Medical officer of Health SHOR 14 Annual Report ON THE HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch, IN THE COUNTY OP LONDON, FOR THE YEAR 1903, BY LEWIS T. FRASER BRYETT, M.D. (Lond.), Medical Officer of Health; Diplomats in Public Health, Royal Colleges oj Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; Fellow of the Royal Institute of Public Health &c. [Printed by Order of the Health and Housing Committee.] printed by a. t. roberts, son and co., ltd., hackney road, n.e. 10 4 . Metropolitan Borough of Sboreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH HEALTH DEPARTMENT, TOWN HALL, OLD STREET, E.C., January, 1904. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. SIR and GENTLEMEN, This report relates to the public health, sanitary condition and vital statistics of the Borough of Shoreditch for the year ending December 31st, 1903. POPULATION. The number of inhabitants in the Borough for the year under consideration is estimated at 117,740, as compared with 117,948 for last year, distributed in the four registration sub-districts as follows:—Shoreditch South, 15,800; Hoxton New Town, 29,600; Hoxton Old Town, 26,350; and Haggerston, 45,990. In the New Town registration sub-district is situate the Holborn Union Workhouse, the inmates of which, numbering at the 1901 census 1,375, are not regarded as persons belonging to Shoreditch, and are for certain statistical purposes not included in estimating the population in that sub-district. For these purposes the population of the New Town registration sub-district becomes, therefore, 28,225, and the population for the whole borough 116,365. The decrease in the population of the Borough, which has been going on since 1861 is mainly attributable to the demolition of dwelling-houses to make room for business premises. A number of such cases, which came under observation during the past year, are referred to later in this report. The people displaced were practically all of the artizan class. Based upon the special census returns, supplied by the Registrar General under section 9 of the Census (Great Britain) Act, 1900 to the London County Council, I have prepared a map of Shoreditch, showing the variations in the densities of the populations 2 percent. in the 76 enumeration areas into which the Borough was divided for the purpose of the 1901 Census. The results obtained may be briefly stated as follows:—In the major portion of the Shorediteh South registration sub-district the population was less than 100 persons to the acre. In the neighbourhood of the blocks of artizans dwellings, situate in the angle formed between Great Eastern and Paul Streets, the density was from 100 to 200 persons per acre. The population was thickest in Shorediteh South' in the northern portion of the sub-district, where there were one or two localities with . from 250 to 300 persons to the acre. In the Hoxton New Town sub-district, with the exception of the north-west corner in the region of the Wenlock basin of the Regent's Canal the population everywhere averaged more than 100 persons percent. It was thickest in the region of Nile Street. The neighbourhood of Chatham Avenue is one of the most densely populated portions of the Borough. The number of persons dwelling on the area bounded by the centres of the roadways of Britannia, Murray, Provost and Bbenezer Streets was, on the night of the census, 2,139, being no less than 509 persons to the acre. The greater part of this area is occupied by the artizans' dwellings, situate in Chatham Avenue. In none of the enumeration acres of Hoxton Old Town was the population less than 150 persons to the acre. It was thickest in the neighbourhoods of Aske and Fanshaw Streets and Turner's Square. In the latter locality it averaged 478 persons to the acre. The population of the Haggerston subdistrict was in none of the enumeration areas less than 100 persons to the acre. North of the Canal the density was from 100 to 300 per acre. South of the Canal and Bast of the Kingsland Road, the variations in density were between 100 and 400 percent. West of the Kingsland Road is relatively the most populous part of Haggerston. In the neighbourhood of Wilmer Gardens the density was 540, and in the neighbourhood of Essex Street was 547 per acre. It is needless to remark that these very densely populated localities are, practically, entirely occupied by tenement houses. The number of births registered during the year was 3,932, of which 1,999 were male and 1,933 female. In the Shorediteh Infirmary and Workhouse there were 41 males and 40 females born, a total of 81, of which 38 were regarded as legitimate and 43 illegitimate. In the Holborn Union Workhouse, the births numbered 97, of which 57 were male and 40 female, 36 being entered as legitimate and 61 illegitimate. BIRTHS. The distribution of the births in the four Registration sub-districts of the Borough is shown in the subjoined table:— Registration Sub-District. Males. Females. Total. Shorediteh South 223 198 421 Hoxton New Town 523 503 1,026 Hoxton Old Town 484 425 909 Haggerston 769 807 1,576 Total 1,999 1,933 3,932 3 Deducting the births in the Holborn Union Workhouse, the mothers not being persons belonging to Shorediteh, the birth-rate was 32.9 per 1,000 inhabitants, as compared with 28.5 for London. The births in Shorediteh were 1,555 in excess of the deaths. A comparison of the birth-rates in the Registration Sub-Districts is contained in Table VI (see appendix). The birth-rate is a shade less than in 1902. Since 1883 it has been gradually declining. MARRIAGES. The number of marriages registered in Shorediteh during the year was 1,146, as compared with 1,156 in 1902, 1,073 in 1901, 1,157 in 1900, and 1,295 in 1899. The number of persons married was at the rate of 196 per 1,000 inhabitants, as compared with 17.4 per 1,000 for the whole of London. DEATHS. The deaths numbered 2,280, and were distributed amongst males and females in the four Registration Sub-Districts as follows:— Registration Sub-District. Males. Females. Total. Shorediteh South 182 159 341 Hoxton New Town 291 300 591 Hoxton Old Town 265 234 499 Haggerston 445 404 849 Total 1,183 1,097 2,280 The deaths of males were 86 in excess of those of females. The death-rate was 19.6 per 1,000 inhabitants* being 2.7 less than the average for the previous 10 years, and with the exception of that for the year 1889, which was 19.3 per 1,000, the rate was lower than it has yet been in Shorediteh going as far back as the year 1856. The London death-rate was 15.7 and that of England and Wales 15.4 per 1,000. Tables giving the death-rates and the causes of death at various age periods in Shorediteh and its four Registration Sub-Districts together with other information bearing upon the subject are contained in the appendix to this report (Tables I., II., IV., V. VI). With respect to the Registration Sub-Districts the death-rate was highest in Shorediteh South and lowest in Haggerston, being 21.5 in the former and 18.4 in the latter. It is probable that there may have been some connection between the large amount of rain which fell during the year and the exceptionally low death-rate. The rate was highest for the year during the first fortnight of April, when a maximum of 26.7 per 1,000 was reached. This was probably associated with the inclement weather which was experienced during this period, it being very cold for the time of year. The rate was low from the middle of May to the middle of July, the lowest point reached being *Corrected for age and sex distribution, the death-rate was 20.0 per thousand. 4 in the third week of June when the rate was only 8.7 per 1,000 inhabitants. Summer diarrhoea, the prevalence of which in Shoreditch does not seem to have been influenced by the wetness of the season, began to affect the death-rate towards the end of July and its effects were apparent until the end of September. Although the deaths from diarrhoea were fairly numerous the general death-rate of the Borough during the period remained considerably below the average for the corresponding periods in previous years. Towards the end of November a slight rise was noticeable, the elevation lasting until the middle of December. This rise was probably mainly due to an increase in the number of deaths from diseases of the respiratory organs. The deaths of infants under the age of one year numbered 676, of which 348 were of males and 328 of females. They comprised nearly 30 per cent, of the total number of deaths for the year. The chief causes of the mortality amongst infants were diarrhoea, wasting and disorders of the digestive organs which are without doubt in the majority of instances the result of injudicious feeding, prematurity, bronchitis, pneumonia, the various forms of tuberculosis, and measles. Accident or negligence resulted in 37 deaths, of which 34 were caused by suffocation in bed, two by burns and one by drowning. The infant mortality, that is, the number of infants under one year dying during the year per 1,000 births occurring during the year was 176. The infant mortality for the Metropolis was 131 being considerably less than that of Shoreditch. The reasons for this difference have been referred to in previous reports. The deaths of children aged between one and five years numbered 307, and were chiefly attributable to measles, whooping cough, tuberculosis, pneumonia, bronchitis and diarrhoea. Violence through accident or negligence, resulted in 13 deaths, principally from the effects of being run over in the streets, burns and scalds. Altogether 983 or a little in excess of 43 percent. of the total number of deaths in the Borough were of children under five years of age. The deaths of children aged between five and fifteen years numbered 71, and were mainly to be attributed to the various infectious diseases, including 22 due to tuberculosis. Violence through accident or negligence resulted in 6 deaths. Of persons aged from 15 to 25 years 76 died. The deaths were mostly the result of infectious disease, and included 28 due to phthisis or consumption. The deaths of persons aged from 25 to 35 years numbered 121, the chief causes being consumption, which accounted for 51, and diseases of the heart and respiratory organs. Bright's disease caused four deaths, and one was attributed to cancer. Of persons aged from 35 to 45 years there were 199 deaths, of which 70 were attributed to consumption, 10 to alcoholism, 9 to cancer, 9 to various diseases of the nervous system, 16 to affections of the heart, 16 to bronchitis, 16 to pneumonia, 7 to cirrhosis of the liver, and 12 to Bright's disease. Of 9 deaths resulting from violence six were suicidal. 