HAC 73 Metropolitan Borough of Hackney REPORT ON THE Sanitary Condition of the metropolitan borough of hackney FOR THE YEAR 1923, by G. H. DART, M.D., M.R.C.P., Edin.; D.P.H., D.T.M. & H., Camb., Barrister-at-Law. Medical Officer of Health. Administrative Maternity and Child Welfare officer Executive Tuberculosis Officer London: Buck Bros. & Harding, Ltd., 6-7, West Avenue, E.17 1924. inde: Page I. General Statistics 17 11. Extracts from Vital Statistics of year 17 III. Notifiable Diseases during the year 32 IV. Causes of Sickness 71 V. Summary of Nursing Arrangements, Hospitals, etc. 71 VI. Laboratory Work 98 VII. Sanitary Administration 100 VIII. Housing 146 Canal Boats Acts, Report of Inspector 125 Cancer 43 Cleansing of Persons Act, 1907 68 Constitutional Diseases 43 Cowhouses, Dairies and Milkshops 123 Disinfection 65 Food— Articles Surrendered to District Inspectors 104 Articles Purchased for Analysis 121 Prosecutions under Sale of Food and Drugs Acts 122 Registration of Purveyors of Milk 123 Report of Food Inspector 123 Report on Tuberculous Milk Roundsman 115 Housing— Public Health (London) Act, 1891 102 Housing Acts Housing Conditions in the Borough 106 Legal Proceedings 104 Rent and Mortgage Interest (Restriction) Act, 1920-23 101 Verminous Premises 101 Wor-k of Sanitary Inspectors (Table of Inspections) 126 Industrial Statistics— Factory and Workshop Act, 1901 106 Factories, Nuisances found 110 Factories, General Table of Inspections and Defects found 109 Workshops Inspected 109 Workshops, Analysis of Occupations 108 Home Workers 112 Outworkers 113 List of Industries 107 Infectious Diseases— Cerebro Spinal Meningitis 41 Cholera 40 Continued Fever 40 Diarrhoea 43 Diphtheria 37 Diphtheria Anti-toxin 38, 98 Dysentery 42 Encephalitis Lethargica 41 Enteric Fever 39 Erysipelas 40 Influenza 42 Malaria 42 Measles and German Measles 42 Ophthalmia Neonatorum 41 Index Infectious Diseases (continued). Plague 40 Pneumonia 41 Polio-Myelitis 41 Puerperal Fever 40 Scarlet Fever 37 Small-pox 32 Typhus Fever 40 Vaccination 36 Whooping Cough 43 Maternity and Child Welfare— Contributions to Maternity Hospitals 96 Convalescent Aid 96 Health Visiting 92 Infant Consultation and Ante-natal Clinics 95 Provision of Milk and Foods 97 Mortuary 27 Rats and Mice Destruction Act, 1919 102 River Lee 14 Sanitary Inspection—Table of Inspections 126 Shelter 68 Slaughterhouses 123 Tuberculosis— Advanced Cases 63 After Care 64 Discharged Soldiers and Sailors 55 Dispensary Districts: Population 56 Extra Nourishment 63 Health Visitors—Visits of 55 Milk Roundsman—Report on 115 Notifications and Deaths 51 Open-air School 64 Public Health (Tuberculosis) Regulations, 1912 53 Summary of Notifications 54 Summary of Deaths, Number and Classification 57 Reports of Medical Officers 59, 61 Vital Statistics— Acreage of Borough 17 Births and Birth Rates 17, 18 Deaths and Death Rates 21 Deaths in Public Institutions 24 Density of Population 17 Infantile Mortality 23 Institutions outside the Borough receiving Sick from the Borough 25 Illegitimate Birth Rate 20 Marriage Rate 18 Notification of Births 19 Population 17 Registration of Births 18 Senile Mortality 23 Still Births 19 Tables of Causes of Deaths 138 Table (Comparative) of Rates for years 1914-243 29 „ „ „ year 1923—London Boroughs 16 5 PUBLIC HEALTH DEPARTMENT Public Health and Maternity and Child Welfare Committees. Public Health Committee. Ex-officio—Councillor William Hammer, j.p. (Mayor). Chairman—Councillor G. J. Lusher-Pentney. Vice-Chairman—Councillor H. Layland. j Councillor Benwell, Mrs. L. C., J.p. Councillor Layland, H. Chapman, T., j.p., l.c.i Dorley-Brown, G. W Dunsford, A. E. Alderman Elliott, E. Councillor Evans, W. Green, G. Jones, W. Keil, A. Loweth, W. E. Lusher-Pentney, G. J. Palmer, J. M. Payne, A. W. Rushbrooke, T., j.p., m.a., m.r.c.s., l.r.c.p. Ridley, W. A. Smith, A. E. Tozer, O. W. 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. L. C. Benwell, j.p. Vice-Chairman—Councillor T. Rushbrooke, j.p., m.a. Members of the Committee—as set out above with the addition of Mrs. F. M Ashdown, Mrs. J. M. Palmer, and Miss B. W. Payne. 6 STAFF OF PUBLIC HEALTH DEPARTMENT. R. H. Ellis. R. H. Bew. W. C. Vobk. A. Sadler. H. Body. G. F. High. R. J. Sheppard. C. F. Long. W. Goldsworthy W. Peverett. Sanitary Inspectors. E. A. Hillier. E. S. Crook, also Canal Boat Inspector. J. E. Truslove. J. W. Hall. G. Fowler. A. J. Bobbitt (for Cowhouses, Milk shops. Slaughterhouses, etc.) J. Nighy, House to House Inspection. W. E. Galvin, Alice Teebay (for Workshops, Laundries. &c.). Mabel Portlock (for Outworkers' Premises) Health Visitors. Mrs. A. Rhodes. Mrs. L. Harrison. Miss M. Chitson. Mrs. L. E. Bartholomew. Miss D. F. Vidal. Miss G. M. Servante Miss M. Clarke Miss A. K. Roche. Miss M. K. Cockle. Miss S. E. Love. Miss E. D. Mann. for Tuberculosis cases. Medical Officers (Temporary Staff) Municipal Infant Welfare Centres. Elizabeth Wilks, m.d. Reginald Brown, m.r.c.s., l.r.c, Dorothy B. Gere, m.r.c.s., l.r.cj Eva Morton, 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. Disinfecting Station and Shelter Caretakers. E. G. Hasler. Mrs. E. Hasler. Mortuary Keeper—S. W. Boxell. Messenger—H. Storey. Clerical Staff. A. Higgins. P. A. Hitch. V. Welham. I.. W. Harvey. H. C. Bowman. E Whittaker. H. R. Sandford. D. Sorrell. Medical Officer of Health. G. H. Dart, m.d.. m.r.c.p., Edin., d.p.h,, d.ta.m & h. Camb. Barrister-at-Laiv. Metropolitan Borough df Hackney. 7 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1923. 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 1923. A comparative table for the Borough showing the Death, Birth and Infantile Mortality Rates for the past ten years is set out on page 29. The birth-rate is 19 6 per 1,000 for Hackney, compared with 20.2 for the whole of the County of London. The death-rate for Hackney for the past year is 10'6, an improvement on the previous year's rate of 12.7, the rate for the County is also decreased, being 11.12 as compared with 13*4 for the previous year. The death-rate of 10'6 and infantile mortality of 58 are the lowest ever recorded in Hackney. The infantile mortality of the Borough, measured by the number of deaths under 1 year of age per 1,000 births registered, was 58, as compared with 72, the figure for last year; the Borough average during the last 5 years 1918-1922 is 83, 8 and the figure for all London during the past year is 60, as compared with 74 in 1922. The zymotic death-rate is .34 as compared with 63, the figure for 1922. The number of Scarlet Fever cases notified during 1923 was 457, as compared with 674 in 1922, and the number ol Diphtheria cases notified in 1923 was 528, as compared with 732 during 1922. The deaths from Scarlet Fever numbered only 5; 5 less than the previous year, and the deaths from Diphtheria 29, being 7 more than those registered in 1922. One case of Small Pox was notified in Hackney during the year, full details of the case will be found on page 32. Prompt vaccination of the contacts prevented the spread of the disease. Removal to hospital of infected persons and disinfection will not by themselves prevent the spread of this extremely infectious disease; successful vaccination of contacts is the only efficient safeguard, and whatever views may be held about the compulsory vaccination of infants, surely it cannot be denied, apart from the question of protection of the public, that vaccination is preferable to even the mildest attack of Small Pox. In addition to the contacts of the case of Small Pox that occurred in Hackney, it was necessary during the year to keep under observation twelve contacts to cases notified in other Boroughs. As always occurs during periods of anxiety due to Small Poj, a considerable number of illnesses presenting skin eruptions, such as measles, food poisoning, sunburn and other skin complaints were wrongly suspected of being Small Pox, the majority of the suspect cases, however, being severe cases of Chicken Pox. The rate from Cancer is the highest ever recorded in the Borough. 9 The history of deaths from Cancer of the breast were investigated bv Mirs. Harrison, and particulars will be found on page 45. In order to forestall a request from the financial experts at Whitehall for information as to the amount of time spent in this investigation so that the grant allocated to Maternity and Child Welfare work should be proportionately decreased, I hasten to state that this work as well as Mrs. Harrison's work for the Mayor's Distress Fund was carried out in her own time and after office hours. I have not the staff to carry out routine enquiries of this description, or in fact, to make proper use of the clinical material accumulating at the Centres. On the envelope enclosing the monthly review of Vital Statistics, issued by the New York State Health Department, is printed this statement: "Public Health is purchasable. Within natural limitations any community can determine its own Death Rate." Investigators into the probable causes of Cancer are attaching increasing importance to the question of food as a possible agent in the causation of this disease. On <page 115 will be found a note as to the conditions under which food is prepared for sale to the public, and it may well be that action taken in the direction of improving the cleanliness of methods of preparation might be productive of much good to the health of the public and even be helpful as regards the prevention of Cancer. It should also be possible to sample the principal articles of food under official standards which would make it possible to secure convictions for adulteration and for adding preservatives. Maternity and Child Welfare. The Ministry of Health has been requested to consider proposals for extending the Maternity and Child Welfare \york of the 10 Borough, the Maternity and Child Welfare Committee being of opinion that the scheme is inadequate as regards : (1) Healfh Visiting, (2) Treatment of Minor Ailments, (3) Treatment of Non-notifiable Infectious Disease, (4) Clerical assistance, (5) Nursing assistance, (6) Provision of Ante-Natal and Child Welfare Centres. Particulars of the additional measures suggested for improving the service will be found on pages 78 to 91. The additional expenditure would not cause the total cost of the Maternity and Child Welfare service to amount to a penny rate. Following a visit of inspection by a Medical Officer from the Ministry of Health, the Council were requested by the Ministry, in view of the fact that the staff of Health Visitors is barely sufficient for the duties at present carried out, to provide temporary assistance during the absence of any Health Visitor on holiday or sick leave, and the adoption of this measure has been of the utmost help to the work. The Maternity and Child Welfare Committee have been fo. cunate in obtaining, when required, the temporary services of Miss K. Teebay, formerly a valued member of the permanent staff of Health Visitors; and Mrs. Berks, who before marriage was also on the Health Visiting staff, continued to give valuable voluntary assistance at the Centres until she removed to another Borough. The Ministry of Health approved an additional grant by the Council of £50, to Hackney Grove Voluntary Welfare Centre, as from April 1st, 1923. The Ministry of Health has been recently approached, as reported in the general press, in order that permission should be 11 granted lor instruction in Birth Control measures to be given at Welfare Centres, and the Ministry has ruled that legislation would be necessary before the Welfare Centres can be used for this purpose. The Ministry of Health is quite unable to prevent any medical practitioner from giving information under any circumstances where that information is necessary for the prevention of disease, but those who advocate that Birth Control instruction should be given at the Centres wish this to be done as a routine measure, the end in view being the limitation of population not Dnly as regards the feeble-minded and degenerate—who do not attend Welfare Centres—'but of the nation generally. The decision of the Ministry of Health that the Centres cannot be used for this purpose is most welcome, because it is desirable that instruction in Birth Control, if it can be shown that jropaganila directed towards limiting the population of the country s necessary or desirable, should be carried out separately from the Maternity and Child Welfare Scheme. It would be most unfortunate to hinder in any way the work of the Welfare Centres in their purpose of preventing disease and death. Tuberculosis. The Tuberculosis Death-rate shows a slight increase, the mortality being 1T3 per 1,000 of the population, as compared with 105 for 192®, the number of deaths being increased by 18 in 1923, and there were 72 more primary notifications as compared with 1922. One of the outstanding features of the tuberculosis service . is the extremely unsatisfactory conditions under which the treatment of advanced cases is carried out. These cases are permitted to remain at home to infect other members of the family, there Wng- no adequate provision for the institutional treatment of advanced pulmonary tuberculosis and no means by which young 12 children exposed to almost certain infection can be removed to safe surroundings. During the past year 122 or 56 per cent, of the persons who died from pulmonary tuberculosis were unable to secure a separate bedroom during the course of the treatment at home, although some of this number actually died in an institution, the total number of deaths occurring at home during the year being 116,# 53"7 per cent, of the total number, 216. In 69 ot the cases ivlo did not have even a bed to themselves, tubercle bacilli wen known to be present in the sputum. During 1922 the number of deaths at home was 74, or 36.6 per cent, of the total number, 202, so that this year's figures are considerably worse than the previous year. Under these circumstances there is little to wonder at in the fact that this disease is still so prevalent. There were 128 deaths among dispensary patients, and 64 d these patients, or 50 per cent., were in the final stage of the disease on first attendance; 46 patients, or 36 per cent., were in the second stage. It also appears from an examination of the case papers that 74 of these cases, or 57 per cent., had been suffering from this disease for a period varying between three to twelve months before being referred to the dispensary. The Council requested the Ministry of Health to take the necessary steps for authorising the Council to appoint a Tliberalosis Committee, formed upon the same lines as the (Maternity and Child Welfare Committee, of Members of the Public Health Committee and co-opted persons representative of social welfare institutions, in order to co-ordinate all anti-tuberculosis measures now in use, and to have delegated to them all matters in relation to Tuberculosis generally, but the Ministry did not accede to this request. 13 The Ministry of Health has been informed that the Council considers it desirable that local authorities administering- the Tuberculosis Regulations should be able to prevent tuberculous persons from being directly concerned in the distribution of milk, seepage 115. A decision on this matter has not yet been reached by the Ministry. Sanitary Inspection. The work of Sanitary Inspection has been carefully and conscientiously carried out throughout the year, a fact of the utmost importance in view of the crying need for additional housing accommodation for the Borough. The Ministry of Health in the "Manual on Unfit Houses," has stated that:— A fit house should be:— (1) free from serious dampness ; (2) satisfactorily lighted and ventilated ; (3) properly drained and provided with adequate sanitary conveniences, and with a sink and suitable arrangements for disposing of slop water; (4) in good general repair, and should have:— (5) a satisfactory water supply; (6) adequate washing accommodation ; (7) adequate facilities for preparing and cooking food, and (8) a well ventilated store for food. If the Public Health (London) Act, 1891, could be amended so that the conditions described in the Manual as being necessary could be enforced under the Nuisances sections of this Act, a great step forward would be made. Section 28 of the Housing and Town Planning etc., Act, 1919, as amended by Section 10 of the Housing, etc., Act, 1923, does not give the local authorities power to improve housing to any appreciable extent unless they are prepared to meet the cost out of the rates. U It should be possible to induce owners of housing propertv to attend to such matters as the provision of "adequate facilities for preparing and cooking food," and the Housing and Tow Planning Act places the necessity of doing the work upon tie sanitary authority, while giving the owners opportunity in various directions to place the cost upon the local authority. In fact, it has been found a safer proceeding in this Borough, where it has been desired to carry out work by the Council, to obtain a Magistrate's Order under the Public Health (London) Act, 1891, and to work entirely under that Act. The Public Health (London) Act, 1891, however, does not go far enough, and certainly many of the conditions laid down as desirable in the Manual cannot be enforced under that Act. Although the work carried out by the Sanitary Inspectors is of the utmost value in maintaining housing property in a comparatively decent condition, and in checking the formation of slum areas, it is not possible to prevent overcrowding, so that the situation is becoming steadily more difficult in this respect. The extent to which the careful work of the sanitary inspectors and staff of the department has neutralised the ill-effects of overcrowding is not realised. The entire cost of the Public Health service in the Borough, including all staff and the maintenance of the Tuberculosis Dispensaries, the Welfare Centres, the Disinfecting Station, Isolatioo Shelters and Mortuary, and all forms of assistance under the Tuberculosis and Maternity and Child Welfare Schemes is estimated during the coming financial year to amount to a rate of 3*78 pence. The River Lee has remained in the usual offensive condition during the summer months, and frequent protests from the Council resulted in a visit of inspection on July 5th, 1923, by a Chemical Specialist and a Medical Officer of the Ministry of Health. 15 During the visit of inspection the River in the Hackney district was covered with sewage over large areas of its surface, and was, in fact, in a most disgraceful state. 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. 16 COMPARATIVE TABLE, YEAR 1923. Name of Borough. Population. Birth Rate. Zymotic Death Rate. Death Rate all causes. Infant Mortility Battersea 170,600 20.1 0.67 10.8 49 Bermondsey 121,700 24.0 — 12.2 76 Bethnal Green 118,700 22.8 0.88 11.3 88 Camberwell 272,300 20.7 0.7 11.0 56 Chelsea 64,480 15.1 0.4 12.2 58 Deptford 114,900 21.1 0.65 11.1 59 Finsbury 77,230 23.9 0.76 13.0 60 Fulham 161,600 18.4 0.5 10.5 64 Greenwich 102,777 20.5 0.46 10.9 60 Hackney 226,400 19.6 0.34 10.6 58 Hammersmith 133,600 20.2 0.5 11.0 64 Hampstead 87,410 14.3 0.4 10.3 42 Holborn 43,376 13.6 0.53 12.1 79 Islington 336,600 21.1 0.38 11.6 66 Kensington 178,500 17.5 0.69 12.3 70 Lambeth 308,500 27.0 0.4 11.2 42 Lewisham 182,400 18.0 0.4 10.1 43 Paddington 146,200 17.9 0.4 11.7 69 Poplar 166,400 25.6 0.6 11.3 60 St. Marylebone 105,400 15.8 0.4 11.7 66 St. Pancras 214,400 20.3 0.6 12. 63 Shoreditch 106,200 26.9 0.8 13.0 82 Southwark 187,464 24.3 0.8 12.8 68 Stepney 253,850 22.8 0.7 11.0 62 Stoke Newington 52,820 18.2 0.23 10.2 46 Wandsworth 336,100 16.2 0.39 10. 52 Westminster 140,430 12.5 009 10.6 46 Woolwich 140,000 20.5 0.2 9.9 43 City of London 13,480 8.2 0.22 11.2 60 County of London 4,564,109 20.2 - 11.2 60 City of Belfast 25.0 - 13.8 101 „ „ Dublin — 24.0 - 14.4 111 „ „ Glasgow — 25.6 - 14.2 90 „ „ Edinburgh — 20.4 - 13.8 82 „ „ Liverpool — 24.9 - 13.7 99 „ „ Manchester — 21.2 - 13.4 88 17 1. GENERAL STATISTICS. Area (acres) 3,237 Population—Census, 1901 219,1780 ,, —Census, 1911 222,674 „—Census, 1921 222,159 ,, —-Estimated, 1923 226,400 Number of inhabited houses, 1923 33,495 Number of families or separate occupiers (1921) 56,020 Rateable Value £1,270,899 Sum represented by a penny rate £5,207 Population.—'The population for the whole Borough gives a density of 68'8 persons per acre, varying from 53.0 persons per acre in the Northern Sub-district to 99.0 persons per acre iri the South-western Sub-district. The following table gives the estimated population &nd 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 1923. North Central SouthWest SouthEast Total for Hackney Total for London Estimated population 57,321 53,535 58,045 57,499 226,400 4,534,230 Area in square acres 1,080 857 586 764 3,287 74,815 Density, persons per acre 530 624 990 75 2 68.8 60.6 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. M. F. Legitimate 4,343 2,273 2,160 Birth Rate 19.6 Illegitimate 90 Deaths 2,406 Death Rate 10.6 B 13 Number of women dying- in, or in consequence of childbirth:— From sepsis 5 From other causes 5 Deaths of Infants under one year of age per 1,000 births:— Legitimate 56 Illegitimate 133 Total 58. Deaths from Measles (all ages) 15. ,, ,, Whooping Cough (all ages) 14. ,, ,, Diarrhoea (under 2 years of age) 9. *Marriages and Marriage-rates.