HAC 28 Borough of Hackney REPORT on the SANITARY CONDITION of the hackney district, FOR THE YEAR 1913, by J. KING WflRRY, M.D. L0ND, M.R.C.P., Diplomate in Public Health; Licentiate of the Society of Apothecaries; Fellow of the Society of Medical Officers of Health; Member of the Lister Institute of Preventive Medicine; Foreign Associate Member of the Society of Hygiene of France. Medical Officer of Health for the Borough. London: Chas. Straker & Sons, Ltd., 5-9, Bishopsgate Avenue, F..C. 1914. INDEX. PAG* Alcoholism 44 Anthrax Order 58 Birth Rate 9 By-laws—Houses let in Lodgings 54 Canal Boats Act 57 Cancer 44 Census, 1911 8-11 Cerebro-Spinal Fever 40 Cleansing of Persons Act, 1897 86 Combined Drainage and Sewers 77 Constitutional Diseases 42 Cowhouses, Milkshops, and Dairies 51 Customs and Inland Revenue Act 57 Death Rate 14 Deaths in Public Institutions 18 Diarrhcea 40 Diphtheria 35 Disinfection 78 Enteric Fever 36 Erysipelas 39 Estimated Population 8 Factories 70 Factory and Workshops Act, 1901 67 Glanders and Farcy Order 58 Glanders, Anthrax and Hydrophobia in Man 40 Home Work and Out-Workers 73 Houses Let in Lodgings 54 Housing and Town Planning Act, 1909 58 Ice Cream Vendors 58 Illegitimacy 12 Infant Mortality 17 Influenza 40 Marriage Rate 9 Measles 41 Methods of Control of Tuberculosis 61 Mortuary 94 National Insurance Act, 1911 64 Notification of Births Act 10 Notifiable Diseases 34 Non-Notifiable Diseases 40 Offensive Trades 52 Ophthalmia Neonatorum 40 Plague 39 A 2 INDEX. PA01 Polio-myelitis 40 Population and Density 8 Prosecutions under Food and Drugs Acts 107 Prosecutions under Public Health (London) Act 106 Public Health (London) Act, 1891 47 Public Health Legislation 66 Public Health (Tuberculosis) Regulations, 1908-1911 61 Puerperal Fever 39 Register of Sanitary Work 96 Removal of House Refuse 90 River Lee 61 Senile Mortality 17 Scarlet Fever 34 Shelter 86 Slaughter-Houses 52 Small-pox 34 Smoke Nuisances 53 Specific Causes of Death 23-25 Tuberculous Disease 42 Tuberculosis Dispensaries 116 Typhus 39 Vaccination 45 Whooping Cough 41 Workshops and Laundries 67 Zymotic Diseases 34 Tables— Articles Disinfected during 1913 80 Births 9 Bakehouses, List of 140 Causes of Infant Mortality 17 Cowsheds 139 Deaths 25 Death Statistics, according to Causes and Ages 23-25 Dusting Account 93 Infectious Sickness 22 'Inquests. 94 Population, Area and Density in Sub-Districts in Hackney 8 Requests for Removal of Dust 92 Samples of Foods and Drugs Purchased 106 Samples of Milk Analysed 104 Slaughter-Houses, List of 139 Suicides and Accidental Deaths 95 Vaccination 46 Metropolitan Borough of Hackney. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1913. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, N.E. June, 1914. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Gentlemen, I beg to present herewith my Twenty-second Annual Report on the Public Health of the Borough of Hackney. The Borough continues to maintain its position as one of the healthiest in London. The general death rate for the year was 13'6 per 1,000 of the population and the infant mortality 99 per 1,000 births. These figures show a small increase in the mortality compared with 1912. This increase is shared with the other Boroughs of the Metropolis, and is due to an increase in the deaths from summer diarrhoea, measles and respiratory diseases, these last being largely due to a prevalence of influenza. An increase in the prevalence of the notifiable infectious diseases also occurred, the total number of cases from all these diseases being 1,126, compared with 1,071 during the year 1912. The number of deaths from the chief zymotic diseases numbered 255, which is equivalent to a zymotic death rate of 1.1 per 1,000 living. 6 A further decline in the mortality from tuberculosis has also taken place during 1913. This subject is particularly dealt with on page 43 of this Report. The following table, giving the density of population of the Borough and the general and infantile mortality rates for the last fifteen years, shows the public health improvement effected in the Borough during that period:— Year. Density. General Death Rate (per 1,000 living). Infantile Mortality Rate (per 1,000 births). 189!) 67.5 17.9 165 1900 66.5 17.4 162 1901 66.7 16.6 137 1901 67.3 16.0 121 1903 67.9 14.7 127 1904 68.5 16.0 155 1905 69.1 15.0 140 190(5 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 1913 68.0 13.6 99 7 The relative position from the health point of view occupied by Hackney may be seen from the subjoined table, compiled from figures supplied by the Register-General showing the deaths rates 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 1913:— Boroughs Death-rate from all causes per 1,000 living corrected). Deaths under 1 year to 1,000 births. County of London 14.2 105 Lewisham 10.4 78 Wandsworth 10.6 88 Hampstead 11.3 73 Stoke Newington 12.9 82 Fulham 12.9 96 Woolwich 13.0 79 Chelsea 13.2 90 City of Westminster 13.3 96 Paddington 13.4 100 Hackney 13.6 99 Camberwell 13.6 106 Kensington 13.6 112 Hammersmith 13.8 103 Greenwich 14.0 103 Battersea 14.0 111 Lambeth 14.0 102 St. Marylebone 14.3 91 Holborn 14.7 104 Islington 14.8 107 Deptford 15.2 112 St. Pancras 15.2 92 Stepney ,, 15.6 112 City of London 15.8 96 Bethnal Green 16.1 118 Poplar 16.1 112 Southwark 17.6 115 Bermondsey 17.8 132 Finsbury 18.1 138 Shoreditch 19.2 155 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 15), but, as may be seen from the rate of infant mortality for the period in question, Hackney compares very favourably with that of other large Metropolitan Boroughs. The following table shows the kind of change which is gradually taking place in the Borough, viz., a change from a residential locality to that of an industrial centre:— 8 Years. No. of Factories. No. of Workshops. No. of Outworkers. 1910 444 1,321 3,164 1911 489 1,157 3,071 1912 507 1,221 2,559 1913 553 1,217 2,451 Such a change is usually associated with increased sickness and mortality-rates, but the change is being effected in the Borough of Hackney coincident with a diminishing mortality. I have pleasure in stating that the officers of the department have on the whole carried out the duties entrusted to them to my entire satisfaction. Population and Density.—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 223,716. This estimate gives a density of population for the whole Borough of 68'0 persons per acre, varying from 50 3 persons in the North Sub-district to 98'4 persons per acre in the South-West Sub-district. The following table gives the estimated population and density of population per acre for each of the Registration Sub-districts 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 54,444 54,294 57,639 56,992 223,369 4,518,191 Area in square acres 1,081 857 586 764 3,288 74,816 Density—persons per acre 50.3 60.4 98.4 74.6 68.0 60.3 I here give a table taken from Vol. VIII. of the Census of England and Wales, 1911, showing the number of tenements in the Borough and their occupants. HACKNEY. 1901. 1911. Total population 219,110 222,535 Tenements with more than two occupants per room:— „ Families or Separate Occupiers "Private" or other 48,701 50,022 Number, 4,021. Population, all ages 20,562 under 10 years of age 10,319 Population in "Private Families" 214,454 Percentage of Population in " Private Families " Irving more than two in a room 124 Number of Private Families 50,395 No. of Rooms per Tenement. No. of Children under 10 years of age. Number of Persons in Private Families (or Tenements). Total No. of Private Families (or Tenements). Population. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. .11. 12. 13. j 14. 15 and upwards. Number of Private Families (or Tenements). Total. 1-4 — 3,095 7,803 7,144 5,008 3,912 2,390 1,018 927 480 221 90 28 8 2 - 33,938 123,885 5 — 50 378 005 828 834 689 570 380 255 129 74 32 10 2 1 4,912 26,518 6 - 39 302 545 690 713 585 442 304 190 128 07 35 18 4 - 4 068 22,100 7 - 20 180 457 500 577 475 314 220 133 70 58 22 11 2 - 3 120 16,738 8 — 20 J 24 330 400 400 340 254 150 107 00 25 14 11 2 3 2,270 12,284 9 — 3 45 108 141 130 103 138 82 70 42 29 20 3 3 2 985 5,981 10 anrl upwards. — 1 28 94 103 178 186 151 114 67 40 24 10 22 3 9 1,102 6,948 Totals — 3,834 8,800 9,349 8,402 0,750 4,840 3,493 2,192 1.308 708 307 107 83 18 15 50,395 214,454 No. of Rooms per Tenement. No. of Persons per Tenement Tenements of Five Rooms and upwards with more than Two Persons per Room. Total No. of Private Families (or Tenements). Population. No of Children under 10 years of age in Private Families (or Tenements). All ages. Under 10. 0. 1. 2 3. 4. 5. 6. 7. 8. 9. 10. No of Private Families (or Tenements). 5 11 2 1 9 25 19 15 2 1 - - - 74 814 204 12 1 3 8 11 9 - - - - - 32 384 120 13 - - 1 1 1 5 - 1 1 - - 10 130 49 14 — - - 1 — — - — - - - 2 28 8 16 - - - - - - - 1 - - - 1 16 7 6 13 — 2 2 5 2 5 2 — — - — 18 234 00 14 — — 1 1 1 1 — — — - — 4 50 14 Face p. 8. 9 *Marriages and Marriage Rates.—During 1913 there were 1,941 marriages solemnised in the Borough of Hackney. The annual marriage rate for persons married during this period is therefore 17'4 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 during the ten years 19031912:— Year. Borough of Hackney. London. Marriages. Marriage Rate. Marriage Rate. 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 1912 1,967 17 6 18.6 Average 1903—1912 1,841 160 16.9 1913 1,941 174 16.1 Births and Birth-rate.—The births registered in the Borough of Hackney during the year 1913 numbered 5,733, of which 2,916 were males and 2,817 females. The total shows an increase of 308 compared with the number registered in the Borough during 1912. This total is the actual number of births registered in Hackney ; but of these a certain number must be transferred to other districts, and there are also certain births in outlying districts which must be transferred to Hackney in order to get an accurate birth-rate for the Borough. The Registrar-General has supplied me with the *I have here to acknowledge my indebtedness to Mi. H. Brougham Loney, Superintendent' Registrar, who has kindly abstracted for me the number of marriages for the year 1913. 10 number of births which should be so transferred, viz., 302 births to be transferred to other districts and 92 to Hackney. After making these necessary corrections, the correct total of registered births amongst Hackney residents is 5,523. From this figure I calculate the corrected birth-rate for Hackney during 1913 to be 24 7 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. The following table—Under the provisions of this Act, I received 5,603 notifications of births occurring in the Borough during 1913. This total includes notifications from medical practitioners, midwives and other persons. It also includes still births. This total is 80 more than the number registered by the Registrars of Births. Still Births.—Amongst the births notified were 152 still-born. This is equal to 2.per cent, of those notified. I give here a table showing the number of notifications received, with other details, in connection with the same. (6) NOTIFICATION OF BIRTHS ACT, 1907, Notifications of Births (Live or Still-born) received during the year, 1913. ] 1913. Medical Practitioners. Midwives. Parents and Others. Total. , Live. Still. Live. Still. Live. Still. Live. Still. M. F- M. F. M. F M F. M. F. M. F. M. F. M. F. Totals. | 963 902 41 30 1.2S6 1,290 42 26 504 496 5 8 2.763 2,688 88 64 The following table, abstracted from the Census Report of 1911, gives the foreign-born residents in Hackney at that date:— 11 Country of Birth of Persons born in Foreign Countries, enumerated in the Borough of Hackney at Census, 1911. Where Born. Persons. British Subjects. Naturalised British Subjects. Foreigners. Males. Fem. Males. Fem. Males. Fem. EUROPE— Austria 528 3 9 51 42 242 181 Hungary 25 — 2 3 1 13 6 Belgium 49 1 4 6 — 23 22 15 Denmark 40 1 1 3 4 9 France 270 22 30 8 1 88 121 Germany 1,210 12 40 66 53 609 430 Greece 7 1 1 — — 5 — Holland 242 5 18 6 2 101 110 Italy 161 — 5 2 — 102 52 Norway 9 — — 1 — 7 1 Portugal 7 2 — — — 1 4 Russia (including Asiatic Russia) 1,987 17 36 231 180 785 738 Russian Poland (not included above) 999 8 14 145 103 370 359 Servia, Roumania, Bulgaria and Montenegro 125 2 3 16 10 50 44 Spain 27 2 — — 9 12 Sweden 30 1 — 2 3 15 9 Switzerland 96 2 1 1 1 63 28 Turkey (including Asiatic Turkey) 30 2 4 5 2 11 6 ASIA— China 5 1 3 — — 1 - Japan 4 - 2 1 - 1 - Other Countries 14 5 4 — - 5 - AFRICA 16 2 3 — — 6 5 AMERICA— Argentine Republic 10 3 1 — 1 2 3 Brazil 3 1 1 — — 1 — Mexico, Central America and West Indies 4 1 1 - - 2 - United States 221 36 63 3 4 70 45 Other Countries 16 3 8 — — 4 1 BORN ABROAD (Country not stated) 11 2 5 2 1 - 1 BORN AT SEA 44 17 27 — — — — TOTAL BORN in Foreign Countries and at Sea 6,190 154 288 552 408 2,608 2,180 12 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1913 was 452 ; but of these, I am informed by the Registrar-General, that 285 should be transferred to districts outside of Hackney, as the mothers were not Hackney residents, and that 14 births, taking place in other districts, should be transferred to Hackney. Making these corrections, there remain 181 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate-birth-rate of 32'7 per 1,000 registered births. The following table gives the number of registered births birth-rates, &c., for the Sub-districts in the Borough:— Table. Births. Registration District of Hackney. Registration Sub-District. All London. North. Central. SouthWest. South- East. Total No. of Births 5,733 1,032 1,446 1,740 1,515 112,637 Rate per 1,000 living 256 189 266 30 3 265 24.5 No. of Illegitimate Births 181 Kate per 1,000 Births 32.7 13 The following table shows the birth-rates for the Borough and 1 its Sub-districts during the years 1903 to 1913 inclusive:— Birth-rate for the Borough of Hackney and, its Sub-Districts for the Years 1903-1913 compared with that of London. Year. Borough of Hackney. North SubDistrict. Central SubDistrict. South-West SubDistrict. South-East SubDistrict. London. 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 20.4 1907 24.8 19.4 25.1 97.2 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 1912 24.3 18.7 23.9 28.4 25.7 24.5 Average 1903-191:' 25.1 18.9 24.9 28.7 27.2 25.7 1913 25.6 18.9 26.6 30.3 26.5 24.5 Deaths.—The deaths registered in the Borough of Hackney (luring 1913 numbered 3,156, but of these 665 were deaths of nonresidents dying in institutions and other places in the Borough. There were, however, 563 residents of Hackney who died during the year in institutions in other districts. On making the necessary corrections by deducting 665 from the total deaths registered in the Borough, and adding 563 to the result, I obtain the corrected number of deaths amongst Hackney residents during 1913, viz., 3,054. This is an increase of 334 upon the number of deaths occurring during 1912. The general death-rate from all 14 causes for the year is 13.6 per 1,000 of the population. On further correcting this rate for age and sex distribution by means of the factor 1.0066, I obtain the corrected general death-rate of 13 6 per 1,000 of the population for the year 1913. The corrected general death-rate for the year 1912 was 12.2 per 1,000 of the population, so that the death-rate for 1913 is 1.4 per 1,000 higher than that for the previous year. Amongst the registration sub-districts, the death-rate was lowest in the North Sub-district (12.4 per 1,000), and highest in the South-West Sub-district (15"0 per 1,000). Sub-District. Population. No. of Births. Birth rate. Total Deaths. Death- rate. (Crude.) Deaths under 1 year. Infant Mortality per 1,000 Births North 51,444 1,032 19 679 12.4 69 67 Central 51,294 1,446 26 681 12.5 139 96 South-West 57,639 1,740 30 868 15.0 166 95 South-East 56,992 1,515 27 826 14.5 175 115 All Hackney 223,369 5,733 25 3,054 13.6 519 96 The corrected annual death-rate from all causes for London during 1913 is 14.2 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. 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 15.3 1912 12.3 13.6 1908 13.9 14.5 1913 13.6 14.2 15 Infant Mortality.—The deaths under 1 year of age in the Borough during 1913 numbered 549. This is an increase of 123 upon the number of infant deaths during 1912. The infant mortality rate for the year is 99 per 1,000 births. The increased rate is due to an increased number of deaths from diarrhoea and enteritis associated with an increased summer temperature, and to an increase in the number of deaths from bronchitis and pneumonia. Other causes of infants' deaths which deserve mentioning are 82 premature births, 67 attributed to atrophy, debility, and marasmus. Mrs. Rhodes began her work as Health Visitor on February 3rd, amongst nursing mothers and their children. She made during the year 1,178 primary visits and 821 secondary visits. There were also 216 fruitless visits made, the mothers either being out at the time or having changed their address. The weekly meeting of nursing mothers at the Town Hall has been continued with slight interruption. The actual number of meetings were 41, and the total number of infants weighed were 964. The following table gives particulars of the feeding of the infants and the home conditions found by the Health Visitor amongst the 1,178 children visited. 16 PARTICULARS RESPECTING THE FEEDING, CARE, AND ENVIRONMENT OF THE BABIES VISITED, 1913. 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 057 518 093 131 61 555 620 741 434 222 127 374 45 384 23 1028 147 138 78 1037 17 Senile Mortality.—The deaths which occurred in Hackney at 65 years of age and upwards during 1913 numbered 909, and of these 453 were between the ages of 65 and 75 years, 332 between 75 and 85 years, and 124 at 85 and upwards. The annual mortality rate of persons at 65 years and upwards is 4.5 per 1,000 living. TABLE IV.—INFANT MORTALITY. 1913. 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. ^ months and under l» months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 ... 3 3 7 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... 1 ... 1 3 2 ... 4 10 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... 1 1 3 3 8 Abdominal Tuberculosis ... ... ... ... ... 2 5 1 3 11 Other Tuberculous Diseases ... ... ... ... ... 2 2 2 2 8 Meningitis (not Tuberculous) ... ... ... ... ... ... 3 8 2 13 Convulsions ... ... 2 2 9 5 3 3 2 22 Laryngitis ... ... ... ... ... 1 ... 2 ... 3 Bronchitis ... ... 3 2 5 7 10 7 7 36 Pneumonia (all forms) ... 1 2 1 4 12 17 18 33 84 Diarrhoea ... ... ... 1 1 5 9 6 5 26 Enteritis ... ... 1 2 3 24 27 20 7 81 Gastritis ... ... 1 ... 1 1 1 1 1 5 Syphilis ... ... ... ... ... 4 2 1 ... 7 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying 2 1 2 1 6 5 2 ... ... 13 Injury at Birth 5 ... ... ... 5 ... ... ... ... 5 Atelectasis 11 1 2 ... 14 1 ... ... ... 15 Congenital Malformations 7 3 1 1 12 4 1 ... ... 17 Premature Birth 48 13 6 3 70 9 2 2 ... 83 Atrophy, Debility and Marasmus 15 4 2 4 25 15 17 7 3 67 Other Causes 7 3 1 ... 11 5 4 3 3 26 Total 99 25 23 17 167 108 108 87 79 549 b 18 Deaths in Public Institutions.—There were 1,460 deaths iu public institutions in the Borough during 1913; of these 665 were residents of other districts, and the remaining 795 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 1913:— INSTITUTIONS WITHIN THE BOROUGH RECEIVING PERSONS BOTH FROM AND WITHOUT THE BOROUGH. Brooke House, Upper Clapton Road 7 Children's Home, 151, Stamford Hill 2 City of London Infirmary, Clifden Road 70 City of London Workhouse 1 Eastern Hospital, Homerton 146 French Hospital, Victoria Park Road 4 German Hospital, Dalston 125 Hackney Union Infirmary, Homerton 798 Hackney Union Workhouse, Homerton 7 Metropolitan Hospital, Kingsland 187 Nursing Home, 46, Amhurst Park 1 Nursing Home, 47, Nightingale Road 1 Nursing Home, 2, Queensdown Road 5 Nursing Home, 18 and 20, Southwold Road 9 St. Joseph's Hospice, Mare Street 62 St. Scholastica Retreat, Kenninghall, Road 5 Salvation Army Nursing Home, 29, Devonshire Road 1 Salvation Army Maternity Hospital, Mare Street 15 Salvation Army Maternity Hospital, Lower Clapton Road 1 Salvation Army Maternity Hospital, 16, Rectory Road 2 Salvation Army Home, Springfield 9 Salvation Army Home, Rookwood Road 1 Salvation Army Hospital, 15, Gore Road 1 1,460 19 INSTITUTIONS OUTSIDE THE BOROUGH RECEIVING SICK AND INFIRM PERSONS FROM THE BOROUGH. Babies' Home, Shoreditch 2 Banstead Asylum 13 BethnaJ House Asylum 2 Bethnal Green Infirmary 3 Brompton Hospital 2 Cane Hill Asylum 5 Caterham Asylum 2 Camberwell House Asylum 1 Charing Cross Hospital 2 Children's Hospital, Great Ormond Street 4 City of London Lying-in Hospital 2 Claybury Asylum 31 Colney Hatch Asylum 21 City of London Asylum, Stone 1 Cheyne Hospital, Chelsea 1 Dartford Heath Asylum 7 Downs Sanatorium, Sutton 2 Darenth Industrial Colony 1 East London Hospital 1 Freidenheim Hospital 4 Fountain Fever Hospital 2 Guy's Hospital 2 Hackney Workhouse, Brentwood 13 Heart Hospital, Soho 1 Homoepathic Hospital 3 Horton Asylum 6 Hospital for Women, Soho 1 Hanwell Asylum 5 Hospital of St. John and St. Elizabeth, St. Mary- lebone 1 Hostel of God, Clapham 1 Hampstead General Hospital 1 Holborn Workhouse, Shoreditch 1 Home and Hospital for Jewish Incutables 2 Islington Workhouse 2 Islington Infirmary 1 Italian Hospital 1 Invalid Asylum, 187, High Street, Stoke Newington 2 King's College Hospital 1 Leavesden Asylum 13 Long Grove Asylum 10 b 2 20 London Hospital 81 London Temperance Hospital 1 Manor Asylum 5 Middlesex Hospital 7 Mildmay Mission Hospital 5 Mount Vernon Hospital 2 North-Eastern Fever Hospital 14 National Hospital, Queen's Square 4 Northern Hospital, Winchmore Hill 2 North-Western Fevei Hospital, Hampstead 4 Prince of Wales' General Hospital, Tottenham 12 Park Fever Hospital 1 Peckham House 1 Queen's Hospital for Children 85 Queen Mary's Hospital, Carshalton 6 Royal Chest Hospital, City Road 3 Royal Free Hospital 3 St. Bartholomew's Hospital 24 St. Luke's House, Kensington 4 St. Peter's Hospital 1 St. Thomas' Hospital 1 Shoreditch Infirmary 7 Seaman's Hospital 1 South-Eastern Fever Hospital 3 St. George's Hospital 1 St. Pancras Infirmary 1 St. Mary's Hospital 1 Southwark Infirmary, Camberwell 3 Tooting Bee Asylum 25 University College Hospital 4 Victoria Hospital 1 Victoria Park Chest Hospital 5 Whitechapel Infirmary 1 Western Fever Hospital 3 Westminster Hospital 1 West Ham Infirmary 2 Miscellaneous Institutions 62 563 21 TABLE I.