HAC 72 Metropolitan Borough of Thacrney. REPORT on the Sanitary Condition of the metropolitan borough of hackney FOR THE YEAR 192I, by G. H. DART, M.D., M.R.C.P., Edin.; D.P.H., D.T.M & H.,' Camb. Medical Officer of Health. Administrative Maternity and Child Welfare Officer Executive Tuberculosis Officer. London: Buck Bros. & Harding, Ltd., 6-7, West Avenue, 1922. INDEX PAGE Canal Boats Acts, Report of Inspector 116 Cleansing of Persons Act, 1907 65 Constitutional Diseases 42 Cowhouses, Dairies and Milkshops 113 Disinfection 61 Food— Articles Surrendered to District Inspectors 110 Articles Purchased for Analysis 111 Prosecutions under Sale of Food and Drugs Acts 112 Report of Food Inspector 113 Housing— Public Health (London) Act, 1891 94 Housing Acts 101 Housing Scheme 92 Housing Conditions in the Borough 92 Legal Proceedings 95 Rent and Mortgage Interest (Restriction) Act, 1920 93 Verminous Premises 109 Work of Sanitary Inspectors (Table of Inspections) 120 Industrial Statistics— Factory and Workshop Act, 1901 101, 104 Factories, Nuisances found 104 Factories, General Table of Inspections and Defects found 104 Workshops Inspected 102 Workshops, Analysis of Occupations 103 Home Workers 105 Outworkers 107 List of Industries 101, 103, 107 InfectiousDiseases— Anthrax Cerebro Spinal Meningitis 38 Cholera 37 Continued Fever 37 Diarrhoea 39 Diphtheria 34 Diphtheria Anti-toxin 36 Dysentery 39 Encephalitis Lethargica 38 Enteric Fever 36 Ervsipelas 37 Influenza 39 Malaria 39 Measles and German Measles 38 Ophthalmia Neonatorum 38 Plague 37 Pneumonia 39 Polio-Myelitis 38 Puerperal Fever 37 index page Infectious Diseases (continued). Scarlet Fever 34 Small-pox and Vaccination 32 Typhus Fever 37 Whooping Cough 40 Maternity and Child Welfare— General Organisation 8, 69, Contributions to Maternity Hospitals 81 Health Visiting 71 Infant Consultation and Ante-natal Clinics 72 Provision of Milk and Foods 83 Mortuary 30 Rats and Mice Destruction Act, 1919 109 River Lee 116 Sanitary Inspection—Table of Inspections 120 Shelter 65 Slaughterhouses 113 Tuberculosis— Advanced Cases 57 After Care 58 Description of Dispensaries provided for Treatment 46 Discharged Soldiers and Sailors 46 Dispensary Districts: Population 50 Extra Nourishment 56 Health Visitors—Visits of 46 Notifications and Deaths 43 Open-air School 57 Public Health (Tuberculosis) Regulations, 1912 44 Summary of Notifications 45 Summary of Deaths, Number and Classification 51, Reports of Medical Officers 52, 54 Vital Statistics— Acreage of Borough 18 Births and Birth Rates 19 Deaths and Death Rates 22 Deaths in Public Institutions 25 Density of Population 18 Infantile Mortality 23 Institutions outside the Borough receiving Sick from the Borough 25 Illegitimate Birth Rate 20 Marriage Rate 18 Notification of Births 20 Population 18 Registration of Births 21 Senile Mortality 24 Still Births 20 Tables of Causes of Deaths 130 Table (Comparative) of Rates for years 1912-21 31 „ „ „ year 1921—London Boroughs 17 5 PUBLIC HEALTH DEPARTMENT Public Health and Maternity and Child Welfare Committees., Public Health Committee. Ex-officio—Councillor William Parker, J.P. (Mayor). Chairman—Councillor H. P. Piggott. Vice-Chairman—Councillor Mrs. E. Boyce. Councillor Beckett, J. Councillor Benwell, Mrs. L. C. Bowhili., H. A. Boyce, Mrs. E. Brown, H. Chapman, T., j.p., L.c.c. Alderman Elliott, E. Councillor Genese, J. Goold, F. G. Councillor Lacey, W. J. Loweth, W. E. Lusher-Pentney, G. J. Muirhead, Mrs. E. Piggott, H. P. Rushbrooke, T., j.p., m.a., etc. Sherman, J. Vardon, A. D., j.p., l.r.c.p. Wilkinson, E. J. 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 Mrs. E. Boyce. Vice-Chairman—Councillor H. P. Piggott. Members of the Committee—as set out above with the addition of Mrs. M. Mylles, Mrs. M. S. Inkpin, and Miss B. W. Payne. 6 STAFF OF PUBLIC HEALTH DEPARTMENT. Sanitary Inspectors. R. H. Ellis. R. H. Bew. W. C. Vobe. A. Sadler. H. Body. G. F. High. R. J. Sheppard. C. F. Long. W. Goldsworthy. W. Peverett. E. A. Hillier. E. S. Crook, also Canal Boats Inspector. J. E. Truslove. J. W. Hall. G. Fowler. A. J. Bobbitt (for Cowhouses, Milk- shops, Slaughterhouses, etc.) J. Nighy, House to House W. E. Galvin, Inspection. Alice Teebay (for Workshops, Laundries, Sc.). Mabel Portlock (for Outworkers' Premises) Health Visitors. Mrs. A. Rhodes. Mrs. E. A. Cowley. Mrs. L. Harrison. Miss M. Chitson. Mrs. L. E. Bartholomew. Miss G. M. Servante Miss M. Clarke Miss I). F. Vidal. Miss A. K. Roche. Miss M. K. Cockle. Miss S. E. Love. for Tuberculosis cases. Medical Officers (Temporary Staff) Municipal Infant Welfare Centres. Elizabeth Wilks, m.d. Reginald Brown, m.r.c.s., l.r.c.p. J. H. Porter, m.r.c.s., l.r.c.p. Dorothy B. Gere, m.r.c.s., l.r.c.p. Tuberculosis Dispensary Medical Officers (Metropolitan and City of London Hospitals.) L. Unwin Young, M.B. H. Tylford Howell, m.r.c.s. Public Analyst—Leo Taylor, f.i.c. Dust Inspectors. E. J. Tietjen. T. Saunders. Disinfecting Station and Shelter Caretakers. E. G. Hasler. Mrs. E. Hasler. Mortuary Keeper—S. W. Boxell. Messenger—H. Storey. Clerical Staff. J. D. Wilde. A. Higgins. P. A. Hitch. L. W. Harvey. E. Whittaker. V. Welham. H. C. Bowman. H. R. Sandford. Medical Officer of Health. G. H. Dart, m.d., m.r.c.p., Edin., d.p.h,, d.t.m & h. Camb. 7 Metropolitan Borough of Hackney. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1921. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, E,8 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit, in accordance with the instructions of the Ministry of Health, the Annual Report on the health of the Metropolitan Borough of Hackney for the year 1921. The report is presented in the form and sequence of subjects suggested by the Ministry of Health; but before proceeding to a detailed description of the sanitary work of the Borough, a short statistical summary and a comparative table as regards the Death, Birth, Zymotic and Infantile Mortality Rates of Metropolitan Boroughs will be found convenient for immediate reference. A comparative table for the Borough showing the Birth, Death and Infantile Mortality Rates for the past ten years is set out on page 17. The birth-rate is 22.2 per 1,000 for Hackney, as compared with 22.3 for the whole of the County of London. The Infantile Mortality Rate for the Borough, measured by the number of deaths under one year of age per thousand births registered, is 64 as compared with 81, the figure for last year, the Borough average during the last five years (1910 to 1920), is 90, and the figure for all London is 80, as compared with 75 in 1920. 8 The Death-rate for Hackney is 11.5, as compared with 12.4 for the County of London, and is slightly higher than the Deathrate of three of the Metropolitan Boroughs. The Zymotic Death-rate is 0.7, as compared with 1.09, the figure for 1920. The number of scarlet fever cases notified during 1921 was 1,863, as compared with 1,077 during 1920, and the number of diphtheria cases notified during 1921 was 872, as compared with 764 during 1920. The deaths from scarlet fever numbered only 11, and the deaths from diphtheria 46, being 24 less than those registered in 1920. Table II., page 41, gives the number of cases of infection diseases notified and removed to hospital during 1921. Maternity and Child Welfare. The .Maternity and Child Welfare work in Hackney has been further extended during the year. An additional infant Welfare Centre was opened in February by the Council at Northwold Road, and the Hackney Grove Voluntary Infant Welfare Association opened in October an additional centre for the Hackney Grove District, so that there are now seven centres operating in Hackney; four municipal, and three voluntary. The work of Eton Mission Welfare Centre has also been increased in scope by the institution of an Ante-Natal Clinic, and an additional annual grant of £50 per annum by the Council was sanctioned by the Ministry to date from March 31st. At Overbury Street Centre a weekly, instead of a fortnightly, Ante-Natal Clinic, and an additional Child Welfare Clinic were put into operation. Sanction to an additional session at Brooksbys Walk AnteNatal Centre, to the institution of a Dental Clinic, and to other suggested extensions of the work was refused by the Ministry of Health. An agreement was entered into with the Invalid Children's Aid Association to provide convalescent aid to children found at the Centres to be in need of such treatment, see page 81. 9 Midwifery assistance to 104 mothers confined in their homes, and the provision of Home Helps in 8 cases, was provided, in addition to in-patient hospital treatment to 188 confinement cases at the City of London Maternity Hospital and Mothers' Hospital, Clapton, under the Council's agreements with these Institutions. The scope of the agreement with the Mothers' Hospital was extended in September of this year. The King's Home for Nurses has been most helpful to the work of the Public Health Department in dealing with nonnotifiable infectious disease such as Measles and Whooping Cough. Nursing assistance was supplied to 70 necessitous cases under the agreement between the Association and the Council, and 1,050 visits were paid to those cases by the Nurses. The conditions under which milk (fresh and dried) was supplied to necessitous mothers and infants, received careful consideration at the close of 1920, and the arrangement hitherto in force of granting milk through the Maternity and Child Welfare Centres "was discontinued and the present system of direct control by the Maternity and Child Welfare Committee through the Public Health Department was introduced. Various restrictions in the supply of milk were imposed at different times during the year, on the grounds of economy, by the Ministry of Health, but no alterations were suggested in the detailed administration of the scheme which had been put into operation by the Council, see page 82. During the short period that the supply of milk was suspended in order that the approval of the Ministry could be obtained to the system adopted by Local Authorities throughout the country, the greatest suffering was experienced by numbers of poor families in the district, and the deterioration noticed in children attending the centres was specially commented upon by the medical 10 tioners attending the centres at a meeting of these officers held shortly after that time. During the year 4,300 applications were dealt with. In 3,378 cases the parents were unemployed, and in 311 were on short time. 650 of these families at the time of investigation of circumstances were found to be absolutely destitute. There is surely no great extravagance to complain of in this direction and it is difficult to understand how any justification can be attempted for the attacks on the Public Health Services that have been made, on the grounds of economy, in the daily press. In this Borough the removal of household refuse represents a rate of 10d. in the pound, a useful figure for comparison as even the most rigid "economist" does not suggest that household refuse should be allowed to accumulate. The cost of the entire Public Health Department as regard disinfection, inspection of houses, workshops, unsound food, etc-, expenditure in connection with infectious disease, mortuary, cleansing station, tuberculosis dispensaries, maternity and child welfare centres and doctors, and in every other direction ; the entire expenditure, in fact, as regards all the activities of the department represents a rate of little more than half that sum. The net estimated cost to the Borough of Maternity and Child Welfare work, including the supply of milk that has caused so much comment, for the coming year is less than a penny rate; 86d. to be exact. The Electrical Engineer in a report to the Public Health Committee stated that if every householder in Hackney could be induced to burn his waste paper and other inflammable rubbish instead of putting it into the dustbin for removal to the Destructor, the rates in this one direction alone could be reduced by 3¼d. in the pound, more than half the cost of the Public Health Department. In what direction does true economy lie? It has been 11 pointed out that during the war out of every 9 men of military age in the country only 3 were perfectly fit and healthy, and also, that year by year in England over 270,000 years of work are lost on account of sickness. It may or may not prove economical to perpetuate the present state of affairs. Tuberculosis. The Tuberculosis Death-rate shows a slight increase, the mortality being 1.17 per 1,000 of the population, as compared with 1.1 for 1920, the number of deaths being greater by 15 in 1921, although there were 83 fewer primary notifications as compared with 1920. One of the outstanding features of the tuberculosis service is the extremely unsatisfactory conditions under which the treatment of advanced cases is carried out. There is no adequate provision for the institutional treatment of advanced pulmonary tuberculosis. It should also be borne in mind that a large proportion of the cases who are tabulated among the deaths in institutions have in reality, during the greater part of the time that the disease was advanced, been under treatment at home, such cases frequently entering and leaving hospitals and infirmaries (see pages 51 and 57), while in an extremely infective condition. Thus the fact that only 97 deaths, or 45.5 per cent. occurred at home out of a total of 213, is entirely misleading in that the remaining number of cases under treatment in institutions at the time of death by no means represents cases rendered harmless by removal to an institution. A fact that conveys a more accurate idea of the conditions existing that help to spread infection is that out of the total number of deaths from pulmonary tuberculosis 180 or 84.5 per cent. were unable to secure a separate bedroom during the course 12 of treatment at home. All the cases under treatment at the dispensaries, or at one time under treatment at the dispensaries, had a sputum examination carried out, and it is therefore known that as regards 53 of the cases who did not have even a bed to themselves, tubercle bacilli were present in the sputum. A further point of great interest and importance is the stage of the disease at the first attendance of the patients who came under dispensary treatment and died during the year. There were 116 deaths among dispensary patients and 54 of these patients or 46.5 per cent. were in the final stage of the disease on first attendance, 53 patients or 45.6 per cent. were in the second stage. It also appears from an examination of the case papers that 81 of these cases or 69.8 per cent. had been suffering from this disease for a period varying between three to twelve months, but a great many had evidently been ill for a far longer period, suffering evidently from tuberculosis of the lungs as shown by the fact of the history of such conditions as pleurisy and haemorrhage, etc., manifestations which were in all probability in every case tuberculous but which the patients did not realise were connected with the final onset; however, no fewer than 50 of the total number of cases, or 43.1 per cent. had known for a longer period than one year that they were suffering from Consumption. A very great deal could be done for advanced cases by the Tuberculosis Care Committee even under the present unsatisfactory conditions as regards institutional accommodation if sufficient support were given to the Committee, but even the routine work of caring for sanatorium cases has been carried on under very considerable difficulties, owing to the fact that, without any warning whatsoever, the Ministry of Health in a letter dated April 1st, 1921, deducted from the amount of the Tuberculosis Grant payable to the Council, the sum of £100, in respect of Grants to the Tuberculosis Care Committee "as this matter is at 13 present under consideration, and the Minister is not yet in a position to pay a Grant in aid of this expenditure," and that ever since this pronouncement the Ministry has refused to sanction the Committee except for short periods and after considerable delay. A report was presented to the Public Health Committee pointing out that the Care Committee had been constituted at the request of the Central authorities, and carried on in accordance with the Circulars of directions issued from time to time, and instructions were given that the Ministry should be requested to state their reasons for adopting this attitude towards the Committee formed under their instructions. The Ministry thereupon approved the establishment of the Committee for a further period ending September 30th, 1921, in a letter dated August 16th. Permission for the period September 30th to December 31st was received in October, 1921; permission for the period December 31st to March 31st, 1922 was received in March, 1922. At this time, (April, 1922), the Public Health Committee is still awaiting sanction for the present period. In other words, the Council having been induced to accept a certain responsibility, is not now permitted to carry it out. The Report of the Care Committee will be found on page 58. Notification of Tuberculosis is very perfunctorily performed in many instances as shown by the table giving the interval between notification and death, see page 51. Circular 194 of the Ministry of Health was issued during the year permitting, as part of the treatment of Tuberculosis, the granting of extra nourishment to necessitous persons undergoing Dispensary treatment. This is a transfer in greatly attenuated form of a power formerly possessed by the Insurance Committee as regards "Sanatorium Benefit." The Circular restricted the 14 expenditure to an amount not exceeding £2 per 1,000 of the population. Since June 6th, 59 cases of tuberculosis have received assistance under this scheme. Sanitary Inspection. The details of the work of Sanitary Inspection, comprising as it does so many services essential to the health of the community, can be found in the report by referring to the index. This work throughout the year has been carefully and conscientiously carried out, and it is due to this fact that the housing conditions of the Borough have not caused considerable adverse comment. The position is, however, becoming steadily more difficult. The three additions to the inspecting staff have rendered it possible to givel the additional attention that the increasing dilapidation of the housing property renders necessary in order to prevent the formation of large slum areas and maintain housing property in comparatively decent condition, but it is not possible to deal with overcrowding, apart from exceptionally bad cases, or to close -a great deal of property that under other circumstances would necessarily be shut down- There are, as the Council is aware, 37 houses in the Middlesex Wharf and Dockway property alone that the Tyssen Amherst Estate wish to close, and that were reported to the Council in July, 1918. Closing Orders were then made, but owing to the difficulty in finding other accommodation for the tenants, a difficulty by no means less at the present time, the Ministry of Health would not then permit the houses to be closed. A list of troublesome property will be found on page 93. Some of the property, such as Xisbet Street, is only kept habitable by constant attention, but even such property as this has been sufficiently repaired, and some property of this kind, formerly derelict 15 such as Spring Lane Cottages, Bankstock Buildings and Priory Place have been put by the Owners into good condition. The Closing Orders on Spring Lane Cottages were determined by the Council in March, after the Cottages had been put into thoroughly satisfactory repair. It is, however, not a business proposition to adequately repair a great many of the houses in the Borough, and only under pressure is it possible to have any work whatever carried out on much of the property. The following table shows how, with increasing dilapidation, and also as a result of War time neglect, the amount of repairs required has increased, a fact well evidenced by the number of complaints of leaky roofs that follow any heavy downfall of rain. Public Health (London) Act, 1891. Year. Intimation Notices. Statutory Notices. Legal Proceedings. 1913 4,852 223 4 1914 3,980 280 13 1918 2,466 258 24 1919 4,780 405 60 1920 6,781 982 116 1921 8,032 1,701 117 Matters that should receive the careful attention of the authorities are the situation that may arise should the Increase of Rents, etc. Act, 1920, lapse, and the increasing tendency on the part of owners and agents to shelve responsibility by inducing incoming tenants to sign agreements to undertake repairs on property, that is, or is about to become, ruinous. (See pages 93-4.) 16 The River Lee has been in a most offensive and dangerous condition throughout the summer. A short note will be found on page 116. In conclusion, I have to thank the Public Health and Maternity and Child Welfare Committees for their support and kind consideration, and I wish to express my appreciation of the manner in which my staff have performed their duties. I am, Yours obediently, G. H. DART Medical Officer of Health. 