HAC 34 Metropolitan Borough of hackney. REPORT on the SANITARY CONDITION OF THE METROPOLITAN BOROUGH OF HACKNEY FOR THE YEAR 1919, by W. W. E. FLETCHER, M.B., CAMB., D.P.H., Acting Medical Officer of Health for the Borough and Chief Executive Tuberculosis Officer. London: Chas. Straker & Sons, Ltd., 5-9, Bishopsgate Avenue, E.C.3. 1920. INDEX. page Alcoholism 48 Ante-Natal Welfare 82 Anti-Toxin 29 Birth Rate 13 Canal Boats Acts 124 Cancer 48 Cerebro-Spinal Meningitis 31 Cleansing of Persons Act, 1907 71 Continued fever 30 Cowhouses, Dairies, and Milkshops 120 Day Nursery 104 Day Sanatoria 39 Death Rate 16 Deaths in Public Institutions 19 Diarrhœa 34 Diphtheria 27 Disinfection 68 Dysentery 33 Encephalitis Lethargica 31 Enteric Fever 29 Erysipelas 30 Estimated Population 12 Factories 64 Factory and Workshops Act, 1901 64 Food—Unsound 58, 105 Foster-Mothers, Grants to 99 Geology 10 Glanders and Farcy Order 59 Home Work and Home Workers 66 House Refuse 62 Housing of the Working Classes Act, 1890-1903 59 Housing and Town Planning Act, 1909 59 Housing 110 Illegitimacy 14 Industries, List of 120 Infant Mortality 17 Infant Welfare Work 85 Infectious disease 26 Influenza 33 Interim Tuberculosis Care Committee 45 Malaria 32 Main Drainage 12 Marriage Rate 12 Maternity and Child Welfare Act 82 Measles and German Measles 31 Medical Relief (Poor Law) 20 Mortuary 74 Notification of Births Act, 1907 14 Notifiable Diseases 26 A 2 4 index page Non-Notifiable Diseases 33 Offensive Trades 120 Ophthalmia Neonatorum 31 Pensions to Mothers 102 Plague 30 Pneumonia 32 Polio-Myelitis 31 Population 12 Public Health (London) Act, 1891—Inspections under 49 Public Health (London) Act, 1891—Prosecutions under 77 Public Health (Tuberculosis) Regulations, 1912 36 Public Health (Influenza) Regulations, 1918 33 Puerperal Fever 30 Removal of House Refuse 62 River Lea—Floodings 59 Sale of Food and Drugs Act, 1875-1907—Samples purchased 76 Sale of Food and Drugs Act, 1875-1907—Prosecutions under 80 Sanitary Inspectors—Inspections made by 50-57 Scarlet Fever 26 Senile Mortality 18 Sewage Disposal 12 Shelter 71 Slaughter-houses 121 Small-pox 26 Social Conditions 10 Still-births 14 Topography 9 Trench Fever 33 Tuberculosis— Notifications of 35-36 Discharged Soldiers and Sailors, suffering from 38 Dental treatment of uninsured patients 38 Day Sanatoria 39 Accommodation for Advanced cases 40 Interim Tuberculosis Care Committee 45 Typhus Fever 30 Unmarried Mothers 98 Vaccination 143 Verminous Children 74 Vital Statistics 22-25 Water Supply 12, 58 Whooping Cough 34 Workshops 64 Warry, Dr. J. King-, Death of 7 White, Captain G., Death of 8 SPECIAL REPORTS. Canal Boats—Report of Canal Boats Inspector 124 Food—Report of Food Inspector 120 Infant Welfare Centres—Reports of Welfare Medical Officers 90-98 Nisbet Street—Sanitary condition of 138 Tuberculosis—Reports of Tuberculosis Officers 125-137 PUBLIC HEALTH DEPARTMENT. Public Health Committee. Ex-officio—Alfred Payne, Esq., j.p. (Mayor). Chairman—Councillor Mrs. E. Boyce. Vice-Chairman—Councillor T. Chapman, j.p., l.c.c. Councillor Barlow, A. M. Bird, E. W. Bowhill, H. A. Benwell, Mrs. L. C. Boyce, Mrs. E. Capell, H. J. W. Chapman, T., j.p., l.c.c. Genese, J. Goold, F. G. Councillor Loweth, W. E. Muirhead, Mrs. E. Payne, A. W. Piggott, H. P. Rushbrooke, T., j.p , m.a., &c. Sherman, J. Thorpe, W. H. Vardon, A. D., j.p., l.r.c.p. Wigan, E. Maternity and Child Welfare Committee. Consisting of Members of the Public Health Committee, and three persons being women and not Members of the Council. Chairman—Councillor E. W. Bird. Vice-Chairman—Councillor Mrs. E. Muirhead. Members of the Committee—as set out above with the addition of Mrs. E. J Arnold, Miss Adelaide Cox, and Miss B. W. Payne. Staff. Medical Officer of Health (acting)—Wilfred W. E. Fletcher, m.b. Tuberculosis Officers. Metropolitan Hospital Dispensary—L. Unwin Young, m.b. Victoria Park Hospital Dispensary—H. Tylford Howell, m.r.c.s. Medical Officers Municipal Infant Welfare Centres. Elizabeth Wilks, m.d. Reginald Brown, m.r.c s. J. H. Porter, m.r.c.s. Public Analyst—Leo Tayloe, f.i.c., &c. Clerical Staff. Chief Clerk J. D. Wilde. First Assistant Clerk A. Higgins. Second Assistant Clerk P. A. Hitch. Third Assistant Clerk L. W. Hahvey. Fourth Assistant Clerk E. Whittaker. Fifth Assistant Clerk V. Welham. Temporary Clerk H. C. Bowman. „ H. R. Sandford. Sanitary Inspectors. R. H. Ellis. W. Goldsworthy (Temporary). W. Harvey (Temporary). W. Peverett. W. C. Vobe. A. Sadler. R. H. Bew. E. S. Crook (Temporary) also H. Body. Canal Boats Inspector. G. F. High. J. W. Hall. R. J. Sheppard. A. J. Bobbitt (for Cowhouses, S. Punter (Temporary) Milkshops, Slaughterhouses,&c.). Alice Teebay (for Workshops, Laundries, &c.). Mabel Portlock (for Outworkers' Premises). Health Visitors. Mrs. A. Rhodes. Miss K. Teebay. Mrs. E. A. Cowley. Mrs. L. Harrison. Miss M. Chitson. Miss K. O'Neill Fisher. miss g. m. servante Miss M. Clarke Miss N. Priddle for Tuberculosis cases. Dust Inspectors—E. J. Tietjen and T. Saunders. Disinfecting Station and Shelier-—Caretakers—E. G. Hasler and Mrs. Hasler (Temporary). Mortuary Keeper—S. W. Boxell (Temporary). Metropolitan Borough of Hackney. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1919. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, E.8. June, 1920. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Ladies and Gentlemen, I have pleasure in submitting to you my Annual Report on the Public Health of the Metropolitan Borough of Hackney for the year 1919; and upon the work performed by the Public Health Department during that year. Before entering upon the report itself, however, it is fitting that I should make some reference to the unexpectedly sudden death of your late Medical Officer of Health, Dr. John King-Warry, which occurred on March 9th of the year under review, just before the completion of the 64th year of his age. Dr. King-Warry was appointed Medical Officer of Health of the Borough, in a temporary capacity, in April, 1892, during the absence on sick leave for three months of the then Medical Officer of Health, Dr. John William Tripe; but, the latter having died before the expiration of the three months, Dr. Warry's engagement was continued, still in a temporary capacity, at a salary of only £315 per annum, until July, 1894, when he was appointed permanently at a salary commencing at £500 a year and rising to £700. Recently, he was in receipt of an extra £100 per annum as remuneration for his services as Chief Executive 8 Tuberculosis Officer. Thus, he held office for a period of just short of 27 years. Dr. King-Warry had held office for so long a period that he had come to be regarded as a fixture removable only on superannuation, inasmuch as his death was not anticipated; there had been no warning, no premonitory symptoms, no illness. He died "in harness" as many workers would elect to die. I had not the pleasure of his personal acquaintance, but I have heard him spoken of by a member of the late Council as being "an expert in all matters relating to public health." Such an expression of opinion on the part of a capable judge who had known Dr. King-Warry and his work for many years, is a better tribute to his memory than anything which might be said by me. He served the Council well and faithfully for many years. In addition to the death of the late Dr. J. King-Warry the Public Health Department suffered a further loss by death, on September 20th, 1919, of the late Captain George White, one of the Sanitary Inspectors. This much regretted occurrence was reported to the Borough Council by the Acting Town Clerk on September 24th, as follows:— "It is with extreme regret that I have to report the death of Captain George White (Sanitary Inspector) who had been in the service of the Council for a period exceeding 21 years. Mr. White was a sergeant in the Sanitary section of the R.A.M.C. mobilised at the outbreak of war, and engaged for some months supervising the sanitary requirements of the various camps which were constructed in this country, for which he obtained his commission as a lieutenant. Proceeding in March, 1915, to the front in France, he obtained his captaincy. He went to Salonica with the first drafts of men, remaining there until May, 1918, when he was invalided home, and subsequently discharged as unfit for further military duties in October of last year. 9 He recommenced his duties as an officer of the Council and, although far from well, struggled to perform them until February of this year. Since February, he had been on sick leave, ultimately passing away on Saturday last from heart trouble, the result of overwork during his period of service, leaving a widow and two children to mourn his loss. Captain White was held in high esteem by his colleagues at the Town Hall, who sincerely regret his demise at the early age of 47 years." I had only two interviews with Captain White during sick leave, but they were sufficient to enable me to understand the reason why he was so well liked by his colleagues. On March 27th, your predecessors did me the honour of appointing me to fill the vacancy caused by the late Dr. J. King-Warry's death, temporarily until such time as a permanent successor would be appointed. I commenced my new duties on March 31st. THE BOROUGH OF HACKNEY. Area=3,287.8 acres Population—Census, 1901 219,780 „ —Census, 1911 222,674 „ —Estimated, middle of 1919 225,774 Rateable value, 1919 £1,234,824 Topography.—The Borough is situated to the north-east of the City of London. On the east it is separated from the County of Essex by the River Lea. Elsewhere, it is bounded on the north by the Urban District of Tottenham; on the west from north to south, by the Metropolitan Boroughs of Stoke Newington and Islington; on the south, from west to east, by the Metropolitan Boroughs of Shoreditch and Bethnal Green; and at the southeastern corner it adjoins a small portion of the Metropolitan Borough of Poplar. 10 In altitude the surface varies from 14.7 feet at the most easterly corner of the river Lea, to 21.9 feet above mean sea level at the lower part of Hackney Wick District, 36.8 at the northern extremity of Victoria Park. The surface rises gradually towards the north, 57.2 feet at St. Barnabas' Church, Homerton, 56.5 feet at St. John's Church, 74.3 feet at Hackney Downs, 96.7 feet at Springfield, and 109.1 near the junction of Upper Clapton Road and Stamford Hill. In the northern part of the Borough the surface falls steeply to the River Lea. There is a considerable area, known as Hackney Marshes, liable to flooding, and occasionally some of the houses bordering on the marshes become involved. Geology.—The whole district rests upon the "London Clay" which, with subjacent pebbles and sands, covers the chalk formation to a depth of approximately one hundred and forty feet. Patches of surface gravel are found in the Borough and in the valley of the Lea. Social Conditions.—During the last century Hackney used to be a good residential suburb of London. Large numbers of city merchants and business people used to reside in the Borough, and were driven daily to and from the city in their own carriages, or in hired carriages which came to be known as "Hackney Carriages." Hired vehicles for passengers are now known by that title in all districts throughout the County where bye-laws are in force with respect to public vehicles plying for hire. So, also with respect to "Hackney Horses" a term now abbreviated to "hacks"—there is little doubt that the term arose in connection with horses let out on hire in this Borough. Lapse of time and easier facilities tor travel, however, have brought about a great change. Though there are still many good residences, and many families who are "well off," the Borough as a whole has ceased to be "residential" and has become "industrial". Large numbers of workers are employed in many different branches of industry; many factories have been built; many large houses have been converted into factories and 11 workshops; and many others, formerly occupied separately by individual families, are now occupied by two, three,or more, families. While this change from a residential district to an industrial borough, or a manufacturing town, was taking place, changes were taking place of necessity in the general characteristics of the inhabitants; and as a body, the people were falling from a higher to an inferior social status, at any rate as judged from the view point of education, culture and possessions. But another change, a change of a natioual character, has also been taking place. Numbers of foreigners, and people of foreign extraction, migrated into Hackney from neighbouring Metropolitan Boroughs, such as Whitechapel, Bethnal Green, Poplar and other parts of the "east end," and many came from overseas. During the last 20 years the rate of immigration has increased in spite of alien restriction legislation; and during the last few years this immigration bordered on invasion, probably largely due to laxity in the administration, or to absence, of suitable laws restricting their admission. Thus, there is now a very large alien population in the Borough, many of whom are probably "undesirables," filling houses formerly occupied, and doing work formerly performed, by our own people; so that demobilised soldiers who have fought for their Country have returned to find foreigners in their homes and foreigners doing the work which used to provide them with a means of earning a livelihood. In all the circumstances one cannot but admire and praise the self-restraint of these men, wandering about in search of home and work while aliens thrive and, some of them, grow rich as a result of the sacrifices made by our own men. This very large foreign element cannot fail to make its mark upon our citizens in manners, customs, health conditions, habits of cleanliness and in facial expression and appearance and in figure, for intermarriage between natives and aliens does and will occur, and to my mind will not improve the British race. It is not desirable to overload the text of this report by furnishing in this place a long list of the many trades now carried on in 12 the Borough which is, in fact, although a part of the Metropolis, a large manufacturing town. A list of chief industries will be found in the Appendix, page 120. Water Supply—Main drainage and Sewage Disposal.—As the water supply of the Metropolis is under the control and management of the Metropolitan Water Board, and as the Main Drainage and Sewage Disposal are under the jurisdiction of the London County Council, these subjects are not specially dealt with in this report. Population and Density.—The population of the Borough at the middle of the year 1919 is estimated by the Registrar-General to number:— For death-rate 216,736 For birth-rate 225,774 This gives a density of population for the whole Borough of 66.0 persons per acre, varying from 49.1 persons per acre in the Northern Sub-district to 94.6 persons per acre in the South-western 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 1919. North Central Southwest SouthEast Total for Hackney Total for London Estimated population 53,275 53,101 55,462 54,898 216,736 4,358,309 Area in square acres . 1,081 857 586 764 3,288 74,816 Density, persons per acre 491 61.9 94.6 72.0 66.0 58.2 *Marriages and Marriage-rates.—During 1919 there were 2,571 marriages solemnised in the Borough of Hackney. The annual *I have here to acknowledge my indebtedness to Mr. H. Brougham Loney, Superintendent Registrar, who has kindly abstracted the number of marriages for the year 1919. 13 rate for persons married during this period is therefore 22.8 per 1,000 of the population. The following table gives the number of marriages and marriagerates for the Borough of Hackney and London during the 10 years, 1909-1919:— Year. Borough of Hackney. London. Marriages. Marriage rate. Marriage rate. 1909 2,036 17.2 15.8 1910 1,700 14.3 16.0 1911 1,919 17.2 17.8 1912 1,967 17.6 18.6 1913 1,941 17.4 16.1 1914 1,970 17.6 19.2 1915 2,723 25.0 25.8 1916 2,206 21.0 20.3 1917 1,962 18.0 18.5 1918 2,011 18.3 21.0 Average, 1909-1918 2,043 18.3 18.9 1919 2,571 22.8 23.0 Births and Birth-rate.—The births registered in the Borough of Hackney during the year 1919 numbered 4,748, of which 2,456 were male and 2,292 females. The total shows an increase of 920 compared with the numbered registered during 1918; but of these a certain number must be transferred to other districts, and certain births, which occurred in out-lying districts, must be transferred to Hackney in order to get an accurate birth-rate for the Borough. The Registrar-General has supplied the number of these transferable births, viz., 811 births to be transferred to other districts and 204 to Hackney. After these necessary corrections have been made, the correct total of registered births amongst Hackney residents is 4,141. From this figure the birth-rate for Hackney during 1919 has been calculated to be 18.6 per 1,000 of the population. The birth-rate for all London for the same period is 18.3 per 1,000 of the population. 14 Notification of Births Act, 1907.—Under the provisions of this Act 5,155 notifications of births were received during 1919. This total includes notifications from medical practitioners, midwives, parents and others. It also includes still-births. The total is 407 more than the number registered by the Registrar of Births. Still-Births.—Amongst the births notified 123 were still-born. This is equal to 2.3 per cent. of those notified. A table is here given showing the number of notifications received, with other details in connection with the same. NOTIFICATION OF BIRTHS ACT, 1907. Notifications of Births (Live and Still-born) received during the year 1919. Year 1919. 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. 578 522 16 15 1,679 1,554 49 31 390 309 6 6 2,647 2,385 71 52 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1919 was 596; but of these, the Registrar-General states that 448 should be transferred to districts outside the Borough, as the mothers were not Hackney residents, and 34 births which took place in other districts, should be transferred to Hackney. These corrections having been made, there remain 182 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate birth-rate of 43.9 per 1,000 births. 15 The following table gives the number of registered births, birth-rates, etc., for the Sub-districts in the Borough:— Registration District of Hackney Registration Sub-district All London North Central Southwest SouthEast Total No. of births 4,748 734 1,870 960 1,184 85,152 Rate per 1,000 living 21.0 13.2 33.9 16.5 20.6 18.3 No of illegitimate births 182 — — — — — Rate per 1,000 births 43.9 — — — — — It will be noticed that the birth-rate is abnormally high in the Central District compared with other Registration Sub-districts. This is accounted for by reason of 1,075 births occurring during the year at the Salvation Army Mothers' Hospital, which Institution is situate in the Central District. Of this number 734 births are transferable to districts outside Hackney. The following table shows the birth-rates for the Borough and its Sub-districts during the years 1909-1919 inclusive:— Birth-rate for the Borough of Hackney and its Sub-districts for the years 1909-1919 compared with that of London. Year Borough of Hackney North SubDistrict Central SubDistrict South-West SubDistrict South-East SubDistrict London 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 1914 25.5 18.0 32.5 24.4 27.1 24.3 1915 23.0 17.0 28.7 22.3 23.3 22.6 1916 23.9 16.9 32.5 21.6 24.5 23.0 1917 18.9 12.4 29.7 15.4 18.0 17.5 1918 17.2 9.5 30.7 12.7 15.8 16.1 Average 1909-1918 23.0 16.6 27.5 23.9 23.4 22.5 1919 21.0 13.2 33.9 16.5 20.6 18.3 *The Salvation Army's Mothers' Hospital was opened in 1913. 16 Deaths.—The deaths registered in the Borough during 1919 numbered 2,990; but of these 673 were deaths of non-residents who died inside the Borough. There were, however, 530 residents of Hackney who died during the year outside the Borough. On making the necessary corrections, the corrected number of deaths amongst Hackney residents is 2,847. This is a decrease of 861 upon the number of deaths occurring during 1918. The general death-rate from all causes for the year 1919 is 13.0 per 1,000 of the population. Amongst the Registration Sub-districts the death-rate was lowest in the Central Sub-districts (10.9 per 1,000), and highest in the South-west Sub-district (14.2 per 1,000). Subdistrict. Population (estimated). No. of Births. Birthrate. Total Deaths. Deathrate. Deaths under 1 year. Infant Mortality per 1,000 Births. Birthrate. Deathrate. North 55,275 53,275 734 13.2 706 13.2 67 91 Central 55,101 53,101 1,870 33.9 581 10.9 85 45 South - west 58,009 55,462 960 16.5 789 14.2 80 83 South - east 57,389 54,898 1,184 20.3 771 14.0 123 104 All Hackney 225,774 210,736 4,748 21.0 2,847 13.0 355 75 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. 1910 12.3 13.3 1915 14.9 16.1 1911 15.0 15.8 1916 13.8 14.3 1912 12.3 13.6 1917 14.6 15.0 1913 13.7 14.2 1918 18.9 18.9 1914 13.9 14.4 1919 13.0 13.4 17 The relative position from a health point of view occupied by Hackney as compared with other Metropolitan Boroughs may be seen from the following table, compiled from figures supplied by the Registrar-General, showing the death-rates from all causes and the death-rates of infants under 1 year of age for the year 1919:— Boroughs. Death-rate from all causes per 1,000 Living. Deaths under 1 year to 1,000 Births. Hampstead 11.2 81 Wandsworth 11.2 72 Lewisham 11.4 60 Fulham 12.1 83 Woolwich 12.2 85 Hammersmith 12.6 99 Camberwell 12.7 73 Battersea 12.7 73 Stoke Newington 12.7 64 Deptford 12.8 85 HACKNEY 13.0 85 Paddington 13.0 92 St. Pancras 13.2 86 Greenwich 13.5 92 Bermondsey 13.7 92 Bethnal Green 13.9 84 City of Westminster 13.9 89 City of London 14.0 105 Islington 14.1 86 Poplar 14.4 83 Stepney 14.4 79 Chelsea 14.6 80 Lambeth 14.6 85 Kensington 14.9 102 Southwark 14.9 95 St. Marylebone 15.2 89 Finsbury 15.2 86 Shoreditch 15.7 104 Holborn 16.2 94 Infantile Mortality.—The deaths under 1 year of age in the Borough during 1919 numbered 355. This is a decrease of 10 upon the number of infants' deaths recorded during 1918. The infant mortality rate for the year is 85 per 1,000 births. B 18 The causes of death are set out in the following table:— INFANT MORTALITY. 1919. 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 ... ... ... ... ... ... 1 1 ... 2 Measles ... ... ... ... ... 1 1 ... 1 3 Scarlet Fever ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... 2 1 ... 5 8 Diphtheria and Croup ... ... ... ... ... 1 ... 1 ... 2 Erysipelas ... ... 1 ... 1 1 ... ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... 1 1 2 Other Tuberculous Diseases ... ... ... ... ... ... 3 1 1 5 Meningitis (not Tuberculous) ... ... ... ... ... 1 1 ... 1 3 Convulsions 4 3 4 3 14 2 3 1 2 22 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 2 2 7 5 6 3 23 Pneumonia (all forms) 1 2 ... ... 3 8 13 12 8 44 Diarrhœa ... ... ... ... ... ... 3 1 ... 4 Enteritis ... ... ... 1 1 10 6 4 6 27 Gastritis 1 ... ... ... 1 2 1 1 1 6 Syphilis ... ... 1 1 2 6 2 ... 1 11 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... 1 ... l 1 2 ... ... 4 Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 8 3 3 1 15 ... 3 ... ... 18 Congenital Malformations 3 1 1 ... 5 2 3 ... 2 12 Premature Birth 53 5 6 5 69 5 4 1 ... 79 Atrophy, Debility and Marasmus 1 4 2 ... 7 12 16 4 4 43 Other Causes 7 5 3 1 16 6 3 1 4 30 Total 81 23 22 14 140 67 71 36 41 355 Senile Mortality.—The deaths which occurred in Hackney at 65 years of age and upwards during 1919 numbered 1,017, and of these 496 were between the ages of 65 and 75 years, 400 between 75 and 85 years, and 121 at 85 and upwards. The annual mortality rate of persons at 65 years and upwards is 4.6 per 1,000 inhabitants. 19 Deaths in Public Institutions.—There were 1,521 deaths in public institutions in the Borough during 1919; of these 673 were residents of other districts, and the remaining 848 were residents of Hackney. The following lists give the names of the institutions within the Borough receiving persons from both within 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 1919:— Institutions within the Borough receiving persons both from and without the Borough. Brooke House, Upper Clapton Road 18 City of London Infirmary, Clifden Road 48 Eastern Fever Hospital, Homerton 174 French Hospital, Victoria Park Road 3 German Hospital, Dalston 132 Hackney Union Infirmary, Homerton 827 „ „ Workhouse, Homerton 10 Metropolitan Hospital, Kingsland 155 Nursing Home, 46, Amhurst Park 8 „ ,, 286, Amhurst Road 1 „ ,, 47, Nightingale Road 3 „ „ 2, Queensdown Road 3 „ „ 18 and 20, Southwold Road 7 „ „ 75, Stamford Hill 1 St. Joseph's Hospice, Marc Street 70 Salvation Army Nursing Home, 29, Devonshire Road 2 ,, „ 4, Clapton Common 7 Salvation Army Maternity Hospital, Lower Clapton Road 44 ,, Homes, Springfield 8 1,521 b 2 20 With respect to medical relief provided by the Guardians, the Clerk to the Guardians has been kind enough to give the following information:— "The Guardians possess a well equipped Infirmary, where the patients treated are to a large extent suffering from acute as distinct from chronic complaints. The number of patients varies from 500 to 600 in the summer to 800 in the winter. "The amount of out-door medical relief in recent years has diminished considerably, but the indoor admissions have increased. The Guardians are at the present time administering out-door relief in money and kind at the rate of about £13,250 per annum. There is very little relief to able-bodied; the recipients are aged, infirm, and widows with children. "The admissions to the Infirmary include many ordinarily able-bodied but temporarily disabled persons." Institutions outside the Borough receiving sick and infirm persons from the Borough. Banstead Mental Hospital 8 Bethnal House Asylum 1 Bethnal Green Infirmary 2 Brompton Hospital 1 Cane Hill Asylum 2 Caterham Asylum 5 Cancer Hospital, Chelsea 1 Central London Throat and Ear Hospital 1 Charing Cross Hospital 3 Chelsea Hospital for Women 1 Children's Hospital, Great Ormond Street 11 City of London Lying-in-Hospital 3 Claybury Mental Hospital 51 Colney Hatch Mental Hospital 17 Dartford Heath Asylum 4 Downs Sanatorium, Sutton 1 Darenth Industrial Colony 3 Edmonton Infirmary 1 East London Hospital 1 Guy's Hospital 2 21 Hackney Workhouse, Brentwood 11 Homeopathic Hospital 2 Home and Hospital for Jewish Incurables, Tottenham 2 Hospital for Women, Soho 1 Hanwell Mental Hospital 5 Holborn Workhouse, Shoreditch 1 Leavesden Asylum 19 Long Grove Asylum 8 London Hospital 77 Middlesex Hospital 3 Northern Hospital, Winchmore Hill 1 North-Eastern Fever Hospital 15 National Hospital, Queen's Square 3 Northumberland House, Green Lanes 1 North-Western Fever Hospital 9 Park Hospital 4 Prince of Wales' General Hospital, Tottenham 9 Queen Charlotte's Hospital 3 Queen's Hospital for Children 51 Queen Mary's Hospital, Carshalton 3 Royal Chest Hospital, City Road 1 Royal Free Hospital 2 St. Bartholomew's Hospital 20 St. Luke's House, Kensington 5 Shoreditch Infirmary i South-Eastern Fever Hospital 5 Sick Asylum, Bromley 1 St. George's Home, Milman Street 2 Tooting Bee Mental Hospital 25 University College Hospital 3 Victoria Park Chest Hospital 13 Western Fever Hospital 2 Westminster Hospital 1 Whitechapel Infirmary 2 Miscellaneous Institutions 97 530 22 TABLE I.