—HACKNEY DISTRICT. Vital Statistics of Whole District during 1913 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. N umber. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 4913 223,369 5,733 5,523 24.7 3,156 14.1 665 563 549 99 3,054 13.6 22 TABLE II.—HACKNEY DISTRICT. Cases of Infectious Disease Notified during the Year 1913. 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 North. Central South-East South-West. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 326 6 102 170 29 13 6 ... 90 53 77 106 284 Erysipelas 178 2 7 18 13 50 63 25 35 31 62 50 29 Scarlet Fever 807 3 168 520 79 34 3 ... 130 250 202 225 747 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 39 1 1 19 8 6 3 1 8 8 20 3 34 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 Puerperal Fever 19 ... ... ... 3 16 ... ... ... '7 5 7 13 Cerebro-Spinal Meningitis 7 4 1 1 1 ... ... ... 2 1 2 2 6 Polio Myelitis 15 ... 15 ... ... ... ... ... 10 9 2 1 8 Pulmonary Tuberculosis 681 3 14 59 143 313 127 22 103 150 196 232 311 Other forms of Tuberculosis 253 12 38 119 45 27 9 3 42 53 74 84 99 Ophthalmia Neonatorum 28 28 ... ... ... ... ... ... 7 6 6 9 4 Totals 2,354 59 346 906 322 459 211 51 427 561 647 719 1,536 23 TABLE III.—HACKNEY DISTRICT. Causes of, and Ages at, Death during the Year 1913. 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 4 ... ... ... 2 1 1 ... ... 11 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 63 7 25 26 4 1 ... ... ... 61 Scarlet Fever 11 ... 6 2 9 ... 1 ... ... 14 Whooping-cough 21 10 8 3 ... ... ... ... ... 4 Diphtheria and Croup 10 ... 2 2 6 ... ... ... ... 33 Influenza 29 ... ... ... ... ... 6 9 14 1 Erysipelas 7 1 1 ... ... ... 2 3 ... 5 Phthisis (Pulmonary Tuberculosis) 250 1 ... 1 5 47 124 57 15 140 Tuberculous Meningitis 26 8 7 6 3 1 1 ... ... 12 Other Tuberculous Diseases 56 19 6 7 8 4 7 5 ... 34 Cancer, Malignant Disease 250 ... ... 1 ... ... 19 140 90 142 Rheumatic Fever 5 ... ... ... ... 2 2 1 ... ... Meningitis 22 9 3 2 6 ... 1 1 ... 10 Organic Heart Disease 298 ... ... ... 16 9 37 117 119 114 Bronchitis 281 37 3 3 4 ... 4 53 177 80 Pneumonia (all forms) 299 84 32 23 11 11 35 60 43 117 24 HACKNEY DISTRICT—continued. Causes of, and Ages at, Death during the Year 1913. 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. Other Diseases of Respiratory Organs 40 4 2 2 2 ... 6 10 14 35 Diarrhoea and Enteritis 146 107 26 2 1 1 ... 5 4 88 Appendicitis and Typhlitis 20 ... ... 9 4 3 7 3 1 12 Cirrhosis of Liver 38 ... ... ... ... ... 7 24 7 17 Alcoholism 2 ... ... ... ... ... ... 1 1 ... Nephritis and Bright's Disease 97 ... ... 1 1 3 16 49 27 65 Puerperal Fever 6 ... ... ... ... 3 3 ... ... 13 Other Accidents and Diseases of Pregnancy and Parturition 8 ... ... ... ... 2 6 ... ... 3 Congenital Debility and Malformation, including Premature Birth 173 167 2 3 1 ... ... ... ... 31 Violent Deaths, excluding Suicide 110 21 5 8 12 7 15 24 18 53 Suicides 25 ... ... ... ... 1 10 8 6 5 Other Defined Diseases 619 73 15 5 18 17 33 169 239 296 Diseases ill-defined or unknown 138 1 ... ... ... ... 1 2 124 60 Totals 3,054 549 143 99 106 113 394 741 909 1,456 Sub-Entries (included in above figures)— Cerebro-Spinal Meningitis 7 4 1 1 1 ... ... ... ... ... Poliomyelitis 3 ... 2 1 ... ... ... ... ... 1 25 TABLE OF DEATHS Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1913 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. J 65 to 75. 75 to 85. 85 and upwards. All Ages. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... Not „ ... ... ... ... ... ... ... ... ... ... ... ... Doubtful ... ... ... ... ... ... ... ... ... ... ... ... Cowpox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles (Morbilli) 7 51 4 1 ... ... ... ... ... ... ... 63 Epidemic Rose Rash, German Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 8 2 ... 1 ... ... ... ... ... ... 11 Typhus ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... 1 ... ... ... ... ... ... ... ... 1 Influenza ... ... ... ... 4 2 5 ... ... 3 3 29 Whooping Cough 10 11 ... ... ... ... ... ... ... ... ... 21 Mumps ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup ... 5 6 ... ... ... ... ... ... ... ... 11 Cerebro Spinal Fever 4 2 1 ... ... ... ... ... ... ... ... 7 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... 2 1 ... 1 ... ... ... ... ... 4 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Diarrhoea, Epidemic (or Zym.) Enteritis 53 16 ... ... ... ... 1 ... ... ... 70 26 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Diarrhoea, Choleraic Diarrhoea 12 2 ... 1 ... ... ... ... 1 1 ... 17 Dysentery ... ... ... ... ... ... 1 1 1 1 ... 4 Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Farcy ... ... ... ... ... ... ... ... ... ... ... ... Anthrax Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 7 ... ... ... ... ... ... ... ... ... ... ... Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septicaemia, Sapræmia ... ... ... 3 1 2 ... ... ... ... ... 6 Puerperal Pyaemia ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Dolens ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... Infective Endocarditis ... ... 1 2 ... 3 ... ... ... ... ... 6 Epidemic Pneumonia, Pneumonia Fever ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 1 ... ... 1 1 ... 3 ... ... ... 7 Septicaemia (not Puerperal) ... 1 1 1 3 3 3 1 ... 1 ... 14 Pyaemia (not Puerperal) ... 1 ... ... ... ... ... ... 1 ... ... 2 Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... ... ... 1 ... 1 Phagedæna ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 1 ... ... ... ... ... ... ... ... ... ... 1 27 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Tuberculous Phthisis (Pulm. Tuberculosis). 1 1 4 41 63 48 32 14 7 3 ... 214 "Phthisis" ... ... 1 6 10 3 8 3 3 2 ... 36 Tuberculous Meningitis 8 13 3 1 ... 1 ... ... ... ... ... 26 Tuberculous Peritonitis 2 3 5 ... ... 1 ... ... ... ... ... 11 Tabes Mesenterica 9 4 ... ... ... ... ... ... ... ... ... 13 Lupus ... ... ... ... ... ... ... ... ... ... ... ... Tubercle of other Organs ... ... ... 1 3 ... 2 2 ... ... ... 8 General Tuberculosis 8 6 3 3 1 2 1 ... ... ... ... 24 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... ... ... 1 ... ... 1 ... 2 Opium, Morphia Habit ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning by Lead ... ... ... ... ... ... ... ... ... ... ... ... by Phosphorus ... ... ... ... ... ... ... ... ... ... ... ... by Arsenic and other Metals ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... ... 2 2 ... 1 ... ... ... ... 5 Rheumatism of Heart ... ... ... ... ... ... ... ... ... ... ... ... Chronic Rheumatism ... ... ... ... ... ... 1 1 1 ... 1 4 28 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... ... 1 1 2 3 ... 7 Gout ... ... ... ... ... ... ... 1 ... ... ... 1 Carcinoma ... ... ... ... 4 12 40 63 46 16 ... 181 Sarcoma ... 1 ... ... ... ... 4 6 4 ... ... 15 Malignant Diseases, Cancer ... ... ... ... ... 3 5 22 14 8 2 54 Rickets 1 ... ... ... ... ... ... ... ... ... ... 1 Purpura 1 ... 1 ... ... ... ... ... ... ... ... 2 Haemophilia, Hemorrhagic Diathesis 1 ... ... ... ... ... ... ... ... ... ... 1 Anaemia, Leucocythaemia 1 ... ... ... 1 ... ... 2 1 1 1 7 Diabetes Mellitus ... ... 2 2 5 5 5 3 4 2 ... 28 Premature Birth 83 ... ... ... ... ... ... ... ... ... ... 83 Congenital Defects 17 ... 1 ... ... ... ... ... ... ... ... 19 Injury at Birth 5 ... ... ... ... ... ... ... ... ... ... 5 Atelectasis 15 ... ... ... ... ... ... ... ... ... ... 15 Want of Breast Milk 2 ... ... ... ... ... ... ... ... ... ... 2 Teething 1 ... ... ... ... ... ... ... ... ... ... 1 1,047 Disease of Nervous System. Meningitis, Inflammation of Brain 9 5 6 ... 1 ... ... 1 ... ... ... 22 Softening of Brain ... ... ... ... ... ... 1 1 3 7 3 15 General Paralysis of Insane ... ... ... 1 ... 2 6 3 3 ... ... 15 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. Insanity (not Puerperal) ... ... ... ... 2 1 ... 2 1 1 1 8 Chotea ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... 2 3 ... 7 1 2 1 ... ... 16 Convulsions 21 4 ... ... ... ... ... ... ... ... ... 25 Laryngismus Stridulus 1 ... ... ... ... ... ... ... ... ... ... 1 Locomotor Ataxy ... ... ... ... ... 1 3 1 ... ... ... 5 Poliomyelitis ... 3 ... ... ... ... ... ... ... ... ... 3 Paraplegia and Disease of Cord ... ... ... ... ... 2 ... 1 2 3 ... 8 Neuritis, Periph, PolyNeuritis ... ... ... ... ... 1 1 ... ... ... ... 2 Brain Tumour (not specific) ... ... ... ... 1 4 3 ... 2 ... ... 10 Nervous System, other Diseases 1 ... 1 1 ... 1 ... 2 4 1 1 12 Disease of Organs of Sense. 142 Otitis, Mastoid Dis. ... 2 3 ... 1 ... 1 ... ... ... ... 7 Epistaxis, Nose Dis. ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Dis. ... ... ... ... ... ... ... ... ... ... ... ... Accidents 20 11 10 6 6 4 12 8 7 9 1 94 Violence Suicide ... ... ... 1 3 7 4 4 4 2 ... 25 Drowned ... ... 2 1 1 4 3 1 1 ... ... 13 Murder 1 2 ... ... ... ... ... ... ... ... ... 3 Disease of Heart. 142 Valve Dis., Endocarditis ... ... 14 9 13 19 39 44 53 20 3 214 Pericarditis ... ... 2 ... ... 1 ... ... 2 ... ... 5 30 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Hypertrophy of Heart ... ... ... ... ... ... ... 2 2 ... ... 4 Angina Pectoris ... ... ... ... ... 2 1 ... 4 1 ... 8 Dilatation of Heart ... ... ... ... ... 1 3 8 5 4 ... 21 Fatty Degeneration of Heart ... ... ... ... ... 1 5 15 8 14 3 46 / Syncope Heart Dis. (not specified) ... 1 ... ... 3 ... ... 5 6 4 2 21 Disease of Blood Vessels. 319 Cerebral Haemorrhage, Emb., Throm. ... 1 1 2 1 4 14 29 41 13 6 112 Apoplexy, Hemiplegia ... ... ... ... ... ... 5 9 11 10 3 38 Aneurysm ... ... ... ... 1 1 ... 7 1 ... ... 10 Senile Gangrene ... ... ... ... ... ... ... ... 4 3 2 9 Embolism, Thrombosis (not Cerebral) ... ... ... 1 1 ... ... 1 1 ... ... 4 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... Varicose Veins ... ... ... ... ... ... ... ... ... ... ... ... Blood Vessels, other Diseases ... ... ... ... ... ... ... ... 1 1 ... 2 Arteriosclerosis ... ... ... ... ... ... 3 5 14 17 7 46 Disease of Respiratory Organs. 221 Laryngitis 3 ... ... ... ... ... ... ... ... ... ... 3 Membranous Laryngitis (not Diphtheritic) ... 1 ... ... ... ... ... ... ... ... ... 1 Croup (not Spasmod. or Membr.) ... ... ... ... ... ... ... ... ... ... ... ... Larynx. other Dis. (not specified) ... ... ... ... ... ... ... ... ... ... ... ... 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. Bronchitis 37 6 4 ... 2 2 19 34 75 71 31 281 Lobar (Croupous) Pneumonia 2 2 2 4 5 9 6 9 4 2 1 46 Broncho, Catarrhal, Lobular Pneumonia 72 37 7 2 1 3 7 4 7 5 1 146 Pneumonia 10 16 2 5 9 8 14 20 17 5 1 107 Emphysema, Asthma ... ... 1 ... 1 2 1 3 6 3 1 18 Pleurisy 1 ... ... ... 1 ... 3 1 3 ... ... 9 Fibroid Dis. of Lung ... ... ... ... ... ... ... ... ... ... ... ... Respiratory Dis., other ... 3 1 ... ... 2 1 1 1 ... ... 9 Disease of Digestive System. 620 Tonsilitis, Quinsey ... ... ... ... ... ... ... ... ... ... ... ... Mouth, Pharynx, Dis. (not specific) ... ... ... ... ... ... ... ... ... ... ... ... Gastric Ulcer ... ... ... ... 8 4 5 3 4 ... ... 24 Gastric Catarrh 6 ... ... ... 1 ... ... 1 1 2 ... 11 Stomach, other Dis. (not Malig.) 1 ... ... ... ... ... 1 ... ... 1 ... 3 Enteritis 16 4 ... ... ... ... 1 2 1 ... ... 24 Gastro-Enteritis 26 6 1 ... ... ... ... 1 ... 1 ... 35 Appendicitis, Perityphilitis ... 2 4 3 3 4 ... 3 1 ... ... 20 Hernia 1 ... ... ... ... ... 2 4 1 4 ... 12 Intestinal Obstruction 1 1 ... 1 1 1 ... 4 1 3 ... 13 Other Dis. of Intestines ... ... ... ... ... ... ... ... 2 ... ... 2 Peritonitis (not Puerperal) ... ... 1 1 ... 2 1 3 ... ... ... 8 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. Cirrhosis of Liver ... ... ... ... 1 6 12 12 6 ... 1 38 Liver and Gall Bladder, other Diseases ... 2 1 ... ... 3 3 3 3 1 ... 16 Digest. Syst., other Diseases 1 ... ... ... ... 1 ... 1 ... ... ... 3 Lymph Disease. 209 Spleen Disease ... ... ... ... ... ... ... ... ... ... ... ... Lymph System, other Diseases ... ... ... 1 ... ... ... ... ... ... ... 1 Thyroid Body Disease ... ... ... ... ... 1 1 1 ... ... ... 3 Supra Renal Capsules Disease ... ... ... ... ... 1 ... 1 ... ... ... 2 Disease of Urin. Syst. 6 Nephritis, Acute ... 1 1 1 1 1 2 1 ... ... ... 8 Chronic Bright's Dis., Albuminura ... ... ... 2 3 11 25 21 17 8 2 89 Calculus (not Biliary) ... ... ... ... ... ... ... ... ... ... ... ... Bladder and Prostate Dis. ... ... ... ... ... 1 ... 1 5 5 1 13 Urin. Syst., other Dis. ... ... ... ... 2 1 1 3 2 2 ... 11 121 Disease of Gener. Syst. Ovarian Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Ovary ... ... ... ... ... 1 ... ... ... ... ... 1 Uterinal Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Uterus and Vagina ... ... ... ... ... 1 ... ... ... ... ... 1 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. Disorders of Menstruation ... ... ... ... ... ... 1 ... ... ... ... 1 Gener. and Mam. Orgs., other Dis. ... ... ... ... ... ... ... ... ... ... ... ... Accidents Childbirth. 3 Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... 1 2 1 ... ... ... ... ... 4 Placenta Prævia, Flooding ... ... ... 1 ... 2 ... ... ... ... ... 3 Other Accid. of Preg. and Childbirth ... ... ... ... 1 ... ... ... ... ... ... 1 Joint Disease. 8 Caries, Necrosis ... ... 2 1 ... ... 1 1 ... ... ... 5 Anthritis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Locom. Syst. ... 1 ... ... ... ... ... ... ... ... ... 1 Skin Disease. 6 Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus 1 ... ... ... ... ... ... ... ... ... ... 1 Skin Disease, other ... ... ... ... ... ... ... ... ... ... ... ... Ill-Defined Causes. 1 Atrophy, Debility, Marasmus 67 4 ... ... ... ... ... ... ... ... ... 71 Old Age ... ... ... ... ... ... 1 22 66 46 135 Dropsy, Ascites ... ... ... ... ... 1 1 ... ... ... ... 2 Tumour ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause unascertained) ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Causes 1 ... ... ... ... ... ... ... ... ... ... 1 Causes not Specified ... ... ... ... ... ... ... ... ... ... ... 209 Totals 549 242 106 113 175 219 324 417 453 332 124 3,054 C 34 SPECIFIC INFECTIOUS DISEASE. During the year 1913 there were 1,126 cases of acute infectious disease compulsorily notified in the Borough ; of these 81 were found subsequently not to be suffering from infectious disease, thus reducing the number of genuine cases to 1,045. This total shows an increase of 21 cases upon the total notified during 1912. The attack-rate in respect of the acute notifiable infectious diseases for the year is therefore 4.7 per 1,000 persons living. In addition, I received 681 notifications of pulmonary tuberculosis and 253 notifications of other forms of tuberculosis. The deaths from the chief zymotic diseases numbered 255. This is equal to a zymotic death-rate of 1.1 per 1,000 living in the Borough. A.—NOTIFIABLE INFECTIOUS DISEASES (ACUTE). Small-pox.—No case of this disease was notified in the Borough during 1913. Scarlet Fever or Scarlatina.—The number of cases of this disease notified during the year was 807, but of these 30 were afterwards found not to have suffered from this disease. The genuine cases therefore amounted to 777. This is an increase of 271 cases upon the genuine cases notified during 1912. On reference to the chart given with this report, it will be noted that a slight rise in the incidence of this disease took place in the beginning of May which was maintained until the end of August. In the second week of September a considerable rise took place which increased during the months of October, November and December; but fell, however, almost to normal in the last week of December. The rise began as usual early in the month of September. The attack-rate for 1913 is 3.4 per 1,000 persons living. The number of cases of scarlet fever removed to hospital during the year was 747. This is equal to 92 per cent. of the total notified. Chart showing the number of cases of Scarlet Fever, Diphtheria and Enteric Fever weekly during 1913. 35 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. 130 250 225 202 Attack-rate per 1,000 living. 2.4 4.6 4.0 3.5 It will be seen from the above that scarlet fever was most prevalent in the central sub-district. The deaths from scarlet fever during 1913 numbered 11, which is equal to mortality rate of 14 per 1,000 attacked, and .05 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 317 cases of diphtheria and 9 cases of membranous croup notified during the year; but of these 43 cases of diphtheria and 1 case of membranous croup were found subsequently not to be suffering from this disease, thus reducing the total genuine cases of diphtheria in the Borough to 282. This is an increase of 63 upon the number of cases which occurred during 1913. The chart shows the incidence of the disease in the Borough during the year, and shows how the disease increased and decreased in a characteristic manner with scarlet fever. There were 284 cases of diphtheria and membranous croup removed to hospital during 1913. This is equal to 87 per cent. of the total cases notified. c 2 36 The following table shows the distribution of the cases of this disease in the different sub-districts of the Borough during 1913 Sub-Districts. North. Central. South-West. South-East. No. of Cases of Diphtheria and Membranous Croup. 90 53 906 77 Total attack-rate per 1,000. 1.6 .97 1.8 1.3 From the above it will be seen that diphtheritic disease was almost equally prevalent in each of the districts of the Borough. The deaths from diphtheria and membranous croup during the year numbered 11. This is equivalent to a mortality-rate of 4 per cent. attacked and .05 per 1,000 living. The death-rate from diphtheria for London during the same period is .09 per 1,000 living. During the year 345 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically examined, 87 of which gave positive results, 255 negative results, and 3 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 1913, 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 antitoxin of 2,000 units each supplied during the year to medical practitioners, of which 3 were for curative treatment and 16 for prophylaxis. Typhoid or Enteric Fever.—During the year under consideration, 39 cases of this disease were notified, but of these 6 were subsequently found not to be suffering from enteric fever, thus reducing the number of genuine cases to 33. This is an increase of 37 9 on the number of genuine cases notified during 1912. The attack-rate for 1913 is, therefore, "14 per 1,000 living. Of the 39 cases notified, 34 were removed to hospital. This is equal to 87 per cent. of the total notified. It will be seen from the chart that the bulk of the cases occurred during the last five months of the year. The table below gives the distribution of the notified cases in the sub-districts of the Borough Sub-Districts. North. Central. South-West. South-East. No. of Cases of Typhoid. 