HAC 70 Borough of Hacknen. REPORT on the SANITARY CONDITION of the hackney district, FOR THE YEAR 1912, 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 Medical Officer of Health for the District. London: Chas. Straker & Sons, Ltd., 5-9, Bishopsgate Avenue, E.C. 1913. INDEX. PAGE Alcoholism 47 Anthrax Order 67 Birth Rate 13 By-laws—Houses let in Lodgings 156 Canal Boats Act 67 & 164 Cancer 46 Census, 191 12 Cerebro-Spinal Fever 41 Cleansing of Persons Act, 1897 103 Combined Drainage and Sewers 91 Constitutional Diseases 45 Cowhouses, Milk shops, and Dairies 61 Customs and Inland Revenue Act Death Rate 16 Deaths in Public Institutions 21 Diarrhœa 43 Diphtheria 38 Disinfection 93 Enteric Fever 40 Erysipelas 41 Estimated Population 11 Factories 81 Factory and Workshops Act, 1901 78 Glanders and Farcy Order 67 Glanders, Anthrax and Hydrophobia in Man 43 Home Work and Out-Workers 86 House Flies and Disease 51 Houses Let in Lodgings 64 Housing and Town Planning Act, 1909 67 Ice Cream Vendors 67 Illegitimacy 15 Infant Mortality 18 Influenza 43 Marriage Rate 13 Measles 44 Methods of Control of Tuberculosis 70 Mortuary 113 National Insurance Act, 1911 48 & 73 Notification of Births Act 14 Notifiable Diseases 37 Non-Notifiable Diseases 43 Offensive Trades 62 Ophthalmia Neonatorum 42 Plague 41 A 2 INDEX. PAGE Polio-myelitis 42 Population and Density 11 Prosecutions under Food and Drugs Acts 125 Prosecutions under Public Health (London) Act 124 Public Health (London) Act, 1891 57 Public Health Legislation 76 Public Health (Tuberculosis) Regulations, 1908-1911 70-72 Puerperal Fever 41 Register of Sanitary Work 114-131 Removal of House Refuse 108 River Lee 73 Senile Mortality •• •• 20 Scarlet Fever •• 37 Shelter 163 Slaughter-Houses 62 Small-pox 37 Smoke Nuisances 63 Specific Causes of Death 28-36 Tuberculous Disease 43 Tuberculosis Dispensaries 140 „ Regulations—Report on 127 Typhus . ■ 41 Vaccination 47 Whooping Cough 44 Workshops and Laundries ,, ,, ., ,. 83 Zymotic Diseases 37 Tables— Articles Disinfected during 1912 96 Births •. 14 Bakehouses, List of 166 Causes of Infant Mortality 24 Cowsheds 165 Deaths 28-36 Death Statistics, according to Causes and Ages 26-27 Dusting Account 112 Infectious Sickness 25 Inquests 103 Population, Area and Density in Sub-Districts in Hackney 11 Requests for Removal of Dust 111 Samples of Foods and Drugs Purchased 123 Samples of Milk Analysed 122 Slaughter-Houses, List of 165 Suicides and Accidental Deaths 133 Vaccination 50 metropolitan Borough of hackney REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1912. 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 Twenty-first Annual Report on the Public Health of the Borough of Hackney. The year 1912 was noted for its low general death rate, which was only 12.3 per 1,000 of the population, and more especially for its low infant mortality, which was 79 per 1,000 births. These figures show a decline of 2.7 per 1,000 in the general death rate and 11 per 1,000 births in the infant mortality, compared with the corresponding rates for the year 1911. A great decline in the prevalence of notifiable infectious disease was also experienced, the total number of cases from all these diseases being only 1,071, compared with 1,968 during the previous year. The number of deaths from the seven chief zymotic diseases numbered 108, which is equivalent to a zymotic death rate of .48 per 1,000 living, the corresponding figures for 1911 being 438 deaths and a zymotic death rate of 1.9 per 1,000 living. The infectious sickness rate and the mortality rates of the past 3'ear, therefore, give a very encouraging and satisfactory view of the healthiness of the Borough during 1912. The decline in the mortality rates were no 6 doubt largely contributed to by the low temperature of the summer, but this does not account for the whole improvement; much must be attributed to the gradual improvement which has taken place in the sanitary condition of the Borough since the Public Health (London) Act, 1891, came into force; and this in spite of increasing density, and the gradual change from suburban to urban conditions. This improvement may be more clearly seen by a study of the following table, giving the Density, General and Infantile Mortality Rates for the last fourteen years:— 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 1912 67.8 12.3 79 The relative position from a health point of view occupied by Hackney may be seen from the subjoined table, compiled from figures supplied by the Registrar-General, showing the death rates 7 from all causes and the death rates of infants under one year of age in the Metropolitan Boroughs and the City of London for the year 1912:— Boroughs. Death-rate from all causes per 1,000 living (corrected). Deaths under 1 year to 1,000 births. County of London 13.6 91 Lewisham 10.2 70 Wandsworth 10.2 76 Hampstead 10.4 62 Stoke Newington 11.5 72 Woolwich 11.9 73 Hackney 12.3 80 Battersea 12.3 84 Paddington 12.3 98 Cambcrwell 12.7 83 Kensington 12.9 91 Greenwich 12.9 84 Deptford 13.0 89 Hammersmith 13.0 90 Lambeth 13.0 86 City of Westminster 13.0 84 Fulham 13.2 94 Chelsea 13.8 68 Islington 14.0 87 City of London 14.0 81 St. Marylebone 14.1 93 St. Pancras 14.6 88 Holborn 15.4 80 Bethnal Green 16.9 96 Stepney 15.9 105 Poplar 16.2 107 Bermondsey 16.8 111 Southwark 16.8 105 Finsbury 18.6 114 Shoreditch 18.7 123 The measures taken during the year for dealing with the problem of infant mortality are dealt with in another part of this report (see page 18), but, as may be seen from the rate of infant mortality for the period in question, satisfactory progress has been made. Detailed reference to the preventive measures taken in connection with the prevention of the spread of tuberculosis is made in a later part of this report (see page 70). 8 The general sanitary measures, which have been adopted in the Borough during past years, are showing their effects upon the prevalence of this disease in the borough, in a gradual but marked decline in its mortality. This may be seen from the following table:— Mortality from all forms of Tuberculosis for the years 1898-1912 in five yearly periods. Periods. Average Quinquennial Population. Average Annual Number of Deaths. Average Annual Mortality per 1,000 living. 1898-1902 214,210 480 2.24 1903-1907 220,500 405 1.84 1908-1912 221,538 372 1.68 Encouraging as these results are, we may with confidence anticipate in the future a more substantial and continuous decline in the mortality from this disease, especially when the Borough is provided with a Tuberculosis Dispensary, and adequate means are at hand for dealing thoroughly with contacts and the home conditions of tuberculous patients. In my Annual Report for 1911, I stated that there were in the Borough 489 factories, 1,157 workshops and 3,071 out-workers. At the end of 1912 these figures had changed to 507 factories, 1,221 workshops and 2,559 out-workers. On page 81 of this report I give a classified list of the industries carried on in the factories and workshops in the Borough. 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. In a memorandum as to Annual Reports of Medical Officers of Health, issued by the Chief Medical Officer of the Local Government Board at the end of 1910, the attention of Medical Officers 9 of Health is drawn to certain subjects upon which, inter alia, the Board require them annually to report. That part of the memorandum referred to is as follows:— "The following deserve to be especially borne in mind as subject matters concerning which the Board desire to obtain, through annual reports of the medical officer of health, not only definite general information, but record also of particular changes of condition that occur incidentally or by action of the local authority." "General features of the district, and general conditions of its population." "The chief occupations of the inhabitants, and the influence of any particular occupation on public health." "House accommodation, especially for the working classes ; its adequacy and fitness for habitation. Sufficiency of open space about houses and cleanliness of surroundings. Unhealthy areas. Overcrowding. Action under the Housing of the Working Classes Acts, taken or needed." "Water supply of the district or of its several parts." "Milk Supply: Character and wholesomeness of milk supply of the district, condition of dairies, cowsheds and milk shops; administration in regard to milk. Tuberculous milk." "Other Foods: Unsound food and food inspection, sanitary condition of premises where foods are prepared, stored or exposed for sale. Meat inspection, disease in meat, and condition of slaughter-houses. Action under Sale of Food and Drugs Acts taken or needed. Action under Sec. 41 of the Public Health (London) Act, 1891. Number of carcases and parts of 10 carcases condemned for tuberculosis; information on this point should be given even when entirely negative." "Condition of sewers and house drains." "Pollution of rivers and streams in the district. The sources and nature of such pollution, and any action taken to check it." "Removal and disposal of house refuse—whether by local authority or contractors; frequency and method." "Nuisances: Proceedings for their abatement—any remaining unabated." "Bye-laws as to houses let is lodgings, &c. Details as to number of premises coming under each set of bye-laws and action taken. Any need of amendment or further bye-laws." "Schools, especially Public Elementary Schools: Sanitary condition of, including water supply: Action taken in relation to the health of the scholars and for preventing the spread of infectious disease." "Methods of dealing with infectious diseases: Notification; isolation in hospital; disinfection; temporary shelters; mortuaries." "Methods of control of tuberculosis; whether any system of notification of cases of pulmonary tuberculosis is in operation. Number of cases notified; what action is taken in respect of known cases and of deaths. Amount of hospital accommodation for cases of pulmonary tuberculosis in infirmaries and elsewhere, for advanced and for earlier cases of the disease." "With regard to the preceding points it should be remembered that these reports are for the information of the Board and of the County Council, as well as of the Borough Council, 11 and that a statement of the local circumstances and a history of local sanitary questions which may seem superfluous for the latter, may often be needed by the former." "It is expected that each of the preceding points shall be mentioned in the annual report, and the extent of action or the absence of action on each of them definitely stated." I have endeavoured in the following report to deal as far as possible with the subjects above mentioned. Population and Density.— Applying the rate of increase observed during the last intercensal period to the population of Hackney, I estimate the population of the Borough to number 223,022 at the end of June, 1912. This estimate gives a density of population for the whole Borough of 67.8 persons per acre, varying from 50 0 persons in the North Sub-District to 98.6 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 Registration SubDistricts in the Borough:— Table. Showing estimated Population, Area and Density of the Registration Sub-Districts in Hackney, at middle of 1912. North. Central. Southwest. SouthEast. Total for Hackney Total for London. Estimated Population . 54,113 53,987 57,826 57,096 223,022 4,519,754 Area in square acres 1,081 857 586 764 3,288 74,816 Density—persons per acre 500 600 98.6 74.7 67.8 59.4 I give here a table, taken from Vol. VI. of the Census of England and Wales, 1911, which supplies more detailed information concerning the population of the Borough and their dwellings and other buildings. CENSUS OF ENGLAND AND WALES, 1911.—VOL. VI. HACKNEY. Classification of Buildings. 1901. Total. 1911. Total. Ordinary Dwelling Houses Blocks of Flats. S ops. Hotels, Inns and Public Houses. Offices, Warehouses, Workshops, Institutions. Others. Vessels, Sheds. Vagrants, &c. Separate Flats (including column 5) Buildings not used as Dwellings. (13) (14) Places of worship 120 (l) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Number inhabited 30,604 31,090 27,437 519 2,662 201 76 124 71 — 2,876 Government and Municipal buildings 35 Separate occupiers 48,761 50,622 43,601 3,092 3,361 206 86 189 85 2 3,092 Shops 425 Population 219,110 222,533 186,953 12,195 14,286 1,229 335 7,135 392 8 12,195 Offices 50 Uninhabited 1,003 1,501 1,211 6 266 3 7 1 7 — 332 Warehouses, Workshops, Factories 534 Being built 79 53 41 5 6 — 1 — — — 8 Theatres and other places of amusement 15 Average Number of Persons per Inhabited Building. 1901. 1911. 7.16 7.16 Average Number of Persons per Family. 1901. 1911. All Dwellings. All Dwellings. Ordinary Dwelling -houses. 4.49 4.40 4.29 13 *Marriages and Marriage Rates.— During 1912 there were 1,967 marriages celebrated in the Borough of Hackney. The annual marriage rate for persons married during this period is therefore 17'6 per 1,000 of the population. The following table gives the number of marriages, and the marriage rates for the Borough of Hackney and London for the ten years 1903-1912:— Year. Borough of Hackney. London. Marriages. Marriage Rate. Marriage Rate. 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 1911 1,919 17.2 17.8 Average 1902—1911 1,811 15.7 16.8 1912 1,967 17.6 18.6 Births.— The number of births registered in the Borough of Hackney during the year 1912 was 5,425, of which 2,845 were males and 2,582 females. The total shows an increase of 15 compared with the number of births registered in the Borough during 1911. It must be remembered that this total is the actual number of births registered in Hackney, but of these a certain number * I have here to acknowledge my indebtedness to Mr. Tom Hosgood, Superintendent register, who has kindly abstracted for me the number of marriages for the year 1912:. 14 should be transferred to other districts, and there are also certain births 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., 279 births to be transferred to other districts and 121 births transferred to Hackney. After making these corrections, the correct total of registered births amongst Hackney residents is 5,267. From this figure, I calculate the birth rate for Hackney during 1912 to be 23.6 per 1,000 of the population. The birth rate for all London for the same period is 24.5 per 1,000 of the population. Notification of Births.—Under the provisions of the Notification of Births Act, 1907,1 received 5,548 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 120 more than the number registered by the Registrars of Births. Amongst the births notified were 151 still born. This is equal to 2.7 per cent. of those notified. I give here a table showing the number of notifications of births received, with other details in connection with the same:— (b) NOTIFICATION OF BIRTHS ACT, 1907, Notifications of Births (Live or Stillborn) received during thi year, 1912. Medical Practitioners. Midwives. Parents and Others. Total. Year 1911. 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. 878 832 30 25 1,335 1,221 32 39 564 567 16 9 2,777 2,620 78 73 15 Illegitimate Births and Birth-rate—The total number of illegitimate births registered in the Borough during the year 1912 was 370, but of these I am informed by the Registrar-General that 261 should be transferred to districts outside of Hackney, as the mothers were not Hackney residents; and that 13 births taking place in other districts should be transferred to Hackney. Making these corrections there remain 122 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate birth-rate of 22.5 per 1,000 registered births. The following table gives the number of registered births, birthrates, &c., for the sub-districts in the Borough:— Table. Births. Registration District of Hackney. Registration Sub-District. All London. North. Central. SouthWest. SouthEast. Total No. of Births 5,425 1,015 1,293 1,647 1,470 110,353 Rate per 1,000 living 24.3 18.7 23.9 28.4 25.7 24.5 No. of Illegitimate Births 122 Rate per 1,000 Births 225 16 The following table shows the birth-rates for the Borough and its sub-districts during the years 1902 to 1912. Birth- Rate for the Borough of Hackney and its Sub-Districts jo: the Years 1902-1912 compared with that of London. Year. Borough of Hackney. North SubDistrict. Central SubDistrict. South-West SubDistrict. South-past SubDistrict. London. 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 1911 24.3 18.8 24.8 28.0 25.2 24.8 Average 1902—1911 25.4 19.2 25.4 28.9 27.7 26.1 1912 24.3 18.7 23.9 28.4 25.7 24.5 Deaths.— The total number of deaths registered in the Borough of Hackney during 1912 was 2,952, but of these 663 were deaths of non-residents dying in institutions and other places in the Borough. There were, on the other hand, 431 residents who died during the year in institutions in other districts. On making the necessary corrections by deducting 663 from the total deaths registered in the Borough and adding 431 to the result, we obtain the correct number of deaths amongst Hackney residents viz., 2,720. This is a decline of 481 upon the number of deaths which occurred in the Borough during the year 1911. The crude general death-rate from all causes for the year is 12.2 17 per 1,000. On further correcting this rate for age and sex dis tribution by means of the factor 1.0066, I obtain the corrected general death rate of 12.3 per 1,000 of the population for the year 1912. The corrected general death-rate for the year 1911 was 15.0 per 1,000 of the population, so that the death-rate for 1912 is 2.7 per 1,000 of the population lower than the rate for the previous year. The chief causes of this abnormally low death-rate ?re no doubt to be sought in the very low incidence of the infectious fevers and summer diarrhoea during the past year, combined with a very mild winter and summer. Amongst the registration sub-districts the death-rate was lowest in the central sub-district (10.8 per 1,000) and highest in the south-west sub-district (13.6 per 1,000). Sub-District. Population. No. of Births. Birthrate. Total Deaths. Deathrate. (Crude.) Deaths under 1 year. Infant Mortality per 1,000 Births. North 54,113 1,015 18.7 591 10.9 65 64 Central 53,987 1,293 23.9 582 10.8 99 76 South-West 57,826 1,647 28.4 786 13.6 119 72 South-East. 57,096 1,470 25.7 761 13.3 143 97 All Hackney 223,022 5,425 24.3 2.720 12.2 426 79 The corrected annual death-rate from all causes for London during 1912 is 13'6 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. 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 1907 14.4 15.35 1912 12.3 13.6 b 18 Infant Mortality. —The deaths under 1 year of age amongst Hackney residents during the year 1912 numbered 426. This is a decrease of 207 upon the number of infant deaths during the previous year. The infant mortality rate for the year is therefore 79 per 1,000 births. This rate is the lowest on record for the Borough. The decline is mostly due to the very mild summer of last year, and the comparatively remarkable freedon from infectious disease. Whereas during 1911 there were 172 infant deaths due to diarrhoea and enteritis, during last year there were only 52. The deaths also from measles for the same years were respectively 30 and 4. Other causes of infant deaths during the year which must be mentioned are 80 premature births, 56 attributed to atrophy, debility, and marasmus, and 78 to bronchitis and pneumonia. During the first eight months of 1912, Mrs. C. Brown, Health Visitor, who had continued her work amongst nursing mothers and their infants, made 657 primary visits and 900 secondary visits, and in addition 244 fruitless visits, the mothers being out at the time or having changed their address. Unfortunately Mrs. Brown left the service of the Borough Council on the 31st August, and her office was not filled up until the beginning of this year. The weekly meetings at the Town Hall, for advising nursing mothers generally in the care and nurture of their infants, were continued during the year while we had the services of a Health Visitor, but after the resignation of Mrs. Brown they were discontinued. In losing the Services of Mrs. Brown, the Borough Council lost a most capable, conscientious, and energetic Health Visitor, who was deservedly most popular with the mothers whom she visited. I append a table giving information as to the feeding, of infants, and the home conditions found by the Health Visitor amongst the 657 infants visited. 19 PARTICULARS RESPECTING THE FEEDING, CARE, AND ENVIRONMENT OF THE BABIES VISITED, 1912. Babies Visited. Feeding. Separate Cot Provided for Baby. Use of Comforter. Home Conditions of Family. Employment of Father. Secondary Visits. Poor. Fair. Comfortable. Boys. Girls. Breast. Artificial. Mixed. No. Yes. No. Yes. Clean. Dirty Clean. Dirty Clean Dirty. In Work. Out of Work Out. Removed 180 64 363 294 581 31 45 607 50 232 425 118 35 504 26 200 9 567 90 900 B2 20 TABLE IV— INFANT MORTALITY. 1912. 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. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths 1 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... 1 1 ... ... 1 2 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 3 1 6 3 13 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 l Erysipelas 1 ... ... ... 1 1 ... ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... 2 1 3 6 Abdominal Tuberculosis. ... ... ... ... ... 3 1 1 2 7 Other Tuberculous Diseases ... ... ... ... ... ... 1 5 2 8 Meningitis (not Tuberculous) 2 ... ... ... 2 2 3 3 2 12 Convulsions 7 10 ... 2 20 0 3 2 1 32 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 2 ... 2 4 8 8 1 1 22 Pneumonia (all forms) ... 4 ... 3 8 10 13 13 12 56 Diarrhœa 1 ... ... ... 1 10 12 1 2 26 Enteritis ... 1 ... ... 1 10 10 3 2 26 Gastritis ... ... ... 1 2 2 ... ... ... 4 Syphilis ... ... ... 1 1 4 ... ... ... 5 Rickets ... ... ... ... ... ... ... 3 ... 3 Suffocation, overlying 2 1 ... 1 4 10 1 ... ... 15 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 7 ... ... ... 7 ... ... ... 1 5 Congenital Malformations 6 4 1 1 12 ... 1 ... ... 14 Premature Birth. 52 10 8 5 75 3 2 ... ... 80 Atrophy, Debility and Marasmus 10 5 9 3 20 21 8 6 1 56 Other Causes 5 1 2 ... 8 5 7 2 2 24 Total 95 38 16 20 169 98 73 49 37 426 Senile Mortality.— The deaths which occurred in Hackney at 65 years and upwards during 1912 numbered 888, and of these 463 were between the ages of 65 and 75 years, 316 between 75 and 85 years, and 109 at 85 years and upwards. The annual mortality-rate of persons at 65 years and upwards is 3 9 per 1,000 Jiving. 21 Deaths in Public Institutions.— There were 1,387 deaths in public institutions in the Borough during 1912; of these 663 were residents of other districts, and the remaining 718 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 in each institution during the year 1912:— INSTITUTIONS WITHIN THE BOROUGH RECEIVING PERSONS BOTH FROM AND WITHOUT THE BOROUGH. Brooke House, Upper Clapton Road 9 City of London Infirmary, Clifden Road 58 Eastern Hospital, Homerton 171 French Hospital, Victoria Park Road 7 German Hospital, Dalston 106 Hackney Union Infirmary, Homerton 741 Hackney Union Workhouse, Homerton 5 Metropolitan Hospital, Kingsland 190 Nursing Home, 46, Amhurst Park 1 Nursing Home, Downs Road 1 Nursing Home, 18 and 20, Southwold Road 6 St. Joseph's Hospice, Mare Street 62 St. Scholastica's Retreat, Kenninghall, Road 4 Salvation Army Nursing Home, 29, Devonshire Road 2 Salvation Army Maternity Hospital, Mare Street 19 Salvation Army Home, Springfield 3 Salvation Army Maternity Home, 9, Laura Place 1 Salvation Army Hospital, 15, Gore Road 1 1,387 22 INSTITUTIONS OUTSIDE THE BOROUGH RECEIVING SICK AND INFIRM PERSONS FROM THE BOROUGH. Alexandra Nursing Home, Islington 1 Babies' Home, Shoreditch 1 Banstead Asylum 7 Bethnal House Asylum 1 Bethnal Green Infirmary 2 Bethnal Green Workhouse 1 Belgrave Hospital 1 Camberwell Infirmary 1 Cane Hill Asylum 3 Caterham Asylum 4 Central London Throat and Ear Hospital 1 Camberwell House Asylum 3 Channel View, Lancing 3 Charing Cross Hospital 3 Children's Hospital Great Ormond Street 6 City of London Lying-in Hospital 2 Claybury Asylum 37 Colney Hatch Asylum 20 Convalescent Home, Grosvenor Place, Margate 3 Darenth Industrial Colony 1 Dartford Heath Asylum 3 East London Hospital 2 Epileptic Colony, Epsom 2 Friedenheim Hospital 3 Guy's Hospital 4 Grove Fever Hospital 1 Hackney Workhouse, Brentwood 6 Heart Hospital, Soho 2 Holborn Workhouse, Shoreditch 1 Homoepathic Hospital 3 Home Hospital, Fitzroy Square 1 Home and Hospital, Tottenham 2 Home of Good Shepherd, Shoreditch 1 Home for Jewish Incurables. Tottenham 3 Home for Incurable Children, Hampstead 1 Horton Asylum 7 Hospital of St. John and St. Elizabeth 1 Hospital for Women, Soho 1 Islington Infirmary 1 Islington Workhouse1 Invalid Asylum, Stoke Newington 1 23 Italian Hospital, Queen's Square 1 King's College Hospital 1 Leavesden Asylum 8 Long Grove Asylum 6 London Hospital 59 London Fever Hospital 2 Manor Asylum 3 Middlesex Hospital 5 Mildmay Memorial Hospital 2 Mildmay Mission Hospital 2 National Hospital, Queen's Square 1 National Sanatorium, Benenden 1 North-Eastern Fever Hospital 5 North-Western Fever Hospital 1 Prince of Wales' General Hospital, Tottenham 3 Queen's Hospital for Children 55 Queen Mary's Hospital 1 Royal Chest Hospital, City Road 5 Royal London Ophthalmic Hospital 1 St. Bartholomew's Hospital 23 St. George's Hospital 1 St. Luke's House, Kensington 3 St. Mark's Hospital 2 St. Pancras Infirmary 1 St. Peter's Hospital 1 St. Thomas' Hospital 1 Seaman's Hospital 1 Shoreditch Infirmary 7 21, Stamford Hill 1 Sick Asylum, Cleveland Street 1 Sick Asylum, Bromley 1 Tooting Bee Asylum 15 Victoria Park Chest Hospital 6 West London Hospital 1 Whitechapel Infirmary 2 Miscellaneous Institutions 54 431 24 TABLE I.—HACKNEY DISTRICT. Vital Statistics of Whole District during 1912 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 Births. 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 14.9 536 353 721 127 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 5,403 24.3 3,195 14.4 499 430 666 123 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 1912 223,022 5,425 5,267 23.6 2,952 13.2 663 431 426 79 2,720 12.2 25 TABLE II.—HACKNEY DISTRICT. Cases of Infectious Disease Notified, during the Year 1912. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 249 9 98 115 14 11 2 ... 