HAC 75 Metropolitan Borough of backney. REPORT on the Sanitary Condition of the metropolitan borough of hackney FOR THE YEAR 1925, by G. H. DART, M.D., M.R.C.P., Edin.; D.P.H., D.T.M. A H., Camb., Barrister-at-Law. Medical Officer of Health. Administrative Maternity and Child Welfare Officer, Executive Tuberculosis ;Officer. London: Buck Brosr & Harding, Ltd., 6-7, West A vent e ,el7 1926. INDEX. I. General Statistics 26 II. Extracts from Vital Statistics of year 28 III. Notifiable Diseases during the year 40-43 IV. Causes of Sickness 82 V. Summary of Nursing Arrangements, Hospitals, etc. 82 VI. Laboratory Work 95 VII. Sanitary Administration 99 VIII. Housing 160 Canal Boats Acts, Report of Inspector 139 Cancer 51 Cleansing of Persons Act, 1897 79 Constitutional Diseases 51 Cowhouses, Dairies and Milkshops 129 Disinfection 76 Food— Articles Surrendered to District Inspectors 106 Articles Purchased for Analysis 135 Prosecutions under Sale of Food and Drugs Acts 137 Public Health (Meat) Regulations, 1924 115 Registration of Purveyors of Milk 129 Report of Food Inspector 129 Housing— Public Health (London) Act, 1891 99 Housing Acts 19 Housing Conditions in the Borough103 Legal Proceedings 106 Rent and Mortgage Interest (Restriction) Act, 1920-23 100 Verminous Premises 100 Work of Sanitary Inspectors (Table of Inspections)140 Industrial Statistics— Factory and Workshop Act, 1901 106 Factories, Nuisances found 11l Factories, General Table of Inspections and Defects found 11l Workshops Inspected. 110 Workshops, Analysis of Occupations 110 Home Workers 113 Outworkers 114 List of Industries 109 Infectious Diseases— Cerebro Spinal Meningitis 49 Cholera 48 Continued Fever48 Diarrhoea 50 Diphtheria 45 Diphtheria Anti-toxin 46 Dysentery 49 Encephalitis Lethargica 49 Enteric Fever 47 Erysipelas 48 Influenza 50 Malaria 49 Measles and German Measles 50 Ophthalmia Neonatorum 49 index Infectious Diseases (continued). PAGE Plague 48 49 49 48 45 45 48 44 Pneumonia Polio-Myelitis Puerperal Fever Scarlet Fever Small-pox Typhus Fever Vaccination Whooping Cough 50 Maternity and Child Welfare— Contributions to Maternity Hospitals 93 93 88 Convalescent Aid Health Visiting Infant Consultation and Ante-natal Clinics 89 94 38 Provision of Milk and Foods Mortuary Rats and Mice Destruction Act, 1919 101 River Lee 24 Sanitary Inspection—Table of Inspections 140 Shelter 78 Slaughterhouses 130 Tuberculosis— Advanced Cases After Care 74 Discharged Soldiers and Sailors 61 Dispensary Districts: Population 65 Extra Nourishment 72 Health Visitors—Visits of 60 Notifications and Deaths 53 Open-air School 74 Public Health (Tuberculosis) Regulations, 1912 55 Summary of Notifications 56 Summary of Deaths, Number and Classification 67 Reports of Medical Officers 68, 70 Vital Statistics— Acreage of Borough 26 Births and Birth Rates 28, 29 Deaths and Death Rates 32 Deaths in Public Institutions 34 Density of Population 26 Infantile Mortality 33 Institutions outside the Borough receiving Sick from the Borough 35 Illegitimate Birth Rate 30 Marriage Rate 29 Notification of Births 30 Population 26 Registration of Births 31 Senile Mortality 34 Still Births 30 Tables of Causes of Deaths 152 Table (Comparative) of Rates for years 1916-25 39 ,, ,, ,, year 1925—London Boroughs 25 5 PUBLIC HEALTH DEPARTMENT Public Health and Maternity and Child Welfare Committees. Public Health Committee. Ex-Officio—Councillor The Rev. W. Evans, j.p. (Mayor). Chairman—Councillor T. Chapman, j.p. Vice-Chairman—Councillor W. Hughes. Councillor Barnes, J.G. Councillor Loweth, W. E., j.p. Benwell, Mrs. L.C., j.p. Lusher-Pentney, G. J. Bryan, C. L. Moxham, (Rev.) E.C. Alderman Genese, J. Palmer, Mrs. H. A. Councillor Graham, J. Paterson, W. J., j.p. Jones, W. Ridler, J. H. Keil, A. Alderman Rushbrooke, T., j.p., m.a., m.r.c.s., l.r.c.p. Layland, H. Councillor Simpson, S. 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. H. A. Palmer. Vice-Chairman—Councillor J.G. Barness. Members of the Committee—as set out above with the addition of Mrs. F.M. Ashdown, Mrs. T. Smith, and Miss B.W. Payne. 6 STAFF OF PUBLIC HEALTH DEPARTMENT. Sanitary Inspectors. R. H. Bew. E. S. Crook, also Canal Boats W.C. Vobe. Inspector. A. Sadler. J. E. Truslove. H. Body. J.W. Hall. G.F. High. G. Fowler. R.j. Sheppard. A. J. Bobbitt (for Cowhouses, Milk C.F. Long. shops, Slaughterhouses, etc.) W. Goldsworthy. W. Peverett (Food Premises). E.A. Hillier. H.K. Smith, House to House J. Nighy. W.E. Galvin, Inspection. Miss Alice Teebay (for Workshops, Laundries, &c.). Miss Mabel Portlock (for Outworkers' Premises) Health Visitors. Mrs. A. Rhodes. Miss D.F. Vidal. Mrs. L. Harrison. Miss A.K. Roche. Miss M. Chitson. Miss M.K. Cockle. Mrs. L. E. Bartholomew. Miss S.E. Love. Miss G. M. Servants for Tuberculosis cases. Miss M. Clarke Medical Officers (Temporary Staff) Municipal Infant Welfare Centres. Reginald Brown, m.r.c.s., l.r.c.p. Montague Smith, Sylvia Elman, m.r.c.s., l.r.c.p. m.r.c.s., l.r.c.P., Anaesthetist. Dorothy B. Gere, m.r.c.s., l.r.c.p. H.C. Middleton, l.d.s., r.c.S. (Edin.), Eva Morton, m.r.c.s., l.r.c.p. Dental Surgeon. 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. C. J. Haynes. Medical Officer of Health. G.H. Dart, m.d., m.r.c.p. edin., d.p.h., d.t.m. & h. camb. Barrister-at-Law. 7 Metropolitan Borough of Hackney. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925. 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, The Ministry of Health has given instructions that the Annual Report for 1925 should be a Survey Report, and in the Report the Medical Officer of Health should deal with:— (a) The measure of progress made in the area during the preceding five years; (b) The extent and character of the changes made during that period in the Public Health services of the area; (c) Any further action of importance in the organisation and development of the Public Health services contemplated by the local authority, or considered desirable by the Medical Officer of Health. A comparative table for the Borough, showing the death, birth and infantile mortality rates for the past 10 years is set out on page 30. It will be seen from the comparative table that the death rate and infantile mortality rate for the past five years are a considerable improvement on the preceding 5 years, and are, in fact, the lowest ever recorded in the Borough. The death rate for Hackney for the past year is 10.9, a slight decrease on the previous year's rate of 11.4, this rate being also below the County rate, which is 11.7 as compared witti 12.1 for the previous year. The infantile mortality rate of the Borough, measured by the number of deaths under one year of age per 1,000 births, was 8 65; the Borough average during the last five years, 1921-1925, is 65 as compared with 91 for the previous five years, and the figure for London for the year 1925 is 67. The position of Hackney as compared with the other Metropolitan Boroughs, is very satisfactory, as is shown by the table on page 25, which gives the death rates and the infantile mortality rates in 1925. Maternity and Child Welfare. Maternity and Child Welfare work in Hackney has been considerably extended during the past five years, and has resulted during that period in a remarkable fall in the infantile mortality, but this service, instituted in the first instance for mothers and infants, is extending its activities to an ever-increasing extent to the age periods up to 5. Thus, the attendances at the Centres of children over one year of age in 1925 exceeded by 6,674 those for the year 1920, and the total number of attendances of children over one year of age for the past five years amounts in all to 45,757. The aim of the Maternity and Child Welfare Committee is so to improve the health of children below school age that none of them shall, in future, make a first attendance at school suffering from conditions which it will be expensive to alleviate, and which should never have been permitted to develop. There could be no more fatal mistake than to give any grounds for an accusation of extravagance in any public health service, and investigation of probably the most criticised part of the work of a Maternity and Child Welfare Committee, i.e. : the provision of milk and other foods to necessitous mothers and children, will show that in Hackney there has been no extravagance and no abuse. It is evident that the money spent is-yielding a good return, not only in preventing suffering and in preventing death, but principally in preventing crippling; for it must be remembered that it has been stated on good authority that for every child that actually dies three probably survive in a crippled condition to 9 become a burden or an added expense to the country at a later stage of existence. The services that prevent the mortality are preventing the crippling. The cost of the Maternity and Child Welfare service for the coming financial year amounts to a rate of 0 8 pence, which, of course, includes the new centre at 28, Lower Clapton Road. Probably the most useful step that could be taken for the preservation of health at the age periods immediately below the school age would be the provision of Nursery Schools. Unfortunately these institutions do not fall within the scope of Metropolitan Borough Councils, although for many years past a considerable number of Borough Councils have been anxious to open these schools which have proved their usefulness in Deptford and in other Boroughs. At a Conference of Metropolitan Borough Councils, held at Islington on the 10th April, 1923, a deputation was appointed which was received by the Children's Care SubCommittee of the London County Council, but on the 26th July a letter from the County Council was sent to Islington, stating that they were unable to organise additional Nursery Schools. The Council have intimated their willingness to carry out the whole of the powers and duties under Section 6 (2) of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925, and have delegated these powers and duties to the Maternity and Child Welfare Committee. Arrangements have been made with the Metropolitan Hospital to permit of the following-up of children who have been under treatment at that institution; and at the British Red Cross Clinic, for massage or other remedial treatment of children referred from the centres, 38 cases have so far been granted massage. As pointed out later in this report, the Committee are anxious to improve the nursing service, co-operation between the midwives and the Centres, and the arrangements for dealing with nonnotifiable infectious disease. 10 Maternity and Child Welfare Centres. An additional Infant Welfare Centre has been opened at St. Michael's Hall, Northwold Road. At Overbury Street Centre a weekly Ante-natal Clinic is now held, and also an additional Child Welfare Clinic. There are two sessions a week at May field Road Centre instead of one. The Voluntary Centres, which are subsidised by the Borough Council and carry out their work in coordination with the work of the Maternity and Child Welfare Committee, in accordance with the Circular M.C.W. 38, of the Ministry of Health, have also extended their activities ; an Antenatal Clinic has been opened at Eton Mission Welfare Centre, and the Hackney Grove Centre has opened a Branch Centre at Ada Street. In October, 1925, the Lower Clapton Road Centre was opened by H.R.H. The Duchess of York, and is the first institution of this description to commence work in the Borough, as it is equipped to carry on Artificial Light, Dental, Ante-natal, Postnatal and Child Welfare Clinics, and to serve as a Centre of Instruction in the prevention of disease. During the past five years the total number of attendances of children at the Centres numbered 148,633. Of these, 45,757 were made by children aged 1 to 5. The primary cases brought to the Centres numbered 12,642. This figure, allowing for the few hundred children brought for the first time to the Centres at a later age than the infant period, compared with the total number of births—22,461—gives an idea of the importance of these Centres to the infant life of the Borough. During the year 1925, the number of attendances of children at Welfare Centres exceeded those in the year 1920 by 4,000, and the attendances of mothers at Ante-natal Centres has increased from 858 to 2,324, the figure for the year 1925. The work of the new Municipal Centre at 28, Lower Clapton Road will greatly extend the usefulness of the Maternity and Child Welfare service in the Borough, and reduce the preventible infantile mortality and crippling to a greater degree than has 11 hitherto been possible. It is hoped also that some research, directed towards the prevention of the ailments peculiar to childhood, may be carried out by the staff of the institution. Health Visiting. The work of Health Visiting has increased, over 6,000 more visits being paid by Health Visitors during 1925 than in 1920. In particular, the appointment of four additional Health Visitors will render it possible to attempt to control the nonnotifiable infectious diseases, such as Measles and Whooping Cough, which are responsible for so much ill-health, as well as enabling the carrying on of the additional Clinics approved by the Ministry of Health. Discussions with the London County Council are taking place in order that arrangements may be made for improving the supervision of children absent from school owing to these diseases. The work of the Health Visitors is greatly appreciated in the Borough, and it is difficult to give any idea of their activities in a short statement like this. Their work is, of course, connected with every phase of Maternity and Child Welfare work, particulars of which are set out in the body of the Report, but it is of interest to note that it is estimated in the Report of the Departmental Committee on the Causes and Prevention of Blindness, that 21 per cent, of all total blindness occurs in the first year of life, and that one half of these are blinded from a cause almost entirely preventive—Ophthalmia Neonatorum. During the past five years not one child has lost its eyesight from this cause in Hackney, so that it can be stated that on an average at least 30 cases yearly have been saved by Health Visitors; and this is only one of the many useful activities that could be quoted as instances of the value of this work. Nearly 28,000 home visits were made in 1925 by the Health Visitors in addition to their other duties such as attendances at Clinics and at the Town Hall. Maternity Hospital Treatment. The Agreements entered into in 1920 with the City of London Maternity Hospital and Salvation Army Mothers' Hospital, have 12 been extended, and the working arrangements improved. In this connection it is interesting to note that the Mothers' Hospital are extending their Maternity service by the provision of Child Welfare and Ante-natal Clinics, and that the question of the administration of these Clinics in co-ordination with the Borough Council work has been discussed by the Maternity and Child Welfare Committee, at the request of the Ministry of Health. During the past five years arrangements have been made by the Maternity and Child Welfare Committee for the confinement in Hospital, of 1,147 cases. These cases were necessitous from the point of view that it would have been impossible for them to pay the ordinary fees, while on the other hand they did not come within the scope of the poor law service, and bearing in mind that institutional treatment was desirable, either from the nature of the confinements or the unsuitable home conditions, it is obvious that considerable suffering and ill-health, at the very least, has been prevented in this direction. Midwifery Assistance. Applications from necessitous persons, who do not come within the scope of the Poor Law for assistance, for the provision of a midwife, has been arranged by the Maternity and Child Welfare Committee. Cases are visited by the Health Visitor, enquiries are made into the truth of the financial statement submitted by the patient, and the Maternity and Child Welfare Committee arrange for the payment to the midwife, either of the full fee of £1 1s., or for a proportion of the sum, according to the means of the patient. Considerable mental and physical suffering has been alleviated by this action of the Committee, as during the past five years 297 cases have been dealt with in this way. The Committee have had under consideration on several occasions the question of the co-operation of midwives with the Child Welfare and Ante-natal Clinics, but it has not yet been possible to bring about a closer relationship between the work of the Centres and the midwives in the homes. 13 Convalescent Home Treatment. This service came into operation towards the close of 1922, an Agreement being entered into with the Invalid Children's Aid Association, who arrange for the actual treatment. A detailed financial statement of each case is submitted to the Maternity and Child Welfare Committee, together with the medical practitioners of the case from the Welfare Centre. In those cases where it is decided that the parents are able to contribute to the cost of treatment the contributions are collected by the Invalid Children's Aid Association, and are limited to that amount which the parents are able to afford. No payment is made to the Invalid Children's Aid Association by the parent or by the Maternity and Child Welfare Committee, except as a direct contribution towards the actual cost of contribution for each case. This arrangement has only been in active operation during the past three years, but at the close of 1925, 94 cases had been sent away for periods of treatment varying from three weeks to six months. The after reports from the Centres on these cases, many of which were of a most serious nature, have been most encouraging. Home Helps. The Ministry of Health approved in 1922 arrangements submitted by the Council for providing assistance as regards household duties to mothers during the period of confinements. This arrangement has been of service on some occasions, assistance having been granted in 17 cases in all. Fortunately, this difficulty as regards household duties can generally be arranged by the Health Visitor, through the cooperation of neighbours or relatives. Home Nursing. Nursing assistance has been granted under the Maternity and Child Welfare scheme during the past four years, and is one of the most valuable of the Health services. Unfortunately, the Ministry of Health will not permit nursing assistance to be granted under the Maternity and Child Welfare 14 scheme under any conditions other than those specified in Paragraph 19 of the Circular of the 9th August, 1918, M.C.W.4, with the addition of nursing for cases of Polio-Myelitis. The Borough can supply a midwife and a nurse to a confinement case, but if the infant is injured at the confinement no assistance can be given on behalf of the Maternity and Child Welfare Committee. The child may receive treatment at a Centre for such conditions as threadworms, etc., but the nurse must not attend at the home to supplement or administer the treatment advised by the Doctor. In the same way various non-notifiable diseases such as Measles and Whooping Cough can be nursed, but those such as Chickenpox, German Measles, etc., and such conditions as Acute Bronchitis do not come within the scope of Maternity and Child Welfare Nursing. This also applies to mothers in attendance at Ante and Post-natal Centres, who, if referred by their doctors from the Centres for attention, cannot receive nursing assistance for the alleviation of such conditions as inflammation or abscess of the breast. The total number of visits for the past 4 years amounts to 8,199. Provision of Milk and other Foods to Necessitous Mothers and Children. The supply of milk to necessitous mothers and children was first granted as a public measure in 1918. The conditions governing the issue of milk were slightly modified by an Order issued in 1919, these orders being rescinded in March, 1921, the service being permitted by sanction of local schemes under authority given to the Ministry of Health by the Maternity and Child Welfare Act, 1918, the conditions under which this sanction would be given being set out in Circular M.C.W. 185. The conditions under which milk (fresh and dried) was supplied to necessitous mothers and infants received careful consideration in Hackney at the close of 1920 and during 1921, the arrangement hitherto in force of granting milk through the Maternity and Child Welfare Centres was discontinued, and the present system of direct control by the Maternity and Child Welfare Committee, through the Public Health Department, was introduced. At the 15 same time, arrangements were made for co-operation with other authorities, such as the Guardians, and with charitable associations, in order that there should be no abuse of this form of assistance. The Committee also arranged with all milk vendors, who desired to supply milk under the Maternity and Child Welfare Scheme, that milk should be supplied at one penny per quart below current retail price, and this fact, together with the care taken to prevent abuse, have kept the cost per annum at a reasonable figure. The expenditure for the five years, half of which is returned by the Ministry of Health, was as follows:— 1921. 1922. 1923. 1924. 1925. £3,677 £1,777 £1,989 £1,663 £1,426 All applications granted under the Scheme are signed by the Chairman and submitted to the Committee at their Meetings, after the fullest enquiries have been made from all sources of charitable assistance and from employers. T uberculosis. The principal statistics relating to tuberculosis in the Borough during the past five years are as follows:— Years 1921. 1922. 1923. 1924. 1925. Total. Primary Notifications (Pul.) 361 319 387 334 356 1757 Primary Notifications (Non-pul.) 105 85 89 115 109 503 Total 466 404 476 449 465 2260 Deaths (Pul.) 213 202 216 207 191 1029 do. (Non-pul.) 51 36 40 47 33 207 Total 264 238 256 254 224 1236 Mortality rate 1.17 1.05 1.13 1.12 .98 16 At the close of 1925 there were 1,497 cases of pulmonary and 709 cases of non-pulmonary tuberculosis on the register. Tuberculosis Dispensaries. Years 1921. 1922. 1923. 1924. 