5 Of 248 deaths of persons aged from 45 to 55 years, 68 were attributed to consumption, 7 to alcoholism, 27 to cancer, 29 to various disorders of the nervous system including 10 from apoplexy, 23 to heart disease, 12 to bronchitis, 18 to pneumonia, 8 to cirrhosis of the liver, and 18 to Bright's disease. Violence caused 11 deaths three of which were suicidal. Of the 219 deaths of persons aged between 55 and 65 years, 29 were attributed to consumption, 17 to cancer, 26 to various nervous disorders, including 11 from apoplexy, 31 to heart disease, 25 to bronchitis, 17 to pneumonia, 10 to Bright's disease and 9 to malignant disease. Of persons aged between 65 and 75 years 226 died, the chief causes being cancer, which resulted in 18 deaths, old age in 34, apoplexy in 16, heart disease in 25, bronchitis in 48, pneumonia in 15, and Bright's disease in 15. Of 115 persons who died aged from 75 to 85 years, 51 succumbed to the effects of old age, 21 to bronchitis, and 12 to heart disease. Of the 22 persons who died aged 85 years and upwards, sixteen are stated to have died from the effects of age, one from apoplexy, two from heart disease, one from bronchitis, and two from the results of falls. The chief causes of death in the Borough during the year were: tuberculo sis which accounted for 376 deaths, including 271 from consumption or phthisis bronchitis which caused 187 deaths, pneumonia causing 179, diarrhoea 143, heart disease 139, measles 99, cancer 77, prematurity and debility at birth 101, atrophy, debility and marasmus, the results of improper feeding, 94, old age 106, enteritis 66, and Bright's disease 67. Cancer was given as the cause of 77 deaths, of which 33 were of males and 44 of females. With one exception they were all of persons over 35 years of age, and the great majority were of persons aged from 45 to 75 years. The cancer death-rate was 0.66 per 1,000 inhabitants, as compared with 0.74 in 1902, 0.63 in 1901, 0.56 in 1900, 0.63 in 1899, 0.58 in 1898, 0.51 in 1897, 0.45 in 1896, 0.50 in 1895, 0.65 in 1894, and 0.54 in 1893. In addition to the deaths, stated to have been due to cancer, there were 21 attributed to malignant disease. Ten of these were of males and 11 females. These have not been included in calculating the cancer death-rate, but it is probable that in a good proportion of them the cause of death was cancer. With respect to the deaths due to alcoholism, in addition to 22 direotly attributed thereto, 23 were given as the results of cirrhosis of the liver, a complaint which is practically always caused by alcoholic excess. As has been pointed out in previous reports, these figures far from represent the true state of things as to the mortality directly or indirectly attributable to the effects of alcoholic excess. The various forms of violence resulted in 105 deaths, of which 50 were of males and 55 females, 92 being from accident or negligence, one through homicide and 12 through suicide. In six of the latter the victims were males and in six females. 6 DEATHS IN PUBLIC INSTITUTIONS. The numbers and distribution of the deaths of persons, belonging and not belonging to the thorough, in public institutions in Shoreditch, are set out in the subjoined table:— Institution. Persons belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Union Workhouse 6 241 247 Shoreditch Workhouse 477 8 485 Hoxton House Asylum — 34 34 Royal Chest Hospital 11 52 63 Convent Hospital 1 2 3 Total 495 337 832 Elsewhere than in public institutions nine persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various public institutions outside Shoreditch with the numbers of persons belonging to the Borough dying therein:— No. of Asylums. Deaths. Banstead 3 Bethnal House 4 Cane Hill 4 Caterham1 Central London Sick 1 Claybury 16 Colney Hatch 13 Darenth 3 Dartford Heath 8 Hanwell 4 Horton 10 Leavesden 5 Manor 1 Metropolitan Benefit Society's 1 Norwood 1 Tooting Bee 5 Hospitals for I factious Disease. Eastern 32 North Eastern 3 North Western 1 South Eastern 1 South Western 1 General Hospitals. French 1 German 12 Gr. Ormond Street (Children) 17 Guy's 2 Homoeopathic 1 King's College 6 London 13 Metropolitan 52 Mildmay 7 No. of General Hospitals—continued. Deaths. North Eastern (Children) 19 Boyal free 2 Royal Hospital for Incurables 1 St. Bartholomew's 87 St. Francis, Hampstead 1 St. Mary's 1 Shadwell (Children) 1 Temperance 2 University 4 Hospitals for Special Diseases. Brompton Consumption 3 Dissase of the Chest, City of London 1 Heart Hospital, Soho 1 Lying-in, City of London 4 Boyal London Ophthalmic 1 Infirmaries and Workhouses. Bethnal Green Infirmary and Workhouse 10 City Infirmary 1 Greenwich Infirmary 1 Hackney Infirmary 4 Islington Infirmary 2 St. George's Infirmary 1 Wood Green 1 Other Institutions. H.M. Hospital, Stepney 1 H.M. Prison, Wormwood Scrubbs 2 H.M. Prison, Brixton 1 St. Peter's Home 1 Hostel of God 1 7 Of 383 persons belonging to Shoreditch dying in public institutions situate beyond the limits of the Borough, 229 died in general hospitals including 37 in hospitals for children; 38 died in the fever hospitals of the Metropolitan Asylums Board; 80 died in asylums; 10 in hospitals for special diseases; 20 in workhouses and infirmaries and 6 in other institutions. Elsewhere than in public institutions 11 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 839 persons belonging to Shoreditch died in public institutions. SICKNESS AMONGST THE POOR. During the year 1903 some 3,527 cases of illness came under the treatment of the district medical officers in connection with their work at the public dispensary, as compared with 3,403 in 1902, 3,883 in 1901, and 3,267 in 1900. An analysis of the cases is contained in table VII. (appendix). The diseases classed as infectious were responsible for 624 of the cases, and included 209 of consumption or phthisis, 106 of measles, 75 of diarrhoea, 73 of influenza, and 42 of pneumonia. Rheumatism was a common complaint of which there were 287 cases. Gout was the cause of the trouble in 53 cases. The cases of cancer numbered 30 as compared with 12 in 1902, 31 in 1901, 33 in 1900, 18 in 1899, 9 in 1898, 15 in 1897, 21 in 1896, 15 in 1895, 27 in 1894, and 23 in 1893. The effects of old age oaused some 99 persons to seek treatment. Diseases of the nervous system were responsible for 185 cases, and diseases of the heart and blood vessels for 164 cases. Diseases of the respiratory system accounted for 823 of the cases, of which 772 were cases of aoute or chronic bronchitis. Diseases of the organs of digestion gave rise to 269 cases, of which a large proportion were dyspepsia. Enteritis or gastro-enteritis was the cause of trouble in some 50 infants. Diseases of the locomotive system, which in a large proportion mean ulcerated legs, numbered 157 cases, and diseases of the skin 93 cases. Various forms of violence occasioned 116 cases, and some 462 consisted of cases of debility, marasmus and other causes not classified. INFECTIOUS DISEASES. The various infectious diseases which are numbered 1 to 35 in Table V. (see appendix) caused 762 deaths, as compared with 767 in 1902, and 762 in 1901. The deaths from these diseases were a little over 33 percent. of the deaths from all causes. Almost half of the deaths from the infectious diseases resulted from phthisis or consumption and the other forms of tuberculosis. The death-rate due to infectious diseases amounted to 6'5 per 1,000 inhabitants. In the subjoined Table the deaths have been grouped according to ages:— Age period Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 No. of deaths. 219 187 22 15 21 21 63 82 79 38 11 4 The above figures show that deaths from infectious disease in Shoreditch were much more numerous during the first year of life than in any of the subsequent age 8 periods. Diarrhoea, tuberculosis and measles were responsible for most of these deaths. Measles, whooping cough, tuberculosis and diphtheria were the chief causes of death in the 1 to 5 years age group. Altogether of the 762 deaths 406 were of children under five years of age. Taking the total mortality of children under five years from all causes, 41 percent. resulted from the infectious diseases and mainly from those mentioned above After the age of five years the deaths from infectious diseases rapidly decline in number, and they remain few until the 25 to 35 years group is reached, when there is an increase in the number, which continues at a higher level until the 55 to 65 years group is reached. The number then gradually declines. The rise in the latter half of life is due mainly to consumption. Deaths from small-pox, measles, scarlet fever, diphtheria, including membranous croup, whooping cough, enteric fever and diarrhoea are grouped together, and the death-rate due to them is termed the zymotic death-rate. In 1903 the deaths from these diseases numbered 324, the zymotic death-rate being 2.8 per 1,000 inhabitants as compared with 3.6 in 1902, 2.9 in 1901, 3.1 in 1900, 3.6 in 1899, 4.1 in 1898, 4.2 in 1897, 4.3 in 1896, and 3.8 in 1895. A comparison of the zymotic death-rates of London and Shoreditch with its registration sub-districts is contained in Table VI. (see Appendix). The cases of notifiable infectious diseases certified during 1903, excluding 39 cases of chicken pox which remained notifiable in Shoreditch until the end of February,numbered 664. The number of cases certified each year from 1889 together with the attack-rate per 1,000 population are as contained in the following Table:— Year. Number of oases. Attack-rate per 1,000 inhabitants. 1890 1158 9.4 1891 862 7.0 1892 1478 12.0 1893 1987 16.2 1894 1104 9.0 1895 1157 9.4 1896 1473 12.1 1897 1331 10.9 1898 960 7.8 1899 1116 9.2 1900 989 8.1 1901 1146 9.8 1902 1239 10.5 1903 664 5.6 The cases of notifiable infectious disease certified in the Metropolis numbered some 27,686, which gives a rate of attack of 6.0 per 1,000 population. In view of the fact that Shoreditch is one of the most densely populated areas in the Metropolis, it is satisfactory to note that the attack-rate in the Borough was so low, and it may be remarked that the cases of infectious disease notified in 1903 were fewer than in any year since the notification of infectious disease became compulsory. 9 Subjoined is a list of the infectious diseases which are required to be notified to the Medical Officer of Health, together with the numbers of cases certified in Shoreditch during the four quarters of the year, and the numbers and percentages of such cases which were removed to hospital for treatment:— Disease First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox ... ... ... ... ... ... Scarlet Fever or Scar latina 48 57 70 80 255 7 Diphtheria & Membra nous Croup 36 47 34 37 154 21 Typhus ... ... • • • ... ... ... Cholera Enteric Fever (Typhoid) 22 8 22 48 100 13 Continued Fever ... ... ... 