these children were instructed not to allow their children to associate with others, but to keep them at home until further notice. (6) Adults.—As a rule, employers of labour will not allow smallpox contacts to resume work until a certificate is received from the Medical Officer of Health, stating that they may resume work. Frequently such "contacts" are the chief suppport of their families, and if they are deprived of work their wages also disappear, and their families suffer. The result is that, as a rule, such families amongst the working classes have to apply to the Relieving Officers for assistance. Several of the adult contacts were in this position. 134 I found it necessary to keep several of these from their work, but I was enabled to render it unnecessary for any of them to apply to the Poor Law for relief. It will be remembered that during the outbreak of 1901 and 1902 the Local Government Board issued a circular letter to the local authorities of London giving them power, where they thought it necessary, to make reasonable payments to smallpox contacts when they were kept from work by the action of the local authority, in order to prevent the spread of infection. Assuming that such permission would also apply to the present outbreak, I made weekly money allowances to several of the adult contacts mentioned. The advantages of this system over the application of Poor Law relief are manifest. Firstly, I am informed that Poor Law relief to able-bodied men can only be in kind, i.e., in food and such-like necessaries, except by special permission of the Local Government Board. It is obvious that such relief cannot satisfy all the needs of a household. Money is required for things equally as necessary as food, &c. Secondly, the great advantage, however, of this system is that such persons as are receiving an allowance of money, however small, are more amenable to the advice of the Medical Officer of Health, and the cases can usually be found when they are wanted—a most important point—for these contacts require to be watched for at least a fortnight, in order to deal promptly with any who may have been infected. It was necessary to keep from work five such persons—three living at 101, Chapman Road, and one at 39, Berkshire Road—and to these I made a small weekly allowance, the amount depending upon their weekly wages. One other adult I was also obliged to keep from work; but the firm employing him (Messrs. Bush & Co.) informed me they would allow their workman his full pay until I certified he could safely return to work. The total amount of money allowed to these adult contacts was £3 6s.—quite a trifle, considering the advantages accruing from it. 135 3. Disinfection, &c.—Immediately after the removal of each case to hospital, the rooms, which had been occupied by the patients were disinfected, the paper was stripped from the walls, and the walls, ceilings, floors and woodwork thoroughly cleansed, and the ceilings limewashed. The clothing and bedding, &c., were disinfected by high-pressure saturated steam. Source of Infection. There can be no question that the source of infection of Mrs. B. was her son Arthur, whom she had nursed during his four weeks of illness at home. The source of Mrs. L.'s infection cannot be stated with so much certainty, but the fact that she visited 101, Chapman Road, on the 11th and 12th February and once or twice during the next week, where her sister occupied a room, and that on one of these occasions she met Arthur B. in the passage of the house and spoke to him, makes it most probable that he was also the cause of her infection. The source of Arthur B.'s infection is not definitely known. Enquiry as to his habits and work did not reveal anything on this point, but it appears he made a visit to Aldgate on the 21st and 22nd January. He was accompanied by a friend, who has remained in good health since. I am informed they did not enter a house nor enter into any conversation with any persons at Aldgate. It is quite probable, considering the date of this visit, that Arthur B. was infected on this occasion. The cases of smallpox, the subject of this report, would thus appear to be related to the outbreak of smallpox in Stepney. The Result of Vaccination and Re-vaccination. The case of Arthur B., who was nursed at home for four weeks, suffering from smallpox, is most interesting and instructive. On first thoughts it appears surprising, knowing the infectious nature of the smallpox virus, that the whole of the family did not suffer from the disease. It will be remembered that the family consisted of Mr. and Mrs. B. and two other children, aged nine and twelve years, as well as Arthur B. This family occupied three rooms only, 136 two bedrooms and a living room. There was no overcrowding, according to the usual standard, but it must be admitted that the whole of the family came into such close relation with one another that the presence of anything of an infectious nature attacking one member of the family would almost certainly be transmitted to the other members of the family, unless some protective power was at work. At any rate, no family arrangements could be made which would better favour the spread of infection amongst the various members of the family when once introduced. All at once a case of smallpox, one of the most infectious and virulent of fevers, occurs in this family. The patient is nursed by his mother; all members of the family had access to the patient's room, for they were assured the disease was not infectious; as a matter of fact, on my visit to see him on the eve of the 27th February I found the patient with his father, brother and sister together in their small sitting-room, taking their evening meal. How does it come about that only Mrs. B. in this family was infected? This circumstance must be puzzling to those sceptical as to the value of vaccination; but the incident is really an objectlesson of its protective value. What was the condition of the members of this family with respect to vaccination? Mrs. B. was forty-three years old, and had been vaccinated in infancy. The immunity afforded by this vaccination had greatly diminished, but its effect had not altogether vanished. It was still sufficient to cause her attack to be very mild, leaving very few hardly recognisable scars. The two younger children, aged nine and twelve years, had been vaccinated in infancy. These two children had been exposed to constant infection for four weeks, but they escaped. The immunity afforded by their vaccination was still strong enough to protect them from infection. The father had also been vaccinated in infancy, but he had also been re-vaccinated in 1902. The firm for whom he then worked insisted upon their workpeople being re-vaccinated in that year, whilst the 137 disease was prevalent. The immunity conferred by infant vaccination had been renewed in his case by adult re-vaccination. The opportunities for infection were the same for all these members of the family, but only the least protected one of the family acquired the disease. In my opinion, the incident affords a striking illustration of the protective value of vaccination in a threefold form, viz., the protection of the children, who had been vaccinated in infancy, the waning influence of vaccination with advancing years, but still exercising an influence upon the severity of the disease, and the revival of protection by re-vaccination. Arthur B. had also been well vaccinated in infancy, and the mildness of his attack showed that he, too, had benefited by this vaccination. My thanks are due to Mr. F. R. Coles (the Clerk to the Guardians) for kindly supplying me with details respecting vaccinations and re-vaccinations. I am, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Hackney, N.E. April, 1911. 