17 COMPARATIVE TABLE, YEAR 1921. Name of Borough. Population. Birth Rate. Zymotic Death Rate. Death Rate all causes. Infant Mortality. Battersea 169,200 22.12 1.02 12.17 73.8 Bermondsey 120,500 26.81 1.55 13.74 94 Bethnal Green 118,300 25.4 1.75 12.9 98.2 Camberwell 269,600 23.3 - 11.9 74.9 Chelsea 64,290 16.6 0.4 13.5 78.5 Deptford 113,500 23.5 0.95 12.2 88 Finsbury 76,690 25.9 1.4 14.8 93 Fulham 159,400 22.2 - 11.8 83 Greenwich 100,493 22.70 0.76 12.41 76 Hackney 224,200 22.2 0.7 11.5 64 Hammersmith 131,500 21.1 0.98 12.7 88 Hampstead 86,890 15.4 0.59 11.2 88 Holborn 43,520 14.8 0.42 12.8 79 Islington 333,000 23.68 0.86 13.12 81 Kensington 175,686 18.7 1.02 13.8 110 Lambeth 305,700 29.4 0.7 11.9 56 Lewisham 175,800 19.47 0.29 10.47 54 Paddington 145,600 19.63 0.95 12.07 92 Poplar 164,100 27.28 1.59 12.73 83 St. Marylebone 105,200 18.4 0.57 12.8 66 St. Pancras 212,900 22.4 1.04 13.0 76 Shoreditch 105,200 28.5 1.9 14.4 114 Southwark 184,388 27.3 1.23 14.3 90 Stepney 249,738 24.7 1.42 12.94 89 Stoke Newington 52,590 20.4 - 11.5 53 Wandsworth 328,000 18.80 0.70 10.83 67 Westminster 141,317 13.6 0.53 11.5 80 Woolwich 136,307 23.5 1.05 11.7 62 City of London 13,706 9.4 0.22 11.5 93 County of London 4,514,405 22.3 - 12.4 80 City of Belfast - - - 14.4 115 „ „ Dublin - - - 16.8 128 „ „ Glasgow - - - 15.5 104 „ „ Edinburgh - - - 14.4 96 „ „ Liverpool - - - 14.3 107 „ „ Manchester - - - 13.57 97.4 18 VITAL AND OTHER STATISTICS. Population and Density. Area=3,287 acres. Population—Census, 1901 = 219,780 „ —Census, 1911 = 222,674 „ —Census, 1921 = 222,159 The population of the Borough at the middle of the year 1921 is estimated by the Registrar-General to number: 224,200 This gives a density of population for the whole Borough of 68.2 persons per acre, varying from 52.5 persons per acre in the Northern Sub-district to 98.1 persons per acre in the Southwestern 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 1921. North Central South- West South- East Total for Hackney Total for London Estimated population 56,763 53,016 57,480 56,941 224,200 4,514,405 Area in square acres 1,080 857 586 764 3,287 74,815 Density, persons per acre 525 61.8 98.1 74.7 68.2 60.3 *Marriages and Marriage-rates.—During 1921 there were 2,358 marriages solemnised in the Borough of Hackney. The *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 1921. 19 annual rate for persons married during this period is therefore 21.0 per 1,000 of the population. The following table gives the number of marriages and marriage-rates for the Borough of Hackney and London during the 10 years, 1911-1921:— Year. Borough of Hackney. London. Marriages. Marriage rate. Marriage rate. 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 1919 2,571 22.8 23.0 1920 2,380 21.1 21.7 Average, 1910—1920 2,165 196 20.2 1921 2,358 21.0 19.6 Births and Birth-rate.—The births registered in the Borough of Hackney during the year 1921 numbered 5,437, of which 2,818 were males and 2,619 females. The total shows a decrease of 1,049 compared with the number registered during 1920, 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-, 761 births to be transferred to other districts and 302 to Hackney. After these necessary corrections have been made, the correct total of registered births amongst Hackney residents is 4,978. From this figure the birthrate for Hackney during 1921 has been calculated to be 22.2 per 1,000 of the population. The birth-rate for all London for the same period is 22.3 per 1,000 of the population. 20 Notification of Births Act, 1907.—Under the provisions of this Act 5,569 notifications of births were received during 1921. This total includes notifications from medical practitioners, midwives, parents and others. It also includes still-births. The total is 132 more than the number registered by the Registrar of Births. Still-Birtlis.—Amongst the births notified 131 were stillborn. 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. NOTIFICATIONS of BIRTHS ACT, 1907. Notifications of Births (Live and Still-born) received during the year 1921. Year 1921. 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 611 554 16 13 1.773 1.584 52 36 460 456 8 6 2844 2.594 76 55 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1921 was 387, but of these, the Registrar-General states that 271 should be transferred to districts outside the Borough, as the mothers were not Hackney residents, and 30 births which took place in other districts, should be transferred to Hackney. These corrections having been made, there remain 143 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate birth-rate of 25.8 per 1,000 births. 21 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 5.437 955 2,015 1,124 1.343 102,070 Rate per 1,000 living 24.2 16.7 36.9 19.5 23.6 223 No of illegitimate births 143 ... ... ... ... ... Rate per 1,000 births 25.8 ... ... ... ... ... It will be noticed that the birth-rate is abnormally high in the Central District compared with other Registration Subdistricts. This is accounted for by reason of 999 births occurring during the year at the Salvation Army Mothers' Hospital, which Institution is situate in the Central District. Of this number 645 births are transferable to districts outside Hackney. The following table shows the birth-rates for the Borough and its Sub-districts during the years 1911-1921 inclusive:— Birth-rate for the Borough of Hackney and its Sub-Districts for the years 1911-1921 compared with that of London. Year Borough of Hackney North SubDistrict Central SubDistrict South-West SubDistrict South-East SubDistrict London 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 1919 21.0 13.2 33.9 16.5 20.6 18.3 1920 28.7 20.6 41.3 23.6 29.5 26.5 Average 1911-1920 23.2 15.4 30.4 22.3 23.6 22.2 1921 24.2 16.7 36.9 19.5 23.6 22.3 * The Salvation Army's Mothers' Hospital was opened in 1913. 22 Deaths.—The deaths registered in the Borough during 1921 numbered 2,757; but of these 648 were deaths of non-residents who died inside the Borough, There were, however, 471 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 2,580. This is a decrease of 281 upon the number of deaths occurring during 1920. The general death-rate from all causes for the year 1921 is 11.5 per 1,000 of the population- Amongst the Registration Sub-districts the death-rate was lowest in the North Sub-district (11.1 per 1,000), the highest in the South-east Sub-district (11.9 per 1,000). Subdistrict. Population (estimated). No. of Births. Birth rate. Uncorrected. Total Deaths Deathrate. Deat hs under 1 year. Infant Mortality per 1,000 Births. Uncorrected. North 56,763 955 16.7 632 1ll 71 74 Central 53.016 2.015 36.9 599 11.3 71 35 South - west 57,480 1,124 19.5 672 11.7 83 74 South - east 56.941 1,343 23.6 677 11.9 104 77 All Hackney 224.200 5.437 24.2 2,580 11.5 329 60 * The uncorrected figure counts in all births and Infant deaths relating to the whole Borough ; but some of these having occurred in Institutions, etc., are referred to other districts. For corrected figure see page 19. 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. 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 1915 14.9 16.1 1920 12.7 12.4 1916 13.8 143 1921 11.5 12.4 23 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-rate of infants under 1 year of age for the year 1921:— Boroughs. Death rate from all causes per 1,000 living. Deaths under 1 year to 1,000 births. Lewisham 10.4 55 Wandsworth 10.6 67 Hampstead 11.0 65 Woolwich 11.5 62 City of Westminster 11.5 79 HACKNEY 11.5 64 Fulham 11.7 83 Paddington 11.9 90 City of London 11.9 114 Stoke Newington 12.0 59 Battersea 12.1 73 Camberwell 12.1 73 Greenwich 12.1 74 Lambeth 12.1 76 Deptford 12.1 87 Hammersmith 12.4 89 Holborn 12.6 77 St. Marylebone 12.7 73 Poplar 12.8 83 St. Pancras 13.0 75 Bethnal Green 13.0 99 Stepney 13.1 90 Islington 13.2 81 Chelsea 13.4 80 Kensington 13.5 104 Bermondsey 13.8 92 Shoreditch 14.2 110 Southwark 14.3 90 Finsbury 14.9 90 Infantile Mortality.—The deaths under 1 year of age in the Borough during 1921 numbered 329. This is a decrease of 156 upon the number of infants' deaths recorded during 1920. The infant mortality rate for the year is 64 per 1,000 births. 24 The causes of death are set out in the following table:— INFANT MORTALITY, 1921. Nett deaths from stated causes at various ages under 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 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 3 1 2 1 7 Diphtheria and Croup ... 1 ... ... 1 ... ... 2 ... 3 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... 1 ... ... 1 Meningitis (Not Tuberculous) ... 1 ... ... 1 ... 1 1 2 5 Convulsions 1 1 1 ... 3 1 1 1 1 7 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 2 2 1 2 ... 2 7 Pneumonia (all forms) ... ... 1 2 4 7 14 9 9 43 Diarrhoea ... ... 1 1 2 17 24 15 7 65 Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... 1 1 1 ... 3 Syphilis ... ... ... 1 1 ... ... 1 ... 2 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation (overlying) 3 ... ... ... 3 ... ... ... ... 3 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 8 ... ... ... 8 1 ... ... ... 9 Congenital Malformation 15 2 3 3 23 14 2 ... ... 39 Premature Birth 40 3 4 5 52 3 ... ... ... 55 Atrophy, Debility and Marasmus 5 1 1 4 11 10 8 4 2 35 Other Causes 5 2 1 4 12 7 11 7 4 41 78 11 12 22 123 65 67 44 30 329 Senile Mortality.—The deaths which occurred in Hackney at 65 years of age and upwards during 1921 numbered 940, and of these 448 were between the ages of 65 and 75 years, 381 between 75 and 85 years. and 111 at 85 and upwards. The annual mortality rate of persons at 65 years and upwards is 4.2 per 1,000 inhabitants. 25 Deaths in Public Institutions.—There were 1,483 deaths in public institutions in the Borough during 1921; of these 648 were residents of other districts, and the remaining 835 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 1921:— Institutions within the Borough receiving persons both from and without the Borough. Brooke House, Upper Clapton Road 7 City of London Infirmary, Clifden Road 7 Eastern Fever Hospital, Homerton 200 French Hospital, Victoria Park Road 4 German Hospital, Dalston 133 Hackney Union Infirmary, Homerton 819 „ Central Institution, Homerton 6 Metropolitan Hospital, Kingsland 183 Nursing Home, 40, Amhurst Park 2 „ „ 2, Amhurst Park 3 „ „ 117,Mount Pleasant Lane 1 „ „ 75, Stamford Hill 1 „ „ 153, Stamford Hill 3 „ „ 18 and 20, Southwold Road 9 „ „ 157, Richmond Road 4 „ „ 2, Queensdown Road 2 St. Joseph's Hospice, Mare Street 78 Salvation Army Nursing Home, 29, Devonshire Road 2 „ „ 9, Amhurst Park 1 Salvation Army Maternity Hospital, Lower Clapton Road 15 „ Home, Rookwood Road 2 „ „ 39. Powerscroft Road 1 1,483 20 Institutions outside the Borough Receiving Sick and Infirm Persons in the Borough. Bethnal Green Infirmary 3 Brompton Hospital 2 Cane Hill Mental Hospital 1 Caterham Asylum 3 Central London Throat and Ear Hospital 1 Charing- Cross Hospital 3 Children's Hospital, Great Ormond Street 12 City of London Maternity Hospital 7 Claybury Mental Hospital 18 Colindale Hospital 10 Colney Hatch Mental Hospital 22 Darenth Industrial Colony 3 Dartford Heath Mental Hospital 4 Downs Sanatorium 2 Elizabeth Garrett Anderson Hospital 1 Great Northern Hospital 1 Grove Hospital 1 Hanwell Mental Hospital 1 Hospital for Women 1 Homeopathic Hospital 1 Home Hospital for Women, Stoke Newington 2 Home and Hospital for Jewish Incurables, Tottenham 2 Hospital of St. John and St. Elizabeth 1 Horton Mental Hospital 1 Joyce Green Hospital 1 King's College Hospital 2 Leavesden Mental Hospital 21 London Fever Hospital 1 London Hospital 56 London Temperance Hospital 1 Long Grove Hospital 3 Carried forward 188 27 Brought forward 188 Middlesex Hospital 6 Mildmay Memorial Hospital 1 Mildmay Mission Hotspital 6 Mothers' Home, Commercial Road 1 National Hospital, Queen Square 4 Northern Hospital, Winchmore Hill 1 North Eastern Fever Hospital 15 North Western Fever Hospital 5 Northumberland Hospital 1 Park Hospital 3 Peckham House 2 Poplar Hospital 1 Prince of Wales' General Hospital 7 Queen's Hospital for Children 49 Queen Mary's Hospital, Carshalton 4 Royal Chest Hospital, City Road 1 St. Anthony's Home, Cheam 1 St. Bartholomew's Hospital 35 St. Columba's Hospital 2 St. Luke's House, Kensington 4 St. Mark's Hospital 1 St. Peter's Hospital 1 St. Thomas' Hospital 3 St. Pancras Infirmary 2 Shorditch Infirmary 3 South Eastern Fever Hospital 5 South West Hospital 1 Tooting Bec Mental Hospital 20 University College Hospital 2 Victoria Hospital 1 Victoria Park Chest Hospital 15 West London Hospital 1 Westminster Hospital 1 Miscellaneous Institutions 78 Total 471 28 TABLE III.—HACKNEY BOROUGH. Causes of, and Ages at, Death during the year 1921. 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 2 ... ... ... ... 1 ... 1 ... 5 Small-pox ... ... ... ... 1 ... ... ... ... ... Measles 4 1 2 ... ... ... ... ... 2 Scarlet Fever 14 ... 4 5 5 ... ... ... ... 21 Whooping Cough 16 7 6 2 1 ... ... ... ... 7 Diphtheria and Croup 46 3 7 17 17 1 1 ... ... 140 Influenza 32 ... ... ... 3 1 5 12 11 5 Erysipelas 6 ... ... ... ... ... 1 3 2 3 Dysentery 2 ... ... ... ... ... 1 ... 1 1 Phthisis (Pulmonary Tuberculosis) 213 ... ... 2 14 37 94 60 6 127 Tuberculous Meningitis 19 1 6 4 6 1 1 ... ... 10 Other Tuberculous Diseases 32 2 5 2 5 7 5 3 3 13 Cancer, Malignant Disease 289 1 ... ... ... 1 27 145 115 187 Rheumatic Fever 5 ... ... ... 2 1 2 ... ... ... Meningitis 13 5 3 2 ... ... 1 2 ... 7 Organic Heart Disease 282 2 ... ... 6 9 36 84 145 112 Bronchitis 173 7 1 ... ... ... 5 45 115 34 Pneumonia (all forms) 234 43 26 11 5 8 26 59 56 134 29 TABLE III. — HACKNEY BOROUGH—continued. Causes of, and Ages at, Death during the year 1921. CAUSES OF DEATH. Deaths in whole Districts at Subjoined Ages. Deaths in Public Institutions. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Other Diseases of Respiratory Organs 54 ... ... 1 1 1 12 19 20 20 Diarrhoea and Enteritis 75 65 7 1 ... ... ... ... 2 40 Appendicitis and Typhlitis 23 ... 1 ... 5 7 6 2 2 17 Cirrhosis of Liver 8 ... ... ... ... ... 1 4 3 1 Alcoholism 1 ... ... ... ... ... ... 1 ... ... Nephritis and Bright's Disease 80 ... ... 1 ... 2 8 37 32 66 Puerperal Fever 5 ... ... ... ... 1 4 ... ... 7 Other Accidents and Diseases of Pregnancy and Parturition 12 ... ... ... ... 1 11 ... ... 9 Congenital Debility and Malformation, including Premature Birth 97 94 ... 1 ... 2 ... ... ... 39 Violent Deaths, excluding Suicide Suicides 59 25 5 1 2 3 1 8 1 7 6 20 11 13 6 36 6 Other Defined Diseases 758 92 11 7 19 11 64 146 408 434 Diseases ill-defined or unknown 1 1 ... ... ... ... ... ... ... ... Totals 2.580 329 80 58 94 101 324 654 940 1.483 Sub-Entries (included in above figures)— Cerebro-Spinal Meningitis ... ... ... ... ... ... ... ... ... 1 Polio-Myelitis ... ... ... ... ... ... ... ... ... 1 Encephalitis Lethargica 3 ... ... ... 2 ... ... 1 ... 2 30 MORTUARY, 1921. Number of bodies in Mortuary 284 1. To await Inquests— (a) Infectious 2 (b) Non-infectious 279 2. To await Burial 3 Number of Post Mortems 103 Inquests. Verdict. Sex. Male. Female. Natural Causes 84 69 Accidental Death 31 32 Suicide 20 14 Open Verdict 9 4 Manslaughter — — Murder 1 2 Misadventure 10 5 Totals 155 126 Table showing nature of above Suicidal and Accidental Deaths in the Borough of Hackney during the year 1921. Nature of Suicide. No. Nature of Accidental Death. No. Hanging 9 Shock from Burns 1 Poisoning 8 Shock from Fall 13 Cut Throat 4 Suffocation in Bed 1 Shooting 2 Drowning 3 Drowning 9 Run over 12 Run over — Fracture of Skull 11 Others 2 Fracture of Ribs 2 Fracture of Thigh 6 Shock from Scalds 3 Coal Gas Poisoning 2 Choked 1 Others 8 34 63 31 TABLE 1.-HACKNEY BOROUGH. Vital Statistics of Whole District during 1921 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. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1912 223,022 5,425 5,267 236 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 4,827 221 3,402 15.6 723 552 520 107 3,231 14.8 1916 209,636 5,331 5,026 220 2,917 13.9 617 581 423 84 2,881 13.7 1917 196,598 4,207 3,750 171 2,929 14.9 661 585 345 92 2,853 14.6 1918 For Deaths 195,804 For Births, 219,391 3,828 3,266 148 3,836 19.5 820 692 365 111 3,708 18.9 1919 For Deaths 216,736 For Births, 225,774 4,748 4,141 21 0 2,990 13.7 673 530 355 85 2.847 13.0 1920 For Deaths 225,372 For Births, 225,542 6,486 6,010 26 6 3,030 13.4 679 510 485 81 2,861 12.7 1921 224,200 5,437 4,978 22 2 2,757 12.6 648 471 329 64 2,580 11.5 32 SPECIFIC INFECTIOUS DISEASE. During 1921 there were 3,084 cases of acute infectious disease compulsorily notified in the Borough, as set out in Table II.; of these 124 were found subsequently not to be suffering from any notifiable infectious disease, thus reducing the number of genuine cases to 2,960. This total shows a decrease of 786 upon those notified during 1920. The attack-rate in respect of the acute notifiable infectious diseases for the year is 13.2 per 1,000 inhabitants. In addition there were 361 notifications received of pulmonary tuberculosis and 105 notifications of other forms of tuberculosis. The deaths from the chief zymotic diseases numbered 157. This is equivalent to a zymotic death-rate of 0.7 per 1,000 living in the Borough, as compared with a zymotic death-rate of 1.09 during the previous year. NOTIFIABLE INFECTIOUS DISEASES Small-pox.—There was not any notification of small-pox in the Borough during 1921. 33 Summary of Proceedings under the Vaccination Acts, 1867 to 1898, during the year 1921. Registration Sub-District. No. of Cases in Birth Lists received during Year. No. of Certificates of Vaccination received. No. of Certificates of Postponement owing to No. of Certificates under Section 2 of Vaccination Act, 1898, and No. of Statutory Declarations under Section 1 of the Vaccination Act, 1907. No. of Certificates of Insusceptibility or of having had Smallpox. No. of Cases. No. of Entries in Lists sent to Public Vaccinator Health of Child. Condition of House Prevalence of Infectious Disease. Parents Removed out of District. Otherwise not found North 974 504 56 — 2 358 6 30 21 268 Central 2,005 603 27 — — 951 1 342 55 306 South-East 1,393 3 73 18 — — 645 — 29 46 435 South-West 1,146 439 31 — — 551 5 14 16 393 Total 5,516 1,919 132 — 2 2,505 12 415 138 1,402 c 34 Scarlet Fever or Scarlatina.— The number of cases of scarlet fever notified during 1921 was 1,892, but of these 29 were found afterwards not to be suffering from this disease, thus the number of genuine cases was reduced to 1,863. This is an increase of 786 cases upon the number of genuine cases notified during 1920. The prevalence of the disease each week throughout the year is shown on the chart. The attack rate for scarlet fever was 8.3 per 1,000 persons living. The number of cases removed to hospital during the year was 1,729. This is equal to 92 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 437 453 469 504 Attack-rate per 1,000 living 77 85 81 88 It will be seen from the above that scarlet fever was most prevalent in the South East Sub-district. The deaths from scarlet fever during 1921 numbered 14, which is equal to a case mortality of 0.75 per cent. attacked, and a scarlet fever death-rate of 0.064 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 961 cases of diphtheria and membranous croup notified during the year; but of these 89 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 872. This is an increase of 108 35 upon the number of genuine cases notified during 1920. Of the 89 returned cases 11 had been reported on a bacteriological Examination to be positive. The incidence of the disease can be seen by reference to the chart. The Asylums Board were pressed for accommodation during October and November for scarlet fever cases, 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. All cases of diphtheria were promptly removed. The attack rate of diphtheria was 3.9 per 1,000 inhabitants. There were 802 cases removed to hospital during the year. This is equal to 92 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 236 206 139 291 Attack-rate per 1,000 living 41 38 2.4 5 1 From the above it will be seen that diphtheritic disease was most acute in the South-Eastern Sub-district. The deaths from diphtheria and membranous croup during the year numbered 46. This mortality is equal to a death-rate of 5.3 per cent. attacked and 0.20 per 1,000 inhabitants, as compared with a death-rate of 9.1 per cent. attacked, and 0.31 per 1,000 inhabitants for the previous year. The death rate from diphtheria for London during the same Period is 0.25 per 1,000 inhabitants. 36 During the year 1,071 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriological examined, of which 340 gave positive results, 719 negative results. and 12 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 156 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, 12 cases of enteric fever were notified, but of these, 5 cases were found subsequently not to be suffering from this disease, thus reducing the genuine cases to 7. This shows a decrease of 7 on the number of genuine cases notified during 1920. The attack rate was 0.03 per 1,000 inhabitants. Of the 7 cases notified, 5 were removed to hospital. 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 2 2 2 1 The deaths from enteric fever in the Borough last year numbered 2. During 1921 specimens of blood from 28 persons suspected to be suffering from enteric fever were submitted to Widal's test. All these gave a negative reaction. 87 The mortality from enteric fever tor the same period in London was .01 per 1,000 inhabitants. Continued. Fever.—There were no notifications of continued fever in the Borough during the year. Typhus Fever.—There was not any notification of typhus fever in the Borough during the year. Puerperal Fever.