Medical Officer of Health. HAL 71 Borough of Backney REPORT ON THE SANITARY CONDITION OF THE HACKNEY DISTRICT, FOR THE YEAR 1917, BY J. KING WARRY, M.D. LOND., M.R.G.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. Chief Executive Tuberculosis Officer and Medical Officer of Health for the Borough. London: Chas. Straker & Sons, Ltd., 5-9, Bishopsgate Avenue, E.C.3. 1918. INDEX. PAQE Alcoholism 18 Anthrax 16 Birth Kate 6 By-laws—Houses let in Lodgings 20 Cancer 18 Cerebro-Spinal Meningitis 16 Cleansing of Persons Act, 1897 28 Combined Drainage and Sewers 27 Cowhouses, Dairies, and Milkshops 19 Customs and Inland Revenue Act 20 Death Rate 7 Deaths in Public Institutions 9 Diarrhoea 17 Diphtheria 14 Disinfection 28 Enteric Fever 15 Erysipelas 16 Estimated Population 6 Factories 24 Factory and Workshops Act, 1901 24 Glanders and Farcy Order 21 Glanders, Anthrax and Hydrophobia in Man 16 Home Work and Home-Workers 26 Housing and Town Planning Act, 1909 21 Ice Cream Vendors 20 Illegitimacy 7 Infant Mortality 8 Infant Welfare Work 33 Influenza 17 Marriage Rate 6 Measles 16 Mortuary 29 Notification of Births Act 7 Notifiable Diseases 14 A 2 INDEX. PAGE Non-Notifiable Diseases 16 Offensive Trades 19 Ophthalmia Neonatorum 16 Plague 15 Polio-myelitis 16 Population 6 Prosecutions under Food and Drugs Acts 31 Prosecutions under Public Health (London) Act 32 Public Health (London) Act, 1891 18 Public Health (Tuberculosis) Regulations, 1912 21 Puerperal Fever 15 Removal of House Refuse 29 Senile Mortality 9 Scarlet Fever 14 Shelter 28 Slaughter-Houses 19 Small-pox 11 Smoke Nuisances 20 Tuberculous Disease 17 Tuberculosis Dispensaries 23 Typhus 15 Verminous Children 28 Whooping Cough 17 Workshops . 25 Zymotic Diseases 14 Metropolitan Borough of backney. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1917. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, E. 8. August, 1918. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Gentlemen, I beg to present herewith my Twenty-sixth Annual Report on the Public Health of the Borough of Hackney. The general death-rate for the year 1917 was 14 5 per 1,000 of the population and the infant mortality rate 92 per 1,000 births. These figures show a slight increase in the general death-rate and in the infant death-rate, compared with the year 1916. There were 3,016 cases of acute infectious disease notified during the year, giving an attack rate of 15 per 1,000 living. The deaths from the seven chief zymotic diseases numbered 154, which is equivalent to a zymotic death-rate of .78 per 1,000 living. A slight increase in the mortality from tuberculosis took place during the year, the mortality rate being 1.8 per 1,000 living. This subject is dealt with in detail on page 17, and that of infant welfare work on page 33. Detailed reference to the preventive measures taken in connection with the prevention of the spread of tuberculosis is made on page 23. 6 I have pleasure in stating that the Officers of the Department have, on the whole, carried out the duties entrusted to them to my satisfaction. Population.—The Registrar-General has adopted the following estimates of population for the calculation of the death-rate and birth-rate of the Borough of Hackney for the year 1917, viz. :— For the death-rate 196,598 For the birth-rate 219,151 The former is an estimate of the civil population ; the latter of the total population based on the assumption that the ratio between the total and the civil population is the same in the borough as in England and Wales as a whole. Marriages and Marriage Rate.—During 1917 there were 1,962 marriages solemnized in the Borough of Hackney being a decrease of 244 on the previous year. The annual rate for persons married during this period is therefore 18 per 1,000 of the population. Births and Birth-rate.—The births registered in Hackney during the year 1917 numbered 4,207, of which 2,115 were male and 2,092 females. This total is the actual number of births registered in Hackney and requires correction for transferable births. After making these necessary corrections the total of registered births amongst Hackney residents is 3,750. From this figure I calculate the birth-rate during 1917 to be 17-1 per 1,000 of the population. For this calculation I have used the RegistrarGeneral's estimated population of 219,151. Notification of Births Act, 1907.—Under the provisions of this Act, I received 4,235 notifications of births occurring in the Borough during 1917. This total includes notifications from medical practitioners, midwives, and other persons. It also includes still births. 7 Still Births.—Amongst the births notified were 132 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. NOTIFICATION OF BIRTHS ACT, 1907. Notifications of Births (Live or Still-born) received, during the year 1917. Year 1917. Medical Practitioners. Midwives. Parents and Others. * Total. Live. Still. Live. Still. Live. Still. Live. Still. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Totals. 478 492 23 25 1,294 1,205 40 30 316 318 10 4 2,088 2,015 73 59 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1917 was 570; but of these, I am informed by the Registrar-General, 432 should be transferred to districts outside Hackney, as the mothers were not Hackney residents, and 26 births, taking place in other districts should be transferred to Hackney. Making these corrections, there remain 164 illegitimate births amongst Hackney residents. This is an increase of 7 on the number during 1916. The illegitimate birth-rate for Hackney during 1917 is 43.7 per 1,000births, that for 1916 was 31.2 per 1,000 births. Deaths.—After making the necessary corrections for residents dying in outlying institutions and non-residents dying in institutions in the Borough, I find the corrected number of deaths amongst Hackney residents during 1917 was 2,853. This is a decrease of 28 upon the number occurring during 1916. The general death-rate from all causes for the.year .1917 is therefore 14.5 per 1,000 of the population. For the calculation of this rate I have used the Registrar-General's estimated population of 8 196,598. On further correcting this for age and sex distribution, I obtain the corrected general death-rate of 14-6 per 1,000 of the population. Infant Mortality.—The deaths under one year of age in the Borough during 1917, numbered 345. This is a decrease of 78 upon the number of infant deaths recorded during 1916. The infant mortality for the year is 92 per 1,000 births. INFANT MORTALITY. 1917. 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. 3 months and under months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 3 3 Scarlet Fever ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... 2 4 6 Diphtheria and Croup ... ... ... ... ... 1 ... 1 ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 3 4 Abdominal Tuberculosis ... ... ... ... ... ... 2 1 ... 3 Other Tuberculous Diseases ... ... ... ... ... ... 1 ... 1 2 Meningitis (not Tuberculous) ... ... ... ... ... ... ... 3 4 7 Convulsions 4 1 1 1 7 1 1 2 5 16 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 1 ... 