138 SMALLPOX. Case No. 1. Case No. 2. Case No. 3. l. Age 33 years 43 years 20 years 2. Sex F. F. M. 3. Address 39, Berkshire Road 101, Chapman Road 101, Chapman Road 4. Occupation Home Home Tinsmith 5. Date of Notification 25th Feb., 1911 27th Feb., 1911 27th Feb., 1911 6. Date of onset of illness 22nd Feb.,1911 23rd Feb., 1911 1st Feb., 1911 7. Date of appearance of rash. 24th Feb., 1911 27th Feb., 1911 5th Feb., 1911 8. Attack, mild or severe Mild Mild Mild 9. Rash discrete, semiconfluent, confluent, or hæmorrhagic. Discrete Discrete Discrete 10. Duration of illness Disch'ged from Hospital, 27th March Disch'ged from Hospital, 27th March Disch'ged from Hospital, 26th March 11. Result of illness Recovery Recovery Recovery 12. Has the patient had smallpox before? If so, when ? No No No 13. Has the patient been vaccinated ? If so:— Yes Yes Yes 14. Date of vaccination Infancy Infancy Infancy 15. By P.V. or private practitioner P.P. — — 16. Number and character of vaccination marks. * One scar 1 by 1½ inch well marked and foveated Five scars well marked and foveated each scar nearly in. diameter Four scars well marked and foveated each scar about ½ in. diameter 17. Has the patient been revaccinated Yes No No 18. If so, when ? When 10 years old 19. Number and character of revaccination marks Three small plain scars each about ½ inch diameter * This scar no doubt due to confluence of four vaccination vesicles. 139 REPORT OF THE MEDICAL OFFICER OF HEALTH ON TUBERCULOSIS DISPENSARIES. Public Health Department, Town Hall, Hackney, N.E. 1st March, 1911. To the Chairman and Members of the Public Health Committee. Gentlemen, I have considered your reference on the above subject, and beg herewith to report thereon. I understand the wish of the Committee is to obtain information on the subject of Tuberculosis Dispensaries in regard to—(1) The work of such institutions. (2) The results obtainable. (3) The cost of establishing and maintenance. 1. The work of a Tuberculosis Dispensary. In order to explain to the Committee the work of a Tuberculosis Dispensary, I cannot do better than give some account of the Victoria Dispensary for Consumption in Edinburgh, and this I am able to do through the kindness of Dr. Philip, its founder and present senior physician, who has courteously replied to my enquires on the subject. This dispensary was established in the year 1887 by Dr. Philip, and was the first dispensary of its kind. Since then many others have been established on the continent, in America, and in this country, most of them being worked on the same principles as the Edinburgh institution. Dr. Philip, in explaining the object of the Victoria Dispensary for Consumption, states "The scheme rests on the principle that for the eradication of tuberculosis we must not be content with treating the consumptive poor who present themselves (with more or less advanced disease) at the Out-patient Departments of the Various hospitals. We must search for the cases at home. We must follow the consumptive patient to his dwelling and inspect it, and 140 as much as possible, inspect all the members of the household so as to detect cases at the earliest stage. This is a very important aspect of prevention, and forms especially the function of the Consumptive Dispensary." The programme of the work of the Edinburgh Tuberculosis Dispensary in more detail includes the following:— 1. "The reception and examination of patients at the Dispensary, the keeping of a record of every case, with an account of the patient's illness, history, surroundings, and present condition, the record being added to on each subsequent visit." 2. "The bacteriological examination of expectoration and other discharges." 3. "The instruction of patients how to treat themselves, and how to prevent or minimise the risk of infection to others." 4. "The dispensing of necessary medicines, sputum bottles, disinfectants, and, where the patients' conditions seem to warrant it, food stuffs and the like." 5. "The visitation of patients at their own homes by (1) a qualified medical man, and (2) a specially trained nurse for the double purpose (a) of treatment, and (b) of investigation into the state of the dwelling and general conditions of life and the risk of infection to others." 6. "The selection of more likely patients for hospital treatment, either of early cases for sanitoriums or of late cases for incurable homes, and the supervision, when necessary, of patients discharged from hospital." 7. "The guidance generally of tuberculous patients and their friends, and for inquires from all interested persons on every question concerning tuberculosis." The Dispensary in addition to the above interests it self in the after care of persons who have been undergoing sanatorium treatment. Another function of the Dispensary is the selection of suitable employment in the open air for consumptive patients who 141 may not require hospital' treatment; also patients and their families who are in needy circumstances are brought into touch with charitable agencies granting relief. The Dispensary is in close connection with the Public Health Department, the Hospital for Consumption, one or more Sanatoriums and an Open Air Colony. One of the most important duties of the Dispensary doctor is to visit the homes of the patients in order, amongst other things, to ascertain whether any other members of the family are affected with tuberculosis. If other members are found to be so affected, measures are taken to put them under treatment for the disease and to educate them, so that they may not be a source infection to others. This work in Edinburgh has led to the discovery of many other cases of tuberculosis in the incipient stages, which, had they not been discovered, would have been centres of infection and have led to the further spread of the disease. In one instance the Dispensary doctor made a domiciliary visit, and discovered nine other cases in the family which had never been suspected. In another instance a domiciliary visit of the doctor led to the discovery of 15 cases occurring in the same family. Such discoveries of unsuspected disease has led Dr. Philip to make the following remarks as to the prevalence of this disease in Edinburgh. "Taking the city of Edinburgh whose mortality from consumption is approximately 400 per annum, we may assume that