HAC76 Metropolitan Borough of Hackney. REPORT ON THE Sanitary Condition of the metropolitan borough of hackney FOR THE YEAR 1926, BV G. H DART, M.D., M.R.C.P., Edin.; D.P.H., D.T.M. & H., Camb., Barrister-at-Law. Mcdical Officer of Health. Administrative Maternity and Child welfare officer Administrative Tuberculosis Officer 1.on don : Buck Buos. & Harding, Ltd., 6-7, West Avenue, E.17. 1927. INDEX. PAGE- I. General Statistics 20 II. Extracts from Vital Statistics of year 22 III. Notifiable Diseases during the year 34-36 IV. Causes of Sickness 74 V. Summary of Nursing Arrangements, Hospitals, etc. 74 VI. Laboratory Work 90 VII. Sanitary Administration 93 VIII. Housing 137 Canal 'Boats Acts, Report of Inspector 137 Cancer 46 Cleansing of Persons Act, 1897 71 Constitutional Diseases 46 Cowhouses, Dairies and Milkshops 128 Disinfection 68 Food— Articles Surrendered to District Inspectors 99 Articles Purchased for Analysis 132 Milk (Special Designations) Order, 1923 113 Milk and Dairies Order, 1926 114 Premises regulated by By-Laws and Regulations 111 Prosecutions under Sale of Food and Drugs Acts 133 Public Health (Imported Milk) Regulations, 1926 121 ,. ,, (Milk and Cream) Regulations, 1917 126 ,, ,, ^Preservatives, etc., in Food) Regulations, 1925/6 134 ,, ,, (Prevention o<f Epidemic, Endemic, and Infec- Diseases) Order, 1925 122 ,, ,, (Condensed Milk) Regulations, 1923 128 (Dried Milk) Regulations, 1923 128 Reports of Food Inspectors 128-131 Housing— By-Laws with respect to Houses divided into Separate Tenements 97 Floodrngs 17 House-to-House Inspections 99 Housing Conditions in the Borough 97 Legal Proceedings 100 Public Health (London) Act, 1891 93 Rent and Mortgage Interest (Restriction) Act, 1920-23 94 Verminous Premises 94 Work of Sanitary Inspectors (Table of Inspections) 140 Industrial Statistics— Factory and Workshop Act, 1901 103 Factories and Workshops, Nuisances found 106 Factories and Workshops, General Table of Inspections 106 Workshops, Analysis of Occupations 104 Home Workers 108 List of Industries 103 Outworkers 109 index page. Infectious Diseases— Cerebro Spinal Meningitis 43 Cholera 42 Continued Fever 41 Diarrhoea 45 Diphtheria 38 Diphtheria Anti-toxin 39 Dysentery 45 Encephalitis Lethargica 44 Enteric Fever 40 Erysipelas 42 Influenza 45 Malaria 44 Measles and German Measles 45 Ophthalmia Neonatorum 43 Plague 42 Pneumonia 44 Polio-Myelitis 43 Puerperal Fever 41 Puerperal Pyrexia 41 Scarlet Fever 38 Small-pox 38 Typhus Fever 41 Vaccination 37 Whooping Cough 45 Maternity and Child Welfare— Artificial Sunlight Clinic 86 Contributions to Maternity Hospitals 84 Convalescent Aid 84 Dental Clinic 89 Health Visiting 79 Infant Consultation and Ante-natal Clinics 83 Nursing Assistance 85 Provision of Milk and Foods 85 West Hackney Voluntary Centre 13 Mortuary 32 Rainfall 21 Rats and Mice Destruction Act, 1919 95 River Lee 17 Sanitary Inspection—Table of Inspections 140 Shelter Slaughterhouses 128 Tuberculosis— After Care 67 Discharged Soldiers and Sailors 56 Dispensary Districts: Population 60 Extra Nourishment 67 Hackney Borough Council Act, 1926 14 Health Visitors—Visits of 55 Notifications and Deaths 48 Open-air School 67 Public Health (Tuberculosis) Regulations, 1912 50 ,, (Prevention of Tuberculosis) Regulations, 1925 137 INDEX PAGE. Tuberculosis (continued). Public Health (Tuberculosis) Regulations, 1924 55 Summary of Notifications 51 Summary of Deaths, Number and Classification 61 Reports of Medical Officers 63-66 Return of Work at Dispensaries 57 Vital Statistics— Acreage of Borough 20 Births and Birth Rates 23 Deaths and Death Rates 25 Deaths in Public Institutions 28 Density of Population 21 Infantile Mortality 26 Institutions outside the Borough receiving Sick from the Borough 29 Illegitimate Birth Rate 24 Marriage Rate 22 Notification of Births 23 Population 21 Registration of Births 24 Senile Mortality 28 Still Births 23 Tables of Causes of Deaths 152 Table (Comparative) of Rates for years 1917-26 33 ,, ,, year 1920—London Boroughs 19 7 PUBLIC HEALTH DEPARTMENT Public Health and Maternity and Child Welfare Committees. Public Health Committee. Ex-Officio—Councillor W. E. Lovveth, j.p. (Mayor). Chairman—Councillor W. Hughes. Vice-Chairman- -Councillor G. J. Lusher-Pentney. Councillor Barnes, J. G. Benwell, Mrs. I.. C., j.p. Bryan, C. L. Braidman, D. Chapman, T., j.p. Davies, H. W. Goodrich, H. E. Keil, A. Councillor Layland, H. Moxham, (Rev.) E. C. Palmer, Mrs. H. A. Palmer, T. H. Partington, G. Paterson, W. J., j.p. Alderman Rushbrooke, T., j.p., m.a., m.r.c.s., l.r.c.p. 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 Rev. E. C. Moxham. Vice-Chairman—Councillor G. Partington. Members of the Committee—as set out above with the addition of Mrs. F. M. Ashdown, Mrs. T. Smith, and Miss B. W. Payne. 8 STAFF OF PUBLIC HEALTH DEPARTMENT. R. H. Bew. W. C. VOBE. A. Sadler. H. Body. G. F. High. R. J. Sheppard. C. F. Long. VV. Goldsworthy. E. A. Hillier. I. Nighy. Sanitary Inspectors. E. S. Crook, also Canal Boats Inspector. J. E. Truslovb. J. W. Hall. G. Fowler. A. J. Bobbitt (for Cowhouses, Milk- shops, Slaughterhouses, etc.) W. Peverett (Food Premises). H. K. Smith, \ House to House W. E. Galvin, I Inspection. Miss Alice Teebay (for Workshops, Laundries, &c.). Miss Mabel Portlock (for Outworkers' Premises). Health Visitors. Mrs. A. Rhodes. Miss M. K. Cockle. Mrs. L. Harrison. Miss S. E. Love. Miss M. Chitson. Miss G. Hamilton. Mrs. L. E. Bartholomew. Miss N. V. Hobbs. Miss D. F. Vidal. Miss S. E. Thomas. Miss A. K. Roche. Miss E. E. Williamson. Miss G. M. Servante for yiiberculosis 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. Deputy Medical Officer (Infectious Diseases)—a. M. Barlow, m.r.c.s., l.r.c.p. Tuberculosis Dispensary Medical Officers (Metropolitan and City of I.ondon 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. L. W. Harvey. H. C. Bowman. E Whittaker. H. R. Sandford. C. J. Haynes. A. Young. Medical Officer ot Health. G. H. Dart, m.d., m.r.c.p. edin., d.p.h., d.t.m. & h. camb. Barrister-at-Law. 9 Metropolitan Borough of Hackney. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1926. PUBLIC HEALTH DEPARTMENT, Town Hall, Hackney, E. 8. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hackney. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit, in accordance with the instructions of the Ministry of Health, the Annual Report on the health of the Metropolitan Borough of Hackney for the year 1926. A comparative table for the Borough, showing the death, birth and infantile mortality rates for the past 10 years is set out on page 33. The death-rate for Hackney for the past year is 10'8, a slight decrease on the previous year's rate of 10'9, this rate being also below the County rate, which is 11'6, as compared with 11'7 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 59, as compared with 65 for the previous year; the Borough average during the last five years 1922-1926 is 63, as compared with 87 for the previous five years. The figure for London for the year 1926 is 64. The returns for 1926 show the lowest death and infantile mortality rates ever recorded in the Borough. The position of Hackney, as compared with the other Metropolitan Borough, is very satisfactory, and has improved since last year, as is shown by the following table, which gives the death rates and infantile mortality rates in the London Boroughs. 10 Deaths per 1,000 Population. Infantile Deaths per 1,000 Births. Lewisham 10.0 Lambeth 38 Woolwich 10.2 Lewisham 40 Wandsworth 10.3 Woolwich 43 City of London 10.4 Stoke Newington 48 Hampstead 10.6 Deptford 56 Stoke Newington 10.7 Hackney 59 Hackney 10.8 Westminster 59 Greenwich 10.8 Hampstead GO Fulham 10.8 Kensington 60 Camberwell 11.0 Bermondsey 60 Deptford 11.3 Greenwich 61 Battersea 11.4 Battersea 61 Poplar 11.4 Wandsworth 04 Hammersmith 11.4 Chelsea 64 Lambeth 11.5 Fulham 64 Stepney 11.5 Stepney 65 Westminster 11.6 Islington 66 Bethnal Green 11.6 Hammersmith 66 St. Marylebone 11.9 Shoreditch 66 Islington 12.0 Finsbury 66 Holborn 12.1 City of London 66 Bermondsey 12.1 Camberwell 70 Shoreditch 12.2 Southwark 70 St. Pancras 12.4 Poplar 70 Chelsea 12.5 Rethnal Green 70 Paddington 12.6 St. Pancras 76 Southwark 12.7 St. Marylebone 81 Kensington 12.8 Paddington 86 Finsbury 12.9 Holborn 90 The zymotic death-rate is '46 as compared with '49, the figure for 1925. The number of Scarlet Fever cases notified during 1926 was 758, as compared with 531 in 1925, and the number of Diphtheria cases notified in 1926 was 655, as compared with 666 during 1925. The deaths from Scarlet Fever numbered only 4, the same figure as the previous year, and the deaths from Diphtheria 21, being 9 less than those registered in 1925. The question of 1J immunisation against Diphtheria is now engaging the attention of the Public Health Committee. Maternity and Child Welfare. The first year's working of the Municipal Centre at 28, Lower Clapton Road, which includes Ante-natal, Child Welfare, Light and Dental Clinics, is described fully on pages 86 to 90 of this Report. The Light Clinic opened on January 14th, 1926, and one session of two hours weekly is held. The lamp is a KBB type K lamp, Mercury Vapour; the amperage, starting, is 4'5, running 2'7, series resistance 44 ohms; the current used is direct, 240 volts. Dr. Gere has treated 190 cases successfully, the length of time required for treatment varying from 4 weeks in skin diseases to 9 months in that troublesome condition Rickets. An arrangement has been made with the British Red Cross Clinic, Dalston Lane, to supply Dr. Gere with X-Ray photographs of -.he Rickets cases, so that the improvement in the bone condition can be noted. Dr. Gere has also had good results following the irradiation of dried milk. It has recently been shown that Ultra Violet radiations are able to restore to foods devitalised by drying and other methods their original 'life,' and Dr. Gere has had good results from radiating dried milks as part of the treatment of Rickets, Marasmus and other conditions. Dried milk treated in this way becomes not only more palatable and with a closer resemblance to fresh milk, but the fat appears to become more finely divided and remains emulsified longer when the fluid mixture is shaken. It is proposed to try the effects of Ultra Violet radiation on Whooping Cough at a special Clinic held for these cases only. The value of the Dental Clinic has also been proved beyond question by the results of the first year's working. Dental work of every description, including the fitting of dentures and the necessary treatment for some very severe cases, has been most satisfactorily carried out. Cases of such severity as to require a general anaesthetic which was administered by Dr. Montague Smith numbered nearly 150, and a local anesthetic was required in nearly 160 cases. 12 Dentures were fitted to 37 nursing and expectant mothers at a total cost of £89 17s. 6d., £36 8s. 3d. being recovered in contributions from the parents. The Minister of Health has issued Regulations for dealing zvith Ophthalmia Neonatorum (Inflammation of the eyes in new-born children) and Puerperal Fever and Puerperal Pyrexia (Fever and rise in temperature occurring after child birth). Inflammation of the eyes in new-born children is a frequent source of blindness or impairment of vision. The new Regulations modify those of 1914 previously in force, under which a certified midwife is obliged to notify to the Borough Medical Officer of Health any case visited by him in which she has reasonable grounds for supposing that a child is suffering from Ophthalmia Neonatorum, unless the case has already been notified by a medical practitioner. Medical practitioners are required to notify any cases seen by ihem to the Borough Medical Officers of Health, who arranges with the practitioners for such nursing or other services as are required. Puerperal Fever is an ill-defined disease covering several forms of illness, and is not a specific disease comparable with Scarlet Fever or Diphtheria. By making Puerperal Pyrexia, or rise in temperature, notifiable, the medical practitioner is required to notify to the Borough Medical Officer of Health all cases in which a high temperature occurs during the puerperium (period following childbirth). The Ministry of Health state that the notification of this disease has been far from complete, and it is hoped that these Regulations, which are very comprehensive, will permit more effective measures for treatment. Pyrexia—or the High Temperature of these Regulations—is defined as a temperature of 100'4 Fahrenheit or more, sustained during a period of 24 hours or recurring during that period, in a woman within 21 days after childbirth or miscarriage. The Minister of Health consulted the Section of Obstetrics and Gynecology of the Royal Society of Medicine in this matter, and a representative Committee appointed by the Section submitted a report in February, 1925, upon which the new Regulations are based. It had been 13 previously pointed out by the Principal Medical Officer for Maternity and Child Welfare of the Ministry of Health (Dame Janet Campbell) in a Report on Maternal Mortality which was issued in 1924, that whereas the Infantile Mortality of the country had been markedly diminished, the Maternal Mortality had not improved and was still as high as it was twenty years ago, and about 4 per 1,000 women die in childbirth. Many who do not succumb, it is stated, suffer from impaired health as the result of conditions that could have been prevented. The Borough Councils are now empowered with the sanction of the Minister of Health to make provision for the special treatment of women suffering from Puerperal Pyrexia, for consultation with an obstetric specialist, for skilled nursing or for institutional treatment; and it is important, the Ministry state, that these authorities should do all that is possible to meet the request of medical practitioners for special assistance for women suffering from Puerperal Pyrexia which is, or is likely to be, serious in character, in order that maternal mortality and morbidity from this cause may be as far as possible prevented. The Council have arranged that Lady Florence Barrett, M.D., M.S., should act as consultant as regards cases of Puerperal Fever and Puerperal Pyrexia occurring in the Borough, and arrangements have been made with the Camberwell Research Laboratories for the necessary bacteriological work in connection with these cases. Skilled nursing and hospital treatment have been obtainable for some years past under arrangements made by the Council. The West Hackney Voluntary Infant Welfare Clinic was recognised by the Maternity and Child Welfare Committee in November, 1926, and representatives of the Committee were chosen to serve on the Committee of the Voluntary Centre. Co-operation between the Maternity and Child Welfare work of the Borough generally and the Voluntary Centre has been arranged. This Centre has been greatly needed in this district of the Borough and has already relieved Northwold Road to a considerable extent, as there is an average attendance of more than 30 children who would otherwise require attention at Northwold Road. 14 The cost of the Maternity and Child Welfare service for the coming financial year amounts to a rate of .83d. which, of course, includes the new Centre at 28, Lower Clapton Road. Tuberculosis. The number of primary notifications of Pulmonary Tuberculosis for the year is 330 and this figure, with the exception of the year 1922, is the lowest recorded during the past five years. The total number of notifications of Tuberculosis, pulmonary and nonpulmonarv, number 418, also the lowest recorded figures since 1921, with the exception of the year 1922. The deaths from Tuberculosis number 201, also the lowest recorded figure during the past five years. At the close of 1926 there were 1,466 cases of pulmonary tuberculosis and 674 cases of non-pulmonary Tuberculosis on the register. At the Tuberculosis Dispensaries 1,188 suspected cases and 451 contacts to notified cases were examined. Sputum examinations numbered 1,087. The total number of attendances at the Dispensaries was 7,257, and 168 cases were sent for treatment to residential institutions. A full report on the working of the Tuberculosis Dispensaries is contained on Page 57. The circulars forwarded to medical practitioners, containing an extract from Circular 459 of the Ministry of Health which suggested action by the local authority when notification had not been carried out by medical practitioners, has greatly improved the notification, and there is now no delay in notifying these cases; but as regards cases sent for treatment at the Dispensaries there is still considerable room for improvement. The deaths among Dispensary patients during the past year numbered 116, and 44 of these patients, or 38 per cent., were in the final stage of the disease on first attendance; 51 patients, or 44 per cent, were in the second stage. It also appears, from examination of the case papers, that 62 of these cases, or 53 per cent., had been suffering from the disease for a period varying from 3 to 12 months before being referred to the Dispensary. The Hackney Borough Council Act, 1926, has been of considerable assistance as regards those persons suffering from Pulmonary 15 Tuberculosis who were infectious and living under such circumstances as to cause risk of infection to other persons. The experience of this Borough has been the same as that of Birmingham and of other districts where compulsory powers of removal have been obtained. It has been passible to effect considerable improvement in the home surroundings by reference to the powers of removal contained in that Act so that legal proceedings and removal to hospital have not been necessary. Three cases received residential institutional treatment during the year. Sanitary inspection. During the past year over 6,000 Intimation Notices and over 1,600 Statutory Notices have been served, and the detailed work of sanitary inspection has been carefully and conscientiously carried out. The work of sanitary inspection can only be realised by carefully considering the 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. 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 neutralises the ill-effects of overcrowding is not realised: thus, during 1926 no fewer than 155 premises have been cleared of rats, 646 rooms sprayed or otherwise cleared of vermin, 2,245 rooms disinfected, 37,580 articles disinfected and 3,633 adults and children cleansed from parasitic infection, by the staff of the Public Health Department. Systematic house to house inspection under the regulations governing this form of inspection enables careful records to be kept of the housing conditions in each part of the Borough. The results of these inspections are entered up on the card index system, so that the conditions found on inspection and reinspection of any particular street and any house in that street can easily be ascertained. 16 During the past year By-laws with regard to Houses Divided into Separate Tenements and let in lodgings, or occupied by members of more than one family, were approved by the Ministry of Health, and a register of these houses is now being prepared. Draft By-laws with regard to Sanitary Conveniences and House Drainage were under consideration during the year, and various recommendations have been forwarded to the Metropolitan Standing Joint Committee. During the year the alterations at the Disinfecting Station were completed. The stable is now turned into a garage for two motor vans, to take the place of the old horse vans. Particulars of Cleansing and disinfection, both of premises and of articles at the Station, and the cleansing of persons will be found on pages 68 to 73. The fullest use has been made of the powers given to the Council for the purpose of the Protection of Foodstuffs from Contamination. The Council has, from time to time, drawn attention to the various directions in which these powers should be extended. Sampling in order to prevent adulteration and the presence of poisonous substances such as arsenic on apples, and lead in lemonade, has been carried out as usual throughout the year. In particular, attention has been drawn to contamination of ice cream, many samples of badly contaminated ice cream having been taken during the year,; and it was recommended by the Council that ice cream manufacturers and sellers should be compulsorily registered and inspected with the same care as vendors of milk. The conditions under which milk is sold have received the same careful attention as in the past. The opportunity was taken of the Milk and Dairies Order, 1926, to induce persons already registered under the old Orders and the 1908 General Powers Act to conform to the standard laid down by the Public Health Committee in July, 1921, after which date all applications for registration were refused unless the applicants agreed to comply with various sanitary requirements. The Council again expressed the opinion that milk churns should be sealed in railway transit. 17 The Public Health (Preservatives in Food) Regulations, and the Public Health (Preservatives in Food) Amending Regulations, 1926, regulating the use of chemical preservatives in certain foods, came into force during the year. The amount of Foodstuffs Seized or Surrendered during the year amounted to 9 tons. The River Lea has remained, during the past year, in the usual offensive condition. Severe floodings occurred in Hackney as the result of a storm that occurred on the 1st September, the following premises beingmost severely affected:— Marsh Hill:— Nos. 60 to 68. Water in ground floor front and back rooms and back yards, 6 inches deep. On pavement, 6ins. deep. Nos. 34 to 48. Water in back yards, 4ins. deep. Durrington R Dad:— Nos. 37 to 47. Water in kitchens and sculleries. 4ins. deep. No. 62. Water in back yard and front area, 3 ins. deep. No. 66 Water in basement front and back rooms, 1 in. deep. Water in back yard, 3ins. deep. Theydon Read:— Nos. 2 and 3 j- Areas flooded with sewage. 