8 8 3 20 Attack-rate per 1,000 living. .14 .14 .05 .35 From this table it is evident that most of the cases occurred in the south-east sub-district. Amongst the above cases were 6 which occurred amongst the members of one family. This family consisted of the father, a worker in a saw mill, mother, engaged at home in domestic affairs, and 6 children. The family occupied a tenement of three rooms. The following gives in tabular form the circumstances of the six cases. Enquiries as to the source of infection in the first case, that of Henry R., did not reveal anything definite. Fried fish had been consumed as well as watercress, by Henry and other members of the family, but these articles had been obtained from various sources, and they had been consumed by the parents as well as the children. The cases occurring subsequent to Henry appear to me, considering the necessarily close association of the members of the family in a three-roomed tenement, to have arisen by contact infection from Henry. Arthur and Ernest slept in the same bed 38 with Henry from 21st August, 1913, to 11th September, 1913, a period during which Henry was suffering from enteric fever but unrecognised. This fact alone is sufficient, in my opinion, to account for the subsequent cases in the family. CASES OF ENTERIC FEVER AT 23, PRINCE EDWARD ROAD. Date of Notification. Name. Age. Sex. Address. Date of beginning of illness. Date of removal to Hospital. Home circumstances. Years. 15.9.13 Henry, R. 13 M 23, Prince Edward Road 21.8.13 11.9.13 Henry slept in the same bed with 9.10.13 Arthur, R. 14 M. 21.9.13 1.10.13 Arthur and Ernest. May slept with her 13.10.13 Ernest, R. 11 M. 1.10.13 8.10.13 Mother. Sussannah and Catherine slept 16.10.13 May, R. 3 F. 1.10 13 8 10.13 together in same bed. 16.10.13 Sussannah, R 7 F 1.10.13 8.10.13 16.10.13 Catherine, R. 9 F. 1.10.13 8.10.13 39 The deaths from enteric fever in the Borough last year numbered 4. This is equal to a mortality-rate of 12.1 per cent. attacked and .018 per 1,000 living. During 1913 specimens of blood from 28 persons suspected to be suffering from enteric fever were submitted to Widal's test. Of these, 16 gave a positive and 12 a negative reaction. The mortality for all London for the same period is .02 per 1,000 living. Continued Fever.—One case of fever under this name was notified during 1913. Typhus Fever.—No case of typhus fever was notified in Hackney during last year. Puerperal Fever.—There were 19 cases of puerperal fever notified in the Borough during 1913, of which 13 were removed to hospital. The deaths from puerperal septicaemia numbered 6. The attack-rate for the year was 3.4 per 1,000 births, and the death-rate 1.1 per 1,000 births. Plague.—No case of plague occurred in the Borough during last year. Erysipelas.—There were 178 cases of erysipelas notified during 1913. This is equivalent to an attack-rate of .8 per 1,000 living. Of the 178 cases notified, 29 were removed to hospital. The deaths from erysipelas numbered 7. This gives a mortalityrate of 4 per cent. attacked and .03 per 1,000 living. The following table shows the distribution of the disease in the sub-districts of the Borough:— Sub-Districts. North. Central. South-West. South-East. No. of Cases of Erysipelas. 35 31 50 62 Rate per 1,000 living. .64 .58 .80 1.1 40 Cerebro-spinal Fever (Epidemic Cerebro-spinal Meningitis).— During 1913 there were 7 cases of this disease notified in the Borough. Of these 6 were removed to hospital. The whole of the 7 cases were fatal. Poliomyelitis or Polio-encephalitis.—There were 15 cases of this disease notified during 1913 in the Borough. Of these 8 were removed to hospital. Of the total cases notified, 3 proved fatal. The remainder recovered with some impairment of one or other group of muscles. Ophthalmia Neonatorum.—During the year there were 28 cases of this disease notified in the Borough. Four of these cases were removed to hospital. All the cases recovered without any impairment of sight. Glanders, Anthrax, and Hydrophobia in Man.—No case of these diseases was notified in Hackney during 1913. B. NON-NOTIFIABLE DISEASES. Influenza.—During 1913 there were 29 deaths in the Borough registered as due to influenza. This is an increase of 12 on the deaths registered during 1912. The death-rate from influenza is therefore .13 per 1,000. Diarrhoea.—There was a considerable increase in the prevalence of diarrhoea in Hackney during 1913. The total number of deaths registered from this cause was 87, compared with 36 during 1912, thus showing an increase of 51. There were also 59 deaths ascribed to enteritis. The annual mortality for 1913 from diarrhoea and enteritis is .57 per 1,000 living. The above increase in the mortality from diarrhoea and enteritis during 1913 was no doubt due to the high temperature maintained during the summer, especially during the third quarter. 41 The distribution of this disease in the Borough may be seen fiom the following table:— Sub-Districts. North. Central. South-West. South-East. No. of Deaths from Diarrhoea and Enteritis. 11 33 54 48 Death-rate per 1,000 living. .2 .5 .9 .8 Measles.—This disease was more prevalent during 1913 than during the previous year, the deaths during last year being 63, which is an increase of 50 upon the number registered during 1912. No less than 58 of these deaths occurred amongst children under 4 years of age. The annual mortality for 1913 from measles is .3 per 1,000 living, and that for all London is .34 per 1,000 living. The following table shows 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. 10 16 14 23 Mortality-rate per 1,000 living. .18 .30 .24 .40 I received information of 1,180 cases of measles during the year from headmasters and mistresses occuring amongst the scholars of elementary schools in the Borough. There were 184 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 478 42 cases of whooping-cough occurring amongst their scholars during 1913. There were 21 deaths registered from this cause during the same period. This is a decline of 11 on the number registered during 1912, and is equal to a mortality of .1 per 1,000. The death-rate for all London from this disease for the same period is "17 per 1,000 living. The number of cases of whooping-cough removed to the Metropolitan Asylums Board's hospitals during the year was 33. 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 3 9 5 Mortality-rate per 1,000 living. .07 06 16 .09 CONSTITUTIONAL DISEASES. Tuberculosis.—During 1913, I received 934 notifications of tuberculosis, details of which are given on page 63 of this Report. Bacteriological examination of sputa from 444 cases was made during the same period. In 79 of these examinations, the specific organism of the disease was discovered, in 365 cases the result of examination was negative. The number of deaths from tuberculous disease in Hackney during 1913 was 332, 3 decrease of 23 upon the deaths during the previous year. These deaths are classified as follows:— Tuberculous phthisis 214 Phthisis 36 General tuberculosis 24 Tuberculous meningitis 26 Tuberculous peritonitis 11 Tabe mesenterica 13 Tubercle of other organs 8 332 43 This number of deaths gives an annual mortality of T48 per 1,000 living. This death-rate from tuberculous disease is very high; but it is interesting, and at the same time gratifying, to know that it is a progressively declining rate. In order to show this fact, I have extracted the yearly deaths from this disease for the last 15 years, and grouped them in periods of three years as under:— Three Year Periods. Annual average number of deaths from Tuberculous Disease. Percentage decrease on the period 1898-1900. 1898-1900 483 — 1901-1903 452 6.4% 1904-1906 417 13.7% 1907-1909 382 21.0% 1910-1912 363 24.8% 1913 332 31.3% It will be seen from this that the average annual number of deaths from tuberculosis has progressively decreased during the period in question, the decline from the period 1898-1900 to 1913 being equal to 313 per cent. There is ample reason to hope that with the advent of co-ordinated measures for the treatment of this disease, the decline in the mortality in future years will be greater. 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. 61 75 93 97 Mortality-rate per 1,000 living. 1.1 1.2 1.7 1.7 44 Cancer.—There were 250 deaths during 1913 due to the different varieties of malignant disease. This is an increase of 37 on the number registered during 1912. The annual mortality-rate from malignant disease for last year is therefore 1.11 per 1,000 living. The following table gives the distribution of the deaths from this disease in the differenet sub-districts of the Borough:— Sub-districts. North. Central. South-West. South-East. No. of Deaths from Cancerous Disease. 62 49 72 67 Mortality-rate per 1,000 living. 11 90 1.2 1.1 Below is given a table showing the number of deaths and death rates in this Borough during the ten years ending 1913:— Borough of Hackney. Years. 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 Deaths from Cancer. 182 203 175 198 225 214 222 217 213 250 Death-rate per 1,000. .80 .90 .75 .91 .96 .91 .93 .97 .95 1.11 London. Death-rate per 1,000. .99 1.00 1.05 1.03 1.06 .96 .94 1.05 1.11 — ALCOHOLISM. During the year under consideration there were 2 deaths from acute alcoholic poisoning; there were also 38 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. 45 VACCINATION. Appended is a summary of the proceedings under the Vaccination Acts, during the year 1913. 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 5,652 and the number of vaccination certificates received during the same period 2,100. This latter is equal to 40 per cent. of the births, leaving 60 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 2,671 52% 1,475 1912 5,437 2,272 58% 1,833 1913 5 652 2. ion 60% 2.073 46 Summary of Proceedings under the Vaccination Acts, 1867 to 1898, during the year 1913. 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 1,031 488 102 - - 386 - 20 30 330 Central 1,401 489 22 - 1 621 - 28 64 457 South-East 1,494 422 56 - - 548 2 35 93 536 South-West 1,726 701 46 - 1 518 1 237 103 521 Total 5,652 2,100 226 - 2 2,073 3 320 290 1,844 47 PUBLIC HEALTH (LONDON) ACT, 1891. (а) Complaints of Nuisances.—During the year 1913 there were 2,437 complaints of nuisances made to the Public Health Department and investigated by the Sanitary Inspectors of the Borough. Defects or nuisances were discovered in 1,869 of the complaints. Notices for the remedy or abatement of these were served upon the owner or person responsible under the above Act. (b) Infectious Disease.—The occupied dwellings inspected during the year after infectious disease numbered 2,127. This is an increase of 331 upon the number inspected during 1912. Any nuisances or sanitary defect found were dealt with under the provisions of the above Act. (c) House-to-House Inspections.—The number of house-tohouse inspections made by the Inspectors during the year was 1,383. These inspections are in addition to those made under (a) and (b), and exclusive of inspections made under the Housing, Town Planning Act, 1909. The nuisances or sanitary defects found were dealt with in the same manner as those under (a) and (b). 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 1913 was 4,852. The number of statutory notices served were 230 ; and summonses were issued in 4 cases. The following details relate to house-to-house inspections made by the special inspectors engaged for this work. House-to-House Inspections, 1913. No. 7 District. Inspector—W. C. Vobe. Number of premises inspected 169 Number of premises on which nuisances found 133 Intimation notices served 136 Statutory notices served 3 48  Found. Abated. In hand. Outstanding. The house or part in a dirty condition 80 65 10 5 „ „ damp „ 27 24 2 1 „ „ dilapidated „ 53 48 3 2 „ „ dangerous „ 22 20 1 1 „ „ verminous„ 7 7 — — The inlet to the surface drain improperly trapped 1 - - 1 The w.c. so foul as to be a nuisance 3 3 — — „ without a water supply 2 2 — — „ with a deficient supply of water 5 5 - - „ so defective as to be nuisance 11 10 - 1 „ choked 4 4 — — The soil pipe defective 5 3 — 2 „ unventilated 2 1 — 1 „ improperly ventilated 3 — 1 2 Yard paving defective 14 11 2 1 Gully traps improperly placed within the building 4 2 - 2 The sink waste connected directly with the drain 11 6 2 3 „ improperly ing 4 1 2 1 „ untrapped 3 2 1 — „ defective 4 4 — — Lavatory waste choked 1 1 — — No dustbin or dilapidated dustbin 15 12 — 3 The drain defective 31 8 3 20 „ choked 5 5 — — The rain water pipe connected directly with the drain 1 1 - - The rain water pipe defective 15 13 2 — 49  Found. Abated. In hand. Outstanding. The roof defective 25 20 4 1 The gutter defective 15 12 2 1 The area paving defective 3 — — 3 Washhouse paving defective 4 2 2 — The house or part overcrowded 1 1 — — Scullery roof defective 17 15 2 — W.C. roof defective 10 8 2 — Ventilation shaft defective 4 2 1 1 Smoke nuisances from defective coppers, &c. 2 2 - - House-to-House Inspection, 1913.—Homerton District. Inspector—Jas. W. Hall. Number of premises inspected 195 Number of premises inspected in which nuisances were found 185 Number of intimation notices served 230 Number of statutory notices served 3 Found. Abated. In hand. Outstanding. The house or part in a dirty condition 124 94 9 21 „ „ damp „ 56 47 5 4 „ „ dilapidated „ 69 51 8 10 „ „ verminous „ 53 39 6 8 The w.c. in a defective condition 20 18 — 2 „ „ foul condition 2 2 — — „ without a water supply 2 1 1 — „ with a deficient water supply 8 8 — — „ stopped 5 5 — — „ without external ventilation 3 3 — — The soil or drain ventilation pipe defective 15 11 3 1 Yard paving defective 42 26 2 14 Drain openings within premises 2 1 1 — D 50  Found. Abated. In hand. Outstanding. Sink wastes untrapped 15 5 — 10 „ defective 12 5 — 7 Foul water cisterns 13 4 — 9 Water cisterns without proper covers 3 1 — 2 Dustbins defective 38 28 1 9 Drains defective 32 26 2 4 Drain in a choked condition 2 2 — — „ unventilated 1 1 — — Rainwater pipe defective 25 17 3 5 Roof defective 68 59 4 5 Guttering defective 37 18 9 10 Front area paving defective 7 4 3 — Scullery or paving of washhouse defective 14 8 3 3 Animals improperly kept 7 12 1 4 The space under ground or basement floor insufficiently ventilated 26 13 1 6 Living rooms without direct external ventilation 5 5 - - Sundry defects 15 12 1 2 House-to-House Inspections, 1913.—No. 11 District. Number of premises inspected 89 Number of premises inspected in which nuisances were found 5& Number of intimation notices served 56 Found. Abated. The house or part in dirty condition 31 31 „ „ dilapidated condition 9 9 „ „ damp condition 13 13 The w.c. so foul as to be a nuisance 7 7 „ without a water supply 3 3 „ improperly constructed 2 2 „ so defective as to be a nuisance 3 3 51  Found. Abated. The w.c. stopped 2 2 „ improperly placed 1 1 „ insufficiently ventilated 4 4 The soil pipe defective 4 4 „ unventilated 1 1 „ improperly ventilated 2 2 The yard in dirty condition, want of paving 7 7 „ „ and undrained 4 4 The waste pipe of sink connected with drain 2 2 „ „ defective 3 3 The bath waste untrapped 1 1 The want of proper dustbin 16 16 The dustbin defective 10 10 The drain choked and defective 19 19 The rain water pipe defective 7 7 The house without water supply 4 4 The roof and gutters defective 21 21 The washhouse paving defective 6 6 The bakehouse walls and ceiling dirty 1 1 Animals improperly kept 8 8 The house overcrowded 7 7 The ground floor unventilated 1 1 Articles of Food seized or surrendered as Unfit for Food.— During the year the following articles of food were seized, by the Inspectors, or surrendered as being unfit for food, viz.:— 6 cwt. 21 lbs. meat; 10 cwt. 1 qr. 6 lbs. fish; 12 cwt. 3 qrs. 1 lb. fruit and vegetables ; 1 cwt. 3 qrs. 20 lbs. tinned foods. COWHOUSES, DAIRIES AND MILKSHOPS. (a) Cowhouses.—At the end of 1913 there were 14 licensed cowkeepers in the Borough, with 16 sheds. This is a decrease of 2 sheds on the number licensed at the end of 1912. Inspector Bobbitt reports that he made 200 inspections of these, and found D 2 52 it necessary to serve 4 notices for repairs, which notices were immediately complied with. On 13th September the Public Health Committee made their annual visit to the cowhouses in the Borough. These were found in the main to be in a satisfactory condition. The paving was found to be defective in two cases; cleansing was required in four others. In another case fowls were being kept in a cowhouse. These matters were remedied on service of a notice. (b) Dairies and Milkshops.—During the same period 13 milk premises were removed from the Register and 13 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 49 instances. Inspector Bobbitt reports that he made 1,890 visits of inspection to these premises during the year. He served 10 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 Inspector Bobbitt 11 times. He reports that on these occasions he always found the premises in a satisfactory condition. Slaughterhouses.—The number of licensed slaughterhouses in the Borough at the end of 1913 was 20. One had been removed from the Register during the year. Inspector Bobbitt reports that he made 354 visits of inspection to these during that period and always found them in a satisfactory condition. During his visits to the slaughterhouses, which were always made on slaughtering days, the Inspector examined the carcases and organs of 166 oxen, 2,134 sheep and lambs, 6 calves and 35 pigs, and found the following parts and organs diseased, viz.:— 1 carcase of ox with all organs affected with Tuberculosis. Forequarters, heart, head and liver of ox affected with Tuberculosis. 8 ox and 7 sheep livers affected with Distomatosis. 3 ox livers affected with Abscess. 8 sheep plucks affected with Parasitic Cysts. 53 On September 13th the Public Health Committee made their annual visit to the slaughterhouses of the Borough. These were all found in a satisfactory condition, with the exception of two, where the paving was defective, and another which was dirty. The following statement refers to the milk places, cowsheds, slaughterhouses and offensive trades in the Borough:— Premises. Number of Places. Number of Inspections, 1913. Number of Notices, 1913. Number of Prosecutions. On Register at end of 1912. Added in 1913. Removed in 1913. On Register at end of 1913. Milk premises 315 13 13 315 1,890 10 — Cowsheds 18 — 2 16 200 4 — Slaughter-houses 21 — 1 20 354 — — Other offensive trade premises 1 — — 1 11 — — Preserved Provision Factories.—There were 2 wholesale preserved provision and 2 black pudding manufacturers in the Borough at the end of 1913. Inspector Bobbitt reports that he made 31 visits to these, and examined the various pieces of meat being used, and found them all to be sound and free from disease. Smoke Nuisances.—The Smoke Inspector made 1,079 observations of chimneys of factories, workshops and other places in the Borough during the year. These observations lasted from half-anhour upwards. Intimation notices in connection with this nuisance were served to the number of 58. Water Supply.—Under Section 48 (2) of the Public Health (London) Act, 1891, there were 25 certificates of proper and sufficient water supply issued to owners of new or rebuilt dwellinghouses in the Borough. These certificates refer to 52 houses. 54 Bye-laws for Houses Let in Lodgings.—The total number of these houses on the Register at the end of 1912 was 469. All of these, which were occupied, were inspected during the year 1913. The following sets out in detail the results of the inspections made, &c.:— HOUSES LET IN LODGINGS. 