HAC 29 Borough of Hakney REPORT on the SANITARY CONDITION of the hackney district, FOR THE YEAR 1914. by J. KING WARRY, M.D. LOND., M.R.C.P., Diplomate in Public Health; Licentiate of the Society of Apothecaries; Fellow of the Society of Medical Officers of Health; Member of the Lister Institute of Preventive Medicine; Foreign Associate Member of the Society of Hygiene of France. Medical Officer of Health for the Borough. London: Chas. Straker & Sons, Ltd., 5-9, Bishopsgate Avenue, E.C. 1915. INDEX PAGE Alcoholism 47 Anthrax 57,134 Birth Rate 9 By-laws—Houses let in Lodgings 55 Canal Boats Act 57 Cancer 46 Cerebro-Spinal Fever 37 Cleansing ol Persons Act, 1897 82 Combined Drainage and Sewers 77 Constitutional Diseases 45 Cowhouses, Dairies, and Milkshops 52 Customs and Inland Revenue Act 56 Death Rate 12 Deaths in Public Institutions 16 Diarrhoea 38 Diphtheria 34 Disinfection 78 Enteric Fever 35 Erysipelas 87 Estimated Population 8 Factories 70 Factory and Workshops Act, 1901 67 Glanders and Farcy Order 57 Glanders, Anthrax and Hydrophobia in Man 38 Home Work and Out-Workers 73 Houses Let in Lodgings 55 Housing and Town Planning Act, 1909 57 Ice Cream Vendors 57 Illegitimacy 10 Infant Mortality 13 Influenza 38 Marriage Rate 9 Measles 44 Methods of Control of Tuberculosis 60 Mortuary 88 Notification of Births Act 10 Notifiable Diseases 33 Non-Notifiable Diseases 33 Offensive Trades 53 Ophthalmia Neonatorum 37 Plague 37 Polio-myelitis 37 2 A INDEX. PACE Population and Density 8 Prosecutions under Food and Drugs Acts 93 Prosecutions under Public Health (London) Act 92 Public Health (London) Act, 1891 50 Public Health Legislation 66 Public Health (Tuberculosis) Regulations, 1912 60 Puerperal Fever 37 Register of Sanitary Work 94-101 Removal of House Refuse 86 River Lee 60 Senile Mortality 15 Scailet Fever 33 Shelter 82 Slaughter-Houses 53 Small-pox 33 Smoke Nuisances 54 Specific Causes of Death 23-32 Tuberculous Disease 45 Tuberculosis Dispensaries 107 Typhus 36 Vaccination 48 Verminous Children 124 Whooping Cough 44 Workshops and Laundries 70 Zymotic Diseases 33 Tables— Articles Disinfected during 1914 70 Births 11 Bakehouses, List of 103 Causes of Infant Mortality 15 Cowsheds 102 Deaths 24 Death Statistics, according to Causes and Ages 24-32 Dusting Account 87 Infectious Sickness 21 Inquests 89 Population, Area and Density in Sub-Districts in Hackney 8 Requests for Removal of Dust 88 Samples of Foods and Drugs Purchased 91 Samples of Milk Analysed 90 Slaughter-Houses, List of 103 Suicidal and Accidental Deaths 89 Vaccination 48 Metropolitan Borough of Hackney. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1914. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, N.E. June, 1915. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Gentlemen, I beg to present herewith my Twenty-third Annual Report on the Public Health of the Borough of Hackney. The Borough still maintains its position as one of the healthiest in London. The general death rate for the year was 13.9 per 1,000 of the population and the infant mortality 90 per 1,000 births. These figures show a small increase in the general death rate and a decline in the infant death rate. This increase in the general death rate is shared with the other Boroughs of the Metropolis, and is due chiefly to an increase in the deaths from measles and whooping cough. An increase in the prevalence of the notifiable infectious diseases also occurred, the total number of cases from all these diseases being 1,711, compared with 1,126 during the year 1913. The number of deaths from the chief zymotic diseases numbered 341, which is equivalent to a zymotic death rate of 1.5 per 1,000 living. A slight increase in the mortality from tuberculosis took place during the year. This subject is particularly dealt with on page 6 46 of this report. It will be seen there that the mortality from this disease fluctuates from year to year, but the general tendency is to a gradual decline. The following table giving the density of population and the general and infantile mortality rates of the Borough for the last 16 years, shows the public health improvement during that period:— Year. Density. General Death Rate (per 1,000 living). Infantile Mortality Rate (per 1,000 births). 1899 67.5 17.9 165 1900 66.5 17.4 162 1901 66.7 16.6 137 1902 67.3 16.0 121 1903 67.9 14.7 127 1904 68.5 16.0 155 1905 69.1 15.0 140 1906 69.8 14.1 123 1907 70.6 14.4 116 1908 71.0 13.9 117 1909 71.3 13.7 108 1910 70.0 12.3 99 1911 67.1 15.0 119 1912 67.8 12.3 79 1913 68.0 13.6 99 1914 68.0 13.9 90 The relative position from a health point of view occupied by Hackney may be seen from the subjoined table, compiled from figures supplied by the Registrar-General, showing the death rates 7 from all causes and the death rates of infants under one year of age in the Metropolitan Boroughs and the Cities of London and Westminster for the year 1914. Boroughs Death-rate from all causes per 1,000 living (corrected). Deaths under 1 year to 1,000 births. Lewisham 10.7 74 Wandsworth 11.0 89 Hampstead 11.0 89 Stoke Newington 12.5 78 Chelsea 12.9 67 Paddington 12.9 95 Kensington 13.I 94 City ot Westminster 13.2 80 Battersea 13.4 93 Camberwell 13.6 99 Hammersmith 13.7 94 Fulham 13.8 113 Hackney 14.0 90 City of London 14.0 94 St. Marylebone 14.1 98 Woolwich 14.1 85 Deptford 14.3 99 Lambeth 14.3 lot Greenwich 14.5 98 Islington 14.8 105 St. Pancras 15.6 92 Holborn 16.2 90 Bethnal Green 16.0 137 Poplar 16.9 116 Stepney 17.3 124 Bermondsey 17.4 125 Southwark 19.9 124 Finsbury 19.4 123 Shoreditch 19.6 141 The question of infant mortality is dealt with in another part of this Report (see page 13), and it will there be seen from the rate of infant mortality that satisfactory progress has been made in dealing with this problem. Detailed reference to the preventive measures taken in connection with the prevention of the spread of tuberculosis is made in a later part of this Report (see page 60). 8 The following table shows the change which is gradually taking place in the Borough, viz., a change from a residential locality to that of an industrial centre:— 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 1914 563 1,142 2,542 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. Two of the Sanitary Inspectors, G. White and H. Body, who were members of the Sanitary Corps of the R.A.M.C. (T), were called upon during the year to serve in the Expeditionary Force in France. Their places have been temporarily filled by two other inspectors. Population and Density.—Applying the rate of increase observed during the last inter-censal period to the population of Hackney, I estimate the population of the Borough at the middle of the year 1914 to number 223,718. This gives a density of population for the whole Borough of 68.0 persons per acre, varying from 50 -7 persons in the North Sub-district to 98.0 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 1914. North. Central. SouthWest. SouthEast. Total for Hackney Total for London. Estimated Population 54,775 54,601 57,453 56,889 223,718 4,518,021 Area in square acres 1,081 857 586 764 3,288 74,816 Density—persons per acre 50.7 63.7 98.0 74.6 68.0 60.4 9 *Marriages and Marriage Rates.—During 1914 there were 1,970 marriages solemnised in the Borough of Hackney. The annual rate for persons married during this period is therefore 17 6 per 1,000 of the population. The following table gives the number of marriages and marriage rates for the Borough of Hackney and London during the ten years 1905-1914:— Year. Borough of Hackney. London. Marriages. Marriage Kate. Marriage Rate. 1901 1,719 15.1 17.0 1905 1,714 15.0 16.9 1900 1,770 15.4 17.1 1907 1,900 16.4 17.0 1908 1,996 17.0 15.9 1909 2,030 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 1913 1,941 17.4 16.1 Average 1904—1913 1,855 16.2 16.8 1914 1,970 17 6 19-2 Births and Birth-rate.—The births registered in the Borough of Hackney during the year 1914 numbered 5,708, of which 2,965 were males and 2,743 females. The total shows a decrease of 25 compared with the number registered during 1913. 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 occurring 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 number of these transferable births, viz., 354 births to be *I have here to acknowledge my indebtedness to Mr. H. Brougham Loney, Superintendent Registrar, who has kindly abstracted for me the number of marriages for the year 1917 10 transferred to other districts and 106 to Hackney. After making these necessary corrections, the correct total of registered births amongst Hackney residents is 5,460. From this figure, I calculate the corrected birth-rate for Hackney during 1914 to be 24-4 per 1,000 of the population. The birth-rate for all London for the same period is 24-3 per 1,000 of the population. Notification of Births Act, 1907.—Under the provisions of this Act, I received 5,575 notifications of births occurring in the Borough during 1914. This total includes notifications from medical practitioners, midwives, and other persons. It also includes still births. This total is 133 less than the number registered by the Registrars of Births. Still Births.—Amongst the births notified were 174 still-born. This is equal to 3-1 per cent, of those notified. I give here a table showing the number of notifications received with other details in connection with the same. (b) NOTIFICATION OF BIRTHS ACT, 1907. Notifications of Births (Live or Still-born) received during the year 1914. Year 1914. Medical Practitioners. Midwives. Parents and Others. Total. Live. Still. Live. Still. Live. Still. Live Still. INI. F. M. F. M. F M. F M. F. M. F. M. F. M. F. Totals. 1,033 901 42 35 1,254 1,197 44 37 520 499 9 7 2,807 2,597 95 79 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1914 was 437; but of these, I am informed by the Registrar-General, 314 should be transferred to districts outside of Hackney, as the mothers were not Hackney residents, and 14 births, taking place in other districts, should be transferred to Hackney. Making these corrections, there remain 137 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate birth-rate of 25.0 per 1,000 births. 11 The following tabic 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. SouthEast. Total No. of Births 5,708 989 1,774 1,402 1,543 109,667 Rate per 1,000 living 25.5 18.0 32.5 24.4 27.1 24.3 No.of Illegitimate Births 137 Rate per 1,000 Births 25.0 The following table shows the birth-rates for the Borough and its Sub-districts during the years 1904 to 1914 inclusive:— Birth-rate for the Borough of Hackney and its Sub-Districts for the years 1904-1914 compared, with that of London. Year. Borough Hackney. North SubDistrict. Central SubDistrict. South-West SubDistrict. South-East SubDistrict. London. 1904 27.2 19.5 26.5 29.9 33.5 27.9 1905 25.7 19.6 26.8 29.9 27.3 27.1 1906 25.5 19.0 25.4 28.2 28.3 26.4 1907 24.8 19.4 25.1 27.2 26.8 25.8 1908 24.3 18.6 23.0 28.7 26.0 25.2 1909 24.2 18.2 23.1 29.4 24.0 24.2 1910 23.1 17.6 22.9 26.7 24.6 23.6 1911 24.3 18.8 24.8 28.0 25.2 24.8 1912 24.3 18.7 23.9 28.4 25.7 24.5 1913 25.6 18.9 26.6 30.3 26.5 24.5 Average 1901—1913 24.9 18.8 24.8 28.6 26.7 2 5.4 1914 25.5 18.0 32.5 24.4 27.1 24.3 12 Deaths.—The deaths registered in the Borough during 1914 numbered 3,233, but of these 662 were deaths of non-residents dying in institutions and other places in the Borough. There were, however, 557 residents of Hackney who died during the year in institutions in other districts. On making the necessary corrections, I find the correct number of deaths amongst Hackney residents during 1914 was 3,128. This is an increase of 74 upon the number of deaths occurring during 1913. The general deathrate from all causes for the year 1914 is 13.9 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 13.9 per 1,000 of the population for the year 1914. Compared with the corrected general death-rate for 1913, that of 1914 is .2 higher. Amongst the Registration Sub-districts, the death-rate was lowest in the North Sub-district (12.5 per 1,000), and highest in the South-East sub-district (15.4 per 1,000). Sub-District. Population. No. of Births. Birthrate. Total Deaths. Deathrate. (Crude.) Deaths under 1 year. Infant Mortality per 1,000 Births. North 54,775 989 18 0 690 12 5 88 89 Central 51,601 1,774 32 5 692 126 116 65 South-West 57,453 1,402 244 866 150 110 78 South-East 56,889 1,543 271 880 154 178 115 All Hackney 223,718 5,708 255 3,128 139 492 86 The corrected annual death-rate from all causes for London during 1914 is 14.4 per 1,000 living. 13 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. 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 13.7 14.2 1909 13.2 14.0 1914 13.9 14.4 Infantile Mortality.—The deaths under one year of age in the Borough during 1914 numbered 492. This is a decrease of 57 upon the number of infants' deaths recorded during 1913. The infant mortality rate for the year is 90 per 1,000 births. The decreased rate is due chiefly to a decrease in the number of deaths from bronchitis and pneumonia. Other special causes of infant deaths deserving mention are premature birth (81), diarrhoea (109), atrophy debility and marasmus (54). During the year Mrs. Rhodes, health visitor, made 1,316 primary visits to the homes of nursing mothers and their infants, and 829 subsequent visits. There were also 237 fruitless visits, the mothers being either out at the time, or having changed their address. The weekly weighing meetings at the Town Hall have been continued during the year with slight interruption. The actual number of meetings was 47, and the total number of infants weighed 1,501. The following table gives particulars of the feeding of the infants and the home conditions found by the Health Visitor amongst the children visited:— 14 PARTICULARS RESPECTING THE FEEDING, CARE, AND ENVIRONMENT OF THE BABIE5 VISITED, 1914. 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 674 642 1,119 130 67 771 545 691 625 231 92 285 54 592 62 1,160 150 170 67 829 Number of Infants weighed 1,501 15 Senile Mortality.—The deaths which occurred in Hackney at 65 years of age and upwards during 1914 numbered 903, and of these 444 were between the ages of 65 and 75 years, 340 between 75 and 85 years, and 119 at 85 and upwards. The annual mortality rate of persons at 65 years and upwards is 4 3 per 1,000 living. TABLE IV.—INFANT MORTALITY 1914. 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 4 weeks. 4 weeks and under 3 months. months and under 0 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... 1 1 Measles ... ... ... ... ... ... 2 5 9 10 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... 1 3 10 5 5 24 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... 1 ... 1 ... 2 Tuberculous Meningitis ... ... ... ... ... 1 1 3 5 10 Abdominal Tuberculosis. ... ... ... ... ... 1 2 4 7 Other Tuberculous Diseases ... ... 1 ... 1 1 1 1 3 7 Meningitis (not Tuberculous) ... ... ... ... ... 1 1 2 1 5 Convulsions ... 5 1 ... 12 ... 4 2 1 19 Laryngitis ... ... ... ... ... ... ... ... 1 1 Bronchitis ... ... 2 1 3 4 3 9 7 26 Pneumonia (all forms) ... ... 2 2 4 9 10 16 15 54 Diarrhoea ... ... ... ... ... 11 19 13 7 50 Enteritis ... 3 1 2 6 9 29 12 3 59 Gastritis ... ... 1 ... 1 ... ... ... ... 1 Syphilis ... 1 1 ... 2 2 5 ... ... 9 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying 2 ... ... ... 2 2 1 2 ... 7 Injury at Birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis 4 2 1 ... 7 ... ... ... ... 7 Congenital Malformations 9 5 1 ... 16 5 1 ... ... 22 Premature Birth 65 7 3 3 78 3 ... ... ... 81 Atrophy, Debility and Marasmus 14 6 1 ... 23 13 14 4 ... 54 Other Causes 4 1 2 ... 7 2 7 4 4 24 Total 109 30 17 11 167 68 110 83 64 492 16 Deaths in Public Institutions.—There were 1,558 deaths in public institutions in the Borough during 1914; of these 662 were residents of other districts, and the remaining 896 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 1914:— Institutions Within the Borough receiving Persons both From and Without the Borough. Brooke House, Upper Clapton Road 6 City of London Infirmary, Clifden Road 63 ,, Workhouse, Clifden Road 4 Convent of the Sacred Heart, Hassett Road 5 Eastern Fever Hospital, Homerton 108 French Hospital, Victoria Park Road 3 German Hospital, Dalston 154 Hackney Union Infirmary, Homerton 900 „ Workhouse, Homerton 9 Metropolitan Hospital, Kingsland Road 185 Nursing Home, 46, Amhurst Park 1 „ 47, Nightingale Road 3 „ 5, Northfield Road 4 „ 2, Queensdown Road 5 ,, 18 and 20, Southwold Road 5 Private Hospital, 172 and 174, High Street, Homerton 9 Rescue Home, 98, Shacklewell Lane 1 St. John's Nursery Home, 151, Stamford Hill 1 St. Joseph's Hospice, Mare Street 60 St. Scholastica's Retreat, Kenninghall Road 1 Salvation Army Nursing Home, 29, Devonshire Road 3 „ Maternity Hospital, Lower Clapton Road 10 ,, „ „ 16, Rectory Road 2 ,, Homes, Springfield 16 1,558 17 Institutions Outside the Borough receiving Sick and Infirm Persons from the Borough. Banstead Asylum 11 Bethnal House Asylum 3 „ Green Infirmary 8 „ ,, Workhouse 2 Brentwood Asylum 1 Brompton Hospital 1 Cane Hill Asylum 2 Caterham Asylum 3 Camberwell House Asylum 1 Central London Throat and Ear Hospital 2 Charing Cross Hospital 1 Children's Hospital, Great Ormond Street 15 City of London Lying-in Hospital 4 Claybury Asylum 34 Colney Hatch Asylum 20 Dartford Heath Asylum 7 Downs Sanatorium, Sutton 12 Darenth Industrial Colony 2 „ Asylum 1 Edmonton Infirmary 2 Essex and Colchester Asylum 4 French Hospital 1 Friedenheim Hospital 4 Great Northern Hospital 3 Hackney Workhouse, Brentwood 12 Homeopathic Hospital 2 Home and Hospital for Jewish Incurables, Tottenham 1 Horton Asylum 3 Hospital for Women, Soho 1 Hamvell Asylum 4 Hospital of St. John and St. Elizabeth, St. Marylebone 2 B 18 Hostel of God, Clapham 1 Holborn Workhouse, Shoreditch 1 Islington Infirmary 2 King's College Hospital 1 King Edward VII. Hospital, New Windsor 1 Leavesden Asylum 11 Long Grove Asylum 1 London Fever Hospital 3 „ County Asylum, Ilford 2 „ Hospital 68 Middlesex Hospital 5 „ County Asylum, Wandsworth 1 Napsbury 2 Mildmay Mission Hospital 1 ,, Memorial Hospital 3 Mount Vernon Hospital, Northwood 1 North Eastern Fever Hospital 21 National Hospital, Queen's Square 1 Northumberland House, Green Lanes 1 North Western Fever Hospital, Hampstead 11 Nursing Home, 19, Holly Road, Leytonstone 2 „ Institute, Stoke Newington 2 Peckham House 2 Prince of Wales General Hospital, Tottenham 13 Queen Charlotte's Hospital 4 Queen's Hospital for Children 74 Queen Mary's Hospital, Carshalton 7 Royal Victoria Hospital, Netley 2 „ Chest Hospital, City Road 5 ,, Hospital for Incurables 1 ,, Free Hospital 1 St. Anne's Home, Heme Bay 1 St. Bartholomew's Hospital 21 St. Catherine's Hospital, Ventnor 1 19 St. Catherine's Home, Ramsgate 1 St. Luke's House, Kensington 6 Shoreditch Infirmary 8 South Western Fever Hospital 1 Sick Asylum, Bromley 1 St. George's Hospital 1 St. Mark's Hospital 1 Southern Hospital, Gore Farm 1 Tooting Bee Asylum 26 Throat Hospital, Golden Square 1 University College Hospital 2 Victoria Park Chest Hospital 4 West Ham Hospital 1 Walthamstow Hospital 1 Whitechapel Union Workhouse 1 „ Infirmary 1 West London Hospital 1 Westminster Hospital 1 Miscellaneous Institutions 55 557 B 18 Hostel of God, Clapham 1 Holborn Workhouse, Shoreditch 1 Islington Infirmary 2 King's College Hospital 1 King Edward VII. Hospital, New Windsor 1 Leavesden Asylum 11 Long Grove Asylum 1 London Fever Hospital 3 „ County Asylum, Ilford 2 „ Hospital 68 Middlesex Hospital 5 „ County Asylum, Wandsworth 1 Napsbury 2 Mildmay Mission Hospital 1 „ Memorial Hospital 3 Mount Vernon Hospital, Northwood 1 North Eastern Fever Hospital 21 National Hospital, Queen's Square 1 Northumberland House, Green Lanes 1 North Western Fever Hospital, Hampstead 11 Nursing Home, 19, Holly Road, Leytonstone 2 „ Institute, Stoke Newington 2 Peckham House 2 Prince of Wales General Hospital, Tottenham 13 Queen Charlotte's Hospital 4 Queen's Hospital for Children 74 Queen Mary's Hospital, Carshalton 7 Royal Victoria Hospital, Netley 2 „ Chest Hospital, City Road 5 „ Hospital for Incurables 1 „ Free Hospital 1 St. Anne's Home, Heme Bay 1 St. Bartholomew's Hospital 21 St. Catherine's Hospital, Ventnor 1 19 St. Catherine's Home, Ramsgate 1 St. Luke's House, Kensington 6 Shoreditch Infirmary 8 South Western Fever Hospital 1 Sick Asylum, Bromley 1 St. George's Hospital 1 St. Mark's Hospital 1 Southern Hospital, Gore Farm 1 Tooting Bee Asylum 26 Throat Hospital, Golden Square 1 University College Hospital 2 Victoria Park Chest Hospital 4 West Ham Hospital 1 Walthamstow Hospital 1 Whitechapel Union Workhouse 1 „ Infirmary 1 West London Hospital 1 Westminster Hospital 1 Miscellaneous Institutions 55 557 13 20 TABLE I.