2 7 8 6 2 25 Pneumonia (all forms) ... 1 1 ... 2 3 8 7 12 32 Diarrhoea ... ... ... ... ... 7 14 10 4 35 Enteritis 1 2 ... 1 4 4 9 7 3 27 Gastritis ... ... ... ... ... 1 ... ... 1 2 Syphilis ... 1 ... ... 1 ... 1 ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 2 ... 1 1 4 2 3 ... ... 9 Injury at Birth 2 1 ... ... 3 ... ... ... ... 3 Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformations 1 2 ... ... 3 6 2 ... ... 11 Premature Birth 34 8 5 1 48 ... 1 1 ... 50 Atrophy, Debility and Marasmus 12 3 6 6 27 21 20 10 3 81 Other Causes 4 ... 3 ... 7 7 2 9 1 19 Total 65 20 18 10 113 60 72 53 47 345 9 Senile Mortality.—The deaths which occurred in Hackney at 65 years and upwards during 1917 numbered 1,002, of which 494 were between the ages of 65 and 75 years, 361 between 75 and 85 years, and 147 at 85 years and upwards. The annual mortality rate of persons at 65 years and upwards is 5.1 per 1,000. Deaths in Public Institutions.—There were 1,464 deaths in public institutions in the Borough during 1917 ; of these 688 were residents of other districts, and the remaining 776 were residents of Hackney. TABLE I.—HACKNEY DISTRICT. Vital Statistics of Whole District during 1917 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 1910 222,384 5,493 5,240 23.5 2,878 12.9 506 450 543 104 2,822 12.6 1911 222,674 5,410 5,243 23.5 3,546 15.9 779 443 633 120 3,210 14.4 1912 223,022 5,425 5,267 23.6 2,952 13.2 663 431 426 79 2,720 12.2 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 1915 217,883 5,091 4,827 22.1 3,402 15.6 723 552 520 107 3,231 14.8 1916 209,636 5,331 5,026 22.0 2,917 13.9 617 581 423 84 2,881 13.7 1917 196,598 4,207 3,750 17.1 2,929 14.9 661 585 345 92 2,853 14.6 10 TABLE II—HACKNEY DISTRICT. Cases of Infectious Disease Notified, during the Year 1917. Notifiable Disease. Cases Notified in whole Districts. Total Cases Notified in each Locality. Total cases removed to Hospital. At Ages—Years. 1 2 3 4 At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. North. j Central. [South-East. South-West. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 286 3 107 131 31 11 3 ... 43 71 101 71 273 Erysipelas 121 3 7 7 14 25 52 13 29 24 40 28 22 Scarlet Fever 292 2 71 190 17 11 1 ... 58 97 60 77 263 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 19 ... 2 4 8 4 1 ... 6 5 7 1 17 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 1 ... ... ... ... 1 ... ... ... 1 ... ... ... Puerperal Fever 9 ... ... ... 1 6 2 ... 3 2 2 2 6 Cerebro-Spinal Meningitis 17 3 7 3 1 3 ... ... 3 5 7 2 14 Polio Myelitis 1 1 ... ... ... ... ... ... 1 ... ... ... ... Ophthalmia Neonatorum 27 27 ... ... ... ... ... ... 2 5 8 12 1 Pulmonary Tuberculosis 709 ... 6 54 164 379 98 8 142 148 197 222 316 Other forms of Tuberculosis 161 4 23 85 20 17 10 2 22 39 64 36 70 Measles 1,637 85 667 780 74 31 ... ... 471 234 476 456 103 German Measles 606 17 108 316 109 50 5 1 287 48 95 176 ... Totals 3,886 145 998 1,570 439 538 172 24 1,06 7 679 1,057 1,083 1,085 11 TABLE III.—HACKNEY DISTRICT. Causes of, and Ages at, Death during the Year 1917. CAUSES OF DEATH. Deaths in whole Districts at Subjoined Ages. Deaths in Public Institutions. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 5 ... ... ... ... 3 1 1 ... 7 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 12 3 4 2 3 ... ... ... ... 61 Scarlet Fever 7 1 ... 4 2 ... ... ... ... 18 Whooping-cough 21 6 7 4 4 ... ... ... ... 8 Diphtheria and Croup 23 2 3 9 8 ... 1 ... ... 72 Influenza 28 1 ... ... 1 1 2 10 13 2 Erysipelas 5 ... ... ... ... ... ... 3 2 3 Phthisis (Pulmonary Tuberculosis) 304 ... ... 3 6 55 147 81 12 139 Tuberculous Meningitis 20 4 5 7 2 2 ... ... ... 9 Other Tuberculous Diseases 36 6 1 8 7 4 7 3 ... 14 Cancer, Malignant Disease 230 ... ... ... ... 3 16 120 91 130 Rheumatic Fever 2 ... ... ... ... ... 1 1 ... ... Meningitis 16 5 2 3 3 ... 1 2 ... 6 Organic Heart Disease 320 1 ... 1 3 16 41 106 152 120 Bronchitis 319 25 14 7 2 3 20 72 176 151 Pneumonia (all forms) 242 31 28 33 11 11 33 49 46 88 TABLE III.—HACKNEY DISTRICT—continued. Causes of, and Ages at, Death during the Year 1917. CAUSES OF DEATH. All Ages. Deaths in whole Districts at Subjoined Ages. 65 and upwards. Deaths in Public Institutions. 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. Other Diseases of Respiratory Organs 37 ... 1 ... 1 1 5 16 13 8 Diarrhoea and Enteritis 86 64 5 3 3 ... 1 6 4 52 Appendicitis and Typhlitis 8 1 ... 1 1 ... 4 ... 1 6 Cirrhosis of Liver 10 ... ... ... ... ... 2 5 3 2 Alcohol ism ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 78 ... ... 1 2 ... 19 33 23 54 Puerperal Fever 4 ... ... ... ... ... 4 ... ... 3 Other Accidents and Diseases of Pregnancy and Parturition. 7 ... ... ... ... 2 5 ... ... 5 Congenital Debility and Malformation, including Premature Birth 151 142 5 1 3 ... ... ... ... 77 Violent Deaths, excluding Suicide 85 2 2 8 14 4 11 19 25 84 Suicides 10 ... ... ... ... ... 3 7 ... 2 Other Defined Diseases 556 51 15 12 20 12 76 155 215 270 Diseases ill-defined or unknown 231 ... ... ... ... ... 2 3 226 155 Totals 2,853 345 92 107 96 117 402 692 1,002 1,546 Sub-Entries (included in above figures)— Cerebro-Spinal Meningitis 14 3 4 3 2 ... 2 ... ... 9 Poliomyelitis ... ... ... ... ... ... ... ... ... ... 13 14 SPECIFIC INFECTIOUS DISEASE. During 1917 there were 3,024 cases of acute infectious disease notified in the Borough ; of these 36 were subsequently found not to be suffering from infectious disease, thus reducing the number of genuine cases to 3,016. The attack rate in respect of the acute notifiable infectious diseases for the year is 15 per 1,000 living. The deaths from the chief zymotic diseases numbered 154. This is equivalent to a zymotic death rate of .78 per 1,000 living inthe Borough. A.—NOTIFIABLE INFECTIOUS DISEASE (ACUTE). Small-pox.—No case of this disease was notified in the Borough during 1917. Scarlet Fever or Scarlatina.—The number of cases of scarlet fever notified during 1917 was 305 but of these 13 were found afterwards not to be suffering from this disease, thus reducing the genuine cases to 292. This is a decrease of 105 upon the number of genuine cases notified during 1916. The attack rate for scarlet fever is 1.5 per 1,000 persons living. The number of cases removed to hospital was 263 which is over 95 per cent. of the total notified. The deaths from this disease numbered 7, which is equal to a mortality rate of 2'4 per cent. attacked and .03 per 1,000 living. Diphtheria and Membranous Croup.—There were 306 cases of diphtheria and membranous croup notified during the year, but of these 20 cases were found subsequently not to be suffering from diphtheritic disease, thus reducing the genuine cases to 286. This is a decrease of 65 upon the number of cases occurring during 1916. The attack rate is 1.4 per 1,000 living. There were 273 cases of diphtheria and membranous croup removed to hospital during 1917. This is equal to 97 per cent. of the cases notified. 15 The deaths from diphtheritic disease numbered 23. This is equal to a mortality rate of .12 per 1,000 living. During the year 290 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically examined, 43 of which gave positive results, 243 negative results, and 4 were doubtful. Diphtheria Anti-toxin Order.