—There were 18 cases of puerperal fever notified during 1921; 10 cases were removed to hospital. The deaths from puerperal fever and septicaemia numbered 5. The attack-rate for the year was 3.5 per 1,000 births, and the deathrate 1.0 per 1,000 births. Plague.—There was not any plague in the Borough during the year. Cholera.—One case was notified, which was pronounced not to be suffering from Cholera when examination was made at the Infirmary, to which institution the notifying doctor had sent the patient. Erysipelas.—There were 91 cases of Erysipelas notified during 1921. This is equal to an attack-rate of 0.4 per 1,000 inhabitants. Of the 91 cases notified, 37 were removed to hospital. The deaths from erysipelas numbered 6. This gives a mortality-rate of 6.6 per cent. attacked, and of .02 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 21 23 26 21 Rate per 1,000 living 37 .45 .45 37 38 Cerebrospinal Meningitis.— During 1921 there were 2 cases of this disease notified in the Borough. These were removed to hospital. Polio-myelitis.— There was 1 case of Polio-myelitis notified in the Borough during the year. Ophthalmia Neonatorum.— There were 37 cases of this disease notified during the year. 5 of these were removed to hospital. All the cases recovered without any impairment of sight. Measles and German Measles.— The Public Health (Measles and German Measles) Regulations, 1915, were withdrawn by Order in Council on 31st December, 1919. Four deaths were recorded from this disease. The annual mortality is therefore .01 per 1,000 inhabitants, compared with London .05 per 1,000 inhabitants. Information of 334 cases of measles was received from headmasters of elementary schools in the Borough. A few cases were discovered by the Health Visitors, and parents advised (in the event of no medical man being in attendance) to obtain proper treatment for the cases. When the nursing was considered inadequate a nurse was provided at the expense of the Council through the King's Home for Nurses. Encephalitis Lethargica.— The Public Health (Acute Encephalitis Lethargica and Acute Polio Encephalitis) Regulations, 1918, came into operation on 1st January, 1919. During the year 1921 12 cases were notified, of which number 3 were fatal. All the patients were removed to hospital. All necessary particulars were supplied by the medical practioners in attendance. 39 Influenzal Pneumonia and Pneumonia.— There were 9 cases of influenzal pneumonia and 42 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. 3d. per visit. During the year 608 visits were so made at a cost to the Council of £38 0s. Od. Influenza, unless complicated by pneumonia, is not notifiable. Malaria.— The total number of cases of Malaria certified was 3, all of which, it was ascertained upon enquiry, had been contracted out of England. Dysentery.— There were 3 cases of dysentery certified, all being contracted abroad; 2 deaths were registered. London (Notification of Glanders Order), 1907. No notification of glanders in animals in the Borough was received from the Veterinary Inspectors of the London County Council during 1921. NON-NOTIFIABLE INFECTIOUS DISEASES. Influenza.— During 1921 there were 32 deaths in the Borough. This is a decline of 53 on the deaths from this cause registered during 1920. The annual mortality rate from influenza is 014 per 1,000 inhabitants. Diarrhœa.— There was an increase in the number of deaths due to diarrhœal disease in the Borough during 1921. The total number of deaths from this cause was 75, and of these 65 were under 1 year of age. The annual mortality for diarrhoea and enteritis during the year is 0.33 per 1,000 inhabitants. 40 The distribution of this disease in the Borough may be seen from the following table:— Sub-Districts. North. Central. South-west. South-east. Number of deaths from diarrhoea and enteritis 14 19 22 20 Whooping Cough.— The deaths from this cause during the year numbered 16. This is a decrease of 40 upon the number registered during 1920. Seven 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, 12 per 1,000 inhabitants. Information was received from the head masters and head mistresses of elementary schools in Hackney of 412 cases of whooping cough occurring among their scholars during the year. 41 TABLE II.— HACKNEY BOROUGH. Cases of Infectious Disease notified during the year 1921. Notifiable Dieseases. Cases Notified in whole District. Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. 1 9 3 4 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. North. Central. South-East. South-West. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including ... ... ... ... ... ... ... ... ... ... ... ... ... branous Croup) 872 19 183 441 120 97 10 2 236 206 139 291 802 Erysipelas 91 6 4 6 5 21 42 7 21 23 26 21 37 Scarlet Fever 1 863 13 354 1,253 175 65 3 437 453 469 504 1,729 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 7 ... ... 5 2 ... ... ... 2 2 2 1 5 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 18 ... ... ... 5 13 ... ... 3 6 5 4 16 Cerebro-Spinal Meningitis 2 2 ... ... ... ... ... ... ... 2 ... ... 2 Polio Myelitis 1 ... 1 ... ... ... ... ... 1 ... ... ... ... Ophthalmia Neonatorum 37 37 ... ... ... ... ... ... 8 6 10 13 5 Pulmonary Tuberculosis 361 ... 3 22 87 175 68 6 81 76 106 98 202 Other Forms of Tuberculosis 105 1 11 53 23 9 8 ... 23 29 24 29 33 Encephalitis Lethargica 12 ... 1 4 3 1 2 1 4 4 3 1 12 Influenzal Pneumonia 9 ... 1 ... 1 3 2 2 2 1 3 3 2 Pneumonia 42 1 4 4 5 12 12 4 7 11 15 9 13 Malaria 3 ... ... ... ... 3 ... ... ... 1 1 1 ... Dysentery 3 ... ... ... 1 2 ... ... 1 2 ... ... 1 Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 3,426 79 562 1,788 427 401 147 22 826 822 803 975 2,859 42 CONSTITUTIONAL DISEASES. For table of Deaths, see pages 28 and 29. Cancer.— There were 289 deaths during 1921 due to the different varieties of malignant disease. This is an increase of 43 on the number registered during 1920. The annual mortality rate from malignant disease for last year is therefore T28 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 76 61 84 68 Mortality-rate per 1,000 inhabitants 1.3 1.1 1.4 1.2 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 1921:— Borough of Hackney. Years. 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 Deaths from Cancer. 213 250 256 276 245 230 236 274 246 289 Death-rate per 1,000. .95 1.11 1.14 1.26 1.16 1.17 1.07 1.26 1.09 1.28 London. Death-rate per 1,000. 1.11 1.10 1. 13 1.16 1.18 1. 25 1.26 1.20 1.20 1.31 48 Alcoholism. Alcoholism.— During the year under consideration there was one death from alcoholic poisoning; there were, however, 8 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. During 1921, 466 primary notifications of tuberculosis were received, details of which are given on page 45 of this Report. Bacteriological examination of sputa from 154 cases was made by the Council's Bacteriologist during the same period. In 54 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 1921, was 264, an increase of 15 upon the deaths during 1920. These deaths are classified as follows:— Tuberculous phthisis 199 "Phthisis" 14 General tuberculosis 5 Tuberculous meningitis 19 Tuberculous peritonitis 10 Tabes mesenterica 2 Tubercle of other organs 15 264 This number of deaths gives an annual mortality of 1.17 per 1,000 inhabitants. In the following table the yearly deaths from tuberculous TUBERCULOSIS. 44 disease in the Borough for the last 23 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 1919-1921 261 45.9 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 the period 1919-1921, being equal to 45.9. There is good reason to believe that the Borough Council's Tuberculosis Scheme is doing valuable work, although much might be done in the direction of improving the present scheme. 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 50 64 67 83 Mortality rate per 1,000 inhabitants .88 12 1.1 1.4 Public Health (Tuberculosis) Regulations, 1912. Under these Regulations 975 notifications of tuberculosis were received during the year, of which 800 were pulmonary and 175 non-pulmonary notifications. Summary of Notifications during the Period from 3rd January, 1921, to 31st December, 1921. 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 2.5 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Notifications. Primary Total Pulmonary Males ... 3 2 7 17 31 65 39 23 14 1 204 231 „ Females ... ... 6 5 14 25 38 33 15 14 5 155 184 Non-Pulmonary Males ... 6 21 9 6 5 4 2 1 1 ... 55 58 „ „ Females 1 5 8 12 7 5 2 1 3 3 ... 47 55 Age Periods. Number of 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 ... ... 2 2 3 37 197 „ Females ... ... ... ... 2 43 103 Non-Pulmonary Males ... 2 ... 2 4 4 28 „ „ Females ... ... 1 1 2 2 22 46 Visits paid by Tuberculosis Visitors. New Cases. Contacts Sailors and Soldiers Other Persons. Total. Insured. Noninsured. Miss Servante 226 148 664 1,999 3,037 1,621 1,416 Miss Clarke 298 318 589 1,906 3,111 1,457 1,654 524 466 1,253 3,905 6,148 3,078 3,070 Discharged Tuberculous Soldiers and Sailors. Arrangements were made at the commencement of 1919 with the Ministry of Pensions for the home visiting and after care of discharged soldiers and sailors suffering from tuberculosis. The Tuberculosis Health Visitors visit the homes of these patients and advise them of any alterations which they deem desirable in the sleeping accommodation, sanitary conditions, cleanliness, etc., and also encourage 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 466, and the total number of visits of this kind made was 1,253. 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 three. TREATMENT OF TUBERCULOSIS. The scheme for providing dispensary treatment for tuberculous persons in London is set out in the Circular letter of the Local Government Board, dated 19th December, 1913. 47 The expenditure of the Borough Council on their dispensary scheme, after deducting the payment made by the Insurance Committee in respect of the treatment of insured persons or any other contribution, being made as follows:— (a) 50 percent. from the Board (now the Ministry of Health). (b) 25 ,, ,, the London County Council. (c) 25 ,, out of the rates of the Borough. The functions of the Insurance Committee as regards the provision of treatment for insured persons have been transferred to the London County Council both in respect to the dispensaries and the provision of sanitorium treatment, so that the London County Council are entirely responsible for the provision of sanatorium treatment and partly responsible for the provision of dispensary treatment, although the direct responsibility for providing the dispensaries is laid upon the Borough Council. The Council has entered, as previously reported, into contracts for the provision of treatment for tuberculosis with the Metropolitan and City of London Hospitals; the Boroughs of Bethnal Green and Stoke Newington also contracting with these institutions for the part use of the dispensary services. The Scheme for carrying out Dispensary Treatment and After-care was thrust ready-made upon the Borough Council, so that the following authorities are now interested in the Dispensary treatment of Tuberculosis in Hackney:— Hackney Borough. Council, Stoke Newington Borough Council, Bethnal Green Borough Council, Ministry of Health, London County Council, Metropolitan Hospital Management Committee, Victoria Park Hospital Management Committee. 48 There can be little doubt, moreover, that the policy of the Central Authorities in endeavouring to turn the Tuberculosis Officers into a sort of combination of Sanitary Inspector, Panel Practitioner, and Medical Officer of Health will yield very little useful result. The Tuberculosis Officers are appointed primarily for Clinical work. If they are to be of the greatest use they must be regarded as consultants by the general practitioners. Not only will this not result from the policy now being steadily pursued by the Central Authorities, but it is quite evident that the increasing spate of forms and reports required of the Tuberculosis Officers must greatly curtail the time available for clinical work and research to the great disadvantage of the entire scheme. Mention of some of the forms that do not relate to the actual treatment of patients such as case papers, etc., that would naturally be kept by a physician (but less elaborately than those kept at the Dispensary) may be of interest:— Form M.P.M.S.D. 28—Relating to Treatment. Case Card for Index at Dispensary. Form 1.— Examinations of Sputa Record. X-Ray examination sheet record. Form 2.—Details as to person attending Dispensary—Insured and uninsured, home consultations, sputum examined, etc. Form R. (buff)—Return of work carried out at Dispensary for six monthly periods. Single foolscap sheet. Form 8.—Examination of Contact Case. Form A.—Record of Personal History and Primary Examination, (double foolscap) with printed diagram. 49 Form M.P.M.S.D. 118.— Relating to commencement of treatment for Tuberculous ex-service men combined with vocational training-. Form M.P.M.S.D. 117.— Vocational Training of Tuberculous Men—England. (Form of Application to be sent to War Pensions Committee). (Buff.) Form M.P.M.S.D. 80.—Certificate relating to Termination or refusal of Treatment for Tuberculosis. (Buff.) Form A.D. 1. (Buff)—Certificate for Dental Treatment. Ministry of Pensions. Form M.P.M.S.D. 32.—Ministry of Pensions Special Diet Claim (disabled man). (Buff.) Form M.P.M.S.D. 119.—Vocational Training of Tuberculous Men—Medical Report. Card (Green) M.O. 33.—School Children Form, headed with Registration No. and form below for name, age, school, treatment centre, disease, etc. Typewritten duplicated form (Cir. T. 22A.)—Enquiry for particulars to be furnished to M.O.H. of L.C.C., respecting discharge of patient from Hospital under diagnosis of "tuberculosis not found." Form C. (IV.).—L.C.C. enquiry for particulars respecting a patient recently under Tuberculosis Scheme of L.C.C. at a Sanatorium or Hospital. Form Med. 40. National Health Insurance.—First Certificate and Notice of Sickness. Form for reference of patient from Dispensary to Relieving Officer, with perforations and slip to be sent to Relieving Officer through post. Form, Invalid Children's Aid Association, for particulars of name, address, age, etc., of patient, nature of disease and requirements, to be sent to I.C.A.A. D 50 Form M.P. X 9 T.—Report to Medical Board. Form M.P.M.S.D. 28.—For Local War Pensions Committee pension. Form M.P.A. 36 T.O.—For Local War Pensions Committee, Continuance of treatment, etc. It should also be remembered that the Tuberculosis Officer in addition to the primary duty of diagnosis and treatment of tuberculosis, has to attend meetings of the Advisory Committees, Care Committees and Case Committees, and prepare tables of statistics for the information of the Committees. He is also expected, according to Circular 149, to visit at least once, the home of each dispensary patient; and should also visit for the purpose of examining contacts, and for consultation and reporting purposes as often as may be required. The three Tuberculosis Officers appointed at the two Dispensaries are required to carry out the treatment of Tuberculosis in three Metropolitan Boroughs containing in 1920 a total estimated population of 392,997, with 488 deaths from tuberculosis and with 954 primary cases of tuber, culosis notified during that year alone. DISPENSARY DISTRICTS. Estimated Population in Electoral Wards. Metropolitan Hospital Area— Stamford Hill 33,035 West Hackney 19,160 Kingsland 23,217 Downs 17,204 92,616 Estimated population (1921) — Borough of Stoke Newington 52,590 145,206 51 DISPENSARY DEATHS. Condition of Patient on First \ttendance. Pulmonary Tuberculosis 116. 1st Stage. 2nd Stage. 3rd Stage. Number 9 53 54 Percentage 7.76% 45.69% 46.55% Victoria Park Hospital Area— Clapton Park 42,868 Homerton 37,490 South Hackney 23,226 Hackney 28,000 131,584 Estimated population (1921)— Borough of Bethnal Green 118,300 249,884 395,090 Estimated Population (1921) Hackney 224,200 ALL DEATHS FROM TUBERCULOSIS. Interval elapsing between Notification and Death. 1920. 1921 Pul. Non-pul. Pul. Non-pul. 1. Number of Deaths from Tuberculosis 190 59 213 51 1. Number of cases only notified at death 6 16 10 10 3. Do. notified within a month of death 17 1 17 23 27 4. Do. do. 3 months of death 14 4 5. Do. do. 6 months of death 23 1 1 6. Number of deaths not notified under Tuberculosis Regulations 7 11 23 25 52 It has been stated that too little attention is paid to the examination of contacts, but every endeavour has been made during the past year to examine the contacts to every notified case. During 1921, 466 primary cases were notified, and the contacts to these cases number in all 1,285 persons, and of these 431 contacts were examined, making the number examined slightiy over 33 per cent. As one must bear in mind that adult contacts generally refuse examination unless in ill-health, under the circumstances already recorded, this percentage is very fair. During the year 1921, 264 deaths were registered—213 pulmonary and 51 non-pulmonary; but of these 23 pulmonary and 25 non-pulmonary were not originally notified under the regulations. Enquiries as to contacts, however, were made in all cases, with the exception of deaths occurring in Mental Hospitals. Of the pulmonary deaths, there were 523 contacts, of which 299 were examined, representing 57 per cent. examined; and of the non-pulmonary deaths there were 103 contacts of which 56 were examined, representing 54 per cent. examined. The actual treatment of patients at the Dispensaries has been most ably and carefully carried out, and the immense amount of useful work done is tabulated in the reports of the medical officers in charge of the dispensaries. CITY OF LONDON HOSPITAL TUBERCULOSIS DISPENSARY. (Dr. Howell.) HACKNEY CASES TREATED. 1.—The Totals of New Cases. Males 405 Females 405 Total 810 53 2.—The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 132 52 Local Practitioners 141 50 London War Pensions Committee 42 15 Contact cases 426 7 London Insurance Committee London County Council 15 6 Victoria Park Hospital 33 30 Other sources 21 10 3.—The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 16. Males. Females. Pulmonary Tuberculosis... 61 19 5 20 32 137 Non-pulmonary Tuberculosis 8 2 20 2 1 33 Non-tuberculous 106 79 282 20 109 596 Doubtful 18 6 8 3 9 44 Total 193 106 315 45 151 810 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 6 Non-pulmonary tuberculosis 1 Non-tuberculous 410 Doubtful 9 Total 426 54 5.—Sputum Examinations of Insured and Uninsured Patients. Insured. Uninsured. Total. Tubercle Bacilli present 127 28 155 Tubercle Bacilli absent 368 125 493 6.—Other Figures. Insured. Uninsured. Total number of attendances 3,124 3,235 Systematic examinations at the above 1,209 1,100 Number of letters written 1,890 Number of visits to patients at their homes 65 42 Number of patients sent to hospital or sanatorium 122 38 Number of patients referred to:— X-ray Department 36 22 Other Departments 28 29 METROPOLITAN HOSPITAL TUBERCULOSIS DISPENSARY. (Dr. Young.) HACKNEY CASES TREATED. 1.—The Totals of New Cases. Males 193 Females 310 Total 503 55 2.—The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 70 36 Local Practitioners 91 46 London War Pensions Committee 7 7 Contact cases 275 10 London Insurance Committee — — London County Council 7 4 Metropolitan Hospital 11 9 Other sources 42 19 3.—The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 16. Males. Females. Pulmonary Tuberculosis 44 13 5 16 23 101 Non-pulmonary Tuberculosis 7 2 17 — 4 30 Non-tuberculous 39 32 148 16 49 284 Doubtful 26 11 28 7 16 88 Total 116 58 198 39 92 503 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 3 Non-pulmonary tuberculosis 7 Non-tuberculous 246 Doubtful 19 Total 275 56 5.—Sputum Examinations of Insured and Uninsured Patients. Insured. Uninsured. Total. Tubercle Bacilli present 77 40 117 Tubercle Bacilli absent 162 66 228 6.—Other Figures. Insured. Uninsured. Total number of attendances 1,463 2,207 Systematic examinations at the above 361 362 Number of letters written 450 261 Number of visits to patients at their homes 18 8 Number of patients recommended for hospital or sanatorium 60 43 Number of patients referred to:— X-ray Department 41 22 Other Departments 22 44 Extra Nourishment. The Scheme came into operation on 6th June, 1921, and from that date to December 31st, 59 cases have received assistance. The length of time each patient has been in receipt of nourishment has varied from a few days to several weeks. Those cases who received this assistance for a few days only ceased to receive it on account of their removal to Sanatorium. The Tuberculosis Officers have entire freedom under Circular 194 as to the granting of Extra Nourishment, provided 57 that the number of cases in receipt of this assistance is not so large as to cause the approved expenditure to be exceeded. The total cost to 31st December is £135 3s. 5d. Advanced Cases. The following table shows the place of death of Hackney inhabitants, and it is apparent from this table what a large proportion of deaths occur in the patients' homes. Place where death occurred. Phthisis and Pulmonary Tuberculosis. Other forms of Tuberculosis. Totals. At Patients' Homes 97 14 1ll At Hackney Infirmary 56 10 66 At other Institutions 60 27 87 213 51 264 It should be remembered that the deaths which occur in institutions cannot be considered to represent the number of persons who were prevented while in an advanced stage from spreading infection, as, at least the majority of these persons have been treated on several occasions in the infirmary and similar institutions, entering and leaving while in an infective condition, before death occurred. The result of this is placed on record in the Final Report of the Departmental Committee on Tuberculosis: "Infection is frequently disseminated by persons suffering from advanced pulmonary tuberculosis who are in the habit of entering and leaving Poor Law Institutions, having regard merely to their own convenience, and not to the interests of their family or of the community in which they live." Day Sanatorium (Open Air School) for Tuberculous Children. The work of the Stormont House School, which was opened by the London County Council on 8th September, 1919, is of 58 increasing value to the tuberculosis service. The number of children on the register is now 84. Dr. Howell, TuberculosisOfficer to the City of London Hospital Tuberculosis Dispensary is responsible for the medical care of the children, and visits the School once weekly. After Care.