—HACKNEY DISTRICT. Vital Statistics of Whole District during 1914 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1901) 222,095 5,702 5,436 24.4 3,123 14.0 442 447 616 113 3,128 14.0 1910 222,381 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 1913 223,369 5,733 5,523 24.7 3,156 14.1 665 563 549 99 3,054 13.6 1914 223,718 5,708 5,460 25.5 3,233 14.4 662 557 492 85 3,128 13.9 21 TABLE II.—HACKNEY DISTRICT. Cases of Infectious Disease Notified during the Year 1914. Notifiable Disease. Cases Notified in whole Districts. Total Cases Notified in each Locality. Total cases removed to Hospital, At all Ages. At Ages—Years. 1 2 3 4 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. North. Central South-East South-West. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ••• ... ... ... ... ... ... Diphtheria (including Membranous Croup 474 10 157 232 40 31 4 ... 135 80 129 130 409 Erysipelas 290 5 20 17 38 100 88 28 51 79 92 74 57 Scarlet Fever 790 4 160 502 88 32 4 146 229 163 252 693 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 23 ... 1 3 11 8 ... ... 9 7 13 1 19 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 2 ... 1 1 ... ... ... ... ... ... 2 ... 2 Puerperal Fever 17 ... ... ... 6 11 ... ... 3 5 8 1 11 Cerebro-Spinal Meningitis 3 2 ... ... l ... ... ... ... 2 1 ... 2 Polio Myelitis 5 ... 3 2 ... ... ... ... 3 1 ... 1 1 Ophthalmia Neonatorum 45 45 ... ... ... ... ... ... 14 9 11 11 ... Pulmonary Tuberculosis 550 7 41 131 269 89 13 96 111 161 182 310 Other forms of Tuberculosis 148 13 33 59 25 16 ... ... 20 28 56 44 49 Anthrax 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 Totals 2,354 79 382 857 341 467 187 41 470 552 636 i 696 1,554 22 TABLE III.—HACKNEY DISTRICT. Causes of, and Ages at, Death during the Year 1914. 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. Go and upwards. Enteric Fever 7 ... ... ... ... 1 6 ... ... 9 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 105 16 49 34 6 ... ... ... ... 61 Scarlet Fever 8 ... ... 5 9 1 ... ... ... 15 Whooping-cough 50 24 16 8 2 ... ... ... ... 10 Diphtheria and Croup 37 1 8 13 15 ... ... ... ... 60 Influenza 17 ... ... ... 1 ... 2 5 9 Erysipelas 5 2 ... ... ... ... 1 ... ...) 6 Phthisis (Pulmonary Tuberculosis) 289 ... 1 3 12 61 126 77 9 169 Tuberculous Meningitis 29 10 2 9 6 2 ... ... ... 14 Other Tuberculous Diseases 49 14 11 6 6 7 3 1 1 26 Cancer, Malignant Disease 256 ... ... ... 2 3 25 131 95 159 Rheumatic Fever 12 ... ... ... 2 2 4 3 1 ... Meningitis 24 8 4 2 5 2 2 ... 1 9 Organic Heart Disease 301 ... ... 3 7 20 43 102 126 125 Bronchitis 264 26 7 ... ... ... 8 51 172 86 Pneumonia (all forms) 282 54 38 26 11 12 34 49 58 113 23 TABLE III.—HACKNEY DISTRICT—continued. Causes of, and Ages at, Death during the Year 1914. 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. 58 2 ... 1 2 1 8 26 18 30 Diarrhoea and Enteritis 134 107 13 7 ... ... 1 3 3 84 Appendicitis and Typhlitis 15 ... ... ... 5 ... 5 5 ... 9 Cirrhosis of Liver 31 ... ... ... ... ... 5 21 5 14 Alcoholism 1 ... ... ... ... ... 1 ... ... 3 Nephritis and Bright's Disease 116 2 ... 3 ... 4 17 51 39 67 Puerperal Fever 4 ... ... ... ... ... 4 ... ... 6 Other Accidents and Diseases of Pregnancy and Parturition 9 ... ... ... ... 2 7 ... ... 11 Congenital Debility and Malformation, including Premature Birth 173 164 2 4 1 1 1 ... ... 44 Violent Deaths, excluding Suicide 90 4 2 10 8 5 19 22 20 61 Suicides 23 ... ... ... ... 1 10 10 2 4 Other Defined Diseases 613 58 15 4 28 32 80 176 220 311 Diseases ill-defined or unknown 126 ... 1 ... ... ... ... 3 122 52 Totals 3,128 492 169 138 121 157 412 736 903 1,158 Sub-Entries (included in above figures)— Cerebro-Spinal Meningitis 6 3 ... 1 1 1 ... ... ... ... Poliomyelitis 3 ... 3 ... ... ... ... ... ... ... 24 TABLE OF DEATHS Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1914 AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... Not ... ... ... ... ... ... ... ... ... ... ... ... Doubtful ... ... ... ... ... ... ... ... ... ... ... ... Cowpox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox 1 ... ... ... ... ... ... ... ... ... ... 1 Measles (Morbilli) 16 83 6 ... ... ... ... ... ... ... ... 105 Epidemic Rose Rash, German Measles ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 5 2 1 ... ... ... ... ... ... ... 8 Typhus ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... 1 ... 1 1 3 2 4 5 ... 17 Whooping Cough 24 24 2 ... ... ... ... ... ... ... ... 50 Mumps ... 1 ... ... ... ... ... ... ... ... ... 1 Diphtheria, Membranous Croup 1 21 15 ... ... ... ... ... ... ... ... 37 Cerebro Spinal Fever 3 1 1 1 ... ... ... ... ... ... ... 6 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... 1 6 ... ... ... ... ... ... 7 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Diarrhœa, Epidemic (or Zym.) Enteritis 41 6 ... ... ... ... ... ... ... ... ... 47 25 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All Ages. Diarrhœa, Choleraic Diarrhœa 9 3 ... ... ... ... ... ... ... ... ... 12 Dysentery ... ... ... 1 3 1 ... 2 1 ... ... 8 Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Farcy ... ... ... ... ... ... ... ... ... ... ... ... Anthrax Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... 1 ... 1 ... ... ... ... 2 Syphilis 9 1 ... ... ... ... ... ... ... ... ... 10 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septicæmia, Sapræmia ... ... ... ... 2 1 ... ... ... ... ... 3 Puerperal Pyæmia ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Dolens ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... 1 ... ... ... ... ... ... 1 Infective Endocarditis ... ... 6 8 ... 1 1 1 ... ... ... 17 Epidemic Pneumonia, Pneumonia Fever ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 2 ... ... ... ... 1 ... ... 2 ... ... 5 Septicemia (not Puerperal) ... 2 ... 1 1 1 2 ... 1 ... ... 8 Pyaemia (not Puerperal) ... 1 ... ... ... 1 ... ... ... ... ... 2 Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... ... 1 1 ... 2 Phagedæna ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... ... ... ... ... ... ... 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. Tuberculous Phthisis (Pulm. Tuberculosis). ... 4 12 51 55 61 51 17 9 ... ... 260 "Phthisis" ... ... ... 10 4 6 8 1 ... ... ... 29 Tuberculous Meningitis 10 11 6 2 ... ... ... ... ... ... ... 29 Tuberculous Peritonitis 2 5 2 1 ... ... ... ... ... ... ... 10 Tabes Mesenterica 5 3 ... ... ... ... ... ... ... ... ... 8 Lupus ... ... ... ... ... ... ... ... ... ... ... ... Tubercle of other Organs ... 1 1 1 ... 1 1 ... ... ... ... 5 General Tuberculosis 7 8 3 5 2 ... ... ... 1 ... ... 26 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... 1 ... ... ... ... ... ... 1 Opium, Morphia Habit ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning by Lead ... ... ... 1 ... ... ... ... ... ... ... 1 by Phosphorus ... ... ... ... ... ... ... ... ... ... ... ... by Arsenic and other Metals ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... 2 2 2 2 2 1 1 ... ... 12 Rheumatism of Heart ... ... ... ... ... ... ... ... ... ... ... ... Chronic Rheumatism ... ... ... ... ... ... ... ... 1 1 1 3 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. G5 to 75. 75 to 85. 85 and upwards. All Ages. Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... ... ... ... 2 3 ... 5 Gout ... ... ... ... ... ... ... ... 1 ... ... 1 Carcinoma ... ... ... ... 5 13 36 55 50 10 2 171 Sarcoma ... ... 2 3 ... 3 4 3 3 ... ... 18 Malignant Diseases, Cancer ... ... ... ... ... 4 12 21 17 11 2 67 Rickets 1 2 ... ... ... ... ... ... ... ... ... 3 Purpura ... ... ... ... ... ... ... ... ... ... ... ... Haemophilia, Hemorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Leucocythnemia ... 1 2 ... 1 1 2 4 ... ... ... 11 Diabetes Mellitus ... ... 2 1 3 1 1 13 5 ... ... 26 Premature Birth 81 ... ... ... ... ... ... ... ... ... ... 81 Congenital Defects 22 ... 1 1 1 ... ... ... ... ... ... 25 Injury at Birth 4 ... ... ... ... ... ... ... ... ... ... 4 Atelectasis 7 ... ... ... ... ... ... ... ... ... ... 7 Want of Breast Milk 9 ... ... ... ... ... ... ... ... ... ... 2 Teething 3 1 ... ... ... ... ... ... ... ... ... 4 Suffocation-Overlaying 7 ... ... ... ... ... ... ... ... ... ... 7 Disease of Nervous System. 1,165 Meningitis, Inflammation of Brain 5 5 4 1 1 1 ... ... 1 ... ... 18 Softening of Brain ... ... ... ... 1 1 2 ... 2 5 1 12 General Paralysis of Insane ... ... ... 2 3 8 11 3 1 ... ... 28 23 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. . 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Ail Ages, Insanity (not Puerperal) ... ... ... 1 ... 1 ... 3 1 4 1 11 Chorea ... ... 1 1 ... ... ... ... ... ... ... 2 Epilepsy ... ... 3 ... 4 ... 1 3 3 ... ... 14 Convulsions 19 2 ... ... ... ... ... ... ... ... ... 21 Laryngismus Stridulus ... ... 1 ... ... ... ... ... ... ... ... 1 Locomotor Ataxy ... ... ... ... ... ... ... ... 1 ... ... 1 Poliomyelitis ... 3 ... ... ... ... ... ... ... ... ... 3 Paraplegia and Disease of Cord ... ... ... 1 ... 1 1 1 2 ... ... 6 Neuritis, Periph, PolyNeuritis ... ... ... ... ... ... 1 ... ... ... ... 1 Brain Tumour (not specific) ... ... 2 ... ... 1 ... 1 ... ... ... 4 Nervous System, other Diseases ... ... ... ... 1 2 3 4 4 5 1 20 Disease of Organs of Sense. 142 Otitis, Mastoid Dis. 1 ... 3 6 ... ... ... ... 1 ... ... 11 Epistaxis, Nose Dis. ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Dis. ... ... ... ... ... ... ... ... ... ... ... ... Accidents 4 12 6 3 9 6 2 16 4 9 5 76 Violence Suicide ... ... ... 1 3 7 2 8 2 ... ... 23 Drowned ... ... 9 2 2 2 3 ... 1 ... ... 12 Murder ... ... ... ... ... ... ... 1 1 ... ... 2 Disease of Heart. 124 Valve Dis., Endocarditis ... 1 6 18 12 25 31 47 47 27 3 217 Pericarditis ... 1 ... 1 ... 1 ... ... ... ... ... 3 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. Hypertrophy of Heart ... ... ... ... ... ... ... ... ... ... ... ... Angina Pectoris ... ... ... ... ... ... 1 1 6 ... ... 8 Dilatation of Heart ... ... ... ... 1 ... 1 ... 1 1 1 5 Fatty Degeneration of Heart ... ... ... ... 2 2 5 13 17 8 5 52 Syncope Heart Dis. (not specified) ... 1 1 1 ... ... 1 2 3 5 2 16 Disease of Blood Vessels. 301 Cerebral Hæmorrhage, Emb., Throm. 2 1 1 ... 1 8 19 36 30 26 5 129 Apoplexy, Hemiplegia. ... ... ... ... 1 ... 3 8 10 14 6 42 Aneurysm ... ... ... 1 ... 2 3 4 2 ... ... 12 Senile Gangrene ... ... ... ... ... ... ... ... 3 6 ... 9 Embolism, Thrombosis (not Cerebral) ... ... ... ... 1 1 ... ... ... ... ... 2 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... Varicose Veins ... ... ... ... ... ... ... ... ... ... ... ... Blood Vessels, other Diseases ... ... ... ... 1 ... ... ... ... 1 ... 2 Arterio Sclerosis ... ... ... ... ... 1 1 5 12 16 3 38 Disease of Respiratory Organs. 234 Laryngitis 1 ... 1 ... ... ... ... ... ... ... ... 2 Membranous Laryngitis (not Diphtheritic) ... ... ... ... ... ... ... ... ... ... ... ... Croup (not Spasmod. or Membr.) ... ... ... ... ... ... ... ... ... ... ... ... Larynx, other Dis. (not specified) ... ... ... ... ... ... ... ... ... ... ... ... 30 TABLE OF DEATHS—continued. AGES Under 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 26 7 ... ... 1 7 14 37 66 76 30 264 Lobar (Croupous) Pneumonia 1 5 2 4 5 11 5 6 11 2 ... 52 Broncho, Catarrhal, Lobular Pneumonia 49 51 4 2 3 4 5 8 12 4 1 143 Pneumonia 4 8 5 6 6 5 10 15 16 7 5 87 Emphysema, Asthma ... ... ... ... 1 ... 2 9 10 2 1 25 Pleurisy 1 1 ... ... 1 3 4 5 3 1 ... 19 Fibroid Dis. of Lung ... ... ... ... ... 1 1 1 ... ... ... 3 Respiratory Dis.,other ... ... 1 1 1 1 3 1 ... 1 ... 9 Disease of Digestive System. 604 Tonsilitis, Quinsey ... 1 ... 1 ... ... ... ... ... ... ... 2 Mouth, Pharynx, Dis. (not specific) ... ... ... ... ... ... ... ... ... ... ... ... Gastric Ulcer ... ... ... 9 4 6 7 5 1 1 ... 26 Gastric Catarrh or Gastritis 1 1 1 ... 1 2 ... ... 4 4 ... 11 Stomach, other Dis. (not Malig.) 2 ... ... ... ... ... ... ... ... ... ... 2 Enteritis 32 5 ... ... ... 1 ... 2 ... 1 ... 41 Gastro-Enteritis 25 6 ... ... ... ... ... 1 1 1 ... 34 Appendicitis, Perityphlitis ... ... 5 ... 1 4 3 9 ... ... ... 15 Hernia ... ... 1 ... ... ... ... 9 3 ... ... 6 Intestinal Obstruction 2 ... ... 1 ... ... 2 ... 4 1 ... 10 Other Dis. of Intestines ... ... 1 ... ... ... ... ... 1 ... ... 2 Peritonitis (not Purerepal) 1 1 1 ... 3 ... 1 1 1 ... ... 9 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. Cirrhosis of Liver ... ... ... ... 1 4 8 13 5 ... ... 31 Liver and Gall Bladder other Diseases ... 1 1 ... 1 1 ... 4 1 ... ... 9 Digest. Syst., other Diseases ... ... 1 ... 1 ... ... 1 ... 1 ... 4 Lymph Disease. 205 Spleen Disease ... ... ... ... ... ... 1 ... ... ... ... 1 Lymph System, other Diseases ... ... 1 2 ... ... ... ... ... ... ... 3 Thyroid Body Disease ... ... ... ... ... ... ... ... ... ... ... ... Supra Renal Capsules. Disease ... ... ... ... ... 1 ... ... ... ... ... 1 Disease of Urin. Syst. 5 Nephritis, Acute 2 2 ... ... 1 ... 2 ... ... ... ... 7 Chronic Bright's Dis., Albuminura ... 1 ... 4 7 9 19 30 25 13 1 109 Calculus (not Biliary) ... ... ... ... ... 1 ... 1 ... ... ... 2 Bladder and ProstateDis. ... ... ... ... ... 1 1 8 4 7 ... 21 Urin. Syst., other Dis. ... ... ... ... ... ... ... ... ... 1 ... 1 Disease of Gener. Syst. 140 Ovarian Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Ovary ... ... ... ... ... ... ... ... ... ... ... ... Ulerinal Tumour (not Malig.) ... ... ... ... ... 1 ... ... ... ... ... 1 Other Dis. of Uterus and Vagina ... ... ... ... 1 ... ... ... ... ... ... 1 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. Disorders of Menstruation ... ... ... ... ... ... ... ... ... ... ... ... Gener. and Mam. Orgs., other Dis. ... ... ... ... ... 1 ... ... ... ... ... 1 Accidents Childbirth. 3 Abortion, Miscarriage. ... ... ... ... ... 1 ... ... ... ... ... 1 Puerperal Mania ... ... ... ... ... 1 ... ... ... ... ... 1 Puerperal Convulsions ... ... ... 1 ... ... ... ... ... ... ... 1 Placenta Prævia, Flooding ... ... ... ... 2 1 ... ... ... ... ... 3 Other Accid. of Preg. and Childbirth ... ... ... 1 ... 2 ... ... ... ... ... 3 Joint Disease. 9 Caries, Necrosis ... ... ... 1 ... ... 1 ... ... ... ... 2 Anthritis, Periostitis ... ... ... ... ... ... ... ... ... 1 ... 1 Other Dis. of Locom. Syst ... ... ... 1 ... ... 1 ... ... 1 ... 3 Skin Disease. t> Ulcer, Brdsore ... ... ... ... ... ... ... ... ... ... ... ... Eezema 1 ... ... ... ... ... ... ... ... ... ... 1 Pemphigus 2 ... ... ... ... ... ... ... ... ... ... 2 Skin Disease, other ... ... ... ... 1 ... ... ... ... ... ... 1 Ill-Defined Causes. 4 Atrophy, Debility, Marasmus 54 6 ... ... ... ... ... ... ... ... ... 60 Old Age ... ... ... ... ... ... ... 1 22 57 43 123 Dropsy, Ascites ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... 2 Abscess ... 1 ... ... ... ... 1 ... ... ... ... 2 Sudden Death (cause unascertained) ... ... ... ... ... ... ... 1 ... ... ... 1 Other Ill-defined Causes ... ... ... ... ... ... ... ... ... ... ... ... Causes not Specified ... ... ... ... ... ... ... ... ... ... ... 186 Totals 492 307 121 157 174 233 306 430 444 340 110 3,128 33 SPECIFIC INFECTIOUS DISEASE. During 1914 there were 1,711 cases of acute infectious disease, compulsorily notified in the Borough; of these 55 were found subsequently not to be suffering from notifiable infectious disease, thus reducing the number of genuine cases to 1,656. This total shows an increase of 611 upon those notified during 1913. The attack rate in respect of the acute notifiable infectious diseases for the year 1914 is 7.4 per 1,000 persons living. In addition I received 550 notifications of pulmonary tuberculosis and 148 notifications of other forms of tuberculosis. The deaths from the chief zymotic diseases numbered 341. This is equivalent to a zymotic death rate of 1*5 per 1,000 living in the Borough. A.—NOTIFIABLE INFECTIOUS DISEASES (ACUTE). Small-pox.—No case of small-pox was notified in the Borough during 1914. Scarlet Fever or Scarlatina.—The number of cases of scarlet fever notified during 1914 was 816, but of these 26 were found afterwards not to be suffering from this disease, thus reducing the genuine cases to 790. This is an increase of 13 cases upon the number of genuine cases notified during 1913. On reference to the chart given with this report, it will be noted that the inciden of the disease was high at the beginning of the year, but fell rapidly during January and continued low during the months of February to August. There was another rise in the month of September, which was maintained during October and November. During December the incidence fell almost to the normal. c 34 The attack rate for scarlet fever is 3T per 1,000 persons living. The number of cases scarlet fever removed to hospital during the year was 693. This is equal to 85 per cent. of the total notified. The following table shows the distribution of scarlet fever in the respective sub-districts of the Borough:- Sub-Districts. North. Central. South-West. South-East. No. of Cases of Scarlet Fever. 146 229 252 163 Attack-rate per 1,000 living. 2.6 4.6 4.4 3.0 It will be seen from the above that scarlet fever was most prevalent in the South-West sub-district. The deaths from scarlet fever during 1914 numbered eight, which is equal to a mortality of 10 per 1,000 attacked and .04 per 1,000 living. The mortality rate for London from scarlet fever during the same year was .07 per 1,000 living. Diphtheria and Membranous Croup.—There were 488 cases of diphtheria and 7 cases of membranous croup notified during the year ; but of these 20 cases of diphtheria and 1 case of membranous croup were found subsequently not to be suffering from this disease, this reducing the total genuine cases of diphtheric disease to 474. This is an increase of 192 upon the number of cases notified during 1913. The chart shows that diphtheritic disease was prevalent during the whole year, the cases being fairly evenly distributed during the 12 months. The attack rate for diphtheria is 2.1 per 1,000 living. There were 409 cases of diphtheria and membranous croup removed to hospital during 1914. This is equal to 86 per cent. of the cases notified. 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 Diphtheria and Membranous Croup. 135 80 130 129 Total attack-rate per 1,000. 24 1.5 2.3 2.2 From the above it will be seen that diphtheritic disease was fairly evenly spread over the whole Borough. The deaths from diphtheria and membranous croup during the year numbered 37. This is equal to a mortality rate of 8 per cent, attacked and -16 per 1,000 living. The death rate from diphtheria for London during the same period is T6 per 1,000 living. During the year 538 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically examined, 134 of which gave positive results, 389 negative results, and 15 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 1914, and issued as required to medical practitioners applying for it in cases of diphtheria amongst the poorer in habitants of the Borough. During the year 32 bottles of antitoxin of 2,000 units each were supplied to medical practitioners, 8 of which were for curative treatment and 24 for prophylaxis. Typhoid or Enteric Fever.—During the year under consideration, 29 cases of enteric fever were notified, but of these 6 were c 2 36 subsequently found not to be suffering from this disease, thus reducing the number of genuine cases to 23. This is a decline of 10 on the number of genuine cases notified during 1913. The attack rate is.1 per 1,000 living. Of the 29 cases notifed, 19 were removed to the hospital. This is equal to 65 per cent. of the total notified. The cases occurred mostly in the last three months of the year, but isolated cases were notified at intervals during the whole 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. 2 7 1 13 From this table it is evident that most of the cases occurred in the south-east sub-district. The deaths from enteric fever in the Borough last year numbered 7. This is equal to a mortality rate of 30 per cent, attacked and .03 per 1,000 living. During 1914 specimens of blood from 23 persons suspected to be suffering from enteric fever were submitted to Widal's test. Of these, 4 gave a positive and 19 a negative reaction. The mortality from enteric fever for the same period is -03 per 1,000 living. Continued Fever.—Two cases of fever were notified as continued fever during the year. Typhus Fever.—No case of this disease was notified in the Borough during the year. 37 Puerperal Fever.—There were 17 cases of puerperal fever notified during 1914, of which 11 were removed to hospital. The deaths from puerperal fever and septicaemia numbered 4. The attack-rate for the year was 2.9 per 1,000 births, and the deathrate 0.7 per 1,000 births. Plague.—No case of plague occurred in the Borough last year. Erysipelas.—There were 296 cases of erysipelas notified during 1914. This is equal to an attack-rate of T3 per 1,000 living. Of the 296 cases notified, 57 were removed to hospital. The deaths from erysipelas numbered 5. This gives a mortalityrate of 1.7 per cent. attacked and .02 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. 