1 8 and 9 14 and 15 20 and 21 Prince Edward Road:— Nos. 56 to 82 (14 houses) Flooded under and over floors to depth of 6ins. Sewage and faecal matter lying in houses and over the road. Berkshire Road:— No-. 70 to 100 (16 houses) Flooded to a depth of 18 inches in re?ir. Sewage and refuse over floors and roadway. Flood depth in front 9ins. Nos 102 to 110 (5 houses) Flooded to a depth of 13ins. in rear. Sewage and fa;ces over floors and vard. Chickens drowned. Berkshire Terrace:— Nos. 1 to 6 (6 houses) Yards and sculleries flooded—sewage. Fn?ces over vards. wallis Road:— Nos. 47, 49, 51. Flooded to depth of 12ins. over floors. Sewage over floors. Bridge Street, Homerton:— Nos. 21, 23, 25, 27. Water in ground floors 1ft. 6ins. to 2ft. deep. Chatswortli Road:— Nos. 126 to 148 and 107. Basements and yards flooded—sewage left after water subsided. 1ft. 6ins. deeo. Prince Edward Road:— Nos. 2 to 22. Damage to furniture, linoleum and clothing. 18 These floodings are due to the inability of the existing sewers to carry away storm water, but it is stated that the London County Council are contemplating improvements to their sewerage system which will prevent future floodings. The entire cost of the Public Health service in the Borough, including all staff, and the maintenance of the Tuberculosis Dispensaries, the Welfare Centres, 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 3.87d. This includes the expenditure required by the expansion of the Maternity and Child Welfare service. Administration of the health services is made more difficult by the fact that in Hackney, with its total population of 228,500, there is also, quoting from the last Census return, a population of 28,457 persons, equal in number to many Urban Districts, living in two room dwellings, and 9,627 living in one room dwellings. In spite of the difficulties that the housing conditions obviously make, it is indeed a matter of great satisfaction that the health of the Borough should, on the whole, remain so good. It is interesting to notice that it is stated in the Annual Report of the Metropolitan Hospital, that both in-patients and out-patients and attendances at the Hospital were considerably fewer in number than in 1925, and that " the decrease in the figures should be considered satisfactory, for it was attributed to the health of the working classes generally." This bears out the facts indicated by the Registrar General's Returns as to the death rate and infantile mortality in the Borough. In conclusion, I have to thank the Public Health and Child Welfare Committees for their support and kind consideration, ar.d I also 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. 19 COMPARATIVE TABLE, YEAR 1926. Name of Borough. Population. Birth Rate. Zymotic Death Rate. Death Rate all causes. Infantile Mortality. Battersea 171,900 17.3 0.7 11.4 61.6 Bermondsey 123,100 19.6 0.76 12.1 60 Bethnal Green 119,600 20.9 — 11.6 70 Camberwell 275,400 16.6 — 11.0 70 Chelsea 64.S20 13.3 0.7 12.5 64 Deptford 115,700 18.2 0.7 11.3 56 Finsbury 77,550 21.4 0.67 12.9 66 Fulham 164,300 16.2 0.6 10.8 64 Greenwich 104,300 17.7 0.4 10.8 61 Hackney 228,500 17.2 0.46 10.8 59 Hammersmith 134,400 16.3 0.6 11.4 66 Hampstead 87,530 12.3 0.23 10.6 60 Holborn 43,200 12.8 0.5 12.1 90 Islington 339,200 190 0.5 12.0 66 Kensington 180,000 15.1 0.6 12.8 60 Lambeth 311,000 17.9 0.5 11.5 38.4 Lewisham 187,800 15.3 0.2 10.0 40 Paddington 146,700 15.3 0.8 12.6 86 Poplar 169,000 21.6 0.9 11.4 70 St. Marylebone 105,800 12.7 0.5 11.9 81 St. Pancras 216,800 16.7 0.8 12.4 76 Shoreditch 106,400 23.5 0.6 12.2 66 Southwark 188,600 20.2 0.9 12.7 70 Stepney 256,100 19.4 0.79 11.5 65 Stoke Newington 53,080 160 0.8 10.7 48 Wandsworth 342,100 141 0.6 10.37 64 Westminster 138,400 11.3 0.44 lie 59.7 Woolwich 141,900 17.4 0.3 10.2 43 City of London 13,230 7.1 0.07 10.4 66 County of London 4,605,600 17.1 — 11.6 64 City of Belfast 24.9 - 15.4 112 „ „ Dublin — 26.0 - 15.3 114 „ „ Glasgow — 23.4 - 15.0 104 „ „ Edinburgh . — 18.7 — 13.5 80 „ „ Liverpool — 23.2 — 13.3 103 „ „ Manchester — 19.3 - 13.0 83 20 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, 1926 228,500 Physical Features and General Character of the Area.—The Borough varies in elevation between 16 feet and 110 feet above orc'nance 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 (1926) 35,136 Number of families or separate occupiers (1921) 56,020 Rateable value (December, 1926) £1,432,226 Sum represented by a penny rate £5,880 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 pianos, and the production of tailored clothes. The factories and workshops are in very good condition and the sanitary auangements are kept under constant supervision. 21 Population.—The population for the whole Borough gives a density of 69'5 persons per acre, varying from 53'5 persons per acre in the Northern Sub-district to 99'9 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 1926. North Central SouthWest SouthEast Total for Hackney Total for London Estimated population 57,851 54,023 58,588 58,038 228,500 4,605,600 Area in square acres 1,080 857 586 764 3,287 74,816 Density, persons per acre 53 5 630 999 75 9 60 5 615 Register of Rainfall during the year at Clapton Pond—1926. Month. Total rainfall, ins. No. of days on which rain fell. Heaviest fall, ins. January 2.16 18 0.33 February 3.19 17 0.91 March 0.29 7 0.06 April 3.49 18 0.76 May 1.39 13 0.51 June 3.04 13 0.70 July 2.14 15 0.36 August 2.22 13 0.44 September 1.04 9 0.36 October 2.10 13 0.38 November 4.23 21 0.87 December 0.41 4 0.22 Total 26.00 161 22 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR, Births— Total. M. F. Legitimate 3,833 1,976 1,973 Birth Rate 17.2 Illegitimate 116 Deaths 2,472 Death Rate 10.8 Number of women dying in, or in consequence of childbirth :— Fiom sepsis ... 3 From other causes 12 Deaths of Infants under one year of age per 1,000 births:— Legitimate, 56. Illegitimate, 155. Total, 59. Deaths from Measles (all ages) 12. ,, ,, Whooping Cough (all ages) 4. ,, ,, Diarrhoea (under 2 years of age) 63. *Marriages and Marriage-rates.—During 1926 there were 1,888 marriages solemnised in the Borough of Hackney. The annual rate for persons married during this period is therefore 16'5 per 1,000 of the population. The following table gives the number of marriages and mat riage-rates for the Borough of Hackney and London during the years 1916-1926. Year. Borough of Hackney. London. Marriages. Marriage rate. 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 1925 2,039 17.8 17.2 Average, 1916—1925 2.173 19.4 19.4 1926 1,888 16.5 17.2 * I have here to acknowledge my indebtedness to Mr. George Jewells, Deputy Superintendent Registrar, who has kindly abstracted the number of marriages for the year 1926. 23 Bitihs and Birth-rate.—The births registered in the Borough of Hackney during the year 1926 numbered 4,763, of which 2,383 were males and 2,380 females. The total shows a decrease of 43 compared with the number registered during 1925, 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., 1,175 births to be transferred to other districts and 361 to Hackney. After these necessary corrections have been made, the correct total of registered births amongst Hackney residents is 3,949. From this figure the birth rate for Hacknev during 1926 has been calculated to be 17.2 per 1,000 of the population. The birth-rate for all London for the same period is 171 per 1,000 of the population. Notification of Births Act, 1907.—Under the provisions of this Act 4,835 notifications of births were received during 1926. This total includes notifications from medical practitioners, midwives, parents and others. It also includes still-births. The total is 72 more than the number registered by the Registrars of Births. Still-Births.—Amongst the births notified 123 were still-born. This is equal to 2.5 per cent, of those notified. A table is here given showing the number of notifications received, with other details in connection with the same. 24 NOTIFICATION of BIRTHS ACT, 1907. Notifications oj Births (Live and Still-born) received during the year 1926. Year 1926. Medical Practitioners Midwives. Parents and Others. Total, Live. Still. Live. Still. Live. Still. Live. Still M. F M. F. M. F. M. F. M. F. M. F. M. F. M. F. Totals 353 375 11 6 1554 1488 54 39 486 456 6 7 2393 2319 71 51 Illegitimate Births and Birth-rate.—The total number of illegitimate births registered in the Borough during the year 1926 was 446, but of these, the Register-General states that 351 should be transferred to districts outside the Borough, as the mothers were not Hackney residents, and 21 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 29'3 per 1,000 births. The following table gives the number of registered births birth-rates, etc., lor the Sub-districts in the Borough:— Registration District ol Hackney Registration Sub-district All London North Central SouthWest SouthEast Total No. of births 4,763 721 2,123 856 1,063 78.825 Rate per 1,000 living 2.08 12.4 39.3 14.6 18.3 17.1 No of illegitimate births 116 ... ... ... ... ... Rate per 1,000 births 29'3 ... ... ... ... ... 25 It will be noticed that the birth-rate is abnormally high in the. Central District compared with other registration Subdistricts. This is accounted for bv reason of 1,423 births occurring during this year at the Salvation Army Mothers' Hospital, which Institution is situate in the Central District. Of this number 973 births are transferable to districts outside Hackney. The following table shows the birth-rates for the Borough and its Sub-Districts during die years 1916-1926, inclusive :— Birth-rate for the Borough of Hackney and its Sub-Districts for the years 1916-1926 compared with that of London. Year Borough nf Hackney North SubDistrict Central SubDistrict South-West SubDistrict South-East SubDistrict London 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 1925 21.0 13 .1 37 .6 15.8 18.7 18.0 Average 1916-1925 22.1 14.6 35.5 17.8 21.1 20.1 1926 20.8 12.4 39.3 14.6 18.3 17.1 Deaths.—The deaths registered in the Borough during 1926 numbered 2,751; but of these 678 were deaths of non-residents who died inside the Borough. There were, however, 399 residents of Hackney who died during the year outside the Borough. On making the necessary corrections, the corrected number of deaths amongst Hackney residents is 2,472. This is a decrease of 142 upon the number of deaths occurring during 1925. The general death-rate from all causes for the year 1926 is 10 8 per 1,000 of the population. 26 Amongst the Registration Sub-districts the death-rate was lowest in the Central Sub-district (9.7 per 1,000), the highest in the South-East Sub-district (11.9 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 57,851 721 12.4 605 10 .4 37 51 Central 54,023 2.123 39.3 526 9.7 57 26 South - west 58,588 856 14.6 654 11.1 57 66 South - east 58,038 1,063 18.3 687 11.9 83 78 All Hackney 228,500 4,763 20.8 2,472 10.8 234 49 * 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 33. 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. 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 1921 11.5 12.4 1926 10.8 11.6 Infantile Mortality.—The deaths under 1 year of age in the Borough during 1926 numbered 234. This is a decrease of 34 upon the number of infants' deaths recorded during 1925. The infant mortality rate for the year is 59 per 1,000 births. The causes of death are set out in the following table 27 INFANT MORTALITY, 1926. Nett deaths from stated causes at various ages under 1 year of age. Cause of Death. Under 24 hrs. 1 day to 1 wk. 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 1 under 1 year. Sniall-pox ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 2 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... 1 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous ... ... ... ... ... ... ... ... ... ... ... Diseases Meningitis (noc Tuberculous) ... ... ... ... ... ... ... ... 2 2 4 Convulsions ... ... ... ... ... ... ... 1 1 1 3 Laryngitis ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 4 1 2 2 9 Pneumonia (all forms) ... ... 1 1 l 3 11 16 16 8 54 Diarrhœa ... ... ... 1 ... 1 16 19 10 1 47 Enteritis ... ... 1 2 1 4 1 10 3 ... 18 Gastritis ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... Suffocation (overlying) ... 1 1 ... 1 3 ... ... ... ... 3 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... Atelectasis 3 3 ... ... ... 6 ... ... ... ... 6 Congenital Defects 7 4 2 ... 13 1 2 ... ... 16 Premature Birth 17 14 4 3 2 40 4 ... ... ... 44 Atrophy, Debility and Marnsmus ... 2 ... ... 2 4 4 5 ... ... 13 Other Causes 2 2 1 2 ... 7 3 1 1 12 22 29 12 11 7 81 44 55 36 18 234 28 Senile Mortality.—The deaths which occurred in Hackney at 65 years of age and upwards during 1926 numbered 1,033, and of these 515 were between the ages of 65 and 75 years, 410 between 75 and 85 years, and 108 at 85 years and upwards. The annual mortality rate of persons at 65 years and upwards is 4'5 per 1,000 inhabitants. Deaths in Public Institutions.—There were 1,671 deaths in public institutions in the Borough during 1926; of these 679 were residents of other districts, and the remaining 992 were residents of Hackney. The following lists give the names of the institutions within the Borough receiving persons from both within and without the Borough, and also the institutions outside the Borough, receiving sick and infirm persons from the Borough, with the number of deaths in each institution during the year 1926 :— Institutions within Hie Borough receiving persons both from and without the Borough. Brooke House, Upper Clapton Road 10 Eastern Fever Hospital, Homerton 149 French Hospital, Victoria Park Road 1 German Hospital, Dalston 142 Hackney Hospital, Homerton 976 „ Central Institution, Homerton 9 Metropolitan Hospital, Kingsland 174 Nursing Home, 46, Amhurst Park 6 ,, ,, 2, Amhurst Park 5 Carried forward 1,472 29 Brought forward 1,472 Nursing Home, 7, Dunsmure Road 1 ,, ,, 7, Powell Road 3 ,, ,, 94, Cazenove Road 1 ,, ,, 18 and 20, Southwold Road 6 ,, ,, 4, Navarino Road I ,, ,, 2, Queensdown Road 6 f, ,, 122, King Edward Road 2 ,, ,, 262, Victoria Park Road 2 St. Joseph's Hospice, Mare Street 140 Salvation Army Maternity Hospital, Lower Clapton Road 35 ,, ,, Home, 13, Laura Place 1 ,, ,, ,, 39, Devonshire Road 1 1,671 Institutions outside the Borough receiving sick and infirm persons residing in the Borough Banstead Mental Hospital 7 Bethnal Green Infirmary 3 Brompton Hospital 3 Cancer Hospital 3 Cane Hill Mental Hospital Charing Cross Hospital 2 Children's Hospital, Gt. Ormond Street 5 City of London Maternity Hospital 2 City of London Mental Hospital 1 Claybury Mental Hospital 25 Colindale Hospital 11 Colney Hatch Mental Hospital 9 Carried forward 74 30 Brought forward 74 Darenth Industrial Colony, Dartford 1 Dartford Heath Mental Hospital 1 Downs Hospital, Suttcn 1 Edmonton Epileptic Colony 1 ELizabeth Garrett Anderson Hospital 3 Evelina Hospital, Southwark 1 Fountain Mental Hospital * 1 Grove Park Hospital 4 Guy's Hospital 1 Hackney Branch Institution, Brentwood 1 Horton Mental Hospital 4 Hampstead General Hospital 1 Hanwell Mental Hospital 3 Home & Hospital for Jewish Incurables 5 Home Hospital for Women, Stoke Newington 1 Homeopathic Hospital 1 Hospital for Women & Children, Paddington 1 Infants' Hospital, Vincent Square 2 Kensington General Hospital 1 Leavesden Mental Hospital 3 London Fever Hospital (T.B.) 3 London Hospital 38 London Jewish Hospital 1 London Temperance Hospital 1 Long Grove Mental Hospital 3 Middlesex Hospital 9 Mildmay Mission Hospital 4 National Heart Hospital 1 Carried forward 171. 31 Brought forward 171 National Hospital, Queen's Square 3 Nordi-Eastern Fever Hospital 5 North Middlesex Hospital, Edmonton 2 Northern Hospital, Winchmore Hill 3 Prince of Wales' General Hospital 11 Queen's Hospital for Children 31 Queen Mary's Hospital, Carshalton 3 Royal Chest Hospital, City Road 2 Royal Free Hospital 3 Royal Hospital for Incurables 2 Royal Northern Hospital 3 St. Bartholomew's Hospital 17 St. Columba's Hospital 3 St. George's Home, Chelsea 4 St. George's Hospital 1 St. Leonard's Hospital, Shoreditch 4 St. Luke's Hospital 5 St. Mary's Hospital 1 St. Peter's Hospital 1 St. Thomas' Hospital 1 Tooting Bee Mental Hospital 15 University College Hospital 5 Victoria Park.Hospital 21 West End Hospital, St. Pancras 2 West Ham Mental Hospital 1 West Park Mental Hospital 5 Westminster Hospital 1 Miscellaneous Institutions 73 399 32 MORTUARY, 1926. Number of bodies in Mortuary 268 1. To await Inquests—(a) Infectious — (b) Non-Infectious 242 2. To await Burial 26 Number of Post Mortems 136 I nquests. Verdict. Sex. Male. Female. Natural Causes 71 38 Accidental Death 45 36 Suicide 23 11 Open Verdict 12 3 Manslaughter ... ... Murder 1 ... Misadventure 1 1 Totals 153 89 Table showing nature of Suicidal and Accidental Deaths in the Borough of Hackney during the year 1926. Nature of Suicide. No. Nature of Accidental Death. No. Poisoning 20 Shock from Burns 9 Drowning 6 Shock from Fall 24 Jumping from window 2 Run over 27 Cut throat 3 Siiock from Scalds 6 Shooting 2 Poisoning 5 Others 1 Fall from ladder 3 Others 7 34 81 33 TABLE 1 Vital Statistics of Whole District during 1 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. of Nonresidents registered in the District. of residents not registered in the District. Under 1 Year of Age At all Ages. Uncorrected Number. Nett Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1917 196,598 4,207 3,750 17.1 2,929 14.9 661 585 345 92 2,853 14.6 1918 For Deaths 195,804 3,828 3,266 14.8 3,836 19.5 820 692 365 111 3,708 18.9 For Births, 219,391 19191 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 19201 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 2,406 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 1926 228,500 4,763 3,949 17.2 2,751 12.0 678 395 234 59 2,472 10.8 34 III.—NOTIFIABLE DISEASES DURINC THE YEAR. During 1926 there were 1,620 cases of acute infectious disease compulsorily notified in the Borough, as set out in Table II. This total shows an increase of 272 unon those notified during 1925. The attack-rate in respect of the acute notifiable infectious diseases for the year is 7 0 per 1,000 inhabitants. In addition there were 333 notifications received of pulmonary tuberculosis and 89 notifications of other forms of tuberculosis. The deaths from the chief zymotic diseases numbered 106. This is equivalent to zymotic death-rate of 0'46 per 1,000 living in the Borough, as compared with a zymotic death-rate of 0"49 during the previous year. Notifiable Diseases during the year 1926 (Deaths in Hospitals). Disease. No. of Deaths in Hospitals. Total Deaths. Diphtheria 19 21 Erysipelas 1 3 Scarlet Fever 3 4 Puerperal Fever 7 7 Cerebro-Spinal Meningitis 1 2 Typhoid Fever Encephalitis Lethargica 3 4 Influenzal Pneumonia t 2 Acute Primary Pneumonia 2 4 Polio Myelitis 1 1 39 48 35 Notifiable Diseases during the year l926 (Age groups of notifications). Diseases. Cases Notified Total Cases Notified in each Locality. Total cases removed lo 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-VVest. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 655 31 29 52 44 66 229 78 33 85 5 2 1 87 171 246 151 645 Erysipelas 59 4 1 ... 1 1 3 2 1 3 9 25 9 15 9 20 15 30 Scarlet Fever 758 5 27 36 83 68 378 87 28 41 4 1 ... 166 178 207 207 718 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 10 ... ... 1 ... 1 2 1 1 2 1 1 ... 4 2 3 1 7 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 30 ... ... ... ... ... ... ... ... 23 7 ... ... 5 8 5 12 30 Puerperal Pyrexia 25 ... ... ... ... ... ... ... 2 22 ... 1 ... 7 12 2 4 22 Cerebro-Spinal Meningitis 2 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 1 Polio Myelitis 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Ophthalmia Neonatorum 21 21 ... ... ... ... ... ... ... ... ... ... ... 3 6 5 7 9 Pulmonary Tuberculosis 330 ... 1 1 ... ... 9 7 36 130 71 66 9 72 77 81 99 220 Other forms of Tuberculosis 88 ... 6 4 5 5 24 11 12 16 3 1 1 . 20 20 18 31 53 Encephalitis Lethargica 8 ... ... ... ... 1 ... ... ... 5 ... 1 1 2 2 3 1 7 Influenzal Pneumonia 4 ... ... ... ... ... ... ... ... 1 1 1 1 1 ... 2 1 3 Acute Primary Pneumonia 46 2 ... ... 2 2 8 1 5 8 7 9 2 6 4 13 23 21 Malaria 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 2,038 64 64 94 135 144 655 187 118 336 108 109 24 390 489 605 554 1,768 36 Notifiable Diseases during the year 1926 (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) 655 645 1 3 7 2 1 6 1 ... ... ... ... ... 21 Erysipelas 59 30 1 ... ... ... ... ... ... ... ... 1 ... 1 3 Scarlet Fever 758 718 ... 1 ... ... ... ... ... ... ... ... ... ... 4 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 10 7 ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 30 30 ... ... ... ... ... ... ... ... ... ... ... ... 7 Puerperal Pyrexia 25 22 ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Meningitis 2 1 ... ... ... ... ... 1 ... ... ... ... ... ... 2 Polio Myelitis 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Ophthalmia Neonatorum 21 9 ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 8 7 ... ... ... ... ... ... ... ... 2 ... 1 ... 4 Influenzal Pneumonia 4 3 ... ... ... ... ... ... ... ... 1 ... 1 ... 2 Acute Primary Pneumonia 46 21 ... ... ... ... ... ... ... ... ... ... 4 ... 4 Malaria 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1620 1495 3 4 7 2 2 11 1 7 4 6 1 48 For iirc groups of notifications (including Tuberculosis) , see range 35 37 Summary of Proceedings under the Vaccination Acts, 1867 to 1898, during the year 1926. 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 ir Lists sen to Public Vaccinato Health of Child. Condition of House. Prevalence of I nfectious Disease. Parents Removed out of District. Otherwise not found. North 721 384 23 — — 259 1 39 — 98 Central 2,132 384 25 — — 794 1 542 53 205 South-East 1,031 209 6 — - 483 — 119 43 217 South-West 866 399 14 — — 394 — 43 — 188 Total 4,750 1,376 68 — — 1,930 2 743 96 708 38 Small-Pox.—There were no notifications of small-pox in the Borough during- 1926. Scarlet Fever or Scarlatina.