1925. Total New cases examined 1313 989 1211 1100 1067 5680 Contacts examined 701 555 707 577 537 3077 Sputum examinations 993 1080 1220 1171 1185 5649 Total No. of attendances 10029 8671 9053 8431 8175 44359 No. of home visits by Tuberculosis Officers 133 160 289 297 287 1166 No. of patients recommended for institutional treatment 263 182 183 191 192 1011 The Tuberculosis Dispensaries were formerly under the direct control of the General Management Committees of the Metropolitan and Victoria Park Hospitals, but in 1922 the Hospital Authorities and the Borough Council agreed to form Joint Dispensary Committees, consisting of Members of the Management Committee of the Hospitals and of the Council, to undertake control of the Dispensaries. The Council requested the Ministry of Health to take the necessary steps for authorising the Council to appoint a Tuberculosis Committee, upon which various representative persons from outside the Council could be co-opted, as in the case of the Maternity and Child Welfare Committee, so that the Tuberculosis Committee could have delegated to them all matters relating to tuberculosis throughout the Borough. The Ministry of Health did not approve of this suggestion. The Ministry of Health were requested to secure an Amendment of the Poor Law, to permit the Guardians taking care of the children of a tuberculous woman in cases where the father was an able-bodied man out of employment, who refused 17 to enter the workhouse. Cases were brought to the notice of the Care Committee where mothers suffering from pulmonary tuberculosis, who had been under treatment in the Infirmary, had left that Institution to take charge of their children, thus exposing them to the risk of contracting tuberculosis. The Public Health (Tuberculosis) Regulations, 1921, set out in detail the procedure to be followed in the Public Health Department as regards returns and the keeping of the Tuberculosis Register. An extract from Circular 549 of the Ministry of Health, suggesting action by the local authority when notification had not been carried out by medical practitioners, has been brought to the attention of those medical practitioners who had failed to notify their cases. The Public Health (Tuberculosis) Regulations, 1925, are now in force, giving power to local authorities to prevent tuberculous persons in an infectious condition from engaging in the milk trade. (For Report see page 125.) During the past five years arrangements have been made for granting the following accessories to treatment at the Tuberculosis Dispensary:— Finsen Light treatment. Artificial Pneumo-thorax treatment. Artificial Light treatment. Dental treatment. Extra Nourishment for Sanatorium cafes waiting or returned. Shelters for home use. These forms of assistance are strictly limited in amount to the expenditure approved by the Ministry of Health and the London County Council: as regards Finsen Light, £45 per annum; Artificial Pneumo-thorax, £45 per annum; Artificial Light 18 ment, £80 per annum; Extra Nourishment, £2 per 1,000 of the population; Dental treatment, £70 per annum. During the past year 100, or 53 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 79, or 41.3 per cent. of the total number, 191. In 31 of the cases who did not have even a bed to themselves, tubercle bacilli were known to be present in the sputum. During 1924 the number of deaths at home was 99, or 47 8 per cent. of the total number, 207, so that this year's figures are slightly better than the previous year. There were 125 deaths among dispensary patients, and 44 of these patients, 35.2 per cent., were in the final stage of the disease on first attendance; 68 patients, or 54.4 per cent. were in the second stage. It also appears from an examination of the case papers that 94 of these cases, or 75 per cent., had been suffering from this disease for a period varying between three to twelve months before being referred to the dispensary. The Hackney Borough Council Act, 1926, will facilitate, to a limited extent, the removal of persons suffering from pulmonary tuberculosis who are infectious and live under such circumstances that there is serious risk of infection to other persons. Sanitary Inspection. In Hackney, with its total population of 228,300, there is also, quoting from the last Census return, a population of 28,457 persons, equal in number to many Urban Districts, living in tworoomed dwellings, and a population of 9,627 living in one-roomed dwellings. This fact indicates the necessity for careful sanitary inspection, and comparing the notices and proceedings as regards housing property "nuisances" during the last five years with 19 a previous five years' period, omitting the period of the War, when sanitary work was necessarily diminished, it will be seen that the work has increased. Intimation Statutory Legal Notices. Notices. Proceedings. Years 1921-1925 33,361 7,472 362 Years 1913-14-18-19-20 22,859 2,148 217 The work of sanitary inspection has, in fact, been carefully and conscientiously carried out during the past five years, a circumstance of the utmost importance in view of the overcrowding in Hackney and neighbouring boroughs. Systematic "House-to-House" inspection, under the Regulations governing this form of inspection, was commenced in 1921. A total of 190 streets (including under the word " street " terraces, &c.), have been inspected, some of them, such as Nisbet Street and Crozier Terrace, more than once. The results of these inspections are entered up on the card index system so that the conditions found on inspection and reinspection as regards any particular street and any house in that street, can be easily ascertained. A list of the streets inspected in this manner will be found on page 104. 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. Thus, during 1925, no fewer than 143 premises have been cleared of rats, 886 rooms sprayed or otherwise cleared of vermin, 459 rooms cleansed, 33,895 articles disinfected, 3,434 adults and children cleansed from parasitic infection, by the staff of the Public Health Department. The work of sanitary inspection, however, can only be realised by carefully considering the 20 tables of inspection of food premises, food seizure, drain testing, sampling, notices served, nuisances abated and other details of the work of the department set out in the body of this report. The Council has on several occasions requested that the County Council should make by-laws whereby the Council could improve sanitary conditions as regards houses let in lodgings, and these are now in draft, and the Council has also pressed for powers to deal with disused drains, to prevent the establishment of ■workshops and factories under unsuitable conditions, and to prevent the spread of infectious disease in insanitary offices and workshops, and that the powers conferred by Part III of the London County Council (General Powers) Act, 1922, in respect of filthy or verminous articles in any house, should be extended to any place, including a stall, space, street or premises where such articles as second-hand furniture, bedding, clothing, etc., are stored or exposed for sale. By-laws have been put into operation respecting the construction of soil pipes, the business of a slaughterer of poultry, of rag and bone dealer, and of a dresser of fur skins. The work of the Cleansing Station as regards school children is showing very satisfactory results, and it is reported that considerable improvement is noticed in this respect in the school children in the Borough. In 1922, the Disinfecting Station was thoroughly overhauled as regards repairs required to the fittings and appliances, and a settlement of the foundations of the boiler-house, which might have become very serious. No. 3 Disinfector required re-setting, the brickwork of the boiler-shaft had become defective, and various other repairs were also needed and were carried out at a total cost of £930 7s. 6d. 21 Alterations are now taking place at the Disinfecting Station. The stable is being turned into a garage for two motor vans, which will take the place of the old horse vans that are now practically beyond repair. Particulars of cleansing and disinfection, both of premises and of articles at the Station, and the cleansing of persons, will be found on pages 76 and 79. Additional powers for preventing ill-health through Chemical Contamination of food have been obtained, and the Public Health (Preservatives in Food) Regulations, 1925, which come into operation generally on the 1st January, 1927, and on the 1st January, 1928, so far as they relate to butter and cream, debar the use of chemical preservatives, except as regards a list of articles, 17 in all, mentioned in a schedule appended to the Regulations, to which certain chemicals may be added in the proportions stated in the schedule. The articles include sausages, fruit (fresh or dried), unfermented grape juice and non-alcoholic wines, cordials and fruit juices, jam, sugar, gelatine, beer, cider, alcoholic wines and sweetened mineral waters. Metallic colouring matters containing arsenic, copper, mercury, lead, etc., are debarred, also gamboge and some coal-tar colours. Boric acid has also been excluded from all foods. One of the great difficulties as regards the sampling of foods is thus, to a large extent, removed, but the difficulty with regard to Lack of Official Standards still remains. Thus, many articles of food, the average composition of which is well known, cannot be sampled with any useful result. Representations have been made to the Ministry of Health as regards this difficulty. As an example of this, as the result of complaints that inferior vinegar was being sold in the Borough, samples were analysed and a certificate was returned by the analyst stating that water had been added, but the Committee were informed bv the legal advisers of the Council that the Analyst's report of added water was based 22 merely on a statement of a Medical Officer of the Local Government Board that vinegar should contain 4 per cent. of Acetic Acid, and similarly that vinegar prepared by colouring and flavouring a solution of Acetic Acid, should not be represented as merely "vinegar" or "malt vinegar"; it was, therefore, resolved that no proceedings should be taken, that copies of the Analyst's certificate be forwarded to the Ministry of Health, and the views of the Ministry requested thereon. This difficulty has also arisen from time to time as regards other commonly-used articles of food. The Council have also drawn the attention of the Ministry of Health to the difficulties that exist as regards the Protection of Foodstuffs from Contamination. The filthy conditions under which bread is often prepared, even though the premises have been constructed according to the Regulations governing food premises, and the filthy condition in which it may be delivered to the consumer is an instance of this fact. The Council also drew attention to the danger of permitting undesirable articles of food to be brought wholesale into the country, and then distributed to retailers, as, for instance, apples sprayed with arsenical mixtures, and cherries infected with larval parasites. Attention was also drawn to the need for the protection of articles of food liable to contamination, and exposed for sale on street stalls or open shop fronts, and it was pointed out that fish, fruit, sweets and other articles of food are often exposed for sale in the open street without any protection from flies and dust in dry weather, or from being bespattered with particles of mud in wet weather. The Public Health (Meat) Regulations, 1924, are a great step in the right direction, and a special report on the working of these Regulations in the Borough will be found on page 126. The necessity for the thorough inspection of food and food premises is apparent and a card index has been prepared of all premises connected with the preparation of food for sale, and of the conditions found on inspection and reinspection; the necessity for this 23 is at once evident when it is noted that, among other circumstances, fat has been removed from a sink waste grease trap, and after being clarified, used for pastry fat, and that meat has been found stored in a water-closet (see page 127). The amount of Foodstuffs Seized or Surrendered during the past five years amounted to about 38 tons. The conditions under which milk is sold have engaged the attention of the Council for some time past. In 1921 it was resolved to register, under the Dairies, Cowsheds and Milkshops Orders and the London County Council (General Powers) Act, 1908, only those applicants who agreed to comply with the following stipulations:— (1) The lighting and ventilation must be maintained in a satisfactory condition. (2) No room which is used as a sleeping room must communicate directly with the room or shop in which the milk is sold or stored. (3) The premises must be so constructed that every part of the interior is capable of being maintained in a satisfactory state of cleanliness. (4) There must be no inlet to any drain in the room or place in which milk is sold or stored. (5) Milk must be stored in suitable receptacles with close-fitting covers of suitable material. (6) Efficient means of cleansing the milk vessels, either by steam or hot water must be available. (7) A plentiful supply of water must be provided, and where a storage cistern is necessary such cistern must be properly covered and ventilated and so placed as to be readily accessible. (8) No premises will be registered where it is possible that milk may be stored in close proximity to any article capable of contaminating such milk, as for instance, paraffin, coal, vegetables, vinegar and pickles (except when stored in unopened bottles), fish, &c., and no such articles must be sold from the premises. (9) No premises will be registered if there is manure or other offensive accumulation in close proximity. (10) Efficient means for the storage and removal of refuse must be provided. The Council has expressed the opinion that milk churns should be sealed in railway transit. The Council has requested that it should be made compulsory to notify illness of persons engaged in the dairy trade. 24 The River Lea remains, and has remained during the past 5 years, in a most offensive condition, and has been the subject of many complaints. 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, Isolation 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 3.9 pence. This includes the expenditure required by the extension of the Maternity and Child Welfare Service. In 1921, the Electrical Engineer in a report to the Public Health Committee, stated that if every householder in Hackney could be induced to burn his waste paper and other inflammable rubbish instead of putting it into the dustbin for removal to the Destructor, the rates in this one direction alone could be reduced by 3¼d. in the pound. No doubt prices have considerably altered since that date, but the comparison still remains an interesting one. 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. 25 COMPARATIVE TABLE, YEAR 1925. Name of Borough. Population. Birth Rate. Zymotic Death Rate. Death Rate all causes. Infant Mortality. Battersea 172,100 18.5 0.4 10.5 58.1 Bermondsey 123,000 23.4 - 12.6 78 Bethnal Green 119,800 21.9 1.3 12.0 80.6 Camberwell 275,400 17.7 0.5 11.1 64.7 Chelsea 64,820 14.4 0.4 13.6 6.9 Deptford 115,900 18.8 0.8 12.1 6.3 Finsbury 77,560 22.6 0.8 13.6 59.8 Fulham 163,700 16.9 0.5 10.7 76 Greenwich 103,936 18.8 0.57 11.23 70 Hackney 228,300 17.9 0.49 10.9 65 Hammersmith 134,500 17.5 0.7 *1.9 65 Hampstead 88,040 12.0 0.19 10.2 55 Holborn 43,315 12.16 0.43 12.51 63 Islington 339,200 19.4 0.39 12.26 63 Kensington 179,600 15.8 0.5 13.2 78 Lambeth 311,100 24.6 0.5 12.1 62 Lewisham 185,600 15.6 0.3 10.3 55 Paddington 147,100 15.9 0.4 12.1 72 Poplar 168,500 22.7 0.9 11.7 75 St. Marylebone 106,100 14.1 0.5 11.6 63 St. Pancras 215.900 17.9 0.8 12.7 72 Shoreditch 107,300 24.6 1.2 13.3 88 Southwark 189,000 21.2 0.9 13.1 77 Stepney 255,370 21.2 0.94 11.9 73 Stoke Newington 53,190 15.8 0.34 11.2 61 Wandsworth 340,900 14.31 0.33 10.43 52 Westminster 139,600 10.7 0.37 12.3 69 Woolwich 140,740 18.3 0.4 10.8 55 City of London 13,340 7.5 0.53 11.8 60 County of London 4,602,000 18.0 - 11.7 67 City of Belfast - 23.4 - 14.0 104 „ Dublin - 24.5 - 15.4 111 „ „ Glasgow - 24.6 - 14.8 102 „ „ Edinburgh - 18.6 - 14.5 96 „ „ Liverpool - 22.9 - 13.7 98 „ „ Manchester - 19.4 - 14.1 92 26 1. GENERAL STATISTICS. Natural and Social Conditions of the Area. Area (in acres) 3,287 Population—Census, 1901 219,780 Census, 1911 222,674 Census, 1921 222,142 Estimated, 1925 228,300 Physical features and General Character of the Area.—The Borough varies in elevation between 16 feet and 110 feet above ordnance datum. The north-west portion lies on yellow clay, and there is a considerable area on a bed of gravel and sand of varying depths, other portions are on brick earth, and in the Lea Valley there is a bed of alluvial gravel. Underlying the whole of the Borough is the London blue clay, which in a few places appears near the surface. Number of inhabited houses (1925) 35,145 Number of families or separate occupiers (1921) 56,020 Rateable value (December, 1925) £1,297,122 Sum represented by a penny rate £5,275 Social Conditions, including the chief occupations of the inhabitants, and the influence of any particular occupation on public health.—The population is mainly working class, and the chief occupations are the manufacture of boots, shoes, cabinets and 27 pianos, and the production of tailored clothes. The factories and workshops are in very good condition and the sanitary arrangements are kept under constant supervision. The Amount of Poor Law Relief.—The extent to which hospital and other forms of gratuitous medical relief are utilised.— On the 20th December, 1925, the number of persons in receipt of Poor Law Relief per 10,000 of population amounted to 283. This compares with 297 for the whole of the North District and 1,101 for the whole of the East District, and 493 for the whole of London. The proportions were one-third Institutional Relief and two-thirds Domiciliary Relief. During the year 5,618 persons were admitted to the Hackney Hospital, 716 patients remained on the 31st December, 1925, and in the last week of 1925, 121 persons received medical relief only. These figures relate to the whole of the Hackney Union. Population.—The population for the whole Borough gives a density of 094 persons per acre, varying from 53'5 persons per acre in the Northern Sub-district to 99.8 persons per acre in the South-western Sub-district. The following table gives the estimated population and density of population per acre for each of the Registration Sub-districts in the Borough:— Table showing Estimated Population, Area and Density of the Registration Sub-Districts in Hackney at middle of 1925. North Central SouthWest SouthEast Total for Hackney Total for London Estimated population 57,801 53,973 58,538 57,988 228,300 4,602.000 Area in square acres 1,080 857 586 764 3,287 74,816 Density, persons per acre 53.5 62.9 99.8 75.9 69.4 61.5 28 Register of Rainfall during the year at CAapton Pcnd—1925. Month. Total rainfall. No. of days on which rain fell. Heavieest fall. Remarks. ins. ins. January 1.80 12 0.55 - February 2.77 15 0.65 - March 0.53 11 0.10 - April 1.71 15 0.65 30th Thunderstorm May 1.38 17 0.32 - June 0.12 2 0.10 - July 3.78 14 1.20 18th, 20th, 21st & 22nd Thunderstorm. August 2.57 13 0.83 - September 1.90 18 0.32 - October 2.87 13 0.85 - November 1.46 14 0.32 - December 2.65 15 0.68 - Total 23.54 159 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Births— Total. M. F. Legitimate 3,977 Birth Rate 17.9 Illegitimate 116 Deaths 2,614 Death Rate 10.9 Number of women dying in, or in consequence of childbirth:— From sepsis 3 From other causes 12 Deaths of Infants under one year of age per 1,000 births:— Legitimate 60. Illegitimate 232. Total 65. Deaths from Measles (all ages) 17. ,, ,, Whooping Cough (all ages) 32. ,, ,, Diarrhoea (under 2 years of age) 28. 29 *Marriages and Marriage-rates.—During 1925 there were 2,039 marriages solemnised in the Borough of Hackney. The annual rate for persons married during this period is therefore 178 per 1.000 of the population. The following table gives the number of marriages and matriage-rates for the Borough of Hackney and London during the years, 1915-1925. Year. Borough of Hackney. London. Marriages. Marriage rate. 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 1923 1,971 17.4 17.3 1924 2,024 17.8 17.3 Average, 1915—1924 2,241 20.2 20.2 1925 2,039 17.8 17.2 Births and Birth-rate.—The births registered in the Borough of Hackney during the year 1925 numbered 4,806, of which 2,470 were males and 2,336 females. The total shows an increase of 4 compared with the number registered during 1924, but of these a certain number must be transferred to other districts, and certain births, which occurred in outlying districts, must be transferred to Hackney in order to get an accurate birth-rate for the Borough. The Registrar-General has supplied the number of these transferable births, viz., 1,037 births to be transferred to other districts and 324 to Hackney. After these necesssary corrections have been made, the correct total of registered births amongst Hackney residents is 4,093. From this figure the birthrate for Hackney during 1925 has been calculated to be 17-9 per *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 1925. 30 1,000 of the population. The birth-rate for all London for the same period is 18.0 per 1,000 of the population. Notification of Births Act, 1907.—Under the provisions of this Act 4,779 notifications of births were received during 1925. This total includes notifications from medical practitioners, midwives, parents and others. It also includes still-births. The total is 27 less than the number registered by the Registrars of Births. Still-Births.—Amongst the births notified 146 were still-born This is equal to 3'0 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 1925. Year Medical Practitioners Midwives. Parents and Others. Total. Lire. Still. Live. Still. Live. Still. Live. Still. 1935. M. F M. F. M. F. M. F. M. F. M. F. M. F. M.. F. Totals 384 382 16 26 1636 1533 58 44 353 345 1 1 2373 2260 75 71 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1925 was 385, but of these, the Registrar-General states that 289 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 116 illegitimate births amongst Hackney residents. This is equivalent to an illegitimate birth-rate of 28 3 per 1,000 births. 31 The following table gives the number of registered births birth-rates, etc., for the Sub-districts in the Borough:— Registration District of Hackney Registration Sub-district All London North Central SouthWest SouthEast Total No. of births 4,806 762 2,030 928 1,086 82,401 Rate per 1,000 living 21.0 13.1 37.6 15.8 18.7 18. 0 No of illegitimate births 116 ... ... ... ... ... Rate per 1,000 births 283 ... ... ... ... ... It will be noticed that the birth-rate is abnormally high in the Central District compared with other registration Subdistricts. This is accounted for by reason of 1,293 births occurring during this year at the Salvation Army Mothers' Hospital, which Institution is situate in the Central District. Of this number 889 births are transferable to districts outside Hackney. The following table shows the birth-rates for the Borough and its Sub-Districts during the years 1915-1925, inclusive:— Birth-rate for the Borough of Hackney and its Sub-Districts for the years 1915-1925 compared with that of London. Year Borough of Hackney North SubDistrict Central SubDistrict South-West SubDistrict South-East SubDistrict London 1915 23.0 17.0 28.7 22.3 23.3 22.6 1916 23.9 16.9 32.5 21.6 24.5 23.0 1917 18.9 12.4 29.7 15.4 18.0 17.5 1918 17.2 9.5 30.7 12.7 15.8 16.1 1919 21.0 13.2 33.9 16.5 20.6 18.3 1920 28.7 20.6 41.3 23 .6 29.5 26.5 1921 24.2 16.7 36 .9 19.5 23.6 22.3 1922 23.4 15.8 37.7 18.3 22.5 21.0 1923 22.3 14.5 38.7 17.4 19.8 20.2 1924 21.1 13.6 36.5 17.5 18.0 18.7 Average - - - - - - 1915-1924 22.3 15.0 34 .6 18.4 21.5 20.6 1925 21.0 13.1 37.6 15.8 18.7 18.0 32 Deaths.—The deaths registered in the Borough during 1925 numbered 2,866; but of these 696 were deaths of non-residents who died inside the Borough. There were, however 444 residents of Hackney who died during the year outside the Borough. Or. making the necessary corrections, the corrected number of deaths amongst Hackney residents is 2,614. This is an increase of 26 upon the number of deaths occurring during 1924. The crude general death-rate from all causes for the year 1925 is 11.4 per 1,000 of the population. On correcting this for age and sex distribution by means of the factor .958 the general death rate is 10.. Amongst the Registration Sub-districts the death-rate was lowest in the Central Sub-district (110 per 1,000), the highest in the South-west Sub-district (12. 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 57,801 762 13 1 655 11.3 47 61 Central 53,973 2,030 37'6 599 11.0 60 29 South - west 58,538 928 158 704 12.0 86 92 South - east 57,988 1,086 187 656 11.3 75 69 All Hackney 228,300 4,806 210 2,614 11.4 268 55 * 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 correct figure see page 39. 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. 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 1919 13.0 13.4 1924 11.4 12.1 1920 12.7 12.4 1925 10.9 11.7 33 Infantile Mortality.—The deaths under 1 year of age in the Borough during 1925 numbered 268. This is an increase of 14 upon the number of infants' deaths recorded during 1924. The infant mortality rate for the year is 65 per 1,000 births. The causes of death are set out in the following table:— INFANT MORTALITY, 1925. Nett deaths from stated causes at various ages under 1 year of age. Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 2 4 6 ... 15 Diphtheria and Croup ... ... ... ... ... ... 1 ... ... 1 Erysipelas ... ... ... ... 1 ... ... ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 2 Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 1 Meningitis (Not Tuberculous) ... ... ... ... ... ... ... 2 ... 3 Convulsions ... 2 ... ... 