—In accordance with the above Order 10 bottles of anti-toxin of 2,000 units each were supplied to medical practitioners during the year 1917, all of which were used for prophylaxis. Typhoid Fever or Enteric Fever.—During the period under consideration, 19 cases of typhoid were notified, but of these one case was afterwards found not to be suffering from this disease. This is a decrease of 2 on the number of genuine cases notified during 1916. The attack rate is .09 per 1,000 living. Only 5 deaths were registered in the Borough from this disease during 1917. Of the 19 cases notified 17 were removed to hospital. During the year 17 specimens of blood from persons suspected to be suffering from enteric fever were submitted to Widal's test 4 of which gave a positive, 10 a negative, and 3 a doubtful reaction. Continued Fever.—One case of continued fever was notified during the year. Typhus Fever.—No case of this disease was notified during 1917. Puerperal Fever.—There were 9 cases of puerperal fever notified during 1917, of which 2 died. Plague.—No case of this disease occurred in the Borough last year. 16 Erysipelas.—There were 121 cases of erysipelas notified during 1917. This is equal to an attack rate of .61 per 1,000 living. The deaths numbered 5, which gives a mortality rate .03 per 1,000 living. Cerebro-Spinal Meningitis.—During 1917 there were 17 cases of this disease notified in the Borough 14 of which were removed to hospital. The deaths numbered 14 which is equivalent to a mortality of .07 per 1,000 living. Polio-myelitis or Polio-encephalitis.—There was one case of this disease notified during 1917. Ophthalmia Neonatorum.—The number of cases of this disease notified during the year was 27. Glanders, Anthrax and Hydrophobia in man.—No case of these diseases was notified during the year. THE PUBLIC HEALTH (MEASLES AND GERMAN MEASLES) REGULATIONS, 1915. Measles.—During the year 1637 cases of measles were notified by medical practitioners under the Regulations, and 469 other cases were brought to my notice by parents and others. Of the total, 103 were removed to hospital. The deaths from measles numbered 12 of which 9 were under 5 years of age. The annual mortality is equivalent to .06 per 1,000 living. German Measles.—During the same period 606 cases of this disease were notified. There was one death registered from this disease. B.—NON-NOTIFIABLE INFECTIOUS DISEASE. Chicken-pox.—No death was registered in the Borough during 1917. 17 Whooping-cough.—There were 21 deaths from this cause during 1917, of which 17 occurred in amongst children under 5 years of age. The annual mortality is .11 per 1,000 living. I received information of 343 cases of whooping-cough, from the head masters and mistresses of Elementary schools in the Borough, occurring amongst their scholars during the year. Influenza.—During 1917 there were 28 deaths in the Borough due to influenza. The annual mortality rate is .14 per 1,000. Diarrhoea.—The total number of deaths due to this cause was 86, of which 40 were registered as diarrhoea and 46 as enteritis or gastro-enteritis ; and of these 63 were under one year of age. The annual mortality rate for diarrhoeal disease is .43 per 1,000 living. CONSTITUTIONAL DISEASES. Tuberculosis.—During 1917, I received 1,043 notifications of tuberculosis, details of which are given on page 22 of this report. Bacteriological examination of sputa from 256 cases was made during the same period. In 23 of these examinations the specific organism of the disease was found ; in 233 the results were negative. The number of deaths from tuberculous disease in Hackney during 1917 was 360. These deaths are classified as follows :— Tuberculous phthisis 275 Phthisis 29 General Tuberculosis 13 Tuberculous meningitis 20 „ peritonitis 6 Tabes mesenterica 7 Tubercle of other organs 10 360 This number of deaths gives an annual mortality of 1.8 per 1,000 living. B 18 Cancer.—There were 230 deaths during 1917 due to the different varieties of malignant disease. The annual mortalityrate from malignant disease for last year is 1.17 per 1,000 living. Alcoholism.—No death was registered during last year as due to acute alcoholic poisoning, but there were 10 deaths registered as due to cirrhosis of the liver, a condition regarded as being caused by excessive indulgence in alcohol, extending over lengthy periods. PUBLIC HEALTH (LONDON) ACT, 1891. (a) Complaints of Nuisance.—During the year 1917 there were 1,577 complaints of nuisance made to the Public Health Department and investigated by Sanitary Inspectors of the Borough. Defects or nuisance were discovered in 1,195 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 1,654. This is a decrease of 1,329 upon the number inspected during 1916. Any nuisances or defects found were dealt with under the provisions of the above Act. (ic) House-to-House Inspections.—The number of house-to-house inspections made by the Inspectors during the year was 186. These inspections are in addition to those made under (a) and (b), 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 1917 was 2,491. The number of Statutory Notices served was 244. Legal proceedings were initiated in 23 cases. 19 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.: 12 sides and 25 fore-ends of bacon ; 9 boxes of ox cheeks; 30 rabbits; 50 tins of corned beef; 5 boxes of fish ; ½ cwt. cheese ; 1 sack of potatoes. COW-HOUSES, DAIRIES, AND MILKSHOPS. (a) Cow-houses.—At the end of 1917 there were 13 licensed cowkeepers in the Borough with 15 sheds. Inspector Bobbitt reports that he made 40 inspections of these during the year, and found it necessary to serve one notice for repairs which was immediately attended to. (b) Dairies and Milkshops.—During the year 9 premises were removed from the register and 4 new premises added, thus making the total on the register at the end of the year 287. The proprietors of milk premises were changed in 6 instances. Inspector Bobbitt reports that he made 151 visits of inspection to these premises during the year. Offensive Trades.—Two visits of inspection were made by Inspector Bobbitt to the only offensive trade premises in the Borough, viz., a tripe boiler. Slaughter-houses.—The number of slaughter-houses in the Borough at the end of 1917 was 20. Inspector Bobbitt reports that he made 73 visits of inspections to these during that period, and examined the carcases of 39 oxen, 463 sheep or lambs, and found the following parts and organs diseased, viz.:—The carcase and organs of a sheep emaciated and dropsical; two ox livers affected with abscess. B s 20 The following statement refers to the milk-places, cow-sheds, slaughter-houses and offensive trades in the Borough:— Premises. Number of Places. Number of Inspections, 1917. Number of Notices, 1917. Number of Prosecutions. On Register at end of 1916. Added in 1917. Removed in 1917. | On Register at end of 1917. Milk premises 292 4 9 287 151 — None. Cow-sheds 15 — — 15 40 1 „ Slaughter-houses 20 — — 20 73 — „ Other offensive trade premises 1 — — 1 — — „ Preserved Provision Manufacturers.