—Every effort has been made by the Care Committee to carry out every duty possible under existing circumstances. Tuberculosis Care Committee Report. In January 1916 an Interim Tuberculosis Care Committee was formed for the Boroughs of Hackney and Stoke Newington in connection with the London County Council Tuberculosis scheme, which at the time and until October 1921, dealt only with insured patients. The objects of this Committee were:— 1. To enquire into the home conditions of the patients and to make an assessment of the family's contribution, if any, to the cost of Sanatorium treatment. 2. To arrange for the after care of discharged Sanatorium patients. The Committee was a voluntary one and the Hon. Secretary was the Secretary of the local branch of the Invalid Children's Aid Association, because many of the patients were children and already known to the Association, and under the London County Council scheme at least one third of the total number of children, i.e., those needing Convalescent Home or boarding out, rather than actual Sanatorium treatment, were dealt with by the Association. During the War the Committee worked under great difficulties as voluntary Social workers were almost unobtainable. 59 In 1919 the increase in the amount of the work and the lack of Social Workers, made it impossible for the Hon. Secretary to continue without regular assistance, and application was made to the two Borough Councils requesting that the Interim Committee should be constituted a conjoint Borough Committee with a grant for administrative expenses. In November, 1919, the Public Health Committee of each Borough Council acceded to this request. The agreement being:— "That the existing Interim Committee be appointed a Tuberculosis Care Committee with the addition of representatives from the Borough Councils. That such Committee be authorised to incur an expenditure in the provision of secretarial and clerical assistance with office; facilities, including stationery and postages,, to an amount not exceeding £280 per annum, and that such expenditure be apportioned the basis of population between the Borough Councils of Stoke Newington and Hackney. That the expenditure so defrayed by the contributory Borough Councils be charged to the tuberculosis accounts, with a view to the Ministry of Health refunding 50 per cent. and the London County Council one half of the remaining moiety." The Borough Committee has now worked for two years and the following statistics show the number of cases which have been dealt with. The number is rapidly increasing now that the Insured patients are included. Statistics for the Year ending October 31st, 1920. No. of cases on Register Oct. 51st, 1919 243 ,, New cases for year ending Oct. 31st, 1920 151 (Adults 58) ,, New Cases sent to Institutions ,, 89 ,, Still away Oct. 31st, 1920 45 Amount of Patient's payments collected for L.C.C. £423 12s. l1d. No. of cases brought before Committee 292 60 Statistics for the Year ending October 31st, 1921. No. of cases on Register Oct. 31st, 1920 391 ,, New cases 157 (Adults 65) ,, New cases sent to Institutions 92 ,, Cases still away Oct. 31st, 1921 53 Amount of Patients' payments collected and paid to L.C.C £554 3s. Od. No. of Cases brought before Committee 294 Total No. on Register Oct. 31st, 1921 551 The functions of a Tuberculosis Care Committee include— 1. Arranging for the provision of Shelters for suitable cases. 2. Assisting in advising parents of tuberculous children with regard to medical appliances; arranging for medical assistance of a minor nature, such as dental and other treatment. 3. Assisting as regards separate sleeping accommodation; provision of beds and bedding. 4. Preventing the spread of infection by arranging for removal to hospital of advanced cases. 5. Advising the parents of tuberculous or pre-tuberculous children in order that they may not become engaged in unsuitable forms of work. 6. Provision of extra nourishment and clothing for debilitated children of tuberculous parents; following up these cases and arranging for open-air school or class attendance. 7. Arranging for the placing of 'patients returned from sanatorium in suitable occupations, so that the money expended on their treatment shall not be wasted; keeping the family of sanatorium patients under observation and assisting to the fullest possible extent in order to prevent the premature return of patients from sanatorium in order to look after their families. 61 Hitherto it has been very difficult to provide services beyond those reported upon, as the Committee has had no funds. It is possible in many cases requiring assistance to get the necessary help from existing philanthropic Societies such as the Invalid Children's Aid Association, Charity Organisation Society, Local War Pensions Committees and Board of Guardians, etc., with all of whom the Committee works in close co-operation. There are some cases, however, which do not come within the scope of any of these Societies, and in order to meet the needs of these, and to fulfil more adequately the duties of an After-Care Committee, it is proposed to start a relief fund which shall be used by the Committee for such emergency cases as cannot otherwise be helped. Extra food and clothing are frequently required by those sufferers who often have to work short time for a reduced wage, on account of their disability, and therefore are unable to provide these necessities. The co-operation and help of local influential persons in securing either more suitable employment locally or in the country is also much needed. For these purposes the Committee feels the necessity for more support from the two Boroughs in which it is working. DISINFECTION. (a) Rooms.—Duringl921 there were 3,385 rooms fumigated and 1,041 rooms cleansed in the Borough by the staff of the Public Health Department. In these totals are included disinfec* tions 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:— 62 Number of rooms fumigated and cleansed each month during 1921. Month, January Rooms fumigated. 253 Rooms cleansed. 86 February 251 48 March 239 96 April 273 82 May 279 87 June 276 96 July 259 8o August 246 81 September 386 81 October 364 108 November 290 105 December 269 88 Total 3,385 1,041 (b) Articles of Clothing, Furniture, etc.— The number of articles under this head disinfected during last year was 20,927. This is an increase of 6,379 upon the number disinfected during 1920. A table is here given showing details of the articles disinfected each month. 63 Articles Disinfected, 1921. Description of Articles. January. February. March. April. May. Jurte. July- August. September. October. November. December. Totals. House linen and furniture 1,465 1,380 1,459 1,646 1,425 1,540 1,210 1,235 1,733 1,788 1,763 1,821 18,470 Men's clothing ... 7 9 ... 11 8 8 2 5 50 Women's clothing ... 2 13 2 9 9 1 3 1 7 11 6 64 Children's clothing ... ... ... ... 1 ... ... ... ... ... 3 79 83 Other articles 219 288 196 212 158 224 68 230 150 125 141 249 2,260 Total 1,684 1,677 1,677 1,860 1,593 1,784 1,287 1,476 1,886 1,920 1,928 2,155 20,927 64 Articles Disinfected, 1921. In addition to these there were 85 articles destroyed on request from the owners. These are set out in the following table:— Articles Destroyed. Beds 31 Bolsters 2 Mattresses 23 Pillows 2 Sundry Articles 27 Total 86 (c) Public Library Books.— During the past year 835 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 62 February 60 March 32 April 77 May 46 June 62 July 67 August 30 September 127 October 121 November 81 December 70 835 65 Isolation Shelter. During the year there were 111 persons admitted to the Shelter whilst their homes were being disinfected. This total consisted of 20 men, 31 women and 60 children. The cost of maintenance of these persons admitted was £16 18s. 0d. 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 total number of baths given during that period was 4,883 (483 to adults and 4,400 to children). This total shows a decrease of 2,897 upon the number given during 1920. Of the 4,883 baths given, 3,028 were sulphur baths for scabies, and 1,855 for pediculi. The great majority of those persons presenting themselves for baths were children from the elementary schools in the Borough. The children received 4,400 baths, a decrease of 2,728 upon the number given during 1920. The following are the Schools from which children were sent to the Cleansing Station, with the number of baths given:— Schools. Number Hot Baths. Cleansed. Sulphur Baths. Benthal Road 141 45 Berger Road 96 48 Cassland Road — 4 Church Street 3 37 Craven Park 58 2 Daubeney Road 199 183 Detmold Road 132 33 Eleanor Road — 41 Carried forward 629 393 66 Brought forward 629 393 Enfield Road 3 29 Gainsborough Road — 4 Gayhurst Road 37 9 Glyn Road 114 12 Hackney Parochial 38 93 Haggerston Road — 16 High Street 1 49 Holy Trinity 2 8 Homerton Row 109 85 Lamb Lane 16 4 London Fields 1 7 Mandeville Street 161 119 Millfields Road 13 26 Morning Lane 104 95 Newington Green 3 100 Northwold Road 108 53 Orchard Street 75 57 Percy Road 47 25 Princess May Road 1 37 Queen's Road 21 21 Rams 12 — Rushmore Road 56 183 St. James' 4 36 St. John the Baptist — 30 St. Joseph's 15 — St. Jude's 1 48 St. Matthias — 49 St. Michael's IB 8 St. Paul's — 3 St. Scholastica's — 13 Shacklewell 2 40 Carried forward 1586 1653 Brought forward 1586 1653 Sidney Road 180 134 Sigdon Road 54 403 Tottenham Road 4 137 Wilton Road — 4 Wordsworth Road — 21 Other young children 18 206 1,842 2,558 67 68 The following table gives particulars of the number, etc., of persons who were bathed and cleansed for parasitic disease at the Disinfecting Station during the year. January. February. March. April. May. June. July. August. September. October. November. December. Totals 1 Receiving Hot Baths. Men 1 ... ... 3 2 ... l 1 1 1 1 ... 11 Women ... ... ... ... ... ... ... ... ... 2 ... 2 Children 107 163 103 174 201 241 in 18 144 225 174 176 1842 Receiving Sulphur Baths. Men 21 19 20 24 15 43 22 12 17 13 14 34 254 Women 13 9 13 54 28 22 16 1 13 13 13 21 216 Children 351 303 234 281 181 355 193 ... 62 152 156 283 2558 69 MATERNITY AND CHILD WELFARE. Extension of the work in the following directions is urgently necessary— Centres.—Reports from the Centres show that the work carried out is meeting a great need, but that the Centres are inadequate for the work required. There are too few Centres, which results in overcrowding, and at Northwold Road Infant Welfare Centre and Brooksby's Walk Ante-natal Centre there is particular need for additional Clinics Infectious Disease.— No attempt can be made under present conditions to control non-notifiable infectious disease, such as Measles, Whooping Cough and Epidemic Diarrhoea, which are responsible for so great an infant mortality. The school authorities forwarded notifications during the year of 334 children absent from school on account of Measles. It is practically impossible to attempt the routine visiting of these cases. Only urgent cases brought to notice can be dealt with. The King's Home for Nurses renders the greatest assistance in regard to these urgent cases, but if one compares the number assisted in this way with the number reported from schools (and school age is much less dangerous than infancy as regards Measles), it is evident that this disease alone requires further measures to bring about any degree of control. The Health Visiting Staff is barely able to carry out the duties as regards notification of births and Centre work, and any additional duties would mean the relinquishing of work now being performed. During the past year only four deaths occurred from Measles, but the total number of cases was small as compared with the previous year, when 79 deaths were recorded, and there was an increase of 37 in the deaths under 1 year of age from Epidemic Diarrhoea. 70 Dental Clinic.— The Medical Officers of the Centres have repeatedly urged the necessity for the installation of a Dental Clinic. Proposals were put forward by the Committee for the estblishment of a Dental Clinic at Eton Mission in co-operation with the London County Council School Dental Clinic. The establishment of this Clinic would have cost £130, but the additional expenditure was not approved by the Ministry of Health. DESCRIPTION OF THE WORK DURING THE PAST YEAR. The work carried out during- 1921 can be conveniently reported under the following descriptive titles:— 1. Health Visiting; 2. Consultation and Ante-natal Clinics; 3. Provision of Midwifery Assistance and Convalescent Home treatment; 4. Provision of milk and other foods to necessitous mothers and children. 71 1.— HEALTH VISITING. The following table gives details of the visits made by the Council's Health Visitors daring the year :— Miss M. Chitson Mrs. A. Rhodes Miss K. Fisher Miss D. F. Vidal Mrs. L. E. Bartholomew Miss S. Love Miss A. Roche Mrs. E. A. Cowley Miss K. Teebay Mrs. L. Harrison Miss M. Cockle Totals. Number of visits to infants under 1 year of age 329 457 451 405 371 145 215 361 149 234 53 3,170 Number of visits to children 1-5 years of age 295 360 122 527 168 40 334 181 — 425 141 2,593 Number of secondary visits to infants and children ... 755 628 447 783 152 162 659 463 402 382 90 4,923 Total number of infants and children visited 1,379 1,445 1,020 1,715 691 347 1,208 1,005 551 1,041 284 10,686 Number of visits to Measles cases - - - - - - - - - - - - Number of visits to Pneumonia cases 7 12 8 1 1 2 9 1 3 7 1 52 Number of visits to Ophthalmia Neonatorum cases ... 16 4 12 10 2 2 — 6 2 5 3 62 Number of visits to expectant mothers 85 37 6 80 25 5 25 — 11 53 4 331 Number of special visits ... 291 199 138 166 321 18 75 464 213 417 66 2,368 Total number of visits paid during the year 1,778 1,697 1,184 1,972 1,040 874 1,317 1,476 780 1,523 358 13,499 Total number of Clinics attended during the year 107 145 84 160 120 31 92 162 75 128 20 1,124 72 Conditions Found by the Visitors. No. of Infants visited. Method of Feeding. Separate cot provided for Infant. Use of Comforter. Home conditions. Secondary visits. Breast Mixed. ficial. Yes. No. Yes. No. Satisfac tory. Un- satisfac tory. 3540 2931 345 264 1974 1566 1590 1950 3053 487 4923 2.—INFANT CONSULTATION AND ANTE-NATAL CLINICS. Part-time (temporary i.e., not on the permanent staff) Medical Officers have been appointed to conduct the work of the consultation centres, the duties of medical officers having been arranged as follows:— 1. Attend the centre one afternoon per week. 2. To examine all infants brought to the centre, of parents living in the Borough. 3. To advise the parents as to the feeding and care of their infants. 4. Treat minor ailments in the infant when circumstances indicate the need for this. 5. To enter on a case paper to be provided for each infant, certain particulars, with notes on advice and treatment given, and the condition and progress of the infant. 6. To furnish monthly, a return to the Medical Officer of Health as to the number of infants seen and treated at the centre. N.B.—If the ailment of the infants is such as to necessitate continuous medical supervision and treatment, the medical officer must refer the case either to the usual medical attendant or to a hospital for children, such as the Queen's Hospital for Children, Hackney Road. The centre is not intended or fitted to take the place either of the general practitioner or the outpatient department of the hospitals. 73 (1) OVERBURY STREET. (Dr. Elisabeth Wilks). (Infant Consultation.) Number of times Centre open 103 Number of primary cases brought to Centre 633 Repeated visits to Centre 6,443 Total attendances 7,076 Total attendances of infants under 1 year 6,663 Total attendances of children over 1 year 413 Dr. Wilks states that even among normally healthy babies it is noteworthy how frequently it happens that after a mother has not brought her child for weeks or months the child on its return is found to have gained no weight and then picks up 2 or 3 lbs. in as many weeks. The gain in weight is often due to the granting of free milk, or of Cod Liver Oil. Every week several children in whom a defect is found are referred from Overbury Street to their private doctor, or to a Hospital for special treatment. Unfortunately there are still a number of artificially fed babies, but the proportion is smaller than formerly, owing to advice given during the Ante-natal period, and even the artificially fed babies are doing better, as they are not so habitually fed and wrongly fed. (Ante-natal Centre.) Number of times opened 51 NumEer of expectant mothers attending 253 Number of repeated attendances at Centre 410 Total attendances 663 Number of visits to expectant mothers at their homes by the Health Visitors— Number of cases 16 Number of visits 16 74 Dr. Wilks states that the Ante-natal Centre justifies its existence over and over again, and makes the importance of ante-natal care and examination very manifest. A mother attending the Infant Consultation Centre with her babies was repeatedly warned by the Health Visitors of the necessity of ante-natal examination, but she failed to attend. At the confinement a serious abnormality was discovered too late, and the poor woman died. Another mother warned of an abnormality in the position of the baby failed to enter a Hospital as advised, and lost her baby, to her bitter disappointment. On the other hand, babies have been saved. For instance, one woman gave a history of a first baby still-born at full term: a year or two ago she attended the Centre, and was advised to enter a Hospital for the confinement, as her pelvis was slightly contracted. She failed to take advice and the second child also was still-born. During her third pregnancy she attended the Centre and arrangements were made for her to enter a Hospital for the confinement, with the result that she now has a healthy, living child. Two cases of tumour have been discovered—one case after being watched during the whole of pregnancy was admitted to Hospital for Caesarian Section, but operation, in the end proved unnecessary, and manipulations enabled her child to be born by the natural path. There are many instances of women in poor health who have been cared for at the Centre and have become well and strong before the confinement. As an example of these numerous cases one may take a poor woman with Heart Disease, who, very ill at her first attendance, has gradually regained her usual health and has lately had a well nourished baby. With reference to the arrangements for the supply of free milk, Dr. Wilks states that the present income scale places the 75 small family at a disadvantage as compared with the large family, and that this disadvantage is most marked in the case of the widow, and woman with an illegitimate child. Dr. Wilks urges the necessity for a dental clinic and a school for mothers. (2). BROOKSBY'S WALK. (Dr. Reginald Brown.) (Infant Consultation). Number of times Centre open 52 Number of primary cases brought to Centre 659 Repeated visits to Centre 4,707 Total attendances 5,866 Total attendances of infants under 1 year 4,159 Total attendances of children over 1 year 1,207 Dr. Brown reports that every child is examined at its first attendance, and on subsequent occasions as often as is necessary. Altogether 1,511 examinations were made. During these examinations the following cases were discovered:— 1 case of spina bifida, 1 ,, ,, pneumo thorax, 1 ,, ,, pneumonia, 1 ,, ,, congenital facial paralysis, not following instrumental delivery, 1 ,, ,, congenital syphilis, 1 ,, ,, abdominal tubercle and lardaceous disease, 1 ,, ,, mental deficiency, 2 cases of Mongolian Imbecility, 2 ,, ,, congenital heart disease, 1 case (doubtful) of early Cretinism. All the cases in which there was a possibility of successful active treatment were referred to the Queen's Hospital for Children. 