3 1 1 2 ... 7 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 2 ... 1 3 5 3 2 1 14 Pneumonia (all forms) ... ... ... 2 2 10 15 12 10 49 Diarrhœa ... ... ... ... 2 ... 4 1 1 8 Enteritis ... ... ... ... ... 5 10 2 2 19 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... 1 ... ... ... 1 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 1 ... 1 3 ... ... ... ... 3 Atelectasis 7 3 ... ... 10 ... ... ... ... 10 Congenital Defects 7 2 ... 1 10 4 2 ... ... 17 Premature Birth 37 5 3 1 46 4 ... ... ... 50 Atrophy, Debility and Marasmus 2 1 1 2 6 5 7 ... 1 19 Other Causes 7 6 1 2 16 9 7 6 4 42 64 23 6 10 103 45 54 37 29 268 34 Senile Mortality.—The deaths which occurred in Hackney at 65 years of age and upwards during 1925 numbered 1,058, and of these 476 were between the ages of 65 and 75 years, 435 between 75 and 85 years, and 147 at 85 years and upwards. The annual mortality rate of persons at 65 years and upwards is 4 6 per 1,000 inhabitants. Deaths in Public Institutions.—There were 1,671 deaths in public institutions in the Borough during 1925; of these 696 were residents of other districts, and the remaining 975 were residents of Hackney. The following lists give the names of the institutions within the Borough receiving persons from both within and without the Borough, and also the institutions outside the Borough, receiving sick and infirm persons from the Borough, with the number of deaths in each institution during the vear 1925:— Institutions within the Borough receiving persons both from and without the Borough. Brooke House, Upper Clapton Road 16 Eastern Fever Hospital, Homerton 165 French Hospital, Victoria Park Road 6 German Hospital, Dalston 149 Hackney Hospital, Homerton 970 ,, Central Institution, Homerton 4 Metropolitan Hospital, Kingsland 198 Nursing Home, 46, Amhurst Park 1 ,, ,, 2, Amhurst Park 4 ,, ,, 7, Dunsmure Road 4 ,, ,, 7, Powell Road 3 ,, ,, 94, Cazenove Road 5 Nursing Home, 18 and 20, Southwold Road 2 ,, ,, 4, Navarino Road 3 ,, ,, 2, Queensdown Road 5 St. Joseph's Hospice, Mare Street 103 Salvation Army Maternity Hospital, Lower Clapton Road 32 ,, ,, Home, 4, Clapton Common 1 1,671 35 Institutions outside the Borough receiving sick and infirm persons residing in the Borough. Banstead Mental Hospital 4 Bethnal Green Infirmary 4 Brompton Hospital 1 Brook Hospital, Greenwich 2 Cancer Hospital 2 Cane Hill Mental Hospital 1 Caterham Mental Hospital 2 Charing Cross Hospital 2 Children's Hospital, Great Ormond Street 13 City of London Maternity Hospital 9 Claybury Mental Hospital 17 Colindale Hospital 7 Colney Hatch Mental Hospital 19 Darenth Industrial Colony, Dartford 2 Dartford Heath Mental Hospital 6 East London Hospital 5 Edmonton Epileptic Colony 1 Grove House,Wandsworth 3 Guy's Hospital 2 Hackney Branch Institution, Brentwood 1 Hampstead General Hospital 3 Hanwell Mental Hospital 2 Home Hospital for Women, Stoke Newington 5 Homeopathic Hospital 4 Hospital for Women, Westminster 1 Hostel of God 3 Leavesden Mental Hospital 6 London Fever Hospital 1 London Fever Hospital (T. B.) 2 London Hospital 44 London Temperance Hospital 1 Long Grove Mental Hospital 2 Middlesex Hospital 4 Carried forward 181 36 Brought forward 181 Mildmay Memorial Hospital 1 Mildmay Mission Hospital 6 Ministry of Pensions Hospital, Orpington 3 National Heart Hospital 1 National Hospital, Queen's Square 3 Northumberland House, Green Lanes • 2 North-Eastern Fever Hospital 9 North Middlesex Hospital, Edmonton 3 Nortli-Western Fever Hospital 1 Park Fever Hospital 2 Prince of Wales' General Hospital 4 Queen's Hospital for Children 48 Queen Mary's Hospital, Wandsworth 1 Queen Mary's Hospital, Carshalton 2 Royal Chest Hospital, City Road 5 Royal Free Hospital 3 Royal Northern Hospital 6 St. Bartholomew's Hospital 32 St. Columba's Hospital 3 St. George's Home, Chelsea 3 St George's Hospital 3 St. Luke's Hospital 5 St. Mary's Hospital 1 St. Peter's Hospital 3 St Thomas' Hospital 3 Seaman's Hospital, Greenwich 1 Shoreditch Infirmary 3 South London Hospital 1 Tooting Bec Mental Hospital 16 University College Hospital 3 Victoria Park Hospital 12 West Bank Mental Hospital 1 Westminster Hospital 3 Western Fever Hospital 2 Carried forward 376 37 Brought forward 376 West London Hospital 1 Whipps Cross Hospital, Leyton 1 Miscellaneous Institutions 66 444 Death Rates and Infantile Mortality Rates in the London Boroughs for the year 1925. Deaths per 1,000 Population. Infantile Deaths per 1,000 Births. Hampstead 10.2 Wandsworth 52.0 Lewisham 10.3 Lewisham 55.0 Wandsworth 10.43 Woolwich 55.0 Battersea 10.3 Hampstead 55.0 Fulham 10.7 Battersea 58.0 Woolwich 10.9 Finsbury 59.8 Hackney 10.9 Stoke Newington 61.0 Camberwell 11.1 Lambeth 62.0 Stoke Newington 11.2 Islington 63.0 Greenwich 11.23 Deptford 63.0 St. Marylebone 11.6 St. Marylebone 63.0 Poplar 11.7 Holborn 63.0 Hammersmith 11.9 Camberwell 64.7 Stepney 11.9 Hammersmith 65.0 Bethnal Green 12.0 Hackney 65.0 Lambeth 12.1 Westminster 69.0 Deptford 12.1 Chelsea 69.0 Paddington 12.1 Greenwich 70.0 Islington 12.26 St. Pancras 72.0 Westminster 12.3 Paddington 72.0 Holborn 12.51 Stepney 73.0 Bermondsey 12.6 Poplar 75.0 St. Pancras 12.7 Fulham 76.0 Southwark 13.1 Southwark 77.0 Kensington 13.2 Kensington 78.0 Shoreditch 13.3 Bermondsey 78.0 Chelsea 13.6 Bethnal Green 80.6 Finsbury 13.6 Shoreditch 88.0 38 MORTUARY, 1925. Number of bodies in Mortuary 282 (a) Infectious — 1. To await Inquests— (b) Nor.-Infectious 233 2. To await Burial Number of Post Mortems 130 Inquests. Verdict. Sex. Male. Female. Natural Causes 54 52 Accidental Death 45 22 Suicide 23 18 Open Verdict 9 6 Manslaughter 1 Murder ... 1 Misadventure 1 1 Totals 133 100 Table showing nature of Suicidal and Accidental Deaths in the Borough of Hackney during the year 1925. Nature of Suicide. No. Nature of Accidental Death. No. Hanging 6 Shock from Burns 7 Poisoning 15 Shock from Fall 20 Drowning 11 Suffocation 2 Jumping from window 5 Drowning 1 Cut throat 4 Run over 27 Stock from Scalds 1 Poisoning 1 Fall from Window 2 Fall from ladder 1 Others 4 41 67 39 TABLE I. Vital Statistics of Whole District during 1925 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 1916 209,636 5,331 5,026 22.0 2,917 13.9 617 581 423 84 2,881 13 .8 1917 196,598 4,207 3,750 17 .1 2,929 14 .9 661 585 345 92 2 853 14 .6 19181 For Deaths 195.804 j3,828 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 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 2.4C6 10.6 1924 226,900 4,802 4,214 18 .5 2,844 12.5 680 424 254 60 2.588 11.4 1925 228,300 4,806 4.093 17 .9 2,866 12.5 696 444 268 65 2,614 10 .9 40 III.—NOTIFIABLE DISEASES DURING THE YEAR. During 1925 there were 1,348 cases of acute infectious disease compulsorily notified in the Borough, as set out in Table II. This total shows an increase of 95 upon those notified during 1924. The attack-rate in respect of the acute notifiable infectious diseases for the year is 5.9 per 1,000 inhabitants. In addition there were 356 notifications received of pulmonary tuberculosis and 109 notifications of other forms of tuberculosis. The deaths from the chief zymotic diseases numbered 114. This i.s equivalent to a zymotic death-rate of 0.49 per 1,000 living in the Borough, as compared with a zymotic death-rate of 045 during the previous year. Notifiable Diseases during the year 1925 (Deaths in Hospitals) Disease. No. of Deaths in Hospitals. Total Deaths. Diphtheria 30 30 Erysipelas 6 6 Scarlet Fever 4 4 Puerperal Fever 3 3 Cerebro-Spinal Meningitis - 1 Typhoid Fever 2 2 Encephalitis Lethargica 5 6 Influenzal Pneumonia - 1 Acute Primary Pneumonia - 4 50 57 41 TABLE II.-INFECTIOUS DISEASE. Notifiable Diseases during the Year 1925 (Age groups of notifications). Diseases. Cases Notified Total Cases Notified in each Locality. Total cases removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 Under 1. 1 to 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. Central. South-East. South-West. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 666 12 27 48 71 60 263 78 39 57 9 2 ... 116 172 251 127 654 Erysipelas 58 2 1 ... ... ... 2 ... 2 8 8 30 5 13 11 16 18 25 Scarlet Fever 531 7 20 37 48 58 224 75 26 29 5 2 ... 144 147 125 115 509 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 7 ... ... ... ... ... ... 2 1 3 ... 1 ... 1 2 2 2 7 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 13 ... ... ... ... ... ... ... ... 11 2 ... ... 7 2 1 3 13 Cerebro-Spinal Meningitis 4 2 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 2 3 Polio Myelitis 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 Ophthalmia Neonatorum 22 22 ... ... ... ... ... ... ... ... ... ... ... 2 10 5 5 9 Pulmonary Tuberculosis 356 ... ... ... 4 ... 10 3 37 157 67 68 10 89 75 82 110 244 Other forms of Tuberculosis 109 3 7 4 3 3 30 20 13 13 7 4 2 18 29 33 29 77 Encephalitis Lethargica 11 ... ... ... ... ... ... ... ... 3 2 4 2 3 ... 4 4 9 Influenzal Pneumonia 7 ... ... ... ... ... 2 ... ... 2 1 1 1 2 ... 4 1 2 Acute Primary Pneumonia 27 ... ... 1 2 2 ... 2 5 2 6 5 2 1 9 12 5 9 Malaria 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1,813 48 56 90 128 123 532 180 123 285 108 118 22 397 458 537 421 1,563 42 Notifications of Infectious Disease, years 1921-5. Disease. 1921 1922 1923 1924 1925 Diphtheria 872 732 528 546 666 Erysipelas 91 64 73 48 58 Scarlet Fever 1863 674 457 528 531 Enteric Fever 7 4 17 8 7 Puerperal Fever 18 10 22 11 13 Cerebro-Spinal Meningitis 2 4 1 8 4 Polio Myelitis 1 1 3 2 1 Ophthalmia Neonatorum . 37 30 25 25 22 Encephalitis Lethargica 12 4 7 34 11 Influenzal Pneumonia 9 17 5 9 7 Pneumonia 42 33 30 34 27 Malaria 3 5 ... ... 1 Dysentery 3 1 ... ... ... Small Pox ... ... 1 ... ... 43 Notifiable Diseases during the year 1925 (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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 666 654 1 1 2 6 5 14 ... 1 ... ... ... ... 30 Erysipelas 58 25 1 ... ... ... ... ... ... ... 1 1 1 2 6 Scarlet Fever 531 509 ... ... 2 2 ... ... ... ... ... ... ... ... 4 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 7 7 ... ... ... ... ... ... ... ... 1 1 ... ... 2 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 13 13 ... ... ... ... ... ... ... ... 2 1 ... ... 3 Cerebro-Spinal Meningitis 4 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 Polio Myelitis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 22 9 ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 11 9 ... ... ... ... ... ... ... ... 1 ... 5 ... 6 Influenzal Pneumonia 7 2 ... ... ... ... ... ... ... 1 ... ... ... ... 1 Acute Primary Pneumonia 27 9 ... ... ... ... ... ... ... 1 ... ... 2 1 4 Malaria 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1348 1242 2 1 4 8 5 14 - 3 5 3 0 3 57 For age groups of notifications (including Tuberculoids) seepage 41. 44 Summary of Proceedings under the Vaccination Acts, 1867 to 1898, during the year 1925. Registration Sub-District. No. of Cases in Birth Lists received during Year. No. of Certificates of Vaccination received. No of Certificates of Postponement owing to No. of Certificates under Section 2 of Vaccination Act, 1898, and No, of Statutory Declarations under Section 1 of the Vaccination Act, 1907. No. of Certificates of Insusceptibility or of having had Smallpox. No. of Cases. No. of Entries in Lists sent to Public Vaccinator Health of Child. Condition of House. Prevalence of Infectious Disease. Parents Removed out of District. Otherwise not found. North 772 388 24 — - 269 3 42 - 319 Central 1,997 403 28 — — 814 4 512 48 221 South-East 1,128 276 12 — — 521 — 111 49 246 South-West 952 395 14 — — 428 1 52 — 365 Total 4,849 1,462 78 — — 2,032 8 717 97 1,151 45 Small-Pox.—There were no notifications of small-pox in the Borough during 1925. Scarlet Fever or Scarlatina.—The number of cases of scarlet fever notified during 1925 was 531. This is an increase of 3 cases upon the number of genuine cases notified during 1924. The attack rate for scarlet fever was 2'32 per 1,000 persons living, and for England and Wales 2.36. The number of cases removed to hospital during the year was 509. This is equal to 96 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 144 147 115 125 Attack-rate per 1,000 living 2.4 2.7 1.9 2.1 It will be seen from the above that scarlet fever was most prevalent in the Central Sub-district. The deaths from scarlet fever during 1925 numbered 4, which is equal to a case mortality of 0.75 per cent. attacked, and a scarlet fever death-rate of 0.017 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 666 cases of diphtheria and membranous croup notified during the year. This is an increase of 120 upon the number of genuine oases notified during 1924. The attack rate of diphtheria was 2.9 per 1,000 inhabitants, compared with T23 for England and Wales. There were 654 cases removed to hospital during the year. This is equal to 98 per cent. of the cases notified. 46 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 116 172 127 251 Attack-rate per 1,000 living 2.0 3.1 2.1 4.3 From the above it will be seen that diphtheria was most acute in the South-East Sub-district. The deaths from diphtheria and membranous croup during the year numbered 80. This mortality is equal to a death-rate of 4.5 per cent. attacked and 0.13 per 1,000 inhabitants, as compared with a death-rate of 6.2 per cent. attacked, and 0.15 per 1,000 inhabitants for the previous year. The death-rate from diphtheria for London during the same period is 0.11 per 1,000 inhabitants. During the year 1,278 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically examined, of which 158 gave positive results, .1,100 negative results, and 20 were returned as doubtful. Diphtheria Anti-toxin.—In accordance with the Anti-toxin Order of 1910, a supply of diphtheria anti-toxin was provided during the. year, and issued as required to medical practitioners applying for it in cases of diphtheria or suspected cases of diphtheria amongst the poorer inhabitants of the Borough. During the year 139 bottles of anti-toxin of 8,000 units each were supplied to medical practitioners, most of which was used for prophylactic purposes. 47 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 48 333 71 11 6 ... Diphtheria 29 409 112 9 ... ... 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, 7 cases of enteric fever were notified. This shows a decrease of one on the number of genuine cases notified during 1924. The attack rate was 0.03 per 1,000 inhabitants, compared with 0.07 for England and Wales. All the cases were removed to hospital. The table below gives the distribution of the notified cases in the Sub-districts of the Borough:— Sub-Districts. North. Central. South-west. South-east. Number of cases of Typhoid Fever 1 2 2 2 48 There were two deaths from enteric fever in the Borough last year. During the year 19 specimens of blood from persons suspected to be suffering from enteric fever were submitted to Widal's test. All gave a negative reaction. 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 13 cases of puerperal fever notified during 1925; all the cases were removed to hospital. The deaths from puerperal fever and septicaemia numbered 3. The attack-rate for the year was 3T per 1,000 births, and the deathrate 0.7 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 58 cases of Erysipelas notified during 1925. This is equal to an attack-rate of 0.25 per 1,000 inhabitants, compared with 0.39 for England and Wales. Of the 58 cases notified, 25 were removed to hospital. There were 6 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 13 11 18 16 Rate per 1,000 living .22 .20 .30 .27 49 Cerebro-spinal Meningitis—During 1925 there were four cases of this disease notified in the Borough, three were removed to hospital. One death occurred. Polio-myelitis.—There was one case 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 22 13 9 22 - - - Encephalitis Lethargica.—The Public Health (Acute Encephalitis Lethargica and Acute Polio Encephalitis) Regulations, 1918, came into operation on 1st January, 1919. During the year 1925 11 cases were notified, 6 being fatal. Nine patients were removed to hospital. Influenzal Pneumonia and Pneumonia.—There were 7 cases of influenzal pneumonia and 27 of primary pneumonia notified. As provided in the Regulations, where the nursing was found to be inadequate a nurse was sent from the King's Home for Nurses in accordance with an arrangement made with the Superintendent at a fee of 1s. 3d. per visit. During the year 109 cases, including cases of pneumonia and broncho-pneumonia, were nursed and 1,994 visits were paid to those cases. Influenza, unless complicated by pneumonia, is not notifiable. Malaria.—There was one notification 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 1925. D 50 NON-NOTIFIABLE DISEASES. Measles and German Measles.—The Public Health (Measles and German Measles) Regulations, 1915, were withdrawn by Order in Council on 31st December, 1919. Seventeen deaths were recorded from measles. The annual mortality, is therefore, 07 per 1,000 inhabitants, compared with London .08 per 1,000 inhabitants. Information of 1,374 cases of measles and 99 cases of German 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 1925 there were 16 deaths in the Borough. This is a decrease of 30 on the deaths from this cause registered during 1924. The annual mortality rate from influenza is 0.2 per 1,000 inhabitants. Diarrhoea.—There was an increase in the number of deaths due to diarrhoea] disease in the Borough during 1925. The total number of deaths from this cause was 29, and of these 27 were under 1 year of age. The annual mortality rate for diarrhoea and enteritis during the year is 012 per 1,000 inhabitants. Whooping Cough.—The deaths from this cause during the year numbered 32. This is an increase of 16 upon the number registered during 1924. 30 deaths occurred in children under five years of age. The mortality for Hackney is equal to 0.14 per 1,000 inhabitants, and that for all London, 0.19 per 1,000 inhabitants. The King's Home for Nurses attended to 8 cases and paid 110 visits. 51 Information was received from the head masters and head mistresses of elementary schools in Hackney of 816 cases of whooping cough occurring among their scholars during the year. CONSTITUTIONAL DISEASES. For Table of Deaths see pages 152 to 159. Cancer.—There were 301 deaths during 1925 due to the different varieties of malignant disease. This is a decrease of 9 on the number registered during 1924. The annual mortality rate from malignant disease for last year is therefore 1.31 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 88 72 78 63 Mortality-rate per 1,000 inhabitants 1.5 1.3 1.3 1.0 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 1925:— London. Borough of Hackney. Years. 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 Deaths from Cancer. 245 230 236 274 246 289 285 303 310 301 Death-rate per 1,000. 1.16 1.17 1.07 1.26 1.09 1.28 1.26 1.33 1.36 1.31 Death-rate per 1,000. 1.18 1.25 1.26 1.20 1.20 1.31 1.30 1.35 1.40 1.40 52 CANCER, 1925. Analysis of the Deaths from Cancer, Malignant Tumour, Sarcoma and other forms. 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75-85 and up. 85 wards Total. Brain or Meninges ... ... ... 1 1 1 2 1 ... ... 6 Mouth and Annexa ... ... ... ... 1 1 7 11 2 1 23 Oesophagus ... ... ... ... ... 2 3 6 3 ... 14 Stomach ... ... ... 1 7 11 19 16 4 1 59 Pancreas ... ... ... ... 1 2 3 ... 1 1 8 Intestine (large or small) ... ... ... ... 6 3 9 19 2 2 41 Rectum ... ... ... ... 4 5 6 13 2 1 31 Liver ... ... ... ... 2 2 5 6 2 ... 17 Larynx ... ... ... ... ... ... 2 3 ... ... 5 Lung ... ... ... ... 1 2 1 2 1 ... 8 Bladder ... ... ... ... ... 1 1 7 1 ... 10 Breast ... ... ... 3 5 11 10 8 6 1 44 Uterus and appendages ... ... 2 ... 2 5 10 2 2 ... 23 Bones and Joints 1 2 ... 1 ... ... 1 ... 1 ... 6 Other and ill-defined situations 1 ... 3 ... 1 ... 1 ... ... ... 6 2 2 6 6 31 46 80 94 27 7 301 53 Alcoholism. Alcoholism.—During the year under consideration there were no deaths from alcoholic poisoning; but 13 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 ... ... 2 1 ... ... 2 1 1 1 3 11 6 ... ... 9 2 5 4 6 17 13 ... ... ... 1 10 1 2 U 9 ... 2 1 2 15 19 18 5 8 5 11 1 3 20 28 26 4 1 8 20 ... ... 25 52 51 5 3 25 21 2 2 35 42 25 1 6 23 22 ... 4 45 25 11 1 2 20 9 1 1 55 21 11 1 ... 12 7 ... ... 65 and upwards 4 6 ... 2 4 2 ... 1 Totals 197 159 58 51 97 94 16 17 During 1925, 465 primary notifications of tuberculosis were received, details of which are given on page 56 of this Report. Bacteriological examination of sputa from 472 cases was made by the Council's Bacteriologist during the same period. In 71 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 1925, was 224, a decrease of 30 upon the deaths during 1924. These deaths are classified as follows:— 54 Pulmonary Tuberculosis 191 General tuberculosis 1 Tuberculous meningitis 12 Tuberculous peritonitis 5 Lupus - Tabes mesenterica - Tubercle of other organs 15 224 This number of deaths gives an annual mortality of 0.98 per 1,000 inhabitants. Primary Notifications and Deaths during the years 1916-1925. Year. Primary Notifications. Deaths. Death Rate. Pul. Non-pul. Total. Pul. Non-pul. Total. 1916 575 158 733 274 85 359 1.7 1917 709 161 870 304 56 360 1.8 1918 793 109 902 307 64 371 1.8 1919 483 143 626 219 52 271 1.2 1920 410 139 549 190 59 249 1.1 1921 361 105 466 213 51 264 1.17 1922 319 85 404 202 36 238 1.05 1923 387 89 476 216 40 256 1.13 1924 334 115 449 207 47 254 1.12 1925 356 109 465 191 33 224 .98 In the following table the yearly deaths from tuberculous diseases in the Borough for the last 28 years are shown, grouped in periods of 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 1922-1924 249 48.2 1925 224 53.6 55 There were only two instances where a notification was not received, and in these cases the deaths were certified on inquests. There were, however, 17 deaths certified as due to tuberculosis of persons who had not previously been notified under the Regulations, and in accordance with the circular letter 549 of the Ministry of Health, dated 22nd December, 1924, the attention of the medical attendant in each case was called to their neglect. In every case the certificate was forthcoming and the explanation satisfactory. 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 1898-1900 to the year 1925, being equal to 53.6 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 44 52 70 58 Mortality rate per 1,000 inhabitants .76 .96 1.2 1.0 Public Health (Tuberculosis) Regulations, 1912. Under these Regulations 1,196 notifications of tuberculosis were received during the year, of which 958 were pulmonary and 238 non-pulmonary. 56 Summary of Notifications during the period from 4th January, 1925, to 2nd January, 1926. Age Periods. Notifications on Form A. and 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 Total Primary Notifications. Pulmonary Males ... 1 4 1 17 25 47 39 22 18 4 178 215 „ Females ... 3 6 1 17 22 49 23 11 11 6 149 173 Non-Pulmonary Males ... 4 15 9 4 4 4 1 1 1 ... 43 46 „ „ Females ... 5 12 7 7 1 2 4 1 ... 1 40 49 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 ... ... ... ... ... 35 157 „ Females ... ... ... ... ... 39 68 Non-Pulmonary Males „ „ Females ... ... ... ... ... 1 ... 1 ... 1 ... 1 27 37 57 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the same period, otherwise than by notification on Form A or Form B, under the Public Health (Tuberculosis) Regulations, 1912. Age periods. 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 Total Cases. Fulmonary Males ... ... ... ... 2 3 5 3 3 3 ... 19 „ Females ... ... ... 1 1 4 2 2 ... ... ... 10 Non-pulmonary Males 2 7 2 2 1 ... 1 ... ... ... ... 15 „ Females 1 1 1 1 1 ... 1 2 1 ... 1 10 58 Copies of Letters and Circulars forwarded to Medical Practitioners regarding cases where delay had occurred in notifying cases wider the Regulations. I find from my returns of deaths that the above-named was certified by you to have died on the-from-,but I have not received a notification as required by the Public Health (Tuberculosis) Regulations, 1012. Article V. of the Regulations requires that" every medical practitioner shall within 48 hours after becoming aware that such person is suffering from tuberculosis, make and sign a notification of the case in Form A., and shall transmit the notification to the Medical Officer of Health for the district within which the place of residence of the person is situate at the date of notification." I am forwarding, for your information, an extract from Circular 549 of the Ministry of Health with reference to the Public Health (Tuberculosis) Regulations, 1912 and 1921. The Ministry of Health are paying increasing attention to the question of notification of Tuberculosis, and 1 should be glad if vou would co-operate with me in this respect as fullv as possible. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912 and 1921. Circular 549—Ministry of Health—22nd December, 1924. "Notifications under the Regulations"—Paragraph 5:— "The Minister desires to take this opportunity of impressing upon Local Authorities the responsibility which attaches to them for seeing that the requirements of the Regulations are fully observed in their Districts, and I am to state that where (as in the case of a death certified as due to tuberculosis of a person who 59 had not previously been notified under the Regulations) there is 'prima facie' evidence of neglect to notify on the part of the medical attendant, immediate steps should be taken by the Local Authority to obtain an explanation from the medical attendant as to the circumstances under which formal notification under the Regulations was not made. If the explanation is not satisfactory, it should be borne in mind that the Local Authority have power to institute proceedings for the recovery of a penalty under Section 1 (3) of the Public Health Act, 1896, in cases of wilful neglect or refusal to carry out the Regulations; and it appears to the Minister that it may even be desirable to proceed to a prosecution in one or two cases of the kind where the circumstances warrant such action in order to secure the objects of the Regulations." I have received information that a sample of sputum in respect of the above-named patient has been found to contain tubercle bacilli, but I do not appear to have received a notification as required by the Public Health (Tuberculosis) Regulations, 1912. Article V. of the Regulations requires that "every medical practitioner shall within 48 hours after becoming aware that such person is suffering fram tuberculosis, make and sign a notification of the case in Form A., and shall transmit the notification to the Medical Officer of Health for the district within which the place of residence of the person is situate at the date of notification." I am forwarding, for your information, an extract from Circular 549 of the Ministry of Health with reference to the Public Health (Tuberculosis) Regulations, 1912 and 1921. The Ministry of Health are paying increasing attention to the question of notification of Tuberculosis, and I should be glad if you would co-operate with me in this respect as fully as possible. 60 Public Health (Tuberculosis) Regulations, 1924. Return for 1925. The following is a summary of the quarterly returns furnished to the London County Council during the year:— Pulmonary. Non-pulmonary. Male. Female. Male. Female. Number of cases on Register at 1st January, 1925 912 610 350 342 Number of cases notified under Regulations (1912) during the year and added to the Register 177 148 44 40 Transfers from other Districts 5 6 1 1 182 154 45 41 Number of cases removed from the Register during the year 207 154 32 37 Total number of cases on Register at 31st December, 1925 887 610 363 346 1497 709 Visits paid by Tuberculosis Visitors. New Cases. Contacts Sailors and Soldiers Other Persons. Total. Insured. Noninsured. Miss Servanté 178 134 314 1657 2283 1201 1082 Miss Clarke 246 233 293 1463 2235 1138 1087 424 367 607 3120 4518 2339 2179 The Staff of the King's Home for Nurses paid 1,925 visits to 39 cases. 61 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 154, and the total number of visits of this kind made was 607. The proportion of the number of visits to such cases to the total number of visits made by Tuberculosis Health Visitors to tuberculous cases in the Borough was as one to seven. See page 60. TUBERCULOSIS SCHEME. The Ministry of Health request precise information as to the following details of the Tuberculosis Dispensary service:— (i.) A list of dispensaries, branch dispensaries, &c., and a list of Tuberculosis Officers and Assistant Tuberculosis Officers employed in Dispensary work. (ii.) In Administrative Counties, precise particulars of arrangements for co-operation with Sanitary Authorities and their officers. (iii.) The nature and extent of co-operation with general and special hospitals, school clinics and other institutions. (iv.) Any special arrangements made to secure the co-operation of medical practitioners, and the working of the arrangements set out in Memorandum No. 286, in regard to the co-ordination of the work of Tuberculosis Officers and Insurance Practitioners. (v.) The arrangements for following up patients in cases in which the diagnosis is doubtful. (vi.) The arrangements for securing the examination and systematic supervision of " home contacts." (vii.) Information as to special methods of diagnosis and treatment in use, and the number of persons to whom these special methods have been applied. 62 (viii.) The results of local experience as to the relative value of each form of treatment. (ix.) The nature and extent of any dental treatment provided by the Council for tuberculous patients. (x.) Any arrangements for the provision of nursing or of extra nourish, ment for patients living at home. (xi.) The arrangements for treating non-pulmonary tuberculosis, especially tuberculosis of bones and joints in adults and in children, and for the provision of surgical apparatus, etc. (xii.) The arrangements for "care" and "after-care" and their working. (xiii.) Particulars as to any local arrangements for finding employment for patients. (xiv.) Statement as to the supply and supervision of shelters at the homes of patients. (xv.) Any special points noted locally as to the incidence of tuberculosis (e.g., occupation). (xvi.) Any special methods adopted or proposed for the prevention of tuberculosis. (xvii.) Special difficulties encountered. (i) There are two Tuberculosis Dispensaries—Victoria Park Hospital Tuberculosis Dispensary, with a Chief Clinical Tuberculosis Officer, Dr. Howell, and an Assistant, Dr. Hamilton; and the Metropolitan Hospital Tuberculosis Dispensary, with Dr. Young in sole charge. (ii) Residential treatment for Dispensary cases who are under observation is provided by the Hospitals. All other residential treatment is provided by the London County Council. (iii) Co-operation between the Metropolitan and Victoria Park Hospitals and the Dispensaries is adequate, and the services of the Specialists at each of these Hospitals can readily be obtained by the Tuberculosis Officers. The School Clinics are under the control of the London County Council. (iv) Co-operation with medical practitioners is invited, cases are seen in consultation with medical practitioners either at the homes or the Dispensaries, and the fullest information given to the medical practitioners concerning cases sent for examination. 63 The work of the Tuberculosis Officers is co-ordinated with the Insurance practitioners on the lines set out in Memorandum No. 286. (v) Cases in which the diagnosis is doubtful, who remain in their homes, are kept under observation by Tuberculosis Health Visitors and at the Tuberculosis Dispensaries. Other cases are kept under observation at the Metropolitan and Victoria Park Hospitals. (vi) The examination and systematic supervision of home contacts is carried out by the Tuberculosis Visitors and Tuberculosis Officers; contacts are examined either in their homes or at the Dispensaries, and are kept under supervision by the Tuberculosis Visitors who arrange for re-examination when the health of contacts appears to be failing in any way. (Vii) Cases in which the diagnosis cannot be decided by dispensary examinations are referred to the hospitals for observation by the Specialists in the various departments. All such cases are X-rayed and weekly examination of the sputum carried out. All specific remedies such as Dreyer's Vaccine are given in hospital. (viii) The forms of treatment that have given most beneficial results have been the usual non-specific remedies. Creosote in increasing doses has given good results at Victoria Park Dispensary, and X-ray treatment of Tuberculous glands at the Metropolitan Hospital. The Dreyer Vaccine is not now given. (ix) Dental treatment, fillings and extractions are carried out at the Victoria Park Hospital, and is limited to an expenditure of £70 per annum. Arrangements for dentures have to be made through charitable Associations. (x) Nurses are supplied from the King's Home for Nurses under an agreement with the Council. Extra nourishment to the extent of £2 per 1,000 of the population is supplied to Sanatorium cases, i.e., cases either waiting for admission, or recently discharged from Sanatoria, on the recommendation of the Tuberculosis Officer, and provided that the home circumstances require this assistance. 64 (xi) Non-pulmonary tuberculosis is dealt with by admission to the Victoria Park and Metropolitan Hospitals, and surgical apparatus can only be supplied through Charitable Associations. (xii) Care and After-care is carried out by the Hackney and Stoke Newington After-care Committee. A report on the work of this Committee is now being prepared, but will not be completed in time for inclusion in this report. (xiii) Employment for patients is sometimes found by the Care Committee, who have stated their opinion that their powers are inadequate in this direction. (xiv) Three Shelters are supplied by the Council, and are in constant use. More shelters are required. (xv) No special points that are not generally common to other districts have been noted as to the incidence of tuberculosis. (xvi) It is proposed, if possible, to care for the advanced cases to a greater extent than has been possible in the past. (xvii) The special difficulties have been often mentioned in reports of Conferences, resolutions forwarded to the Ministry and in Annual Reports, and would require a fairly large report to set out fully. It may briefly be stated that the special difficulties are those experienced in the administration of the Tuberculosis Dispensaries (see page 65), in Care and After-care, in home conditions where overcrowding exists, and particularly as regards the employment of tuberculous patients. 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 65 that the following authorities are now interested in the Dispensary' treatment of Tuberculosis in Hackney:— Hackney Borough Council, Stoke Newington Borough Council, Bethnal Green Borough Council, Ministry of Health, London County Council, Metropolitan Hospital Management Committee, Victoria Park Hospital Management Committee. A Tuberculosis Officer, in addition to the primary duty of diagnosis and tieatment 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 1925 a total estimated population of 401,290 with 420 deaths from Tuberculosis and with 817 primary cases of Tuberculosis notified during that year alone. DISPENSARY DISTRICTS. Estimated Population in Electoral Wards. Metropolitan Hospital Area— Stamford Hill 33,660 West Hackney 19,651 Kingsland 23,651 Downs 17,519 94,341 Estimated population (1925)— Borough of Stoke Newington 53,190 47,531 E 66 Brought forward 147,531 Victoria Park Hospital Area— Clapton I'ark 43,653 Homerton 38,128 South Hackney 123,660 Hackney 28,518 133,959 Estimated population (1925)— Borough of Bethnal Green 119,800 253,759 401,290 Estimated population (1925) Hackney 228,300 DISPENSARY DEATHS. Condition of Patient on First Ittendance. Pulmonary Tuberculosis 1st Stage. 2nd Stage. 3rd Stage. Number 13 68 44 Percentage 10.4% 54.4% 35.2% Duration of illness before attending Dispensary Under 1 month 7 1 to 3 months 24 3 to 6 months 19 6 to 9 months 9 9 to 12 months 5 Over 12 months 40 Period indefinite 21 67 ALL DEATHS FROM TUBERCULOSIS. Interval elapsing between Notification and Death. 1923. 1924. 1925. Pul. Non-pul. Pul. Non-pul Pul. Non-pul 1. Number of Deaths from Tuberculosis 216 40 207 47 191 33 2. Number of cases only notified at death 15 3 3 6 16 21 8. Do. notified within a month of death 16 2 19 6 26 4 4. Do. do. 3 months of death 19 1 22 1 21 1 5. Do. do. 6 months of death 9 1 20 1 14 — 6. Number of deaths in cases not notified under Tuberculosis Regulations 26 18 16 25 2 — 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 1925, 465 primary cases were notified, and the contacts to these cases number in all 1,085 persons, and of these 571 contacts were examined, making the number examined over 52 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 1925, 224 deaths were registered—191 pulmonary and 33 non-pulmonary; but of these only 2 pulmonary cases were not originally notified under the regulations, both being certified as due to this cause on inquest. Enquiries as to contacts, however, were made in all cases, with the exception of deaths occurring in Mental Hospitals. 68 Of the pulmonary deaths, there were 558 contacts, of which 361 were examined, representing 66 per cent, examined; and of the non-pulmonary deaths there were 84 contacts, of which 29 were examined, representing 34 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 309 Females 369 Total 678 2.—The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 94 46 Local Practitioners Primary 192 199 64 Contact 7 War Pensions Committee 15 6 Contact cases (Tuberculosis Visitors) 331 10 London County Council 10 5 Victoria Park Hospital 13 12 Other sources 16 6 69 3.—The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 15. Males. Females. Pulmonary Tuberculosis 55 25 4 16 24 124 Non-pulmonary Tuberculosis 3 5 17 1 2 28 Non-tuberculous 81 60 221 16 105 483 Doubtful 14 10 11 1 7 43 Totals 153 100 253 34 138 678 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 10 Non-pulmonary tuberculosis 3 Non-tuberculous 314 Doubtful 11 Total 338 5.—Sputum Examinations of Insured and Uninsured Patients. Tubercle Bacilli present 154 Tubercle Bacilli absent 542 Total 696 70 6.—Other Figures. Insured. Uninsured. Total number of attendances 1845 3727 Systematic examinations at the above 2667 Number of letters written 1622 Number of visits to patients at their homes 153 Number of patients sent to hospital or sanatorium by London County Council 74 24 Number of patients referred to:- X-ray Department „ 88 Dental Department 21 Other Departments 55 METROPOLITAN HOSPITAL TUBERCULOSIS DISPENSARY. (Dr. Young.) HACKNEY CASES TREATED. 1.—The Totals of New Cases. Males 206 Females 183 Total 389 2.—The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 59 37 Local Practitioners 101 39 War Pensions Committee 1 1 Contact cases (Tuberculosis Visitors) 199 6 Ministry of Pensions 3 — London County Council — — Metropolitan Hospital 15 11 Other Hospitals 4 4 Other sources 7 3 71 3.—The Diagnosis of the New Cases. Diagnosis. Insured. Uninsured. Total. Males. Females. Children under 15. Males. Females. Pulmonary Tuberculosis 28 17 3 19 15 82 Non-pulmonary Tuberculosis — 1 14 1 3 19 Non-tuberculous 58 35 117 21 50 281 Doubtful 1 1 1 3 1 7 Totals 87 54 135 44 69 389 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 5 Non-pulmonary tuberculosis 1 Non-tuberculous 192 Doubtful 1 Total 199 5.—Sputum Examinations of Insured and Uninsured Patients. Tubercle Bacilli present 175 Tubercle Bacilli absent 314 Total 489 72 6.—Other Figures. Insured. Uninsured. Total number of attendances 1265 1338 Systematic examinations at the above 456 392 Number of letters written 167 109 Number of visits to patients at their homes 71 63 Number of patients recommended for hospital or sanatorium 58 36 Number of patients referred to:— X-ray Department 32 11 Dental „ 8 10 Other Departments 3 16 Extra Nourishment. The Scheme came into operation on 6th June, 1921, and during the year 147 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 £438 7s. 7d. 73 Advanced Cases. The following table shows the place of death of Hackney inhabitants during 1925, and it is apparent from this what a large proportion of deaths occur in the patients' homes. Place where death occurred. Pulmonary Tuberculosis. Other forms of Tuberculosis. Totals. At Patients' Homes 79 7 86 At Hackney Hospital 59 6 65 At other Institutions 53 20 73 191 33 224 It should be remembered that the oeaths 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." PULMONARY TUBERCULOSIS. Places where death occurred during the years 1921-5. Year. At home. At Hackney Infirmary. Other Institutions. Total. 1921 97 56 60 213 1922 74 64 64 202 1923 116 58 42 216 1924 99 56 52 207 1925 79 59 53 191 74 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 87, with an average attendance of 75. 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. Boarding-out of Children. 1 he County Council decided to put into operation for a period of twelve months from 1st April, 1925, the following scheme for providing facilities in co-operation with the Invalid Children's Aid Association for— (1) The removal of children from heavily infected and overcrowded homes during the terminal stage of a dying case of pulmonary tuberculosis in the family. (2) The boarding-out of children who are being discharged from sanatorium treatment and whose homes are unsuitable and inimical to maintenance of health. (3) The boarding-out of "weakly" children living under conditions likely to subject them to infection, and of children in suitable instances whose parents are under treatment for tuberculosis. 75 Category (1).—The scheme is designed to board out or remove to an institution, children living in heavily infected and overcrowded homes. It is suggested that the icmoval of the children should take place at a time when it may be anticipated that during their absence the source of the infection will be removed permanently either by death or permanent transfer to an institution. By this means it should be possible to ensure that the children will return to an environment from which serious risk of infection has been withdrawn, and thus confer substantial benefit on the children and afford indirect assistance to the family at a time when the strain is greatest and when help is most needed. Category (2).—This category comprises those children who, on discharge from sanatorium, have to return to unsuitable home conditions militating against the benefit derived in the residential institution. The number of such children is limited as it is not proposed to deal with cases in which the home conditions are so unfavourable that there is no prospect of ultimate improvement. The children in all categories may be kept away as long as the conditions in the home are unfavourable to the return of the children. The parents of children sent away under the three schemes are assessed by the Invalid Children's Aid Association in the same way as cases referred to that Association for convalescence under existing arrangements with the County Council. During the year, 28 children (contacts of 17 cases) were recommended by the Tuberculosis Officers for boarding-out, and 2 children recommended for convalescent treatment after sanatorium treatment. Of this number, 9 were boarded-out under the .scheme. In 11 cases the parents refused to allow the children to leave home, but in 5 of these cases they afterwards withdrew their opposition. The remaining cases were outstanding at the end of the year. 76 DISINFECTION. (a) Rooms.—During 1925 there were 2,086 rooms fumigated and 459 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 1925. Month. Rooms Fumigated. Rooms Cleansed. January 202 58 February 150 46 March 179 35 April 152 43 May 116 38 June 205 38 July 220 50 August 141 27 September 156 54 October 160 50 November 196 20 December 209 — Total 2,086 459 (b) Articles of Clothing, Furniture, etc.—The number of articles under this head disinfected during last year was 33,895. This is an increase of 11,701 upon the number disinfected during 1924. A table is here given showing details of the articles disinfected each month. 77 Articles Disinfected, 1925. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Totals. House linen and furniture 3,259 2,159 2,434 1,989 1,692 2,189 2,147 1,760 2,224 2,398 2,853 2,751 27.855 Men's clothing 114 69 65 58 44 27 61 28 64 37 95 219 881 Women's clothing 261 208 171 120 91 107 89 127 127 106 155 216 1,778 Children's clothing 40 32 14 28 13 13 19 26 27 19 43 26 300 Other articles 368 272 205 230 180 178 220 262 271 256 300 339 3,081 Total 4,042 2,740 2,889 2.425 2,020 2,514 2,536 2,203 2,713 2,816 3,446 3,551 33,895 78 In addition to these there were 566 articles destroyed on request from the owners. These are set out in the following table:— Articles Destroyed. Beds 77 Bolsters 30 Mattresses 43 Pillows 72 Sundry Articles 344 Total 566 (c) Public Library Books.—During the past years 452 book from homes in which infectious diseases had occurred were dis infected. The method of disinfection of books practised is t expose the books in a closed chamber to the action of burninj sulphur. Books Disinfected. Month. Number. January 40 February 48 March 43 April 36 May 35 June 31 July 24 August 28 September 48 October 43 November 48 December 28 452 Isolation Shelter. During the year there were 180 persons admitted to the Shelter whilst their homes were being disinfected. This total consisted of 48 men, 49 women and 83 children. The cost of maintenance of these persons admitted was £14 15s. 79 Cleansing of Persons Act, 1897. The baths provided by the Borough Council under the above Act, for the cleansing of verminous persons, were in constant use. The total number of baths given during the year was 4,569 (200 to adults and 4,369 to children). This total shows an increase of 508 upon the number given during 1924. Of the 4,569 baths given, 1,107 were sulphur baths for scabies, and 3,462 for pediculi. The great majority of those persons presenting themselves for baths were children from the elementary schools in the Borough. The children received 4,369 baths, an increase of 451 upon the number given during 1924. The following are the Schools from which children were sent to the Cleansing Station, with the number of baths given:— Schools. Number Hot Baths. Cleansed. Sulphur Baths. Benthal Road 95 6 Berger Road 159 23 Cassland Road 6 — Church Street — 4 College Lane 2 — Craven Park 65 — Dalston Central 2 — Daubeney Road 465 40 Detmold Road 245 56 Eleanor Road — 4 Gainsborough Road — 4 Gayhurst Road 39 27 Glyn Road 88 94 Hackney Downs — 28 Hackney Parochial 99 33 Haggerston Road — 18 High Street 1 1 Holy Trinity — 43 Carried forward 1,266 381 80  Hot Baths. Sulphur Baths. Brought forward 1,266 381 Homerton Row 356 55 Lamb Lane 2 — Laura Place 14 — Lauriston Road 1 2 London Fields — 2 Mandeville Street 373 7 Millfields Road 24 48 Morning Lane 236 6 Newington Green — 8 North Hackney Central 12 — Northwold Road 133 45 Oldfield Road — 15 Orchard Street 173 8 Paragon Road 1 — Percy Road 79 — Queen's Road 66 — Rams 8 — Rushmore Road 122 174 St. James' 8 — St. Joseph's 45 73 St. Jude's - 17 St. Matthias — 7 St. Michael's 15 — St. Thomas' 2 — St. Scholastica's 9 — Shacklewell — 3 Sidney Road 125 8 Sigdon Road 140 20 Stormont House 4 — Tottenham Road — 7 Wilton Road 71 — Other young children 141 57 Total 3,426 943 81 The follow1ng table g1ves part1culars of the number, etc., of persons who were bathed and cleansed for paras1t1c d1sease at the D1s1nfect1ng Stat1on dur1ng the year. January. February. March. April. May. June. July. August. September. October. November. December. Totals Receiving Hot Baths Men 4 1 2 4 1 3 1 4 1 5 3 29 Women ... ... ... ... 2 1 1 ... ... 2 1 ... 7 Ch1ldren 271 307 291 236 242 314 259 40 469 386 388 223 3426 Rece1v1ng Sulphur Baths. Men 15 10 17 10 6 6 3 2 8 6 10 ... 93 Women 8 7 4 14 14 3 6 ... 7 7 1 71 Ch1ldren 20 44 116 80 175 ICO 87 34 64 122 74 27 943 82 IV.— CAUSES OF SICKNESS. 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, bronchitis, and the pneumonias is evidence of this. The housing accommodation is inadequate, and much misery and ill-health exists as a result of this fact. 