51 79 74 92 Rate per 1,000 living. .93 1.4 1.3 1.6 Cerebro-spinal Meningitis.—During 1914 there were 3 cases of this disease notified in the Borough. Of these 2 were removed to hospital. All the cases notified were fatal. Polio-myelitis or Polio-encephalitis.—There were 5 cases of this disease notified during 1914. Of these 1 was removed to hospital. Of the 5 cases notified 1 died, the remainder recovering with some inpairment of one or other group of muscles. Ophthalmia Neonatorum.—There were 45 cases of this disease notified during the year. None of these were removed to hospital. All the cases recovered without any impairment of sight. 38 Glanders, Anthrax, and Hydrophobia in Man.—Two cases of anthrax in adults were notified during the year, but one case was found afterwards not to be a case of anthrax. The circumstances attending the genuine case are detailed in a special report, copy of which is to be found in the appendix to this report. B.—NON-NOTIFIABLE INFECTIOUS DISEASES. Influenza.—During 1914 there were 17 deaths in the Borough due to influenza. This is a decline of 12 on the deaths from this cause registered during 1913. The annual mortality rate from influenza is .08 per 1,000 living. Diarrhœa.—There was an increase in the number of deaths due to diarrhœal disease in the Borough during 1914. The total number of deaths from this cause was 134, of which 59 were registered as diarrhoea and 75 as enteritis or gastro-enteritis, and of these 107 were under 1 year of age. The annual mortality for diarrhoea and enteritis during 1914 is -6 per 1,000 living. The distribution of this disease in the Borough may be seen from the following table:- Sub-Districts. North. Central. South-West. South-East No. of Deaths from Diarrhoea and Enteritis. 26 30 26 52 Death-rate per 1,000 living. .49 .54 .45 .91 In the month of March of last year a special conference was arranged by the authorities of the Queen's Hospital for Children to discuss the question of Summer Diarrhoea and its prevention. The following is an account of the proceedings of the Conference, drawn up by the Secretary of the Hospital:— 39 39 THE QUEEN'S HOSPITAL FOR CHILDREN. Hackney Road, Bethnal Green. Co-operation in regard to Infantile Summer Diarrhoea. On Wednesday, 11th March, 1914, at 8.30 p.m., a Conference was held in the Board Room of the Hospital on the subject of possible measures for the prevention or mitigation of the annual visitation of Summer Diarrhoea amongst infants in the districts surrounding the Institution. The Earl of Shaftesbury, K.P., K.C.V.O. (President of the Hospital), in the Chair. The Conference was attended by members of various local Municipal bodies, officials and members of Committees of a number of Charities in the neighbourhood, and by three representatives of the Local Government Board. The following resolutions were adopted:- 1. Resolution proposed by the Senior Physician of the Hospital, Dr. Porter Parkinson, seconded by Dr. King Warry (Medical Officer of Health for Hackney), and supported by Mr. Pett Ridge, Miss E. J. Charlesworth (Senior Health Visitor of the Borough of Shoreditch), and Dr. Murray Leslie (Physician to the Prince of Wales' General Hospital, Tottenham). "That epidemic summer diarrhoea is a preventable disease, dependent on a variety of conditions which can best be dealt with by concerted action on the part of Public Health Authorities and Voluntary Organisations ; and that Borough Councils and Boards of Guardians be urged to seek the cooperation of voluntary organisations for the purpose of supplementing the work of the Borough Councils' Visitors, with a view to arranging a complete and thoroughly efficient system of home visiting in every case, in order that treatment prescribed at Hospitals and other institutions, and by the general practitioners, may be enforced as far as possible. 40 Further, that all Medical Charities and all Medical Practitioners be urged to undertake the voluntary notification to the Medical Officer of Health of all cases that may be brought to their notice." 2. Resolution proposed by Dr. Eric Pritchard, seconded by The Mayor of Bethnal Green (Mr. Councillor W. J. Lewis, J.P.), and supported by Miss Mary E. E. James (member of the Bethnal Green Board of Guardians), Mr. H. F. Garrard (Ragged School Union), and Dr. Chas. Porter :— " That this meeting recommends the adoption of one uniform plan for dealing with the problem of Summer Diarrhoea; recognises the importance of securing the goodwill and cooperation of the parents ; and strongly urges upon charitable institutions, London County Council Care Committees, and other bodies concerned, the adoption of a system of reference to the Medical Officers of Health of the Boroughs before making arrangements for home visiting." A Committee of representatives of the various interests concerned was then formed, with power to add to its number. Several meetings have been held. Arrangements have been made for home visiting for the distribution of instruction papers drawn up by a Medical Sub-Committee of the Summer Diarrhoea Committee, and subsequently adopted by the Public Health Authorities of Hackney and Bethnal Green, and by the Medical Staff of the Hospital. The Committee proposes to continue its labours in preparation for the ensuing year. T. GLENTON-KERR, Hon. Secretary of the Sumtner Diarrhoea Committee. July, 1914. The Medical Sub-Committee referred to above consisted of Dr A. E. Gow, Assistant Physician to the Queen's Hospital, and myself. 41 The following is a copy of the instruction paper which was adapted from a leaflet used by the hospital physicians amongst their patients. I may here add that the Public Health Committee of the Hackney Borough Council were represented at this Conference and approved of and supported its action :- BOROUGH OF HACKNEY. Simple Rules for the Prevention of Summer Diarrhoea. Summer diarrhoea occurs during the hot months of the year, and causes the deaths of hundreds of infants. It is largely due to giving milk and food which has been exposed to the air, dust and flies, or stored in a dirty vessel, and to the use of " comforters." It is therefore Preventable. Summer diarrhoea attacks bottle fed children especially, but seldom those fed entirely on the breast. Therefore children should be fed entirely on the breast, and not weaned during the hot months of the year, except under doctor's orders. Comforters must not be Used. The mother should consult a doctor directly a child begins to suffer with vomiting or looseness of the bowels. For Bottle Fed Babies. The poison of summer diarrhoea is carried generally by the milk, but the poison may be destroyed by boiling. Keeping the milk cool also prevents the poison increasing. Therefore— 1. Obtain milk fresh twice a day. 2. Fetch and keep milk in a jug previously washed out with boiling water, to which a little soda has been added. 42 3. Cover jug with a double layer of clean muslin to protect milk from dust and flies, and stand it in a basin of cold water in a cool place. 4. The measured feed should be boiled for two minutes, then allowed to cool before use, the mother thoroughlycleansing her hands before preparing the feed. She must on no account moisten the teat in her own mouth. 5. The bottle and teat must be scalded twice a day and washed out with water, to which a little soda has been added, immediately after each feed, then rinsed out under the tap with cold water before the new milk is put into it. Sanitary Measures. 1. The presence of offensive smells, accumulation of refuse, or any insanitary conditions should be immediately reported to the Public Health Department of the District. 2. As flies are the means of contaminating food, especially milk, this should always be covered and kept in a cool place, and means adopted to destroy the flies and prevent their breeding. Therefore the whole of the premises, including the yards, should be kept clean. The sinks, drains and yard gullies flushed daily with water. House and other refuse must not be kept on the premises longer than necessary. 3. All rooms should be kept scrupulously clean, cool, and as well ventilated as possible. Simple Rules for the Treatment of Summer Diarrhoea. As soon as summer diarrhoea threatens all milk and solid food must be stopped absolutely and the child taken to a doctor. The child's napkin and linen must be changed directly it is soiled and placed in a pail of water to which a tablespoonful of a disinfectant, such as carbolic acid or Izal, has been added. It should soak for at least two hours in this before being removed for washing. The mother's hands must be washed immediately after removing the soiled linen. 43 Unless the doctor advises to the contrary, nothing but cold water, which has been recently boiled, must be given for at least twenty-four hours. The child may have as much water as it will take. This abstinence does nothing but good, so long as the child is kept well wrapped up. If the diarrhoea and vomiting has completely ceased in twentyfour hours, feeding with milk powder may be commenced. Milk powder can be obtained at the chemists; but if any difficulty is experienced in getting it, enquiry should be made at a hospital. On the First Day :- Half-a-teaspoonful of the powder dissolved in four tablespoonfuls of warm water every three hours. As much boiled water may be given between whiles as the child will take (given with a clean spoon). On the Second Day:— Provided there is no return of sickness, one tablespoonful of the powder in four tablespoonfuls of warm water every two hours. On the Third Day Two teaspoonfuls of the powder in six tablespoonfuls of warm water, every two hours. Brandy and other alcoholic stimulants should in no circumstances be given, unless ordered by the doctor. No cow's milk to be given until ordered by the doctor. Nursing mothers should invariably wash the nipples with soap ard warm water, and carefully dry, before and after putting the baby to the breast. J. KING WARRY, M.D., D.P.H., Medical Officer of Health. These leaflets were used during the hot months of the year, a copy being sent to the mother of each child born in the Borough immediately after I received the notification of its birth. 44 Measles.—There was an increased number of deaths from this disease in the Borough during last year over that of the previous year. The total number was 105. This is an increase of 42. No less than 99 of these deaths occurred amongst children under five years of age. The annual mortality for 1914 from measles is, therefore, •47 per 1,000 living and that for all London .31 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. 6 34 21 44 Mortality-rate per l,000.1iving .11 .62 .36 .8 I received information of 1,416 cases of measles during the year from headmasters and mistresses occurring amongst the scholars of Elementary Schools in the Borough. There were 6 cases of measles removed to the Metropolitan Asylums Board's Hospitals during the same period. Whooping Cough.—There was an increased prevalence of this disease in the Borough during 1914. The deaths from this cause numbered 50. This is an increase of 29 upon the number registered during 1913. No less than 48 of the deaths occurred in children under five years of age. The mortality for Hackney is equal to •22 per 1,000 living, and that for all London .20 per 1,000 living. The number of cases removed to the Metropolitan Asylums Board's Hospitals during the year was 20. I received information from the headmasters and mistresses of Elementary Schools in Hackney of 691 cases of whooping cough occurring amongst their scholars during the year. 45 The distribution of the disease in the Sub-districts of the Borough is given in the following table:- Sub-Districts. North. Central. South-West. South-East. No. of Deaths from Whooping-cough. 4 21 13 12 Mortality-rate per 1,000 living. .07 .4 .23 .21 CONSTITUTIONAL DISEASES. Tuberculosis.—During 1914 I received 1,362 notifications of tuberculosis, details of which are given on page 61 of this Report. Bacteriological examination of sputa from 548 cases was made during the same period. In 113 of these examinations the specific organism of the disease was discovered ; in 434 the result was negative, and in 1 doubtful. The number of deaths from tuberculous disease in Hackney during 1914 was 367, an increase of 35 upon the deaths during 1913. These deaths are classified as follows:— Tuberculous phthisis 260 Phthisis 29 General tuberculosis 26 Tuberculous meningitis 29 „ peritonitis 10 Tabes mesenterica 8 Tubercle of other organs 5 367 This number of deaths gives an annual mortality of 1.6 per 1,000 living. 46 In the following table I have abstracted the yearly deaths from tuberculous disease in the Borough for the last 16 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. Per cent. 1898-1900 483 - 1901-1903 452 6.4 1904-1906 417 13.7 1907-1909 382 21.0 1910-1912 363 24.8 1913-1914 349 28.0 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 1914 being equal to 28 per cent. There is good reason to hope that when the Borough Council's tuberculosis scheme is in working the decline will, in future years, be more marked. 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. 64 80 120 103 Mortality-rate per 1,000 living. 1.1 1.4 2.0 1.8 Cancer.—There were 256 deaths during 1914 due to the different varieties of malignant disease. This is an increase of 47 6 on the number registered during 1913. The annual mortalityrate from malignant disease for last year is therefore 1.14 per 1,000 living. The following table gives the distribution of the deaths from this disease in the different sub-districts of the Borough:— Sub-districts. North. Central. South-West. South-East. No. of Deaths from Cancerous Disease. 69 55 67 65 Mortality-rate per 1,000 living. 1.2 1.0 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 1914:— Years. 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Borough of Hackney. Deaths from Cancer. 203 175 198 225 214 222 217 213 250 250 Death-rate per 1,000. .90 .75 .91 .96 .91 .93 .97 .95 1.11 1.14 | London. Death-rate per 1,000. 1.00 1.05 1.03 1.06 .96 .94 1.05 1.11 1.10 — ALCOHOLISM. During the year under consideration there was 1 death from acute alcoholic poisoning; there were also 31 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. 48 VACCINATION. Appended is a summary of the proceedings under the Vaccination Acts, during the year 1914. 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 5,723 and the number of vaccination certificates received during the same period 2,099. This latter is equal to 37 per cent, of the births, leaving 63 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 1906 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% 48% 954 1910 5,498 2,862 1,329 1911 5,413 2.571 52% 1,475 1912 5,437 2,272 58% 1,833 1913 5,652 2,100 60% 2,073 1914 5,723 2,099 63% 2,284 Summary of Proceedings under the Vaccination Acts, 1867 to 1898, during the Year 1914. 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 998 490 82 — - 396 - 16 37 278 Central 1,761 516 32 — — 700 - 278 53 448 South-East 1,551 456 17 — 1 653 — 41 76 495 South-West 1,413 637 42 — — 635 3 48 93 485 Total 5,723 2,099 173 - 1 2,284 3 383 259 1,706 49 5U PUBLIC HEALTH (LONDON) ACT, 1891. (a) Complaints of Nuisances.—During the year 1914 there were 2,095 complaints of nuisances made to the Public Health Department and investigated by the Sanitary Inspectors of the Borough. Defects or nuisances were discovered in 1,593 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 2,186. This is an increase of 59 upon the number inspected during 1913. 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 1,162. These inspections are in addition to those made under (a) and (6), 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 1914 was 3,980. The number of statutory notices served were 286; 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, 1914.—No. 11 District. Inspector: E. F. Kemp. Number of premises inspected 82 Number of premises inspected in which nuisances were found 42 Number of intimation notices served 42 Found. Abated. The house or part in dirty condition 39 39 ,, ,, dilapidated condition 7 7 The w.c. so foul as to be a nuisance 5 5 ,, without a water supply 1 1 51 Found. Abated. The w.c. improperly constructed 2 2 ,, so defective as to be a nuisance 2 2 „ stopped 3 3 „ insufficiently ventilated 1 1 The soil pipe defective 1 1 „ improperly ventilated 1 1 The yard in dirty condition for want of paving 3 3 The waste pipe of sink connected with drain 4 4 „ ,, defective 2 2 The want of proper dust bin 9 9 The drain choked and defective 1 1 The rain water pipe defective 5 5 The house without a water supply 1 1 The roof and gutters defective 10 10 The washhouse paving defective 5 5 The bakehouse walls and ceiling dirty 1 1 The animals improperly kept 5 5 The house overcrowding 3 3 The ground floor unventilated 2 2 House-to-House Inspection, 1914.—Homerton District. Inspector: J as. W. Hal.l. Number of premises inspected 92 Number of premises inspected in which nuisances were found 87 Number of intimation notices served 125 Number of statutory notices served 16 Out- Found. standing. Abated. House, or part in a dirty condition 66 3 63 „ damp condition 15 2 13 ,, dilapidated condition 51 3 48 „ verminous condition 19 2 17 Water-closet with a defective water supply 9 - 9 „ improperly constructed 4 - 4 D 2 52 Found. Out-standing. Abated. Water-closet defective 4 1 3 „ stopped 7 - 7 Drain ventilation pipe defective 5 - 5 Yard paving defective 17 2 15 Sink waste pipes defective, &c 10 - 10 „ untrapped 11 - 11 Defective dustbins and manure receptacles 14 2 12 „ drains 33 5 28 Drains choked 7 - 7 Rainwater pipe defective 16 - 10 Roof defective 25 - 25 Guttering defective 18 2 16 Forecourt and area paving defective 6 2 4 Wash-house paving defective 6 - 6 Animals improperly kept 2 - 2 The house, or part, overcrowded 5 1 4 The space under basement or ground floor insufficiently ventilated 13 1 12 Sundry defects 7 - 7 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.: 1 ton 3 cwts. 1 qr. meat; 14 cwts. 3 qrs. fish; 3 cwts. 3 qrs. fruit and vegetables; 1 cwt. 19 lbs. tinned foods. Cow-houses, Dairies, and Milkshops. (a) Cow-houses.—At the end of 1914 there were 14 licensed cowkeepers in the Borough with 16 sheds. Inspector Bobbitt reports that he made 198 inspections of these, and found it necessary to serve three notices for repairs, which notices were immediately complied with. On the 26th September the Public Health Committee made their annual visits to the cowhouses in the Borough. 53 These were found on the whole to be in a satisfactory condition. One cow-house required lime whiting, and in another the channelling of the paving was defective. The defects were remedied on service of a notice. (b) Dairies and Mitkshops.—During the year 11 premises were removed from the Register and 14 new premises added, thus making the total on the register at the end of last year, 318. The proprietors of milk premises were changed in 49 instances. Inspector Bobbitt reports that he made 1,580 visits of inspection to these premises during the year. He served six notices for repairs and cleansing, 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 15 times. He reports that on these occasions he always found the premises in a satisfactory condition. Slaughter-houses.—The number of licensed slaughter-houses in the Borough at the end of 1914 was 20. Inspector Bobbitt reports that he had made 323 visits of inspection to these during that period, and found them always in a satisfactory condition. During his visit to the slaughter-houses, the Inspector examined the carcases and organs of 145 oxen, 1,889 sheep and lambs and 30 pigs, and found the following parts and organs diseased, viz.:— One carcase of ox with all organs affected with tuberculosis. Heart and lungs of ox affected with tuberculosis. Carcase of a sheep in a dying condition when bled. Portions of hind quarters of an ox unsound. Five ox and three sheep livers affected with distomatosis. Four ox livers affected with abscess. Six sheep plucks affected with parasitic cysts. On September 26th, the Public Health Committee made their annual visit to the slaughter-houses of the Borough. These were 54 all found in a satisfactory condition with the exception of two, the sheep pound of one having a defective floor and another sheep pound was insufficiently ventilated. The defects were remedied on service of a notice. The following statement refers to the milk places, cowsheds, slaughter-houses and offensive trades in the Borough:— Premises. Number of Places. Number of Inspections, 1914. Number of Notices, 1914. Number of Prosecutions. On Register at end of 1913. Added in 1914. ' Removed in 1914. On Register at end of 1914. Milk premises 315 14 11 318 1,580 6 — Cowsheds 16 — — 16 198 3 — Slaughter-houses 20 — — 20 323 — — Other offensive itrade premises 1 — — 1 15 — — Preserved Provision Factories.