—The number of cases of scarlet fever notified during 1926 was 758. This is an increase of 227 cases upon the number of cases notified during 1925. The attack rate for scarlet fever was 3*31 per 1,000 persons living, and for England and Wales 2'10. The number of cases removed to hospital during the year was 718. This is equal to 94-7 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 166 178 207 207 Attack-rate per 1,000 living 2.9 3.3 3.5 3.5 It will be seen from the above that scarlet fever was most prevalent in the South-west and South-east Sub-districts. The deaths from scarlet fever during 1926 numbered 4, which is equal to a case mortality of 0'52 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 655 cases of diphtheria and membranous croup notified during the year. This is a decrease of 11 upon the number of genuine cases notified during 1925. The attack rate of diphtheria was 2.8 per 1,000 inhabitants, compared with 1.31 for England and Wales. There were 645 cases removed to hospital during the year. This is equal to 98.4 per cent, of the cases notified. 39 The following table shows the distribution of diphtheria in the respective Sub-districts of the Borough:— Sub-Districts. North. Central. South-west. South-east. Number of cases of Diphtheria and Membranous Croup 87 171 246 151 Attack-rate per 1,000 living 1.5 3.1 4.2 2.6 From the above it will be seen that diphtheria was most acute in the South-West Sub-district. The deaths from diphtheria and membranous croup during the year numbered 21. This mortality is equal to a death-rate of 3"2 per cent, attacked and 0.09 per 1,000 inhabitants, as compared with a death-rate of 45 per cent, attacked, and 0.13 per 1,000 inhabitants for the previous year. The death-rate from diphtheria for London during the same period is 0.12 per 1,000 inhabitants. During the year 1,419 swabbings from throats of persons suspected to be suffering from diphtheria were bacteriologically examined, of which 158 gave positive results, 1,253 negative results, and 8 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 92 bottles of anti-toxin of 8,000 units each were supplied to medical practitioners, most of which was used for prophylactic purposes. 40 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 58 493 96 21 16 ... Diphtheria 56 340 124 2 7 ... 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, 10 cases of enteric fever were notified. This shows an increase of three on the number of genuine cases notified during 1925. The attack rate was 0'04 per 1,000 inhabitants, compared with 0 07 for England and Wales. Seven 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 4 2 3 1 There were not any deaths from enteric fever in the Borough last year. 41 During the year 12 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 30 cases of puerperal fever notified during 1926; all the cases were removed to hospital. The deaths from puerperal fever and septicaemia numbered 7. The attack-rate for the year was 7'6 per 1,000 births, and the deathrate 1-7 per 1,000 births. Puerperal Pyrexia.— THE PUBLIC HEALTH (NOTIFICATION OF PUERPERAL FEVER AND PUERPERAL PYREXIA) REGULATIONS, DATED 31st JULY, 192G. By making Puerperal Pyrexia notifiable, the medical practitioner is required to notify to the Medical Officer of Health all cases in which a high temperature occurs during the puerperium (period following childbirth). The Ministry of Health state that the notification of this disease has been far from complete, and it is hoped that these Regulations, which are very comprehensive, will permit more effective measures for treatment. Pyrexia—or the High Temperature of these Regulations—is defined as a temperature of 100'4 Fahrenheit or more, sustained during a period of 24 hours or recurring during that period, in a woman within 21 days after childbirth or miscarriage. The Minister of Health consulted the Section of Obstetrics and Gynaecology of the Royal Society of Medicine in this matter, and a representative Committee appointed by the Section submitted a report in February, 1925, upon which the new Regulations are 42 based. It had been previously pointed out by the Principal Medical Officer for Maternity and Child Welfare of the Ministry of Health (Dame Janet Campbell) in a Report on Maternal Mortality which was issued in 1924, that whereas the Infantile Mortality of the country had been markedly diminished, the Maternal Mortality had not improved and was still as high as it was twenty years ago, and about 4 per 1,000 women die in childbirth. Many who do not succumb, it is stated, suffer from impaired health as the result of conditions that could have been prevented. The Borough Council is empowered with the sanction of the Minister of Health to make provision for the special treatment of women suffering from Puerperal Pyrexia, for consultation with an obstetric specialist, for skilled nursing or for institutional treatment ; and it is important, the Ministry state, that the authority should do all that is possible to meet the request of medical practitioners for special assistance for women suffering from Puerperal Pyrexia which is, or is likely to be, serious in character, in order that maternal mortality and morbidity from this cause may be as far as possible prevented. Arrangements have been made with Lady Florence Barrett, M.D., M.S., to act as Consultant at a fee not exceeding £3 3s. per consultation. From the time the Regulations came into force until the end of the year 25 cases were notified. 22 cases were removed to Hospital. 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 59 cases of Erysipelas notified during 1926. This is equal to an attack-rate of 0.25 per 1,000 43 tants, compared with 0.38 for England and Wales. Of the 59 cases notified, 30 were removed to hospital. There were 3 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 15 9 20 15 Rate per 1,000 living .26 .16 .34 .25 Cerebro-spinal Meningitis.—.During 1926 there were two cases of this disease notified in the Borough, one was removed to hospital. Both patients died. 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 21 12 9 21 — — — PUBLIC HEALTH (OPHTHALMIA NEONATORUM) REGULATIONS, 1926, DATED 31st JULY, 1926. Inflammation of the Eyes in New-born Children.—This is a frequent source of blindness or impairment of vision. The new Regulations modify those of 1914 previously in force under which a certified midwife is obliged to notify to the Medical Officer of Health any case visited by her in which she has 'reasonable grounds for supposing that a child is suffering from Ophthalmia 44 Neonatorum, unless the case has already been notified by a medical practitioner. A midwife, under the Rules of the Central Midwives Board— which remain in force—is required to call in medical help for any inflammation of, or discharge from, the eyes however slight, and to send notice thereof to the local Supervising Authority which, in London, is the London County Council, who supervise the carrying out of these rules by the midwives. This system, it is said, has tended to confuse the midwife and, under the new 1926 Regulations, the midwife is required to notify only the London County Council who supervise her work, and the duty of informing the Medical Officer of Health (so that die Health Visitors can follow up the case) is laid upon the Inspector of Midwives, who is a medical practitioner employed by the London County Council. Medical practitioners are required to notify any cases seen by them to the Medical Officer of Health who arranges with the practitioners for such nursing or other services as are required. Encephalitis Lethargica.—The Public Health (Acute Encephalitis Lethargica and Acute Polio Encephalitis) Regulations, 1918, came into operation on 1st January, 1919. During the year 1926 8 cases were notified, 4 being fatal. Seven patients were removed to hospital. Influenzal Pneumonia and Pneumonia.—There were 4 cases of influenzal pneumonia and 46 of primary pneumonia notified. As provided in the Regulations, where the nuising was found to be inadequate a nurse was sent from the King's Home for Nurses in accordance with an arrangement made with the Superintendent at a fee of Is. 3d. per visit. During the year 83 cases, including cases of pneumonia and broncho-pneumonia, were nursed and 1,495 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. 45 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 1926. 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. Twelve deaths were recorded from measles. The annual mortality is, therefore, '05 per 1,000 inhabitants, compared with London 0"20 per 1,000 inhabitants. Information of 1,297 cases of measles and 34 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 1926 there were 45 deaths in the Borough. This is a decrease of one on the deaths from this cause registered during 1925. The annual mortality rate from influenza is 019 per 1,000 inhabitants. Diarrhoea.—There was an increase in the number of deaths due to diarrhceal disease in the Borough during 1926. The total number of deaths from this cause was 63, and of these 61 were under 1 year of age. The annual mortality rate for diarrhoea and enteritis during the year is 0'27 per 1,000 inhabitants. Whooping Cough.—The deaths from this cause during the year numbered 4. This is a decrease of 28 upon the number registered during 1925. These deaths occurred in children under 46 five years of age. The mortality for Hackney is equal to 0.017 per 1,000 inhabitants, and that for all London, 0.05 per 1,000 inhabitants. The King's Home for Nurses attended to three cases and paid 34 visits. Information was received from the head masters and head mistresses of elementary schools in Hackney of 168 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 322 deaths during 1926, due to the different varieties of malignant disease. This is an increase of 21 on the number registered during 1925. The annual mortality rate from malignant disease for last year is therefore 1'40 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 73 70 94 85 Mortality-rate per 1,000 inhabitants 1.2 1.2 1.6 1.4 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 1926:— London. Boiough of Hackney. Years. 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 Deaths from Cancer. 230 236 274 246 289 285 303 310 301 322 Death-rate per 1,000. 1.17 1.07 1.26 1.09 1.28 1.26 1.33 1.36 1.31 1.40 Death-rate per 1,000. 1.25 1.26 1.20 1.20 1.31 1.30 1.35 1.40 1.40 1.42 47 CANCER, 1926. 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 up85 wards Total Brain and Meninges ... ... ... 1 ... 4 2 4 1 ... 12 Mouth and Annexa ... ... ... ... ... 4 3 3 3 ... 13 Oesophagus ... ... ... ... 2 2 4 6 3 ... 17 Stomach ... ... ... ... 2 8 22 22 8 ... 62 Pancreas ... ... ... ... ... 3 6 3 4 ... 17 Intestine (large or small) ... ... ... ... 1 8 9 17 11 1 48 Rectum ... ... ... ... ... 2 7 10 5 ... 24 Liver ... ... ... ... ... 2 3 6 3 ... 14 Larynx ... ... ... ... ... 1 1 2 2 ... 6 Lung ... ... ... ... 1 6 3 4 ... 14 Bladder ... ... ... ... 1 1 5 8 2 ... 17 Breast ... ... ... ... 1 6 5 9 2 ... 23 Uterus and appendages ... ... ... ... 2 2 8 4 4 1 21 Bones and Joints ... ... 1 2 ... ... 2 2 2 ... 9 Other and ill-defined situations ... ... 1 5 5 1 3 5 2 1 25 ... 2 3 8 16 50 83 105 52 3 322 43 Alcoholism. Alcoholism.—During the year under consideration there were two deaths from alcoholic poisoning, and seven deaths registered as due to cirrhosis of the liver, a condition regarded, as a rule, to be due to excessive indulgence in alcohol, extending over lengthy periods. TUBERCULOSIS. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. 0— 1 ... ... ... ... ... ... ... ... 1— 5 1 1 11 9 ... ... 5 3 5—10 3 6 19 5 1 ... 6 ... 10—15 6 1 7 4 ... ... 1 2 15- 20 16 20 3 9 6 10 1 2 20—25 20 33 3 7 13 14 ... ... 25—35 35 42 2 4 21 15 ... ... as—45 47 24 2 1 19 17 ... ... 45—55 29 12 1 ... 22 6 ... 1 55—65 17 8 ... ... 14 10 ... ... 65 and upwards 5 4 1 ... 9 3 ... ... Totals 179 151 49 39 105 75 13 8 During 1926, 418 primary notifications of tuberculosis were received, details of which are given on page 51 of this Report. Bacteriological examination of sputa from 467 cases was made by the Council's Bacteriologists during the same period. In 65 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 1926, was 201, a decrease of 23 upon the deaths during 1925. These deaths are classified as follows:— 49 Pulmonary Tuberculosis 180 General tuberculosis 1 Tuberculous meningitis 17 Tuberculous peritonitis 2 Lupus — Tabes mesenterica — Tubercle of other organs 1 201 This number of deaths gives an annual mortality of 0.88 per 1,000 inhabitants. Primary Notifications and Deaths during the years 1915-1926. Year. Primary Notifications. Deaths. Death Rate. Pul. Non-pul. Total. Pul. Non-pul. Total. 1917 709 161 370 304 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 1926 330 88 418 180 21 201 .88 In the following table the yearly deaths from tuberculous diseases in the Borough for the last 29 years are shown, grouped in periods of three years:— Three year periods. | Annual average number of deaths from Tuberculous Disease. Percentage decrease on the period 1898-1900. Per cent. 1898-1900 483 — 1901-1903 452 6.4 1904-1906 417 13.7 1907-1909 382 21.0 1910-1912 363 24.8 1913-1915 360 25.4 1916-1918 363 24.8 1919-1921 261 45.9 1922-1924 249 48.2 1925-1926 202 58.1 50 There were only three instances where a notification was not received, and in these cases the deaths were certified on inquests. There were, however, 14 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 explanation was 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 1926, being equal to 58" 1 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 40 41 52 68 Mortality rate per 1,000 inhabitants .69 .75 .88 1.1 Public Health (Tuberculosis) Regulations, 1912. Under these Regulations 1,077 notifications of tuberculosis were received during the year, of which 898 were pulmonary and 179 non-pulmonary. Summary of Notifications during the period from 3rd January, 1926. to 1st January. 1927. 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 23 to 35 35 to 45 15 to 55 55 to 65 65 and upward Total Primary Notifications Pulmonary Males ... 1 1 6 14 18 33 42 27 15 4 161 198 „ Females ... 1 4 1 17 28 36 21 12 4 3 127 148 Non-Pulmonary Males ... 8 13 7 3 3 2 2 1 ... 1 40 44 „ „ Females ... 7 2 3 9 7 4 ... ... ... ... 32 36 Age Periods. Number of Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Under 5 5 to 10 10 to 15 Total Primary Notifications. Pulmonary Males ... ... ... ... ... 39 154 „ Females ... ... ... ... ... 33 76 Non-Pulmonary Males ... ... ... ... ... ... 17 „ „ Females ... ... ... ... ... ... 21 51 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. Pulmonary Males ... ... 2 ... 2 2 2 5 2 2 1 18 „ Females ... ... 2 ... 3 5 6 3 ... 4 1 24 Non-pulmonary Males ... 3 6 ... ... ... ... ... ... ... ... 9 „ Females ... 2 3 1 ... ... ... 1 ... ... ... 7 52 53 Copies of Letters and Circulars forwarded to Medical Practitioners regarding cases where delay had occurred in notifying cases under 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, 1912. 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 I should be glad if you would co-operate with me in this respect as fully as possible. Will you therefore kindly inform me whether the diagnosis was only made after the death of the patient, as in such cases a notification is not required. 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 54 case of a death certified as due to tuberculosis of a person who 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 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 I should be glad if you would co-operate with me in this respect as fully as possible. 55 Public Health (Tuberculosis) Regulations, 1924. The following is a summary of the quarterly returns under these regulations during the year:— Pulmonary. Non-pulmonary. Male. Female. Male. Female. Number of cases on Register at 1st January, 1926 887 610 363 346 Number of cases notified under Regulations (1912) during the year and added to the Register 162 126 42 30 Number of cases coming to the notice of Medical Officer of Health other than by notification under the Regulations and added to the Register 15 15 2 4 Total number of cases added to the Register 177 141 44 34 Number of cases removed from the Register during the year 206 143 58 55 Total number of cases on Register at 31st December, 1926 858 608 349 325 1466 674 Visits paid by Tuberculosis Visitors. New Cases. Contacts Sailors and Soldiers Other Persons. Total. Insured. Noninsured. Miss Servant 236 156 146 1606 2144 1122 1022 Miss Clarke 162 131 119 1117 1529 726 803 398 287 265 2723 3673 1848 1825 The Staff of the King's Home for Nurses paid 2,303 visits to 49 cases requiring nursing assistance. 56 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 127, and the total number of visits of this kind made was 265. 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 fourteen. See page 55. TUBERCULOSIS SCHEME. Return showing the work of the Dispensaries during the year 1926. Diagnosis. Pulmonary. Non-pulmonary. Total. (6)Adults. (6)Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F M. F. A—New Cases(7) examined during the year (excluding contacts) :— (a) Definitely tuberculous 98 62 4 1 2 7 16 8 100 69 20 9 (b) Doubtfully tuberculous(8) ... ... ... ... ... ... ... ... 35 26 14 4 (c) N on-tuberculous ... ... ... ... ... ... ... ... 124 129 101 90 13 —Contacts examined during the year :— (a) Definitely tuberculous 5 4 1 1 1 ... 3 ... 6 4 4 1 (b) Doubtfully tuberculous(8) ... ... ... ... ... ... ... ... 5 6 3 2 (c) Non-tuberculous ... ... ... ... ... ... ... ... 67 128 104 121 C.—Cases written off the Dispensary Register(9) as (a\ Cured (10) 1 1 1 1 ... 2 4 1 1 3 5 2 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) ... ... ... ... ... ... ... ... 253 352 284 308 D.—Number of Persons on Dispensary Register(9) on December 31st:— (a) Diagnosis completed 459 356 42 27 38 60 125 81 497 416 167 108 (b) Diagnosis not completed ... ... ... ... ... ... ... ... 9 2 7 2 57 1. Number of persons on Dispensary Register^) on January 1st 1786 2. Number of patients transferred from other areas and of "lost sight of "(11) cases returned 29 3. Number of patients transferred to other areas and cases " lost sight of " 455 4. Died during the year 116 5 Number of observation cases(8) under A (b) and B (b) above in which period of observation exceeded 2 months 39 6. Number of attendances at the Dispensary j (including Contacts) 7257 7. Number of attendances of non-pulmonary cases at Orthopadic Out-stations for treatment or supervision 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light " treatment 345 (b) Other special forms of treatment 104 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 35 10. Number of consultations with medical practitioners :— (a) At Homes of Applicants 34 (b) Otherwise 447 11. Number of other visits by Tuberculosis Officers to Homes 260 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3673 13. Number of (a) Specimens of sputum, etc., examined 1087 (b) X-ray examinations made in connection with Dispensary work 139 14. Number of Insured Persons on Dispensary Register(9) on. the 31st December 564 15. Number of Insured Persons under ciliary Treatment(4) on 31st December 499 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 12 (b) Form G.P. 36 144 58 59 NOTES. (N.B.—Notes 1 to 5 below repeat definitions (d) to (h) on p. 7 of Memorandum 37/T.) (1) Public Medical Treatment.—Treatment at a dispensary or residential institution or “general suDervision," under a scheme approved by the Minister of Health for the treatment of tuberculosis, of a person who has been diagnosed to be suffering from tuberculosis. (Note.—A patient under domiciliary treatment should be regarded as also under “general supervision" by the Tuberculosis Officer.) (2) Patient-A person who has beer, diagnosed to be suffering from tuberculosis and is under public medical treatment for tuberculosis. (The term does not include a person who is kept under observation pending the establishment of the diagnosis, and who is referred to in the Memorandum as an “observation case," but includes all persons on the Dispensary Register who are under “general supervision," even if not in receipt of any treatment.) (3) Dispensary Treatment.—Treatment by a Tuberculosis Officer in cases where the patient is seen not Jess frequently than once in every month, and is examined not less often than once in three months. (4) Domiciliary Treatment.—Treatment of an insured patient by his Insurance practitioner on the recommendation of the Tuberculosis Officer. (5) Year.—The calendar year ending on the 31st day of December. (6) Adults.—'For the purposes of Tuberculosis Records all patients of 15 years and upwards should be classed as adults. (7) New Cases.— (a) All persons examined for the first time at, or in connection with, the Dispensary, except definite cases of tubercuiosis transferred from the areas of other local authorities. Persons seen in consultation, who will subsequently be deal: with by their own private practitioners, should be included. (b) Persons who have been dealt with previously bv the Dispensary and discharged as cured," or provisionally diagnosed as not, at that time, suffering from tuberculosis, who return to the Dispensary as suspected cases of tuberculosis. (8) Observation Cases.—Persons attending at, or in connection with, the Dispensary, in whose cases the Tuberculosis Officer cannot, within a period of one month from his first examination of the case, come to a definite diagnosis after physical examination and the application of the necessary tests. In completing sections A and B, such cases should be entered under sub-head (b) in eadh section. (9) Dispensary Register.—List containing names of all persons attending at, or seen in connection with, the Dispensary for diagnosis or for treatment for tuberculosis, including patients under “general supervision" (whether or not accompanied by domiciliary treatment), and patients or observation cases in residential institutions, and “contacts." (This must be distinguished from the Notification Register kept by the Medical Officer of Health.) 60 (10) Cured.