—HACKNEY BOROUGH. Vital Statistics of Whole District during 1919 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 Number. Rate. of Nonresidents registered in the District. of residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. N umber. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1.56 723 552 520 107 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 For Deaths, 195.804 For Births. 219,391 4,207 3,750 17.1 2,929 14.9 661 585 345 92 2,853 14.6 1918 3,828 3,266 14.8 3,836 19.5 820 692 365 111 3,708 18.9 For Deaths, 216,736 For Births. 225,774 1919 4,718 4,141 21. 0 2,990 13. 7 673 530 355 85 2,847 13.0 23 TABLE II.- HACKNEY BOROUGH. Cases of Infectious Disease Notified during the Year 1919. Notifiable Disease. Cases Notified in whole Districts. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 North. Central. South-East. South-West. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 669 8 184 384 61 30 2 ... 87 200 220 162 630 Erysipelas 110 1 2 7 10 31 46 13 18 24 42 26 34 Scarlet Fever 644 7 127 424 60 24 2 ... 183 148 156 157 535 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 22 ... 1 6 4 8 3 ... 7 5 6 4 15 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever 2 ... ... ... ... 1 1 ... ... 1 1 ... ... Puerperal Fever 16 ... ... 1 4 11 ... ... 3 7 3 3 8 Cerebro-Spinal Meningitis 7 1 2 2 ... 1 1 ... 3 ... 1 3 5 Polio Myelitis 6 ... 4 2 ... ... ... ... 1 1 4 ... 1 Ophthalmia Neonatorum 36 36 ... ... ... ... ... ... 5 6 13 12 20 Pulmonary Tuberculosis 483 ... 2 41 95 240 96 9 88 108 142 145 270 Other forms of Tuberculosis 143 2 13 84 27 10 6 1 33 28 39 43 40 Measles 452 13 173 256 7 2 1 ... 155 40 128 129 23 German Measles 103 4 22 67 2 7 1 ... 26 16 34 27 1 Encephalitis Lethargica 8 ... ... 2 1 2 3 ... 2 3 2 1 6 Influenzal Pneumonia 181 1 10 23 35 64 40 8 34 6 42 69 47 Pneumonia 67 6 11 10 5 18 14 3 11 12 22 22 7 Malaria 124 ... ... ... 28 92 4 ... 17 30 43 34 7 Dysentery 2 ... ... ... ... 2 ... ... ... 1 ... 1 ... Trench Fever 2 ... ... ... 1 1 ... ... ... 2 ... ... ... Totals 3,077 79 551 1,309 340 544 220 34 673 668 898 838 1,650 to TABLE III.—HACKNEY BOROUGH. Causes of, and Ages at, Death during the Year 1919. CAUSES OF DEATH. Deaths in whole Districts at Subjoined Ages. Deaths in Public Institutions. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 3 ... ... 1 ... 1 ... 1 ... 5 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 6 3 1 ... 2 ... ... ... ... 8 Scarlet Fever 8 1 ... 3 3 1 ... ... ... 14 Whooping-cough 16 7 3 5 1 ... ... ... ... 9 Diphtheria and Croup 91 2 3 30 54 2 ... ... ... 131 Influenza 165 6 3 7 7 22 58 39 23 69 Erysipelas 12 2 2 1 ... ... 2 2 3 7 Dysentery 1 ... ... ... ... ... 1 ... ... ... Phthisis (Pulmonary Tuberculosis) 206 ... ... 1 4 37 88 68 8 94 Tuberculous Meningitis 13 1 1 3 5 3 ... ... ... 11 Other Tuberculous Diseases 52 8 1 1 9 5 17 8 3 26 Cancer, Malignant Disease 274 ... 1 1 1 2 31 129 109 166 Rheumatic Fever 3 ... ... ... 1 ... 1 ... 1 ... Meningitis 11 3 i 1 4 ... 1 ... 1 3 Organic Heart Disease 353 ... ... 2 7 15 33 97 199 199 Bronchitis 246 23 4 4 2 ... 10 52 151 31 Pneumonia (all forms) 193 38 17 17 10 5 25 44 37 94 Carried forward 1,653 94 37 77 110 93 267 440 535 867 25 TABLK III.—HACKNEY BOROUGH—continued. Causes of, and Ages at, Death during the Year 1919. 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. Brought forward 1,653 94 37 77 110 93 267 440 535 867 Other Diseases of Respiratory Organs 53 ... ... ... ... ... 7 20 26 33 Diarrhoea and Enteritis 43 34 5 2 ... ... ... ... 2 22 Appendicitis and Typhlitis 16 ... ... 1 3 4 4 2 2 7 Cirrhosis of Liver 9 1 ... ... ... ... 1 6 1 ... Alcoholism 1 ... ... ... ... ... 1 ... ... 1 Nephritis and Bright's Disease 120 ... ... ... 5 5 15 43 52 73 Puerperal Fever 5 ... ... ... ... 2 3 ... ... 5 Other Accidents and Diseases of Pregnancy and Parturition 5 ... ... ... ... 2 3 ... ... 6 Congenital Debility and Malformation, including Premature Birth 135 134 1 ... ... ... ... ... ... 47 Violent Deaths, excluding Suicide 71 2 1 11 8 3 11 19 16 58 Suicides 16 ... ... ... ... 9 4 7 3 1 Other Defined Diseases 698 87 7 12 18 11 48 140 375 388 Diseases ill-defined or unknown 22 3 1 ... 4 1 3 5 5 13 Totals 2,847 355 52 103 148 123 367 682 1,017 1,521 Sub-Entries (included in above figures)— Cerebro-Spinal Meningitis 8 1 1 1 2 ... 1 2 ... 11 Polio Myelitis ... ... ... ... ... ... ... ... 1 Encephalitis Lethargica 6 1 ... ... 9 1 1 1 ... 2 26 SPECIFIC INFECTIOUS DISEASE. During 1919 there were 2,470 cases of acute infectious disease compulsorily notified in the Borough, as set out in Table II.; of these 19 were found subsequently not to be suffering from any notifiable infectious disease, thus reducing the number of genuine cases to 2,451. This total shows a decrease of 509 upon those notified during 1918. The attack rate in respect of the acute notifiable infectious diseases for the year is 11.3 per 1,000 inhabitants. In addition there were 483 notifications received of pulmonary tuberculosis and 143 notifications of other forms of tuberculosis. The deaths from the chief zymotic diseases numbered 167. This is equivalent to a zymotic death-rate of 0.77 per 1,000 living in the Borough. NOTIFIABLE INFECTIOUS DISEASES. Small-pox.—There was not any notification of small-pox in the Borough during 1919. Vaccination.—For some comments on vaccination, and on this year's small pox epidemic in Glasgow, still current, see "Addendum" to the Appendix, p. 143, et seq. Scarlet Fever or Scarlatina.—The number of cases of scarlet fever notified during 1919 was 647, but of these three were found afterwards not to be suffering from this disease, thus the number of genuine cases was reduced to 644. This is an increase of 378 cases upon the number of genuine cases notified during 1918. The disease was normal during the first eight months of the year, and rose rapidly, after the school holidays, in September, and the incidence of the disease remained high during the remainder of the year. The Metropolitan Asylums Board were unable to provide immediate accommodation to patients owing to the prevalence of the disease in the whole of London, and to the limited accommodation at their disposal by reason of two of their largest institutions not having been vacated by the military authorities. (This is precisely what is happening again this current year, October, 1920.) 27 The attack rate for scarlet fever was 2.97 per 1,000 persons living. The number of cases removed to hospital during the year was 535. This is equal to 83 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. Number of cases of Scarlet Fever 183 148 157 156 Attack-rate per 1,000 living 3.4 2.7 2.8 2.8 It will be seen from the above that scarlet fever was most prevalent in the North Sub-district. The deaths from scarlet fever during 1919 numbered 8, which is equal to a case mortality of 1.24 per cent. attacked, and a scarlet fever death rate of 0.03 per 1,000 inhabitants. The mortality rate for London from scarlet fever during the same year was 0.06 per 1,000 inhabitants. Diphtheria and Membranous Croup.—There were 679 cases of diphtheria and 4 cases of menbranous croup notified during the year; but of these 14 cases of diphtheria were found subsequently not to be suffering from this disease, thus the total of genuine cases of diphtheritic disease was reduced to 669. This is an increase of 213 upon the number of genuine cases notified during 1918. The incidence of the disease was high at the beginning of the year and fell rapidly at the end of January, but rose somewhat above normal at the end of February and remained so until the end of May ; the disease was normal during the months of June, July and August, but rose rapidly after the school holidays and remained high during the remainder of the year. The Asylums Board were pressed for 28 modation during the last three months of the year for the same reasons as stated regarding the removal of cases of scarlet fever, but it is very gratifying to record that the Board provided accommodation in nearly every instance of cases of a severe type when application was made from the office. Where cases could not be removed immediately the medical attendant was advised to adminster the maximum dose of anti-toxin in accordance with the recommendations contained in a memorandum circulated by the Asylums Board during the time of pressure. The attack rate for diphtheria was 3.08 per 1,000 inhabitants. There were 630 cases removed to hospital during the year. This is equal to 94 per cent. of the cases notified. The following table shows the distribution of diphtheria in the respective Sub-districts of the Borough :— Sub-districts. North. Central. South-west. South-east. Number of cases of Diphtheria and Membranous Croup 87 200 162 220 Attack-rate per 1,000 living 1.0 3.7 2.9 4.1 From the above it will be seen that diphtheritic disease was more acute in the Central and South-Eastern Sub-districts of the Borough than in the Northern and South-Western Sub-districts. The deaths from diphtheria and membranous croup during the year numbered 91. This mortality is equal to a death-rate of 13.6 per cent. attacked and 0.42 per 1,000 inhabitants. The death rate from diphtheria for London during the same period is 0.18 per 1,000 inhabitants. During the year 413 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically 29 examined, of which 64 gave positive results, 334 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, and issued as required to medical practitioners applying for it in cases of diphtheria or suspected cases of diphtheria amongst the poorer inhabitants of the Borough. During the year 44 bottles of anti-toxin of 2,000 units each were supplied to medical practitioners, most of which was used for prophylactic purposes. Typhoid or Enteric Fever.—During the year under consideration, 23 cases of enteric fever were notified, but of these 1 was subsequently found not to be suffering from this disease; thus, the number of genuine cases was reduced to 22. This shows an increase of 5 on the number of genuine cases notified during 1918. The attack rate was 0.1 per 1,000 inhabitants. Of the 22 cases notified, 15 were removed to hospital. This is equal to 68 per cent. of the total notified. 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. Number of cases of Typhoid Fever 7 5 4 6 The deaths from enteric fever in the Borough last year numbered 3. This is equal to a mortality rate of 13.6 per cent. attacked and .01 per 1,000 inhabitants. During 1919 specimens of blood from 24 persons suspected to be suffering from enteric fever were submitted to Widal's test. Of these, 2 gave a positive and 21 a negative reaction, and 1 was returned as doubtful. 30 The mortality from enteric fever for the same period in London was .01 per 1,000 inhabitants. Continued Fever.—Two cases of continued fever were notified during the year. Typhus Fever.—There was not any notification of typhus fever in the Borough during the year. Puerperal Fever.—There were 17 cases of puerperal fever notified during 1919; but of these 1 case was subsequently found not to be suffering from this disease, thus the number of genuine cases was reduced to 16. 8 cases were removed to hospital. The deaths from puerperal fever and septicaemia numbered 5. The attack-rate for the year was 3.8 per 1,000 births, and the deathrate 1.2 per 1,000 births. Plague.—There was not any plague in the Borough during the year. Erysipelas.—There were 110 cases of erysipelas notified during 1919. This is equal to an attack-rate of 0.5 per 1,000 inhabitants. Of the 110 cases notified, 34 were removed to hospital. The deaths from erysipelas numbered 12. This gives a mortality-rate of 10.9 per cent. attacked, and of .05 per 1,000 inhabitants. The following table shows the distribution of the disease in the Sub-districts of the Borough:— Sub-districts. North. Central. South-west. South-east. Number of cases of Erysipelas 18 24 26 42 Rate per 1,000 living .33 .45 .46 .76 31 Cerebro-spinal Meningitis.—During 1919 there were 7 cases of this disease notified in the Borough. Of these 5 were removed to hospital. All the cases notified were fatal. Polio-myelitis.—There were 6 cases of this disease notified during 1919. Of these 1 was removed to hospital. All the cases recovered with some impairment of one or other group of muscles. Ophthalmia Neonatorum.—There were 36 cases of this disease notified during the year. 20 of these were removed to hospital. All the cases recovered without any impairment of sight. Measles and German Measles.—There were 452 cases of measles and 103 of German measles notified during the year, of which 23 cases of measles and 1 case of German measles were removed to hospital. Only 6 deaths were recorded from this disease. The annual mortality is therefore .027 per 1,000 inhabitants, compared with London .08 per 1,000 inhabitants. In addition, information of 141 cases of measles and of 22 German measles was received from headmasters of elementary schools in the Borough. The Public Health (Measles and German Measles) Regulations, 1915, were withdrawn by Order in Council on 31st December, 1919. Encephalitis Lethargica.—The Public Health (Acute Encephalitis Lethargica and Acute Polio Encephalitis) Regulations, 1918, came into operation on 1st January, 1919. During the year 8 cases were notified, of which number 6 were fatal. The Ministry of Health and the London County Council were in the majority of cases supplied with full histories of the course of each patient's illness, but in several instances the medical practitioners in attendance on cases certified by them definitely refused to furnish the details desired upon the grounds that there was no statutory obligation cast upon them to do so and no fees 32 were paid to them for writing the reports. In view of the great importance of collecting as much information as possible relating to this obscure disease, the withholding of details as to symptoms, etc., is to be regretted; it ought to be obtained, and to be paid for. Pneumonia, Malaria, etc.—The Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919. These regulations, which were made by the Local Government Board, came into force on 1st March, 1919, and provide for the notification by medical practitioners of malaria, dysentery, trench fever, acute primary pneumonia and acute influenzal pneumonia. They contain provisions for the special treatment of patients suffering from these diseases, and in this connection memoranda were issued by the Board dealing with the nature of the diseases and the action authorised and advised. Pneumonia.—There were 181 cases of influenzal pneumonia and 67 of primary pneumonia notified. As provided in the Regulations, where the nursing was found to be inadequate a nurse was sent from the King's Home for Nurses in accordance with an arrangement made with the Superintendent at a fee of 1s. per visit, or where there were two or more cases in the house, l0d. per visit. During the year 969 visits were so made at a cost to the Council of £45 1s. 6d. Malaria.—The total number of cases of malaria certified was 124, all of which, it was ascertained upon enquiry, had been contracted out of England. Col. Sir Donald Ross., F.R.S., Consultant in Malaria to the War Office, and Lt.-Col. S. P. James, M.D., Medical Inspector and Adviser on Malaria to the Local Government Board, drew up a series of "Suggestions for the Care of Malaria Patients" for the information of medical practitioners, and copies of these "Suggestions" were supplied by the Public Health Department to medical practitioners who notified cases of the disease and who were desirous of obtaining expert information. 33 Dysentery.—There were 2 cases of dysentery certified, both being contracted abroad; 1 death was registered. Trench Fever.—2 cases of this disease were certified during the year. NON-NOTIFIABLE INFECTIOUS DISEASES. Influenza.—During 1919 there were 165 deaths in the Borough due to a continuation into the early part of the year of the epidemic of influenza, which prevailed during the latter portion of the preceding year. This is a decline of 533 on the deaths from this cause registered during 1918. The annual mortality rate from influenza is 0.75 per 1,000 inhabitants. PUBLIC HEALTH (INFLUENZA) REGULATIONS, 1918. In February, the attention of the Managers of the 12 cinema theatres in the Borough, was called to the Regulations which provide that places of public entertainment shall not carry on any entertainment continuously for more than four hours, after which there should be an interval of not less than 30 minutes during which the place of public entertainment shall be effectually and thoroughly ventilated. Several inspections took place and it was discovered that in most of these places of entertainment the Regulations were not strictly complied with. It was thought by some Managers that by stopping the performance for a certain time, and by opening the doors and windows without clearing the auditorium, the Regulation was observed. It was pointed out to them that by opening doors and windows, and sending a strong current of air through the Hall, the audience was chilled and rendered more susceptible to the disease; and, moreover, that, if any one of the audience happened to be suffering from the disease in its initial c 34 stage, such a procedure would in all probability cause severe complications which might have a fatal issue. In spite of these communications it was found necessary to prosecute the Proprietors of the following Cinema Theatres:— Hackney Electric Theatre, 2, Clarence Fined £2 2s. and Road £2 2s. costs. Kingsland Imperial Picture Theatre, 538, Fined £3 3s. and Kingsland Road. £2 2s. costs. Kingsland Imperial Cinema, 432, Kings- Fined £3 3s. and land Road. £2 2s. costs. Majestic Picture Palace, 36, High Street, Fined £3 3s. and Stoke Newington. £2 2s. costs. Diarrhœa.—There was a slight increase in the number of deaths due to diarrhœal disease in the Borough during 1919. The total number of deaths from this cause was 43, and of these 34 were under 1 year of age. The annual mortality for diarrhœa and enteritis during the year is 0.19 per 1,000 inhabitants. The distribution of this dsease in the Borough may be seen from the following table:— Sub-districts. North Central. South-west. South-east. No. of deaths from diarrhœa and enteritis 3 5 10 25 Whooping Cough.—The deaths from this cause during the year numbered 16. This is a decrease of 39 upon the number registered during 1918. No less than 15 of the deaths occurred in children under five years of age. The mortality for Hackney is equal to .07 per 1,000 inhabitants, and that for all London, .05 per 1,000 inhabitants. The number of cases removed to the Metro politan Asylums Board's Hospitals during the year was 4. 35 Information was received from the headmasters and headmistresses of Elementary Schools in Hackney of 227 cases of whooping cough occurring amongst their scholars during the year. CONSTITUTIONAL DISEASES. Tuberculosis.—During 1919, 626 primary notifications of tuberculosis were received, details of which are given on page 37 of this Report. Bacteriological examination of sputa from 325 cases was made by the Council's Bacteriologist during the same period. In 38 of these examinations the specific organism of the disease was discovered, and in the remainder the result was negative. The number of deaths from tuberculous disease in Hackney during 1919, was 271, a decrease of 100 upon the deaths during 1918. These deaths are classified as follows:— Tuberculous phthisis 206 Phthisis 13 General tuberculosis 13 Tuberculous meningitis 13 Tuberculous peritonitis 13 Tabes mesenterica 0 Tubercle of other organs 13 271 This number of deaths gives an annual mortality of 1.2 per 1,000 inhabitants. In the following table the yearly deaths from tuberculous disease in the Borough for the last 21 years are shown, grouped in periods of three years:— 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 1913-1915 360 25.4 1916-1918 363 24.8 1919 271 43.9 c 2 36 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 1919, being equal to 43.9. There is good reason to believe that the Borough Council's Tuberculosis Scheme is doing valuable work. The deaths are distributed in the sub-districts of the Borough as shown below:— Sub-districts. North. Central. South-West. South-East. No. of deaths from Tuberculous Disease 52 86 72 Mortality rate per 1,000 inhabitants .97 1.1 1.5 1.3 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Under these Regulations 870 notifications of tuberculosis were received during the year, of which 677 were pulmonary and 193 non-pulmonary notifications. 37 The following table gives the age and sex distribution of the notified cases:— Summary of Notifications during the period from the 29th December, 1918, to the 3rd January, 1920. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upward Total Primary 3. Notifications. Pulmonary Males — 1 7 9 13 27 67 52 36 28 5 245 298 „ Females — 1 1 12 31 24 78 43 21 11 4 226 278 Non-pulmonary Males — 4 20 11 8 5 2 3 5 — — 58 67 „ „ Females 2 8 9 16 10 4 4 1 1 - 1 56 68 Age-periods Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males — 5 1 6 8 17 144 „ Females — 3 3 6 6 27 92 Non-pulmonary Males — 14 2 16 17 8 2 „ „ Females 1 7 5 13 18 8 5 38 DISCHARGED TUBERCULOUS SOLDIERS AND SAILORS. Arrangements were made at the commencement of the year with the Ministry of Pensions for the home visiting and after care of discharged soldiers and sailors suffering from tuberculosis. An additional Tuberculosis Health Visitor was appointed, who, together with the two Tuberculosis Health Visitors already appointed, visited the homes of these patients, and became conversant with their surroundings, and advised them of any alterations which they deemed desirable in the sleeping accommodation, sanitary conditions, cleanliness, etc., and also encouraged them to carry out the instructions of the doctor in attendance, or the Tuberculosis Officer, as to their mode of living. During the year the number of discharged men visited was 266, and the total number of visits of this kind made was 763. The proportion of the number of visits of such cases to the total number of visits made by Tuberculosis Health Visitors to tuberculous cases in the Borough was as one is to six. Towards the end of the year the Ministry of Pensions asked that the Tuberculosis Medical Officers be allowed to examine cases of tuberculosis which appear before a Ministry of Pensions Medical Board, and about which an expert opinion is required, The Council resolved that the request be granted, and that they be allowed to serve as members of Ministry of Pensions Medical Boards, or to make expert reports to the Board on tuberculous patients, provided that their doing so would not interfere with their attendances at the Dispensaries. DENTAL TREATMENT OF UNINSURED ADULTS AND CHILD PATIENTS. The Council were informed that the London County Council, with the approval of the Ministry of Health, had extended its scheme for the treatment of persons in London suffering from 39 tuberculosis to the provision of dental treatment, and dentures, for uninsured adults and child patients under treatment at Dispensaries established by Metropolitan Borough Councils, such expenditure to rank for the grant payable by the Council under its Tuberculosis Scheme. These matters are always carefully attended to by the Tuberculosis Officers. They endeavour to see that all carious teeth are removed from patients awaiting sanatorium treatment. Children of school age suffering from enlarged tonsils and adenoids are usually referred to the school clinics or to the London Hospital, Metropolitan Hospital or Queen's Hospital for Children. No operations were performed at the City of London Chest Hospital, but a good many are performed at the Metropolitan Hospital. Arrangements could be made with the Managers of City of London Chest Hospital for dental treatment and operations, on payment of additional fees. Dentures are only provided for those who can pay for them. At the Metropolitan Hospital this is sometimes arranged by deferred payments approved by the Almoner. No additional expense upon the Tuberculosis Scheme was incurred on this account during the year. DAY SANATORIA (SCHOOLS) FOR TUBERCULOUS CHILDREN. Following upon the report of the late Medical Officer of Health on this subject (see Annual Report for 1918) arrangements were made by the London County Council for Stormont House, Downs Park Road, to be adapted for the accommodation of such children. This school was opened on 8th September, 1919, with one class, and arrangements were made by this Council, with the consent of the London County Council, for the attendance of Dr. Howell, Tuberculosis Officer at the Victoria Park Hospital Dispensary, for his attendance once a week at a remuneration of £50 per annum, for the medical supervision of the school, and also for the services of a nurse from the Dispensary for one-third of her time at a remuneration of £50 11s. 4d. per annum. 