within the area of the city more than 8,000 are already seriously affected by the disease. This figure applies to involvement of the lungs only." That is to say, for every death from pulmonary consumption, there are at least 20 persons who are suffering from the disease in a serious form. A further result of the domiciliary visits by the doctor is the discovery of what are called by Dr. Philip "tuberculous nests," that is houses, flats, or tenements, in which case after case of tuberculosis occurs amongst different families successively occupying the same dwelling. Dr. Philip records the following instance of a "tuberculous nest." "In one street of 22 houses one dwelling consisting of four flats shows a record of no fewer than 32 separate cases 142 of consumption in 15 different families. Quite recently a newlymarried couple flitted to this tuberculous nest. In due course both husband and wife have developed grave manifestation of disease." The Edinburgh Institution was established, and is maintained by voluntary subscriptions. The municipality of Edinburgh, however, grants a yearly subsidy to the dispensary. The Medical Officer of Health, Dr. Maxwell Williamson, informs me "only comparatively recently the local authority agreed to pay a subsidy of £500 per annum in order through co-operation with the dispensary, to have the fullest possible advantages from it. That arrangement is now in force and is working satisfactorily." 2. Results obtainable from the working of a Tuberculosis Dispensary. It is obvious that by means of the domiciliary visits of the doctor and nurse of the Institution a more complete knowledge of the whereabouts of cases in all stages of the disease is obtainable, and in course of time the whole of the cases existing in the Borough could be brought under the control of the dispensary. A further result of this knowledge would be the more thorough education of the persons suffering, as well as other members of their families, in the necessary measures for preventing the spread of the disease. Opportunity here arises also for recommending the appropriate treatment for patients in different stages of the disease, and for bringing necessitous patients and their families into touch with institutions granting relief. The final result unquestionably would be a diminished prevalence and mortality from consumption in the Borough. Dr. Philip, when commenting upon the result of the antituberculosis effort carried on for some years in Edinburgh, compares the curve of tuberculosis mortality, for the years 1887 to 1906, of that city with that of London, and further adds:—"In the case of Edinburgh, I think, without straining the point, the curve affords significant evidence of the influence exercised on tuberculosis by the institution of organised and co-ordinated effort. In addition to less 143 definite agencies there has occurred in Edinburgh from 1887 onwards the gradual evolution of an anti-tuberculosis scheme, including the dispensary, with its system of domiciliary visitation, etc." "The charts show how, from 1887 onwards, the mortality from tuberculosis has fallen progressively. The Edinburgh fall during the latter ten years is especially striking. It is quite out of proportion to that of the preceding ten years, and remarkably more rapid than that shown in the London curve. It seems fair to associate this to some degree with the development of the completer organisation." 3. The cost of establishing and maintaining a Tuberculosis Dispensary. This of course will vary with the character of the institution and the extent of its operations. The Edinburgh Dispensary has been established now over 23 years and has grown into an institution of considerable magnitude, and the extent of its operations has grown pari passu. There are now six physicians attending at this dispensary, four of whom are salaried, and two honorary; and the patients receiving treatment at the dispensary during the year April 1st, 1909, to March 31st, 1910, numbered 20,119. In London two tuberculosis dispensaries have been established on the lines of the Edinburgh system, viz., at Paddington and at St. Marylebone. The former has been working two years; the latter has only just been opened. In three other Boroughs dispensaries are being founded. The cost of establishing a tuberculosis dispensary suitable for a London Borough need not be very great. In the first annual report issued by the Committee managing the Paddington Dispensary the following account is given Cost of altering and fitting up premises taken on £ s. d. lease 127 17 10 Funiture and fixtures 100 18 6 Instruments and appliances 17 11 0 £246 7 4 The maintenance for the year, including Salaries and Wages, Rent, Rates and Taxes, Drugs and Sundry Expenses £787 11 1 144 During the year in question 857 patients attended the dispensary. The St. Marylebone Dispensary for Consumptives has just been opened. The cost incurred in establishing it, I am informed by Dr. Sutherland, its Medical Officer, was about the same as that of the Paddington Dispensary, viz., about £250, and the initial yearly cost of maintenance £750. The staff required at first for a tuberculosis dispensary should consist of one Medical Officer, specially trained for the work, a nurse, and a caretaker resident on the premises. These dispensaries are established on the principle that only cases of consumption are treated which are not under medical treatment and supervision, unless the case is recommended by a special written request from the patient's medical attendant. This rule avoids all conflict with local medical practitioners. Hitherto, these dispensaries have been established and maintained by voluntary subscriptions; but it is competent for a local authority to provide and maintain such an institution out of the rates under Section 75 of the Public Health (London) Act, 1891, for persons other than " poor persons," as follows:— 75.—(1) Any sanitary authority may provide for the use of the inhabitants of their district, hospitals, temporary or permanent, and for that purpose may (a) Themselves build such hospitals, or (b) Contract for the use of any hospital or part of a hospital, or (c) Enter into any agreement with any person having the management of any hospital for the reception of the sick inhabitants of their district, on payment of such annual or other sum as may be agreed upon. The Necessity for Tuberculosis Dispensaries. The importance of a Tuberculosis Dispensary in any scheme for the prevention of the spread of tuberculosis has been proved in this country, in America, and on the Continent. In a recent memorandum by the Medical Officer of the Local Government Board on the administrative measure against tuberculosis, the following remarks occur:- 145 "A well organised tuberculosis dispensary becomes a valuable aid in securing more general notification of cases of tuberculosis; and its visitors can not only secure that domestic precautions are taken, but also that the patients are brought into touch with the different forms of domestic aid, or with the sanatorium or