—There were two wholesale preserved provision and two black pudding manufacturers in the Borough at the end of 1914. Inspector Bobbitt reports that he made 32 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 619 observations of chimneys of factories, workshops, and other places in the Borough during the year. These observations lasted from halfan-hour upwards. Notices in connection with this nuisance were served to the number of 45 Intimation and 3 Statutory Notices. Water Supply.—Under section 48 (2) of the Public Health (London) Act, 1891, there were 5 certificates of proper and sufficient water supply issued to owners of new or rebuilt dwellinghouses in the Borough. These certificates refer to 7 houses. 55 Bye-laws for Houses Let in Lodgings.—The total number of these houses on the Register at the end of 1914 was 469. All of these, which were occupied, were inspected during the year 1914. The following sets out in detail the results of the inspections made, &c.:— HOUSES LET IN LODGINGS. 1914. No. 7 District. Number on register at end of 1914 243 Number of premises inspected 172 „ on which nuisances were found 79 „ „ „ abated 36 Intimation notices served 79 Found. Abated. In hand. Outstanding House, or part, in a dirty condition 66 21 5 40 „ dilapidated 5 - - 5 „ verminous 7 2 2 3 W.C. with a deficient water supply 12 3 6 3 „ so defective as to be a nuisance 7 5 — 2 „ choked 1 1 - - Yard paving defective 14 3 - 11 Sink waste defective 3 - 3 Ventilation shaft defective 2 - 2 - No dustbin, or dustbin defective 8 1 7 - Rainwater pipe choked 2 2 - - ,, defective 8 2 2 4 Roof defective 35 7 - 28 Gutter defective 1 1 - - Wash-house paving defective 1 - - 1 House or part overcrowded 2 2 - - Scullery roof defective 7 - - 7 W.C. roof defective 2 - 1 1 Scullery sink defective 3 - 3 - 56 No. 11 District. Number on register 226 Number of premises inspected 195 empty 31 „ nuisances found 86 „ ,, abated 86 Intimations served 86 Found. Abated. House or part in dirty condition 49 49 „ dilapidated condition 6 6 W.C. in foul condition 14 14 „ without water supply 1 1 ,, defective 9 9 „ so foul as to be a nuisance 3 3 „, stopped 4 4 Yard dirty for want of proper paving 7 7 Sink waste connected with drain 2 2 No dustbin 13 13 Drain foul and choked 3 3 Rainwater pipe defective 11 11 Roof leaky and defective 17 17 Gutters defective 28 28 Wash-house paving defective 5 5 Animals improperly kept 3 3 House overcrowded 14 14 No ventilation under ground floor 2 2 CUSTOMS AND INLAND REVENUE ACT, 1890. The following is a list of premises which I inspected during the year 1914, 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 34 and 36, Boleyn Road 5 2, Church Road, Kingsland 4 14, Stamford Hill 3 19, De Beauvoir Square 2 57 CANAL BOATS ACTS, 1877 1894. The Canal Boats Inspector reports that he made 80 visits to the waterways in the Borough during 1914 and inspected 21 boats during 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. ICE-CREAM VENDORS. At the end of 1914 there were 185 ice-cream vendors in the Borough, a decrease of 13 on the number present at the end of 1913. These were all inspected during the past year. Sanitary defects were found on 20 of these premises, which were remedied by the service of intimation notices. GLANDERS AND FARCY ORDER, 1907. One notification of glanders in animals in the Borough was received from the Veterinary Inspectors of the London County Council during 1914. DISEASES OF ANIMALS ACTS.—ANTHRAX ORDER OF 1910. One notification of Anthrax in animals in the Borough was received during 1914. HOUSING OF THE WORKING CLASSES ACTS, 1890 1903. No representation was made nor action taken under the abovenamed Acts during the year 1914. 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 58 the Committee, during the year 1914, the undermentioned lists of houses which, in my opinion, should be inspected under Section 17 of the above Act, viz.:— February 5th.—150, 160, 172,186, 190, 192, 196, 200, 202, 204, 206, 216, 218, 222, 224, 228, 234, 236, 238, 248, 250, Rushmore Road. April 23rd.—260, 268, 119, 129, 135, 137, 145, 165, 177, 179, 183, 185, 187, Rushmore Road. May 21st.—117, 193, 197, 199, 201, 203, 205, 207, 217, 223, 225, 227, 235, 245, Mandeville Street. September 17th.—2 to 86 (even numbers) ; 1, 3, 5, 7, Sheep Lane. Of these premises 69 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 69 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 — 3. The number of representations made to the Local Authority with a view to the making of closing orders — 4. The number of closing orders made — 5. The number of dwelling-houses the defects in which were remedied without the making of closing orders 69 6. The number of dwelling-houses which after the making of closing orders were put into a fit state for human habitation — 7. General character of the defects found to exist. 59 Number of premises where the conditions were found to be satisfactory or otherwise under the following heads:— Mandeville Street (part), Rushmore Road (part), Sheep Lane (part). Satisfactory. Unsatisfactory. 1. The arrangements for preventing the contamination of the water supply 69 — 2. Closet accommodation 69 — 3. Drainage 59 10 4. The condition of the dwelling-house in regard to light, the free circulation of air, dampness, and cleanliness 10 59 5. The paving, drainage, and sanitary condition of any yard or outhouse belonging to or occupied with the dwelling-house 48 21 6. The arrangements for the deposit of refuse and ashes 55 14 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 — — 8. Any defects in other matters which may tend to render the dwellinghouse dangerous or injurious to the health of the inhabitants 62 7 60 THE RIVER LEE. No serious complaints of nuisance from this River were received during the year. METHODS OF CONTROL OF TUBERCULOSIS. 1.—Notification. Public Health (Tuberculosis) Regulations, 1912. Under these Regulations, I received 1,174 notifications of cases of pulmonary tuberculosis, during the year 1914, of which 624 were duplicates ;also 188 non-pulmonary notifications, of which 40 were duplicates. The following Tables A and B give the age and sex distribution of the notified cases:— 61 A—Pulmonary Tuberculosis. Notifications received during the Year 1914. Under 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 and upwards. Duplicates. Total. M F. M. F. M. F- M. F. M. F. M F. M. F. M. F. Form A 2 5 16 12 60 44 83 52 59 37 55 34 70 52 345 236 Form B — — 3 2 — — — - — — — 1 — 4 2 Form C — — 2 8 9 7 12 4 10 5 12 3 186 86 231 113 Form D — — — 1 6 1 5 — — — — 1 155 74 166 77 Totals 2 5 21 23 75 52 1 100 56 69 42 67 38 412 212 746 428 B—Non-Pulmonary Tuberculosis. Notifications received during the Year 1914. Under 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 and upwards. Duplicates. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Form A 18 22 22 17 6 19 5 2 5 3 1 1 7 3 64 67 Form B - - - - - - - - - - - - - - 2 - Form C 3 1 9 7 1 - - - - - - - 7 9 20 17 Form D 1 1 1 1 - - - - - - - - 9 5 11 7 Totals 22 24 34 25 7 19 5 2 5 3 1 1 23 17 97 91 62 2.—Action taken during the Year. This was practically the same as that taken during 1913, and may be summarised as follows:— 1. Disinfection of rooms and articles infected by tuberculous patients. 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 relative to prevent the spread of the disease. 4. The gratuitous supply of sputum flasks ; the number of flasks thus supplied was 73. In the month of September I presented a report to the Public Health Committee containing my views on a complete scheme of Tuberculosis Dispensary treatment for the Borough of Hackney. This scheme was afterwards adopted by the Borough Council and forwarded to the Local Government Board and the County Council for their approval. Their approval was subsequently given to the scheme as a whole, subject to certain slight alterations in detail. A copy of the report will 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 (page 64). The following Table gives the number of cases of tuberculosis notified respectively amongst Insured and Non-Insured persons under the National Insurance Act, 1911 (page 63). 63 National Insurance Act, 1911. Tuberculosis, 1914. Sex. Insured Cases. Non-Insured Cases. Percentage Insured. Pulmonary NonPulmonary. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male 219 14 115 62 652 18% Female 85 15 127 59 402 20% Total 304 29 242 121 562 19% 64 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. Queen Mary's Hospital for Children (M A.R ) Carshalton. *2 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. The Guardians of the Hackney Union. Mill field Home for Children (M A B.), Rustington. *2 By grant of Indoor relief by Guardians and subsequent classfication by Medical Officer. No. None to destitute persons. Liable relatives pay according to ability. No. No. No. (b) Intermediate cases. The Guardians 01 the Hackney Union. Queen Mary's Hospital tor Children (M.A.B.), Carshalton. *2 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. The Guardians of the Hackney Union Grosvenor Sanatorium, Ltd.. Kennington, Ashford, Kent. *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. No. No. No 65 PHTHISIS: SANATORIUM AND HOSPITAL ACCOMMODATION—continued. 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 case 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? (b) Intermediate cases The Guardians of the Hackney Union. Southern Convalescent Homes, Lancing-on-Sea *5 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. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *12 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. Queen Mary's Hospital for Children (M.A.B.) Carshalton. *1 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. The Guardians of the Hackney Union. Hackney Union Infirmary, Homerton. *34 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 *46 Kennington *7 Lancing *5 Carshalton *5 Rustington 2 *These numbers are for the 29th May, 1915, and the number of beds available for Phthisical cases in the Hackney Union Infirmary is 88, but the number of beds available at Carshalton, Rustington, Kennington and Lancing varies, as they are allotted as required. e 66 PUBLIC HEALTH LEGISLATION, 1914. (1) The Milk and Dairies Act, 1914.—This is an Act to make better provision with respect to the sale of milk and the regulation of dairies. (2) The Education (Provision of Meals) Act, 1914.—An Act to amend the Education (Provision of Meals) Act, 1906. (3) Housing Act, 1914.—An Act to make provision with respect to the housing of persons employed by or on behalf of Government Departments where sufficient dwelling accommodation is not available. Memorandum of Local Government Board.—Drainage and Disposal of Waste Matters at Public Elementary Schools. Memorandum, Local Government Board.—Provision of New Residential Institutions for the Treatment of Pulmonary Tuberculosis. Circular Letter, Local Government Board.—Epidemic Diarrhoea. Circular Letter, Local Government Board.—Maternity and Child Welfare. 67 THE FACTORY AND WORKSHOP ACT, 1901. Factories, Workshops, Workplaces and Homework. I.—IXSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions Factories (Including Factory Laundries) 95 11 ... Workshops (Including Workshop Laundries) 2,173 329 ... Workplaces (Other than Outworkers' premises included in Part 3 of this Report) ... ... ... Total 2,268 340 ... 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 212 239 ... ... Want of ventilation 33 36 ... ... Overcrowding 12 10 ... ... Want of drainage of floors 3 ... ... ... Other nuisances 81 69 ... ... Sanitary accommodation— ... ... ... Insufficient 2 2 ... ... Unsuitable or defective 68 46 ... ... Not separate for sexes 8 9 ... ... Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (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 ... ... ... ... *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. (1) Making, &c. 320 34 3,293 43 ... 182 383 ... ... ... ... ... ... ... ... (2) Cleaning and Washing 2 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets 2 ... 16 1 ... 4 2 ... ... ... ... ... ... ... ... Furniture and Upholstery 4 ... 21 2 ... 6 3 ... ... ... ... ... ... ... ... Electro-plate 9 ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... Umbrellas, &c. 4 ... 10 ... ... ... 4 ... ... ... ... ... ... ... ... Artificial Flowers 4 ... 65 1 ... 3 10 ... ... ... ... ... ... ... ... Tents 2 ... 104 ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper Bags 2(5 ... 443 1 ... 4 23 ... ... ... ... ... ... ... ... Brush Making 20 ... 609 1 ... 21 22 ... ... ... ... ... ... ... ... Stuffed Toys ?, ... 22 ... ... ... 2 ... ... ... ... ... ... ... ... Cosaques, Christmas crackers, Christmas stockings, &c. ... ... ... 1 ... 25 ... ... ... ... ... ... ... ... ... Total 400 34 4,590 50 ... 245 450 ... ... ... ... ... ... ... ... 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 1,074 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 77 Reports (of action taken) sent to H.M. Inspector 77 Other Jnderground Bakehouses (S. 101):— In use at the end of the year 51 70 Factories.—During the year 95 factories were inspected by the officers of the Public Health Department, two being factory laundries and 93 factories in which articles of clothing, &c., were made and altered. In 17 factories the sanitary accommodation was defective, unsuitable or insufficient:— Nuisance. Found. Abated by Workshop Inspector. Abated by District Inspector. Outstanding. Total. Unsuitableor Defective w.c.'s 17 12 4 1 17 Insufficient „ 3 1 1 1 3 Not separate for the sexes. - - - - - Workshops.—The number of workshops registered in Hackney at the end of 1914 was 1,074, an increase of 16 on the number registered at the end of 1913. Of this total, 802 were workshops in which females were employed. Of these latter, 581 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, &c., 181 in which other articles were manufactured, &c., and 34 were domestic workshops. Amongst the workshops manufacturing wearing apparel, there were 421 employing females alone, and 152 employing both males and females. In workshops of other occupations, there were 114 employing females alone, and 73 employing both males and females. Of the domestic workshops, females alone were employed in 20 and both males and females in 14. During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints Factories 20 „ Workshops 55 Notices „ 91 71 Analysis of Occupations Carried On in the Registered Workshops of Hackney. (A) Wearing Apparel. Occupations. No. of Workshops. Occupations. No. of Workshops. Artifical Flower Makers 6 Hats 8 Baby Linen 2 Infants' Millinery 7 Beading 1 Mantles 60 Belts 1 Millinery 45 Blouses 40 Needlework 2 Boot and Shoe Manufacturers 75 Pinafores 3 Shirts 3 Boot Machinists 112 Stays 7 Children's Costumes 18 Tailoring 62 Clerical Robes 1 Ties 45 Clothing 5 Trimmings 11 Collars 1 Underclothing 19 Dressmakers 92 Vests 11 Dressing and Tea Gowns 8 Waterproofs 5 Fancy Bows on Shoes 3 Fall Net Chenilling 1 705 Furriers 51 (b) Other Occupations. Bakers and Confectioners 29 Rubber Goods 5 Baskets 4 Toy Makers 4 Box Makers 16 Trunk and Bag Makers 5 Brush Makers 9 Umbrella Makers 3 Cabinet Makers 57 Upholsterers 12 Doll Manufacturers and Dressers 3 Upholsterers' Trimmings 3 Miscellaneous 103 Fancy Leather Goods 20 369 Laundries 81 Pianoforte Makers 15 During 1914 Miss Teebay, the Workshops Inspector, made 2,284 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections 280 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, 1914. Outstanding at end of 1913. Found in 1914. Outstanding at end of 1914. Abated in 1914. By Inspector of Workshops. By District Inspector. Total. Want of Cleanliness 39 212 9 239 3 242 Want of Ventilation 10 33 7 36 ... 36 Overcrowding ... 12 2 10 ... 10 Want of Drainage of Floors ... 3 1 2 ... 2 Other Nuisances 7 81 2 69 17 86 Insufficient Sanitary Accommodation ... 2 ... 2 ... 2 Unsuitable or defective Sanitary Accommodation 1 68 7 46 16 62 No separate Sanitary Accommodation for sexes 5 8 3 9 1 10 73 Outworkers.—The number of outworkers on the register at the end of 1914 was 2,542, against 2,451 at the end of 1913. There were thus 91 outworkers added to 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 36 Hats 13 Baby Linen 22 Lace Trimmed Goods 14 Belts 31 Millinery 205 Blouses 164 Pinafores 1 Boots and Shoes 581 Shirts 43 Boxes 185 Shoe Bows 14 Braces 2 Skirts and Mantles 207 Brushes 178 Tailoring 163 Canvas Goods 29 Ties 196 Children's Costumes 18 Trimming 30 Clothiers and Outfitters 62 Umbrellas 22 Collars and Bibs 23 Underclothing 153 Confectionery Packing 19 Upholsterer's Trimmings 5 Corsets 1 Vests 4 Dolls 5 Miscellaneous 20 Dressing and Tea Gown 14 Fancy Goods 30 2,512 Fur Trade 52 The local authorities from which I have received names and addresses of outworkers during the year 1914 are the following:— Battersea 7 Paddington 6 Bermondsey 4 Poplar 97 Bethnal Green 335 St. Marylebone 46 Bromley (Kent) 2 St. Pancras 2 Camberwell 1 Shoreditch 231 Chelsea 12 Southwark 9 City of London 1,165 Stepney 106 Deptford 1 Stoke Newington 123 Finsbury 521 Tottenham 9 Hampstead 6 Walthamstow 12 Holborn 8 Wandsworth 1 Hornsey 2 West Ham 6 Ilford 1 Westminster 25 Islington 234 3,026 Kensington 12 Leyton 42 74 On examination of the lists of outworkers sent in by employers in this Borough during 1914,1 found 2,423 whose addresses were in other districts. The names and addresses of these were forwarded to their respective local authorities, as given in the following list:— Acton 1 Leeds 3 Amersham 2 Lewisham 9 Axminster 3 Leyton 133 Beer (Devon) 1 Newport (Essex) 2 Bermondsey 6 Northampton 2 Bethnal Green 478 Paddington 2 Bexhill 2 Pontypridd 1 Brentford 2 Poplar 192 Brentwood 2 Romford 3 Bridlington 1 St. Marylebone 3 Bristol 1 St. Pancras 10 Camberwell 35 Shoreditch 399 Cardiff 2 Southend 2 Chadwell Heath 1 Southgate 4 Chard (Somerset) 4 Southwark 13 Chelmsford 6 Stepney 237 Chingford 7 Stokenchurch (Berks) 2 Chiswick 3 Stoke Newington 139 Chulmleigh (Devon) 1 Surbiton 1 City of London 1 Tadcaster 1 Croydon 2 Tottenham 130 Deptford 6 Twickenham 1 East Ham 15 Walthamstow 168 Edmonton 16 Wandsworth 4 Enfield 2 Wembley 1 Finsbury 10 West Ham 31 Frome 2 Westminster 3 Fulham 6 Willesden 2 Hammersmith 4 Woodford 1 Hastings 1 Wood Green 12 Holborn 1 Woolwich 1 Hornsey 6 Worksop (Notts) 1 Ilford 10 2,423 Islington 260 Lambeth 10 75 During the year 1914, Miss Portlock (the inspector appointed for the inspection of outworkers premises) made 1,261 inspections and 566 re-inspections. She also made 545 visits without inspections, the outworkers having left the premises (211), or having given up homework (38), or being out at the time of visit (181), or owing to a wrong address being given (65), or the premises being workshops (40), or male workers alone being employed (10) Miss Portlock also discovered 12 new workshops and handed their addresses in for registration. During her visits of inspection Miss Portlock discovered 479 premises with sanitary defects. For the abatement of these she served 355 intimation notices. Of the 1,261 premises inspected, in only 73 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 63 „ „ and living room 51 ,, ,, ,, kitchen 25 ,, and kitchen 864 ,, ,, bedroom 120 „ ,, parlour 53 ,, ,, scullery 8 „ ,, bath rooms 2 „ „ landing 2 Workroom provided separate 73 Total 1,261 7 The following table gives details of the nuusances found their abatement :- NUISANCES IN OUTWORKERS' PREMISES, 1914. Outstanding at end of 1913. Found in 1914. Outstanding at end of 1914. Abated in 1914 :— By Inspector of Outworkers. By District Inspector. Total. Want of Cleanliness 53 280 61 271 1 272 Want of Ventilation 4 27 ... 30 1 31 Overcrowding 2 3 ... 3 2 5 Number of Premises on which other Nuisances found 27 266 49 235 9 244 Sanitary Accommodation Defective 6 101 23 84 ... 84 77 List of Combined Drainage Works referred to the Borough Engineer and Surveyor during the year 1914. Date of Reference. Situation of Premises. 10th January 9, 11, 13, 15, Penshurst Road. 13th „ Yard and premises adjoining 2, Tilia Road. 16th „ 50 and 52, Ballance Road. 16th „ 6 and 8, Montague Road, Dalston. 21st „ 4, 10, 12, 31st 134, Queen's Road. 17th February 16-30, Farleigh Road. 17th „ 22, Mountford Road. 25th „ 132, Mapledene Road. 25th 1, Tilia Road. 9th March 139 and 141, Amhurst Road. 17th „ 26, Morning Lane and 5, Jackson's Buildings 18th „ 112 and 114, Mandeville Street. 30th „ 27, 28, 29, 30, 31, Church Crescent. 1st April 91 and 93, Downham Road. 7th „ 20 and 22, Killowen Road. 1st May 65, Farleigh Road. 2nd „ 26, 28, 30, Graham Road. 11th „ 13 and 14, Bradbury Street. 13th „ 37, Manor Place. 18th „ 5, Sutton Place, Hackney. 