1913. No. 7 District. No. on register at end of 1913 243 No. of premises inspected (1 empty) 242 No. of premises on which nuisances found 152 „ „ „ abated 152 Intimation notices served 158 Statutory notices served 3 Found. Abated. The house or part in a dirty condition 120 120 „ „ damp condition 15 15 „ „ dilapidated condition 58 58 „ „ dangerous condition 13 13 „ „ verminous condition 8 8 The w.c. so foul as to be a nuisance 3 3 „ without a water supply 3 3 „ with a deficient supply of water 13 13 „ so defective as to be a nuisance 5 5 „ choked 6 6 Yard paving defective 12 12 The sink waste defective 2 2 The ventilation shaft defective 2 2 No dustbin or dilapidated dustbin 12 12 The drain choked 1 1 The rainwater pipe choked 2 2 The rainwater pipe defective 6 6 The roof defective 33 33 The gutter defective 8 8 55  Found. Abated. Wash-house paving defective 3 3 The house or part overcrowded 2 2 An underground room occupied as a dwelling contrary to the provisions of the Act 1 1 The space beneath the ground floor insufficiently ventilated 1 1 Scullery roof defective 17 17 The w.c. roof defective 5 5 Scullery sink defective 1 1 Smoke nuisances from defective coppers, &c. 4 4 No. 11 District. No. on register at end of 1913 226 No. of premises inspected 175 „ empty 51 „ nuisances found 61 „ „ abated 61 No. of intimations served 61 Found. Abated. The house or part in dirty condition 51 51 „ dilapidated condition 8 8 The w.c. foul 13 13 „ without water supply 4 4 „ defective 8 8 „ so defective as to be a nuisance 5 5 „ stopped 2 2 „ soil pipe unventilated 3 3 The yard dirty 10 10 The water cistern foul 2 2 The sink waste pipe connected 4 4 No dustbin 19 19 The drain foul 5 5 The drain choked 12 12 The rain water pipe defective 13 13 56  Found. Abated. The house without water supply 3 3 The roof defective 21 21 The gutters defective 31 31 The wash-house paving defective 7 7 Animals improperly kept 5 5 The house overcrowded 22 22 No ventilation under ground floor 7 7 The following Bye-law was made by the London County Council on the 15th April, and allowed by the Local Government Board 11th July, 1913:— Bye laws made by the London County Council under the Public Health (London) Act, 1891. Bye-laws under Section 39 (1). With respect to Water-closets, Earth-closets, Privies, Ashpits, Cesspools and Receptacles for Dung, and the proper accessories thereof, in connection with buildings, whether constructed before or after the passing of this Act. Bye-law made by the Council defining the person responsible under the Bye-laws made in pursuance of the provisions of Section 39 (1) of the Public Health (London) Act, 1891, in so far as they relate to the construction of any Water-closet, Earthcloset, Privy, Ashpit, Cesspool or Receptacle for Dung, and the proper accessories thereof. Notwithstanding anything contained in the Bye-laws made by the London County Council in pursuance of the provisions of Section 39 (1) of the Public Health (London) Act, 1891, in the case of the construction of any Water-closet, Earth-closet, Privy, 57 Ashpit, Cesspool or Receptacle for Dung and the proper accessories thereof, the builder shall observe all the requirements contained in the said Bye laws, and he shall be liable to the penalties provided for a breach of the said Bye-laws. Provided that this Bye-law shall not remove or interfere with any of the obligations which have been specifically imposed by the said Bye-laws upon the owner or occupier of any premises. In this Bye-law "builder" means the builder, contractor or person actually carrying out the work, but does not include a workman in the employ of such builder, contractor or person. CUSTOMS AND INLAND REVENUE ACT, 1890. The following is a list of premises which I inspected during the year 1913, 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. 25 and 26, Gore Road 2 16, Stamford Road 3 109, Chatsworth Road 4 183, Evering Road 2 Clevedon House, Clevedon Street 12 106, Greenwood Road 2 7a, 7b, 10a, 10b, 13a and 13b, Market Parade, Stamford Hill 6 CANAL BOATS ACT, 1877-1894. The Canal Boats Inspector reports that he made 80 visits to the waterways in the Borough during 1913, and inspected 23 boats (luring that period. No infringements of the Canal Boats Acts or Regulations were observed on these visits. A copy of the Inspectors' report will be found in the Appendix to this Report. 58 ICE-CREAM VENDORS. At the end of 1913 there were 198 ice-cream vendors in the Borough, an increase of 8 on the number present at the end of 1912. These were all inspected during the past year. Sanitary defects were found on 21 of these premises, which were remedied by the service of intimation notices. GLANDERS AND FARCY ORDER, 1907. No notification of glanders or farcy in animals in the Borough was received from the Veterinary Inspectors of the London County Council during 1913. DISEASES OF ANIMALS ACTS.—ANTHRAX ORDER OF 1910. No notification of the existence of Anthrax in the Borough was received. HOUSING OF THE WORKING CLASSES ACTS, 1890-1903. No representation was made nor action taken under the above Acts during the year 1913. HOUSING, TOWN PLANNING, &c., ACT, 1909. In accordance with a resolution passed by the Public Health Committee, and approved by the Borough Council, I submitted to the Committee, during the year 1913, the under-mentioned lists of houses which, in my opinion, should be inspected under Section 17 of the above Act, viz.:— April 17th.— Nos. 5, 21, 23, 33, 35, 37, 39, 49, 55, 57, 59, 61 63, 2, 4, 10, 18, 24, 30, 40, 42, 48, 50, 58 and 60, Holmbrook Street. April 17th.—Nos. 1, 5, 6, 7, 8, 9, 11, 12, 14, 15, 17, 18, 19, 23 and 24, Crozier Terrace. 59 Nos. 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 59, 63, 69, 71, 75, 77, 79, 81, 83, 85, 87, 91, 95, 97, 99, 101, 157, 159, 165, 167, 2, 8, 12, 14, 16, 18, 20, 26, 30, 34, 36, 40, 56, 62, 66, 74, 84, 86, 90, 94, 96, 100, 104, 106, 108, 114, 116, 118, 124, 134, 140, 150, 156 and 160, Mandeville Street. Of these premises 88 were inspected during the year by Sanitary Inspector Hall under my supervision, and notices were served as provided by the Act for any defects found. The following] table gives information respecting the inspection of the above dwelling-houses as required by Article V. of the Regulations made under Section 17 (1) of the Housing, Town Planning, &c., Act, 1909. 1. Number of dwelling-houses inspected under and for the purposes of Section 17 of the Housing, Town Planning, &c. Act, 1909 90 2. The number of dwelling-houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 3. The number of representations made to the Local Authority with a view to the making of closing orders 2 4. The number of closing orders made 2 5. The number of dwelling-houses the defects in which were remedied without the making of closing orders 88 6. The number of dwelling-houses which after The above two the making of closing orders were put into were converted fit state for human habitation. into workshops. 7. General character of the defects found to exist. 60 Number of premises where the conditions were found to be satisfactory or otherwise under the following heads:- Holmbrook Street, Crozier Terrace, and Mandeville Street (part). Satisfactory. Unsatisfactory. 1. The arrangements for preventing the contamination of the water supply 88 - 2. Closet accommodation 88 — 3. Drainage 82 6 4. The condition of the dwellinghouse in regard to light, the free circulation of air, dampness, and cleanliness 3 85 5. The paving, drainage, and sanitary condition of any yard or outhouse belonging to or occupied with the dwelling-house 26 62 6. The arrangements for the deposit of refuse and ashes 63 25 7. The existence of any room which would, in pursuance of Subsection (7), be a dwelling-house so dangerous or injurious to health as to be unfit for human habitation 88 - 8. Any defects in other matters which may tend to render the dwelling-house dangerous or injurious to the health of the inhabitants 71 17 On the 4th December, 1913, I represented to the Public Health Committee, under Section 17 of the Housing, Town Planning, &c., Act, 1909, the following premises, viz., 1 and 2, Cross Road Mews, owing to their dilapidated and filthy condition, to be in a state 61 so dangerous or injurious to health as to be unfit for human occupation. Closing orders were subsequently made by the Borough • Council (15th January, 1914) and copies served upon the owner. Regulations under Section 17 (7) of the Housing, Town Planning, &c., Act, 1909. During the year regulations under the above Act were prescribed by the Borough Council and approved of by the Local Government Board. A copy of these regulations will be found in the Appendix to this Report. The River Lee. No serious complaints of nuisance from this river were received during the year. METHODS OF CONTROL OF TUBERCULOSIS. 1.—Notification. (a) Public Health (Tuberculosis) Regulations, 1908. During January, 1913, I received 45 notifications of tuberculosis under these regulations. Of these 29 were notifications of cases previously notified. (b) Public Health (Tuberculosis in Hospitals) Regulations, 1911. Under these regulations I received 32 notifications during January, 1913. Of this total 18? were duplication of cases previously notified. (c) Public Health (Tuberculosis) Regulations, 1911. Under these regulations I received 49 notifications of cases of tuberculosis during the month of January, 1913. Of these 12 were duplicates of cases previously notified. The following table gives the age and sex distribution of the 126 primary cases notified during January, 1913, under the above three series of regulations. 62 PULMONARY TUBERCULOSIS. Notifications received from 1st to 31st January, 1913. Regulation. Sex. Under 6 years. 5 to 15 years. 15 to 25 years. 25 to 35 years. 35 to 45 years. 45 years and upwards. Total prima y cases. Duplicate Certificates received. Total. Public Health (Tuberculosis) Regulations, 1908. Male. 2 1 2 4 2 3 14 20 34 45 Female. — — 1 — 1 — 2 9 11 Public Health (Tuberculosis in Hospitals) Regulations, 1911. Male. — 1 1 3 — 1 6 8 14 32 Female — 1 4 1 2 — 8 10 18 Public Health (Tuberculosis) Regulations, 1912. Male. 1 1 5 5 8 5 25 6 31 49 Female. — 2 5 — 2 3 12 6 18 Totals. Male. 3 3 8 12 10 9 45 34 79 126 Female. — 3 10 1 5 3 22 25 47 Of the above cases—22 died during the year, 9 in Hackney Infirmary, 2 in Hospital and 11 in their own homes. On the 1st February, 1913, the above three sets of regulations were superseded by a new set of regulations, viz.:—The Public Health (Tuberculosis) Regulations, 1912, dated December 19th, 1912. Whereas by the previous regulations only pulmonary tuberculosis was compulsorily notifiable, the Public Health (Tuberculosis) Regulations, 1912 require all forms of tuberculosis to be notified. These regulations also simplify the method of notification and revise the fees payable to medical practitioners. The following table gives the number, age and sex distribution with other details of the cases of tuberculosis notified during the eleven months ending 31st December, 1913. 63 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from 1st February to 31st December, 1913. Age periods. Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form D. Total Notifications received. Primary Notifications Total Notifications (i. e., including cases previously notified by other doctors). Primary Notifications. Total Notifications (i. e., including cases previously notified by other doctors). Law Poor Institutions. Sanatoria. Poor Law Institutions. Sanatoria. Under 5 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 and upwards. Total. Under 5. 5 to 10. 10 to 15. Total. Pulmonary—Males 6 23 59 84 59 72 303 410 1 2 2 5 5 47 68 31 70 631 „ Females ... 6 18 53 73 46 56 252 326 ... 1 1 2 3 32 49 15 45 470 Non-pulmonary—Males 24 45 14 11 3 4 101 111 ... 5 12 17 17 7 3 3 4 145 „ Females 17 28 30 7 4 9 95 108 ... 2 2 4 4 8 3 3 9 135 Totals 53 114 156 175 112 141 751 955 1 10 17 28 29 94 123 52 128 1381 Of the above cases 141 died during the year, 25 in the Infirmary, 34 in Hospitals and 82 in their own homes. 64 2.—Action taken during the Year.—This was practically the same as that taken during 1912, and may be summarised as follows: 1. Disinfection of rooms and articles infected by tuberculous patients. The number of such rooms disinfected during 1913 was 462. 2. Inspection of dwellings occupied by persons suffering from tuberculosis with a view to the removal of any condition likely to prejudice the patient or lead to the spread of the disease. 3. Instruction in the measures to be observed by the patient and relatives to prevent the spread of the disease. 4. The gratuitous supply of sputum flasks; the number of flasks thus supplied were 61. In the month of February, 1913, I presented a report on the provision of tuberculosis dispensaries for the Borough of Hackney. A copy of the report may be found in the Appendix. 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. The following Table gives the number of cases of tuberculosis notified respectively amongst Insured and Non-insured persons under the Insurance Act, 1911. National Insurance Act, 1911. Tuberculosis, 1913. Sex. Insured Cases. Non-Insured Cases. Percentage Insured. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male 228 23 160 114 59% 17% Female 105 21 188 95 36% 18% Total 333 44 348 209 49% 17% 65 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. *7 By grant of Indoor relief by Guardians and subsequent classification by Medical Officer. Yes. None to destitute persons. Liable relatives pay according to ability. (1) No. No. No. (2) No. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *1 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. *15 By grant of Indoor relief by Guardians and subsequent classification by Medical Officer. Yes. None to destitute persons. Liable relatives pay according to ability. No. No. No. (c) Advanced cases. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *46 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 *62 Sandgate *7 * These numbers are for the 18th April, 1914, and the number of beds available for Phthisical cases in the Hackney Union Infirmary is 88, but the number of beds available at Sandgate varies, as they are alloted as required. 66 PUBLIC HEALTH LEGISLATION. During the year 1913 certain Orders, Circulars, Letters and Memoranda bearing upon Public Health were issued to Local Authorities. The following are the chief of these:— Bye-laws. Bye-laws: Mortuaries, Model Clauses, issued by the Local Government Board, March, 1913. Factory and Workshop Act, 1901. Home Work Order of 20th January, 1913. The Housing of the Working Classes Acts, 1890 to 1909. Memorandum with respect to the provision and arrangement of houses for the working classes, 25th March, 1913. Circular. Receptacles for poisonous liquids intended to be used for the purpose of disinfection. Order in Council. Applying Section 5 of the Poisons and Pharmacy Act, 1908, to certain liquid preparations containing not more than 3 per cent, of phenols. Circular. Public Health: Epidemic Diarrhoea; Feeding of Infants; Notification of Births Act, 1907. Memorandum. Memorandum on the construction and arrangement of inex pensive buildings for Tuberculous patients. Local Government Board, February, 1913. The following also became law: The Public Health (Prevention and Treatment of Diseases) Act, 1913. 67 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) 45 3 ... Workshops (Including Workshop Laundries) 2,074 341 ... Workplaces (Other than Outworkers' premises included in Part 3 of this Report) ... ... ... Total 2,119 344 ... 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 253 261 ... ... Want of ventilation 30 28 ... ... Overcrowding 12 13 ... ... Want of drainage of floors 4 3 ... ... Other nuisances 100 89 ... ... Sanitary accommodation— Insufficient 2 I ... ... Unsuitable or defective 79 76 ... ... Not separate for sexes 13 10 ... ... Offences under the Factory and Workshop Acts:— 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 493 481 ... ... Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. E 2 68 3.—HOME WORK. Nature of Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices Served. Prosecutions. Instances. Orders Made (Section 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) Making, &c. 348 34 3,311 30 ... 173 355 ... ... ... ... ... ... ... ... (2) Cleaning and Washing 2 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... Household Linen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Curtains, and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 2 ... 12 ... ... ... 4 ... ... ... ... ... ... ... ... Electro-plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... File Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and Brass Articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur Pulling 8 ... 26 2 ... 6 14 ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. 2 ... 7 1 ... 2 2 ... ... ... ... ... ... ... ... Artificial Flowers 6 ... 41 2 ... 24 11 ... ... ... ... ... ... ... ... Nets, other than Wire Nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks 2 ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, PaperBags 24 ... 440 ... ... ... 13 ... ... ... ... ... ... ... ... Brush Making 22 ... 580 1 ... 2 20 ... ... ... ... ... ... ... ... Pea Picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather Sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of Buttons, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys 2 ... 25 ... ... ... 3 ... ... ... ... ... ... ... ... Basket Making 2 ... 3 ... ... ... 1 ... ... ... ... ... ... ... ... Chocolates and Sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 69 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 1,058 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (S. 133, 1901) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (S. 5,1901) Notified by H.M. Inspector 62 Reports (of action taken) sent to H.M. Inspector 62 Other Underground Bakehouses (S. 101):— Certificates granted during the year None. In use at the end of the year 51 70 Factories.—During the year 45 factories were inspected by the officers of the Public Health Department, three being factory laundries and forty-two factories in which articles of clothing, &c., were made and altered. In seven 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 7 5 - 2 7 Insufficient „ 1 - 1 1 1 Not separate for the sexes. 1 1 - 1 1 Workshops.—The number of workshops registered in Hackney at the end of 1913 was 1,058, a decrease of 13 on the number registered at the end of 1912. Of this total 793 were workshops in which females were employed. Of these latter 583 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, &c., 174 in which other articles were manufactured, &c., and 36 were domestic workshops. Amongst the workshops manufacturing wearing apparel there were 441 employing females alone, and 142 employing both males and females. In workshops of other occupations there were 112 employing females alone, and 62 employing both males and females. Of the domestic workshops, females alone were employed in 21 and both males and females in 15. During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints Factories 9 „ Workshops 53 Notices „ 99 71 ANALYSIS OF OCCUPATIONS CARRIED ON IN THE REGISTERED WORKSHOPS OF HACKNEY. (A) Wearing Apparel. Occupations. No. of Workshops. Occupations. No. of Workshops. Artificial Flower Makers 6 Hats 8 Baby Linen 2 Infants' Millinery 8 Beading 1 Mantles 57 Belts 3 Millinery 43 Blouses 38 Needlework 2 Boot and Shoe Manufacturers 78 Pinafores 3 Shirts 4 Boot Machinists 112 Skirts — Children's Costumes 16 Stays 7 Clerical Robes 1 Tailoring 55 Clothing 5 Ties 44 Collars 1 Trimmings 8 Dressmakers 100 Underclothing 18 Dressing and Tea Gowns 9 Vests 12 Fancy Bows on Shoes 4 Waterproofs 5 Fall Net Chenilling 1 701 Furriers 50 (b) Other Occupations. Bakers and Confectioners 28 Rubber Goods 5 Baskets 4 Toy Makers 2 Box Makers 16 Trunk and Bag Makers 5 Brush Makers 9 Umbrellas 2 Cabinet Makers 54 Upholsterers 12 Doll Manufacturers and Dressers 2 Upholsterers' Trimmings 3 Miscellaneous 101 Fancy Leather Goods 15 Laundries 84 357 Pianoforte Makers 15 Daring 1913, Miss Teebay, the Workshop Inspector, made 2,119 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections, 344 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:— 72 NUISANCES IN WORKSHOPS, 1913. Outstanding at end of 1912. Found in 1913. Outstanding at end of 1913. Abated in 1913. By Inspector of Workshops. By District Inspector. Total. Want of Cleanliness 50 253 39 261 3 264 Want of Ventilation 8 30 10 28 ... 28 Overcrowding 1 12 ... 13 ... 13 Wrant of Drainage of Floors ... 4 ... 3 1 4 Other Nuisances 12 100 7 89 16 105 Insufficient Sanitary Accommodation. ... 2 ... 1 1 2 Unsuitable or defective Sanitary Accommodation 6 79 1 76 8 84 No separate Sanitary Accommodation for sexes 2 13 5 10 — 10 73 Outworkers—The number of outworkers on the register at the end of 1913 was 2,451, against 2,559 at the end of 1912. There were thus 108 outworkers removed from the register during the past year. The following analysis shows the trades followed by these outworkers:— Trade. No. of Outworkers Trade. No. of Outworkers. Artificial Florist 31 Lace 1 Baby Linen 15 Millinery 198 Beading 7 Pinafores 1 Belts 28 Shirts 53 Blouses 116 Shoe Bows 9 Boots and Shoes 580 Skirts and Mantles 256 Boxes 189 Tailoring 161 Braces 3 Lampshades 1 Brushes 154 Ties 214 Children's Costumes 32 Trimmings 28 Collars and Bibs 11 Umbrellas 21 Corsets 1 Underclothing Upholsterer's Trimmings 115 Clothiers and Outfitters 62 6 Dolls 7 Vests 4 Dressing and Tea Gown 14 Wearing apparel (unclassified) 23 Fancy Goods 9 Feather sorting 1 Miscellaneous 18 Fur Trade 54 2,451 Haberdashery 10 Hats 43 The local authorities from which I have received names and addresses of outworkers during the year 1913, are the following:— Battersea 7 Paddington 6 Bethnal Green 310 Poplar 67 Bromley (Kent) 1 St. Marylebone 49 Camberwell 4 Shoreditch 200 Chelsea 10 Southwark 7 City of London 1,297 Stepnev 92 East Ham 2 Stoke Newington 171 Finsbury 644 Tottenham 1 Hampstead 5 Walthamstow 37 Holborn 9 Wandsworth 1 Hornsey 2 West Ham 8 Islington 247 Westminster 48 Kensington 12 303 Lambeth 1 Leyton 35 71 On examination of the lists of outworkers sent in byemployers in this Borough during 1913, I found 2,287 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 4 Islington 206 Amersham 2 Lambeth 7 Axminster 2 Leeds 3 Barking 2 Leigh-on-Sea 2 Battersea 1 Lewisham 5 Bermondsey 6 Leyton 119 Bethnal Green 541 Newport (Essex) 2 Brentford 2 Paddington 2 Brentwood 3 Pontypridd 2 Camberwell 34 Poplar 200 Cardiff 2 Reading 1 Chad well Heath 2 St. Pancras 8 Chard 4 Shoreditch 333 Chelmsford 2 Southend 3 Chingford 3 Southgale 3 City of London 2 Southwark 10 Croydon 4 Stepney 258 Deptford 5 Stokenchurch 2 Ealing 1 Stoke Newington 122 East Ham 11 Tottenham 112 Edmonton 16 Twickenham 1 Enfield 7 Walthamstow 154 Finchley 1 Wandsworth 2 Finsbury 15 West Ham 26 Frome 2 Westminster 2 Fulham 3 Willesden 1 Hammersmith 1 Woodford 1 Hampstead 2 Wood Green 8 Hornsey 2 Woolwich 4 Ilford 5 Worksop (Notts.) 