hospital treatment that the needs of the individual case indicate." Most cases of tuberculosis are only notified at present when there are well marked signs that the lungs are seriously affected, and the patient has already become a centre of infection to others. To deal with such a patient alone is not enough to prevent the spread of the disease; an effort should be made to ascertain whether any other members of the family are affected, and measures taken to deal with them also. This can be best done by the help of a tuberculosis dispensary working on the lines of the Edinburgh institution. Tuberculosis in Hackney. During the last ten years the deaths from tubercular disease in the Borough of Hackney have averaged over 400 per annum. If we were to apply to Hackney the ratio calculated by Dr. Philip, of Edinburgh, between the deaths and existing cases of tuberculosis in that city, viz., at least 20 cases to each death, it would appear that there are about 8,000 cases of tuberculosis in the Borough of Hackney existing at the present. I do not think that this is an exaggeration when we consider the large number of persons dying from other diseases who present evidence of having suffered at some time from tuberculosis in one or other form and stage of the disease. It must be remembered that a large proportion of these 8,000 cases are centres of infection. In the earlier stages there is not so much danger of conveying infection, but the danger grows with the disease; and when expectoration sets in then the most dangerous stage of conveying infection is entered upon. Amongst 197 persons notified to me as suffering from tuberculosis during 1910, I find on inquiry that 102 expectorated profusely. The appearance of one such case of consumption in a family, living in restricted accommodation, as a large proportion of the population of Hackney lives, k 146 is the signal for the infection of other members of the family, unless means are adopted to isolate or remove the patient to some institution. This process of infection is going on in hundreds of homes in Hackney at the present time, and will continue until more comprehensive measures are adopted to cope with this condition of things. At present the preventive measures adopted in the Borough to put a check upon the spread of tuberculosis are insufficient for attaining the object desired. The following taken from my Annual Report for the year 1909 will show how far they fall short of a comprehensive scheme for preventing the spread of this disease in Hackney. Measures Taken during the Year 1909. (1) The disinfection of every room occupied by a tuberculous person, with any infected articles, either after removal of the patient to some institution or after death. The number of such rooms disinfected during 1909 was 247. (2) On the notification of a case under the regulations a visit of enquiry is made by one of the sanitary inspectors, and a printed leaflet on the prevention of the spread of consumption is sent to each patient. (3) Arrangements have been made for the gratuitous bacteriological examination of sputa sent by any medical practitioner practising in the Borough. The number of such examinations made during the year was 104. To make any marked impression upon the spread of tuberculosis in Hackney it is necessary to supplement the above measures by the addition of a tuberculosis dispensary in the Borough. Such an addition will, I am sure, furnish the best hope for controlling and ultimately eradicating consumption from our midst. Believing that the Committee desire to check the spread of this disease in the Borough, I strongly recommend the establishment of a tuberculosis dispensary in some central position in the district, to be conducted on the lines of the Edinburgh system. I am, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., D.P.H., Medical Officer of Health. 147 HACKNEY BOROUGH COUNCIL. prevention of infantile or summer diarrhŒa. Infantile Diarrhœa is a very serious and fatal form of illness occurring during the hot months of the year (July, August, September), chiefly affecting infants under one year old. The disease is more common in towns than in rural districts. Many circumstances, of which the following are the chief, favour its prevalence, most of these being preventable. Circumstances Favouring the Prevalence of Infantile Diarrhœa. (а) Heat and Dryness of the Atmosphere. Where a hot summer is combined with a small rainfall, summer diarrhœa will be present in excess. Whereas, on the contrary, a cool, wet summer brings this disease to its lowest point. (b) Density of Population and Dwellings with Overcrowding. These conditions, either singly or combined, are always found associated with a high diarrhœal death rate. (c) Darkness and Dirtiness of Dwellings. These are other conditions which promote a high death rate from summer diarrhœa. (d) Want of Ventilation through and about the Dwellings. The want of ventilation gives rise to a "fusty" smell which is most unhealthy and is productive of an increase in summer diarrhma. (e) Offensive Smells, in or about the House, from Decomposing Organic Matter, Animal or Vegetable (such as frequently arise from foul dustbins, drains, w.c.'s, yards, &c.) favour the disease. (f) Surface Pollutions of Streets, Courts, Alleys, &c. The fouling of the surface soil by horse manure and other organic filth is also a powerful cause of summer diarrhœa. k 2 148 (g) Polluted Drinking Water. Diarrhœal disease has frequently been traced to this cause. (h) Stale or Tainted Food, especially Meat, Fish, Fruit and Milk. Food stored in ill-ventilated cupboards, or exposed to foul smells, very soon decomposes; and, if so taken, will undoubtedly cause diarrhœal disease. This is especially the case with milk, the chief diet of infants. These are, as above pointed out, the chief sufferers from this complaint. Heat or dryness of the atmosphere alone, it is believed, will not cause summer diarrhœa; but a combination of these, with one or more of the other conditions will undoubtedly bring about a prevalence of this disease. • From a consideration of the above conditions favourable to the spread of summer diarrhœa it will be readily seen what measures should be adopted in order to bring about a decrease in its prevalence. Measures to be Adopted to Prevent the Spread of Infantile Diarrhœa. 1. Offensive smells or the presence of rats or any defects in the water closets or drainage of the house should be at once reported to the Public Health Department. 2. House refuse must not be allowed to accumulate on the premises until it becomes a nuisance, but should be removed at frequent intervals. This will be done every week by the Borough Council's dustmen, who are instructed to call once a week at every inhabited house in the parish. Any neglect to make the weekly visit should be at once reported to the Public Health Department. Householders should recognise their own responsibility in this matter by always allowing the dust to be removed when called for If possible, all vegetable refuse should be burned, provided it can be done without creating a nuisance. Dustbins ought to be portable, 149 kept clean, and in thorough repair. Where there are any fixed brick ashpits the fact should be reported to the Public Health Department. 