40 The number of children on the Register attending the School at the end of 1919, was 35. (The attendance is now, October, 1920, 73.) ACCOMMODATION FOR ADVANCED CASES OF TUBERCULOSIS. In May, 1919, I reported to the Public Health Committee on this question, as follows:— "Both for their own comfort and welfare, and, more especially in the interests of their relatives and friends, and of the community generally, I have for many years held the opinion that the segregation of patients suffering from advanced pulmonary tuberculosis is very desirable; it is, in fact, urgently required. "Enquiries have been made of the doctors who attend Infant Welfare Centres, who, I assumed, would be well acquainted with local conditions and requirements, and as a result I have been informed that a large proportion of those dying from the complaint have, as a last resource, resorted to the Union Infirmary. So long as possible, it seems, they remained at home; but, ultimately, they tire of home, or their people tire of nursing them, or are too poor to feed them adequately, and then only the Workhouse Infirmary remains for them. I think I may safely say that all the doctors attending the Welfare Centres are in favour of providing accommodation for advanced cases of the disease. Dr. Wilks especially favours such provision, and insists upon its being local accommodation so that there may be facilities for the visiting of patients by friends and relations. "Dr. Tylford Howell, Tuberculosis Officer of the Victoria Park Hospital Dispensary, strongly urges the necessity for such accommodation; and he as strongly urges that it should be provided locally, because patients in advanced stages would refuse to go to places far removed from their friends and relations. He points out that such cases are not suitable for admission to Sanatoria which exist for the cure of, or amelioration of the conditions affecting. 41 such patients as may be regarded as having a fair chance of cure, or, at least, of benefit, by suitable treatment. He knows of many cases which ought to be removed to some place where they could be made comfortable, and be properly attended to, and he has great difficulty in finding hospitals, or homes, which will receive the cases. "Dr. F. K. Moos, Tuberculosis Officer of the Metropolitan Hospital Dispensary, is in complete accord with Dr. Howell both as to the necessity of providing a home for advanced cases, and as to the desirability of such provision locally, rather than at some distant centre. He thinks that one might be provided at some local centre which might be sufficiently easy of access to the friends and relations of patients from the three Boroughs of Hackney, Stoke Newington and Bethnal Green; or that one might be associated with each of the two dispensaries, the one at Victoria Park Hospital, and the other at the Metropolitan Hospital. Speaking for his own district, he said that he could well do with 24 beds for advanced cases at the present time, and probably a like number, at least, would be required by Dr. Howell for his district; as a minimum some 50 beds should be provided in the first instance. He said that the conditions of some of the patients were very sad as they were quite unsuitably housed and fed. It need hardly be added that these cases are also a source of danger to their relations. '* Thus it is clear that the concensus of such medical opinion, largely that of experts in tuberculosis work, as I have been able to obtain, is very strongly in favour of provision for advanced cases of tuberculosis, and that provision on some local readily accessible site rather than at some large central institution for an extended area, situated, probably, at some distance from this district. I am in complete accord with the views expressed, and would strongly urge your Committee to take steps to arrange for the early provision of the required accommodation. 42 "If you agree, I would suggest that, as a first step, you instruct me, in concert with the Tuberculosis Officers, to enquire as to suitable buildings, or sites, to visit and inspect them, inquire as to rents, etc., accommodation, probable costs, etc., and all other points pertinent and to report to you at an early date. "I must, however, point out to your Committee that, at the conclusion of the letter from the County Council, dated 22nd March last, it is stated, in reply to an inquiry made by you:— 'It would be contrary to the principles upon which the Council's scheme is based to make a grant towards the capital cost of any institution of the character in question.' « "It is to be assumed, therefore, that, though the County Council will not contribute towards 'establishment charges' they might contribute towards 'maintenance charges' once the provision had been made and was actually ' in being.' "The figures given below will serve to show the urgency of this matter. TUBERCULOSIS Deaths of Hackney Inhabitants. Phthisis and Pulmonary Tuberculosis. Other forms of Tuberculosis. Totals. At Patient's Homes 111 47 158 At Hackney Infirmary 71 11 82 At other Institutions 73 112 255 97 352 "Thus, of the pulmonary cases, 255 in number, 144, more than half, died in institutions; and of these, practically half had to 43 resort to the Workhouse Infirmary at the last. There can hardly be doubt that many of the 111 who died at home lived and died in poverty, devoid of proper accommodation, of suitable and adequate supplies, and of efficient nursing; and that they were for long periods a source of danger to their own families and to other inmates of the houses in which they lived." In June, I reported further as follows "In accordance with your instructions, I have conferred with the Medical Officers of Health of the adjoining Boroughs of Bethnal Green (Dr. Bate) and Stoke Newington (Dr. Kenwood), also I have discussed the question with Dr. Menzies, representing the London County Council. "Dr. Menzies stated that the County Council is desirous of seeing every Borough in London provided with a "Home" where people in advanced stages of the disease should be housed and made comfortable. These places should be regarded as "Homes," not as hospitals, and they should be centrally situated in relation to the individual Boroughs served by them so as to be readily accessible to friends and relations who would desire to visit patients. The Council recognize the fact that a few large institutions, each centrally situated for a large group of Boroughs, would not meet the difficulty for the reason that people would not consent to be removed to any such distance from their homes as would make it difficult for their friends and relations to visit them. As to the expenses, although the London County Council would not contribute to the cost of establishing such a home, i.e., towards building one, or towards purchasing a house, they would contribute towards the cost of its subsequent maintenance. "If a house were rented, I understand Dr. Menzies to say that the rent might be regarded as part of the maintenance, and in that case the County Council could contribute to that also. On his 44 estimate he considered that at least 30 beds should be provided in the first instance. If at any time all the beds were not required by Hackney, spare beds might be utilised lor patients from other districts at agreed fees. "Dr. Bate, Medical Officer of Health of Bethnal Green, said that, if I would place a definite proposal before him, he would submit the matter to his Council and give it his support. "Dr. Kenwood, Medical Officer of Health of Stoke Newington, says that for years past he has advised his Committee, in his annual reports, that provision should be made to prevent those known to be suffering from tuberculosis from spreading infection. He is strongly in favour of providing homes for advanced cases, and brought the subject before his Committee at their last meeting. I have his permission to say that the members of the Committee regard the proposal to provide accommodation for advanced cases, unsuitable for sanatorium benefit, with sympathy; and that they will consider any proposal put before them by the Hackney Borough Council. I gathered from what Dr. Kenwood said, however, that he himself thinks it would be best for each Council to provide for its own district, chiefly because by so doing the homes would be more central for individual districts, and more easily accessible to the friends and relations, of patients." The position at the end of the year was that the London County Council proposed to provide large institutions in various parts of London. This proposal was not viewed by my Committee as being suitable for the reasons set out above, and a Resolution of the Committee was forwarded to the London County Council stating this Council propose to proceed with a scheme for a home for advanced cases of tuberculosis in the Borough in the near future in preference to the institutions proposed by the London County Council's scheme." 45 INTERIM TUBERCULOSIS CARE COMMITTEE. With respect to this subject, on July 11th, 1919, I reported as follows:— "The Local Government Board in a circular letter to Local Authorities, dated 29th April, 1915, indicated amongst other matters, the desirability of supplementing the work of tuberculosis dispensaries by the formation of Care Committees to keep in touch with patients who were under treatment at dispensaries, or who had undergone or might require, sanatorium treatment; the Committees were in fact to look after the general welfare and interests of patients, and to see that they did not suffer from lack of sufficient "food, change of air, clothing, better home conditions, more suitable occupation, etc., that may be needed to enable patients to benefit to the fullest extent from the treatment provided," and the Board urged that such Committees should be appointed. They pointed out that the work of such Committees should relate to the "whole community," not merely to insured patients, and proposed that the Committees should be formed of representatives from "Local Authorities, Boards of Guardians, Insurance Committees, and from all charitable and social work organisations in the district." Also, "Medical Officers of Health, and Tuberculosis Officers should be ex-officio members of the Committees, and School Medical Officers should also be included." "Schemes for the organising of Care Committees were to be submitted for the approval of the Board before final adoption, and the expenses were expected to be met mainly by voluntary contrib` utions, but the Council was empowered to provide from its funds expenses incurred in providing "secretarial and clerical assistance and office facilities (including stationery and postage), and to charge such expenses to the tuberculosis account." "Subsequently the London County Council took the matter up, and in June, 1915, published a scheme as a basis on which the Metropolitan Boroughs would form their Care Committees, which 46 scheme, however, was not adopted in view of the difficulties experienced by Borough Councils owing to circumstances arising out of the war, but in lieu thereof, an Interim Care Committee was set up by the County Council jointly for the Boroughs of Hackney and Stoke Newington which Interim Committee has continued in existence, and up to the present time has done very valuable work. It was suggested that the difficulties previously experienced have largely disappeared and the time has now arrived for permanent Care Committees to be appointed by the Borough Councils concerned. *The Council concurred in the suggestion and were of opinion that the existing Committee, of which all the members were willing to act, should be constituted the Tuberculosis Care Committee, subject to a proviso that representatives from the Borough Council should be added thereto. The Council communicated with the Borough Council of Stoke Newington who concurred in the suggestion. "From particulars which were obtained as to the approximate expenditure which would be involved in connection with secretarial and clerical assistance and office facilities, including stationery and postages, it was found that the amount, including remuneration for the part time services of the Organising Secretary and the whole time Assistant Secretary, stationery, postages, travelling expenses, rent, light and heating of office, would total to about £280 per annum, and such expenditure by the Councils concerned (subject to the approval of the Ministry of Health) could be charged to the Tuberculosis Account. The Council of the Borough of Stoke Newington agreed to share in the expenditure on a population basis and the proportion incurred by this Borough, being a charge on the Tuberculosis Account, would be repayable in the same proportion as the other expenditure for the same work, namely 50 per cent. by the Ministry of Health, and one-half of the remaining 50 per cent. by the London County Council. Taking an expenditure of £280 per 47 annum, £56 of this amount would be the share of Borough of Stoke Newington, and £224 the proportion for this Borough, of which amount £112 would be refunded by the Ministry of Health, and £56 by the London County Council, so that the net expenditure chargeable for the work to the Borough Council would amount to £56 per annum. This amount is, however, exclusive of Sanatorium treatment of patients, which has hitherto been defrayed by voluntary contributions." A joint Tuberculosis Care Committee has now been appointed for the Boroughs of Hackney and Stoke Newington, and the old Interim Committee now forms the Tuberculosis Care Committee with the addition of two representatives from each of the respective Borough Councils. The Committee is now authorised to incur an expenditure in the provision of secretarial and clerical assistance with office facilities, including postages, to an amount not exceeding £280 per annum, and this expenditure is apportioned according to the basis of population between the Borough Councils of Hackney and Stoke Newington. From the time the new Committee was formed until the end of the year 49 patients were sent to institutions under the London County Council's Tuberculosis Scheme, and 93 new patients were referred to them for consideration. The total number of cases on the Register at the end of the year was 253, all of whom are kept under constant supervision by the Secretary of the Committee. REPORTS OF TUBERCULOSIS OFFICERS. The report of the Tuberculosis Officer appointed by the Council for the Dispensary at the Metropolitan Hospital, submitted to the Committee of Management of that Hospital, and the report made by the Committee of Management of the Victoria Park Hospital on the work of the Dispensary attached thereto for the year 1919 are set out in the appendix (pages 125-137). 48 Cancer.—There were 274 deaths during 1919 due to the different varieties of malignant disease. This is an increase of 38 on the number registered during 1918. The annual mortality rate from malignant disease for last year is therefore 126 per 1,000 inhabitants. 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. 80 49 73 72 Mortality-rate per 1,000 inhabitants. 1.4 0.9 1.3 1.3 Below is given a table showing the number of deaths and death rates due to malignant disease in this Borough for the 10 years ending 1919:— Years. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 Borough of Hackney. Deaths from Cancer. 222 217 213 250 256 276 245 230 236 274 Death-rate per 1,000. .93 .97 .95 1.11 1.14 1.26 1.16 1.17 1.07 1.26 London Death-rate per 1,000. .94 l.05 1.11 1.10 1.13 1.16 1.18 1.25 1.26 1.20 ALCOHOLISM. During the year under consideration there was 1 death from acute alcoholic poisoning; there were also 9 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. 49 PUBLIC HEALTH (LONDON) ACT, 1891. (a) Complaints of nuisances.—During the year 1919 there were 3,361 complaints of nuisances made to the Public Health Department and investigated by the Sanitary Inspectors of the Borough. Defects or nuisances were discovered in 2,910 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 1,608. This is an increase of 261 upon the number inspected during 1918. Any nuisances or sanitary defects found were dealt with under the provisions of the above Act. (c) House-to-House Inspection.—The number of house-tohouse inspections made by the Inspectors during the year was 452. These inspections are in addition to those made under (a) and (b). The nuisafices 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 1919 was 4,780. The number of statutory notices served was 405; and summonses were issued in 60 cases. The following table sets out in detail inspections made by the several Sanitary Inspectors together with other information relative to their work :— D 50 51 INSPECTIONS BY SANITARY INSPECTORS, 1919. Mr. Ellis, No. 1 District. Mr. Harvey, No. 2 District. Mr. Vobe, No. 3 District. /*Mr. Bcw, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. Punter, No. 8 District. Mr. Goldsworthy, No. 9 District. Mr. Peverett, No. 10 District. Mr. Sadler, No. 11 District. Mr. Crook, No. 12 District. Mr. Hall, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. INSPECTIONS— (a) On Complaint— No. of premises inspected 196 204 378 300 94 363 362 271 190 441 111 223 190 - 38 - 3,361 No. of premises in which defects were discovered 183 195 318 222 66 346 294 235 178 349 108 204 179 - 33 - 2,910 No. of premises in which nuisances were abated 173 189 225 180 58 281 245 208 126 300 88 192 139 - 25 - 2,429 (b) House to House— No. of houses inspected 8 14 25 35 - 6 54 - 51 98 95 51 15 - - - 452 No. of houses in which nuisances were discovered 3 12 14 35 - 1 23 - 51 75 91 43 7 - - - 360 No. of houses in which nuisances were abated 3 12 12 25 - 1 28 - 48 74 69 38 7 - - - 317 (c) Houses after Infectious Disease- No. of houses inspected 115 123 112 162 65 171 142 114 164 152 63 97 128 - - - 1,608 No. of houses in which nuisances were discovered 23 74 36 64 21 58 39 18 147 47 42 44 79 - - - 692 No. of houses in which nuisances were abated 23 71 30 40 18 50 39 16 81 45 31 39 71 - - - 554 (d) Housing, Town Planning, etc. Act, 1909— No. of houses inspected - - - - - - - - - - - - - - - - - No. of houses in which defects were found - - - - - - - - - - - - - - - - - No. of houses in which defects were abated - - - - - - - - - - - - - - - - - Factories and Workshops— No. of inspections (other than laundries) 1 41 4 - 1 4 11 4 3 13 - 1 13 - 1,184 - 1,280 No. of inspections (Laundries) - - - - - - - - - - - - - - 20 - 20 No. of premises on which defects were discovered - 18 4 - 1 1 11 4 2 11 - 1 9 - 390 - 452 No. of premises on which defects were abated - 16 4 - 1 1 11 4 2 11 - 1 9 - 284 - 444 Outworkers— No. of inspections - - - - - - - - - - - - - - - 1,525 1,525 No. of premises on which defects were discovered - - - - - - - - - - - - - - - 378 378 No. of premises on which defects were abated - - - - - - - - - - - - - - 358 358 D 2 52 53 Mr. Ellis, No. 1 District. Mr. Harvey, No. 2 District. Mr. Vobe, No. 3 District. Mr. Bew, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. Punter, No. 8 District. Mr. Goldsworthy, No. 9 District. Mr. Pevcrett, No. 10 District. Mr. Sadler, No. 11 District. Mr. CrookNo. 12 District. Mr. Hall, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Inspections—con tinued. Bakehouses— No. on Register at end of 1918 8 14 9 10 12 10 6 7 13 7 2 — — — — 107 No. on Register at end of 1919 8 14 9 9 12 9 10 6 7 13 7 2 — — — — 106 No. of Inspections 8 14 9 8 7 9 20 12 14 26 14 4 9 — — — 154 No. of Notices 3 2 — — — — 1 3 2 7 10 — 6 — — — 34 No. of prosecutions — — — — — — — — — — — — — — — — — No. of Bakehouses above ground 7 8 4 5 4 1 4 S 5 11 7 61 No. of Bakehouses underground 1 6 5 4 8 8 6 1 2 2 _ 2 — — — — 45 Houses Let in Lodgings— No. on Register at end of 1918 — — 243 — — — 227 — — — — — 470 No. on Register at end of 1919 — — — — — — 243 — — 227 — — — — — 470 No. of Inspections — — — — — — — — — 8 — 2 — — — 10 No. of Notices — — — — — — — — — — 8 — 2 — — — 10 No. of prosecutions — — — — — — — — — — — — — — — — — Insanitary Houses Closed— No. closed under Public Health (London) Act, 1891 No. closed under Housing of Working Classes Act, 1890 — — — — — — — — — — — — — — — — — Verminous Premises— No. cleansed 2 15 3 13 3 2 28 6 55 48 7 3 — — — 27 212 Underground Rooms—Illegal occupation dealt with No. of rooms closed — — — — — — — — — — — — — — — — Places where Food Prepared for Sale (Restaurants, Coffee Shops), Etc.— No. on Register at end of 1918 3 5 14 5 12 14 10 4 14 12 — 4 — — — — 97 No. on Register at end of 1919 3 s 14 5 12 14 10 4 14 12 — 4 — — — 97 54 I 55 Mr. Ellis, No. 1 District. Mr. Harvey, No. 2 District. Mr. Vobe, No. 3 District. Mr. Bew, No. 4 District. Mr. Body, No. 5 District. Mr. High. No. 6 District. Mr. Shepprml, No. 7 District. Mr. Punter, No. 8 District. Mr. Goldsworthy, No. 9 District. Mr. Peverett, No. 10 District. Mr. Sadler, No. 11 District. Mr. Crook, No. 12 District. Mr. Hal', Special. i 1 Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. Total Inspections—continued— Places where Food Prepared for Sale (Restaurants Coffee No. of Inspections 3 — — — 12 14 — 4 14 12 — 4 — — — — 63 No. of Notices - - - - - 6 — 1 2 7 - - - - - - 16 Ice Crtam Premises— No. on Register at end of 1918 11 9 15 8 8 16 10 8 9 3 3 6 — — — — 106 No. on Register at end of 1919 21 14 33 8 12 16 20 13 16 9 3 12 — — — — 177 No. of Inspections 21 14 33 8 12 16 20 13 32 9 — 12 7 — — 197 No. of Notices — — — — — 1 — — — 3 — — 2 — — — 6 No. of Prosecutions - - - - - - - - - - - - - - - - - Tenement Houses— No. provided with additional water supply - - -—- - - - - - - - - - - - - - - Overcrowding— No. of houses overcrowded — 7 2 4 - 2 - 4 - 3 4 - 3 - - 8 39 No. remedied — 3 2 2 — 2 — 4 — 3 — — 3 — — 6 25 No. of prosecutions - - - - - - - - - - - - - - - - - Dairies, Cowsheds and Milkshops Order— No. of Cowsheds inspected - - - - - - - - - - - - - 110 - - 110 No. of Diaries inspected - - - - - - - - - - - - - 1,168 - - 1,168 No. of nuisances found — — - - - - - - - - - - - 2 - - 2 No. of nuisances abated — - — - - - - - - - - - - 1 1 Slaughterhouses— No. of Inspections - - - - - - - - - - - - - 278 - - 278 No. of nuisances found — — - - - - - - - - - - - - - - - No. of nuisances abated - - - - - - - - - - - - - - - - - 56 57 Mr. Ellis, No. 1 District. Mr. Harvey, No. 2 District. Mr. Vobe, No. 3 District. Mr. Bew, No. 4 District. Mr. Body, No. 5 District. Mr. High , No. 6 District. Mr. Sheppard, No. 7 District. Mr. Punter, No. 8 District. Mr. Goldsworthy, No. 9 District. Mr. Peverett, No. 10 District. Mr. Sadler, No. 11 District. Mr. Crook, No. 12 District. Mr. Hall, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Port lock, Specia. TOTAL. Inspections—continued— Mews and Stables — 6 2 — — l — 1 3 4 14 - - - - - 31 Fishmongers' and Poulterers' Yards — 2 - - - - - - 2 1 — — — - — — 5 Greengrocers' Yards — 3 — - — - — 1 3 — — — — — — — 7 Schools — — — 3 — - — 1 — — — — — — — 4 Urinals 9 4 12 — 25 5 7 12 4 12 6 3 3 — — - 102 Canal Boats - - - - - - - - - - - 14 — — — - 14 Visits to Waterways - - - - - - - - - - - 33 — — — - 33 Animals improperly kept - 3 — 3 — — — 4 2 3 — 2 7 — — 9 33 Offensive Trades - - - - - - - - - - - - - - - - 3 New Buildings - - - - - - - - - - - - - - - - - Floodings 40 - - - - - - - - - - 94 — — — 134 Special Inspections 19 73 297 159 51 57 . — 14 — 366 55 75 159 410 — — 1,735 No. of Re-inspections (all forms of Inspection) 1,426 2,483 1,849 1,870 460 1,781 1,825 1,879 1,442 2,144 1,213 1,477 1,533 - 1,023 805 23,212 No. of nuisances abated (all forms of Inspection) 206 290 278 297 79 344 330 248 264 450 225 270 213 — 309 358 4,161 No. of nuisances outstanding (all forms of Inspection) 10 27 75 98 20 73 49 29 121 150 61 22 56 — 114 22 927 Total number of Intimation Notices served (all forms of Inspection) 215 237 354 395 85 417 379 277 382 508 286 292 284 — 385 284 4,780 No. of Statutory Notices served 8 3 55 32 10 44 17 15 50 57 4 16 38 — 56 — 405 Proceedings before Magistrate under Public Health Act — 3 8 2 7 4 5 2 10 3 — 8 1 7 — 60 Food Adulteration— Samples collected for analysis 60 60 60 72 30 66 78 60 60 74 54 84 67 65 12 — 902 Proceedings taken before Magistrate 2 — 3 2 4 6 2 6 7 2 2 2 4 7 — 49 58 ARTICLES OF FOOD SEIZED OR SURRENDERED AS UNFIT FOR FOOD. During the year the following articles of food were seized by the inspectors, with the exception of Mr. Bobbitt (Food Inspector), or surrendered to them as being unfit for food, viz., Fish, 3 cwts., Meat, 23¼ cwts. (of which 9 cwts. was condemned for tuberculosis) and 34 cwts. of fruit and vegetables. REPORT OF FOOD INSPECTOR. See Appendix—page 120. REPORT OF CANAL BOATS INSPECTOR. See Appendix—page 124. SANITARY CONDITION OF NISBET STREET. Owing to certain assertions which were made by the Rev. A. H. Dacombe, St. Barnabas Vicarage, Homerton, regarding the condition of the houses in this street, the late Medical Officer submitted a special report upon the inspections made. (See Appendix, page 138.) WATER SUPPLY. Two samples of water were obtained from the public service during the year for analysis, and the Public Analyst reported as follows :— "Sample from Upper Clapton.—The organic contents are higher than they should be for the time of the year and require explanation. Sample from South Hackney.