1 2,287 75 During the year 1913, Miss Portlock (the inspector appointed for the inspection of outworkers premises) made 1,307 inspections and 876 re-inspections. She also made 552 visits without inspection, the outworkers having left the premises (317), or having given up homework (24), or being out at the time of visit (115), or owing to a wrong address being given (54), or the premises being workshops (30), or male workers alone being employed (10). Miss Portlock also discovered 20 new workshops and handed their addresses in for registration. During her visits of inspection Miss Portlock discovered 914 sanitary defects. For the abatement of these she served 527 intimation notices and 4 statutory notices. Of the 1,307 premises inspected, in only 89 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 57 „ „ and living room 33 „ „ „ kitchen 36 „ and kitchen 884 „ „ bedroom 131 „ „ parlour 62 „ „ scullery 10 „ ,, bath rooms 3 „ landing 2 Workroom provided separate 89 Total 1,307 76 The following table gives details of the nuisances found and their abatement:— NUISANCES IN OUTWORKERS' PREMISES, 1913. Outstanding at end of 1912. Found in 1913. Outstanding at end of 1913. Abated in 1913:— By Inspector of Outworkers. By District Inspector. Total. Want of Cleanliness 35 422 53 403 1 404 Want of Ventilation 1 45 4 42 ... 42 Overcrowding ... 5 ... 5 ... 5 Number of Premises on which other Nuisances found 31 305 27 298 14 312 Sanitary Accommodation Defective 19 137 6 136 4 140 77 LIST OF COMBINED DRAINAGE WORKS REFERRED TO THE BOROUGH ENGINEER AND SURVEYOR DURING THE YEAR 1913. The following is a list of premises, the drainage of which had been found defective and referred to the Borough Engineer and Surveyor for his attention, owing to the fact that the owners of the premises repudiated liability for reconstruction, claiming that such liability for repair and maintenance rested with the Borough Council:— Date of Reference. Situation of Premises. 2nd January 146, Amhurst Road. 8th 96 and 98, Well Street. 8th 51 and 53, Christie Road. 9th 288, Amhurst Road. 11th 42, Tresham Avenue. 17th 55 and 57, Christie Road. 20th 24, Christie Road. 23rd 4-8, Ufton Grove. 24th „ 20 and 22, Sandringham Road. 24th „ 41, Spurstowe Road. 27th 49, Christie Road. 28th 151, Amhurst Road. 11th February 222 and 224, Well Street. 21st „ 152, Victoria Park Road. 22nd 154, Victoria Park Road. 25th 160, Victoria Park Road. 28th 1-31, Stockmar Road. 1st March 19, Ufton Road. 5th 6, Comberton Road. 7th 57, Mayfield Road. 18th 21, Christie Road. 20th 13, Bodney Road. 12th April 70, Paragon Road. 12th „ 5, Welbury Street. 15th 216, Well Street. 23rd 289, Amhurst Road. 25th 10 and 12, De Beauvoir Crescent. 9th May 291, Amhurst Road. 21st „ 11, Chatsworth Road. 78 Date of Reference. Situation of Premises. 27th May 42, Middleton Road. 27th „ 142, Tottenham Road. 2nd June 3, Shafton Road. 9th „ 38, Stockmar Road. 12th July 32, 34, 36 and 40, Groombridge Road. 21st „ 75 and 77, High Street, Kingsland. 23rd 79, High Street, Kingsland. 5th August 323, Amhurst Road. 18th 325, Amhurst Road. 1st September 1, Cross Road. 3rd 133a, Amhurst Road. 10th 285 and 289, Victoria Park Road. 15th 291, Victoria Park Road. 17th 277 and 279, Victoria Park Road. 29th „ 137, Mapledene Road. 1st October 210, Amhurst Road. 3rd ,, 30, 32 and 24, Mapledene Road. 3rd 80, Sheep Lane. 11th 71, Southborough Road. 11th 2, Batley Road. 15th „ 63 and 67, Southborough Road. 24th 32 and 33, Florfield Road. 24th 4 and 6, Batley Road. 24th 87, Benthal Road. 1st November 183 and 185, Queen's Road. 8th ,, 48, Englefield Road. 10th 20, Ribstone Street. 10th 69, Southborough Road. 22nd 10, Isabella Road. 24th „ 108, Mare Street. 28th „ 17 and 19, Gayhurst Road. 8th December 145, Amhurst Road. 17th „ 191 and 193, Glyn Road. Disinfection. {a) Rooms.—During the year 1913 there were 2,219 rooms fumigated and 936 rooms cleansed in the Borough by the staff of the Public Health Department. In these totals are included the 79 disinfections, not only after cases of the notifiable infectious diseases, but also after measles, whooping-cough and tuberculosis. The number of rooms fumigated and cleansed each month is set out in the following table :— Number ol Rooms Fumigated and Cleansed each Month during 1913. Month. Rooms Fumigated. Rooms Cleansed. Remarks. January 219 70 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 190 56 March 172 65 April 139 69 May 192 74 June 175 75 July 156 78 August 127 66 September 182 90 October 245 107 November 196 85 December 226 101 Total 2,219 936 (b) Articles of Clothing, Furniture, &c.—The number of articles under this head disinfected during last year was 18,823. This is an increase of 2,612 upon the number disinfected during 1912, and is due to the increased number of cases of notifiable infectious disease occurring in the Borough during the year. The following table gives a summary of the articles disinfected :— 80 Articles Disinfected during the Year 1913. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. HOUSE LINEN AND FURNITURE. Beds and Bolsters 301 241 265 208 281 210 218 151 235 308 315 334 3,067 Bed Furniture 40 23 15 28 13 16 15 22 21 15 15 30 253 Blankets 204 186 139 151 151 113 144 91 151 161 255 315 2,061 Carpets 2 ... ... ... ... ... ... ... ... ... 1 1 4 Cushions, 50 67 48 52 27 29 22 28 48 69 79 104 623 Mattresses (Horse-hair, Wool, Straw or Spring) | 85 89 71 77 102 11 84 76 109 95 121 108 1,074 Mats and Rugs 13 ... ... 3 ... 7 4 10 3 ... 12 28 80 Palliasses 8 1 9 10 17 14 19 12 ... 3 5 6 104 Pillows and Pillow Cases 323 306 250 228 327 102 281 197 273 360 363 407 3,417 Quilts 174 141 110 97 108 99 107 92 133 150 187 228 1,626 Sheets 175 98 114 119 123 99 132 85 155 180 178 201 1,659 Table Cloths ... 1 ... ... ... ... ... ... ... 2 ... ... 3 Toilet Covers 5 ... ... ... ... ... ... ... ... 7 ... ... 12 81 Articles Disinfected doling the Year 1913. —continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. Towels 21 15 13 3 14 8 21 29 9 16 ]1 20 180 Window Blinds and Curtains 20 7 3 6 10 6 13 6 21 10 1 12 115 14,278 MEN'S. Caps, Coats &c 15 20 12 31 15 14 25 10 24 ?5 44 50 285 Drawers ... ... 5 5 8 12 10 16 6 19 81 Flannels 18 ... ... 6 18 10 23 16 15 16 20 12 154 Neck Ties ... ... ... 2 40 ... 15 ... ... ... ... ... 57 Shirts 11 8 ... 10 11 15 31 17 9 19 30 29 190 Socks 17 ... 4 10 8 10 ... 4 11 9 ... 6 79 Trousers 8 6 3 10 5 6 10 16 9 10 16 24 123 Overcoats ... ... ... ... ... 6 4 ... ... 2 ... ... 12 Waistcoats 6 12 4 9 13 5 14 22 10 10 15 25 145 WOMEN'S. 1,126 Aprons 4 6 ... 8 ... ... ... ... ... 5 ... 18 41 S2 Articles Disinfected during the Year 1913.— continued. Inscription of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Total. Body Linen 57 30 40 36 54 23 27 28 76 73 75 99 618 Corsets 11 1 7 ... ... 8 7 1 ... 9 15 27 86 Dresses and Skirts ... 5 1 4 ... ... 1 ... 6 ... 16 17 50 Dressing Gowns 3 ... 6 ... ... ... 3 1 12 16 1 22 64 Flannel Petticoats and Vests 9 14 17 12 19 7 12 12 39 31 23 40 235 Jackets 6 8 9 6 3 4 16 ... 5 ... 19 19 95 Petticoats and Bodices 6 8 13 20 14 9 14 7 18 ... ... 35 155 Shawls 17 1 6 6 2 2 14 11 3 8 33 19 122 Stockings 12 14 8 20 14 10 31 16 36 29 30 44 264 1,730 CHILDREN'S. Boys' Knickers 5 5 4 7 9 9 12 2 ... 18 26 18 129 „ Jackets 9 12 7 1 10 5 13 4 45 11 15 11 143 Frocks and Pelisses 5 ... 2 16 15 6 7 2 14 6 8 15 96 Pinafores ... 6 3 1 ... ... 1 2 ... ... ... 6 19 387 83 Articles Disinfected during the Year 1913. continued. Description of Articles. January. February. March. April. May. June. July. August. September. October. November December. Total. OTHER ARTICLES. Boots, Shoes, &c ... ... ... ... 2 1 10 ... 2 ... ... 14 29 Handkerchiefs 21 7 21 3 19 1 13 13 14 19 23 47 201 SUNDRIES 42 71 42 106 52 47 83 61 123 110 127 208 1,072 1,302 1,703 1,409 1,251 1,311 1,504 970 1,446 1,054 1,659 1,802 2,096 2,618 Total 18,823 84 In addition to these disinfections there were 163 articles destroyed on request from the owners. These are set out in the following table:— Articles Destroyed. Beds 36 Pillows 15 Bolsters 5 Palliasses 36 Blankets 4 Rugs 1 Caps 1 Sheets 4 Cushions 12 Sundry Articles 28 Mattresses 21 Total 163 (c) Public Library Books.—During the year, 323 books from homes in which infectious diseases had occurred were disinfected. Of this total, there were 280 books which had been borrowed from the Hackney Borough Library and 43 from other Libraries. The method of disinfection practised is to expose the open books in a closed chamber to the action of formic aldehyde gas, which is generated in a lamp from formalin tablets. Books Disinfected, 1913. Month. Number of Books Disinfected. From Hackney Public Library. From other Libraries. Totals. January 2 3 5 February 5 ... 5 March 17 ... 17 April 21 1 22 May 25 3 28 June 16 2 18 July 37 3 40 August 6 1 7 September 24 6 30 October 45 4 49 November 28 1 29 December 54 19 73 Total 280 43 323 In addition to these, two boxes of books were destroyed on request from their owner. 85 Number of persons lodged and maintained at the Council's Shelter in Millfields IZoad, Clapton, N.E., during the year ended 31st December, 1913. Month. No. of Persons Admitted. Cost of Maintenance. Average period of Stay. Diseases. Men. Women. Children. Total. £ s. d. January ... ... ... ... ... ... ... Days. February ... ... ... ... ... ... ... ... March ... ... ... ... ... ... ... ... April ... ... ... ... ... ... ... ... May ... ... ... ... ... ... ... ... June 1 1 1 ... ... 3 9 1 Scarlet Fever. July ... ... ... ... ... ... ... ... August ... ... ... ... ... ... ... ... September 1 1 2 4 ... 5 ... 1 Diphtheria. October 1 1 2 4 ... 5 ... 1 Scarlet Fever. November ... ... ... ... ... ... ... ... December ... ... ... ... ... ... ... ... 3 3 5 11 ... .3 9 1 86 THE SHELTER. During the past year, there were 11 persons admitted to the shelter whilst their homes were being disinfected. This total consisted of 3 men, 3 women and 5 children. Tliis is a decrease of 2 persons on the number admitted during 1913. The cost of maintenance of the 11 persons thus admitted was 13s. 9d. The average length of stay in the shelter was 1 day. The table on page 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 baths provided by the Borough Council under the above Act for the cleansing of verminous persons, were in constant use during 1913, no less than 2,366 baths being given during that period. This total shows an increase of 994 upon the number given during 1912 - The following shows the number of baths given to verminous persons since the baths were first provided:— Year. 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 No. of Baths 3 11 9 241 330 457 724 667 568 721 1,372 2366 Of the 2,366 baths given, 10 were sulphur baths for scabies, and 2,356 for pediculi. The great majority of those persons presenting themselves for baths, were children from the elementary schools in the Borough. These children received 2,326 baths, an increase of 990 upon the number given during 1912. Two other children had sulphur baths on the recommendation of their medical attendant. 87 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. 11 ... Brought forward 1,485 ... Benthal Road 8 ... Berkshire Road 224 ... Mandeville Street 312 ... Berger Road lii ... Morning Lane 177 ... Cassland Road 3 ... Millfields Road 11 ... Daubeney Road 134 ... Northwold Road 30 ... Detmold Road 57 ... Orchard Street 25 2 Eleanor Road 27 ... Percy Road 29 ... Gainsborough Road 129 ... Rams Episcopal 8 ... Gayhurst Road 73 ... Rushmore Road 17 ... Glyn Road 98 ... 3t. John's R.C. 82 ... Hackney Parochial 14 ... St.Scholastica's R.C. 15 ... Holy Trinity ... Sidney Road 66 ... (Mayfield Road) 10 ... Sigdon Road 3 ... Homerton Row 332 ... Tottenham Road 50 ... Lauriston Road 1 ... Schools outside ... Lamb Lane 8 ... Borough 8 ... London Fields 232 ... Carried forward 1,485 ... Totals 2,324 2 88 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 10 4 2 2 2 3 1 5 ... 3 ... ... 32 Women ... ... ... ... ... ... ... ... ... ... ... ... ... Children 138 271 131 270 198 286 181 31 221 271 182 141 2324 2356 Receiving Sulphur Baths. Men. ... ... ... ... 2 ... ... ... 3 ... ... ... 5 Women 1 ... ... ... ... ... ... ... ... ... ... ... 1 Children ... ... ... ... ... ... 2 ... ... ... 2 ... 4 10 89 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 1913. Shelters. £ s. d. £ s. d. Wages—Female Caretaker 50 0 0 Subsistence Allowance 0 13 9 Maintenance, Repairs, etc.— Electricity Supply 4 13 8 Water 4 12 0 Electric Fittings 2 16 10 Coals 3 12 0 Stores, etc. 3 0 0 Matron's Uniform 0 17 0 Repairs 17 0 0 36 11 6 87 5 3 Disinfecting Station. Wages 3 74 17 11 Electricity Supply 9 7 5 Water 9 2 0 Hire of Horse 76 15 0 Repairs— To Caretaker's House and Station 52 14 8 To Boiler 13 7 0 Engine Fitters (Wages) 12 15 2 Laundrymen ( „ ) 5 0 0 Electrician ( „ ) 1 4 11 85 1 9 Electric Fittings 5 13 8 Recording Gauge Sundries 1 2 5 Boiler Powder 3 0 0 Coal— Steam 48 11 0 Kitchen (Lodge) 7 4 1 55 15 1 Stores, Firewood, etc. 5 19 1 £626 14 4 90 Cleansing of Verminous Children. Attendant's Wages 50 2 6 Towels, Sheets, etc. 4 12 3 Disinfectants 1 15 0 Sponges, Brushes, Combs, etc. 2 11 3 £59 1 0 London County Council (General Powers) Act, 1904. During the year my attention was drawn by the Medical Officer (Education) of the L.C.C. to 1,035 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 results:— 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. 1,035 80 82 873 Amongst the 162 verminous homes there were 82 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 265; 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. The total quantity of refuse removed from occupied houses in the Borough to the destructor by the Council's contractors, 91 during the year 1913, amounted to 39,516 tons 4 qrs. 14 lbs. During the quarter ending March 31st the price paid by the Borough Council to the contractors was 5s. 6|d. per ton for the North Division and 5s. 6d. per ton for the South Division; during the remainder of the year the prices were—for the North Division 4s. 9d., and for the South Division 5s. 5d. The total cost for this removal for the whole year amounted to £10,307 12s. Id. The total cost of destruction has been calculated by the Electrical Engineer, who is in charge of the destructor, to be £6,016 6s. 2d., thus bringing the total cost of removal and destruction of refuse to £16,923 18s. 3d. Distributing this cost over the estimated population of the Borough, it amounts to Is. 61d. per head. In the Appendix to this Report will be found a copy of a report on the present system of removal of house refuse in the Borough. I give below a table showing the number of "refusals" and "no answers" given to the dustmen at their weekly calls:— 92 DUST REFUSALS AND NO ANSWERS FOR THE YEAR 1913. Week ending Refusals. No Answers. Week ending Refusals. Answers. Jan. 4th 803 736 July 5th 911 1,060 „ 11th 2,327 1,549 „ 12th 996 1,1015 „ 18th 1,862 1,325 „ 19th 976 1,072 „ 25th 1,527 1,245 „ 26th 1,016 1,22(1 Feb. 1st 1.437 1,334 Aug. 2nd 926 1,416 „ 8th 1,458 1,054 „ 9th 1,016 1,897 „ 15th 1,441 1,159 „ 16th 964 1,673 „ 22nd 1,5?0 1,143 „ 23rd 924 1,577 Mar. 1st 1,449 1,125 „ 30th 1,049 1,535 „ 8th 1,368 1,107 Sept. 6th 1,198 1,275 „ 15th 1,429 1,031 „ 13 th 1,034 1,200 „ 22nd 1,315 1,131 „ 20 th 1,113 1.130 „ 29th 1,092 1,112 „ 27 th 1,087 1,087 April 5th 1,246 1,181 Oct. 4th 964 1,044 „ 12th 1,255 1,177 „ 11th 1,183 1,071 „ 19th 1,286 1,215 „ 18th 1,079 990 „ 26 th 1,200 1,155 „ 25th 1,206 1,078 May 3rd 1,198 1,061 Nov. 1st 1,184 970 „ 10th 1,173 1,096 „ 8th 1,093 1,021 „ 17 th 1,039 1.177 „ 15th 1,372 1.120 „ 24th 1,209 1,077 „ 22nd 1,066 1,128 „ 31st 971 1,024 „ 29th 1,194 1,117 June 7th 1,029 1,005 Dec. 6th 1,222 1,075 „ 14th 1,109 1,063 „ 13th 1,137 1,117 „ 21st 987 988 „ 20th 1,067 1.123 „ 28 th 962 1,062 „ 27th 1,084 1,131 „ 31st 557 720 The following table shows the number of requests made for the removal of house refuse during the ten vears endinsr 1913:— List of the requests for the removal of Dust daring the ten vears ending December, 1913. 1904 1905 1905 1907 1908 1909 1910 1911 1912 1913 Jan. 28 12 14 12 6 4 4 7 25 16 Feb. 3 5 5 5 6 5 6 5 8 3 March 10 6 6 10 4 4 8 10 5 17 April 21 10 14 9 3 4 9 10 12 15 May 11 10 7 6 11 11 5 13 11 24 June 18 16 13 11 11 10 3 14 16 13 July 19 lfi 16 7 6 10 0 20 16 7 August 10 8 3 9 5 9 6 12 20 11 Sept. 6 9 8 6 5 4 1 19 14 8 Oct. 14 0 1 2 5 1 3 7 15 9 Nov. 5 6 4 5 3 2 3 7 16 10 Dec. 10 4 7 7 2 6 4 12 12 3 Totals 155 108 98 89 67 70 52 136 170 136 93 DUSTING ACCOUNT, 1913. 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. f, s. d. January 1,887 0 3 14 522 18 10 2,127 7 2 14 584 19 10 4,014 14 2 0 1,107 18 8 February 1,733 12 3 7 480 7 3 1,962 9 1 14 539 13 6 3,696 2 0 21 1,020 0 9 March 1,548 16 9 0 429 3 2 1,720 6 0 7 473 1 8 3,269 2 3 7 902 4 10 April 1,521 15 2 0 361 8 4 1,675 11 0 14 453 15 11 3,197 6 2 14 815 4 3 May 1,551 7 3 0 368 9 1 1,669 8 2 7 452 2 9 3,220 16 1 7 820 11 10 June 1,465 1 3 21 347 19 3 1,647 6 2 14 440 3 0 3,112 8 2 7 794 2 3 July 1,355 12 0 7 321 19 1 1,500 7 3 0 424 4 7 2,921 19 3 7 740 3 8 August 1,209 10 2 7 287 5 3 1,391 2 3 7 376 15 4 2,000 13 1 14 664 0 7 September 1,340 10 0 21 319 16 0 1,514 17 3 14 410 5 8 2,801 8 0 7 730 1 8 October 1,415 9 1 0 336 3 4 1,550 15 0 21 419 19 11 2,900 4 1 21 756 3 3 November 1,681 17 0 0 399 9 0 1,807 12 3 21 489 11 2 3,489 9 3 21 889 0 2 December 1,987 2 2 21 471 19 1 2,178 14 3 7 590 1 1 4,165 17 2 0 1,062 0 2 Totals 18,704 3 1 14 4,646 17 8 20,812 0 3 0 5,660 14 5 39,510 4 0 14 10,307 12 1 Cost of Deatruction £3,131 2 3 £3,485 3 11 £6,616 6 2 £10,923 18 3 94 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 452 1. To await inquests—(a) Infectious 1 (b) Non-Infectious 419 2. To await burial 32 Number of post-mortems made 132 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 142 119 Accidental death 68 55 Suicide 15 7 Open Verdict 6 3 Manslaughter 1 ... Murder 1 2 Misadventure 1 ... Totals 234 186 95 Table showing nature of above Suicidal and Accidental Deaths in the Borough of Hackney during the year ended 1913. Suicides. Accidental Deaths. Nature of Suicide. No. Nature of Accidental Death. No. Poisoning 4 Shock from fall 35 Cut throat 2 Suffocated 8 Drowning 5 Shock from burns 11 Hanging 7 Drowning 5 Fall from window 1 Run over 17 Shooting 1 Shock from scalds 6 Stabbing 1 Fracture of skull 10 Cutting blood vessel 1 Suffocated in bed 14 Wound of hand 3 Poisoning 2 Others 12 Total 22 Total 123 90 97 REGISTER OF 1 SANITARY WORK, 1913. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Pew, Clapton. Mr. Hody, Kingsland. Mare Strett 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. Sheppared Mr. Punier. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. T. 1 1 No. 8. No. 9. No. 10 No. 11 No. 12. INSPECTIONS— (a) On complaint 211 212 154 143 287 236 298 153 283 210 84 82 17 52 ... 15 ... 2,437 No. of premises on which defects were discovered 170 189 83 111 250 201 168 134 227 160 49 69 13 32 ... 10 ... 1,869 (b) House to House— No. of houses inspected ... 62 ... 12 38 110 65 240 22 124 89 251 195 169 ... ... ... 1,383 No. of houses in which defects were discovered ... 49 ... 12 38 29 42 165 20 86 56 204 185 133 ... ... ... 1,019 No. of Notices served ... 49 ... 12 38 29 421 1 165 20 89 56 204 230 136 ... ... ... 1,070 c) Houses after Infectious Dis. No. of houses inspected 150 142 161 225 298 232 2391 102 231 154 112 56 12 13 ... ... ... 2,127 No. of houses in which defers were discovered 34 68 34 94 46 49 49 I 23 57 54 34 10 3 3 ... ... ... 558 (d) Miscellaneous— Fishmongers'and Poulterers yards ... 2 ... 17 ... ... ... 2 3 2 6 6 3 ... ... ... ... 41 Slaughterhouses ... ... ... ... 3 ... 2 ... ... ... ... ... ... ... 354 ... ... 359 Cowhouses (premises), Dairies and Milkshops ... ... ... ... ... 4 ... 1 ... ... ... ... ... ... ... 2,090 ... ... 2,095 Greengrocers' yards ... 2 ... ... ... 1 1 1 ... ... 11 ... ... ... ... ... ... 16 Schools ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Factories and Workshops— No. of inspections 3 12 1 ... 