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 Nurses, who employ 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 ihe 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 83 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 cases 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 lhe nursing association is 1s. 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 regards 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 £200, and under the general nursing heading £210, making in all a total of £420 for nursing assistance. For information as to visits paid see page 94. Midwives— There are no whole-time midwives employed by the Council. The fees of midwives attending the confinements of necessitous persons are paid as regards cases approved by the Maternity and Child Welfare Committee. There are 55 midwives practising in the Borough. 84 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) Borough Council. Weekly weighing (Health Visitors] 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, Northwold Road, Upper Clapton. One clinic weekly (Doctor] Borough Council. Hackney Mothers' and Babies' Welfare, Mission House, 23, Hackney Grove (Voluntary Centre) One clinic weekly (Doctor) Hackney Mothers' and Babies' Welfare, subsidised by Borough Council One weekly "weighing" (Health Visitors) St. Martin's Mission, Ada Street (Voluntary Centre) One weekly "weighing" (Health Visitors) do. One fortnightly clinic (Doctor) Eton Mission, Gainsborough Road, Hackney Wick (Voluntary Centre) One weekly clinic (Doctor) One weekly clinic "Weighing" 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) Dental. 23, Lower Clapton Road. Ont> weekly clinic (Dentist) (d) Tuberculosis. Metropolitan Hospital, Kingsland Road Tuberculosis Dispensary Borough Council. Victoria Park Hospital, Bonner Road, E.2. Tuberculosis Dispensary Borough Council. (e) School Clinics. Cleansing Station, Millfields 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 Orthopa;dic Clinic, Dalston Lane Massage and remedial treatment British Red Cross 85 (f) Venereal Diseases. Name and Situation. Mature 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 (43 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 93. (3) Children Agreement with the Invalid Children's Aid Association whereby this Association arranges convalescent aid under 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. (8) Other Hospitals Metropolitan Hospital, Kingsland Road A General Hospital supported by voluntary contributions. It has accommodation for in- and out-patients. 1 German Hospital, Ritson Road, Dalston Ditto. Hackney Hospital, High Street, Homerton Maintained by the Hackney Board of Guardians. Mission of Help to the Suffering Poor, Upper Clapton Assistance to aged and infirm. Medical and dental treatment in hospital. Institutional 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 86 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. Lome House 1., 16, Rectory Road Home for 12 mothers and 8 babies Salvation Army. Lome House 11., 4 Clapton Common Mothers' Hospital, 1'53, Home for 20 mothers and 14 babies Maternity Hospital for 80 Salvation Army. Salvation Army Lower Clapton Road St. Mary's, 153, Stamford Hill mothers 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. MATERN1TY AND CH1LD WELFARE. The original scheme for extension of this service was altered, in accordance with the wishes of the Ministry of Health, by the substitution of No. 28, Lower Clapton Road, as a Maternity and 87 Child Welfare Centre in place of the smaller treatment centre that it was proposed to erect at Millfields Road, and by proposing- the installation of ihe extra clinics at No. 28, Lower Clapton Road, instead of at premises rented for that purpose. Particulars of the extension are as follows:— (1) An increased contribution of £50 per annum to the King's Home for Nurses, for nursing assistance. (2) The appointment of an additional Fifth Class Clerk, and the promotion of Mr. H. C. Bowman from Class 4 to Class 2; the additional salary required amounting to £180 per annuim. (3) The appointment of four additional Health Visitors, the total additional salaries amounting to £980 per annum. (4) (a) The transfer from the Electricity Department to this Department of No. 28, Lower Clapton Road, at the sum of £1,771, the annual loan charge on this amount (30 years at 4f per cent.) being £111. (b) The provision of equipment at an estimated cost of £416. (c) An estimated expenditure upon rates and taxes at the rate of £70 per annum. (5) The appointment of a Resident Caretaker at a salary (including value of emoluments) of £234 10s. 0d. per annum. (6) The provision of two Welfare, two Ante-Natal, one Dental, and one Light Treatment Clinic, at an expenditure of £680 per annum. 88 (7) Alteration of the premises by the Borough Engineer and Surveyor, at an estimated cost of £750. DESCRIPTION OF THE WORK DURING THE PAST YEAR. The work carried out during 1925 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 tables (pages 90 and 91) give details of the visits made by the Health Visitors during the yea. Conditions Found by the Visitors. No. of Infants visited. Method of Feeding. Separate cot provided for Infant. Use of Comforter. Home conditions. Secondary visits. Breast Artificial. Mixed. Yes. No. Yes. No. Satisfac tory. Un- satis- fac- tory. 3352 2917 270 165 2367 985 1395 1957 3046 306 19262 89 2.—INFANT CONSULTATION AND ANTE-NATAL CLINICS. Part-time (temporary, i.e., not on the permanent staff) Medical Officers have been appointed to conduct the work of the consultation centres, the duties of medical officers having been arianged as follows:— 1. Attend the centre one afternoon per week. 2. To examine all infants brought to the centre, of parents living in the Borough. 3. To advise the parents as to the feeding and care of their infants. 4. Treat minor ailments in the infant when circumstances indicate the need for this. 5. To enter on a case paper to be provided for each infant, certain particulars, with notes on advice and treatment given, and the condition and progress of the infant. 6. To furnish monthly, a return to the Medical Officer of Health as to the number of infants seen and treated at the centre. N.B.—If the ailment of the infants is such as to necessitate continuous medical supervision and treatment, the medical officer must refer the case either to the usual medical attendant or to a hospital for children, such as the Queen's Hospital for Children, Hackney Road. The centre is not intended or fitted to take the place either of the general practitioner or the outpatient department of the hospitals. 90 91 1. Pr1mary V1s1ts 2. Total v1s1ts. V1S1TS OF HEALTH V1S1TORS 1925. M1ss M. Ch1tson Mrs. A. Rhodes M1ss D. F. V1dal Mrs. L. E. Bartholomew M1ss S. Love M1ss A. Roche Mrs. L. Harr1son M1ss M. Cockle Temporary V1s1tors. Eton M1ss1on (voluntary) Hackney Grove (voluntary) Totals. 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Infants (Leg.) under 1 year of age 233 745 251 526 366 763 353 915 374 629 331 899 199 931 335 1250 296 689 241 1597 347 726 3326 9670 „ (Illeg) „ „ „ ... ... 3 5 2 2 2 2 4 4 1 2 ... ... 3 5 1 1 6 31 4 12 26 64 Children 1-5 years of age ... 964 8 1463 30 1336 ... 704 ... 1097 ... 1027 ... 952 ... 978 ... 791 ... 1578 ... 028 38 12918 Total visits to 1nfants & Children 233 1709 262 1994 358 2101 355 1621 378 1730 332 1928 199 1883 338 2233 297 1481 247 3206 151 2766 3390 22652 St1ll B1rths 10 10 11 11 3 5 6 6 5 5 10 10 7 7 9 9 13 13 5 5 6 6 85 87 Death Enquiries 12 12 14 14 16 24 28 28 13 13 10 10 16 16 13 13 20 20 20 20 36 36 198 206 Ophthalmia Neonatorum 2 3 1 3 ... ... 2 2 3 3 11 20 5 13 ... ... 10 18 2 13 3 10 39 85 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Expectant Mothers 42 56 34 47 50 79 27 27 24 24 130 142 73 97 52 116 42 58 121 261 41 62 636 969 Other Visits (outs, removals, etc.) ... 164 ... 228 ... 228 ... 302 ... 308 ... 135 ... 120 ... 130 ... 254 ... 053 ... ... ... 2922 Infants 2 3 4 4 5 5 7 7 ... ... 6 6 6 6 4 4 5 5 12 21 ... ... 51 61 Children 1 1 15 15 33 33 2 2 6 6 6 9 23 23 ... ... ... ... 28 38 28 45 142 172 Whooping Cough Infants 7 9 15 16 11 11 20 20 ... ... 3 3 6 6 5 8 12 12 32 64 6 14 117 163 Children 6 15 11 22 36 41 11 11 14 14 17 17 5.2 52 12 16 ... ... 36 46 43 86 238 320 Epidemic Diarrhœa 1nfants 4 4 ... ... ... ... 4 4 ... ... 8 12 ... ... 5 5 ... ... 34 49 ... ... 55 74 Children 1 1 ... ... ... ... ... ... 3 3 5 5 ... ... ... ... ... ... 4 7 1 2 14 18 Polio-Myelitis 1nfants ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Children ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 2 Total Visits paid during the year 320 1987 367 2354 552 2527 462 2030 446 2106 538 2297 387 2223 438 2534 399 1861 541 4783 516 3029 4966 27731 No. of Clinics attended Morning 3 ... 7 7 9 48 17 4 41 136 Afternoon 121 75 108 84 111 110 115 97 104 127 154 1205 92 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. No. of attendances of infants and children before Welfare Doctor. 1. Overbury Street Morn. 51 255 2,680 2,935 1,476 1,459 1,367 Aft. 51 215 3,035 3,250 1,645 1,605 1,592 2. Brooksby's Walk 51 425 3,636 4,061 3.140 921 1,602 3. Mayfield Road Mon. 47 35 1,159 1,194 644 550 — Fri. 50 420 3,850 4,270 3.089 1.181 1,361 4. Northwold Road 51 426 5,804 6 230 3.918 2.312 2,058 5.* Hackney Mothers' and Babies', Hackney Grove 102 173 3,792 3,965 3,356 1,696 3,107 Do. Ada Street 52 65 1,022 1,087 6.*Eton Mission 1 Wed. 101 201 4,251 4,452 3,127 1,325 2,217 Fri. Totals 556 2,215 29,229 31,444 20,395 11,049 13,304 *These are Voluntary Centres and are co-ordinated with the Infant Welfare work in the Borough. The Hackney Mothers' and Babies' Welfare Centre receives an annual grant of £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 No. of examinations by Doctor. 1 Overbury Street 51 614 1,118 1,732 1,732 2 Brooksby's Walk 26 132 172 304 282 3 *Eton Mission 26 115 173 288 126 Totals 103 861 1,463 2,324 2,140 *Voluntary Centre. 93 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, 1924. Necessitous Cases. Cases. Cost. Salvation Army Mothers' Hospital 63 3 0 City of London Lying-in Hospital 129 135 9 0 192 £201 12 0 (2) Agreement for the Provision of Convalescent Home Treatment. An agreement has been entered into, with the sanction of the Ministry of Heailli, 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 lhe actual cost of the treatment provided at the Convalescent Home. The number of cases assisted during the year was 30. (3) Provision of Midwives.—During the year the fees of midwives in attendance on 28 mothers confined in their homes were paid by the Council and in 1 cases a Home Help was provided. 94 4.—NURSING ASSISTANCE. As already stated, only a fraction of the cases have been dealt with. No. of cases Nursed. Vo. of Visits paid. Pneumonia 35 558 Whooping Cough 8 110 Measles 15 259 Bronchitis 7 69 Ophthalmia Neonatorum 10 185 Post Confinement, etc. 16 452 Other Ailments 30 341 Totals 121 1,974 5—PROVISION OF MILK AND OTHER FOODS TO NECESSITOUS MOTHERS AND CHILDREN. In each case dealt with, every form of assistance was taken into account, including, of course, that given by the Guardians. Milk supplied free of cost to necessitous cases involved the Council in an expenditure of £1,081 2s. 2d. for cows' milk and £345 6s. 7d. in respect of dried milk. The applications dealt with for milk numbered 2,671, and those for milk food amounted to 952. Dried Milk, Foods, Medicines, etc. (a) Supplied free of charge to necessitous mothers:— £ s. d. Glaxo 55 1 7 Cow and Gate 281 15 0 Milkal 8 10 0 Virol 17 11 0 Marylebone Cream 11 15 10 Cod Liver Oil and Malt 19 1 6 Sundries 12 16 8 £406 11 7 95 (b) Supplied at cost price:— £ s. d. Glaxo 287 10 0 Cow and Gate 1,489 13 0 Virol 109 17 0 Lactagol 16 1 3 Marylebone Cream 131 7 10 Petroleum Emulsion 49 9 11 Syrup Ferri 11 9 5 Cod Liver Oil and Malt 58 19 6 Sundries 117 10 11 £2,271 18 10 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. Od., Laboratories. blood of suspected Enteric Fever cases 3s. 6d. plus charges for telephone and telegraph, the Laboratories providing outfit. Royal Institute of Diphtheria swahs, sputa and blood 3s. Od. Public Health. 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. 96 Diphtheria Antitoxin. Arrangements have been in force for some time past in this Borough for supplying Diphtheria Antitoxin to medical practitioners on request. 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 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. The medical practitioners in the Borough have been circularised on this matter, and a copy of the following memorandum 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 doses 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 irom 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 97 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." 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.' " 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 for antitoxin last year increased, 139 bottles of antitoxin of 8,000 units each being supplied to medical practitioners, as compared with 108 the previous year. Sanitary Circumstances of the Area. Water Supply.—The water supply of the Borough is under the control of the Metropolitan Water Board. Several complaints from householders regarding the condition of the water were investigated during the year. There were no adverse reports on the samples taken for analysis. Sewerage.—The responsibility for the sewerage of the district is shared by the London County Council and the Engineer's G 98 partment of the Borough Council. During the year the Sanitary Inspectors reported 33 premises on which sewers were defective and repairable by the Borough Council. These were referred to the Borough Engineer for his attention. Refuse Disposal and Scavenging.—This matter is under the control of the Borough Engineer. Refuse from private houses is collected by electric vehicles and destroyed at the Dust Destructor. The entire system has been altered from horse-drawn vehicles to electrically-propelled vehicles during the past five years. During the year 324 complaints were received from the Borough Engineer regarding houses without dust-bins or with defective dust-bins. These were dealt with by the service of 240 informal notices and 41 statutory notices. Premises and Occupations (other than Food Premises) controlled by Statute, By-laws or Regulations. Number. Factory and Workshop Act, 1901 Workshops and Workplaces 836 do. Outworkers' Premises 2,467 Canal Boats Acts Canal Boats (inspected during year) 25 London County Council Bye-laws Rag and Bone Dealers 27 do. Offensive Trades— Fur Skin Dressers and Poultry Slaughterers 19 Local Bye-laws Houses Let in Lodgings 473 Local Regulations Underground Rooms 7,667 99 Local By-laws and Regulations. By-laws made under the Public Health (London) Act, 1891 (approved February 9th, 1894). Tanks and Cisterns. Water-closets. Nuisances in streets. Offensive matter. Keeping of animals. Paving of yards. Regulations prescribed by the Council under Section 17 (7) of the Housing and Town Planning Act, 1909, for Underground Rooms. (Approved April 27th, 1914.) SANITARY ADMINISTRATION. HOUSINC AND WORK OF SANITARY INSPECTION. Public Health (London) Act, 1891. Year. Intimation Notices. Statutory Notices. Legal Proceedings. 1913 4,852 223 4 1914 3,980 280 13 1918 2,466 258 24 1919 4,780 405 60 1920 6,781 982 116 1921 8,032 1,701 117 1922 6,713 1,207 95 1923 6,553 1,376 42 1924 6,241 1,608 57 1925 5,822 1,580 51 100 Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923. The number of certificates granted under the Increase of Rejit and Mortgage Interest (Restriction) Acts during the year was 19. In 15 cases the work (required on the notice was carried out without action being taken, and in the remaining 4 cases the work was in hand at the end of the year. In 3. cases certificates were applied for but were not granted, the rent in one case not having been increased, and in the remaining cases the necessary work was done before the certificates could be granted. 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 satisfactorilv, 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 41 homes in the Borouglh 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. 41 3 14 24 The verminous bedding and clothing were taken to the disinfecting station and steamed, and the verminous rooms fumigated or sprayed, and, where necessary, notices were served upon the owners to cleanse and strip the rooms if vermin was afterward? found present. 101 There were also 34 notices received from the London County Council in respect of children suffering from Scabies. The bedding in all these cases was disinfected on receipt of information and again ten days later. In addition to the cleansing of verminous rooms or premises by owners and tenants after service of notice by the Sanitary Inspectors, 886 rooms were discovered to be verminous where neither tenant nor owner could be shown to be directly responsible. These rooms were cleansed of vermin by spraying by the staff of the Public Health Department. Rats and Mice Destruction Act, 1919. The number of complaints received during the year of premises being infested with rats was 422. These complaints were effectually dealt with in most cases by the repair or reconstruction of defective sewers, drains and sanitary fittings, under the supervision of the Sanitary Inspectors. In 67 cases it was necessary to serve notices under the Act upon the occupiers of the land or premises. Fourteen premises were cleared under the agreement with Messrs. Howard & Son, (Ratcatchers), under the supervision of the Council's Sanitary Staff. In 152 cases poison baits have been provided and laid down under the supervision of the Sanitary Inspectors. By this means 143 premises have been effectively cleared of rats and 9 premises were under observation and treatment at the end of the year. This method has proved to be very successful and has resulted in the extermination of a very large number of rats without any complaints of smells after the rats have been poisoned. 102 SANITARY INSPECTION. Public Health (London) Act, 1891. (a) Complaints of Nuisances.—During the year 1925 there were 4,329 complaints of nuisances made to the Public Health Department and investigated by the Sanitary Inspectors of the Borough. Defects or nuisances were discovered in 3,500 of the complaints. Notices for the remedy or abatement of these were served upon the owner or person responsible under the above Act. Drainage. Plans for reconstruction of drains under notice and supervision of the Sanitary Inspectors at 199 premises were reported to the Public Health Committee during the year. Smoke Nuisance. In addition to 270 observations of chimneys of large works in the Borough made by the Sanitary Inspectors, 534 observations were made by an Assistant detailed for that purpose. 31 Intimation notices were served on the persons responsible for the issue of black smoke in contravention of the Public Health (London) Act, 1891. 7 Statutory Notices were served and I Summons issued. Dangerous Structures. Complaints of alleged dangerous structures at 205 premises were forwarded to the London County Council during the year. Water Fittings. Complaints of defective water fittings at 174 premises were forwarded to the Metropolitan Water Board during the year. Dust Receptacles. During the year 324 complaints were received from the Borough Engineer and Surveyor, of houses without dust bins, or with defective dust bins. 103 These complaints were dealt with by the service of 240 informal notices and 41 statutory notices. Offensive Trades. The only offensive trades carried on in the Borough are that of Fur Skin Dressing and Poultry Slaughtering. These arc controlled under Special bye-laws. They number at present 19 (Fur Skin Dressers 16, Poultry Slaughterers 3). 68 inspections were made during the year. There were no contraventions of the bye-laws. (b) Infectious Diseases.—The occupied dwellings inspected during the year after infectious disease numbered 1,293. This is an increase of 151 upon the number inspected during 1924. Any nuisances or sanitary defects found were dealt with under the provisions of the above Act. (c) 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 1,320. (d) Inspections.—The number of inspections, other than those arising on complaint, made by the Inspectors during the year was 8,634. These inspections are in addition to those made under (a), (b) and (c). The nuisances or sanitary defects found were dealt with in the same manner as those under (a), (b) and (c). 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 1925 was 5,822. The number of statutory notices served was 1,580; and summonses were issued in 51 cases. 104 House-to-House Inspection. The following roads have been inspected during the years 1921 to 1925:— No. 1 District:— Tottenham Road (twice) Belfast Road Tottenham Square Brewery Buildings Welbury Street (part twice) Conduit Place (part) No. 6 District:— Conduit Court (part) Blackstone Road Conduit Street Blanchard Road Caroline Cottages Blanchard Street Caroline Street Croston Street Gibson's Street Casterton Street Northwold Road (part) Florfield Road Olinda Road Graham Mansions Rossington Street Hackney Grove Stoneham Road New Steet No. 2 District:— Parkholme Road Amhurst Terrace Reading Lane Clevedon Street Tower Street Buildings Clevedon House No 7 District Clevedon Passage Ada Street Glading Terrace Andrews Road Garnham Street Antwerp Street Heatherley Street Bayford Street Landfield Road Devonshire Place Wellington Street Dericote Street Ottaway Street Duncan Road Stellman Street Duncan Square Sandford Lane East Street Sandford Terrace Exmouth Place No. 4 District:- Fortescue Avenue Glyn Road (part) Frampton Park Road (part) Mandeville Street (part) Goring Street Millfields Road (part) Gransden Avenue Oswald Street Havelock Road Oswald Mansions Helmsley Place Overbury Street (part) Helmsley Street (part) Pedro Street (part) Lyme Grove (part) Presburg Street Lamb Lane Rushmore Road (part) North Street (twice) Pemberton Place No. 5 District:— Sidworth Street Acton Street Sheep Lane Bankstock Buildings Tudor Grove De Beauvoir Crescent (part) Triangle Road Downham Road (part) Urban Place Frederick Place (twice) Weston Place Haggerston Road Warburton Road Hertford Road (part) Warburton Square Holly Street Warburton Street Kingsland Road (part) Welshpool Street 105 Ho. 8 District:— Stockmar Road Askew Street (part) Stevens Avenue (part) Albert Grove Woolpack Place Balcorne Street Wick Road (par ) Conrad Street Warwick Villas Cornwall Road No.11 District:- Derby Road Mallard Street (part) Elsdale Street Trowbridge Road Eaton Place (twice) Trowbridge Place Fox s Buildings Havelock Road No. 12 District:— Lauriston Road (part) Detmold Road Loddiges Road (part) Dockway Morning Lane (part) Harrington Hill Morpeth Grove Inver Road Minson Road Mundford Road (part) Palace Road Otley Terrace Priory Place Prout Road Percy Road South wold Road (part) Queen's Court Theydon Road Rayner Street Rutland Road No. 13 District: Swiss Cottages Daubeney Road (part) Shafton Road Durrington Road Trelawney Road Maiwand Road (part) Roding Road (part) No. 9 District Crozier Terrace (twice) No. 14 District:— College Street Arcola Street Church Terrace Abbott Street Marion Street (twice) Apsland Grove Mehetabel Road Brown's Place Nisbet Street (twice) Bonby Place Rosina Cottages Dunn Street Rosina Street Dyssell Street Sedgwick Street Elizabeth Buildings (twice) Shepherd's Lane Gillett Street Wardle Street (twice) Hartwell Street No. 10 DistrictHindle Street Arthur Street James Cottages Anderson Road Laurel Street Brunswick Street Mayfield Road (part) Berger Road (part) Middle Street Bentham Road (part) Miller's Terrace Bridge Street (part) Milton House Mansions Church Road (part) Ramsgate Street Digby Road Ridley Road Durham Place Rosebery Place Hockley Street Shacklewell Row Homerton Terrace (part) Shacklewell Lane Margaret Street Somerford Grove Milborne Street Temple Street Meads Place Tyssen Street Marlow Road Woodland Street Middlesex Place Wellington Road Ribstone Street Winchester Place 106 Factory and Workshop Act, 1901. During the year, 250 inspections were made of factories and 2,187 of workshops by the officers of the Public Health Department. In 130 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 105 92 11 24 Insufficient w.c.'s 16 2 9 5 Not separate to sexes 9 11 — 1 Other defects 364 244 116 50 (e) 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. Bobbit (Food Inspector), or surrendered to them as being unfit for food, viz., Fish 4 cwt. 2 qrs.; Meat 3 cwts. 3 qrs.; Fruit 6 cwts.; Tea 100 lbs. Prosecutions under the Public Health (London) Act, 1891, and Regulations during the year 1925. Inspector. Address. Complaint. Magistrate's decision. Fine. Costs. £ s. £. s. d. A. S. 6, Rushmore Crescent Roof defective Withdrawn (work done) 0 10 6 G. F. H. 19, Hackney Grove General insanitary condition do. do. 1 11 6 H. B. 451, Kingsland Road Non-compliance with Magistrate's order Withdrawn 3 3 0 C. F. L. 159, Well Street Rooms dirty Withdrawn (work done) 0 10 6 A. S. 4, Rushmore Crescent Roof defective do. do. 0 10 8 A. S. 190, Rushmore Road do. Order to abate in 7 days 1 1 0 A. S. 104, Blurton Road Rooms dirty do. 1 1 0 ' W. P. 3, Valentine Road General insanitary condition Order to abate in 28 days 1 1 0 107 Inspector. Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. £ s. d. W.P. 14, Rvbstone Street General insanitary condition Order to abate in 14 days 1 1 0 H.B. 2, Welbury Street Ceiling of room dirty Order to abate in 7 days 1 11 6 H.B. 108, Haggerston Road Ceiling and walls of room dirty Withdrawn (work dent) 0 10 6 J.W. H. 218, Dalston Lane Eaves, gutter and waste pipes defective do 1 1 0 R.H. B. 3, Narford Road Defective drain do. 2 2 0 E.H. 427, Wick Road Roof defective do. 0 10 6 E.H. 429 do. do. do. do. do. 0 10 6 J.N. 309, Kingsland Road Roof defective, rooms dirty do. 1 1 0 J.N. 311 do. do. Rooms dirty and damp do. I 1 0 G.F.H. 17, Hackney Grove Rain-water and soil pipes defective do. 1 1 0 G.F.H. 19 do. do. Roof of W.C. defective rooms dirty do. 1 1 0 W.P. Stall, Chatsworth Road Meat stall not suitably screened Dismissed on payment of 1 1 0 W.P. do. do. do. do. do 0 10 6 W.P. do. do. do. do. do. 0 10 6 W.P. do. do. do. do. do. 0 10 6 J.E.T. 67, Redwald Road Waste preventer and dust-bin defective Withdrawn (work done) 1 1 0 A.J.B. 9, Ridley Road Market Imported meat exposed for sale not bearing a label, as required Frined 2 0 1 1 0 A.J.B. Stall, Ridley Road do. do. do 2 0 1 1 0 W.E.G. 19, Andrews Road Roof defective Withdrawn (work done) 1 1 0 W.E.G. 29 do. do. Roof, rain-water pipe, &c., defective do 1 1 0 W.E.G. 37 do. do. do. do. do. 1 1 0 W.E.G. 31, Ada Street do. do. do. 1 1 0 G.F. 9, Durley Road Roof defective Order to abate in 14 days 2 2 0 J.N. 95, Tottenham Road Water supply cistern defective Withdrawn on payment of 1 1 0 G.F.H. 3, Eleanor Road Rooms dirty, &c. Order to abate in 14 days 1 1 0 W.P. Stall, Ridley Road Tea exposed for sale; unfit for food Fined 3 0 2 2 0 W.P. do. do. Tea dust do do 2 0 1 1 0 W.C.V. 4, Clarence Cottages Dust-bin defective Withdrawn (new bin supplied) 1 1 0 W. C. V. 3, Clarence Terrace Roof and gutters defective Withdrawn (work done) 1 11 6 w.c. V. 1, Hindrey Place do. do. do 1 11 6 108 Inspector. Address. Complaint. Magistrate's decision. Fine. Costs. £ s. £ s. d. J. E. T. 201, High Street, Homerton Rooms dirty Withdrawn (work done) 1 11 6 J. E. T. 217 do. do. Roof and rain-water pipe defective do. 1 11 6 G. F. H. 136, Queen's Road Burst water pipe do 0 2 0 G. F. H. 36, Eleanor Road General insanitary con dition Order to abate in 21 days 1 1 0 W. P. 225, Well Street Meat not protected from flies and contamination Fined 10 0 W. P. do. do. Bacon exposed for sale, unfit for food do. 10 0 W. P. do. do. Rabbits do. do. 3 0 2 2 0 W. P. 126, Clarence Road ... Meat found on premises liable to contamination Withdrawn 2 2 0 R. J. S. 4, Helmsley Place Roof defective Withdrawn (work done) 0 10 6 R. J. S. 12, Warneford Street . Fowls deposited for purpose of sale stored in passageway adjoining to sleeping places Fined 0 10 0 10 6 R J. S. do. do. Fowls deposited for sale in room also used as sleeping place do 1 0 0 10 6 J. W. H. 187, Amhurst Road Drain clearing eye uncapped and unsealed Order to abate forthwith 1 1 0 R. J. S. 203, Mare Street S moke nuisance Order to abate in 21 days 1 11 6 £33 10 £5 4 6 109 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 1925, was 836, an increase of 84 on the number registered at the end of 1924. Of this total, 600 were workshops in which females were employed. Of these latter, 391 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, etc., 187 in which other articles were manufactured, etc., and 22 were domestic workshops. Amongst the workshops in which wearing apparel is manufactured, there were 223 in which females alone, and 164 in which both males and females were employed. In workshops of other occupations, there were 103 in which females alone, and 88 in which both males and females were employed. Of the domestic workshops, females alone were employed in 16, and both males and females in 9. During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints—Factories 12 Complaints—Workshops 23 Notices—Workshops 103 110 Analysis of Occupations Carried on in the Registered Workshops of Hackney. (a) Wearing Apparel. Occupations. No. of workshops. Occupations. No. of Workshops. Artificial Flower Makers 9 Mantles 32 Baby Linen 1 Millinery 31 Blouses 16 Needlework 4 Boot& Shoe Manufacturers 80 Shirts 2 Boot Machinists 6 Tailoring 110 Children's Costumes 6 Ties 17 Clothing 2 Trimmings 9 Corsets 4 Underclothing 8 Dressmakers 58 Vests 5 Dressing & Tea Gowns 3 Waterproofs 2 Fancy Bows on Shoes 4 Miscellaneous 7 Furriers 65 Hats 2 485 Infants' Millinery 2 (b) Other Occupations. Bakers 57 Baskets 3 Box Makers 12 Brush Makers 4 Cabinet Makers 60 Confectionery 9 Cycle Makers 3 Leather Goods 25 Laundries 16 Pianoforte Makers 14 Picture Frames 2 Fur Skin Dressers 16 Rag Sorting 3 Rubber Goods 2 Toy Makers 9 Upholsterers 6 Upholsterers' Trimmings 2 Miscellaneous 108 351 During 1925, Miss Teebay, the Workshops Inspector, made 2,053 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections, 249 intimation and 22 statutory notices were served. 111 The Factory and Workshops Act, 1901. Factories, Workshops, Workplaces and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 250 73 - Workshops (Including Workshop Laundries) 2,187 389 - Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 70 1 Total 2,507 463 — 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 235 230 ... ... Want of ventilation 14 14 ... ... Overcrowding 12 12 ... ... Want of drainage of floors 2 1 ... ... Other nuisances 78 80 ... ... Sanitary accommodation— Insufficient 16 11 ... ... Unsuitable or defective 105 103 ... ... Not separate for sexes 9 11 ... ... Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse (s. 101) ... ... ... ... Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). 23 23 ... ... Total 494 485 ... ... "Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 112 3.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Total number of Workshops on Register 836 4.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act, 1901, (S. 133) 38 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act, 1901, (S. 5.) Notified by H.M. Inspector 35 Reports (of action taken) sent to H.M. Inspector 45 Other - Underground Bakehouses (S. 101):— In use at the end of the year 51 113 5.—HOME WORK. Nature of Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108 Outwork in Infected Premises Sections 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders Made (Section 110). Prosecutions (Sections 109, 110. Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Falling to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Con. tractors Workmen. Wearing Apparel— (1) Making, &c 252 98 2311 37 2 146 244 ... ... ... ... ... ... ... ... (2) Cleaning and Washing ... ... 1 ... 1 3 ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets 4 ... 15 ... ... ... 2 ... ... ... ... ... ... ... ... Furniture and Upholstery 8 10 65 ... ... ... 7 ... ... ... ... ... ... ... ... Fur Pulling 6 ... 6 2 ... 3 12 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers 8 ... 43 1 ... 1 11 ... ... ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., Boxes, Paper Bags 30 ... 329 ... ... ... 19 ... ... ... ... ... ... ... ... Brush Making 20 ... 307 1 ... 1 11 ... ... ... ... ... ... ... ... Stuffed Toys 6 ... 36 ... ... ... 2 ... ... ... ... ... ... ... ... Basket Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas crackers, Christmas stockings, &c ... ... ... 2 ... 10 6 ... ... ... ... ... ... ... ... Totals 334 108 3112 44 2 162 317 ... ... ... ... ... ... ... ... 114 Outworkers.—The number of outworkers on the register at the end of 1925 was 2,467, against 2,481 at the end of 1924. There were thus 14 outworkers removed from the register during the past year. The following analysis shows the trades followed by these outworkers:— Trade. No. of Outworkers. Trade. No. of Out workers. Artificial Florist 57 Fur Trade 64 Baby Linen 21 Gaiters 6 Belts and Bags 14 Hats 5 Blouses 125 Hosiery 3 Boots and Shoes 516 Lace Goods 13 Boxes and Paper Bags 210 Leather Goods 7 Braces 4 Mantles and Costumes 249 Brushes 164 Millinery 101 Children's Costumes 31 Pyjamas and Shirts 57 Children's Millinery 40 Shoe Bows 32 Christmas Crackers, etc. 40 Tailoring 141 Clothiers and Outfitters 91 Tennis Ball Covering 5 Collars and Bibs 12 Ties and Neckwear 134 Confectionery Packing 7 Trimmings 62 Dolls and Toys 25 Umbrellas 19 Dressing Gowns 22 Underclothing 49 Dress Making 29 Upholsterers' Trimmings 20 Embroidery 12 Miscellaneous 31 Fancy Goods 22 2,467 Fancy Paper Goods 20 Feather Trade 7 2,447 names and addresses of outworkers residing in Hackney and receiving work from other districts were forwarded by the local authorities concerned. On examination of the lists of outworkers sent in by employers in this Borough, addresses of 1,466 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 1925, Miss Portlock, the Inspector appointed for the. inspection of Outworkers' premises, made 1,145 inspections and 920 re-inspections. She also made 304 visits 115 without inspections, the outworkers having left the premises (88), or having given up home work (102), or being out at the time of visit (73), or owing to a wrong address being given (29), or the premises being workshops (7), or the outworkers having died (5). Miss Portlock also discovered 3 new workshops and handed in their addresses for registration. During her visits of inspection she found 321 premises with sanitary defects. For the abatement of these she served 230 intimation, and 29 final notices. Of the 1,145 premises inspected, in only 10 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 73 ,, ,, and living room 59 ,, ,, kitchen 364 ,, and kitchen 558 ,, ,, bedroom 61 ,, ,, parlour 12 ,, ,, scullery 8 ,, provided separately 10 1,145 FOOD. A very welcome step has been taken by the Ministry of Health in issuing the Public Health (Meat) Regulations, 1924, but it is necessary again to point out that 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 (see page 117) 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 116 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. The following notices are used to bring to the attention of the tenants of food premises, stalls, shops, etc., the sanitary requirements relating to their premises:— NOTICE IS HEREBY GIVEN that the above Regulations have been made by the Minister of Health. STALLS, SHOPS, STORES, etc.—GENERAL. 1. "Meat" means the flesh of cattle, swine, sheep, or goats, including bacon and ham and edible offal and fat, which is sold or intended for sale for human consumption, and "animal" means any animal from which meat is derived. 2. "Inspector" means the Medical Officer of Health or any other Officer of a Local Authority, having under the Acts relating to Public Health or any Local Act, power to inspect and examine meat intended for the food of man, and who, for the purpose of ascertaining whether these Regulations are being observed are empowered at all reasonable times to enter and inspect any slaughter-house, room, or other place and any stall or vehicle to which these Regulations apply. 3. Stall includes any stall, barrow or vehicle from which meat is offered for sale in a street or other open space or in any market place. 4. "Room" includes a shop, cellar, passage or other space forming the whole or part of a building other than a slaughter-house. 5. A person shall, if so required, give to any officer of a Local Authority acting in the execution of these Regulations, all reasonable assistance in his power, and shall, in relation to anything within his knowledge, furnish any such officer with all information he may reasonably require for the purposes of the Regulations. 6. No person who is for the time being suffering from an infectious disease shall take part in the slaughtering of animals intended for human consumption or the handling of meat. PART IV.—STALLS. 19. A person selling meat or exposing or offering meat for sale from any stall— (a) shall keep his name and address legibly painted or inscribed or such stall in some conspicuous position; 117 (b) shall cause such stall (if not placed in an enclosed and covered market place) to be suitably covered over and to be screened at the sides and back thereof in such a manner as to prevent mud, filtfh or other contaminating substance being splashed or blown from the ground upon any meat on the stall; (c) shall cause every counter, slab, vessel or other article on or in which meat is placed for sale and all knives and other implements used in connection with the meat to be thoroughly cleansed after use and to be kept at all times in a cleanly condition; (d) shall take all such steps as may be reasonably necessary to guard against the contamination of the meat by flies; (e) shall not place or cause to be placed any meat on, or within eighteen inches of the ground or floor, unless the meat is placed in a closed cupboard or other adequately protected space not less than nine inches from the ground or floor; (f) shall cause all trimmings, refuse and rubbish to be placed in properly covered receptacles kept for the purpose apart from any meat intended for sale. PART V.—SHOPS, STORES, Etc. 20.—1. The occupier of any room in which meat is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to future sale, and any person who knowingly lets any room or suffers any room to be occupied for such purpose shall cause the following provisions to be complied with:— (a) No urinal, water-closet, earth-closet, privy, ashpit or other like sanitary convenience shall be within such room or shall communicate directly therewith, or shall be otherwise so placed that offensive odours therefrom can penetrate to such room; (b) No cistern for supplying water to such room shall be in direct communication with or directly discharge into any such sanitary convenience; (c) No drain or pipe for carrying off faecal or sewage matter shall have any inlet or opening within such room unless it is efficiently trapped; (d) No such room shall be used as a sleeping place, and, so far as may be reasonably necessary to prevent risk of the infection or contamination of any such meat as aforesaid, no sleeping place shall communicate directly with such room; (e) Except in the case of a room used as a cold store, adequate means of ventilation shall be provided. 2. The occupier of any such room shall not cause or suffer any refuse or filth whether solid or liquid to be deposited or to accumulate therein except so far as may be reasonably necessary for the proper carrying on of the trade or business. 118 3. Such occupier shall cause the walls and ceiling of such room to be whitewashed, cleansed or purified as often as may be necessary to keep them in a proper state. 4. Such occupier and every other person engaged in such room shall observe due cleanliness in regard to such room and all articles, apparatus and utensils therein. 5. The occupier of any such room— (a) shall take all such steps as may be reasonably necessary to guard against the contamination of the meat therein by flies and shall cause the meat to be so placed as to prevent mud, filth or other contaminating substance being splashed or blown thereon; (b) shall not permit any gut-scraping, tripe-cleaning or household washing to be carried on therein; (c) shall cause every counter, slab, vessel or other article on or in which meat is placed for sale and all knives and other implements used in connection with the meat to be thoroughly cleansed after use and to be kept at all times i.n a cleanly condition; (d) shall cause all trimmings, refuse and rubbish to be placed in properly covered receptacles kept for the purpose apart from any meat intended for sale. PART VI.—TRANSPORT AND HANDLING. 21.—1. Every person who conveys or causes to be conveyed any meat in a vehicle— (a) shall cause to be kept clean the inside and covering of the vehicle, the receptacles in which the meat is placed, and such parts of any slings or other implements or apparatus used for loading or unloading as come into contact with the meat or its covering; and (b) if the vehicle is open at the top, back, or sides or if any other commodity is being conveyed therein, shall cause the meat to be adequately protected by means of a clean cloth or other suitable material; (c) shall not permit any live animal to be conveyed in the vehicle at the same time as meat. 2. A person engaged in the handling or transport of meat— (a) shall not permit any part of the meat to come into contact with the ground; and (b) shall take such other precautions as are reasonably necessary to prevent the exposure of the meat to contamination. 3. Every person who employs a person to carry meat in or about a market or other place in which meat is sold by wholesale or in or about any place wholly or mainly used for the storage of meat before it is distributed to retailers, shall cause such person while so occupied to wear, and every person while so occupied shall wear, a clean and washable head covering and overall. 119 4. This article shall not apply to any meat which is packed in hampers or other strongly constructed and impervious cases or is adequately wrapped in jute or some other stout fabric. NOTE.—The Public Health Act, 1896, provides by sub-section (3) of Section 1, that if any person wilfully neglects or refuses to obey or carry out, or obstructs the execution of any regulations made under any of the enactments mentioned in that Act, he shall be liable to a penalty not exceeding £100, and, in the case of a continuing offence, to a further penalty not exceeding £50 for every day during which the offence continues. FOOP PREMISES. NOTICE IS HEREBY GIVEN that Part II of the London County Council (General Powers) Act, 1908, provides as follows:— From and after the passing of this Act the following provisions shall apply to any room, shop or other part of a building within the county an which ANY ARTICLE whether SOLID OR LIQUID intended or adapted for the food of mam is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to further sale: (a) No urinal water-closet earth-closet privy ashpit or other like sanitary convenience shall be within such room shop or other part of a building or shall communicate therewith except through the open air or through an intervening ventilated space; (b) No cistern for supplying water to such room shop or other part of a building shall be in direct communication with and directly discharge into any such sanitary convenience; (c) No drain or pipe for carrying off fæcal or sewage matter shall have any inlet or opening within such room shop or other part of a building; (d) No such room shop or other part of a building shall be used as a sleeping place and so far as may be reasonably necessary to prevent risk of the infection or contamination of any such article as aforesaid no sleeping place shall adjoin such room; shop or other part of a building and communicate therewith except through the open air or through an intervening ventilated space; (e) Refuse or filth whether solid or liquid shall not be deposited or allowed to accumulate in any such room shop or other part of a building except so far as may be reasonably necessary for the proper carrying on of trade or business; (f) DUE CLEANLINESS shall be observed in regard to such room shop or other part of a building and all articles apparatus and utensils therein and shall be observed by persons engaged in such room shop or other part of a building. If any person occupies or lets or knowingly suffers to be occupied any such room shop or other part of a building wherein any of the conditions prohibited by this section exist or does or knowingly permits any act or thing therein in contravention of this section he shall be liable on summary conviction to a fine not exceeding for the first offence twenty shillings and for every subsequent offence five pounds and in either case to a daily penalty not exceeding twenty shillings. 120 Food Premises Regulated by Statute Bye-laws or Regulations. Number. London County Council Bye-laws Fish-friers and Curers 61 do. do. Slaughterers of Poultry 3 do. do. Slaughter Houses—Cattle 17 do. do. Cowhouses 7 Dairies, Cowsheds and Milk shops Orders Milk Purveyors 372 Factory and Workshops Act Bakehouses (aboveground) 52 do. (underground) 51 London County Council (General Powers Act) Ice Cream premises 257 London County Council (General Powers Act and Public Health Meat Regulations, 1924) Coffee Shops, Restaurants, &c. 182 do. do. Preserved Meat Factories 4 do. do. Butchers 136 do. do. Meat Stalls 64 do. do. Provision Shops 27 do. do. Butchers' Stores 43 Inspection of Food. Milk Supply. The whole of the milk consumed is brought into the Borough by rail or motor with the exception of the comparatively small amount produced in the seven local dairies keeping 39 cows. 131 samples of milk for analysis were taken in the course of delivery from farmers to retailers in the Borough. Of these 10 were found not to be genuine. There are 372 retailers of milk in the Borough, some in a large way of business, but many doing a very small trade. 625 samples of milk were taken in shops or in the streets of the Borough in course of delivery by roundsmen to customers. Of these 9 were found not to be genuine. Average percentage of adulteration of all samples of milk procured during the year—2.5. 121 Sterilised milk in bottles is now being sold in large quantities by a few firms. This milk is usually delivered twice weekly, direct to customers, but a large and increasing trade is being done by small shop-keepers of all kinds who act as agents and sell the milk in unopened bottles. The tendency in the milk trade is for the elimination of the smaller dairyman with the growth of the larger firms. There has been a large increase in the use of bottles for milk delivery and these are sometimes filled by the roundsmen in the streets when delivering. Metal hand cans, filled from the churn in the street, are still largely used in the poorer districts. Condensed milk, skimmed and whole, has a very large sale in the poorer districts, probably due to its convenience in use and storage, and a mistaken idea as to its cheapness as compared with fresh milk. Adequacy of Milk Supply.—The arrangements for the supply and distribution of the milk within the Borough are adequate. Milk (Special Designations Order), 1923. The special designations under which milk may be sold or offered or exposed for sale in pursuance of this Order are the following:-"Certified," "Grade, A. (Tuberculin tested)," "Grade A. (Pasteurised)," and "Pasteurised," and the Borough Council is authorised to grant licenses to any person other than a producer to sell such graded milk. The licenses are valid for a period ending on the 31st December of the year in which they are granted. Applications were received during the year from the undermentioned dealers, all of whom satisfied the Local Authority that 122 their arrangements for the storage, treatment and distribution of the milk complied with the conditions required : Welford & Co., 83, Upper Clapton Road. "Certified." A. Stapleton & Sons, Brookland Farm Northwold Road "Grade A. (Tuberculin tested)." do. do. do. " Pasteurised." A. Stapleton & Sons, 124, Dalston Lane " Grade A. (Tuberculin tested)." Manor Farm Dairy, Ltd., 164, Stamford Hill "Pasteurised." do. do. do. "Certified." A. B. Mansfield & Sons, 2, Maury Road " Pasteurisejd." do. 73, Powerscroft Road "Certified." J. Akam & Sons, 53, Kynaston Road " Pasteurise,d." In accordance with the Order the following; samples were taken and submitted to bacteriological examination:— Date. Producer. Dealer. Bacteriologist's report. 