—The organic figures in this water are somewhat higher than one would expect, but the variation for the time of the year is not serious." The attention of the Metropolitan Water Board was called to these reports and they replied that, with regard to the sample taken 59 from premises in Upper Clapton, the Board's analysis showed that the quality of water supplied to consumers generally in that district during the month of April was much better than is shown by the Public Analyst, and that Sir Alexander Houston, the Board's Director of Water Examination, suggested that some local disturbance must have occured for the Analyst's results ; further, that the bacteriological results of the supply to this district for the month of April were excellent. The Water Board regard the sample from South Hackney as not seriously contaminated. LONDON (NOTIFICATION OF GLANDERS) ORDER, 1907. One notification of glanders in animals in the Borough was received from the Veterinary Inspectors of the London County Council during 1919. HOUSING OF THE WORKING CLASSES ACTS, 1890-1903. No representation was made nor was any action taken under the above-named Acts during the year 1919. HOUSING, TOWN PLANNING, &C., ACT, 1909. Closing Orders—1 to 8, Retreat Place; 4 to 16, and 38 to 64, Spring Lane ; 20 to 42, and 57 to 91, Middlesex Wharf. Following upon the report of the late Medical Officer, as set out in the Annual Report for 1918, adopted by the Council in July, 1918, recommending them to make closing orders for these cottages by reason of their being flooded when the River Lee from various causes periodically overflows its banks, and the spreading waters seriously affect and damage the houses, and suggesting that they be not used for human habitation until in the judgment of the Council they should be rendered fit for that purpose, the matter subsequently came to public notice by reason of the report. A protest was received from 19 tenants of houses in Middlesex 60 Wharf and a further protest from l6 tenants living in Spring Lane against the closing orders, requesting the orders be rescinded on various grounds. A protest was also received from the Solicitors to the ground landlords against the closing of the houses in Middlesex Wharf. The various letters and representations were considered by the Public Health Committee, and it was resolved that as long a time as possible be accorded to the occupiers of the houses in question to give up possession. Certain difficulties were afterwards encountered in ascertaining the names of the owners of the properties affected, but before the end of 1918, all the notices were served upon the owners and occupiers. The owners, however, of the houses 20 to 42, and 57 to 91, Middlesex Wharf, and 10 to 16, Spring Lane, considered themselves injured and aggrieved by the proposal to close these premises, maintaining that they were not so dangerous or injurious to health as to be unfit for human occupation, and notices of appeal were given respectively by them to the Local Government Board within the period of fourteen days prescribed by sub-section (3) of the Act. The Local Government Board thereupon directed a public enquiry into the subject, and W. H. Collin, Esq. was appointed to hold the enquiry at the Town Hall, Hackney, on 14th April, 1919. On behalf of the Council, it was pointed out to the Inspector of the Local Government Board at the enquiry that the houses were within an area which from time to time became flooded by the overflow of the River Lea, and sometimes for several weeks the lower parts of the houses were flooded or affected by dampness to a height of several feet from the ground. When the floods subsided, slimy deposit was left behind on and under the floors, and in many cases the furniture in the lower rooms was much affected 61 by this muddy deposit; the walls remained damp and otherwise affected for long periods. It was considered by the Council that, where dampness was present, the atmospheric conditions were also adversely affected, and the slimy and insanitary deposits left after these floods caused the accumulation of impurities, and combined to make the places unhealthy apart from other dangers of disease being present; and it was obvious, therefore that persons living in such conditions must be more subject to neuralgia, rheumatism and malarial diseases than persons living under ordinary conditions; but it was somewhat remarkable to record that, despite the disadvantages to which the inhabitants were subject, they were generally not abnormally unhealthy, and many of the tenants had resided in these houses for a great number of years. It was believed that many of the tenants continued to live there because they had done so for so many years, and in their approaching old age, felt disinclined to alter their habits of life. On the other hand, new tenants are believed not to stop long enough to experience more than one flood ; they then make their escape to more healthy and comfortable surroundings. It was also explained to the Inspector that the houses were very small and let at low rentals, but had considerably longer gardens than could be obtained at such rentals, or attached to similar accommodation, elsewhere in the neighbourhood. The Ministry of Health on 13th August informed the Council that they had considered the report of their Inspector and after careful consideration of the case had decided that the closing orders made in respect of certain of the houses should be quashed, but in the circumstances, did not make any order in regard to costs; also that they had informed the owners of 10 to 16, Spring Lane accordingly. With respect to the property in Middlesex Wharf, the Ministry had come to the conclusion that the condition of the houses justified the making of the closing orders, but understood that if the houses were closed, then the tenants would be unable to find other housing accommodation, and in order to avoid any 62 difficulty they proposed to defer giving their formal decision on the appeal for a period of one year, on the understanding that, if within that period any of the houses become vacant, they should not be relet. The Ministry, however, on 3rd September, modified the condition imposed so as to allow the reletting of any of the houses which might become vacant within the next year, provided that the period of tenancies was limited to 12 months from that date. These conditions were conveyed to the owners of the property in Middlesex Wharf by the Ministry. With regard to the houses in which the owners did not appear to the Local Government Board, viz., the cottages Nos. 40, 42, 44, 46, 48, 50, 52, 56, 58, 60, and 62, Spring Lane, these are now in course of reconstruction, involving concrete floors, damp-proof courses, vertical cementing to a height of 3 feet 6 inches on all external and internal walls and new concrete roofs. The owner of No. 38, Spring Lane, who resides on the property, has also promised to carry out similar work to his house. (No. 38, now completed, October, 1920.) In respect to the remaining houses the owners have not yet undertaken any alterations, but the Council have given permission for the occupants to remain until such time as the housing accommodation in the Borough is increased. It is gratifying to report that no further floods have occurred since the date of the appeal. HOUSE REFUSE COLLECTION. The refuse from houses in the Borough is collected weekly by Contractors using covered horse-drawn vans, and is destroyed at the Council's Destructor Works. With few exceptions all the houses in the Borough are provided with portable dust-bins. At the early part of the year the control of house refuse collection was transferred from the late Medical Officer of Health to the Borough Engineer and Surveyor. The quantity of house refuse removed during the year, and the cost of removal, are shown in the table which follows:— 63 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. 1919. January 1,579 19 1 21 730 19 0 1,791 6 0 14 773 14 4 3,371 5 2 7 1,504 13 4 February 1,269 18 1 14 578 19 9 1,696 1 0 14 726 16 0 2,965 19 2 0 1,305 15 9 March 2,934 9 1 0 855 12 7 2,717 12 0 21 998 16 4 5,652 1 1 21 1,854 8 11 April 1,974 12 1 7 799 10 7 2,299 6 1 14 1,011 1 2 4,273 18 2 21 1,810 11 9 May 1,519 10 2 14 914 9 1 1,793 1 2 0 1,023 14 11 3,312 12 0 14 1,938 4 0 June 1,118 0 2 21 633 8 0 1,311 5 1 14 716 9 0 2,429 6 0 7 1,349 17 0 July 1,146 6 I 7 662 8 3 1,422 0 1 0 796 11 0 2,568 6 2 7 1,458 19 3 August 935 7 1 0 613 11 3 1,190 2 2 7 751 6 10 2,125 9 3 7 1,364 18 1 September 1,153 17 0 21 689 1 8 1,375 1 2 14 800 5 4 2,528 18 3 7 1,489 7 0 October 1,451 7 1 7 825 13 7 1,736 3 3 7 972 12 7 3,187 11 0 14 1,798 6 2 November 1,789 3 3 7 992 18 4 1,049 7 0 14 1,069 17 4 3,738 10 3 21 2,062 15 8 December 1,957 8 0 14 1,054 9 7 2,152 9 0 14 1,216 19 9 4,109 17 1 0 2,271 9 4 Cost of extra Contractors 1,160 16 3 710 9 3 1,871 5 6 Totals 18,830 0 2 21 10,511 17 11 21,433 17 0 21 11,568 13 10 40,263 17 3 14 22,080 11 9 Of the foregoing total 737 tons 18 cwts. 1 qr. went to the Shoot. 64 In 24 factories the sanitary accommodation was defective, unsuitable or insufficient:— Nuisance. Found. Abated by Workshop Inspector. Abated by District Inspector. Outstanding. Unsuitable or defective w.c.'s 21 21 1 Insufficient w.c.'s 2 2 — — Not separate for sexes 2 2 — — * One outstanding from 1918 was abated, and one 1919 case is carried forward. Workshops.—The number of workshops registered in Hackney at the end of 1919, was 1,008, an increase of 21 on the number registered at the end of 1918. Of this total, 697 were workshops in which females were employed. Of these latter, 459 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, etc., 206 in which other articles were manufactured, etc., and 32 were domestic workshops. Amongst the workshops in which wearing apparel is manufactured, there were 306 in which females alone and 153 in which both males and females were employed. In workshops of other occupations, there were 118 in which females alone, and 88 in which both males and females were employed. Of the domestic workshops, females alone were employed in 19, and both males and females in 13. FACTORY AND WORKSHOP ACT, 1901, Factories.—During the year, 164 factories were inspected by the officers of the Public Health Department, 1 being a factorylaundry, and 163 factories in which articles of clothing, etc. were made and altered. 65 During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints—Factories 25 Complaints—Workshops 145 Notices- Workshops 104 Analysis of Occupations Carried on in the Registered Workshops of Hackney. (a) Wearing Apparel. Occupations. No. of Worksho . Occupations. No. of Workshops Artifical Flower Makers 8 Hats 10 Baby Linen 2 Infants' Millinery 8 Beading 1 Mantles 48 Belts 0 Millinery 34 Blouses 47 Needlework 0 Boot and Shoe Pinafores 0 turers 57 Shirts 1 Boot Machinists 111 Stays 8 Children's Costumes 8 Tailoring 76 Clerical Robes 1 Ties 27 Clothing 5 Trimmings 7 Collars 1 Underclothing 15 Dressmakers 62 Vests 7 Dressing and Tea Gowns 4 Waterproofs 4 Fancy Bows on Shoes 5 Fall Net Chenilling 0 618 Furriers 61 (b) Other Occupations. Bakers and Confectioners 36 Rubber Goods 5 Baskets 4 Toy Makers 7 Box Makers 19 Trunk and Bag Makers 10 Brush Makers 11 Umbrella Makers 2 Cabinet Makers 62 Upholsterers 12 Doll Manufacturers and Upholsterers' Trimmings 3 Dressers 9 Miscellaneous 115 Fancy Leather Goods 34 Laundries 40 390 Pianoforte Makers 21 E 66 During 1919, Miss Teebay, the Workshops Inspector, made 2,227 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections, 385 intimation and 56 statutory notices were served for the abatement of the nuisances found. Outworkers.—The number of outworkers on the register at the end of 1919 was 3,025, against 1,988 at the end of 1918. There were thus 1,037 outworkers added to the register during the past vear. The following analysis shows the trades followed by these outworkers:— Trade. No. of Outworkers. Trade. No. of Outworkers. Artificial Florist 94 Hosiery 11 Baby Linen 16 Ivory Workers 3 Belts 29 Lace Trimmed Goods 3 Blouses 270 Leather Goods 3 Boots and Shoes 560 Millinery 200 Boxes 273 Paper Bags 21 Braces 9 Pyjama Making 9 Brushes 263 Shirts 53 Children's Costumes 12 Shoe Bows 32 Clothiers and Outfitters. 107 Skirts and Mantles 208 Collars and Bibs 27 Tailoring 144 Confectionery Packing . 26 Ties 152 Corsets 1 Trimming 101 Dolls and Toys 94 Umbrellas 26 Dressing Gowns 17 Underclothing 56 Embriodery 21 Upholsterers' Trimmirings 14 Fancy Goods 16 Miscellaneous 52 Feather Curling 17 Fur Trade 71 3,025 Gloves 3 Hats 11 67 2,616 names and addresses of outworkers residing in Hackney and receiving work from other districts were forwarded by the local authorities concerned. On examination of the lists of outworkers sent in by employers in this Borough, addresses of 2,617 were found to be in other districts, and these names and addresses were forwarded to the local authorities of the respective districts. During the year 1919, Miss Portlock, the Inspector appointed for the inspection of Outworker's premises, made 1,525 inspections and 805 re-inspections. She also made 263 visits, without inspections, the outworkers having left the premises (21), or having given up home work (35), or being out at the time of visit (183), or owing to a wrong address being given (8), or the premises being workshops (16). Miss Portlock also discovered 6 new workshops and handed in their addresses for registration. During her visits of inspection she found 378 premises with sanitary defects. For the abatement of these she served 358 intimation notices. Of the 1,525 premises inspected, in only 29 was a room set apart entirely for the work. In the remainder, work was carried on in rooms used for other purposes, as under:— Workroom, bedroom, kitchen and living rooms 39 „ and living room 56 „ „ „ kitchen 37 „ and kitchen 1,165 „ „ bedroom 124 „ parlour 68 „ scullery 4 „ bath room 2 „ „ landing 1 „ provided separately 29 1,525 E 2 68 DISINFECTION. (a) Rooms.—During 1919, there were 2,093 rooms fumigated and 278 rooms cleansed in the Borough by the staff of the Public Health Department. In these totals are included disinfections after measles, whooping cough and tuberculosis, in addition to those in connection with the present notifiable infectious diseases. The number of rooms fumigated and cleansed each month is set out in the following table:— Number of rooms fumigated and cleansed each month during 1919. Month. Rooms fumigated Rooms cleansed. January 124 21 February 121 18 March 140 15 April 154 19 May 155 11 June 145 14 July 173 12 August 176 16 September 194 31 October 225 50 November 243 34 December 213 37 Total 2,093 278 (b) Articles of Clothing, Furniture, etc.—The number of articles under this head disinfected during last year was 13,129. This is an increase of 1,638 upon the number disinfected during 1918. A table is here given showing details of the articles disinfected each month. 69 Articles Disinfected, 1919. Description of Articles. January. February. March. April. May. June. July August. September. October. November. December. Total. House linen and furniture 838 868 933 1,016 988 670 862 337 740 1,201 1,316 1,036 10,805 Men's clothing 6 8 11 4 4 4 3 23 ... 6 3 I 73 Women's clothing 40 4 14 14 9 6 9 4 4 6 3 2 115 Children's clothing ... ... 1 ... ... ... ... ... 9 ... ... ... 10 Other articles 109 157 362 217 80 112 145 79 137 274 294 160 2,126 993 1,037 1,321 1,251 1,081 792 1,019 443 890 1,487 1,616 1,199 Total ... 13,129 70 Articles Disinfected, 1919. In addition to these, there were 107 articles destroyed on request from the owners. These are set out in the following table:— Articles Destroyed. Beds 15 Palliasses 8 Bolsters 4 Quilts 4 Blankets 3 Sheets 6 Mattresses 7 Sundry articles 43 Pillows 17 Total 107 (c) Public Library Books.—During the past year 219 books from homes in which infectious diseases had occurred were disinfected. 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. Month. Number. January 4 February 7 March 9 April 14 May 6 June 14 July 21 August 18 September 25 October 25 November 22 December 54 219 71 THE SHELTER. During the year there were six persons admitted to the Shelter whilst their homes were being disinfected. This total consisted of one man, two women and three children. The cost of maintenance of these persons admitted was only 12s. 6d. During the latter part of the year the Shelter was painted and redecorated. 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. The number of baths given during that period was 3,424. This total shows a-decrease of 794 upon the number given during 1918. Of the 3,424 baths given, 2,681 were sulphur baths for scabies, and 743 for pediculi. The great majority of those persons presenting themselves for baths were children from the elementary schools in the Borough. These children received 3,193 baths, a decrease of 772 upon the number given during 1918. The following are the Schools from which children were sent to the Cleansing Station, with the number of baths given :— Schools. Numbei Hot Baths. Cleansed. Sulphur Baths. Ballance Road, R.C. 7 — Benthal Road 1 61 Berkshire Road 52 144 Berger Road 27 89 Church Street — 80 College Lane — 48 Craven Park — 19 Dalston Central 5 9 Daubeney Road 104 65 Detmold Road 8 53 Carried forward 204 568 72 Schools. Number Cleansed. Hot Baths. Sulphur Bath- Brought forward 204 568 Enfield Road — 25 Gainsborough Road 21 33 Gayhurst Road 15 5 Glyn Road 58 75 Hackney Parochial 12 — High Street — 41 Holy Trinity 4 111 Homerton Row 55 181 Lamb Lane 3 — Lauriston Road — 6 London Fields - 6 Mandeville Street 154 261 Morning Lane 12 122 North wold Road 12 7 Orchard Street 11 9 Percy Road 2 23 Princess May Road — 54 Queen's Road 16 4 Rushmore Road 24 63 St. Jude's — 19 St. Paul's - 54 St. Michael's — 5 Shacklewell — 150 Sidney Road 123 28 Sigdon Road — 57 Tottenham Road — 90 Wilton Road 4 6o Other Schools 5 395 735 2,458 73 The following table fives 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. Men ... 2 1 1 1 ... ... ... ... 2 ... ... 7 Receiving Hot Baths Women ... ... ... ... ... ... ... ... 1 ... ... ... 1 Children 21 29 46 21 8 88 81 ... 70 148 185 38 735 Men ... 3 5 4 17 18 4 ... 4 22 20 12 109 Receiving Sulphur Baths, Women 12 9 13 9 12 14 8 9 5 7 12 4 114 Children 160 153 228 176 368 228 203 160 111 56 243 372 2458 74 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1904. During the year attention was drawn by the Medical Officer (Education) of the London County Council to 226 homes in the Borough from which children were attending school in a verminous condition, asking that steps be taken to deal with them under the above Act. These homes were inspected, with the following results :— the above Act. These homes were inspected, with the following results:— No. of Homes Inspected. No. of Homes where Rooms alone were found Verminous. No. of Homes where Bedding or Clothes and Rooms were found Verminous. No. of Homes not Verminous 226 3 6 217 The verminous bedding and clothing were taken to the disinfecting station and steamed, and the verminous rooms fumigated and, where necessary, notices were served upon the owners to cleanse and strip the rooms if vermin was afterwards found apparent. THE MORTUARY. The following tables give the number of bodies deposited in the Mortuary during the year, also the number of inquests held there, with the causes of death, etc. Number of bodies deposited in Mortuary 379 1. To await inquests—(a) Infectious — (b) Non-infectious 353 2. To await burial 26 Number of post-mortems made 117 75 INQUESTS. Verdicts. Sex. Male. Female. Natural causes 127 106 Accidental death 52 38 Suicide 11 1 Open Verdict 4 - Manslaughter 1 - Murder — Misadventure 1 - Totals 1 157 Table showing nature of above Suicidal and Accidental Deaths in the Borough of Hackney during the year 1919. Nature of Suicide. No. Nature of Accidental Death. No. Hanging 4 Shock from burns 7 Poisoning 6 Shock from fall 41 Cut throat 1 Concussion 1 Wound on arm 1 Suffocation in bed 6 Drowning 8 Drowning 2 Run over 1 Overdose of chloroform 1 Run over 12 Suffocation 4 Wound on finger 1 Caught in machinery 2 Accidental blow 1 Crushed 5 Shooting 1 Others 6 Total 21 Total 90 76 SALE OF FOOD AND DRUGS ACTS, 1875-1907. SAMPLES PURCHASED DURING 1919. Articles Purchased. Number Purchased. Number Adulterated. Number where Proceedings taken. Milk 576 32 21 Margarine 152 — 6 (exposed for sale unlabelled). 7 (served in plain w rapper). Coffee 26 1 — Cocoa 53 — — Butter 38 2 — Arrowroot 5 — — Cornflour 3 — — Custard Powder 9 — — Mustard 3 — — Pepper 3 — Baking Powder 9 — — Dripping 7 2 — Malt Vinegar 6 2 — Vinegar 6 — — Olive Oil 3 — — Lard 3 — — Totals 902 39 34 77 Prosecutions under the Public Health (London) Act, 1891, during the year 1919. Address. Complaint. Magistrate's Decision. Penalty. Costs. £ s. d. £ s. d. Obstructing Inspector in the execution of the Public Health Act. Fined 1 0 0 2 2 0 8, Prince Edward Road. General insanitary condition. Order to abate in 14 days. — 2 2 0 21, Church Crescent „ „ „ „ — 2 2 0 19, Nisbet Street „ „ Order to abate in 28 days. — 0 11 6 21, Nisbet Street „ „ „ „ — 0 11 6 37, Nisbet Street „ „ „ „ — 0 11 0 41, Nisbet Street „ „ „ „ — 0 11 6 256, Dalston L.ane Paving at side of house dilapidated. „ „ — 2 4 0 34, Nisbet Street General insanitary condition. Order to abate in 7 days. — — 38, Nisbet Street „ „ Order to abate in 28 days. — 1 12 6 44, Nisbet Street „ „ Order to abate in 21 days. — — 4b, Australian Av. „ „ Withdrawn. (Work done). — 1 11 6 5c, Australian Av. „ „ „ „ — 1 11 6 1, Clarence Place Order to abate in 1 11 6 „ „ 21 days. 3, Clarence Place Leaky roof „ „ — 1 11 6 4b, Culford Mews „ Order to abate in - 1 11 6 4c, Culford Mews „ 28 days. Withdrawn. 2 2 0 (Work done). 80a, Shacklewell Lane. Insufficient sanitary accommodation for women. Fined 5 0 0 2 2 0 17, Berger Road Roof and ceiling defective. Order to abate in 21 days. 1 11 6 19, Berger Road „ „ „ „ — 1 16 6 25, Ridley Road General insanitary condition. Withdrawn. (Work done). — 1 13 6 8, Ridley Road Roof leaky „ „ — 1 13 6 Carried forward 6 0 0 31 5 0 78 Prosecutions under The Public Health (London) Act, 1891, during the year 1919—continued,. Address. Complaint. Magistrate's Decision. Penalty. Costs. Brought forward £ s. d. £ s. d. 6 0 0 31 5 0 24, London Road Defective drain Order to abate in 14 days. — o 6 0 24, London Road Non-com pliancewith Magistrate's Order Fined 5 0 0 o 2 0 59, Oriel Road General insanitary condition. Withdrawn. (Work done). — 1 13 6 69, King Edward Road. Damp walls „ — 1 13 6 17, Berger Road Non-compliancewith Magistrates' Order Fined 2 0 0 1 14 6 19, Berger Road „ 2 0 0 1 14 6 169, Well Street General insanitary condition. Order to abate in 14 days. — 1 18 6 80a Shacklewell Lane. Non-compliancewith Magistrate's Order Withdrawn. (Necessary number of w.c.'s provided). - 10 10 e 207, Glyn Road ... Damp walls Order to abate in 14 days. — 2 2 0 66, Hertford Road General insanitary condition Withdrawn, (premises empty) — z 68, Hertford Road „ „ — — 0 5^a, Mare Street ... Insufficient sanitary accommodation for women. Withdrawn, (nuisance abated) - 5 5 0 117a, Tottenham Road. Leaky roof. Withdrawn. (Work done). — 2 2 0 54, Rodney Road... Soilpipe improperly ventilated. „ „ — 1 1 0 36, Spurs owe Road Roof d ;fective, rooms dirty. Order to abate in 14 days. — 1 1 0 175, Dalston Lane Rooms dirty Withdrawn. (Work done). — 1 13 i 50, Buckingham Road. Roof defective, wall damp, &c. Order to abate in 21 days. — 1 5 0 19, Brampton Road Walls damp Order to abate in 14 days. — 1 1 0 26, Lauriston Road Rooms dirty; dust bin dilapidated; w.c. defective. Withdrawn. (Work done). - I 13 6 48, Holmbrook St. No dust bin; rooms dirty; defective w.c. »> ?» - 1 3 0 36, Spur tow Road Non compliancewith Magistrate's Order Fined 0 12 0 1 1 0 Carried forward 15 12 0 74 5 6 79 Prosecutions under the Public Health (London) Act, 1891, during the year 1919 —continued. Address. Complaints. Magistrate's Decision. Penalty. Costs. £ s. d. £ s. d. Brought forward 15 12 0 74 5 6 19, Brampton Road Non-compliance with Magistrate's Order Fined 2 0 0 1 1 0 2, Durrington Road General insanitary condition. Order to abate in 7 days. — 1 1 0 53, Amhurst Road „ „ Order to abate in 14 days. — 0 10 6 53, Lower Clapton Road. 14 lbs. pears deposited for sale unfit for food. Fined 5 0 0 3 3 0 11, Hassett Road Dust bin defective Order to provide dust bin in 7 days — 1 15 6 3, Hassett Road General insanitary condition. Order to abate in 21 days. — 1 15 6 9, Hindrey Place Roof defective; rooms dirty. Order to abate in 14 days. — 1 15 6 15, Hindrey Place General insanitary condition. „ „ - 1 15 6 5, Clarence Cottages Roof and w.c. dirty „ „ — 1 15 6 16, Prince Edward Road. General insanitary condition. Withdrawn. (Work done). — 1 15 6 18, Prince Edward Road. „ „ „ „ - 1 15 6 22, Prince Edward Road. „ „ „ „ — 1 15 6 150, Lower Clapton Road Leaky roof Order to abate in 14 days. — 2 0 6 £22 12 0 £96 5 6 80 Prosecutions under the Sale of Food and Drugs Acts during the year 1919. No. of Sample. Article. Adulteration of Offence. Result of Legal Proceedings. Fine. Costs. £ s. d. £ s. d. 1r Milk 52.94% added water Fined 20 0 0 5 5 0 13r „ 10% fat abstracted „ 2 0 0 — 15r „ 40.67% „ „ 5 0 0 3 3 0 45r Margarine Exposed for sale unlabeled. „ 3 0 0 - 21r „ „ „ „ 2 0 0 — 21r „ Served in plain wrapper. „ 2 0 0 — 40r Milk 17.42% added water Dismissed. (Warranty proved.) — — 41 r „ 5.06% „ „ — — 128p „ Gave false warranty to milk vendor. Dismissed. (It being held that defendant had reason to believe that statements in warranty given were true.) - - 161p „ „ „ „ „ — — 95r „ 26.82% added water Dismissed. (Warranty proved.) — — 40r „ Gave false warranty to milk vendor. Adjourned, sine die. — — 41r „ „ „ Dismissed — — 155r Margarine Exposed for sale unlabelled. Fined 0 5 0 — 156r „ „ „ „ 0 5 0 — 199r Milk 5.8% fat abstracted Dismissed. (Warranty proved.) — — 230r Margarine Served in plain wrapper. Fined 3 0 0 — 15s Milk Served in improperly marked wrapper. „ 1 0 0 — 1s „ 5.53% added water Dismissed. (Warranty proved.) — — 3s „ 3.41% „ „ „ — — 224r „ 3.5% „ „ „ — — 95r „ Gave false warranty to milk vendor. Dismissed — — 199r „ „ „ „ „ — — 43s „ 23.4% fat abstracted Withdrawn. (Warranty proved.) — — 46s „ 4.36% added water „ „ — — Carried forward. 