—During 1923 there were 1,971 marriages solemnised in the Borough of Hackney. The annual rate for persons married during this period is therefore 17.4 per 1,000 of the population. The following table gives the number of marriages and marriage-rates for the Borough of Hackney and London during the years, 1913-1923. Year. Borough of Hackney. London. Marriages. Marriage rate. 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 1921 2,358 21.0 19.6 1922 2,212 19.6 18.3 Average, 1913—1922 2,233 20.1 20.3 1923 1,971 17.4 17.3 Births and Birth-rate.—The births registered in the Borough of Hackney during the year 1923 numbered 5,065, of which 2,592 * 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 1923. 19 were males and 2,473 females. The total shows a decrease of 205 compared with the number registered during 1922, 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 ot these transferable births, viz., 913 births to be transferred to other districts and 281 to Hackney. After these necessary corrections have been made, the correct total of registered births amongst Hackney residents is 4,433. From this figure the birthrate for Hackney during 1923 has been calculated to be 19'6 per 1,000 of the population. The birth-rate for all London for the same period is 20 2 per 1,000 of the population. Notification of Births Act, 1907.—Under the provisions of this Act 5,166 notifications of births were received during 1923. This total includes notifications from medical practitioners, midwives, parents and others. It also includes still-births. The total is 101 more ithan the number registered by the Registrar of Births. Still-Births.—Amongst the births notified 134 were stillborn. This is equal to 2.6 per cent, of those notified. A table is here given showing the number of notifications received, with other details in connection with the same. NOTIFICATION of BIRTHS ACT, 1907. Notifications of Births (Live and Still-born) received during the year 1923. Year 1923. Medical Practitioners Mid wives. 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 479 427 14 13 1,638 1.643 43 43 460 485 14 7 2,577 2,455 71 63 20 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1923 was 342, but of these, the Registrar-General states that 272 should be transferred to districts outside the Borough, as the mothers were not Hackney residents, and 20 births which took place in other districts, should be transferred to Hackney. These corrections having been made, there remain 90 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate birth-rate of 20'3 per 1,000 births. 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 5.065 835 2,075 1,012 1,143 91,662 Rate per 1.000 living 22 3 14.5 38.7 174 198 20 2 No of illegitimate births 90 ... Rate per 1,000 births 203 It will be noticed that the birth-rate is abnormally high in the Central District compared witff other Registration Subdistricts. This is accounted for by reason of 1,113 births occurring during the year at the Salvation Army Mothers' Hospital, which Institution is situate in the Central District. Of this number 763 births are transferable to districts outside Hackney. The following table shows the birth-rates for the Borough and its Sub-Districts during the years 1913-1923, inclusive:— 21 Birth-rate for the Borough of Hackney and its Sub-Districts for the years 1913-1923 compared with that of London. Year Borough of Hackney North SubDistrict Central SubDistrict South-West SubDistrict South-East SubDistrict London 1913 25.6 18.9 26.6* 303 26.5 24.5 1914 25.5 18.0 32.5 244 27.1 24.3 1915 23.0 17.0 28.7 223 23.3 22.6 1916 23.9 16.9 32.5 216 24.5 23.0 1917 18.9 12.4 29.7 154 18.0 17.5 1918 17.2 9.5 30.7 127 15.8 16.1 1919 21.0 13.2 33.9 165 20 .6 18.3 1920 28.7 20.6 41.3 23 6 29.5 26.5 1921 24.2 16.7 36.9 19 5 23.6 22.3 1922 23.4 15.8 37.7 183 22.5 21.0 1913-1922. 23.1 15.9 33.0 20'4 23.1 21.6 1923 22.3 14.5 38.7 174 19.8 20.2 * The Salvation Army's Mothers' Hospital was ODened in 1913. Deaths.—The deaths registered in the Borough during 1923 numbered 2,561; but of these 554 were deaths of non-residents who died inside the Borough. There were, however, 399 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 2,406. This is a decrease of 473 upon the number of deaths occurring during 1922. The general death-rate from all causes for the year 1923 is 10.6 per 1,000 of the population. Amongst the Registration Sub-districts the death-rate was lowest in the North Sub-district (10.0 per 1,000), the highest in the South-west Sub-district (113 per 1,000). Subdistrict. Population (estimated). Total No. of Births, Uncorrected. Birth rate. Uncorrected. Total Deaths Cor'ted. Deathrate. Deaths under 1 year. Infant Mortality per 1,000 Births. Uncorrected. North 57,321 835 14.5 575 10.0 59 70 central 53,535 2,075 38.7 569 10.6 61 29 South - west 58,045 1,012 17.4 657 11.3 59 58 South - east 57,499 1,143 19.8 605 10.5 78 68 A11 Hackney 226,400 5.065 22.3 2,406 10.6 257 50 * 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 29. 22 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. 1914 13.9 14.4 1919 13.0 13.4 1915 14.9 16.1 1920 12.7 12.4 1916 13.8 14.3 1921 11.5 12.4 1917 14.6 15.0 1922 12.7 13.4 1918 18.9 18.9 1923 10.6 11.2 The relative position from a health point of view occupied by Hackney as compared with other Metropolitan Boroughs maybe 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 1923 :— Boroughs. Death rate from all causes per 1,000 living. Deaths under 1 year to 1,000 births. Woolwich 9.9 43 Lewisham 10.14 43 Wandsworth 10.14 52 Stoke Newington 10.2 46 Hampstead 10.3 42 Fulham 10.5 64 City of Westminster 10.6 46 HACKNEY 10.6 58 Battersea 10.8 49 Greenwich 10.9 60 Camberwell 11.0 56 Stepney 11.0 62 Hammersmith 11.0 64 Deptford 11.1 59 Lambeth 11.2 42 City of London 11.2 60 Poplar 11.3 60 Bethnal Green 11.3 68 Islington 11.6 66 St. Marylebone 11.7 66 Paddington 11.7 69 St. Pancras 12.1 63 Holborn 12.1 79 Chelsea 12.2 58 Bermondsey 12.2 76 Kensington 12.3 70 Southwark 12.8 68 Finsbury 13.0 60 Shoreditch 13.0 82 23 Infantile Mortality.—The deaths under 1 year of age in the Borough during 1923 numbered 257. This is a decrease of 87 upon the number of infants deaths recorded during 1922. The infant mortality rate for the year is 58 per 1,000 births. The cause& of death are set out in the following table :— INFANT MORTALITY. 1923. Nett deaths from stated causes at various ages under 1 year of age. Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 we' ks ard under 3 months. 3 months and under 6 months. 6 months and under 9 month . 9 months and under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 3 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... 1 3 ... 3 1 8 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (Not Tuberculous) ... ... ... 1 1 1 1 2 ... 5 Convulsions 2 ... ... 1 4 ... 2 1 ... 7 Laryngitis ... ... ... ... ... 1 ... ... ... 1 Bronchitis ... ... 2 ... 2 2 1 5 ... 10 Pneumonia (all forms) ... ... 1 ... 3 13 11 10 9 46 Diarrhoea ... ... ... ... ... 2 3 3 1 9 Enteritis ... ... ... ... ... 2 1 ... ... 3 Gastritis ... ... ... ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... 1 ... ... 1 Suffocation (overlying) 1 ... ... ... 1 2 ... ... ... 3 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 8 1 ... ... 9 ... ... ... ... 9 Congenital Malformation 7 1 1 1 10 4 4 ... 1 19 Premature Birth 38 7 4 5 54 4 ... ... ... 58 Atrophy, Debility and Marasmus 5 7 2 3 17 5 4 2 1 29 Other Causes 8 1 1 1 11 3 11 8 7 40 71 21 12 12 116 42 41 35 23 257 Senile Mortality.—The deaths which occurred in Hackney at 65 years of age and upwards during 1923 numbered 930 and of these 485 were between the ages of 65 and 75 years, 337 between 24 75 and 85 years, and 108 at 85 years and upwards. The annual mortality rate of persons at 65 years and upwards is 4.1 per 1,000 inhabitants. Deaths in Public Institutions.—There were 1,338 deaths in public institutions in the Borough during 1923; of these 554 were residents of other districts, and the remaining 784 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 ol deaths in each institution during the year 1923 :— Institutions within the Borough receiving persons both from and without the Borough. Brooke House, Upper Clapton Road 8 Eastern Fever Hospital, Homerton 101 French Hospital, Victoria Park Road 2 German Hospital, Dalston 118 Hackney Union Infirmary, Homerton 746 ,, Central Institution, Homerton 3 Metropolitan Hospital, Kingsland 178 Nursing Home, 46, Amhurst Park 4 ,, „ 2, Amhurst Park 6 ,, ,, 65, Lauriston Road 1 ,, ,, 166, High Street, Homerton 1 ,, ,, 94, Cazenove Road 1 ,, ,, 18 and 20, Southwold Road 12 ,, ,, 157, Richmond Road 3 ,, ,, 2, Queensdown Road 7 St. Joseph's Hospice, Mare Street 116 Salvation Army Nursing Home, 9, Amhurst Park 1 Salvation Army Maternity Hospital, Lower Clapton Road 25 ,, Home, Rookwood Road 1 ,, ,, 29, Devonshire Road 5 ,, ,, 4, Clapton Common 1 1,338 25 Institutions Outside the Borough Receiving Sick and Infirm Persons Residing in the Borough. Bancroft Lodge, Mile End 1 Banstead Mental Hospital 2 Bethnal Green Infirmary 2 Brompton Hospital 5 Central London Throat and Ear Hospital 3 Charing Cross Hospital 2 Children's Hospital, Gt. Ormond Street 9 City of London Asylum, Stone 2 City of London Maternity Hospital 4 Claybury Mental Hospital 19 Colindale Hospital 8 Colney Hatch Mental Hospital 19 Dartford Heath Mental Hospital 1 East London Hospital 1 Elizabeth Garrett Anderson Hospital 1 Grove Fever Hospital 1 Guy's Hospital 2 Hackney Branch Institution, Brentwood 3 Hampstead General Hospital 1 Hanwell Mental Hospital 3 Hospital for Jewish Incurables, Tottenham 2 Homeopathic Hospital 1 Horton Mental Hospital 3 Hospital of St. John and St. Elizabeth 1 Hospital for Women, Soho 1 Jubilee Hospital, Woodford 1 King's College Hospital 1 Leavesden Mental Hospital 6 London Hospital 39 Carried forward 144 20 Brought forward 144 London Jewish Hospital, Stepney 2 London Temperance Hospital 1 Long Grove Mental Hospital 1 Manor House Hospital, Golders Green 1 • Middlesex Hospital 12 Mildmay Memorial Hospital 2 Mildmay Mission Hospital 3 Mount Vernon Hospital 1 National Heart Hospital 1 National Hospital, Queen's Square 4 Northern Hospital, Winchmore Hill 1 North-Eastern Fever Hospital 5 North Middlesex Hospital, Edmonton 1 North-Western Fever Hospital 2 Peckham House 1 Poplar Hospital 1 Prince of Wales' General Hospital 6 Queen's Hospital for Children 35 Queen Mary's Hospital, Carshalton 1 ,, ,, Stratford 2 Royal Chest Hospital, City Road 3 Royal Free Hospital 3 Royal London Ophthalmic Hospital 1 Royal Northern Hospital 5 St. Bartholomew's Hospital 20 St. Columba's Hospital 2 St. George's Home, Chelsea 1 St. John's Hospital 1 St. Luke's House, Kensington 2 St. Mark's Hospital 1 Carried forward 273 27 Brought forward 273 St. Thomas' Hospital 2 Seamen's Hospital, Greenwich 1 Shoreditch Infirmary 1 Springfield Mental Hospital 1 South-Eastern Fever Hospital 1 South London Hospital 1 Tooting Bee Mental Hospital 15 University College Hospital 5 Victoria Park Hospital 22 West London Hospital 1 Miscellaneous Institutions 76 Total 399 MORTUARY, 1923. Number of bodies in Mortuary 266 1. To await Inquests-(a) Infectious — I (b) Non-Infectious 244 2. To await Burial 22 Number of Post Mortems 139 Inquests. Verdict. Sex. Male. Female. Natural Causes 65 50 Accidental Death 44 26 Suicide 21 13 Open Verdict 15 8 Manslaughter — — Murder - - Misadventure 2 — Totals 147 97 28 Table showing nature of Suicidal and Accidental Deaths in the Borough of Hackney during the year 1923. Nature of Suicide. No. Nature of Accidental Death. No. Hanging 3 Shock from Burns 7 Poisoning 24 Shock from Fall 19 Cut Throat 2 Suffocation 2 Drowning 3 Drowning 6 Jumping from window 2 Run over 18 Fracture of Skull 6 Shooting 1 Shock from Scalds 6 Poisoning 1 Others 4 34 70 29 TABLE I. Vital Statistics of Whole District during 1923 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 1914 223,718 5,708 5,460 25.5 3,233 14.4 662 557 492 85 3,128 13.9 1915 217,883 5,091 4.827 22.1 3,402 15.6 723 552 520 107 3,231 14.8 1916 209,636 5,331 5,026 22 .0 2,917 13.9 617 581 423 84 2,881 13. 7 1917 196,598 4,207 3,750 17.1 2,929 14.9 661 585 345 92 2,853 14.6 1918 For Deaths 195.804 3,828 3,266 14.8 3(836 19.5 820 692 365 111 3,708 18. 9 For Births, 219,391 1919 For Deaths 216,736 4,748 4,141 21.0 2,990 13.7 673 530 355 85 2,847 13.0 For Births, 225,774 1920 For Deaths 225,372 J 6,486 6,010 26.6 3,030 13.4 679 510 485 81 2,861 12.7 For Births, 225,542 1921 224,200 5,437 4,978 22.2 2,757 12'.6 648 471 329 66 2,580 11.5 1922 225,400 5,270 4,743 21.0 3,098 13.7 678 459 344 72 2,879 12.7 1923 226,400 5,065 4,433 19.6 2,561 11.3 554 399 257 58 2,406 10.6 30 TABLE II.—HACKNEY BOROUGH. Notifiable Diseases during the Year 1923 (Age groups of notifications). Di seases. At all Ages. Cases Notified l'otal Cases Notified ii each Locality. Total cases removed to Hospital. At Ages—Years. 1 2 3 4 Under 1. 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and upwards. North. 1 Central. South-East. South-West Small-pox 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diptheria (including Membranous Croup) 528 7 34 35 57 35 164 84 44 48 13 6 1 126 157 151 94 517 Erysipelas 73 1 1 2 ... 3 4 3 8 13 28 10 14 13 21 25 21 Scarlet Fever 457 5 20 40 43 37 177 78 25 25 6 1 ... 81 106 139 131 438 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 17 ... ... ... 1 ... 2 3 ... 4 ... 4 ... ... 5 1 8 14 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 22 ... ... ... ... ... ... ... 3 18 ... ... ... 4 6 5 7 21 Ccrebro-Spinal Meningitis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Polio Myelitis 3 ... ... ... 1 ... 2 ... ... ... ... ... ... 1 1 ... 1 1 Ophthalmia Neonatorum 25 25 ... ... ... ... ... ... ... ... ... ... ... 7 4 7 7 5 Pulmonary Tuberculosis 387 ... 1 ... 1 1 13 22 34 138 83 82 12 76 82 117 112 255 Other forms of Tuberculosis 89 1 1 1 4 4 25 24 9 15 ... 4 1 16 27 26 20 29 Encephalitis Lethartrica 7 ... ... ... ... ... ... ... ... 2 3 2 2 2 ... 3 5 Influenzal Pneumonia 5 ... ... ... ... ... ... ... ... 2 1 1 1 2 ... ... 3 ... Acute Primary Pneumonia 30 1 2 ... 1 1 6 4 2 5 2 5 1 1 6 17 6 8 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... T^ysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Total 1,645 41 58 T7 130 78 392 219 1 20 266 1 25 1 33 26 333 400 485 418 1.316 IS Notifiable Diseases during- the Year 1923. (Age Groups of Deaths). Disease. Total cases notified. Cases admitted to Hospital. Age Groups of Deaths. Total deaths at all ages. Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 .to 20 20 to 35 35 to 45 45 to 65 65 and upwards. Small-pox 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 528 517 ... 3 5 4 4 8 3 2 ... ... ... ... 29 Erysipelas 73 21 ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 457 438 ... 1 1 1 ... 2 ... ... ... ... ... ... 5 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 17 14 ... ... ... ... ... ... ... ... 1 ... ... ... 3 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 22 21 ... ... ... ... ... ... ... ... 5 ... ... ... 5 Cerebro-Spinal Meningitis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Polio Myelitis 3 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Ophthalmia Neonatorum 25 5 ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 7 5 ... ... ... ... ... ... ... ... ... 1 2 ... 3 Influenzal Pneumonia 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Acute Primary Pneumonia 30 8 1 1 ... ... ... ... ... ... 1 ... ... ... 4 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1169 1032 2 5 6 5 4 a 3 2 7 1 5 1 52 For age groups of notifications (including Tuberculosis) see previous page. 32 INFECTIOUS DISEASE. During 1923 there were 1,169 cases of acute infectious disease compulsorily notified in the Borough, as set out in Table II. This total shows a decrease of 410 upon those notified during 1922. The attack-rate in respect of the acute notifiable infectious diseases for the year is 5.1 per 1,000 inhabitants. In addition there were 387 notifications received of pulmonary tuberculosis and 89 notifications of other forms of tuberculosis. The deaths from the chief zymotic diseases numbered 78. This is equivalent to a zymotic death-rate of 0'34 per 1,000 living in the Borough, as compared with a zymotic death-rate of 0 63 during the previous year. I y III. NOTIFIABLE DISEASES DURING THE YEAR. Small-pox.—There was one notification of small-pox in the Borough during 1923. All contacts escaped infection. My report to the Committee was as follows:— 18th September, 1923. The Committee are aware that a case of Small-pox was removed on September 14tb from No. 8, Poplar Avenue, one of the Council's converted Army huts. The infection, so far as can be ascertained, was incurred at a laundry, where the patient had been engaged in washing bedclothing from a hotel in Central London, where a case of Smallpox, unrecognised at the time, was known to have paid a visit and to have infected a servant employed at that hotel, who fell ill with Small-pox on September 2nd. The information as to this bed-clothing was received on the 10th September, and on the same day the laundry was visited, notices re vaccination posted, a list of employees and their 33 dition as regards vaccination compiled, and the manager requested to give information as to any employee absent through illness. The patient was then at work, but had evidently been infected for many days. The manager did not connect his absence on September 11th from a "strained back" with Small-pox, and although the laundry had been visited daily since September 10th, the fact that the patient was ill was not known to me until the 14th. The Public Vaccinator has not called at the laundry either before or since the patient was removed, as only one of the staft has agreed to be vaccinated on this occasion; a considerable number of the staff, however, have been vaccinated fairly recently, thus the five employees living in Walthamstow who are considered likely to have come into contact with the patient at his work have all been vaccinated between 1914 and 1917, and this is the case with a large number of the employees. The Hackney case was notified on September 14th, and removed to Hospital, on the same day the home contacts were vaccinated by the Public Vaccinator at the Hut and at a house in an adjoining street. Also on the same day the contacts at No. 8 Hut, after being vaccinated, were -removed to the Isolation Shelter, and disinfection of the Hut and contents and the neighbouring house was carried out. Hut No. 8, after disinfection, was thoroughly washed down and cleansed, the occupants returning on September 17th. The list of home contacts is as follows:— Age. Occupation Vaccination. 1. 8/12 — September 14th 2. 30 Housewife Infancy and Sept. 14th. 3. 29 Extra Postman „ „ „ 4. 28 Shoe Factory Worker „ „ „ 5. 2 — September 14th. 6. 7 School „ „ c 34 The home contact, aged 3, unvaccinated, had been removed on September 13th to a house in a neighbouring street, the other occupants of this house being: "A" Vaccinated in infancy; "B" Working at another laundry in the Borough, unvaccinated; and "C," working at Poplar, vaccinated 1914 & 1922. These contacts, with the exception of Contact "C," were vaccinated on September 14th by the Public Vaccinator. With the exception of Contact "A" they are not direct contacts. The Ministry of Health and the Postal authorities have been notified of the case, and the Medical Officers of Health of the Boroughs concerned have been notified of the contacts. Five Hackney contacts employed at the laundry are under daily visitation at their homes in addition to the occupants ol the Huts. One person living in the Huts, at No. 1 Poplar Avenue, is also a contact to the patient at the laundry, and as a matter of emergency I have arranged that two of the contacts at the laundry shall be put off their duties at the laundry as neither of these men have been vaccinated during the last 20 years, and both are close contacts. The laundry is visited daily and enquiry made as to illness, so that investigation can be made of the illness of any employee not known to have been associated with the patient at the laundry. Those known to be so are visited daily at home. The Public Vaccinator, who vaccinated the home contacts at the Huts and at the house in the neighbouring street on September 14th, attended on September 15th and offered vaccination to the occupants of the other Huts, and vaccination was carried out as regards the occupants of Huts 3, 4, 5, 6 and 7. It has been arranged for the Public Vaccinator to call at the School and the Shoe Factory this afternoon for the purpose of carrying out vaocination. There are only 3 contacts at this factory, one recently vaccinated and the others willing to be done. 35 Only one man has agreed to be done at the laundry where the patient worked, so that the Public Vaccinator for that District will not call. The other laundry do not wish the Public Vaccinator to attend at their premises, and Contact "C," who works there, has not herself been to Poplar Avenue during the past six weeks. The usual posters and leaflets are being distributed. In addition to those contacts being kept under observation as regards the Hackney case, there are two contacts from a case notified from Margate, and one from a case notified from the City Road, now under observation. 36 Summary of Proceedings under the Vaccination Acts, 1867 to 1898, during the year 1923. 