3. Where there is constant dampness of the soil near the dwelling, or of its walls, it should be reported to the Public Health Department. 4. Ventilation must be thoroughly attended to, and as much fresh air as possible allowed to circulate through the dwelling. Overcrowding must be avoided. 5. (a) All food should be stored in well ventilated and lighted cupboards, away from any foul or offensive smells. Cupboards under stairs or in cellars should not be used for this purpose. (6) No tainted or stale food should be eaten. This especially applies to stale or unripe fruit, stale vegetables, fish or milk. All milk received on the premises should be boiled immediately. (c) Parents who artificially feed their infants on milk ought to see that it is quite fresh, and also give particular attention to the condition of the feeding bottles, cups, &c., used for this purpose. These should be scalded in every case before use. (d) It is believed that flies are a cause of summer diarrhœa, by conveying filth into different articles of food, especially milk. Such food should always be covered and means should be used to destroy the flies, such as fly papers. But it is a fact, that where scrupulous cleanliness is observed flies are present only in small numbers. 6. Yards, forecourts, and streets, &c., should be kept thoroughly clean and free from deposits of offensive or decaying material. 150 7. All sinks, drains and yard gullies should be well flushed with water daily. 8. Cisterns supplying drinking water ought to be frequently cleaned out, and where such cisterns supply water closets the fact should be reported to the Public Health Department at the Town Hall. 9. Personal and domestic cleanliness must receive the first care. 10. Attention should also be paid to the general health, all excesses either of eating or drinking being avoided. 11. Parents are strongly advised to seek proper medical advice and treatment on the first appearance of any looseness of the bowels or diarrhœa amongst the members of their family. By Order of the Public Health Committee, J. KING WARRY, M.D., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Hackney, N.E. August, 1911. 151 HACKNEY BOROUGH COUNCIL. On the Care of Infants. Advice to Mothers and Others in Charge of Infants. During the last ten years the deaths of infants under one year old in Hackney have averaged over 800 per year. A large number of these deaths have been due to preventable causes, such as improper feeding and clothing, and carelessness on the part of those having the charge of infants. This, it is believed, has arisen mostly from want of knowledge: therefore it has been thought desirable, in the interest of Public Health, to attempt to supply this want by compiling the following few rules for the guidance of young mothers and others inexperienced in the proper feeding and care of infants. 1.—Inflammation in the Eyes of the New Born Child. This is a very dangerous and infectious disease. It is the cause of 36 per cent. of the total blindness of children. But it is quite preventible by observing the following few simple rules:— At birth the infant's eyes should be carefully washed by the nurse or midwife. Each day during the next week, the infant's eyes should be carefully examined, and if the eyelids show any redness or swelling, or if there is any discharge from the eyes, a doctor should be immediately sent for, and his instructions carefully followed. In the meantime, the affected eye or eyes of the infant should be gently washed, plain cold water and soft rag or cotton wool being used for this purpose. The rag or wool must not be used more than once, and must then be burnt. The same piece of rag or wool must not be used for both eyes. Care must also be taken by the nurse, midwife, or other person attending to the infant, not to allow any discharge to get into her own eyes, because this discharge is extremely infectious. 2.—Infant Feeding. (a) Natural Feeding.—If possible, all infants from birth until the time of weaning should be suckled by the mother, if she is healthy. This is the best and natural form of infant feeding. During 152 the first month of life the infant should he given the breast every two hours, from 5 a.m. till 11 p.m. It may be necessary to feed the child once during the night. During the second month every 2½ hours, and during the third and subsequent months every 3 hours. If the mother can only give the breast once a day, this should be done in preference to wholly feeding on cow's milk. No child should be suckled under the best conditions longer than the first year, or rickets may follow. It may be explained here that human milk differs greatly in quality from cow's milk, the latter containing much less sugar than the former; it also forms more curd, which is much firmer than that formed from human milk. It is owing to the firmness and excess of curd formed in cow's milk that it has to be largely diluted, otherwise it is difficult for infants to digest it. There are other most important differences between the two kinds of milk. It has of late years been accepted that human milk contains constituents which has the property of protecting the infant from disease-producing microbes. It is extremely rare for suckling infants to be attacked by infectious disease. Infants, on the contrary, fed on cow's milk are very liable to contract disease, especially during the summer months. Mothers should bear these facts in mind. Another disadvantage in the use of cow's milk is, that owing to the fact that cow's milk is frequently polluted, both during the process of milking and in transit, and even in some dairies large quantities of preservatives are often added to prevent fermentation and putrefaction. Milk so treated is liable to cause infants serious intestinal disorders. Finally, it cannot be urged too strongly, that breast feeding is the natural, most nourishing, and healthy form of infant feeding; and any artificial feeding by cow's milk or otherwise, is but a poor substitute for the real and natural feeding, and mothers who are capable will give their infants the best protection from disease, and endow them with the best chance in the struggle for existence by suckling them during the first nine months of life. 153 (b) Artificial Feeding.—From birth to the end oj six months.— If the mother cannot, or can only partially, suckle her child, it should be fed-on fresh cow's milk, diluted in the proportion of one part of milk to two parts of either water or barley water, and slightly sweetened with sugar. Two tablespoonfuls of this mixture should be given to the infant during the first month every two hours, between the hours of 5 a.m. and 11 p.m., and once during the night. As this mixture is rather deficient in fat, it is better to add a teaspoonful of cream to one of the meals each day, or to give half a teaspoonful of cod liver oil twice a day. After the first week the quantity and composition of the milk given, and the periods of feeding, must be modified in accordance with the following table up to the end of the sixth month. FOOD TABLE FOR AVERAGE INFANT UP TO END OF 6th MONTH. Period. Intervals of feeding. Quantities for each meal. No. of Feeds in 24. Hours. Composition of Food. 1st week 1st month 2 hours 2 hours 2 tablespoonfuls 4 tablespoonfuls 10 10 One part milk, two parts water or barley water. 