—These have been periodically inspected by Inspector Bobbitt during the year. Smoke Nuisances.—There were 13 notices served for the abatement of smoke nuisances during the year. Water Supply.—Two certificates of proper and sufficient water supply under Section 48 (2) of the Public Health (London) Act, 1891, were applied for during the year. Bye-laws for Houses let in Lodgings.—The number of these houses on the Register at the end of 1917 was 470. Of these 184 were inspected during the year and any defects found were remedied by the service of a notice. CUSTOMS AND INLAND REVENUE ACT, 1890. No certificate for exemption from Inhabited House Duty was granted by me during 1917. ICE-CREAM VENDORS. At the end of 1917 there were 106 ice-cream premises in the Borough, all of which were inspected during the year. 21 GLANDERS AND FARCY ORDER, 1907. No notification of this disease was received during 1917. DISEASE OF ANIMALS ACT.—ANTHRAX ORDER OF 1910. No notification of anthrax in animals in the Borough was received during 1917. HOUSING, TOWN PLANNING, &c., ACT, 1909. No action under the above was taken during 1917. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Under these regulations, I received 1,043 notifications of cases of pulmonary tuberculosis during the year 1917 of which 334 were duplicates; also 204 non-pulmonary notifications of which 43 were duplicates. The following tables A and B give the age and sex distribution of the notified cases. A—Pulmonary Tuberculosis. Notifications received during the Year 1917. 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 4 19 30 99 65 132 77 129 41 65 41 54 50 500 308 Form B — — 4 1 — — — — — — — — 1 2 5 3 Form C - - - - - - - - - - - - - - 127 100 B—Non-Pulmonary Tuberculosis. Notifications received during the Year 1917. 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 14 12 48 29 11 9 6 7 3 1 3 9 11 7 96 74 Form B 1 — 4 4 - - - - - - - - 3 2 8 6 Form C - - - - - - - - - - - - - - 12 8 Notifications on Form D not included. 22 23 The following is a statement in tabular form of the relative number and percentage of insured and non-insured of primary cases of tuberculosis notified during 1917. National Insurance Act, 1917. Tuberculosis, 1917. Sex. Insured Cases. Non-Insured Cases. Percentage Insured. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male 295 10 155 80 65% 11% Female 97 11 I62 60 37% 15% Total 392 21 317 140 55% 13% ACTION TAKEN DURING THE YEAR 1917. The action taken includes disinfection of rooms and the articles infected by tuberculous patients, inspection of dwellings occupied by tuberculous persons, and the removal of any condition prejudicial to health, instruction of patients in measures to prevent the spread of the disease, and the gratuitous supply of sputum flasks, the number of these supplied during the year being 66. TREATMENT—TUBERCULOSIS DISPENSARIES. A.—Dispensary at Victoria Park Hospital.—During the year 1917 there were 1,549 new patients examined at the Dispensary, 737 males and 812 females. Of the total 535 were insured and 1,014 uninsured persons. The result of examination shows 260 to have pulmonary tuberculosis, 59 non-pulmonary tuberculosis, 44 were doubtful and 1,186 not suffering from tuberculosis. Contact Cases.—There were 974 contact cases examined, of which 18 were found to be tuberculous, 18 doubtful and 938 non-tuberculous. 24 Attendances.—The total number of attendances during the year was 5,453. B.—Dispensary at Metropolitan Hospital. During the same period 752 new patients were examined at this Dispensary, 373 male and 379 female. Of the total, 255 were insured and 497 were uninsured persons. The result of examination shows 181 to have pulmonary tuberculosis, 14 non-pulmonary tuberculosis, 125 were doubtful, and 432 not suffering from tuberculosis. Contact Cases.—There were 445 contact cases examined, of which 31 were found to be tuberculous, 24 were doubtful, and 390 non-tuberculous. Attendances.—The total number of attendances during the year was 2,152. MATERNITY AND CHILD WELFARE. See appendix page 33 for special report on the above for the year 1917. THE FACTORY AND WORKSHOP ACT, 1901. Factories.—During the year 159 factories were inspected by the officers of the Public Health Department, 2 being factory laundries and 157 factories in which articles of clothing, &c., were made and altered. In 24 of these factories, the sanitary tion was defective, unsuitable or insufficient:— Nuisance. Found. Abated by Workshop Inspector. Abated by District Inspector. Outstanding. Total. Unsuitable or Defective w.c.'s 16 13 — 3 16 Insufficient „ 8 8 - - 8 Not separate for the sexes. — — — - — 25 Workshops.—The number of workshops registered in Hackney at the end of 1917 was 1,039, a decrease of 61 on the number registered at the end of 1916. Of this total, 743 were workshops in which females were employed. Of these latter, 492 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, &c., 220 in which other articles were manufactured, &c., and 31 were domestic workshops. Amongst the workshops manufacturing wearing apparel, there were 352 employing females alone, and 140 employing both males and females. In workshops of other occupations, there were 136 employing females alone, and 84 employing both males and females. Of the domestic workshops, females alone were employed in 18 and both males and females in 13. During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints Factories 10 „ Workshops 3 Notices „ 52 26 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 9 Hats 7 Baby Linen 2 Infants' Millinery 7 Beading 1 Mantles 54 Belts 1 Millinery 38 Blouses 47 Needlework 0 Boot and Shoe Manufacturers 55 Pinafores 0 Shirts 4 Boot Machinists 110 Stays 7 Children's Costumes 11 Tailoring 67 Clerical Robes 1 Ties 35 Clothing 6 Trimmings 13 Collars 1 Underclothing 14 Dressmakers 72 Vests 7 Dressing and Tea Gowns 4 Waterproofs 5 Fancy Bows on Shoes 5 649 Fall Net Chenilling 1 Furriers 65 (b) Other Occupations. Bakers and Confectioners 35 Rubber Goods 5 Baskets 4 Toy Makers 7 Box Makers 22 Trunk and Bag Makers 6 Brush Makers 11 Umbrella Makers 2 Cabinet Makers 61 Upholsterers 11 Doll Manufacturers and Dressers 9 Upholsterers' Trimmings 3 Miscellaneous 118 Fancy Leather Goods 31 397 Laundries 52 Pianoforte Makers 20 During 1917 Miss Teebay, the Workshops Inspector, made 2,337 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections 293 intimation and statutory notices were served for the abatement of the nuisances found. Outworkers.—The number of outworkers on the register at the end of 1917 was 1,884, against 2,868 at the end of 1916. 