39 9 65 13 9 18 ... ... ... 1 ... 846 ... 1,016 No. of premises on which defects were discovered ... 8 1 ... 30 2 17 9 6 10 ... ... ... 1 ... 383 ... 460 Housing, Town Planning, &c. Act, 1909— No. of houses inspected ... ... ... ... ... ... ... ... ... ... ... ... 88 ... ... ... ... 88 No. of houses in which defects were found ... ... ... ... ... ... ... ... ... ... ... ... 85 ... ... ... ... 85 No. of houses in which defects were remedied ... ... ... ... ... ... ... ... ... ... ... ... 59 ... ... ... ... 59 98 99 REGISTER OF SANITARY WORK, 1913 —continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Pew, Clapton. Mr. Tody. 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. Sheppa rd. 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 1912 8 12 10 10 14 9 11 5 6 11 7 2 ... ... ... ... ... 105 „ „ „ 1913 8 12 10 10 14 8 10 5 6 12 8 2 ... ... ... ... ... 105 „ above ground 6 6 4 5 6 1 4 2 4 10 8 ... ... ... ... ... ... 56 No. underground 2 6 6 5 8 7 6 3 2 2 ... 2 ... ... ... ... ... 49 „ of Inspections, 1913 17 12 ... 39 28 30 25 12 20 30 15 17 ... ... ... ... ... 245 „ of Notices, 1913 1 4 ... ... ... 3 3 4 ... 4 3 ... ... ... ... ... ... 22 „ of Prosecutions, 1913 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Urinals 13 25 14 13 19 13 21 16 26 39 31 17 ... 1 ... ... ... 248 Canal boats ... ... ... ... ... ... ... ... ... ... ... 23 ... ... ... ... ... 23 Visits to waterways ... ... ... ... ... ... ... ... ... ... ... 80 ... ... ... ... ... 80 Animals improperly kept ... 4 ... ... ... ... 3 14 4 4 5 ... 17 ... ... ... 8 59 Laundries ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 77 ... 79 Offensive trades ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 11 ... ... 12 Outworkers' Premises No. on which defects were ... 9 1 ... ... 2 ... ... ... 20 ... ... ... ... ... ... 1,307 1,339 discovered ... 6 1 ... ... 2 ... ... ... 8 ... ... ... ... ... ... 609 626 New buildings 22 ... ... ... 9 1 3 ... ... ... ... ... ... ... ... ... ... 49 Special Inspections 10 116 36 205 ... 35 96 48 198 133 39 6 356 109 216 ... ... 1,603 Re-inspections 2,219 2,260 2,060 2,119 1,717 1,836 2,105 2,799 2,321 2,338 2,472 1,544 2,656 2,307 ... 1,181 876 32,866 Houses Let in Lodgings— No. on Register at end 1912 ... ... ... ... ... ... ... ... ... 1 1 226 ... ... 243 ... ... ... 470 1913 ... ... ... ... ... ... ... ... ... 1 226 ... ... 243 ... ... ... 470 „ of Inspections, 1913 ... ... ... ... ... ... ... ... ... 2 143 ... ... 242 ... ... ... 387 o Notices, 1913 ... ... ... ... ... ... ... ... ... 2 61 ... ... 158 ... ... ... 221 „ of Prosecutions, 1913 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 101 REGISTER OF SANITARY WORK, 1913.—continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg. Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street md South Hatkney. 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. Sheppa rd. 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—contintied. Common Lodging Houses— No. on Register at end of 1912 ... ... ... ... ... 9 4 ... 1 ... ... ... ... ... ... ... ... 7 „ 1913 ... ... ... ... ... 9 4 ... 1 ... ... ... ... ... ... ... ... 7 Mews.and Stables 7 6 1 ... ... 1 ... 2 ... 7 7 ... ... 9 ... ... ... 33 Floodings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tenement Houses— No. provided with additional water supply during 1913 ... 10 ... ... 5 ... 2 ... ... ... ... ... ... ... ... ... ... 17 Overcrowding— No. of dwelling rooms overcrowded 1 8 ... 8 6 2 9 3 5 10 13 10 ... 3 ... ... 5 90 No. remedied ... 8 ... 8 6 2 9 3 5 10 13 10 7 3 ... ... 5 89 „ of Prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Insanitary Houses— No. closed under Public Health (I.ondon) Act. 1891 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. closed under Housing of Working Classes Act, 1800 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of verminous premises cleansed 1 16 4 61 3 10 ... 20 33 71 35 ... 53 15 ... ... 92 146 Underground Rooms— Illegal occupation dealt with ... 1 ... ... 7 ... ... ... ... ... ... ... ... 1 ... ... ... 9 No. of rooms closed ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Places where Food prepared for Sale- No. on Register at end 1913 8 15 ... ... 10 22 5 7 5 15 7 6 ... ... 31 ... ... 131 of Inspections, 1913 8 ... ... ... 20 99 10 14 5 24 ... ... ... ... 31 ... ... 134 „ of Notices ... ... ... ... ... 7 ... 3 ... 11 ... ... ... ... ... ... ... 21 Other workplaces ... 2 ... ... ... ... 3 ... ... 4 ... ... ... ... ... ... ... 9 Miscellaneous Inspections 30 15 ... 93 31 ... 76 ... 26 75 19 28 ... ... ... ... ... 393 102 103 REGISTER OF SANITARY WORK, 1913.—continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Marc Street South Hackne 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. Punier. No. 1. No. 2. No. 3. No. 4. No. 6. No. 6. No. 7. No. 8. No. 9. No. 10. No. 11. No. 12. Inspections continued. Ice Cream Premises— No. on Register at end 1912 10 19 33 20 9 15 13 8 19 19 9 10 ... ... ... ... ... 190 1913 16 16 32 17 9 18 15 12 17 24 8 14 ... ... ... ... ... 198 „ of Inspections 26 19 41 19 16 19 15 12 17 28 17 28 ... ... ... ... ... 257 No. of Notices ... ... 1 9 1 7 ... 1 2 1 3 ... ... ... ... ... ... 21 „ „ Prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total number of Intimation Notices served 218 229 173 274 360 275 283 360 353 384 204 312 271 352 15 262 527 4,852 Peremptory or Final Notices served 30 15 23 12 40 10 23 43 25 9 21 10 7 20 ... 51 63 402 Statutory Notices served 4 19 2 24 24 21 25 8 16 30 1 24 3 12 ... 13 4 230 Proceedings before Magistrates or Justices under the Public Health Act ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Nuisances abaled 190 234 132 250 298 247 257 358 289 340 187 210 242 307 15 367 ... ... Seized and Condemned as Unfit for Human Food— Fish qr 1 qr. 1 ... ... ... ... cwt 4 qr. 3 lbs. 8 qr. 1 lbs. 7 ... ... qr. 3 lbs. 16 ... ... qr. 1 lbs. 21 Cwt 3 qr. 1 ... ... cwt. 10 qr. 1 lbs. 6 Fruit and Vegetables lbs. 20 ... ... ... ... 1 2 0 ... ... ... 0 14 ... ... ... cwt. 10 qr 3 lb 23 ... ... 11 3 1 Meat ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 0 21 ... ... 6 0 21 Tinned Foods ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 20 ... ... 1 0 20 Other Articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Open spaces cleared 9 1 ... ... ... ... ... ... 2 ... ... 4 ... ... ... ... ... 16 Special Reports to Medical Officer of Health ... 4 76 9 4 8 51 ... 2 10 ... 3 19 6 18 ... ... 210 Food Adulteration— Samples collected for analysis 60 72 ... 66 60 60 66 66 66 60 66 60 72 73 66 ... ... 925 Proceedings taken before Magistrates 1 2 ... 1 2 ... ... 2 2 ... ... ... ... 2 ... ... ... 12 104 RETURN OF SAMPLES OF MILK ANALYSED For the Year 1913, showing the percentage of Samples found "Genuine" and "Adulterated." SAMPLES. Percentage of Samples found No. examined. No. found genuine No. adulterated in which no action was taken. No. adulterated in which action was taken. Adulterated. Genuine. No proceedings. Proceedings taken. 538 488 1 to 2% 7 5 to 6% 3 80 1-3 90.7 2 „ 3% 23 6 „ 7% 1 3 „ 4% 9 9 „ 10% 2 4 „ 5% 1 11 „ 12% 1 8 „ 9% 1 13? Boric acid 1 22% 1 538 488 43 7 80 1.3 90.7 105 SAMPLES PURCHASED DURING 1913. Articles Purchased. Number Purchased. Number Adulterated. Number where proceedings taken. Number of Samples Adulterated with percentage of Adulteration. Milk 538 50 7 (See next page). Heturn of Milk samples. Butter 261 8 5 100% foreign fat. 4 16.8% „ 1 .8% excess of water. 2 .5% „ 1 Margarine 6 Cocoa 9 Coffee 15 Demerara Sugar 12 o Sugar crystals dyed with an artificial colouring matter, 2. Arrowroot 6 Lard 6 i ioo% fat other than lard. Olive Oil 3 Dripping 6 i 3 57% water. Cream (preserved) 6 3 .11% excess Boric acid. .12% „ .31%. „ Pepper 3 Mustard 6 Camphorated Oil 3 Whisky 4 1 3.59% excess of water. Oin 2 Pickles 12 Jam 12 Sweets 12 922 66 12 106 Prosecutions under the Public Health (London) Act, 1891, during the year 1913. Address. Complaint. Magistrate's Decision. Penalty. Costs. £ s. d. £ s. d. 42, Farleigh Road Defective watercloset and rain water pipe. Order to abate nuisance in four days. 45, Chatham Place General insanitary condition of premises. Withdrawn (work done) 51, Chatham Place Do. Do. 79, Paragon Road Worl^ooni inefficiently ventilated. Do. Total 107 Prosecutions under the Sale of Food and Drugs Acts during the year 1913. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fine. Costs. £ s. d. £ s. d. 48s Margarine Exposed for sale unlabeled. Fined 0 10 0 0 15 6 44t Butter Wholly foreign fat Fined 15 0 0 0 17 6 „ Margarine Served in plain wrapper Withdrawn. (See above summons) 37V Milk- 11.64% added water Fined 1 10 0 0 15 6 59V Milk 5.8% added water Dismissed on proof of warranty 751 Butter Wholly foreign fat Fined 3 0 0 0 10 6 „ Margarine Served in plain wrapper Fined 0 0 0 10 6 79Z Milk 9®o fat abstracted Fined 2 0 0 0 10 6 60A Butter Wholly foreign fat . Fined 4 0 0 2 2 0 Margarine Served in plain wrapper Withdrawn. (See above summons) 63A Milk 5'41"« added water Withdrawn. (Warranty proved) 70A Milk 5.06% added water No conviction 1 3 0 14B Butter 16*8u/> foreign fat Fined 20 0 0 2 2 0 58D Milk 9.18% added water No conviction - 5 0 65E Milk 6.12% added water Fined 0 10 0 0 12 0 Total 48 10 0 12 4 6 108 APPENDIX. To the Chairman and Members of the Public Health Committee. Gentlemen, TUBERCULOSIS. Introduction. In 1882 Koch, of Berlin, made the discovery that tuberculosis was caused by a micro-organism, the bacillus tuberculosis, which is present at intervals in the sputum of the persons suffering from tuberculosis of the lungs, and that, consequently the disease belongs to the class of specific infectious diseases. This important discovery immediately removed this disease from the class of incurable diseases, as it was then regarded, into that of preventable diseases. Measures were then introduced in many places in order to prevent as far as possible the spread of the disease. With this view many Local Authorities made the disease voluntarily notifiable, and many obtained powers to make it compulsorily notifiable. With the same object the Borough Council, in the year 1906, recognising the fact that it was their duty to help to join in this fight against tuberculosis, made this disease voluntarily notifiable. The only preventive measures then practicable, viz., the disinfection of premises when vacated by tuberculous patients, and the education of the public as to the nature of the disease and its possible prevention were actively put in operation in the Borough. Tuberculosis Regulations. In 1908 the Local Government Board made regulations under Section 130 of the Public Health Act, 1875, as amended by the Public Health Act, 1896, and the Public Health (London) Act, 1891, requiring all cases of pulmonary tuberculosis occurring 109 amongst persons in receipt of Poor Law medical relief to be notified to the Medical Officer of Health. In May, 1911, further regulations made by the Local Government Board under the same powers came into force, and extended notification to cases of pulmonary tuberculosis occurring in hospitals. On the 1st January, 1912, a third set of regulations made by the Local Government Board under the same powers as the former regulations came into force, and extended notification of pulmonary tuberculosis to all cases coming to the knowledge of private practitioners. Again, on the 19th December, 1912, another set of regulations was issued by the Local Government Board revoking the former tuberculosis regulations and substituting for them an amended set which came into force on the 1st February, 1913. The chief alteration in these amended regulations is to extend notification to the Medical Officer of Health to all forms of tuberculosis. These regulations give special powers and impose special duties upon Local Authorities. They are set out in Article XIII., as follows :— Special Powers and Duties of Local Authorities. Article XIII.—For the purposes of these Regulations 1. A Local Authority 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 tuberculosis, 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-section of this Article shall be deemed to authorise a Local Authoritity to take any of the measures herein mentioned at any institution other than one belonging to the Local Authority. 110 2. A Local Authority on the advice of their Medical Officer of Health may provide and publish or distribute suitable summaries of information and instruction respecting tuberculosis, and the precautions to be taken against the spread of infection from that disease. Certain special duties are also imposed by these Regulations on Medical Officers of Health, as follows:— Duties of Medical Officers of Health. Article XI.—1. A Medical Officer of Health on receipt of a notification which has been erroneously addressed to him by a medical practitioner, shall forthwith transmit the notification to the Medical Officer of Health, to whom the notification ought, in pursuance of these Regulations, to have been addressed, and shall at the same time inform the medical practitioner that he has done so, and shall give to him the name and address of the Medical Officer of Health to whom the notification has been sent. 2. Every Medical Officer of Health shall cause to be entered in a Register to be kept by him for that purpose the full particulars contained in every notification received by him under these Regulations and relating to a person whose place of residence or place of destination is situate within the district for which he is Medical Officer of Health. The said Register shall be kept in the custody of the Medical Officer of Health and shall not be open to inspection by any person other than a person specially authorised by resolution of the Local Authority, the Medical Officer of Health for the Administrative County within which the district is situate, a School Medical Inspector for any atea within which the district is situate, or an officer of any Government Department authorised in that respect by that Department. Every notification and every document relating to a person notified under these Regulations shall be regarded by the Medical Officer of Health, and by every person who has access thereto, as confidential. 11l 3. The Medical Officer of Health shall, as soon as practicable after the end of each week, send to the Medical Officer of Health for the Administrative County within which the district is situate a statement of every notification received by him during the week in pursuance of these Regulations and relating to a person whose place of residence is situate within the district for which he is Medical Officer of Health. The statement shall show on which form the notification was made, and shall contain the information in regard to each person which was given in the notification. 4. Any expenses incurred by a Medical Officer of Health in carrying out the duties imposed upon him by this Article shall be defrayed by the Local Authority of the district for which he is Medical Officer of Health. Article XII.—Upon receipt of a notification under these Regulations, the Medical Officer of Health, or an officer of the Local Authority, acting under the instructions of the Medical Officer of Health, shall make such enquiries and take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable to infection. Provided that nothing in this Article shall be deemed to authorise a Medical Officer of Health or other Officer to take any of the steps herein mentioned at any institution other than one belonging to the Local Authority, except with the consent of the Managers of that institution. Tuberculosis and the National Insurance Act, 1911. In addition to the Regulations above referred to, the subject of the treatment and prevention of tuberculosis is further dealt with by the National Insurance Act, 1911. The following is a summary of the sections of that Act referring to this subject:— 112 Summary of Sections. 16, 17, 22 and. 77. Sec. 16.—For the purpose of giving sanatorium benefit Insurance Committees are required to make arrangements to the satisfaction of the Insurance Commissioners: 1. For the treatment of insured persons suffering from tuberculosis or other disease in sanatoria and other institutions approved by the Local Government Board with persons and authorities (other than Poor Law authorities) having such institutions. 2. For the treatment of such persons otherwise than in sanatoria or other institutions with persons and Local Authorities (other than Poor Law authorities) approved of by the Local Government Board. The money available for sanatorium benefit in each year will be (a) One shilling and threepence for each insured person in the County or County Borough from the Benefits Fund of the Act; (b) One penny for each insured person from moneys provided by Parliament. But this latter sum may be devoted by the Insurance Commissioners to the purposes of research. 3. "An insured person shall only be entitled to sanatorium benefit on the recommendation of the Insurance Committee. 4. An Insurance Committee may defray partly or wholly the expenses of conveying an insured person to or from a sanatorium or other institution. Sec. 17.—(a) The Insurance Committee of any County or County Borough may extend sanatorium benefit to the dependents of insured persons ; (b) If the amounts available during any year to meet the expenses for sanatorium benefit to insured persons and their dependents are insufficient, the estimate of expenditure may be sent to the Treasury and the County Council, who may sanction the excess; (c) The Treasury and the County Council having sanctioned such excess of expenditure shall each be liable to pay one-half of such excess. 113 Sec. 22.—A Borough Council may agree to pay to the County Council the whole of such excess where such excess of expenditure is properly attributable to the Borough. Sec. 77.—Provides that the Local Government Board may for the purposes of certain parts of the Insurance Act hold local enquiries and investigations as they think fit, and shall have the same powers for this purpose as they have for enquiries, &c., under the Public Health Acts, and the expenses of such enquiries shall be paid by such authorities or persons out of such funds or rates as the Board may direct. Departmental Committee on Tuberculosis. In order that the Government and all authorities concerned in the prevention of the spread of tuberculosis should work in harmony and in accordance with the general principles of a complete scheme for dealing with this disease, a Departmental Committee was appointed by the Government in February, 1911. The terms of reference were:— "To report at an early date upon the consideration of general policy in respect of the problem of tuberculosis in the United Kingdom, in its preventive, curative, and other aspects, which should guide the Government and local bodies in making or aiding provision for the treatment of tuberculosis in sanatoria or other institutions or otherwise." In May, 1912, this Committee presented to Parliament an Interim Report in which, inter alia, they state the conditions which should be observed in dealing with the problem of tuberculosis, as follows:— " 4.—Any scheme which is to form the basis of an attempt to deal with the problem of tuberculosis should provide : 1. That it should be available for the whole community. 2. That those means which experience has proved to be most effective should be adopted for the prevention of the disease. H 114 3. That a definite organisation should exist for the detection of the disease at the earliest possible moment. 4. That, within practicable limits, the best methods of treatment should be available for all those suffering from the disease. 5. That, concurrently, with the measures for the prevention; detection, and treatment, provision should be made for increasing the existing knowledge of the disease, and the methods for its prevention, detection, and cure by way of research." The Committee further recommend that for the prevention, detection, and treatment of the disease, existing Public Health administration should be supplemented by the establishment and equipment of two units linked up to the general public health and medical work now carried on, and working in harmony with the general practitioner. The first unit consists of the tuberculosis dispensary. The second unit consists of institutions in which in-patient treatment is given. The "dispensary unit" which consists of the dispensary, acting in co-operation with the private practitioners of the district, deals with patients resident in their own homes; and must provide for the diagnosis of cases suspected to be tuberculous, recommendation as to treatment, and provision of actual treatment for those persons who can be suitably treated in connection with the dispensary. The functions of a tuberculosis dispensary should be to serve as:— 1. Receiving house and centre of diagnosis. 