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 sen to Public Vaccinator Health of Child. Condition of House. Prevalence of Infectious , Disease. Parents Remove* out of District. Otherwise not found. North 815 507 33 — — 223 3 26 8 263 Central 2,104 779 38 — — 717 3 385 110 324 South-East 1,183 583 17 — — 450 — 12 29 442 South-West 1,012 536 30 — — 389 1 31 21 417 Total 5,114 2.465 118 — — 1,779 7 454 168 1446 • * Chart showing the Number of Cases of SCARLET FEVER and DIPHTHERIA weekly during 1923. 37 Scarlet Fever or Scarlatina,.—The number of cases of scarlet fever notified during 1923 was 457. This is a decrease of j21V cases upon the number of genuine cases notified during 1922. The prevalence of the disease each week throughout the year is shown on the chart. The attack rate for scarlet fever was 2'01 per 1,000 persons iving, and for England and Wales 223. The number of cases removed to hospital during the year was 438. This is equal to 95 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 81 106 139 131 Attack-rate per 1,000 living 1.4 1-9 2-3 2-2 It will be seen from the above that scarlet fever was most prevalent in the South-west Sub-district. The deaths from scarlet fever during 1923 numbered 5, which is equal to a case mortality of 1*0 per cent, attacked, and a scarlet fever death-rate of 0'02 per 1,000 inhabitants. The mortality rate for London from scarlet fever during the same year was 0.02 per 1,000 inhabitants. Diphtheria and Membranous Croup.—There were 528 cases of diphtheria and membranous croup notified during the year. This is a decrease of 208 upon the number of genuine cases notified during 1922. The incidence of the disease can be seen by reference to the chart. 38 The attack rate of diphtheria was 2.3 per 1,000 inhabitants, compared with 104 for England and Wales. There were 517 cases removed to hospital during the year, This is equal to 97 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 126 157 151 94 Attack-rate per 1,000 living 21 2.9 2.6 1.6 From the above it will be seen that diphtheria was most acute in the Central Sub-District. The deaths from diphtheria and membranous croup during the year numbered 29. This mortality is equal to a death-rate of 5 4 per cent, attacked and 0'12 per 1,000 inhabitants, as compared with a death-rate of 3'0 per cent, attacked, and 0'12 per 1,000 inhabitants for the previous year. » The death-rate from diphtheria for London during the same period is 013 per 1,000 inhabitants. During the year 724 swabbings ifrom throats of persons suspected to be suffering from diphtheria were bacteriologicall; examined, of which 104 gave positive results, 602 negative results, and 18 were returned as doubtful. Diphtheria Anti-toxin.—In accordance with the Anti-toxir. Order of 1910, a supply of diphtheria anti-itoxin was provided 39 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 56 bottles of anti-toxin of 8,000 units each were supplied to medical practitioners, most of which was used for prophylactic purposes. The following- table shows the number of attacked persons under 15 years of age not known to have had a previous attack of Scarlet Fever and Diphtheria as they are housed, as follows:— Disease. Cases removed to Hospital Cases nursed at Home Less than 1 person per room 1 to 2 persons per room More than 2 persons per room Less than 1 person per room 1 to 2 persons per room More than 2 persons per room Scarlet Fever 43 251 63 8 7 — Diphtheria 28 276 101 4 2 — It is not possible to show the attack rates per 1,000 persons under 15 years of age, as the records do not give the information as to the housing conditions of the population coming within this age period. Typhoid or Enteric Fever.—During the year under consideration, 17 cases of enteric fever were notified. This shows an increase of 13 on the number of genuine cases notified during 1922. The attack rate was 0-07 per 1,000 inhabitants, compared with 0 08 for England and Wales. 14 of the cases were removed to hospital. 40 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 3 5 1 8 The deaths from enteric fever in the Borough last year numbered 3. During the year 34 specimens of blood from persons suspected to be suffering from enterifc fever were submitted to Widal's test. 28 gave a negative reaction and 6 positive. The mortality from enteric fever for 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 22 cases of puerperal fever notified during 1923; 21 cases were removed to hospital. The deaths from puerperal fever and septicaemia numbered 5. The attack-rate for the year was 4'9 per 1,000 births, and the deathrate 1.1 per 1,000 births. Plague.—There were no notifications of plague in the Borough during the year. Cholera.—There were no notifications of Cholera in the Borough during the year. Erysipelas.—There were 73 cases of Erysipelas notified during 1923. This is equal to an attack-rate of 0"32 per 1,000 inhabitants, compared with 0.32 for England and Wales. Of the 73 cases notified, 21 were removed to hospital. 41 There were no deaths certified to be due to erysipelas. 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 14 13 21 25 Rate per 1,000 living .24 .24 .36 .43 Cerebrospinal Meningitis.—During 1923 there was 1 case of this disease notified in the Borough, which was removed to hospital. Polio-myelitis.—There were 3 cases of Polio-myelitis notified in the Borough during the year. Ophthalmia Neonatorum.—There were:— Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 25 20 5 25 — — — Encephalitis Lethargica.—The Public Health (Acute Encephlitis Lethargica and Acute Polio Encephalitis) Regulations, 1918, came into operation on 1st January, 1919. During the year 1923 7 cases were notified, 3 being fatal. Five patients were removed to hospital. Influenzal Pneumonia and Pneumonia.—There were 5 cases of influenzal pneumonia and 30 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 Is. 3d. per visit. During the year 79 cases were nursed 42 and 1,318 visits paid to those cases. Influenza, unless compli. cated by pneumonia, is not notifiable. Malaria.—There were no notifications of Malaria in the Borough during the year. Dysentery.—There were no notifications of Dysentery in the Borough during the year. 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 1923. NON-NOTIFIABLE. Measles and German Measles.—The Public Health (Measles and German Measles) Regulations, 1915, were withdrawn by Order in Council on 31st December, 1919. Fifteen deaths were recorded from this disease. The annual mortality is therefore .06 per 1,000 inhabitants, compared with London '08 per 1,000 inhabitants. Information of 796 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. Influenza.—During 1923 there were 49 deaths in the Borough. This is a decrease of 64 on the deaths from this cause registered during 1922. The annual mortality rate from influenza is 0 21 per 1,000 inhabitants. 43 Diarrhœa.—There was ail increase in the number of deaths due to diarrhoeal disease in the Borough during 1923. The total number of deaths from this cause was 15, and of these 12 were under 1 year of age. The annual mortality rate for diarrhoea and enteritis during the year is 0'06 per 1,000 inhabitants. Whooping Cough.—The deaths from this cause during the year numbered 14. This is a decrease of 48 upon the number registered during 1922. Thirteen of the deaths occurred in children under five years of age. The mortality for Hackney is equal to '06 per 1,000 inhabitants, and that for all London, -09 per 1,000 inhabitants. The King's Home for Nurses attended to 2 of the cases and paid 29 visits. Information was received from the head masters and head mistresses of elementary schools in Hackney of 299 cases of whooping cough occurring among their scholars during the year. CONSTITUTIONAL DISEASES. For Table of Deaths see pages 138 to 145. Cancer.—There were 303 deaths during 1923 due to the different varieties of malignant disease. This is an increase of 18 on the number registered during 1922. The annual mortality rate from malignant disease for last year is therefore 1'33 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 81 62 80 80 Mortality-rate per 1,000 inhabitants 1.4 1.1 1.3 1.3 44 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 1923:— London. Borough of Hackney. Years. 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 Deaths from Cancer. 256 276 245 230 236 274 246 289 285 303 Death-rate per 1,000. 114 1'26 116 117 107 126 109 1'28 126 133 Death-rate per 1,000. 1 13 116 118 125 126 120 120 131 130 135 45 Deaths frotn Cancer of Breast during the Year 1923. Age. Civil State. When growth was When a Doctor first noticed. was first consulted. Whether there was an operation, and if so, wjien Remarks. 47 Wife of Boot Laster 12 months before death At once No Received X-ray treatment at Metropolitan Hospital for 11 months before death. Patient was told that she was too stout for an operation as the area for such would be too great. 54 Wife of Wine and Spirit Merchant's Traveller 3 years before death 1 year after growth was first noticed Yes—4 months after consulting a doctor 6 months after 1st operation a second operation was performed when the whole of breast was removed. Patient received radium treatment for 1 year and 9 months. She had a blow on right breast 3 years before she noticed any growth. No previous history of Cancer known in family. 54 Spinster—Mantle Maker 3 years before death 9 months after noticing growth Yes—2 years before death and 1 month after consulting doctor Right breast was entirely removed 2 years before death. Growth rapidly spread up the neck and over the shoulder to the left breast and further operation impossible. 66 Widow No information obtainable as deceased is unknown at the address given on the death re turns. 81 Wife of Night Watchman 6 months before death No Impossible to obtain information as no relatives living except husband, and he is unable to give any details. 46 Age Civil State. When growth was first noticed. When a Doctor was first consulted. Whether there was an operation, and if so, when Remarks. 43 Wife of Sewing Machine Repairer July, 1917 November, 1917 Yes—December, 1917 Patient was receiving Radium treatment after breast was removed. Attended hospital monthly. When .husband was unemployed she discontinued treatment and went out to work. No history of Cancer known in family. 47 Wife of House Painter February, 1922 6 months after swelling was first noticed Yes—6 weeks prior to death Patient had no family. Said to be always healthy, but complained of continuous lassitude and periodical pains in the arm and thought same was Rheumatism; this went on for about 6 months before growth was noticed. No .history of Cancer is known in family. 65 Spinster— Housekeeper 10 years prior to death At once Yes—1 week after consulting doctor Left breast entirely removed at London Hospital. 3^ years after another operation was performed. After a period of 3 years a third operation was .performed on the Right breast. One previous case of Cancer known on the maternal side. 58 Wife of Thames Lighterman No information ob tainable 52 Married woman do. do. 47 Wife of Exporter's Code Clerk do. do. 47 46 Wife of Provision Dealer's Clerk No information oh Itainablc. 55 Spinster—Tie Machinist 7 months prior to to death 6 months before death and 1 month after growth noticed Yes—1 month before death Breast not removed as growth was said to be too near a large artery, but an abdominal operation was performed. No history of Cancer known in family. Bad history of Tuberculosis—both parents and 5 brothers having died. 54 Widow of Woollen Warehouseman 1 year before death At once Yes—2 months after consulting doctor Daughter states there is a history of Cancer in family, but cannot give particulars. 58 Wife of Scientific Instrument Maker years before death At once Yes—6 months after consulting doctor Right breast entirely removed at Metropolitan Hospital, and afterwards X-ray treatment administered until 2 weeks prior to death. History of Cancer on both maternal and paternal sides of family. 49 Spinster— Domestic Servant 4 years before death 6 months after swelling noticed Yes—a few days after consulting doctor 6 months after breast was removed a swelling was noticed in left side of neck and a further operation was performed. After a lapse of 2 years the growth spread to the liver. For 3 or 4 years before swelling was noticed deceased complained of feeling desperately tired and run down. 76 Widow of an Accountant No information ob tainable 42 Spinster—Restaurant Waitress 4 years before death 2 years before death Yes—2 weeks after consulting doctor Deceased was an Epileptic subject and attended a doctor continually, but did not mention anything about her breast until 2 years before she died. No history of Cancer in family. 48 Age. Civil State. When growth was first noticed When a Doctor was first consulted. Whether there was an operation, and if so, when Remarks. 39 Wife of Insurance Agent 10 years before death At once Yes—1½ years prior to death Right breast entirely removed 1J years before death. Deceased did not have X-ray or Radium treatment either before or after operation, but attended a local doctor on and off nearly the whole of the 8J years before operation. No history of Cancer in family. 50 Spinster—No Occupation 8 years before death 2 months after growth noticed Yes—4 months after noticing growth Patient went to Germany on 3 occasions for Radium treatment, after having breast wholly removed. Treatment extended for periods of 3 or 4 weeks. When growth was first noticed patient did not suffer any pain. History of Cancer in family and one sister died of T.B. 67 Wife of Wood Carver 14 years ago. Dispersed at Homeopathic Hospital Went to Hospital as soon as growth was noticed Yes—years before death Right breast removed, May, 1921, and a further operation in May, 1922. Under treatment the whole period as outpatient. No history of Cancer in family. 77 Widow of Solicitor's Managing Clerk 1 year before death At once No Growth spread rapidly and affected the stomach, causing persistent vomiting. Doctor in attendance did not advise operation owing to patient's exhausted condition. No history of Cancer in family. 49 65 Wife of Cartage Contractor 8½ years before death 9 months after growth was noticed Yes—3 weeks after consulting doctor Patient attended the London Hospital on and. off for a period of 6.½ years for Radium treatment. Mrs. Wade's father died from Cancer. No further information obtainable. 36 Widow of Rubber Merchant's Traveller 3 years before death 1 year after growth was noticed Yes—6 months after consulting doctor Patient attended Metropolitan Hospital on and off for 5 years. 2 years before growth was noticed suffered with headaches and sore throat. Father and husband both died from Cancer. 78 Wife of Lamp Lighter 3¾ years before death 1 year before death No Doctor said patient was too far advanced for operation, as treatment should have been obtained 2 years previously. Patient noticed what she thought was a little corn under the breast 3¾ years before death. No history of Cancer in family. Husband died of T.B., and one grandson suffering from T.B. 67 Spinster—Dyer and Cleaner 5 months prior to death At once Yes—6 weeks after growth was noticed For 3 months after growth was noticed patient felt a pricking sensation in Right breast, and also pain in Right elbow, and thought the pain in elbow was Rheumatism and rubbed the arms with oils. Growth was found embedded in the breast the size of a Tangerine orange. Right breast completely removed. No history of Cancer in family. 50 Age. Civil State. When growth was first noticed When a Doctor was first consulted. Whether there was an operation, and if so, when Remarks. 84 Widow of Market Gardener 10 months prior to death At once No Growth too far advanced. Deceased had a blow on Right breast 5 years previous to noticing growth and felt no pain after a few days. 2 years afterwards the pain returned and deceased was treated by a local doctor who applied a plaster. Did not complain again until 10 months before death, when a discharge was noticed coming from the nipple of the Left breast. 72 Spinster—Fancy Trimming Weaver 10 years before death As soon as growth was noticed Yes—2 weeks after consulting doctor Deceased had a blow on Right breast 30 years before death, causing a wound which, after treatment, healed up. 10 years after Right breast removed, and in 1920 Left breast removed. Deceased's mother died from Cancer. 51 Alcoholism. Alcoholism.—During the year under consideration there were no deaths from alcoholic poisoning; there were, however, 12 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. TUBERCULOSIS. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. - F. M. F. 0 - - - 1 - - 1 1 2 1 4 7 - 1 6 3 5 3 10 16 7 - - - 1 10 12 10 14 12 2 2 3 5 15 11 23 4 3 7 7 3 3 20 22 17 1 5 9 14 1 1 25 48 51 3 6 25 26 2 1 35 49 34 - - 28 22 2 1 45 36 17 2 1 24 14 3 1 55 19 10 2 — 20 4 1 - 65 and upwards 5 7 1 - 6 5 1 22 1 Totals 207 180 47 42 121 95 18 During 1923, 476 primary notifications of tuberculosis were received, details of which are given on page 54 of this Report. Bacteriological examination of sputa from 406 cases was made by the Council's Bacteriologist during the same period. In 51 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 1923, was 256, an increase of 18 upon the deaths during 1922. 52 These deaths are classified as follows:— Pulmonary tuberculosis 216 General tuberculosis 6 Tuberculous meningitis 11 Tuberculous peritonitis 8 Lupus 1 Tabes mesenterica 1 Tubercule of other organs 13 256 This number of deaths gives an annual mortality of 113 per 1,000 inhabitants. In the following table the yearly deaths from tuberculous diseases in the Borough for the last 25 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 1922-1923 247 48.8 There were 44 deaths where a notification had not been received under the Regulations. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is therefore as 1 is to 6. 15 deaths occurred in hospitals, 7 in the Hackney infirmary, 4 in mental hospitals, 3 certified on inquest, and in 15 cases the deaths were certified by local practitioners. In 7 cases post mortems were performed to ascertain the cause of death. 53 Enquiries were made in all these cases, with the exception of deaths in Mental Hospitals, to ascertain, if possible, the extent of treatment prior to death. It was found that in 11 cases the patient had only attended a local doctor or had been admitted to hospital from 1 to 7 days before their death, and in 12 others for a period under 3 months. Endeavours were made for the contacts to attend the Dispensary for examination. It will be seen from the preceding table that the average annual number of deaths from tuberculosis has progressively decreased during the period in question, the decline from the period 18981900 to the year 1923, being equal to 48.8 per cent. 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 49 60 70 77 Mortality rate per 1,000 inhabitants .85 1.1 1.2 1.3 Public Health (Tuberculosis) Regulations, 192. Under these Regulations 1,243 notifications of tuberculosis were received during the year, of which 1,039 were pulmonary and 184 non-pulmonary. 54 Summary of Notifications during the Period from 31st December, 1922, to 29th December, 1923. Age Periods. Notifications on Form A. Number of Primary Notifications Total Notifications, on Form A. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Notifications. Primary Total Pulmonary Males ... 2 3 12 11 22 48 49 36 19 5 207 224 „ Females ... 1 10 10 23 17 51 34 17 10 7 180 197 Non-Pulmonary Males ... 4 16 14 4 1 3 ... 2 2 71 47 52 „ „ Females 1 5 7 10 5 5 6 ... 1 ... ... 40 42 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 ... ... ... ... ... 39 187 „ Females ... ... ... ... ... 38 90 Non-Pulmonary Males ... ... ... ... ... 1 26 „ Females ... 2 ... 2 2 ... 19 55 Visits paid by Tuberculosis Visitors. New Cases. Contacts Sailors and Soldiers Other Persons. Total. Insured. Noninsured. Miss Servanté 181 188 459 1644 2472 1384 1088 Miss Clarke 296 275 406 1471 2448 1129 1319 477 463 865 3115 4920 2513 2407 Discharged Tuberculous Sailors and Soldiers. Arrangements were made at the commencement of 1919 with the Ministry of Pensions for the home visiting and after care of discharged sailors and soldiers 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 381, and the total number of visits of this kind made was 865. 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 five. 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. 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:— 56 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. A Tuberculosis Officer in addition to the primary duty of diagnosis and treatment of tuberculosis, is required 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 1923 a total estimated population of 397,920 with 481 deaths from tuberculosis and with 863 primary cases of tuberculosis notified during that year alone. DISPENSARY DISTRICTS. Estimated Population in Electoral Wards. Metropolitan Hospital Area— Stamford Hill 33,358 West Hackney 19,346 Kingsland 23,445 Downs 17,372 93,521 Estimated population (1923)— Borough of Stoke Newington 52,820 146,341 57 Victoria Park Hospital Area— Clapton Park 43,290 Homerton 37,862 South Hackney 23,454 Hackney 28,273 132,879 Estimated population (1923)— Borough of Bethnal Green 118,700 251,579 397,920 Estimated population (1923) Hackney 226,400 DISPENSARY DEATHS. Condition of Patient on First Attendance. Pulmonary Tuberculosis 1st Stage. 