57 61 64 67 218 Erysipelas 211 7 8 18 27 58 71 22 24 34 82 71 52 Scarlet Fever. 518 4 154 305 35 17 3 ... 93 201 112 112 473 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 28 ... 2 7 4 10 ... ... 5 9 8 6 24 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 27 ... ... ... 7 19 ... ... 6 6 6 9 17 Cerebro-Spinal Meningitis 7 3 1 2 1 ... ... ... 1 3 1 2 7 Polio Myelitis 8 ... 8 ... ... ... ... ... 2 ... 3 3 4 Pulmonary Tuberculosis ... 4 10 87 141 368 168 48 144 221 224 237 322 Ophthalmia Neonatorum 23 23 ... ... ... ... ... ... 5 3 6 9 ... Totals 1,897 50 281 534 229 483 250 70 337 538 506 516 1,117 26 TABLE III.—HACKNEY DISTRICT. Causes of, and Ages at, Death during the Year 1912. 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 3 ... ... ... ... ... 2 1 ... 4 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 13 4 5 4 ... ... ... ... ... 79 Scarlet Fever 8 3 2 3 ... ... ... ... 13 Whooping-cough 32 13 5 13 1 ... ... ... ... 22 Diphtheria and Croup 12 1 3 1 7 ... ... ... ... 30 Influenza 17 ... ... ... ... ... 2 9 6 ... Erysipelas 6 2 ... ... ... ... 1 3 ... 6 Phthisis (Pulmonary Tuberculosis) 291 3 1 2 8 48 106 94 29 194 Tuberculous Meningitis 25 6 6 5 6 1 1 ... ... 13 Other Tuberculous Diseases 39 11 8 5 6 6 2 1 ... 25 Cancer, Malignant Disease 213 ... 1 1 2 1 24 98 86 121 Rheumatic Fever 7 ... ... ... 4 ... 1 1 1 4 Meningitis 31 13 3 5 3 3 2 2 ... 10 Organic Heart Disease 279 ... 1 1 13 13 34 103 113 147 Bronchitis 245 22 7 ... 1 1 12 47 155 62 Pneumonia (all forms) 264 56 25 19 9 4 38 58 55 104 27 HACKNEY DISTRICT-continued. Causes of, and Ages at, Death during the Year 1912. 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 40 ... 1 ... ... 2 5 13 19 25 Diarrhoea and Enteritis 60 44 9 1 1 1 ... 1 3 34 Appendicitis and Typhlitis 11 ... ... ... 5 2 1 3 ... 9 Cirrhosis of Liver 30 ... ... ... ... ... 14 12 4 14 Alcoholism. 5 ... ... ... ... ... ... 5 ... 1 Nephritis and Bright's Disease 85 ... ... 1 2 2 16 37 27 50 Puerperal Fever 9 ... ... ... ... ... 9 ... ... 3 Other Accidents and Diseases of Pregnancy and Parturition 8 ... ... ... ... 1 7 ... ... 7 Congenital Debility and Malformation, including Premature Birth 161 158 1 2 ... ... ... ... ... 49 Violent Deaths, excluding Suicide 97 20 3 5 11 4 12 21 21 65 Suicides 25 ... ... ... ... 2 8 10 5 9 Other Defined Diseases 540 72 4 8 16 21 56 156 207 214 Diseases ill-defined or unknown 166 1 2 1 ... ... ... 4 157 73 Totals 2,720 426 88 76 98 112 353 679 888 1,387 Sub-Entries (included in above figures)— Cerebro-Spinal Meningitis ... 1 1 ... 1 2 ... ... ... ... Poliomyelitis ... ... ... ... ... .... .... .... .... .... 28 TABLE OF DEATHS Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1912. 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) 4 9 ... ... ... ... ... ... ... ... ... 13 Epidemic Hose Rash, German Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 5 3 ... ... ... ... ... ... ... ... 8 Typhus ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... 2 ... ... ... ... ... 17 Whooping Cough 13 18 1 ... ... ... ... ... ... ... ... 32 Mumps ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup 1 4 7 ... ... ... ... ... ... ... ... 12 Cerebro Spinal Fever 1 1 1 2 ... ... ... ... ... ... ... 5 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... 1 ... ... ... ... ... 3 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Diarrhoea, Epidemic (or Zym.) Enteritis 8 3 ... ... ... ... 1 ... ... ... ... 12 29 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. __ 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Diarrhœa, Choleraic Diarrhœa 18 2 ... 1 ... ... ... ... 1 1 1 24 Dysentery ... ... ... ... 1 1 ... 2 ... ... ... 4 Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... Slanders, Farcy ... ... ... ... ... ... ... ... ... ... ... ... Anthrax Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 5 1 ... ... ... ... ... 1 ... ... ... 7 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septiæmia, Sapræmia ... ... ... ... 3 2 ... ... ... ... ... 5 Puerperal Pyæmia ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Dolens ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... 3 1 ... ... ... ... ... 4 Ifective Endocarditis ... ... ... 5 1 2 1 ... ... ... ... 9 Epidemic Pneumonia, Pneumonia Fever ... ... ... ... ... ... ... ... ... ... ... ... Eysipelas 2 ... ... ... ... 1 2 1 ... ... ... 6 Septicæmia (not Puerperal) 1 1 2 1 5 ... 1 1 ... 1 ... 13 Pyæmia (not Puerperal) ... ... 2 ... ... 1 2 ... ... ... ... 5 Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... ... 1 ... ... 1 Phagedæna ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... ... ... ... ... ... ... 20 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). 2 2 7 43 44 51 51 35 17 6 ... 258 "Phthisis" 1 1 1 5 5 6 4 4 3 3 ... 33 Tuberculous Meningitis 6 11 6 1 ... 1 ... ... ... ... ... 35 Tuberculous Peritonitis 1 4 ... 1 1 ... ... ... ... ... ... 7 Tabes Mesenterica 6 ... ... ... ... ... ... ... ... ... ... 6 Lupus ... ... ... ... ... ... ... ... ... ... ... ... Tubercle of other Organs ... ... 2 4 ... 1 ... 1 ... ... ... 8 General Tuberculosis 4 9 4 1 ... ... ... ... ... ... ... 18 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... Scurvy 1 ... ... ... ... ... ... ... ... ... ... 1 Alcoholism, Delirium Tremens ... ... ... ... ... 2 3 ... ... ... ... 5 Opium, Morphia Habit ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning by Lead ... ... ... ... ... ... 1 ... ... ... ... 1 by Phosphorus ... ... ... ... ... ... ... ... ... ... ... ... by Arsenic and other Metals ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... 4 ... 1 ... 1 ... 1 ... ... 7 Rheumatism of Heart ... ... ... ... ... ... ... ... ... ... ... ... Chronic Rheumatism ... ... ... ... ... ... ... ... 1 1 ... 2 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. Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... ... 2 3 1 ... ... 6 Gout ... ... ... ... ... ... ... 2 1 ... ... 3 Carcinoma ... ... ... ... 3 11 22 40 44 17 3 140 Sarcoma ... 1 1 1 ... ... 1 4 3 ... ... 11 Malignant Diseases, Cancer ... 1 1 ... 3 7 12 19 14 5 ... 62 Rickets 2 ... ... ... ... ... ... ... ... ... ... 2 Purpura 1 ... ... ... ... ... ... ... ... ... ... 1 Hæmophilia, Hæmorrhagic Diathesis 1 ... 1 ... ... ... ... ... ... ... ... 2 Anæmia, Leucocythæmia ... 1 1 1 2 ... 1 3 2 ... ... 11 Diabetes Mellitus ... ... 1 ... 2 1 4 9 7 2 ... 26 Premature Birth 80 ... ... ... ... ... ... ... ... ... ... 80 Congenital Defects 14 1 ... ... ... ... ... ... ... ... ... 15 Injury at Birth 2 ... ... ... ... ... ... ... ... ... ... 2 Atelectasis 8 ... ... ... ... ... ... ... ... ... ... 8 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... Teething 1 1 ... ... ... ... ... ... ... ... ... 2 922 Disease of Nervous System. Meningitis, Inflammation of Brain 12 7 2 1 1 1 2 ... ... ... ... 26 Softening of Brain ... ... ... ... ... ... 2 3 5 3 3 16 General Paralysis of Insane ... ... ... 1 1 7 2 ... ... ... ... 11 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. Insanity (not Puerperal) ... 1 ... ... ... ... ... 3 4 2 ... 10 Chorea ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... 1 2 ... 2 1 2 1 1 ... 10 Convulsions 32 1 ... ... ... ... ... 1 ... ... ... 34 Laryngismus Stridulus ... ... ... ... ... ... ... ... ... ... ... ... Locomotor Ataxy ... ... ... ... 2 1 ... ... ... ... 3 Paraplegia and Disease of Cord 1 ... 1 1 ... 4 3 3 ... ... 13 Neuritis, Periph, PolyNeuritis ... 1 ... ... ... 1 ... ... ... ... ... 2 Brain Tumour (not specific) ... ... 1 1 ... 1 1 2 ... ... ... 6 Nervous System, other Diseases ... ... 1 1 2 1 1 5 4 1 ... 16 Disease op Organs of Sense. 14? Otitis, Mastoid Dis. ... 1 ... 2 2 ... ... 1 ... ... ... 6 Epistaxis, Nose Dis. ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Dis. ... ... ... ... ... ... ... ... ... ... ... ... Accident. 19 6 9 3 1 6 11 6 6 9 5 81 Violence Suicide ... ... ... 2 3 5 3 7 4 1 ... 25 Drowned ... 2 2 1 2 3 2 1 1 ... ... 14 Murder 1 ... ... ... ... ... 1 ... ... ... ... 2 128 Disease of Heart. Valve Dis., Endocarditis ... 2 10 12 13 18 34 44 48 30 2 213 Pericarditis ... ... 3 ... ... 1 ... 1 ... ... ... 5 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 Hypertrophy of Heart ... ... ... ... ... ... 1 ... ... ... ... 1 Angina Pectoris ... ... ... ... ... ... 1 1 1 3 ... 6 Dilatation of Heart ... ... ... 1 ... 1 2 5 3 2 ... 14 Fatty Degeneration of Heart ... ... ... ... ... 1 3 11 14 8 2 39 Syncope Heart Dis. (not specified) 1 ... ... ... ... ... ... 2 11 6 1 21 Disease of Blood Vessels. 299 Cerebral Haemorrhage, Emb., Throm. 9 1 1 2 1 3 9 21 37 17 3 100 Apoplexy, Hemiplegia ... ... ... ... ... 1 8 5 7 10 1 32 Aneurysm ... ... ... ... ... 1 4 2 4 ... 1 12 Senile Gangrene ... ... ... ... ... ... ... 1 1 2 1 5 Embolism, Thrombosis (not Cerebral) 1 ... 1 ... ... ... ... 1 ... ... ... 3 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... Varicose Veins ... ... ... ... ... ... ... ... ... ... ... ... Wood Vessels, other Diseases ... ... ... ... ... 1 3 ... 6 8 2 20 Disease of Respiratory Organs. 172 Laryngitis ... ... ... ... 1 ... ... 1 ... ... ... 2 Membranous Laryngitis (not Diphtheritic) ... ... ... ... ... ... ... ... ... ... ... ... Croup (not Spasmod. or Membr.) ... ... ... ... ... ... ... ... ... ... ... ... other Dis. (not specified) ... ... ... ... ... ... ... ... ... ... ... ... c 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 Ages. Bronchitis 22 7 1 1 1 11 13 34 69 67 19 245 Lobar (Croupous) Pneumonia 1 2 1 1 8 11 7 9 4 1 2 47 Broncho, Catarrhal, Lobular Pneumonia 44 34 7 ... 2 4 4 6 16 9 2 128 Pneumonia 11 8 1 3 4 9 10 22 12 6 3 89 Emphysema, Asthma ... ... ... ... ... 1 2 1 12 1 2 19 Pleurisy ... 1 ... 2 ... 1 5 2 4 ... ... 15 Fibroid Dis. of Lung ... ... ... ... ... ... ... ... ... ... ... ... Respiratory Dis.,other ... ... ... ... 1 1 1 1 ... ... ... 4 Disease of Digestive System. ... ... ... ... ... ... ... ... ... ... ... 549 Tonsilitis, Quinsey 1 ... ... ... ... ... ... ... ... ... ... 1 Mouth, Pharynx, Dis. (not specific) 1 ... ... ... ... ... ... ... ... ... ... 1 Gastric Ulcer ... ... ... 1 2 4 6 1 1 ... ... 15 Gastric Catarrh 4 ... ... ... ... ... ... 1 ... 2 ... 1 Stomach, other Dis. (not Malig.) ... ... ... ... ... ... ... ... ... 2 ... 2 Enteritis (not Epid.) 8 1 ... ... 1 ... ... ... ... 1 ... 11 Gastro-Enteritis 18 5 1 ... ... ... ... ... ... ... ... 24 Appendicitis, Perityphilitis ... ... 5 2 1 ... 1 2 ... ... ... 11 Hernia ... ... ... ... ... ... 1 1 2 2 ... 6 Intestinal Obstruction 3 1 ... ... ... 1 1 4 6 1 1 18 Other Dis. of Intestines ... ... ... ... ... ... 1 ... ... ... ... 1 Peritonitis (not Puerperal) ... 2 ... ... ... 1 ... 1 ... ... ... 4 35 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 ... ... ... ... 3 11 7 5 4 ... ... 30 Liver and Gall Bladder, other Diseases 2 ... ... 1 ... 1 3 4 4 1 ... 16 Digest. Syst., other Diseases ... ... ... ... ... ... ... ... ... ... 1 1 Ltmph Disease. 148 Spleen Disease ... ... ... ... ... ... ... ... ... ... ... ... Lymph System, other Diseases ... ... 2 ... ... ... ... 2 1 ... ... 5 Thyroid Body Disease ... ... ... ... ... ... 1 2 1 ... ... 4 Supra Renal Capsules Disease ... ... ... ... ... ... ... ... ... ... ... ... Disease of Urin. Syst. 9 Nephritis, Acute ... 1 2 1 3 ... 1 ... ... ... ... 8 Chronic Bright's Dis., Albuminura ... ... ... 1 4 9 17 19 24 3 ... 77 Calculus (not Biliary) ... ... ... ... ... ... ... ... ... ... ... ... Bladder and Prostate Dis. ... ... ... ... ... ... 1 1 5 5 2 14 Urin. Syst., other Dis. ... ... ... ... ... ... ... ... 2 ... ... ... Disease of Gener. Syst. 101 Ovarian Tumour (not Malig) ... ... ... 1 ... ... ... 1 ... ... ... 2 Other Dis. of Ovary ... ... 1 ... ... ... ... ... ... ... ... 1 L'terinal Tumour (not Malig.) ... ... ... ... ... ... ... ... 1 1 ... 2 Other Dis. of Uterus and Vagina ... ... ... ... 1 ... ... ... ... ... ... 1 3 C 36 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages Disorders of Menstruation ... ... ... ... ... ... ... ... ... ... ... ... Gener. and Mam. Orgs., other Dis. ... ... ... ... ... ... ... ... ... ... ... ... Accidents Childbirth. 6 Abortion, Miscarriage ... ... ... ... 1 ... ... ... ... ... ... 1 Puerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... 1 ... 1 ... ... ... ... ... 2 Placenta Praevia, Flooding ... ... ... ... 4 1 ... ... ... ... ... 5 Other Accid. of Preg. and Childbirth ... ... ... ... ... ... ... ... ... ... ... ... Joint Disease. 8 Caries, Necrosis 1 ... ... 1 ... ... ... ... 1 ... ... 3 Anthritis, Periostitis 2 ... ... ... ... ... ... 1 ... 1 ... 4 Other Dis. of Locom. Syst ... ... 1 ... ... ... ... ... ... ... ... 1 Skin Disease. 8 Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... 1 ... ... ... ... 1 Skin Disease, other ... ... ... ... ... ... ... ... 1 ... ... 1 Ill-Defined Causes. Atrophy, Debility, Marasmus 56 2 ... ... ... ... ... ... ... ... ... 58 Old Age ... ... ... ... ... ... ... 1 31 71 52 155 Dropsy, Ascites ... ... ... ... ... ... 2 ... 1 ... ... 3 Tumour ... ... ... ... ... ... ... ... 2 ... ... 2 Abscess 1 ... ... ... ... ... ... ... ... ... ... 1 Sudden Death ... ... ... ... ... ... ... ... ... ... ... ... (cause unascertained) Other Ill-defined Causes ... 1 ... ... ... ... ... 1 ... ... ... 2 Causes not Specified . ... ... ... ... ... ... ... ... ... ... ... ... 222 Totals 426 164 98 112 139 214 293 386 463 316 109 2,720 Chart showing the number of cases of Scarlet Fever, Diphtheria and Enteric Fever weekly during 1912. Face Page 36, 37 SPECIFIC INFECTIOUS OR ZYMOTIC DISEASE. During the year 1912 there were 1,071 cases of acute infectious disease compulsorily notified in the Borough; of these 47 were subsequently found not to be suffering from infectious disease, thus reducing the number of genuine cases to 1,024. This total shows a decrease of 449 cases upon that of 1911. The attack-rate in respect of the acute notifiable infectious diseases for the year is therefore 4.6 per 1,000 persons living. In addition, I received 220 primary notifications of pulmonary tuberculosis under the Public Health (Tuberculosis) Regulations, 1808, and 238 under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, and 368 under the Public Health (Tuberculosis) Regulations, 1912. The deaths from the chief zymotic diseases during the year numbered 108. This is equal to a zymotic death-rate of .48 per 1,000 living persons in the Borough. A.—NOTIFIABLE INFECTIOUS DISEASES (ACUTE). Small-pox.—No case of this disease was notified in the Borough durng the past year. Scarlet Fever or Scarlatina.—The number of cases of this disease notified during the year was 518, but of these 12 were afterwards found not to be cases of scarlet fever. The genuine cases were thus reduced to 506. This is a decline of 78 cases upon the genuine cases notified during the year 1911. On reference to the chart accompanying this report, it will be observed that the incidence of scarlet fever was low almost all the year, a slight rise taking place in the last week of the month of June, and a more continuous rise taking place in the months of September, October, and November. This last rise began as usual in the first week of September. The attack-rate for 1912 is, therefore, 2.2 per 1,000 persons living. 38 The number of cases of scarlet fever removed to hospital during the year was 473. This is equal to 91 per cent, of the total cases 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. 93 201 112 112 Attack Rate per 1,000 living. 1.7 3.7 1.9 1.9 It will be seen from the above that scarlet fever was most prevalent in the central sub-district. The deaths from this disease during 1912 numbered 8, which is equal to a mortality-rate of 16 per 1,000 attacked and -036 per 1,000 living. The mortality-rate for London from scarlet fever during the same year was .04 per 1,000 living. Diphtheria and Membranous Croup.—There were 240 cases of diphtheria and 9 cases of membranous croup notified during the year 1912, but of these 27 cases of diphtheria and 3 membranous croup were found subsequently not to be suffering from this disease, thus reducing the total of genuine cases of diphtheria in the Borough to 219. This is a reduction of 65 upon the number which occurred during 1911. The chart shows the disease to have been prevalent all the year, its incidence, however, keeping low with the exception of the month of January, when there was a slight rise in the number of cases notified. There were 218 cases of diphtheria and membranous croup removed to hospital during 1912. This is equal to 87 per cent, of the total cases notified. 39 The following table shows the distribution of the cases of this disease in the different sub-districts of the Borough during 1912:— Sub-Districts. North. Central. South-West. South-East. No. of Cases of Diphtheria and Membranous Croup. 57 61 67 64 Total attack rate per 1,000. 1.0 1.1 1.2 1.1 From the above it will be seen that diphtheric disease was equally prevalent in the whole of the sub-districts of the Borough. The deaths from diphtheria and membranous croup during the year numbered 12. This is equivalent to a mortality rate of 5.5 per cent, attacked and .05 per 1,000 living. The death-rate from diphtheria for London during the same period is .10 per 1,000 living. During the year 258 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically examined, 63 of which gave positive results, 190 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 was provided during the year 1912, and it was issued as required to medical practitioners applying for it in cases of diphtheria amongst the poorer inhabitants of the Borough. There were 19 bottles of anti-toxin of 2,000 units each supplied during the year to medical practitioners, of which 4 were for curative treatment and 15 for prophylaxis. 40 Typhoid or Enteric Fever.—There were 28 notifications of enteric fever made to me during 1912, but of these 4 were afteivvards found not to be suffering from this disease, thus reducing the genuine cases of enteric fever to 24. This is a decrease of 15 on the number of genuine cases notified during 1911. The attack-rate is therefore .10 per 1,000 living. Of the 28 cases notified, 24 were removed to hospital. This is equal to 85 per cent, of the total notified. It will be seen lrom the chart that the bulk of the cases of enteric fever occurred during the last five months of the year, but cases were scattered over the whole year. 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 9 6 8 Attack Rate per 1,000 living. 10 16 .10 .14 From this table it is evident that most of the cases occurred in the central and south-east sub-districts. The deaths from enteric fever in the Borough last year numbered 3. This is equal to an annual mortality-rate 12.5 per cent, attacked and .011 per 1,000 living. During 1912 specimens of blood from 38 persons suspected to be suffering from enteric fever were submitted to Widal's test. Of these 12 gave a positive and 26 a negative reaction. The mrtality for all London for the same period is .03 per 1,000 living. 41 Cerebro-Spinal Fever (Epidemic Cerebro-Spinal Meningitis).— At a meeting of the London County Council, held on the 27th February, 1912, an Order was made adding the above disease to those infectious diseases notifiable under Section 55 of the Public Health (London) Act, 1891. The Order reads as follows:— "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, from and including the 13th day of March, 1912, to the disease known as Cerebro-Spinal Fever (Epidemic Cerebro-Spinal Meningitis)." During the year 1912 there were 7 cases of this disease notified, and 5 deaths were registered in the Borough. Typhus Fever.—No case of this disease occurred in the Borough during the year 1912. Continued Fever.—No case of continued fever was notified in Hackney during 1912. Puerperal Fever.—There were 26 cases of puerperal fever notified during 1912, of which 17 were removed to the Infirmary. The deaths from puerperal fever numbered 9. The attack-rate for the year was 5 per 1,000 births, and the death-rate 1.7 per 1,000 births. Plague.—No case of plague occurred in Hackney during 1912. Erysipelas.—There were 211 cases of erysipelas notified to me during 1912. This is equivalent to an attack-rate of .9 per 1,000 living. Of the 211 cases notified, 52 were removed to hospital. There were 6 deaths from erysipelas during the year, which gives a mortality-rate of nearly 3 per cent. attacked and .026 per 1,000 living. 42 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. 24 34 71 82 Rate per 1,000 living. .4 .6 1.2 1.4 Polio-myelitis or Polio-encephalitis.—At a meeting of the London County Council, held on the 27th February, 1912, an Order was made adding the above-named disease to those infectious diseases notifiable under Section 55 of the Public Health (London) Act, 1891. The Order reads as follows:— "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, from and including the 13th day of March, 1912, to the disease known as Acute Polio-myelitis or Acute Polio-encephalitis. During the year 1912 there were 8 cases of this disease notified, 4 of which were removed to hospital. No deaths from this disease occurred during this period. Ophthalmia Neonatorum.—During the year 23 cases of this disease were notified. Each case was visited by the Council's Health Visitor, and where the case was not under medical treatment, advice was tendered to seek medical treatment. The cases were kept under observation until recovery. Ten 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 were also visited by the Health Visitor, and the parents, where necessary, persuaded to obtain medical help for their infants. 43 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 DISEASES. Influenza.—During 1912 there were 17 deaths registered as due to tnis disease. This is a decline of 3 on the deaths registered during 1911. The death-rate from influenza for the year 1912 is .08 per 1,000 living, and that for all London .11 per 1,000 living. Diarrhœa.—There was a great decline in the prevalence of diarrhoea in Hackney during 1912. The total number of deaths registered from this cause was only 36, compared with 184 during 1911, thus showing a decrease of 148. There were also 35 deaths ascribed to enteritis. The annual mortality for 1912 from diarrhoea is .16 per 1,000 living. The great decline above shown in the mortality from diarrhoea during 1912 was due to the very low temperature maintained during the whole summer, especially during the third quarter of the year. 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 Diarrhoea. 3 4 12 17 Death Rate per 1,000 living. .05 .07 .20 .30 44 Measles.— This disease was not very prevalent during 1912, the deaths numbering only 13 as compared with 145 deaths during 1911. The whole of the 13 deaths occurred amongst children undet 5 years of age. The annual mortality rate from measles is .6 per 1,000 living, and that for all London '40 per 1,000 living. 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. 0 5 4 4 Mortality Rate per 1,000 living. 0 .1 .07 .07 I received information of 769 cases of measles from head masters and mistresses of elementary schools during the year, There were 104 cases of measles removed to the Metropolitan Asylums Board's Hospitals during the same period. Whooping Cough.—I received information from the head masters and mistresses of elementary schools in Hackney of 458 cases of whooping cough, occurring amongst their scholars during 1912. There were 32 deaths registered from this disease during the same period. This is a decline of 20 on the number registered during 1911, and is equal to a mortality of .14 per 1,000. The death-rate for all London from this disease for the same period is .22 per 1,000 living. The number of cases of whooping cough removed to the Metropolitan Asylums Board's Hospitals during the year was 58. 45 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 6 9 13 Mortality Rate per 1,000 living. .07 .11 .15 .23 CONSTITUTIONAL DISEASES. Tuberculosis.—During 1912, I received 1,525 notifications of pulmonary tuberculosis, details of which are given on page 71 of this report. Bacteriological examination of sputa from 246 cases was made during the same period. In 51 of these examinations, the specific organism of the disease was discovered, in 194 cases the result of examination was negative, and in 1 case doubtful. The number of deaths from tuberculous disease in Hackney during 1912 was 355, a decrease of 44 upon the deaths during the previous years. These deaths are classified as follows:— Tuberculous Phthisis 258 Phthisis 33 General Tuberculosis 18 Tuberculous Meningitis 25 „ Peritonitis 7 Tabes Mesenterica 6 Tubercle of other Organs 8 355 This number of deaths gives an annual mortality of 159 per 1,000 living. 46 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. 55 91 102 107 Mortality rate per 1,000 living. 1.0 1.6 1.7 1.8 Cancer.— There were 213 deaths during 1912, ascribed to the different varieties of malignant disease. This is a decrease of 4 upon the number registered during 1911. The annual death. rate from cancer for the last year is .95 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. 54 45 65 49 Mortality rate per 1,000 living. 1.0 .83 .11 .87 Below is given a table showing the number of deaths and death rates in this Borough during the ten years ending 1912:— Years. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Borough of Hackn Deaths from Cancer. 192 182 203 175 198 225 214 222 217 213 Death rate per 1,000. .85 .80 .90 .75 .91 .96 .91 .93 .97 .95 London. Death rate per 1,000. .87 .99 1.00 1.05 1.03 1.06 .96 .94 1.05 1.11 The death-rate from cancer for all London for the year 1912 is 1.11 per 1,000 persons living. 47 ALCOHOLISM. During the year under consideration there were 5 deaths from acute alcoholic poisoning; there were also 30 deaths registered as 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 1912. It will be seen from this that the practice of vaccination in the Borough is still declining. The number of birth certificates received during last year was 5,437 and the number of vaccination certificates received during the same period 2,272. This latter is equal to 42 per cent, of the births, leaving 58 per cent, of infants unvaccinated. This is the highest percentage of infants escaping vaccination, recorded since the year 1898. 