20th „ 59, 67, Farleigh Road. 21st „ 63, 30th „ 52, Christie Road. 5th June 33, Stamford Road. 17th 59, Sandringham Road. 27th „ 110, Clarence Road. 4th July 82, Farleigh Road. 14th „ 37, 39, 41, 43, Downham Road. 18th „ 108, High Street, Stoke Newington. 21st August 2, 4, 6, 8, Greenwood Road. 4th September 74, Rendlesham Road. 4th „ 19-23, Wetherell Road. 15th „ 33, Trederwen Road. 25th „ 1, Wick Road and 87, Berger Road. 78 List of Combined Drainage, &c.—continued. Date of Reference. Situation of Premises. 1st October 90, 92, 96, 98, Mare Street. 10th 27, Hockley Street and 5, Ribstone Street. 13th 105, London Road. 30th 13 and 17, Ballance Road. 31st 15, 2nd November 4 and 5, Clarence Terrace. 20th „ 101, Median Road. 20th „ Factory at rear of 62, Overbury Street. 1st December 123, 125, 127, 129, Forest Road. DISINFECTION. (a) Rooms.—During 1914 there were 2,500 rooms fumigated and 714 rooms cleansed in the Borough by the staff of the Public Health Department. In these totals are included the disinfections after measles, whooping cough and tuberculosis, in addition to those in connection with notifiable infectious diseases. The number of rooms fumigated and cleansed each month is set out in the following table:— (b) Articles of Clothing, Furniture, &c.—The number of articles under this head disinfected during last year was 22,259. This is an increase of 3,436 upon the number disinfected during 1913, and is due to the increased number of cases of notifiable infectious disease C???ing in the Borough during the year. Number of Rooms Fumigated and Cleansed each Month during 1914. Month. Rooms Fumigated. Rooms Cleansed. Remarks. January 315 90 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 151 43 April 168 48 May 165 47 June 126 36 July 164 47 August 166 47 September 273 78 October 287 82 November 255 73 December 236 67 Total 2,502 714 79 The following thable gives a summary of the article fected:- Articles Disinfected, 1914. Description of Articles. January. February. March. April. May. June. July August. September. October. November. December. Total House linen and furniture 1,670 1,333 1,490 1,368 1,236 968 1,078 1,206 1,401 1,447 1,582 2,346 17,125 Men's clothing 173 95 123 121 84 73 41 68 85 65 97 102 1,127 Women's clothing 2l6 106 134 112 139 125 46 62 152 128 133 182 1,565 Children's clothing 56 19 42 60 47 42 10 29 32 15 38 61 451 Other articles 127 122 208 197 140 117 136 122 184 188 228 222 1,991 2,272 1,675 1,997 1,858 1,646 1,325 1,311 1,487 1,854 1,843 2,078 2,913 Total 22,259 80 In addition to these there were 243 articles destroyed on request from the owners. These are set out in the following table :— Articles Destroyed. Beds 47 Overlays 1 Bolsters 14 Pillows 45 Blankets 4 Palliasses 56 Cushions 21 Rugs 2 Sundry articles 15 Sheets 2 Mattresses 31 Quilts 5 Total 243 (c) Public Library Books.—During the past year, 507 books from homes in which infectious diseases had occurred were disinfected. Of this total, there were 447 books which had been borrowed from the Hackney Borough Library and 60 from other Libraries. The method of disinfection of books practised is to expose the books in a closed chamber to the action of formic aldehyde gas, which is generated in a lamp from formalin tablets. Books Disinfected, 1914. Month. Number of Books Disinfected. From Hackney Public Library. From other Libraries. Totals. January 32 5 37 February 28 2 30 March 24 10 34 April 36 1 37 May 13 10 23 June 26 5 31 July 32 4 36 August 18 3 21 September 43 9 52 October 65 9 74 November 45 1 46 December 85 1 86 Total 447 60 507 81 Number of persons lodged and maintained at the Council's Shelter in Millfields Road, Clapton, N .E., during the year ended 31st December, 1914. Month. No. of Persons Admitted. Cost of Maintenance. Average period of Stay. Diseases. Men. Women. Children. Total. £ s. d. January 2 2 3 7 0 8 9 Days. 1 Diphtheria. February ... ... ... ... ... ... ... ... March ... 1 1 2 0 2 6 1 Scarlet Fever. April ... ... ... ... ... ... ... .. May .. ... ... ... ... ... ... ... June 1 1 ... 2 0 2 6 1 Scarlet Fever. July 1 1 3 5 0 6 3 1 Scarlet Fever. August 1 1 2 4 1 0 0 4 Diphtheria. September ... ... ... ... ... ... ... ... October ... ... ... ... ... ... ... ... November ... ... ... ... ... ... ... ... December 1 1 9 4 0 5 0 1 Diphtheria. 6 7 11 24 2 5 0 15 82 THE SHELTER. During the past year there were 24 persons admitted to the shelter whilst their homes were being disinfected. This total consisted of 6 men, 7 women and 11 children. This is an increase of 13 persons on the number admitted during 1913. The cost of maintenance of the 24 persons thus admitted was £2 5s. The average length of stay in the shelter was 1.5 days. The table on page 81 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 last year, 1,541 baths being given during that period. This total shows a decrease of 625 upon the number given during 1913. The following shows the number of baths given to verminous persons since the baths were first provided :— Year. 1902 1903 1904 1905 1900 1907 1908 1909 1910 1911 1912 1913 1914 No. of Baths 3 11 9 241 330 457 724 667 508 721 1,372 2,360 1,511 Of the 1,541 baths given, 5 were sulphur baths for scabies, and 1,536 for pediculi. The great majority of those persons presenting themselves for baths were children from the elementary schools in the Borough. These children received 1,506 baths, a decrease of 820 upon the number given during 1913. 83 The following are the Schools from which children were sent to the Cleansing Station, with the number of baths given:— Schools. Number Cleansed. Hot Baths. Sulphur Baths. Ballance Road, R.C. 19 — Benthal Road 3 — Berkshire Road 215 — Berger Road 85 — Cassland Road 2 — Daubeney Road 84 — Detmold Road 26 — Eleanor Road 14 — Gainsborough Road 172 — Gayhurst Road 18 — Glyn Road 9 — Hackney Parochial 18 — Homerton Row 179 — London Fields 217 — Mandeville Street 201 — Morning Lane 119 — Millfields Road 1 — Northwold Road 14 — Orchard Street 29 — Percy Road 3 — Rushmore Road 3 — St. John's, R.C 18 — St. Scholastica's, R.C 9 — St. Joseph's, R.C. 9 — Sidney Road 22 — Sigdon Road 2 — Tottenham Road 3 — Schools outside Borough 8 4 Total 1,502 4 e 2 84 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. January. February. March. April. May. June. July August. September. October. November. December. Totals. Receiving Hot Baths Men 9 3 1 ... 2 2 2 2 9 2 2 ... 34 Women ... ... ... ... ... ... ... ... ... ... ... ... ... Children 178 155 181 74 162 167 113 14 154 127 102 75 1,502 1,536 Receiving Sulphur Baths. Men ... ... ... ... ... ... ... ... ... ... ... 1 1 Women ... ... ... ... ... ... ... ... ... ... ... ... ... Children ... ... 1 ... ... ... 2 ... ... ... ... 1 4 5 85 The following shows the expenditure in detail incurred in conncction with the Disinfecting Station, including that relating to the Shelter :— EXPENDITURE AT THE DISINFECTING STATION FOR THE YEAR 1914. Shelters. £ s. d. £ s. d. Wages, Female Caretakers 50 0 0 Subsistence Allowance 2 7 6 Maintenance, Repairs, &c.— Electricity Supply 4 10 8 Water 4 12 0 Electric fittings 1 16 6 Coal 3 6 11 Stores, &c 5 7 7 Matron's Uniform 0 17 0 Repairs 0 13 5 21 4 1 £73 11 7 Disinfecting Station. Wages 378 2 1 Electricity Supply 9 13 3 Electric Fittings 3 13 0 Water 9 2 0 Hire of Horse 78 0 0 Repairs— To Caretaker's House 16 3 9 To Disinfecting Station 5 19 4 To Boiler 15 16 9 To Disinfector 2 17 7 To Disinfecting Van 12 0 0 To Fence 12 1 10 64 19 3 Recording Gauge Sundries 2 1 7 Boiler Powder 2 16 0 Overalls and Blouses 4 3 5 Laundryman's Wages 6 0 0 Coal— Steam 46 6 0 Kitchen (Lodge) 6 13 10 52 19 10 Stores, Firewood, &c 10 15 3 £622 5 8 86 Cleansing of Verminous Children. £ s. d. Attendant's Wages 50 2 6 Sponges, &c 1 8 6 £51 11 0 London County Council (General Powers) Act, 1904. During the year my attention was drawn by the Medical Officer (Education) of the I..C.C. to 618 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. cf 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. 618 71 27 520 Amongst the 71 verminous homes there were 27 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 85; and, where necessary, notices were served upon the owners to cleanse and strip the rooms to free them from vermin. 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, during the year 1914 amounted to 39,971 tons 11 cwts. During the quarter ending March 31st the price paid by the Borough Council to the contractors per ton for the North Division was 4s. 9d., and 5s. 5d. for the South Division ; during the remainder of the year the prices were:— for the North Division, 4s. 2d. and for the South Division, 4s. 3d. per ton. The total cost for this removal for the whole year amounted to £8,915 18s. 9d. The total cost of destruction of the refuse and disposal of the resulting clinker has been calculated by the Electrical Engineer to be £7,052 19s. 9d., thus bringing the total cost of removal and disposal of refuse to £15,968 18s. 6d., a decrease of £954 19s. 9d. 87 DUSTING ACCOUNT, 1914. Month. Northern Division. Southern Division. Totals. Weight. Cost. Weight. Cost. Weight. Cost. tons cts. qrs. lbs. £ s. d. tons cts. qrs lbs. £ s. d. tons cts. qrs. lbs. £ s. d. January 1,494 11 0 14 354 18 10 1,612 9 0 7 436 7 8 3,107 0 0 21 791 6 6 February 1,877 3 1 14 445 15 9 2,055 6 0 7 556 12 7 3,932 9 1 21 1,002 8 4 March 2,028 4 0 7 481 14 1 2,223 16 1 14 602 5 8 4,252 1 0 21 1,083 19 9 April 1,736 12 2 21 361 16 0 1,931 9 9 0 410 7 3 3,667 15 0 21 772 3 3 May 1,613 3 1 14 336 1 6 1,758 8 3 21 373 13 4 3,371 12 1 7 709 14 10 June 1,404 13 1 14 292 12 9 1,590 8 0 21 337 19 6 2,995 1 2 7 630 12 3 July 1,412 9 0 21 294 5 9 1,587 15 0 0 337 7 9 3,000 4 0 21 631 12 11 August 1,120 18 1 0 233 10 6 1,343 15 9 21 285 11 0 2,461 13 3 21 519 1 6 September 1,264 19 0 21 263 10 8 1,463 18 0 7 311 1 9 2,728 17 1 0 574 12 5 October 1,518 16 9 21 316 8 6 1,692 1 3 7 359 11 4 3,210 18 9 0 675 19 10 November 1,586 9 3 14 330 9 0 1,745 19 9 7 371 0 6 3,332 9 1 21 701 9 6 December 1,854 1 9 7 386 5 4 2,054 13 1 0 436 12 4 3,908 14 3 7 822 17 8 Totals 18,911 16 9 0 4,097 8 1 21,059 14 2 0 4,818 10 8 39,971 11 0 0 8,915 18 9 Cost of Destruction £3,336 6 5 £3,716 13 4 £7,052 19 9 £15,968 18 6 88 DUST REFUSALS AND NO ANSWERS FOR THE YEAR 1914. Months. Refusals. No answers Month. Refusals. No answers. January 4,591 4,856 July 2,650 3,733 February 4,400 4,035 August 3,800 5,912 March 4,480 4,296 September 2,975 3,785 April 3,531 4,117 October 4,527 4,824 May 4,211 4,572 November 3,837 3,963 June 2,999 3,509 December 4,591 4,741 The following table shows the number of requests made for the removal of House Refuse during the 10 years ending 1914 :— Year. Requests. Year. Requests. Year. Requests. 1905 108 1909 70 1912 170 1906 98 1910 52 1913 136 1907 89 1911 136 1914 190 1908 67 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, &c. Number of bodies deposited in Mortuary 477 1. To await inquests—(a) Infectious 1 (b) Non-infectious 444 2. To await burial 32 Number of post-mortems made 146 89 INQUESTS. Verdicts. Sex Male. Female. Natural causes 155 120 Accidental death 58 66 Suicide 21 5 Open Verdict 11 7 Manslaughter Murder Misadventure Totals 245 200 Table showing nature of above Suicidal and Accidental Deaths In the Borough of Hackney during the year ended 1914. Suicides. Accidental Deaths. Nature of Suicide. No. Nature of Accidental Death. No. Poisoning 5 Shock from fall 46 Cut throat 2 Suffocation 6 Drowning 6 Shock from burns 4 Hanging 7 Drowning 4 Fall from window 3 Run over 25 Shooting 2 Shock from scalds 12 Run over 1 Fracture of skull 6 Suffocated in bed 7 Poisoning 5 Others 9 Total 20 Total 124 90 RETURN OF SAMPLES OF MILK ANALYSED For the Year 1914, showing the percentage of Samples founc "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. 543 471 2 to 3% 40 4 to 5% 1 10.0 3.3 86.7 3 „ 4% 7 5 ,, 6% 5 21% Boric acid 1 6 „ 7% 1 8 „ 9%. 1 9 „ 10% 2 10 „ 11% 1 12 „ 13% 2 14 ,, 15% 1 16 „ 17% 1 19 „ 20% 1 25 „ 20% 1 11% Boric acid 1 543 471 54 18 10.0 33 86.7 91 SAMPLES PURCHASED DURING 1914. Articles Purchased. Number Purchased. Number Adulterated. Number where proceedings taken. Number of Samples Adulterated with percentage of Adulteration. Milk 543 72 18 See preceding page. (Return of Milk samples). Butter 251 6 1 100% foreign fat. 1.8% excess of water. 1.3% „ .9% „ 5% „ .3% „ Margarine 3 - - Cocoa 8 - - Coffee 6 - - Arrowvroot 7 - - Lard 12 - - Olive Oil 6 - - Dripping 12 3 - 3.55% water. 3.5% „ Cream (preserved) 3 - - 3.0 % „ Cream 5 4 2 18% Boric acid. .28% „ .33% „ Pepper 9 - - .49% „ Borax 6 - - Sweet Spirits of Nitre 3 - - Whisky 12 - - Gin 3 - - Sausages 12 - - Cheese 4 - - Hum 3 1 - .93% excess of water. 908 86 21 92 Prosecutions under the Public Health (London) Act, 1891, during the year 1914. Address. Complaint. Magistrate's Decision. Penalty. Costs. 11, Milborne Street Rain water pipe and dust bin defective Order to do work in 14 days £ s. d. £ s. d. - 1 1 0 7-!l, Middleton Road Roof defective Withdrawn. (Work done) - 0 12 6 27, Madaren Street Yard paving and dust bin defective ,, - - 108, Morning Lane Workshop dilapidated, yard paving defective Order to abate in 14 days - 1 3 0 14, Tilia Road Drains defective Order to abate in two months - 2 6 0 10, ,, ,, ,, - 0 4 0 18, ,, ,, ,, - 0 4 0 20, ,, ,, ,, - 0 4 0 22, ,, ,, ,, - 0 4 0 24, ,, ,, ,, - 0 4 0 158, Morning Lane Non-compliance with Magistrate's Order Fined 5 0 0 2 2 0 Stall in Chatsworth Road Fruit deposited for sale unfit for food ,, 0 17 0 1 3 0 95, Amluirst Road Unsound meat deposited for sale ,, 25 0 0 - Total 30 17 0 9 7 6 93 Prosecutions under the Sale of Food and Drugs Acts during the year 1914. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fine. Costs. 6F Milk 5.%76 added water - £ s. d. £ s. d. 0 12 6 1J ,, 8.12% ,, - - 2 2 0 67j ,, 5.77% ,, Fined 1 0 0 1 3 0 3.18% fat abstracted 39l ,, .11% Boric acid Withdrawn - - 77l ,, 9.29% added water+ Fined <2 0 0 1 3 0 19m ,, 5.41% ,, Withdrawn. (Warranty proved) - - 39m ,, 10.24% ,, Fined 0 2 0 1 3 0 62m ,, 12.23% ,, Withdrawn. (Warranty proved) - - 45N ,, 6.47% ,, Fined 0 17 0 1 3 0 48n „ 12.24% ,, ,, 1 7 0 1 3 0 54N ,, 5% fat abstracted Dismissed. (Warranty proved) - - 15P ,, 16.352 added water ,, ,, - - 3 .98% fat abstracted 59P Butter 100% foreign fat Fined - 1 3 0 70p Milk 9.41% added water ,, 2 0 0 1 3 0 19R Cream .18% Boric acid Dismissed on payment to the Council of - 3 3 0 21r ,, .49% ,, Fined 0 17 0 1 3 0 52r Milk 14.24% added water ,, 2 0 0 1 3 0 59r ,, 19.53% ,, ,, 2 0 0 1 9 0 78r ,, 5.88% ,, Dismissed. (Warranty proved) - - 1t ,, 25.06% ,, ,, ,, - - 39t ,, 4.59% ,, - - 0 12 6 Total 12 3 0 18 0 0 94 95 REGISTER OF SANITARY WORK, 1914—continued. Mr. Ellis. Stamford Hill Mr. Harvey, West Hackney. Mr. Legs, Hackney. Mr. Bew, Clapton. Mr. Body. Kingsland. Mare Street and South Hackney Mr. Haben. Homerton, F. 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. Mr. Goldsworthy Special. Totals. Mr. High. Mr. Sheppard. Mr. Punter. No. 1. No. 2. No. 3. No 4 No. 5. No. 6. No. 7. 1 No. 9. No. 9. No 10. No. 11. No. 12. INSPECTIONS— (a) On complaint 174 170 139 175 130 199 230 165 212 198 84 86 18 98 ... 16 1 ... 2,095 No. of premises on which defects were discovered .. 135 163 113 125 121 142 137 132 174 169 31 70 ... 68 ... 12 1 ... 1,593 (b) House to House— No. of houses inspected 20 60 15 23 11 166 98 154 37 79 82 205 92 86 ... ... 34 ... 1,162 No. of houses in which defects were discovered 11 60 15 23 11 87 47 68 34 53 42 135 87 70 ... ... 13 ... 756 No. of Notices served 11 60 15 23 11 87 47 68 34 55 42 135 125 70 ... ... 13 ... 796 (c) Houses after Infectious Dis. No. of houses inspected 170 173 5 233 171 264 259 118 291 191 121 61 5 124 ... ... ... ... 2,186 No. of houses in which defects were discovered 30 137 2 85 85 54 57 15 58 54 72 14 5 24 ... ... ... ... 592 (d) Miscellaneous— Fishmongers'and Poulterers' yards 4 5 ... ... ... 2 ... 2 4 ... 6 1 ... 4 ... ... ... ... 28 Slaughterhouses 7 ... ... ... ... ... 2 ... ... ... ... ... ... ... 323 ... ... ... 332 Cowhouses (premises), Dairies and Milkshops 7 ... ... ... ... ... 3 10 ... ... ... ... ... ... 1,778 ... ... ... 1,798 Greengrocers' yards 6 2 ... 4 ... ... 1 3 ... 3 13 ... ... ... ... ... ... ... 32 Schools ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Housing, Town Planning, &c. Act, 1909— No. of houses inspected ... ... ... ... ... ... ... ... ... ... ... ... 69 ... ... ... ... ... 69 No. of houses in which defects were found ... ... ... ... ... ... ... ... ... ... ... ... 62 ... ... ... ... ... 62 No. of houses in which defects were remedied ... ... ... ... ... ... ... ... ... ... ... ... 76 ... ... ... ... ... 76 Factories and workshops— No. of inspections 2 27 1 37 12 6 57 | 15 21 44 ... ... ... 2 ... 957 ... ... 1,161 No. of premises on which defects were discovered 2 22 1 10 12 3 21 5 8 24 ... ... ... 2 ... 3,34 ... ... 444 96 REGISTER OF SANITARY WORK, 1914—continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South Haeknev Mr. Hahen. Homerton, F. 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 Port lock, Special. Mr. Goldsworthy Special. Totals. Mr. High. Mr. Sheppard. Mr. Puntpr. 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. Outworkers' Premises— No. of inspections ... 1 ... ... ... ... ... ... ... 10 ... ... ... ... ... ... 1,261 ... 1,272 No. of premises on which defects were discovered ... 1 ... ... ... ... ... ... ... 7 ... ... ... ... ... ... 465 ... 473 Bakehouses— No. on Register at end 1913 8 12 10 10 14 8 10 5 6 12 8 2 ... ... ... ... ... ... 105 ,, ,, ,, 1911 8 12 10 9 12 9 9 5 7 12 8 2 ... ... ... ... ... ... 103 „ above ground 6 6 4 5 4 1 3 9 5 10 8 ... ... ... ... ... ... ... 54 No. underground 2 6 6 4 8 8 6 3 2 2 ... 2 ... ... ... ... ... ... 49 „ of Inspections, 1914 11 21 ... 15 24 24 48 12 40 57 17 ... ... 5 ... ... ... ... 274 „ of Notices, 1914 5 3 ... ... 8 1 ... 3 ... 9 3 ... ... 4 ... ... ... ... 36 „ of Prosecutions, 1914 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Urinals 5 12 14 13 1 9 2 12 14 28 34 ... ... 5 ... ... ... ... 149 Canal boats ... ... ... ... ... ... ... ... ... ... ... 17 ... ... ... ... ... ... 17 Visits to waterways ... ... ... ... ... ... ... ... ... ... ... 36 ... ... ... ... ... ... 36 Animals improperly kept 3 5 ... 3 11 ... 5 9 3 5 5 1 ... 2 ... ... 5 ... 50 Laundries ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 130 ... ... 133 Offensive trades ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 15 ... ... ... 17 New buildings 10 ... ... ... ... 1 3 ... ... ... ... 1 ... ... ... ... ... ... 15 Special Inspections 6 96 17 101 130 45 06 12 162 124 13 30 166 165 298 ... ... ... 1,431 Re-inspections 1,741 2,749 1,631 2,121 1,792 1,945 2,148 2,516 2,426 2,142 2,187 1,279 1,710 2,282 ... 1,181 566 ... 30,446 Houses Let in Lodgings- No. on Register at end 1913 ... ... ... ... ... ... ... ... ... 1 226 ... ... ... ... ... ... 243 470 1914 ... ... ... ... ... ... ... ... ... 1 226 ... ... ... ... ... ... 243 470 ,, of Inspections, 1914 ... ... ... ... ... ... ... ... ... 2 195 ... ... ... ... ... ... 172 369 of Notices, 1914 ... ... ... ... ... ... ... ... ... 2 86 ... ... ... ... ... ... 79 167 „ of Prosecutions, 1914 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 97 G 98 99 REGISTER OF SANITARY WORK, 1914—continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body. Kingsland. Mare Street and South Hackney Mr. Haben. Homerton. K. 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. Mr. Goldsworthy Special. Totals. Mr. High. Mr. Sheppard. Mr. Punter. No. 1. No. 2. No. 3. No.4. No. 5. No. 6. No. 7. No. 8. No. 9. No. 10. No. 11. No.12. Inspections—continued. Common Lodging Houses— No. on Register at end of 1913 ... ... ... ... ... 2 4 ... 1 ... ... ... ... ... ... ... ... ... 7 ,, ,, ,, 1914 ... ... ... ... ... 2 4 ... 1 ... ... ... ... ... ... ... ... ... 7 Mews and Stables 7 6 ... ... ... 2 ... 2 ... 30 5 3 ... 4 ... ... ... ... 59 Floodings ... ... ... ... ... ... ... ... ... ... ... 43 ... ... ... ... ... ... 43 Tenement Houses— No. provided with additional water supply during 1914 ... 4 ... ... 11 ... 1 ... ... ... ... 8 ... ... ... ... ... ... 24 Overcrowding— No. of dwelling rooms overcrowded ... 9 ... 5 3 1 6 6 10 10 ... 5 ... 3 ... ... 3 1 6 No. remedied ... 9 ... 5 3 1 6 6 10 10 ... 5 ... 3 ... ... 3 1 62 „ of Prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Insanitary Houses— No. closed under Public Health (London) Act, 1891 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. closed under Housing of Working Classes Act, 1890 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of verminous premises cleansed 5 25 ... 39 19 11 29 17 19 43 41 13 34 7 ... ... 55 ... 357 Underground Rooms— Illegal occupation dealt with ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of rooms closed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Places where Food prepared for Sale— No. on Register at end 1914 8 9 12 18 10 20 10 1 8 15 6 6 ... ... ... ... ... ... 