2nd Stage. 3rd Stage. Number 18 46 64 Percentage 14% 36% 50% Duration of illness before attending Dispensary Under 1 month 4 1 to 3 months 25 3 to 6 months 25 6 to 9 months 19 9 to 12 months 5 Over 12 months 35 Period indefinite 15 58 ALL DEATHS FROM TUBERCULOSIS. Interval elapsing between Notification and Death. 1921. 1922. 1923. Pul. Non-pul. Pul. Non-pul. Pul. Non-pul. 1. Number of Deaths from Tuberculosis 213 51 202 36 216 40 2. Number of cases only notified at death 10 10 11 4 15 3 3. Do. notified within a month of death 17 ... 20 1 16 2 4. Do. do. 3 months of death 23 ... 25 1 19 1 5. Do. do. 6 months of death 27 1 24 1 9 1 6. Number of deaths in casas not notified under Tuberculosis Regulations 23 25 24 20 26 18 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 1923, 476 primary cases were notified, and the contacts to these cases number in all 1,104 persons, and of these 641 contacts were examined, making the number examined slightly over 58 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. Some of these contacts were examined privately and not at the Dispensary. During the year 1923, 256 deaths were registered—216 pulmonary and 40 non-pulmonary; but of these 26 pulmonary and 18 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. 59 Of the pulmonary deaths, there were 622 contacts, of which 359 were examined, representing 57 per cent. examined; and of the non-pulmonary deaths there were 115 contacts, of which 63 were examined, representing 55 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 386 Females 442 Total 828 2.—The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 103 43 Local Practitioners Primary 169 | 178 56 Contact 9 4 war Pensions Committee 24 9 Contact cases (Tuberculosis Visitors) 482 28 London County Council 11 5 Victoria Park Hospital 15 14 Other sources 15 5 60 3.—The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 16. Males. Females. Pulmonary Tuberculosis 65 21 3 8 30 127 Non-pulmonary Tuberculosis 6 3 25 2 1 37 Non-tuberculous 119 79 271 30 133 632 Doubtful 11 6 5 3 7 32 Totals 201 109 304 43 171 828 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 19 Non-pulmunarv tuberculosis 13 Non-tuberculous 446 Doubtful 13 Total 491 5.—Sputum Examinations of Insured and Uninsured Patients. Insured. Uninsured. . Tubercle Bacilli present 140 36 176 Tubercle Bacilli absent 427 187 614 61 6.—Other Figures. Insured. Uninsured. Total number of attendances 2264 4148 Systematic examinations at the above 1446 1546 Number of letters written 1866 Number of visits to patients at their homes 236 Number of patients sent to hospital or sanatorium 83 33 Number of patients referred to:— X-ray Department 67 Dental Department 63 Other Departments 32 METROPOLITAN HOSPITAL TUBERCULOSIS DISPENSARY. (Dr. Young.) HACKNEY CASES TREATED. 1.—The Totals of New Cases. Males 184 Females 199 Total 383 2.—The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 47 31 Local Practitioners 79 37 War Pensions Committee 5 4 Contact cases (Tuberculosis Visitors) 215 6 Ministry of Pension 8 1 London County Council 6 3 Metropolitan Hospital 9 4 Other Hospitals 11 10 Other sources 3 3 62 3.—The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 16. . Males. Females. Pulmonary Tuberculosis 35 14 7 10 19 85 Non-pulmonary Tuberculosis 1 3 9 - 1 14 Non-tuberculous 45 30 133 12 47 267 Doubtful 4 1 8 1 3 17 Totals 85 48 157 23 70 383 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 4 Non-pulmonary tuberculosis 2 Non-tuberculous 206 Doubtful Total 216 5.—Sputum Examinations of Insured and Uninsured Patients. Insured. Uninsured. Total. Tubercle Bacilli present 87 60 147 Tubercle Bacilli absent 213 70 283 63 6.—Other Figures. Insured. ured. Total number of attendances 1296 1345 Systematic examinations at the above 433 380 Number of letters written 114 83 Number of visits to patients at their homes 36 17 Number of patients recommended for hospital or sanatorium 37 30 Number of patients referred to:— X-ray Department 41 22 Other Departments 12 23 Extra Nourishment. The Scheme came into operation on 6th June, 1921, and during the year 146 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 the cases come within the "necessity" limit of the Council, are early or sanatorium cases and 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 for the year is £420 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. 64 Place where death occurred. Pulmonary Tuberculosis. Other forms of Tuberculosis. Totals. At Patients' Homes 116 9 125 At Hackney Infirmary 58 11 69 At other Institutions 42 20 62 216 40 256 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 increasing value to the tuberculosis service. The average number on the roll for the year is 86, with an average attendance of 74. Dr. Howell, Tuberculosis Officer 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. 65 DISINFECTION. (a) Rooms.—During 1923 there were 1,804 rooms fumigated and 490 rooms cleansed in the Borough by the staff of the Public Health Department. In these totals are included disinfections after measles, whooping cough and tuberculosis, in addition to those in connection with the present notifiable infectious diseases. The number of rooms fumigated and cleansed each month is set out in the following table:— Number of rooms fumigated and cleansed each month during 1923. Month. Rooms fumigated. Rooms cleansed. January ... 165 ... 39 February ... 144 ... 33 March ... 156 ... 36 April ... 119 ... 33 May ... 177 ... 57 June ... 138 ... 53 July ... 165 ... 44 August ... 96 ... 25 September ... 136 ... 31 October ... 144 ... 42 November ... 164 ... 57 December ... 200 ... 40 Total ... 1,804 ... 790 (b) Articles of Clothing, Furniture, etc.—The number of articles under this head disinfected during last year was 14,530. This is an increase of 1,819 upon the number disinfected during 1922. A table is here given showing details of the articles disinfected each month. 66 Articles Disinfected, 1923. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Totals. House linen and furniture 915 825 1.095 829 1,090 1,134 912 698 937 997 1,183 1,338 11,953 Men's clothing 2 6 9 4 5 3 2 ... 14 5 15 3 68 Women's clothing 6 3 9 5 13 2 3 2 12 13 18 25 111 Children's clothing ... ... ... ... ... ... ... ... ... 3 ... ... 3 Other articles 130 128 268 167 223 249 205 80 151 228 341 225 2,395 Total 1,053 962 1,381 1.005 1.331 1,388 1,122 780 1,114 1,246 1,557 1,591 14,530 67 In addition to these there were 181 articles destroyed on request from the owners. These are set out in the following table:— Articles Destroyed. Beds 36 Bolsters 8 (Mattresses 24 Pillows 19 Sundry Articles 94 Total 181 (c) Public Library Books. During the past year 432 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 burning sulphur. Books Disinfected. Month. Number. January 52 February 47 March 37 April 33 May 18 June 29 July 21 August 29 September 20 October 42 November 51 December 53 432 68 Isolation Shelter. During the year there were 132 persons admitted to tie Shelter whilst their homes were being disinfected. This total consisted of 31 men, 32 women and 69 children. The cost of maintenance of these persons admitted was £13 8s. 0d. Cleansing of Persons Act, 189.7. The baths provided by the Borough Council under the above Act for the cleansing of verminous persons, were in constant use, The total number of baths given during the year was 4,651 (303 to adults and 4,348 to children). This total shows a decrease of 1,118 upon the number given during 1922. Of the 4,651 baths given, 1,998 were sulphur baths for scabies, and 2,653 for pediculi. The great majority of those persons presenting themselves for baths were children from the elementary schools in the Borough. The children received 4,318 baths, an increase of 1,025 upon the number given during 1922. The following are the Schools from which children were sen to the Cleansing Station, with the number of baths given Schools. Number Hot Baths. Cleansed. Sulphur Baths, Benthal Road 123 177 Berger Road 111 18 Church Street 2 20 College Lane 1 8 Craven Park 64 - Daubeney Road 309 27 Detmold Road 278 168 Enfield Road 1 39 Carried forward 889 357 69 Hot Baths. Sulphur Baths. Brought forward 889 357 Gainsborough Road - 6 Gayhurst Road 36 - Glyn Road 66 - Hackney Parochial 84 - Homerton Row 282 28 Lamb Lane 8 — Lauriston Road - 27 Mandeville Street 208 14 M'illfields Road 50 - Morning Lane 106 39 Newington Green — 62 Northwold Road 142 83 Orchard Street 98 — Percy Road 40 — Princess May Road 2 157 Queen's Road 23 — Rams 11 — Rushmore Road 118 66 St. Joseph's 28 54 St. Jude's — 44 St. Matthias 1 115 St. Michael's 20 — St. Paul's 00 St. Scholastica's 8 39 Sidney Road 108 77 Sigdon Road 110 318 Stoke Newington Parochial — 74 Wilton Road 122 18 Wordsworth Road 9 — Other young children 21 160 2,590 1,758 70 The following table gives particulars of the number, etc., of persons who were bathed and cleansed for parasitic disease at the Disinfecting Station during the year. January. February. March. April. May. June. July. August. September. October. November. December. Totals Receiving Hot Baths. Men 8 9 4 2 4 3 2 7 3 2 2 ... 46 Women ... ... 1 4 1 2 2 1 ... 3 2 1 17 Children 167 216 185 119 281 326 276 30 290 249 310 141 2590 Receiving Sulphur Baths. Men 14 7 14 8 13 7 11 3 5 12 4 1 99 Women 3 4 12 3 13 21 31 16 4 3 20 11 141 Children 167 202 225 225 112 113 148 78 111 117 109 151 1738 71 IV.—CAUSES OF SICKNESS. The special causes of sickness and invalidity are those resulting from miserable environment and adulterated and dirty food. The insufficiency of present methods for preventing infectious disease, in particular non-notifiable diseases in infancy and childhood, naturally results in enfeebled constitutions unable at any time to combat any additional stress. The high number of deaths from cancer, heart diseases, bronohitis, and the pneumonias is evidence of this, and it is worthy of note that there were 25 cases of suicide among Hackney residents during the year. V.—SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS, AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home— (a) General.—This is carried out in the Borough by the King's Home for Nurseswhoemploy a staff, including the Superintendent, of 12 trained nurses who attend at the houses of the sick, at such times as are necessary, to carry out skilled nursing. (b) For Infectious Diseases.—Arrangements made between the King's Home and the Borough Council for nursing selected cases of infectious disease, the agreed working being as follows:— 1. Nursing assistance is granted under the Maternity and Child Welfare scheme in cases of Ophthalmia Neonatorum, Puerperal Fever, Measles and German Measles, Whooping Cough, Epidemic Diarrhoea and Polio-Myelitis. One half of the money expended under this head is returned by the Ministry of Health. Except as regards Ophthalmia Neonatorum and Puerperal Fever no attempt is made to grant routine nursing assistance to any but emergency cases; by emergency I mean that only where representation is made by a member of my staff or by medical 72 practitioners that nursing is an urgent necessity is this assistance granted; the scheme does not permit the granting of routine nursing assistance. Of these diseases Ophthalmia Neonatorum, Puerperal Fever and Polio-Myelitis only are notifiable in this Borough. 2. Nursing assistance is granted under the various regulations, etc., to oases of Tuberculosis, Pneumonia, Dysentery, etc., and here again nursing assistance is only granted to those most urgently requiring this assistance. 3. The agreed amount to be paid to the nursing association is Is. 3d. per visit. 4. A return is rendered by the Superintendent of the King's Home for Nurses, giving the details of the cases nursed as regard-, name, age, sex, address, disease, number of visits made and amounts, if any, of contributions given to the Home by -those in charge of the patients nursed. 5. Where the patients or their relatives are able to make a contribution to the nursing association, the amount so contributed is deducted from the amount payable by this Council to the nursing association. 6. The amount estimated, which will probably be expended during the current year, under the (Maternity and Child Welfare heading is £100, and under the general nursing heading £80, making in all a total of £180 for nursing assistance. For information as to visits paid see page 97. Mid-wives.— There are no whole-time midwives employed by the CouncilThe fees of midwives attending the confinements of necessitous persons are paid as regards cases approved by the Maternity and Child Welfare Committee. There are 36 midwives practising in the Borough. 73 Clinics and Treatment Centres.— (a) Infant Welfare Centres. Name and Situation. Nature of Accommodation By whom provided. Wesleyan Church Schools, Mayfield Road, Dalston One weekly clinic (Doctor) Weekly weighing (Health Visitors Borough Council. Grove Mission, Brooksby's Walk, Homerton One clinic weekly (Doctor) Borough Council. All Souls' Schoolroom, Overbury St., Clapton Park Two clinics weekly (Doctor) Borough Council. St. Michael's Hall, North wold Road, Upper Clapton. One clinic weekly (Doctor Borough Council. Hackney Mothers' and Babies' Welfare, Mission House, 41, Hackney Grove (Voluntary Centre) One clinic weekly (Doctor) One weekly "weighing" (Health Visitors) Hackney Mothers' and Babies' Welfare, subsidised by Borough Council St. Martin's Mission, Ada Street (Voluntary Centre) One weekly "weighing" (Health Visitors) Eton Mission, Gainsborough Road, Hackney Wick (Voluntary Centre) One weekly clinic (Doctor) Eton College, subsidised by Borough Council. (b) Ante-Natal Clinics. Grove Mission, Brooksby's Walk, Homerton One fortnightly clinic (Doctor) Borough Council. All Souls' Schoolrooms, Overbury Street One weekly clinic (Doctor) Borough Council. Eton Mission, Gainsborough Road, Hackney Wick (Voluntary Centre) One fortnightly clinic (Doctor) Eton College, subsidised by Borough Council (c) Tuberculo sis. Metropolitan Hospital, Kingsland Road Tuberculosis Dispensary Borough Council. Victoria Park Hospital, Bonner Road, E.2. Tuberculosis Dispensary Borough Council. (d) School Clinics. Cleansing Station, Mill fields Road, E.5. Inspection and Treatment of skin conditions Premises by Borough Council, Staff by London County Council. Treatment Centre, Lower Clapton Road Minor ailments London County Council Orthopaedic Clinic, Dalston Lane Massage and remedial treatment British Red Cross 74 (e) Venereal Diseases. Name and Situation. Nature of Accommodation. By whom provided. Metropolitan Hospital, Kingsland Road, E.8 Treatment Clinic London County Council Hospitals provided or subsidised by the Local Authority or by the London County Council.— Name and Situation. | By whom provided. (1) Tuberculosis St. Joseph's Hospice for the Dying (33 beds for Tuberculosis), Cambridge Lodge, Mare Street This is a Religious Institution, but beds are obtainable by Local Authorities. In London residential treatment of tuberculosis is provided by the London County Council. (2) Maternity Salvation Army Mothers' Hospital, Lower Clapton Road, and (see below) City of London Lying-in Hospital, City Road Agreement with these two Institutions to pay sum of one guinea in respect of each necessitous case admitted from the Borough. A necessitous case is defined on page 96. (8) Children Agreement with the Invalid Children's Aid Association whereby this Association arranges convalescent aid undor the Maternity and Child Welfare Scheme. There is no Hospital for Children in the Borough. (4) Fever Eastern Fever Hospital, The Grove, Homerton This Hospital is the property of the Metropolitan Asylums Board. (5) Other Hospitals Metropolitan Hospital, Kingsland Road A General Hospital supported by voluntary contributions. It has accommodation for in- and out-patients. German Hospital, Ritson Road, Dalston Hackney Infirmary, High Street, Homerton Mission of Help to the Suffering Poor, Upper ClaDton Ditto. Maintained by the Hackney Board of Guardians. Assistance to aged and infirm. Medical and dental treatment in hosDital. In, eitutional Provision for Unmarried mothers, illegitimate infants and homeless children.— The following; institutions are subsidised by the Ministry of Health, but not by the Borough Council, with the exception of 75 the Salvation Army Mothers' Hospital, Clapton, and afford, in most instances, accommodation for both married and unmarried mothers. Name and Situation. Nature of Accommodation. By whom provided. Brent House, 27, Devonshire Road Home for 30 mothers and 18 babies Salvation Army. Cotland, 9, Amhurst Park Home for 33 mothers and 23 babies Salvation Army. Lore House I., 16, Rectory Road Home for 12 mothers and 8 babies Salvation Army. Lorne House II., 4 Clapton Common Home for 20 mothers and 14 babies Salvation Army. Mothers' Hospital, 1'53, Lower Clapton Road Maternity Hospital for 80 mothers Salvation Army. St. Mary's, 153, Stamford Hill Home for 24 mothers and 15 babies Church of England. Maternity Refuge, 6, Pembury Road Preventive and Rescue Aid—16 mothers and babies Church of England. Sapsworth House, 122, Lower Clapton Road Home for mothers and babies Salvation Army. Rescue Home, 181/183, Amhurst Road Home for 32 mothers and 18 babies Salvation Army. Ambulance Facilities.— (a) For infectious cases.—Provided by the Metropolitan Asylums Board. Ambulance Station: Eastern Hospital, Homerton Grove. (b) For non-infectious and accident cases.—The Council has repeatedly urged the establishment in Hackney of an ambulance station by the London County Council. MATERNITY AND CHILD WELFARE. The expenditure estimated to be met out of the rates during the coming year amounts to a little more than a halfpenny rate, which includes all salaries and expenses of every description. A comparison showing the percentage of expenditure attributable to the various details of the service for the previous year as compared with a similar table of percentages published by the Ministry of Health is of interest, although as Items Nos. 4, 7, 9 . and 11, are either not provided by this Borough, or very slightly, strict comparison is not possible. -Ministry of Health, 1922-1928. Hackney, Year ended March, 1923. £ Percentage of Total Expenditure. £ Percentage of Total Expenditure. 1. Medical Officers of Health and Assistant Medical Officers for Maternity and Child Welfare Work 103,524 % Medical Officer of Health 52 % .9 7.5 Centre Medical Practitioners 500 8.2 2. Health Visitors, etc. 420,399 30.4 2,182 35.7 3. Midwifery 51,805 3.7 67 1.1 4. Fees paid to Doctors called in by Midwives 28,596 2.1 - - 5. Nurses 16,248 1.2 73 1.2 6. Centres 147,510 10.7 *555 9.1 7. Day Nurseries 44,977 3.3 - - 8. Maternity Homes and Hospitals, Infants' Hospitals 206,446 15.0 267 4.4 9. Convalescent Homes 5,644 .4 19 .3 10. Milk and Food 280,946 20.3 *2,032 33.2 11. Home Helps 7,041 .5 1 - 12. Establishment and Miscellaneous Expenses 67,176 4.9 364 5.9 * net. £6,112 100,0 o 77 The ultimate costliness of the policy of permitting preventable disease to continue in order to avoid a present small expenditure is becoming more and more appreciated. Maternity and Child Welfare work is preventive; it prevents the development of the host of ailments that so greatly diminish industrial efficiency and cost the community vast sums in curative services. Prevention is not only better; it is cheaper than cure. It is fortunate that this view is spreading, although any extension of the preventive medical services always meets with the opposition that arose on the grounds of economy to their establishment in the first instance, and that still endeavours to hinder their successful performance. Many early resolutions recorded in this direction make interesting reading, for instance, a reference to the Public Health Committee in Hackney at the outset of an epidemic of small-pox, objecting to the coach hire of the Medical Officer, this particular London epidemic costing approximately half a million of money in hospital treatment alone. Also resolutions reflecting unfavourably on the temerity of officials who (have •condemned a water supply as compared with resolutions adopted after an epidemic of water-bourne disease has directed the attention of the country to the locality. Small-pox and Typhoid Fever are, of course, spectacular diseases as compared with Measles and other non-notifiable infectious diseases, but the cost to the country nevertheless of these latter is incalculable. It should be remembered that deficiency in any one respect interacts on other parts of a preventive scheme. Too few clerks results in Health Visitors doing clerical work. Too few Centres results in overcrowded Centres and three or four Health Visitors being required at each Clinic, and in the doctor being unable to see all those cases he should see. Too few Health Visitors results in no "following up," and attention only to curative instead of preventive work. Greenwich, for instance, where Measles, Whooping Cough and Zymotic Enteritis are notifiable is particularly well cared for as regards nursing, there being three 78 nursing institutions, the largest of these, the Ranyard Association, employing nine nurses in the Borough; it would be absurd to have these diseases notifiable in Hackney where no useful steps can be taken to combat their effects or prevent infection. Extension of Maternity and Child Welfare work in the following directions is urgently necessary— Adequate attention to non-notifiable diseases; Sufficient nursing assistance; Health visiting of ages 1 to 5 years; Sufficient clerical assistance Provision for treatment of minor ailments; Provision for dental treatment; Adequate Centre accommodation—Ante-natal and Child Welfare. At present attempts can only be made to deal systematically with the age period from birth to one year, and in this age period as regards Health Visiting only. The mortality for this period measured by the number of deaths under one year of age per thousand births, called the infantile mortality rate, during the years 1900—1923 has been as follows:— Year. Year. Year. 1900 158 1908 123 1916 84 1901 135 1909 113 1917 92 1902 121 1910 104 1918 1ll 1903 127 1911 120 1919 85 1904 155 1912 79 1920 81 1905 140 1913 99 1921 66 1906 123 1914 85 1922 72 1907 116 1915 107 1923 . . 