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 6,356 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 1912 5 437 2,272 58% 1,833 48 The last column in this table shows the rapid growth of indifference to the protective value of vaccination. It seems it has now reached such a pass that only by the wholesale destruction of innocent victims by an outbreak of small-pox, will the public be convinced of their folly. It may be here pointed out, that in the event of an outbreak of small-pox, due to the neglect to enforce the vaccination Acts, individuals will not only sutler loss of relatives and other losses and discomforts; but it appears from the following extract from the National Insurance Act, 1911, that the local authority or even the Central authority may be required to compensate the the sufferers for their neglect. THE NATIONAL INSURANCE ACT, 1911. Excessive Sickness. "Section (63.—1) Where it is alleged by the Insurance Commissioners or by any approved society or Insurance Committee that the sickness which has taken place among any insured persons, being, in the case where the allegation is made by a society or committee, persons for the administration of whose sickness and disablement benefits the society or committee is responsible is excessive, and that such excess is due to the conditions or nature, of employment of such persons, or to bad housing or insanitary conditions in any locality, or to an insufficient or contaminated water supply, or to the neglect on the part of any person or authority to observe or enforce the provisions of any Act relating to the health of workers in factories, workshops, mines, quarries, or other industries, or relating to public health, or the housing of the working classes, or any regulations made under any such Act, or to observe j or enforce any public health precautions, the Commissioners or the society or committee making such allegation may send to the person or authority alleged to be in default a claim for the payment of the amount of any extra expenditure alleged to have been incurred by reason of such cause as aforesaid, and, if the Commissioners, society, or committee and such person or authority fail to arrive at any agreement on the subject, may apply to the Secretary of State or the Local Government Board, as the case may require, for an inquiry, and therefore the Secretary of State or Local Government Board may appoint a competent person to hold an inquiry." 49 "(2) If, upon such inquiry being held, it is proved to the satisfaction of the person holding the inquiry that the amount of such sickness has (i.) during a period of not less than three years before the date of the enquiry; or (ii.) if there has been an outbreak of any epidemic, endemic, or infectious disease, during any less period ; been in excess of the average expectation of sickness by more than 10 per cent., and that such excess was in whole or in part due to any such cause aforesaid, the amount of any extra expenditure found by the person holding the enquiry to have been incuired under this Part of this Act by any societies or committees where the allegation is made by the Insurance Commissioners, or, if the allegation is made by a society or committee, by the society or committee, in question, by reason of such cause shall be ordered by him to be made good in accordance with the following provisions:—" (a) "(b) Where such excess or such part thereof as aforesaid is due to bad housing or insanitary conditions in the locality, or to any neglect on the part of any local authority to observe or enforce any such Act or regulation or such precautions as aforesaid, it shall be made good by such local authority as appears to the person holding the inquiry to have been in default, or, if due to the insanitary condition of any particular premises, shall be made good either by such authority or by the owner, lessee, or occupier of the premises who is proved to the satisfaction of the person holding the inquiry to be responsible." The average expectation of sickness due to small pox is practically nil where efficient vaccination is enforced, therefore almost any outbreak arising from neglect of vaccination should engage the attention of the Insurance Commissioners, with a view to apportioning the extra expenditure, due to the excessive sickness on the defaulting authorities, in accordance with the above section. d 50 Summary of Proceedings under the Vaccination Acts, 1867 to 1898, during the year 1912. Registration Sub-District. No. of Cases in Birth Lists received during Year. 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 1,006 554 92 - - 318 3 12 47 305 Central 1,292 512 49 1 — 547 — 21 60 486 South-East 1,469 451 89 — 1 518 — 31 99 587 South-West 1,670 755 45 - 1 459 — 260 89 555 Total 5,437 2,272 275 1 2 1,833 3 324 295 1,933 51 THE PREVENTION OF THE SPREAD OF DISEASE BY HOUSE FLIES. RELATION OF HOUSE FLIES TO DISEASE. From very early ages it has been suspected that flies were instrumental in the spread of disease, but it was not until the Spanish American War in 1898, and in the Boer War of 1900, that they were proved, under certain conditions, to be the most important factors in the dissemination of typhoid or enteric fever. Flies may convey the organisms of disease in two ways. If a fly has been in contact with infectious matter, some of it may be carried away on its limbs, which are very hairy; or if it has been feeding on such matter, the organisms of disease will be taken into its digestive system, from which they will be discharged either by regurgitation or defaecation. In most cases the infectious matter which is carried by the fly is deposited in food, which thus becomes contaminated and capable of infecting human beings. In one, or both of these ways typhoid fever, or summer diarrhoea or even tuberculosis may be spread. There are other diseases which flies are believed at times to convey from deceased to healthy persons; but the above-mentioned are enough to justify the most extreme measures being adopted to diminish their prevalence. In order to understand how best to apply preventive measures, it is necessary to consider briefly the life history of the fly. LIFE HISTORY OF THE DOMESTIC FLIES.—Flies begin breeding in the months of June and July, and continue to breed until 52 October, the greatest activity being in the months of August and September, this being greatly influenced by heat, the higher the temperature the more rapid the development. Their chief breeding place is stable manure, but they will breed equally well in any collections of manure, or excrement, or any collections of waste animal or vegetable substances, provided there is a certain amount of moisture present, and the temperature is favourable. The fly is an extremely prolific insect, a single female being able to lay from 120 to 150 eggs at one time, which it usually deposits in dark crevices, and this may be repeated five or six times during its short life. The metamorphosis of the fly. It must here be explained that in the development of the fly from the egg, the insect goes through certain changes of form and habit which are known as a metamorphosis. The egg is first hatched and a maggot is produced, which is called in technical language a larva. This hatching of the egg takes place in warm weather in from eight to twenty-four hours after the eggs are laid. The larva, which prefers dark moist places, continues in this state about five days, during which time it moults or casts its skin twice. At the end of this time, it is full grown, having reached the size of ½-inch. At the end of the larval stage it seeks a dry place, and encases itself with a dark reddish-brown covering, which is called a puparium, in which condition it remains at rest a few days, gradually undergoing the change from the pupa to the developed fly. This period is known as the pupal stage. If the temperature is high, the perfect fly emerges from its sac between the 3rd and 4th day after pupation, by pushing off the anterior end or the pupal case. Flies become sexually mature in from 10 to 14 days after emergence from the pupal state, and four days after mating, they are able to deposit eggs. 53 Provided the conditions are favourable, the whole developm nt from the egg to the perfect fly may be accomplished in about 9 or 10 days, and 14 days later the second generation may be depositing eggs. THE HABITS OF THE HOUSE FLY—The most particular and prominent of these is the habit of constant feeding. It seems tobe indifferent to the fly, whether it feeds on the putrid contents of the bust-bin or the food on our tables; and it will pass from one to the other with the utmost impartiality. It is this special feature of its life, which renders it so dangerous. The fly cannot take solid food. It must dissolve all solids before taking them into its digestive system; and this it does by means of its saliva, which is produced in abundance by its salivary glands, of which it has two. The ducts of these glands are connected to a single tube which opens into the mouth On a suitable stimulus, the saliva is secreted, and poured out upon the particle the fly desires to dissolve and absorb. The fluid food is then sucked up by a powerful sucking arrangement, with which it is provided, first into its crop, then at leisure into the proventriculus, and afterwards into the stomach, where it undergoes digestion. Another prominent habit of the fly is that of returning its food from the crop, in the form of large drops of liquid. Some of these drops are deposited on the surface upon which the fly is resting. It matters not where that may be, whether on the rim of the milk jug or the dust-bin. These drops are known as "vomit spots." In most cases they are re-absorbed by the fly. The "vomit spots" are distinguishable from the excreta spots by being of light colour, the latter being brown. Another habit of the fly is its activity. This is so well known as to become proverbial. Connected with its activity is its range of flight. This has been ascertained to be about a mile. 54 The duration of life of the fly is not long. In the winter most flies die, the remainder hibernate, and at the return of warm weather produce the first broods of the summer. PREVENTION.—The measures which should be adopted to prevent the spread of disease through the agency of flies are very similar to those which have been applied with so much success to preventing the spread of malaria by means of mosquitoes, and consist in (1) destroying them during the larval and pupal stages of development (2) destroying them when fully developed, and (3) protecting food against contamination. It will be remembered that the chief breeding places for flies are manure and any collections of garbage. In Hackney there is a large number ot stables for horses and cows. These are provided with dung-pits which are mostly uncovered, thus allowing flies to enter freely and deposit their eggs. If such manure is left undisturbed for nine days, the eggs will have become fully developed flies; so that in order to diminish their number, it will be most effectual to apply preventive measures during the development stages. In the first place, the dung pit should be kept covered, so that, if possible, flies may not enter and deposit their eggs. The larval may be destroyed by adding chloride of lime to the dung or by spraying the same with a solution of ferrous sulphate, two pounds to the gallon of water. Both of these will destroy the larvae and so prevent their developing into adult flies. In all cases, stable manure should be removed twice a week, and not deposited within a mile of the Borough, unless the manure is treated with one of the insecticides above mentioned; and where the object is not only to prevent development in the Borough, but elsewhere, the insecticides should be always used when the 55 dung is removed. To sum up, dung-pits must be so covered as to prevent the fly depositing its eggs in the pit, and an insecticide added so as to destroy the larvae as they are hatched from the eggs. Flies not only breed in manure as above stated, but also in waste animal and vegetable substances, commonly known as garbage. Included in this are house refuse, street refuse and some kinds of trade refuse. House refuse. In order to prevent flies breeding in house refuse, it is only necessary that the bin should be kept covered, and the refuse removed sufficiently often. It will be remembered that it takes nine days at least for the eggs to develop into the young fly. A regular weekly collection of the house refuse will prevent this development; because all refuse in the Borough of Hackney is destroyed by fire directly after collection. Householders should assist in this endeavour by keeping their dust-bins covered, and their yards clean and free from collections of decaying animal or vegetable matter, or other dirt. Trade refuse. Manufacturers and builders, etc., should be urged not to keep on their premises any collections of waste material of an organic character, but to get them taken away at least once a week and destroyed. If this cannot be done, they should be treated with either of the insecticide preparations above-mentioned. Street refuse. Street refuse from the point of view of preventing the breeding of flies, should be collected at least once a week, and should not be stored within the Borough, or within a mile of the same, unless it is treated with an insecticide preparation. This is especially important if the sweepings are collections of manure. 56 Prevention at home. This may be summed up in the three measures; (1) cleanliness; (2) protection of food supplies; (3) use of household fly killers. 1. The dirtier premises are, the more they are affected with flies. This applies also to the person, so that the cleaner the house and contents are, the less attractive they become to flies. 2. Food is, of course, the great attraction, so this, when not being used, should be kept covered. Odd pieces of food should not be left uncovered unnecessarily; but if useless, should be burnt, or if this is impracticable placed in the dust-bin. 3. The exposure in suitable places in rooms, infested with flies, of fly-killers has been found to diminish them considerably. Lately the following recipe for a fly-killer, has been found very effective:— One ounce of 40 per cent, formalin mixed with one pint of milk. This should be placed in shallow plates about the rooms, with a piece of bread in the middle of each plate for the flies to alight upon. 57 PUBLIC HEALTH (LONDON) ACT, 1891. (a) Complaints of Nuisances.—During the year 1912 there were 2,030 complaints of nuisances received by the Public Health Depart ment, and investigated by the Sanitary Inspectors of the Borough. Notices for the remedy of any nuisance or defect found, weie served upon the person or persons responsible under the above Act. (b) Infectious Disease.—The occupied dwellings inspected duiing the year after infectious disease numbered 1,796. This is a decline of 480 upon the number inspected during 1911. These inspections include those made after pulmonary tuberculosis. Any nuisances or sanitary defects found, were dealt with under the provisions of the above Act. (c) House-to-House Inspections.—These inspections are in addition to those made under (a) and (b). The number of house-tohouse inspections made by the inspectors duiing the year was 1,515. The nuisances or sanitary defects found, were dealt with in the same manner as those under (a) and (6). Nuisances or defects found on inspection were remedied in most cases on service of an intimation notice only. The total number of such notices served during 1912 was 4,505. The number of statutory notices, 305; and legal proceedings were initiated in 8 cases. The following details relate to house-to-house inspections made by the special inspectors engaged for this work. House-to-House Inspections, 1912.—No. 7 District. Inspector—W. C. Vobe. Number of premises inspected 192 Number of premises on which nuisances were found 127 Intimation notices served 130 Statutory notices served 20 d 2 58 Found. Abated. In hand. Outstanding The house or part in a dirty condition 76 70 3 3 ,, damp „ 18 17 1 — „ dilapidated,, 45 42 1 2 „ verminous „ 11 11 — — The inlet to the surface drain improperly trapped 1 1 - - The w.c. so foul as to be a nuisance 2 2 — — „ without a water supply 2 2 — — „ with a deficient supply of water 8 7 1 ,, improperly constructed 1 1 — — „ so defective as to be a nuisance 4 4 — — „ choked 2 2 — — The yard paving defective 10 8 — 2 The gulley trap improperly placed within the house 1 1 - - The sink waste defective 2 2 — — No dustbin or dilapidated dustbin 8 8 — — The drain defective 6 6 — - The drain choked 1 1 — - The rainwater pipe defective 7 6 1 - The roof defective 28 26 1 1 The gutter defective 12 11 1 — The washhouse paving defective 5 5 — — The house or part overcrowded 1 1 — - Insufficient ventilation beneath the ground floor 2 2 - — Defective sinks 1 1 — — The scullery roof or w.c. roof defective 12 11 1 — Manhole covers unsealed 2 2 — — Smoke nuisances 3 3 — — Burst water pipes 2 2 — — Yards dirty 4 4 — — Ventilation shaft defective 2 2 — — Dangerous structures 8 8 — — 59 House-to-House Inspections, 1912—Homerton District. Inspector—Jas. W. Hall. Number of premises inspected 341 Number of premises on which nuisances were found 280 Number of intimation notices served 372 Number of statutory notices served 22 Found. Abated. In hand. Outstanding. The house or part in a dirty condition 141 124 3 14 Ditto in a damp condition 61 45 6 10 Ditto in a dilapidated condition 69 64 3 2 Ditto in a verminous condition 33 28 1 4 Water closet with unsatisfactory water supply 15 15 - - Water closet in a defective condition 26 25 1 — Ditto stopped 3 3 — — Ditto with insufficient external ventilation 10 4 3 3 Insufficient water closet accommodation 1 1 - - The drain ventilation, or soil, pipe defective 13 12 - 1 Yard paving defective 26 21 3 2 Drain openings within premises 29 28 — 1 Sink wastes directly connected with drains 6 6 - - Ditto untrapped 67 61 1 5 Ditto defective 12 11 — 1 Accumulation of refuse in yard 11 11 — — Dustbins defective 51 44 1 6 Drains defective 79 62 5 12 Drains in choked condition 14 14 — — Rainwater pipe directly connected with drain 7 4 3 - Ditto defective 17 16 — 1 1 House without a proper water supply 3 3 — — 60 Found. Abated. In hand. Outstanding Roof defective 44 1 1 2 Guttering defective 35 28 5 2 The forecourt, or area, paving defective 5 3 — 2 Scullery, or washhouse, paving or flooring defective 7 7 - - Animals improperly kept 3 3 — — The space under ground, or basement, floor insufficiently ventilated 70 57 7 6 Sundry defects 27 22 2 3 House to House Inspections, 1912—No. 11 District. Inspector—Edward F. Kemp. Number of premises inspected 110 Number of premises on which nuisances were found 64 Number of intimations served 64 Found. In hand. Abated. Outstanding. The house or part in dirty condition 49 — 49 — „ dilapidated „ 7 — 7 - damp „ 11 — 11 — The w.c. so foul as to be a nuisance 5 — 5 - „ without a water supply 16 — 16 - „ improperly constructed 1 — 1 - „ stopped and defective 13 — 13 — „ Improperly placed 3 — 3 - Insufficient ventilation to w.c. 3 — 3 — The soil pipe defective 3 — 3 - „ unventilated 2 — 2 — Improperly ventilated 5 — 5 — The yard in dirty condition for want of paving 9 — 9 — The yard dirty and undrained 6 — 6 — The waste pipe of sink connected with drain 4 - 4 — 61 Found. Abated. In hand. Outstanding, The waste pipe of sink defective 10 — 10 — The bath waste untrapped 2 — 2 — The want of proper dustbin 18 — 18 — Dustbin defective 14 — 14 — The drain defective 19 — 19 — The drain choked 5 — 5 — The rain water pipe defective 13 — 13 — The house without a water supply 10 — 10 — The roof and gutters defective 33 — 33 — The washhouse paving „ 3 — 3 — The bakehouse walls and ceilings dirty 3 — 3 — Animals improperly kept 9 — 9 — The house overcrowded 11 — 11 — The ground floor unventilated 3 — 3 — Articles of Food Seized or Surrendered as Unfit for Food.— During the year 1912 the following articles of food were seized by the Inspectors or surrendered as being unfit for food, viz.:— 13cwt. 2 qrs. meat; 1 ton 8 cwt. 3 qrs. 2 lbs. fish; 1 ton 2 cwt. 1 qr. 13 lbs. fruit and vegetables; 3 cwt. 3 qrs. 26 lbs. 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 1912 they numbered 14. with 18 cowsheds. One licence and 2 cowsheds had been given up during the year. Inspector Bobbitt reports that he made 174 visits of inspection to the cowsheds during the year. He served two intimation notices for repair, one of which was immediately complied with, but the other not until objection had been made to the renewal of the license. 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 with the exception of 3, which were dirty, and in 5 others an excess of cobwebs were present. The required cleansing was done on the service of notices. 62 (b) Dairies and Milkshops.—During the past year 11 milk premises were removed from the register, and 15 new milk premises added, thus making the total on the register at the end of last year 315. The proprietors of milk premises were changed in 47 instances. Inspector Bobbitt reports that he made 1,593 visits of inspection to these premises during the year, and discovered dirty utensils in 13 instances. He also served 5 notices for cleansing and repairs, which were immediately complied with. Offensive Trades.—The only offensive trade premises in the Borough, viz., that of tripe boiler, was visited by the inspector 9 times during the year. He reports that on these occasions he always found the premises in a satisfactory condition. Slaughter Houses.—The number of licensed slaughter houses in the Borough at the end of 1912 remained as at the end of the previous year, viz., 21. Inspector Bobbitt reports that he made 311 visits of inspection to these during the year, and found them in a satisfactory condition. During his visits to the slaughter houses, which were always made on slaughtering days, the Inspector examined the carcases and organs of 1,572 sheep and lambs, 189 oxen, 8 calves, and 41 pigs, and found the following parts and organs diseased and had them destroyed, viz.:— 1 carcase of ox with all organs affected with tuberculosis. 12 ox livers affected with distomatosis. 19 sheeps livers affected with distomatosis. 18 sheeps livers affected with parasitic cysts. 16 sheeps lungs affected with parasitic cysts. 2 flanks of beef affected with inflammation. 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, except 1 slaughter house which was dirty. 63 The following statement refers to the milk places, cowsheds, slaughter-houses and offensive trades in the Borough:— Premises. Number of Places. Number of Inspections, 1912. Number of Notices, 1912. Number of Prosecutions. On Register at end of 1911. Added in 1912. Removed in 1912. On Register at end of 1912. Milk premises 311 15 11 315 1,593 5 — Cowsheds 20 — 2 .18 174 2 — Slaughter-houses 21 — — 21 311 — — Other offensive trade premises 1 — — 1 9 — — Preserved Provision Factories.—There were 2 wholesale preserved provision and 2 black pudding manufacturers in the Borough at the end of 1912. Inspector Bobbitt reports that he made 34 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 1,521 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 40. Water Supply.—Under Section 48 (2) of the Public Health (London) Act, 1891, there were 26 certificates of proper and sufficient water supply issued to owners of new or rebuilt dwellinghouses in the Borough. These certificates refer to 33 houses. By-laws for Houses let in Lodgings.—In the month of July, 1912, the Borough Council received a letter from the London County Council calling attention to Section 16 of the Housing, Town Planning, &c., Act, 1909, and Section 94 of the Public Health (London) Act, 1891, with respect to lodging houses intended for 64 the working classes, and suggesting the desirability of remaking any by-laws which had been made under Section 94 of the Act of 1891, before the Act of 1909 came into force. The desirability of remaking such by-laws had arisen out of of a decision of the Divisional Court, that the owner of a lodginghouse had no power to enter it to carry out work imposed by these by-laws in the absence of any agreement with the tenant. A clause in the Housing and Town Planning, &c., Act, 1909, that he (the owner) should have power of entry was intended to supersede the decision. The Act is not retrospective and the by-laws now in force in the Borough do not give the owner that power. It is therefore necessary that the by-laws should be re-enacted in order to give the owner that power of entry. The Council agreed to remake the by-laws in existence with the slight modification of leaving out the rental limit; so that any house intended for the working classes which is let in lodgings or occupied by members of more than 1 family, may be registered if the Council so decide. The remade by-laws were allowed by the Local Government Board on the September 4th, 1912. A copy of the by-laws will be found in the appendix to this report. The total number of houses on the register at the end of 1912, was 501. All of the occupied houses registered as let in lodgings were inspected during 1912. The following sets out in detail the result of the inspections made, etc.:— HOUSES LET IN LODGINGS. 1912. No. 7 District. No. of premises on register end of 1912 243 No. of premises inspected 236 No. of premises empty 7 No. of premises on which nuisances found 125 ,, ,, ,, ,, abated 125 Intimation notices served 130 Statutory notices served 5 65 Found. Abated. The house or part in a dirty condition 89 89 ,, ,, damp ,, 9 9 „ „ dilapidated condition 39 39 „ „ verminous „ 12 12 The w.c. so foul as to be a nuisance 3 3 „ without a water supply 2 2 „ with a deficient supply of water 13 13 „ so defective as to be a nuisance 7 7 „ choked 12 12 Defective yard paving 9 9 The sink waste defective 1 1 No dustbin or dilapidated dustbin 10 10 The drain defective 1 1 The drain choked 2 2 The rain water pipe defective 6 6 The roof defective 28 28 The gutter defective 7 7 The wash house paving defective 2 2 The house or part overcrowded 4 4 Insufficient ventilation beneath the ground floor 3 3 Scullery or w.c. roofs defective 11 11 Smoke nuisances 3 3 Yards dirty 4 4 Dangerous structures 10 10 No. 11. District. No. of premises on register end of 1912 226 No. of premises inspected 167 No. of premises empty 59 No. of premises on which nuisances found 68 Intimation notices served 68 66 Found. Abated. The house or part in dirty condition 49 49 „ „ dilapidated condition 9 9 The w.c. in foul condition 10 10 „ without water supply 6 6 „ defective 13 13 „ improperly placed 3 3 „ so defective as to be a nuisance 7 7 „ stopped 4 4 The soil pipe unventilated 2 2 „ yard dirty 16 16 „ water cistern foul 1 1 „ sink waste pipe connected 1 1 No dustbin 19 19 The drain foul 5 5 „ choked 7 7 The rain water pipe defective 29 29 „ house without water supply 6 6 „ roof defective 27 27 „ gutters defective and leaky 19 19 „ washhouse paving defective 10 10 Animals improperly kept 10 10 The house overcrowded 21 21 No ventilation under ground floor 5 5 CUSTOMS AND INLAND REVENUE ACT, 1890. The following is a list of premises which I inspected during the year 1912, and for which I gave certificates for exemption from Inhabited House Duty, after necessary alterations, repairs and cleansing had been completed:— Premises. No. of Tenements. 