76 (Ante-natal Centre.) Number of times Centre open 27 Number of expectant mothers attending 295 Number of repeated attendances at Centre 194 Total attendances 489 Number of visits to expectant mothers at their homes by the health visitors 85 Dr. Brown reports that each case is examined on her first attendance, her pelvic measurements taken, and in the case of primiparæ, a vaginal examination is made. No case of outstanding interest was found during the year, but one case of moderately contracted pelvis was discovered and referred to Dr. Bright Banister, who admitted her to Queen Charlotte's Hospital where labour was successfully induced and a living child born. Two cases of acute vaginitis were also seen and treated by Dr. Bright Banister. Many expectant mothers were advised on small points, and any doubtful cases were sent to Dr. Bright Banister at the Prince of Wales' Hospital, Tottenham. (3). MAYFIELD ROAD. (Dr. J. H. Porter). Number of times Centre open 96 Number of primary cases brought to Centre 640 Repeated visits to Centre 6,089 Total attendances 6,729 Total attendances of infants under 1 year 4,951 Total attendances of children over 1 year 1,778 Dr. Porter states that during the year 1921 the attendances of mothers and children at the Mayfield Road Infant Welfare Centre has been very well maintained; and that notwithstanding the drastic restrictions in the conditions under which free milk may be granted in exceptional cases. 77 1,580 consultations with the Medical Officer are recorded. Dr. Porter states that a feature of this year's work has been the special difficulties in which mothers are placed as a result of the prevailing unemployment: in many cases the supply of maternal milk has failed through malnutrition, and in many more the cost of bottle feeding has resulted in an inadequate or unsuitable supply of food. (A similar state of affairs was reported by Dr. Laughton at the close of last year at Hackney Mothers' and Babies' Welfare Centre.) (4). NORTHWOLD ROAD. (Dr. D. B. Gere). Number of times Centre open 44 Number of primary cases brought to Centre 519 Number of repeated visits to Centre 3,215 Total attendances 3,734 Total attendances of infants under 1 year 2,534 Total attendances of children over 1 year 1,200 Dr. Gere gives the following description of the methods employed at this Centre:— 1. Breast feeding is always strongly encouraged, and many cases which had been weaned in the early months for insufficient reason, have been got back to breast-feeding or mixed feeding, even after a lapse of several weeks. 2. Where artificial feeding is unavoidable, most cases are now put on to dried (Cow and Gate) milk, made up with Marylebone cream and sugar to human milk standard. 3. Instruction is given to mothers at the Centre on infant management. 4. A large number of cases of chronic otorrhœa have been seen and sent to their own doctor or hospitals, or treatment ordered which is carried out at their own homes by Queen's Nurses. (Dr. Gere states that it would be of great advantage 78 if some arrangement could be made with the School Clinic for the treatment of these important cases, and the treatment of cases of conjunctivitis.) 5. Many cases, medical and surgical, have been sent for treatment, whenever possible, to private practitioners; otherwise to hospitals. Cases of interest seen have included one case of lipoma, to be operated on shortly; and several cases of mental deficiency, including one of microcephalic, and two cases of mongolism. (5). HACKNEY MOTHERS' AND BABIES' WELFARE CENTRE, (Dr. J. M. Laughton). Number of times Centre open 108 Number of primary cases brought to Centre 450 Repeated visits to Centre 3,106 Total attendances 3,556 Total attendances of infants under 1 year 2,047 Total attendances of children over 1 year 1,509 Dr. Laughton states that during the year the Welfare Centre has progressed steadily. The average attendance has increased, and the mothers have continued to appreciate the advice given to them. By coming to the Centre they have seen for themselves the results of regulated feeding, and have been encouragd to carry it out at home. As in previous years a large number of visits have been paid to mothers in their own homes by the Superintendent and the other lady workers. These visits have been of great service, especially to young mothers who have had little experience in the management of infants. Dr. Laughton hopes that the new Centre opened in Ada Street in October will carry the work to the poorest part of the district where it is most required. 79 (6). ETON MISSION, (Dr. E. J. F. Moore). Number of times Centre open 98 Number of primary cases brought to Centre 293 Repeated visits to Centre 4,981 Total attendances5,274 Total attendances of infants under 1 year 4,716 Total attendances of children over 1 year 558 Dr. Moore states that many of the babies are brought within the first two weeks of life, and of those brought later the most common reason is some condition due to error of diet, often readily put right. The smallest baby seen was one of 14 days, (a premature infant), whose weight was only 2 lb. 13 oz., and this child although only partially breast fed, has progressed uninterruptedly and at the last weighing (Feb. 10th, 1922), when child was 7 months' old was 14 lbs. 12 ozs., the child being bright and strong; another infant at 7 weeks when first seen, weighed 7 lbs. 3½ ozs., and Dec. 30th, 1921, when 12 months' old, weighed 22 lbs. 8 ozs. As before, every endeavour is made to get mothers to breast feed babies, entirely if possible, or with aid of supplementary artificial food, if this is advisable. Cases requiring medical or surgical treatment such as bronchitis, pneumonia, skin eruptions, discharging ears, circumcision, etc., are referred to private doctors, or local Hospitals. 80 SUMMARY OF CENTRE WORK. Infant Consultation Centres. 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 103 633 6,443 7,076 6,663 413 2. Brooksby's Walk 52 659 4,707 5,366 4,159 1,207 3. Mayfield Road 96 640 6,089 6,729 4,951 1,778 4. North wold Road 44 519 3,215 3,734 2,534 1,200 5."Hackney Mothers' and Babies', Hackney Grove 108 450 3,106 3,556 2,047 1,509 6.*Eton Mission, Gainsborough Road 98 293 4,981 5,274 4,716 558 Total 501 3,194 28,541 31,735 25,070 6,665 *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 £200 from the Council and the Eton Mission Centre £100. Ante-Natal Welfare Centres. Overbury Street. Brooksby's Walk. Eton Mission. Number of times Centre opened 51 27 22 Number of expectant mothers attending 253 295 90 Number of repeated attendances at Centre 410 194 53 Total attendances 663 489 143 Number of visits to expectant mothers at their homes by the Health Visitors Number of cases 16 —. 96 Number of visits 16 85 255 81 3.—HOSPITAL AND MIDWIFERY ASSISTANCE. (1) Maternity Hospitals.—The Council pays the sum of one guinea in respect of each necessitous case admitted from the Borough for treatment at either of these institutions. A necessitous case being considered a patient who, by reason of poverty or other causes, is unable to pay for the treatment received, an amount equal to one-half the average cost per patient of the maintenance and administration charges for the year ended December 31st, 1918. Necessitous Cases. Cases. Cost. Salvation Army Mothers' Hospital 72 £ 75 12s. 0d. City of London Lying-in Hospital 116 16s. 0d. Cases 188 £197 8s. 0d. (2) Provision of Midwives.—During the year the fees of midwives in attendance on 104 mothers confined in their homes were paid by the Council and in 8 cases Home Helps were provided. (3) Agreement for the Provision of Convalescent Home Treatment. 1. The Invalid Children's Aid Association Committee agree to submit each case as it arises to the Maternity and Child Welfare Committee, for approval, before proceeding to obtain convalescent aid for each case. 2. The Invalid Children's Aid Association undertake to submit a detailed financial statement with each case, so that the Maternity and Child Welfare Committee are fully informed as. regards every case dealt with. F 82 3. The Invalid Children's Aid Association will carry out investigations on the same lines as hitherto, and will submit a medical certificate in those cases that are not referred directly from the Welfare Centres. 4. In order to avoid overlapping, and to make sure of selecting the best convalescent home for each particular case, cases referred from the Welfare Centres to the Medical Officer of Health will be investigated and exact details obtained for the information of the Maternity and Child Welfare Committee, through the Staff of the Invalid Children's Aid Association; it being understood that this arrangement shall not be permitted to interfere with the work falling within the scope of the health visitors of the Borough. 5. In those cases where it is decided that the parents are able to contribute to the cost of treatment, contributions will be collected by the Invalid Children's Aid Association, and the Maternity and Child Welfare Committee will, in no case, be required to meet any cost other than that which the parents are unable to afford, i.e., no payment will be made to the Invalid Children's Aid Association by the parent or by the Maternity and Child Welfare Committee except as a direct contribution towards the actual cost of treatment of each case. 6. It is, of course, understood that only those cases that are strictly within the scope of the Maternity and Child Welfare Committee work of the Borough are to be considered by the Maternity and Child Welfare Committee. 4.—PROVISION OF MILK AND OTHER FOODS TO NECESSITOUS MOTHERS AND CHILDREN. The supply of milk for necessitous mothers and children was first granted as a Public Health measure in 1918, by the Milk (Mothers and Children) Order, and the conditions concerning 83 the issue of milk were slightly modified by an Order issued in 1919; the Milk Orders were rescinded in March, 1921—the continuance of the service being permitted by sanction of each local scheme under authority given to the Ministry by the Maternity and Child Welfare Act, 1918, this action being taken by the Ministry, according to Circular 185, in order to ensure a uniform system of milk distribution throughout the country. I reported to the Maternity and Child Welfare Committee on the points raised by the Ministry in Circular 185, as follows:— April 8th, 1921. Supply of Milk for Expectant and Nursing Mothers and for Infants. The Members of the Committee have probably already been informed by the General Press that the Ministry of Health and the Food Controller have revoked the Orders under which Borough Councils were empowered to supply milk to mothers and infants, and that special sanction is now required before the arrangements for supplying milk, either as at present in force or modified in detail can be continued. In order, therefore, that there should be no delay in presenting the necessary scheme for approval by the Ministry I am reporting on the present arrangements and setting out the details in which the scheme of the Borough Council differs from the scheme suggested by the Ministry in the circular accompanying the copies of the rescission orders. (1) The circular of the Ministry states that sanction for the supply of milk will be granted only to nursing mothers, expectant mothers in the last three months of pregnancy, and children up to 3 years of age, as a routine measure. The Committee are aware that expectant mothers, with no restriction as to date of pregnancy, and children up to 5 years of' age were previously permitted under the Orders to receive milk. 84 I may state that it has always been the custom in Hackney to restrict the supply of milk to expectant mothers in the later months of pregnancy, and in all doubtful cases the certificate of a midwife or the Medical Officer of the Centre has been required. (2) The quantity of milk to be supplied has been reduced to half a pint per diem, but in exceptional cases 1½ pints may be supplied to infants between 3 months and 18 months of age. (3) The Ministry state that milk should be given only where a Medical Officer is satisfied that a supply is essential on grounds of health. This restriction has also been followed in Hackney, if one considers that starvation is likely to cause injury to health. Special certificates are required where one and a half pints to infants is supplied, and for supplying children between the agesof 3 and 5 years. (4) Milk should be given to nursing mothers only where they are actually suckling their children. (5) Applications have not hitherto been considered by the Committee as the Ministry suggest should be done before theOrder has been sent to the milk vendor. Applications have been passed by the Medical Officer of Health after *the responsible financial officer appointed by the Council for the purpose—Mr. Bowman—has checked the amounts, etc. Mr. Bowman is responsible under the direction of the Medical Officer of Health for the issue of stores, drugs, dried milks, etc., at the Centres, and the issuing of orders authorised by the Medical Officer of Health to milk vendors. Mr. Bowman is also responsible for the payment for sales at cost price at the Centres, for checking and making out orders for drugs and dried milks, and he attends the municipal Centres —Northwold Road Centre on Tuesday afternoon; Overbury Street, two sessions on Wednesday; Brooksby's Walk, Thursday afternoon; Mayfield Road, Friday afternoon. 85 Mr. Bowman must arrange for sufficient stores to be at the Centres one week in advance, and is responsible for seeing that shortage does not occur, and that the accounts are in every detail correct. So great has been the amount of work caused by the number of applications for milk owing to the prevailing distress, the number of applications being as many as 42 in one day, that it has been necessary to put on an additional temporary clerk—Mr. Shave—to attend to the work of entering and indexing the account and making out the orders. I should like to point out that both these clerks are unable to cope with the work by working in the Council's time only. The routine working has been as follows:—Each repeat and fresh enquiry form (the enquiry form having been filled in by the Health Visitor when either verbal application or application by letter has been made), has to be turned up in the jedger and in the enquiry form file and indexed. Each order form must be written in duplicate, i.e., including the carbon copy retained for office use, and an order form is made out for each family supplied. The invoices returned by the milk vendors are then checked against the order counterfoils and each corresponding order counterfoil cancelled. The amount in the invoice having been verified is signed as correct by Mr. Bowman. The amount is then entered in the account book, against the particulars of the application and indexed. The invoice signed as correct by Mr. Bowman is signed by the Medical Officer and placed before the Maternity and Child Welfare Committee, so that each invoice relating to each family and the total sum owing to each milkman is placed before the Maternity and Child Welfare Committee and the statement of account owing to each milk vendor is signed by the Chairman, who has at the time of signing each separate invoice "before him. The milk enquiry forms giving the financial circumstances are also brought to the Committee meeting. 80 It is, of course, inevitable that some delay will result in sending out the orders should applications have to wait for consideration until Committee meetings are held. (6) The scale of income for determining necessity has been adopted by the Council as follows:— Families with an income per head of 10s. and upwards, full price. 9s to 10s., 75 per cent. 8s. to 9s., 50 per cent. 7s. to 8s., 25 per cent. Under 7s., Free. Arising out of my report to the Committee that in 15 Boroughs of London rent is deducted before calculating income per head and that in five Boroughs there is no fixed scale, each case being considered on its merits, the Committee decided that, where circumstances warranted, the Medical Officer should be authorised to deduct rent and other special expenses before calculating the amount of money left per head for the purchase of food. This arrangement obviated the necessity for a sliding scale, and, in fact, it was considered to be more economical by the Committee than to adopt a recommendation applying to every case that rent and other outgoings should be deducted. It isnecessary to submit this scale for approval to the Ministry, and1 I would suggest that the Ministry be asked to approve the present scale and adopted recommendation. (7) An enquiry as advised by the Ministry, into the financial circumstances of each applicant for milk at less than cost price is made in every case, the particulars being hitherto filled in by the Health Visitor. The Ministry wish the application to be made on a printed form signed by both parents, and that persons making fraudulent application should be prosecuted. 87 In my report to the Committee last December I stated that it is difficult to prevent fraudulent applications; that enquiries should be made from employers in all cases of doubt; and that the applicant should be made to sign the application form, and that cases where fraud is proved should be prosecuted. (8) The Ministry advise that reasonable steps should be taken to verify particulars of income and to prevent overlapping with bodies concerned in the same manner. It has always been a routine measure to consider the amount of help given by the Guardians and the particulars obtained as regards amount of milk or assistance in kind are entered by the Health Visitor on the enquiry form. These enquiries hitherto have only been made from the parents and not from the Guardians themselves. The Committee might consider whether registration with the Mutual Registration of Assistance Association which registers all assistance given by social associations and local authorities in a district should be carried out. The Association for the Mutual Registration of Assistance does not carry out enquiry at the homes but merely hands on information to the various bodies concerned, thus giving information as to what is being done in the way of assistance by such associations as the War Pensions Committee, Tuberculosis Care Committee, Invalid Children's, Association, Charity Organisation Society and military associations, and I understand that the Guardians are also registering. (9) The Ministry suggests that where investigations have not been completed milk should only be distributed at less than cost price after a medical certificate has been obtained, and that where the investigation is satisfactory a supply should be given for not more than a month at a time. It would be simple enough to put this recommendation into force; and as regards the time limit of one month, this limit has never been exceeded in Hackney in making out the orders to the milkmen, and in fact many orders are made out for a fortnightly 88 period, and at the expiration of the period a further enquiry form has hitherto been completed and signed as regards every "repeat" case. (10) The Ministry suggest a model form of invoice. The invoice in use in this Department is considerably better than that suggested by the Ministry. When the order is made out a duplicate carbon copy is filled in at the same time and the order and invoice are sent out together on one sheet (separated by perforations), to the milkmen, the order being retained by the milkman as his authority to supply, and the invoice being retained by the office where the carbon copy of the order is cancelled before the invoice is sent forward to the Finance Committee for payment, after consideration by the Maternity and Child Welfare Committee. Both the order and invoice used in this Department state the proportion of cost to be met by the parent, and in addition on the invoice the vendor certifies that the proportion has in fact been paid. It is desirable that the present system should be retained and it will be simple enough to insist in the future that the person supplied signs that the milk has been delivered, this being the one improvement on our present form as compared with the model form of the Ministry. It is particularly desirable that the milkman should return a separate invoice for each family, rather than an invoice for several families, as suggested in the Ministry's model form. (11) IF the Ministry wish a milk card to be issued in addition, this can be carried out, but there appears to be no real necessity for such proceeding, particularly if the recipient of the milk is to sign the invoice on completion of the order. (12) It has been the regular custom to take samples for examination by the Public Analyst. The difficulty of seeing that milk is consumed by the person for whom it is intended is very 89 great. Some check is possible from the observation of the progress of children at the Centres. (13) The recommendation of the Ministry that conditions attached to the supply of dried milk at less than cost price should be the same as the conditions attached to the supply of fresh milk should be carried out as strictly as possible. Voluntary and municipal Centres give this milk free or at cost price, and it will greatly simplify matters if the procedure hitherto followed is continued, i.e., that if, for instance, an applicant is unable to meet the whole cost of the milk and he can afford to pay a proportion of the cost, a quantity of milk is given free and the remaining quantity is purchased at cost price. This results, as far as the accounts are concerned, in the dried milk being given free, or purchased at cost price, whereas in a certain proportion of cases the parents have in fact contributed a percentage of the cost. It is advisable in future that applications for dried milk should be made on similar forms as those for wet milk in order to comply more thoroughly with the request of the Ministry of Health. I should also state that neither of the voluntary Centres give dried milk away unless an enquiry form has been sent to the Health Office and the cost is to be met by the Council, to that the enquiry or application form is filed as regards all cases of free dried milk issued and a Milk Order form respecting each person supplied with dried milk is sent to the Centre concerned, and when the milk has been delivered the invoice is returned for payment to be made to the voluntary Centre supplying the milk. The Ministry requests that stock books and vouchers should be kept and that there should be periodical stocktakings. Mr. Bowman has always kept a stock book showing receipts of issues, and there is a yearly stocktaking in addition to the 90 weekly survey at the municipal Centres. The procedure followed has been that the Medical Officers of the Municipal Centres sign a requisition on the Health Office for goods required for the following week. All goods ordered for the Health Office are, of course, ordered by the Medical Officer of Health. The voluntary Centres supply their own needs except with regard to the issue of free dried milk. .The amount issued to each municipal Centre is entered up into a receipt book signed by the Health Visitor, of the Centre. Each day when Mr. Bowman attends a Centre he verifies the stock left from the previous week, adds the stock requisitioned for the current week by the Medical Officer of the Centre, and signed for on delivery by the Health Visitor as stated above, and enters a note of correctness before starting on the day's sales. At the end of the day the difference between the amount of stock started with and that remaining is made up by the money taken by Mr. Bowman, less the stock given free of charge, which is signed for by the Medical Officer of the Centre in a book kept for that purpose in the Consulting Room, in which is entered particulars of applicant's financial condition; the amount to be given free is also entered on the Weight Cards as Mr. Bowman's immediate authorisation to supply without delaying to consult the book already mentioned, which is kept in the doctor's room during the Clinic. A detailed statement of goods sold and goods given is handed in by Mr. Bowman together with the cash after each Centre session. (14) The practice previously in force of supplying or ordering milk from the Centres was discontinued some months ago, with the exception of dried milks sold at cost price. Distribution of dried milk at less than cost price and distribution of wet milk is entirely carried out through the Health Office. The Ministry recommend that the time of Health Visitors or other trained officers should not be taken up with the clerical work of distribution. 