58 79 The fall in death rates is a very poor indication of the actual saving to the community. At least three infants are crippled for each one that actually succumbs to insanitary environments within and without the home and to preventable disease; and the protection of these children by the measures that prevent the mortality is not appreciated. The increasing figures of attendances at the Centres and the fact that the Centres have become greatly overcrowded shows that their usefulness is appreciated by parents in spite of the inadequate and uncomfortable nature of the accommodation. Unfortunately, as will be shown later, the arrangements of infant life protection cannot, under existing circumstances, be extended up to the school age of 5, and even as regards the period from birth to the end of the first year the present measures are insufficient. Infectious Disease.—No attempt can be made under present conditions to control non-notifiable infectious disease, such as Measles and Whooping Cough, which are responsible for so much ill health. The school authorities forwarded notifications during the year of 796 children absent from school on account of Measles, and 299 children absent on account of Whooping Cough. It is 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. 80 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. The principal diseases to be considered under this heading are Measles and Whooping Cough. These, and some other infectious diseases principally affecting the infant population are compulsorily notifiable in some London Boroughs as, for instance, Greenwich. In Hackney no attempt can be made under present circumstances to do more than attend to cases brought urgently to the notice of the Public Health Department. There can be no systematic attempt to cope with the school notifications. As long ago as 1915 the Medical Officer of the Local Government Board, in an official memorandum on the subject of Measles, stated :— "Notification of cases of Measles by itself has only a statistical interest. Its practical value depends upon the extent to which the information is utilised in securing the coordinated adoption of all the measures available for preventing the spread of infection and for diminishing the mortality from the disease. Past lack of success in reducing; its mortality through notification has, in part at least, been dm to the failure to utilise all practicable measures in each case Very commonly, for instance, the only action taken has been to leave a leaflet of instructions and possibly to arrac;: for disinfection after recovery or death." This is exactly the procedure, as a general rule, in Hackney The memorandum states that each case should be recognised as 81 a means of discovering other cases. "Often it is among the un-reported cases that the chief risk of spread of infection and of a fatal result arises." More recently, in 1920, the Medical Officer of the London County Council reported on Measles, and stated:— "In my opinion the effective control of Measles depends upon the extent to which the existing machinery can be further perfected and closer co-ordination secured between the School Medical Officers and the Health services administered by the Borough Councils." A Conference of the County and Borough Councils was held in 1921 and Resolutions directed to bringing about more efficient control were adopted by the Conference, but the Council could not take action with the staff approved at that time by the Ministry of Health. For convenience of comparison two diseases, Measles and Whooping Cough, can be considered together when the small number of cases visited, as compared with the number notified from the schools, can be seen at a glance, as, of course, only the worst cases specially brought to the notice of the Department can be visited or nursed. Measles and Whooping Cough. 1922. 1923. Cases notified from Schools 2,605 1,095 Cases visited 24 180 Removed to Hospital 99 43 Nursed 24 17 Died 107 29 But there are several other important facts that this table does not disclose. The number of deaths gives no idea of the 82 permanent damage caused owing to lack of care of these diseases. Measles, for instance, is frequently considered to be the reason for the development of serious tuberculous infection, and whether it lights up a quiescent infection which the child was combating or leaves the child unable to cope with an infection subsequently received, as is sometimes thought to occur, is beside the question. What matters is the frequency, in the history of tuberculous infection, that "the child has never been right since it had the Measles." Measles also causes its deaths principally in the children below school age, many of whom very probably would not contract the disease or would certainly be sufficiently cared for if the school notifications were followed up; thus during 1922, 102 of the 107 deaths took place in children under 5, and last year 27 out of the 29 deaths were of children under school age. There have been 9 deaths up to February 27th of this year, all among children under 5 years of age, but, as already stated, deaths alone give no indication of the damage caused by these diseases. The number of cases notified in 1924 from the schools already has reached 863, and 75 cases have been removed to Hospital. Nursing Assistance.—The King's Home for Nurses under present arrangements will receive a sum (estimated) during the coming financial year, of £100 for nursing assistance granted under the Maternity and Child Welfare scheme, this payment by the Maternity and Child Welfare Committee being made on behalf of necessitous cases and as regards those families where the King's Home certify that no contribution towards the cost of nursing can be made by the family. For this money the nurses will pay 1,600 visits, all, be it noted, to urgent cases found at the Centres or brought to the notice of the Public Health Department by medical practitioners and others. 83 There is no attempt to search out and supply nursing assistance to all cases who may be greatly in need of this help. I have already given for previous years the figures showing the smallness of the number of cases that can be visited or nursed under present arrangements at the instance of the Maternity and Child Welfare Committee. No additional work can, I am informed, be undertaken by the present staff of the King's Home who number, including the Superintendent, 12 in all. It is now recognised that the present staff of this Institution are fully extended, and additional work on behalf of the Borough Council would require the appointment of additional staff. This Institution, in addition to the assistance they render to the Maternity and Child Welfare Committee, supply the London County Council, who have also, of course, a staff of whole-time nurses for the school medical service, with 2 part-time Clinic nurses, for which the Institution receives the sum of £360 per annum. An increased contribution of £400 would permit of an additional 6,400 visits, or of help being given at the Treatment Centre for a proportional period of time as regards visits not paid. This would require an additional sum of £200 to be met out of the rates. Age Period 1—5 years. The duties of the Health Visitors extend to every branch of the Committee's activities, thus applicants for milk assistance or Maternity and Child Welfare assistance may be interviewed at the Town Hall or at their homes, cases of infectious disease visited to see whether a nurse is required, or to insist on treatment and inspect the results of treatment as in Ophthalmia Neonatorum. In addition there are the Centre duties, arranging for Convalescent Aid or Home Helps, etc. 84 During 1923, 320 women received hospital midwifery or midwifery assistance in their homes on the instructions of the Committee; 4,921 milk applications were dealt with; 1,402 attendances by Health Visitors were made at the Clinics, including the Voluntary Centres where voluntary help is forthcoming (as at the larger Municipal Clinics, owing to the overcrowding, at least three Health Visitors must assist or chaos would result) and 18,607 visits were paid. Of this total number of visits only 7,879 were paid to children between the ages of 1 and 5. There is an average of over 5,000 births notified yearly in the Borough, and to these infants, 9,927 visits were paid, many infants, of course, requiring considerably more visits than others, so that the inadequacy of the number paid to the child population between the ages of 1 and 5 is obvious. In fact it is only immediately after the notification is received that systematic visiting can be attempted. This state of affairs, of course, reacts on other medical services ; large numbers of children contracting diseases of a preventable nature at the time that they should have been cared for by the Maternity and Child Welfare scheme. The Committee reported to the Council that a letter, dated July 11th, 1923, was received from the Ministry directing attention to the satisfactory manner in which the work, so far as is possible under present conditions, was being conducted, and requesting the appointment of temporary Health Visitors during the absence of permanent staff; much of the illness amongst the Health Visiting staff being possibly due to the excessive work required of them. The additional duties required of the Health Visiting staff, if the recommendation contained in this report were adopted, would necessitate the appointment of four more Health Visitors, at a cost of £818 at the present rate of salary, and of this sum £409 would fall upon the rates. 85 Clerical Assistance. The Public Health Department has always been understaffed, and this throws an unfair burden upon the present staff. This is the only department where a clerk cannot be detailed for correspondence, filing, and duties of similar nature alone, an appointment carrying with it, in other departments, a grading of Second Class. Where so multifarious a number of Orders, Regulations, and forms arising therefrom have to receive attention as in a Public Health Department, this duty is most important, and a great deal of difficulty at times arises from not having all this work in the same hands. It has been realised on previous occasions by the Public Health Committee that the clerical assistance in this Department was inadequate, and on April 27th, 1922, a recommendation was sent to the Establishment and General Purposes Committee requesting the appointment of an additional First Class Clerk for the Department. Much information that would be of great value in assisting the Committee in their duties of safeguarding the health of the community cannot be obtained. I cannot do better, for the information of the Council, than quote directly some of the more important suggestions relating to the investigation of vital statistics put forward by Sir George Newman, in the Ministry of Health Report of 1919-1920:— "Instead of accepting a total of, say 1,000 deaths and its resultant death-rate in a given area, we must proceed to analysis and differentiation in order to answer the following questions:— Wfiat is their distribution in sub-districts, streets, courts, alleys, slums? 86 What is their distribution in houses, tenements, and rooms, and what is the relation to soil or topographical situation? What influence does overcrowding and domestic sanitation bear to the deaths recorded? What influence is exerted on the death rate by diet, alcoholism and social and economic conditions of the family? What is the relation between occupation, industrial conditions and fatigue and the deaths of a district, and between the deaths and the factories, workshops, workplaces and homes where the occupation is followed? What is the number and character of the deaths due to conditions originating in childhood, or to heredity, diathesis or disposition of body? What is the number and character of the deaths which have occurred in the area which appear to be due in large degree to inadequate treatment?" There is also another very important source of information which is not being properly utilised at the present time—that is the information relating to sickness, as noted on the records of the consultation Centres, and this information should be available to assist in the general survey of all circumstances that is necessary before an accurate picture of sanitary environment can be formed. Attendances at the Centres should be filed in streets; notifications of births should be filed in streets; infantile diarrhoea, infantile deaths, etc., should be investigated and tabulated in the same manner, so that comparison as to streets, not only large wards, should be possible; it should be possible to get information 87 from routine returns as to what proportion of the mothers in crowded areas are using the Centres, and also to investigattmany matters concerning which at present no idea can be formed —such as, for instance, the mortality occurring among infants of the same sanitary environment, brought to the Centres, and others not reached by the work of the Centres. The present system does not permit of sufficient information being obtained on many vital matters affecting the health of the Borough, and this is particularly true as regards tuberculosis and maternity and child welfare. The present clerical staff are absolutely unable to cope with any additional duties. The Health Department is understaffed and the two evils necessarily resulting are that essential information cannot be obtained, and that the technical staff have clerical duties to carry out. An additional Fifth Class Clerk and the promotion of Mr. H. C. Bowman to Second Class with responsibility for the clerical work arising out of the new measures, would cause at present rates of salary an additional expenditure of £198, of which £99 would fall upon the rates. Treatment Centre. It is estimated that this building as planned would cost £2,350, including £202 for installation of lighting and heating. Equipment for Ante-natal Clinic, Treatment Clinic (for minor ailments, including skin conditions) and Dental Clinic, would amount to an additional £250. Half the money expended on equipment as well as the annual loan charge on the building, amounting, on £2,350 on a 30 years' loan at 4f per cent, interest, to £148 should be met by the Ministry of Health. 88 Dental Clinic.—Hackney is almost, if not quite, alone among the London Boroughs in failing to provide a Dental Clinic. The cost of providing dental treatment is trifling as compared with the costliness of dealing with the diseases and crippling that so often result from dental caries. The necessity of attention to oral sepsis and dental caries, if health is to be preserved, is so well known by now that it is not necessary to give any facts as to the amount of ill-health caused by neglect in this direction. Minor Ailments.—There is no treatment for ailments such as minor septic conditions, discharging ears, phimosis, naevi, neglected rickets, adenoids, skin ailments, etc. Massage for conditions supervening on paralytic infections (poliomyelitis) and rickets could also be carried out at the Centre. Ante-natal Clinics.—Three Ante-natal Centres, two of them fortnightly Clinics, is surely inadequate for a Borough of the size of Hackney. Millfields Road Treatment Centre would relieve Overburv Street of its excess attendances and would permit of an Antenatal Clinic being held for mothers attending Northwold Road Northwold Road Centre greatly needs an Ante-natal Clinic. These clinics are needed both in order to prevent injury and loss of maternal life in child-bjrth and also to prevent the loss of infantile life in the days immediately following confinement, which still remain to a considerable degree unaffected by present measures. The Medical Officer of the Ministry of Health has recently stated:— 89 "The death rate of women in child-birth remains approximately what it was 25 years ago, and we lose by death every year upwards of 3,000 mothers in the fulfilment of one of their principal and most vital duties to the State, a mortality almost entirely preventable. Then there is also a large volume of abortion, miscarriage, still-birth and ophthalmia neonatorum, much of it perfectly avoidable." Still-births in Hackney have certainly not diminished; the figures for last year were:— Number of still-births Number of registered Number of Still-births per 1,000 registered births. notified. live births. 5,065 134 26 In 1918, 108 still-births were notified and in 1919, 123 stillbirth were notified, being in that year equal to 23 per 1,000 notified live births. The Council will realise how insufficient three Ante-natal Centres are for the needs of the whole Borough when it is remembered that most of the mothers attending do so owing to the midwife having reason to suspect complications, so that the examinations cannot be too careful and attentive. Pregnant women will not attend a Centre where the conditions are unsatisfactory, and midwives, who very often attend with their patients cannot find time to do so when a large number of women have to be dealt with at each Clinic. Although under present conditions very little can be done as regards prevention of ophthalmia neonatorum, the Council will be interested to know that prompt following up and careful supervision by the Health Visitors of the 92 cases notified during the past three years has resulted in a perfect cure in every instance. 90 Child Welfare Centres. In the Borough of Hackney with its population of nearly a quarter of a million and a number of births averaging 5,000 annually, and containing over 100 miles of streets there are seven Welfare Centres (including one branch Centre at which a doctor does not attend), and at these Centres eleven weekly Welfare Clinics are held. At Hackney two of the Ante-natal Centres are only in use on alternate weeks, and of the 11 Welfare Clinics a doctor is only in attendance at seven. It is interesting to note in the 1922 Report of the Chief Medical Officer to the. Ministry of Health these two paragraphs ... 46. "Unfortunately, no similar improvement can be observed in the maternal mortality rate which, though some diminution has occurred in the relative number of deaths from puerperal sepsis, remains now as high as it was in the beginning of the century for 'accidents ' and other causes of death from child-birth. It is generally recognised that many of these deaths are preventable, and given adequate and skilled professional care a large proportion of them should not occur." 47. "The most successful results of maternity and child welfare work are thus seen in the improvement of the health of infants under one or two years of age. The care of the mother before and at the time of child-birth, and the care of the little child, say, from two years up to school age, have not been developed to anything like the same extent. This is largely due in the case of the mother to difficulties inherent in any general attempt to exercise supervision over the health of the pregnant woman, but it is also due to financial considerations which have prevented the maturing of schemes for ante-natal work. The supervision of children below school age has also been hampered through lack of staff and lack of accommodation." 