24, Sandringham Road 2 31 and 33, High Street, Homerton 6 2a, 3a, 3b, Market Parade Stamford Hill 3 190, Millfields Road 2 11 a, 11b, 2b, 16a, 16 b, Market Parade, Stamford Gill 5 6, Stamford Road 3 67 CANAL BOATS ACTS, 1877-1894. The Canal Boats Inspector reports that he made 85 visits to the waterways in the Borough during 1912, and inspected 30 boats during that period. No infringements of the Canal Boats Acts or Regulations were observed on these visits. A copy of the Inspector s report will be found in the appendix to this report. ICE CREAM VENDORS. At the end of 1912 there were 190 ice cream vendors in the Borough, an increase of 15 on the number present at the end of 1911. These were all inspected during the past year. Sanitary defects were found on 31 of these premises which were remedied on the service of intimation notices. GLANDERS AND FARCY ORDER, 1907. During the past year I received 4 notifications of glanders in animals, in the Borough, from the Veterinary Inspectors of the London County Council. In each case I had the premises inspected and made enquiries respecting the health of the stable men, &c., but in no instance did it appear that the diseases had been conveyed to man. DISEASES OF ANIMALS ACTS—ANTHRAX ORDER OF 1910. During 19121 received 1 notification of the existence of anthrax on premises in the Borough. Similar steps were taken as in the case of glanders above described. HOUSING OF THE WORKING CLASSES ACTS, 1890-1903. No representation was made nor action taken under the above Acts during the year 1912. HOUSING, TOWN PLANNING, ETC., ACT, 1909. In the month of February, 1912, I represented to the Public Health Committee, under Section 17 of the above Act, the following premises, viz., Nos. 48, 50, 52, 54, 56, 58, 60, 62 and 64, Middlesex Wharf, Lea Bridge, to be in a state so dangerous or injurious to health as to be unfit for human occupation. 68 The following particulars of the defective and insanitary condition of the premises were submitted to the Committee, with my representation thereon:— Report of the Inspection of 48, 50, 52, 54, 56, 58, 60, 62, and 64, Middlesex Wharf, by the Medical Officer of Health. 48.—(Unoccupied). G.F.B. walls very damp; floor formed of stone slabs and damp. G.F.F. walls very damp; no through ventilation under floor, defective floor, window sash defective. F.F.F. walls very damp; roof defective, window sill defective. F.F.B. walls damp; no fireplace in room, roof defective, casement defective; premises generally dirty and dilapidated. 50.—(Occupied by three Adults). G.F.B. walls damp; cement floor, damp. G.F.F. walls damp; no through ventilation under floor; staircase walls damp. F.F.B. walls damp; no fireplace; defective window sill. F.F.F. walls slightly damp: defective roof. 52.—(Occupied by two Adults and six Children). G.F.B. walls damp; detective and damp cement floor. G.F.F. no through ventilation under floor ; rather damp walls ; defective staircase; detective roof. F.F.F. rather damp walls ; defective roof. F.F.B. no fireplace; damp wall; generally dilapidated. 54.—(Occupied by two Adults and five Children). G.F.B. walls very damp; floor concrete and damp. G.F.F. walls damp; no through ventilation under floor; staircase walls damp. F.F.B. walls damp; no fireplace in room; defective window sashes. F.F.F. (large room) defective wall under sill; roof defective; Small room: damp wall, no fireplace, root leaky, defective casement, detective floor. 69 56.—(Unoccupied). G.F.B. walls damp; stone slab floor damp. G.F.F. walls damp; no through ventilation under floor; staircase walls damp; defective and dangerous staircase. F.F.F. in fail condition. F.F.B. damp walls; defective window sills; no fireplace. 58.—(Unoccupied). G.F.B. damp walls; stone floor; sashes and frames of windows in a defective condition. G.F.F. damp walls; no through ventilation under floor; staircase walls damp and defective and the staircase dangerous. F.F.F. walls damp; defective sill of window. F.F.B. no fireplace; walls damp; sashes and frames of windows defective and rotten. 60.—(Occupied by two Adults and four Children). G.F.B. walls damp; damp stone floor. G.F.F. walls damp; window sashes and frame defective; no through ventilation under floor. F.F.F. damp walls; window sashes defective. F.F.B., no fireplace: sashes and frames of windows dilapidated; wall damp. 62.—(Unoccupied). G.F.B. walls very damp; damp and defective stone floor. G.F.F. walls very damp; no through ventilation under floor; defective floor; staircase walls damp; defective stairs. F.F.B. walls damp; no fireplace; defective window sashes. F.F.F. walls damp; defective floor; defective sashes. 64.—(Unoccupied). G.F.B. walls very damp; floor partly stone and wood, damp. G.F.F. walls very damp; no through ventilation under floor; staircase walls damp ; defective staircase. F.F.B. walls very damp; defective window-sashes; no fireplace; defective roof. F.F.F. walls very damp; defective roof; defective windowsashes. 70 The guttering to the whole of these cottages is more or less defective. Paving (stone) extends to about 5 feet from the backs of houses. The remainder of back yard is not paved. Water is supplied from two standpipes in the back yard. Five W.C.'s are also provided in the yard for the use of the nine cottages. This representation was submitted by the Public Health Committee to the Borough Council on the 15th February, and closing orders were then authorised to be served on the owners. The owners immediately complied with the orders of the Borough Council, and in the month of June following the premises were demolished. POLLUTION OF RIVER LEE. Owing to the low temperature prevailing during the summer months of last year, the usual complaints of foul odours from this stream were not forthcoming. This does not mean that any improvement has been effected in the condition of its water. It still receives the treated sewage from Walthamstow and Leyton, and until this is diverted from the river complaints of nuisance will still be made when the atmospheric conditions are favourable. METHODS OF CONTROL OF TUBERCULOSIS. 1.—Notification. (a). Public Health (Tuberculosis) Regulations, 1908. During 1912 there were 645 notifications received by me under these regulations. Of these, 425 were duplications of cases previously notified—128 during 1909, 1910 and 1911—and 271 during 1912 under these regulations, and 26 under the Hospital Regulations. The 220 primary cases had the age and sex distribution as follows 71 Ages and Sex of Cases Notified. Ages- Under 5 years. 5 to 15 years. 15 to 25 years. 25 to 35 years. 35 to 45 years. 45 years and upwards. Totals. Males — 8 11 19 25 59 122 Females 1 9 15 13 13 47 98 Totals 1 17 26 32 38 106 220 Further, 22 of the above cases were notified from the workhouse, 6 from the casual ward and 9 from the City of London Workhouse, Clifden Road. Of the cases notified, 89 died during the year, 79 in the infirmary and 10 at their homes. (b). Public Health (Tuberculosis in Hospitals) Regulations, 1911. Under these regulations 422 notifications were received by me during the past year. Of this total 184 were duplicates of cases previously notified—51 during 1911 and 43 during 1912 under these regulations, 15 under the Poor Law Regulations, and 75 cases had been notified previously under the regulations of 1912. The remaining 2-38 primary cases had their age and sex distributed as follows:— Ages and Sex of Cases Notified. Ages- Under 5 years. 5 to 15 years. 15 to 25 years. 25 to 35 years. 35 to 45 years. 45 years and upwards. Totals. Males 2 12 22 40 30 27 133 Females — 5 31 46 13 10 105 Totals 2 17 53 86 43 37 238 Further, 42 of these cases died during the year, 12 in hospitals and 17 at private addresses and 13 in the Hackney Infirmary. e 72 (c) Public Health (Tuberculosis) Regulations, 1912. Under the above regulations 458 notifications were received by me during 1912. Of this number 90 were duplicates of cases previously notified—11 under these regulations, 61 under the Hospitals' regulations, and 18 under the Poor Law Regulations. The 368 primary notifications are distributed as regards age and sex, as follows:— Ages and Sex of Cases Notified. Ages- Under 5 years. 5 to 15 years. 15 to 25 years. 25 to 35 years. 35 to 45 years. 45 years and upwards. Totals. Males 5 23 27 44 32 52 183 Females 4 31 36 59 34 21 185 Totals 9 54 63 103 66 73 368 Of the above primary cases—93 died during the year, 66 in their own homes, 19 in the Hackney Infirmary, and 8 in Hospitals. Amongst these notifications were 45 received from School Medical Officers—40 primary and 5 duplicates. 2. Action taken during the Year.—These were (1) the disinfection of the rooms occupied by a tuberculous person, and any infected articles, either alter removal of the patient to some institution or after death. The number of such rooms disinfected during 1912 was 499; (2) on the notification of a case under the Regulations a visit of inquiry was made by one of the Sanitary Inspectors as to the following circumstances: occupation, housing accommodation, sleeping arrangements, precautions respecting expectoration, use of separate eating and drinking utensils, ventilation and its maintenance. Where any of these were found to be such as to promote the danger of infection, steps were taken, as far 73 as legally possible, to alter them. (3) A printed leaflet of advice as to the measures to be observed by the patient to prevent the spread of infection was sent to the patient. Sputum flasks were supplied to patients needing them; the number of flasks thus supplied gratuitiously during 1912 was 74. NATIONAL INSURANCE ACT, 1911. Medical Benefits. This Act of Parliament came into operation on the 15th July, 1912, six months after receiving the Royal assent. Medical benefits under the Act did not come into force until six months' later, viz., 15th January, 1913; but the Insurance Committee of the County of London resolved to grant sanatorium benefit to those suffering from pulmonary tuberculosis as soon as possible after 15th July, 1912. For this purpose, a temporary local sanatorium sub-committee was formed for tne Borough of Hackney, which consisted of 12 members, including myself, as ex-officio member. The Committee met first at the Town Hall on September 20th. After tne election of Councillor Dr. Rushbrooke, as chairman of the sub-committee, I was requested to report to the Committee on the formulation of a scheme for dispensary and domiciliary treatment of cases of pulmonary tuberculosis in accordance with the following memorandum. Sanatorium Benefit. "Suggested form of request to Medical Officer of Health to report as to formulation of scheme for dispensary and domiciliary treatment of cases." "That the Medical Officer of Health be requested to prepare and submit a scheme for the treatment of cases referred to the sub-committee for dispensary or domiciliary treatment; that he do indicate the arrangements which he suggests should exist as e 2 74 regards: (1) The fees to be paid to dispensaries and doctors; (2) the purchase of drugs and medicines and the price to be paid therefor; (3) the preparation of lists of doctors who shall attend patients at their homes, and (4) the linking, where necessary, of dispensary and home treatment." My report prepared on this reference was presented to the Committee at their next meeting, and is set out in the appendix to this report. Early in September, I was asked by the Clerk to the Insurance Committee for London to arrange with a local practitioner for the domiciliary treatment of an insured person suffering from pulmonary tuberculosis. I made arrangements satisfactory to both Insurance Committee and medical practitioners in this case, as also in subsequent cases arising amongst insured persons and requiring treatment for pulmonary tuberculosis until the end of the year. The total number of such cases so dealt with up to the end of 1912, was 22. In October the Clerk to the Insurance Committee announced publicly by means of a poster that the Insurance Committee were prepared to give Sanatorium Benefit at once to insured persons suffering from pulmonary tuberculosis. 3. Hospital Accommodation.—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:— 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. *13 By grant of Indoor relief by Guardians and subsequent classification by Medical Officer. No. Under Visiting Medical Officer. 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. *7 By grant of Indoor relief by Guardians and subsequent classfication by Medical Officer. Yes. 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. *35 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. e) Advanced cases. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *36 *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 78 Sandgate Allotte d as required. * These numbers are for the 15th March, 1913, and the approximate number of total Phthisis beds in the Hackney Union Infirmary is 100. 75 76 PUBLIC HEALTH LEGISLATION. During the year 1912 certain orders, circular letters ana memoranda bearing upon public health matters were issued to Local Authorities. The following are the chief of these:— Orders of the Local Government Board. 1. Metropolitan Asylums (Whooping Cough) Order, 1912.— This order allows the Asylums Board to admit into their hospitals, under certain conditions and upon the recommendation of a Medical Officer of Health of a Metropolitan Borough, a person who is not a pauper, and is suffering lrom Whooping Cough ; it they have more accommodation than necessary for pauper patients suffering from the same disease. 2. Metropolitan Asylums (Puerperal Fever) Order, 1912.— This Order allows the Asylums Board to admit into their hospitals, under certain conditions and upon the recommendation of a Medical Officer of Health of a Metropolitan Borough, a person who is not a pauper, and is sufrering lrom Puerperal Fever; if they have more accommodation than necessary lor pauper patients suffering from the same disease. 3. domiciliary Treatment of Tuberculosis Order, 1912. Regulations of the Local Government Board. 1. Public Health (Tuberculosis) Regulations, 1912.—These regulations revoke all tuberculosis regulations previously issued, substituting in their place other regulations. The chief alteration in these is to extend notification of tuberculosis to all forms of the disease. 2. Rag Flock Regulations, 1912.—These regulations fix a standard of cleanliness to which flock manufactured from rags shall conform, in accordance with Section 1 (1) of the Rag Flock Act, 1911. The standard lixed is as follows:— " Flock shall be deemed to conform to the standard of cleanliness for the purposes of sub-section (1) of Section 1 of the Act, when the amount of soluble chlorine in the form of chlorides removed by thorough washing with distilled water 77 at a temperature not exceeding 25 degrees Centigrade, from not less than 40 grammes of a well mixed sample of Flock does not exceed 30 parts of chlorine in 100,000 parts of the Flock." 3. Regulations under the Public Health (Regulations as to Food) Act, 1907.—" These regulations are designed to secure that no preservative shall be added to milk, or to cream containing less than 35 per cent, by weight of milk fat, at any stage from the place of production to that of delivery to the purchaser. In the case of cream containing over 35 per cent, of milk fat, the addition of boric acid, borax or a mixture of these preservative substances or of hydrogen peroxide is not prohibited by the regulations, but is subject to a system of declaration which is required to be followed by all persons dealing with such cream for the purpose of sale for human consumption." Further, article IV. (a) prohibits the addition of any thickening substance to cream or preserved cream. Circular letters and Memoranda of the Local Government Board. 1. Circular letter on Parliamentary grant for sanatorium purposes. 2. Circular letter.—Treatment of tuberculosis, provisional and permanent arrangements. 3. Memorandum.—Acute Polio myelitis. 4. Memorandum.—Investigations of outbreaks of illness suspected to be due to food poisoning. Regulations by the Board of Agriculture and Fisheries. Sale of Food and Drugs Acts : Sale of Milk Regulations, 1912.— These regulations amend the Sale of Milk Regulations, 1901, in so far as they relate to skimmed or separated milk and replace the limit of 9 per cent, of total milk solids on which under article 3 of those regulations a presumption that the milk is not genuine is based, by a limit of 8-7 per cent, of milk solids other than milk fat. National Insurance Act, 1911. Memorandum of the National Health Insurance Commissioners ^England) on the Administration of Sanatorium Benefit. 78 THE FACTORY AND WORKSHOP ACT, 1901. Factories, Workshops, Workplaces and Homework. I.— INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 59 11 ... Workshops (Including Workshop Laundries) 2,100 390 ... Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 1 ... Total 2,160 401 ... 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 262 222 ... ... Want of ventilation 51 52 ... ... Overcrowding 15 15 ... ... Want of drainage of floors 1 4 ... ... Other nuisances 129 100 ... ... Sanitary accommodation— Insufficient 2 3 ... ... Unsuitable or defective 100 76 ... ... Not separate for sexes. 5 6 ... ... 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 568 478 ... ... * Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 79 ??? 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 Occupiers as to j 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 304 34 2,988 46 ... 197 296 ... ... ...... ... ... ... ... ... (2) Cleaning and Washing 2 ... 4 ... ... ... ... ... ... ...... ... ... ... ... ... Household Linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets 2 ... '7 ... ... ... 3 ... ... ... ... ... ... ... ... Curtains, and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 6 ... 61 ... ... ... 4 ... ... ... ... ... ... ... ... Electro-plate 2 ... 5 ... ... ... 2 ... ... ... ... ... ... ... ... File Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and Brass Articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur Pulling 8 ... ... 3 ... 4 14 ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. 2 ... 6 ... ... ... 2 ... ... ... ... ... ... ... ... Artificial Flowers 6 ... ... 4 ... 16 11 ... ... ... ... ... ... ... ... Nets, other than Wire Nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, PaperBags 22 ... ... 3 ... 83 18 ... ... ... ... ... ... ... ... Brush Making 22 ... ... 1 ... 11 21 ... ... ... ... ... ... ... ... Pea Picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather Sorting ... ... ... 1 ... 1 3 ... ... ... ... ... ... ... ... Carding, &c., of Buttons, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys 2 ... ... 1 ... 1 4 ... ... ... ... ... ... ... ... Basket Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and Sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 380 34 3,071 59 ... 313 379 ... ... ... ... ... ... ... ... 80 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Important classes of workshops, such as workshop bakehouses may be enumerated here. Total number of Workshops on Register 1,071 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) 51 Action taken in matters referred Notified by H. M. Inspector 48 by H. M. Inspector as able under the Public Health Reports (of action taken) sent to H. M. Inspector 41 Acts, but not under the Factory and Workshop Act (S. 5) Other Underground Bakehouses (S. 101):— Certificates granted during the year None. In use at the end of the year 50 81 Factories.— During the year 32 factories were inspected by the officers of the Public Health Department; ten being factory laundries, and twenty-two factories in which articles of clothing &c., were made and altered. In twelve factories the sanitary accommodation was defective or unsuitable. Nuisance. Found. Abated by Workshop Inspector. Abated by District Inspector. Outstanding Total. Unsuitableor Defective w.c.'s 12 10 1 1 10 Insufficient „ 2 2 — — - Not separate for the sexes. 1 1 - - - * ANALYSIS OF OCCUPATIONS CARRIED ON IN FACTORIES IN THE BOROUGH OF HACKNEY. Clothing. &c. Artificial flowers 1 Boot button holes 1 Boot repairs 10 Boot manufacturer 31 Celluloid combs 1 Blouses 10 Clothing 7 Children's dresses 2 Children's millinery 1 Costumes and coats 2 Corsets 3 Dyers 7 Embroidery 4 Furrier 1 Fur rugs 1 Fur trimmings 1 Lace blinds 1 Laundry 26 Helmets 1 Nursery shoes 4 Skirts and mantles 8 Shirts 2 Silk winding 2 Tailoring 4 Tents 1 Trimmings 1 Trimmings (Upholsterers) 1 Underclothing 2 Food, &c. Aerated water 5 Baker 10 Beer bottling 1 Brewery 2 Chicory roasting 2 Confectioner 5 Drags and chemicals 3 Gum 1 Grist 1 Margarine and butter blending 2 Pasteurizing milk 1 Pills 3 Rennet L Salt 1 Sausages and pressed meats 9 Vinegar 2 *'For the opportunity of abstracting this analysis, I am indected to Mr. S. Muter, H.M. Inspector of Factories. 82 Woodwork, &c. Barge building 1 Coach builder 1 Cabinet-making 17 Drawing boards 1 Firewood chopping 3 Joinery works 18 Lead pencils 1 Mirror frames 1 Moulding 2 Mouse-trap maker 1 Overmantels 2 Pianoforte maker 12 Packing cases 2 Perambulators 1 Picture frames 2 Racks 1 Saw mills 5 Surveyor's staves 1 Tobacco pipes 4 Toys 3 Tennis racquets 1 Wood flooring 1 Wood turning 1 Wheelwright 2 Wood wool 1 Wood patterns 1 Walking sticks 1 Wood and cardboard boxes 15 Iron, Stone, Glasswork, &c. Artificial stone 2 Brass turning 3 Balances 1 Bone turning 1 Cutlery 1 Electro-plating 1 Emery paper 1 Fumigators 1 Fountain pens 1 Fibrous plaster 1 Glass bottles 11 Glass blower 1 Glass letters 1 Glass bevelling 1 Gas stoves 1 Ivory turning 1 Lamps 1 Lead seals 1 Mortar 1 Metal stamping 1 Ore crushing 1 Piano frames 1 Pumps 1 Railway signals 1 Sand blasting 1 Screws 6 Slate and marble 1 Safes 1 Smith 1 Spelter 1 Tin cans 1 Tool grinding 3 Type founding 1 Machinery. &c. Calculating machines 1 Cycle repairs 5 Electricity 3 Electrical fittings 6 Engineering 25 Machinery 1 Motor repairs 1 Mathematical instruments 1 Musical instruments 1 Scientific instruments 2 Surgical instruments ' Sewing machines 1 83 Miscellaneous. Antimony 1 Blacking 1 Boiler covering 1 Brushes 12 Bookbinding 4 Carpet beating 1 Cameras 1 Chaff cutting 4 Carbonic acid gas 1 Confetti 2 Cigarettes 2 Curled hair 1 Dandy rolls 1 Flax 1 Fire lighters 1 Fire extinguishers 1 Flageolets 1 Gelatining 1 Gold beater's skin 1 Indiarubber 2 Labels 1 Leather goods 4 Mats 1 Perfumery 2 Paper staining 1 Paper bags 2 Paper cutting 3 Paste 1 Printing 41 Paints and varnish 4 Printing and drawing ink 2 Rope manufacturer 1 Skin dressing 5 Signs 3 Silversmith 1 Photo appliances 1 Workshops.— The number of workshops registered in Hackney at the end of 1912 was 1,071, an increase of 2 over the number registered at the end of 1911. Of this total, 818 were workshops in which females were employed. Of these latter, 602 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, &c:, 177 in which other articles were manufactured, and 34 were domestic workshops. Amongst the workshops manufacturing wearing apparel there were 458 employing female labour alone, and 144 employing both male and female labour. In workshops of other occupations there were 110 employing females alone and 67 employing both males and females. Of the domestic workshops, females were employed in 25 alone, and both males and females in 14. Thus of the total number of workshops registered in the Borough, 593 employed female labour alone, 225 both male and female labour, and 253 male labour alone. During the year notices and complaints were received from H.M. Inspectors of Factories as follows :— Complaints Factories 9 „ Workshops 37 Notices „ 184 84 ANALYSIS OF OCCUPATIONS CARRIED ON IN THE REGISTERED WORKSHOPS OF HACKNEY. (a) Wearing Apparel. Occupations. No. of Workshops. Artificial Flower Makers 6 Baby Linen 2 Beading 1 Belts 6 Blouses 41 Boot and Shoe Manufacturers 80 Boot Machinists 110 Children's Costumes 14 Clerical Robes 1 Clothing 5 Collars 1 Dressmakers Ill Dressing and Tea Gowns 7 Fancy Bows on Shoes 4 Fall Net Chenilling 1 Furriers 53 Gloves 1 Occupations. No. of Workshops. Hats 5 Infants' Millinery 7 Mantles 50 Millinery 47 Needlework 2 Pinafores 4 Shirts 5 Skirts 1 Stays 7 Tailoring 58 Ties 39 Trimmings 8 Underclothing 20 Vests 14 Waterproofs 4 715 (b) Other Occupations. Bakers and Confectioners 28 Baskets 4 Box Makers 15 Brush Makers 9 Cabinet Makers 53 Doll Manufacturers and Dressers 3 Fancy Leather Goods 13 Laundries 93 Pianoforte Makers 15 Rubber Goods 5 Toy Makers 2 Trunk and Bag Makers 5 Umbrellas 2 Upholsterers 10 Upholsterers' Trimmings. 4 Miscellaneous 95 356 During 1912, Miss Teebay, the Workshop Inspector, made 2,160 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections, 401 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 :— 85 NUISANCES IN WORKSHOPS, 1912. Outstanding at end of 1911. Found in 1912. Outstanding at end of 1912. Abated in 1912. By Inspector of Workshops. By District Inspector. Total. Want of Cleanliness 20 202 50 222 10 232 Want of Ventilation 9 51 8 52 ... 52 Overcrowding 1 15 1 15 ... 15 Want of Drainage of Floors 6 4 ... 4 6 10 Other Nuisances 65 127 12 100 80 180 Insufficient Sanitary Accommodation 1 2 .. 3 ... 3 Unsuitable or defective Sanitary Accommodation 49 100 6 76 67 143 No separate Sanitary Accommodation for sexes 4 5 2 6 1 7 86 Outworkers—The number of outworkers on the register at the end of 1912 was 2,559, against 3,071 at the end of 1911. There were thus 512 outworkers removed from the register during the past vear. The following analysis shows the trades followed by these outworkers: — Trade. No. of Outworkers Trade. No. of Outworkers. Artificial Florist 40 Hats 12 Baby Linen 9 Lace Trimmed Goods . 