1 1 ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever 4 1 1 1 7 1 Erysipelas 41 28 34 44 147 7 Totals 151 141 161 211 664 49 Numbers and percentages of cases removed to hospitals 1 98 65% 101 72% 119 74% 150 71% 468 70% As compared with the figures for 1902, the above Table shews that there was a slight increase in the number of cases of scarlet fever but very marked decreases in the number of cases of diphtheria, enteric fever, puerperal fever and erysipelas. The most noticeable feature, however, is the absence of any eases of small-pox. This will be referred to later. The deaths from notifiable infectious disease numbered 49 as compared with 144 in 1902, 72 in 1901, 99 in 1900, 121 in 1899, 96 in 1898, 136 in 1897, 135 in 1896 and 117 in 1895. The deaths from notifiable infectious disease were the fewest recorded since the notification of infectious disease became compulsory. The deaths from the principal zymotio diseases which are notifiable namely, small-pox, scarlet fever, diphtheria and enteric fever, were at the rate 0-3 per 1,000 inhabitants as compared 1.2 in 1902 and 0.6 in 1901; deaths from the principal zymotic diseases which are not notifiable, namely, measles, whooping cough and diarrhoea, were at the rate of 2.4 per 1,000 inhabitants. METROPOLITAN ASYLUMS BOARD. With few exceptions the whole of the cases removed to hospital for treatment were taken into the various hospitals of the Metropolitan Asylums Board. The infectious diseases which are received into the Board's hospitals are small-pox, scarlet fever, diphtheria and typhoid fever. Including one case of continued fever, a disease which frequently is found later on in its course to be typhoid fever, the number of 10 cases of these diseases certified was 509, and the number removed to hospital was 462 or 90.7 percent. as compared with 93.1 percent. in 1902, 86.3 in 1901, 84.7 in 1900, 82.4 in 1899, 81.4 in 1898, 71.4 in 1897, 65 in 1896,57 in 1895, and 61 in 1894. The marked increase in the percentage, which is observable for the year 1902, was the result of the small-pox outbreak as mentioned in the report for that year, and is exceptional, still, comparing with the percentages for the years prior to 1902, a very material increase in the number of cases sent to hospital for treatment is to be observed for the year under consideration. That 90 percent. of the infectious cases referred to above were removed to hospital is of itself a sufficient indication as to the extent the advantages afforded by hospital treatment of such cases is appreciated by the people of Shoreditch. As has been mentioned in previous reports isolation in the proper sense of the word is practically impossible in the vast majority of the homes in the Borough. The prompt removal of the patients becomes therefore one of the most important elements in the prevention of the spread of infection. No difficulty or hitch in securing the prompt removal of patients by the Metropolitan Asylums Board on the part of the Authorities came under my notice, during the year. Since the middle of March the Board have adopted the plan, which I believe will prove very useful, of sending intimations to Medical Officers of Health as to the dates when it is proposed to discharge patients from their hospitals. Thirteen instances of recurrence of infectious disease in houses, shortly following the return of patients who had been treated in the hospitals of the Board, came under my notice during the year. In 12 of the 13 cases the disease was scarlet fever and in the other it was diphtheria. In 6 of the instances, all cases of scarlet fever, the evidence associating the return of the patient from the hospital with the recurrence of the disease was very strong and left little room for doubt that the returning patient was the source of infection. In the other cases the evidence was not sufficient to warrant such a conclusion being arrived at. SMALL-POX. Comparatively few cases of small-pox occurred in London during 1903. Altogether a few over four hundred were certified in the Metropolis. Cases occurred in all the sanitary districts except two. They were most numerous in Stepney, Poplar, Wandsworth, St. Pancras, Battersea, Southwark, Westminster and Lambeth, Shoreditch was free from cases. From the date of the last cases in November 1902 until the end of the year 1903 not a single ease was certified amongst the residents of Shoreditch. One intimation was received as to a man having been admitted to the Holborn Union Workhouse suffering from small-pox from the Holborn Sanitary District. The case was notified to the Medical Officer of Health of the district from which the patient came to the institution and removed to the small-pox hospital. The necessary steps were taken to prevent the spread of infection and no further cases occurred. Several intimations were received from Medical Officers of Health relative to persons working or 11 residing in Shoreditch who might have been exposed to infection elsewhere. The necessary precautions were taken in each case and no case of small-pox resulted through these "contacts" within the borough. VACCINATION. The activity with respect to vaccination during the year 1902 decreased towards the end of the year as the small-pox subsided. From what can be gathered from the public vaccinators, during 1903 it might perhaps have been on the whole a shade more brisk than the last few years prior to 1902. Subjoined is a Table shewing the percentages of children born, not finally accounted for as regards vaccination, including postponed cases, each year from 1885 to 1900 inclusive, in Shoreditch, London and the rest of England Year. Shoreditch. London. Rest of England. Year. Shoreditch. London. Rest of England. 1885 5.6 7.0 5.5 1893 16.2 18.2 15.7 1886 6.3 7.8 6.1 1894 33.9 20.6 19.0 1887 5.6 9.0 6.7 1895 47.5 24.9 19.8 1888 3.7 10.3 8.2 1896 55.5 26.4 22.3 1889 5.5 11.6 9.6 1897 67.4 29.1 21.6 1890 9.3 13.9 10.9 1898 68.8 34.4 25.4 1891 8.8 16.4 12.9 1899 52.4 28.7 19.4 1892 10.8 18.4 14.3 1900 53.0 26.8 18.7 With respect to the above figures it is to be noted that the infants accounted for include those successfully vaccinated, those described as unsusceptible to vaccination, those dying unvaccinated and those whose vaccination was postponed. It is also to be noted that for the years 1898, 1899 and 1900, infants unvaccinated by reason of certificates of exemption granted by Magistrates under the Vaccination Act, 1898, have been taken into account. The certificates granted for Shoreditch infants during the three years were 16, 10 and 9 respectively. Since the last Vacoination Act came into operation the above Table shews that there has been a reduction in the number of infants not accounted for as regards vaccination in Shoreditch. SCARLET FEVER (SCARLATINA). The cases of scarlet fever certified during the year numbered 255, or six more than last year. Intimations were received from the Metropolitan Asylums Board authorities that in 18 of these cases the patients were not suffering from scarlet fever. Deducting these the number of cases was 237, as compared with 241 for 1902. 12 The distribution of the cases certified and the deaths amongst males and females during the year 1903 in the Borough and its four registration sub-districts is as shewn in the subjoined Table:— Sub-District. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 13 16 29 1 1 Hoxton New Town 36 39 75 — 3 3 Hoxton Old Town 32 23 55 — 2 2 Haggerston 39 57 96 1 — 1 Total for the whole Borough 120 135 255 2 5 7 Of the cases certified, 238 or 93.3 percent. were removed to hospital as compared with a little under 94 percent. in 1902, 88 percent. in 1901, 83 percent. in 1900, 85 in 1899, 86 in 1898, 75 in 1897, 70 in 1896, 60 in 1895*, 65 in 1894, and 37 percent. in 1893.* The deaths numbered 7 and the death-rate was 0.05 per 1,000, as compared with 0.06 in 1902, and 0.17 in 1901. In the report for last year it was mentioned that the death-rate was exceptionally low as regards scarlet fever in Shoreditch during 1902; it was in fact the lowest recorded for forty years in the Borough. It is satisfactory to note that the death-rate for 1903 is still lower. The cases certified were at the rate of 2.1 per 1,000 population, as compared with 2.1 in 1902, 4.7 in 1901 and 2.7 in 1900, The mortality was at the rate of 2.7 percent. of the cases certified, as compared with 33 percent. in 1902, 35 in 1901, 5.4 in 1900, 4.1 in 1899, 4.7 in 1898, 4.9 in 1897, and 5.4 in 1896. Amongst children under 5 years of age there were 109 cases with 3 deaths, the mortality being 2.7 percent. (or allowing for the cases not regarded as being scarlet fever at the fever hospitals a little over 3 percent.), as compared with 5.3 percent. in 1902, 6 8 in 1901, 12 in 1900, and 9.1 percent. in 1899. Amongst persons aged five years and upwards there were 146 cases with 4 deaths, the mortality being at the rate of 2.7 percent of the cases certified, as compared with 2 percent. in 1902, and 1.7 percent. in 1901. Not only were the cases less numerous and the death-rate lower in 1903, but the severity of the disease as judged of by the case mortality was also less than in previous years. The cases of scarlet fever certified in the Metropolis during 1903 numbered 12,536, the attack-rate being 2.7 per 1,000 inhabitants, as compared with 3.9 in 1902, During portions of these years owing to lack of accommodation at the fever hospitals many cases had to be treated at home which would otherwise have been removed. 13 4.4 in 1901, 3.0 in 1900, 3.9 in 1899, 3.7 in 1898, 5.1 in 1897, and 5.8 in 1896. With respect to the incidence of scarlet fever attacks Shoreditch does not compare unfavourably with the Metropolis as a whole, which must be regarded as satisfactory considering the density with which the Borough is populated. Taking the six years, 1896-1901, for which the complete figures are available, the average attack-rate per 1,000 inhabitants for Shoreditch was 4.1; for the whole Metropolis during the same period it was 4.3. The percentage of the cases notified removed to hospital during this period in Shoreditch and London were 81 and 72 respectively. It is possible that in this difference in the percentages of removals lies the reason why the incidence of scarlet fever in Shoreditch, which is about three times as thickly populated as the Metropolis taken as a whole, is only about the same as the average for London. The deaths from scarlet fever in London numbered 361, as compared with 560 in 1902, 584 in 1901 and 361 in 1900, the death-rate being 0.07 per 1,000, as compared with 0.12 in 1902, 3 13 in 1901, 0.08 in 1900, 0.09 in 1899, and 0.13 in 1898. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 154, including 13 which were subsequently stated not to be cases of diphtheria by the authorities of the Metropolitan Asylums Board. The eases were fewer in number than in any year since the notification of infectious disease became compulsory. The deaths numbered 21 and the death-rate was 0.18 per 1,000, as compared with 0.18 in 1902, 0.23 in 1901, 0.45 in 1900, and 0.52 in 1899 (appendix Table VI). The attacks during 1903 were somewhat more fatal than in 1902, the mortality being 13.6 percent. of the cases certified (14.9 allowing for the cases not regarded as diphtheria at the fever hospitals), as compared with 10.7 percent. in 1902. The case mortalities for previous years were, 8.8 in 1901, 15.3 in 1900, 17.0 in 1899, 17 3 in 1898, 22.1 in 1897, 21.0 in 1896, 24.1 in 1895, 24.0 in 1894, and 29.0 in 1893. The whole of the deaths during 1903 were of children under the age of 5 years, and the mortality amongst them amounted to 23.8 percent. of the cases certified (256 percent. allowing for the cases not regarded as diphtheria by Hospital Authorities), as compared with 20.5 percent. in 1902, 15.4 in 1901, 22 7 in 1900, 34.2 in 1899, 29.5 in 1898, 36.0 in 1897, 31 8 in 1896, 47.5 in 1895, 43.0 in 1894 and 61.0 in 1893. The figures for the last two years, 1902-03, indicate that whilst the cases of diphtheria have become fewer the severity of the attacks has somewhat increased. The disease however is far from being the fatal disorder it was 10 years ago. 14 The number of cases and the deaths amongst males and females in the Borough and its four registration sub-districts are given in the subjoined Table:— DIPHTHERIA (Including Membranous Croup.) Sub-District. Casks Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 12 10 22 3 1 4 Hoxton New Town 16 11 27 1 2 3 Hoxton Old Town 18 10 28 2 1 3 Haggerston 38 39 77 4 7 11 Total for the whole Borough 84 70 154 10 11 21 The cases are grouped according to ages in Table III. (appendix). The cases certified were at the rate of 1.3 per 1,000 inhabitants, as compared with 2 per 1,000 in 1902, 2.6 in 1901, and 3 in 1900. The cases of diphtheria certified in the Metropolis numbered 7,571, being at the rate of 1.6 per 1,000 inhabitants, and the deaths numbered 740, the death-rate being 0.16 per 1,000 inhabitants. Nearly 88 percent. of the cases certified in Shoreditch were removed to hospital for treatment, as compared with 84 percent. in 1902, 83 in 1901, 86 in 1900, 80 in 1899, 77 in 1898, 67 in 1897, and 55 in 1896. In connection with the enquiries made as to the circumstances attending 116 of the oases of diphtheria certified during the year, the distribution of the cases amongst males and females at certain age periods was found to be as follows:— Age Period. Male. Female. Total. Under 1 year 4 1 5 From 1 to 2 years 8 6 14 ,, 2 ,, 3 ,, 8 5 13 ,, 3 ,, 4 ,, 5 8 13 ,, 4 „ 5 „ 11 9 20 ,, 5 ,,10 ,, 14 14 28 ,, 10 ,, 13 „ 3 2 5 Over 13 years 9 9 18 Total 62 54 116 Of the 116 cases, in 49 instances the children suffering had been attending school, and in 39 instances they were at school within a week of the onset of symptoms. In a few of the cases the children must have been at school and mixing with other children whilst they were actually suffering from the disease before it was recognised to be diphtheria. In 49 of the other cases, although the patients themselves were not attending school, there were children, members of the same family or dwelling under 15 the same roof, who were attending at the time the cases occurred. In 17 instances there were histories of "sore throats" in connection with the cases, either in the patients' families or amongst other people dwelling in the patients' houses. In 15 instances there was pretty clear evidence of infection from previous cases. In 69 of the cases the sanitary condition of the houses in which the patients resided was satisfactory. In the remainder of the houses insanitary conditions of major or minor importance were met with, and in 23 instances the houses in which the patients were living were found to be in a distinctly unsatisfactory state, more or less serious defects being discovered in connection with the drains, and the houses being in a dirty condition generally. ENTEEIC OR TYPHOID FEVER. Including one case certified as continued fever, which was removed as being enteric fever, the cases notified numbered 101, which is below the average for the preoeding thirteen years. Ten of the cases certified, including that certified as continued fever, were found, after being under observation at the fever hospitals, not to be suffering from enteric fever. Cases were most numerous during the fourth quarter of the year. The numbers of cases certified since 1889 are shown in the subjoined Table:— Year. Number of Oases. Year. Number of Cases. 1890 202 1897 107 1891 111 1898 91 1892 91 1899 171 1893 111 1900 122 1894 85 1901 96 1895 99 1902 149 1896 114 1903 101 The cases certified were at the rate of 0.8 per 1,000 inhabitants, the attacks being at the rate of 0.8 in Shoreditch South, 1.0 in Hoxton New Town and Hoxton Old Town, and 0.6 per 1,000 in Haggerston. In six of the cases the patients were under the age of five years, and in three of these the cases were not regarded as being enteric fever. The deaths numbered 13, the death-rate being 0.11 per 1,000, as compared with 0.20 in 1902, 0.08 in 1901, 0.11 in 1900, 0.2 in 1899, 0.14 in 1898, 0.15 in 1897, 0.14 in 1896 and 0.17 in 1895. The rate was therefore below the average for previous years. Deducting the cases not regarded as being enteric fever, the attacks proved fatal in 14.2 percent. of the cases, as compared with 17.2 in 1902, 11.3 in 1901, 12.7 in 1900, 16.1 in 1899, 18.6 in 1898, 17.7 in 1897, 15.7 in 1896, 21 2 in 1895, 14.1 in 1894 and 15.8 in 1893. 16 The distribution of the cases and deaths amongst males and females in the four registration sub-districts during 1903 is as shown in the subjoined Table:— Sub-District. TYPHOID FEVER. Notifications Fatal Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 5 8 13 2 2 Hoxton New Town 17 14 31 2 2 4 Hoxton Old Town 18 10 28 1 1 2 Haggerston 18 11 29 5 — 5 Total for the whole Borough 58 43 101 10 3 13 A grouping of the cases according to ages is shown in Table III (Appendix). Of the cases certified 88 percent. were removed to hospital for treatment. The cases certified as enteric fever in London during 1903 numbered 2,337, as compared with 3,405 in 1902, 3,193 in 1901, 4,309 in 1900, and 4,460 in 1899; the attack rate being 0.50 per 1,000 inhabitants, as compared with 0.74 in 1902, 0.70 in 1901, 0.93 in 1900, and 0.97 in 1899. The deaths due to enteric fever in the Metropolis numbered 368 and the death-rate was 0.08, as compared with 0.11 in 1902, 0.12 in 1901, and 0.17 in 1900. The usual enquiries into the circumstances attending the occurrence of cases of typhoid fever in the Borough were made during the year. With respect to the association of the disease with the consumption of shell-fish, the following cases were noted:— (1). A young man, J.W., aged 19, who sold fish from a stall in Hoxton was taken ill about the middle of December, 1902, and certified to have typhoid fever on January 11th following. No definite information was obtained as to the extent he was in the habit of eating shell-fish, but it is probable that he did eat both oysters and mussels from time to time. This patient continued to follow his employment up to a few days before his oase was certified. (2). A girl, A. H., aged 15, employed in domestic duties at home, fell ill towards the end of January or beginning of February. She is stated to have eaten two oysters and a few mussels purchased at the stall where case (1) was serving on January 9th. The oysters were said to have come from Sittingbourne, and the mussels from Holland. 17 (3). A married woman, F. W., aged 26, was taken ill with typhoid fever about May 24th. There is reason for believing that a fortnight previously she had had oysters from a stall in Hoxton, but not the one referred to above. (4). A young man, A. J., aged 17, by occupation a tailor, was first noticed to be ill on August 18th, took to his bed on August 22nd, and was certified to be suffering from typhoid fever on August 29th. There was no history of any recent illness in the house where he resided, which was in very fair sanitary condition. He was at Southend on August 3rd, and whilst there had cockles to eat. He brought some cockles home with him, and a few of them were eaten by two persons in the house, but the rest were thrown away as they were not considered to be quite fresh. The two persons who ate of these cockles remained well. (5). A school-girl, H. B., aged 10, was at Leigh, near Southend, from August 1st to August 29th. On her return home she was noticed to be ill about August 31st, took to her bed on September 2nd, was certified on September 9th and removed to hospital the following day. Whilst at Leigh she ate cockles on numerous occasions. With respect to the first three of the foregoing cases the evidence as to infected shell-fish being the cause of the disease is not very convincing. There may have been a direct connection between case (2) and case (1), for there must be a risk of spreading infection when a person suffering from enteric fever is handling food which is to be consumed by other people. In cases (4) and (5) the probability is greater that the consumption of the cockles was the cause of the patients' suffering from the disease. The evidence from various parts of the country as to the danger attending the consumption of shell-fish which have been exposed to sewage contamination, has satisfied the Eoyal Commission on Sewage Disposal that a considerable number of cases of enteric fever result from eating shell-fish which have been grown under conditions exposing them to such contamination. In their fourth report the Commissioners recommend, therefore, that tidal waters should be placed under the jurisdiction of some authority with power to prevent shell-fish being taken from any dangerous position and to enforce regulations for preventing pollution of the shell-fish. It is to be hoped that there will bo no unnecessary delay in giving effect to the recommendation of the Commission and that prompt steps will be taken to secure that the conditions under which shell-fish are grown for human consumption shall be above suspicion. The