2nd month 2 ½ hours 6 to 8 tablespoonfuls 8 Equal parts of milk and water, etc. 3rd and 4th month 3 hours 8 to 10 tablespoonfuls 7 Equal parts of milk and water, etc. 5th and 6th month 3 hours 12 to 14 tablespoonfuls 7 Two parts of milk to one of water, etc. N.B.—All milk or water used should be previously boiled. This table is only intended to be an average. It will, no doubt, be necessary to depart in certain cases from the quantities and proportions as experience teaches, perhaps more being given at one time and less at another; but it would be advisable to keep as close as possible to it, especially as regards the intervals. 154 Condensed milk should only be used under medical advice, as it is likely to lead not only to rickets but other forms of disease. Condensed skim milk or condensed separate milk must not be used on any account. If cow's milk diluted and prepared as above does not suit the child, humanised milk—i.e., cow's milk so prepared as to have the average composition of human milk—should be tried. Sterilized humanised milk may be obtained in London from several wellknown firms, who will be pleased to supply any customer daily. It cannot be too clearly understood, that infants from the beginning of life should be taught to have their food at stated intervals; and to feed an infant whenever it cries is a most pernicious habit, which leads in most cases to chronic indigestion, vomiting, and wasting. 2. Seventh month.—Infants, if thriving, may be kept on the above diet until the seventh month of life, but at this time the digestive organs of the child are able to deal with a small quantity of starchy food, so a teaspoonful of wheaten flour, which must be thoroughly cooked, should now be added to the milk once a day. 3. Ninth month.—At nine months old one of the infants' foods may be added to the diet, either Liebig's, Mellins, Savory and Moore's or Nestle's, with an occasional cup of beef tea or broth, or yolk of an egg, but the main bulk of the food must still be cow's milk. The Feeding Bottle.—Of course artificial feeding requires the use of a bottle. This should be one having a smooth internal surface, free from angles and crevices, and provided with a teat capable of being easily cleaned. The bottle should not have any tubes, because it is impossible to keep these clean. It is very convenient if the bottle is also marked in tablespoon measurements. The advantage of a bottle of this kind is, that it can easily be kept scrupulously clean, and it must be held by the mother or nurse whilst feeding, who can thus prevent the child from bolting its food, 155 or taking too much, both very common faults, and causing much misery to children. The bottle after use should be immediately rinsed out, the india-rubber teat turned inside out, and the whole then placed in a basin of clean water, to which a little boracic acid has been added, until the next meal is required. It is better to have two bottles and use them alternately. Twice a day, at least, the bottle and its several parts must be thoroughly washed in hot water. Any milk remaining over from one feed must not be used for the next. During the intervals of feeding, the infant should not be allowed to suck rubber rings or teats, etc., as they cause flatulence, and are the means of conveying dirt to the mouth. Weaning.—The child should be weaned at the end of the ninth month, and the process, if possible, should be gradual, occupying at least three or four weeks. During the first week of weaning, the infant should have one feed of cow's milk as prepared for infants at nine months old, instead of the breast. During the second week the child must have two such feeds daily, and so on. The bottle at this time must be discarded, the feeding being by spoon and cup. Do not wean:— 1. When the child is cutting a tooth ; 2. Nor, if possible, during the hot season of the year, or the child may get summer diarrhœa; 3. Nor, if it has just recovered from an illness. Food at One Year and after. At one year old a little bread and butter may be taken at breakfast, and at mid-day a little potato mashed with gravy. When the child is about 18 months old the double teeth are beginning to appear. This is the time to give a little meat, such as mutton or beef, which must be pounded. Veal, pork, pastry, fruit, cheese, tea, coffee, etc., should not be given to infants. 156 3.—CLOTHING. As infants are extremely sensitive to cold, it is clear that they should be warmly clothed, and in such a manner as to prevent catching cold. The infant should be provided with a binder of soft flannel—soft enough not to irritate the skin, and not so tight as to render the child uncomfortable after having a meal. The remainder of the clothing should be warm and made to cover the neck and limbs. When the child is "shortened," the clothes should be made so as to prevent exposure of the limbs. The neck should be high, and the sleeves come down to the wrist. In addition, the clothing should be fairly loose. Attention to these points is necessary to avoid chilling. A large part of infant mortality is due to respiratory diseases, chiefly bronchitis and pneumonia, which are mostly due to chills. During 1910 there were 35 deaths from the former and 50 from the latter disease amongst children under one year, in Hackney. 4. CLEANLINESS. Infants should have at least one warm bath every day. Great care should be taken to have the water at the proper temperature. Any attempt to harden the infant by having the water cold will inevitably lead to its illness and probable death. The proper temperature is 95 deg. Fahr. Soap should not be used with children under nine months old, as it irritates the tender skin of very young children. A good substitute is a handful of oatmeal stirred up with the bath water. 5. SANITARY CONDITION OF THE HOME. Careful feeding and attention to infants may be rendered absolutely useless by inattention to the sanitary conditions of the home and its surroundings. Infants are the first to be affected by insanitary surroundings; so well is this known that the death rate of infants under one year is taken by sanitarians as a measure of the sanitary condition of the place. In order to make the feeding and attention of infants successful it will be absolutely necessary to look to the following in connection with the house. 157 1. Cleanliness.—The whole of the premises should be kept scrupulously clean by the periodical cleansing of rooms, stairs, passages and yards. 2. Foul Smells.