91 I have already reported to the Committee that the Health Visitors' time is far too urgently needed on their districts to be taken up with clerical work of this description, or, in fact, with any of the clerical work connected with the administration of the Centres. Applications Received for the Supply of Free Milk. Total No. of Applications. No. of unemployed. No. of unemployed found destitute. No. of applicants on short time. 4,300 3,378 650 311 The number of applicants in distressing circumstances other than those classified as above was 611. A number of applications for relief to the Mayor's Distress Fund were made by families containing young children and infants, and visits were made by the Health Visitors, to do anything possible in the direction of preventing injury to the health of the infants and young children and to consider the question of the supply of milk to them. These applications thus referred numbered 3,311. In every case dealt with, every form of assistance was taken into account, including, of course, that given by the Guardians. Milk supplied free of cost to necessitous cases involved the Council in an expenditure of £3,677 3s. 6d. Dried Milk, Foods, Medicines, etc. (a) Supplied free of charge to necessitous mothers:— £ s. d. Glaxo 302 4 10 Cow and Gate 43 19 8 Virol 20 9 0 Marylebone Cream 19 10 9 Cod Liver Oil and Malt 16 16 9 Sundries 21 0 8 £424 1 8 92 (b) Supplied at cost price— £ s. d. Glaxo 2,450 6 8. Cow and Gate 470 11 9 Virol 151 7 0 Sugar 2 18 11 Lactagol 16 12 1 Marylebone Cream 45 14 0 Petroleum Emulsion 44 17 5 Syrup Ferri 17 12 5 Malt 1 18 8 Cod Liver Oil and Malt 15 15 0 Sundries 76 11 4 £3,303 5 3 HOUSINC AND WORK OF SANITARY INSPECTION. Housing Scheme.—Considerable progress has been made •during the year as regards the provision by the Council of the additional housing accommodation needed in the Borough. 'I he Housing Scheme of the Council provides accommodation for 21 families in nine houses converted into tenements; and, as a temporary measure, accommodation for 12 families in nine converted Army huts. During the year 40 out of the total 80 cottages to be erected in Casimir, Cleveleys, and Gunton Roads were completed, and a scheme has been adopted for the erection of 62 maisonettes in Daubeney Road, Adley Street, and Gilpin Road. Housing Conditions in the Borough. Owing to the age of the houses, neglect during the War, and the cost of carrying out repairs, much of the housing property in the Borough cannot recompense the owner for extensive reconstruction. Property such as Nisbet Street, and Mundford 93 and Theydon Road flats have been considered from every aspect by the Public Health Committee and all possible steps have been taken to bring about improvement in condition. Some of the property now causing anxiety is set out below:— Berger Road, No. 22. Haywood Buildings, Nos. 1, 2, 3 and 4. Crozier Terrace, No. 32. Duncan Square, Nos. 6. 7 and 8. Caroline Cottages, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,. 12, 13, 14, 15 and 16. Clarence Cottages, Nos. 1, 2, 3, 4, 5, 6 and 7. Clarence Terrace, Nos. 1, 2, 3, 4, 5, 6, 7 and 8. Queen's Court, Nos. 1, 2, 3, 4, 5 and 6. Swiss Cottages, Nos. 1, 2, 3 and 4. Middlesex Wharf, Nos. 20, 22, 24, 26, 28, 30, 32, 34,. 36, 38, 40, 42, 57, 59, 61, 63, 65, 67, 69, 71, 73, 75, 77, 79, 81, 83, 85, 87, 89 and 91. High Hill Ferry, Nos. 1, 2, 3, 4, 5, 6, 7 and 8. Prince of Wales' Terrace, Nos. 1, 2, 3, 4, 5, 6, 7 and 8. Fulham Place, Nos. 1, 2, 3, 4, 5, 6 and 7. Lyme Grove, Nos. 15, 17, 19, 21, 23, 25, 27, 29 and 31. Retreat Cottages, Nos. 3, 4, 6, 7, 8, 9 and 10. The number of certificates granted under the Increase of Rent and Mortgage Interest (Restriction) Act, 1920, during the year was 35. In order to obtain any relief under the Sanitary Certificate Section action must be taken by the tenant at the County Court, and there is on this account no eagerness to take advantage of the Section. An owner of property bringing in approximately £2,000 a year in small sums varying from 9s. to 12s. weekly has informed me that when the Act expires steps will be taken as regards this particular housing property, not only to raise the rent, but to induce the tenants to sign repairing agreements. 94 I am informed that there is nothing to prevent this procedure being adopted on a large scale; in fact, this defence of nonresponsibility of the owner, as the result of repairing agreements, has been raised on several occasions recently. The fallowing illustrates a type of case:— "In answer to your letter of the 8th inst., 1 must kindly inform you the true facts of the case. In the first place, I do not possess an agreement as the landlady refused to give me a copy, also that I do not remember signing to put a new lavatory pan in. I had to do my own decorations, which cost me just on £20, as the place was in a filthy condition, also that I am paying 35s. a week rent, which works out for 12 months at the rate of £2 3s. Od. a week. You must agree with me that it's scandalous paying all that money for 3 rooms, and on top of that she is trying to make me fix a new pan. It's the first time I have heard of a weekly tenant being responsible for drains.'' Extract from Agreement signed in above case:— "I agree and undertake to do all necessary repairs and to keep the drains, soil and other pipes and sanitary and water apparatus in good, sufficient and tenantable repair and condition." SANITARY INSPECTION. Public Health (London) Act, 1891. (a)* Complaints of Nuisances.—During the year 1921 there were 4,638 complaints of nuisances made to the Public Health Department and investigated by the Sanitary Inspectors of the Borough. Defects or nuisances were discovered in 3,906 of the complaints. Notices for the remedy or abatement of these were served upon the owner or person responsible under the above Act. 95 (b) Infectious Diseases.—The occupied dwellings inspected during the year after infectious disease numbered "2,854. This is an increase of 779 upon the number inspected during 1920. Any nuisances or sanitary defects found were dealt with under the provisions of the above Act. (c) General Inspections.—The number of other inspections made by the Inspectors during the year was 1,955. These inspections are in addition to those made under (a) and (b). The nuisances or sanitary defects found were dealt with in the same manner as those under (a) and (b). Nuisances or defects found on inspection were remedied in most cases on service of an intimation notice only. The total number of such notices served during 1921 was 7,923. The number of statutory notices served was 1,657; and summonses were issued in 115 cases. Prosecutions under the Public Health (London) Act, 1891, during the year 1921. Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. 28, Percy Terrace General Insanitary condition Withdrawn — — 57, Southborough Rd. Dilapidated dust bin Order to provide in 7 days — 2 2 0 203, Queens Road Rooms dirty, defective sashes Order to abate in 14 days — 2 2 0 26, Lauriston Road Damp wall, no vent under ground floor, W.C. door dilapidated ,, ,, ,, - 1 15 6 30, Lauriston Road Roof defective, rooms dirty and dilapidated ,, ,, ,, — 1 15 6 33, Clifden Road Sink waste pipe untrapped, damp walls Order to abate in 21 days - 1 5 0 136, Lower Clapton Road Kitchen stove defective, walls and ceiling of room dirty Order to abate in 14 days - 1 5 0 Carried forward 10 5 0 96 Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. Brought forward — 10 5 0 7, Ufton Road . General Insanitary condition Withdrawn (Work dono/i ■— 1 16 0 la, Forest Road . Separate sanitary accommodation for sexes not provided Dismissed on technical error 9, Durrington Road . . General Insanitary condition Withdrawn (Work done) — 2 2 0 11, Durrington Road ,, ,, ,, ,, ,, — 2 2 0 2, Mortimer Road Non-compliance with Magistrate's order Fined — 1 13 6 4 , ,, ,, ,, ,, ,, ,, — 1 13 6 1, Albert Road . General Insanitary condition Order to abate in 21 days — 2 2 0 17, Southwold Road ,, ,, ,, Withdrawn (Work done.) - 1 13 6 36, Nisbet Street . Rooms dirty, dust bin, yard paving, and eaves gutters defective Order to abate in 14 days - 1 15 6 40, Rooms dirty, rain water pipe and yard paving defective ,, ,, - 1 15 6 39, Berger Road . General Insanitary condition Withdrawn (Work done.) - 1 13 6 22, „ ,, Rooms exposed to weather owing to walls being removed Order to abate in 7 days - 1 15 6 44, Malvern Road General Insanitary condition Order to abate in 21 days - 2 2 0 9, Shepherd's Lane Rooms dirty, dust bin and yard paving defective Withdrawn - - - - 59, Clifden Road . No yard paving, W.C. dirty Order to abate in 21 days - 1 1 0 248, Rushmore Road Yard paving, sink waste pipe and dust bin defective Withdrawn (No costs) - - - - 37, De Beauvoir Sq. Rooms dirty, W.C. pan broken Order to abate in 14 days - 2 2 0 12, Homerton Grove Unregistered milk vendor Fined - 10 6 13, Clarence Road Rooms dirty Withdrawn (Work done.) - 1 13 6 2, Clarence Terrace Rooms dirty, eaves gutter and roof defective ,, ,, - 1 13 6 3, Hindrey Place Eaves gutter defective ,, ,, — 1 13 6 5, ,, ,, Window dilapidated ,, ,, - 1 13 6 Carried forward — 42 16 0 97 Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. Brought forward — 42 16 0 7, Hindrey Place Roof, floors and eaves gutter defective Withdrawn (Work done.) - 1 13 6 11, ,, Sink waste pipe defective ,, ,, — 1 13 6 13, „ Rooms dirty, window dilapidated ,, ,, - 1 13 6 34, Pembury Grove W.C. and eaves gutter defective ,, ,, - 1 13 6 25, Warwick Villas Rooms dirty, roof and W.C. defective Order to abate in 21 days — 1 15 6 19, Wick Road General insanitary condition Withdrawn (Work Jone.) — 1 13 6 171, Sandringham Rd. Rooms dirty, W.C. defective Order to abate in 14 days — 1 15 6 Devonshire Works Devonshire Road W.C. choked Withdrawn (Work done.) - 1 15 6 27, Hackney Grove W.C. pan broken ,, ,, — 1 15 6 179, Amhurst Road General insanitary condition ,, ,, — 3 3 0 35, Farleigh Road Rain water pipe and sink waste pipe defective ,, ,, - 1 15 6 113, Overbury Street Drains defective Order to abate in 21 days — 1 15 6 31, Cadogan Terrace General insanitary condition Withdrawn (Work done.) - 1 15 6 31, Oswald Street Rooms damp ,, ,, — 1 15 6 82, Clifden Road Rooms and floors damp Order to abate in 21 days — 1 15 6 57, Tottenham Road Roof and yard paving defective Withdrawn (Work )one.) - 1 15 6 81, Paragon Road Drains defective Order to abate in 28 days. - 1 15 6 203, Queen's Road Non-compliance with Magistrate's order Fined 1 0 1 15 6 24, Mayfield Road Staircase, walls and ceilings dirty and dilapidated Withdrawn (Work done.) - 1 15 6 9, Church Road Wall damp ,, ,, — i 13 6 63, High Street Homerton Roof defective, Rooms dirty ,, ,, — . 2 2 0 87, Balls Pond Road Damp wall, no through vent under ground floor Withdrawn (Work done) - - - - 12, Mortimer Road Defective W.C. Dirty rooms Order to abate in 14 days - 1 15 6 Carried forward 1 0 82 19 0 G 98 Address. • Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. Brought forward 1 0 82 19 0 9, Balmes Road Dirty rooms, roof and door of workshop defective Order to abate in 14 days. - 1 15 6 20, Tower Street No dust bin Withdrawn (Bin supplied) - 1 13 6 6, King Edward Road House without a proper and sufficient water supply Withdrawn - - - - 18, Durrington Road No dust bin, yard paving defective... Withdrawn (Work done.) - 1 15 6 6, ,, ,, Dust bin defective Withdrawn (Bin supplied) - 1 13 6 17, Presburg Street Rooms dirty, eaves gutter and copper defective Withdrawn (Work done.) - 1 13 6 la Forest Road Separate sanitary accommodation for sexes not provided ,, ,, - 2 2 0 6, Frampton Park Rd. Rooms dirty, sink waste pipe and dust bin defective ,, ,, - 1 15 6 41, Avenue Road Rooms dirty, roof, eaves gutter and rain water pipe defective ,, ,, - 1 15 6 57, Holmbrook Street Rooms dirty, yard paving and roof defective ,, ,, - 1 15 6 23, Wardle Street General Insanitary condition Order to abate in 14 days - 2 2 0 10, de Beauvoir Crst. ,, ,, ,, Order to abate in 28 days - 1 13 6 53, de Beauvoir Road 5, Olinda Road ,, ,, ,, Eaves gutter defective ,, ,, Withdrawn (Work done,) — 1 1 13 15 6 6 81, Trowbridge Road General insanitary condition Order to abate in 14 days - 1 15 6 126, Daubeney Road Rooms dirty Withdrawn (Work done.) — 1 15 6 38/40, Upper Clapton Roac W.C.'s dirty and dilapidated ,, ,, - 1 15 6 34, Clapton Square W.C. defective ,, ,, — 1 l5 6 44, Pembury Grove General Insanitary condition ,, ,, — I 13 6 40, Victoria Park Rd Rooms dirty ,, ,, — I 15 6 Arches Nos. 372/380 Lamb Lane Yard in insanitary condition, urinal adjoining Arch 380 defective ,, ,, - 2 2 0 190, Lower Clapton Road 4 tins of salmon unfit for food Fined 2 0 0 2 2 0 Carried forward 2 1 0 120 18 6 99 Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. Brought forward 2 1 0 120 18 6 1 Stoke Newington Common Damp wall, insufficient dust bin accommodation Withdrawn (Work done.) - 1 15 6 91, Evering Road Eaves gutter defective, staircase ceilings dirty „ „ - 1 15 6 17, Wellington Road Vent and rain water pipe defective, rooms dirty „ „ - 1 15 6 6, Pear Tree Place Rooms dirty, roof defective „ „ - 1 15 6 184, Amhurst Road Rooms dirty, W.C., gulley and gratings defective Order to abate in 14 days - 2 2 0 Lawrence Buildings (Factory) No separate sanitary accommodation Order to abate in 28 days - 3 3 0 110, Downs Park Rd. Lavatory waste pipe defective Withdrawn (Work done.) — 1 15 6 4a, Mead's Place Roof defective Order to abate in 28 days - 1 15 6 22, Berger Road Rooms exposed to weather owing to walls being removed „ „ - 1 15 6 5, Stockmar Road Staircase and passage walls dirty Withdrawn (Work done.) - 2 0 6 21, Ottaway Street Dust bin defective Withdrawn (New bin supplied) - 1 15 6 9, Benthal Road Foul stone sink in scullery Order to abate in 14 days - 2 0 6 134, Well Street General Insanitary condition „ „ - 1 15 6 85, Nisbett Street Rooms dirty, rain water pipe, eaves gutter and W.C. defective Dismissed (No proof of ownership) - - 38, „ „ General Insanitary condition Order to abate in 14 days — 1 15 6 182, Stoke Newington Road Rooms dirty, roof leaky Order to abate in 21 days - 2 0 6 1, Southboro' Road Staircase walls dirty Withdrawn (Work done.) - 1 15 6 32, Holcroft Road Passage and staircase dirty, W.C. defective Order to abate in 14 days - 1 15 6 1, Caroline Street Ground floor front room damp Order to abate in 14 days - 1 15 6 Carried forward 2 1 0 155 6 6 100 Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. Brought forward 2 1 0 155 6 6 253, Glyn Road General insanitary condition Order to abate in 8 weeks — — 6, Glenarm Road Rooms dirty, roof defective Withdrawn (Work done.) — 1 1 0 79, Paragon Road Sink, waste and roof defective Dismissed (5s. costs against Council - - 158, Morning Lane General Insanitary condition Withdrawn (Work done.) - 1 15 6 8, St. Thomas' Place Ground floor back room dirty Order to abate in 14 days - 1 15 6 43, Well Street Basement front room dirty „ „ - 1 15 6 182, „ „ Roof defective Order to abate in 7 days - 1 1 0 23, Clapton Square No proper water supply to house „ „ - 1 4 6 111, Richmond Road Rooms dirty Dismissed (Tenant liable) - - 6, Little Hill Fail to repair W.C. Withdrawn (Work done.) - - 6, „ „ Fail to provide dust bin „ „ - 1 10 0 2, „ „ W.C. defective „ „ - 1 2 6 45 Cricketfield Road General insanitary condition Order to do work in 21 days - 1 1 0 57, London Road Rooms dirty, flooring, range and copper defective Withdrawn (Work done.) - 10 6 14, Sylvester Road W.C. defective Order to do work in 14 days - 1 10 0 92, Richmond Road Stove dilapidated Withdrawn (Work done.) - 1 3 0 6, Colvestone Crescent Roof defective, W.C. door dilapidated Order to do work in 7 days - 1 10 9 13, Arthur Street Rooms dirty, roof defective, no dust bin Withdrawn (Work done.) - 1 3 0 90, Berkshire Road Rooms dirty, eaves gutter defective Order to abate in 21 days - 1 1 0 92, „ „ Rooms dirty, yard paving and flooring defective „ „ - - 70, Prince Edward Rd. No dust bin, stove and copper defective „ „ - 1 1 0 179, Amhurst Road General insanitary condition Order to abate in 14 days - 2 2 0 1, Caroline Street Non-compliance with Magistrate's order Fined 5 0 0 1 1 0 £7 1 0 178 14 6 101 Housing and Town Planning Acts. It was possible during the year to commence a systematic inspection under the Housing and Town Planning Regulations. The three additional appointments of Sanitary Inspectors recently made permits systematic inspection to be made and an accurate card indexed record to be compiled of the housing conditions of the Borough. The number of houses inspected under these regulations during the year was 1,622. Factory and Workshop Act, 1901. Factories.—During the year, 310 factories were inspected by the officers of the Public Health Department, 4 being factory laundries, and 306 factories of other occupations. In 26 factories the sanitary accommodation for women was defective, unsuitable or insufficient, or not separate from that for men. Nuisance. Found. Abated by Workshop Inspector. Abated by District Inspector. Outstanding. Unsuitable or defective w.c.s 23 30 — 2 Insufficient w.c.s — 1 — — Not separate to sexes 3 3 - 1 List of Industries in the Borough of Hackney. The chief staple industries are the manufacture of boots, shoes, cabinets and pianos, but there are also extensive productions of the following:— , Tailored clothes for males and females; dresses, shirts, ties, clothing and underclothing generafly, millinery, hats, 102 etc., 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; also there are several furriers, and a number of laundries. Workshops.—The number of workshops registered in Hackney at the end of 1921, was 1,021, an increase of 7 on the number registered at the end of 1920. Of this total, 699 were workshops in which females were employed. Of these latter, 465 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, etc., 207 in which other articles were manufactured, etc., and 29 were domestic workshops. Amongst the workshops in which wearing apparel is manufactured, there were 293 in which females alone and 170 in which both males and females were employed. In workshops of other occupations, there were 110 in which females alone, and 97 in which both males and females were employed. Of the domestic workshops, females alone were employed in 17, and both males and females in 12. During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints—Factories 30 Complaints—Workshops 40 Notices—Workshops 80 103 Analysis of Occupations Carried on in the Registered Workshops of Hackney. (a) Wearing Apparel. Occupations. No. of Workshops. Occupations. No. of Workshops. Artificial Flower Makers 7 Furriers 63 Baby Linen 2 Hats 10 Beading 1 Infants' Millinery 8 Blouses 39 Mantles 43 Boot and Shoe Manufacturers 53 Millinery 24 Stays 8 Boot Machinists 115 Tailoring 96 Children's Costumes 7 Ties 28 Clerical Robes 1 Trimmings 9 Clothing 6 Underclothing 14 Collars 1 Vests 9 Dressmakers 65 Waterproofs 4 Dressing and Tea Gowns 3 621 Fancy Bows on Shoes 5 (b) Other Occupations. Bakers and Confectioners 41 Rubber Goods 5 Baskets 4 Toy Makers 13 Box Makers 19 Trunk and Bag Makers 11 Brush Makers 13 Umbrella Makers 2 Cabinet Makers 68 Upholsterers 13 Doll Manufacturers and Dressers 6 Upholsterers' Trimmings 4 Miscellaneous 117 Fancy Leather Goods 31 400 Laundries 31 Pianoforte Makers 22 During 1921, Miss Teebay, the Workshops Inspector, made 2,555 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections, 352 intimation and 77 statutory notices were served for the abatement of the nuisances found. In ten instances legal proceedings were taken against owners of premises. 