2. Clearing house and centre for observation. 3. Centre for curative treatment. 4. Centre for the examination of "contacts." 5. Centre for after care. 6. Information bureau and educational centre. 115 The "sanatorium unit" comprises the various classes of institutions available for tuberculous persons who need residential treatment. The Departmental Committee further suggest that "as regards London, it seems desirable to the Committee that it should be considered whether some of the sanatoria and hospitals required should not be provided by the Metropolitan Asylums Board, and whether dispensaries should not be provided by the Metropolitan Borough Councils." This view above expressed has been approved of by the Local Government Board who have invited the Borough Councils to provide or arrange for the provision of tuberculosis dispensaries. I have thought it desirable to give the foregoing details respecting tuberculosis and the steps which have been taken in various legislative Acts to bring this disease under the laws relating to public health and under the control of Local Authorities, in order that the Committee might more clearly realise the position of the Borough Council in the national scheme for the treatment and prevention of tuberculosis. The primary duty of preparing a complete scheme for the whole County of London rests with the London County Council, but both the London County Council and the Local Government Board, in accordance with the recommendation of the Departmental Committee, look to the Borough Councils to provide the dispensary unit for their Boroughs. The Committee will remember that the Borough Council, as a Sanitary Authority, exercises under the Public Health Acts and Regulations made under them, certain powers as to the prevention, &c., of infectious disease; also, that tuberculosis is an infectious disease, which has been made by Regulations notifiable, so that their duties and responsibilities in respect to the prevention, &c., of this disease are the same as they are with respect to other notifiable infectious diseases. In order to fully appreciate this H2 116 fact, it is necessary that the Tuberculosis Regulations should be taken and considered by the Sanitary Authority in conjunction with the clauses of the Public Health Acts, relating to sanitation and the control of infectious diseases. If this is done, the Committee will have no difficulty in arriving at the conviction that it is the clear duty of the Borough Council to take their place in the national scheme for the treatment and prevention of tuberculosis. The part which is recommended by the Departmental Committee, with the approval of the Local Government Board, to be assigned to the Metropolitan Boroughs, is as above indicated, the provision of the "dispensary unit," each Borough Council being responsible, so far as dispensary treatment is concerned, for the treatment of the tuberculous sick of its inhabitants. With regard to the premises themselves, the Committee report: "In most instances it will probably be found that existing buildings can readily be adapted for the purpose of a dispensary; in other cases it may be necessary to build a dispensary; or, again, it may be convenient that the dispensary should form a department of an existing hospital or infirmary. The dispensaries should be easy of access to the working class population." Financial Arrangements. With regard to the financial arrangements between Exchequer, Insurance Committees, London County Council, and Metropolitan Boroughs for the treatment of tuberculous persons, these are far from being settled. The present position may be gathered from the following extract from the Local Government Board's letter of 11th December, 1912, on this subject, addressed to the London County Council:— "On the question of finance the County Council will have seen the general statements made in the Board's circulars of the 14th May and the 6th instant. In the former it was stated that the Board proposed to adopt the financial 117 tions made by the Departmental Committee on Tuberculosis in regard to the distribution of the capital grant. In the latter circular the Board stated the intention to be that the amount of the annual maintenance grant should be one-half of the total net cost incurred within reasonable limits by or on behalf of the County Council in the treatment in dispensaries, sanatoria and hospitals, which form parts of a scheme approved by the Board for the general treatment of tuberculosis in the area, of all persons, whether insured persons, dependents of insured persons, or persons who are neither themselves insured persons nor their dependents, after deducting the amounts received from Insurance Committees out of the monies available under the National Insurance Act for sanatorium benefit and any sums received in respect of the treatment of non-insured persons or otherwise." "If the County Council are willing to make themselves responsible for the provision of in-patient accommodation, the grant in aid of the expenditure on this service would be paid direct to them. "The question of the financial arrangements to be made in regard to dispensaries was discussed when the representatives of the County Council attended at this office. "The Board will be glad to receive the observations of the County Council on this question, and particularly on the point whether the arrangements for dispensary treatment under the Insurance Act should be by the County Councillor by Borough Councils with the Insurance Committees, and whether the expenditure should be locally or centrally defrayed, and the grant for maintenance of the dispensaries be allotted to the Borough Councils individually or to the County Council. In any case, it seems to be important that the dispensary work should be brought into proper relation with the general scheme for the Metropolis. 118 "As regards capital expenditure, the Board are prepared, subject to the consent of the Treasury, to make grants in aid in accordance with the recommendations of the Departmental Committee. So far as practicable, existing accommodation which is suitable should be utilised. "In framing a complete scheme regard should be had to the needs of the community and not to the needs of insured persons alone." It remains now to show how the Borough Council may provide the dispensary unit for the Borough. This can, of course, at present only be set out in outline. The Borough Council may (1) establish a dispensary themselves, retaining complete control over the institution, appointing the officers, &c., and making it a part of the Public Health Department. In this case the Council would either erect a new building suitable for a dispensary or adapt some existing building in a suitable locality. Or the Borough Council may (2) make use of accommodation if suitable in connection with existing hospitals or infirmaries. With regard to the first suggestion for the Council to provide, maintain and retain complete control over a dispensary, I have already reported to the Committee on this aspect of the question. (See Reports of Medical Officer of Health, 1st March, 1911, and 31st January, 1912.) The second suggestion to utilise accommodation at existing hospitals, although at first sight more difficult to arrange, will in the end be much less expensive, I believe, to the Borough Council, and will have some very striking advantages over the former proposal. The hospitals in or near to Hackney having suitable existing accommodation are the Metropolitan Hospital, Kingsland Road, and the Victoria Park Hospital, Bonner Road, Bethnal Green. 119 The authorities of the former hospital have already approached the Local Government Board and asked their approval of the Provident Department of that Hospital as a tuberculosis dispensary under Section 16 (1) (a) of the National Insurance Act, 1911. This Provident Department was closed on the 15th January this year owing to the sickness section of the National Insurance Act coming into operation at that time. The opportunity of utilising these premises for the purpose suggested should not be allowed to slip by without a careful enquiry as to the desirability of the proposal. The authorities of the Victoria Park Hospital for Diseases of the Chest are, I understand, desirous that their Hospital should also be utilised as a Tuberculosis Dispensary. This Hospital is situated just beyond the south-east boundary of the Borough. If this Hospital is to enter into the Dispensary Scheme for Hackney, it should serve for the tuberculous population of the south-east sub-district, while the Metropolitan Dispensary would serve the remainder of the Borough. Area and Population Served.—The Departmental Committee, in their report, suggest one dispensary and its equivalent staff for every 150,000 to 200,000 population in an Urban District. Hackney has a total population estimated at the middle of 1911 at 222,674 persons. These are distributed in the different registration subdistricts as follows:— Estimated Population of Hackney at the Middle of 1911. Registration Subdistricts. North. Central. South- West. SouthEast. Total for Hackney. Estimated Population 53,783 53,681 58,012 57,198 222,674 It will be seen that, on the standard suggested by the Departmental Committee, Hackney will require two dispensaries. If the Victoria Park Hospital Dispensary is made to serve the needs of 120 the south-east sub-district, i.e., a population of 57,198, the remaining population of 165,476 may be satisfactorily served by the Metropolitan Hospital Dispensary. Situation and Means of Access to these Hospital Dispensaries.— The Victoria Park Hospital Dispensary is situated in the Borough of Bethnal Green at the end of Bonner Road and close to the south-east boundary of the Borough. It is within easy walking distance of a considerable part of south-east Hackney, and may be without difficulty approached by motor omnibus, tram or railway from all other parts of the Sub-district. The Metropolitan Hospital Dispensary is also easily reached from all parts of the other three sub-districts, either by trams, motor omnibuses or railway. Advantages of this Scheme over that of the Council providing and maintaining the Dispensaries.—(1) Less expensive, as the premises and equipment of the institution are already provided and no great capital outlay will be required. The amount which would be allowed for capital charges in any case would not exceed for Hackney the sum of £240. This sum is estimated from Section 1 (Financial Recommendations of the Interim Report of the Departmental Committee on Tuberculosis). This sum would not go very far towards building a new Dispensary. (2) These dispensaries being in connection with existing Hospitals, beds can be retained for observation cases, &c., as required for each dispensary. (The Local Government Board's memorandum of December 6th, 1912, states on this point "It is desirable that observation beds should be available for use in connection with a dispensary, though the beds need not be in the dispensary itself.") (3) The Hospital consulting staff may be made available, if necessary, on terms to be agreed upon. 121 (i) These Hospitals are each provided with X-ray, Throat, Bacteriological and Dental Departments, which would be available for patients treated at the dispensary. Several Metropolitan Borough Councils have already prepared Dispensary Schemes for their respective Boroughs, with the approval of the Local Government Board, in connection with neighbouring Hospitals. Amongst these are the following:— Shoreditch Tuberculosis Dispensary in connection with the City Road Hospital. City of London St. Bartholomew's Hospital. Lambeth St. Thomas' Hospital. At present it is not possible to go into details as to the arrangements to be made between the Borough Council and the Hospital authorities. The obvious thing to do in the first instance is to determine whether the Council should establish one or more dispensaries in the Borough and retain complete control over the same themselves, or to accept the offer made by the authorities of the Hospitals in question to utilise their premises, &c., for the same purpose. If the Committee decide for the latter scheme, negotiations should then be opened with the Hospital authorities in order to draft a scheme which, while meeting with the approval of the Local Government Board, the London County Council and the Insurance Committee, will be acceptable to both Borough Council and the Hospital authorities concerned. In conclusion, I venture to express the hope that the Committee will favourably consider the offer of the Hospitals in question for the reasons above given. I am, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., D.P.H., Medical Officer of Hfaith. 122 REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE BUSINESS OF FUR SKIN DRESSING AND THE PREVENTION OF NUISANCE ARISING THEREFROM. To the Chairman and, Members of the Public Health Committee. Gentlemen, I have carefully considered the letter from the Clerk of the London County Council, dated 25th February, 1913, in which he states that the Deptford Metropolitan Borough Council has suggested that further bye-laws should be made dealing with offensive businesses, such as sorting and manipulation of gut (other than gut scraping), cleansing of offal and treatment of skin and viscera, and fat melting for dripping, and asking for the observations of the Hackney Borough Council on this proposal, together with any information which can be supplied relative to the extent to which such businesses are carried on in the Borough and as to nuisance, if any, which arises therefrom, and I beg herewith to report thereon. With respect to the businesses named, certain of them, such as sorting and manipulation of gut (other than gut scraping), cleansing of offal, and the treatment of viscera are not carried on in Hackney. Fat melting for dripping by butchers is carried on to a small extent; but I have had no complaints of nuisance or inconvenience from this cause. The treatment of skins, other than that process known as skin dressing, which is already subject to bye-laws of the London County Council, is carried on in the Borough to a considerable extent; but I regret to say that in certain cases the business has been conducted in such a way as to give rise to serious nuisance, and as a consequence to energetic complaints; moreover, considerable difficulties have been experienced in obtaining an abatement of the nuisances complained of, and the prevention of their recurrence. 123 The business referred to is that known as fur skin dressing. The fur skin dresser treats certain raw skins in such a way, as to render them fit for being made up by the furrier into trimmings or articles of clothing. Skins to be so treated are usually received in a more or less dried condition in parcels or bales, and may consist of skins of the following animals, viz.:— Small Skins. Large Skins. Mole. Stone Marten. Bear. Fitch. Opossum. Tiger. Skunk. Sable. Leopard. In order to give some idea of the way in which nuisances may arise from this business, it is necessary to describe briefly the processes the skins are subjected to on the premises. The first part of the treatment, after unpacking and sorting, is to place the skins to soak in an astringent solution such as alum. They remain in this solution a variable time from 12 hours to 3 days, depending upon the size of the skins. After sufficient soaking, the skins are taken out of the solution and the water drained from them. The under or fleshy side of the skin is then scraped, by means of a special knife which is fixed with its sharp edge pointing upwards. Over this sharp edge the skins are scraped. The fleshings, as they are called, which are removed by the knife, consist of flesh, connective tissue and fat. The scraped skins are then placed in a heated room to dry, and after drying, grease is worked into the hairless side of the skins. They are then placed in layers in a large tub, each layer being separated from the next by a layer of sawdust (satin wood), then trodden by men with their bare feet—the men standing in the tub and holding on to its edge; or the skins are treated in a machine which has the same effect as tubbing. After this process, which lasts about from 1 to 6 hours, the skins are taken out of the tubs and well shaken and beaten, to get rid of the sawdust. They are then ready for the furrier. 124 Possibilities of Nuisance.—Nuisances may arise in this business from:— 1. The astringent alum solution. 2. The fleshings. 3. The sawdust used in the tubbing of the skins. 4. Unsuitable premises. 1. The astringent solution may be kept so long as to become putrid. This is especially the case during the warmer months of the year ; and when the tubs containing such a solution are emptied, it causes a very offensive smell on the premises and in its neighbourhood, which will persist for some time. 2. The fleshings, if kept too long on the premises and improperly dealt with, may by their decomposition cause a foul odour to pervade the works and neighbourhood. 3. The sawdust, if kept too long on the premises, will create a nuisance from the decomposition of organic matter contained in it. This is especially the case if the sawdust, after being kept some time, is disturbed by shovelling it into carts or other receptacles on its removal from the premises. The sawdust gives rise to nuisance when it is burnt, as sometimes happens, in furnaces or fires on the premises ; and frequently, when this destruction is effected, opportunity is taken to burn the fleshings at the same time, mixed with the sawdust. This, of course, intensifies the nuisance. There is a great temptation to dispose of the sawdust and fleshings in this way, as by so doing, the expense of removal is saved. 4. Usually, the first intimation I receive that a fur skin dresser has established his business in the Borough is from some complaint of neighbours, of the foul smell at times caused by the business. It is then found, that the business is conducted without any precautions being taken to prevent nuisance, in premises totally unfit for the purpose. Mostly, some old house is taken, or some old workshop, too dilapidated to be used for any other purpose. 125 Precautions. 1. The astringent solution should not be kept long enough to become offensive; if it is offensive, it should be treated before being passed into the drains, so as to prevent nuisance. 2. The fleshings should be collected and removed from the workroom daily, and placed in airtight receptacles and the contents not disturbed until they can be removed from the premises. 3. The sawdust after use, should be placed in receptacles or sacks and removed periodically from the premises without disturbing the contents. 4. Neither fleshings nor sawdust should be burnt on the premises. 5. The soaking and fleshing should not be done in rooms having a wooden floor, or walls covered with paper or absorbent plaster, owing to the liability of the floors and walls becoming impregnated with offensive organic matter. The tubbing process should also be done in a room where the floor is paved with a jointless pavement. For the above reasons, I am of opinion that bye-laws should be drafted for the conduct of the business known as fur skin dressers, and that these bye-laws should provide for the following :— 1. That the premises should be suitable for the business carried on therein. 2. That any soaking solutions if offensive when agitated should be treated before being passed in the sewer. 3. That the fleshings shall be stored so as not to cause a nuisance, and be removed from the premises regularly, and in covered and airtight receptacles. 126 4. That the sawdust after being used in tubbing shall be placed in receptacles which shall be removed from the premises periodically, without the contents being disturbed. 5. That the burning of sawdust used in the business or fleshings on the premises be prohibited under a penalty. 6. The maintenance of general cleanliness of the premises. I am, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., D.P.H., Medical O fficer of Health. May, 1913. 127 REPORT OF THE MEDICAL OFFICER OF HEALTH AS TO THE OCCURRENCE OF EIGHT CASES OF POLIOMYELITIS IN THE BOROUGH OF HACKNEY DURING THE THREE WEEKS ENDED 28th JUNE, 1913. To the Chairman and Members of the Public Health Committee. Gentlemen, I beg to report herewith the circumstances connected with the occurrence of the above-mentioned cases of poliomyelitis. General Remarks.