27 The following analysis shows the trades followed by these outworkers:— Trade. No. of Out workers. Trade. No. of Out Workers. Artificial Florist 43 Hats 5 Baby Linen 3 Lace Trimmed Goods 1 Belts 16 Millinery 89 Blouses 212 Shirts 41 Boots and Shoes 443 Shoe Bows 4 Boxes 125 Skirts and Mantles 154 Braces 1 Tailoring 53 Brushes 168 Ties 58 Canvas Goods 4 Trimming 58 Children's Costumes 10 Umbrellas 4 Clothiers and Outfitters 68 Underclothing 39 Collars and Bibs 10 Upholsterers' Trimmings 11 Confectionery Packing 13 Miscellaneous 125 Dolls 91 1,884 Fancy Goods 7 Fur Trade 28 I received 2,677 names and addresses of Hackney outworkers receiving work during 1917 from Local Authorities of other districts. On examination of the list of outworkers sent in by employers in this Borough during 1917, I found 2,664 whose addresses were in other districts. During the year 1917 Miss Portlock (the inspector appointed for the inspection of outworkers' premises) made 1,182 inspections and 1,065 re-inspections. She also made 534 fruitless visits. Miss Portlock also discovered 3 new workshops and handed their addresses in for registration. During her visits of inspection Miss Portlock found 498 outworkers' premises with sanitary defects. For the abatement of these she served 431 intimation notices. Of the 1,182 outworkers' premises inspected, in only 73 was a room set apart entirely for work. COMBINED DRAINAGE WORKS REFERRED TO THE BOROUGH ENGINEER AND SURVEYOR DURING 1917. During this year 6 notices of defective systems of combined drainage works were referred for consideration to the Surveyor. 28 DISINFECTION. (a) Rooms.—During 1917 there were 1,988 rooms fumigated and 257 rooms cleansed in the Borough by the staff of the Public Health Department. These totals include disinfections after measles, whooping cough and tuberculosis, in addition to those in connection with notifiable infectious diseases. (b) Articles of Clothing, Furniture, &c.—The number of articles under this head disinfected during last year was as follows:— House, linen and furniture 9,790 Men's clothing 198 Women's clothing 268 Children's clothing 48 Other articles 2,322 Total 12,626 (c) Public Library Books.—During the past year 295 books from homes in which infectious diseases had occurred were disinfected. THE SHELTER. During 1917 there were 14 persons admitted to the shelter whilst their homes were being disinfected. 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, 2,164 baths being given during that period. This total shows an increase of 877 upon the number given during 1916, Of the 2,164 baths given, 1,538 were sulphur baths for scabies and 626 for pediculi. The great majority of those persons presenting themselves for baths were children from the elementary schools in the Borough. These children received 2,095 baths, an increase of 254 upon the number given during 1916. Of those persons receiving hot baths, 19 were men and 607 children; of those receiving ulphur baths, 12 were men, 38 women and 1,488 children. 29 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904. During the year my attention was drawn by the Medical Officer (Education) of the London County Council to 112 houses 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 and found that of the 112 homes, 8 had verminous rooms and 3 had both verminous rooms and bedding or clothing. REMOVAL AND DISPOSAL OF HOUSE REFUSE. The total quantity of refuse removed from occupied houses in the Borough by the Council's Contractors during the year 1917, amounted to 29,022 tons 18 cwts., at a total cost of £9,454 19s. 3d. Owing to certain difficulties it was necessary to deposit some of the refuse on "Shoots" in the neighbourhood of the Borough. The quantity so deposited during the year was 9,084 cubic yards. The cost of this is included in the total above given. 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 the Mortuary 423 1. To await inquests— (a) Infectious 6 (b) Non-infectious 400 2. To await burial 17 Number of post-mortems made 140 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 123 128 Accidental death 81 55 Suicide 8 6 Open Verdict 2 — Murder — — Misadventure 2 1 Totals 216 190 30 SALE OF FOOD AND DRUGS ACTS. Samples purchased during 1917. Article. Number Purchased. Number Adulterated. Number where proceedings taken. Milk 530 58 15 Butter 143 2 — Margarine 67 — — Cocoa 29 — — Coffee 40 2 1 Arrowroot 12 — — Custard Powder 5 — — Egg Powder 2 — — Flour 18 — — Pepper 23 — — Mustard 8 — — Medicine 5 — — Baking Powder 11 — — Paregoric 1 — — Jam 6 — — 900 62 16 31 Prosecutions under the Sale of Food and Drugs Acts during the year 1917. No. of Sample. Article. Adulteration or Offence. Result of Legal Proceedings. Fine. Costs. £ s. d. £ s. d. I5x Margarine Exposed for sale unlabeled Fined 2 0 0 1 1 0 I6x ,, ,, ,, ,, 2 0 0 1 1 0 17x ,, ,, ,, ,, 2 0 0 1 1 0 27Y ,, ,, ,, Ordered to pay — 1 1 0 27y ,, The word "Margarine" not stamped on wrapper ,, - 2 2 0 60y Milk 4.71 % added water Withdrawn (Warranty proved) - - 34z Margarine Served in plain wrapper Fined 2 0 0 1 1 0 60y Milk Give false warranty to milk vendor Dismissed - — 67A ,, 5.18% added water — 2 2 0 26B ,, 10% fat abstracted Dismissed (Warranty proved.) — — 91B ,, 6.71% added water Fined 2 0 0 1 14 6 92B ,, 4% ,, ,, 2 0 0 1 14 6 94B ,, 10.59% ,, Dismissed — 2 2 0 26B ,, Give false warranty to milk vendor ,, — — 20D ,, 6.94% added water Fined 1 1 0 3 3 0 2E ,, 5.29% ,, ,, 1 10 0 1 1 0 3E ,, 7.52% Adjourned sine die — — 22E ,, 9.65% Withdrawn by order of Public Health Committee. - - 3F ,, 23.3% fat abstracted — — 2 2 0 4F ,, 26.7% ,, — — 2 2 0 78F Margarine Served in plain wrapper Fined 10 0 0 2 2 0 54G ,, ,, ,, ,, 1 0 0 2 2 0 79G ,, ,, ,, ,, 0 10 0 1 1 0 64G Coffee 11.07% chicory Withdrawn by order of Public Health Committee - - 6H Milk 2% added water Withdrawn (Warranty proved.) - — 39H ,, 3.65% added water Fined 0 5 0 1 15 0 58H ,, 2.47% ,, ,, 1 0 0 2 2 0 Total 27 6 0 32 10 0 32 Prosecutions under the Public Health (London) Act, 1891, during the year 1917. Address. Complaint. Magistrate's Decision. Penalty. Costs. £ s. d. £ s. d. 34, Stockmar Road Gutter defective Withdrawn. (Work done.) - 1 5 30, Stockmar Road Roof and dustbin defective. ,, ,, - 1 5 75, Glenarm Road General insanitary condition. Order to abate in six weeks. — 2 2 39A,Cadogan Terrace Fail to comply with Magistrate's order. Fined 4 0 0 1 1 ,, ,, ,, ,, ,, ,, 4 0 0 1 1 30, Well Street Roof and gutters defective. Withdrawn. (Work done.) — 1 13 55, London Road Fail to comply with Magistrate's order. Fined 0 10 0 1 1 22, Tower Street General insanitary condition. Order to abate in seven days. — 1 5 94, Cassland Road Roof and gutters defective. Ordered to pay — 2 2 9, Junction Place Roof, W.C., rain water pipe, &c., defective. Order to abate in 14 days. - 1 6 75, Glenarm Road Fail to comply with Magistrate's order. Fined 3 0 0 2 2 22, High Street, Homerton. W.C., roof, &c., defective. Order to abate in seven days. — 0 10 8, High Street, Homerton. ,, ,, ,, ,, - 1 5 1, Isabella Road Walls damp. Order to abate in one month. — 2 2 12, Blurton Road Roof and dustbin defective. Order to abate in seven days. - 1 5 34, Amhurst Road Roof defective Withdrawn. (Work done.) — - 244, Glyn Road Gutter defective ,, ,, - 1 3 3, Lockner Road Manhole cover broken. ,, ,, — 1 3 22, Chevet Street General insanitary condition. Order to abate in seven days. 2 0 0 2 2 15, Nisbet Street ,, ,, Order to abate in 14 days. — 2 2 5, Holmbrook Street W.C., roof and rain water pipe defective. Withdrawn. (Work done.) - 1 13 £13 10 0 29 9 33 (APPENDIX.) REPORT ON INFANT WELFARE WORK DURING THE YEAR 1917. Public Health Department, Town Hall, Hackney, E. 8. 