—Patients with tuberculosis should not be deleted from the Dispensary Register as "cured" until in the case of non-pulmonary tuberculosis, 3 years, and in the case of pulmonary tuberculosis, 5 years, have elapsed without any symptoms of active disease (i.e., arrest has been maintained for 3 years). (11) Cases "lost sight of."—Patients who have failed to submit themselves for examination during two consecutive calendar years notwithstanding all efforts to trace them. These should be written off the Dispensary Register at the end of the year. (Patients who are known to have left the district permanently but who cannot be transferred to another local authority because their destination is not known, and patients seen onlv in consultation for the purpose of diagnosis, and others who desire no further assistance under the tuberculosis scheme for public medical treatment, may be marked off at once.) DISPENSARY DISTRICTS. Estimated Population in Electoral Wards. Metropolitan Hospital Area— Stamford Hill 35,600 West Hackney 19,700 Kingsland 23,300 Downs 18,200 96,800 Estimated population (1926)— Borough of Stoke Newington 53,080 149,880 Victoria Park Hospital Area— Clapton Park 43,500 Homerton 36,600 South Hackney 23,100 Hackney 28,500 131,700 Estimated population (1926)— Borough of Bethnal Green 119,600 251,300 401,180 Estimated population (1926) Hackney 228,500 61 DISPENSARY DEATHS. Condition of Patient on First Attendance. Pulmonary Tuberculosis 1st Stage. 2nd Stage. 3rd Stage. Number 21 51 44 Percentage 18.0% 44.0% 38.0% Duration of illness before attending Dispensary Under 1 month 9 1 to 3 months 29 3 to 6 months 14 6 to 9 months 11 9 to 12 months 7 Over 12 months 30 Period indefinite 16 ALL DEATHS FROM TUBERCULOSIS. Interval elapsing between Notification and Death. 1924. 1925. 1926. Pul. Non-pul. Pul. Non-pul. Pul. Non-pul 1. Number of Deaths from Tuberculosis 207 47 191 33 180 21 2. Number of cases only notified at death 3 6 16 21 17 10 3. Do. notified within a month of death 19 6 26 4 19 1 4. Do. do. 3 months of death 22 1 21 1 14 - 5. Do. do. 6 months of death 20 1 14 - 11 - 6. Number of deaths in cases not notified under Tuberculosis Regulations 16 25 2 - 2 1 62 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 1026, 118 primary cases were notified, and the contacts to these cases number in all 958 persons, and of these 541 contacts were examined, making the number examined over 56 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 1926, 201 deaths were registered—180 pulmonary and 21 non-pulmonary; but of these only 3 cases were not originally notified under the regulations, these 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. Of the pulmonary deaths, there were 440 contacts, of which 268 were examined, representing 60.9 per cent. examined; and of the non-pulmonary deaths there were 69 contacts, of which 25 were examined, representing 36 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. 63 CITY OF LONDON HOSPITAL TUBERCULOSIS DISPENSARY. (Dr. Howell.) HACKNEY CASES TREATED. 1.—The Totals of New Cases. Males 397 Females 408 Total 805 2.—The Sources of the New Cases. Total. Tuberculous. Medical Officer of Health 291 40 Local Practitioners 208 57 War Pensions Committee 5 - Contact cases (Tuberculosis Visitors) 257 7 London County Council 17 4 Victoria Park Hospital 6 6 Other sources 21 12 3.—The Diagnosis of the New Cases. Diagnosis. Adults. Children under 15. Total. Males. Females. Males. Females. Pulmonary Tuberculosis 65 34 4 1 104 22 Non-pulmonary Tuberculosis 2 4 12 4 Non-tuberculous 140 188 150 165 643 Doubtful 19 7 5 5 36 Totals 226 233 171 175 805 64 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 4 Non-pulmonary tuberculosis 3 Non-tuberculous 240 Doubtful 10 Total 257 5. —Sputum Examinations. Tubercle Bacilli present 130 Tubercle Bacilli absent 497 Total 627 6.—Other Figures. Total number of attendances 4901 Systematic examinations at the above 2607 Number of letters written 1613 Number of visits to patients at their homes 156 Number of patients sent to hospital or sanatorium bv London County Council 89 Number of patients referred to:— X-ray Department 95 Dental Department 18 Sunlight Department 7 Other Departments 32 65 METROPOLITAN HOSPITAL TUBERCULOSIS DISPENSARY. (Dr. Young.) HACKNEY CASES TREATED. 1.—The Totals of New Cases. Males 197 Females 186 Total 383 2.—The Sources of the New Cases. Total. Tuberculous. - Medical Officer of Health 58 34 Local Practitioners 99 50 War Pensions Committee 9 5 Contact cases (Tuberculosis Visitors) 194 8 London County Council 5 - Metropolitan Hospital 5 4 Other sources 13 8 3.—The Diagnosis of the New Cases. Diagnosis. Adults. Children under 15. Total. Males. Females. Males. Females. Pulmonary Tuberculosis 46 38 2 2 88 Non-pulmonary Tuberculosis 2 5 9 5 21 Non-tuberculous 66 82 57 52 257 Doubtful 9 6 2 - 17 Totals 123 131 70 59 383 e 66 4.—The Diagnosis of Contact Cases. Pulmonary tuberculosis 7 Non-pulmonary tuberculosis 1 Non-tuberculous 182 Doubtful 4 Total 194 5.—Sputum Examinations. Tubercle Bacilli present 181 Tubercle Bacilli absent 279 Total 460 6.-Other Figures. Total number of attendances 2356 Systematic examinations at the above 1149 Number of letters written 342 Number of visits to patients at their homes 118 Number of patients recommended for hospital or sanatorium 79 Number of patients referred to:— X-ray Department 48 Dental „ 17 Sunlight „ 4 Other Departments 24 67 Extra Nourishment. The Scheme came into operation on 6th June, 1921, and during the year 156 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 £392 2s. 8d. 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 71. 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. During the year, 18 children (contacts of 8 cases) were recommended by the Tuberculosis Officers for boarding-out, under the County Council's scheme. Of this number only 5 were boarded-out, in 2 cases the parents refused to allow the children to leave home, and in the remaining cases the County Council could not accept, as the infecting cases were not at home. 68 DISINFECTION. (a) Rooms.—During 1926 there were 2,245 rooms fumigated in the Borough by the staff of the Public Health Department. In these totals are included disinfections after measles, whoopingcough and tuberculosis, in addition to those in connection with the present notifiable infectious diseases. The number of rooms fumigated each month is set out in the following table:— Number of rooms fumigated each month during 1926. January 193 February 201 March 263 April 185 May 193 June 178 July 183 August 129 September 161 October 194 November 200 December 165 Total 2,245 (b) Articles of Clothing, Furniture, etc.—The number of articles under this head disinfected during- last year was 37,580. This is an increase of 3,685 upon the number disinfected during; 1925. A table is here given showing details of the articles disinfected each month. Articles Disinfected, 1926. Description of Articles. January. February. March. April. May. June. July. August. September. October. November. December. Totals. House linen and furniture 2,261 2,411 2,812 2,279 2,584 2,119 2,720 1,665 2,218 2,729 2,994 2,440 29,232 Men's clothing 79 125 84 64 126 53 135 40 91 140 85 141 1,163 Women's clothing 180 237 224 245 213 160 207 121 165 312 275 186 2,525 Children's clothing 28 31 33 32 46 24 38 24 41 67 46 40 450 Other articles 311 282 523 296 387 238 466 195 262 423 408 419 4,210 Total 2,859 3,086 3,676 2,916 3,356 2,594 3,566 2,045 2,777 3,671 3,808 3,226 37,580 69 70 In addition to these there were 506 articles destroyed on request from the owners. These are set out in the following table :— Articles Destroyed. Beds 55 Bolsters 15 Mattresses 118 Pillows 65 Sundry Articles 253 Total 506 (c) Public Library Books.—During the past year 306 books from homes in which infectious diseases had occurred were disinfected. The method of disinfection of books practised is to expose the books in a closed chamber to the action of burning sulphur. Books Disinfected. January 32 February 22 March 23 April 23 May 26 June 7 July 24 August 25 September 34 October 36 November 17 December 37 306 Isolation Shelter. During the year there were 115 persons admitted to the Shelter while their homes were being disinfected. This total consisted of 32 men, 34 women, and 49 children. The cost of maintenance of these persons admitted was £10 13s. 6d. 71 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 4,229 (250 to adults and 3,979 to children). This total shows a decrease of 340 upon the number given during 1925. Of the 4,229 baths given, 596 were sulphur baths for scabies, and 3,633 for pediculi. The great majority of those persons presenting themselves for baths were children from the elementary schools in the Borough. The children received 3,979 baths, a decrease of 390 upon the number given during 1925. The following are the Schools from which children were sent to the Cleansing Station, with the number of baths given:— Schools. Number Cleansed. Hot Baths Sulphur Baths. Ballance Road - 1 Benthal Road 88 4 Berger Road 248 2 Berkshire Road - 9 Church Street 2 - College Lane 6 6 Craven Park 36 - Dalston Central 9 - Daubeney Road 590 - Detmold Road 172 21 Eleanor Road 2 30 Gainsborough Road - 11 Gayhurst Road 29 - Glyn Road 94 9 Hackney Downs - 8 Hackney Parochial 86 87 Carried forward 1,362 188 72 Hot Baths. Sulphur Baths. Brought forward 1,362 188 Holy Trinity 3 63 Homerton Row 291 - Holcroft Road 202 - Lady Holies 1 - London Fields 2 1 Mandeville Street 358 9 Millfields Road 23 3 Morning Lane 299 - North Hackney Central 5 - Northwold Road 143 5 Oldfield Road - 6 Orchard Street 38 - Princess May Road 8 - Percy Road 64 - Queen's Road 48 - Rams 7 - Rushmore Road 80 34 St. James’ 5 - St. Joseph's 63 - St. Matthias 1 2 St. Michael's 33 4 St. Paul's - 2 St. Scholastica's 14 - Shacklewell - 4 Sidney Road 232 - Sigdon Road 85 4 Stormont House 1 15 Wilton Road 72 28 Other young children 128 40 Total 3,571 408 The following table gives particulars of the number, etc., of persons who were bathed and cleansed for parasitic disease at the Disinfecting Station during the year. January. February. March. April. May. June. July. August. September. October. November. December. Totals Receiving Hot Baths Men 4 7 3 5 2 3 5 4 8 2 3 4 50 Women 1 4 ... ... ... ... 6 1 ... ... 2 ... 12 Children 191 271 409 199 156 538 327 121 492 344 318 205 3571 Receiving Sulphur Baths, Men 9 11 24 5 9 23 14 6 7 10 4 9 131 Women ... 2 8 7 9 14 9 ... 3 ... 1 4 57 Children 6 56 93 19 19 32 13 26 52 45 40 7 408 73 74 IV.—CAUSES OF SICKNESS. The insufficiency of present methods for preventing- infectious disease, in particular nan-notifiable diesases 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.—SUM MARY 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 the money expended under this head is returned by the Ministry of Health. Except as regards Ophthalmia Neonatorum and Puerperal Fever, no attempt is made to grant routine nursing assistance to any but emergency cases; by emergency I mean that only where representation is made by a member of my staff or by medical 75 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 the nursing association is Is. 3d. per visit. 4. A return is rendered by the Superintendent of the King's Home for Nurses, giving the details of the cases nursed as 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 £150, and under the general nursing heading £300, making in all a total of £450 for nursing assistance. For information as to visits see page 85. 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 34 midwives practising in the Borough. 76 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, North wold Road, Upper Clapton. One clinic weekly (Doctor) Borough Council. 28, Lower Clapton Road One weekly clinic (Doctor) Borough Council. Hackney Mothers' and Babies' Welfare, One clinic weekly (Doctor) Hackney Mothers' and Babies' Welfare, sion House, 23, Hackney Grove (Voluntary Centre) One weekly "weighing" (Health Visitors) sidised by Borough Council St. Martin's Mission, Ada Street (Voluntary One weekly "weighing" (Health Visitors) do. Centre) One fortnightly clinic (Doctor) Eton Mission, Gainsborough Road, One weekly clinic (Doctor) Eton College, subsidised by Borough Council. ney Wick (Voluntary Centre) One weekly clinic “Weighing” West Hackney, Evering Rd. (Voluntary Centre) One weekly clinic (Doctor) West Hackney Infant Welfare Committee. (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. 28, Lower Clapton Road 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. 28, Lower Clapton Road. One weekly clinic (Dentist) Borough Council. Do. One monthly clinic (Dentist & Anaesthetist) Borough Council. 77 (d) Artificial Sunlight Clinic. Name and Situation. Nature of Accommodation. By whom provided. 28, Lower Clapton Road One weekly clinic (Doctor) Borough Council. (e) Tuberculosis. Metropolitan Hospital, Kingsland Road Tuberculosis Dispensary Borough Council. Victoria Park Hospital, Bonner Road, E.2. Tuberculosis Dispensary Borough Council. (f) 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, Clapton Square Minor ailments London County Council Orthopaedic Clinic, Dalston Lane Massage and remedial treatment British Red Cross (g) Venereal Diseases. 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. (8) Children A necessitous case is defined on page 84. 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. 78 Name and Situation. By whom provided. (6) Other Hospitals Metropolitan Hospital, Kingsland Road A General Hospital supported by voluntary contributions. It has accommodation for in- and out-patients. German Hospital, Ritson Road, Dalston Hackney Hospital, High Street, Homerton Mission of Help to the Suffering Poor, Upper Clapton Ditto. Maintained by the Hackney Board of Guardians. 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 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, 39, 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 I., 16, Rectory Road Home for 12 mothers and 8 babies Salvation Army. Lome House II., 4 Clapton Common Home for 20 mothers and 14 babies Salvation Army. Mothers' Hospital, 1.53, Lower Clapton Road Maternity Hospital for 80 mothers Salvation Army. St. Mary's, 153, Stamford Hill Home for 24 mothers and 15 babies Church of England. Maternity Refuge, 6, Pembury Road Preventive and Rescue Aid—16 mothers and babies Church of England. Sapsworth House, 122, Lower Clapton Road Home for mothers and babies Salvation Army. Rescue Home, 181/183, Amhurst Road Home for 32 mothers and 18 babies Salvation Army. Ambulance Facilities.— (a) For infectious cases.—Provided by the Metropolitan Asylums Board. Ambulance Station: Eastern Hospital, Homerton Grove. 79 (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. VI.—MATERNITY AND CHILD WELFARE. DESCRIPTION OF THE WORK DURING THE PAST YEAR. The work carried out during 1926 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 81 and 82) give details of the visits made by the Health Visitors during the year. Conditions Found by the Visitors. No. of Infants visited. Method of Feeding. Separate cot provides for Infant. Use of Comforter. Home conditions. Secondary visits. Breast Artificial. Mixed. Yes. No. Yes. No. Satisfac tory. Unsatis factory. 3858 3293 373 192 2806 1052 1363 2495 3381 477 24333 80 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 10 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. 81 82 Pr1mary V1s1ts. 2 Total V1s1ts. VISITS OF HEALTH VISITORS, 1926 Mrs. L. E. Bartholomew M1ss M. Ch1tson M1ss M. Cockle M1ss E. Ham1lton. Mrs. L. Harr1son Miss N. V. Hobbs. M1ss S. E. Love M1ss A. Roche Mrs. A. Rhodes M1ss G. S. Thomas. M1ss K. Teebay. M1ss E. E. W1ll1amson. M1ss D. F. V1dal 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 1 2 1 2 1 2 1 2 1 2 1nfants (Leg.) under 1 year of age 189 435 189 497 194 772 130 634 227 926 138 428 334 556 174 780 297 800 240 632 323 583 229 765 272 538 159 348 278 1420 460 1262 3833 11376 „ (IIIeg.) „ „ „ ... ... ... ... 2 3 l 1 1 2 ... ... ... ... 2 4 ... 5 1 1 3 5 3 8 3 8 1 2 3 33 5 16 275 88 Ch1ldren 1-5 years of age ... 459 3 875 ... 931 6 1062 ... 1013 1 871 1 1070 18 1209 ... 1380 3 746 ... 875 ... 1738 28 1086 2 642 2 1393 3 1444 67 16794 Total v1s1ts to Infants & Ch1ldren 189 894 192 1372 196 1706 137 1697 228 1941 139 1299 335 1626 194 1993 297 2185 244 1379 326 1463 232 2511 303 1632 162 992 283 2846 468 2722 3925 28258 St1ll B1rths 1 1 3 3 6 8 4 4 7 7 2 2 7 7 9 9 8 8 7 9 6 6 4 5 5 2 2 7 7 10 10 88 93 Expectant Mothers 38 38 48 58 36 65 20 42 52 115 35 35 40 40 121 142 22 29 65 93 34 36 15 18 29 40 24 40 118 289 35 63 732 1143 Death Enqu1r1es 13 13 6 6 11 11 3 3 22 . 22 4 4 14 14 8 8 16 16 8 10 11 11 12 13 5 5 5 5 17 17 22 22 177 180 Ophthalmia Neonatorum 6 6 2 2 ... ... 2 3 1 4 1 1 5 5 5 9 7 8 6 17 2 4 ... ... 3 5 8 8 4 13 3 9 55 94 'Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other V1s1ts (outs, removals, etc.) ... 199 ... 153 ... ... ... 432 ... 90 ... 512 ... 235 ... 30 ... 162 ... 235 ... 441 ... 215 ... 142 ... 205 ... 853 ... 611 ... 4519 Spec1al 6 6 ... ... ... ... 24 49 ... ... 32 32 2 26 ... ... 6 6 32 49 17 17 106 116 26 27 20 26 9 9 ... ... 280 363 Measles and German Measles— Infants 14 14 ... ... 2 4 18 18 12 16 1 1 ... ... ... ... 3 3 ... ... 2 2 ... ... 6 6 ... ... 88 95 6 11 152 170 Ch1ldren 9 9 1 2 ... ... 5 5 60 64 33 33 27 27 48 52 90 90 2 2 39 39 79 79 80 82 1 1 23 23 14 19 511 527 Whoop1ng Cough Infants ... ... 1 1 2 1 ... ... 4 4 ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 3 3 ... ... 7 37 5 12 25 62 Ch1ldren 2 ... ... ... 1 l 2 2 5 5 4 4 5 5 2 4 3 3 ... ... ... ... 7 7 27 29 ... ... 12 23 39 73 109 158 Ep1dem1c D1arrhoea Infants ... ... ... ... 3 3 ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... 2 2 ... ... ... ... 18 35 ... ... 25 42 Ch1ldren ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 7 ... ... ... ... ... ... 1 1 ... ... ... ... 23 25 ... ... 29 34 'ol1o-Myel1t1s Infants ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... ... 1 4 Ch1ldren ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total V1s1ts pa1d dur1ng the year 278 1182 253 1597 257 1800 215 2255 391 2268 251 1923 436 1990 393 2256 453 2511 364 1794 437 2019 460 2969 487 1976 222 1279 610 4276 602 3552 6109 35647 No. of Cl1n1cs attended Morn1ng 15 27 ... 3 9 9 10 40 2 7 42 27 ... 15 ... ... 206 Afternoon 98 81 72 83 85 100 137 58 74 72 65 90 106 48 272 154 1595 83 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 Morn. 51 206 3.302 3,508 1,801 1,707 1,490 Street Aft. 51 180 2,105 2,285 1,314 971 1,119 2 Brooksby's Walk 51 384 3,191 3,575 2,725 850 1,360 3 Mayfield Road Mon. 48 3C 1,392 1,422 709 713 Fri. 51 437 4,135 4,572 3,095 1,477 1,792 4Northwold Road 50 319 4,945 5,264 3,093 2,171 1,726 5Lower Clapton Rd. (C.W.) 32 437 1,804 2,241 1,382 859 872 do. (Sunlight) 46 190 1,390 1,580 135 1,445 1,580 do. (Dental) 53 †l98 499 697 ... 119 119 6*Hackney Mothers' and Babies', Hackney Grove 102 194 4,132 4,326 3,684 and 578 expectant mothers. 1,841 2,442 Do. Ada Street 52 101 1,098 1,199 7*Eton Mission Wed 49 ... 2,150 2,150 1,126 1,024 ... Fri. 50 212 2.002 2,214 1,476 738 1.711 Totals 686 2,888 32,145 35,033 20,540 13,915 14,211 and 578 cx pcctant mothers *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. †Including expectant mothers. 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. Overburv Street 51 342 503 845 845 2. Brooksby’s Walk 25 176 167 343 318 3. Lower Clapton Rd. 34 315 401 716 591 4*Eton Mission 42 147 229 376 212 Totals 152 980 1,300 2,280 1,966 *Voluntary Centre. F 84 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, 1925. Necessitous Cases. Cases. Cost. Salvation Army Mothers' Hospital 151 £158 11 0 City of London Lying-in Hospital 121 127 1 0 272 £285 12 0 (2) Agreement jor the Provision of Convalescent Home Treatment. An agreement has been entered into, with the .sanction of the Ministry of Health, with the Invalid Children's Aid Association, whereby the Association arranges, on behalf of the Maternity and Child Welfare Committee, convalescent aid under the Council's Maternity and Child Welfare scheme. The Maternity and Child Welfare Committee, under this arrangement, is not required to meet any cast other than that the parent is unable to contribute towards the actual cost of the treatment provided at the Convalescent Home. The number of cases assisted during the year was 20. (3) Provision of Midwives.—During the year the fees of midwives in attendance on 33 mothers confined in their- homes were paid by the Council. 85 4.-NURSING ASSISTANCE. No. of cases Nursed. No. of Visits paid. Pneumonia 39 625 Whooping Cough 3 34 Measles 21 372 Bronchitis 17 160 Ophthalmia Neonatorum 13 194 Post Confinement, etc. 27 693 Other Ailments 90 1,215 Totals 210 3,293 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 £1,207 7s. Id. for cows' milk and £402 18s. 3d. in respect of dried milk. The applications dealt with for milk numbered 2,908, and those for milk food amounted to 1,032. Dried Milk, Foods, Medicines, etc. (a) Supplied free of charge to necessitous mothers:— £ s. d. Glaxo 64 6 10 Cow and Gate 325 4 0 Milkal 1 6 8 Virol 21 1 0 Marylebone Cream 9 8 4 Cod Liver Oil and Malt 26 12 6 Sundries 14 12 8 » £462 12 0 86 (b) Supplied at cost price:— £ s. d. Glaxo 187 16 0 Cow and Gate 1,303 1 0 Virol 90 9 0 Lactogol 13 17 6 Marylebone Cream 106 5 3 Petroleum Emulsion 41 0 4 Syrup Ferri 15 6 11 Cod Liver Oil and Malt 98 7 6 Sundries 109 17 9 £1,966 1 3 6.— ARTIFICIAL SUNLIGHT TREATMENT CLINIC, LOWER CLAPTON ROAD. Opened—14th January, 1926. Total number of patients treated, 190. Fee charged, to 14th October, Is. Afterwards increased to 2s. Total amount received in fees during the year (55 cases), £3 16s. Od. Diseases treated— Malnutrition (older children) 70 cases. Rickets 6 Debility after acute illness 6 Marasmus 6 Anaemia 3 Impetigo 2 Eczema 3 Acne 1 Boils 1 Knock-knees 1 99 (91 other cases were still under treatment at the end of the year.) 87 Routine course of dosage.—Begun with 4 minutes (half back and half front) at 4 feet from lamp, then 4 minutes at 3 feet, increasing by 1 minute per week at that distance up to 7 minutes. In delicate babies the initial dose is less. In strong children and for skin diseases the distance is lessened. Average Duration of Treatment.