8 Beading 2 Millinery 144 Bedding 2 Pinafores 8 Belts 33 Shirts 42 Blouses 133 Shoe Bows 13 Boots and Shoes 610 Skirts and Mantles 262 Boxes 187 Tailoring 209 Braces 4 Ties 242 Brushes 154 Trimming 30 Children's Costumes 33 Umbrellas 22 Collars and Bibs 16 Underclothing 99 Corsets 1 Upholsterer's Trimming 10 Clothiers and Outfitters 128 Vests 7 Dolls 6 Miscellaneous 16 Dressing and Tea Gowns 13 Fancy Goods 6 Feather sorting 4 Fur Trade 53 Gloves 1 2,559 The local authorities from which I have received names and addresses of outworkers during the last year are the following: Battersea 6 Leyton 31 Bethnal Green 357 Paddington 6 Camberwell 10 Poplar 95 Chelsea 12 St. Marylebone 50 City of London 1,423 St. Pancras 1 East Ham 1 Shoreditch 239 Finsbury 646 Southwark 9 Hampstead 8 Stepney 92 Holborn 9 Stoke Newington 71 Hornsey 1 Walthamstow 12 c Hford 2 West Ham 5 Islington 330 Westminster 44 Kensington 16 3,478 Lambeth 2 87 On examination of the lists of outworkers sent in by employers in this Borough during 1912, I found 2,472 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 3 Amersham 5 Axminste 2 Barking 4 Battersea 2 Bermondsey 6 Bethnal Green 626 Brentford 2 Camberwell 30 Chingford 1 Chiswick 2 City of London 2 „ Westminster 4 Croydon 2 Deptford 3 East Ham 21 Edmonton 20 Enfield 6 Erith 2 Finchley 1 Finsbury 24 Great Missenden 2 Hornsey 7 IIford 10 Islington 208 Lambeth 7 Lewisham 3 Ley ton 105 Poplar 234 Romford 2 St. Pancras 8 Shoreditch 396 Southend 2 Southgate 3 Southwark 8 Stepney 248 Stoke Nevvington 138 Tottenham 97 Walthamstow 187 Wandsworth 1 West Ham 24 Willesden 2 Woodford 3 Wood Green 6 Woolwich 3 2.472 During the year 1912, Miss Portlock (the inspector appointed for the inspection of outworkers premises) made 1,029 inspections and 629 re-inspections. She also made 570 visits without inspection, F 88 the outworkers having left the premises (307), or having given up homework (61), or being out at the time of visit (110), or owing to a wrong address being given (59), or the premises being workshops (23), or male workers only being employed. During her visits Miss Portlock discovered 651 sanitary defects. For the abatement of these she served 348 intimation notices and 35 final notices. Of the 1,029 premises inspected, in 77 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, kitchen and living rooms 38 „ „ and living room 25 „ „ „ kitchen 20 „ and kitchen 671 „ „ bedroom 114 „ „ parlour 72 „ „ scullery 7 „ „ bath rooms 3 „ landing 2 Workroom provided separate 77 Total 1,029 89 The following table gives details of the nuisances found and their abatement:— NUISANCES IN OUTWORKERS' PREMISES, 1912. Outstanding at end of 1911. Found in 1912. Outstanding at end of 1912. Abated in 1912:— By Inspector of Outworkers. By District Inspector. Total. Want of Cleanliness 68 270 35 298 5 303 Want of Ventilation 5 21 1 24 1 25 Overcrowding 2 9 ... 11 ... 11 Number of Premises oil which other Nuisances found 45 249 34 240 20 200 Sanitary Accommodation Defective 15 102 19 90 8 98 90 Factory and Workshops Acts.—In a memorandum issued in March, 1912, by the Home Office as to the duties of Local Authorities under the Factory and Workshops Acts, the Secretary of State makes the following observations:— "Before proceeding to describe those requirements of the Acts in regard to which the Council are made the supervising authority and the observance of which will in general be enforced by periodic inspection on the part of its officials, the Secretary of State would remind the Council that, apart, from inspection.it will greatly facilitate the administration both of these requirements and of any other requirements of the Act of a structural character, if the Council and its officers when considering the plans of any new building intended to be used as a factory or workshop will see that all requirements of that character whether falling to be administered by the Local Authority or by the Factory Inspector have been met. In several cases it has happened that the Public Health Department has not been consulted by the Surveyor's Department of the Local Authority before approving plans and that owners of factories have subsequently been called upon by the Council or by the Factory Inspector to make alterations (e.g., as to sanitary accommodation or means of escape from fire), which have put them to considerable expense and inconvenience. It is therefore very desirable that the attention of persons submitting plans should be drawn to the requirements of the Acts. These are summarised in a Memorandum issued by the Home Office, to which persons submitting or proposing to submit plans may be referred." "As regards textile factories in particular the recent Departmental Committee on Accidents in Factories have called attention to the danger caused by crowding of machinery (see par. 7, page 5, of the Memorandum referred to), and have suggested that the Local Authority should inform the Factory Inspector for the district when plans of such factories are 91 submitted, so that he may have an opportunity of discussing the intended location and spacing of the machinery before the building is actually commenced. The Secretary of State hopes that the District Council will be able to act upon this suggestion." COMBINED DRAINAGE WORKS AND SEWERS. In the course of the year, many combined drains are found by the Sanitary Inspectors of the Borough so defective, as to be a nuisance, dangerous or injurious to health. In many of such cases, the owners, when notice to reconstruct has been served upcn them, have repudiated liability for reconstruction, and insisted that the liability for the repair and maintenance of such drains rested with the Borough Council. In all such cases.it is my practice to get the opinion of the Solicitor to the Council, and where he advises that the liability for repair and maintenance belongs to the Council, I refer the case to the Borough Engineer and Surveyor for his attention. The following is a list of such cases referred during 1912 List of Combined Drainage Works referred to the Borough Engineer and Surveyor during the year 1912. Date of Reference. Situation of Premises. 10th January 3, Tottenham Square. 13th „ 1, 2 and 3, Swiss Cottages. 19th „ 413, Mare Street. 26th „ 16, Ivydene Road. 26th „ 105, Wick Road. 29th „ 39, Trederwen Road. 31st „ 10, Elsdale Street 11th February - 7, 11, 15 and 16, Eaton Place. 92 List of Combined Drainage Works—continued. Date of Reference. Situation of Premises. 17th February 8, Eaton Place. 26th ,, 12, 13 and 14, Eaton Place. 29th „ 4 and 6, Terrace Road. 1st March 27 and 29, Triangle Road, and 1-7, Warburton 15th „ 23, Osbaldeston Road. [Square. 15th „ 22, Digby Road. 25th „ 32 and 36, Greenwood Road. 11th April 34, Greenwood Road. 13th „ 2, Victoria Grove. 24th 10, Lea Bridge Road. 1st May 132, King Edward Road. 6th „ 62, Dalston Lane. 10th „ 66a, Dalston Lane. 31st „ 19, Salisbury Road. 10th June 82, Old Hill Street. 12th 63, Sandringham Road. 20th „ 2, Balmes Road. 21st „ 4, 6 and 8, Lea Bridge Road and Shelford Mews. 24th „ 59, 61 and 63, Hassett Road. 28th „ 72, Dunlace Road. 1st July 150, Queen's Road. 2nd „ 106-8, Cassland Road. 4th „ 102, Norfolk Road. 9th „ 110, Cassland Road. 11th „ 52, 54 and 56, Middleton Road. 12th „ 32-42, Alvington Crescent. 13th „ 82, Clifden Road. 13th „ 212, Glyn Road. 16th „ 16, Church Road, West Hackney. 23rd „ 88, Mortimer Road. 31st „ 61, Morning Lane. 24th August 156, Wick Road. 26th „ 123, Rendlesham Road. 6th September 25, London Road. 6th „ 57, Hassett Road. 12th 2, Massie Road. 93 List of Combined Drainage Works—continued. Date of Reference. Situation of Premises. 21st September 24, Speldhurst Road. 26th 58, Cassland Road. 27th 62, Cassland Road.' 27th 24, 32 and 34, Digby Road. 8thOctober 42, Groombridge Road. 10th „ 25 and 27, St. Thomas' Road. 10th „ 2, Fassett Road. 12th „ 27, 28, 29, 30 and 31, Palace Road. 12th „ 37, 39 and 41, Hertford Road. 19th 19-35, Hertford Road. 21st 8, Wellington Road. 23rd „ 1, Annis Road. 24th „ 9, Annis Road. 24th 25 and 26, Palace Road. 7 th November 3, Annis Road. 11th „ 1-9, Trederwen Road. 15th „ 158, Wick Road. 20th „ 44, Lauriston Road. 23rd „ 44-52, Annis Road. 13th December 42, Penshurst Road. 14th „ 4, Comberton Road. 17th „ 94, Well Street. 30th „ 529, Kingsland Road. DISINFECTION. (a) Rooms.—During the year 1912 there were 1,953 rooms fumigated and 865 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 infectious diseases, but also disinfection after measles and whooping cough. 94 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 1912. Month. Rooms Fumigated. Rooms Cleansed. Remarks. January 192 89 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 139 94 March 145 69 April 120 39 May 161 42 June 184 53 July 187 70 August 127 72 September 150 78 October 181 97 November 175 89 December 192 73 Total 1,953 865 (6) Articles of Clothing and Furniture.— The number of articles under this head disinfected last year was 16,211. This is a decrease of 1,415 upon the number disinfected during 1911, and is due chiefly to a decrease of infectious disease in the Borough during the past vear. The following table gives a summary of the articles disinfected :— 95 Articles Disinfected during the Year 191Z. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. HOUSE LINEN. Beds (feather, flock, wool) 122 130 107 76 81 109 131 110 112 165 140 137 1,420 Bed Vallance ... ... 33 ... ... ... ... ... ... ... ... ... 33 „ Covers 27 16 ... 17 22 24 22 20 26 18 34 9 235 „ Furniture ... ... ... ... ... ... ... ... ... ... ... ... ... Blankets 231 157 143 128 145 121 143 124 111 187 175 205 1,870 Bolsters 106 92 80 63 70 59 80 81 72 110 101 100 1,014 Box Covers ... ... ... ... ... ... ... ... ... ... ... ... ... Carpets 2 ... ... ... ... ... ... ... ... ... ... 3 5 Chair Ped Cushions 30 24 9 20 17 16 10 6 17 20 22 34 225 Coverlets ... ... ... ... ... ... ... ... ... ... ... Cushions 47 22 15 19 12 14 28 34 15 28 25 30 289 Glass Cloths ... ... ... ... ... ... ... ... ... ... ... Hearth Rugs. 15 2 3 14 ... ... 2 2 3 4 4 49 Mattresses (Horse-hair, Wool, Straw or Spring) | 87 65 45 68 93 75 77 66 56 102 97 92 923 96 Articles Disinfected during the Year 1912. continued. Description of Articles. January. February. March. April. May. June. July- August. September. October. November. December. r Total. Mats 3 ... ... ... 8 ... ... ... ... ... ... 2 13 Matting ... ... ... ... ... 10 ... ... ... ... 8 ... 18 Palliases 17 12 13 6 40 16 13 9 6 14 ... 26 172 Pillows 280 258 215 159 218 203 244 209 210 304 295 303 2,901 Pillow and Bolster Cases ... ... ... ... ... ... ... 109 100 ... ... ... 209 Quilts 145 127 94 62 82 103 86 ... ... 161 147 121 1,128 Round Towels ... 4 3 ... ... ... ... ... ... ... ... ... 7 Rugs 17 ... ... 2 4 ... ... 6 ... ... ... 10 39 Sheets 145 108 83 69 95 117 89 103 101 131 158 134 1,333 Sofa Squabs 1 ... ... ... ... ... ... ... ... ... ... ... 1 Table Cloths 8 ... ... ... 6 ... 4 ... 1 6 ... ... 25 Toilet Covers ... ... ... 2 2 ... ... ... ... ... ... ... 4 Towels 30 7 9 3 21 9 5 16 4 24 9 17 154 Window Blinds ... ... ... ... ... ... ... ... ... ... ... ... ... Window Curtains 5 15 7 5 22 5 10 1 8 19 26 5 128 2,195 97 Articles Disinfected during the Year 1912.—continued. Description of Articles. January. February. March. April. May. June. July. August. September October. November December. Total. MEN'S. Caps 1 2 3 1 7 1 Coats 13 30 9 11 14 12 15 14 25 20 20 183 Collars ... ... ... ... ... ... ... ... ... ... ... ... ... Drawers 7 11 6 10 16 18 4 10 4 11 97 Flannels ... ... ... ... ... ... ... ... ... ... ... ... ... Flannel Vests 17 10 2 6 5 16 2 17 5 10 6 5 101 Hats ... 1 ... ... ... ... ... ... ... ... ... ... 1 Neck Ties ... ... ... ... ... ... 3 ... ... ... ... ... 3 Night Shirts 14 18 9 10 5 8 3 4 7 11 89 Shirts 11 8 3 2 15 10 3 9 8 1 5 1 76 Socks G 9 4 14 16 7 14 10 4 17 10 4 115 Suits of Clothes 2 ... ... ... ... ... ... ... ... 3 ... ... 5 Trousers 25 10 10 ... 1 7 19 4 9 6 1 9 101 98 Articles Disinfected during the Year 1912.— continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. Ulsters ... ... 1 ... ... ... ... ... ... ... ... ... 1 Waistcoats 14 14 4 1 12 14 18 9 10 8 104 883 WOMEN'S. Aprons 9 ... ... ... ... ... ... ... 3 ... 3 4 19 Caps 2 ... ... ... 2 ... 3 ... ... ... ... ... 7 Chemises 22 22 12 15 22 9 4 17 18 36 17 26 220 Cloaks ... ... 1 ... ... ... ... ... ... ... ... ... 1 Collars ... ... ... ... ... ... ... ... ... 5 ... ... 5 Corsets 8 4 2 ... 8 5 1 7 12 27 13 8 95 Cuffs ... ... 8 ... ... ... ... ... 2 ... ... ... 10 Drawers 19 8 ... ... 12 9 6 5 5 21 9 10 104 Dresses 2 4 2 ... ... 1 ... ... 5 6 5 4 29 Dress Bands ... ... ... ... ... ... ... ... ... ... ... ... ... Dressing Gowns 14 ... 3 10 15 10 4 4 6 14 7 4 91 99 Articles Disinfected during the Year 1912.—continued. Description of Articles. January. February. March. April. May. June. July. August. September October. November December. Total. Flannel Petticoats ... 18 ... ... ... ... ... ... ... ... ... ... 18 „ Vests 24 ... 6 14 8 5 4 10 11 14 7 23 126 Jackets 11 23 8 1 11 ... ... ... 1 11 ... 6 72 Night Dresses 32 13 15 11 13 ... 10 16 14 15 21 31 191 Petticoats 18 12 4 6 ... 3 3 4 14 33 11 11 119 Petticoat Bodices ... ... ... ... 24 ... ... ... ... ... ... ... 24 Sashes 1 ... ... ... ... ... ... ... ... ... ... ... 1 Shawls 24 7 15 6 ... 7 1 8 6 13 10 22 119 Skirts 11 23 1 1 11 ... 11 10 3 18 ... 90 Stockings 19 20 11 18 15 12 16 14 12 32 10 18 197 1,538 CHILDREN'S. Boys' Knickers 8 6 6 ... 15 14 9 8 4 8 18 3 99 „ Jackets 9 15 7 9 6 13 8 8 10 18 5 15 123 „ Suits ... 1 ... ... ... ... ... ... ... ... ... 10 11 100 Articles Disinfected during the Year 1912. -continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. Feeders ... ... ... ... ... ... ... 3 ... ... ... ... 3 Frocks 8 12 4 13 ... 5 1 ... 5 13 7 8 76 Pelisses ... ... ... ... ... ... ... ... ... ... ... ... ... Pinafores 1 1 5 8 8 5 ... 4 ... 8 5 ... 45 357 OTHER ARTICLES. Boots ... ... ... ... ... ... ... ... ... ... ... ... ... Handkerchiefs 13 22 8 2 12 4 2 38 12 11 14 6 144 Shoes ... ... 2 ... ... ... ... ... ... ... ... ... 2 Slippers ... ... ... ... ... 1 ... ... ... 10 ... ... 11 SUNDRIES 88 105 58 50 126 40 88 58 91 119 49 209 1,081 1,238 1,777 1,466 1,084 901 1,325 1,100 1,204 1,195 1,137 1,804 1,501 1,717 Total 16,211 101 In addition to these there were 202 articles destroyed on request from the owners. These are set out in the following table:— Articles Destroyed. Beds 42 Mattresses 25 Bolsters 8 Overlays 1 Blankets 7 Pillows 23 Carpets 2 Palliasses 33 Cushions 12 Rugs 2 Hats 1 Sheets 6 Sundry Articles 35 Quilts 5 Total 202 (c) Public Library Books.—During the past year, 280 books from homes in which infectious diseases had occurred were disinfected. Of this total, there were 140 books which had been borrowed from the Hackney Borough Library and 140 from other Libraries. The method of disinfection of books practised is to expose the books in a closed chamber to the action of formic aldehyde gas, which is generated in a lamp from formalin tablets. Books Disinfected, 1912. Month. Number of Books Disinfected. From Hackney Public Library. From other Libraries. Totals. January 20 5 25 February 8 1 9 March 12 5 17 April 6 ... 6 May 4 1 5 June 7 3 10 July 16 12 28 August 12 1 13 September 16 4 20 October 27 5 32 November 2 1 3 December 10 102 112 Total 140 140 280 102 Number of persons lodged and maintained at the Council's Shelter in Millfields Road, Clapton, N.E, during the year ended 31st December, 1912. Month. No. of Persons Admitted. Cost of Maintenance. Average period of Stay. Diseases. Men. Women. Children. Total. £ s. d. January ... 1 3 4 0 5 0 Days. 1 Diphtheria. February ... ... ... ... ... ... ... ... March ... ... ... ... ... ... ... ... April 1 1 2 4 0 10 0 2 Diphtheria. May ... ... ... ... ... ... ... ... June ... ... ... ... ... ... ... ... July ... 1 1 2 0 2 6 1 Scarlet Fever. August ... ... ... ... ... ... ... ... September ... ... ... ... ... ... ... ... October ... ... ... 3 0 3 9 1 Scarlet Fever. November ... ... ... ... ... ... ... ... December ... ... ... ... ... ... ... ... 1 4 8 13 1 1 3 1.25 103 THE SHELTER. During the past year, there were 13 persons admitted to the shelter whilst their homes were being disinfected. This total consisted of 1 man, 4 women and 8 children. This is a decrease of 22 persons on the number admitted during 1911. The cost of maintenance of the 13 persons thus admitted was £1 1s. 3d. The average length of stay in the shelter was 1.25 days. The table on page 102 gives particulars relating to these contacts. No expense was incurred during the year in the conveyance of persons to or from the shelter. CLEANSING OF PERSONS ACT, 1897. The facilities provided by the Borough Council under the above Act for the cleansing of verminous persons, were in constant use during the year 1912, no less than 1,372 baths being given during that period. This total shows an increase of 651 on the number who presented themselves for cleansing at the station during 1911. 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 1912 No. of Baths 3 11 9 241 330 457 724 667 568 721 1,372 Of the 1,372 baths given, 38 were sulphur baths for scabies and 1,334 for pediculi. The great majority of those presenting themselves for baths, were children from the public elementary schools in the Borough. These children received 1,338 baths, an increase of 794 on the number given during 1911 g 104 The following are the Schools from which children were sent to the Cleansing Station, with the number sent. Schools. No. Cleansed. Schools. No. Cleansed. Hot Baths. Sulphur Baths. Hot Baths. Sulphur Baths. Ballance Road, R.C. 7 ... Brought forward 972 23 Bay Street 7 ... Benthal Road 14 ... Morning Lane 74 ... Berkshire Road 127 ... Northwold Road 12 ... Berger Road 84 ... Orchard Street 16 ... Daubeney Road 122 ... Percy Road 20 ... Detmold Road 14 ... Queen's Road 2 ... Eleanor Road 18 ... Rushmore Road 14 ... Gainsboro' Road 43 3 Sidney Road 55 ... Gayhurst Road 23 ... Sigdon Road 6 ... Glyn Road 52 10 St. John's. R.C. 38 ... Hackney Parochial 11 ... St. Joseph's, R.C. 3 ... Holy Trinity (Mayfield Road) 29 ... St. Michael's 10 ... •St. Paul's (Broke Road) 8 ... Homerton Row 68 ... Lamb Lane 11 ... Shacklewell 55 ... London Fields 238 ... Tottenham Road 26 ... Mandeville Street 104 10 Wilton Road 4 ... Carried forward 972 23 Totals 1315 23 * Outside Borough. The full value of this crusade against body parasites cannot as yet be estimated but it will no doubt bring about results beneficial to the public health. Good results may be anticipated, and are probably being experienced already in improved health of the children. Young growing children suffer in their health when infested with such vermin as lice, fleas or bugs. These are all biting insects, and live and thrive at the expense of their hosts, in this way undermining their health. Apart from this, they are a source of constant irritation to the children, disturbing their sleep at night, and distracting their attention during the day from healthy pursuits. Their presence also is detrimental to the child's idea of a high standard of cleanliness. Summing up from the point of view of 105 the child, destruction of these vermin will improve its general health and comfort and confer increased resistance to disease. The public will also benefit. The greater the effort made to exterminate these pests, the less chance of accidental contamination in public vehicles. The particular part, if any, and its extent, played by these biting insects in the spread of infectious disease is not yet known, except that it has been experimentally proved that the body louse is capable of conveying certain diseases; other insects are also known to be very active in the spread of certain tropical fevers. These facts open up possibilities that the domestic parasites, bugs, fleas and lice, of our country may be in their way playing a part, small or great, in the maintenance and spread of infectious disease. If this be so, and it is not improbable, every effort to reduce their number will reduce the amount of infectious disease. In view of this possibility, I have arranged, in certain cases, for the spraying of walls, ceilings and floors of rooms, with an insecticide solution, where there are evidences of vermin. 2 106 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 ... 3 ... 2 ... ... ... ... 9 4 4 4 19 Women ... ... ... ... ... ... ... ... ... ... ... ... ... Children 113 81 164 79 77 115 133 13 149 148 140 100 1315 1334 Receiving Sulphur Baths. Men 1 3 ... ... ... ... ... ... ... 1 ... ... 5 Women ... ... ... ... ... ... ... ... 3 2 2 3 10 Children ... ... ... 3 ... ... 20 ... ... ... ... ... 23 38 107 The following shows the expenditure in detail incurred in connection with the Disinfecting Station, including that relating to the Shelter. EXPENDITURE AT THE DISINFECTING STATION FOR THE YEAR 1912. Shelters. £ s. d. £ s. d. Wages—Female Caretaker 50 0 0 Subsistence allowance 1 1 3 Maintenance, Repairs, etc. Electricity supply 5 4 1 Water 4 12 0 Electric Fittings 0 7 4 Coals 4 0 2 Stores, etc. 4 6 6 Matron's Uniform 0 16 8 Repairs 1 1 4 20 8 1 71 9 4 Disinfecting Station. Wages 373 0 0 Electricity Supply 10 8 3 Water 9 2 0 Hire of Horse 77 0 0 Repairs— To Caretaker's House 4 15 0 To Station 4 0 3 To Boiler 10 17 1 Engine Fitters (Wages) 24 7 9 Laundryman 5 16 0 49 16 1 Formalin Lamp (Sundries) 0 5 4 Electric Fittings 0 14 9 New Oak Gates 10 19 6 Boiler Powder, Engine Oil, &c. 3 12 6 Coal- Steam 44 14 0 Kitchen (lodge) 8 0 4 52 14 4 Stores, Firewood, etc. 8 13 1 Cleansing of Verminous Children. Attendant's Wages 48 5 0 Towels Sheets, etc. 6 1 11 Potassium Sulphide 0 6 8 54 13 7 £650 19 5 108 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 filthy, dangerous or unwholesome condition that health is affected or endangered thereby, or to prevent risk of, or to check infectious disease. During the year 1912 my attention was drawn by the Medical Officer (Education) to 1,180 homes in the Borough from which children were attending school in a verminous condition, and I was asked to deal with them under the above Act. 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. 1180 118 30 1032 Amongst the 118 verminous homes there were 30 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. Some of the verminous rooms were fumigated and others sprayed with a germicide, these latter numbered 55 ; and, where necessary, notices were served upon the owners to cleanse and strip the rooms to free them from vermin. I find that fumigation alone does not destroy all the vermin; thorough spraying with a germicidal solution is more effectual in destroying both the adult vermin and their eggs. Removal and Disposal of House Refuse—whether by Local Authority or Contractors; Frequency and Method. The house refuse is removed from occupied houses in the Borough by contractors, at a certain price per ton removed and delivered at the Destructor. The Contractors have to supply a 109 sufficient number of men, horses, and covered vans to ensure a weekly visit to each house in the Borough. Penalties are provided for any breach of the contract. For the purposes of house refuse removal, the Borough is divided into two divisions North and South. To each of these divisions the Council has appointed a dust inspector, whose duties are generally to see that the Contractor's men visit and remove the house refuse from occupied houses regularly at stated times. Each division is divided for convenience into a certain number of sub-divisions, each of which is of a size sufficient to enable the carman in charge of a dust van to call at each occupied house at least once a week, and remove the house refuse therefrom. These sub-districts number 17 in the North Division, and 19 in the South Division. As a check upon the collection, each carman is provided daily with a sheet, on which he is instructed to enter the numbers of every occupied house visited, where he is unable to remove the dust and stating the reason. These sheets are sent by the Contractors to the office the next morning. If a subsequent complaint of nonremoval of house refuse is made, the returns will show whether this is the fault of the dustman or the householder. While a weekly collection of house refuse is insisted upon, it has been my practice for some years to have large blocks of tenement dwellings cleared of house refuse at least twice a week ; some, indeed, three times a week, and some large institutions have been visited daily by the dustmen (except, of course, on Sunday). In the course of a year the dustmen record a very large number of refusals on the part of the householders to have the dust removed. There is also almost an equal number where the dustmen get no replies to their applications to remove the refuse. 110 The total quantity of house refuse removed from occupied houses in the Borough to the destructor by the Council's contractors during the year 1912. amounted to 39,429 tons 4 cwt. 3 qrs. During the first quarter of the year the price paid by the Borough Council to the contractors for both divisions was 4s. 4½d. ; during the remainder of the year the prices were, for the North Division 5s. 6½d. per ton, and for the South Division 5s. 6d. per ton. The total cost for this removal for the whole year amounted to £10,189 17s. 7d. As stated above, the house refuse after removal is conveyed to the Borough destructor where it is destroyed by fire. The cost for this destruction of the above quantity of refuse is calculated by the Electrical Engineer, who is in charge of the destructor, to be £6,449, the total cost for removal and destruction being £16,638 17s. 7d. Distributing this cost over the estimated population of the Borough, it amounts to rather more than 1s. 5¾d. per head. The cost of destruction appears very high, but this is partly due to the peculiar method adopted of transferring the refuse from the vans to the furnace. The method is briefly, as follows The refuse on arrival at the destructor works is shovelled out of the vans into large hoppers placed below the ground level. From this the refuse is lifted by buckets fixed on an endless chain driven by electricity to a large chamber situated about 20 feet above the furnaces. From there it passes partly by gravity to shoots leading to the feed holes of the furnaces. But here manual labour is employed to drag the refuse down the shoots to the feed hole. The whole of the refuse burnt is raised first of all in a most expensive way, i.e.