38 10 0 8 8 0 81 Prosecutions under the Sale of Food and Drugs Acts during the year 1919—continued. No. of Sample Article. Adulteration of Offence. Result of Legal Proceedings. Fine. Costs. £ s. d. £ s. d. Brought forward 38 10 0 8 8 0 73s Milk 4.24% added water Dismissed on pay ment of — 2 2 0 109s „ 25.42% „ Fined 10 0 0 5 5 0 154s „ 3.5% „ ,, — 2 2 0 1s „ Gave false warranty to milk vendor. Dismissed. — — 3s „ „ „ „ — — 224r „ „ „ „ — — 160s Margarine Served in plain wrapper. Dismissed on payment of — 0 5 0 176s Milk 3.65% added water „ „ — 3 3 0 46s „ Gave false warranty to milk vendor. Dismissed — — 43s „ „ „ Fined 20 0 0 3 3 0 251s „ 8.35% added water Dismissed (Warranty proved.) — — 273s „ 11.7% fat abstracted „ „ — — 45r „ 23.88% added water „ „ — — 251s „ Gave false warranty to milk vendor. Dismissed — — 273s „ „ „ „ „ — — 104r „ 9.29% added water Fined 5 0 0 1 0 0 97r Margarine Served in plain wrapper. „ 3 0 0 1 0 0 97r „ Exposed for sale unlabelled. „ 45r Milk Gave false warranty to milk vendor. Dismissed — — 127r Margarine Exposed for sale unlabelled. Fined 2 0 0 — 14v Milk 6% added water Dismissed under the Probation of Offenders' Act. - 1 11 6 19v Margarine Served in plain wrapper. Fined 0 5 0 — 85v „ „ „ „ „ 2 0 0 1 11 6 105v „ „ „ „ „ 2 0 0 1 11 6 £82 15 0 31 2 6 F 82 MATERNITY AND CHILD WELFARE. This important branch of the work of the Department was further developed during the year. In the first place the Maternity and Child Welfare Committee appointed by the Council at the end of 1918 had its first meeting in January, 1919, and is now a Standing Committee of the Council; some of the most important matters dealt with by this Committee are alluded to in the latter part of this report. The Ante-natal Welfare work which commenced in 1918 showed a much better attendance of patients during 1919, and the results achieved have been quite satisfactory, as shown by the reports of the Medical Officers of the Clinics. (See pages 91-98). The following table gives information relating to the Clinics :— Ante-natal Welfare Centres, 1919. Overbury Street Brooksby's Walk. Number of times Centre opened 26 25 Number of expectant mothers attending 177 110 Number of repeated attendances at Centre 200 81 Total attendances 377 191 Number of visits to expectant mothers at their homes by the Health Visitors :— Number of cases 192 70 Number of visits 248 70 These figures show an increase of 188 expectant mothers attending the two centres compared with the year 1918. The Maternity and Child Welfare Committee extended the scope of this work in entertaining applications for grants towards the maintenance of patients residing in the Hackney Borough receiving treatment at the Salvation Army Mother's Hospital, 83 Lower Clapton Road, and the City of London Maternity Hospital, City Road, and particulars of the accommodation and income of these institutions are here given :— (a) Salvation Army Mother's Hospital, Lower Clapton Road. The audited accounts which were submitted for examination for the year ended 31st December, 1918, show that the total cost for maintenance and administration amounted to £6,679 14s., the in-patients admitted during the year numbered 969, the average period each patient was resident was 25½ days, and the average cost of each in-patient during residence was £6 18s. 8d. The income during the same period from all sources, including payments by patients, grants from funds, entertainments and other sources, fell short of the expenditure by £1,620, which difference was met by a grant to balance the amount from the Salvation Army Women's Social Work Fund. The patients from the Hackney Borough dealt with at the hospital during the stated period numbered 263, comprising 248 married mothers and 15 unmarried mothers, and, on the basis of the average of £6 18s. 8d. per patient, the total expenditure in dealing with the 263 patients amounted to £1,823 9s. 4d., whilst the sums paid by the patients amounted to £993 8s., indicating that in connection with the treatment of Hackney patients, the expenses exceeded the contributions by the sum of £830 1s. 4d. Dealing further with the statistics appertaining to the patients from Hackney for the year ended 31st March, 1919, the Salvation Army informed the Committee that 28 patients were able to contribute sums in excess, 84 contributed more than 50 per cent., and 151 less than one-half the average cost of maintenance. The Maternity and Child Welfare Committee considered that the work carried on at this hospital clearly comes within the scope of maternity and child welfare work, producing important and far- f 2 84 reaching effects to the advantage of mothers and infants alike, and recommended the Borough Council to make a contribution towards the funds of the hospital in " necessitous cases," such term to mean, and be applicable to, cases from the Hackney Borough in which the patients might be unable to pay for treatment an amount equal to one-half the cost to the hospital authorities (on the year's figures, £3 9s. Id.), and that such contribution be one guinea in each case. The Ministry of Health consented to the recommendation of this Council, and an amount of £99 15s., representing 95 patients, has been paid by this Council for necessitous cases treated at this institution from 1st April, to 31st December, 1919. (b) City of London Maternity Hospital, City Road. The audited accounts foi the year ended 31st December, 1918, showed an expenditure on maintenance and administration of £7,881 13s. 6d., the number of beds available for patients, 61, and the average number of patients resident for the year 50-16. The expenditure for the year was £1,055 17s. Id. in excess of income. During the year in question 123 Hackney in-patients were admitted and treated, and from 1st January to 16th October, 1919, the number was 68. The average cost of each in-patient during 1918 was £2 18s. 11d. Of those who make payment the majority pay no more than 12s. 6d., a nominal amount payable by the mother out of the maternity benefit of 30s. receivable under the National Insurance Act, so that the hospital loses £2 6s. 5d. per case. At this hospital it appears that patients are at liberty, but are not required, to obtain subscriber's letters before admission, which entitles them to free treatment ; these letters are intended for bestowal upon deserving cases only. At the time the National Insurance Act was passed, the Hospital Committee considered the question of the fees to be charged where subscriber's letters were not provided, and taking into consideration the fact that the 85 majority of the patients arc very poor, and frequently embarrassed to meet the incidental expenses of their confinement, it was decided that a fee of 12s. 6d. only should be charged, except where upon inquiry it should appear that the patient could afford more ; great care is said to be taken in every case to fix a fee commensurate with the patient's means. From the 1st January to 31st December, 1919, the amount paid by 94 Hackney residents was £40 5s. 6d. The Maternity and Child Welfare Committee considered that the work carried on at this hospital also clearly comes within the scope of maternity and child welfare work producing important and far-reaching results to the advantage of mothers and infants alike, and therefore recommended the Council to make a contribution towards the funds of the hospital in " necessitous cases," such term to mean, and be applicable to, cases from the Hackney Borough in which the patients might be unable to pay for treatment an amount equal to one-half the cost to the hospital authorities (on the past year's figures, £2 18s. 11d.), and that a contribution of one guinea be granted in each case. The Ministry of Health has been asked to consent to the recommendation of this Council in the foregoing terms as from 1st April, 1920. Infant Centres. The year's work, both at the three municipal centres and the two voluntary centres has been exceptionally good, and the attendances have been greater than the Medical Officers and Health Visitors could properly deal with. As will be seen from the table below the weekly attendances at the Overbury Street and Brooksby's Walk centres averaged 70-76, with the result that the centres have had to remain open nearly twice as long as the scheduled time , steps are, however, now being taken to open a further Council centre so as to prevent the present overcrowding and diminish the work of the officers in attendance. 86 Summary of Infant Welfare Centre Work during the year, 1919. Centre. No. of times Centre open. No. of primary cases brought to Centre. Repeated visits to Centre. Total attendances Total attendances of Infants under 1 year. Total attendances of children over 1 year. 1. Overbury Street 52 437 3,244 3,681 2,472 1.209 2. Brooksby Walk 51 523 3,354 3,877 2,965 912 3. Mayfield Road 61 347 2,533 2,880 2,077 803 4.†*Hackney Mothers' and Babies', Hackney Grove. 50 431 2,044 2,475 1,250 1,225 5.*Eton Mission, Gainsborough Road. 96 206 2,425 2,631 1,729 902 Total 310 1,944 13,600 15,544 10,493 5,051 * These are Voluntary Centres and are co-ordinated with the Infant Welfare work in the Borough. The Hackney Mothers' and Babies' Welfare Centre receives an annual grant of £100 from the Council. † In addition this Centre was opened 52 times during the year for health talks, baby weighing, etc. Babies who attend on these occasions are babies who attend for consultations. The number who attended during the year was 2,461. The total attendances at all the centres exceeded those of 1918 by 5,368, those under one year of age by 2,616, while the number of children over one year was more than doubled in number. Home Visitation. The work of home visitation was considerably curtailed during the year owing to the large attendances of mothers at the centres, which required the services of more health visitors than hitherto, and consequently the work of home visitation was somewhat neglected. The Maternity and Child Welfare Committee realizing the great advance in the welfare work in the borough approached the 87 Ministry of Health for their consent to the appointment of three additional Health Visitors to the present staff of six. Consent having now been obtained it is expected that with these additions to the staff the work ot home visitation will not suffer in the future. The following table gives detailed results of the visits made during 1919 :— 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. 2,502 2,097 218 187 961 1,538 1,156 1,346 2,293 209 6,359 Foods and drugs, etc., as set out below, to the value of £1,938 7s. 7d. were supplied at cost price at the Municipal Welfare Centres during the year:— £ s. d. Glaxo 1,598 4 0 Cow and Gate 82 0 0 Mellin's Food 9 18 0 Virol 84 12 0 Sugar 2 4 0 Lactagol 28 3 3 Marylebone Cream 14 10 3 Petroleum Emulsion 23 15 3 Syrup. Ferri 17 13 8 Malt 1 5 6 Cod Liver Oil and Malt 23 5 0 Sundries 52 16 8 £1,938 7 7 88 In addition to the dried milk and drags, etc., sold articles, of the same character to the value of £218 11s. 3d. were supplied to mothers free of cost. Milk (Mothers and Children) Order, 1918. The provisions of this Order were extended in January to the Voluntary Infant Welfare Centres in the Borough, on the recommendation of the Medical Officers in attendance at the centres. This extension has been of great benefit to the mothers attending those centres as will be seen by the reports of the Medical Officers. Milk supplied free of cost to necessitous cases during the year involved the Council in an expenditure of £566 5s. 2d. Free supply of fresh and dried milk. Towards the end of the year it was found that the question of milk supply to expectant mothers, to nursing mothers, to infants, and to young children under school age, i.e., under five years of age, required serious consideration. The attendances of mothers and children at the Centres had very largely increased in number, and the demands for free milk, or milk at reduced rates, had become very numerous, so numerous, in fact, that at the five Centres controlled by the Council some 3,000 pints of milk per month were given away, and at a time when milk cost Is. per quart. In addition, some 1,400 lbs. of " Glaxo " and of " Cow and Gate " Dried milk were sold each month at the three Borough Council's Centres. This meant that at the then rate of distribution and cost, the rate of expenditure on fresh cow's milk supplied free was something like £900 per annum. Since a Hackney Borough Council's Centre was first instituted, it had been the custom to grant supplies of ordinary cow's milk free of any charge in instances in which upon inquiry it appeared that the means of a family were so small that there was difficulty in obtaining the necessary supplies, and thus all cow's milk as such 89 had been supplied free; no attempt had been made to regulate prices according to weekly incomes and the size of families. It was felt that the time had arrived when some effort should be made to establish a scheme by which reduced prices could be fixed in some proportion to the weekly income per head of the family, and the giving of milk free of cost could be confined strictly to such cases as were really necessitous. With regard to the sale of " Glaxo," etc., at cost price, it was thought that some sliding scale should be adopted, and mothers attending the Centres should not consider that they thereby acquire a right to obtain goods at a reduced rate of free of cost, but all should be required to pay according to their means ; otherwise the Council was entering an unfair competition with ordinary tradesmen, and attendances might be made not so much in the interests of the children as in the interest of the parents' pockets. The Health Visitors endeavour to ascertain, as far as they can, what is the weekly income, the number in the family, the number of children under school age, the rent, and other weekly payments, such as insurance, etc., in each case ; but, even if the mothers, whom they interview, be perfectly honest and truthful, misleading, or incomplete, information may be received; for frequently motheis do not know the wages earned by their husbands, and give as income merely the sum which their husbands allow them for housekeeping purposes. Hence, it was feared, the Health Visitors were often misinformed, sometimes undesignedly, sometimes, probably, deliberately; and there can be little doubt that in many instances people who can afford, and who ought to be able to bring up their children without help, obtain necessaries through the Centres at reduced cost, or even free of cost. Moreover, there is no means of insuring that supplies obtained are strictly reserved for use by those for whom they are intended. In a family in which there are several children under school-age, a baby, and an expectant or nursing mother, when a suitable allowance of 90 milk, for example, has been made, it may be that this milk becomes general stock for the whole family, and that the gift of free milk does away with the purchase of milk for the lest of the family. There is among many of the applicants for milk a spirit of greed taking the place of the good old spirit of scorn of charity and of independence and self-reliance which we like to associate with the character of Englishmen. Recently an application was made by a married couple without children, having a weekly income of £3 5s., on the ground that the wife was " expectant " ; the application, of course, was refused. On the other hand, an application was received on behalf of a family of ten persons, father out of work, three daughters in work, who gave the mother 29s. a week jointly, and this was all they had to live on and to pay the rent, which was 13s. 6d. per week. These circumstances were brought to the notice of the Maternity and Child Welfare Committee with a suggestion that payment by parents commensurate with their means should be instituted, and that a calculation might be made by dividing the weekly income of a family by the number in the family, which would give the weekly allowance per head, and a limit per head per week fixed above which payments should be made which would not involve any loss to the Council. The following scale was suggested— Families with an income of 10s. and upwards per head—No allowance. „ „ „ 9s. to 10s. ... To pay 75 % ,, ,, w 8s. to 9s. ... „ 50 ,, „ „ „ 7s. to 8s. ... „ 25 „ Under 7s. ... Given free. Under the above scale for a family requiring a quart of milk daily, and whose circumstances were such that they should pay 91 75 per cent., an order would be given to the milkman by the Council to supply a quart, half of a pint free of payment by the recipient, and the other three half-pints to be purchased and paid for by the recipient. So, also, if the recipient required a quart and ought to pay 25 per cent., an order would be issued for three half-pints at the Council's expense, leaving the parents to pay the remaining half-pint. The aid given would be dependent on the recipients purchasing the balance, and the milkmen receiving payments from the Council would be asked to make out their accounts so as to show the daily supply and the actual amount ordered. In this way the amount reallv required and that actually supplied would be recorded and help would thus be given to those who help themselves, and they are the people most worthy of consideration. The Maternity and Child Welfare Committee agreed to put this scheme into operation as an experiment, and although the accounts have become more complicated the scheme has up to the present worked very successfully. It may be mentioned that in a few cases where the income of the family has exceeded 10s. per head per week, the circumstances have warranted an allowance of milk, and the scale in such cases has not been strictly adhered to as provided for in accordance with the Order. REPORTS OF MEDICAL OFFICERS OF WELFARE CENTRES. 1. Overbury Street. Infant Welfare. During the year 1919, 437 new children, the majority infants, have been brought to the Centre, and there have been 3,681 attendances, an average of 72 for each consultation, the highest attendance on one afternoon being 115. Several mothers have stated that they would attend the Centre, were the rooms not so dark and ill-ventilated. 92 Every effort has been made to impress on mothers the importance of breast-feeding, and they are distinctly less ready to adopt artificial feeding than they were three years ago. Success with wasting babies is greater than formerly; unfortunately several doing well have succumbed lately to bronchial catarrh. The provision of free milk to needy mothers has been a great boon to many children. One feeble, puny child of 2 years, unable to walk or talk, increased by more than half its original weight in four months (15½ to 23½ lbs.) and became an apparently normal child, the only change in the circumstances being a good supply of cow's milk and oil. This is not the only case of a remarkable change due to suitable food. Nursing mothers and their babies still sometimes suffer from an insufficient supply of cow's milk, especially in small families, where no reduction in the price of milk is usually allowed. Ante-natal Welfare. The mother's consultations appear to be as much appreciated as the Infants' Centres, although the numbers must necessarily be smaller. There have been 177 new cases and 377 attendances, an average of 15 per consultation. A much larger number could not be dealt with satisfactorily in one afternoon, as all new cases require a thorough examination and detailed instructions about the management of pregnancy, the expected confinement, and the early care of the baby until it can be brought to the Centre. Nursing mothers frequently express their appreciation of the maternity consultations, especially those who for the first time have been able to nurse their own babies. A considerable minority of the mothers attending are found to be suffering from some abnormality, and nine cases of general disease, mostly heart, lung, or kidney trouble, have been referred to a private doctor, or to a hospital, for a prolonged course of treatment. Six cases of suspected venereal disease have been sent to a special centre for 93 diagnosis and treatment. The local midwives frequently send up cases on account of abnormalities in previous confinements ; and, in several instances where difficulty was again expected, arrangements have been made for the mother to enter a hospital for her confinement. Women occasionally attend for sterility, and in several suitable cases arrangements have been made for operation. A greater number come up on account of an impending miscarriage, some of these have been successfully treated, but unfortunately the impossibility of complete rest in the case of working women has in most cases rendered miscarriage unavoidable. There is much room for the development of the centre. More teaching for mothers is, perhaps, the greatest need ; many are very anxious for instruction, and one wonders if the time for waiting on the ante-natal day could not be utilised for class-teaching in such respects as the rearing of infants, care of the home, etc. The state of the teeth of the expectant mother is sometimes deplorable, and facilities for local dental treatment would be of great benefit to mothers during the confinement and nursing period, and indirectly, therefore, to the child. The general working of the centre is satisfactory. The Health Visitors are enthusiastic in their work and are always ready to visit difficult cases frequently. Mrs. Holmes has now for three years assisted on the consultation day, and her help is much valued. Altogether, work is carried on with complete harmony among the workers. (Sgd.) Elizabeth Wilks, M.D. 2. Brooksbys' Walk. Infant Welfare. During the year 523 children have been brought to the centre, and have subsequently paid 3,354 attendances. Each child has been weighed and carefully examined and notes taken of any abnormality present, and the mother advised if any 94 active treatment was necessary ; and in the case of poor people they have been directed where to apply for medical help. In this way quite a large number are sent to hospitals for various reasons. During the year only a few cases presented serious symptoms. One case of gonorrhoeal ophthalmia with gonorrhoeal arthritis of the shoulder ; this was sent to Mr. Tyrrell Gray at the Hospital for Sick Children, Great Ormond street, who kindly undertook the treatment. One case of curvature of the spine. Mr. Tyrrell Gray also treated this case at Great Ormond street. One case of congenital heart disease ; in this case the mother was advised. One case of head nodding, kindly seen by Dr. Hutchinson at Great Ormond Street. Two cases of mental deficiency ; in these cases the mothers were advised. In a large number of cases the mothers were advised in regard to the dieting and general care of their children. One feature of the centre has been the distribution of free milk. This has undoubtedly been of immense assistance to poor mothers, and, so far as I can ascertain, has not been abused, though great care has to be taken to see that only cases of real distress are helped. The sale of " Glaxo " and other proprietary foods at the Centre has proved very popular, though I should like to point out a real danger in that the mothers may come to look on the centre chiefly as a distributing centre for food and not a Welfare centre for their children. I wish to draw the attention of the Council to the splendid work done by the Health Visitors who work at the centre, I cannot speak too highly of their efficiency. I must also take this opportunity of thanking Dr. Robert Hutchison, Mr. Tyrrell Gray, Mr. Elmore Bremerton and Dr. Thursfield for seeing cases at the Hospitals, and kindly writing me in regard to their treatment. 