104 The Factory and Workshops Act, 1901. Factories, Workshops, Workplaces and Homework. I.— INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 310 70 4 Workshops (Including Workshop Laundries) 2,387 532 6 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 11 8 ... Total 2,708 610 10 2.— DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts—* Want of cleanliness 263 259 ... 3 Want of ventilation 34 27 ... ... Overcrowding 18 14 1 ... Want of drainage of floors 1 1 ... ... Other nuisances 98 104 ... 1 Sanitary accommodation— Insufficient 2 3 ... ... Unsuitable or defective 136 137 ... 4 Not separate for sexes 13 15 ... 3 Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 28 28 ... ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) ... ... ... ... Total 593 588 1 11 including those specified in sections 2, 3, 7 and 8, of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 105 HOME WORK. Nature of Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108 Outwork in Infected Premises. Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders Made (Section 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Con. tractors Workmen. Wearing Apparel— (1) Making, &c. 224 45 2098 29 7 139 63 ... ... 1 ... ... ... ... ... (2) Cleaning and Washing 2 ... 2 1 ... 2 ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets 2 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 12 5 129 1 ... ... 3 ... ... ... ... ... ... ... ... Fur Pulling 4 ... 5 4 ... 5 2 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers 8 ... 129 2 ... 6 1 ... ... ... ... ... ... ... ... Racquet and Tennis Balls 2 ... 8 1 ... 5 ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper Bags 26 ... 289 1 ... 3 3 ... ... ... ... ... ... ... ... Brush Making 22 ... 510 2 ... 5 4 ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... 3 ... 16 1 ... ... ... ... ... ... ... ... Basket Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas crackers, Christmas stockings, &c. ... ... ... 1 ... 8 ... ... ... ... ... ... ... ... ... Total 302 50 3176 45 7 189 77 ... ... 1 ... ... ... ... ... 106 4.— REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Important classes of workshops, such as workshop bakehouses may be enumerated here. Total number of Workshops on Register 1,021 5.— OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (S. 133, 1901) 6 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (S. 5, 1901) Notified by HM.. Inspector 70 Reports (of action taken) sent to H.M. Inspector 53 Other Underground Bakehouses (S. 101):— In use at the end of the year 51 107 Outworkers.— The number of outworkers on the register at the end of 1921 was 2,360, against 2,993 at the end of 1920. There were thus 633 outworkers removed from the register during the past year. The following analysis shows the trades followed by these outworkers:— No. of No. of Trade. Outworkers. Trade. Outworkers. Artificial Florist 74 Hats 9 Baby Linen 25 Hosiery 7 Belts 17 Lace Goods 8 Blouses 154 Lamp Shades 1 Boots and Shoes 539 Leather Goods 3 Boxes 197 Mantles and Costumes 174 Braces 5 Millinery 101 Brushes 236 Paper Bags 3 Children's Costumes 19 Pyjamas and Shirts 33 Children's Millinery 17 Shoe Bows 36 Christmas Crackers, etc 17 Skirts 6 Clothiers and Outfitters 70 Tailoring 139 Collars and Bibs 13 Tennis Ball Covering 13 Confectionery Packing 5 Ties and Neckwear 163 Corsets 1 Trimmings 56 Dolls and Toys 11 Umbrellas 13 Dressing Gowns 14 Underclothing 52 Embroidery 5 Upholsterers' Trimmings 28 Fancy Goods 7 Miscellaneous 23 Feather Trade 6 Fur Trade 60 2,360 2,104 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 108 outworkers sent in by employers in this Borough, addresses of 1,659 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 1921, Miss Portlock, the Inspector appointed for the inspection of Outworkers' premises, made 1,181 inspections and 1,167 re-inspections. She also made 398 visits, without inspections, the outworkers having left the premises (99), or having given up home work (84), or being out at the time of visit (112), or owing to a wrong address being given (71), or the premises being workshops (23), or the outworkers having died (9). Miss Portlock also discovered 2 new workshops and handed in their addreses for registration. During her visits of inspection she found 468 premises with sanitary defects. For the abatement of these she served 408 intimation, 40 final, and 4 statutory notices. Of the 1,181 premises inspected, in only 8 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 49 „ „ and living room 68 „ „ „ kitchen 114 „ and kitchen 831 „ „ bedroom 92 „ „ parlour 6 „ „ scullery 10 „ „ bath room 2 „ „ landing 1 „ provided separately 8 1,181 109 London County Council (General Powers) Act, 1904. V During the year attention was drawn by the Medical Officer (Education) of the London County Council to 235 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:— 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. 235 10 19 206 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. Rats and Mice Destruction Act, 1919. The agreement entered into between the Council and Messrs. Howard and Sons, has worked most satisfactorily throughout the year, the scale of fees payable in those cases where the persons responsible for the destruction of rats desire the work to be done by Messrs. Howard under the supervision of the Council's Sanitary Staff is as follows:— £ s. d. Small houses 1 1 0 each Warehouses, according to size, say on the average 5 0 0 „ Railway arches110„ Stables, up to 10 horses 1 5 0 „ 110 During the year the following premises have been cleared of rats:— 1 Factory, 1 Religious Institution, 37 Houses. Enquiries are of course made, in all cases where information of the presence of rats is received, into the condition of the drains. After a premises has been cleared of rats by ferrets, etc., the rat catcher fills in any openings with cement as necessary and carries out any small repairs required to defective footings. After dealing with each house he keeps it under observation for one month to ascertain if there should be any re-invasion by rats. Drains found to be defective are dealt with in the ordinary way by the Sanitary Inspectors. 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, cwts.; Meat, 77 lbs.; tinned foods, 17 cwts.; 195 rabbits. 111 Sale of Food and Drugs Acts, 1875-1907. Samples purchased during 1921. Articles Purchased. Number purchased Number Adulterated Number where Proceedings taken Milk 572 23 14 2 (no name of address on vehicle) Do. (separated) 5 1 1 Margarine 75 1 1 3 (served in plain wrapper) Cocoa 23 — — Cocoa Essence 1 — — Lard 12 — — Coffee 21 1 — Pepper 15 — — Mustard 15 1 — Olive Oil 14 1 1 Custard Powder 6 — — Baking Powder 6 — — Dripping 9 — — Butter 54 — — Vinegar (Malt) 21 — — Vinegar 3 — — Cornflour 9 — — Arrowroot 9 — — Cream (preserved) 5 — — Cream 3 1 — Cream of Tartar 3 — — Camphorated Oil 6 1 — Whisky 3 2 1 Rum 3 2 1 Gin 3 1 — Brandy 3 1 — Syrup of Squill 2 2 1 Totals 901 38 25 112 • Prosecutions under the Sale of Food and Drugs Acts during the year 1921. No. of Sample Article Adulteration or Offence Result of Legal Proceedings Fine Costs £ s. d. £ s. d. 134a Margarine Served in plain wrapper Fined 1 10 0 119a Milk 3.89% added water Withdrawn (abnormal and above standard) 141a „ 3.3% fat abstracted Withdrawn 173a „ 13.3% fat abstracted Dismissed under Probation of Offenders Act 3 3 0 160a Margarine Served in plain wrapper Fined 10 0 4b Milk 4.24% added water Fined 1 0 0 2 4 0 „ No name or address on vehicle Fined 10 0 11r „ 8.12% added water Dismissed (Warranty proved) 7r „ 10.25% added water „ „ 13e „ 13.3% fat abstracted Fined 10 0 0 4 4 0 14e Skimmed Milk 4.48% added water Fined 5 0 0 8p Milk 9.3% fat abstracted Dismissed (Warranty proved) „ No name and address on vehicle Fined 2 0 0 Withdrawn 12d „ 3.77% added water (Incapable of analysis) 13m „ 16.7% fat abstracted Dismissed under Probation of Offenders Act 1 1 0 14m „ 3.3% „ „ „ „ 15m „ 10.0% „ „ „ „ 16m „ 26.7% „ „ „ „ 3 3 0 14p Margarine Served in plain wrapper Fined 10 0 1 1 0 20m „ 4% excess of water 1 4 6 26y Milk 21.88% added water Fined 10 0 0 2 2 0 29e Whisky 13% excess of water Withdrawn on payment of 2 12 6 30e Rum 14.06% excess of water „ „ 2 12 6 35n Olive Oil 100% Cottonseed Oil Dismissed 36m Syrup of Squill 33.69% deficient in Vinegar of Squill Withdrawn on payment of 1.85% deficient in Sugar 2 12 6 31 0 0 26 0 0 113 Report of Food Inspector during the year 1921, (Mr. A. J. Bobbitt). Milkshops and Dairies.—1,587 inspections were made during the year. 6 notices have been served for cleansing and repairs, all of which have been complied with. In 8 cases vendors have been warned for having dirty or unwashed measures in use. 38 new milksellers have been registered. 2 applications for registration have been refused on account of the unsuitability of the premises. 1 unregistered milkseller was prosecuted for selling milk from unsuitable premises and fined 20s. and 10s. 6d. costs. Cow Houses.—There are now 9 licensed cowkeepers, with 10 sheds, one cowkeeper not having applied for a renewal of his license. 122 inspections were made during the year, and on two occasions I found accumulations of manure in the yards. In all other respects I found that the premises were kept in accordance with the bye laws. Slaughterhouses and Meat Inspections.—294 visits were made to these during the usual slaughtering times, when I have examined the carcases and organs of 145 oxen and heifers, 2 cows, 15 calves, 2,613 sheep and lambs, 54 pigs, and 6 goats. One breach of the bye laws was found, viz., bleeding a pig in the pound instead of in the slaughterhouse, and on one occasion I had to complain of the dirty condition of a pound and the approach thereto. This was promptly remedied on calling the attention of the licensee to same. The carcases examined have H 114 been remarkably free from disease and only minor affections have been met with. Tuberculosis, the most common disease among bovines, has been entirely absent. One case was discovered in a pig, and then only in a slight degree in the pluck. The following I found diseased and had destroyed :— Portions 2 fore quarters of an ox extensively bruised. Livers of 7 oxen and 9 sheep affected with Distomatosis. Livers of 2 oxen and 4 sheep affected with Abscess. Livers and lungs of 6 sheep affected with Parasitic Cysts. 1 pig's pluck affected with Tuberculosis. Wholesale Preserved Provision Factories.—49 visits were made to these, and on each occasion I found the premises kept in a cleanly condition and the meat of various kinds sound and free from disease. Sale of Food and Drugs Acts.—48 samples were purchased for analysis. Miscellaneous Inspections and Unsound Food.—500 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. One prosecution has been taken during the year for exposing unsound tins of salmon for sale, resulting in a fine of £2, and 2 guineas costs. The Sale of Food Order, 1921, which came into operation on September 1st, imposed on meat retailers the duty of marking all imported meat exposed for sale, and I have found that very few of them knew of its existence. I have observed many failures to comply with the Order and have warned offenders that proceedings may follow if they do not comply with the provisions as to efficient marking of all imported meat exposed for sale. During the year a large number of stall butchers (mostly ex-service men), have started in business in the market 115 thoroughfares, and considerable time has been devoted to inspecting the premises where they were storing their meat and utensils. Many of them had the idea that any old shed or yard was good enough for the purpose, and in one case I found meat stored in a very dirty stable, with two horses, and which opened direct on to the street without any open yard, and I had to serve this man with a written notice before he would look for more suitable accommodation, which he has now obtained. The following foodstuffs have been condemned and destroyed :— 516 Tame Rabbits 9 lbs. imported Cheeses 140 Wild „ 45 cwt. 2 qrs. 15 lbs of Skinless 1 carcase of Mutton Hams 10 stones 4 lbs. Beef 47 bales of Dutch Bacon 1cwt. 1qr. 10 lbs. 3 cwts. 2 qrs. 21 lbs. Danish Pork trimmings Bacon 9 bags of Peas 32 boxes of Tomatoes 94 Bananas 2 bags of Walnuts 1 barrel of Apples 1 barrel of Herrings 4 boxes „ „ 1 box of Herrings 2 bushels „ „ 8 boxes of Kippers 170 tins of Milk 2 boxes of Skate 1,354 tins of Sardines 14 lbs. Skate 67 tins of Meat 2 boxes of Haddock 1783 tins of Pineapple 2 boxes of Scotch Eel 526 Eggs 1 case of Cod 32 Australian Cheeses 2 bags of Winkles Total weights of all foodstuffs destroyed :— Meat 13 cwt. 3 qrs. 15 lbs. Bacon and Ham 14 tons 4 cwts. 1 qr. 8 lbs. Fish 8 cwts. 1 qr. 14 lbs. Fruit 4 cwts. 3 qrs. 19 lbs. Provisions 1 ton 7 cwts. 1 qr. 8 lbs. 110 Report of the Canal Boats Inspector for the year 1921. (Mr. E. S. Crook.) Number of visits to waterways 43 „ boats inspected 25 „ boats not registered 1 „ boats conforming to the Acts 24 „ boats infringing the Acts — „ Certificates examined 24 „ persons for which boats were registered—adults 81 children — „ persons living on boats so registered—men 51 women and children — The boats inspected were found to be in a good condition, and there were no infringements of the Acts. The boat not registered under the Canal Boats Acts was a ship registered under the Merchant Shipping Acts. RIVER LEE. The following extracts from the Annual Reports of Dr. King Warry, late Medical Officer of Health, are interesting as they show what a continued nuisance the condition of the Lee has been to the Borough of Hackney since the reconstitution of the Lee Conservancy Board, which it was hoped would materially improve the condition of the river:— 1901.—Foul condition of River Lee reported. Medical Officer of Health reported reconstitution of Lee Conservancy Board. A table contrasting Lee Board of 1868 with that of 1900 is printed in the Report. The Report states "The new Board 117 does not come into office until April, 1901, so that it can hardly be expected that anything radical will be done to remedy the existing insanitary condition of the Liver Lee in Hackney during the year, but it would be advisable for the Hackney Borough Council to bring their case at an early date before the new Board." 1902.—A long report on foul condition. 1904.—The Medical Officer of Health reports: "The following analysis of samples of water indicate the kind and extent of pollution to which that river was exposed during the summer months of 1904. Nothing has been done since to reduce the pollution." 1905.—The Medical Officer of Health reports: "This river as it passes through the Borough remains in its usual filthy condition, causing a nuisance during the hot summer months of the year to persons frequenting the large open space adjoining it, as also to persons living in its vicinity." 1900.—"No improvement." 1907.—The Medical Officer of Health reports: "Polluted condition shows no sign of improvement." 1908.—The Medical Officer of Health reports no improvement in condition. 1909 and 1910.—No complaints; but this, as pointed out by the Medical Officer of Health, does not mean that the river was in good condition. 1911.—"River Lea became very offensive." Communication sent to the Local Government Board. River reported to Public Health Committee to be in foul condition. Certificate of analysis and letter to Local Government Board reported in Annual Report. 118 1912.—Although no complaints were made during the year—due to low atmosphere temperatures—there was no betterment of effluents received. The Medical Officer of Health states that "absence of complaints does not mean that any improvement has been effected in the condition of the water." 1913.—"No change" reported. The War period was evidently an unfavourable time to refer to even such pressing matters as the pollution of the Lee, but during 1921, before I had held the appointment of Medical Officer of Health many months, the foul condition of the river soon manifested itself so plainly as to evidently require the immediate attention of the Council. As an example I cannot do better than give some extracts from letters received during the summer which by no means exaggerate the condition of the river:— (a) 26th May, 1921. "I have to direct your attention to the filthy condition of the river due to the flow of sewage matter from the direction of Tottenham Lock. Early every morning the mass of pollution is accumulated between my boats and the Wharf edge, and seriously injured the varnish and spoils my work. In addition to this, the smell is obnoxious, and people will not patronise, seriously injuring my position as a ratepayer." (b) 24th May, 1921. "I have to report that the river is still in a filthy and disgusting condition in the section between the old sluice gates and Tottenham Lock. The filth on the surface here could be gathered with a spade and eventually floats into that portion of the river in the jurisdiction of Hackney." 119 (c) 28th May, 1921. "I note you were taking samples of the water above Spring Hill yesterday. The rains up country the previous day, wind, and the falling temperature had apparently cleared the river somewhat as it was not so bad as on Thursday. At the same time a great amount of pollution was trapped between Messrs. Radley's boats at the bottom of Spring Hill, and higher up the river gas bubbles and matter were rising to the surface, the latter boiling and seething until its 'viciousness' had spent itself. Between the sluice gates and Tottenham Lock the presence of bubbles on the surface presented identically the same appearance as if a shower of rain was in progress and was just as audible." Analyses of samples taken from time to time showed a high degree of sewage pollution to be present. Following representation by the Council to the Ministry of Health and to the Members of Parliament for the Borough, a Conference of representatives of the Authorities concerned was held at the Ministry of Health, and the matter was referred to the Engineering Advisors of the Ministry and the Authorities concerned to consider the most practicable means of dealing with the sewage of those Authorities that are at present discharging sewage into the Lee. 120 121 INSPECTIONS BY SANITARY INSPECTORS, 1921. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. Sadler, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. .Long, No. 8 District. Mr. Goldsworthy No. 9 District. Mr. Peverett, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler, Special. Mr. Nighy, Special. Mr. Galvin, Special. Mr. Harvey, Special. Mr. Punter, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Inspections. On Complaint— No. of premises inspected 173 225 267 286 409 343 488 393 194 318 253 260 235 402 20 65 59 77 124 ... 47 ... 4638 No. of premises in which defects were discovered 158 154 218 247 330 298 420 327 181 283 227 222 210 310 18 58 37 90 76 ... 42 ... 3906 Builder's Notices— No. of premises inspected 4 28 13 9 ... 3 17 15 24 13 ... 16 13 42 ... 15 ... 12 4 ... ... ... 228 House to Houses- No. of premises inspected ... ... 73 3 17 ... 15 9 4 17 18 3 147 22 502 920 200 5 ... ... ... ... 1955 No. of premises in which defects were discovered ... ... 56 3 14 ... 11 9 4 15 15 3 134 21 449 795 152 5 ... ... ... ... 1686 Infectious Disease— No. of premises inspected 132 204 121 238 341 220 224 189 107 95 122 171 239 281 14 32 20 70 34 ... ... ... 2854 No. of premises in which defects were discovered 46 77 38 104 167 93 69 87 53 30 35 92 130 133 4 17 8 40 8 ... ... ... 1231 No. of re-inspections. (All forms of inspection) 1182 1662 2415 2229 1377 2569 2389 2045 1829 2438 2756 1733 2862 2031 2556 1930 476 1554 716 ... 1084 1167 39000 No. of premises in which defects were discovered. (All forms of inspection.) 226 259 329 398 504 413 545 489 309 352 305 390 491 524 489 870 228 134 89 ... 352 468 8164 No. of premises in which defects were abated. (All forms of inspection.) 222 209 298 439 483 454 589 511 340 373 367 336 503 620 392 615 72 120 94 ... 347 408 7792 Total number of intimation notices served 109 270 329 409 482 406 536 489 303 422 308 368 517 613 471 892 228 119 89 ... 352 320 7923 Total number of Final Notices served 48 52 43 5 23 ... 43 10 87 6 23 33 ... 79 44 ... 3 7 27 ... 57 40 630 Total number of Statutory Notices served 10 81 100 98 72 97 83 144 10 167 69 70 208 128 96 142 24 13 8 ... 77 4 1701 Proceedings before Magistrate under Public Health (London) Act ... 7 15 5 13 5 4 6 9 11 5 5 5 4 4 1 ... 1 3 2 10 ... 115 Factories and WorkshopsNo. of inspections (other than laundries) ... ... ... 