129 of Inspections, 1914 8 2 ... ... ... 11 10 14 8 26 6 ... ... ... ... ... ... ... 85 „ of Notices ... 2 ... ... ... ... ... 2 ... 13 1 ... ... ... ... ... ... ... 18 Other workplaces ... ... ... ... ... ... ... ... ... 17 ... ... ... ... ... ... ... ... 17 Miscellaneous Inspections 20 13 ... 101 ... ... 47 ... 31 89 5 ... ... ... ... ... ... ... 306 G 2 109 101 REGISTER OF SANITARY WORK, 1914—continued. Mr. Ellis, Stamford Hill. Mr. Harvey, West Hackney. Mr. Legg, Hackney. Mr. Bew, Clapton. Mr. Body, Kingsland. Mare Street and South Hackney Mr. Haben, Homerton, F. 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. Mr. Goldsworthy Special. Totals. Mr. High. Mr. Sheppard. Mr. Punter. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. No. 10. No. 11. No. 12. Inspections—continued. I Ice Cream Premises— No. on Register at end 1913 16 16 32 17 9 18 15 12 17 21 8 14 ... ... ... ... ... ... 198 „ „ „ 1914 17 16 29 19 8 8 17 12 19 23 6 11 ... ... ... ... ... ... 185 „ of Inspections 17 12 34 22 8 9 17 12 19 29 19 11 ... ... ... ... ... ... 209 No. of Notices ... 1 ... 6 ... ... 1 ... 2 8 2 ... ... ... ... ... ... ... 20 „ „ Prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total number of Intimation Notices served 191 233 122 304 238 299 263 261 273 362 207 180 136 194 9 261 355 92 3,980 Peremptory or Final Notices served 20 ... 37 30 18 2 17 47 28 17 31 15 12 18 ... 60 41 ... 393 Statutory Notices served 4 26 ... 28 56 24 22 4 5 33 1 22 16 26 ... 19 ... ... 286 Proceedings before Magistrates under the Public Health Act ... ... ... 1 ... ... ... ... ... 2 ... ... 1 6 3 1 ... ... 14 Nuisances abated 180 227 119 380 209 296 229 220 280 310 187 140 173 144 ... 355 393 38 3,886 Seized and Condemned as Unfit for Human Food— cwt. qr. cwt. qr. cwt. qr. cwt. qr. c*'t. nr. Fish ... ... ... 1 2 ... ... 3 2 ... ... ... ... 1 2 ... ... 8 1 ... ... ... 14 3 Fruit and Vegetables ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 3 2 ... ... ... 3 3 Meat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ton cwt.qr. 1 3 1 ... ... ... ton cwt. qr. 13 1 Tinned Foods ... ... ... ... ... ... ... ... ... ... ... ... ... ... cwt. qr. 1 1 ... ... ... cwt. qr. 1 1 Other Articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Open spaces cleared 10 3 ... ... ... ... ... ... 3 ... 4 1 ... ... ... ... ... ... 21 Special Reports to Medical Officer of Health 5 9 17 13 3 ... 15 2 3 7 ... 1 4 12 22 9 22 1 145 Food Adulteration— Samples collected for analysis 72 72 ... 72 42 71 71 66 66 66 66 42 65 66 65 ... ... 6 908 Proceedings taken before Magistrates 5 ... ... 1 ... 1 4 1 1 ... 1 2 3 1 1 ... ... ... 21 102 APPENDIX, LIST OF LICENSED COW-SHEDS IN THE BOROUGH OF HACKNEY, OCTOBER, 1914. No. of Sheds. Name. Address. Jenkins, John 2, Buckingham Road 2 Wright, George 84, Clifden Road 1 Evans, Rees 11, Downham Road 1 Francis, Hannah 67, Downham Road 1 Pocock, B., & Sons 46a, Leswin Road 1 Warner, J. & A. 23, Mare Street 1 Stapleton, A., & Sons, Ltd. Stoke Newington Common 2 Snewin, Wm. H. 67, Old Hill Street 1 Lewis, Jenkin 6, Palace Road 1 Francis, Thomas 257, Queen's Road 1 Protheroe, Timothy 79, Shacklewell Lane 1 Welford, Richard W 83, Upper Clapton Road 1 Briggs, Jas. J. 180, Victoria Park Road 1 Thomas, David 6, Warburton Road 1 Total Cow-sheds 16 LIST OF LICENSED SLAUGHTER-HOUSES IN THE BOROUGH OF HACKNEY, SEPTEMBER, 1914. Name. Address. Patchett, T. H. 133, Lower Clapton Road. Toop, C. W. 73, Upper Clapton Road. Clarke, A. E. 150, Upper Clapton Road. Young, C. J. 220, High Street, Stoke Newington. Row, F. W. 130, High Street, Stoke Newington. Hammer, Wm. 103, Rendlesham Road. Friday, R. G. 235, Amhurst Road. Austin, W. E. 51, Wilton Road. Joyce, J. 531, Kingsland Road. Adams, H. 94, Southgate Road. 103 List of Licensed Slaughter-houses—continued. Name. Address. Gooch, H 71, High Street, Kingsland. Roberts, F 49, High Street, Kingsland. Wragg, W. J. 57, Holly Street. Wood, H. P. 90, Frampton Park Road. Tyler, S. 92, Well Street. Raymond, Geo. 186, Cassland Road. Stoneman, P. 3, Terrace Road. Tyler, R. A. 80, Mare Street. Teat, T. 177, Mare Street. Hussey, A. J. 37, Church Road, Homerton. LIST OF BAKEHOUSES, OCTOBER, 1914. No. 1 District. Samson, W. J. 77, Upper Clapton Road. Buddin, J. 87, Reighton Road. Blain, G. W. 123, Northwold Road. *Austin, W. H. 74, Fountayne Road. Morgan, A. 33, Old Hill Street. *Vincent, A. 104, Old Hill Street. Hygienic Welsh Bakery Co. 143, Clapton Common. Zanetti, C. 84, Stamford Hill. No. 2 District. Heyward 216, High Street, Stoke Newington. *Kurtz 176, High Street, Stoke Newington. Biddlecombe, G. 114, High Street, Stoke Newington. *Norman, A. 128, Stoke Newington Road. *Cohen 144, High Street, Kingsland. *Seufert, C. 40, Shacklewell Lane. Brenner, W. 73, Shacklewell Lane. *Karsch, J. 239, Amhurst Road. *Mezger, A. 33, Rectory Road. Vogt, C. 62, Evering Road. Burch, Mrs. H. 9, Maury Road. Willsmer, C. 8, Stellman Street. 104 List of Bakehouses—continued. No. 3 District. Name. Address. Thorowgood, A. C. 38, Amhurst Road. *Newell & Co. 393, Mare Street. Erbach, J. 9, Clarence Road. *Engel, 71, Lower Clapton Road. *Parish, W. 117, Lower Clapton Road. Eade, W. A. 215, Lower Clapton Road. *Newling, G. 26, Downs Road. Lawrence, E. 68, London Road. *Strudwick, P. 50, London Road. *Seward, R. 240, Dalston Lane. No. 4 District. Mack, W. 13, Median Road. Blain, G. W. 138, Chatsworth Road. *Adolph, H. 94, Chatsworth Road. *Maloney, J. 36, Chatsworth Road. *Wickert, E. 19, Chatsworth Road. *Knapp, Wm. 219, Glyn Road. Latham, J. 326, Glyn Road. *Lunken, J. 52, Mandeville Street. Saur, H. 258, Rushmore Road. No. 5 District. *Rowe, J. 207, Queen's Road. Gotlieb, G. 20-22, Forest Road. *Pay, E. T. 106, Hertford Road. *Sedgwick, E. 329, Kingsland Road. Best, C. 376, Kingsland Road. Bolton, Elizabeth 513, Kingsland Road. *Chappell, W. 550, Kingsland Road. 105 List of Bakehouses—continued. Name. Address. *Calton, A. 48, De Beauvoir Road. Allardyce, S. W. 98, Southgate Road. *Henkelmann, H. 174, Southgate Road. *Chappell, W. 1, Balls Pond Road. *Hohl, J. 72, Dalston Lane. No. 6 District. *Spenner, A. 81, Wilton Road. Liebsch, H. 49, Greenwood Road. *Tidy 25, West Side, London Fields. *Spenner, H. 68, Lansdowne Road. *Theis 69, High Street, Kingsland. *Roessle, W. 88, High Street, Kingsland. *Willicombe, F. 28, John Campbell Road. *Brill, C. 178, Dalston Lane. *Nieman & Kelb 103c, Dalston Lane. No. 7 District. *Wragg, A. H. 27, Morning Lane. *Ebert, J. 77, Frampton Park Road. *Reitz, C. 183, Mare Street. Slade, C. 139, Mare Street. Morse, H. 77, Mare Street. *Bushell, F. 10, Broadway, London Fields. Payne, A. 54, Broadway, London Fields. *May, H. 70, Broadway, London Fields. *Stumm, K. 39, Westgate Street. No. 8 District. *Skaer, P. 76, Well Street. Martin, J. 105, Well Street. *Durham, L. V. 142, Victoria Park Road. *Mustard, E. 79, Lauriston Road. *Slade, C. 106, Gore Road. 106 List of Bakehouses—continued. No. 9 District. Name. Address. Juniper, J. T. 18, Brooksby's Walk. Silver, S. 3, Churchill Road. Grimwood, T. 39, High Street, Homerton. Grimwood, T. 59, High Street, Homerton. Bradford, G. 95, High Street, Homerton. *Gibbons, G. 131, High Street, Homerton. *Hewitt, A. 167, High Street, Homerton. No. 10 District. Harris 184, Cassland Road. Collins, J. 95, Harrogate Road. Bremmer, G. 92, Wick Road. Parker, G. 220, Wick Road. *Gunner, Mrs. 34, Church Road, Homerton. Weber, G. 50, Kenton Road. Withers, C. 142, Well Street. Beerli, O. 154, Well Street. *Stark, W. 186, Well Street. Gilsdorf 233, Well Street. Scott, J. R. 27, Elsdale Street. Cave, H. R. 60, Fox's Buildings. No. 11 District. Selzer, H. 89, Sidney Road. Lunken, L. 276, Wick Road. Dance, Mrs. A. 315, Wick Road. Brake, G. 370, Wick Road. James, G. 389, Wick Road. Davis, S. 71, Felstead Street. Haupt, C. 41, Osborne Road. Warner, H. R. 13, Gainsborough Cottages. No. 12 District. *Crowe, W. 18, Upper Clapton Road. *Kurtz 200, Lower Clapton Road. *Underground Bakehouses. 107 REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE TUBERCULOSIS DISPENSARY SCHEME FOR THE BOROUGH OF HACKNEY. Public Health Department, Town Hall, Hackney, N.E. 17th September, 1914. To the Chairman and Members of the Public Health Committee. Gentlemen, In a report presented to the Public Health Committee in February of last year, I pointed out the most advisable means of providing a Dispensary Unit in connection with the Borough of Hackney, for the treatment of cases of Tuberculosis. On January 15th of this year the Borough Council approved of the principle of providing two Tuberculosis Dispensaries for the Borough, one in connection with the Metropolitan Hospital, and the other in connection with the Victoria Park Hospital, and authorised the Public Health Committee to continue their negotiations with the Hospital Authorities in question and to make such other enquiries as shall enable them to submit a complete report of their scheme to the Borough Council. These negotiations have now arrived at such a stage as to enable the complete scheme to be formulated. This scheme has been drafted to provide Dispensary treatment for cases of Tuberculosis in the Borough amongst both insured and uninsured persons, and may be said to consist of three parts:— (1) the provision of one or more Dispensaries for the medical treatment of Tuberculous persons; (2) the adoption of measures to discover incipient cases of that disease, and to prevent its spread; (3) the arrangements necessary to provide "After-care" and help to patients supplementary to treatment. I will now deal with these three sections seriatim. 108 I.—The Tuberculosis Dispensaries. It will be remembered that in the report above referred to, i recommended the Borough Council to arrange with the governing bodies of the Victoria Park Hospital, and the Metropolitan Hospital, to provide a Dispensary in connection with each of these Hospitals for the treatment of cases of Tuberculosis amongst the residents of Hackney, the Dispensary connected with the former Hospital serving the needs of the South-East Sub-district, with a population of 57,198, and the Dispensary of the latter Hospital, the other three Sub-districts of the Borough, with a population of 165,198. This arrangement was provisionally suggested on the probable assumption that Bethnal Green would be inclined also to enter into similar arrangements as Hackney, with the governing body of the Victoria Park Hospital. This grouping of the activities of the proposed Dispensaries must now be modified, owing to the Stoke Newington Borough Council signifying their desire to use the Metropolitan Hospital Dispensary for their Tuberculosis scheme, and also because of the apparent disinclination of the Bethnal Green Borough Council to use the Victoria Park Hospital Dispensary. Broadly, the arrangement I now suggest is that the Metropolitan Hospital Dispensary should, besides serving the needs of Stoke Newington, serve the following Wards, viz.:— Areas. Population. Stamford Hill Ward 32,790 West Hackney „ 19,018 Kingsland „ 23,045 Downs „ 17,076 91,929 Borough of Stoke Newington 50,454 Total 142,383 109 and the Victoria Park Hospital Dispensary, the following Wards:— Areas. Population. Clapton Park Ward 42,454 Homerton „ 37,211 South Hackney „ 23,163 Hackney „ 27,776 130,604 If the Borough of Bethnal Green resolves ultimately to come into the scheme in connection with this Dispensary, another distribution will be necessary, which may easily be made without detriment to the whole scheme. Situation and Means of Access to these Hospital Dispensaries. As stated in my earlier Report, the Victoria Park Hospital Dispensary is situated in the Borough of Bethnal Green, in Bonner Road, close to the south-east boundary of the Borough. It is within easy walking distance of South Hackney Ward, and may be without difficulty reached by motor 'bus, tram or railway from all parts of the remaining Wards. The Metropolitan Hospital Dispensary, which is situated in Kingsland Road, is also easily reached from all parts of the area served by it, either by motor 'bus, trams or railway. It will be seen that the above arrangement is in agreement with the requirements of the Local Government Board, as expressed in the following extract from the Board's Circular Letter, dated 19th December, 1913, as follows:— "Where there is a General Hospital, or a Hospital for Consumption, situated in the Borough, or sufficiently near to serve as a Dispensary for the Borough, or some part of the Borough, and the authorities of the Hospital are willing to provide a Tuberculosis Dispensary which will comply with 110 any rules which the Board may find it necessary to make as to Dispensaries in London, and to work in co-operation with the Borough Council and the London County Council, the Board are of opinion that arrangements should be made for such a Dispensary to serve the whole or part of the Borough." Functions of the Dispensaries. The Dispensaries will fulfil the following functions as suggested in the Interim Report of the Departmental Committee on Tuberculosis:— 1. Receiving house and centre of diagnosis; 2. Clearing house and centre of observation; 3. Centre for curative treatment; 4. Centre for examination of "Contacts"; 5. Centre for "After-care"; 6. Information Bureau and Educational Centre. The following are the conditions under which the Victoria Park Hospital, and the Metropolitan Hospital Authorities have agreed to establish Tuberculosis Dispensaries for the use of patients from the Metropolitan Borough of Hackney. Conditions. (a) Victoria Park Hospital Dispensary. 1. The Hospital Governors are prepared to institute a Tuberculosis Dispensary in connection with the Hospital, separate and distinct from their out-patient department, for the examination and treatment of patients from the Borough of Hackney. The Dispensary shall be open to patients on at least two evenings in every week. 2. They will appoint a whole time Medical Tuberculosis Officer, at a salary of not less than £400 per annum. The Officer appointed will be "a man of experience not only in dealing with Tuberculosis affection, but also in general medicine." 111 3. The Dispensary will be properly equipped with apparatus by the Hospital Authorities, the premises and the whole arrangements being satisfactory to the Local Government Board, the London County Council, and the Insurance Committee of the County of London. 4. The Dispensary will be under the control of the Hospital Authorities, except such administrative control as devolves on the Medical Officer of Health of the Borough of Hackney, as chief administrative Tuberculosis Officer of the Hackney Municipal Tuberculosis Scheme. 5. The Hospital shall appoint a Special Advisory Committee in relation to the Tuberculosis Dispensary, consisting of certain members of the Committee of the Hospital, together with the Medical Officer of Health for Hackney, two representatives nominated by the Hackney Borough Council, and two representatives nominated by the London Insurance Committee, of whom one shall be a Panel Doctor. 6. The Medical Tuberculosis Officer, upon the request of the Medical Officer of Health, shall examine persons at their homes either suffering from Tuberculosis or suspected to be suffering from this disease who are unable, or cannot be persuaded, to attend the Dispensary. He shall be available, either at the Dispensary or in the patients' own homes, for consultation and diagnosis on application being made through the Medical Officer of Health for his services by any medical practitioner practising within the Borough of Hackney. Where the Tuberculosis Officer has any doubt or difficulty in diagnosis or treatment of any case of Tuberculosis, he shall have the right of consultation with members of the visiting staff of the Hospital, whose decision shall be for the time binding. 7. For the first year, as a temporary measure, subject to subsequent revision, a charge of 2s. per head for each patient's 112 attendance at the Dispensary will be made, attendances in separate departments to be counted as separate attendances. The examination of specimens of sputa of patients not attending the Dispensary, for the detection of tubercle bacilli, and each domiciliary visit to each patient will be charged as an attendance in each case. 8. No patient shall be treated at the Dispensary who is already under the care of a general practitioner, unless and until such general practitioner's consent or request to treat the patient has first been received. 9. The Dispensary shall be hnked up to the Public Health work of the Borough, and the panel work of the general practitioners in connection with the treatment of Tuberculosis under the National Insurance Act, and shall be open to inspection by the London Insurance Committee, in accordance with the conditions laid down by the Insurance Committee of the County of London in their memorandum of the 23rd April, 1914. 10. The Dispensary scheme shall provide that the general principles set out by the London County Council in their memorandum of the 18th November, 1913, shall be observed. 11. The Tuberculosis Officer shall carry out such duties as are prescribed by the Local Government Board's General Order, of the 26th July, 1912, or any subsequent Order referring to insured persons suffering from Tuberculosis, and receiving domiciliary treatment under panel practitioners. (b) Metropolitan Hospital Dispensary. These conditions are practically the same as the above, the only important difference being that the Borough Council being the providing authority for the Tuberculosis Dispensary scheme, will be responsible for any necessary alterations and equipment required at the Dispensary, and that the remuneration of the Tuberculosis Officer of this Dispensary has been fixed at £500 per annum. 113 Duties of Medical Staff of Tuberculosis Dispensary. 1. The examination at the Dispensary of any person either suffering from Tuberculosis or suspected to be suffering from this disease, sent by the Medical Officer of Health, or at the request of the Insurance Committee, or on their behalf by panel practitioners. 2. The treatment of any such persons at the Dispensary who are found after examination to be suffering or suspected to be suffering from Consumption. The Tuberculosis Officer shall be available for consultation and diagnosis, on application for his services being made through the Medical Officer of Health, by any medical practitioner practising within the Borough of Hackney, and, on the request of the Medical Officer of Health, to visit, for purposes of diagnosis or consultation only at their homes, such persons as are unable to attend the Dispensary. 3. To furnish the Medical Officer of Health with a list of such cases as require institutional treatment elsewhere than at a Tuberculosis Dispensary, or domiciliary treatment for patients whose conditions render them unsuitable for treatment at a Dispensary. 4. To keep in touch with the Medical Officer of Health and furnish him with such information respecting the stage, treatment, and diagnosis of the disease as he may require for statistical purposes only, also to furnish similar information to any medical practitioner carrying out domiciliary treatment, or in a case which is referred to a sanatorium, to the Medical Officer of such institution. 5. The notification to the Medical Officer of Health of all cases which have presented themselves for examination and treatment at the Dispensary. H 114 6. The examination of specimens of sputa for the detection of tubercle bacilli. 7. The attendance of the Tuberculosis Officer at intervals (probably not more than once a month) at meetings of Insurance Committees, for the consideration of cases of recommendation for special treatment of cases of Tuberculosis or otherwise as required. 8. The examination of any contacts or suspects, referred by the Medical Offier of Health, or any general practitioner through the Medical Officer of Health, at the Dispensary, or in cases where the "Contacts" or "Suspects" are unable or unwilling to attend the Dispensary, at their homes. 