—Poliomyelitis is a disease of the nervous system, attacking chiefly young children, and due to an inflammation of the grey matter of the spinal cord, especially its anterior horns. The inflammation is set up, it is believed, by some organism, which has not yet been either isolated or identified, but which is believed to belong to the group of ultra-microscopic organisms. The disease is more prevalent in summer than in winter, and it does not appear to have any special relation with insanitary surroundings. The disease sets in usually with an attack of feverishness with pains of certain limbs or of the body generally. Other symptoms supervene indicating implication of the nervous system, especially when the brain is involved in the morbid process. Shortly after the appearance of these symptoms, certain muscles of the body are found to be paralysed. If the brain or coverings of the brain are affected, the case may resemble tubercular meningitis or cerebro-spinal fever. The disease is extremely fatal, the mortality amounting from 10 to 12 per cent, of the cases attacked. The paralysis of the muscles leaves the patient more or less crippled; more than half of those attacked by the disease being crippled for life. 128 Experiments have demonstrated that the virus is present in the mucous membrane of the nose and pharynx. Prevalence.—During 1912, eight cases of poliomyelitis were notified to me, all of which recovered, leaving some permanent paralysis of muscles. The first case notified during the present year was on June 7th. This is the first of the series of eight cases on which the Local Government Board desires my report. Appended is a list of these cases, with circumstantial details. The age of the patients were all under 6 years of age; saven were females and one male. Six of the cases were removed to the Queen's Hospital for Children, and notified by their Medical Officer. One case was notified by a local medical practitioner, and removed soon after to the Eastern Fever Hospital; and one case was notified by the Medical Officer of the Metropolitan Hospital, Kingsland Road, where the case had been in attendance as an out-patient for some days. Two of the cases were fatal; the other six recovered with some permanent paralysis of muscles. No difficulty appears to have arisen in connection with the diagnosis of the cases; even in the two fatal cases no examination of the cerebro-spinal fluid appears to have been made. It will be seen from the details of each case given, that the source of infection was not ascertained, no contact with previous cases could be traced and no subsequent case has arisen amongst the members of the affected families, nor had there been any intercourse between the members of the respective families. All precautions considering the characteristics of the disease were taken to prevent spread of infection. There are no data available for comparing the present incidence of this disease in the Borough with that of previous years, 129 as the disease was only made notifiable in 1912. Comparison with the mortality of previous years will not help, as this may vary considerably in different years. I do not regard the cases in question as other than sporadic cases, and have no reason to think they are the precursors of an epidemic outbreak. I am, Gentlemen, Your obedient Servant, (Signed) J. KING WARRY, M.D., D.P.H., Medical Officer of Health. September, 1913. Details of Cases Notified. 1. Gladys Levington (1 ½ years), 45, Stockmar Road. Fell ill 2nd June. Taken to Metropolitan Hospital as outpatient. Notified 7th June. Father, boot finisher. Five other children in family, four going to Homerton Row School and one too young for school. Family occupy flat of four rooms. On inspection bugs and fleas found in rooms, but no other nuisance. Family kept under observation, no further cases occurred, nor was this case found to be connected with any previous case. No examination of blood or cerebro-spinal fluid made. Premises cleansed. Patient recovered with some muscles permanently paralysed. 2. Frank Withrington (2 years), 24, Ottaway Street. Fell ill 10th May. Removed to Queen's Hospital 14th May. Notified 13th June. Father a baker's carman. Family occupy three rooms. Other children in family, one too young to go to school. No nuisance found on inspection. No connection with I 130 other cases traced. Family kept under observation, no other cases developed. No examination of blood or cerebro-spinal fluid made. Patient recovered with some muscles permanently paralysed. 3. Rosie Bolton (2½ years), 27, Montague Road. Fell ill 6th June. Removed to Queen's Hospital 6th June. Notified 13th June. Father engaged in laundry work. Four other children in family, all too young to go to school. Family occupy a flat of four rooms. On inspection one room was found infested with bugs and fleas. Case could not be traced to any other case. Family kept under observation, but no other cases occurred. The verminous room has been stripped and cleansed. No examination of blood or cerebro-spinal fluid made. Patient recovered with some muscles permanently paralysed. 4. Florence Bailey (1¾ years), 29, Inver Road. Fell ill 6th June. Removed to Queen's Hospital same day. Died next day. Notified 13th June. Father a warehouse porter. Two other children in family going to Detmold Road School. Family occupy a flat of three rooms. All rooms infested with bugs or fleas. A few unimportant other nuisances found and remedied. A post mortem examination of body was made. The spinal cord was found slightly enlarged. No connection was traced with other cases. No examination of blood or cerebro-spinal fluid made. All rooms cleansed and freed from vermin. 5. Phoebe Reeve (5 years), 5, Aveley Road. Fell ill 7th June. Admitted to Queen's Hospital 12th June. Notified 13th June. Died the same date. Father, electrician. One other child in family, who was in good health, but too young to go to school. Family occupy a flat of two rooms. No nuisance found on premises. No connection traced with other cases. This child attended the Detmold Road School. No other case in this school. Post mortem made, but result of examination not known, nor is^it known if the blood or cerebro-spinal fluid was examined. 131 6. Hilda West (4 years), 89, Rushmore Road. Fell ill 16th May. Removed to Queen's Hospital 25th May. Notified 13th June. Father a carpenter. Family occupy a flat of four rooms and scullery. Two other children in same family going to Millfields Road School. No other case in this school. No connection traced with other cases. Family kept under observation, but no other cases occurred. No nuisance on premises. No examination of blood or cerebro-spinal fluid made. Patient recovered with some muscles permanently paralysed. 7. Eleanor Mead (3½ years), 9, Retreat Cottages. Fell ill 11th June. Removed to Queen's Hospital 16th June Notified 21st June. Father, builder's labourer. Four other children in same family going to Detmold Road School. Patient too young for school. Family occupy a flat of two rooms. The bedrooms said to have a few fleas. No other nuisances on premises. Rooms cleansed and freed from vermin. Family kept under observation, but no other case has occurred in family. Case not traced to any other source. Spinal fluid examined. Result: spinal fluid clear; albumen, .025 per cent.; small number of lymphocytes; sterile culture. Patient recovered with some muscles permanently paralysed. 8. Grace Faulkner (3 years), 42, Garnham Street. Fell ill 20th Jun2. Notified 27th June. Removed to Eastern Fever Hospital, Homerton, 28th June. Two other children in family, both well. Father an engineer's labourer. The family occupy a flat of three rooms. One room infested with bugs. This was stripped and cleansed. Case not traced to source. Family kept under observation, but no other cases occurred. The two other children attended the High Street, Stoke Newington, School. No examination of the blood or spinal fluid. Patient recovered with some muscles permanently paralysed. i 2 132 Public Health Department Town Hall, Hackney, N.E. To the Chairman and Members of the 30th June, 1913. Public Health Committee. Gentlemen, Proposed Regulations for Preventing Contamination of Food. I have carefully considered the letter of the Town Clerk to the Borough Council of St. Pancras on the above subject and beg herewith to report thereon. The proposal of the St. Pancras Borough Council is that the London County Council should be asked to promote legislation, in one of their General Powers Bills, to enable them to make regulations with the object of preventing the pollutions, resulting from the exposure of food and food receptacles by butchers, fishmongers and provision dealers in public places or places adjacent to the public streets, and suggesting that a regulation should be made, requiring such perishable goods to be p!aced not less than 3 ft. above the pavement. That there is need for some such measure, no one will, I am sure, dispute, who has observed the way in which articles of food, are exhibited for sale in our busy market thoroughfares. A walk through Chatsworth Road, London Fields, Ridley Road, Kingsland Road, Well Street, or any of the market thoroughfares of the Borough, on a Saturday will convince the most sceptical, that there is room for the adoption of further precautions against contamination of food supplies. In the thoroughfares mentioned above, there are, in addition to many provision shops, a large number of stalls, some owned by the shopkeepers themselves, but the majority belonging to costermongers, who may be living in the neighbourhood or may be visitors, for the purpose of business, from other districts. To whichever class of trader the stalls 133 belong, there is not much difference in the way in which the exposed food for sale is treated. Meat, fish, fruit and vegetables are uncovered and frequently placed sometimes under the stalls, in close proximity to the ground, or on the ground by the side of the stalls. In some of the shops themselves biscuits, &c. are piled up in open tins from the ground upwards. These are all exposed to contamination from dust and from the attentions of roaming dogs. In the case of the resident shopkeepers, there is no reason why articles of food should be placed in any position which may expose them to pollution; but with regard to the costers who come from a distance there is this difference, that they usually carry to their market place more stock than they can satisfactorily exhibit at one time on their stalls, and they have no place of storage for the remainder. This ean only be placed either under the stall, or at its side. But even this fact should not stand in the way of the adoption of some effectual measure for preventing food from contamination. After careful consideration, I am of opinion that the proposal of the St. Pancras Borough Council is a very reasonable one. It will not press heavily upon the shopkeepers, who have stalls in the street, as they have accommodation in their shops to keep their surplus stock out of the reach of contamination. With regard to the costers' stall, the proposed regulation will press more heavily upon them; but even with these, I am of opinion that articles of food exposed by them for sale should be raised at least 3 ft. above the surface of the ground, and if there is more stock than can be displayed or placed on the stall, it should be covered up and enclosed in receptacles in such a way as to prevent any and all danger of contamination. I am, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., D.P.H., Medical Officer of Health. 134 METROPOLITAN BOROUGH OF HACKNEY. REGULATIONS Prescribed by the Council of the Metropolitan Borough of Hackney under Section 17 (7) of the Housing, Town Planning, &c., Act, 1909. Every room habitually used as a sleeping place the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room shall comply with the following regulations, namely:— 1.—The subsoil of the site of the room shall be effectually drained by means of a subsoil drain properly trapped and ventilated wherever the dampness of the site renders such a precaution necessary. 2.—Every drain passing under the room, other than a drain for the drainage of the subsoil of the site of the room, shall be gastight and watertight. 3.—The room shall be effectually protected against the rising of any effluvium or exhalation by means of a layer of asphalt or of good concrete at least six inches thick or four inches thick if properly grouted, laid upon the ground of the site of the entire room or in some equally effectual manner. 4.—The space (if any) beneath the floor shall be provided with adequate means of ventilation. 5.—(i.) Every wall of the room shall be provided with a proper horizontal damp-proof course which if the floor of the room be formed of woodwork shall be beneath the level of the lowest timbers or woodwork of such floor and in every other case shall be not less than one inch below the level of the upper surface of such floor. 135 (ii.) No part of any wall of the room shall where it is practicable to avoid it be in contact with the ground or earth, provided that where any wall of the room is in contact with the ground or earth, such wall or such part thereof as is so in contact shall unless constructed as a hollow wall have an efficient vertical damp-proof course extending from the base thereof to a height of at least six inches above the surface of such ground or earth. 6.—Unless the room is provided with a fireplace and a flue properly constructed and properly connected with such fireplace it shall be provided with special and adequate means of ventilation by one or more suitably placed apertures or air shafts. 7.—An area or open space properly paved with impervious material and effectually drained by means of a properly trapped gulley shall adjoin the room and extend either throughout the entire length of one side thereof or at least throughout the entire width of any window or windows required by these regulations and (except where the area of such window or windows shall be of not less extent than one-seventh of the floor area of the room) for three feet on both sides of such window or windows. Such area or open space shall be not less than four feet wide, in every part thereof and shall be open upwards from a level three inches below the level of the damp-proof course in the adjoining wall of the room. Provided (a) that where a bay window in the room having side lights overlooks such area the width thereof in front of such window may be three feet at the least. 136 (b) that any steps necessary for access to any part of the building comprising the room may be placed in or over such area if they are so placed as not to be over or across any window of the room required by the regulation in that behalf. 8.—(i.) The room shall be effectually lighted by means of one or more windows opening directly into the external air. (ii.) Every such window shall be so constructed that onehalf at the least may be opened and that the opening may extend to the top of the window. (iii.) The total area of such window or windows clear of the sash frames shall be equal at the least to oneeighth of the floor area of the room and a portion of such total area equal in extent to at least one-tenth of such floor area shall be so situated that a line making an angle of thirty degrees with a horizontal plane can be drawn upwards from any point thereon in a vertical plane at right angles to the plane of the window so as not to intersect within a distance of ten feet measured horizontally from the window any wall of any area adjoining the room or any other wall or any kerb or other obstruction except an open fence. For the purposes of this paragraph a bay window having side lights shall be assumed to be equivalent to a flat window of the same area and of the same height in relation to the room and situated at a distance from the outside area wall equal to the mean width of the area. 137 (iv.) In estimating the area of a window or windows for the purpose of this regulation no account shall be taken of any part of any such window which is above the mean level of the ceiling of the room. (v.) Any such window or windows shall overlook the area or open space provided in pursuance of the regulation in that behalf. The Common Seal of the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney was hereunto affixed, pursuant to a Resolution of the Council duly passed in the presence of: CHARLES WINKLEY, Mayor. A. H. LEHMANN, ] JAS. S. LEESON, Members. NORMAN SCORGIE, Deputy Town Clerk. 29th January, 1914. The consent of the Local Government Board is hereby given to the foregoing Regulations this Twenty-seventh day of April, 1914. H. C. MONRO, Secretary, Acting on behalf of the said. Board under the authority of their General Order dated the Twenty-sixth day of May, 1877. 138 ANNUAL REPORT OF CANAL BOATS INSPECTOR FOR 1913. To the Council of the Metropolitan Borough of Hackney. 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 80 „ boats inspected 23 „ comforming to Acts 23 „ „ infringing Acts None „ certificates examined 23 ,, persons for which boats were registered— Adults 83 Children 3 Number of persons living on boats so registered— Men 41 Women 1 Children 3 No legal proceedings were taken. I have the honour to be, Gentlemen, Your obedient Servant, GEORGE WHITE, Sanitary Inspector and Inspector under the Canal Boats Acts. 139 LIST OF LICENSED COWSHEDS In the Borough of Hackney, October, 1913. Name. Address. No. of 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 Francis, T. 257, Queen's Road, Dalston 1 Protheroe, T. 79, Shacklewell Lane, Hackney 1 Stapleton, A., & Sons, Ltd. Stoke Newington Common 3 Briggs, J. J 180, Victoria Park Road 1 Thomas, David 6, Warburton Road, Hackney 1 Total Cowsheds 17 LIST OF LICENSED SLAUGHTER-HOUSES In the Borough of Hackney, October, 1913. Name. Address. Friday, Richard G 235, Amhurst Road. Raymond, George 186, Cassland Road. Hussey, A. J. 37, Church Road, Homerton. Wood, Henry 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. Joyce, John 531, Kingsland Road. 140 List of Licensed Slaughter houses—continued. Name. Address. 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, Frederick William 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, W. E. 51, Wilton Road. LIST OF BAKEHOUSES, 1913. No. 1 District. Samson, W. J. 77, Upper Clapton Road. Buddin, J 87, Reighton Road. ‡Vincent, A 104, Old Hill Street. Morgan, A 33, Old Hill Street. 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. Wilkinson 114, High Street, Stoke Newington. Heyward 216, High Street, Stoke Newington. ‡Mezger, A 33, Rectory Road. Vogt, C. H 62, Evering Road. Burch, Mrs. H 9, Maury Road. Willsmer, C. 8, Stellman Street. ‡Guscott, J 128, Stoke Newington Road. 141 List of Bakehouses—continued. Name. Address. ‡Seufert, C 40, Shacklewell Lane. ‡Karsch, J 239, Amhurst Road. Brenner, W. 73, Shacklewell Lane. ‡Cohen 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, Lower Clapton Road. ‡Engel, J. 71, Lower Clapton Road. Cowley, P. G. 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. ‡Adolph, H 94, Chatsworth Road. Lunken, H. 71, Chatsworth Road. ‡Maloney, J 36, Chatsworth Road. ‡Wickert, W. 19, Chatsworth Road. ‡Knapp, W 219, Glyn Road. Latham, J 326, Glyn Road. No. 5 and 6 District. Liebsch, H. 49, Greenwood Road. Spenner, A 81, Wilton Road. 142 List of Bakehouses—continued. Name. Address. ‡Roberts 178, Dalston Lane. ‡Hohl, J 72, Dalston Lane. 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, Kingsland Road. Best, C. 376, Kingsland Road. ‡Sedgwick, F. C 329, Kingsland Road. ‡Henkelmann, H 174, Southgate Road. Allardyce, S. W 98, Southgate Road. ‡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. No. 7 District. Payne, A 54, Broadway, London Fields. ‡May, H 70, Broadway, London Fields. ‡Bushell, F 10, Broadway, London Fields. ‡Stumm, K 26, West Street. Slade, C 139, Mare Street. ‡Reitz, C 183, Mare Street. Wragg, A. H. 27, Morning Lane. Morse, H 77, Mare Street. Zimmerman, P 52, Sheep Lane. ‡Stimson 77, Frampton Park Road. 143 List of Bakehouses—continued. No. 8 District. Name. Address. ‡Skaer, P 76, Well Street. Martin, J 105, Well Street. ‡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, High Street, Homerton. ‡Gibbons, G 131, High Street, Homerton. Bradford, G. 95, High Street, Homerton. ‡Hewitt, A 167, High Street, Homerton. 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. Holman, A 154, Well Street. ‡Stark, W 186, Well Street. Gilsdorf 233, Well Street. 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. 144 List of Bakehouses—continued. Name. Address. Dance, Mrs. A 315, Wick Road. Brake, G 370, Wick Road. James, G 389, Wick Road. Warner, H. R. 13, Gainsboro' Cottages. Davis, S 71, Felstead Street. Haupt, C 41, Osborne Road. No. 12 District. ‡Crowe, W 18, Upper Clapton Road. ‡Kurtz, W 200, Lower Clapton Road. ‡Underground Bakehouses.