subjoined series of cases came under obserration during the year, and may be recorded as further illustrating the manner in which typhoid fever not infrequently spreads amongst the members of a family when the conditions are favourable:— (1). On September 3rd, Mrs. H., aged , of No. 2, D-Crescent, went hop-picking on a farm at Yalding in Kent. She returned about October 18 2nd, ill, and went into the Hackney Infirmary on October 3rd. There appears to have been a good deal of sickness amongst the hop-pickers forming the party to which Mrs. H. belonged. The water supply for the hop-pickers is said to have been obtained from a "running stream." She was poorly towards the latter end of September and gradually became worse. Mrs. H. was certified to have enteric fever on October 7th, and died on October 15th. (2). On the admission of the above patient to the Infirmary, her baby, aged one year and seven months, was taken in by a relative, the mother of George E., at 33, W Place. The baby was with her at 33, W Place, for two or three weeks and all the time was ill with feverishness diarrhoea and sickness. It was subsequently removed by its father whose address could not be found. (3). George E., aged 15, of 33, W Place, lived and slept in the same room as the baby above mentioned. He was taken ill about October 30th, and was certified to have enteric fever on November 7th. It should be mentioned that George E. formed one of the same party of hop-pickers as Mrs. H., coming back to London on October 2nd. The interval of nearly a month after his return before the onset of symptoms renders it extremely unlikely that he was infected whilst at Yalding. (4). Maurice M., aged 14, of 79, P Street, was first noticed to be ill on November 7th, but it is possible that he may have been ailing for a few days before. He took to his bed on November 11th, and his case was certified to be one of enteric fever on November 18th. This patient was a brother of Mrs. H., and a playmate of George E., and was in the habit of going in and out at No. 33, W Place, and being in the room in which Mrs. H.'s sick infant was. He is said not to have seen Mrs. H. whilst she was ill. This lad was hop-picking at Farleigh, a considerable distance from where Mrs. H.'s party were, and was not brought in contact with them. He returned to London on October 1st. (5). Julia O'C., aged three, of 33, W Place, was taken ill about November 8th, and gradually becoming worse, was taken to St. Bartholomew's Hospital on November 17th, and was certified to be suffering from enteric fever on November 19th. This child was in no way related to the other families, but was, prior to her illness, very frequently in the rooms occupied by the family of George E. None of the members of the family to which Julia O'C. belonged had been hop-picking. With respect to the above cases, it is to be mentioned that the people were very poor, and the conditions under which they lived were favourable to the spread of the infection of a disease like enteric fever. Case (1) contracted infection not long after she commenced hop-picking, that is to say early in September. Case (2) although 19 hot certified to have had enteric fever in all probability had an attack of the disease, but whether it was infected from the same source as the mother, or whether it was infected by the mother it is impossible to say. Probably, owing to the intimate relations between a mother and child of its age the infection was through the mother. Cases (3) (4) and (5) were in all probability infected through case (2). The following cases occurred in connection with Nos. 67, N Street and 42 A Street, premises which were sanitarily in a very fair condition. (1.) Eobert S., aged 20, residing at No. 42, A Street, but working at No. 67, N Street, a greengrocer's shop, was admitted into St. Bartholomew's Hospital on July 8th, and certified to be suffering from typhoid fever on July 19th. This patient was still in hospital on September 23rd. (2.) Minnie S., aged 38, mother of the above, residing at No. 67, N Street, was taken ill about September 3rd, admitted into St. Bartholomew's Hospital on September 6th, and certified to be suffering from enteric fever on September 21st. She had been in the habit of visiting her son in the hospital during his illness about once a week. The following cases occurred at No. 68, W Terrace, a house in a very fair sanitary condition. (1.) Ludwig K., aged 28, cabinet maker, was first observed to be unwell about the end of August. He became worse and finally took to his bed and kept his bed for about six weeks. He began to get about again from October 14th, but on October 28th was still weak and looked as if he bad had a serious illness. The symptoms which were noticed by the patient's wife or complained of by him were headache, loss of appetite, feverishness which appears to have lasted a considerable time and diarrhoea on two or three occasions. The history of his case was consistent with his illness having been enteric fever. (2.) Albert M., aged 20, a lodger at No. 68, W Terrace, was first observed to be ailing about October 7th. He was certified to have enteric fever on October 26th and was removed to the house of some relatives in an adjoining Borough the following day. The patient worked with case (1) as a cabinet maker. (3.) Clara K., aged 26, wife of case (1) was noticeably ailing towards the end of October, and was certified to be suffering from enteric fever on November 8th. This patient waited upon her husband during his illness and at the same time attended to her household duties, amongst other things prepared the food for case (2) who probably was thus infected. The following cases occurred at No, 7, Little Street, a house in fair sanitary condition, consisting of four small rooms. 20 (1.) Annie S., aged 22, working at a wholesale stationer's in Whitechapel, was ill from the beginning of September, took to her bed about September 14th and was certified to have typhoid fever on September 28th, and removed to hospital. (2.) Edith S., aged 6, was ailing from the beginning of October and was certified to have enteric fever and removed to hospital on October 24th. (3.) Robert S., aged 50, father of the above patients, was taken ill about October 17th and certified and removed to hospital on October 26th. The wife of Robert S. looked after case (1) during her illness and also after the other two cases. She also attended to her household duties and prepared food for the family. There were several other children besides the patients in the family. The probability is that case (1) infected case (2) and case (2) passed the infection on to case (3). It is possible, however, that cases (2) and (3) were infected through the medium of food prepared by the mother whilst she was nursing the first case. One of the chief reasons why the disease spreads in the manner illustrated by the series of cases given above, lies in the fact that the primary cases are frequently not recognised to be enteric fever until a considerable period has elapsed, often amounting to three or four weeks from the beginning of the illness. The infectious nature of the malady is not realized, and no precautions are consequently taken. Granting that there is no superabundance of room space in the dwelling, and that the means for efficient nursing at home are inadequate which is likely to be the rule in a working class district like Shoreditch, it can hardly be held surprising that secondary cases occur, for even in hospitals where cases are treated under the very best of conditions nurses and doctors sometimes take the disease. Other conditions which are favourable to the spread of infection are unskilled nursing and want of cleanliness, and there is always great risk when a person engaged in attending to a patient suffering from enteric fever is in the habit of preparing food for other people. In a large proportion of the cases of enteric fever certified in Shoreditch no reliable information throwing light upon the source of the disease is obtainable. It is therefore impossible to form anything like an accurate estimate as to how far personal infection plays a part in the propagation of the disease. It may, however, be mentioned that of some 730 cases of enteric fever occurring in Shoreditch during the six years, 1898-1903, in 78 or 12 percent. there were good grounds for believing that infection was more or less directly conveyed from or taken from previous cases within the Borough. In consequence of a communication from the Medical Officer of Health for the City of London in the early part of the year my attention was directed to army blankets which were being sold to persons in the Borough. An outbreak of enteric fever occurred on board the training ship "Cornwall," in connection with which blankets sent back from South Africa were suspected of conveying infection. It appears that a large quantity of these blankets had been disposed of by certain firms in London to persons in various parts of the country and some of them found their way into Shoreditch. All the blankets which could be discovered at the time in the Borough were 21 taken possession of and disinfected at the Borough Disinfecting Station. About 60 were disinfected, and a good proportion of them were very dirty and stained. Careful enquiries were subsequently made as to the enteric fever cases in the borough, with a view to ascertaining whether there were any reasons for believing that blankets from South Africa had had anything to do with the origin of the cases, but the results were negative. In connection with the subject of typhoid fever, mention may be made of "paratyphoid" or "paracolon fever," a condition which has, during the last few years, been attracting the attention of observers in this country, Prance, Germany, America and elsewhere. "PARATYPHOID" FEVER is a malady which may be said to resemble typhoid fever in every feature, but is generally a less severe disease. It is stated chiefly to affect young adults. It is not caused by the Bacillus Typhosus, but by, a different though closely related microorganism, the "paratyphoid" bacillus of which there appear to be several varieties About a hundred cases have now been described. The disease is only to be differentiated from typhoid fever by bacteriological examination. If in a case resembling typhoid fever Widal's reaction is absent or but slightly developed, "paratyphoid"fever may be suspected. One case which may have been "paratyphoid" fever attracted my attention during the year; a confirmatory test as to the presence of the "paratyphoid" bacillus was, however, not applied so that a positive statement as to the diagnosis cannot be made. For the information as to the clinical features of the case I am indebted to Dr. James, of Pitfield Street, and the house physician at the Great Northern Central Hospital. The patient, F. G., aged 34, seems to have been taken ill about October 9th, and was under the care of Dr. James from October 11th to October 19th, when his case was certified to be one of typhoid fever, and it was thought advisable for him to be removed to the hospital above mentioned. The signs and symptoms were similar to those met with in mild attacks of typhoid fever. Spots resembling those of enteric fever were observed on the abdomen on October 18th. The temperature varied between 101° to 103° F. The result of a Widal's examination made by Dr. Bulloch at the London Hospital was negative. Widal's test was also repeated at the Great Northern Hospital, but the results were negative. The case was regarded at the hospital as one of mild typhoid, and was certified as such accordingly. The disease ran the usual course of a mild uncomplicated case of typhoid fever. ERYSIPELAS. The cases certified as Erysipelas numbered 147, as compared with 173 last year. The numbers for previous years are given in the report for 1901. The deaths were 7, as compared with 8 in 1902, 6 in 1901,10 in 1900, 16 in 1899, 11 in 1898, 5 in 1897, 3 in 1896, 5 in 1895, 5 in 1894, and 15 in 1893. 