4 2 ... 7 2 7 17 ... 3 4 5 ... ... ... 10 ... ... 1403 ... 1464 122 123 INSPECTIONS BY SANITARY INSPECTORS, 1921. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. Sadler, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. Long, No. 8 District. Mr. Goldsworthy No. 9 District. Mr. Peverett, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler, Special. Mr. Nighy, Special. Mr. Galvin, Special. Mr. Harvey, Special. Mr. Punter, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Factories and Workshops continued. No. of Inspections (laundries) ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 ... 22 No. of inspections (other workplaces) ... ... 4 ... ... ... ... ... ... 7 ... ... ... ... ... ... ... 7 ... ... ... ... 18 No. of premises in which defects were discovered ... ... 5 4 ... ... 7 2 5 11 ... 3 2 5 ... ... ... 4 ... ... 352 ... 400 No. of premises in which defects were abated ... ... 5 4 ... ... 8 1 5 11 ... 1 2 ... ... ... ... ... ... ... 347 ... 384 Bakehouses— No. of inspections 8 22 14 16 55 13 19 18 4 51 8 4 2 26 ... ... ... 2 ... ... ... ... 262 No. of Notices ... 3 5 7 5 2 1 3 3 4 3 ... 2 ... ... ... ... 1 ... ... ... ... 39 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Food Adulteration— Samples collected for analysis 36 54 54 48 54 54 54 48 55 54 48 54 48 48 48 36 12 30 18 48 ... ... 901 Proceedings taken before Magistrate ... ... ... 2 2 1 ... 2 1 1 ... 7 ... 1 2 ... ... ... ... 6 ... ... 25 Houses Let in Lodgings— No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of Notices ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Insanitary Houses Closed— No. closed under Public Health (London) Act, 1891 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. closed under Housing of Working Classes Act, 1890 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Outworkers' Premises— No. of premises inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1181 1181 No. of premises in which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 468 468 No. of premises in which defects were abated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 408 408 124 125 INSPECTIONS BY SANITARY INSPECTORS, 1921. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. Sadler, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. Long, No. 8 District. Mr. Goldsworthy No. 9 District. Mr. Peverett, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler, Special. Mr. Nighy, Special. Mr. Galvin, Special. Mr. Harvey, Special. Mr. Punter, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Verminous Premises Cleansed- On notice from London County Council ... 2 2 ... 3 14 15 ... ... 45 ... ... 8 22 ... ... 3 ... ... ... ... ... 114 On complaint ... ... 31 13 ... ... ... 8 ... ... 7 12 ... ... ... ... ... ... ... ... ... ... 71 Underground Rooms— Illegal occupation dealt with ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of Rooms closed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Places where Food Prepared for Sale (Restaurants, Coffee Shops), etc. No. of inspections 5 6 4 3 5 2 8 12 ... 24 19 8 1 ... ... ... ... ... ... 49 ... ... 146 No. of Notices 4 2 ... 3 2 ... ... 8 ... 17 8 1 ... ... ... ... ... ... ... ... ... ... 45 Ice Cream Premises- No. of inspections 15 8 15 10 14 3 19 24 ... 13 4 13 6 13 ... ... ... ... ... ... ... ... 157 No. of Notices 3 ... ... 2 1 1 2 10 ... 4 ... 1 ... 2 ... ... ... ... ... ... ... ... 26 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tenement Houses— No. provided with additional water supply ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 Overcrowding— No. of houses overcrowded ... ... 4 2 ... ... 4 ... 2 ... ... 2 ... ... 4 ... ... ... ... ... ... ... 18 No. remedied ... ... 3 ... ... ... 4 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 8 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dairies, Cowsheds and Milkshops Order— No. of cowsheds inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 ... ... 122 No. of dairies inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1587 ... ... 1587 No. of dirty utensils discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 ... ... 8 126 127 INSPECTIONS BY SANITARY INSPECTORS, 1921. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. Sadler, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. Long, No. 8 District. Mr. Goldsworthy No. 9 District. Mr. Peverett, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No 13 District. Mr. Hall, No. 14 District. Mr. Fowler, Special. Mr. Nighy, Special. Mr. Galvin, Special. Mr. Harvey, Special. Mr. Punter, Special. Mr. Bobbitt, Special Miss Teebay, Special. Miss Portlock, Special. TOTAL. No. of premises where in fringements of By-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... ... 6 No. of new registrations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 ... ... 38 Slaughter-houses. No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 294 ... ... 294 No. of premises where infringements of by-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Miscellaneous Inspections- Mews and stables ... ... 13 ... ... ... ... ... 3 6 1 ... ... ... ... ... ... ... ... ... ... ... 23 Urinals 6 10 23 3 33 21 15 27 20 21 5 13 3 34 ... ... ... ... 9 ... ... ... 243 Canal boats ... ... ... ... ... ... ... ... ... ... ... 25 ... ... ... ... ... ... ... ... ... ... 25 Visits to waterways ... ... ... ... ... ... ... ... ... ... ... 43 ... ... ... ... ... ... ... ... ... ... 43 Animals improperly kept ... ... 4 ... ... ... 3 ... ... 4 2 4 6 1 7 ... 2 ... ... ... ... ... 33 Offensive trades ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... New buildings (water certicates) 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Floodings ... ... ... ... ... ... ... ... ... ... ... 6 ... 15 ... ... ... ... ... ... ... ... 21 Special inspections ... 153 335 69 94 22 72 259 41 138 29 141 28 101 35 ... 19 ... 1 500 ... 398 2435 Drains relaid or repaired 6 24 42 17 19 20 23 64 15 26 26 31 10 45 74 ... 1 ... ... ... ... ... 443 Attendances at Police Court 5 37 15 9 23 17 23 18 12 16 12 16 6 5 19 ... ... ... 8 ... 19 ... 260 Condemned as Unfit for Human Food— c qr lbs c. qr. lb. Fish ... ... ... ... ... ... ... ... ... 1 cwt ... ... ... cwt. ... 406lbs ... ... ... 8 1 14 ... ... 13 2 0 Fruit and Vegetables ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 19 ... ... 4 3 19 Meat (specially state number of carcases or parts of demned for tuberculosis) t c qr lbs t c qr lbs ... ... ... ... ... ... ... ... ... 3 lbs. ... ... ... ... ... 74lbs. ... ... 14 18 0 23 ... ... 14 18 3 16 128 129 INSPECTIONS BY SANITARY INSPECTORS, 1921. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. Sadler, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. Long, No. 8 District. Mr. Goldsworthy No. 9 District. Mr. Peverett, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler, Special. Mr. Nighy, Special. Mr. Galvin, Special. Mr. Harvey, Special. Mr. Punter, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Tinned foods ... ... ... ... ... ... ... ... tins cwts. ... ... ... ... ... ... ... ... ... ... ... c qr lbs 23 154 16 3 21 185 Rabbits Other articles ... ... ... ... ... ... ... ... Rabbits ... ... ... ... ... Rabbit ... ... ... t c qr 1bs t c qr lbs 152 12 21 1 7 1 8 1 7 1 8 Smoke Nuisances— No. of observations ... ... 11 ... ... ... 18 ... 12 3 ... 25 ... 8 ... ... ... ... ... ... ... ... 77 No. of Intimation Notices served ... ... 4 ... ... ... 4 ... 2 3 ... 4 ... 4 ... ... ... ... ... ... ... ... 21 No. of Statutory Notices served ... ... 1 ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... 4 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... General Information— Bakehouses— No. on Register at end of 1920 8 10 9 7 10 6 8 8 7 13 7 2 ... 12 ... ... ... ... ... ... ... ... 107 Do. do. 1921 8 10 5 8 11 6 8 8 7 13 7 2 2 12 ... ... ... ... ... ... ... ... 107 No. above ground 7 6 1 3 6 2 4 1 5 11 7 ... 1 2 ... ... ... ... ... ... ... ... 56 No. underground 1 4 4 5 5 4 4 7 2 2 ... 2 1 10 ... ... ... ... ... ... ... ... 51 Houses Let in Lodgings— No. on Register at end 1920 ... ... ... ... ... ... 243 ... ... ... 227 ... ... ... ... ... ... ... ... ... ... ... 470 Do. do. 1921 ... ... ... ... ... ... 237 ... ... ... 226 ... ... ... ... ... ... ... ... ... ... ... 463 Ice Cream Premises— No. on Register at end 1920 21 15 16 4 12 4 13 18 9 9 4 14 ... 21 ... ... ... ... ... ... ... ... 160 do. do. 1921 15 8 15 11 10 5 15 18 5 13 4 13 6 15 ... ... ... ... ... ... ... ... 153 Places where Food Prepared for Sale— No. on Register at end 1920 3 4 14 16 12 3 10 4 7 6 5 5 ... ... ... ... ... ... ... ... ... ... 89 Do. do. 1921 5 6 4 11 14 3 8 6 6 20 14 7 1 18 ... ... ... ... ... ... ... ... ... 130 TABLE OF DEATHS. Of Inhabitants of the Hackney District between 1st Jan. and 31st Dec., 1921. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Small pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... Not „ ... ... ... ... ... ... ... ... ... ... ... ... ... Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... Cowpox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles (Morbilli) 1 2 ... 1 ... ... ... ... ... ... ... ... 4 Epidemic Rose Rash, German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 4 5 5 ... ... ... ... ... ... ... ... 14 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... 3 1 3 2 4 8 6 5 ... 32 Whooping Cough 7 6 2 1 ... ... ... ... ... ... ... ... 16 Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup 3 7 17 17 1 1 ... ... ... ... ... ... 46 Cerebro Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... 1 ... ... 1 ... ... ... ... 2 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... 2 ... ... ... 1 ... ... ... ... 3 Epidemic Diarrhœa, Epidemic (or Zym.) Enteritis 65 7 1 ... ... ... ... ... ... 2 ... ... 75 131 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Diarrhœa, Choleraic Diarrhœa ... ... ... ... ... ... ... ... ... ... 2 ... 2 Dysentry ... ... ... ... ... ... 1 ... ... 1 ... ... 2 Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Farcy ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... 1 ... ... ... ... ... ... ... ... ... 1 Syphilis 2 ... ... 1 ... 1 ... 1 1 ... ... ... 6 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... 1 ... ... 1 Puerperal Septicæmia Sapræmia ... ... ... ... ... 3 1 ... ... ... ... ... 4 Puerperal Pyæmia ... ... ... ... 1 ... ... ... ... ... ... ... 1 Puerperal Phlegmasia Dolens ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Infective Endocarditis ... ... ... 1 ... 2 ... ... ... ... ... ... 3 Epidemic Pneumonia, Pneumonic Fever ... ... ... ... ... ... 1 ... ... ... ... ... 1 Erysipelas ... ... ... ... ... 1 ... 1 2 2 ... ... 6 Septicæmia (not Puerperal) ... ... ... ... 1 ... 1 ... ... ... ... ... 2 Pyæmia (not Puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... ... ... 1 ... ... 1 Phagedæna ... ... ... ... 1 ... 1 1 1 ... ... ... 4 Other Septic Diseases ... ... ... 1 ... 1 ... ... ... ... ... ... 2 132 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Tuberculous Phthisis (Pulm. Tuberculosis). ... ... 2 14 35 50 37 28 27 6 ... ... 199 "Phthisis" ... ... ... ... 2 4 3 3 2 ... ... ... 14 Tuberculous Meningitis 1 6 4 6 1 1 ... ... ... ... ... ... 19 Tuberculous Peritonitis ... 1 ... 3 3 ... 2 1 ... ... ... ... 10 Tabes Mesenterica 1 ... 1 ... ... ... ... ... ... ... ... ... 2 Lupus ... ... ... ... ... ... ... ... ... 1 1 ... 2 Tubercle of other Organs 1 2 ... 2 3 1 1 1 1 1 ... ... 13 General Tuberculosis ... 2 1 ... 1 1 ... ... ... ... ... ... 5 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... ... ... ... 1 ... ... ... ... 1 Opium, Morphia Habit ... ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning by Lead ... ... ... ... ... ... ... ... ... ... ... ... ... by Phosphorus ... ... ... ... ... ... ... ... ... ... ... ... ... by Arsenic and other Metals ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... ... 2 1 2 ... ... ... ... ... ... 5 Rheumatism of Heart ... ... ... ... ... ... 1 ... ... ... ... ... 1 Chronic Rheumatism ... ... ... ... ... 2 ... 1 ... 1 2 ... 6 133 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... 1 ... ... 4 2 4 ... 11 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... Carcinoma ... ... ... ... ... 4 11 42 67 52 25 1 202 Sarcoma 1 ... ... ... 1 1 1 3 5 ... 1 1 14 Malignant Diseases, Cancer ... ... ... ... ... 1 9 8 20 22 12 1 73 Rickets 1 1 ... ... ... ... ... ... ... ... ... ... 2 Purpura ... ... 1 ... ... ... 1 ... ... ... ... ... 2 Hæmophilia, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... Anæmia, Leucocythæmia ... ... ... ... 1 ... ... 3 2 2 ... ... 8 Diabetes Mellitus ... ... ... ... 1 ... 4 2 6 3 3 ... 19 Premature Birth 55 ... ... ... 1 ... ... ... ... ... ... ... 56 Congenital Defects 39 ... 1 ... 1 ... ... ... ... ... ... ... 41 Injury at Birth 3 ... ... ... ... ... ... ... ... ... ... ... 3 Atelectasis 9 ... ... ... ... ... ... ... ... ... ... ... 9 Want of Breast Milk 1 ... ... ... ... ... ... ... ... ... ... ... 1 Teething 2 ... ... ... ... ... ... ... ... ... ... ... 2 Suffocation-Overlaying 3 ... ... ... ... ... ... ... ... ... ... ... 3 Diseases of Nervous System. Meningitis, Inflammation of Brain 5 3 2 ... ... ... 1 1 1 ... ... ... 13 Softening of Brain ... ... ... ... ... ... ... 1 ... 2 1 ... 4 General Paralysis of Insane ... ... ... ... ... ... 3 6 ... 1 ... ... 10 134 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Insanity (not Puerperal) ... ... ... ... ... 1 ... ... ... ... ... ... 1 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... ... 1 1 1 2 3 1 1 1 ... 11 Convulsions 7 1 ... ... ... ... ... ... ... ... ... ... 8 Laryngismus Stridulus 1 ... ... ... ... ... ... ... ... ... ... ... 1 Locomotor Ataxy ... ... ... ... ... ... ... ... 3 ... ... ... 3 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... Paraplegia and Disease of Cord ... ... ... ... ... ... 2 3 ... 1 ... ... 6 Neuritis, Periph, PolyNeuritis ... ... ... 1 ... ... ... ... ... ... ... ... 1 Brain Tumour (not specific) ... ... ... 1 ... ... 2 1 3 1 ... ... 8 Nervous System, other Diseases 1 1 1 ... ... 1 3 ... 3 6 2 1 19 Diseases of Organs of Sense. Otitis, Mastoid Dis. ... ... ... 6 1 2 ... 1 ... ... ... ... 10 Epistaxis, Nose Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... Accidents 3 1 2 2 3 5 ... 9 7 6 4 3 45 Violence Suicide ... ... ... 1 1 2 4 7 4 6 ... ... 25 Drowned 1 ... ... ... 4 1 ... 1 3 ... ... ... 10 Murder 1 ... ... 1 1 ... 1 ... ... ... ... ... 4 Diseases of Heart. Valve Dis., Endocarditis ... ... ... 4 8 12 14 17 38 55 27 9 184 Pericarditis ... ... ... 1 1 ... ... 1 ... ... ... ... 3 135 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Hypertrophy of Heart ... ... ... ... ... ... ... ... ... ... ... ... ... Angina Pectoris ... ... ... ... ... ... 1 ... 1 ... 1 ... 3 Dilatation of Heart ... ... ... ... ... ... ... ... ... 1 1 ... 2 Fatty Degeneration of Heart ... ... ... ... ... ... 1 2 2 3 7 1 16 Syncope Heart Dis. (not specified) 2 ... ... 1 ... 5 3 5 18 15 21 4 74 Diseases of Blood Vessels. Cerebral Hæmorrhage Emb., Throm. 1 ... ... ... ... ... 2 16 32 35 45 8 139 Apoplexy, Hemiplegia ... ... ... ... ... ... 2 2 1 6 2 1 14 Aneurism ... ... ... ... ... ... ... 1 2 3 1 ... 7 Senile Gangrene ... ... ... ... ... ... ... ... 1 2 1 1 5 Embolism, Thrombosis (not Cerebral) ... ... ... ... ... 1 1 ... ... ... ... ... 2 Phlebitis ... ... ... ... ... ... ... ... ... 1 ... ... 1 Varicose Veins ... ... ... ... ... ... ... ... ... ... ... ... ... Blood Vessels, other diseases ... ... ... ... ... 1 ... 3 ... ... 3 1 8 Arterio Sclerosis ... ... ... ... ... ... 1 1 10 19 45 21 97 Diseases of Respiratory Organs. Laryngitis ... ... 1 ... ... 1 ... ... ... ... ... ... 2 Membranous Laryngitis (not Diptheritic) ... ... ... ... ... ... ... ... ... ... ... ... ... Croup (not Spasmod. or Membr.) ... ... ... ... ... ... ... ... ... ... ... ... ... Larynx, other Dis. (not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... 136 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Bronchitis 7 1 ... ... ... 1 4 16 29 64 44 7 173 Lobar (Croupous) Pneumonia 1 2 ... ... 1 8 7 11 11 12 1 1 55 Broncho, Catarrhal, Lobular Pneumonia 37 18 9 4 3 2 4 9 8 11 8 2 115 Pneumonia 5 6 2 1 4 3 2 10 10 12 6 3 64 Emphysema, Asthma ... ... ... ... ... 1 5 4 10 8 6 ... 34 Pleurisy ... ... ... 1 1 1 1 1 3 4 ... ... 12 Fibroid Dis. of Lung ... ... ... ... ... ... ... ... 1 ... ... ... 1 Respiratory Dis., other ... ... 1 ... ... 2 2 ... ... 2 ... ... 7 Diseases of Digestive System. Tonsilitis, Quinsey ... ... 2 1 ... ... 1 1 ... ... ... ... 5 Mouth, Pharynx, Dis. (not specific) ... ... 1 ... ... ... ... ... ... ... ... ... 1 Gastric Ulcer ... ... ... ... 1 1 ... 2 4 3 1 ... 12 Gastric Catarrh or Gastritis 3 ... ... ... ... ... ... ... ... 1 3 ... 7 Stomach, other Dis. (not Malig.) 1 ... ... ... ... ... 2 1 ... 1 3 ... 8 Enteritis (not Epidemic) ... ... ... ... ... ... ... ... 1 ... 1 ... 2 Gastro-Enteritis ... ... ... ... ... ... 1 ... ... 1 ... ... 2 Appendicitis, Perityphilitis ... 1 ... 5 7 5 1 1 1 2 ... ... 23 Hernia ... ... ... ... 1 ... ... ... ... 4 3 1 9 Intestinal Obstruction ... ... ... 1 1 1 2 2 4 3 2 ... 16 Other Dis. of Intestines 22 5 ... ... 1 1 ... ... 2 1 1 ... 33 Peritonitis (not puerperal) ... ... ... 1 ... 1 ... 1 ... 1 ... ... 4 137 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Cirrhosis of Liver ... ... ... ... ... 1 ... 4 1 2 ... ... 8 Liver and Gall Bladder, other Diseases ... 1 ... ... ... ... 1 ... 2 3 1 ... 8 Digest. Syst., other Diseases ... ... ... 1 ... ... ... ... ... 2 ... 1 4 Lymph Diseases. Spleen Disease ... ... ... ... ... ... ... ... ... ... ... ... ... Lymph System, other Diseases ... ... ... ... 1 1 ... ... 2 ... ... ... 4 Thyroid Body Disease ... ... ... ... ... ... ... ... ... ... ... ... ... Supra Renal Capsules Disease ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Urin. Syst. Nephritis, Acute ... ... 1 ... 2 2 4 18 17 16 7 5 72 Chronic Bright's Dis. Albuminura ... ... ... ... ... ... 2 ... 2 4 ... ... 8 Calculus (not Biliary) ... ... ... ... ... ... ... ... ... ... ... ... ... Bladder and Prostate Disease ... ... ... ... ... ... ... 1 1 3 7 1 13 Urin. Syst., other Dis. ... ... ... ... ... 3 1 1 ... ... ... ... 5 Diseases of Gener. Syst. Ovarian Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Ovary ... ... ... ... ... 2 1 ... 1 ... ... ... 4 Uterinal Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Uterus and Vagina ... ... ... ... ... ... 3 2 ... ... 1 1 7 138 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Disorders of Menstruation ... ... ... ... ... ... ... ... ... ... ... ... ... Gener. and Mam, Orgs., other Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... Accidents Childbirth. Abortion, Miscarriage ... ... ... ... ... 1 1 ... ... ... ... ... 2 Puerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... ... 1 ... ... ... ... ... 1 Other Accid. of Preg. and Childbirth ... ... ... ... 1 5 3 ... ... ... ... ... 9 Joint Diseases. Caries, Necrosis ... ... ... ... ... ... ... ... ... ... ... ... ... Arthritis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Locom. Syst. ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Diseases. Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... 1 ... ... ... ... ... ... ... ... ... Skin Disease, other ... ... ... ... ... ... ... ... ... ... ... ... ... Ill.Defined Causes. Atrophy Debility, Marasmus 35 2 ... ... ... ... ... ... ... ... ... ... 37 Old Age ... ... ... ... ... ... ... ... ... 21 69 36 126 Dropsy, Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause unascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Causes 1 ... ... ... ... ... ... ... ... ... ... ... 1 Causes not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 329 80 58 94 101 155 169 268 386 448 381 111 2580 139 APPENDICES. HOUSING CONDITIONS. Statistics—Year ended 31st December, 1921. 1.—GENERAL. (1) Estimated population 224,200 (2) General death-rate 11.5 (3) Death-rate from Tuberculosis 1.17 (4) Infantile mortality 64 (5) Number of dwelling-houses of all classes 34,710 (6) Number of working-class dwelling- houses—Rateable value of £20 or under, approximately 13,000 (7) Number of new working-class houses erected and occupied (portion of scheme for the erection of 80 houses). 40 2.—UNFIT DWELLING-HOUSES. 1.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9,234 (2) Number of dwelling-houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 1,622 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 140 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 70 2.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers ... No record. 3.—Action under Statutory Powers. A.—Proceedings under section 28 of the Housing, Town Planning, etc., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit— (a) by owners — (b) by Local Authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 7,923 141 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 7,792 (b) by Local Authority in default of owners — C.— Proceedings under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling - houses having been rendered fit (Closing Orders made in 1918) 17 (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 3.—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890:- 142 (1) Name of Area (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced Nil 4.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under section 25 of the Housing, Town Planning, etc., Act, 1919 Nil. 5.—Staff engaged on housing work with, briefly, the duties of each officer Nil. (No officers are exclusively engaged on housing work.)