91 Certainly this is a very accurate description of the state of affairs in Hackney; although there is considerable evidence, as already stated, to show that Hackney is far behind some Boroughs in the development of the service. Two additional Centres in the region of West Hackney and South Hackney Wards would be of the utmost value to the development and usefulness of the service. It is quite impossible to carry on these Centres on the lines laid down in M. & C. W. 14 of the Ministry of Health, where it is stated that " Not more than 30 or at most 40 children can ordinarily be dealt with at one session." The attendances at Overbury Street and Northwold Road are now in the neighbourhood of 100 at each session. There is no doubt that the congested condition of the Centre deters many persons in need of assistance and advice from attending. The cost to the rates of two additional Centres with one clinic at each Centre weekly would be £390. Summary of Additional Expenditure. Four Health Visitors at £204 12s. 0d £ 818 Clerical Staff (Fifth Class additional and promotion from Fourth to Second Class) 198 Two additional Centres (one session weekly) 390 Millfields Road Centre (Dental, Treatment and Ante-natal sessions, annual expenditure) 600 Annual loan charge on Building (30 years' loan at 4¾ per cent, interest on £2,350) 148 Equipment 250 Nursing assistance (District and Centre) 400 £2,804 92 Half only of this expenditure would be met by the rates, and this together with the amount already approved by the Committee for the coming financial year would give a rate of .66 of a penny for the entire service. Bearing in mind that Hackney has over 100 miles of streets and a larger population than 29 of the administrative Counties of England and Wales and 23 of the Boroughs and Cities of London, the total proposed expenditure is very moderate, and in fact essential if the Maternity and Child Welfare work of the Borough is to be efficiently performed. DESCRIPTION OF THE WORK DURING THE PAST YEAR. The work carried out during 1923 can be conveniently reported under the following descriptive titles:— 1. Health Visiting; 2. Consultation and Ante-natal Clinics; 3. Provision of Hospital Treatment, Convalescent Home Treatment, Midwifery Assistance, Home Helps; 4. Nursing assistance; 5. Provision of milk and other foods to necessitous mothers and children. 1 .—HEALTH VISITING. The following table gives details of the visits made by the Health Visitors during the year:— 93  Miss M. Chitson Mrs. A. Rhodes Miss D. F. Vidal Mrs. L. E. Bartholomew Miss S. Love Miss A. Roche Miss E.D. Mann. Mrs. L. Harrison Miss M. Cockle Miss K. Teebay (temporary) Miss E. Whelan (temporary) Eton Mission (voluntary) Hackney Grove (voluntary) Totals. Number of visits to infants under 1 year of age (first visits) 270 253 597 272 246 355 374 211 368 262 258 276 390 4,132 Secondary visits to infants under 1 year of age 677 455 521 295 199 387 253 253 507 133 82 1,253 780 5,795 Number of visits to children 1-5 years of age 1,122 490 828 590 380 424 856 409 485 133 259 1,216 687 7,879 Total number of infants and children visited 2,069 1,198 1,946 1,157 825 1,166 1,483 873 1,360 528 599 2,745 1,857 17,806 Number of visits to tant mother 77 42 93 26 9 80 61 66 62 11 24 222 28 801 INFECTIOUS DISEASES— Total visits to Ophthalmia Neonatorum cases 8 10 11 19 4 8 5 12 7 2 4 13 1 104 Total visits to Puerperal fever case - - - - - - 8 - 1 - - - - 9 Total visits to Measles and German Measles Cases 3 3 20 2 3 8 20 28 1 - - - - 88 Total visits to Whooping Cough cases 14 14 39 1 8 8 20 3 1 - - - - 108 Total visits to Epidemic Diarrhoea cases 4 4 - 2 5 6 4 16 5 - - - - 46 Total visits to Poliomyelitis cases - - 1 - - - - - - - - - - 1 Number of special visits 33 46 76 77 - 40 40 148 38 76 58 70 - 777 Number of fruitless visits (outs, removals, etc.) 231 92 377 380 209 114 71 15 367 159 218 935 556 3,724 Total number of visits paid during the year 2,439 1,409 2,563 1,664 1,138 1,430 1,712 1,161 1,842 776 903 8,985 2,442 23,464 Total number of Clinics attended during the year 120 88 117 45 131 136 136 151 40 64 54 114 103 1,299 94 Conditions Found by the Visitors. No. of Method of Feeding. Separate cot provided for Infant. Use of Comforter. Home conditions. ■Sfi Infants visited. Breast Arti- ... , a . , Mixed, ncial. Yes. | No. Yes. No. O . Satisfac tory. Unsatis factory. 0.2 a > !/) 4132 3441 430 261 2590 1542 2187 1945 3724 408 13674 2.—INFANT CONSULTATION AND ANTE-NATALCLINICS. 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 supennsion 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. 95 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. >0—1I/KK. 51 51 230 262 2,979 3,175 3,209 3,437 2,103 1,923 1,106 1,514 1 Brooksby's Walk 1 Mayfield Road j pr°^yX ( Northwold Road 51 47 50 51 451 65 372 376 4,322 989 3,622 5,334 4,773 1,054 3,994 5,710 3,598 649 2,821 3,720 1,175 405 1,173 1,990 S'Hackney Mothers' and Babies', Hackney Grove ... Do. Ada Street 103 51 216 77 2,630 714 2,846 791 f- 2,714 923 ... . i Wednesday & Eton Mission j pr;day 49 50 216 1,069 2,105 1,069 2,321 | 2,716 674 Totals 554 2,265 26,939 29,204 20,244 8,960 •These are Voluntary Centres and are co-ordinated with the Infant Welfare work in the Borough. The Hacknev Mothers' and Babies' Welfare Centre receives an annual grant of £250 from the Council, and the Eton Mission Centre £100. Ante-Natal Welfare Centres. Centre. No. of times Centre opened No. of expectant mothers attending No. of repeated attendances at Centre Total attendances 1 Overbury Street 51 530 935 1,465 2 Brooksby's Walk 26 155 141 296 3 "Eton Mission 26 95 112 207 Totals ... 103 780 1,188 1,968 •Voluntary Centre. 96 3.—HOSPITAL, CONVALESCENT 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, 1922. Necessitous Cases. Cases. Cost. Salvation Army Mothers' Hospital 144 £151 4 0 City of London Lying-in Hospital 89 93 9 0 233 £244 13 0 (2) Agreement jor the Provision of Convalescent Home Treatment. An agreement has been entered into, with the sanction of the Ministry of Health, with the Invalid Children's Aid Association, whereby the Association arranges, on behalf of the Maternity and Child Welfare Committee, convalescent aid under the Council's Maternity and Child Welfare scheme. The Maternity and Child Welfare Committee, under this arrangement, is not required to meet any cost other than that the parent is unable to contribute towards the actual cost of the treatment provided at the Convalescent Home. The number of cases assisted during the year was 16. (3) Provision of Midwives.—During the year the fees of midwives in attendance on 78 mothers confined in their homes were paid by the Council and in 4 cases Home Helps were provided. 97 i.—rNURSING ASSISTANCE. As already stated, only a fraction of the cases have been dealt with. No. of cases No. of visits nursed. paid. Pneumonia 16 259 Whooping Cough 2 29 Measles 15 232 Diarrhoea 2 11 Ophthalmia Neonatorum .. 7 85 Post Confinement, etc. 70 862 Totals .. 112 1,478 5 .—PROVISION OF MILK AND OTHER FOODS TO NECESSITOUS MOTHERS AND CHILDREN. In each case dealt with, every form of assistance Vas 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 £1,969 10s. 4d. The applications dealt with for milk numbered 4,291, and those for milk food amounted to 630. Dried Milk, Foods, Medicines, etc. (a) Supplied free of charge to necessitous mothers :— £ s. d. Glaxo Cow and Gate Virol Marylebone Cream ... Cod Liver Oil and Malt Sundries 120 115 24 9 7 0 1 10 2 0 0 4 26 17 1 20 8 9 £315 17 0 g 98 (b) Supplied at cost price :— Glaxo Cow and Gate Virol Lactagol Marylebone Cream Petroleum Emulsion Syrup Ferri Cod Liver Oil and Malt Sundries £ s. d. 820 12 4 760 8 8 139 3 0 12 7 6 54 14 9 38 2 2 13 6 11 49 12 10 85 10 5 £1,973 18 7 VI —LABORATORY WORK. Arrangements have been made with the Camberwell Research Laboratories and the Royal Institute of Public Health for bacteriological examinations at the following charges :— Camberwell Research Diphtheria swabs 3s. Od., sputa 3s.0d., Laboratories. blood of suspected Enteric Fever cases 3s. 6d. plus charges for telephone and telegraph, the Laboratories providing outfit. Royal Institute of Public Health. Diphtheria swabs, sputa and blood 3s. Od. plus telephone and telegraph charges. Council charged for outfits. Special Examinations 1 to 2 guineas. Full details of bacteriological examinations during the year will be found under the heading of Infectious Diseases. Diphtheria Antitoxin. Arrangements have been in force for some time past in this Borough for supplying Diphtheria Antitoxin to medical practitioners on request. 99 Antitoxin can be obtained at any time by a medical practitioner on applying to this department during office hours, and after office hours to the resident hall porter. It has been my experience that not only is the mortality increased by delay in injecting antitoxin but that paralytic and other complications are far more likely to occur. A circular memorandum as follows was sent in February, 1922 to the medical practitioners in the borough and a copy is issued with each dose of antitoxin:— "The Ministry of Health suggest that Medical Officers of Health should arrange to send out with each phial of antitoxin a slip stating that the whole of the contents of each phial of 8,000 units of antitoxin should be regarded as ordinarily constituting a single dose for a patient of any age. The 'Ministry state that 'Experience has shown that for the purposes of treatment it is seldom safe practice to rely on any dose which is less than 8,000 units, whatever the age of the patient may be. The magnitude of the initial dose and the occasions on which subsequent closes are given must be determined by close observation of the case, and it is impossible to lay down a stereotyped procedure. As an indication it may be stated, especially from the experience of Metropolitan Asylums Board Hospitals, that when in a case seen early in the attack an initial dose of 8,000 units (16,000 or more if the case is severe), is followed by definite improvement at the end of about 12 hours, further administration of antitoxin is unnecessary. On the other hand, if at the end of about 12 hours (or sooner in urgent cases), there is no evidence of improvement, or it is clear that the disease is advancing, a second dose of similar magnitude should be given, followed by a further dose if no distinct improvement occurs. 100 Larger initial doses, e.g., from 16,000 to 30,000 units, are specially required when for any reason the administration of antitoxin has been delayed until the third or fourth day from the onset. The need for further administration will be determined by the progress of the disease, on the lines just indicated.' " The Circular, however, did not result in many additional applications, the total doses applied for, both for curative and prophylactic purposes, being 129. In 1920 when the Asylums Board were pressed for accommodation during the last quarter of the year, medical practitioners were advised to administer the maximum dose of antitoxin, but even in that year only 82 bottles of antitoxin of 2,000 units each were requisitioned. The number of applications last year was still less, only 56 bottles of antitoxin of 8,000 units each being supplied to medical practitioners. VII.—SANITARY ADMINISTRA TION. HOUSINC AND WORK OF SANITARY INSPECTION. Year. Public Health (London) Act, 1891. 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 1922 6,713 1,207 95 1923 6,553 1,376 42 10 Rent and Mortgage Interest (Restriction) Acts 1920 and 1923. The number of certificates granted under the Increase of Rent and Mortgage Interest (Restriction) Acts during the year was 12. In 9 cases the work required on the notice was carried out without action being taken. In 2 cases action was taken and the work carried out. In one case the work was done bv the tenant who had purchased the premises. In 5 cases certificates were applied for but were not granted, the repairs required having been carried out. Under Section 5 of the Rent and Mortgage Interest (Restriction) Act, 1923, it is not now necessary for the tenant to take proceedings at the County Court, but a copy of the certificate must be served on the landlord, who may, if the work is completed satisfactorily, obtain a certificate to this effect from the Sanitary Authority on payment of one shilling. London County Council (General Powers) Act, 1904. During the year attention was drawn by the Medical Officer (Education) of the London County Council to 150 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. 150 28 32 90 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 present. 102 In addition, 365 houses were discovered to be verminous under conditions where neither tenant nor owner could be shown to be directly responsible. The rooms in these houses, numbering 575, were cleared of vermin by the Public Health Department. Rats and Mice Destruction Act, 1919. Approximately 300 complaints were received during the year of premises being infested with rats. These complaints were effectually dealt with in most cases by the Sanitary Inspectors, having defective sewers, drains and sanitary fittings renewed or repaired. In 60 cases it was necessary to serve notices under the Rats and Mice (Destruction) Act, 1919, upon the owners or occupiers. Twenty-five premises were cleared under the agreement with Messrs. Howard & Son, (Ratcatchers), under the supervision of the Council's Sanitary Staff. 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. SANITARY INSPECTION. Public Health (London) Act, 1891. (a) Complaints of Nuisances.—During the year 1923 there were 4,273 complaints of nuisances made to the Public Health Department and investigated by the Sanitary Inspectors of the Borough. Defects or nuisances were discovered in 3,427 of the complaints. Notices for the remedy or abatement of these were served upon the owner or person responsible under the above Act. 103 Drainage. Plans for reconstruction of drains under notice and supervision of the Sanitary Inspectors at 239 premises were reported to the Public Health Committee during the year. Smoke Nuisance. In addition to observations made by the Sanitary Inspectors, 347 observations were made of chimneys of large works in the Borough by an Assistant detailed for that purpose, as regards the abatement of Smoke Nuisance. Dangerous Structures. Complaints of alleged dangerous structures at 183 premises were forwarded to the London County Council during the year. Water Fittings. Complaints of defective water fittings at 171 premises were forwarded to the Metropolitan Water Board during the year. (b) Infectious Diseases.—The occupied dwellings inspected during the year after infectious disease numbered 1,085. This is a decrease of 388 upon the number inspected during 1922. Any nuisances or sanitary defects found were dealt with under the provisions of the above Act. (c) Inspections.—The number of inspections, other than those arising on complaint, made by the Inspectors during the year was 2,002. 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 1923 was 6,553. The number of statutory notices served was 1,376; and summonses were issued in 42 cases. 104 (d) 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 2 cwts. 3 qrs. 21 lbs.; Meat 1 qr. 23½ lbs.; Cake 4 cwts. 17½ lbs. Fruit, 14 cwts. Prosecutions under the Public Health (London) Act, 1891, during the year 1923. Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. 6, Queen Ann Road General insanitary condition Withdrawn (Work done.) - 1 12 6 14, Ridley Road do. do. ,, ,, - 1 5 0 25, do. do. do. ,, ,, - 1 5 0 299, Kingsland Road do. do. ,, ,, - 1 3 0 205, High Street, Homerton do. do. ,, ,, - 1 5 0 205, Wick Road do. do. ,, ,, - 1 5 0 240a, Amhurst Road Roof and gutters defective ,, ,, - 2 2 0 la, Colvestone Crest. Workroom dirty ,, ,, - 2 2 0 Connell's Laundry, Lea Valley Smoke Nuisance Order to abate in 42 days - 3 3 0 220, Wick Road Cake exposed for sale in shop unfit for food Ordered to pay - 3 3 0 do. do. Cake deposited for sale in store unfit for food See above summons - do. do. Cake deposited for the purpose of preparation for sale in the bakehouse unfit for food ,, ,, - 32, Sandringham Road Rear gutter defective Withdrawn (Work done.) - 1 1 0 Carried forward - 19 6 6 105 Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. brought forward - 19 6 6 70, Welbury Street Roof and W.C. Withdrawn - 0 10 6 4, Frampton Pk. Rd. defective Vent, pipe defective (Work done) „ „ - 0 15 6 26, Moresby Road Roof defective, drain choked Order to abate forthwith. - 182, Stoke Newington Road No proper sanitary accommodation for Fined 7 0 0 3 3 0 26, Moresby Road sexes Non-compliance with Magistrate's order Fined 2 0 0 1 11 6 34, Victoria Park Road Rooms exposed to weather owing to flank wall being Order to abate in 28 days - 1 1 0 23, Fortescue Avenue removed Wall damp; stove defective Withdrawn (Work done.) - 2 2 0 27, Gransden Avenue Roof of W.C. tive „ „ - 2 2 0 34, Groombridge Road General insanitary condition „ „ - 0 10 6 44, Lauriston Road do. do. „ „ - 0 10 6 117, Well Street Rooms dirty; W.C. defective Order to abate in 21 days. - 1 1 0 8a, London Lane Smoke Nuisance Withdrawn - 2 2 0 17, Presburg Street General Insanitary condition (Nuisance abated) Order to abate in 21 days - 1 1 0 19, Presburg Street General Insanitary condition Order to abate in 21 days - 1 1 0 21, Presburg Street do. do. „ „ - 1 1 0 44, Malvern Road Sink waste pipe defective Order to abate forthwith - 1 1 0 15, Urban Place General insanitary condition Order to abate in 7 days - 1 1 0 16, Urban Place do. do. „ „ - - 15, Gransden Avenue do. do. „ „ - 1 1 0 29, Andrews Road W.C. choked; dustbin defective Withdrawn (Work done.) - 0 10 6 39, Hindrey Place Windows defective „ „ - 1 11 6 41, Hindrey Place Roof defective; window sash and „ „ - 1 11 6 Carried forward 9 0 0 44 15 6 106 Address. Complaint. Magistrate's Decision. Fine. Costs. Brought forward £ s. d., f. s. d. 9 0 0 44 15 6 18, Duncan Square Roof defective Withdrawn (Work done) - 1 1 0 19, Welshpool Street General insanitary condition „ „ - 1 1 0 199, High Street, Homerton Rooms dirty; roof and gutter defective „ „ - 1 5 0 44, Malvern Road Non-compliance with Magistrate's order Fined. 5 0 0 2 2 0 220, High Street, S. Newington (Slaughterhouse) Blood of slaughtered animal allowed to enter drain Ordered to pay - 2 2 0 118, Brougham Road Roof defective Order to abate in 14 days. - 1 11 6 92, Richmond Road Roof and gutters defective „ „ - 1 11 6 £14 0 0 £55 9 6 Housing and Town Planning Regulations. A systematic inspection is being made and an accurate card indexed record compiled of the housing conditions of the Borough. The number of houses inspected under these regulations during the year was 1,709. Factory and Workshop Act, 1901. Factories.—During the year, 181 inspections were made of factories and 2,469 of workshops by the officers of the Public Health Department. In 138 of these premises the sanitary accommodation was defective, unsuitable or insufficient, or not separate for the sexes. Nuisance. Found. Abated by Workshop Inspector. Abated by District Inspector. Outstanding. Unsuitable or defective w.c.'s 120 121 3 3 Insufficient w.c.'s 7 7 - Not separate to sexes 11 5 3 3 Other defects 274 223 79 107 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 generally, millinery, hats, 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 1923, was 874, a decrease of 7 on the number registered at the end of 1922. Of this total, 650 were workshops in which females were employed. Of these latter, 427 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, etc., 194 in which other articles were manufactured, etc., and 29 were domestic workshops. Amongst the workshops in which wearing apparel is manufactured, there were 255 in which females alone and 172 in which both males and females were employed. In workshops of other occupations, there were 103 in which females alone, and 91 in which both males and females were employed. Of the domestic workshops, females alone were employed in 16, and both males and females in 13. 108 During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints—Factories 5 Complaints—Workshops 7 Notices—Workshops 22 Analysis of Occupations Carried on in the Registered Workshops of Hackney. (a) Wearing Apparel. No. of No. of Occupations. Work Worksshops. Occupations. Workshop Artificial Flower Makers 5 Infants' Millinery 3 Baby Linen 1 Mantles 40 Blouses 30 Millinery 30 Boot and Shoe Manufacturers 100 Shirts 3 Stays 5 Boot Machinists 12 Tailoring 93 Children's Costumes 9 Ties 22 Clothing 9 Trimmings 11 Collars 1 Underclothing 6 Dressmakers 77 Vests 4 Dressing & Tea Gowns 2 Waterproofs 3 Fancy Bows on Shoes 3 - Furriers 65 536 Hats 2 - (b) Other Occupations. Bakers & Confectioners 39 Rag Sorting 4 Baskets 5 Rubber Goods 2 Box Makers 12 Toy Makers 11 Brush Makers 8 Trunk & Bag Makers 8 Cabinet Makers 62 Umbrella Makers 3 Doll Manufacturers & Upholsterers 10 Dressers 5 Upholsterers' Trimmings 1 Fancy Leather Goods 24 Miscellaneous 104 Laundries 26 Pianoforte Makers 14 338 109 During 1923, Miss Teebay, the Workshops Inspector, made 2,194 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections, 221 intimation and 25 statutory notices were served for the abatement of the nuisances found. The Factory and Workshops Act, 1901. Factories, Workshops, Workplaces and Homework. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Inspections. Number of Written Notices. Prosecutions. Factories (Including Factory Laundries) 181 47 - Workshops (Including Workshop Laundries) 2,459 420 2 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 10 - - Total 2.650 467 2 110 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 160 193 ... 1 Want of ventilation 16 15 ... ... Overcrowding 12 8 ... ... Want of drainage of floors ... 1 ... ... Other nuisances 69 68 ... ... Sanitary accommodation— ... ... ... ... Insufficient 7 7 ... ... Unsuitable or defective 120 134 ... ... Not separate for sexes 11 8 ... 1 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) 16 16 ... ... Other offences 1 1 ... ... (Excluding offences relating to outwork which are included in Part 3 of this Report.) ... ... ... ... Total 412 451 ... 2 •Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 111 3.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Total number of Workshops on Register 874 4.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Acts, 1901, (S. 133) 35 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Acts, 1901, (S. 5.) Notified by H.M. Inspector 12 Reports (of action taken) sent to H.M. Inspector 7 Other — Underground Bakehouses (S. 101):— In use at the end of the year 49 112 5.