22 The cases and deaths amongst males and females in the four registration sub-districts were distributed as set out below:— Sub-District. ERYSIPELAS. Cases Certified. Fatal Gases. Male. Female. Total. Male. Female. Total. Shoreditch South 8 15 23 2 - 2 Hoxton New Town 23 22 45 — 2 2 Hoxton Old Town 11 15 26 1 - 1 Haggerston 17 36 53 1 1 2 Total for the whole Borough 59 88 147 4 3 7 The death-rate was 006 per 1,000 inhabitants, as compared with 0 06 in 1902, 0.05 in 1901, 0.08 in 1900, and 0.13 in 1899. The deaths were at the rate of 4.7 percent. of the cases certified, as compared with 4.6 in 1902, 4.2 in 1901, 5.8 in 1900, and 8 in 1899. Blood poisoning (pyaemia and septicaemia) resulted in 17 deaths, 11 of males and 6 of females. Infective endocarditis was given as the cause of death in 3 cases. Other diseases allied to the foregoing caused 2 deaths. PUERPERAL FEVER. Seven cases were certified, the attacks per 1,000 births being at the rate of 1.7, as compared with 2.2 in 1902, 1.7 in 1901, and 2.5 in 1900. The death-rate due to the disease was 0.2, as compared with 0.7 in 1902, and 0.5 in 1901. DIARRHœA. Diarrhoea was most prevalent in the Borough during August and September. The deaths from diarrhoea were 16 in July, 47 in August, 45 in September, and 14 in October. A few deaths were registered prior to July, and 8 during the months of November and December. The total number of deaths due to the disorder was 143, excluding 66 deaths, attributed to enteritis and gastro-enteritis. Of the deaths from diarrhoea, 117 were of infants under one year, 23 of young children under the age of five years, and the remaining 3 were of adults of thirty-five years and upwards. The death-rate due to diarrhoea was 1.23 per 1,000 inhabitants, as compared with 1.12 in 1902, 1.30 in 1901, 1.40 in 1900, 1.75 in 1899, 1.79 in 1898, and 1.74 in 1897. The rate was highest in Hoxton New Town, and lowest in Haggerston. The deaths from diarrhoea in the Metropolis numbered 2,949, of which 1,930 occurred during the 23 months of August, September, and October. The deaths from diarrhoea in the . Metropolis were at the rate of 0.64 per 1,000 inhabitants, as compared with 0.53 in 1902, and 0.85 in 1901. In the subjoined Table is contained a comparison of the mortalities from diarrhoea in Shorediteh and London of infants under one year per 1,000 births during the years 1895 to 1902 inclusive. Year 1895 1896 1897 1898 1899 1900 1901 1902 Shorediteh 30.5 28.7 38.2 38.9 39.7 35.7 3.15 27.0 London 20.7 18.9 24.2 26.1 25.0 21.8 24.1 14.5 During 1903, the mortality from diarrhoea amongst infants under one year in Shorediteh was at the rate of 30.5 per 1,000 births. MEASLES. The above destructive disorder accounted for 99 death, 48 of males, and 51 of females, all of children under ten years of age. Seven of the deaths belonged to Shorediteh South fifty to Hoxton New Town, seventeen to Hoxton Old Town, and 25 to Haggerston. The disease was most fatal in the New Town registration subdistrict. The deaths in the Borough were at the rate of 0.85 per 1,000 inhabitants, as compared with 0.72 in 1902, 0.64 in 1901, 0.63 in 1900, 0.69 in 1899, 0.83 in 1898, and 0.91 in 1897. The rates for previous years are given in the report for 1901, The deaths from measles during 1903 were most numerous in the months of March, April, May and June. The most deaths in any one month occurred in June. The fewest deaths occurred during the taree months September, October and November. The deaths from measles in London during 1903 numbered 2,046, and the deathrate was 0.44 per 1,000 inhabitants. Early in the year an order was made by the London County Council applying to measles in the administrative county of London, the provisions of sections 60, 61, 62, 63, 64, 65, 68, 69, 70, 72, 73 and 74, of the Public Health (London) Act, 1891. This order, duly approved by the Local Government Board, came into operation on April 1st of the year under consideration. The sections mentioned relate to dangerous infectious disease, and deal with the cleansing and disinfection of premises, bedding, and other articles, and other measures for the prevention of the spread of infection. Measles, although for the purposes of these sections classed amongst the dangerous infectious diseases—and it undoubtedly is a dangerous infectious disease—is not a notifiable disease, nor are cases of it receivable into the fever hospitals of the Metropolitan Asylums Board. 24 Since the order came into operation, up to the end of the year, intimations were received as to the existence of measles at 342 houses. The great majority of these intimations were from school teachers. The enquiries made showed that in 42 instances the illness appeared not to have been due to measles, and in two others the patients did not belong to Shoreditch. The number of premises in which measles actually existed was, therefore, 298, and in 279 of these the information as to the existence of the disease came from school teachers. Disinfection up to the end of the year was carried out by the officers of the Borough in 207 instances, the usual steps being taken as to the removal of the bedding and the fumigation of the rooms occupied by the patients. Altogether 221 rooms were fumigated, and 162 beds, 42 mattresses, 306 pillows, 97 bolsters and 968 other textile articles of various descriptions were removed and disinfected at the Borough Disinfecting Station. The Council's order has resulted in a considerable amount of additional work falling upon the sanitary staff, as all houses in which cases of measles are said to exist, which come under observation, have to be visited with a view to instructions being given for the prevention of the spread of the disease and the necessary precautions being taken as to disinfection. Unfortunately, owing to the fact that it is practically impossible to isolate cases of measles under ordinary conditions in Shoreditch, the chances of checking the spread of infection in a house are not very hopeful. The order, however, may be expected to have a good effect in checking the spread of infection from household to household, by keeping patients confined to their dwellings, preventing them being taken in public conveyances, or otherwise exposed to the danger of the public, by the exclusion of children, belonging to infected families, from school, and by ensuring adequate measures being taken as to disinfection before children return to school. WHOOPING COUGH. Whooping cough resulted in 41 deaths, 18 of males and 23 of females. All were of children under ten years of age, and 39 of them were under five years. The death-rate due to this disorder was 0.35 per 1,000 inhabitants, as compared with 063 in 1902, and 0.49 in 1901. The rates for previous years are contained in the report for 1901. Deaths from the disease were more numerous during the first half of the year. The deaths from whooping cough in the Metropolis during 1903 amounted to 1,627, and the death-rate was 0.35 per 1,000 inhabitants. INFLUENZA. Influenza was accountable for 19 deaths, as compared with 14 in 1902, 16 in 1901, 52 in 1900, 35 in 1899, 22 in 1898, and 16 in 1897. The figures for previous years are contained in the report for 1901. The deaths from influenza were mostly 25 registered the first five months of the year under consideration. None were registered during the five months, June to October, and only three during November and December. In the great majority the fatal cases of influenza—and the same remark applies in the cases of measles and whooping cough—were complicated by the onset of pneumonia and bronchitis. The deaths from influenza in London during 1903 numbered 644, as compared with 1,036 in 1902, 664 in 1901, 1,950 in 1900, and 1,817 in 1899. The deaths were most numerous in January, February and March, and least so ia August September and October. TUBERCULOSIS. Tuberculosis (Appendix Table V. Nos. 29 to 34), was given as the cause of 376 deaths, as against 295 in 1902, 363 in 1901 and 343 in 1900. Of the total number of deaths in Shoreditch during 1903 no less than one-sixth was attributed to tuberculosis. The great majority of these deaths were registered as due to phthisis or consumption. The death-rate from tuberculosis in the Borough was 3.2 per 1,000 inhabitants. The deaths from consumption numbered 271, of which 171 were of males, and the deathrate was 2.3 per 1,000, as compared with an average rate of 2.05 for the previous 10 years in the Borough, and a Metropolitan death-rate for 1903 of 1.5 per 1,000 inhabitants. During the year, disinfection was carried out by the officers of the Borough Council in connection with 67 houses in which persons suffering from tuberculosis had resided before death. In some 62 houses more or less efficient measures were taken by responsible persons resident therein in preference to allowing the Council's officers to act. In most instances consumption was the form of the disease which required to be dealt with. In all cases in which information is received as to deaths from consumption occurring in the Borough in dwelling houses, the friends are communicated with by letter advising that proper precautions should be taken as to disinfection, and pointing out that the necessary measures are carried