11th March, 1918. To the Chairman and Members of the Public Health Committee. Gentlemen, I beg herewith to report on the Infant Welfare work accomplished in the Borough during the year 1917. The Committee will remember that Infant Welfare work really began when the Welfare Centres were established in the Borough— two opening in the first week in January and another in May— and a sufficient staff of Health Visitors were appointed to work these Centres, and especially to make home visitations in order to advise where advice is required and acceptable. This report naturally consists of two parts—1. Administrative; 2. Medical. I. Administrative. This may be further considered under the following heads; (a) Infant Centres; (b) Home Visitation; (c) Nursing and Treatment of Disease. Infant Centres. By the Notification of Births Act, 1907, all births are required to be notified to the Medical Officer of Health within six hours of their occurrence, by the father of the child, if he is actually c 34 resident at the time of birth, and of any person in attendance upon the mother at the time of birth. On the doctor or midwife ceasing to attend on the mother, I forward to her a leaflet, "On the Care of Infants"; subsequently, in suitable cases, one of the Health Visitors, on my instruction, visits the mother and invites her to attend one of the Welfare Centres with her babe, leaving with her, at the same time, a card containing the address of the Centre, and the day and hours it is open. While inviting mothers to attend, they are given quite to understand that their attendance is quite voluntary. On attending the Centre, the weight of the infant is taken and recorded; the infant is then seen and examined by the attending doctor and the parent advised as to its feeding and care. Treatment is also given in cases of simple ailment, especially those affecting the digestive system or any other temporary deviation from the normal standard of health. If the infant happens to be suffering from any definite illness requiring continuous treatment, the case is referred to a medical practitioner or a hospital. In a Memorandum on Maternity and Child Welfare Centres by the Medical Officer of the Local Government Board, he defines the object of such Centres in the following terms:— "The chief object of the Centre is to secure the medical supervision of the expectant and nursing mother and of her child. This supervision takes the form of a medical consultation, followed by the giving of hygienic advice, and by treatment, especially for minor complaints, when local circumstances indicate the need for this. It is not intended that the work of the Centre should replace that of private practitioners. The chief utility of the Centre consists in the giving of advice based on medical knowledge of the condition of the patient." 35 Further:- "At the most satisfactory Centres, each child is seen at definite intervals by the doctor. It is unsatisfactory for the non-medical staff to select children to be seen by the doctor; still more so for the doctor to discontinue seeing children after the first visit, if in the opinion of the non-medical worker they present no symptoms of illness. Early departures from health are difficult to detect, and unless medical supervision is continuous, disorder or disease may be overloooked for a considerable time. Commonly, it will be desirable to secure that each infant attending the Centre is seen by the doctor at least every four or six weeks. After the early months of life, less frequent attendances will be needed, but the consultations should suffice to secure early recognition of rickets, &c." The following table gives information as to the attendances of infants at the three Centres in the Borough during the year 1917 Summary of Infant Welfare Centre work during the year 1917. Centre. Period. No. of times Centre open. No. of primary cases brought to Centre. Repeated visits Centres. Total attendances Total attendances of Infants under 1 year. Total attendances of children over 1 year. 1. "All Souls," Over bury St. 1st January to 31st December 51 473 1,718 2,191 1,883 308 2. Brooksby's Walk 1st January to 31st December 51 465 1,818 2,283 2,130 153 3. Mayfield Rd. 1st May to 31st December 34 251 944 1,195 978 217 136 1,189 4,480 5,669 4,991 678 C2 36 These figures must at once dissipate the doubts of those well-meaning critics who regard the Infant Welfare work as an infringement of the rights of parents and a species of grandmotherly interference. If the figures mean anything, it is that mothers are desirous of being instructed in the feeding and care of their babies, and are even willing to receive such instruction from the Borough Council's officials. Indeed, the Centres are becoming so popular and the attendances so numerous as sometimes to embarrass the doctor and Health Visitors in attendance. Home Visitation. These visits begin as stated above, soon after the doctor or midwife has left their patient. In addition to attending at the Centres once a week and assisting the Medical Officers in attendance, the Health Visitors, on the instruction of the Medical Officer of Health, visit the homes of nursing mothers, advise them to bring their infants to the Centre, urge them to carry out any instructions of the doctor and note any condition in the house adverse to the health of the occupants. With respect to the number of home visits to be paid by the Health Visitor to each infant, the Board's Medical Officer remarks as follows:— "The experience of industrial towns and districts indicate that about eight visits are required on an average during the first year after birth for each infant born. Some infants will require a larger number of visits, and some less or none." "The average daily number of visits that can be made by a Health Visitor may be placed at 15. Thus, as a rule, one Health Visitor should be allowed for not more than 500 births, on the assumption that the whole of her time is devoted to this work." "The visits should be continued at intervals up to school age, attendances at the Centre being encouraged for purposes of medical 37 inspection at such intervals as will Enable a record to be kept of each child's health and sickness up to the time when the child attends school and becomes the subject of school medical inspection." I may here add that the Health Visitors, with a few exceptions, are welcomed at the homes they visit. In a few cases, the visits have been declined; in others, where at first the Visitors have been received with reserve, this has disappeared on the object of the visit being explained. In no case am I aware of open hostility to the Visitors. The following table gives details of the results of the visits of the Health Visitors during the year 1917:— Particulars respecting the Feeding, Care and Environment of the Infants visited at their homes, by the Health Visitors during the year 1917. No. of Infants visited. Method of Feeding. Separate cot provided for Infant. Use of Comforter. Home conditions. Secondary visits. Breast Artificial. Mixed. Yes. No. Yes. No. Satisfac tory. Unsatis factory. 