11 Mar. Lord Rayleigh, Witham, Essex A. B. Mansfield, 73, Powerscroft Road. Conforms to the standard for certified milk. 7 July do. do. do. do. do. do. do. 20 Aug. do. do. do. do. Does not conform to the standard required for certified milk as the sample contains more than 30,000 organisms per c.c. 10 Nov. do. do. do. do. Conforms to the standard for certified milk. Milk Retarders in use in the Borough.—Messrs. Stapleton & Sons, Northwold Road—Milk delivered on the rounds is treated by "Astra Retarder," and that sent out in bottles by the "BarryWehmiller National Pasteurizer." Messrs. Mansfield, 2, Maury Road.—The machine in use here is the "Enock Improved Milk Retarder." 123 Refusal or Revocation of Registration of Retailers.—No. licenses for the sale of milk were refused or revoked during the year. Two retailers were, however, removed from the register, the nature of their businesses rendering the premises unsuitable for the sale of milk. Milk and Dairies (Consolidation) Act, 1915.—Under this Act 10 applications were made by retailers, from whom samples of milk had been procured, to have samples of milk taken from their respective wholesalers in the course of delivery to them. In eight cases no action was taken as the retailers' samples were certified to be genuine. Thirteen samples of milk from consignments in course; of delivery to retailers in the Borough were procured by Authorities outside the Borough. No adulteration was found to exist in any of the samples. Public Health (Milk and Cream) Regulations, 1912 and 1917. 1. Milk ; and Cream not sold as Preserved Cream. (a) (b) Number of Samples examined for the presence of a Preservative. Number in which Preservative was reported to be present, and Percentage of Preservative found in each Sample. Milk 769 Nil. Cream 2 1. 0 21% Boric Acid. Nature of preservative in each case in column (b) and action taken under the Regulations in regard to it. Boric Acid.—The statement of the vendor was accepted by the Public Health Committee. 124 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i) Correct statements made 1 (ii) Statements incorrect Nil (iii) Percentage of preservative found in each sample .3% Percentage stated on Statutory label .4% (b) Determinations made of milk fat in cream sold as served cream. (i) Above 35 per cent. 1 (ii) Below 35 per cent. Nil (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cre^m in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken Nil. 3. Thickening Substances.—Any evidence of their addition to cream or to preserved cream. Action taken where found. Nil. 4. Other observations, if any. Nil. Public Health (Condensed Milk) Regulations, 1923. Public Health (Dried Milk) Regulations, 1923. There were no contraventions of these Regulations during the year. Twelve samples of condensed milk and one of dried milk were taken for analysis, all being found to be genuine. 125 Public Health (Tuberculosis) Regulations, 1925. Upon a report submitted by the Public Health Committee, to the Borough Council on the 23rd January, 1924, the Minister of Health was requested to issue an Order empowering the local authorities responsible for administering the Tuberculosis Regulations to prevent infectious tuberculous persons from engaging in any occupation connected with the milk trade that would be likely to result in the milk becoming infected. Further representations in this direction were made to the Minister of Health upon a report submitted by this Committee to the Borough Council on the 27th May, 1925. The above-named Regulations, made by the Minister of Health, are now in operation and forbid any person suffering from tuberculosis of the respiratory tract to enter on any employment or occupation which would involve the milking of cows, handling of vessels used for milk, or the treatment of milk. Any person suffering from tuberculosis 6f the respiratory tract and in an infectious state can be required to discontinue his employment at a week's notice, with right of appeal to the Courts. The Medical Officer of Health is requested in the Circular accompanying the Regulations, to take all reasonable steps, including expert clinical and bacteriological examination, to be sure that a suspected person is really suffering from tuberculosis. Local Authorities are urged to make every effort to preserve the confidential character of notifications as far as this is consistent with the due exercise of the, new Regulations. Meat. Meat Inspection.—All animals, with few exceptions, killed at the slaughterhouses in the Borough are inspected at the time of slaughter or shortly afterwards. No request has been made for the marking of meat inspected,, and no arrangements have been made for doing so. 126 Condemned meat and food is destroyed at the Dust Destructor (for details see Food Inspector's Report). Public Health (Meat) Regulations, 1924.—An Inspector now devotes the whole of his time to the supervision of Butchers' shops, Provision shops with open fronts, and the market street stalls, hawke,rs, etc. (For particulars of inspection see Inspector's report). Public Slaughterhouses.—There are no public slaughterhouses in the Borough. Private Slaughterhouses.— In 1920. In January, 1925. In December, 1925. Registered — — — Licensed 19 17 17 Unsound Food and Food Inspection.—The food exposed for sale or prepared for sale in the Borough is kept under observation by two Sanitary Inspectors, who visit the Slaughterhouses, Butchers' Shops, Street Market thoroughfares, etc., and generally by the District Inspectors when visiting food premises. 3,794 visits were paid during the year to places where food was prepared or sold. 244 notices were served for defects on these prernises. During the year the following unsound food was surrendered or destroyed:— Tons. Cwts. Qrs. Lbs. Meat, bacon and rabbits 2 5 1 12 Fish — 8 3 24 Fruit, tinned goods, etc. 1 9 1 11 127 Unsound food condemned by Magistrates:— Tea—100 lbs. Contained dirt and iron filing's. Fined £3 and £2/2/costs. Tea dust—61bs. do. Fined £2 and £1/1/- costs. Bacon—45 lbs. Unsound. Fined £10. Rabbits—31bs. do. Fined £3 and £2/2/- costs. Food Protection and Cleanliness.—Approximately 50 per cent, of the butchers in the Borough have glass fronts to their shops. Six shops were provided with glass fronts during the year. This problem of food protection and cleanliness is partly in the hands of the public. In shops where the better class of trade is done, there is not so much need to expose meat outside as in shops that do a cheaper trade. In the cheaper trade the customer desires to observe the nature and price of the article before purchasing. There is verv little prospect of butchers in or near market streets voluntarily providing glass fronts to their premises while owners of meat stalls are allowed to sell meat from stalls that, although protected at back, top and sides, are open at the front. Some examples of Food Contamination found during the year. Apples and Confectionery.—Sold outside places of entertainment, and the stock kept in a bed-living room occupied by man, wife and two children, the children suffering from chicken-pox. Poultry.—Stored prior to sale in bedroom and sold in private passage-way into which two bedrooms open. Bananas.—Found hanging to ripen in shop parlour. The fruit was infested with bed-bugs. 128 Fat.—Being removed from grease trap in waste pipe of sink in a meat cooking-room, rendered down and used as cooking fat for pastry making. Fish.—Stored in a partitioned-off portion of fowls run. Grapes.—Being emptied in market street on dirty asphalt road for sorting. Street Markets and Street Trading. Street Markets.—Street marketing is now done on a large and increasing scale in the Borough. A census of the stalls, taken during December, showed there were 64 meat stalls, and approximately 300 other stalls where food of all kinds was being sold. 432 stalls were selling articles other than food. In addition to these, there are a number of perambulating food hawkers selling food all over the Borough. The principal market thoroughfares are as follows:— Chatsworth Road, Ridley Road, Well Street, London Fields (Broadway), and Kingsland Road. In addition to the stalls on the public highway in Ridley Road, 44 private sites on the railway embankment at the side of the footpath have now been let to stall-holders. Street Trading.—The control by the Public Health Department is limited to meat stalls (screening, etc., of meat) under the Public Health (Meat) Regulations, 1924, and the seizure of food exposed for sale, if unsound. Food exposed for sale,, such as rabbits, fish, poultry, cooked meats, pastries, confectionery, fruit, etc., are all as much exposed to contamination as meat was before the Meat Order was made. Food waiting to be sold is often stored in the gutter under the stall, and sometimes exposed for sale on the kerb exposed to contamination by dogs, dust, dirt and flies. 129 Fish stalls in the streets are not subject to bye-laws, and fish offal is thrown under the stall or placed in open boxes. The dirty waste-water used at the fish stalls is thrown or is allowed to run into the gutter and under other stalls to the nearest gully, which is made to receive rain-water and is not suitable for the reception of waste-water. Many of the stall-holders or assistants live a distance from the market thoroughfare, and the only provision of sanitary accommodation is the nearest public convenience. There are no facilities for obtaining clean water for ablution purposes, or for the washing of fish, utensils on ice cream and refreshment barrows, stalls, etc. This lack of provision of water and sanitary accommodation affects about 1,600 persons who attend at about 800 stalls. The provision for storage of food to be sold at the stalls is an important one, as the street vendors look out for disused stables, sheds, etc., or use their own private houses and yards for the purpose. The attraction of the market being its reputation for cheapness, second-rate and doubtful goods often find their way there, and these in many cases are sorted at the stalls. Constant supervision is necessary to ensure that articles unfit for food are not exposed or sold. Report of Food Inspector, Mr. A. J. Bobbitt, for the year 1925. Dairies and Milkshops.—1,509 inspection were made during the year. 87 new milksellers have been registered. I 130 2 milksellers have been removed from the register for noncompliance with the regulations, and 4 have been warned for having dirty or unwashed measures in use. Cow-Houses.—These now number 7, a reduction of 1 since last year. 89 inspections were made and on each occasion 1 found the premises kept in a satisfactory condition. Offensive Trades.—There are now 16 dressers of Fur Skins in the Borough, an increase of 3 since last year. One complaint was received of a nuisance arising during the removal of the refuse of the business from one factory; this was remedied by the provision of further receptacles for the fleshings which enabled them to be removed in the van without the necessity of emptying their contents. 48 inspections were made when I found all the premises were being kept in accordance with the regulations. . Slaughterhouses and, Meat Inspection.—416 visits were made to the 17 slaughterhouses during the year. The new Regulations that came into force on April 1st, require 3 hours' notice to be given before slaughtering is commenced. This has been well observed and has been the means of ensuring that practically all carcases have been examined before sale. Previously, I made many visits without finding any slaughtering in progress, whereas now I know where and at what times I can be sure of finding slaughtering finished or in progress and can examine the carcases for disease. This has often entailed late visits in the afternoons and occasionally Saturday evenings and Sunday morning, as there is no provision in the regulations that slaughtering shall be done within prescribed hours, and the butcher can and does suit his own convenience as to when and at what times it shall be done. Practically the whole of the butchers in the borough, who have slaughterhouses, kill none but prime cattle, sheep and pigs, therefore the amount of disease found among them is necessarily small and confined usually to the organs only. There are only 3 slaughterers of poultry in the Borough and their premises 131 are well-kept and in a cleanly condition. I have examined 187 oxen and heifers, 2 cows, 1,728 sheep and lambs, 19 calves, and 141 pigs. The following I found diseased and had destroyed:— Head, tongue, heart and lungs of an ox affected with Tuberculosis. Heart and lungs of an ox affected with ,, Lungs only ,, ,, ,, ,, 3 Pigs' plucks Affeoted with Tuberculosis. 4 Cows' kidneys Chronic Inflammation. 2 Pigs' kidneys ,, 1 Pig's liver (Boar) ,, ,, 14 Ox livers and 10 Sheeps' livers ,, Distomatosis. Ribs and lungs of a Sheep ,, Pleurisy. 1 Pig's lungs ,, „ 2 Sheeps' lungs ,, Pneumonia. 3 Ox and 6 Sheeps' livers ,, Abscess. 13 Sheeps' lungs and 9 livers ,, Parasitic Cysts. Portions of 2 Oxen and 2 Cows ,, Extensive Bruising. Wholesale Meat Factories.—39 visits were made to these when I found the premises clean and the meat sound and free from disease. Miscellaneous Inspections and Unsound Food.—439 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 inspection of the coverings of the meat stalls and the storage premises of the street butchers has been taken over by Inspector Peverett, who is enforcing the provisions of the Meat Regulations 132 other than Slaughterhouses. 2 prosecutions were taken under the Meat Marking Order, resulting in fines of 40/- and 1 guinea costs 'in each case. The following foodstuffs have been condemned and destroyed : 1 hindquarter of Beef. 18 boxes of Apples. 71 Rabbits. 1 box of Herrings. Several parcels of Bacon. 1 ,, ,, Monk. 144 tins of Corned Beef. 3 boxes of Roker. 99 ,, ,, Loganberries. 70 lbs. of Eels. 320 ,, ,, Pineapple. 5 boxes of Kippers. 2,197 Eggs. Total weight of Foodstuffs Condemned:— Meat and Bacon 2 tons 1 cwt. 2 qrs. 12 lbs. Fish — 4 cwt. 1 qr. 24 lbs. Fruit and Tinned Goods ... 1 ton 1 cwt. 1 qr. 23 lbs. Sale of Food and Drugs Acts.—GO samples were purchased for analysis. Report of Food Inspector (Mr. IV. Peverctt). The Public Health (Meat) Regulations came into operation on 1st April, 1925. During the latter part of the year I visited the butchers' premises in the Borough, the provision shops having open fronts where meat is displayed, the butchers' stalls in the market thoroughfares, and the butchers' stores. The occupiers in each case were given a copy of the Regulations and advised to any alterations that were necessary to bring the premises or stalls into conformity with the Regulations. In all cases the premises were inspected for their general sanitary condition, and in most cases the alterations, repairs and cleansing required has been done or is in hand. It has, however, been necessary to serve notices for work to be done in a few cases. 133 Screening of Meat Exposed for Sale.—The occupiers of shops having open fronts have been asked to protect meat exposed beyond the shop fronts by providing side and top blinds or sheets, and to take such other precautions as may be required from time to time. (This is in accordance with the Public Health (Meat) Regulations Order and Circular.) Market Stalls.—The butchers' stalls have all been provided with top, side and back screens, but constant supervision is required as the Regulations are regarded by most of the stallholders as irksome and a restraint to their trade. There are now on the Register in the Borough—136 butchers' shops, including 28 Kosher butchers, 81 having glass fronts and 55 open fronts. 64 butchers' stalls, mostly in market streets. 43 butchers' stores used by stall-holders for the storage of meat and their stalls. 27 provision shops where meat is sold from open fronts. 93 food rooms in connection with the above premises where meat is prepared and cooked. Persons Employed.—There are approximately 600 men and 100 women employed at the shops in the sale and preparation of food, and approximately 130 persons employed at the meat stalls. Defects.—The following have been dealt with or are in hand— Drainage defects 17 Animals improperly kept 5 Water-closet accommodation defective 18 Dustbin in food room 7 Refuse on premises 16 Without proper receptacles for trade refuse 59 Trade receptacles (refuse) defective 25 Yards dirty 8 134 Food rooms dirty 47 iWalls and flooring of food rooms defective 12 Utensils dirty 15 Cellar used as food room 1 Water-closet opening into food room 7 Food room opening into stable 1 Food not properly stored 8 Meat safes dirty or defective 5 Notices served for contravention of the Regulations 66 Visits of inspection—Food premises 370 Inspections of butchers' shops and food stalls in market streets for supervision 188 Warning notices sent to stall-holders and shopkeepers 50 Prosecutions.—One summons was issued, after previous warnings, against a shopkeeper for failing to keep meat on his premises free from contamination and flies; a fine of £10 was imposed. One summons, for exposing meat to contamination, was withdrawn on payment of £2 2s. costs and the execution of certain work. Four summonses were issued against stallholders for not complying with the Regulations as to screening of the meat exposed for sale. The Magistrate warned the defendants in each case, and dismissed the summonses on payment of 10s. 6d. costs on each of three summonses, and 21s. on one summons. Unsound Food—Prosecutions.—Two summonses were issued for selling tea unfit for food. The Vendor was fined £3 and £2 2s. costs on one summons, and £2 and £1 1s, costs on the 135 other. Apart from the penalties in this particular case, the publicity given to it has had a very salutary effect and to a large extent has apparently stopped the trade in uncleaned tea sweepings. This tea contained a large amount of dirt, metal and iron filings, and was exposed for sale at a low price on a stall in a market thoroughfare. One summons was issued for selling unsound bacon and the Vendor fined £10. One summons was issued for selling rabbits which were unfit for food, the Vendor in this case being fined £3 and £2 2s. costs. There are approximately 300 stalls other than meat stalls, where all kinds of food is sold and attention has been paid to the quality and soundness of the food thereon. Stallholders have been warned, where necessary, in regard to sorting and sale of damaged and unsound food. Sale of Food and Drugs Acts, 1875-1907. Samples purchased during 1925. Articles Purchased. Number purchased Number Adulterated. Number where Proceedings taken. Milk 685 19 14 Do. (sterilized) 58 — — Do. (condensed) 12 — — Do. (pasteurised) 1 — — Do. (dried) 1 — — Butter 63 1 — Margarine 57 — 1 Dripping 6 1 — 136 Articles Purchased. Number purchased. Number Adulterated. Number where Proceedings taken. Lard 12 — — Cream 2 1 — Do. (preserved) 1 — — Cocoa 14 — — Coffee 16 — — Coffee and Chicory 2 — — Custard Powder 7 — — Baking Powder 5 — — Beef Sausages 10 — — Pork do. 2 1 — Sausage Meat 2 — — Chocolate 3 — — Confectionery 6 — — Camphorated Oil 5 — — Olive Oil 3 — — Lime Water 2 1 — Turpentine 2 — — Disinfecting Fluid 4 — — Carbolic Acid 2 — — Cornflower 3 — — Ice Cream 10 — — Salmon & Shrimp Paste . 1 — — Jonathan Apples 3 3 — Totals 1000 27 15 137 Prosecutions under the Sale of Food and Drugs Acts, during the Year 1925. No. of Sample Inspector Article Adulteration or Offence Result of Legal Proceedings Fine Costs £ s. d. £ s. d. 6N W. G. Milk 5.7% fat abstracted Vendor ordered to pay 2 2 0 1D G. F. H. ,, 13% „ Withdrawn (warranty produced) 16H R. J. S. ,, 5.3% Withdrawn (warranty proved) 12N W. G. ,, 16.7% Fined 2 0 0 3 3 0 13J W. P. ,, 13.41% added water Vendor ordered to pay 7 7 0 14J W. P. ,, 4.4% fat abstracted Vendor ordered to pay 3 3 0 20N W. G. ,, 8% Fined 2 0 0 2 2 0 23N W. G. ,, 7.7% Vendor ordered to pay 3 3 0 24P G. F. ,, 4.3% Withdrawn (3rd sample burst in cold storage) 29N W. G. ,, 13.3% Vendor ordered to pav 3 3 0 27H R. J. S. ,, 5.88% added water do. 2 4 0 26P G. F. ,, 26.7% fat abstracted Withdrawn 39L J. W. H. Margarine Served in plain wrapper Vendor Ordered to pay 2 2 0 46M E. S. C. Milk 7% fat abstracted Withdrawn (warranty produced) 53X E. A. H. ,, 20% Fined 5 0 0 1 1 0 do. ,, Vendor's name & address not on Milk vehicle Fined 2 0 0 11 0 0 29 10 0 138 Public Health (Preservatives, etc., in Food) Regulations, 1925. Upon reports submitted by this Committee to the Borough Council on the 28th January and 27th May, 1925, representations were made to the Prime Minister and to the Minister of Health, urging- them to introduce at an early date the necessary legislation to give effect to the recommendations of the Departmental Committee on Preservatives and Colouring Matters in Food. The Ministry have now issued "the above-named Regulations, which come into operation generally on the 1st January, 1927, and on the 1st January, 1928, so far as they relate to butter and cream. Chemical preservatives are not entirely debarred. A Schedule appended to the Regulations specifies a series of articles, seventeen in all, to which certain chemicals may be added in proportions stated in the Schedule. The articles include sausages, fruit (fresh or dried), unfermented grape juice and nonalcoholic wines, cordials and fruit juices, jam, sugar, gelatine, beer, cider, alcoholic wines and sweetened mineral waters. Metallic colouring matters containing arsenic, copper, mercury, lead, etc., are debarred, also gamboge and some coal-tar colours. Boric acid has also been excluded from all foods. The Regulations can be regarded as a great advance, and special mention must be made of the fact that the due labelling of foods, containing permitted preservatives is required, and that both the preservative and its percentage are to be stated. Local authorities still require powers as regards:— Contamination of food during preparation for sale, in transit, in storage, and while exposed for sale. Adulteration, safely carried out owing to the absence of recognized standards. 139 Report of the Canal Boats Inspector (Mr. E. S. Crook), 1925. Number of visits to waterways 47 Number of boats inspected 25 Number of boats not registered Nil Number of boats conforming to Acts 25 Number of boats infringing the Acts Nil Number of Certificates examined 25 Number of persons for which boats were registered—Adults 88 Children Nil Number of persons living on boats so registered—Men 50 Women Nil Children Nil Number of Notices issued Nil Number of Notices complied with Nil Legal proceedings taken Nil 140 141 INSPECTIONS BY SANITARY INSPECTORS. 1925. Mr. Ellis, No. 1 District. Mr. Bew. No. 1 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. No. 10 and Special District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler. No. 1 and Special District. Mr. Nighy, No. 10 and Special District. Mr. Galvin, Special. Mr. Bobbitt, i Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL Inspections. On Complaint— No. of premises inspected 107 209 261 236 414 304 369 346 144 124 304 276 232 345 218 284 131 ... 25 ... 4329 No. of premises in which defects were discovered 95 178 218 204 313 243 269 293 118 101 270 232 198 248 153 229 118 ... 22 ... 3500 Builder's Notices— No. of premises inspected ... 45 13 10 ... 19 34 20 29 16 8 33 14 27 18 ... 2 ... ... ... 288 House to House— No. of premises inspected ... ... 29 ... ... 50 61 ... 3 51 ... ... 67 31 146 520 362 ... ... ... 1320 No. of premises in which defects were discovered ... ... 25 ... ... 17 49 ... 3 39 ... ... 52 27 73 346 239 ... ... ... 870 Infectious Disease— No. of premises inspected 36 83 41 105 75 93 67 93 62 48 86 74 131 124 69 89 17 ... ... ... 1293 No. of premises in which defects were discovered 9 49 13 40 27 35 25 45 24 21 45 41 70 68 29 40 11 ... ... ... 592 No. of re-inspections. (All forms of inspection) 672 1861 1940 1834 1619 2133 1982 2120 1835 1138 1983 1360 1719 1853 1766 2283 2526 ... 