95 Ante-nutal Welfare. During the year 110 new cases have attended the Centre and paid 81 subsequent visits. Each case has been carefully examined and all abnormalities noted, and the expectant mothers have been advised if any treatment has been necessary. Fortunately very few abnormal or sick cases have been found, and in the great majority everything has been normal. The gifts of free milk to expectant mothers have been of great help and much appreciated, and I am thoroughly in agreement with the principle of helping all poor, expectant, or nursing mothers in this way. I believe the midwives of the district appreciate the value of these Centres where doubtful cases can be sent for examination, as the attendances are showing a steady improvement, and I believe in the future the usefulness of the work will be much extended. I cannot speak too highly of the work of the Health Visitors who help at the Centre, and I wish to mention specially Miss Chitson, whose unfailing tact and gentleness has been of the greatest help. (Sgd.) Reginald Brown, M.R.C.S., L.R.C.P. 3. Mayfield Road. In presenting a brief report of the work done at this centre during the year 1919, apart from submitting the figures which represent the number of attendances for the year, I can only speak from the somewhat limited experience of temporary duty commencing September 25th, 1919, on which date I took charge of the work for Dr. Hunt, my own appointment to the centre having been made by the Borough Council in the following February. Before proceeding further I must record for those who have been associated with Dr. Hunt in this work, as well as for myself, 96 the deepest regret and sorrow at his prolonged and grave illness, and at permanently losing one who for so many years has filled an honoured position in the life and work of this Borough. During the year the Centre has been opened 61 times. The number of new attendances has been 317 ; the number of subsequent attendances, 2,533; making the total attendances, 2,880. The number of children under one year old was 2,077 and of children over one year, 803. The number of consultations by the .Medical officer was 1,299. Among the infants the great majority are brought on account of digestive troubles or through failure to make satisfactory gain in weight,and need regulation of the diet rather than medicines; as may be supposed by far the larger number of these cases are artificially fed. A striking fact is the extreme frequency with which constipation among both breast and bottle-fed babies occurs as a factor of great importance in hindering assimilation and thereby retarding nutrition and progress. Our accommodation up to the present has been very limited and inadequate, but arrangements have been made with the responsible authorities of the Mayfield road Chapel to renovate and place at our disposal a small hall and commodious adjacent rooms which will greatly facilitate our work, and enable it to be carried on under better and more hygienic conditions as regards space, ventilation and lighting, and this will undoubtedly have an important effect in further popularising it and promoting its extension. (Sgd.) J. Houston Porter, M.R.C.S., L.R.C.P. 4. Hackney Mothers' and Babies, Welfare Centre. (Voluntary.) The past year has been a busy one at the Hackney Mothers' and Babies' Welfare Centre. There has been a considerable increase in the average attendance, both on Tuesdays and Fridays, and the mothers have continued to show a keen appreciation of the work. 97 As before, breast-feeding has been encouraged as far as possible and in many cases the mother's health has received attention with the view of increasing the supply. Where bottle-feeding had to be carried out, wholly or partially, cows' milk was sometimes difficult to obtain, and we had to depend chiefly on dried or condensed railk, but on the whole our results have been very satisfactory. This success has been largely contributed to by the tactful way in which the home visits have been carried out by the Superintendent and the voluntary workers. (Sgd.) J. M. Laughton, M.B. 5. Eton Mission, Gainsborough Road. (Voluntary.) The number of attendances at the above Centre during the year 1919 was 2,631 (as compared with 885 during 1918, which was the first complete year). The children are now brought at an earlier age than when the Centre was first opened, often before the third week of age, and this gives a better chance of giving useful advicc. In the case of babies over three or four months of age, the most frequent causes for seeking advice are wasting and conditions due to errors of feeding, and these can often be rectified quickly. The smallest child brought was one weighing 3 lbs. 12] ozs. at five weeks of age ; seven months this infant weighed 11 lbs. and had cut two teeth. Another child weighed 6 lbs. 2¾ ozs. at three and a half months, and eleven months later weighed 16 lbs. 4¾ ozs., could stand, and had cut three teeth. Every endeavour is made to get the mothers to breast-feed babies entirely if possible, or with the aid of supplementary artificial foods if necessary. In some cases milk is supplied to the mothers, and this often enables them to breast-feed their babies. A number of children have been referred to the Queen's Hospital for treatment, such as for nsevi or circumcision, or to a private, doctor or hospital, for bronchitis, discharging ears, or skin eruptions. g 9S Nurse Hastings, the Superintendent, gives short addresses to the mothers on matters relating to the health of themselves and the babies, once a week, and Nurse Cripps gives general assistance. Mrs. Eggar has given very regular and valued help with the work ; also Mrs. Christie kindly assists with the weighing and other matters, likewise Miss McAnaly has attended regularly since the opening of the Centre, and gives much general assistance. (Sgd.) E. J. F. Moore, M.D. ACCOMMODATION FOR UNMARRIED MOTHERS AND THEIR CHILDREN. In June I reported to the Maternity and Child Welfare Committee that there is at the Hackney Infirmary accommodation for destitute women, married or single, who require quarters during the lying-in period. Also, the Salvation Army have four receiving houses for expectant mothers who, when about actually to be confined are removed to the Salvation Army's Mothers' Hospital. There is, also, in Pembury Road, another house supported by voluntary contributions, where some half-a-dozen expectant mothers can be housed prior to their confinements, and subsequently with their babies, during convalescence. These mothers mostly spend the actual lying-in period in the City of London Maternity Hospitaj in the City Road. There is, therefore, no urgent need for lying-in accommodation. These institutions, however, do not provide for the prolonged stay of mother and child, and there is no institution in the Borough where mother and child can be kept together for a considerable time on a scale sufficiently large to meet this requirement. There is one such institution (of a religious character) at Stamford Hill, but it is not reserved for Hackney cases. I see no way of meeting this requirement other than by providing a special institution for this purpose, for what may be called " the after-care treatment of mother and child " in the interests of both. 99 Such a building might be used for a threefold purpose— 1. A day-time creche for children whose mothers, married or single, were out at work daily, returning home at night. 2. A boarding-house, or a home, for the children of unmarried mothers whose work precluded them from bringing up their own babies, e.g., those engaged at work at places where they were required to " sleep in." 3. Accommodation for unmarried mothers and their babies in instances when the mothers did not desire to be separated from their babies. Such mothers could make themselves useful in helping generally in the work of the establishment, feeding and washing, etc., of other babies, and opportunity could be found for teaching them useful work for their own support when they found themselves once more out in the world on their own sole resources. The fact that there occur in Hackney some 164 illegitimate births to mothers who reside in Hackney in a year is an indication of the desirability of taking action in the interests of both mothers and infants. An empty house was recommended as suitable for this purpose in the Upper Clapton Road, containing 15 rooms, rent £90 per annum. This was inspected by two members of the Committee and myself, but before any definite steps were taken it was sold privately by the owner. Up to the present no other suitable place in the borough has been found. GRANTS TO FOSTER-MOTHERS. During the year, upon the instructions of the Maternity and Child Welfare Committee, I reported to them on this question, as follows :— " In very many instances there is no doubt that great, and not seldom undeserved, hardship falls upon unmarried mothers who g 2 100 are compelled to work for a living, especially upon those whose occupation is domestic work as servants, or who are engaged in employments of other kinds which impose upon them the necessity of boarding out their babies entirely, or during the day when they themselves are at work. The wages earned are insufficient in many cases to enable them to make payments to foster-mothers, and others undertaking the care of the babies, commensurate with the work done for, and the food required by, such infants. Inasmuch as this work is not undertaken on account of disinterested benevolence, or charity, but for profit, it follows that the payments should be in excess of the expenses incurred in providing milk and other foods so as to leave a balance as a recompense for the trouble and labour involved. If this balance be insufficient to satisfy the fostermother there will be ever present the temptation to enlarge the balance by diminishing the amount spent on milk and other foods, and, if the temptation be not resisted, the child may have to suffer through inadequacy of food supplies, possibly through actual starvation. It is to meet such cases as these that supplementary payments to foster-mothers have been proposed ; also, in this same connection, that some means might be found for the avoidance of so early a separation of mother and child as most commonly has to be endured. " It seems to me that there are several courses which might be adopted, either conjointly, or separately. " 1. A list might be made giving the names and addresses of all women known to be in the habit of receiving such children, and classifying them so as to distinguish those who take in babies during the day only and those who take them in entirely as boarders. The Health Visitors might assist in making out the lists, and in subsequently visiting and reporting upon the ' foster-mothers,' their homes and surroundings, their methods of feeding babies, sufficiency of food of a proper land, general cleanliness, personal and domestic, and general 101 cleanliness and appearance of babies, and conditions as to health. Those only who proved satisfactory in all respects under the Health Visitor's investigations should be registered by this Committee, and those only should be recognised as worthy of receiving official aid. "Such a register having been formed, mothers should be encouraged to send their babies to the registered foster-mothers rather than to others not on the register ; and by judicious aid it might be ordained that charges at the recognised homes should be not more for mothers but, if possible, less than charges at those not on the register. This would encourage mothers to use the good homes in preference, and might result eventually in starving out the others. " 2. Creches to receive, during working hours, the babies of unmarried mothers while at work, and also to receive, as boarders, children of unmarried mothers, who, on account of the nature of their work, e.g., domestic service, etc., are compelled to board out their children. These creches should be under the complete control of this Committee, with a Matronin-Charge, or a foster-mother, as a servant of the Committee, appointed by and removable by the Committee. There should be several such institutions suitably placed so as to be accessible for all parts of the Borough. " 3. A number of day creches in well-chosen spots throughout the borough for day workers, and a sufficiently large central establishment for children whose mothers desired to board them out. These should be completely under the Committee's control, and the people serving in them should be appointed, and subject to removal, by the Committee. This last scheme, is the one which I, personally, should prefer. If so desired the central establishment might be used also as a day nursery, 102 but I am inclined to think there might be advantage in keeping the two classes of mothers apart." Subsequently I reported to the Committee that I had had an opportunity of conferring with Dr. Menzies of the London County Council on this subject, and ascertained that administration regarding foster-mothers falls to the duty of the London County Council, and that he did not think his Committee would favour the scheme of local registration of local foster-mothers, and of administration in relation to them, by local authorities, as the foster-mothers would get over-inspected, and would tire of visits made first by inspectors of one authority and then those of another authorit) . I also informed the Committee that I advocated the transference of the duties regarding foster-mothers from the County Council to local authorities, on the ground that it is preferable for each master to rule in his own house, subject to the proviso that the power should remain to the County Council to enforce action, or to undertake the work themselves, in cases in which local authorities proved negligent. The Committee at the end of the year had not come to any conclusion regarding the grants to foster-mothers. PENSIONS MOTHERS AND THEIR CHILDREN. The Maternity and Child Welfare Committee considered this question during the year and presented the following report to the Borough Council recommending that the proposal for the payment of mothers' pensions in Great Britain be supported, and that the Ministry of Health, the Parliamentary members of the Borough, and Lady Rhondda's Committee be asked to support the scheme :— Our attention has been called to the system of Mothers' Pensions introduced by Judge Henry Neil and adopted in the U.S.A. by thirty-five out of forty-eight states. 103 The name " Pensions for Mothers " which h?s been applied to the Neil system, and the immediate idea under consideration in Great Britain, is that all mothers who are widowed and have several children dependent upon them should be granted as pension by the Government a sum which will be sufficient to enable them to bring up a family without the mothers having to go out to work. For mothers who, either through absence of wages or through the husband's incapacity for work, are unable to support their children it is considered necessary that a system of mothers' pensions should be established instead of their being allowed to become inmates of the Workhouse, for the Poor Law Regulations do not give the Guardians power to afford them out-door relief. The matter came before Parliament on 8th April, 1919, for the firsl time. The Government then accepted Mothers' Pensions in principle, and agreed that, at as early a date as possible, it would bring forward a Bill to put this system into operation here. The proposals are as follow :— 1. That these pensions be limited to necessitous mothers with more than one child, and that only where the father is dead or incapacitated from work. 2. That the same amounts be given to the war widows and their children, and that they be administered in the same way by the same Department, the Ministry of Pensions. 3. That the same supervision be given as is given in the case of war widows and their children. 4. That 75 per cent. of the money be provided by the National Exchequer and 25 per cent. by the local rates. The mothers being paid by the State are able to look after their children at home instead of sending them to an institution, thus preventing the separation of mothers and their children. 104 With regard to unmarried mothers, only one state law, that of Michigan, grants an allowance to them, and when that is done, it is not paid to her as such, i.e., as an " unmarried mother," but the Court records her as a " deserted mother." Up to the end of 1917 no unmarried mothers had been pensioned. The question as to whether British mothers can be trusted has been raised. All over England where Judge Neil lectured on the need for mothers' pensions he found people who said, " This plan may work well in America ; but it would be hopeless here, because the mothers would spend every penny in drink." As against this argument it may be stated that Lady Beatty organised a fund for the wives and children of the sailors killed in action. She supplemented the war pensions by regular monthly cheques, so that these mothers need not go out to work, but could stay at home and look after their children. Four hundred widows were cared for in this Way, and out of this number only two were found incapable. So that among the ordinary rank and file of British mothers the pensions plan has already been tried with signal success. We have carefully considered this question, and are unanimously in favour of the proposal, which we believe would be beneficial to home life and infant welfare. DAY CRECHES. There are three day creches in the Borough, one situated in the east end of the Borough, Eton Mission Day Nursery, and the others in the west end of the Borough, the " John " Day Creche at 61 Downham Road, and another at 49, Mortimer Road, both in De Beauvoir Town. The latter is reserved for the children of married parents (orphans). Owing to lack of public support the " John " Day Creche was , closed definitely at the end of March, 1920. 105 All are conducted on voluntary lines and are doing good work in the interests of child welfare. The Committee of the "John" Day Creche approached the Council for a grant as they were urgently in need of funds in order to carry out certain repairs to their building, and the Council after perusing their accounts granted them £100 for this purpose. The Board of Education, and later in its place, the Ministry of Health, also contributed to its funds. FOOD INSPECTION. In addition to the tabulated statement with respect to samples of food purchased under the Sale of Food and Drugs Acts, the Inspector of Foods has furnished his usual Annual Report which will be found in the Appendix to this Report, together with that of the Inspector of Canal Boats. In his Annual Report for 1918, embodied in my Annual Report for that year, the Inspector wrote the following paragraph:— "Miscellaneous Inspections and Unsound Food. During the year (i.e., 1918) I have examined quantities of imported bacon and hams, approximately 250 tons, at the premises of a wholesale provision dealer and bacon dryer, who at the request of the Ministry of Food dealt with parcels of faulty bacon and hams which had to be cleansed, smoked, and alter inspection disposed of to tradesmen with a quick sale, who were given permits to sell the same free of coupons. This entailed a large amount of work in examination for taint, &c., and 1 tons, 8 cwt., 2 qrs., 27 lbs. were condemned and sent to the soap-boilers." In this year's (1919) Report he states:— "I have again had to deal with large quantities of faulty imported bacon and hams during the year, and 37 tons, 18 cwt., 3 qrs., 9 lbs. have been condemned and sent to the fat-melters for soap-making." 106 The Inspector does not give, even approximately, the total amount examined; but the figures are suggested thus:— If, during 1918, 4 tons, 8cwt., 2qrs.,27 lbs. were condemned out of "approximately 250 tons" examined, how many tons were examined during 1919 to secure the condemnation of 37 tons,18cwt.,, 3 qrs., 9 lbs. ? Very nearly nine times as much was condemned in 1919 as was condemned in 1918 ! If the proportion of unsound to sound meat was about the same in both years, about 2,000 tons, in round figures, must have been examined in 1919; or the proportion of unsound to sound meat must have been very much greater in 1919 than it was during 1918, and probably this was the case. In any event great quantities of this "suspect" material were sent to Hackney alone, and it would be interesting to know what was the total amount sent out by the Ministry of Food to all districts to be similarly dealt with. Similar "parcels" of bacon and hams are coming to hand from time to time during this current year of 1920. Comparison of the figures relating to all foodstuffs condemned during 1919 with the corresponding figures given in the 1918 report will be sufficient to persuade any reader that the year 1919 brought to the Food Inspector a very large amount of extra and very responsible work as the aftermath of the Great War—work which would never have been necessary, had there not been a war. How far the enormous food wastage that has occurred, and is still occurring, has been due to bad management on the part of the Ministry of Food, and how far to bad luck and unavoidable causes, I have no means of judging; and, even if I had the knowledge, it is not my business to apportion the responsibility. Nor is it for me to decide as to how far a Government Department is justified in endeavouring to dispose of, by quick sale without coupons, materials of doubtful quality which admittedly require 107 careful examination by experts in foods before any can be safely put upon the market; but it is my duty to see, so far as is possible, that no such foods imported into the Borough are released for human consumption unless they have been examined and found fit to be placed on sale. It is only right and fair to state that timely notice is given of the proposed dispatch to Hackney of the consignments of bacon and hams and other foodstuffs, so that arrangements for inspection may be made; I have no knowledge of any attempt having been made to rush the bacon and hams through the bacon-curers' hands quickly and surreptitiously, or to place such food upon the market without the knowledge of the officials of the Public Health Department. THE HOUSING PROBLEM IN HACKNEY. Hackney, though comparatively a young Metropolitan Borough, is, nevertheless an old town; and, like most other towns, it contains a very considerable amount of old and more or less dilapidated property. On the other hand, large portions of the borough are comparatively modern, and consist of streets of houses which appear to be of good construction and in fair repair. But it is frequently found that these appearances are deceptive, and that internally much cleansing and reparative work is required. This condition is due, at least in part, to the fact that streets of houses, originally intended for occupation by individual families have become occupied by people of the working classes who cannot afford to pay the rents of the houses, so that the houses have ceased to be occupied as single dwellings, and have become tenement dwellings, let out floor by floor, or even by rooms. As the class of occupier has become lower, and the numbers of occupants in individual houses have increased, so also has there been increase correspondingly in wear and tear internally, so that there are always numbers of houses which require repairs. Every effort is made by the Council to improve houses which are in dirty or dilapidated 108 conditions, but the task is a difficult one, partly owing to the scarcity of labour and materials and the high price of such labour and materials as are available; and partly owing to the impecuniosity of many of the owners of property, some of whom own little or nothing in addition to the property, and have no means to cover the cost of repairs. The task of keeping property in repair is, in the cases of many tenement houses, and of the worst kind of dwellings almost impossible of accomplishment owing to the dirty and destructive habits of the lower classes of tenants, who speedily render abortive the efforts of the Council and property owners to provide them with decent, cleanly houses. Houses are constantly being repaired and redecorated, and in a few months, or a year, may be found in need of another thorough overhauling. Thus, it follows that general improvement throughout the borough is a very slow process, and must proceed, to some extent, pari passu with improvement in education, manners and habits of certain of the lower classes. The housing question in Hackney is at present very difficult of solution in a satisfactory manner. The borough is very seriously overcrowded, and many hundreds are desirous of, and are anxiously, seeking, houses or accommodation in lodgings, or tenements. Many families are crowded together, each occupying only three, two or even one room for all purposes—living, eating and sleeping. Piteous appeals are constantly made at the Town Hall for help to find accommodation,or for information as to where it may be likely to be found; but every available house is occupied. As a consequence, much overcrowding has of necessity to be overlooked, whereas in more normal times it would be dealt with promptly. So, also, houses which are questionably fit for human habitation, some indeed, only fit for demolition and rebuilding, have to be tolerated until such time as additional accommodation shall have been provided. As regards provision of new houses to ease, so far as may be, the present position, the Council, through a newly appointed 109 Housing Committee, took steps to this end, but up to the close of the year only one house had been provided by the Council. A scheme, however, had been devised which comprised the following items:— Houses which will provide a parlour, living-room and three bedrooms 11l Nine Army Huts to be converted into bungalows, viz.:— Living-room, scullery with bath, and three bedrooms 8 Living-room, scullery with bath, and two bedrooms 4 Total 123 Existing houses to be acquired, and 1. Made suitable for the working classes—Applied for, 54. 2. Converted into flats—1. In these altered houses it is anticipated that about 165 families will be accommodated. The average number of houses to the acre will be about 20. Application had been made to the Ministry of Health for powers to acquire land, viz., six acres in Dalston Lane, and land at the back of Brooke House, for the purpose of erecting blocks of tenements, but both proposals have been abandoned through no fault of the Housing Committee. A preliminary survey of all the available land in the borough was made with a view to preparing housing schemes when time and opportunity would permit ; and since the end of the year 1919 much useful work has been done. This work will be dealt with in the Annual Report for the year 1920. The information which follows is supplied at the request of the Ministry of Health in the form of replies to headings, etc., set out by them. 110 HOUSING. (I.) General housing conditions in the district:— (1) Number of houses—total number.— Assuming that the term "houses" means "tenements" there are probably 52,000 or 53,000 of such habitations. Number for the working classes.— It is not possible to apportion this number without a special investigation throughout the borough. New houses for the working classes erected during the year, or in course of erection.— (2) Population—with information as to any important changes during the year or anticipated in the future 225,774. (Registrar General's estimate.) (3) (a) Extent of shortage or excess of houses? About 850 tenements or houses now being asked for. (b) Measures taken or contemplated to meet any shortage ? See scheme set out on page 109, ante. (II.) Overcrowding:— (1) Extent ? Very serious extent. Many hundreds of houses are wanted to ensure abatement. (2) Causes ? Reduced building prior to and stoppage during war. Great influx of aliens who got possession of houses vacated by families of men on service, and still occupy them. (3) Measures taken or contemplated to deal with overcrowding ? Answered by reply to I (3) (b) above. (4) Principal cases of overcrowding dealt with during the year and action taken ? Practically nothing could be done pending provision of new houses which could not be accomplished during the year. The results of work done during 1919 will not become effective until some time during 1920 and later. Ill (III) Fitness of houses:— (1) (a) General standard of housing in the district ? ing that Hackney is now essentially a working-class borough the standard may be considered, on the whole, as very fair. (b) General character of the defects found to exist in unfit houses? Faulty eaves-gutters, leaky roofs, damp walls, defective water-closets and drains, dirty and verminous conditions, and general dilapidations. (2) Action taken as regards unfit houses under (a) the Public Health Acts, (b) the Housing Acts ? (Note.