9. The Tuberculosis Officer shall carry out any duties imposed by the General Order of the Local Government Board, 26th July, 1912, or any subsequent Order referring to insured persons receiving domiciliary treatment for Tuberculosis, under panel practitioners; also such duties which a Tuberculosis Officer may be required to perform in accordance with tbe principles set out by the London County Council in their Memorandum of the 18th November, 1913; also such duties which he may be required to perform with respect to the treatment of insured persons, in accordance with the Memorandum of the Insurance Committee for the County of London, dated 23rd April, 1914. Huts, Shelters, &c., for Tuberculosis Persons. In the Local Government Board's Circular letter of the 6th December it is recommended that "shelters and other articles which could be suitably used by the patient in his own home should be lent out for the use of patients when required," and the London Insurance Committee state in their Memorandum of the 23rd April, 1913, Section 6:— 115 "The Committee desire to be advised of any provision made in Dispensary schemes of Borough Councils in regard to the provision of huts and shelters for the use of persons suffering from Tuberculosis, and the extent to which such huts and shelters will be available for insured persons." The provision of an adequate number of shelters forms an important part of any complete scheme dealing with the treatment of Tuberculosis. Many cases may be treated at home, if provided with suitable shelters suitably placed, which otherwise would require residence in a Sanatorium. Such shelters at home may also in certain cases shorten the duration of residential treatment; and, after Sanatorium treatment, the health of many consumptives may be maintained by the judicious use of an open-air shelter at home. It is desirable, therefore, in view of their usefulness, that a sufficient number of these should be available for the use of Hackney patients. I recommend that, for a commencement, six such shelters be provided and that the London Insurance Committee be informed that these will be available for insured persons as well as non-insured persons. The cost of shelters vary both with their size and also their make; but very serviceable portable shelters may be obtained at a cost of £10 each, or even less. Linking up Dispensary Treatment with Institutional and Domiciliary Treatment. The London County Council is the authority in London for providing institutional treatment for non-insured Tuberculosis patients, and the Insurance Committee for the County of London for insured persons; the latter is also responsible for the domiciliary treatment of insured persons. h 2 116 The London County Council, in a report of their Public Health Committee, dated 21st May, have outlined the method of linking up institutional and dispensary treatment. The same method, with perhaps certain modifications, will probably be adopted by the Insurance Committee in the case of insured persons. The Local Government Board, in their Memorandum of the 26th July, 1912, have prescribed the procedure in the case of the domiciliary treatment of insured persons. Conditions under which the London County Council and the Insurance Committee will Approve of the Dispensaries. It is not necessary to set out in detail these conditions, which are rather lengthy. It is sufficient to state that the conditions under which the Hospital governing bodies have agreed to provide the Dispensaries, have been drafted to be in harmony with the conditions imposed by the above central authorities. 2.—Preventive Measures. The nature and scope of these may be gauged from the following extract from the Circular Letter of the Local Government Board, dated 5th December, 1912:— "The Board wish to emphasize the fact that it is the duty of the Medical Officer of Health for the Sanitary District, upon the receipt of a notification under the Tuberculosis Regulations, either himself, or through an officer acting under his instructions, to make such enquiries and take such steps as may appear to him necessary or desirable for preventing the spread of infection and for removing conditions favourable to infection. These enquiries will necessarily include investigations into sources of infection, search for contacts and enquiry into housing conditions." 117 Where a systematic medical examination of persons who have been in contact with those suffering from Tuberculosis, has been made, and so become, as it were, "suspects," it has been shown that at least 10 per cent. of such persons are also suffering from the disease, in most cases in the early stages. The above enquiries, therefore, form a most important part of the preventive side of the Borough Council's Dispensary Scheme for dealing with Tuberculosis. Only by thoroughly pursuing this line of investigation, in conjunction with the treatment of Tuberculous cases, will a more rapid decline in the death rate from this disease be realised. In order to make these investigations and enquiries it will be necessary to supplement the present staff by the addition of at least two nurses, who have had special instruction and training in the nursing of Tuberculous patients. These will act under the direct instruction of the Medical Officer of Health in this work of searching for "contacts" and the adoption of measures for preventing the spread of Tuberculosis, especially amongst members of the same family. I have fixed the number at two, one working in that portion of the Borough served by the Metropolitan Hospital Dispensary, and the other in that served by the Victoria Park Hospital Dispensary. It is not necessary here to give in detail the duties of the nurses appointed, but in general they will be required, acting under the instructions of the Medical Officer of Health, to investigate sources of infection, search for " contacts," or "suspects," and enquire into the housing accommodation, &c., of the Tuberculous cases. These reports will be considered by the Medical Officer of Health in detail, and the lines of action determined thereon. In certain individual cases it may be necessary for the Medical Officer of Health personally to make the investigation. Another duty of these nurses will be to assist in the work of "after-care," by keeping under observation cases returning home after Sanatorium treatment. 118 Therefore, for the preventive section of the Borough's Dispensary Scheme, I recommend that two nurses be appointed who have had not only the usual training of a nurse in a general hospital, but have also had at least three months' experience in the wards of a Hospital for Diseases of the Lungs. The salary of such officers might begin at £80 per annum, rising to a maximum of £100 by annual increments of £5. 3.—After-Care. That after-care forms an important factor in the treatment of Tuberculosis may be gathered from the following extract from the Report of the London County Council on the "Treatment of Tuberculosis Scheme for London:"— "Upon discharge of an adult patient from a Hospital or Sanatorium due notice shall be given by the Medical Officer of Health of the County to the Medical Officer of Health of the Borough, in such patient resides, with a view to securing, through the staff of the Dispensary, or otherwise, the after-care of such person. Notice should also be given by the local Medical Officer of Health to the institution or practitioner under whose care the patient was before he received residential treatment." The object of this after-care is, as far as possible, to ensure that the patient shall not, after residential treatment, relapse owing to unsuitable work or surroundings or insufficient nourishment. This is to be accomplished by bringing to the assistance of the returning patient advice as to home conditions, advice and help in obtaining suitable employment and providing sufficient nourishment, if such is needed. The maintenance of the improved health obtained by treatment and residence in a Sanatorium, may largely depend on the assistance to be derived from the after-care, and every effort should be made to render this part of the local scheme as complete as possible. 119 The arrangements existing for after-care in connection with Dispensary Schemes already working in London differ very much, some being more comprehensive than others. It appears that the more complete measures for dealing with the after-care of Tuberculous patients include the appointment of a Committee consisting of representatives of the Borough Council, the Tuberculosis Officer, the Medical Officer of Health, the Board of Guardians and local charitable institutions in touch with the local Labour Bureau. The function of such a Committee is to arrange for the after-care of cases of Tuberculosis returning from residential institutions. At this stage it is not possible to do more than state in general terms the object of after-care and the machinery necessary to provide it. Finance. The following extract from the Circular Letter of the Local Government Board, dated 19th December, 1913, indicates how the cost of the Dispensary is to be met:— "The expenditure of the Borough Council on their Dispensary Scheme, after deducting the payment made by the Insurance Committee in respect of the treatment of insured persons, and any other contributions, will be met as follows:— (a) 50 per cent. from the Board ; (b) 25 „ from the London County Council; (c) 25 „ out of the Rates of the Borough." "The Board may observe that the promise of the grant of 50 per cent. of the net cost of schemes is subject to the expenditure being kept within reasonable limits." Huts, Shelters, &c. I am informed the cost of providing these necessary adjuncts in the Dispensary treatment of Tuberculosis may be included in the general costs of maintenance, 50 per cent. of which will be defrayed by the Local Government Board, as indicated above. 120 Contribution from the Insurance Committee. The Insurance Committee are prepared to enter into an agreement with the Borough Council for the treatment of Tuberculous persons in Dispensaries, who are recommended by the Committee for Sanatorium benefit, and, in consideration thereof, to contribute a sum towards the cost of maintenance of the Dispensary, subject to certain conditions, according to the proportion of attendances made by insured patients to the total number of attendances made at the Dispensary, together with an agreed sum in respect of other services rendered to the Committee, not specifically referred to in their Memorandum of 23rd April, 1914. Capital Grant. For making alterations and providing necessary equipment in connection with the Metropolitan Hospital Dispensary it will be necessary to make formal application to the Local Government Board for a capital grant, in accordance with the Board's Circular Letter of the 7th November, 1913, Section 9, as follows:— "In cases where it is proposed that a voluntary institution should be utilised as part of a scheme, and that a capital grant should be made by the Board towards the cost of extensions or improvements at the institution, it is necessary that some security should be obtained for the continued maintenance of the institution in a manner approved by the Board, or that provision should be made for repayment of the grant, or of some portion of the grant, in the event of the authorities of the institution failing to maintain it to the satisfaction of the Board. "In these cases it is desirable that an agreement should be made between the authorities of the institution and the Council proposing to utilise it as part of their scheme, providing for the contingent reversion of the institution to the Council, or, in 121 the alternative, for the repayment of the grant, or a proportionate part of the grant, to the Board. A scheme or order of the Charity Commissioners will usually be found necessary in order to validate the agreement." I have endeavoured in the above to give the fullest available information respecting the Hackney Borough Tuberculosis Dispensary Scheme. Many details will, no doubt, require attention during the initiation of the scheme in order to ensure its smooth working and to achieve the best results, but these need not cause any difficulty or anxiety. In conclusion, I believe the scheme will be found to be well suited to the requirements of the Borough, and will bring about, in an economical way, the best results to be obtained from a Tuberculosis Dispensary Scheme. I remain, Yours obediently, J. KING WARRY, M.D., D.P.H., &c., Medical Officer of Health. Tuberculosis Dispensaries. Approximate estimate of the cost of maintenance of the Tuberculosis Dispensaries established in connection with the Victoria Park Hospital and the Metropolitan Hospital for the year from 1st April, 1914, to 31st March, 1915 (page 122). Estimated Cases of Tuberculosis. Number of Cases. Number of visits per case per Annum. Total Number of Visits for the Year. Rate per Visit to Dispensary. Total Cost. Remarks. Estimated number of cases of Pulmonary Tuberculosis notified during the year 1914-15 700 20 14,000 s. d. £ 2 0 1,400 About 50 per cent. of these are insured persons. Estimated number of cases of Pulmonary Tuberculosis requiring treatment from previous years 200 20 4,000 2 0 400 Estimated number of cases of NonPulmonary Tuberculosis notified during the year 1914-15 300 5 1,500 2 0 150 About 25 per cent. of these are insured persons. Estimated number of cases of NonPulmonary Tuberculosis still requiring treatment from previous years 50 5 250 2 0 25 Two trained nurses commencing at a salary of £80 each per annum - - - - - 160 Six shelters — — - - - 65 Sundry additional expenses — — — - - 100 Totals 1,250 — 19,750 - - £2,300 122 123 Estimate of Contributions from Central Authorities towards the Expenditure of the Borough Council on their Dispensary Scheme. This estimate is based upon the following statement made by the Local Government Board in their circular letter of the 19th December, 1913, page 4, viz.:— The expenditure of the Borough Council on their Dispensary scheme after deducting the payment made by the Insurance Committee in respect of the treatment of insured persons, and any other contributions, will be met as follows:— (a) 50 per cent. from the Local Government Board. (b) 25 per cent. from the London County Council. (c) 25 per cent. out of rates of the Borough. Estimated expenditure £2,300 Contribution from Insurance Committee (about one-fifth of total) £460 Contribution from Local Government Board to remainder of expenditure 920 Contribution from the London County Council 460 Contribution from local rates 460 Capital Cost.—No capital charges will arise in connection with the Victoria Park Hospital Dispensary, but the Capital Cost in connection with the Metropolitan Hospital Dispensary for alterations and equipment will probably amount to about £400, of which four-fifths will probably be contributed by the Local Government Board. J. KING WARRY, M.D., D.P.H., &c„ Medical Officer of Health. September, 1914. 124 REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE CLEANSING OF CHILDREN ATTENDING THE ELEMENTARY SCHOOLS IN THE BOROUGH OF HACKNEY. Public Health Department. Town Hall, Hackney, N.E. To the Chairman and Members 21s/ October, 1914. of the Public Health Committee. Gentlemen, In September, 1911, the Hackney Borough Council began, under an agreement with the London County Council, the systematic cleansing of verminous children attending the Public Elementary Schools of the Borough, the chief form of vermin being head and body lice. The cleansing has continued up to the present time. In conjunction with this body cleansing, the staff of the Public Health Department have been engaged in the cleansing of rooms, clothing and bedding in connection with these children. I propose here to make a report as to the amount of cleansing which has been done by the Borough Council during the two and half years ending 31st March, 1914, the general results obtained, and to make a few observations on the continued prevalence of this form of uncleanliness. During the period in question 1,965 children have been cleansed at the Borough Cleansing Station, a large proportion of these being cleansed only once; but many others twice, thrice and oftener. The following shows the number of children and how many times they were cleansed during the two and half years ending 31st March, 1914:- Number of Childred. 1,128 252 265 98 04 47 33 18 23 14 Number of Baths given to each Child. 1 2 3 4 5 6 7 8 9 10 Number of Children. 8 7 1 1 1 1 1 1 2 1,965 Number of Baths given to each Child. 11 12 14 15 16 18 28 29 32 4,499 125 From a consideration of the above, it is very evident that a great deal of re-infection is taking place. Out of a total of 1,965 children, there were 1,128 who received one cleansing only during the period in question, these being equal to over 57 per cent. of the total, those receiving two cleansings equalled over 12 per cent., and those receiving three cleansings over 13 per cent., the remainder receiving four or more cleansings. The question naturally arises, what are the causes bringing about this re-infection An attempt to answer this question is the chief object of this report. Re-infection may be brought about in three ways:- 1. By some verminous article of clothing or bedding escaping disinfection. 2. By some other member of the family above or below school ages being verminous. 3. By the purchase of second-hand articles of clothing which are verminous. 1. Re-infection by some verminous article of clothing or bedding escaping disinfection is, of course, possible, but I do not think this cause is sufficient to account for the large amount of re-infection taking place. 2. Re-infection by members of the family other than those at school ages may also occur, and there are some who think this is the chief cause of re-infections. Where one member of a family is verminous it is quite likely that others are infected also; but while this may be a cause in some cases, I do not think it will account for the whole of the re-infection taking place; for it must be remembered that parents are giving more attention to the cleanliness cf their children and homes (this is unquestionable), but the total amount of this form of uncleanliness is not diminishing in proportion to the preventive measures taken. 126 3. Re-infection by the introduction into the family of verminous second-hand wearing apparel has, I believe, much evidence in its favour. My attention was drawn to the possibility of this owing to the fact that during enquiries made by the inspectors as to the cleanliness of rooms, bedding, &c., in connection with these vermin ous cases, more than one parent volunteered the statement that they attributed the unclean condition of their children to the wearing of certain second-hand articles of clothing which they discovered soon after purchase to be verminous. In view of the obvious fact that re-infection was taking place on a large scale and of the statements of the parents, I decided to investigate the possibility of second-hand clothing being the cause or a cause of re-infection. I give below the result of this investigation. For this purpose I adopted three lines of enquiry, i.e., I endeavoured to ascertain :— 1. The proportion of verminous children wearing second-hand clothing. 2. The proportion of non-verminous children wearing second-hand clothing. 3. By actual examination whether second-hand clothing is verminous. 1. I endeavoured to find out in the first place, the number and proportion of those children sent to the cleansing station for baths, whose parents were in the habit of purchasing second-hand clothing for their children. This I was able to find out by instiucting each inspector to make the enquiry of the parent. To my astonishment, I found that the result of the first enquiries revealed a large proportion of purchasers of such clothing amongst the parents of verminous children. In order to get a reliable average, I continued the eriquiries five months, viz. from the beginning of January to the end of May, 1914. During this period, I received notices from the London County Council to inspect premises occupied by 280 families, amongst whom were one or more children infected with 127 lice or their " nits." The result of my enquiries amongst these families shows that the parents of 129 of the 280 families purchased some of their children's clothing from second-hand dealers. This gives a proportion of 46 per cent, of the total, i.e.