out by the Borough Council free of charge. Disinfection is not undertaken by the Council's officers in public institutions which are under the supervision of responsible medical officers. A large proportion of the deaths from tuberculosis, especially consumption, takes place in public institutions. The important question of the provision of places especially constructed and adapted for the treatment of persons suffering from consumption has been occupying the attention of Sanitary Authorities in various parts of the Kingdom for some time past. In the Metropolis Shoreditch and a number of the other local authorities are in favour of the Metropolitan Asylums Board undertaking the task of providing the accommodation necessary for the treatment of such cases, and it has been proposed to the managers that they should establish sanatoria. It would unquestionably be a great boon to the people of London if proper institutions were provided for this 26 purpose. At the present time large numbers of cases of phthisis or consumption, at a stage of the disease when much good might be hoped for with appropriate treatment, are compelled to live under conditions which are not only most prejudicial to their chances of escaping death from the disease, but also render them sources of danger to their friends and relatives and to the general public. In such cases it is' easy to advise the friends as to the danger of infection and the steps which should be taken, but where the accommodation is insufficient and there is a lack of means, as is unfortunately the case to a very large extent in the poorer districts of the Metropolis, such advice is for all practical purposes futile. In many cases the patients eventually drift into public institutions, usually poor-law infirmaries. In them they are well looked after, but it is in the vast majority of cases too late for the sufferers to derive any permanent benefit. Moreover these institutions were not constructed with the idea of affording a special treatment for consumption cases, and other inmates who are not afflicted with the disease may be more or less exposed to danger. It seems to me that the time has come when proper sanatoria for the treatment of the disease should be provided for the use of the people of London, and with its years of experience in hospital management the Metropolitan Asylums Board is in my opinion the most appropriate authority for this purpose. The Managers of the Metropolitan Asylums Board have had the matter under their consideration. They regard the question of the proposed establishment of sanatoria for consumptive persons, as one of vital and far-reaching importance to the community. The proposal is, however one, which, if adopted, would entail a considerable extension of their duties and responsibilities, and a large increase in their expenditure. Before taking action, therefore, the Managers have called for some authoritative expression of opinion on the part of the Local Government Board. TETANUS. Five deaths from tetanus, a disease more generally known as lockjaw, were registered during the year. This disease is common to man and certain animals, especially horses, sheep and oxen, and is most frequently met with amongst persons employed on farms, in gardens, and in stables. It is due to a micro-organism, which obtains entrance to a wound through want of proper attention to cleanliness, or through infected soil contaminating wounds, or through inoculation with discharge from an animal suffering from the disease. The disease is extremely fatal. Of the 5 deaths 2 were of infants five days old. One occurred in March, and the other in August, the former being registered as due to tetanus neonatorum, and the latter to umbilical irritation, trismus, and traumatic tetanus. The other 3 cases are interesting and worthy of note:— (1.) Richard L., aged 29, a brass turner, living at No. 44, H-Street, punctured his left foot under the ball of the big toe, on May 10th, with 27 a rusty nail, which was sticking up in a piece of wood forming part of an old chicken coop. The puncture was made through the sole of his boot. It appeared to heal, but subsequently matter gathered in the wound. The patient was seen by his doctor, on May 19th, when it was observed that there was some difficulty in swallowing. Stiffness of the neck was noticed by the patient the day before. On May 20th the jaw was fixed, and there was rigidity of the muscles of the back and neck and elsewhere, and a good deal of pain was complained of. He was removed to University College Hospital, where he died on May 24th. The backyard where the chicken coop had been lying abuts on the back of the stables belonging to an Omnibus Company. (2.) M., aged 63, a horse hair curler, residing at 34, E-Street, and employed in Bunhill Bow, whilst at work, dislocated one of his fingers and wounded one of his hands, on May 30th. The wound became inflamed, and he went into hospital on June 2nd, and died from tetanus on June 5 th (3.) F., aged 3 11/12, daughter of a carman, living at No. 28, P-Street, was knocked down and crushed by a tramcar in the New North Road, on May 27th. She sustained serious injuries to her head, and died from tetanus in St. Bartholomew's Hospital, on June 10th. It will be observed that in all three cases it is possible that infection came from the horse, for in the first case the yard in which the chicken coop was lying was in close proximity to stables, where there were a large number of horses; in the second case, the man worked with horse hah; and in the last case, the little girl was the daughter of a carman, and was crushed on a road where probably infection obtained access to her wounds. INFECTIOUS DISEASES AND SCHOOLS. In the following Table are set forth the numbers of children, belonging to Shoreditch, who were suffering from infectious diseases, or were members of households in which infectious diseases existed, concerning whom intimations of exclusion from school were received from the head teachers, in accordance with the requirements of the regulations of the London School Board:— 28 SCHOOL. Smallpox. Diphtheria Scarlet Fever Measles Chickenpox Whooping Cough Mumps Other Diseases Total Bath Street ... l ... 5 2 ... ... 1 9 Columbia Road ... l ... ... ... ... ... ... 1 Canal Road 1 l 3 84 37 14 10 1 151 Chatham Gardens ... • • • ... 8 ... ... ... 3 11 Curtain Road ... ... ... 31 ... ... ... 1 32 Daniel Street ... ... ... 1 ... ... ... ... 1 Fellows Street ... 2 ... 68 ... 5 4 2 81 Gopsall Street ... 3 6 90 22 27 206 28 382 Haggerston Road ... 3 9 94 20 3 4 14 147 Hammond Square ... ... ... 27 ... 2 ... ... 29 Maidstone Street ... 1 ... 58 11 2 4 31 107 Napier Street ... 1 1 78 7 ... ... 8 95 Richards Road ... ... ... 6 ... ... ... ... 6 Redvers Street ... ... ... ... ... 2 ... ... 2 Scawfell Street ... 4 1 156 40 1 43 31 276 Scrutton Street ... ... ... 6 5 ... 13 4 28 Shepperton Road ... ... ... 2 2 ... ... ... 4 St. John's Road ... 4 1 43 1 ... 2 5 56 Teesdale Street ... ... ... 1 ... ... ... ... 1 Trinity Place ... ... ... 98 13 ... ... 1 112 Virginia Road ... ... ... 9 1 ... ... ... 10 Wenlock Road ... 1 1 93 11 ... 1 11 118 Totals l 22 22 958 172 56 287 141 1659 The information respecting a case of small-pox, included in the above Table, was on enquiry, found to be erroneous. During the year attention was especially directed to the undermentioned schools:— Scawfell Street School—came under notice in January by reason of the prevalence of measles amongst the children attending the infants' department. The infants' room was closed for three weeks, and the necessary disinfection was carried out by the sanitary authority. Trinity Place School—came under notice early in March, and then again just before the Easter holidays. On the latter occasion it was found that about 37 per cent. of the children attending the babies' class were absent on account of measles. The holidays of the babies were extended to 17 days, during which period the class-room was thoroughly cleansed and aired. Napier Street School—came under observation towards the end of May. The babies' room in the infants' department was closed on account of measles, and 29 disinfected. A watch was kept on the infants' department, but the prevalence of the disease becoming less no further steps were necessary. Haggerston Road School—one of the class-rooms in the infants ' department was closed for a fortnight in June, on account of measles, and disinfected. St. John's Road School—came under notice in September, by reason of a case of scarlet fever having been discovered amongst the children attending one of the classes. The necessary steps were taken as to disinfection. About 12 days after a second case was found in the school, but in another class. This patient was desquamating. So far as could be ascertained no connection was traceable between these cases beyond the fact that they were attending the same school. The precautions as to disinfection were repeated, and no cases occurred amongst the children attending the school which could be traced to either of the cases above mentioned. Canal Road School—came under notice early in December, on account of the prevalence of measles. The decrease in the attendance of the infants in the babies' room amounted to 34 per cent., and the room was closed for a fortnight and disinfected. Gopsall Street School—came under observation in December, also on account of measles in the infants' department. The babies' room was closed for a fortnight, and disinfected. In all the foregoing cases the rooms were closed on the advice of the Medical Officer of the School Board. BACTERIOLOGICAL EXAMINATIONS. In 32 cases of suspected infectious disease, bacteriological examinations were made by Dr. Bulloch at the London Hospital Medical School. In ten of the cases the disease suspected was consumption, in twelve it was diphtheria, and in ten typhoid fever. In seven of the suspected consumption cases and in two of the diphtheria cases the results as to the presence of the specific micro-organism were positive. In half of the suspected cases of typhoid fever the examinations for Widal's reaction yielded positive results. DISINFECTION. During the year 740 premises were disinfected. The number of articles removed to the Borough disinfecting station for disinfection amounted to 8,911, as compared with 55,025 in 1902, and 17,226 in 1901, and included 703 beds, 493 mattresses, 1,301 pillows, 509 bolsters and 5,905 miscellaneous articles. Seven beds and two palliasses 30 were destroyed and new ones were supplied in their place by the Borough Council. The great difference between the amount of disinfection in 