—The detailed statistics as to action under the Housing Acts will be given in the Appendices.) (3) Difficulties in remedying unfitness, special measures taken, and any suggestions in the matter? Scarcity and high prices of both material and labour. Poverty of certain of the owners of property. Suggestion—Removal of control and freeing of materials. Governmental insistence on the right of every free-born Briton, and especially of every ex-service man, to work for whom he likes, at whatever work he likes, and for what wages he likes, without let or hindrance by any third party. (i) Conditions, so far as they affect housing, as regards water supply, closet accommodation, and refuse disposal, together with measures taken during the year in these matters? Water supply ample and satisfactory in quality. Waterclosets usually adequate. Refuse disposal transferred from Medical Officer's control to that of the Borough Engineer in January, 1919. Work generally efficiently performed. (IV.) Unhealthy areas:— (1) Action taken as regards areas represented before the beginning of the year under Part I. or Part II. of the 112 Housing Act of 1890? Certain of the houses condemned by the Borough Council and closed during 1918 have been put into excellent habitable condition, and work is in progress to complete others on similar lines. Four in Spring Lane so dealt with, and seven more under the same contract to be proceeded with as speedily as practicable. (2) Particulars of, and action taken as regards, areas represented during the year ? No representations made. (3) Information as to complaints made during the year that areas were unhealthy and action taken? No complaints made. (V) By-laws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc.:— (1) As to working of existing by-laws ? Satisfactory. (2) As to need for new by-laws or revision of existing by-laws ? London County Council's By-laws as to Houses Let in Lodgings now under revision. (VI) General and Miscellaneous:— Generally, an account of any action bearing on the public health, not covered by the above particulars, which has been taken during the year by the local authority in connection with overcrowding, insanitary property, and housing, whether under the Housing Acts or the Public Health Acts ? Overcrowding has had, perforce, to be ignored. Insanitary property.— Always being consistently and persistently dealt with. Housing dealt with so far as practicable—much loss of time through prolonged negotiations with the Housing Board of the Ministry of Health. 113 (VII) Appendices. Statistics for the 12 months ended 31 st December, 1919. (1) Number of dwelling-houses in respect of which complaints were made that they are unfit for human habitation, (a) By householders? None, i.e., in a serious and literal sense, though such expression may have been used colloquailly. (2) Action under Section 17 of the Housing Act of 1909.— (a) Number of dwelling-houses inspected under and for the purpose of the section; (b) Number of dwelling-houses which were considered to be unfit for human habitation ; and (c) Number of dwelling-houses the defects in which were remedied without the making of closing orders? No action under Section 17. (3) Action under Section 28 of the Housing Act, 1919.— (a) Number of orders for repairs issued; (b) Number of cases in which repairs carried out by the local authority; (c) Number of dwelling-houses voluntarily closed on notice by owner that they could not be made lit without reconstruction ? No action during 1919. (4) Closing Orders.—(a) Number of representations made to the local authority with a view to the making of closing orders? No representations, (b) Number of closing orders made? None, (c) Number of dwelling-houses in regard to which closing orders were determined on th e houses being made fit for human habitation ? None. (5) Demolition Orders.—(a) Number of demolition orders made ? None. (b) number of houses demolished in pursuance of demolition orders ? None. (6) Number of dwelling-houses demolished voluntarily? Two. (7) Obstructive Buildings.—(a) Number of representations made (section 38 of the Housing Act of 1890) ? None. h 114 (b) Number of buildings demolished? None. (c) Number of representations still under consideration ? None. (8) Staff engaged in housing work with, briefly, duties of each Officer? Housing work performed in conjunction with the Housing Board of the Ministry of Health has been organised and supervised by the Borough Engineet, and carried out by some members of the staff of his department, assisted by the Rating Surveyor. Thus, the following have been engaged upon the work:— Borough Engineer and Surveyor: Organiser and Chief Administrator. 1 Assistant Surveyor 1 Inspector of Sewers and Drains Supervision of drainage, etc. 1 Engineering Assistantand Draughtsman 1 Draughtsman Preparations of plans. Preparing quantities and making estimates. 1 Rating Surveyor: Inspection and reports re unoccupied houses with a view to their requisition by the Council. WORK OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT. I am glad to be able to confirm fully the favourable opinion of the work of the whole staff of this department which I expressed when writing my Annual Report for the year 1918. During the year 1919, the work has been performed efficiently and conscientiously by every branch of the department, and it is quite time that those who in the past have thought fit to belittle the work of the department, and to question the efficiency of the staff ceased to do so. The work of the department, is the most important work performed under the Borough Council, which, indeed, exists for the purpose of looking after the public health of the Borough; and upon the efficient and faithful performance of the work of the department the health of the Borough depends. I do not believe that there is any 115 department in the Town Hall which works harder, or does better work, than the Public Health Department. Some of the new Councillors have thought that causes of complaint sometimes have not been removed so quickly as they might have been, or ought to have been; but complaints are always promptly attended to, and such delay as may occasionally occur is due, in the main, to procrastination of owners, or their agents, sometimes to builders, and to the fact that Sanitary Inspectors are compelled to observe legal formalities with respect to the serving of intimation and statutory notices, and the taking of legal proceedings; difficulty in obtaining, and the high price of both materials and labour, and the impecuniosity of some owners of property have been, not infrequently, contributory causes of delay. On several occasions Councillors have brought definite complaints of delay before the Public Health Committee, and invariably, so far, a satisfactory explanation has been forthcoming. The work of the department has greatly increased, and the staff of Sanitary Inspectors has been shorthanded. During the year 1919, the Staff of Male Inspectors nominally comprised fifteen permanent men, but in the early part of the year several were still absent on military service, and during the remainder of the year the staff numbered only fourteen, including two who were retained, although normally they would have been superannuated, and two who were engaged temporarily, but who have now (1920) been appointed permanently. Further, in view of the extra work in connection with "Housing" the sanction of the Ministry of Health was sought, and obtained, for the appointment of three additional Inspectors, so that the full staff of Sanitary Inspectors will number eighteen, of whom sixteen have already been appointed. The increase of work necessitated an increase of staff also in the Clerical branch from five to eight, in the number of Health Visitors from six to nine, and in that, of the Tuberculosis Health Visitors from two to three. H 2 116 All the increases of staff referred to above received the sanction of the Ministry of Health in 1920, and will become effective during the current year. The problem of finding proper office accommodation for this large staff is one with which the Council will have to deal. In the Clerical department seven of the Clerks are crowded together in one room which affords barely sufficient space to accommodate their chairs and desks, while the eighth has to do his work at a small table in the corner of the Sanitary Inspectors' room. The Sanitary Inspectors' room is rather of the nature of a large cubicle, since it is one portion of a very large room which has been partitioned off into a number of compartments, that allotted to the Inspectors being completely shut off from the external walls so that it is deficient in means of ventilation, and in the supply of sunlight, and artificial light is necessary even during the day-time; moreover, it has been overcrowded by fourteen Inspectors and cannot accommodate more. The two female Inspectors, Factory and Workshops Inspector, and Inspector of Outworkers and their premises, occupy a small room at the back of the building. The Health Visitors, who formerly used the "Members' room " in the mornings, now have to use one of the Committee rooms, which is sometimes partially in use for other purposes at the same time as it is in use by the Visitors. The Tuberculosis Health Visitors have to use a small room intended for use as a waiting-room. If good, steady work is to be really well done it is essential that the workers should be well housed, and should have an ample supply of fresh air and daylight; a stuffy atmosphere and constant use of artificial light during the hours of daylight should not be tolerated, especially by a Public Health Authority; such conditions as those which exist in the Inspectors' room would not be permitted in a factory or workshop, and would be condemned promptly in any elementary school. Moreover, it is not conducive to good work, and concentration of mind on work, that too many people should occupy 117 one room; such an arrangement tends to constant interruptions, distraction of attention, and talk instead of work. A series of smaller rooms, each constructed for four or six workers, with ample cupboard-and-shelf provision for the storage of books and papers would be far preferable to large rooms occupied by many persons. Moreover, it would be more convenient if the staff were concentrated in one portion of the Town Hall. During the latter part of the year 1919 and during this year the whole of the staff working at the Town Hall, the staff of the Electricity department, and the Libraries and Public Baths Staffs have been re-classified. It is well known to the Council that I had a strenuous struggle with the Establishment and General Purposes Committee in my efforts to secure what I deemed to be fair and equitable treatment for the Public Health Department. I am not now desirous of complaining of the classification allotted to the Sanitary Inspectors (2nd class) and Health Visitors (4th class), but I think that the three senior Inspectors should have been placed in the first class, if only as affording a something to look forward to for the others, and an encouragement to induce them to stay in their present office instead of seeking better appointments elsewhere ; for it should be recognised that Sanitary Inspectors become most useful when they have become thoroughly acquainted with their districts, and with the property-owners, occupiers, builders, &c. For this reason frequent changes are not desirable, and a wise Council will endeavour to retain its Inspectors by making it wcrth their while to stay. As to the Health Visitors, in view of their training and 'professional qualifications, I think that they might have been equitably placed in the third class. But it is against the classification of the Clerical staff that I feel bound to record my strong protest. What I thought would be a proper classification was:— 1 Special class, 2 first class, 1 second, 2 third, 1 fourth, 1 fifth. The classification which was granted was:—1 Special class, 1 first, 1 second, 1 third, 2 fourth, 2 fifth. So we have half the clerks in this 118 department in the fourth and fifth classes, although the staff is doing, and doing well, as important, as necessary, and as technical work as is any other staff of clerks in the Council's employ. The clerks in the fifth class have, as regards pay, been put on the same footing as the men who sweep the streets, and as shorthand typewriters, although one of them has had some thirty years of commercial work, and six years in the Council's service, and is now doing responsible work. I sincerely hope that the Establishment and General Purposes Committee, or their successors, will right this wrong at the earliest opportunity and will not allow themselves to be guided by advice other than that of the head of the Department who is, or should be, the best judge of the value of the work of every official working under him. The Borough of Hackney is one of the largest, in population and area, of the twenty-eight Boroughs in the Metropolitan area, and the question of the appointment of an Assistant Medical Officer of Health may have to be considered by the Council in the near future if the amount of work should continue to increase as it has done during recent years. Tuberculosis work, Maternity and Child Welfare work, and "Housing" work have brought many extra duties to the hands of the Medical Officer of Health, and it would be well if he had more time to devote to personal inspections and investigations in the district. The imposition in the future of additional duties may still further curtail his time for outdoor work, which should form an important part of his almost daily routine if he is to comply with his Official Instructions, one of which states : "He shall by inspection of his district, both systematically at certain periods and at intervals as occasion may require, keep himself informed of the conditions injurious or dangerous to health existing therein." The position, therefore, will have to be watched; and, if it be found necessary in the interests of the Borough, the Council should 119 be prepared to consider carefully any representations on the subject made to them by the Medical Officer of Health, who is best qualified to advise them on the question, because he best appreciates the requirements of the Borough, and he ought to be the best judge of his own capacity for work. In conclusion, I desire to express my best thanks to the Mayor, Aldermen and Members of the Borough Council, as well as to the Officers of all Departments, for their constant kindness and courtesy towards me during my tenure of office, which is now rapidly drawing to a close, and for the ready help and advice which have always readily been given to me whenever sought. To the Public Health Department my sincere thanks are especially due. The members of the whole staff, male and female, have worked with me willingly, loyally, and efficiently, and to the best of my belief, conscientiously. There is no question as to their competency, capability, or efficiency. The work of the department has been well performed; and I feel that the credit is rightly due to the experience and industry of the staff rather than to any share I have had in it. As regards the clerical staff, I can only repeat what I stated at the end of my report for the year 1918. My thanks are most especially due to them for having lightened my work by undertaking the drudgery entailed in preparing this, my second Annual Report. 1 am. Ladies and Gentlemen, Your obedient servant, WILFRED W. E. FLETCHER. v 120 APPENDIX. LIST OF INDUSTRIES IN THE BOROUGH OF HACKNEY. The chief staple industries are the manufacture of boots, shoes, and pianos, but there are also extensive productions of the following:— Tailored clothes for males and females; dresses, shirts, ties, clothing and underclothing generally, millinery, hats, etc.; cabinets, upholstery and furniture generally; lead pencils, brushes, boxes, artificial flowers, toys, leather goods, gas mantles, dolls, rubber goods, scents, drugs, dyes, paints and varnishes, artists' colours, joinery, foundry work (iron), electric signals, electrical instruments, glass, surgical instruments silk-weaving and embroidery, chemicals, aeroplanes; also there are several furriers, and a number of laundries. REPORT OF FOOD INSPECTOR FOR THE YEAR 1919. Milkshops and Dairies.—One thousand, one hundred and sixty-eight inspections were made during the year. Three Notices were served for cleansing and repairs, all of which have been complied with. In six cases vendors were warned for having dirty or unwashed measures in use. Thirty-seven new retailers have been registered. The condition of the dairies generally has been good. Cow Houses.—There are now thirteen licensed cowkeepers with fourteen sheds. One hundred and ten inspections were made of these, and one notice was served for dirty and dilapidated condition; in this case owing to a change of ownership, I had considerable trouble in getting the premises put into proper order. Offensive Trades.—There is only one registered offensive business in the Borough, viz., a tripe boiler. Three visits were made during the year, but no boiling has been done for the last two years, as the coppers and apparatus, etc., are out of repair. 121 Slaughterhouses and Meat Inspection.— Two hundred and seventy-eight visits were made to these during the usual slaughtering times, when I have examined the carcases and organs of 371 oxen, 5 bulls, 70 cows, 1,079 sheep and lambs, 31 calves, 25 pigs and 13 goats The following I found diseased and had removed and destroyed:— Carcases and all the organs of 5 cows affected with tuberculosis. Carcases and all the organs of 3 oxen affected with tuberculosis. Carcases and all the organs of 1 heifer affected with tuberculosis. Fore-quarters, head, tongue and pluck of a cow affected with tuberculosis. Heart, lungs, liver and gut-fat of a cow affected with tuberculosis. Head and tongue of an ox affected with tuberculosis. Head, tongue, pluck, liver and gut-fat of an ox affected with tuberculosis. Fore-quarters, pluck, liver, head and gut-fat of an ox affected with tuberculosis. Head and tongue, pluck and liver of a bull affected with tuberculosis. Portions of the fore-quarters of an ox for extensive bruising. Portions of the fore-quarters of 3 cows for extensive bruising. The livers of 6 cows, 1 bull, and 3 oxen affected with abscess. The livers of 5 cows and 4 oxen affected with distomatosis. The livers of 10 sheep affected with distomatosis. The livers and lungs of 8 sheep affected with abscess. The livers and lungs of 15 sheep affected with parasitic cysts. Portions of the hind-quarters of a sow with broken pelvic bone. Wholesale Preserved Provision Factories.—Fifty-three visits were made to these and large quantities of meat of all kinds, carcases, 122 ox and pigs' heads, etc., have been examined and found to be sound and tree from disease. Miscellaneous Inspections and Unsound Food.—I have again had to deal with large quantities of faulty imported bacon and hams during the year, and 37 tons, 18cwts., 3 qrs.,9 lbs. have been condemned and sent to the fat melters for soap making. Four hundred and ten visits and inspections have been made on complaint and in connection with the sale of food. The market thoroughfares have been frequently visited and the goods on the costers' stalls inspected. Considerable time during the year has also been devoted to the work under the Food Control Orders in prosecuting offenders at the Police Court. The following foodstuffs have been condemned and destroyed:— 627 English rabbits. 1 box and 63 imported rabbits. 3 partridges. 2 fowls. 44 lbs. of butter. 3 whole cheeses and 396 lbs. 1,105 imported eggs. 329 tins of condensed milk. 11 6-lb. tins of corned beef. 1 box of imported tripe. 16 cwt., 1 qr., 17 lbs. of imported bacon and ham. 13 boxes of tomatoes. 24 boxes of dates and 84 lbs. 1 barrel of apples. 71 boxes of kippers. 3 bushels of winkles. 8 boxes of mackerel. 3 barrels of herrings. 2 boxes of herrings. 2 barrels of roker. 123 2 boxes of roker. 1 box of lemon soles. 2 boxes of dabs. 1 case of haddocks. 2 boxes of haddocks. 16 drafts of eels. 2 bags of pigs' lungs. 1 tub of pigs' hearts. 1 tub of pigs' milts. 92 lbs. of pigs' milts and fats. 3 qrs., 2 lbs. of pigs' livers. 2 carcases of imported sheep. 1 fore-quarter of imported sheep. 1 carcase of imported lamb. 1 carcase of Scotch lamb. Portions of 2 fore-quarters imported beef. Portions of 2 hind-quarters imported beef. Portions of 1 hind-quarter home-killed beef. Total weights of all foodstuffs destroyed:— Meat, 4 tons, 14 cwt., 1 qr., 25 lbs. Bacon, 38 tons, 15 cwt., 0 qr., 26 lbs. Fish, 1 ton, 13 cwt., 0 qrs., 24 lbs. Fruit, 11 cwt., 0 qr., 0 lbs. Provisions, 9 cut., 0 qr., 21 lbs. Arthur J. Bobbitt, Inspector of Meat and other Foods. 124 REPORT OF THE CANAL BOATS INSPECTOR FOR THE YEAR 1919. Public Health Department, Town Hall, Hackney, E. To the Chairman and Members of the Public Health Committee. 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 33 ,, boats inspected 14 „ boats conforming to Acts 14 „ boats infringing Acts Nil. „ certificates examined 14 Number of persons for which boats were registered—. Adults 52 Children Nil. Number of persons living on boats so registered— Men 24 Women Nil. Children Nil. The books inspected were found to be in good condition. No legal proceedings were taken. I am, Gentlemen, Your obedient Servant, EDWIN S. CROOK, (Temporary) Sanitary Inspector and Inspector under Canal Boats Acts. 125 REPORT MADE BY THE COMMITTEE OF MANAGEMENT OF THE CITY OF LONDON HOSPITAL FOR DISEASES OF THE CHEST, VICTORIA PARK, ON THE WORK OF THE TUBER CULOSIS DISPENSARY ATTACHED THERETO FOR THE YEAR, 1919. During the first three months of 1919 the dispensary arrangements which had been in force during the preceding year were adhered to, but in order to cope with the large number of patients attending the dispensary it was found advisable in April to provide two separate tuberculosis officers, one for Hackney and one for Bethnal Green. It so happened that Dr. Howell, the original tuberculosis officer for Hackney, was demobilised early in the year; he therefore resumed charge of the Hackney patients, while Dr. Hebert continued in charge of those from Bethnal Green. This necessitated the use of two consulting rooms, which fortunately were at our disposal, and no alteration of times to which patients had become accustomed was necessary. Each consulting room is provided with two dressing-rooms, and a dark room for throat examinations, and has proved entirely satisfactory for the rather special requirements of a dispensary. The patients are seen in the waiting room outside by the nurse, who weighs them and takes their temperatures, and they come singly into the consulting-room. The patients are therefore encouraged to mention to the tuberculosis officer any private or domestic details, and the tuberculosis officer is not disturbed during his examination by noise made by patients who are waiting to see him. The clinical notes of cases, with all correspondence, most of which is of a confidential character, are brought into the consulting room by the nurse, so that all details of the case are available without being seen by the patient himself. The prescriptions are written on a card used solely for this purpose, so that the notes are not soiled by patients handling them. There are seven sessions each week, four in the mornings from 10 to 12, and three in the evenings from 7.30 to 9 o'clock. One of 126 the mornings is a Saturday, when school children can attend without missing time from school. It is generally necessary to extend a session beyond the advertised closing time, but patients must reach the hospital before 12 noon and 9 p.m. respectively. It often happens that several new cases present themselves just at the close, with the result that perhaps an extra hour is added to the session. This could be remedied if the new cases were directed to attend before 11 a.m. and 8 p.m. respectively. In difficult cases, when special examinations are necessary, the assistance of the Out-patient Physicians, the Radiologist, the Laryngologist and the Surgeon has been most useful, and personal interview with these members of the staff, such as is possible at Victoria Park Hospital, is much more valuable than a written opinion. The services of the Dentist in the extraction of teeth have been a valuable aid to treatment. The help of charitable societies, such as the Invalid Children's Aid Association, the Jewish Board of Guardians, and the Charity Organisation Society, has been extremely valuable, for although the London Insurance Committee and the London County Council are responsible for providing hospital or sanatorium treatment for definitely diagnosed tubercular cases, there is no state provision for obtaining convalescent treatment for adults and children who are in ill-health, and who may be suffering from early tuberculosis. Such treatment, especially in children, is often the means of averting the onset of serious disease. In this connection special mention should again be made of the excellent work which is done through the Hackney branch of the Invalid Children's Aid Association in sending a large number of "pre-tuberculous" children into the