—HOME WORK. Nature of Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108 Outwork in Infected Premises, Ssctions 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. Falling to send Lists. Lists. Outworkers. Lists. Outworkers. Con* tractors Workmen. Con. Iraciors Work men. Wearing Apparel— (1) Making, &c. 298 98 2505 23 1 75 239 ... ... ... ... ... ... ... ... (2) Cleaning and Washing 2 ... 2 ... ... 2 ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets 4 ... 15 ... ... 2 ... ... ... ... ... ... ... ... Furniture and Upholstery 8 10 120 1 ... 15 6 ... ... ... ... ... ... ... ... Fur Pulling 10 ... 15 1 ... 1 12 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers 6 ... 52 1 ... 4 11 ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... 1 ... 3 3 ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper Bags 24 ... 287 1 ... 6 17 ... ... ... ... ... ... ... ... Brush Making 20 ... 382 1 ... 14 ... ... ... ... ... ... ... ... Stuffed Toys 4 ... 20 1 ... 3 3 ... ... ... ... ... ... ... ... Basket Making ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas crackers, Christmas stockings, Ac ... ... ... 3 ... 15 3 ... ... ... ... ... ... ... ... Totals 376 108 3398 33 1 122 312 ... ... ... ... ... ... ... ... 113 Outworkers.—The number of outworkers on the register at the end of 1923 was 2,492, against 2,601 at the end of 1922. There were thus 109 outworkers removed from the register during the past year. The following analysis shows the trades followed by these outworkers:— Trade. of Outworkers. Trade. No. of Outworkers. Artificial Florist 70 Fur Trade 83 Baby Linen 25 Gaiters 8 Belts and Bags 12 Hats 4 Blouses 170 Hosiery 4 Boots and Shoes 531 Lace Goods 12 Boxes and Paper Bags 187 Leather Goods 9 Braces 6 Mantles and Costumes 229 Brushes 205 Millinery 114 Children's Costumes 21 Pyjamas and Shirts 34 Children's Millinery 30 Shoe Bows 47 Christmas Crackers, etc 24 Skirts 9 Clothiers & Outfitters 81 Tailoring 141 Collars and Bibs 10 Tennis Ball Covering 8 Confectionery Packing 11 Ties and Neckwear 130 Corsets 2 Trimmings 91 Dolls and Toys 12 Umbrellas 10 Dressing Gowns 18 Underclothing 60 Dress Making 13 Upholsterers' Trimmings 21 Embroidery 12 Miscellaneous 20 Fancy Goods 12 2,492 Feather Trade 6 2,410 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 H 114 outworkers sent in by employers in this Borough, addresses of 1,630 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 1923, Miss Portlock, the Inspector appointed for the inspection of Outworkers' premises, made 1,283 inspections and 1,082 re-inspections. She also made 362 visits, without inspections, the outworkers having left the premises (56), or having given up home work (114), or being out at the time of visit (146), or owing to a wrong address being given (29), or the premises being workshops (8), or the outworkers having died (9). Miss Portlock also discovered 6 new workshops and handed in their addresses for registration. During her visits of inspection she found 389 premises with sanitary defects. For the abatement of these she served 294 intimation, 49 final, and 5 statutory notices. Of the 1,283 premises inspected, in only 18 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 62 ,, ,, and living room 53 ,, ,, ,, kitchen 102 ,, and kitchen 884 ,, ,, bedroom 141 ,, ,, parlour 16 ,, ,, scullery 6 ,, ,, bath room 1 ,, provided separately 18 1,283 115 FOOD. At the present time local authorities can only endeavour, very inadequately, to protect the public against contamination of two articles of food—meat and milk. The Bye-laws and other legal powers relating to food are directed to securing ordinary sanitation of the premises; food obviously dangerous to the public can be seized, but there are practically no powers to prevent the [preparation of food in such a manner that it is really dangerous to the public health, while after treatment, appearing sound to ordinary inspection, if inspection should come that way. As regards the milk supply it is suggested that all milk diould be partially cooked or sterilised in order to kill disease germs, milk containing cooked disease germs instead of clean milk being the highest attainable ideal, and the percentage of Tuberculous milk detected in the London supply varying from 3 to 10 per cent, of samples. One would think it obvious, for instance, that tuberculous persons should not be engaged in handling food stuffs that are to be consumed uncooked, but there is nothing to prevent this. I reported on a recent case as follows:— 10th December, 1923. "A case has recently been reported in the newspapers of a man, engaged as a milk roundsman, who collapsed in the street in Hackney and died from pulmonary tuberculosis, and the statements made by the Coroner and the Home Office Pathologist, accrding to the newspaper account, are as follows:— 'Dr. R. M. Bronte, the Home Office Pathologist, said he should have thought that an ordinary medical examination would have revealed the state of the man's lungs, as the disease was well marked.' 116 The Coroner, (Dr. Edwin Smith): 'Being a milk-roundsman, that is not a very pleasant thing to reflect Upon.' Dr. Bronte: 'No, anything but thait, when it is a case of a man delivering milk, for every time he coughed or sneezed he would be disseminating the tubercle. It was a very undesirable occupation both from his own point of view and also that of the public safety.' "This was not a notified case, and was therefore unknown to the Public Health Department, but the Committee are possibly unaware that beyond asking the man to relinquish his work as a milk-roundsman no steps could have been taken to protect the public even if the case had been notified, even though, as also reported to have been stated by Dr. Bronte—' There must have been coughing and sneezing for months, and a consequent dissemination of germs.' Powers of the Public Health Authorities. "The Local Authority can now enforce notification. Notification was at first permitted as a voluntary measure, but in Sheffield a local Act, permitting of compulsory notification of Pulmonary Tuberculosis was passed, subject to the proviso that none of the sections in the Public Health Acts relating to infectious diseases should apply to Tuberculosis. In 1908, under the powers contained in the Public Health Acts 1875 and 1896 and the Public Health (London) Act, 1891, the Local Government Board issued an Order requiring the Medical Officers of Poor Law Authorities to notify Pulmonary Tuberculosis coming under the care of the Guardians. "In 1911 an Order was issued requiring the notification of cases of Pulmonary Tuberculosis occurring among in-patients and out-patients at hospitals or similar voluntary institutions, and in 1912 an Order was issued consolidating and amending the 117 existing Regulations and requiring notification by medical practitioners generally of all forms of Tuberculosis, but the powers of the Public Health authorities in preventing infection by tuberculous persons remain purely persuasive, being circumscribed by Article XVI of the Public Health (Tuberculosis) Regulations, 1912, which is as follows:— 'Exception and application of Enactments. Article XVI.—Nothing in these Regulations shall have effect so as to apply, or so as to authorise or require a Medical Officer of Health or a Local Authority, or any other person or authority, directly or indirectly, to put in force with respect to any person in relation to whom a notification in pursuance of these Regulations has been transmitted to a Medical Officer of Health any enactment which renders the person, or any one in charge of the person, or any other person, liable to a penalty, or subjects the person to any restriction, prohibition or disability affecting himself, or his employment, occupation or means of livelihood, on the ground of his suffering from Tuberculosis.' Recent Consideration of this Question. "This question of tuberculous persons engaged in the milk trade has recently been the subject of a questionnaire to Medical Officers of Health in London, and it is evident from the summary of replies circulated by the Medical Officer of Health of Hampstead, that 'persuasion' remains the only means of dealing with these cases. "The Medical Officer of Health of Greenwich has recently had difficulties in dealing with a Tuberculous milk-roundsman, persuasion having proved useless, and the matter was referred to the Ministry of Health who find themselves unable to suggest any useful method of dealing with a Tuberculous milk-roundsman who refuses to be persuaded to change his occupation. 118 Conclusion. "It will be noticed that Tuberculosis is excluded from the -usual administrative procedure that is possible as regards other infectious diseases owing, of course, to the character of the disease, its chronic nature in many instances, and the hardship that would result to Tuberculous persons if Tuberculosis were treated as an ordinary infectious disease. "Notification, its-elf, was only introduced very gradually, and the results of notification in each particular class carefully considered before further advance was made. Article XVI, moreover, of the Public Health (Tuberculosis) Regulations, 1912, expressly protects the tuberculous person from hardship, but exposes the public to the hardship of permitting easily infected foodstuffs to be purveyed by infectious persons. "Since the date of these Regulations, however, public opinion has probably undergone a change in the direction of realising the danger that arises from lack of care as regards the handling of foodstuffs; and it is now probable that a modification of the Regulations in the direction of preventing higHy infectious tuberculous persons from remaining in such an occupation as that of a milk-roundsman would be welcomed by the public. "I suggest to the Committee that it is now time that the Ministry of Health make this very desirable and necessary change in the Regulations governing the control of Tuberculosis." 119 As there is no registration except of milk dealers, and as regards those occupations mentioned in the following table as being regulated by bye-laws, a great deal of food must be prepared under filthy conditions even as regards general sanitation, but in addition adulteration and the disguising of deterioration has become a highly scientific proceeding, and as regards adulteration, the absence of standards on which proceedings can be successfully taken very materially limits the process of sampling. District Numbers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Totals. Food Premises Regulated by Bye-Laws— Ice Cream Premises 13 6 20 26 18 12 19 26 6 18 6 11 9 28 218 Fried Fish Premises - 2 3 5 8 1 5 6 4 7 7 1 3 10 62 Slaughterers of Poultry — 2 - — — — — 1 — — — — — 4 7 Slaughter Houses (Cattle) 1 4 1 — 2 1 — 1 3 — 1 1 4 19 Cowhouses 1 — — — 3 — 1 2 — — — — — 2 9 Purveyors of Milk— 16 16 7 28 45 20 23 33 19 25 22 8 26 20 308 Other Food Premises— Coffee Houses, etc. 5 6 9 13 12 4 21 12 10 26 10 8 1 30 167 Bakehouses (above ground) 7 6 1 3 6 1 4 3 5 11 7 — 1 2 57 (underground) 1 4 4 5 5 4 4 5 2 2 — 2 1 10 49 120 For instance, under the Sale of Food Order, 1921, made by the Board of Trade, standards were fixed as regards the comiposition of jam, marmalade, and the composition of dripping, margarine, and the edible fats. Circular 225, from the Ministry of Health, accompanying the order stated:— "The Minister is aware that in the past local authorities have occasionally experienced difficulties in dealing with cases of excessive water in dripping, lard substitutes, etc., and it is hoped that the present Order by specifying a definite maximum percentage, will assist in the removal of these difficulties. Similarly, the provisions of the Order prescribing a standard of composition for jam and marmalade will be found useful." Unfortunately the parts of that Order relating to the standards for these foodstuffs were within a few months revoked, but it cannot be denied that standards on which proceedings could be successfully taken are required as regards most of the common articles of diet. In my report for last year it will be seen that one sample of coffee, three of dripping, four of malt vinegar, and one of vinegar were, in the opinion of the Analyst, adulterated, but the difficulty of obtaining convictions in these cases is so great that sampling is almost a useless proceeding. Briefly the state of affairs is most unsatisfactory as regards:— Contamination of food during preparation for sale, Addition of Preservatives, Absence of standards as regards adulteration. 121 Sale of Food and Drugs Acts, 1875-1907. Samples purchased during 1923. Articles Purchased. Number purchased Number Adulterated Number where Proceedings taken Milk 641 28 14 Do. (separated) 3 — — Do. (sterilized) 20 — — Margarine 46 1 — Cocoa 19 — — Lard 12 — — Coffee 20 1 — Pepper 9 — — Mustard 3 — — Do. (compound) 3 — — Olive Oil 11 — — Custard Powder 3 — — Baking Powder 5 - — Medical Prescriptions 15 3 3 Butter 51 — — Gin , 3 — — Rum 2 1 1 Whisky 3 1 — — Cornflour 6 — — Arrowroot 9 — — Cream (preserved) 8 — — Do. (sterilized) 1 — — Cream 8 2 — Breakfast Sausage 1 — — Totals 900 36 18 122 Prosecutions under the Sale of Food and Drugs Acts during the year 1923. No. of Sample Article Adulteration or Offence Result of Legal Proceedings Fine Costs £ s. d. £ s. d. IP Milk 6-7% fat abstracted Ordered to pay 2 2 0 3P ,, 3■ 3% fat abstracted ... Dismissed la Medical Prescription (Mistura Tussis) Excessive in Syr. Tolu 95-3%. Totally deficient in Aqua Chloroform! Fined 5 0 0 1 10 0 2a Medioal Prescription (Mistura Ferri et Strychnina) 47-2% deficient in Liquor Ferri Perchloridi Fiined 5 0 0 1 10 0 6a Medical Prescription (M istura Gentian Composita) Totally deficient in Emulsion Chloroformii & Acidum Hydrocyanicum Dilutum Fined 1 0 0 10 10 0 6J Milk 6-24% added water Dismissed 21P ,, 2-47% added water Dismissed 24M ,, 3-3% fat abstracted Fined 2 0 0 1 1 0 21a ,, 3-3% fat abstracted Dismissed (Warranty proved) 27N ,, 3-3% fat abstracted Dismissed on payment of 2 2 0 SON ,, 3-3% fat abstracted Dismissed on payment of 2 2 0 31N ,, 10% fat abstracted Fined 5 0 0 2 2 0 33N ,, 10% fat abstracted Fined 5 0 0 2 2 0 2SY Rum 3-36% added water Dismissed on payment of 5 5 0 38X Milk 4-7% fat abstracted Ordered to pay 2 2 0 43V ,, 3-3% fat abstracted Fined 3 0 0 1 1 0 46D ,, 6-7% fat abstracted Dismissed (Warranty proved] 47D ,, 6-7% fat abstracted Dismissed (Warranty proved' 26 0 0 33 9 0 123 Report of the Food Inspector for the Year 1923. (Mr. A. ]. Bobbin). Dairies and Milkshops.—1,746 inspections were made during the year; 4 notices have been served for repairs and limewhiting; 71 new milksellers have been registered; 5 applications for registration were refused by the Public Health Committee on account of unsuitability of the premises; 3 vendors have been warned for having unwashed measures in use. Cow-Houses.—112 visits were made to the 9 licensed cowhouses, and on each occasion I found the premises kept in a satisfactory condition. Offensive Trades.—The new by-laws for regulating the conduct of the business of fur skin dressing came into operation in the month of March, when there were 18 such businesses in the Borough. At the end of the year these were reduced to 14— 4 having given up business or removed to districts outside London wtfiere there are no restrictions. 62 inspections have been made and some difficulty has been experienced in getting the proprietors to comply with the requirements as to limewhiting and the provision of refuse products of the business, and it was necessary to report one firm for a prosecution. Slaughterhouses and Meat Inspection.—318 visits were made to these during the usual slaughtering times, when I have examined 103 oxen and heifers, 4 cows, 1,670 sheep and lambs, 65 pigs and 8 calves. One offence under the by-laws was reported for which a summons was issued, resulting in the licensee being ordered to pay 2 guineas costs. Owing to the prevalence of Foot and Mouth disease, the movement of cattle has been much restricted, this being the cause of a reduction in the number of animals slaughtered in the Borough. No serious case of disease has been met with and Tuberculosis has been entirely absent. 124 The following: I found diseased and had destroyed:— Livers of 5 oxen and 8 sheep affected with Distomatosis. Livers of 3 oxen and 10 sheep affected with Abscess. Livers and lungs of 11 sheep affected with Parasitic Cysts. Wholesale Preserved Provision Factories.—39 visits were made to these and on each occasion I found the premises 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 Inspection and Unsound Food.—353 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. The storage premises of the street butchers have been regularly inspected and limewhiting, etc., done when required. The following foodstuffs have been condemned and destroyed:— 9 legs and i20 shoulders of 7 Baskets of Pears. Mutton. 1 Trunk of Haddock Roe. 1 loin of Beef. 1 Barrel of Herrings. 6 lbs. of Veal. 2 Boxes of Herrings. 2 hampers of Pork Trimmings. 1 Case of Herrings. 166 Rabbits. 3 Trunks of Haddock. 6 Fowls. 2 Boxes of Haddock. 3 cwt. 3 qrs. of Bacon & Ham. 4 stones of Cod. 56 Boxes of Oranges. 3 Boxes of Plaice. 16 Boxes of Tomatoes. 2 Boxes of Dabs. 1 Barrel of Apples. 4 Boxes of Skate. 3 Bags of Potatoes. 6 stones of Roker. Total Weight of all Foodstuffs condemned:— Meat and Bacon l0cwt. 0qrs. 261bs. Fish l0cwt. 3qrs. 0lbs. Fruit and Vegetables l ton 13cwt. 0qrs. 201bs. 125 Report of Canal Boats Inspector for the Year 1923. (Mr. E. S. Crook). Number of visits to waterways 49 ,, boats inspected 19 „ ,, not registered 1 ,, ,, conforming to Acts 15 ,, ,, infringing the Acts 3 ,, certificates examined 16 ,, persons for which boats were registered— Adults 59 Children Nil ,, persons living on boats so registered— Men 34 Women 1 Children Nil ,, Notices issued 3 ,, ,, complied with 2 Legal proceedings taken Nil The details of the infringements of the Acts are as follows:— (a) Certificates not produced 2 (b) Painting and cleansing required 2 (c) Bedding not provided 1 The boat not registered was a ship registered under the Merchant Shipping Acts; and the outstanding notice is due to the boat in question being docked for a complete overhauling and refitting. 126 127 INSPECTIONS BY SANITARY INSPECTORS, 1923. 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, 1 No. 10 District| Mr. Hillier. I 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. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. 1nspections. On Complaint— No. of premises inspected 206 153 339 244 395 | 296 339 366 196 335 811 245 205 308 52 97 174 ... 12 ... 4273 No. of premises in which defects were discovered 176 121 261 194 297 241 281 309 165 275 266 206 167 195 44 72 148 ... 9 ... 3427 Builder's Notices— No. of premises inspected 7 37 18 12 ... 21 29 7 34 17 12 16 9 28 10 10 ... ... ... 267 House to House- No. of premises inspected ... ... 49 ... ... 12 37 ... 15 7 2 105 66 456 880 373 ... ... ... 2002 No. of premises in which defects were discovered ... ... 17 ... ... 9 36 ... 9 7 2 74 52 384 585 265 ... ... ... 1440 Infectious Disease— No. of premises inspected 53 73 60 78 81 76 72 78 54 91 59 58 90 115 12 11 24 ... ... ... 1085 No. of premises in which defects were discovered 12 30 11 22 33 37 25 42 14 39 23 33 45 67 4 5 11 ... ... ... 453 No. of re-inspections. (All forms of inspection) 1182 1720 2072 1883 1367 2212 2291 1819 1999 2272 2663 1649 2305 1958 2750 3118 2980 ... 847 1092 38179 No. of premises in which defects were discovered. (All forms of inspection.) 170 169 301 251 332 330 353 396 219 440 314 288 295 431 477 762 455 ... 254 389 6626 No. of premises in which de fects were abated. (All forms of inspection.) 145 185 290 249 308 299 314 374 243 495 359 314 319 424 515 493 387 ... 270 335 6318 Total number of Intimation notices served 199 200 301 259 341 310 374 361 247 442 314 312 345 439 452 716 427 ... 221 294 6553 Total number of Final Notices served 32 62 10 3 29 2 56 6 ... ... 27 29 3 53 45 ... 6 ... 33 49 445 Total number of Statutory Notices served 16 44 80 44 84 49 62 114 60 102 27 45 92 58 22 123 118 ... 7 1177 Notices served for infringements of Bye-Laws ... ... 3 4 ... ... 6 9 14 10 9 4 2 14 7 8 5 ... 18 5 118 Notices served for Infringements of L.C.C. General Powers Acts, Public Health Acts, etc. ... 20 8 ... ... ... ... 1 1 8 ... 8 6 12 ... ... 17 ... ... ... 81 128 129 INSPECTIONS BY SANITARY INSPECTORS, 1923. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 8 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. 18 District. Mr. Hall, No. 14 District. Mr. Fowler, Special. Mr. Nighy, Special. Mr. Galvin, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL Notices served under Rats & Mice Destruction Act, 1919 1 5 9 ... ... ... ... 15 ... l 3 4 ... 21 1 ... ... ... ... ... 60 Inspections for Certificates under Increase of Rent, Mortgage Interest (Restrictions) Act, 1920-3 ... ... ... ... ... ... ... ... ... ... 1 1 ... 7 1 ... 1 ... ... ... 11 Proceedings before Magistrate under Public Health (London) Act, &c. ... 1 2 ... 2 4 2 4 ... 4 ... 3 3 3 ... 3 8 1 2 ... 42 Attendances at Police Court ... 9 ... 4 4 11 9 6 5 10 2 14 7 12 ... 3 36 2 3 ... 137 Miscellaneous Inspections— Mews and stables 14 ... 7 3 ... 1 1 ... 1 15 7 2 6 2 2 ... 