—These must be removed. Very often they arise from neglected sinks, gullies, foul w.c. pans, or accumulations in the dust-bins. The sinks and gullies should be cleaned occasionally with hot soda water and flushed with water regularly, the pans must be cleaned with a little acid, and the foul dust-bins will be emptied on application to the Town Hall, Hackney. Foul water and slops often accumulate in defective paving. The paving should be repaired. 3. Ventilation.—Want of ventilation gives rise to a stuffiness of the home, which has a bad effect upon the health of the inmates, especially infants. It is, therefore, necessary to keep the windows of the rooms open some portion of the day. Bedrooms require special attention. Bedclothes should be freely exposed to the air before the beds are made up for sleeping, the windows being left open for this purpose. Fire-places and chimneys should not be closed or blocked up as they act as ventilators to the rooms. In most cases one or more windows of the bedrooms should be kept slightly open all night. There are several simple contrivances to effect this without causing draughts. Cupboards where food is stored should always be well lighted, ventilated, and free from bad smells. 4. Overcrowding.—This leads to the same results as want of ventilation, and to accidents such as overlaying when children are compelled to sleep in the same bed with their parents. This should never be allowed; a cot, or substitute for one, should be provided at the side of the mother's bed for the infant, and handy for her to attend to the child during the night. 5. Other insanitary conditions, which the tenant cannot deal with, should be reported to the Public Health Department, Town Hall. 158 6.—USEFUL FOOD PREPARATIONS FOR INFANTS. Albumin Water.—Take the white of a fresh egg and break it up with a clean pair of scissors. Shake it up well in a clean bottle with six ounces of water and a pinch of salt, strain through muslin, sweeten with a little sugar. This may be given alone or with milk. Suitable for infants and children who digest milk badly. Barley Water.—Place a teaspoonful of washed and wellcrushed barley in a jug, pour on it a half-pint of boiling water, stand it by the fire for an hour, stirring frequently, and then strain through muslin. This should be made fresh every day. Beef Juice.—Take a piece of fresh raw beef, mince it very finely; place it in a cup and cover with pure cold water to which a little salt has been added. Let it stand for one hour, then strain it through muslin. A teaspoonful of this may be given to an infant with or without milk. It must be made fresh. Lime Water.—This may be obtained of any chemist. By Order of the Public Health Committee, J. KING WARRY, M.D., D.P.H., Medical Officer of Health, Town Hall, Hackney, N.E. 159 THE METROPOLITAN BOROUGH OF HACKNEY. PREVENTION OF MEASLES. Measles is a highly infectious fever occurring chiefly amongst children, especially those under five years of age, and is equally common in both sexes. Although regarded of trifling importance by parents, it causes more deaths than scarlet fever or diphtheria. In London alone it causes nearly 3,000 deaths every year, and in Hackney more than 100 deaths. In addition it leaves many children much weakened in health or even injured for life. The disease is dangerous to very young children and especially to those in the second year of life ; so that, if by any means the attack only is delayed until the age of four or five years is reached, there would be a large saving of life. One difficulty in preventing the spread of measles is the fact that a child may be ill two or three days with the early symptoms before the rash appears which proves the nature of the disease, and during this time the sick child is extremely infectious and may infect other children; but this difficulty may be greatly overcome by parents and guardians acquainting themselves with the early signs of measles, thus enabling them to isolate any sick child at an early period of the disease. Another difficulty is that the public generally believe that measles is a mild and harmless disease which children must take, and the earlier they take it the better; whereas, on the contrary, measles is a most dangerous disease, and the later in life it is taken the less serious it is likely to be. The danger attaching to measles is mostly due to serious complications which frequently arise during the course of the disease, owing to want of proper medical treatment and to careless exposure to cold. If parents and guardians would bear these facts in mind, and in all cases of measles take such precautions as are here suggested 160 to prevent its spread, we might reasonably expect a large decrease in its prevalence and a corresponding saving in subsequent illhealth and in deaths. It is with a view to this end that this leaflet has been prepared. Symptoms.—In severe cases the disease may begin with a convulsion, or shivering, or an attack of diarrhœa; but in ordinary cases an observant parent will notice the child looks poorly, does not eat its food as usual, or complains of feeling tired, or is fretful. Then the child develops what appears to be a cold, he sneezes, the eyes get red, and a watery discharge sets in from both eyes and nose, and a slight cough arises. At the same time the child becomes feverish. This condition lasts about three days; then the rash of measles appears. This consists of small dark red spots occurring in irregular patches, first on the face, and then spreading to the trunk and limbs. The rash lasts about four days and then disappears in the same order in which it appears, after which the skin is partly shed in very fine scales. The child is infectious from the commencement of the disease until the disappearance of rash and cough, and until the skin has ceased to peel. This period of infection is usually about 21 days. It should be specially noted that the child is extremely infectious before the rash appears as well as after. The breath, the secretion from the running eyes and nose, and probably the odour given off from the skin, will all spread the disease. It follows that the clothes, with the bedding and room used by the child will be infectious. From the above short account it may be easily gathered what should be done to check the spread of measles. Measures to be adopted to prevent the spread of Measles. 1. As soon as there any suspicion of a child sickening for measles, it should be removed to a warm, well-ventilated room, free from draughts, apart from the remainder of the household, from which all unnecessary clothings, hangings, carpets, &c., have been removed. 2. The discharges from nose, eyes and mouth should be received on soft pieces of rag, and immediately burned. 161 3. The washable clothings and bedding, and the towels used by the patient, should, before removal from the bedroom, be placed in a tub of water to which some disinfectant has been added. Cups, saucers, spoons, &c., should be scalded before being used by others. 4. Persons attending upon a child ill from measles should wash their hands before leaving the sick room and associating with others. 