country for prolonged convalescence, and, in addition, in following up the cases by visiting the homes for purposes of after-care. The after-care of uninsured tuberculous patients is in the hands of the Interim Tuberculosis Care Committee, which in the case 127 of Hackney was converted during the autumn into a Borough Tuberculosis Care Committee. Another important undertaking for the treatment of children is the Stormont House Open-air School, which was opened in September. The majority of the children come from Hackney, and the remainder from Bethnal Green and Stoke Newington. At first a single class of 25 children of either sex was formed, but by the end of the year a second class of 25 was started. Accommodation is available for 75 children, and it is expected that the school will soon be full. The school is brought into close touch with the dispensary, as Dr. Howell is Medical Officer in charge, and the dispensary nurse spends one-third of her time at the school, visiting it daily. At the beginning of the year, when the London County Council moved the adoption of open-air schools, two types were contemplated—one such as Stormont House for definitely tubercular children, the other for delicate children of the so-called pre-tuberculous type. Many of the children who attend the dispensary would be suitable for the latter kind of school, and it is to be hoped that a site for one can be found in the neighbourhood. Such a school would undoubtedly help considerably as a preventive measure in the reduction of tuberculosis. A further preventive measure which is universally acknowledged to be of very great importance is the establishment of homes for advanced and for dying cases. At present there is accommodation in the different sanatoria for the comparatively hopeful cases, but very little for the large number of advanced ones among the civilian population. Realising this, the London Insurance Committee are contemplating the establishment of institutions for this class of case, the first having been opened at Hendon to accommodate several hundred patients. Whether these institutions will satisfactorily solve the question depends rather on their situation. The patient 128 who has not long to live wants to be within easy reach of his friends, and he would probably be more comfortable in a smaller institution with about 50 beds in the immediate vicinity of his home. The London Insurance Committee has made ample provision for discharged soldiers and sailors with advanced tuberculosis. Beds have been obtained at fever hospitals as well as in the country and at the seaside, and the waiting period for admission is seldom more than a few days. Although institutional treatment in the case of ex-soldiers is well provided tor, the problem of employment for those who have derived benefit from this treatment is still unsolved. Many would be better for some light work to occupy part of their time, but the War Pensions Committee have rarely been able to find such employment for them, and there is no existing organisation to deal with the matter. The Tuberculosis Officers acted as Medical Referees for the Local War Pensions Committees on tuberculous cases, and also on cases suspected of having tuberculosis by Pensions Medical Boards. This entailed a good deal of work, but it kept them in close touch with all discharged men of both services. The statistical tables given later are self-explanatory and need few remarks. The totals of new cases have fallen slightly in both Boroughs—in Hackney largely owing to the fact that about 300 fewer "contacts" were sent to the dispensary for examination. The number of patients sent by local practitioners remains high compared with the figures of other dispensaries, and most of the doctors in the neighbourhood make use of the dispensary for purposes of consultation, and every effort has been made to encourage them to do so. The written reports to local practitioners on cases sent by them to the dispensary amounted to 557 from the two boroughs. 129 The number of cases of pulmonary and non-pulmonary tuberculosis in Hackney was almost the same as in the preceding year, but in Bethnal Green there was a decided decrease, owing no doubt to the fact that in 1918 many previously recognised cases were sent to the dispensary, which had only recently opened. It is felt that notification of a patient as tuberculous is a step that should not be taken without strong clinical evidence of the disease, and in a large number of cases the diagnosis is left open for a time. Before the end of the year, however, the majority have received a definite diagnosis of either tuberculous or non-tuberculous, and the few who remained undiagnosed are chiefly the cases whose first attendance was during the last few months of the year and who are still under observation. In Table 4 it will be seen that the percentage of tuberculous cases among contacts was just over three in each borough. The figures given in the last table compare closely with those of the preceding year, except that the total number of attendances amounting to over 10,500 for the department, shows a decided increase (i.e., for both boroughs). In conclusion we should like to thank the Dispensary Committees, the Medical Officers of Health, the Hospital Physicians, and the hospital Secretary for their help and advice, and also the Dispensers, the Clerk, the Nurse, and the Porter, all of whom have done their work very efficiently. H. TYLFORD HOWELL, M.R.C.S., L.R.C.P., Tuberculosis Officer for Hackney. L 130 1. The totals of New Cases. Males 420 Females 445 Total 865 2. The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 189 93 Local Practitioners 141 72 London War Pensions Committee 59 31 Contact cases 404 13 London Insurance Committee 18 14 London County Council 6 5 Victoria Park Hospital 34 31 Other sources 14 8 3. The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 16. Males. Females. Pulmonary Tuberculosis 97 36 16 10 48 207 Non-pulmonary Tuberculosis 10 7 35 1 7 60 Non-tuberculous 104 59 268 6 94 531 Doubtful 28 9 17 0 13 67 Total 239 111 336 17 162 865 131 4. The Diagnosis of Contact Cases. Pulmonary tuberculosis 9 Non-pulmonary tuberculous 4 Non-tuberculosis 373 Doubtful 18 Total 404 5. Sputum Examinations of Insured, and Uninsured Patients. Insured. Uninsured. Total. Tubercle bacilli present 78 21 99 „ „ absent 339 157 496 6. Other Figures. Insured. Uninsured. Total number of attendances 2,783 3,195 Systematic examinations at the above 846 891 Number of letters written 1,4 06 „ visits to patients at their homes 33 13 „ patients sent to hospital or sanatorium 84 34 „ patients referred to:— X-ray Department 68 31 Other Departments 23 13 I 2 132 REPORT OF THE TUBERCULOSIS OFFICER OF THE METRO POLITAN HOSPITAL TUBERCULOSIS DISPENSARY FOR THE YEAR 1919. (Submitted to the Committee of Management of that Hospital.) January 19 th, 1920. To the Committee of Management, Metropolitan Hospital Tuberculosis Dispensary. Gentlemen, I beg to present the report for the year 1919, the fifth since the dispensary opened. 1 commenced my duties on the 1st November, immediately after you did me the honour of appointing me as Medical Tuberculosis Officer, and in view of my short period of office, my observations on the work done during the year are limited, and I must leave the figures given in the appended tables to speak for themselves. I have formed the opinion, however, during my short experience of the work, and by knowledge gained hy a survey of the notes and figures for the year, that the dispensary is continuing to fulfil, with efficiency, its share of the work in the tuberculosis schemc of the boroughs. The work was carried on with enthusiasm and ability during the first ten months of the year by Dr. F. N. Moos, and the methodical and extensive notes carefully made by him have aided me greatly in carrying on with the treatment of the cases. Thanks are due to Mr. Buchanan for his kind assistance in administrative matters, and to Miss Bennett for her co-operation in kindly supplying nurses, whose valuable services are much appreciated. To the medical and surgical staff in charge of the various departments of the hospital I am much indebted for their expert and ready assistance in cases referred to them ; and especially to Dr. Mowat for the many X-Ray examinations and reports, which have proved so valuable in forming a diagnosis. 133 I also desire to express my thanks and gratitude to Professor Kenwood, M.O.H., Stoke Newington, and Dr. Fletcher, Hackney, for their courtesy and encouragement, and for their advice in matters relating to the administration of the dispensary in connection with the tuberculosis scheme in their respective boroughs. Several of the medical practitioners in the neighbourhood have sent their patients to the dispensary for an opinion and treatment, and to them I offer my thanks for their hearty co-operation in the work. A large and increasing number of ex-service men have been referred to the dispensary by the local War Pensions Committees, and in connection with these cases a considerable amount of clerical work is required. Miss Fellowes, who has continued during the year to perform her duties as clerk-dispenser accurately, and in a highly satisfactory manner, has undertaken this additional work with commendable enthusiasm. Treatment. Early cases are as a rule recommended for admission to Sanatoria, and the reports obtained on the discharge of the patients, invariably show that great benefit has been derived from this form of treatment. Of the patients dealt with at the dispensary, the majority are chronic and fairly advanced cases, who, while able to perform a certain amount of work, attend regularly for treatment. Many others, in whom the disease has been arrested, and who have returned to their usual occupations (generally after residence in a sanatorium), are kept under observation, and come up to the dispensary for reexamination from time to time. 134 The systematic examination of "contacts" is carried out at the dispensary; and in some cases, at their homes. This constitutes one of the most important branches of the work. The suggested scheme for providing homes for advanced open cases has not yet materialised, but it is to be hoped that this most desirable provision will be proceeded with at an early date, not only for the benefit and comfort of those afflicted, and in the interests of those who by contact are constantly exposed to infection, but as a further protection to the community. The open air school at Stormont House, Hackney Downs, now receives "notified" tubercular children between the ages of eight and fourteen. This school will be of great benefit to Hackney children, but it is to be regretted that it is so inaccessible for the Stoke Newington cases. There is no means of reaching the school by public conveyance, and parents residing in Stoke Newington strongly object to send their children so far on foot; as they rightly consider that a long walk, especially during inclement weather, would be harmful to a delicate child. This disadvantaage might be overcome by supplying a conveyance to collect and transport the scholars to and from school, as in the case of crippled children, and I propose to suggest this procedure to the school authoiities. Another great objection, however, is that, under the arrangement by which the children attending this school come under the treatment of the school medical officer, who is also the tuberculosis officer for Hackney, at the Victoria Park Hospital, any medicine required has to be fetched from the tuberculosis dispensary at Victoria Park, which is about two-and-a-half miles from Stoke Newington. Under these existing circumstances, as far as Stoke Newington is concerned, the aims of this branch of the tuberculosis scheme are practically annulled. 135 The Interim Tuberculosis Care Committee for Hackney and Stoke Newington has recently been constituted a Permanent Committee under the joint Borough Councils, and as such, will now be able to carry on its most important work with greater facility and scope. Statistics. The total attendances of Hackney patients for the year numbered 3,875, of which 3,340 were old, and 535 were new cases. The corresponding figures for 1918 were:—3,860 total attendances, of which 3,009 were old, and 851 new cases. This shows an increase of 15 on the total attendances; an increase of 331 old cases, but a decrease of 316 new cases. The "contacts" examined numbered 284, of whom 18 were found to be suffering from pulmonary, and 5 from non-pulmonary tuberculosis ; 20 were doubtful, and 241 non-tubercular. Altogether 309 sessions were held, giving an average attendance of Hackney patients of 13-18 per session. Of 165 specimens of sputa examined, 52 were found to be positive. Trusting that you will find this report of the work done at the dispensary during the year satisfactory, I am, Your obedient Servant, L. UN WIN YOUNG, Medical Tuberculosis Officer. 136 Returns shouting the result of the Examination of persons for the purpose of Diagnosis. Original cases found pulmonary tuberculosis 150 Contact cases found pulmonary tuberculosis 18 168 Original cases found non-pulmonary tuberculosis 24 Contact cases found non-pulmonary tuberculosis 5 29 Original cases found doubtful 30 Contact cases found doubtful 20 50 Original cases found non-tubercular 47 Contact cases found non-tubercular 241 288 Total of new cases 535 Classification and Detailed Statistics of Attendances. Insured Persons. Male. Insured Persons. Female. Uninsured Persons. Male. Uninsured Persons. Female. Contacts. Total. Male. Female. I. U. I. U. New Patients attending 97 43 53 47 21 86 32 149 528 Attendances of Old Patients 1,242 518 396 621 26 199 67 271 3,340 Patients visited in their homes 10 3 1 5 - - - - (new) (old 7 12 Specimens of sputa examined 83 29 13 26 4 — 4 6 165 137 Table showing attendances of New and Old Patients for each Month of the Year. Month. Morning Sessions. Evening Sessions. Times Open. Patients Times Open. Patients. New. Old. New. Old. January 20 34 197 9 19 104 February 16 34 151 8 24 91 March 16 31 154 8 15 92 April 17 32 162 8 13 103 May 18 42 167 9 26 106 June 16 28 153 8 8 108 July 19 31 195 9 20 116 August 17 20 173 9 19 95 September 17 38 184 9 12 128 October 19 17 175 9 14 132 November 16 18 148 8 23 117 December 16 19 168 8 8 121 Totals ... 207 334 2,027 102 201 1,313 Averages:— Mornings—New patients 1.6 Evenings—New patients 2.0 „ Old patients 9.8 „ Old patients 12.8 Total average sessional attendance 13.1. 138 SPECIAL REPORT BY THE LATE DR. J. KING WARRY, DATED "JANUARY 30th, 1919." To the Chairman and, Members of the Public Health Committee. Sanitary Condition of Nisbet Street. Gentlemen, I have carefully considered the Rev. A. H. Dacombe's letter, dated 6th November, 1918, on the above subject and beg herewith to report thereon. In the first place I wish to state that my attention was drawn to the condition of the Nisbet Street houses about the middle of September last, owing to the occurrence of some cases of diphtheria amongst the children living there. From the result of. the inspections following these notifications, I detailed as soon as possible two sanitary inspectors to make a house-to-house inspection of the whole street. They began their work on the 14th October and continued it until the whole of the 75 houses in this street were inspected. In the letter of the Rev. A. H. Dacombe, four definite assertions are made respecting the Nisbet Street houses, viz.:— 1. "There have been many cases of diphtheria there lately." 2. "Some of the houses, I know, are infested with rats." 3. "Many of them are quite unfit for habitation." 4. "These houses which are really unfit for swine to live in." (1) With respect to the incidence of diphtheria, I give below a table showing the total number of cases of diphtheria which 139 have occurred amongst the occupants of Nisbet Street during the several months of the year 1918:— Cases of Diphtheria Jan. Feb. Mar. April May June 0 0 0 0 0 0 July Aug. Sept. Oct. Nov. Dec. 1 0 4 1 0 1 The "many cases" consist of a total of seven, during the last six months of the year, of which four occurred in the month of September, one other case in each of the months of July, October and December. With respect to the four cases in September, two occurred in one famuly, and one each in two other families. The source of these cases of diphtheria was quite definitely ascertained, and had no relation to the condition of the houses. During the month of September, an early outbreak of diphtheria occurred chiefly in Homerton associated with two of the elementary schools in that neighbourhood. In one of these schools no less than eleven cases occurred during September, and thirty-five during October; in the other school two cases occurred during September and ten during October. Moreover, bacteriological examination of the throats and noses of certain children attending the former school revealed the presence of quite a number of carriers, i.e., children having the organism of diphtheria present in their throats or noses without the children showing the slightest signs of any illness. On one day early in October, seven such carriers and five other children with suspicious organisms in their nasopharyngeal passages were discovered in the first-mentioned school. Later on other carriers and suspicious cases were discovered amongst the scholars of the same school. Suspicious cases were also discovered in the second school. Of the five cases from Nisbet Street in September and October, three attended these schools, one of them being a carrier. A fourth case in October also attended another school in which cases of diphtheria had occurred during August, September and October, but the cases were not as numerous as in the two first schools mentioned. 140 The "many cases" of diphtheria referred to were in reality few, and due to a definite cause quite apart and distinct from house sanitation. 2. With repsect to some of the houses being infested with rats, the following facts were ascertained on investigation by the Sanitary Inspectors, viz.:— East side of Nisbet Street.—The drains of the whole of these houses (39 in number) were tested, and the only defect found was one defective trap. The tenants of five houses complained of rats. Three of these tenants stated they had not seen any rats but had heard gnawing under the floor. The Inspector took up the floor boards but could not find any evidence of rats beneath. In one of the other two houses, the tenant stated a rat had been seen in the house. The Inspector found two holes in the flooring which he took up, but failed to find either rat runs or other evidence of rats or any communication with the drains. In the fifth house, the tenant stated the cat had caught a rat in the house some time before. The floor boards were also taken up here with negative results. West side of Nisbet Street.—The drains of the whole of these houses (36 in number) were tested but no defect was discovered in any of the drains. The tenants of three houses complained of rats ; two of these stated that their cats had brought dead rats into the house. The Inspector searched for evidence of the presence of rats, taking up the floor boards for this purpose, but no evidence was found. In the third house, the tenant complained of the presence of rats and stated they had caught several in a trap. The Inspector found, in this case, rat holes in the front cupboard. The floor boards were taken up and evidence of nesting was found in this case, but neither "rat runs" nor communications with drains were discovered. 141 It is quite evident from the information available, that the rats complained of did not proceed from any defective drains on the premises, but came from some external source. It was found that one or two air bricks inserted in the walls below the ground floor were broken, and allowed sufficient space for rats to get in below the floors. Where they came from, it is impossible to say definitely, but measures have been adopted to destroy any stray rats which may still be on the premises. 3. Before dealing with the actual condition of the houses in question and the nuisances or defects found on inspection, it is desirable that the Committee should have full information, as to the class of house forming Nisbet Street. There are altogether 76 houses in Nisbet Street, one of which is empty. The remaining 75 consist of 10 six-roomed tenements, 53 four-roomed tenements, one off-licensed public house with 4 living rooms, scullery, shop, and one general shop of 3 living rooms with scullery, &c. The total accommodation consists of:— Living rooms 319 Sculleries 75 W.C.'s, &c 75 Population 110 adults and 127 children. From the above, it will be seen that the accommodation is ample for the population, and I have ascertained that there is no overcrowding in any of the tenements. The chief defects found on inspection were dirty or dilapidated walls and ceilings of living rooms, sculleries or w.c.'s, defective roofs, gutters or rain-water pipes, defective floors or staircases defective yard paving or dustbins, defective water supply to w.c.'s 142 and a few minor defects. The following sets these out in greater detail:— Living rooms.—Walls and ceilings dirty or broken, or both—65. Verminous—6. Damp—5. Defective floors—7. Defective roofs or gutters or rain-water pipes—32. Defective windows or defective sash-lines—36. Staircases and passages.—Walls and ceilings dirty or dilapidated, or both—16. Staircases defective—2. Water closets.—Walls and ceilings dirty or dilapidated, or both—16. Defective pans or choked—8. Defective roofs, doors or seats—32. Defective flush or water supply—19. No fastenings to doors—11. Sculleries.—Dirty—6. Defective paving, or roofs, or doors, or walls or windows—40. Yard paving.—Defective—10. Dustbins.—Defective—10. Other nuisances.—12. The result of the inspection does not, in my opinion, reveal such insanitary conditions as to justify the dosure of these houses ; the defects are easily remediable during occupation. 4. No comment is required on this statement. I should like to remind the Committee that the Nisbet Street class of house requires, and received before the war, periodical inspection; but owing to nearly half the staff of inspectors being called up for military service, periodical inspections have had to be suspended; moreover, during the last three years there has been increasing difficulty in obtaining suitable labour and material for house repairs, hence the Nisbet Street houses and others of the like character have suffered. 143 At the present time, most of the work required on these premises has either been completed or is in process of completion. Work completed 28 „ in hand 20 „ outstanding 19 Summonses heard 4 I am, Gentlemen, Your obedient Servant, J. KING WARRY, M.D., D.P.H., Public Health Department, Medical Officer of Health. Town Hall, Hackney, E.8. 30th January, 1919. Addendum. VACCINATION. Previously to the war it was the duty of Vaccination Officers to make out returns every half-year—in February and August— showing in detail how the births registered during the half-years •ended seven months before the returns were made out were accounted for—numbers of children " exempted " dead, vaccinated, postponed, left the district, etc. Also, in addition to these " halfyearly returns," they were required to make out every year in February a " supplemental return," giving similar details with respect to the year ended thirteen months before the making of the return. Thus, the official return for the complete year 1919 will not be due until'February, 1921. Before the war a roughly approximate return for the year might have been obtained by adding together the two half-yearly returns, but during recent years these have been abandoned. For these reasons it is not possible to give any accurate figures. There is, however, reason for supposing that 144 the percentage of children born in Hackney, and subsequently vaccinated, is somewhere about 50. Thus, the proportion of unvaccinated to vaccinated in the population of the Borough is steadily increasing year by year, and this fact is of serious moment, for year by year the population as a whole, is becoming less and less protected against the infection of small-pox, and if the disease should be introduced into the Borough and once "got a hold," the consequences might be an extensive epidemic. It must be remembered that neglect of vaccination has been growing during the past thirty years, since the time when the Royal Commission on Vaccination commenced its enquiries, and that for more than twenty years abstention from vaccination has been legalised. At the present time, therefore, there must be, especially among the younger portion of the population, a large percentage of unvaccinated persons who are a potential source of danger to the community. In this connection the following figures, relating to an epidemic of small-pox which has been continuing in Glasgow for many months past, have been published recently, and may well be reproduced here. The difference in fatalities among the vaccinated and unvaccinated patients should be noted. Glasgow Small-pox Epidemic. A recent return gives the following particulars:— Patients admitted to hospital 446 Children under 15 years (unvaccinated 91 Children under 15 years (vaccinated) 29 Deaths of unvaccinated children 31 Deaths of vaccinated children - None of the cases aged 15 years and over showed any evidence of successful vaccination since 1901. The relative mortality 145 between vaccinated and unvaccinated is shown in the following table:— No. of Cases. Deaths. Mortality Rate per cent. Vaccinated in infancy 342 51 15 Unvaccinated 99 37 37 No definite evidence of vaccination 5 1 20 446 89 20 The relative excess of mortality among the unvaccinated therefore continues. It may be added that so far no cases have occurred among the medical, nursing or administrative staff engaged in dealing with the patients. W. W. E. FLETCHER, October 9th, 1920.