888 920 32412 No. of premises in which defects were discovered. (All forms of inspection.) 110 244 257 287 370 337 346 368 216 224 347 324 334 458 283 615 375 ... 266 321 6082 No. of premises in which defects were abated. (All forms of inspection.) 110 224 243 261 344 319 292 327 216 220 334 262 327 454 252 464 301 ... 270 299 5519 Total number of Intimation notices served 110 247 257 264 359 320 350 311 220 238 348 275 311 448 277 644 364 ... 249 230 5822 Total number of Final Notices served 10 28 7 ... 47 3 37 9 ... 3 13 35 4 ... 57 ... ... ... 57 29 339 Total number of Statutory Notices served 10 63 75 65 87 49 58 127 37 33 105 62 90 88 16 75 66 ... 13 ... 1119 Notices served for infringements of Bye-Laws ... ... ... ... ... 6 7 14 ... 42 15 21 13 61 3 ... ... ... 9 ... 191 Notices served for Infringements of L.C.C. General Powers Acts, Public Health Acts, Meat Regulations, etc. ... 13 18 36 ... ... 1 66 ... 80 5 1 8 17 6 2 17 ... ... ... 270 142 143 INSPECTIONS BY SANITARY INSPECTORS, 1925. 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. Mo. 10 and Special District. Mr. Hillier, No. 11 District. Mr. Crook, | No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler. No. 1 and Special District. Mr. Nighy. No. 10 and Special District. Mr. Galvin, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Notices served under Rats & Mice Destruction Act, 1919 1 8 4 1 1 2 ... 2 ... 1 3 11 18 14 1 ... ... ... ... ... 67 Inspections for Certificates under Increase of Rent, Mortgage Interest (Restrictions Act), 1923 ... ... 1 ... ... ... ... 3 ... ... ... 5 ... 6 7 ... ... ... ... ... 22 Proceedings before Magistrate under Public Health (London) Act, &c. ... 1 3 4 3 6 4 1 ... 12 2 ... 3 2 1 3 4 2 ... ... 51 Attendances at Police Court ... 10 1 4 12 19 9 8 6 16 7 3 2 3 6 9 4 7 ... ... 126 Miscellaneous Inspections— Mews and stables ... 7 ... ... ... 6 ... ... 9 12 3 ... 3 ... ... ... ... ... ... ... 40 Urinals ... 24 8 3 29 35 13 10 18 ... 6 6 ... 4 3 ... 7 ... ... ... 175 Canal boats ... ... ... ... ... ... ... ... ... ... ... 25 ... ... ... ... ... ... ... ... 25 Visits to waterways ... ... ... ... ... ... ... ... ... ... ... 47 ... ... ... ... ... ... ... ... 47 Animals improperly kept 3 ... ... 1 ... ... 2 7 1 2 2 ... 3 ... ... ... ... ... ... ... 31 Offensive trades ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 48 ... ... 48 New buildings (water certificates) ... ... ... ... ... ... ... ... ... ... ... ... ... 231 ... ... ... ... ... ... 231 Floodings ... ... ... ... ... ... 6 ... ... 25 2 12 16 ... ... ... ... ... ... ... 61 Special inspections 25 140 305 163 130 84 52 337 73 161 231 156 62 179 66 53 195 439 ... ... 2851 Drains relaid 6 17 26 30 21 19 23 17 22 24 19 18 14 14 26 17 ... ... ... ... 313 do. repaired 9 29 28 19 65 23 52 21 5 26 29 64 17 44 19 7 34 ... ... ... 491 Drains and Sanitary Fittings tested and examined 70 110 187 125 280 274 84 115 35 98 132 194 81 385 216 121 398 ... ... ... 2905 Places where Food Prepared for Sale (Restaurants, Coffee Shops), etc.— No. of inspections ... 13 10 12 20 8 20 13 6 370 23 31 37 33 11 6 ... 39 ... ... 652 No. of Notices ... 4 5 5 ... ... ... 3 1 98 1 6 ... 12 3 1 ... ... ... ... 139 144 145 INSPECTIONS BY SANITARY INSPECTORS, 1925. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. Vobe, No. 3 District. Mr. Sadler, No. 4 District. Mr. Body, No. 5 District. Mr. High, No. 6 District. Mr. Sheppard, No. 7 District. Mr. Long, No. 8 District. Mr. Goldsworthy No. 9 District. Mr. Peverett. No. 10 and Special District. Mr. Hilllier. No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No 13 District. Mr. Hall, No. 14 District. Mr. Fowler, No. 1 and Special District. Mr. Nighy, No. 10 and Spccial District. Mr. Galvin, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL Ice Cream Premises— No. of inspections ... 20 48 54 42 26 40 54 24 70 24 30 24 72 32 ... ... ... ... ... 560 No. of Notices ... 1 1 7 ... 5 1 2 ... 14 ... 3 1 11 1 ... ... ... ... ... 47 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tenement Houses— No. provided with additional water supply ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Overcrowding— No. of houses overcrowded ... ... 2 ... 1 2 3 8 2 29 5 8 15 ... 8 ... 5 ... ... ... 92 No. remedied ... ... 1 ... ... 1 1 1 ... ... 6 1 2 ... ... ... ... ... ... ... 13 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Verminous Premises— Verminous Premises Cleansed 2 25 38 50 26 35 76 72 13 33 52 33 28 67 13 17 57 ... ... ... 637 Inspections after complaint by London County Council ... ... ... 2 ... 1 10 2 ... 2 12 ... 4 4 2 ... ... ... ... ... 39 Verminous conditions found after complaint by L.C.C. ... ... ... 2 ... 1 10 1 ... 2 10 ... 3 4 ... ... ... ... ... ... 33 Bakehouses— No. of Inspections 6 24 10 16 22 18 16 16 14 13 15 4 4 24 7 12 ... ... ... ... 221 No. of Notices 5 2 1 10 ... ... ... 5 7 1 12 ... 4 1 2 8 ... ... ... ... 58 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Street Markets— No. of inspections ... ... ... ... ... ... ... ... ... 188 ... ... ... ... ... ... ... ... ... ... 188 Food Adulteration— Samples collected for analysis ... 60 60 60 60 54 60 60 66 52 60 60 60 60 60 54 54 60 ... ... 1000 Proceedings taken before Magistrate ... ... ... ... ... 1 2 ... 5 2 2 1 ... 1 2 ... ... ... ... ... 16 146 147 INSPECTIONS BY SANITARY INSPECTORS, 1925. 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, Mo. 10 and Special District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler. No. 1 and Special District. Mr. Nighy, No. 10 and Special District. Mr. Galvin, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL Factories and Workshops— No. of inspections (other than laundries) ... 23 16 3 53 23 36 31 7 12 3 8 6 14 7 5 ... ... 1118 ... 1365 No. of Inspections (laundries) ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 20 ... 21 No. of inspections (other workplaces) ... ... ... ... ... ... ... ... ... 8 ... ... ... ... 1 ... ... ... 2 ... ... No. of premises in which defects were discovered ... 2 5 3 6 9 25 7 ... 8 ... 3 2 7 3 3 ... ... 266 ... 349 No. of premises in which defects were abated ... ... 2 5 3 6 6 20 7 ... 8 ... 2 2 6 3 2 ... ... 270 ... 342 Smoke Nuisances— No. of observations ... 5 ... 49 ... ... 2 106 ... ... 5 2 15 73 7 5 1 ... ... ... ... 270 No. of Intimation Notices served 1 ... 5 ... ... 2 11 ... ... 1 ... 2 3 5 ... 1 ... ... ... ... 31 No. of Statutory Notices served ... ... 1 ... ... ... 5 ... ... ... ... ... 1 ... ... ... ... ... ... ... 7 No. of prosecutions ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Outworkers' Premises— No. of premises inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1449 1449 No. of premises in which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 321 321 No. of premises in which defects were abated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 299 299 Dairies, Cowsheds and Milksiiops Order— Cowsheds—No. of Inspections and Re-inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 ... ... 89 Dairies, do. do. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1509 ... ... 1509 No. of dirty utensils discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of premises where infringements of By-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of new registrations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 ... ... 87 148 149 INSPECTIONS BY SANITARY INSPECTORS, 1925. Mr. Ellis, No. 1 District. Mr. Bew. No. 2 District. Mr. V'obe, 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. Goldsworlhy No. 9 District. Mr. Peverett, No. 10 and Special District Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler. No. 1 and Special District. Mr. Nighy, No. 10 and Special District. Mr. Galvin, Special. Mr. Bobbitt, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Slaughter-houses. No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 416 ... ... 416 No. of premises where infringements of by-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 Condemned as Unfit for Human Food— cwt. t.c.q.lbs. t.c.q.lbs. Fish ... ... ... ... ... ... ... ... ... 4½ ... ... ... ... ... ... ... 4.1.24 ... ... 8.3.24 Fruit and Vegetables ... ... ... ... ... ... ... ... ... cwt. 6 ... ... ... ... ... ... ... ... ... ... 6.0. 0 Meat (specially state number of carcases or parts of condemned for tuberculosis) ... ... ... ... ... ... lbs 84 ... ... cwt. 3 ... ... ... ... ... ... ... 2.1.2.12 ... ... 2.5.1.12 Tinned foods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1.1.1.23 ... ... 1.1.1.23 Other articles ... ... ... ... ... ... ... ... ... Tea. 100 lbs. ... ... ... ... ... ... ... 1 cwt. ... ... 1.3.16 Housing, Town Planning, etc., Act, 1909— No. of premises inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 No. of premises in which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 No. of premises in which defects were abated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Underground Rooms— Illegal occupation dealt with ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 No. of rooms closed ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Houses Let in Lodgings— No. of inspections ... ... ... ... ... ... 557 ... ... ... 626 ... ... ... ... ... 366 ... ... ... 1549 No. of Notices ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 151 INSPECTIONS BY SANITARY INSPECTORS, 1925. Mr. Ellis, No. 1 District. Mr. Bew. N'o. 2 District. Mr. Vobc, 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. Goldsworfhy No. 9 District. Mr. Peverett. No. 10 and Special District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove No. 13 District. Mr. Hall, No. 14 District. Mr. Fowler. No. 1 and Special District. Mr. Nighy, No. 10 and Special District. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bakehouses— No. on Register at end of 1924 8 10 5 8 10 5 8 8 7 13 7 2 2 12 ... ... ... ... ... ... 105 No. on Register at end of 1925 7 10 5 8 10 5 8 8 7 13 7 2 2 11 ... ... ... ... ... ... 103 No. above ground 6 6 1 3 5 1 4 1 5 11 7 ... 1 1 ... ... ... ... ... ... 52 No. underground 1 4 4 5 5 4 4 7 2 2 ... 2 1 10 ... ... ... ... ... ... 51 Houses Let in Lodgings— No. on Register at end of 1924 ... ... ... ... ... ... 237 ... ... ... 236 ... ... ... ... ... ... ... ... ... 473 No. on Register at end of 1925 ... ... ... ... ... ... 237 ... ... ... 236 ... ... ... ... ... ... ... ... ... 473 Ice Cream Premises— No. on Register at end of 1924 14 7 23 20 18 12 20 30 9 22 7 ... 15 40 ... ... ... ... ... ... 248 No. on Register at end of 1925 17 10 24 27 18 12 20 27 6 24 12 12 12 36 ... ... ... ... ... ... 257 Places Where Food Prepared for Sale—Eating Houses— No. on Register at end of 1924 5 6 8 10 21 4 21 12 8 27 9 8 4 29 ... ... ... ... ... ... 172 No. on Register at end of 1925 15 13 9 12 21 4 20 13 8 16 23 23 37 30 ... ... ... ... ... ... 244 152 TABLE OF DEATHS Of Inhabitants of the Borough of Hackney during the year 1925. 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 ... 2 1 1 ... ... ... ... ... ... ... ... 4 Measles (Morbilli) 5 8 3 1 ... ... ... ... ... ... ... ... 17 Epidemic Rose Rash. German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... 4 ... ... ... ... ... ... ... ... ... 4 Influenza 4 ... 1 ... ... 1 6 7 12 7 4 3 46 Whooping Cough 15 9 6 2 ... ... ... ... ... ... ... ... 32 Diphtheria, Membranous Croup 1 1 13 14 1 ... ... ... ... ... ... ... 30 Cerebro Spinal Fever ... ... ... ... ... ... ... ... 1 ... ... ... 1 Enteric Fever ... ... ... ... 1 ... 1 ... ... ... ... ... 2 Encephalitis Lethargica ... ... ... ... ... 1 ... 4 1 ... ... ... 6 Epidemic Diarrhoea, Epidemic (or Zym.) Enteritis 8 1 ... ... ... ... ... ... ... ... ... ... 9 Diarrhœa, Choleraic Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 2 ... ... ... ... ... ... ... ... ... ... ... 2 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septiæmia, Sapræmia fever ... ... ... ... ... 2 1 ... ... ... ... ... 3 153 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. Infective Endocarditis ... ... ... ... ... 2 ... ... ... ... ... ... 2 Erysipelas 1 ... ... ... ... 1 1 1 ... 1 1 ... 6 Septicaemia (not Puerperal) ... ... ... 1 1 1 ... ... ... ... ... ... 3 Pyaemia (not Puerperal) ... ... ... 1 ... ... ... ... ... ... ... ... 1 Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... ... 1 ... ... ... 1 Other Septic Diseases ... 1 ... ... ... 1 1 2 ... ... 1 ... 6 Tuberculous Phthisis (Pulm. Tuberculosis). ... ... ... 2 44 46 45 29 19 6 ... ... 191 Tuberculous Meningitis 2 2 4 2 1 1 ... ... ... ... ... ... 12 Tuberculous Peritonitis ... 2 1 ... 1 ... 1 ... ... ... ... ... 5 Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... Tubercle of other Organs 1 2 ... 2 2 2 3 2 ... 1 ... ... 15 General Tuberculosis ... ... ... ... ... 1 ... ... ... ... ... ... 1 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... 1 1 ... ... ... ... ... ... ... ... 2 Rheumatism of Heart ... ... 1 ... ... ... ... 1 ... ... ... ... 2 Chronic Rheumatism ... ... ... 1 ... ... ... ... 2 1 1 ... 5 Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... 1 ... 2 2 4 1 1 11 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... Carcinoma ... ... ... ... ... 4 24 42 70 70 21 6 237 Sarcoma ... 2 ... 2 2 1 2 1 3 2 2 ... 17 154 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 ... ... ... ... 4 1 5 3 7 22 4 1 47 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... Haemophilia, Hemorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... Anæmia, Leucocythaemia ... ... ... ... ... 2 ... 4 1 6 2 ... 15 Diabetes Mellitus ... ... ... ... ... ... 1 ... 4 10 2 ... 18 Premature Birth 50 ... ... ... ... ... ... ... ... ... ... ... 50 Congenital Defects 17 2 2 ... 2 ... ... ... ... ... ... ... 23 Injury at Birth 3 ... ... ... ... ... ... ... ... ... ... ... 3 Atelectasis 10 ... ... ... ... ... ... ... ... ... ... ... 10 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... Teething ... 1 ... ... ... ... ... ... ... ... ... ... 1 Suffocation-Overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Nervous System. Meningitis, Inflammation of Brain 3 ... 2 ... 1 1 3 4 3 1 ... ... 18 Softening of Brain ... ... ... ... ... ... ... ... ... ... ... ... ... General Paralysis of Insane ... ... ... ... 1 ... 2 2 ... ... ... ... 5 Insanity (not Puerperal) ... ... ... ... ... ... 1 ... ... ... ... ... 1 Chorea ... ... ... ... 1 ... ... ... ... ... ... ... 1 Epilepsy ... ... 1 ... 4 1 2 ... ... 1 ... ... 9 Convulsions 7 1 ... ... ... ... ... ... ... ... ... ... 8 Laryngismus Stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... Locomotor Ataxy ... ... ... ... ... ... ... 1 ... ... ... ... 1 155 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 ... ... ... ... ... ... ... ... ... ... ... ... ... Paraplegia and Disease of Cord ... ... ... ... ... 1 ... ... 1 ... ... ... 2 Neuritis, Periph, PolyNeuritis ... ... ... ... ... ... ... ... 1 ... 1 ... 2 Brain Tumour (not specific) ... ... ... ... 1 1 2 ... ... ... ... ... 4 Nervous System, other Diseases 2 ... ... 1 2 2 ... 4 2 6 2 ... 21 Diseases of Organs of Sense. Otitis, Mastoid Dis. 2 ... 1 ... ... ... ... ... ... ... ... ... 3 Epistaxis, Nose Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Kye Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... Accidents 1 3 2 10 5 5 2 3 10 9 6 2 58 ,, Drowned ... ... ... 1 1 ... 1 ... 3 ... ... ... 6 Suicide Drowned ... ... ... ... ... ... ... 2 4 ... ... ... 6 Other ... ... ... ... 1 3 6 7 6 2 ... ... 25 Diseases of Heart Valve Dis., Endocarditis ... ... ... 1 6 9 to 17 27 38 26 11 145 Pericarditis ... ... ... 2 3 ... ... 1 1 ... ... ... 7 Hypertrophy of Heart ... ... ... ... ... ... ... ... ... ... ... ... ... Angina Pectoris ... ... ... ... ... ... ... 2 4 7 1 ... 14 Dilatation of Heart ... ... ... ... ... 1 ... 1 17 22 29 10 80 Fatty Degeneration of Heart ... ... ... ... ... 1 ... 3 8 4 2 ... 18 Syncope Heart Dis. (not specified) ... ... ... ... 2 3 5 5 7 11 9 2 44 156 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 Hæmorrhage Emb., Throm. 3 ... ... 1 ... 1 6 8 30 63 49 12 173 Apoplexy, Hemiplegia ... ... ... ... ... ... 1 ... 3 5 1 ... 10 Aneuysm ... ... ... ... ... 1 1 1 ... 4 ... ... 7 Senile Gangrene ... ... ... ... ... ... ... ... ... 2 7 ... 9 Embolism. Thrombosis (not Cerebral) ... ... ... ... ... ... ... 1 1 ... ... ... 2 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... Blood Vessels, other diseases ... ... ... ... 1 1 ... 1 3 2 5 2 15 Arterio Sclerosis ... ... ... ... ... ... ... 2 9 22 64 20 117 Diseases of Respiratory Organs. Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 14 3 2 1 ... ... 3 17 43 55 63 17 218 Lobar (Croupous) Pneumonia 3 2 1 ... 5 3 6 7 6 6 4 ... 43 Broncho, Catarrhal, Lobular Pneumonia 42 25 11 7 ... 3 1 5 2 12 11 1 120 Pneumonia 4 3 2 ... 2 2 1 7 5 4 9 1 40 Emphysema, Asthma ... ... ... ... ... 1 4 9 11 14 11 2 52 Pleurisy ... ... ... ... ... 1 1 1 ... ... 2 ... 5 Fibroid Dis. of Lung ... ... ... ... 1 ... 4 2 1 1 1 1 11 Respiratory Dis., other ... ... 1 1 1 1 3 4 5 2 1 ... 19 Diseases of Digestive System. Tonsilitis, Quinsey ... ... ... ... ... ... ... ... ... 1 ... ... 1 Mouth, Pharynx, Dis. (not specific) ... 1 ... 1 ... ... ... ... ... ... ... ... 2 Gastric Ulcer ... ... ... ... 1 3 9 2 7 2 1 ... 25 157 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. Gastric Catarrh or Gastritis ... ... ... ... ... ... ... ... ... 1 2 1 4 Stomach, other Dis. (not Malig.) 1 ... ... ... ... ... 1 2 ... ... 1 ... 5 Enteritis (not Epidemic) 4 ... ... ... ... ... ... ... ... ... 2 ... 6 Gastro-Enteritis 15 ... 1 ... ... ... ... ... ... ... ... ... 16 Appendicitis, Perityphilitis ... ... 1 4 2 1 ... 1 2 2 ... ... 14 Hernia ... ... ... ... 1 ... ... 1 4 ... 1 ... 7 Intestinal Obstruction 1 ... ... ... ... ... 2 2 1 2 2 ... 10 Other Dis. of Intestines 20 2 1 ... ... ... 3 ... 1 1 ... ... 28 Peritonitis (not puerperal) 2 ... 2 1 2 2 1 1 1 ... ... ... 12 Cirrhosis of Liver ... ... ... ... ... ... 1 3 7 2 ... ... 13 Liver and Gall Bladder, other Diseases ... ... ... 1 ... 1 1 1 ... 1 ... ... 6 Digest. Syst., other Diseases ... 1 ... ... ... ... ... ... ... 1 1 ... 3 Lymph Diseases. Lymph System, other Diseases 1 ... ... ... ... ... ... 3 2 3 ... ... 9 Thyroid Body Disease ... ... ... ... 1 ... 1 1 ... ... ... ... 3 Supra Renal Capsules Disease ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diseases of Urin. Syst. Nephritis, Acute ... 1 1 ... 2 4 11 14 22 14 15 3 87 Chronic Bright's Dis. Albuminura ... ... ... ... ... ... 1 2 1 ... 1 ... 5 Calculus (not Biliary)... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 Bladder and Prostate Disease ... ... ... ... ... ... ... ... 5 7 3 ... 15 Lrin. Syst., other Dis. 2 1 ... ... 1 ... 1 2 2 2 1 1 13 158 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 Gener Syst. Ovarian Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Ovary ... ... ... ... ... ... ... ... ... ... ... 1 ... l Uterinal Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Uterus and Vagina ... ... ... ... ... ... ... 1 ... ... ... ... l Accidents Childbirth. Abortion. Miscarriage ... ... ... ... ... 1 1 ... ... ... ... ... 2 Puerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... ... 1 ... ... ... ... ... 1 Other Accid. of Preg. and Childbirth ... ... ... ... 1 7 1 ... ... ... ... ... 9 Joint Diseases Caries, Necrosis ... ... ... ... ... ... ... 1 ... ... ... ... 1 Arthritis, Periostitis ... ... ... ... ... ... ... ... ... 1 ... ... 1 Other Dis. of Locom. Syst. ... ... ... 1 ... ... 1 ... ... ... ... ... 2 Skin Diseases. Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Disease, other ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-Defined Causes. Atrophy, Debility, Marasmus 19 1 ... ... ... ... ... ... ... ... ... ... 20 Old Age ... ... ... ... ... ... ... ... ... 13 61 50 124 Dropsy, Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... 1 ... ... ... ... 1 Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause unascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Causes 3 ... ... ... ... 1 ... 1 ... ... ... ... 5 Causes not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 268 77 66 63 109 132 193 255 393 476 435 147 2614 159 TABLE III. Causes of, and Age at, Death during the year 1925. Causes of Death. Deaths at Subjoined Ages. Deaths in Public Institutions. All Ages Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Enteric Fever 2 ... ... ... ... 1 1 ... ... 4 Small-Pox ... ... ... ... ... ... ... ... ... ... Measles 17 5 8 3 1 ... ... ... ... 10 Scarlet Fever 4 ... ... 4 ... ... ... ... ... 9 Whooping Cough 32 15 9 6 2 ... ... ... ... 59 Diphtheria and Croup 30 1 1 13 14 1 ... ... ... 75 Influenza 46 4 ... 1 ... 1 7 19 14 2 Erysipelas 6 1 ... ... ... ... 2 1 2 1 Dysentery ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 191 ... ... ... 2 44 91 48 6 142 Tuberculous Meningitis 12 2 2 4 2 1 1 ... ... 9 Other Tuberculous Diseases 21 1 4 1 2 3 7 2 1 16 Cancer, Malignant Disease 301 ... 2 ... 2 6 37 126 128 186 Rheumatic Fever 2 ... ... 1 1 ... ... ... ... 2 Meningitis 18 3 ... 2 ... 1 4 7 1 8 Organic Heart Disease 308 ... ... ... 3 11 29 93 172 192 Bronchitis 218 14 3 2 1 ... 3 60 135 62 Pneumonia (all forms) 203 49 30 14 7 7 16 32 48 138 Other Diseases of Respiratory Organs 87 ... ... 1 1 2 15 33 35 38 Diarrhoea and Enreritis 31 27 1 1 ... ... ... ... 2 22 Appendicitis and Typhlitis 14 ... ... 1 4 2 2 3 2 21 Cirrhosis of Liver 13 ... ... ... ... ... 1 10 2 3 Alcoholism ... ... ... ... ... ... ... ... ... ... Nephritis & Brights' Disease 92 ... 1 1 ... 2 16 39 33 67 Puerperal Fever 3 ... ... ... ... ... 3 ... ... 4 Other Accidents and Diseases of Pregnancy and Parturition 12 ... ... ... ... 1 11 ... ... 5 Congenital Debility and Malformation, including Premature Birth 73 67 2 2 ... 2 ... ... ... 47 Violent Deaths, excluding Suicide 64 1 3 2 11 6 8 16 17 53 Suicide 31 ... ... ... ... 1 9 19 9 9 Other defined Diseases 778 75 11 7 10 17 61 139 458 337 Diseases ill-defined or unknown 5 3 ... ... ... ... 1 1 ... ... 2614 268 77 66 63 109 325 648 1058 1521 Sub-entries (included in above figures)— Cerebro-Spinal Meningitis, 1 ... ... ... ... ... ... 1 ... ... Polio Myelitis ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 6 ... ... ... ... ... 1 5 ... 5 160 VIII.— HOUSING. 1.—GENERAL. Number of Houses erected during the year:— (a) Total 87 (b) With State assistance under the Housing Acts, 1919 or 1923:— (i) By the Local Authority 48 maisonettes (ii) By other bodies or persons 39 2.—UNFIT D WELLING-HOUSES. 1. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,579 (2) Number of dwelling-houses which were spected and recorded under the Housing (Inspection of District) Regulations, 1910 or the Housing Consolidated Regulations, 1925 1,320 (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 5,571 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 4,452 161 3.—Action under Statutory Powers. A.—Proceeding's under section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) by owners — (b) by Local Authority in default of 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 5,822 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) by owners 5,519 (b) by Local Authority in default of owners — C.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders — 162 (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-houses 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 — There is very little land remaining available for building purposes in the Borough. Land previously in use as gardens for large private houses is now being utilised for the building of houses and private premises. Hackney is largely a residential district, but there is a progressive growth in the number of premises used for industrial purposes. By-laws—Houses Let in Lodgings.—There are 473 on the present register. Local by-laws for these were approved on 4th September, 1912. New by-laws dealing with these have been drafted by the London County Council, and are awaiting the approval of the Ministry of Health. Tents, Vans and Sheds.—There are no by-laws controlling these. Difficulties that arise occasionally by the temporary occupation of land by travelling showmen are dealt with by the use of the Nuisance Clauses of the Public Health (London) Act, 1891. Underground Rooms.—There are 7,607 underground rooms in the Borough. Regulations affecting these, if used for sleeping purposes, were approved on 27th April, 1924 One contravention of these Regulations was dealt with during the year.