2,509 2,067 210 152 637 1.727 1,704 725 2,029 331 5,162 Home Nursing and Treatment of Disease. Measles.—Early in the year, the Council resolved, in accordance with the wish of the Local Government Board, to adopt certain measures in the Borough with the object of combating as far as possible, the high mortality attending measles. These measures consist in:— (a) forwarding a printed leaflet on the precautions to be taken to prevent the spread of this disease; (b) the visit of a Health Visitor acting under the instruction of the Medical Officer 38 of Health, to obtain particulars as to whether the home conditions are satisfactory for home nursing and treatment of the child, and whether the visit of a trained nurse is necessary. Where a nurse is necessary, one is sent, on the order of the Medical Officer of Health, either from the King's Home for Nurses, Lower Clapton Road, or from the Shoreditch and Bethnal Green Nursing Association, 80, Nichols Square, Hackney Road; (c) where home conditions are unfavourable for nursing and medical treatment, the case is, if possible, removed to hospital. During the year 1917, there were 1,632 cases of measles notified by medical practitioners and 469 cases by other persons—a total of 2,101 cases. Of these, 1,763 cases were visited by the Health Visitor. On their reports, nurses were sent to 63 cases. These were attended daily by the nurse until her services became unnecessary. Amongst the total cases notified, there were 107 cases removed to hospital. Apart from the actual saving of life by early nursing and treatment, the measures above outlined serve to impress upon parents the fact that measles is not a trivial child's ailment, but is a most serious complaint which is responsible for a large percentage of deaths among children. Ophthalmia Neonatorum.—This is a dangerous and severe inflammation of the eye, acquired by newly born infants. During the year, 27 cases were notified, all of which were visited by the Health Visitors and the mothers advised to seek medical treatment. Special nurses were sent to five cases. All of the cases recovered without damage to the eye. The beneficial effect of the measures adopted by the Borough Council will, I believe, continue to make itself increasingly felt. I have pleasure in stating that the Health Visitors have performed their duties during the year to my complete satisfaction. 39 II.—Medical. The following are the reports of the Medical Officers of the Borough Council's Infant Welfare Centres on the cases attended at the Centres during the year 1917:— 1. Brooksby's Walk Infant Welfare Centre. During 1917, 416 infants and 49 children have been brought to the Centre. There have been 2,283 attendances in all. Of the 416 infants, 102 were breast-fed up to three months, 190 up to six months, 28 partially breast-fed, and 67 artificially fed, while in 23 the method of feeding was not ascertained. During the year, 18 of the children attending the Centre died from the following causes:— Wasting, eight cases (all of these were artificially fed, and only attended the Centre a few times); tubercular peritonitis, one; diarrhoea and vomiting, three; congential syphilis one (this was suspected but did not attend long enough to verify); menigitis, two; whooping cough, one; pneumonia, one; undetermined, one. In 10 cases, the children were artificially fed; in six cases, breast-fed; in two cases, they were over two years old. These are highly suggestive figures, though not sufficient in number to warrant any definite deductions being made. Very many of the children have required attention in regard to dieting, and minor ailments, and the results have been quite satisfactory. There have also been several cases of more severe indisposition—five of true marasmus, i.e., cases of wasting, where no signs of disease could be found. All five did remarkably well, though it was some time before the food which suited them best was found. In three of the cases, Mellin's Food was of the greatest advantage, and I am indebted to Messrs. Mellins for a gift of 12 bottles of their food to be given to mothers unable to afford it. 40 Three cases of congenital syphilis presented themselves. In two of these, "syphilitic epiphysitis" was the only sign present. In the third, wasting and a distinct family history made diagnosis possible. All three cases have done well on treatment by mercury (Pulv. Hyd. C. Cret. gr. ½ n.m.). Two cases of mongolian imbecility have been brought to the Centre. The mothers were advised in regard to the condition, and the children are still under observation. One case of Erb's obstetric palsy was observed, and this has been placed under the care of Mr. Addison, Surgeon to the Hospital for Sick Children, Great Ormond Street, and is, I understand, improving. One case diagnosed as empyaemia, was sent to the Evelina Hospital, but finally proved to be a case of pleuro pneumonia with considerable thickening of the pleura from plastic exudation. This child, too, has much improved in health. One case of abdominal tubercle was admitted into the Hospital for Sick Children, Great Ormond Street, but I regret to learn, has since died. I am not surprised, as the disease was very advanced when the child was brought to the Centre. One case of renal tumour was sent to the same hospital, but I have no knowledge of the subsequent development of the condition. Apart from the clinical side of the Centre, it has, I believe, proved of the greatest assistance to the mothers in helping them to secure a supply of milk foods for their children at a time when there was a great dearth of fresh milk, especially in the poorer neighbourhoods; and this also applies to the supply of sugar. I cannot but think that this economic aspect is of the highest importance at such a time like this. 41 In conclusion, I should like to bring before your notice, the splendid service of the Health Visitors who have assisted me at the Centre; especially Miss Clarke and Miss Piggott who have been more intimately associated with this Centre. Their invariable tact and gentleness, the thoroughness with which they have carried out the work, and their kind co-operation could not, in my opinion, have been improved upon. I wish also to acknowledge my indebtedness to the members of the staff of the hospital to which I have sent patients, and especially to Dr. Hutchison and Dr. Horton-Smith-Hartley, who have been most kind in seeing and advising in regard to patients sent to them. (Sgd.) Reginald Brown, M.R.C.S., &c. 20th January, 1918. 