—in small quantities at a time to a great height, whence it must, as already stated, be drawn by manual labour to the leed hole. If instead of this complicated manipulation, the refuse were carried to a platform adjacent to the furnace feed holes, the cost of destruction would be considerably less. 111 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 1912. Week ending Refusals. No Answers. Week ending Refusals. No Answers. Jan. 6th 1,167 796 July 6th 1,064 948 „ 13th 1,157 864 „ 13th 1,019 800 „ 20th 1,143 912 „ 20th 1,245 1,179 „ 27th 1,135 923 „ 27th 1,264 1,162 Feb. 3rd 1,153 934 Aug. 3rd 1,487 1,876 „ 10th 1,132 976 „ 10th 1,408 1,847 „ 17th 1,156 874 „ 17th 1,481 1,583 „ 24th 1,149 796 „ 24 th 1,429 1,413 Mar. 2nd 1,112 1196 „ 31st 1,241 1,253 „ 9th 1,124 856 Sept. 7th 1,201 1,142 „ 16th 1,145 927 „ 14th 1,214 1,121 „ 23rd 1,157 935 „ 21st 1,222 1,101 „ 30th 1,146 878 „ 28th 1,380 1,234 April 6th 1,203 932 Oct. 5th 1,359 1,017 „ 13th 1,735 945 „ 12th 1,280 1,123 „ 20th 1,190 869 „ 19th 1,349 1,036 „ 27th 1,193 927 „ 26 th 1,339 1,065 May 4th 1,301 1,087 Nov. 2nd 1,447 1,103 „ 11th 1,243 944 „ 9th 1,312 1,122 „ 18th 1,325 1,010 „ 16th 1,419 1,144 „ 25th 1,222 1,060 „ 23rd 1,402 1,145 June 1st 1,543 1,323 „ 30th 1,337 1,147 „ 8th 1,381 1,122 Dec. 7th 1,354 1,171 „ 15th 1,352 1,072 „ 14th 1,489 1,145 „ 22nd 1,222 1,024 „ 21st 1,319 1,078 „ 29th 1,371 927 „ 28th 1,216 1,076 3 days 31st 207 246 The following table shows the number of requests made for the removal of house refuse during the ten years ending 1912:— List of the requests for the removal of Dust during the ten years ending December, 1912. 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 Jan. 28 28 12 14 12 6 4 4 7 25 Feb. 11 3 5 5 5 6 5 6 5 8 March 23 10 6 6 10 4 4 8 10 5 April 63 21 10 14 9 3 4 9 10 12 May 43 11 10 7 6 11 11 5 13 11 June 45 18 16 13 11 11 10 3 14 16 July 47 19 16 16 7 6 10 0 20 16 August 12 10 8 3 9 5 9 6 12 20 Sept. 25 6 9 8 6 5 4 1 19 14 Oct. 13 14 6 1 2 5 1 3 7 15 Nov. 10 5 6 4 5 3 2 3 7 16 Dec. 11 10 4 7 7 2 6 4 12 12 Totals 331 155 108 98 89 67 70 52 136 170 112 DUSTING ACCOUNT, 1912. 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 1,806 14 1 21 414 18 1 2,175 3 3 7 475 16 0 4,071 18 1 0 890 14 7 February 1,793 6 2 21 392 5 10 2,057 7 1 7 450 1 0 3,850 14 0 0 842 6 10 March 1,933 9 1 0 422 19 0 2,226 18 0 21 487 2 8 4,160 7 1 21 910 1 8 April 1,332 1 3 14 369 1 10 1,508 19 3 7 414 19 3 2,811 1 2 21 784 1 1 May 1,405 18 3 7 389 11 2 1,583 0 3 21 435 6 9 2,988 19 3 0 824 17 11 June 1,306 3 0 0 361 18 4 1,497 12 3 0 411 17 0 2,803 15 3 0 773 15 4 July 1,286 14 0 0 356 10 6 1,487 12 3 21 409 1 11 2,774 6 3 21 765 12 5 August 1,152 3 0 7 319 5 0 1,380 5 1 0 379 11 3 2,532 8 3 7 698 19 5 September 1,391 3 3 21 385 9 6 1,681 12 1 0 462 8 10 3,072 16 0 21 847 18 4 October 1,576 16 0 7 436 18 2 1,756 8 9 0 483 0 3 3,333 4 2 7 919 18 5 November 1,608 19 1 21 445 16 5 1,798 14 2 14 494 13 0 3,407 14 0 7 910 9 5 December 1,677 14 0 14 464 17 5 1,914 3 0 21 526 7 9 3,591 17 1 7 991 5 2 Totals 18,361 5 0 21 4,759 11 3 21,067 19 2 7 5,430 6 4 39,429 4 3 0 10,189 17 7 113 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 442 1. To await inquests—(a) Infectious 0 (b) Non-Infectious 412 2. To await burial 30 Number of post-mortems made 130 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 131 106 Accidental death 75 58 Suicide 15 13 Open Verdict 6 6 Manslaughter ... ... Murder 1 1 Misadventure ... ... Totals 228 184 Table showing nature of above Suicidal and Accidental Deaths in the Borough of Hackney during the year ended 1912. Suicides. Accidental Deaths. Nature of Suicide. No. Nature of Accidental Death. No. Poisoning 8 Shock from fall 34 Cut throat 2 Suffocated 2 Drowning 7 Shock from burns 10 Hanging 6 Drowning 11 Run over 1 Run over 24 Shooting 3 Shock from scalds 12 Strangulation 1 Fracture of skull 9 Suffocated in bed 15 Wound of hand 2 Poisoning 3 Others 11 Total 28 Total 133 114 115 REGISTER OF SANITARY WORK, 1912. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Pew, 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 170 177 153 133 218 201 262 126 164 214 61 68 15 32 ... 35 1 2,030 No. of premises on which defects were discovered 129 108 80 88 190 166 103 91 118 165 31 38 13 19 ... ... ... 1,339 (b) House to House— No. of houses inspected 23 94 ... 22 56 68 71 207 41 138 110 146 341 192 ... ... ... 1,515 No. of houses in which defects were discovered 22 56 ... 21 32 60 52 134 33 104 64 83 280 127 ... ... ... 1,068 No. of Notices served 22 56 ... 21 32 60 52 134 33 104 64 83 372 130 ... ... ... 1 163 (c) Houses after Infectious Dis. No. of houses inspected 113 141 94 220 108 175 226 88 256 197 90 63 3 22 ... ... ... 1,796 No. of houses in which defects were discovered 20 69 12 61 39 35 71 28 66 53 51 16 3 6 ... ... ... 530 Premises re-inspected 1,920 2,869 2,252 2,307 1,679 1,919 2,497 2,484 2,510 2,890 2,914 1,391 2,763 2,134 ... 1,123 629 34,281 (d) Miscellaneous— Fishmongers'and Poulterers' yards ... 2 ... 4 10 ... ... 2 10 5 7 2 ... ... ... ... ... 42 Slaughterhouses 7 ... ... ... 3 ... 1 ... ... ... ... ... ... ... 311 ... ... 322 Cowhouses (premises), Dairies and Milkshops 5 ... ... ... 4 ... 1 ... ... ... ... ... ... ... 1,767 ... ... 1,777 Greengrocers' yards ... 2 1 1 ... ... 2 1 ... 1 4 ... ... ... ... ... ... 12 Schools ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Factories and Workshops 5 33 5 11 39 3 43 12 11 34 ... ... ... ... ... 911 ... 1,107 No. of premises on which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 423 ... 423 Housing, Town Planning, &c. Act, 1909— No. of houses inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of houses in which defects were found ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of houses in which defects were remedied ... ... ... ... ... ... ... ... ... ... ... ... 7 31 ... ... ... 38 116 117 REGISTER OF SANITARY WORK, 1912 —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. Bakehouses— No. on Register at end 1911 8 12 10 10 16 9 10 6 7 13 8 2 ... ... ... ... ... 111 ,, ,, ,, 1912 8 12 10 10 14 9 11 5 6 11 7 2 ... ... ... ... ... 105 „ above ground 6 0 4 5 6 1 5 2 4 9 7 ... ... ... ... ... ... 55 No. underground 2 6 6 5 8 8 6 3 2 2 ... 2 ... ... ... ... ... 50 „ of Inspections, 1912 24 24 10 21 28 15 33 12 20 33 22 6 ... 14 ... ... ... 262 „ of Notices, 1912 4 3 3 3 ... ... ... 2 ... 4 5 ... ... ... ... ... ... 24 „ of Prosecutions, 1912 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Urinals 25 39 51 27 53 60 32 10 45 150 44 14 ... ... ... ... ... 550 Canal boats ... ... ... ... ... ... ... ... ... ... ... 30 ... ... ... ... ... 30 Visits to waterways ... ... ... ... ... ... ... ... ... ... ... 85 ... ... ... ... ... 85 Animals improperly kept ... 4 2 ... 2 ... ... 1 4 5 9 2 3 ... 1 ... 11 44 Laundries" ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 90 ... 93 Offensive trades ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 9 ... ... 10 Outworkers' Premises ... 13 32 ... ... ... ... ... 2 3 ... ... ... ... ... ... 1,029 1,079 No. on which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 396 396 New buildings 36 ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... ... 40 Special Inspections ... 19 36 170 121 22 41 45 175 107 27 ... 133 276 ... 1 ... 1,173 Houses Let in Lodgings— No. on Register at end 1911 ... ... ... ... ... ... ... ... ... 1 226 ... ... 243 ... ... ... 470 ,, ,, ,, 1912 ... ... ... ... ... ... ... ... ... 1 226 ... ... 243 ... ... ... 470 „ of Inspections, 1912 ... ... ... ... ... ... ... ... ... 1 167 ... ... 236 ... ... ... 404 ,, of Notices, 1912 ... ... ... ... ... ... ... ... ... 1 68 ... ... 130 ... ... ... 199 „ of Prosecutions, 1912 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 118 119 REGISTER OF SANITARY WORK, 1912.—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. Common Lodging Houses — No. on Register at end of 1911 ... ... ... ... ... 1 4 ... 1 ... ... ... ... ... ... ... ... 6 ,, ,, ,, 1912 ... ... ... ... ... 1 4 ... 1 ... ... ... ... ... ... ... ... 6 Mews and Stables 6 6 5 ... ... 1 1 2 ... 6 5 ... ... ... ... ... ... 32 Floodings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tenement Houses— No. provided with additional water supply during 1912 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overcrowding— No. of dwelling rooms overcrowded ... 7 ... 5 6 ... 3 4 10 7 11 ... 3 6 ... ... 9 71 No. remedied ... 7 ... 5 6 ... 3 4 10 7 11 ... 3 6 ... ... 9 71 „ 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 ... 21 8 58 ... 19 8 9 23 58 36 4 28 67 ... ... 69 408 Underground Rooms— Illegal occupation dealt with ... ... 1 ... 12 ... ... ... ... ... ... ... ... ... ... ... 1 14 No. of rooms closed ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Places where Food prepared for Sale— No. on Register at end 1912 ... 15 ... ... 10 ... ... 6 11 15 7 10 ... ... 43 ... ... 117 of Inspections, 1912 ... 4 ... ... 20 ... ... 6 6 22 ... 10 ... ... 43 ... ... 111 „ of Notices ... 2 ... ... ... ... ... 2 ... 7 ... ... ... ... ... ... ... 11 Other workplaces ... ... ... ... ... ... ... ... 4 3 ... ... ... ... ... 1 ... 8 Miscellaneous Inspections 40 15 ... 117 191 ... ... ... 27 142 21 ... ... ... 210 ... ... 763 H 120 121 REGISTER OF SANITARY WORK, 1912.—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. on Register at end 1911 16 17 30 16 9 15 13 11 13 18 9 8 ... ... ... ... ... 175 ,, ,, ,, 1912 16 19 33 20 9 15 13 8 19 19 9 10 ... ... ... ... ... 190 „ of Inspections 26 19 33 13 14 13 ... 8 19 21 9 11 ... ... ... ... ... 186 No. of Notices 4 ... 3 2 ... ... 13 1 2 2 4 ... ... ... ... ... ... 31 „ „ Prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total number of Intimation Notices served 190 231 152 277 239 281 228 304 280 390 327 195 390 358 7 308 348 4,505 Peremptory or Final Notices served 30 ... 31 10 41 6 13 37 29 ... 33 4 10 17 ... 76 35 372 Statutory Notices served 4 30 2 33 31 22 23 6 13 52 ... 9 22 40 ... 18 ... 305 Proceedings before Magistrates or Justices under the Public Health Act 3 ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... 8 Nuisances abated 180 230 116 304 243 253 198 290 282 375 305 113 299 329 ... 359 361 4,242 Seized and Condemned as Unfit for Human Food— lbs. cwt. qr. cwt. qr. cwt. qr. qr. lbs. cwt qr. cwt. qr. cwt qr. Ton cwt qr lb. Fish ... ... ... ... 1 2 ... 7 0 ... ... ... 3 1 ... ... 1 1 14 3 ... ... 1 7 3 0 Fruit and Vegetables 11 ... ... ... ... ... 2 1 2 2 ... ... qr. 1 lbs. 16 ... ... ... cwt 17 lbs. 14 ... ... 1 2 1 13 Meat ... ... ... ... ... ... ... ... ... ... ... ... ... ... cwt 13 qr. 2 ... ... 0 13 2 0 Tinned Foods ... ... ... ... ... ... ... ... 1 26 ... ... ... ... ... 3 2 ... ... 0 3 3 26 Other Articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Open spaces cleared 6 ... ... ... ... ... ... ... 3 ... 1 2 ... ... ... ... ... 12 Special Reports to Medical Officer of Health 3 11 51 6 ... ... 90 ... 7 7 2 ... 12 6 24 ... ... 219 Food Adulteration— Samples collected for analysis 66 66 ... 66 66 66 65 60 72 73 73 79 60 66 65 ... ... 95 0 Proceedings taken before Magistrates 2 ... ... 2 ... ... ... 2 2 1 2 3 1 3 2 ... ... 20 H 2 122 RETURN OF SAMPLES OF MILK ANALYSED. For the Year 1912, 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. Ge nuine. No proceedings. Proceed ings taken. 545 502 Under 1% 1 4 to 5% 1 605 1.83 92.11 1 to 2% 2 5 „ 6% 1 3 „ 4% 26 6 „ 7% 1 4 „ 5% 3 8 „ 9% 1 20 „ 21% 1 12 „ 13% 3 13 „ 14% 1 14 and above 2 545 502 33 10 605 1.83 92.11 123 SAMPLES PURCHASED DURING 1912. Articles Purchased. N umber Purchased. Number Adulterated. Number where proceedings taken. Number of Samples Adulterated with percentage of Adulteration. Milk 545 43 10 (See next page). Return of Milk samples. Butter 281 10 8 100% foreign fat. 7 79% „ 1 28% „ 1 4% excess of water 1 Margarine 4 Black Currant Jelly 3 Cocoa 5 Coffee 13 Demerara Sugar 15 Arrowroot 9 Lard 9 Olive Oil 10 Dripping 7 2 1 29.9% of water. 3.4% „ Paregoric 3 Cream 12 4 1 .58% Boric acid. .19% ,, .15% ,, .13% ,, Pepper 6 Mustard 6 Camphorated Oil 6 2 7.69% deficient in camphor. 6.53% ,, ,, Vinegar 3 1 Acid derived from wood and not malt. Whisky 3 2 4.85% excess of water. 3.09% ,, Gin 3 Brandy 4 2 2.84 % excess of water. 2.23% ,, Liquorice Powder 3 950 66 20 124 Record of Prosecutions under the Public Health (London) Act, 1891, during the year 1912. Address. Complaint. Magistrate's Decision. Penalty Costs. £ S. d. £ s. d. 20, Ribstone Street Walls damp, roof and first floor front room ceiling defective. Withdrawn (work done) ... 0 5 0 10, Woolpack Place Drain defective Do. ... ... 12, ,, ,, Do. Do. ... ... 14, ,, „ Do. Do. ... ... 16, ,, ,, Do. Do. ... ... 25, Clapton Common Reconstruct pan and trap of a w.c. without causing such trap to be ventilated Do. ... ... Do. Reconstruct lavatory basin waste pipe without causing pipe to discharge over properly trapped gully. Do. ... ... Do. Fitting new pan and trap without giving notice to Sanitary Authority. Withdrawn ... ... Total 0 5 0 125 Prosecutions under the Sale of Food and Drugs Acts during the year 1912. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fine. Costs. £ s. d. £ s. d. Obstructing Inspector Fined 15 0 0 0 15 6 15e Milk 6.12% added water Fined 0 10 0 0 10 6 32e Butter 100% foreign fat Ordered to pay ... 0 17 6 ,, Margarine Served in plain wrapper Withdrawn. (See other summons) ... ... 27f Butter 79% foreign fat Fined 4 0 0 1 3 6 ,, Margarine 11% excess of butter fat. Withdrawn. (See other summons) ... ... 49f Butter 100% foreign fat Fined 5 0 0 1 7 0 ,, Margarine Served in plain wrapper Withdrawn. (See other summons) ... ... 67f Milk 5.41% added water Ordered to pay ... 1 3 0 50g Milk 13.3% fat abstracted Fined 5 0 0 1 1 0 63g Dripping 29.9% water Fined 1 0 0 0 15 6 54h Cream .58/1 boric acid Withdrawn by order of Public Health Committee. ... 0 15 6 70h Milk 12.71% added water Fined 0 1 0 1 6 0 5j Milk 12.67% fat abstracted Fined 0 10 0 1 6 0 5k Butter 100% foreign fat Fined 3 0 0 1 10 0 ,, Margarine Served in plain wrapper Withdrawn. (See other summons) ... ... 22k Butter 100% foreign fat Fined 0 2 0 1 10 0 " Margarine Served in plain wrapper Withdrawn. (See other summons) ... ... Carried forward 34 3 0 14 1 0 126 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 34 3 0 14 1 0 49k Milk 12.9% fat abstracted Fined 0 5 0 0 15 6 60l Milk 40% fat abstracted Fined 3 0 0 0 15 6 78l Milk 8.6% added water Fined 2 0 0 0 15 6 7m Margarine Served in plain wrapper Fined 0 6 0 0 14 0 12m Butter Wholly foreign fat Fined 3 0 0 0 15 0 ,, Margarine Served in plain wrapper Withdrawn. (See other summons) ... ... 2n Separated Milk 4.71% added water Fined 0 5 0 0 15 6 30n Butter Wholly foreign fat Fined 1 0 0 0 17 6 ,, Margarine Served in plain wrapper Withdrawn. (See other summons) ... ... 43 19 0 19 9 6 127 APPENDIX. REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1911, RESPECTING THE NOTIFICATION AND TREATMENT OF PULMONARY TUBERCULOSIS. To the Chairman and Members of the Public Health Committee. Gentlemen, These regulations, which come into operation on the 1st January, 1912, are the last of a series of regulations made under Section 130 of the Public Health Act, 1875, the Public Health (London) Act, 1891, and the Public Health Act, 1896, having for their object the prevention of the spread of Tuberculosis. The first set of regulations was made by an Order of the Local Government Board on the 18th December, 1908, and came into force on the 1st January, 1909. The chief object of these regulations is to make all cases of Pulmonary Tuberculosis, occurring amongst persons in receipt of Poor Law Medical Relief, notifiable to the Medical Officer of Health of the area in which the person notified is resident. The form of notification under these regulations is fourfold, viz.:— 1.—The Medical Officer of a Poor Law Institution must notify any poor person, an inmate of the Poor Law Institution, within forty-eight hours of his becoming aware that such person is suffering from Pulmonary Tuberculosis. 128 2.—A District Medical Officer must notify any poor person upon whom he is in attendance as Poor Law Medical Officer, as soon as he becomes aware that such person is suffering from Pulmonary Tuberculosis. 3.—The Superintending Officer of a Poor Law Institution must notify any poor person, who has been an inmate of such institution and has previously been notified as suffering from Pulmonary Tuberculosis, on leaving that institution. 4.—A Relieving Officer must notify any poor person, who has already been notified as suffering from Pulmonary Tuberculosis by a District Poor Law Medical Officer within his district, on his becoming aware of a change of address of such poor person. These regulations, it will be observed, only concern patients who are receiving Poor Law Medical Relief. The second set of Regulations was issued by an Order of the Local Government Board in March, 1911, under the title "Regulations as to Tuberculosis (Hospitals)," and they came into operation on the 1st May, 1911. These Regulations require all Medical Officers of Hospitals ('hospital' including dispensaries and similar institutions), to notify to the Medical Officer of Health of the area in which The hospital is situate, the name, age, sex and address of any person on whom he is in attendance, who is suflering from Pulmonary Tuberculosis. The third and last set of Regulations, which completes the system of notification commenced in 1908, was made by an Order of the Local Government Board on the 15th November, 1911, and came into operation on the 1st January, 1912. Whereas the first set of Regulations deals only with persons who are in receipt of Poor Law Medical Relief, and the second set with persons attending hospitals, dispensaries and similar institutions, 129 the third and last set extends notification to private patients and to children attending Public Elementary Schools, and provides that— Every medical practitioner attending on or called in to visit any person must, within forty-eight hours after he becomes aware that such person is suffering from Pulmonary Tuberculosis, notify the case to the Medical Officer of Health of the area in which the person's residence is situate. Every medical practitoner who is a School Medical Inspector must also notify to the Medical Officer of Health of the area in which the school is situate any cases of Pulmonary Tuberculosis of which he becomes aware during the course of his inspections. It is also especially provided in these Regulations, as in the previous regulations, that "nothing in these Regulations shall have effect so as to apply, or so as to authorise or require a Medical Officer of Health or a Council, or any person or authority, directly or indirectly, to put in force with respect to any patient, in relation to whom a notification in pursuance of these regulations has been transmitted to a Medical Officer of Health, any enactment which renders the patient, or a person in charge of a patient, or any other person liable to a penalty, or subjects the patient to any restriction, prohibition or disability affecting himself or his employment, occupation or means of livelihood, on the ground of his suffering from Pulmonary Tuberculosis." Object of Notification of Pulmonary Tuberculosis. The main object of making Pulmonary Tuberculosis a notifiable disease is to enable Local Authorities, firstly, to obtain accurate knowledge of the prevalence of this disease in their respective areas; and, secondly, to apply such means of treatment and prevention as are required in order to eradicate the disease from the community. 130 There is no doubt that the prevalence of this disease is at the present time on the decline. In the year 1881 the mortality from Pulmonary Tuberculosis was 18.25 per 10,000 of the population ; in 1909 it was reduced to 10.93, the mortality thus during twenty-eight years falling 7.3 per 10,000 of the population. Gratifying as this decline is, the mortality is still extremely high. During the last five years the number of deaths from Tuberculous disease in the Borough of Hackney was as under:— Year. No. of Deaths from Tuberculous Disease. 1906 415 1907 372 1908 379 1909 395 1910 335 These give an average during this period of 379 deaths per year from Tuberculous Disease. The average number of deaths per year in the Borough during the same period from the whole of the following diseases, viz. Scarlet Fever or Scarlatina, Diphtheria or Membranous Croup, Enteric Fever, Measles and Whooping Cough, was 175; that is to say, the annual mortality from tuberculous disease in the Borough is more than twice that from the whole of the infectious diseases quoted. It must further be remembered that Pulmonary Tuberculosis is a very chronic disease, greatly incapacitating those suffering from it from carrying on their ordinary avocations as citizens during its course. These facts should be incentive enough to local authorities to use all the powers they are entrusted with to assist in eradicating such a disease from our midst. No other disease offers in my opinion such promising prospects of yielding to treatment and prevention as the disease under discussion. 131 Characteristics of Pulmonary Tuberculosis. Before considering the question of the measures which should be adopted in order to obtain the best results from the notification of Pulmonary Tuberculosis, it is necessary to bear in mind the fact that this disease has characters distinguishing it very clearly from the acute infectious fevers such as Small-pox, Scarlet Fever, Diphtheria, Enteric Fever, &c., which are also notifiable and have been so for years, and also what these distinguishing characters are:— The following will serve to give a general idea of the distinctions referred to:— (1) Acute Infectious Fevers (Ex. Smallpox, Scarlet Fever, Diphtheria, Enteric Fever, Erysipelas, &c.).—These fevers have a comparatively short but variable incubation period. The onset of symptoms is sudden. The duration of the disease is measured by a few weeks. They spread from person to person, not only by contact, but also through the air. They vary as to their degree of infection, but this does not last more than a few weeks. In the early stages as a rule the danger of infection is greatest. (2) Pulmonary Consumption.—The symptoms appear gradually, existing perhaps for months before suspicions of the disease is aroused. The duration of the disease is measured by years, from perhaps two years to ten years, and in some cases more. Infection is derived from the lungs of the sufferer, the infective agent or germs being discharged in the expectoration or spit. The disease is not infectious in the early stages, but it is infectious later on, when expectoration has commenced, and the danger of infection is in proportion to the amount of expectoration containing the infective agent. A careful consideration of these points will clearly show that the measures which have been adopted and are appropriate for 132 preventing the spread of the acute infectious fevers would not be suitable, without considerable modification, to apply to Pulmonary Tuberculosis. In the acute specific fevers the patient requires immediate isolation apart from the remainder of the household, or removal to hospital. If removed to hospital the house, clothes and bedding are disinfected. If nursed at home, the disinfection is done on the complete recovery, or on the death of the patient. It is quite clear that consumptive patients cannot be treated in the above way. Isolation cannot be applied to these in the same sense as in the case of the acute specific fever cases, nor can hospitals be available to receive all cases of Pulmonary Consumption, nor, indeed, are these measures necessary to prevent the spread of this disease. The ability to convey infection is limited and intermittent, and infection can be prevented by the patient himself, when he has learnt and is not too ill to practice elementary precautions. This will be more obvious after considering. The Chief Way in which Pulmonary Tuberculosis is Spread. In ordinary cases of Tuberculosis, infection is transmitted from person to person by means of the sputa, or spit, coughed up from the lungs of the consumptive patient, either in mass, or as cough spray, because such spit contains at intervals the live germs of the disease. Even when the spit is dried and reduced to powder the germs of the disease remain alive, and if this dried and powdered spit is inhaled or swallowed by healthy persons, the disease may be so introduced into the healthy individual. The danger of spreading the disease in this way is dependent on:— (1) The Stage of the Disease.—In the early stage of the disease expectoration may be absent, or very slight in amount; consequently the danger of spreading infection is absent or 133 reduced to a minimum: but if the stage of the disease is advanced, expectoration is, as a rule, more constant and profuse and the danger of spreading the disease by this means is greater. (2) Ignorance or Carelessness of the Patient.—Ignorance or carelessness will lead patients to be negligent in the disposal of their expectoration. Instead of adopting the ordinary precautions of depositing their expectorations in suitable receptacles and periodically destroying them, they will spit indiscriminately about their rooms, in fireplaces, on floors or furniture, or in handkerchiefs carried about in their pockets, and sometimes left in odd places about the living room. Expectorations so distributed will dry up and become pulverised, and ultimately disseminated through the atmosphere, to the danger in this way of infecting other members of the family. (3) The Amount of Air-space and Ventilation of such Space enjoyed by the Patient in his Home.—Even in the acute specific fevers, plenty of air-space and fresh air reduces the danger of spreading infection from person to person. In cases of Pulmonary Tuberculosis the same result follows where the air-space and ventilation is ample ; on the contrary, where the air-space is restricted and ventilation is imperfect the danger of conveying infection is greatly increased. (4) Closeness of Association between Patient and other Persons.—The nearer related people are, the closer the association and the greater danger of conveyance of infection to one another. Husband and wife and children are more likely to infect one another than more distant relatives or strangers. Two or more persons sleeping in the same bed are more likely to infect one another, than if they were sleeping in different beds ; and such persons sleeping in the same bedroom are more likely to infect one another than if they slept in separate rooms. 