—For Malnutrition 3 to 5 months. Rickets 6 to 9 months. Anaemia 3 months. Debility 6 weeks. Marasmus 3 months. Skin diseases About 4 weeks. Pulse and Temperature.—Temperature taken before first treatment and at any time if the child appears to be unwell. Pulse is never taken, as this appears to be valueless in children who may be nervous. Febrile patients are never treated. Record of Weights and Heights.—It has not been found practicable to take heights except in special cases. Average gain in weight of patients per week:— Malnutrition 1.7 ozs. Rickets 2.5 ,, Marasmus 5 ,, Debility 4.25 ,, Anaemia 2.25 ,, As the malnutrition cases are chiefly children which have been stationary or losing weight for weeks or months, a gain of 1.7 ozs. is more noteworthy than it appears. General opinion as to brightness.—In many cases the mothers volunteer the information that the children are brighter and more cheerful. 88 Observations on the Skin.—Erythema is not aimed at. In those cases which have shown Erythema (in each case fair-haired children) the results have not been good. One child in particular had to give up treatment, as, although the mother was very anxious for the child to have it, she appeared to be light-sensitive, and definitely became languid and lost weight even with small doses, recovering her tqne when the light treatment was stopped for two periods. Pigmentation only occurs definitely in a few cases, those being dark-haired children with a rather coarse complexion. Effect of Light on Local Lesions.—Dramatic result in impetigo and some cases of eczema and acne. Special Improvement noted, in Particular Cases:— C.F., aged 7 months—Marasmus. Breast-fed to 2 months, then milk and water to 5£ months, when he came under the care of the Centre. Was put on dried milk and cod liver oil and malt with little improvement for six weeks before beginning light treatment. He then at 7 months weighed 10 lbs. loozs. Had 14 treatments and part of this time the dried milk was also irradiated. He gained 6 lbs. and at 10½ months was in splendid condition. D.S., aged 9 months—Marasmus and Chronic Dyspepsia. Was on dried milk and Virol and attended Centre regularly. Weighed 14½ lbs. With 11 treatments he gained 6lbs. 14½ozs. and digestion became normal, and he was a thoroughly healthy baby. B.B., aged H years—Rickets. Had been fed on dried milk from birth to 1 year with no cod liver oil. Very marked bow-legs. Cured with 17 treatments. D.J., aged 3¾ yearsi—Malnutrition. She was a pale, very nervous and fretful child. With 12 treatments she was a different child—a good colour, quiet, cheerful, eating and sleeping well. A.B., aged 2¾ years—Debility after Influenza. Had lost 9 ozs. during previous 3 months. With 5 treatments she berame fit and strong and gained 2 lbs. 89 G.S., aged 2½ years—Impetigo. A large very bad patch on scalp after a burn. Comes from a not very clean home. Practically entirely cured with 2 treatments of 4 minutes at feet. Mrs. S., aged 27 years (Nursing Mother)—Acne. Very distressing acne of face, especially around mouth, of five years' standing. Had had various treatments. Practically cleared up with 9 treatments spread over 3 months. Type of Lamp Used.—Kelvin, Bottomley and Baird Type "K" Lamp, Mercury Vapour. Amperage: Starting 4.5: Running 2.7. Series resistance: 44 ohms. Direct current, 240 volts. Average cost of current per hour: ¾d. Average Cost of each Patient's Treatment.—9s. Id. for the year, exclusive of overhead charges, but includes salaries of medical officer and nurse, and deduction of payments made. 7.—DENTAL CLINIC, LOWER CLAPTON ROAD. Opened: 17th December, 1925. No. of Sessions to 31st December, 1926 53 No. of first attendances 198 No. of repeat attendances 499 Total attendances 697 No. of teeth extracted 1,146 No. of teeth stopped 50 No. of scalings and dressings 85 General anaesthetic cases 151 Local anaesthetic cases 160 No. of dentures—Nursing and expectant mothers 37 Total cost of dentures supplied £89 17 6 Total amount received from patients 36 8 3 Cost to Council £53 9 3 90 21 of the cases where dentures were fitted did not contribute towards the cost as their circumstances did not permit of any charge being made. An amount of £ 2 1s. Od. was collected during the year from patients whose circumstances allowed the treatment fees of 1s. and 2s. respectively to be charged. 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. 0d., sputa 3s. 0d., Laboratories. blood of suspected Enteric Fever cases 3s. 6d. plus charges for telephone and telegraph, the Laboratories providing outfit. Royal Institute of Diphtheria swabs, 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. Diphtheria Antitoxin. Arrangements have been in force for some time past in this Borough for supplying Diphtheria Antitoxin to medical practitioners on lequest. 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. 91 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 consisting 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 from the experience of Metropolitan Asylums Board Hospitals, that when in a case seen early in the attack an initial dose of 8,000 units (16,000 or more if the case is severe), is followed by definite improvement at the end of about 12 hours, further administration of antitoxin is unnecessary. On the other hand, if at the end of about 12 hours (or sooner in urgent cases) there is no evidence of improvement, or it is clear that the disease is advancing, a second dose of similar magnitude should be given, followed bv 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.' " 92 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, 92 bottles of antitoxin of 8,000 units each being supplied to medical practitioners, as compared with 139 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. Sewers.—During the year the Sanitary Inspectors reported 12 premises on which sewers were defective and repairable by the Borough Council. These were referred to the Borough Engineer for his attention. Premises and Occupations (other than Food Premises) controlled by Statute, By-laws or Regulations. Factory and Workshop Number. Act, 1901 Workshops and Workplaces 873 do. Outworkers' Premises 2,270 Canal Boats Act Canal Boats (inspected during year) 27 London County Council Bye-laws Rag and Bone Dealers 27 do. Offensive Trades— Fur Skin Dressers and Poultry Slaughterers 18 Local Regulations Underground Rooms 7,667 93 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.) VII.—SANITA RY 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 1926 6,181 1.663 49 94 Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923. The number of certificates granted under the Increase of Rent and Mortgage Interest (Restriction) Acts during the year was 20. In 13 cases the work required on the notice was carried out without action being taken. In one case action was taken by the tenant before completion of the work. In the remaining case no action was taken, the owner having died. In one case a certificate was applied for but not granted, the rent not having been increased. Under Section 5 of the Rent and Mortgage Interest (Restriction) Act, 1923, it is not now necessary for the tenant to take proceedings at the County Court, but a copy of the certificate must be served on the landlord, who may, if the work is completed satisfactorily, obtain a certificate to this effect from the Sanitary Authority on payment of one shilling. London County Council (General Powers) Act, 1904. During the year attention was drawn by the Medical Officer (Education) of the London County Council to 146 homes in the Borough from which children were attending school in a verminous condition, asking that steps be taken to deal with them under the above Act. These homes were inspected, with the following results:— No. of Homes Inspected. No. of Homes where Rooms alone were found Verminous. No. of Homes where Bedding or Clothes and Rooms were found Verminous. No. of Homes not Verminous. 146 40 37 69 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 afterwards found present. 95 There were also 25 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, 646 rooms at 412 premises where neither tenant nor owner could be shown to be directly responsible, were cleansed of vermin by spraying by the staff of the Public Health Department. During the latter half of the year, owing to the difficulties in obtaining reliable insecticide and the apparatus to apply it with, arrangements were made to loan hand sprayers and sell insecticide at cost price to owners and tenants in order to assist them in clearing their premises of vermin. Material to the value of £8 13s. 10d. was sold for this purpose. Rats and Mice Destruction Act, 1919. The number of complaints received during the year of premises being infested with rats was 374. 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 70 cases it was necessary to serve notices under the Act upon the occupiers of the land or premises. Two premises were cleared under the agreement with Messrs. Howard & Son, (Ratcatchers), under the supervision of the Council's Sanitary Staff. 384 poison baits were provided and laid down under the supervision of the Sanitary Inspectors. By this means 155 premises have been effectively cleared of rats and 5 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. 96 SANITARY INSPECTION. Public Health (London) Act, 1891. (a) Complaints of Nuisances.—During the year 1926 there were 4,921 complaints of nuisances made to the Public Health Department and investigated by the Sanitary Inspectors of the Borough. Defects or nuisances were discovered in 3,826 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 129 premises were reported to the Public Health Committee during the year. Smoke Nuisance. In addition to 212 observations of chimneys of large works in the Borough, made by the Sanitary Inspectors, 333 observations were made by an Assistant detailed for that purpose. 25 Intimation notices were served on the persons responsible for the issue of black smoke in contravention of the Public Health (London) Act, 1891. 4 Statutory Notices were served. Dangerous Structures. Complaints of alleged dangerous structures at 214 premises were forwarded to the London County Council during the year. Water Fittings. Complaints of defective water fittings at 275 premises were forwarded to the Metropolitan Water Board during the year. Dust Receptacles. During the year 2,670 complaints were received from the Borough Engineer and Surveyor, of houses without dust bins, or with defective dust bins. 97 663 informal notices were served. The remainder of the complaints were in hand at the end of the year. Offensive Trades. The only offensive trades carried on in the Borough are those of Fur Skin Dressing and Poultry Slaughtering. These are controlled under Special bye-laws. They number at present 18 (Fur Skin Dressers 17, Poultry Slaughterers 1). 40 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 1,464. This is an increase of 171 upon the number inspected during 1925. 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 849. (d) Inspections.—The number of inspections, other than those arising on complaint, made by the Inspectors during the year was 11,134. 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 1926 was 6,181. The number of statutory notices served was 1,663; and summonses were issued in 49 cases. Bye-laws with respect to Houses divided into Separate Tenements, etc. The bye-laws with respect to Houses let in Lodgings that have been in force in the Borough have been repealed and new 98 bye-laws dealing with houses divided into separate tenements have been made by the London County Council and approved by the Ministry of Health on 15th March, 1926. Inspections are being made and a new Register formed of houses in the Borough that will be affected by the new bye-laws. The bye-laws have to be enforced by the Borough Council with the exception of a clause dealing with the stability of the houses which is enforced by the London County Council. The bye-laws apply to houses used for occupation by the working classes and let in lodgings or occupied by members of more than one family, but do not apply to houses in which the tenant resides and not more than one family is lodged. The bye-laws provide for:— Fixing the number of persons who may occupy a lodging house. For separation of the sexes. For the registration and inspection of lodging houses. For enforcing drainage and promoting cleanliness and ventilation. For provision of W.C. accommodation, washing accommodation, accommodation for storage, preparation and cooking of food. For securing stability and the prevention of and safety from fire. For cleansing and decorating and paving of courts and courtyards. For provision of handrails to staircases. For adequate lighting of all rooms. For precautions in connection with infectious disease. 99 Some of the provisions of the new bye-laws as regards structural alterations will not come into force until six months after the Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923, or any re-enactment thereof, with or without modifications, relating to dwelling houses shall have ceased to be in force. (e) Articles of Food Seized or Surrendered as Unfit for Food. —During the year the following articles of food were seized by the Inspectors, or surrendered to them as being unfit for food, viz., Fish 1 ton 11 cwt. 1 qr.; Meat 1 ton 14cwt. 3 qrs. 8 lbs.; Fruit 2 tons 16 cwts. 7 lbs. ; Tinned Foods 3 tons 18 cwts. 18 lbs. House-to-House Inspection. The following roads have been inspected during the year :— Ballance Road, Bartrip Street (part), Chapman Road, Clifden Road (108-126), Felstead Street, Florfield Road, Helmsley Place, Hockley Street, King Edward Road, Maclaren Street, Prince Edward Road, Ribstone Street, Rushmore Road (16-48), Selman Street, Wick Road (393-433), Woolpack Place. G 100 Prosecutions under the Public Health (London) Act, 1891, and Regulations during the year 1926. Inspector. Address. Complaint. Magistrate's decision. Fine. Costs. W. P. 72, London Road Beef (30 lbs.) exposed for sale; unfit for food Fined £ 5 s. 0 £ s d. W. P. do. do. Mutton (8 lbs.) exposed for sale; unfit for food do. 5 0 W. P. do. do. Pork (36 lbs.) deposited for sale; unfit for food do. 5 0 W. P. do. do. Beef (49 lbs.) deposited for sale; unfit for food do. 5 0 W. P. do. do. Mutton (17 lbs.) deposited for sale; unfit for food do. 5 0 W. P. do. do. Failed to observe due cleanliness of room, articles, utensils, etc. do. 5 0 10 10 0 G. F. Honry Villa, Stoneham Road Roof leaky and defective. Walls and ceilings dirty and defective Order to abate in 7 days 1 1 0 A. S. 98, Elderfield Road Drains leaky and defective Order to abate in 21 days 0 4 0 R. J. S. 1, East Side Absence of a roof, permitting premises to be exposed to inclement weather Order to abate in 7 days J. W. H. 187, Amhurst Road Non-compliance with Magistrate's Order Withdrawn (Nuisance Order complied with before hearing) H. B. 22, Ardleigh Road Defective stone steps to front entrance door. Defective and worn-out dust-bin Withdrawn (work done) 0 12 H. B. 74, Buckingham Rd. General insanitary condition do. do. 0 12 6 H. B. 18, Mortimer Road Defective roof, copper and gutter of back addition do. do. 0 12 6 H. B. 148, Culford Road General insanitary condition do. do. 0 12 6 C. F. L. 22, Havelock Road do. do. do. do. 0 12 6 J. N. 69, Paragon Road do. do. do. do. 0 12 6 Inspector Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. £ s. d. g.f.h. 140, Mapledene Road . Defective roof, caves gutter, and stove Order to abate in 10 days 1 1 0 g.f.h. 142 do. do. General insanitary condition Withdrawn (work done) r.j. s. 38, Warburton Road do. do. Order to abate in 7 days 1 1 0 j. e. t. 142, Mabley Street Kitchen and first floor stoves defective. Sash cords defective Withdrawn (work done) 0 15 0 r.h. b. 1, Stoke Newington Common General insanitary condition do. do. 1 11 6 G.F 91, Cazenove road Did connect soil pipe with W.C., etc., in an unsuitable and inefficient manner Fined 2 0 1 1 0 g.f. do. do. Did partially reconstruct certain drain pipes, etc., without sending notice to the sanitary authority do 1 0 1 1 0 g.f. 60£, Windus Road Did partially reconstruct certain drain pipes, etc., without depositing plans with sanitary authority Withdrawn on payment of costs 2 2 0 r.h. b. 337, Amhurst Road Defective vent pipe, sashes and wall Withdrawn (work done) 1 1 0 g.f. 62, Chardmore Road Did partially reconstruct a soil pipe without sending notice to the sanitary authority Wihdrawn (explanation of defendant accepted) 2 2 0 g.f. do. do. Did partially reconstruct a soil pipe with rain-water pipe communicating with a sewer in an unsuitable and inefficient manner Withdrawn (work satisfactorily completed) 2 2 0 c.f. L. 58, Paragon Road Gutters defective. Stove and flue defective. Ceiling dirty Order to abate in 14 days 1 1 0 c. f. L. 9, St. Thomas' Road .. Eaves gutters and stone steps leaky Walls damp and sash cords defective do. do. 1 11 6 j.w. H. 7, Hartwell Farm Yd., Sigdon Road Heating stove in workshop defective and causing smoke nu's ance Withdrawn (Nuisance abated) 2 2 0 101 102 inspector. Address. Complaint. Magistrate's decision. Fine. Costs. £ s. £ s. d. J. E. T. 9, Gilpin Road General insanitary condition Order to abate in 14 days 1 1 0 J. E. T. 15, Gilpin Road do. do. do. do. 1 1 0 R. H. B. 56, Foulden Road General dilapidations do. do. 1 1 0 J.N. 71, Paragon Road Defective sink waste pipe Withdrawn (work in hand) 1 1 0 G. F. H. 86, Brougham Road General insanitary condition Withdrawn (work done) 0 10 6 C. F. L. 58, Paragon Road Non-compliance with Magistrate's Order 2 0 2 2 0 H. K. S. 7, Hockley Street Defective roof Order to abate in 14 days 1 11 6 H. K. S. 1, Woolpack Place General insanitary condition do. do. 2 2 0 H. K. S. 7 do. do. do. do. Order to abate in 7 days H. K. S. 9 do. do. Walls and ceilings, various. dirty and (or) verminous do. do. H. B. 4, Mortimer Road General insanitary condition Withdrawn (work done) 1 1 0 H. B. 24, De Beauvoir Cres. do. do. do. do. 1 1 0 J. E. T. 9, Overbury Street do. do. Order to abate in 14 days 1 1 0 J. E. T. 15, Chevet Street do. do. Withdrawn (work done) 1 1 0 C. F. L. 9. St. Thomas' Road Non-compliance with Magistrate's Order Fined 5 0 5 5 0 G. F. 41, Ravensdale Road General insanitary condition Order to abate in 14 days 1 1 0 R. J. S. 15, King Edward Road do. do. Withdrawn (work done) 1 1 0 R. J. S. 20, Sheep Lane Defective roofs do. do. 0 10 6 R. J. S. 22 do. do. General insanitary condition do. do. 0 10 6 £40 0 £57 4 0 103 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. Factory and Workshop Act, 1901. During the year, 268 inspections were made of factories and 2,334 of workshops by the officers of the Public Health Department. In 152 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 128 106 22 24 Insufficient w.c.'s 10 4 4 7 Not separate to sexes 14 9 2 4 Other defects 344 253 82 59 Workshops.—The number of workshops registered in Hackney at the end of 1926, was 873, an increase of 37 on the number; registered at the end of ] 925. Of this total, 624 were workshops in which females were employed. Of these latter, 410 were workshops in which articles of wearing apparel were manufactured, altered or prepared for sale, etc., 192 in which other articles were manufactured, etc., and 22 were domestic workshops. 104 Amongst the workshops in which wearing apparel is manufactured, there were 227 in which females alone, and 180 in which both males and females were employed. In workshops of other occupations, there were 106 in which females alone, and 89 in which both males and females were employed. Of the domestic workshops, females alone were employed in 16, and both males and females in 6. During the year notices and complaints were received from H.M. Inspectors of Factories, as follows:— Complaints—Factories 21 Complaints—Workshops 23 Notices—Workshops 47 Analysis of Occupations Carried on in the Registered Workshops of Hackney. (a) Wearing Apparel. No. of No. of Occupations. Workshops. Occupations. Workshops. Artificial Flower Makers .. 9 Mantles 35 Baby Linen 1 Millinery 31 Blouses 16 Needlework 4 Boot & Shoe Manufacturers 82 Shirts 2 Boot Machinists 7 Tailoring 123 Children's Costumes 6 Ties 17 Clothing 2 Trimmings 9 Corsets 4 Underclothing 8 Dressmakers 57 Vests 5 Dressing & Tea Gowns 3 Waterproofs 2 Fancy Bows on Shoes 4 Miscellaneous 7 Furriers 70 Hats 2 508 Infants' Millinery 2 105 (b) Other Occupations. Bakers 70 Baskets 4 Box Makers 13 Brush Makers 4 Cabinet Makers 59 Confectionery 9 Cycle Makers 3 Leather Goods 24 Laundries 15 Pianoforte Makers 15 Picture Frames 2 Fur Skin Dressers 17 Rag; Sorting 2 Rubber Goods 2 Toy Makers 11 Upholsterers 7 Upholsterers' Trimmings 2 Miscellaneous 106 365 During 1926, Miss Teebay, the Workshops Inspector, made 2,126 inspections and re-inspections of factories and workshops where females are employed. In connection with these inspections, 248 intimation and 18 statutory notices were served. 106 The Factory and Workshops Act, 1901. Factories, Workshops, Workplaces and Homework. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 268 84 - Workshops (Including Workshop Laundries) 2,334 321 1 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 33 4 - Total 2,635 409 1 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 207 200 Want of ventilation 17 17 Overcrowding 5 5 Want of drainage of floors 2 2 Other nuisances 96 94 1 Sanitary accommodation— Insufficient 10 8 Unsuitable or defective 128 128 Not separate for sexes 14 11 Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse (s. 101) Other offences 17 17 (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). Total 496 1 482 1 *Including those specified in sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 107 3.