2. "All Souls," Clapton Park Infant Welfare Centre. During 1917, 473 children have attended the Centre; of these 100 were at their first visit over one year of age. There have been 2,191 attendances in all. Some mothers bring the children regularly every week or fortnight; other children, especially the older ones, are only brought once to be examined as to their general health, or on account of ailments such as scabies, impetigo, otorrhaea, conjunctivitis, adenoids, enlarged glands, &c. Such cases have been generally referred to the private practitioner or to a hospital or occasionally to the Queen's nurses, who have kindly taken them in hand. I encourage breast-feeding in every possible case, attention to the health of the mother, and the prescribing of lactagol or iron has often rendered the continuance of lactation possible in difficult cases. When breast milk is insufficient, I find the giving of a few spoonfuls of dilute Nestle's milk or Glaxo after each natural meal, better than alternative bottle-feeding, as the latter plan often leads to complete artificial feeding. Of the 473 children, 185 have been 42 breast-fed entirely up to at least six months, 98 to at least three months. 51 have been only partially breast-fed, and 59 artificially fed from birth; in the other cases the method of feeding has not been noted. It is chiefly among the artificially fed babies that severe indigestion and wasting occur, but I believe that these cases have all been dealt with successfully. I have heard of eight deaths among the children who have attended the Centre, two from diarrhoea, five others from whooping cough, congenital syphilis, diphtheria, tuberculosis and congenital heart disease respectively; one died suddenly from a cause not ascertained. Of these eight children, six had been artificially fed from birth. There have been three definite cases of congenital syphilis, and two have been treated at the New Hospital for Women by means of injection of a salvarsan substitute to the mother; both have done well. I have suspected the disease in two other cases but the diagnosis has not been confirmed by the Wassermann test. There have been three cases of cleft palate, one combined with a hare lip; the dieting in these cases has been difficult but successful. One of them is the child who died suddenly, another is unfortunately probably an imbecile. Three other children whom I believe to be imbecile are brought to the Centre. A case of infant paralysis, one of clubfoot, one of fractured thigh, a curious case of aphonia, and several bad cases of rupture have been sent to suitable hospitals for treatment. The diet difficulty has been great, as mothers have at times been unable to obtain cow's milk or Nestle's milk, but a better supply of foods at the Centre now obviates this difficulty. There are, however, always a few mothers who are too poor to obtain sufficient nourishment, and the children suffer in consequence. Help for the poorer mothers is needed. 43 The mothers are, generally speaking, grateful for instruction and gradually learn to follow advice given. There is very little intentional neglect; one case of neglect I put into the hands of the Society for Prevention of Cruelty to Children and the result to the child has been good, as I hear that it is doing well. The work of the Centre is carried on very smoothly, owing to the unfailing tact and efficiency of the Health Visitors, Miss Teebay and Mrs. Lear. I much regret that Mrs. Lear has now left. The Sister and nurses from the Dunlace Road Maternity Institute have also given us invaluable help during the year and we owe a debt of gratitude to our voluntary worker, Mrs. Holmes, who has attended regularly and helped us very much. (Sgd.) Elizabeth Wilks, M.D., B.S. 26th January, 1918. 3. Mayfield Road Infant Welfare Centre. (From May 2nd, 1917, to December, 31st 1917.) During the eight months this Centre has been running, there have been 270 infants and children placed on the roll; 204 of these were infants under one year and 66 were over one year. The number of attendances made by mothers was 1,013, the average attendance per consultation being 37.9, whilst the greatest number of attendances at any one consultation was 51, which occurred on three occasions. The Centre has been open for 34 weeks. The War has made conditions very difficult for the nursing mother. The anxiety associated with air raids has interfered in a large number of cases with lactation and not infrequently after an air raid the mother's milk has totally disappeared and has not returned again. It has been difficult too for the nursing mother to get proper nourishing food for herself, especially with the present scarcity of milk, meat and eggs, and this has acted detrimentally in the mother, and through her, in the child. 44 Notwithstanding these adverse conditions, 73.5 per cent. of the mothers nursed their children either wholly or in part on the breast, whilst 26.5 per cent. were bottle fed. One of the most valuable features of the Centre is their educational value. Formerly a poor mother whose child was not doing well, was dependent on the advice of a kindly neighbour as to whether the child should be taken off the breast or no. An increasing number of mothers who are in difficulty, come to the Centres for advice with great advantage to the child and frequently they volunteer the information that they were sent by another mother who had herself attended under similar circumstances. On points of general hygiene and cleanliness, the mothers are most conscientious in carrying out instructions. It is to be noted that the Centres in Hackney are mostly attended by the thrifty, careful mother, the class which it is most important from the National point of view to help, as it is from them that the best results in the bringing up of healthy offspring will be obtained. Work in slum areas and amongst the poor and improvident is of a different kind and must partake more of the nature of social work, in trying to elevate the general tone as well as to ameliorate conditions. In this class, the work is always slow and often discouraging. But in the thrifty, though frequently poor, artisan class such as we have to deal with in Hackney, the mothers are exceedingly anxious to do their best for their children, and advice given at the Centres is regularly accepted and acted upon. The benefit accruing to these children is immediate and systematically carried out over the country, must have a marked immediate effect in reducing infant mortality and in producing a healthier and more robust type. The supplying of foods especially of dried milks has developed largely. It is unfortunate that the mere sale of food should take up so much of the Health Visitor's time. The visitation of the mother in the home by the nurse is one of the most important parts of the work of the Centre and is rightly, the branch of the work most stress is laid on by the Local 45 Government Board. No medicinal treatment has been carried on at the Centre, or at least only of the very simplest kind, but in many cases requiring medicinal treatment, the mother has been advised to consult her own doctor, and if she is unable to employ a private doctor she has taken a signed note from the Centre to a hospital. As a rule, the hospitals have been very considerate in the treatment of these cases. (Signed) J. Lawson Dick, M.D., F.R.C.S. 3rd February, 1918. I remain, Yours obediently, J. KING WARRY, M.D., M.R.C.P., D.P.H., Medical Officer of Health.