5. After recovery or death, the room, bedding, clothes, &c., used by the patient should te 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 measles. 6. No child should be allowed to go to school from a house in which there is a case of measles until the complete recovery of the patient, and the disinfection of the house, &c. 7. No child should be allowed to attend school who has been exposed to the infection of measles until 16 days after exposure, and not even then if there are signs of the disease having been contracted. By Order of the Public Health Committee, J. KING WARRY, M.D., D.P.H., Medical Officer of Health. Note.—According to the London County Council's School Regulations, children suffering from Measles must be excluded for at least one month. Children coming from houses in which Measles exists, but are not themselves suffering. Infants.— All infants to be excluded until Monday following fourteen days from occurrence of last case. Seniors.— If the child has had the disease, not to be excluded. If the child has not had the disease, exclude until Monday following fourteen days from occurrence of first case. Public Health Department, Town Hall, Hackney, N.E. June, 1909, 162 ANNUAL REPORT OF CANAL BOATS INSPECTOR, FOR 1911, To the Hackney Borough Council, Gentlemen, I beg to submit my annual report upon the canal boats inspected under the Canal Boats Act and Regulations, 1877 and 1884. The details are as follows:— Number of visits to waterways 69 ,, boats inspected 27 „ „ conforming to Acts 27 „ infringing Acts None „ „ inspected not used as dwellings 1 ,, certificates examined 26 „ persons for which boats were registered 87 (adults) „ „ living on boats so registered 38 The boats inspected were found to be in good condition. No legal proceedings were taken. I have the honour to be, Gentlemen, Your obedient Servant, George White, Sanitary Inspector and Inspector under Canal Boats Acts. LIST OF COMMON LODGING HOUSES IN THE BOROUGH OF HACKNEY, 1911, 18a, Dyssel Street Elizabeth Hensman. 32, Goring Street Edmund Barton. 85, Hackney Grove Thomas Alfred Felton. 1, High Street, Homerton Thomas Levy. 23 and 25, Well Street James Shuttleworth. 50, Well Street Charles Thomas Felton. 163 LIST OF LICENSED COW-SHEDS In the Borough of Hackney, October, 1911. No of Name. Address. Sheds. Jones, David 46, Brooksby's Walk, Homerton 1 Jenkins, John 2, Buckingham Road, Kingsland 2 Frances, Hannah 67, Downham Road, Kingsland 1 Evans, R. 11, Downham Road, Kingsland 1 Snewin, W. H. 67, Old Hill Street, Upper Clapton i Welford, R. W. 83, Upper Clapton Road 3 Pocock, B. 46a, Leswin Road, Stoke Newington 1 Warner, J. C. 23, Mare Street 1 Lewis, J. 6, Palace Road, Hackney 1 Williams, Owen 257, Queen's Road, Dalston 1 Williams, Sarah 79, Shacklewell Lane, Hackney 1 Welford, R. W. Sigdon Road, Hackney 1 Stapleton, A .E. & J. G. Stoke Newington Common 3 Briggs, J. J. 180, Victoria Park Road 1 Thomas, David 6, Warburton Road, Hackney 1 Total Cow-Sheds 20 LIST OF LICENSED SLAUGHTER-HOUSES In the Borongh of Hackney, October, 1911. Name. Address. Friday, Richard, G. 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 Toop, C. W. 73, Upper Clapton Road 164 List of Licensed Slaughter-Houses—continued. Name. Address. Goodwin, H. J. 78, Stamford Hill Joyce, John 531, Kingsland Road Patchett, T. H. 133, Lower Clapton Road Tyler, Rose, A 80, Mare Street Teat, Thomas 177, Mare Street Hammer, William 103, Rendlesham Road Adams, H. 94j Southgate Road Row, Fredk. Wm. 130, High Street, Stoke Newington Young, C. J. 220, High Street, Stoke Newington Stoneman, P. 3, Terrace Road Clarke, A. E. 150, Upper Clapton Road Tyler, Stanley 92, Well Street Austin, W E. 51, Wilton Road LIST OF BAKE HOUSES, 1911. No. 1 District. Samson, W. J. 77, Upper Clapton Road Buddin, J. 87, Reighton Road ‡ Vincent, A. 74, Old Hill Street Morgan, A. 33, „ Sandrock, F. 123, Northwold Road ‡Austin, W. H. 74, Fountayne Road Zanetti, C. 84, Stamford Hill. Hygienic Welsh Bakery Co 143, Clapton Common No. 2 District. Kurtz 176, High Street, Stoke Newington Pile, W. 114, Haywood 216, ,, „ ‡Mezger, A. 33, Rectory Road Vogt, C. H. 62, Evering Road Burch, Mrs. H. 9, Maury Road 165 List of Bake-Houses—continued. Name. Address. Willsmer, C. 8, Stellman Street ‡Guscott, J. 128, Stoke Newington Road ‡Feuseurt, G. 40, Shacklewell Lane ‡Karsch, J. 237, Amhurst Road Buch, F 75, Shacklewell Lane ‡Bremner, E. 144, High Street, Kingsland No. 3 District. ‡Martin, J. 50, London Road Lawrence 68, London Road ‡Newling, G. 26, Downs Road Eade, W. A. 215, Lower Clapton Road ‡Parish, W. 117, „ ‡Engel, J. 71, Cowley, Mrs. J. 9, Clarence Road ‡Newell & Co. 393, Mare Street Gentry, W. R. 38, Amhurst Road ‡Seward, R. 240, Dalston Lane No. 4 District. Mack, W. 13, Median Road ‡Lunken, J. 52, Mandeville Street Saur, H. 258, Rushmore Road ‡Blain, G. W. 138, Chatsworth Road ‡Ruhl, J. G. 94, ,, Lunken, H. 71, ,, ‡Maloney, J. 36, ,, ‡Wickert, W. 19, ,, ‡Knapp, W. 219, Glyn Road Latham, J. 326, ,, 166 List of Bake-Honses—continued. No. 5 and 6 District. Name. Address. Liebsch, H. 49, Greenwood Road ‡Spenner, A. 81, Wilton Road ‡Goodwin, J. 178, Dalston Lane ‡Hohl, J. 72, Kitchiner, E. 20 and 22, Forest Road ‡Rowe, J. 207, Queen's Road ‡Spenner, H. 68, Lansdowne Road ‡Tidy 25, West-side, London Fields ‡Chappell, W. 550, Kingsland Road Norman, A. 513, „ Best, C. 376, „ Schaeler 89, Tottenham Road ‡Sedgwick, F. C. 239, Kingsland Road ‡Henkelmann, H. 174, Southgate Road Allardyce, S. W. 98, „ Hazell, M. 40, Downham Road ‡Calton, A 48, De Beauvoir Road Eilinger, W. C. 24, Tottenham Road ‡Pay, E. T. 106, Hertford Road Gutheil, F. C. 64, Richmond Road ‡Roessle, W. 88, High Street, Kingsland ‡Willicombe, F. 28, John Campbell Road ‡Theis 69, High Street, Kingsland ‡Chappell, W. 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, 167 List of Bake-Houses continued. Name. Address. ‡Stumm, K. 26, West Street Slade, C. 139, Mare Street ‡Reitz, C. 183, „ ‡Wragg, A. H. 27, Morning Lane Morse, H. 77, Mare Street Zimmerman, P. 52, Sheep Lane ‡Stimson 77, Frampton Park Road No. 8 District. ‡Cannon, G. D. 13, Loddiges Road ‡Skaer, P. 76, Well Street Martin, J. 105, „ ‡Mustard, Mrs. E. C. 79, Lauriston Road ‡Durham, L. V. 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. 95, „ „ ‡jessup, H. 167, „ „ Juniper, J. T. 18, Brooksby's Walk Herman, G. O. 3, Churchill Road No. 10 District. Parker, G. 220, Wick Road Burford 184, Cassland Road Pimm, — 16, Gloucester Road Bremner, G. W. 92, Wick Road ‡Gunner, Mrs. 34, Church Road, Homerton Hohloch, C. 12, Berger Road Weber, G. 50, Kenton Road 168 List of Bake-Houses—continued. Name. Address. Holman, A. 154, Well Street ‡Stark, W. 186, „ Fey, F. 233, „ Matthias, A. C. 27, Elsdale Street Hulstrom, F. K. 142, Well Street Cave, H. R. 60, Morning Lane No. 11 District. Selzer, H. 89, Sidney Road Lunken, L. 276, Wick Road Dance, Mrs. A. 315, „ Brake, G. 370, „ James, G. 389, „ Appleton, J. 41, Osborne Road Hewitt, A. 13, Gainsboro' Cottages Davis, S. 71, Felstead Street No. 12 District. ‡Robinson, W. 18, Upper Clapton Road ‡Kurtz, W 200, Lower Clapton Road ‡Underground Bake-houses.