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Total number of Workshops on Register 873 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) 30 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 44 Reports (of action taken) sent to H.M. Inspector 27 Other - Underground Bakehouses (S. 101):— In use at the end of the year 51 108 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. Failing to send Lists. I.ists Outworkers. Lists Outworkers. Contractors Workmen. Con. tractors Workmen. Wearing Apparel— (1) Making, &c. 248 98 2084 34 5 108 174 (2) Cleaning and Washing Lace, Lace Curtains and Nets 4 22 1 Furniture and Upho;stery 10 8 59 6 Fur Pulling 2 2 2 2 4 10 Umbrellas, &c. 2 26 Artificial Flowers 4 25 1 9 5 Racquet and Tennis Balls Paper, &c.. Boxes, Paper Bags 24 250 2 5 12 Brush Making 29 271 6 Stuffed Toys 6 31 3 Basket Making Cosaques, Christmas crackers, Christmas stockings, &c. 2 13 2 10 3 Totals 331 108 2783 41 5 136 220 109 Outworkers.— The number of outworkers on the register at tne end of 1926 was 2,270, against 2,467 at the end of 1925. There were thus 197 outworkers remove 1 from the register during the past year. The following analysis shows the trades followed by these outworkers:— No. of Trade. Outworkers. Artificial Florist 46 Baby Linen 22 Belts and Bags 14 Blouses 71 Boots and Shoes 514 Boxes and Paper Bags 185 Braces 4 Brushes 142 Children's Costumes 29 Children's Millinery 57 Christmas Crackers, etc. 31 Clock Case Makers 4 Clothiers and Outfitters 98 Collars and Bibs 8 Confectionery Packing 6 Dolls and Toys 18 Dressing Gowns 17 Dress Making and Robes 27 Embroidery 9 Fancy Goods 14 Fancy Paper Goods 18 Feather Trade 1 No. of Trade. Outworkers. Fur Trade 61 Gaiters 6 Hats 7 Hosiery 3 Lace Goods 15 Leather Goods 5 Mantles and Costumes 240 Millinery 87 Overalls, etc. 5 Pyjamas and Shirts 50 Shoe Bows 19 Tailoring 145 Tennis Ball Covering 3 Ties and Neckwear 134 Trimmings 33 Umbrellas 28 Underclothing 47 Upholsterers' Trimmings . 20 Waterproofs 4 Miscellaneous 23 2,270 2,313 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 1,256 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 1926, Miss Portlock, the Inspector appointed for the inspection of Outworkers' premises, made 857 inspections, 680 re-inspections, and 1,100 special calls. She also made 352 110 visits without inspections, the outworkers having left the premises (76), or having given up home work (63), or being out at the time of visit (149), or owing to a wrong address being given (41), or the premises being workshops or factories (17), or the outworkers having died (6). Miss Portlock also discovered 5 new workshops and handed in their addresses for registration. During her visits of inspection she found 256 premises with sanitary defects. For the abatement of these she served 232 intimation, and 21 final notices. Of the 857 premises inspected, in only 23 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 45 „ „ and living room 18 „ „ „ kitchen 82 ,, and kitchen 603 „ „ bedroom 57 „ ,, parlour 28 ,, ,, scullery 1 „ provided separately 23 857 INSPECTION OF FOOD AND FOOD PREMISES. The food premises of the Borough are kept under observation both as to their sanitary condition and cleanliness and the condition and soundness of the food stored, sold or prepared for sale by two Sanitary Inspectors, who visit the butchers, slaughterhouses, markets, dairies, etc., and generally by the District Sanitary Inspectors. 111 The following food premises are regulated by Statute bye-laws or Regulations:— London County Council bye- laws Fish-friers and Curers 71 do. do. Slaughterers of Poultry 1 do. do. Slaughter-houses—Cattle 17 do. do. Cowhouses 5 Dairies, Cowsheds and Milk- shops Order Milk Purveyors 216 Factory and Workshops Act Bakehouses (above ground) . 52 do. (underground) 51 London County Council (General Powers Act) IceCream Premises 268 London County Council (General Powers Act) and Public Health Meat Regulations, 1924 Coffee Shops, Restaurants, &c. 117 do. do. Preserved Meat Factories 4 do. do. Butchers 142 do. do. Meat Stalls 60 do. do. Provision Shops 28 do. do. Butchers' Stores 46 Various 400 In addition there are about 350 food stalls in the market streets of the Borough, and a large number of itinerant vendors who hawk food around the streets. During the year 5,471 inspections were made of food premises and 271 notices were served for defects or contraventions of the law relating to food premises. One summons for exposing meat to contamination resulted in a fine and costs of £15 10s. The total amount of food surrendered for destruction was:— Meat, Bacon, Poultry and Rabbits 1 ton 14cwts. 3 qrs. 8 lbs. Fish 1 ton 11 cwts. 1 qr. Fruit 2 tons 14 cwts. 0 qrs. 7 lbs. Tinned goods, Confectionery, etc. 3 tons 18 cwts. 0 qrs. 18 lbs. 112 Food seized and ordered to be destroyed by Magistrates amounted to:— Beef, 2 qrs. 24 1bs.; Mutton, 25 1bs. Pork, 1 qr. 8 1bs.; Veal, 3 1bs. Five summonses for selling and exposing unsound meat resulted in fines totalling £25. Purity of Food.— During the year 1,000 samples of foods and drugs were taken for analysis under the Sale of Food and Drugs Acts. As a result, 11 vendors were warned and 5 prosecutions instituted resulting in the payment of .£11 9s. Od. in fines and costs. 113 samples of milk for analysis were taken in the course of delivery from farmers to retailers in the Borough. Of these 3 were found not to be genuine. 651 samples of milk were taken in shops or in the streets of the Borough in course of delivery by roundsmen to customers. Of these 4 were found not to be genuine. Average percentage of adulteration of all samples of milk procured during the year—.91. INFORMAL SAMPLES. 37 informal samples of food were purchased or obtained for examination. Some examples of these were:— Lemonade.—The lemonade contained lead due to the use of lead siphon pipe for drawing off the liquid. Vendors using this type of apparatus have been warned and have now ceased to use it. Ice Cream.—Four samples of Ice Cream were obtained for bacteriological examination, and in three cases there was distinct evidence of contamination during some period of manufacture, storage or exposure for sale. 113 Flour.—(Part of a large consignment.) Some evidence of contamination, the bacteria being greater than that usual in a clean flour. Bread.—Presence of undesirable organism. Bread.—Presence of Ants in the bread. Chocolate.—Presence of Moths and Eggs. Vinegar.—Presence of Vinegar Eels. 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 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 " Grade A. (Tuberculin tested.)" do. 73, Powerscroft Road " Pasteurised." J. Akam & Sons, 53, Kynaston Road " Pasteurised." S. P. Snewin, 67, Oldhill Street " Grade A. (Tuberculin tested.)" G. F. Lodge, 1, West Side "Certified." 114 MILK AND DAIRIES ORDER, 1926. The attention of all persons engaged in the storage, distribution and sale of milk in the Borough was called to the following summary of the principal provisions of the Orders and Regulations affecting persons engaged in the storage, distribution and sale of milk. Definitions. "Milk" means milk intended for sale for human consumption or for use in the manufacture of products for sale for human consumption, and includes cream, skimmed milk and separated milk; "Dairy" includes any farm, cowshed, milk store, milk shop or other place from which milk is supplied on or for sale, or in which milk is kept or used for purposes of sale or manufacture into butter, cheese, dried milk or condensed milk for sale, and, in the case of a purveyor of milk who does not occupy any premises for the sale of milk, includes the place where he keeps the vessels used by him for the sale of milk, but does not include a shop from which milk is not supplied otherwise than in properly closed and unopened receptacles in which it was delivered to the shop or a shop or other place in which milk is sold for consumption on the premises only. "Registered premises" means any building or other premises required to be registered under the provisions of this order. 1. Every Cowkeeper and dairyman shall take all practicable steps to make the provision of this order known to every person in or about any registered premises in his occupation so far as such provisions impose any duties or restrictions on such person and so far as they relate to the processes carried out by such person. Registration and Notices. 2. (1) Every sanitary authority shall keep registers of all persons carrying on in their district the trade of cowkeeper or dairyman and of all farms and other premises within their district which are used as dairies. (2) Subject to the provisions of Section 2 of the Milk and Dairies (Amendment) Act, 1922, (c) or of any other statutory enactment, the sanitary authority, on the application of any person proposing to carry on in their district the trade of cowkeeper or dairyman or to use any farm or other premises in the district as a dairy, shall register such person or such premises. 115 (3) Subject as aforesaid, no person shall carry on the trade of cowkeeper or dairyman or use any premises as a dairy unless he and any such premises are registered in pursuance of this article. (4) The sanitary authority shall immediately after the commencement of this order inform the county council of the particulars of registration then in force of cowkeepers and their premises, and they shall as soon as may be inform the county council of all alterations made in the registers. 3. Before commencing to use as a cowshed or as a place for the keeping of milk, a building not previously used for that purpose the occupier shall give one month's notice in writing to the sanitary authority of his intention so to do. General Provisions for securing the cleanliness of Dairies, etc., and for protecting milk against infection and contamination. 4. (1) Every cowshed and every building used for keeping milk, other than a cold store, shall be provided with a sufficient number of windows or other openings suitably placed and communicating directly with the external air. The windows or permanent openings shall be such as to secure that the building is sufficiently lighted during the hours of daylight and the openings provided for ventilation shall be kept in proper order and so used as to secure that the air in the building is kept in a fresh and wholesome condition. (2) Every such building in which milking or any other process is carried on during the hours of darkness shall also be provided with such lamps or other means of artificial lighting as will enable any such process to be conducted in a good and proper light. 5. (1) All registered premises shall be provided with a supply of water suitable and sufficient for the requirements of this order. (2) Every receptacle used for the storage or conveyance of water shall be emptied and cleansed from time to time as often as may be necessary to prevent the pollution of the water and to maintain it in a suitable condition for the purpose for which it is required. (3) The water supply used for the watering of cows shall, as far as reasonably possible, be protected against contamination caused by the drainage of foul water. h 116 6. The following provisions shall apply for the purpose of preventing contamination or infection of milk:— (1) Milk shall not be deposited or kept in any place where it is liable to become contaminated or infected. In particular it shall not be deposited or kept— (i) in any room used as a kitchen, scullery, living-room or sleeping-room; or (ii) in any room or part of a building which communicates directly by door, window or otherwise with,— (a) any water-closet, earth-closet, privy, cesspool or receptacle for ashes or other refuse; or (b) any room which is used as a sleeping-room or any room which is occupied by a person suffering from an infectious disease, or which, having been so occupied, has not been subsequently properly disinfected; or (iii) in any room or part of a building in which there is any direct inlet to a drain which is not efficiently trapped : Provided that the foregoing provisions shall not be deemed to prohibit the deposit or keeping of milk intended for use in the manufacture of butter, cream or cheese in a room used as a kitchen. (2) Vessels containing milk shall be properly covered or the milk shall be otherwise effectively protected from dust, dirt, flics or other sources of contamination; (3) No foul or noxious matter or soiled bed or body clothing shall be conveyed through any part of a building used for the keeping or storage of milk. 7. Every person engaged in the milking of cows or the distribution or measuring of milk or otherwise having access to the milk or to the churns or other milk receptacles shall keep his clothing and person in a cleanly condition. 8. A person shall not carry out any process of cooling, bottling, sterilising or pasteurising milk or any other process connected with milk, 117 or keep any appliances connected with any such process, in a cowshed or in any place where the milk or appliances would be liable to contamination arising' from any cowshed, stable or manure-heap, or otherwise. Infectious Disease. 9. Every person having access to the milk or to the churns or other milk receptacles in or about any registered premises, as soon as he becomes aware that any member of his household is suffering from any infectious disease, shall immediately notify the occupier of such premises of the fact and the occupier shall immediately notify the medical officer of health of the district in which the premises arc situate unless notification has already been given to that officer. 10. (1) Where the medical officer of health of a sanitary district is in possession of evidence that any person is suffering from infectious disease caused by the consumption of milk supplied within the district from any registered premises or that the milk at any registered premises within the district has been infected with such disease, he may by a notice in writing to the occupier of such premises specifying such evidence require, if the premises are within the district, that no milk from such premises (or, if the notice so provides, no milk received at such premises from any specified source) shall be sold for human consumption or used in the manufacture of products for human consumption, or, if the premises are without the district, that no such milk shall be sold for human consumption within the district. (2) No person shall sell milk for human consumption or use milk or sell milk for use in the manufacture of products for human consumption contrary to the terms of a notice given by the medical officer of health under this article. 11. (1) Where the medical officer of health of the registering authority by reason of such notification or otherwise suspects that any of the persons in or about any registered premises who have access to the milk or to the churns or other milk receptacles is suffering from an infectious disease or has recently been in contact with any person so suffering or is in such a condition that there is a danger of his transmitting an infectious disease he may give notice to the occupier of such premises that he considers it 118 necessary to make an examination of any or all of such persons; and where he gives such notice, the said occupier and every person concerned shall give to the medical officer of health all reasonable facilities for making such examination. (2) Where from the result of any such examination or otherwise the medical officer of health is of opinion that the employment of any such person is likely to lead to the spread of infectious disease, the medical officer of health may give notice in writing to that effect to the occupier of the registered premises and to the person concerned requiring that, during a period to be specified in such notice, the person to whom the notice relates shall not milk cows or handle vessels used for containing milk or in any way take part in the production, distribution or storage of milk. (3) A person to whom any such notice relates and any other person who is suffering from an infectious disease or has recently been in contact with a person so suffering shall not milk cows or handle vessels used for containing milk or in any way take part in the production, distribution or storage of milk until the expiry of the period mentioned in the notice or, as the case may be, until all danger of the communication of infectious disease by means of the milk has ceased. (4) No cowkeeper or dairyman shall allow any person to whom any such notice relates, or any other person who is so suffering or has recently been in contact as aforesaid, to milk cows or handle vessels used for containing milk or in any way to take part in the production, distribution or storage of milk, until the expiry of the period mentioned in the notice or, as the case may be, until all danger of the communication of infectious disease by means of the milk has ceased. 12. No person shall keep any swine or poultry in any cowshed or room in which cows in milk are kept or milked or in which milk or milk utensils are kept or in any room or shed communicating directly therewith. 13. Every cowkeeper or dairyman shall cause all vessels (including the lids of such vessels) and appliances used or intended to be used by 119 him for containing', measuring or stirring milk, or for any other purpose for which they may be brought into contact with milk, to be kept at all times in a state of thorough cleanliness. For this purpose— (i) Every such vessel, lid and appliance shall be thoroughly washed as soon as may be after use, and shall be cleansed and scalded with boiling water or steam before it is used again. (ii) No oxidising or preservative agent shall be used in the cleansing of any such vessel or appliance. (iii) Every such vessel, lid and appliance, when not in use shall be stored in a clean place and shall be protected from dust and dirt. (iv) No such vessel or appliance shall be used for containing, measuring or applying any process or treatment to any article other than milk or milk products. Special Provisions applicable to Buildings used for the Sale, etc., of Milk. 14. The following provisions shall apply to any building or part of a building which is used for the sale of milk or in which milk is kept or used for the purpose of sale or manufacture into butter, cheese, dried milk or condensed milk for sale:— (1) The occupier shall cause the interior and the furniture and fittings therein to be thoroughly cleansed from time to time as often as may be necessary to secure the maintenance of reasonable cleanliness, and in particular the floors shall be thoroughly cleansed with water at least once in every day. (2) Except in the case of a building or part of a building which is used for the sale of milk by retail the occupier shall cause the floor to be constructed of rendered concrete or other durable and impervious material and to be so sloped as to ensure the removal of all liquid matter which may fall thereon, and to be provided with channels so constructed, sloped and placed as to receive all such liquid matter and to convey it to a suitable drain or other place of disposal outside the building. 120 Conveyance and Distribution of Milk, Churns, etc. 15. A person shall not use, or cause to be used, for the reception, measurement, storage or delivery of milk any churn, vessel or other receptacle, the interior surface of which is incapable of being readily cleansed. 16. Every person shall cause every churn, vessel or other receptacle, other than bottles, in which he despatches milk by rail or road to comply with the following requirements, viz.:— (1) The name and address of the owner shall be permanently marked on the churn, vessel or other receptacle or on a plate or plates of metal properly soldered or otherwise securely affixed thereto. (2) The churn, vessel or other receptacle shall be provided with a lid without openings, which shall be so constructed and fitted as effectively to prevent the access to the milk of dirt, dust or rain water or the return to the interior of the receptaclc of any milk which may have been splashed above the lid. This portion of the Order, viz.: Par. 15-16, will not come into operation until the 1st day of October, 1928. 17. Every person who purchases milk for the purposes of his trade or business, and empties and returns the churns or other receptacles in which the milk is delivered to him, shall cause all such churns and receptacles, other than bottles, to be thoroughly cleansed and securely closed before they leave his custody or control. 18. Every person shall cause every churn, vessel or other receptacle used by him for the conveyance of skimmed or separated milk or for containing such milk at any time when it is exposed for sale to be marked with the words Skimmed Milk" or "Separated Milk," as the case may require, in large and legible type. 19. (1) Except in pursuance of any statutory authority in that behalf, no person shall open any churn, vessel or other receptacle containing milk or transfer milk from one receptacle to another in any railway van or on any railway station: 121 Provided that this article shall not be deemed to prohibit the purchaser or his agent when taking delivery of the milk from opening a churn, vessel or other receptacle containing milk or transferring the milk to another receptacle so far as such opening or transfer may be necessary for the purpose of checking and sampling the milk. (2) Where a person delivers milk in bottles he shall cause every such bottle to be filled and closed on registered premises; and no person shall remove or tamper with the disc or other device used for closing the bottle at any time after it has left such premises and before it is delivered to the. consumer. 20. Every person engaged in the conveyance or distribution of milk shall use all practicable precautions for preventing the milk from being unnecessarily exposed to heat and from being contaminated by dirt, dust, rain water or otherwise. 21. The interior of every vehicle used for the conveyance of milk shall be at all times kept clean. No live animal or any article likely to contaminate the milk shall be conveyed in the vehicle at the same time as milk and no vehicle which has been used for the conveyance of offensive matter shall be used for the conveyance of milk until the vehicle has been thoroughly cleansed and purified. Note.