1 ... ... ... 62 Urinals 4 12 27 ... 20 29 17 14 2 22 6 6 ... ... ... ... ... ... ... ... 159 Canal boats ... ... ... ... ... ... ... ... ... ... ... 19 ... ... ... ... ... ... ... ... 19 Visits to waterways ... ... ... ... ... ... ... ... ... ... ... 49 ... ... ... ... ... ... ... ... 49 Animals improperly kept ... ... 2 ... ... ... 3 4 ... 8 ... 2 1 ... 1 ... 4 ... ... ... 23 Offensive trades ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 62 ... ... 62 New buildings (water certificates) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Floodings ... ... ... ... ... ... ... ... ... 2 3 2 ... ... ... ... 1 ... ... ... 8 Special inspections 265 164 406 103 167 55 58 255 103 198 279 199 88 169 55 11 98 353 ... ... 3019 Drains relaid 31 36 39 35 80 31 81 29 23 116 50 56 27 50 52 22 63 ...' ... ... 811 or repaired Drains and Sanitary Fittings tested and examined 48 148 227 121 126 293 86 104 54 190 83 185 105 350 429 91 788 ... ... ... 3380 Places where Food Prepared for Sale (Restaurants, Coffee Shops), etc.— No. of inspections 6 10 9 12 32 3 6 12 4 27 9 9 ... 7 ... ... ... 39 ... ... 185 No. of Notices 4 3 2 6 1 5 12 1 ... ... 6 ... ... ... ... ... ... 40 130 INSPECTIONS BY SANITARY INSPECTORS, 1923. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. SaJler, 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, 1 No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, So. 14 District. Mr. Fowler, Special. Mr. Nighy, Special. Mr. Galvin, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL Ice Cream Premises— No. of inspections 15 6 20 26 11 22 22 26 6 18 6 13 6 37 ... ... ... ... ... ... 234 No. of Notices 1 ... ... 4 1 1 ... 3 1 16 ... ... 3 4 ... ... ... ... ... ... 34 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tenement Houses— No. provided with additional water supply ... ... ... ... ... ... 1 ... ... 5 ... ... ... ... ... ... ... ... ... ... 6 Overcrowding— No. of houses overcrowded 1 2 2 9 1 ... 3 3 6 18 2 5 3 I 5 ... 1 ... ... ... 62 No. remedied ... ... 1 ... ... ... 1 ... ... ... 1 1 ... 1 1 ... ... ... ... ... 6 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Verminous Premises— Verminous Premises Cleansed ... 8 60 13 2 23 50 44 ... 43 70 26 2 12 ... ... 21 ... ... ... 374 Inspections after complaint by London County Council ... 2 ... 1 6 ... 31 6 ... 4 4 1 6 15 ... ... 4 ... ... ... 80 Verminous conditions found after complaint by L.C.C. ... ... ... ... ... ... 4 3 ... 1 4 ... 8 22 ... ... 23 ... ... ... 65 Bakehouses— No of inspections 12 53 10 16 15 10 53 16 44 27 14 4 4 24 ... ... ... ... ... ... 302 No. of Notices 9 8 4 9 1 1 1 4 5 5 1 ... ... 3 ... ... ... ... ... ... 51 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Food Adulteration— Samples collected for analysis 30 54 54 48 48 49 48 49 53 45 54 54 58 53 54 54 52 48 ... ... 900 Proceedings taken before Magistrate ... 1 ... 1 ... 2 ... ... 4 1 1 1 ... ... 3 ... 4 ... ... ... 18 131 133 132 INSPECTIONS BY SANITARY INSPECTORS, 1923. 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. Golds worthy No. 9 District. Mr. Peverett, 1 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. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Factories and Workshops- No. of inspections (other than laundries) 2 14 6 4 33 8 15 16 ... 11 2 10 4 7 ... ... ... ... 1330 ... 1462 No. of Inspections (laundries) ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 17 ... 19 No. of inspections (other workplaces) ... ... ... ... ... ... ... ... ... 8 2 ... ... ... ... ... ... ... ... ... 10 No. of premises in which defects were discovered ... 2 2 1 2 ... 6 4 ... 6 ... 10 ... 3 ... ... ... ... 254 ... 290 No. of premises in which defects were abated ... ... 2 ... ... ... 4 4 ... 6 ... 7 ... ... 10 ... ... ... 270 303 Smoke Nuisances- No. of observations ... 2 108 5 ... ... 90 ... ... 5 13 56 ... 6 ... ... ... ... ... ... 285 No. of Intimation Notices served ... ... 3 3 ... ... 7 ... ... 4 2 3 ... 6 ... ... ... ... ... ... 28 No. of Statutory Notices served ... ... ... ... ... ... 2 ... ... 1 ... 1 ... ... ... ... ... ... ... ... 3 No. of prosecutions ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Outworkers' Premises— No. of premises inspected ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... No. of premises in which defects were discovered ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 389 391 No. of premises in which de fects were abated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 335 335 Dairies, Cowsheds and Milkshops Order— No of cowsheds inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of dairies inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... 1746 ... ... 1746 No. of dirty utensils discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 3 No. of premises where infringements of By-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of new registrations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 71 No. of new registrations refused ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... 5 134 135 INSPECTIONS BY SANITARY INSPECTORS, 1923. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. SaJler, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. .Long, No. 8 District. Mr. Golds worthy 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. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, SpeciaL TOTAL Slaughter-houses. No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 318 ... ... 318 No. of premises where infringements of by-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Condemned as Unfit for Human Food— c. q. 1b c q. 1b. t. c. q. lb. t. c. q. lb. Fish ... ... ... ... ... ... ... ... 1 0 0 2 3 21 ... ... ... ... ... ... ... ... ... 0 10 3 0 ... ... 0 14 2 21 Fruit and Vegetables ... ... ... ... ... ... ... ... ... ... ... 1 0 0 ... ... ... ... ... c. 2 q. 0 lb. 0 t. 1 c. 13 q. 0 lb. 20 ... ... t. 2 c. 7 q. 0 lb. 20 Meat (specially state number of carcases or parts of condemned for tuberculosis) ... ... ... ... ... ... ... ... 1 2 4 12 ½ 0 ... ... ... ... ... ... ... ... ... t. 0 c. 10 q. 0 lb. 26 ... ... t. 0 c. 10 q. 2 lb. 21½ Tinned foods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other articles ... ... ... ... ... ... ... ... ... ... ... 4 cake 0 17½ ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... t. 0 c. 4 q. 0 lb. 17½ Housing, Town Planning, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... etc., Act, 1909— No. of premises inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of premises in which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of premises in which defects were abated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Underground Rooms— Illegal occupations dealt with ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of rooms closed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Houses Let in Lodgings— No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of Notices ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 137 INSPECTIONS BY SANITARY INSPECTORS, 1923. 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. Golds worthy No. 9 District. Mr. Peverett, J 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. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Insanitary Houses Closed— No. closed under Public Health (London) Act, 1891 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. closed under Housing of Working" Classes Act, 1890 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... General Information— Bakehouses— No. on Register at end of 1922 8 10 5 8 11 5 8 8 7 13 7 2 2 12 ... ... ... ... ... ... 106 Do. do. 1923 8 10 5 8 11 5 8 8 7 13 7 2 2 12 ... ... ... ... ... ... 106 No. above ground 7 6 1 3 6 1 4 3 5 11 7 ... 1 2 ... ... ... ... ... ... 57 No. underground 1 4 4 5 5 4 4 5 2 2 ... 2 1 10 ... ... ... ... ... ... 49 Houses Let in Lodgings— No. on Register at end 1922 ... ... ... ... ... ... 233 ... ... ... 226 ... ... ... ... ... ... ... ... ... 459 Do. do. 1923 ... ... ... ... ... ... 237 ... ... ... 226 ... ... ... ... ... ... ... ... ... 463 Ice Cream Premises— No. on Register at end 1922 13 7 20 20 18 10 17 19 5 9 6 12 9 21 ... ... ... ... ... ... 186 Do. do. 1923 13 6 20 26 18 12 19 26 6 18 6 11 9 28 ... ... ... ... ... ... 218 Places where Food Prepared for Sale— No. on Register at end 1922 5 6 5 8 12 4 18 6 7 11 9 8 1 29 ... ... ... ... ... ... 129 Do. do. 1923 5 6 9 12 12 4 21 12 8 26 9 8 1 30 ... ... ... ... ... ... 163 138 TABLE OF DEATHS. Of Inhabitants of the Borough of Hackney during the year 1923. 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) 4 7 3 1 ... ... ... ... ... ... ... ... 15 Epidemic Rose Rash. German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 1 2 2 ... ... ... ... ... ... ... ... 5 Influenza 1 1 ... 1 ... 2 ... 4 9 16 7 3 49 Whooping Cough 8 4 1 ... 1 ... ... ... ... ... ... ... 14 Diphtheria, Membranous Croup ... 3 13 11 2 ... ... ... ... ... ... ... 29 Cerebro Spinal Fever 1 ... ... ... ... ... ... ... ... ... ... ... 1 Enteric Fever ... ... ... ... ... 1 ... ... 2 ... ... ... 3 Epidemic Diarrhoea. Epidemic (or Zym.) Enteritis 9 ... 3 ... ... ... ... ... ... ... ... ... 12 Diarrhoea, Choleraic Diarrhoea ... ... ... ... ... ... 1 1 ... ... ... ... 2 Dvsentery ... ... ... ... 1 1 ... ... ... ... ... ... 2 Malarial Fever ... ... ... ... ... ... 1 ... ... ... ... ... 1 Anthrax Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... 1 ... ... ... ... 1 Syphilis 1 ... ... ... ... ... 2 ... ... ... ... ... 3 Gonorrhoea. Stricture of Urethra. ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... 1 2 ... ... ... ... 3 Puerperal Septicæmia Sapræmia Fever ... ... ... ... 1 4 ... ... ... ... ... ... 5 139 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. A11 ages, Infective Endocarditis ... ... ... ... ... 1 ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... Septicaemia (not Puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... Pyaemia (not Puerperal ... 1 ... ... ... ... ... ... 1 ... ... ... 2 Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 1 ... ... ... ... 1 1 1 ... 1 1 6 Tuberculous Phthisis (Pulm. Tuberculosis) ... 1 ... 4 37 51 50 38 24 10 1 ... 216 Tuberculous Meningitis ... 1 4 3 2 1 ... ... ... ... ... ... 11 Tuberculous Peritonitis ... 1 ... 2 1 ... 2 2 ... ... ... ... 8 Tabes Mesenterica 1 ... ... ... ... ... ... ... ... ... ... ... 1 Lupus ... ... ... ... 1 ... ... ... ... ... ... ... 1 Tubercle of other Organs ... ... ... 2 4 2 1 2 ... 1 1 ... 13 General Tuberculosis ... 1 2 2 ... ... ... ... 1 ... ... ... 6 Scurvy ... 1 ... ... ... ... ... ... ... ... ... ... 1 Alcoholism, Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Rheumatism of Heart ... ... ... 1 1 1 ... ... ... ... ... ... 3 Chronic Rheumatism ... ... ... ... ... ... ... ... 1 4 2 ... 7 Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... ... ... ... 2 7 3 ... 12 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... Carcinoma ... ... ... ... ... 9 16 41 64 76 32 2 240 Sarcoma 2 ... ... 2 1 5 4 4 1 3 ... ... 22 140 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. Malignant Diseases, Cancer ... ... ... ... ... 2 6 9 7 9 7 1 41 Rickets 1 3 ... ... ... ... ... ... ... ... ... ... 4 Haemophilia, Haemorrhage Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Leucocythsemia ... ... ... ... 1 ... 1 2 2 1 1 ... 8 Diabetes Mellitus ... ... ... ... 1 ... 4 4 10 5 2 ... 26 Premature Birth 58 ... ... ... ... ... ... ... ... ... ... ... 58 Congenital Defects 19 ... 1 ... 1 ... ... ... ... ... ... ... 21 Injury at Birth 2 ... ... ... ... ... ... ... ... ... ... ... 2 Atelectasis 9 ... ... ... ... ... ... ... ... ... ... ... 9 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... Teething 1 1 ... ... ... ... ... ... ... ... ... ... 2 Suffocation-Overlaying 3 ... ... ... ... ... ... ... ... ... ... ... 8 Diseases of Nervous System. Meningitis, Inflammation of Brain 5 3 ... ... ... ... 1 ... ... ... ... ... 9 Softening of Brain ... ... ... ... ... ... 1 ... ... ... ... ... 1 General Paralysis of Insane ... ... ... ... ... 1 4 2 1 1 ... ... 9 Insanity (not Puerperal ... ... ... ... ... ... ... ... ... ... ... ... ... Chorea ... ... ... 1 ... ... ... 1 ... ... ... ... 2 Epilepsy ... ... 1 ... 1 ... ... ... 2 ... ... ... 4 Convulsions 7 ... ... ... ... ... ... ... ... ... ... ... 7 Laryngismus Stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... Locomotor Ataxy ... ... ... ... ... ... ... ... 2 1 ... ... 3 141 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. Poliomyelitis ... ... ... 1 ... ... ... ... ... ... ... ... 1 Paraplegia and Disease of Cord ... ... ... ... ... ... ... ... 1 2 1 ... 4 Neuritis, Periph, Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... Brain Tumour (not specific) ... ... ... ... ... 1 1 1 1 ... ... ... 4 Nervous System, other Diseases ... 1 1 3 1 2 3 3 1 5 2 ... 22 Diseases of Organs of Sense. Otitis, Mastoid Dis ... ... ... 2 ... 3 ... 1 1 1 ... ... 8 Epistaxis, Nose Dis. ... ... ... ... ... ... ... ... ... 1 ... ... 1 Ophthalmia, Eye Dis ... ... ... ... ... ... ... ... ... ... ... ... ... Accidents ... 4 3 6 6 2 4 5 6 7 8 ... 51 Violence Suicide ... ... ... ... 4 2 5 3 3 6 2 ... 25 Drowned ... ... ... 1 ... ... 2 2 ... ... ... ... 5 Murder ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Heart. Valve Dis., Endocarditis ... ... ... 3 2 4 11 22 40 62 36 12 192 Pericarditis ... ... 1 1 ... ... ... 1 ... ... ... ... 3 Hypertrophy of Heart ... ... ... ... ... ... ... ... ... ... ... ... ... Angina Pectoris ... ... ... ... ... ... ... ... 5 5 2 ... 12 Dilatation of Heart ... ... ... ... ... ... ... ... ... ... ... ... ... Fatty Degeneration of Heart ... ... ... ... ... ... ... 4 6 5 3 ... 18 Syncope Heart Dis. (not specified) ... ... ... 1 2 2 2 3 12 21 9 4 56 142 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. Diseases of Blood Vessels. Cerebral Haemorrhage Emb., Throm. 2 ... ... ... 2 1 2 11 31 43 42 11 145 Apoplexy, Hemiplegia I ... ... ... ... ... ... 2 3 4 1 2 13 Aneurysm ... ... ... ... ... ... ... 1 4 3 1 ... 9 Senile Gangrene ... ... ... ... ... ... ... ... ... ... 3 ... 3 Embolism, Thrombosis (not Cerebral) ... ... ... ... ... ... ... ... 1 ... ... ... 1 Phlebitis ... ... ... ... ... ... 2 ... ... ... ... ... 2 Blood Vessels, other diseases 1 ... ... ... ... ... ... 4 5 4 1 1 16 Arterio Sclerosis ... ... ... ... ... ... 1 6 13 16 24 10 70 Diseases of Respiratory Organs. Laryngitis 1 ... ... ... ... ... ... ... ... ... ... ... 1 Bronchitis 10 3 ... 2 ... ... 5 16 23 57 45 19 180 Lobar(Croupous) Pneumonia 3 ... 2 3 5 6 5 15 6 8 1 1 55 Broncho, Catarrhal, Lobular Pneumonia 38 18 12 2 ... ... 6 5 6 7 17 6 117 Pneumonia 5 3 1 2 2 3 1 5 8 9 4 2 45 Emphysema, Asthma ... ... ... ... ... ... 6 6 7 8 3 30 Pleurisy ... ... ... ... ... 1 ... ... 2 2 ... ... 5 Fibroid Dis. of Lung.. ... ... ... ... ... ... 1 ... ... ... ... ... 1 Respiratory Dis., other 2 ... ... 1 1 1 ... ... ... 3 ... ... 8 Diseases of Digestive System. Tonsilitis, Quinsey ... 1 ... ... ... ... ... ... ... ... ... ... 1 Mouth, Pharynx, Dis. (not specific) ... ... ... ... ... ... ... 1 ... ... ... ... 1 Gastric Ulcer ... ... ... ... 1 1 5 3 1 2 ... ... 13 143 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to5. 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. Gastric Catarrh or Gastritis 1 ... ... ... ... 1 ... ... ... 1 3 ... 6 Stomach, other Dis. (not Malig.) 1 ... ... ... ... ... ... ... 1 ... ... ... 2 Enteritis (not Epidemic) 1 ... ... ... ... 1 ... ... ... 1 1 ... 4 Gastro-Enteritis 3 ... ... ... ... ... ... ... ... ... ... ... 3 Appendicitis, Perityphilitis ... ... 1 1 4 1 2 2 3 ... ... ... 14 Hernia ... ... ... ... ... ... ... 3 1 3 1 ... 8 Intestinal Obstruction ... ... ... ... 1 ... ... 1 ... 4 2 ... 8 Other Dis. of Intestines 16 ... ... ... 1 3 2 2 1 ... 2 ... 27 I'eritonitis (not puerperal) ... ... 1 2 2 ... ... ... 3 1 1 ... 10 Cirrhosis of Liver ... ... ... ... ... 1 1 1 5 4 ... ... 12 Liver and Gall Bladder, other Diseases ... ... ... ... ... 2 1 3 4 5 2 ... 17 Digest. Syst., other Diseases 1 ... 1 ... ... ... ... 1 1 3 ... ... 7 Lymph Diseases. Spleen Disease ... ... ... ... ... ... ... ... ... ... ... ... ... Lymph System, other Diseases 3 ... ... 2 1 ... ... 1 ... 1 ... ... 8 Thyroid Body Disease ... ... ... ... ... ... ... ... 1 ... ... ... 1 Supra Renal Capsules Disease ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Urin. Syst. Nephritis, Acute 1 ... 2 1 1 4 7 13 17 17 6 4 73 Chronic Bright's Dis. Albuminura ... ... ... ... ... ... ... 4 2 3 ... ... 9 Calculus (not Biliary) ... ... ... ... ... ... ... ... ... ... ... ... ... Bladder and Prostate Disease ... ... ... ... ... ... ... 1 ... 5 6 2 14 Urin. Syst., other Dis. ... ... ... ... ... 1 2 3 ... 2 ... ... 8 144 TABLE OF DEATHS—continued. AGES Under 1 year. I to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 85. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Diseases of Gener. Syst. Ovarian Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Ovary ... ... ... ... ... ... ... ... ... ... ... ... ... Jterinal Tumour (not Malig.) ... ... ... ... ... ... ... 1 ... ... ... ... 1 Other Dis. of Uterus and Vagina ... ... ... ... ... ... 1 1 ... ... ... ... 2 Accidents Childbirth. Abortion. Miscarriage ... ... ... ... ... 2 ... ... ... ... ... ... 2 Puerperal Mania Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accid. of Preg. and Childbirth ... ... ... ... ... 1 2 ... ... ... ... ... 3 Joint Diseases Caries, Necrosis ... ... ... ... ... 1 ... ... 1 ... ... ... 2 Arthritis, Periostitis ... ... ... 1 ... ... 1 ... ... ... ... ... 2 Other Dis. of Locom. Syst ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Diseases. Ulcer, Bedsore ... ... ... ... ... ... ... ... ... 1 1 ... 2 Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Disease, other ... ... ... ... ... ... ... ... 1 ... ... ... 1 Tll.Defined Causes Atrophy Debility, Marasmus 29 ... ... ... ... ... ... ... ... ... ... ... 29 Old Age ... ... ... ... ... ... ... ... ... 17 81 27 96 Dropsy, Ascites ... ... ... ... ... ... ... ... ... ... ... ... 4 Tumour ... ... ... ... 2 ... ... ... ... 1 ... ... 4 Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death cause unascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Causes 5 ... ... ... 1 ... ... ... 1 ... ... ... 7 Causes not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 257 59 55 67 95 130 182 271 359 485 337 108 2405 145 TABLE III. Causes of, and Ages at, Death during the year 1823. Causes ok 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 ... ... ... ... ... ... ... ... ... ... Small-Pox ... ... ... ... ... ... ... ... ... ... Measles 15 4 7 3 1 ... ... ... ... 17 Scarlet Fever 5 ... 1 2 2 ... ... ... ... 10 Whooping Cough 14 8 4 1 ... 1 ... ... ... 6 Diphtheria and Croup 29 ... 3 13 11 2 ... ... ... 58 Influenza 49 1 1 ... 1 ... 7 13 26 3 Erysipelas ... ... ... ... ... ... ... ... ... ... Dysentery 2 ... ... ... ... ... 1 1 ... 1 Phthisis (Pulmonary Tuberculosis) 216 ... 1 ... 4 37 101 62 11 136 Tuberculous Meningitis 11 ... 1 4 a 2 1 ... ... 10 Other Tuberculous Diseases 29 1 2 2 6 6 5 5 2 22 Lancer, Malignant Disease 303 2 ... ... 2 1 42 126 130 205 Rheumatic Fever 1 ... ... ... ... ... 1 ... ... ... Meningitis 9 5 3 ... ... ... 1 ... ... 9 Organic Heart Disease 281 ... ... 1 5 4 19 93 159 142 Bronchitis 180 10 3 ... 2 ... 5 39 121 33 Pneumonia (all forms) 217 46 21 15 7 7 21 45 55 107 Other Diseases of Respiratory Organs 45 3 ... ... 1 1 9 15 16 16 Diarrhoea and Enteritis 21 13 ... 3 ... ... 2 1 2 6 Appendicitis and Typhlitis 14 ... ... 1 1 4 3 5 ... 19 Cirrhosis of Liver 12 ... ... ... ... ... 2 6 4 4 Alcoholism ... ... ... ... ... ... ... ... ... ... Nephritis & Bright's Disease 73 1 ... 2 1 1 11 30 27 57 Puerperal Fever 5 ... ... ... ... 1 4 ... ... 8 Other Accidents and Diseases of Pregnancy and Parturition 5 ... ... ... ... ... 5 ... ... 6 Congenital Debility and Malformation, including Pre mature Birth 79 77 ... 1 ... 1 ... ... ... 33 Violent Deaths, excluding Suicide 56 ... 4 3 7 6 8 13 15 49 Suicide 25 ... ... ... ... 4 7 6 8 11 Other defined Diseases 702 81 8 4 13 16 57 169 354 369 Diseases ill-defined or unknown 7 5 ... ... ... 1 ... 1 ... ... 2405 257 59 55 67 95 312 630 930 1338 Sub-entries (included in above figures) Cerebro-Spinal Meningitis, 1 1 ... ... ... ... ... ... ... ... Polio Myelitis 1 ... ... ... 1 ... ... ... ... ... Encephalitis Lethargica 3 ... ... ... ... ... 1 2 ... 3 146 VIII.—HOUSING. 1.—GENERAL. Number of Houses erected during the year:— (a) Total 712 (b) With State assistance under the Housing Acts, 1919 or 1923:— (i) By the Local Authority 62 (ii) By other bodies or persons 10 2.—UNFIT DWELUNG-HOUSES. 1.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9,274 (2) Number of dwelling-houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 1,709 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (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 5,978 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 4,602 147 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 - (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 6,553 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 6,318 (b) by Local Authority in fault 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 — 148 (2) Number of dwelling-houses in respect of which Closing Orders were made (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-bouses having been rendered fit (4) Number of dwelling-houses in respect of which demolition orders were made ('5) Number of dwelling-houses demolished in pursuance of Demolition Orders