134 Under this head the question of kissing may be considered. However carefully a person suffering from Pulmonary Tuberculosis may wipe the mouth after expectoration, the lips remain infected, and such a person, by kissing a healthy individual on the lips, may convey infection. The same danger attaches to an infected person using the same eating and drinking utensils as healthy persons, or using the same washing towels. (5) The State of Nutrition of Persons Exposed to Infection.— There is no doubt that poorly nourished or badly housed-andclothed persons are, other things being equal, more likely to take infection than persons who are well fed, clothed and housed, because such social circumstances undermine the health and lower the resistance of the body to disease. Unfortunately, when the bread winner of a family becomes tuberculous, his ability to provide for his family declines; and whilst his increasing illness calls for more attention and comforts he becomes less and less able to afford them. Such a case ultimately finds its end in the Poor Law Infirmary, leaving behind him one or more children—and probably his wife—victims of the same disease. Special Powers of Councils. The powers which Local Authorities possess for dealing with Pulmonary Tuberculosis are set in the following Article IX. of the Public Health (Tuberculosis) Regulations, 1911:— Article IX.—"(1) For the purpose 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 favourable to infection, and for that purpose may appoint such officers, do such acts and make such arrangements as may be necessary." 135 "Provided that nothing in this Sub-section 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 ot their Medical Officer of Health, may provide and publish or distribute in the form of placards, handDills or leaflets suitable summaries or information and instruction respecting Pulmonary Tuberculosis, and the precautions from that disease." Measures already Applied by the Borough Council in Hackney. It will be seen from the above that the Council have power to provide assistance, medical or otherwise, and facilities and articles, and may appoint officers and do such acts and make such arrangements as may be necessary for— 1.—The detection oi Pulmonary Tuberculosis. 2.—The prevention of the spread of infection. 3.—The removal of conditions favourable to infection. I will now consider to what extent the Borough Council have used the powers given them for the above purposes:— (1) The notification of a case of Pulmonary Tuberculosis will only follow after its diagnosis by the medical attendant. To facilitate this diagnosis the Borough Council have arranged for the gratuitous bacteriological examination of samples of sputa from patients residing in the Borough, and suspected to be suffering from Pulmonary Tuberculosis, when forwarded by their medical attendant. During the year 1911 there were 121 samples so examined. (2) On the receipt of a notification of Pulmonary Tuberculosis in any dwelling in the Borough, a visit is made by an inspector and enquiries made as to the sleeping accommodation and the ventilation of the bedroom. If these are unsatisfactory J 136 he advises the person in attendance, in accordance with a leaflet sent to the patient, as to the need for the patient to sleep alone, and the bedroom to be ventilated both day and night. Instruction is also given as to the disposal of the spit, and a spit-flask is given to the patient if it is needed. (3) If there is any insanitary condition which can be dealt with under the law relating to public health the inspector deals with it accordingly. Overcrowding, of course, receives special attention, notices to abate the same being served when required; but more often in tuberculous cases an alteration of the sleeping arrangements removes danger of infection. In some cases endeavour is made to persuade advance cases, accommodated to the danger of other members of the family, to go into the Infirmary. Under this head must also be mentioned the disinfection and cleansing of rooms after the death or the removal of a patient suffering from Pulmonary Tuberculosis, the disinfection of clothes and bedding and the destruction of infected articles. If the above be considered in connection with the powers given to the Council, it will be seen that the Council have not gone to the full extent of their powers, in relation to Pulmonary Tuberculosis under the three heads above set out. Other Measures which can be Applied. It is evident that something more might be done by the Borough Council to combat Pulmonary Tuberculosis in the Borough, and it is certain from Article IX. (1) of the Order above quoted that more is expected by the Local Government Board. With respect to(1) Detection. The Borough Council could most effectually promote the work of detection of cases of Pulmonary Tuberculosis by establishing in the Borough a Tuberculosis Dispensaiy. The Chief Medical Officer 137 to the Local Government Board, in a memorandum recently issued on " Administrative Measures against Tuberculosis," remarks: "A well organised Tuberculosis Dispensary becomes a valuable aid in securing more general notification of cases of Tuberculosis"—i.e., in detecting cases of Tuberculosis. Particulars as to the work of such an institution, the results obtainable, the cost of establishment and maintenance are given in a special report, which I submitted to the Public Health Committee on the 2nd March, 1911. (See Report appended). (2) Prevention of Spread. (а) To limit the spread of this disease, it is most essential that sufferers should be made acquainted with the way in which the disease is spread, and taught how to act, especially how to properly dispose of their expectorations, so that they will not be a danger to their families or the public. What has been done in this direction has already been described, but a Tuberculosis Dispensary would carry on still further this educational work. (b) Further, the Council might help forward the work of prevention by retaining a few beds in certain sanatoria for selected cases of Pulmonary Tuberculosis, because, apart from its curative effect, temporary abode in a Sanatorium is the most effectual means of educating a tuberculous patient in the precautions he should adopt, in order to prevent transmission of infection to other persons. The cost would amount to about 30s. a bed per week. (c) The Council might also make arrangements to supply gratuitously on loan portable shelters for cases which are advised to live as much as possible in the open air. The cost of a portable shelter amounts to about £6, or £7. (d) I wish here to draw special attention to one class of patients suffering from Pulmonary Tuberculosis, that is, the children attending Public Elementary Schools. As stated above, such cases are J 2 138 notified to the Medical Officer of Health by the School Medical Inspectors when discovered during their examination of the children. I have already had five such cases notified to me since the 1st of January, and from personal enquiries made, I find that the children are suffering from Pulmonary Tuberculosis in the early stage, and they are not under any treatment for the disease. The parents are poor, and cannot afford to give the children the necessary treatment or nourishment to enable them to recover. Moreover, the conditions under which they live are not favourable to recovery. Such cases of early Pulmonary Consumption are most promising for treatment. Some, no doubt, will spontaneously recover, in spite of their disadvantages ; but there is no question that, with proper treatment, we might hope to arrest the disease in all. If neglected, many of these cases will die from some acute lung attack, or gradually get worse, and swell the ranks of the chronic cases, infecting, at the same time, other members of the family. Here the Borough Council might render great assistance in the prevention of this disease, by supplying letters for treatment as in- or out-patients at certain Hospitals in the Metropolis for diseases of the lungs, or arranging, where the social circumstances are bad, for these children to be treated in a Sanatorium. (3) Removal of Conditions Favourable to Infection. Under this head a Tuberculosis Dispensary would be very helpful. It would supplement the work of the Council officers in reducing overcrowding and promoting ventilation and cleanliness, &c., in dwelling-houses by bringing sufferers from this disease, needing pecuniary and other help, into relationship with charitable agencies granting relief. Help of this kind would enable patients to obtain more ample housing accommodation and home necessaries, both of which are essential in the work of prevention and treatment. 139 Recommendations. In order to meet the requirements of the Public Health (Tuberculosis) Regulations, 1908, the Public Health (Tuberculosis in Hospitals) Regulations, 1911, and the Public Health (Tuberculosis) Regulations, 1911, I beg to recommend the Borough Council— 1.—To establish a Tuberculosis Dispensary in some central position in the Borough to be established and maintained from the rates with such pecuniary help as may be obtained under the Insurance Act, 1911, to be conducted on the same lines as similar institutions established in other Metropolitan Boroughs. (2) To retain half-a-dozen beds as a commencement in certain suitable Sanatoria. (3) To make arrangements for the supply of portable shelters when necessary for the use of suitable cases of Pulmonary Tuberculosis. (4) Until a Tuberculosis Dispensary is established, to arrange with certain Hospitals in the Metropolis for Diseases of the Lungs for the treatment of such children, as are notified to be suffering from Pulmonary Tuberculosis by the School Medical Inspectors. I am, Gentlemen, Your obedient Servant, J. KING-WARRY, M.D., M.R.C.P., D.P.H., Medical Officer of Health. 140 REPORT OF THE MEDICAL OFFICER OF HEALTH AS TO FORMULATION OF SCHEME FOR DISPENSARY AND DOMICILIARY TREATMENT OF CASES OF TUBERCULOSIS. Reference.—That the Medical Officer of Health be requested to prepare and submit a scheme for the treatment of cases referred to the Sub-Committee for dispensary or domicilary treatment; that he do indicate the arrangements which he suggests should exist as regards: (1) the fees to be paid to dispensaries and doctors. (2) The purchase of drugs and medicines, and the price to be paid therefor. (3) The preparation of lists of doctors who shall attend patients at their homes and (4) the linking, where necessary, of dispensary and home treatment. To the Chairman and Members of the Temporary Local Sanatorium Sub- Committee for the Borough of Hackney. I have carefully considered the above request, and beg herewith to report on the subject matter thereof. It can hardly be expected that I should formulate a scheme which will be complete in all its details, or one which will not want some modification to meet passing needs. It is an advantage to schemes intended to meet new conditions, if at first they are not drafted too much in detail, in order to allow of modification as experience may indicate. Introduction.—Before considering the actual terms of your reference, I think it is necessary in the first place to refer briefly to certain peculiarities of tuberculosis, the manner in which the disease is spread from person to person and its prevention. Tuberculosis, as is well known, is an infectious disease, but it differs from the ordinary acute infectious diseases in that it has in most cases a long duration, lasting in some cases many years. The sufferer is not infectious during the whole of this period, but only at intervals. The means by which the disease is spread from 141 person to person is also peculiar. In most cases, in certain stages of the disease, the patient suffers from distressing cough with more or less expectoration. This expectoration at times contains the active agent of this disease, and it is chiefly by means of the expectoration and the spray or droplets, projected from the mouth during coughing, that the disease is conveyed to other persons. The more advanced the disease is, the more abundant is the expectoration, and the more frequent and distressing the cough. By carelessness, indifference, or ignorance on the part of the patient, sputum or spit may be scattered about floors, furniture clothing, bedding, &c., and there left to dry and to disintegrate and get into the air of the dwelling, or on the hands of healthy members of the same family, whence it may be conveyed into the system by inhaling or swallowing. It is clear that this mode of infection lends itself readily to preventive measures:— 1. If every patient is taught to receive the sputum in proper receptacles, containing some germicide, and to dispose of it so that it cannot harm. 2. To so guard his mouth during the act of coughing as to prevent the spray or droplets passing into the atmosphere, much will be accomplished to prevent the spread of infection, especially if these measures are observed both at home as well as when tiavelling, or in the workplace. 3. If in addition, these precautions are supplemented by the provision of sufficient ventilation and air space in both living and bedrooms, so that accidentally infected air may be largely diluted, the preventive measures becomes more effectual. From these remarks it is evident, that preventive measures must form a considerable part of any scheme dealing with Tuberculosis, which has for its object the diminution of its prevalence. Indeed, if the amount of this disease is to be considerably reduced 142 or the disease removed from our midst, it will be done not by the medical treatment of cases as they arise, but by the general application of administrative measures of a preventive nature. This is further evident from the following considerations. If we consider a typical case of pulmonary consumption, we find that in its early stage there are very few prominent symptoms, malaise, wasting with slight cough and expectoration being the chief. The case is not as a rule infectious during this stage, but later on as the disease progresses, with increase cough and expectoration and other symptoms, the risk of conveying infection increases. In the latest stage when cavities are formed in the lungs, with profuse expectoration and constant cough, and the disease is hastening to its end, the infectiousness of the disease becomes very pronounced. In the first or early stage the disease may be arrested, and the lung may take on a healing process which may leave the patient quite cured. Many cases have been known where this has happened spontaneously, and may where by appropriate medical treatment the same result has been achieved. But as the disease becomes more advanced, these spontaneous cures and cures the result of medical treatment become more rare. The disease in many cases in the second stage, and even early in the third stage, has by medical treatment, including sanatorium treatment been arrested, and the patients improved in health, so much as to permit them to resume their ordinary avocations, or in some cases take on work more suitable to their condition; but in the majority of these cases relapses have occurred which have ultimately had a fatal issue. In the latest stage no medical treatment can be regarded as curative, and the only effect aimed at by treatment is to render the last days of the consumptive free from pain and distress. Summing up, it may be said, that many cases if discovered in the early stages, before there is much consolidation of tubercule 143 in the lungs can be cured, but not all by any means; cases more advanced may be improved in health, and even have their working capacity increased, but ultimately the majority go from bad to worse, until at last death brings a release to their sufferings. I should like here to refer briefly to the powers and responsibilities of the local authority, in regard to preventing the spread of tuberculosis. Pulmonary Consumption being an eminently preventable disease, and having been by law made notifiable to Medical Officers of Health, local authorities are required to put in force the powers entrusted to them for the prevention of the spread of this disease. The powers given to local authorities are very large, as may been seen from Article IX. of the Public Health (Tuberculosis) Regulations, 1911, as follows:— Special Powers of Councils. Article IX.—(I) For the purposes of these regulations and of the Poor Law Regulations and of the Hospital Regulations a Council, on the advice ot 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 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 144 instruction respecting Pulmonary Tuberculosis, and the precautions to be taken against the spread of infection from that disease. The article clearly gives local authorities powers, not only to establish tuberculosis dispensaries and to maintain them, but it also authorises them to undergo expense in removing conditions favourable to infection. Under this latter head might be included the provision of beds, extra rooms, shelters and special forms of food, and other accessories of treatment. The article also enables them to bear the expense of spreading information as to the nature of this disease, and the mode of preventing its spread. I have given these details in order to show if possible the relative importance of medical treatment and preventive treatment, in the scheme for diminishing the prevalence of Tuberculosis, and ultimately eradicating it from the Borough. While mcdical treatment should be given to all cases, in the hope of curing or ameliorating the disease, the limitations of such treatment should be borne in mind. At the same time preventive measures should take the first place, and be applied, wherever there is opportunity of preventing the conveyance of infection. I will now deal with the four points upon which I am requested to report, taking them seriatim. Suggested arrangements which should exist as regards— (1) The fees to be paid to dispensaries and doctors.—I do not think it will be at all practicable to pay dispensaries and doctors by the same method or scale of payments. I am of opinion, taking all points into consideration, that dispensaries should be paid \per capita, i.e..—a certain sum per annum for each separate patient treated at the dispensary. I think this should not be less than 30s. per head, and it might, considering the useful role the dispensary may come to play in the treatment of tuberculosis, be substantially 145 increased. This form and rate of payment, I should recommend whether the dispensary is a general dispensary or a tuberculosis dispensary. The payment to be offered to doctors is not so simple. It is quite clear that it would be useless for me to suggest fees, unless I had some substantial grounds for belief that they would be acceptable to the profession. A capitation fee is quite out of the question for the domiciliary treatment of cases of tuberculosis. I have had an opportunity of ascertaining the views of the local medical practitioners on this point, by discussion with a representative committee, and also by personal correspondence with a large number of practitioners in the Borough. I find that the feeling of the members of the profession is that they should be paid, on an average, the usual fees for consultation at the homes of the patients or at the doctor's surgery. The fees which doctors in this Borough think they should receive for their services, in connection with domiciliary treatment are as follows:— s. d. Consultation at Doctor's surgery or residence 2 6 Visit to patient's home 2 6 Injection of tuberculin 2 6 Quarterly report as per circular of Local Government Board 5 0 Night visits to patient's home between 8 p.m. and 8 a.m. 5 0 These fees do not include the cost of medicine, nor tuberculin; but in the interest of the patient himself, I am of opinion that fees should be increased sixpence each to include medicine. I am of opinion that the doctor who finds it necessary to inject tuberculin should supply this also. I therefore suggest that sixpence to include tuberculin be added to the fee for injection. It will happen that reports will be required from the medical practitioner at more frequent intervals than quarterly. Indeed' 146 in some cases, reports will be needed at fortnightly intervals. These will not need to be so detailed or exhaustive as the quarterly report. I suggest a fee of 2s. 6d. for all inter-quarterly reports. Some rule must be made as to the quantity of medicine supplied at each visit or consultation. This is important when the supply is included in the fee. If further medicine is required before the next visit, I suggest it should be supplied by the doctor, at the rate of 7d. per 8 oz. bottle or its equivalent. Some rule must be formulated to prevent patients unnecessarily calling the doctor to visit him, and also on the other hand unnecessarily visiting the doctor at his surgery. The scale of remuneration I recommend for doctors undertaking domiciliary treatment of cases of tuberculosis is therefore, as follows:— Scale of fees for Doctors attending domiciliary cases of tuberculosis. s. d. Consultation at Doctor's surgery or residence with medicine 3 0 Visit to patient's home with medicine 3 0 Injection of tuberculin, including cost of tuberculin 3 0 Quarterly reports on condition of patient as per order of Local Government Board 5 0 Inter-quarterly reports 2 6 Night visits to patient's home between 8 p.m. and 8 a.m 5 0 Medicine between visits for one 8 oz. bottle of medicine or its equivalent 0 7 The term medicine, as used above, does not include cod liver oil or malt extract or emulsions of these. 147 (2) The purchase of drugs and medicines and the price to be paid therefor. In order to get some idea of the prices which would be acceptable to chemists and druggists, I had an interview with a representative of the Pharmaceutical Society, and discussed the question of prices with him. He suggested the following prices:— s. d. One 8 oz. bottle of medicine 0 7 One pint of cod-liver oil 1 0 One pound of extract of malt 0 9 This suggestion is very far from exhausting the question of prices to be paid for drugs and medicines, but he suggested that the question of the prices of other medicines should be left over, until the Advisory Committee to the Insurance Commissioners have considered the question, in connection with the full scheme of medical attendance. This I am in agreement with, as the information at the disposal of that Committee is much more extensive than that at my disposal, and the question is less urgent, if, as it appears to be advisable, the doctor's fee for domiciliary treatment should include medicines. (3) The preparation of lists of Doctors who shall attend patients at their homes. In order to prepare such a list, it is necessary first ot all to fix upon a scale of remuneration, which will be acceptable to the majority of doctors practising in the area. Such a scale is that above suggested. The next step is to ask each medical practitioner in the district, if he is prepared to attend tuberculous patients at their homes, referred to him by the Insurance Committee, at the fees suggested, and to carry out the treatment decided by the expert tuberculosis officer to the Insurance Committee. (When the local tuberculosis dispensary is established, this will be the Tuberculosis Officer under the control of the Borough Council.) Two 148 further principles will also, I am of opinion, have to be settled— 1st: If any patient desires to be treated by his usual or any particular doctor, the selected doctor should be asked to attend the patient. 2nd: Where no doctor is selected by the patient, the Insurance Committee, on the advice of the Medical Officer of Health, will select one. 3rd: I am of opinion that any doctor selected to attend a patient should live within a reasonable distance of the patient's home. 4th: That it is only reasonable that any doctor called upon to attend a patient at his home, suffering from tuberculosis, should not only be acquainted with the modern treatment of this disease by means of tuberculin but also with its limitations. 5th: If a doctor for certain reasons, which may be of a private nature or otherwise, declines to attend any particular patient, another doctor should be selected. (I do not think this refusal would be at all common, on the contrary, a very rare event, but I think the objection should be allowed.) Copies of the lists so prepared should be kept by the Medical Officer of Health, in order that he may carry out the instructions of the Insurance Committee, in allocating cases for domiciliary treatment. (4) The linking, where necessary, of dispensary and home treatment. It is necessary now to consider the agents or units which require linking up, in the scheme tor the treatment of cases requiring dispensary or domiciliary treatment. These are two, viz.:—(1) The dispensary and dispensary treatment; (2) The medical practitioner and domiciliary treatment. The dispensary and dispensary treatment. At present we have no Tuberculosis Dispensary in Hackney, but for the purpose of this report I will assume that such an institution has been established by the Borough Council, and that it is co-ordinated with the Public Health work of the Borough, by being 149 made a sub-department of the Public Health Department. The Tuberculosis Officer is a whole time official, who has been chosen for his high qualifications and wide experience in the diagnosis and treatment of tuberculosis (pulmonary and other forms). He has at present for assistants, one dispenser, two nurses, the latter being officers of the Borough Council. All medicines and vaccines required for the patients treated at the Dispensary are provided at that Institution. The site of the dispensary is central, not far from the Town Hall, and in telephonic communication with the offices of the Public Health Department. The functions of this dispensary are of a three-fold kind :—(1) 1Clinical; (2) Bacteriological ; (3) Statistical. 