—The Milk and Dairies (Consolidation) Act, 1915, provides by sub-section (3) of section 1 that if any person is guilty of a contravention of, or non-compliance with the provisions of any Milk and Dairies Order, he shall be guilty of an offence against the Act. Sub-section (1) of section 18 of that Act provides that if any person commits an offence against the Act he shall be liable on summary conviction to a fine not exceeding in the case of the first offence five pounds and in the case of a second or subsequent offence fifty pounds, and if the offence is a continuing offence to a further fine not exceeding forty shillings for each day during which the offence continues. The Public Health (Imported Milk) Regulations, 1926 1. (1) Every Sanitary Authority shall enforce and execute these Regulations and shall keep a Register of persons to whom milk imported into their district may be consigned. 122 (2) Any Officer of the Sanitary Authority duly authorised in that behalf, may take a sample of any milk imported into the district. 2. No person shall receive any milk consigned to him from any place outside the British Islands unless he is registered under these Regulations by the Sanitary Authority into whose district the milk is imported. 3. All imported milk shall be in such condition that, on a sample being taken within the district of a Sanitary Authority, the milk shall be found to contain not more than 100,000 bacteria per cubic centimetre and to be free from tubercle bacilli. 4. (1) If the Sanitary Authority are satisfied that any milk imported into their district does not comply with the provisions of these Regulations, they may serve upon the person to whom the milk was consigned a notice to appear before them not less than seven days after the date of the notice, to show cause why they should not, for reasons to be specified in the notice, remove him from the register, either absolutely or in respect of any specified source of supply, and if he fails to show causc to their satisfaction accordingly they may remove him from the register. (2) Any person aggrieved by any such decision of the Sanitary Authority as aforesaid may, within twenty-one days, appeal to a Court of Summary Jurisdiction and that Court may require the Sanitary Authority not to remove him from the register. "Milk" means milk (including skimmed milk and separated milk but not including condensed or dried milk) which is intended for sale for human consumption or for use in the manufacture of products for human consumption. " Imported Milk" means milk imported into England or Wales from any place situated outside the British Islands. The Public Health Prevention of Epidemic, Endemic and Infectious Diseases Order, 1925. 1. No person who is aware that he is suffering from tuberculosis of the respiratory tract shall enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk. 123 2. Notwithstanding anything contained in the Public Health (Tuberculosis) Regulations, 1912, (a) if a local authority, on the report in writing of their Medical Officer of Health, are satisfied that a person residing in their district who is engaged in any such employment or occupation as aforesaid is suffering from tuberculosis of the respiratory tract and is in an infectious state, they may by notice in writing signed by the Clerk or the Medical Officer of Health require such person to discontinue his employment or occupation on or before the date specified in the notice, such date being not less than seven days after the service of the said notice, and such person shall thereupon comply with the said notice. A notice issued by the local authority under these regulations shall be in the form set forth in the Schedule hereto. 3. (1) If any person deems himself aggrieved by a requirement of a local authority under these regulations, he may, within fourteen days after the service of notice of the requirement, appeal to a court of summary jurisdiction and shall in that event give written notice to the Clerk to the local authority of his intention to appeal and the ground thereof. (2) The court may make such order in the matter as may seem equitable to them, and may award costs, which shall be recoverable summarily as a civil debt, and the order so made shall be binding and conclusive. (3) Upon the hearing of an appeal under this article the court shall have power with the consent of the appellant to direct that he be examined by a registered medical practitioner nominated by the court. 4. The provisions of section 308 of the Public Health Act, 1875, (which relates to compensation for damages sustained by reason of the exercise of the powers of the Act) shall apply to any person who sustains any damage by reason of the exercise of any of the powers of these regulations in relation to any matter as to which he is not himself in default. 124 Milk and Dairies (Amendment) Act, 1922. London County Council (General Powers) Act, 1908, S. 5. The Public Health Committee have decided that the following conditions must be complied with by applicants for registration under the above Acts:— (1) The lighting and ventilation must be maintained in a satisfactory condition. (2) No room which is used as a sleeping room must cate 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. (G) 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 he 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, etc., and no such articles must be sold from the premises. 125 (9) No premises will be registered if there is a manure or other offensive accumulation in close proximity. (10) Efficient means for the storage and removal of refuse must be provided. I agree to comply with the above conditions. Signed Address Witness Date Milk and Dairies Order, 1926. The Public Health Committee considered the situation arising from the fact that many persons, amounting in all to 54, had been registered as Purveyors of Milk prior to 27th April, 1922, when it was resolved that applicants for registration as purveyors of milk should be required to give an undertaking to comply with certain conditions. It being necessary under the new Order to register the premises as well as the purveyors of milk and that application had been made by the 54 purveyors referred to for registration, but as these persons were selling "prohibited articles" in addition to milk, the Committee decided that all applications for registration of premises be refused until the conditions laid down on the 27th April, 1922, had been complied with. A list of purveyors who had agreed to discontinue the sale of prohibited articles was afterwards submitted to the Committee, and 15 applications for registration were granted. 64 names of vendors were removed from the register, 14 having discontinued the sale of milk entirely, and 50 having ceased the sale of loose milk and only sold milk in sealed bottles. In one case the vendor was interviewed by the Committee and was informed that so long 126 as she continued to sell "prohibited articles" at her shop, the application for registration could not be granted, but in the event of her discontinuing the sale of loose milk and selling sealed bottles of milk only, no objection would be raised. Milk and Dairies Order, 1926, made under Milk and Dairies (Consolidation) Act, 1915.—Under this Act 6 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 5 cases no action was taken as the retailers' samples were certified to be genuine. In the other case the Analyst reported the sample to be 16% deficient in fat, and the vendor requested a sample to be taken in course of transit from his wholesaler. Two samples were procured both of which were found to be genuine. 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 he present, and Percentage of Preservative found in each Sample. Milk 764 None. Cream 3 None. Nature of preservative in each case in column (b) and action taken under the Regulations in regard to it. No preservatives. 127 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 7 (ii) Statements incorrect 1 (iii) Percentage of preservative found in each sample 1—Three 2—One 3—Three Preservative absent 1 Percentage stated on Statutory label 4 (b) Determinations made of milk fat in cream sold as preserved cream:— (i) Above 35 per cent. 8 (ii) Below 35 per cent. None. (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (i), and the proviso in Article V (2) of the Regulations have not been observed—None. (d) Particulars of each case in which the Regulations have not been complied with, and action taken—None. 3. Thickening Substances.— Any evidence of their addition to cream, or to preserved cream. Action taken where found— None. 4. Other Observations, if any—None. 128 Public Health (Condensed Milk) Regulations, 11)23. 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. REPORT OF FOOD INSPECTOR (Mr. A. J. BOBBITT). Dairies and Milkshops.—1,264 inspections were made during the year. 31 new milksellers have been registered. 11 milksellers have discontinued the sale of milk. Two vendors have been warned for having dirty measures in use. Cow-Houses.— These now number 5, a reduction of 2 since last year. 79 inspections were made, and at each visit the premises were found to be in a satisfactory condition. Slaughterhouses and Meat Inspection.—147 visits were made to the 17 slaughterhouses during the year and examination was made of the carcases and organs of 263 oxen and heifers, 6 cows, 3,269 sheep, 126 pigs, 4 sows, 1 boar, and 83 calves. Tlhe following were found diseased and were destroyed:— Affection or Disease. Forequarter, head, pluck and mesentery of a heifer Tuberculosis. Heart, lungs, liver and mesentery of a cow ,, Parts of 2 cows and 3 oxen Extensive bruising. Parts of a sow Premature parturition. Kidney and surrounding fat of a sow Cyst. Portions of the flanks of a cow Inflammation. Plucks of 4 pigs Tuberculosis. Lungs and pleura of a heifer Pleurisy. Liver of a boar Inflammation. Livers of 21 oxen and 15 sheep Distomatosis. Livers of 4 oxen Abscess. Livers of 6 and lungs of 10 sheep Parasitic cysts. 129 Wholesale Preserved Meat Factories.—24 visits were made, premises found to be clean, and the meat sound and free from disease. Sale of Food and Drugs Act.—60 Samples were purchased for analysis. Miscellaneous Inspections and Unsound Food.—337 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. Observation has been kept on butchers' shops and stalls for the labelling of imported meat, and several have been warned for failure to observe the requirements of the Order. The following foodstuffs have been condemned and destroyed : 1 box of Dabs. 5 Pigs 1 box of Roker. 101 Rabbits. 1 box of Haddock. 4 parcels of Bacon. 1 box of Soles. 41 tins of Cooked Ham. 5 boxes of Kippers. 53 cases of Sardines. 2 cases of Herrings. 30 cases of Mustard. 1 case of Haddocks. 15 tins of Loganberries. 1 trunk of Plaice. 4 cheeses. 1 trunk of Whiting. 257 boxes of apples. 1 barrel of Crabs. 2 sacks of potatoes. 1 bag of Winkles. 4 parcels of groceries, tinned 27 Herrings. goods, jams, marmalade, 28 lbs. of Haddocks. custard powders, etc., etc. 27 stones of Skate. Total weights of all foodstuffs condemned:— Provisions and tinned goods 3 tons 18 cwts. 0 qrs. 18 1bs. Meat and bacon 1 ton 10 cwts. 1 qr. 15 1bs. Vegetables and fruit 1 ton 15 cwts. 3 qrs. 21 1bs. Fish 0 tons 14cwts. 2 qrs. 21 lbs. 130 REPORT OF FOOD INSPECTOR (Mr. W. PEVERETT). During the year I have made 1,496 inspections of various kinds. These included 690 inspections of butchers' premises and premises where meat was sold or stored and prepared for sale, 131 inspections of meat stallholders' stores, 267 visits to market streets regarding screening of meat and the condition of goods exposed for sale, and 121 visits to other food premises. Food Complaints.—36 complaints as to food sold, or as to condition of food premises were investigated and action taken, as required. In addition to verbal warnings and advice given, 83 notices were served for contraventions of Meat Regulations, etc. These included the following:- Insufficient screening of meat 24 Water closet opening into food room 5 Accumulation of refuse 7 Refuse receptacles—defective or insufficient 26 Animals improperly kept 3 Food rooms dirty 10 Utensils dirty 3 Water closets out of repair 10 No name and address on stalls 6 Food room floor and walls defective 5 Improper storage of food 5 Waste pipes improperly discharged 0 Shops dirty 4 Bedrooms opening into food room 1 Food store not properly constructed 3 Drains defective 2 Contravention of Ice Cream Regulations 2 131 There are now on the Register in the Borough 142 butchers' shops (including 30 Kosher butchers), GO butchers stalls, mostly in the market streets, 46 butchers' stores used by stallholders for the storage of meat, 28 provision shops where meat is sold from open fronts. There are 93 food rooms in connection with the above premises where meat is prepared and cooked. Food Sampling.—37 informal samples of food were purchased or obtained for examination or analysis as to soundness or adulteration. These included:— Ice Cream 4 Bread 2 Tea 15 Lemonade 1 Butter 9 Chocolate 2 Cream 1 Cheese 1 Flour 1 Minced Meat 1 46 samples were taken under the Food and Drugs Act for analysis. Screening of Meat exposed for sale.— The screening of meat on stalls and shops, as far as it can be enforced under the Meat Regulations, has been on the whole fairly maintained by the shopkeepers. The stallholders require constant supervision, especially during their busy periods. One Summons was issued for exposing meat to contamination and the trader fined £5 and costs. New butchers' shops are being opened with open fronts in the busier streets. Storage of Meat.—A large proportion of the butchers now have refrigerators to keep their stocks in, and others are gradually having them fixed. Prosecutions for Unsound Food.—Five summonses for exposing and depositing for sale unsound meat were issued, and the vendor fined £25. 132 Unsound hood Surrendered and Destroyed:— Meat 0 tons 1 cwt. 3 qrs. 1 1b. Fruit 0 tons 18 cwts. 0 qrs. 14 1bs. Fish 0 tons 6 cwts. 2 qrs. 7 1bs. Rabbits 0 tons 1 cwt. 0 qrs. 0 lbs. Ducks 0 tons 0 cwts. 1 qr. 14 1bs. SALE OF FOOD AND DRUCS ACTS, 1875-1907. Samples purchased during 1926. Articles purchased. Number Purchased. N umber Adulterated. Number where proceedings taken. Milk 698 7 5 Do. (sterilized) 65 — — Do. (pasteurised) 1 — — Do. (sweetened full cream condensed) 3 — — Do. (sweetened skim condensed 3 — Do. (condensed) 6 - — Do. (dried) 1 — — Milkal 1 — — Virol and Milk 1 — — Butter 51 — — Margarine 51 — — Dripping 6 1 — Coffee 19 — — Coffee and Chicory 1 — — Cocoa 13 — — Custard Powder 7 — — Baking Powder 4 — — Cornflour 1 — — Apples 9 6 - 133 Articles Purchased. Number purchased. Number Adulterated. Number where Proceedings taken. Cream 3 — — Do. (preserved) 8 — — Jam 3 — — Ice Cream 11 — — Ice 1 — — Lard 12 — — Sausage 8 - — Do. (pork) 3 — — Olive Oil 3 — — Camphorated Oil 3 1 — Mince Steak 1 — — Mincemeat 1 — — Minced Sausage Meat 1 1 - Brawn 1 — - Totals 1000 16 5 Prosecutions under the Sale of Food and Drugs Acts, during the Year 1926. No. of Sample Inspector Article Adulteration or Offence Result of Legal Proceedings Fine Costs £ s. d. £ s d. 12J W. P. Milk 10% fat abstracted Vendor ordered to pay 3 3 0 35P G. F. 6.7% fat abstracted Vendor ordered to pay 3 3 0 37N W. G. 20% fat abstracted Fined 2 0 0 3 3 0 39S J. E. T. 7.65% added water Withdrawn (warranty proved) 45L J. W. H. 16% fat abstracted Dismissed (warranty proved) 2 0 0 9 9 0 134 THE PUBLIC HEALTH (PRESERVATIVES, &c. IN FOOD) REGULATIONS, 1925 & 1926. The attention of Manufacturers and Purveyors of Food in the Borough was called to these Regulations, and the following summary of some of its provisions and a list of foods which are permitted to contain amounts of Preservatives was distributed. Special attention was also drawn to the requirements of the Regulations as regards labelling of preservatives and articles of food containing preservative. January 1st, 1927. Preservatives in ALL FOODS prohibited except in certain cases and where standards have been fixed for limited amounts of Sulphur Dioxide and Benzoic Acid. July 1st, 1927. Preservatives Prohibited in Bacon. Ham. Egg Yolk. Articles of food containing preservatives necessarily introduced by the use in their preparation of preserved Margarine. January 1st, 1928. Preservatives Prohibited in Butter. Cream. Articles of food containing preservatives necessarily introduced by the use in their preparation of preserved Bacon. Cream. Egg Yolk. Ham July 1st, 1928. Preservatives Prohibited in Articles of food containing preservatives necessarily introduced by the use in their preparation of preserved Butter. 135 Labelling. Where preservatives as allowed are used in Sausages, Sausage Meat, Coffee Extract, Pickles and Sauces, and where the proportion of benzoic acid exceeds 600 parts per million in grape juice and wine, the purchaser must be notified by label or notice and the nature and amount of preservative present in any article sold as a food preservative must be stated. PART I.—Articles of food which may contain Preservative and nature and Proportion of Preservative in each case:— The articles of food specified in the first column of the following table may contain the preservative specified in the second column in proportions not exceeding the number of parts (estimated by weight) per million specified in the third column:— Food. Preservative. Parts per Million. 1. Sausages and sausage meat, containing raw meat, cereals and condiments Sulphur dioxide. 450 2. Fruit and fruit pulp (not dried) for conversion into jam or crystallised glace or cured fruit as defined in items 6 and 7:— (a) Cherries do. 3,000 (b) Strawberries and Raspberries do. 2,000 (c) Other fruit do. 1,500 3. Dried fruit:— (a) Apricots, peaches, nectarines, apples and pears do. 2,000 (b) Raisins and sultanas do. 750 4. Unfermented grape juice and nonalcoholic wine made from such grape juice if labelled in accordance with the rules contained in the Second Schedule to these Regulations Benzoic Acid. 2,000 5. Other non-alcoholic wines, cordials and fruit juices, sweetened or unsweetened. Either Sulphur dioxide or Benzoic Acid. 350 600 6. Jam (including marmalade and fruit jelly prepared in the way in which jam is prepared) Sulphur dioxide. 40 7. Crystallised glace or cured fruit (including candied peel) do. 100 7a. Fruit and fruit pulp not otherwise specified in this Schedule do. 350 8. Sugar (including solid glucose) do. 70 9. Corn syrup (liquid glucose) do. 450 136 Food. Preservative. Parts per Million. 10. Gelatine Sulphur dioxide. 1,000 11. Beer do. 70 12. Cider do. 200 13. Alcoholic wines do. 450 14. Sweetened mineral waters Either Sulphur dioxide or Benzoic Acid. 70 120 15. Brewed ginger beer Benzoic Acid. 120 16. Coffee extract do. 450 17. Pickles and sauces made from fruit or vegetables do. 250 PART II.— Colouring Matters which may not be added to Articles of Food. 1. Metallic Colouring Matters. Compounds of any of the following metals:— Antimony, Copper, Arsenic, Mercury, Cadmium, Lead, Chromium, Zinc. 2. Vegetable Colouring Matter. Gamboge. 3. Coal Tar Colours. Number in Colour Index of Society of Dyers and Colourists, 1924. Name. Synonyms. 7 Picric Acid Carbazotic Acid. 8 Victoria Yellow Saffron Substitute; Dinitrocresol. 9 Manchester Yellow Naphthol Yellow; Martius Yellow. 12 Aurantia Imperial Yellow. 724 Aurine Rosolic Acid; Yellow Coralline. 137 Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations have been found helpful from a preventative point of view in dissuading persons known to be tuberculous from entering the milk trade, and inducing relatives of persons engaged in the milk trade from refusing institutional treatment. It has fortunately not been necessary to take formal action under these Regulations or to serve notices, as required under Section 5. REPORT OF THE CANAL BOATS INSPECTOR (Mr. E. S. CROOK). Number of visits to waterways 41 Number of boats inspected 27 Number of boats not registered Nil Number of boats conforming to Acts 27 Number of boats infringing the Acts Nil Number of Certificates examined 27 Number of persons for which boats were registered—Adults 95 Children Nil Number of persons living on boats so registered—Men 54 Women Nil Children Nil Number of Notices issued Nil Number of Notices complied with Nil Legal proceedings taken Nil VIII.— HOUSING. 1.—GENERAL. Number of Houses erected during the year:— (a) Total 57 (b) With State assistance under the Housing Acts:— (i) By the Local Authority 1 maisonette (ii) By other bodies or persons 56 138 2.-UNFIT DWELLING-HOUSES. 1.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,780 (2) Number of dwelling-houses which were spected and recorded under the Housing Consolidated Regulations, 1925 819 (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 5,678 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 4,015 3.—Action under Statutory Powers. A.—Proceedings 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 — 139 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6,181 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) by owners 5,662 (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 — (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 1 (4) Number of dwelling-houses in respect of which demolition orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — 140 141 INSPECTIONS BY SANITARY INSPECTORS 1926. Mr. Fowler, 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. Nighy, 1 No. 10 District. 1 Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove, No. 13 District. Mr. Hall, No. 14 District. Mr. Galvin, Special. Mr. Smith, Special. Mr. Bobbitt, Special. Mr. Peverett, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Inspections. On Complaint— No. of premises inspected 297 211 330 254 454 367 554 374 254 268 291 285 368 362 54 137 ... 29 32 ... 4,921 No. of premises in which defects were discovered 225 171 253 193 333 288 391 313 213 225 259 239 283 253 46 100 ... 14 27 ... 3,826 Builder's Notices— No. of premises inspected 38 40 21 10 ... 18 44 17 30 9 16 19 22 42 ... 7 ... 4 ... ... 837 House to House— No. of premises inspected ... ... 8 ... ... 9 ... ... ... ... ... ... ... 29 438 365 ... ... ... ... 849 No. of premises in which defects were discovered ... ... 