—46 per cent, of the children found to be verminous are clothed with one or more garments obtained from these dealers. While I regarded the result of these enquiries as extremely suggestive of a casual connection between second-hand clothing and the verminous condition of school children, I did not consider this evidence alone sufficient to prove the connection. In order to test the above, I found it necessary to pursue the second line of enquiry, viz.:— 2. To ascertain if possible the proportion of non-verminous families in the same social circle as the above, whose parents purchased second-hand clothing for their children. This I was able to do in certain cases of diphtheria and scarlet fever notified. These groups were selected for convenience, and also for the purpose of diverting attention from the real object of the enquiry. I must remark here that the children so affected with diphtheria and scarlet fever were all elementary school children and attended the same schools as the verminous children, but were not verminous children, They represented a population of children drawn from the same social class as the verminous children, and differing alone from them in the circumstances of freedom from vermin and almost complete absence of wearing second-hand garments. The enquiries covered the period from 1st April to 22nd June. Of the families in which cases of scarlet fever had occurred there were 88, but of these the parents of three only purchased second-hand clothing. This gives a rate of 3 4 per cent, of the total. Of the families in which cases of diphtheria occurred, the total of which was 91, there was only one family purchasing such clothing. This gives a rate of 1.1 per cent, of the total. If these two classes of families are added together we get a total of 179 families, four of which clothe their children 128 with second-hand garments yielding a proportion of 2 2 per cent. These facts will be clearer if set out in tabular form, as under:— Number of Families of Verminous Children. Number of Families of NonVerminous Children amongst whom Cases occurred of— Remarks. Scarlet Fever. Diphtheria. Total. Number of Cases investigated. 280 88 91 179 — Number of Families where Parents bought secondhand clothing for their Children. 129 3 1 4 - Percentage of Families wearing second - hand clothing. 48% 3.4% 1.1% 2 2% - It may be assumed (a) That where second-hand clothes, which are occasionally infected with lice or their nits are customarily worn, repeated infection will occur after cleansing, (b) That if second-hand clothes are a source of vermin infection, repeated infection would be more frequent amongst the children customarily wearing them, than amongst families wearing only new or first-hand clothes. Let us see if there is any evidence in this way implicating second-hand clothes. In the following table, I give an analysis of the total number of visits made by the inspectors to the homes of infected children during the five months—January to May inclusive—upon the request of the Medical Officer (Education) of the'London County Council, more than one visit indicating a re-infection:— Number of Homes receiving One Visit from the Inspector. Number of Homes receiving Two Visits from the Inspector. Number of Houses receiving Three Visits from the Inspector. Number of Homes receiving Four Visits fro m the Inspector. Percentage of Re-infections. Non - purchasers of second-hand clothes 138 12 1 — 9.2% Purchasers of secondhand clothes. 103 18 7 1 2.71% 129 We see from the table that re-infections are not only more common amongst the second-hand clothed families ; but there is a preponderating percentage amongst these over families not so clothed, and this is only what may be anticipated. We see that re-infections occur in the former to the extent of 27'1 per cent., and in the latter to the extent of 9 2 per cent, of the total, i.e., of the total number of re-infections 71 per cent, occur amongst the wearers of second-hand clothes. These figures point to more than coincidences and are, in my opinion, additional proofs of infection brought about by second-hand clothes. Supplementary Evidence derived from Information voluntarily given by Mothers or Persons in Charge of Verminous Children. In quite a large number of instances the District Inspectors on visiting homes of verminous children, and making enquiries as to the source of infection, were voluntarily informed, either by the mother or some person in charge of the children, that they had discovered certain articles of wearing apparel, which they had purchased second-hand and had been worn by the affected child, were verminous. Sometimes this discovery was made soon after purchase, but at other times not till a later date. The further information had been volunteered that, on discovery of the verminous clothing, it had either been destroyed or boiled. The number of instances in which the above information had been volunteered are not few. No note was made at the time of these facts, so that the exact number cannot be given ; but the Inspectors who made the enquiries estimate that the number reached roughly from 8 to 10 per cent, of the total families. If this is so, and I have no reason to think the estimate is exaggerated there appears to be a widespread belief amongst mothers that the source of the infection of their homes and children with lice is to be found largely in clothing purchased while in an infected condition. I 130 Evidence derived from the Purchase and Examination of Second-hand Clothing. 3. I have not been able to pursue this line of enquiry so far and so thoroughly as I should have desired. I should have liked to obtain not only evidence of the fact that second-hand clothes, when exposed for sale, were actually verminous, but also to obtain a fair idea of the proportion of such verminous articles amongst second-hand clothing. This latter I have not been able to ascertain, as it would take a considerable time and involve a great expense, and, really at this stage it is not necessary. I have, however, had several parcels of second-hand clothing purchased from the following vendors:— (1) Second-hand clothing shops ; (2) Costers' stalls ; (3) Ragshops. One parcel of clothes bought contained 13 articles. Out of this number only ona article was found to be infected with " nits " of lice. In a second lot of clothing consisting of 10 articles, obtained from second-hand dealers, I found two articles infested with " nits," but no fully developed lice. These samples alone show conclusively and supports the other evidence advanced, that second, hand clothes are responsible for maintaining to a certain extent the verminous condition of the children attending Elementary Schools in the Borough. I may here add that when examining these second-hand garments I noticed that a large proportion of them were in a very dirty and filthy condition. Sources of Second-hand Clothing. There are many places in the Borough where second-hand garments are sold. They vary very much as to the quality of the articles, i.e.—as to their cleanliness. The following is a list of these places:— 131 1. Coster Stalls.— In all the chief markets in the Borough, stalls loaded with second-hand clothes are to be seen. In most cases the articles are put up to auction ; in other instances they are sold separately. 2. Pawnbrokers.—A large quantity of unclaimed clothes is occasionally disposed of by these tradespeople. There is of course no guarantee that these are either clean or free from vermin. 3. Second-hand Dealers.—By these I mean shops dealing especially in second-hand clothes, and other things. 4. Rag shops.—Many garments find their way to these shops, especially from the dustmen, who are asked to remove them by householders in the Borough, on making their usual call for house refuse. The ragshop dealer usually separates the more promising from his heap of rags and offers them for sale. 5. Re-make Shops.—There is a large business carried on in the Borough, and on a larger scale in the East End Boroughs, in the re-making of old clothes. Old clothes of adults are cut down and make up again for children. This is particularly the case with boys' knickerbockers. These articles are then distributed to various dealers. It is obvious that the above-named places are found almost entirely in the poorer parts of the Borough, and are the chief places to which many of the poorer parts of the Borough, especially those having large families, resort for the purchase of their children's clothing. I am informed that the clothes displayed and sold by the costers and some other vendors, are mostly obtained from the large market in Stepney. This draws its supplies from all parts of the country, and even from the Continent. Enquiries have failed to discover that these clothes are subjected to any sterilising or purifying process. 132 REMEDIES. 1. To reduce the number of re-infections due to certain articles of clothing or bedding escaping disinfection, it is only necessary to be more thorough in the home investigations and the examinations of clothing and bedding. This increased efficiency is being brought about. 2. More difficulty seems to attach to finding a remedy for re-infection due to members of the family, other than those at school age. The individuals may be either under school age or above school age. With regard to the former, I am of opinion that when re-infection occurs in any family these younger children should be examined by the school nurse. If there is any suspicion of an adult being infected, a medical cerficate should be required that the adults are free from infection. (This latter should of course, not be required except where there is repeated infection and other sources have been negatived.) 3.—How to prevent the sale of secondhand verminous clothing is a much more difficult problem to solve, yet it is quite clear that if all secondhand clothes were submitted to disinfection the problem would be solved. One of the greatest difficulties in dealing thoroughly with matters of this sort is to avoid, what is regarded by many as an almost unforgivable crime, the interference with what is called a recognised legitimate business. But the sale of verminous clothing should be taken out of the above category. I think the time has come when some check should be placed on the indiscriminate sale of filthy clothing. Some guarantee should be enforced that the articles when sold are clean and free from vermin. The best way to bring this about is not just apparent, but some form of sterilising seems to be indicated. This question of the sale of unclean clothes is surely not beyond the range of Public Health preventive measures. 133 To suggest a remedy, if the evil were only a local one, would be easier; but there is every reason to believe that it is almost universal in all the crowded centres of London. Recommendations. I recommend that the Local Government Board and the London County Council's attention be drawn to the facts set out in the above report, and that the latter be asked to initiate legislation with a view to preventing the sale of verminous and filthy secondhand clothing. I remain, Yours obediently, J. KING-WARRY, M.D., D.P.H., Medical Officer of Health. 134 REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE CIRCUMSTANCES ATTENDING THE OCCURRENCE OF A CASE OF HUMAN ANTHRAX IN THE BOROUGH. Pubi.ic Health Department, Town Hall, Hackney, N.E. To the Chairman and Members of the Public Health Committee. Gentlemen, In accordance with your instructions, I beg herewith to report in detail the circumstance in which George Braybrooke, of 6, Maclaren Street, in this Borough, contracted Anthrax and as to the measures taken to prevent the spread of this disease. History of Case.—The patient, George Braybrooke, is 15 years old and lives at home at 6, Maclaren Street, in this Borough, with his parents and six brothers and sisters, the whole family occupying a flat of four rooms with scullery. He informs me that he was in the employ of the Curled Hair Manufacturing Co., Clarence Road, at the time he fell ill, and had been in the same employment for nine weeks prior to the onset of his illness. Towards the end of May last he noticed what appeared to be a small sore on his right cheek. He consulted a local practitioner, who regarded the lesion as a malignant pustule and sent him to the London Hospital, where he was detained and treated. The Surgical Registrar of this Hospital has very kindly furnished me with the following note of the case:— "George Braybrooke was admitted to the London Hospital 3rd June, 1914. On his right cheek was a lesion having the characteristic appearance of a malignant pustule. 135 He had swelling of the cervical glands. Patient was treated with Sclavo's serum and deemitized ipecac. He was discharged cured 14th June, 1914. Bacteriologist failed to find Anthrax Bacilli in exudate from Pustule." Business of the Curled Hair Manufacturing Co.—This firm treats hair of different kinds, viz., pig hair, cattle hair, and, occasionally horse hair, so as to make it suitable for upholstery work. The process carried on is briefly as follows :—The hair arrives on the premises in sacks, usually in a very dirty condition. It is removed from the sacks and washed in a strong solution (5 per cent.) of Cyllin, then transferred to a tank of water, to which a dye with other ingredients and Cyllin are added, and boiled for several hours. After this, copperas is added to the water and the boiling continued for another hour. The tanks containing the hair are then left standing for seven hours, and the liquid run off. The dyed hair is then removed from the tank, taken to a wash-house and laid out to dry. When dry, it has a resemblance to black horse hair. This hair is made up into ropes by means of a spinning machine, then made wet by immersion in cold water, and finally baked in an oven. The baking gives a permanent curl or crimp to the hair, and makes it suitable for stuffing furniture. This is the process which took place on the premises when the business was first established in the Borough ; but owing to complaints of nuisance arising from the initial processes of cleaning and dyeing, these have ceased to be carried on there. I am assured by the proprietor of the business that since August, 1913, curling only has been done on the premises, the hair arriving already cleansed and dyed. Source of Infection.—As in many cases human anthrax arises in connection with some industrial process in which animal hair of different kinds is manipulated, suspicion naturally points to the business in which the patient had been employed as being probably the source of infection. 136 George Braybrooke informs me that his work while in the employment of the Curled Hair Manufacturing Co. was confined to— 1. Washing cowtails, called in the trade " cow docks " ; and 2. Spinning the dyed hair into ropes. In view of this statement that he was engaged part of his time in washing *' cow docks," it is clear that the business cannot have been confined altogether to the curling process. If this patient's malady were malignant pustule, and the source of infection was connected with his work, then probably the " cow docks " were the offending agent, and as the washing medium was a 5 per cent, solution of Cyllin. which is competent to destroy anthrax bacilli in a few minutes, the infection must have taken place during the transference of the " cow docks " from the sacks into the washing tanks. The subsequent treatment of the hair is such as to completely destroy any anthrax bacilli or their spores which may have survived the cleansing process. Measures taken for Checking the Spread of the Disease.—At the time the case was notified, all material which had been handled by George Braybrooke at his work had been curled and removed from the premises, and could not be traced. Under these circumstances, it was not necessary to subject the premises to any disinfecting process. The clothing and bedding of George Braybrooke was disinfected by high pressure steam and his room was disinfected in the usual way. The Curled Hair Manufacturing Co. have at the time of writing this report removed their business entirely from the Borough. I am, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., D.P.H., &c., Medical Officer oj Health. 8th October, 1914. 137 Public Health Department, Town Hall, Hackney, N.E. Wi November, 1914. To the Chairman and Members of the Public Health Committee. Gentlemen, In accordance with your instructions, I submit herewith a report for the month of October on the following matters :— (a) The nutrition of children under school age and how far it is affected by conditions arising out of the War ; (b) Unemployment or distress amongst homeworkers, especially in the cabinet-making and clothing trades. I should like to refer, in the first place, to the following statement, contained in the letter received from the Secretary of the Intelligence Department of the Local Government Board, at whose request this report is made, viz., " It is not desired that he (the Medical Officer of Health) or any of his officers should undertake special research in the matter, but simply that he should make a short report on what is ascertained in the ordinary course of duty." I wish only, in connection with this statement, to say that if I had not gone beyond what is ordinarily ascertained by the officers of the Public Health Department in the course of their duty, in obtaining information as to the extent children under school age were suffering in their nutrition, owing to conditions brought about by the War, or the amount of unemployment or distress amongst home-workers, the information would have been valueless. K 138 It is obvious that information having the slightest value from a statistical point of view could only be ascertained by making special research ; and, as a matter of fact, special enquiry has been made to obtain the information forming the subject of this report. With respect to (a), the Health Visitor of the Borough Council has made enquiries, during the past month, respecting the nutrition of the children under school age of every nursing mother visited by her. The results are summarised in the following table The Nutrition of Children under School Age. Period during which enquiries were made. No. of Families whom enquiries were made. No. of Families the Nutrition of whose Children is suffering from the Wai. No. of Children under school age so suffering. From 1st to 31st October. 222 19 41 It will be seen from the above that rather over 8.5 per cent, of the children of the families visited are suffering in their nutrition from conditions arising out of the War. In all these cases the nutrition of the children is affected owing to the parents being thrown out of employment, either partially or wholly; this being due to the War. These figures are quite distinct from and in addition to, the distress due to the normal shortage of work at this time of the year. This latter appears from enquiries to be as acute as it was at the corresponding period in 1913. (b) This I have divided into two parts:— 1.—Enquiries of employers were made by the Inspector appointed to inspect workshops where women are employed. The result of these enquiries are set out in the following table:— 139 Information from Employers of Homeworkers Clothing Trades. No. of Employers of Homeworkers visited. No. of Employers who have reduced Homeworkers since Midsummer. No.ot Homeworkers how employed. No. of Homeworkers employed at end of 1st Quarter of 1914. Artificial Flowers 1 - 16 - Blouses 4 2 28 35 Boots and Shoes 21 11 76 145 Children's Costumes 1 1 — 3 Furs 4 3 33 46 Mantles and Costumes 21 10 24 79 Millinery 3 1 — 4 Nursery Shoes 10 5 45 71 Shoe Bows 2 1 — 15 Skirts 2 — 9 9 Tailoring 11 5 7 31 Trimming 2 1 13 20 Ties 4 3 8 33 Underclothing 3 1 4 7 Cabinet-making 1 1 1 4 Totals 90 45 264 502 From this table it appears that the home-workers of the employers questioned have diminished from 502 to 264, or over 47 per cent, on the number employed during the first quarter of the year. 2.—Enquiries were also made of home-workers themselves by the Inspector appointed for the inspection of home-workers' premises. The result of these enquiries are also summarised in the following table:— 140 Information from Home-workers. Clothing Trades. No. of Homeworkers visited. No. of Homeworkers out of work chiefly owing to the War. No. of Homeworkers whose Work or Income has been reduced chiefly owing to the War. Remarks. Artificial Flowers 3 3 - Belts 9 9 - Blouses 9 8 1 half time Boots and Shoes 88 32 28 Fur Linings 3 3 - Mantles 6 — 2 half time Millinery 10 10 — Skirts 3 1 — Tailoring 9 9 — Ties 24 1 4 half time Trimmings 3 1 1 Underclothing 8 8 — Totals 175 85 36 half time It will be observed from the above that the number of homeworkers thrown out of employment is 85 out of 175, or over 48 per cent. This figure coincides very closely with that obtained from enquiries made amongst employers of home-workers. In addition to those actually thrown out of employment entirely, there is a considerable percentage of home-workers working only part time. I remain, Yours obediently, J. KING-WARRY, M.D., D.P.H., Medical Officer of Health. 141 ANNUAL REPORT OF CANAL BOATS INSPECTOR, 1914. To the Council of the Metropolitan Borough 0/ 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 26 „ boats inspected 21 „ ,, conforming to Acts 20 „ „ infringing Acts 1 (certificate not produced) „ certificates examined 20 Number of persons for which boats were registered— Adults 72 Children 4 Number of persons living on boats so registered— Men 36 Women 2 Children 4 The boats inspected were found to be in good condition. No legal proceedings were taken. I have the honour to be, Gentlemen, Your obedient Servant, EDWIN S. CROOK, (Temporary) Sanitary Inspector and Inspector under the Canal Boats Acts. L