1. All cases of tuberculosis (except poor law cases) are examined at the dispensary by the Tuberculosis Officer and the proper treatment recommended for each case. This recommendation in the form of a report is forwarded to the Insurance Committee through the Medical Officer of Health. If the case is recommended domiciliary treatment the Medical Officer of Health has instructions to arrange with local medical practitioners for the patient's proper treatment. The medical practitioners have the opportunity of consulting the Tuberculosis Officer with respect to their patient's treatment. If the case is recommended by the Tuberculosis Officer for sanatorium treatment the report also goes to the Committee, through the Medical Officer of Health, who send the case to the selected Sanatorium. If the Tuberculosis Officer if of opinion that the case is one for hospital, his report is forwarded to the Committee through the same channel as cases requiring sanatorium treatment, and the patient is sent by the Insurance Committee to the hospital chosen for his reception. If the Tuberculosis Officer thinks the case is best dealt with by attendance at the dispensary, the case is so treated. The patents seen at the dispensary receive instruction how to dispose of tneir sputum, and generally how to avoid conveying 150 infection either at home, or while travelling, or at their workAny necessary sputum pots, for home or portable use, are supplied to the patients attending at the dispensary. The patients undergoing domiciliary treatment, under private practitioners will obtain their sputum pots also at this Instutition, upon requisition signed by the attending medical practitioner. 2. The dispensary is also a centre for the bacteriological examination of sputum, in the case of all persons suspected to be suffering from the disease, as well as when necessary the sputum of all conusmptive patients under treatment. 3. All clinical records of patients treated at the dispensary are kept there, and the clinical reports of all cases undergoing domiciliary treatment, by medical practitioners, are ultimately forwarded there. On a patient leaving a sanatorium the continuous record, made during his stay at that Institution, is forwarded to the dispensary. The same is the case with records of cases treated in the hospital, even though it has terminated fatally. All bacteriological records are also kept at the dispensary. All these records are available to the Medical Officer of Health if he needs them for any statistical or other report. Nurses.—When the nurse attached to the Tuberculosis Dispensary are not engaged in assisting the Tuberculosis Officer, they are available for visits to patient's homes under the immediate supervision of the Medical Officer of Health. 2. The medical practitioner and domiciliary treatment. Under the medical practitioner will be placed for domiciliary treatment, those cases of tuberculosis which have been recommended by the Tuberculosis Officer for this treatment. As indicated in the above account of the dispensary, these cases will originally be examined by the Tuberculosis Officer, who will report, through the 151 Medical Officer of Health to the Insurance Committee, that domiciliary treatment is the most suitable for such cases. The Insurance Committee will instruct the Medical Officer of Health to arrange with the medical practitioner for home treatment. The medical practitioner will treat his patient as a private patient, providing where necessary medicines, and applying in suitable cases the tuberculin treatment. He will have the opportunity of consulting with the Tuberculosis Officer as to the treatment to be carried out. If any change of treatment is thought desirable, such as Hospital or Sanatorium treatment, the medical practitioner will consult the Tuberculosis Olficer on this point, who, if he is of the same opinion, will recommend this change of treatment through the Medical Officer of Health to the Insurance Committee. If, owing to social and domestic circumstances, the patient requires a separate bed or special forms of food or nourishment, the medical attendant will make requisition for the same to the Medical Officer of Health, who will be empowered in urgent cases by the Insurance Committee, to arrange for their supply. The Committee may require a report from the Medical Officer of Health before authorising the supply of these articles ; but, I think in urgent cases, the Medical Officer of Health should be empowered to obtain then when circumstances are urgent, reporting his action at each meeting of the Committee. The Tuberculosis Officer in like manner may make requisition for these necessary articles. The medical practitioner will not only treat each case medically, but he will also give the patient instruction with regard to coughing and expectorating, and the precautions necessary to be taken to prevent the conveyance of infection to other persons. The medical practitioner will render, at stated intervals, reports of the progress of the cases of tuberculosis, under his care, to the Medical Officer of Health for transmission to the Insurance Committee. The Tuberculosis Officer will do likewise with respect to cases under his care. K 152 The Link and Linking up. I am of opinion that the linking up or co-ordination of domiciliary with dispensary treatment should be brought about by the Medical Officer of Health, with the help of his department, for the following reasons:— 1. All notifications of pulmonary tuberculosis are made to the Medical Officer of Health. 2. The Medical Officer of Health is the official adviser to the Local Authority on the measures that should be taken to prevent the spread of pulmonary consumption, and he is the Chief Executive Ofiicer in all administrative Acts having for their object the diminution in prevalence, and the prevention of infection from this disease. 3. The local practitioners are in constant communication with the Medical Officer of Health, in connection with tuberculosis. He would therefore be in the best position to co-ordinate their home treatment with that of the dispensary. 4. The dispensary being a sub-department of the Public Health Department, as I have assumed it would be, it is already linked with the Public Health work of the Borough. 5. As I have stated elsewhere, if tuberculosis is to be eradicated from our midst, it will not be by medical treatment of cases, but by medical treatment in conjunction with comprehensive preventive measures, the latter predominating in any scheme of action. How the linking up is to be accomplished has been in a certain measure indicated in the foregoing parts of this report dealing with dispensary and home treatment. A few further details will be necessary to show the sphere of action of the Medical Officer of Health. All cases of pulmonary tuberculosis being notifiable to the Medical Officer of Health, he will receive information of cases immediately they are diagnosed. The following procedure as described by the Medical Officer of the Local Government Board will follow. 153 When a notification of a case of pulmonary tuberculosis has been received by the Medical Officer of Health certain enquiries should follow. These enquiries should be made by the Medical Officer of Health or by a trained assistant and the advice given at these visits should be so given as not to interfere with advice already given by the doctor in attendance on the patient." "Re-visits should be made by an Officer from the Medical Officer of Health's Department, such as an Inspector, Health Visitor, or a nurse set apart for this work who will encourage the patient in carrying out the treatment necessary for maintaining his ability to work, and the precautions needed to prevent infection." The Medical Officer of Health will further ascertain whether the patient's housing accommodation and domestic arrangements are such as to prevent, as far as possible, infection to other members of the same family. The nurses attached to the dispensary, when not engaged at that institution in helping the Tuberculosis Officer in the examination of patients, will make subsequent visits to the homes, in order to see that the patients are observing the precautions they were advised to take, by their medical attendant, or the Tuberculosis Officer, or the Medical Officer of Health. If the circumstances of the lodging of the patient are adverse to his improvement or are calculated to encourage the spread of infection, and they can be dealt with under the Pub'ic Health Acts, the Medical Officer of Health will take immediate steps to remedy these circumstances. If the adverse circumstances arise from poverty, &c., the Medical Officer of Health will report the fact to the Insurance Committee. If, during the enquiries of the Medical Officer, suspicion should arise that other members are infected with tuberculosis, the Medical Officer of Health will arrange for such persons to be examined by the Tuberculosis Officer, and if found to be affected, to report the circumstance to the Insurance Committee, who will on the report of the Tuberculosis Officer give instruction as to their treatment. This is one of the most important duties K 2 154 of the Medical Officer of Health, and the future decline in the'prevalence of tuberculosis will largely depend upon the thoroughness of this investigation. Disinfection and similar routine matters will be dealt with by the officers of the Public Health Department. There is another circumstance, which seems to point to the desirability of the local Sanitary Authority occupying a predominating position in any scheme for dealing with the treatment of tuberculosis, under the Insurance Act, viz.:— It has been decided by the National Health Insurance Commission that Insurance Committees cannot themselves undertake the tieatment of tuberculosis, or provide special articles or forms of food or other accessories of treatment, but they may arrange with persons or local authorities undertaking the treatment of such cases to supply what is needed. From this it is evident that Local Sanitary Authorities are referred to above, and they are expected to undertake this treatment of tuberculosis, by providing a Tuberculosis Dispensary for their districts, with special articles and forms of food and other accessories of treatment. I am therefore of opinion that the Borough Council of Hackney in according with the intention of both the National Insurance Act, 1911, and the Public Health (Tuberculosis) Regulations, 1911, should immediately proceed to establish a Tuberculosis Dispensary in the Borough, for the treatment of cases of tuberculosis, and to undertake to supply any special articles or food or other accessories of treatment, required by such persons, on terms to be arranged with the district Insurance Committee. I append a diagrammatic representation of the scheme above recommended. 155 Diagrammatic Representation of Scheme. Reference. M,—Hospital. F. or C.—Farm or Colony. S.—Sanatorium. D. S.—District Insurance Committee. M. O. H.—Medical Officer of Health. L. A.—Local Authority. M. P.—Medical Practitioner. T. D.—-Tuberculosis Dispensary. P.—Patients' Homes. J. KING WARRY, M.D., &c., Town Hal], Medical Officer of Health. Hackney, N.E. 17th October, 1912. 15C METROPOLITAN BOROUGH OF HACKNEY. Public Health (London) Act, 1891, Sec. 94. BY-LAWS Made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney with respect to Houses Let in Lodgings or Occupied by Members of More than One Family in the Metropolitan Borough of Hackney. Interpretation of Terms. 1.—In these By-laws, unless the context otherwise requires, the following words and expressions have the meanings hereinafter respectively assigned to them; that is to say— "Council" means the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney; "Lodging-house" means a house or part of a house intended for the working-classes which is let in lodgings or occupied by members of more than one family; "Landlord," in relation to a lodging-house, means the owner within the meaning of the Public Health (London) Act, 1891; "Tenant" means the person who, whether as owner or otherwise has an interest in the premises of such nature and extent as to entitle the said person to let the lodging-house in lodgings or for occupation by members of more than one family, or for the time being to receive the profits arising from the said letting; "Lodger" in relation to a lodging-house means a person to whom any room or rooms in the lodging-house may have been let as a lodging or for his use and occupation ; 157 (a) For fixing the number of persons who may occupy a house, or part of a house, which is let in lodgings or occupied by members of more than one family; (b) For the registration of houses so let or occupied; (c) For the inspection of such houses; (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses; (c) For the cleansing and lime-washing at stated times o the premises; (f) For the taking of precautions in case of any infectious disease. 2.—A lodger in a lodging-house, and, subject to the provisions of these By-laws, the tenant of the lodging-house, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of three hundred cubic feet of free air space for each person of an age exceeding ten years, and of one hundred and fifty cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is used exclusively for that purpose, and which, in the case of the lodger, has been let to that lodger. 3.—A lodger in a lodging-house, and, subject to the provisions of these By-laws, the tenant of the lodging-house shall not knowingly cause or suffer a greater number of persons than will admit of the provision of four hundred cubic feet of free air space for each person of an age exceeding ten years and of two hundred cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is not used exclusively for that purpose, and which, in the case of the lodger, has been let to that lodger. 4.—The tenant of a lodging-house, within a period of fourteen days after he has been required by a notice in writing, signed by the Town Clerk of the said Borough and duly served upon or delivered 158 to the tenant to supply the information necessary for the regisration of the lodging-house by the Council, shall, himself, or by his agent, duly authorised in that behalf, sign and furnish to the Council a true statement of the following particulars with respect to the lodging-house , that is to say— (a) The total number of rooms in the house; (b) The total number of rooms let in lodgings or occupied by members of more than one family; (c) The manner of use of each room; (d) The number, age and sex of the occupants of each room used for sleeping; (e) The Christian name and surname of the lessee of each room, and (f) The amount of rent or charge per week payable by each lessee. 5.—Where the tenant of a lodging-house resides in any part of the premises, the tenant, and where the tenant of a lodging-house does not reside in any part of the premises, every lodger who is entitled to have or to exercise the control of the outer door of the premises, and every other person who being resident in any part of the premises is entitled to have or to exercise the like control shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access to the interior of the premises for the purpose of inspection. 6.—Every lodger in a lodging-house shall, at all times when required by the Medical Officer of Health the Sanitary Inspector or any other officer specially appointed or authorised by the Council in that behalf, afford any such officer free access for the purpose of inspection to the interior of any room or rooms which may have been let to the lodger. 159 7.—Where the Medical Officer of Health, the Sanitary Inspector or any other officer specially appointed or authorised by the Council in that behalf, has, for the purpose of inspection, obtained access to the interior of a lodging-house or to the interior of any room or rooms in a lodging-house, a person shall not wilfully obstruct any such officer in the inspection of any part, of the premises, or, without reasonable excuse, neglect or refuse, when required by any such officer, to render him such assistance as is reasonably necessaiy for the purpose of his inspection. 8.—Where a lodger in a lodging-house is entitled to the exclusive use of any court, courtyaid, area, or other open space within the curtilage of the premises, the lodger, and where two or more lodgers in a lodging-house are entitled to the use in common of any court, courtyard, area, or other open space within the curtilage of the premises, the tenant shall, subject ot the provisions of these By-laws, cause the court, courtyard, area, or other open space to be thoroughly cleansed from time to time as often as is requisite for the purpose of keeping the same in a cleanly condition. 9.—Subject to the provisions of these By-laws:— The landlord of a lodging-house shall cause every drain or means of drainage, with which any water closet belonging to the lodging-house may communicate, to be maintained at all times in good order and efficient action. He shall also cause all such means of ventilation as are provided in or in connection therewith to be maintained at all times in good order. 10.—Every lodger in a lodging-house shall cause the floor of every room which has been let to him to be thoroughly swept once at least in every day, and such parts thereof as are not covered with carpet or other unwashable material nailed or fixed down to be thoroughly washed as often as may be necessary for the purpose of maintaining cleanliness. 160 11.—Every lodger in a lodging-house shall cause every window, every fixture or fitting of wood, stone or metal, and every painted surface in every room which has been let to him to be thoroughly cleansed from time to time, as often as may be necessary. 12.—Every lodger in a lodging-house shall cause all solid or liquid filth or refuse to be removed once at least in every day from every room which has been let to him, and shall once at least in every day cause every vessel, utensil, or other receptacle for the said filth or refuse to be thoroughly cleansed. 13.—Where a Jodger in a lodging-house is entitled to the exclusive use of any staircase, landing, or passage in the lodginghouse, the lodger shall cause every part of the staircase, landing, or passage to be thoroughly cleansed from time to time as often as is requisite. 14.—A Jodger in a lodging-house shall not cause or suffer any animal to be kept in any room which has been let to the Jodger, or elsewhere upon the premises, in such a manner as to render the condition of the room or premises filthy. 15.—Subject to the provisions of these By-laws, the tenant of a lodging-house shall cause every common passage or staircase in the lodging-house to be thoroughly cleansed from time to time as often as is requisite. 16.—Subject to the provision of these By-laws— The landlord of a lodging-house shall, in the month of April, May or June in every year cause every part of the premises to be cleansed. He shall, at the same time, cause the walls of every area, the surface of every ceiling, and the interior surface of every wall of every room, staircase and passage in the lodging house 161 and of every water-closet belonging to the premises to be thoroughly lime-washed in every case where lime-washing is necessary for effective cleansing. Provided that the foregoing requirement with respect to lime washing shall not apply in any case where the interior surface of any such ceiling or wall is painted, or where the material of or with which that surface is constructed or covered is such as to render the lime-washing thereof unsuitable or inexpedient, and where the said surface is thoroughly cleansed, and the paint or other covering is renewed, if the renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition. 17.—Subject to the provisions of these By-laws, the landlord of a lodging-house shall provide adequate means of ventilation in or in connexion with every common passage or staircase in the lodginghouse, and shall cause the said means of ventilation to be maintained at all times in good order. 18.—Subject to the provisions of these By-laws, the landlord of a lodging house shall cause all such means ot ventilation as are provided in or in connection with any room in the lodging house to be maintained at all times in good order. 19.—Where, in pursuance of any statutory provision in that behalf, an order of a justice has been obtained for the removal from a lodging-house to a Hospital of a person who is suffering from any dangerous infectious disease and is without proper lodging or accommodation, the tenant of the lodging-house, where the tenant resides in any part of the premises, and the lodger to whom any room whereof the person aforesaid may be an occupant has been let shall, on being informed of the order, forthwith take all such steps as are requisite on the part of the tenant and of the lodger, respectively, 162 to secure the safe and prompt removal of the said person in compliance with the order, and shall in and about the removal adopt all such precautions as, in accordance with any instructions which the tenant and the lodger, respectively, may receive from the Medical Officer of Health of the Council, are most suitable for the circumstances of the case. 20.—Where a duty imposed upon or a prohibition applied to the landlord or the tenant of a lodging-house is by any By-law expressly imposed or applied subject to the provisions of these By-laws, proceedings shall not be taken against the landlord or tenant for an offence against the By-law unless and until the landlord or tenant, after service upon him of a notice in writing by the Council requiring him within such reasonable time as is specified in the notice to comply with the By-law has failed to comply with the By-law within the time so specified. Penalties. 21.—Every person who shall offend against any of the foregoing By-laws shall be liable for every such offence to a penalty of Five Pounds, and in the case of a continuing offence to a further penalty of Forty Shillings for each day after written notice of the offence from the Council. Provided nevertheless that the justices or court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this By-law. Repeal of By-laws. 22.—From and after the date of the confirmation of these By-laws, the By-laws with respect to houses let in lodgings or occupied by members of more than one family, which were made 163 by the Council on the twenty-sixth day of July in the year one thousand nine hundred and six, and which were confirmed by the Local Government Board on the sixth day of October, in the year one thousand nine hundred and six, shall be repealed. The Common Seal of the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney was affixed hereto on the Eleventh day of July, One Thousand Nine Hundred and Twelve, pursuant to a Resolution of the Council duly passed in the presence of The Common Seal of the Metropolitan Borough of Hackney, 1900. L.S W. HAMMER, Mayor. LEWIS PAYTON, D. W. MARPOLE, W. A. WILLIAMS, Members. Town Clerk Allowed by the Local Government Board this fourth day of September, 1912 WALTER T. JERRED, Assistant Secretary. Acting on behalf of the said Board under the authority of their General Order, dated the twenty-sixth day of May, 1877. Seal of the Local Government Board. L.S. 164 ANNUAL REPORT OF CANAL BOATS INSPECTOR, FOR 1912. To the Hackney Borough Council, Gentlemen, I beg to submit my annual report upon the canal boats inspected under the Canal Boats Acts and Regulations, 1877 and 1884. The details are as follows:— Number of visits to waterways 85 „ boats inspected 30 „ „ conforming to Acts 30 „ „ infringing Acts None „ certificates examined 30 „ persons for which boats were registered 113 (adults) „ „ living on boats so registered (men) 54 The boats inspected were found to be in good condition. No legal proceedings were taken. i I have the honour to be, Gentlemen, Your obedient Servant, George White, Sanitary Inspector and Inspector under Canal Boats Acts. 165 LIST OF LICENSED COW-SHEDS In the Borough of Hackney, October, 1912. Name. Address. Sheds. Wright, Henry 84, Clifden Road, Lower Clapton 1 Jenkins, John 2, Buckingham Road, Kingsland 2 Francis, Hannah 67, Downham Road, Kingsland 1 Evans, R. 11, Downham Road, Kingsland 1 Snewin, W. H. 67, Old Hill Street, Upper Clapton 1 Welford, R. W. 83, Upper Clapton Road 1 Pocock, B., & Sons 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 Protheroe, T 79, Shacklewell Lane, Hackney 1 Welford, R. W. Sigdon Road, Hackney 1 Stapleton, A., & Sons, Ld. Stoke Newington Common 3 Briggs, J. J. 180, Victoria Park Road 1 Thomas, David 6, Warburton Road, Hackney 1 Total Cow-Sheds 18 LIST OF LICENSED SLAUGHTER-HOUSES In the Borongh of Hackney, October, 1912. 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 166 List of Licensed Slaughter-Houses—continued. Name. Address. Barclay, E. 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. 94, Southgate Road Row, Fredk. Wm. 130, High Street, Stoke Newington Young, C. J. 220, High Street, Stoke Newington Stoneman, P. 3, Terrace Road Clark, A. E 150, Upper Clapton Road Tyler, Stanley 92, Well Street Austin, WE 51, Wilton Road LIST OF BAKE HOUSES, 1912. No. 1 District. Samson, W. J. 77, Upper Clapton Road Buddin, J. 87, Reighton Road ‡Vincent, A. 104, 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, „ „ Cullen, W 216, ‡Mezger, A 33, Rectory Road Vogt, C. H. 62, Evering Road Burch, Mrs. H. 9, Maury Road 167 List of Bake-Houses—continued. Name. Address. Willsmer, C 8, Stellman Street ‡Guscott, J 128, Stoke Newington Road ‡Seufert, C 40, Shacklewell Lane ‡Karsch, J 239. Arahurst Road Brenner, W. 73, Shacklewell Lane ‡Bremner, E 144, High Street, Kingsland No. 3 District. ‡Tidmarsh 50, London Road Lawrence, E. 68, London Road ‡Newling, G. 26, Downs Road Eade, W. A. 215, Lower Clapton Road ‡Parish, W. 117, „ ‡Engel, J 71, „ Erbach 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, ‡ l 168 List of Bake-Houses— continued. No. 5 and 6 District. Name. Address. Liebsch, H 49, Greenwood Road ‡Spenner, A. 81, Wilton Road ‡ Roberts 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, „ ‡ Sedgwick, F. C 329, Kingsland Road ‡ Henkelmann, H. 174, Southgate Road Allardyce, S. W. 98, „ ‡Calton, A 48, De Beauvoir Road Ellinger, 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, „ „ 169 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. ‡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 No. 10 District. Parker, G. 220, Wick Road Harris, J. 184, Cassland Road Weber, A. F. 92, Wick Road ‡Gunner, Mrs. 34, Church Road, Homerton Hohloch, C. 12, Berger Road Weber, G. 50, Kenton Road 170 List of Bake-Houses—continued. Name. Address. Holman, A 154, Well Street ‡Stark, W. 186, „ Gilsdorf 233, „ Matthieu, A. 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, „ 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.