5 ... ... 3 ... ... ... ... ... ... ... 22 293 294 ... ... ... ... 617 Infectious Disease— No. of premises inspected 89 86 108 83 139 99 101 127 58 126 78 66 130 119 7 42 ... 6 ... ... 1,646 No. of premises in Which defects were discovered 19 45 22 36 60 59 35 71 14 62 41 33 68 45 3 29 ... ... ... ... 642 No. of re-inspections. (All forms of inspection) 1529 1888 1830 1636 1492 2169 2361 2147 2246 1551 1694 1463 2036 1833 1916 2245 ... 27 904 680 81,600 No. of premises in which defects were discovered. (All forms of inspection) 297 237 286 286 409 384 451 433 289 314 368 310 387 443 344 429 ... 84 293 256 6,300 No. of premises in which defects were abated. (All forms of inspection) 252 206 259 291 377 422 339 383 265 317 285 256 331 487 278 340 ... 80 277 217 5,662 Total number of Intimation Notices served 295 286 288 309 400 378 452 372 289 342 368 278 374 476 354 444 ... 1 248 232 6,181 Total number of Final Notices served 57 20 19 3 45 22 39 11 ... ... 8 34 ... 86 2 19 ... ... 51 21 443 Total number of Statutory Notices served 25 60 52 59 72 52 75 177 35 56 107 53 141 36 67 100 ... 4 7 ... 1,178 Notices served for infringements of Bye-Laws 21 14 ... 2 ... 2 2 15 ... ... 15 2 19 20 18 9 ... ... 11 1 146 Notices served for Infringements of L.C.C. General Powers Acts, Public Health Acts, Meat Regulations, etc. 1 2 22 7 ... ... ... 47 8 ... 47 13 12 6 ... 91 ... 83 ... ... 339 142 143 INSPECTIONS BY SANITARY INSPECTORS, 1926. Mr. Fowler, 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. Lone. No. 8 District. Mr. Goldsworthv No. 9 District. Mr. Nighy, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove, No. 13 District. Mr. Hall, No. 14 District. Mr. Galvin, Special. Mr. Smith, Special. Mr. Bobbitt, Special. Mr. Peverett, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Notices served under Rats & Mice Destruction Act, 1919 2 ... 2 ... 1 ... ... 5 ... ... 10 9 24 17 ... ... ... ... ... ... 70 Inspections for Certificates under Increase of Rent, Mortgage Interest (Restrictions Act), 1920 5 ... 1 ... ... ... ... 2 ... ... 1 3 ... 4 ... 1 ... ... ... ... 17 Proceedings before Magistrate under Public Health (London) Act, &c. 7 3 ... 1 6 3 5 5 ... 2 ... ... 5 2 ... 4 ... 6 ... ... 49 Attendances at Police Court 10 12 ... 2 6 9 11 15 2 0 ... 5 12 10 ... 8 ... 7 ... ... 114 Miscellaneous Inspections— Mews and stables 15 5 10 ... ... 2 6 ... ... 82 7 ... ... ... ... 3 ... ... ... ... 80 Urinals 6 22 17 3 33 16 ... 14 17 21 5 8 ... 4 ... 2 ... ... ... ... 168 Canal boats ... ... ... ... ... ... ... ... ... ... ... 27 ... ... ... ... ... ... ... ... 27 Visit to waterways ... ... ... ... ... ... ... ... ... ... ... 41 ... ... ... ... ... ... ... ... 41 Animals improperly kept 2 ... 4 2 ... ... ... 1 1 ... ... 2 1 ... 3 5 ... 2 ... ... 23 Offensive trades ... 1 4 ... 4 2 2 ... 6 8 ... 2 ... 3 ... ... 8 ... ... ... 40 New buildings (water certificates) 33 ... ... ... ... ... 10 2 ... ... ... 9 ... ... ... ... ... ... ... ... 54 Floodings ... ... ... 13 ... ... ... ... 5 ... 20 18 21 ... ... ... ... ... ... ... 77 Special inspections 119 183 423 182 117 60 62 321 81 58 185 150 74 155 156 266 337 160 3 ... 3,092 Drains relaid 21 5 20 22 24 23 24 12 13 9 14 11 ... 18 3 4 ... ... ... ... 223 do. repaired 65 28 34 27 72 21 82 30 21 7 29 72 13 27 60 49 ... 5 ... ... 642 Drains and Sanitary Fittings tested and examined 191 137 203 137 217 323 109 105 52 79 106 188 101 448 325 358 ... 5 ... ... 3,079 Places where Food Sold, Stored, or Prepared for Sale— No. of inspections 37 70 111 52 65 55 27 40 18 114 64 76 73 56 ... ... 24 978 ... ... 1,860 No. of Notices 13 6 4 17 ... 3 1 7 2 13 1 6 7 22 ... ... ... ... ... ... 102 144 145 INSPECTIONS BY SANITARY INSPECTORS. 1926. Mr. Fowler, 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. Nighy, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove, No. 13 District. Mr. Hall, No. 14 District. Mr. Galvin, Special. Mr. Smith, Special. Mr. Bobbitt, Special. Mr. Peverett, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Ice Cream Premises— No. of inspections 26 9 92 31 43 46 38 56 19 58 35 18 30 56 ... ... ... ... ... ... 557 No. of Notices 5 ... 5 5 1 1 ... 7 ... 1 1 ... 4 14 ... ... ... ... ... ... 44 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tenement Houses— No. provided with additional . water supply 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Overcrowding— No. of houses overcrowded .. 3 ... 6 4 ... 7 7 5 9 1 19 4 18 4 ... 52 ... ... ... ... 139 No. remedied 1 ... 4 ... ... 2 3 ... ... ... 3 ... 2 ... ... 5 ... ... ... ... 20 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Verminous Premises— Verminous Premises Cleansed 7 26 35 31 20 85 50 59 6 38 32 19 50 50 40 23 ... ... ... ... 521 Inspections after complaint by London County Council 6 1 2 2 11 6 46 10 2 21 15 1 7 10 1 3 ... ... ... ... 146 Verminous conditions found after complaint by L.C.C. 4 1 2 1 4 4 19 10 1 4 11 1 5 8 ... 8 ... ... ... ... 77 Bakehouses— No. of Inspections 14 20 11 21 20 17 16 17 19 26 20 4 4 24 ... ... ... 2 ... ... 235 No. of Notices 7 3 2 10 ... 1 ... 3 2 1 4 4 3 ... ... ... ... ... ... 40 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Street Markets— No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 267 ... ... 267 Food Adulteration— Samples collected for analysis 54 54 54 54 60 60 53 53 54 60 54 54 54 60 58 54 60 50 ... ... 1,000 Proceedings taken before Magistrate 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 2 ... ... 5 146 147 INSPECTIONS BY SANITARY INSPECTORS, 1926. Mr. Fowler, 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. Nighv, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove, No. 13 District. Mr. Hall, No. 14 District. Mr. Galvin, Special. Mr. Smith, Special. Mr. Bobbitt, Special. Mr. Peverett, Special. Miss Teebay, Special. Miss Port lock, Special. TOTAL. Factories and Workshops— No. of inspections (other than laundries) 24 5 10 4 44 42 9 ... 5 30 1 16 6 16 2 4 ... 3 1200 ... 1,427 No. of Inspections (laundries) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 ... 22 No. of inspections (other workplaces) 4 ... ... ... ... ... ... 6 ... 13 ... 7 ... ... 5 ... ... ... ... ... 35 No. of premises in which defects were discovered 7 ... 3 1 1 6 6 2 ... 5 ... 6 1 9 2 1 ... ... 293 ... 843 No. of premises in which defects were abated 5 ... 3 1 1 4 6 2 ... 4 ... 4 1 9 2 1 ... ... 277 ... 320 Smoke. Nuisances— No. of observations 13 ... 39 1 ... 4 73 ... 2 ... 6 13 59 1 1 ... ... ... ... ... 212 No. of Intimation Notices served 1 ... 6 1 ... 1 10 ... 1 ... ... 1 2 1 1 ... ... ... ... ... 25 No. of Statutory Notices served 1 ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Outworkers' Premises— No. of premises inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1209 1,209 No. of premises in which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 256 258 No. of promisee in which defects were abated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 217 217 Dairies. Cowsheds and Milkshops Order— No. of Cowsheds Inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 79 ... ... ... 79 No. of Dairies Inspected 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1264 5 ... ... 1270 No. of dirty utensils discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of premises where infringements of Bye-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of new registrations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 149 INSPECTIONS BY SANITARY INSPECTORS. 1926. Mr. Fowler, 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. Nighy, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove, No. 13 District. Mr. Hall, No. 14 District. Mr. Galvin, Special. Mr. Smith, Special. Mr. Bobbitt, Special. Mr. Peverett, Special. Miss Teebay, Special. Miss Portlock, Special. TOTAL. Slaughter-houses— No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... 447 16 ... ... 469 No. of premises where infringements of bye-laws discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Condemned as Unfit for Human Food— cwt. c. q. 1bs. c. q. 1bs. t. c. q.lbs. Fish ... ... ... ... ... ... ... ... ... ½ ... ... ... ... ... ... 14.2 21 6.2.7 ... ... 1.11.1.10 t. c. q.1bs. t. c. q.1bs. Fruit and Vegetables ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15.3.21 1.0.0.14 ... ... 2.16.0.7 Meat (specially state number of carcases of part of condemnd for tuberculosis) c.q.1bs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1.10.1.15 4.3.16 ... ... 1.15.1.3 Tinned foods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.18.0.18 ... ... ... 3.18.0.16 Other Articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 Housing, Town Planning, etc., Act, 1909— No. of premises inspected ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of premises in which defects were discovered ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of premises in which defects were abated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Underground Rooms— Illegal occupation dealt with ... 3 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 6 No. of rooms closed ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Houses Divided into Separate Tenements— No. of inspections ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 34 ... ... ... ... 72 No. of Notices ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. of prosecutions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 151 INSPECTIONS BY SANITARY INSPECTORS 1926. Mr. Fowler, 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. Nighy, No. 10 District. Mr. Hillier, No. 11 District. Mr. Crook, No. 12 District. Mr. Truslove, No. 13 District. Mr. Hall, No. 14 District. Mr. Galvin, Special. Mr. Smith, Special. Mr. Bobbitt, Special. Mr. Peverett, 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 1925 7 10 5 8 10 5 8 8 7 13 7 2 2 11 ... ... ... ... ... ... 103 No. on Register at end of 1926 7 10 5 8 10 5 8 8 8 12 7 2 2 11 ... ... ... ... ... ... 103 No. above ground 6 6 1 3 5 1 4 1 6 10 7 ... 1 1 ... ... ... ... ... ... 52 No. underground 1 4 4 5 5 4 4 7 2 2 ... 2 1 10 ... ... ... ... ... ... 51 Houses Divided into Separate Tenements— No. non Register at end of 1925 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No. on Register at end of 1926 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 33 ... ... ... ... 71 Ice Cream Premises— No. on Register at end of 1925 17 10 24 27 18 12 20 27 6 24 12 12 12 36 ... ... ... ... ... ... 257 No. on Register at end of 1926 17 9 27 24 16 13 21 28 17 19 15 15. 15 32 ... ... ... ... ... ... 268 Places where Food Sold, Stored, or Prepared for Sale— No. on Register at end of 1925 15 13 9 12 21 4 20 13 8 16 23 23 37 30 ... ... ... ... ... ... 244 No. on Register at end of 1926 34 33 41 11 48 16 27 29 37 49 31 31 57 31 ... ... ... ... ... ... 475 152 TABLE OF DEATHS Of Inhabitants of the Borough of Hackney during the year 1926 AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Small pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... Not „ ... ... ... ... ... ... ... ... ... ... ... ... ... Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... Cowpox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles (Morbilli) 3 6 3 ... ... ... ... ... ... ... ... ... 12 Epidemic Rose Rash. German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 1 ... 3 ... ... ... ... ... ... ... ... 1 Influenza 3 1 1 ... 3 3 7 2 14 5 5 1 45 Whooping Cough ... 2 2 ... ... ... ... ... ... ... ... ... 4 Diphtheria, Membranous Croup 1 3 0 7 ... ... ... ... ... ... ... ... 21 Cerebro Spinal Fever 1 ... ... 1 ... ... ... ... ... ... ... ... 2 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... 1 ... ... 2 ... 1 ... ... ... ... 4 Epidemic Diarrhœa, Epidemic (or Zym.) Enteritis 47 1 ... ... ... ... ... ... 1 ... ... ... 49 Diarrhoea, Choleraic Diarrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Leprosy ... ... ... ... ... ... ... ... ... 1 ... ... 1 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septicaemia, Sapræmia fever ... ... ... ... 1 3 3 ... ... ... ... ... 7 153 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 ... ... ... ... 3 1 ... 1 ... ... ... ... 5 Erysipelas 1 ... ... ... ... ... 1 ... ... 1 ... ... 3 Septicæmia (not Puerperal) ... ... 1 ... ... ... 1 ... 1 ... ... ... 3 Pyaemia (not Puerperal) ... ... ... ... ... ... 1 ... ... ... ... ... 1 Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 2 ... ... ... 1 ... ... 2 1 1 ... ... 7 Tuberculous Phthisis (Pulm. Tuberculosis). ... ... ... 1 43 36 36 28 24 11 1 ... 180 Tuberculous Meningitis ... 2 5 8 2 ... ... ... ... ... ... ... 17 Tuberculous Peritonitis ... ... ... 1 ... ... ... 1 ... ... ... ... 2 Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... Tubercle of other Organs ... ... ... ... 1 ... ... ... ... ... ... ... 1 General Tuberculosis ... ... 1 ... ... ... ... ... ... ... ... ... 1 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... ... ... ... 1 1 ... ... ... 2 Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... ... ... 1 1 ... ... ... ... ... ... 2 Rheumatism of Heart ... ... ... 2 ... 2 ... ... ... ... ... ... 4 Chronic Rheumatism ... ... ... 1 ... ... ... ... ... 2 ... ... 3 Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... ... ... 1 3 3 1 ... 8 Gout ... ... ... ... ... ... ... ... ... ... 1 ... 1 Carcinoma ... ... ... ... ... ... ... 42 65 87 46 2 250 Sarcoma ... ... ... 1 2 5 3 2 1 5 2 1 22 154 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 ... ... ... 1 1 3 5 6 17 13 4 ... 50 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... Haemophilia, Hemorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Leucocythæmia ... ... ... ... ... 1 1 5 4 2 ... ... 13 Diabetes Mellitus ... ... ... 1 1 ... ... 1 7 8 ... 1 23 Premature Birth 44 ... ... ... ... ... ... ... ... ... ... ... 44 Congenital Defects 16 ... 1 1 ... ... 1 ... ... ... ... ... 19 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 6 ... ... ... ... ... ... ... ... ... ... ... 6 Want of Breast Milk.. ... ... ... ... ... ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation-Overlaying 3 ... ... ... ... ... ... ... ... ... ... ... 3 Diseases of Nervous System. Meningitis, Inflammation of Brain 4 ... ... 3 1 ... ... 1 ... ... ... ... 9 Softening of Brain ... ... ... ... ... ... ... ... ... ... ... ... ... General Paralysis of Insane ... ... ... ... ... 2 4 1 3 1 ... ... 11 Insanity (not Puerperal) ... ... ... ... 1 ... 1 ... ... 1 ... ... 3 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... ... ... 1 1 ... 1 1 ... ... ... 4 Convulsions 3 1 1 ... ... ... ... ... ... ... ... ... 5 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 ... ... ... 1 ... ... ... ... ... ... ... ... 1 Paraplegia and Disease of Cord ... ... ... 1 ... ... 1 ... ... ... ... 2 Neuritis, Periph, PolyNeuritis ... ... ... ... ... ... ... ... 1 ... ... ... 1 Brain Tumour (not specific) ... ... ... 2 1 ... ... 1 1 1 ... ... 6 Nervous System, other Diseases ... ... ... ... ... 2 3 6 10 6 3 ... 30 Diseases of Organs of Sense. Otitis, Mastoid Dis. 1 ... 1 3 1 1 ... 1 1 ... ... ... 9 Rpistaxis, Nose Dis. ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Dis.. ... ... ... ... ... ... ... ... ... ... ... ... ... Accidents 1 ... 4 6 8 5 8 9 10 9 13 2 70 ,, Drowned ... ... ... ... 1 1 5 1 ... 2 ... ... 10 Suicide Drowned ... ... ... ... ... 2 2 3 2 ... ... ... 9 Other ... ... ... ... 1 3 5 5 6 1 2 ... 23 Homicide ... ... ... ... ... ... ... ... 1 ... ... ... 1 Diseases of Heart. Valve Dis., Endocarditis ... ... ... 2 5 12 5 14 31 29 14 2 114 Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... Hypertrophy of Heart ... ... ... ... ... ... ... ... 1 ... ... ... 1 Angina Pectoris ... ... ... ... ... ... 2 ... 6 2 1 1 12 Dilatation of Heart ... ... ... ... ... ... 3 7 18 39 40 9 116 Fatty Degeneration of Heart ... ... ... ... ... ... ... 3 7 8 3 ... 21 Syncope Heart Dis. (not specified) ... ... ... ... ... 2 1 8 14 17 12 2 56 156 TABLE OF DEATHS—continued. AGES Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 85. 35 to 45. 45 to 55 55 to 65. 65 to 75. 75 to 85. 85 and upwards. All ages. Diseases of Blood Vessels. Cerebral Haemorrhage Emb., Throm. 3 ... ... 1 1 4 2 13 31 54 39 5 163 Apoplexy, Hemiplegia ... ... ... ... ... ... 1 1 6 6 4 2 20 Aneurysm ... ... ... ... 1 1 2 2 2 1 ... ... 9 Senile Gangrene ... ... ... ... ... ... ... ... 1 3 3 ... 7 Embolism, Thrombosis (not Cerebral) ... ... ... ... ... ... ... ... ... ... ... ... ... Phlebitis ... ... ... ... ... ... 1 ... ... ... ... ... 1 Blood Vessels, other diseases ... 1 ... 1 ... 1 2 2 4 9 3 2 25 Arterio Sclerosis ... ... ... ... ... ... ... 2 12 39 49 19 121 Diseases of Respiratory Organs. Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 9 ... 2 ... 1 1 10 18 29 51 57 12 190 Lobar (Croupous) Pneumonia 2 3 2 2 6 2 7 12 9 10 7 ... 62 Broncho, Catarrhal, Lobular Pneumonia 51 12 6 3 1 2 3 8 9 8 9 4 111 Pneumonia 1 4 ... 2 1 ... 8 3 2 6 5 1 28 Emphysema, Asthma ... ... ... ... ... ... ... 8 10 10 4 1 34 Pleurisy ... ... ... ... ... ... ... ... ... ... 2 ... 2 Fibroid Dis. of Lung ... ... ... ... ... 1 ... ... 2 ... ... ... 8 Respiratory Dis., other ... ... ... 2 ... 2 ... 3 1 1 1 2 12 Diseases of 'Digestive System. Tonsilitis, Quinsey ... ... ... ... ... ... 1 ... ... ... ... ... 1 Mouth, Pharynx, Dis. (not specific) ... ... ... ... ... ... ... ... ... ... ... ... ... Gastric Ulcer ... ... ... ... 1 2 2 5 11 5 1 ... 27 157 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 ... ... ... ... ... ... ... ... ... ... 2 ... 2 Stomach, other Dis. (not Malig.) ... ... ... ... ... ... ... ... ... ... 1 ... 1 Enteritis (not Epidemic) 4 ... ... ... ... ... ... ... ... ... ... 1 5 Gastro-Enteritis 14 1 ... ... ... ... ... ... ... 1 ... ... 16 Appendicitis, Perityphilitis ... 1 1 5 4 ... 3 1 7 ... 2 ... 24 Hernia ... 1 ... ... ... ... 1 1 1 2 1 1 8 Intestinal Obstruction ... ... ... 2 1 1 2 ... ... 3 1 ... 10 Other Dis. of Intestines ... 1 1 ... 1 ... ... ... ... ... 1 ... 4 Peritonitis (not puerperal) ... 1 ... ... ... ... ... 4 ... ... 1 ... 6 Cirrhosis of Liver ... ... ... ... ... ... 1 2 2 ... 2 ... 7 Liver and Gall Bladder, other Diseases ... ... ... ... ... ... ... ... 1 1 ... ... 2 Digest. Syst., other Diseases 1 ... ... ... ... 1 ... 1 2 1 ... ... 6 Lymph Diseases. Lymph System, other Diseases ... ... ... ... ... ... ... ... ... 1 ... ... 1 Thyroid Body Disease ... 1 1 ... 1 ... ... 5 2 ... ... ... 10 Supra Renal Capsules Disease ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Urin. Syst. Nephritis, Acute ... ... 2 2 2 2 8 12 17 26 9 2 82 Chronic Bright's Dis. Albuminura ... ... ... ... ... ... ... ... 1 2 1 ... 4 Calculus (not Biliary) ... ... ... ... ... ... ... ... ... ... ... ... ... Bladder and Prostate Disease ... ... ... ... ... ... ... ... 1 5 5 1 12 Urin. Syst., other Dis. ... ... 1 ... ... ... 1 ... ... 3 2 1 8 158 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 ... ... ... ... ... ... ... ... ... ... ... ... ... Uterinal Tumour (not Malig.) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Dis. of Uterus and Vagina ... ... ... ... ... ... ... ... ... ... ... ... ... Accidents Childbirth Abortion. Miscarriage ... ... ... ... 1 1 2 ... ... ... ... ... 4 Puerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... 1 ... ... ... ... ... ... 1 Other Accid. of Preg. and Childbirth ... ... ... ... ... 4 3 ... ... ... ... ... 7 Joint Diseases. Caries, Necrosis ... ... ... ... ... ... ... ... ... ... ... ... ... Arthritis, Periostitis ... ... ... ... ... ... ... ... 1 2 ... ... 3 Other Dis. of Locom. Syst. ... ... 1 1 ... ... ... ... ... ... ... ... 2 Skin Diseases. Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Disease, other ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-Defined Causes. Atrophy, Debility, Marasmus 13 ... ... ... ... ... ... ... ... ... ... ... 13 Old Age ... ... ... ... ... ... ... ... ... 10 46 83 89 Dropsy, Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... 1 1 ... ... 1 ... ... ... 3 Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause unascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... Other Ill-defined Causes ... ... ... ... ... ... 1 1 ... ... ... ... 2 Causes not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 234 44 48 66 98 115 162 254 418 515 410 108 2472 159 TABLE III. Causes of, and Age at, Death during the year 1926. 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 ... ... ... ... ... ... ... ... ... 1 Small-Pox ... ... ... ... ... ... ... ... ... ... Measles 12 3 6 3 ... ... ... ... ... 36 Scarlet Fever 4 ... 1 ... 3 ... ... ... ... 11 Whooping Cough 4 ... 2 2 ... ... ... ... ... 17 Diphtheria and Croup 21 1 3 10 7 ... ... ... ... 65 Influenza 45 8 1 1 ... 3 10 16 11 5 Erysipelas 3 1 ... ... ... ... 1 ... 1 4 Dysentery ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 180 ... ... ... 1 43 72 52 12 142 Tuberculous Meningitis 17 ... 2 5 8 2 ... ... ... 14 Other Tuberculous Diseases 4 ... ... 1 1 1 ... 1 ... 3 Cancer, Malignant Disease 322 ... ... ... 2 3 24 133 160 230 Rheumatic Fever 2 ... ... ... ... 1 1 ... ... 1 Meningitis 9 4 ... ... 3 1 ... 1 ... 8 Organic Heart Disease 320 ... ... ... 2 5 25 109 179 163 Bronchitis 190 9 ... 2 ... 1 11 47 120 49 Pneumonia (all forms) 201 54 19 8 7 8 17 38 50 129 Other Diseases of Respiratory Organs 51 ... 1 ... 2 ... 3 24 21 28 Diarrhoea and Enteritis 70 65 2 ... ... ... ... 1 2 71 Appendicitis and Typhlitis 24 ... 1 1 5 4 8 8 2 19 Cirrhosis of Liver 7 ... ... ... ... ... 1 4 2 5 Alcoholism 2 ... ... ... ... ... ... 2 ... 1 Nephritis & Brights' Disease 90 ... ... 2 2 2 10 30 40 71 Puerperal Fever 7 ... ... ... ... 1 6 ... ... 10 Other Accidents and Diseases of Pregnancy and Parturition 12 ... ... ... ... 1 11 ... ... 8 Congenital Debility and Malformation, including Premature Birth 63 60 ... 1 1 ... 1 ... ... 38 Violent Deaths, excluding Suicide 81 1 ... 4 6 4 19 21 26 65 Suicide 32 ... ... ... ... 1 12 16 3 11 Other defined Diseases 701 33 6 8 16 17 49 168 404 466 Diseases ill-defined or unknown 2 ... ... ... ... ... 1 1 ... ... 2472 234 44 48 66 98 277 672 1083 1671 Sub-entries (included in above figures)— Cerebro-Spinal Meningitis, 2 1 ... ... 1 ... ... ... ... ... Polio Myelitis 1 ... ... ... 1 ... ... ... ... ... Encephalitis Lethargica 4 ... ... 1 ... ... 2 1 ... 4