1903, as compared with the amounts for 1902 and 1901, is mainly due to the absence of small-pox in the Borough in 1903. Towards the end of December, spraying the walls of infected rooms with formalin solution (2 per cent.) was substituted for fumigation with sulphur fumes. An "Invicta" sprayer, supplied by Messrs. Lumley and Co., is being used at present for this purpose. It takes from five to twenty minutes, according to size, to thoroughly spray a room, whereas fumigation with sulphur under ordinary circumstances requires about eight hours, and in some cases a good deal longer, for effective action. According to the results of experiments made by bacteriologists, formalin solution of a strength of 2 per cent. is very satisfactory as a germicide. The change in the practice as to dealing with infected rooms promises well, but a longer experience is necessary before a definite opinion can be pronounced as to the result. THE SHELTER. The following are the particulars as to the use of the shelter in Reeve's Place during the year:— Date of admission to Shelter. Length of stay therein. Number of Persons. Address from which the persons were admitted to the Shelter. Disease. June 16 1 day 6 6, Barton Court Enteric Fever September' 14 1 night 3 4, Canal Road Scarlet Fever October 8 1 night 2 30, Fairbank Street Scarlet Fever November 2 1 night 3 1, Collingwood Street Scarlet Fever The shelter was used on four occasions by 14 persons belonging to four families. THE PUBLIC MORTUARY. The dead bodies taken into the mortuary numbered 450, and included the bodies of three persons removed by the Sanitary Authority on account of infection or to prevent nuisance. The number of bodies deposited in the mortuary during the previous six years were as follows:—444 in 1902, 420 in 1901, 443 in 1900, 494 in 1899, 446 in 1898, and 421 in 1897. The post-mortem examinations made in the 31 post-mortem room attached to the mortuary, numbered 245, as compared with 243 in 1902, 215 in 1901, 229 in 1900, 232 in 1899, 164 in 1898, 159 in 1897, 128 in 1896, 109 in 1895, 60 in 1894 and 29 in 1893. The number of inquests held at the Coroner's Court in respect to the bodies of persons belonging to Shorditch, was 323, as compared with 319 in 1902, 298 in 1901, 324 in 1900, 854 in 1899, 339 in 1898, 331 in 1897 and 301 in 1896. WATER SUPPLY. According to the figures given in the reports on the London Water Supply, by Sir William Crookes, E.R.S., and Professor Dewar, F.R.S., during the year 1903, the rainfall at Oxford amounted to 35.84 inches. The mean rainfall for 35 years is given at 25.29 inches. The total excess of rain for the year was, therefore, 10 55 inches; or 41.7 per cent. of the 35 years' average. The year was one of the wettest on record. Most rain fell during the months of May, June, July, August, and October. The wettest month was October, during which month 6.41 inches fell, the amount being 3.65 inches above the 35 years' average. The water supplied by the New River Company was observed to be markedly coloured on several days in October. The colouration—a brownish tint—was readily noticeable with the water in large quantities, as in the public baths in Pitfield Street, and attention was drawn to the fact in the Council by the Chairman of the Baths Committee. The colouration of the water, which was more or less noticeable during the autumn months, was attributable to the excessive rainfall which caused the solution of considerable amounts of vegetable matter. There was nothing to suggest the occurrence of any water-borne diseases in the Borough. Communications were received in accordance with the requirements of section 49, of the Public Health (Lond.) Act, 1891, relative to the water supplies being cut off at 81 premises on the East London Company's District, and 78 on that of the New River Company. In many instances the intimations referred to empty premises. SANITARY WORK. Preliminary notices as to insanitary conditions were served in respect to 2,164 premises. The Chief Sanitary Inspector dealt with 213 premises, Inspector Lear with 485, the late Inspector Quelch with 81, Inspector Firth with 437, Inspector Jordan with 337, Inspector Langstone with 414, and Inspector Clements with 197 premises. In connection with the work, 1,004 letters were written to owners of property, builders, and other parties concerned. In the subjoined Table is contained a summary indicating the nature of the various works carried out for the abatement of nuisances and for the improvement of the 32 In the subjoined Table is contained a summary indicating the nature of the various works carried out for the abatement of nuisances and for the improvement of the dwellings of the people, which has been compiled from the abstracts of their work prepared by the sanitary inspectors:— Chief Insp. Insp. Lear. Insps. Quelch and Clements. Insp. Firth. Insp Jordan. Insp. Langstone. Total New drains constructed 1 9 12 10 4 20 56 Drains re-constructed or repaired 82 31 62 72 31 39 317 Sink waste pipes trapped and disconnected — 31 28 70 29 11 169 Stack pipes re-instated 48 85 81 51 18 30 313 Eaves gutters re-instated 46 89 85 63 5 28 316 Stack pipes disconnected from drains 25 15 24 22 39 7 132 Accumulations of sewage dealt with 9 5 4 1 7 31 57 Cesspools abolished 1 - — — — — 1 New water closets constructed 44 61 10 10 44 5 174 Old water closets re-constructed or repaired 41 55 44 75 52 75 342 Water closets cleansed and white-washed 6 326 155 57 163 62 769 Water restored or newly laid on to water closets 12 49 26 52 16 11 166 Obstructions in water closets removed 11 32 32 16 15 5 111 Overcrowding in houses abated 13 16 4 19 6 27 85 Damp courses in houses provided 15 2 4 7 1 2 31 Walls pointed 27 14 13 49 — 2 105 Roofs repaired 41 101 83 85 29 89 428 Stairs repaired 47 19 50 73 8 14 211 Floors repaired 52 41 45 70 5 26 239 Ventilation under floors provided 4 4 30 40 3 16 97 Doors repaired 46 10 57 73 8 14 211 Door cills provided 61 55 27 57 1 21 222 Sashes repaired 48 70 50 21 1 29 219 Houses cleansed throughout 79 25 53 27 22 14 220 Houses cleansed in part 48 194 118 284 143 127 914 Total number of rooms cleansed.. 567 647 485 826 409 413 3347 Yards or areas lime-washed 31 334 67 34 120 12 598 Yards paved 60 64 44 85 20 51 324 Areas or forecourts paved 7 24 28 29 — 8 96 New areas constructed 4 3 4 1 — — 12 Sculleries paved 11 7 16 21 — 7 62 Dust receptacles provided 35 68 45 91 26 52 317 Dung receptacles provided - - 1 4 — — 5 Insanitary cisterns removed 3 5 1 — — — 9 In connection with the sanitary work carried out, 12 defective brick drains were removed, and in 63 instances nuisances and annoyance caused by the presence of rats on premises were dealt with, in most of which cases the drains were found to be defective and were constructed or repaired, the number so dealt with being included in the figures given above. On 99 premises leaking water pipes required attention. Urinals were constructed on five premises, and on 31 they were repaired or cleansed Foul accumulations of various descriptions to the number of 152 were removed in accordance with requisition from the sanitary officers. On 15 premises animals were found not properly stabled, and the necessary steps were taken to secure this, and in 33 31 instances stable3 were properly paved under the supervision of the sanitary officers. The summary of the sanitary work given above includes that done in connection with the drains and water-closets of new buildings, and also the work done in pursuance of the requirements of the Factory and Workshop Act, 1901, with the exception of that carried out for the purpose of fitting underground bakehouses for the certificate of the Sanitary Authority. This work is more particularly referred to later, when dealing with the subject of bakehouses. In most instances the preliminary notices setting forth the insanitary conditions requiring attention, served by the sanitary inspectors, were complied with. In 195 cases, however, it was necessary for the Sanitary Authority to serve statutory notices under the Public Health (London) Act, 1891, upon persons responsible for the abate- ment of nuisances. For non-compliance with these notices, and for infringement of bye-laws made under the Act, Police-court proceedings were taken in respect to the premises, and with the results as set out below: Premises. Result of Proceedings. Bevenden Street, No. 88 Summons withdrawn, 3/- costs allowed to Council. Goldsmith Row, No. 118 Order for abatement of nuisance, 6/- costs allowed. „ „ „ For non - compliance with Magistrate's order, fined £1 with 3 guineas costs. Hoxton Street, No. 128 Closing order, 6/- costs. Mintern Mews, No. 2 Infringement of L.C.C. Byelaws as to dung removal. Defendants were convicted, but no fines were inflicted or costs allowed by the Magistrates. „ „ 12 „ „ „ „ „ 13 „ „ „ „ „ 14 „ „ „ „ „ 19 „ „ „ „ „ 22 „ „ „ „ „ 23 „ „ „ St. John's Road, No. 41 Order for abatement of nuisance, 6/- costs. Watson's Place, No. 1 For non-compliance with nuisance order, penalty £5, with 2/- costs. „ „ 2 „ „ „ „ „ „ 3 „ „ „ „ „ „ 4 „ „ „ „ „ „ 5 „ „ „ „ „ „ 6 „ „ „ „ „ „ 8 „ „ „ „ Watson's Place, No. 1 No nuisance order made, but 3/- costs allowed Council. „ „ 2 „ „ „ „ „ „ 3 „ „ „ „ „ „ 4 „ „ „ „ „ „ 5 „ „ „ „ „ „ 6 „ „ „ „ „ „ 8 „ „ „ „ Whitfield Street, Nos. 6 to 9 Infringements of L.C.C. Bye-law, 2 summonses, 2/- costs allowed in each case. 34 With respect to No. 88, Bevenden Street, the summons was taken out by Inspector Lear in consequence of non-compliance with a notice in respect to a Combined drain, which was in a defective condition. It was contended that the same was a sewer, and therefore reparable by the Council. The Council, however, was in possession of a complete record relating to the construction of the drain, and when the case came into Court the owner consented to do the necessary work. The summons was thereupon withdrawn on the owner paying 3s., the cost thereof. The proceedings in respect to 118, Goldsmith Row, were taken on account of the leaky condition of the roof of the house. A second summons had to be taken out by Inspector Firth before the order made by the magistrate was complied with. The proceedings as to No. 128A, Hoxton Street, are dealt with later. With regard to the Mews in Mintern Street, complaints were received as to the smells emanating from the dung receptacle provided for the use of the stables situate in the Mews. Intimation notices were served upon the responsible parties, but without effect. It was thereupon decided to take steps under the bylaws made by the London County Council under Section 39 (1) of the Public (London) Act, 1891. Section 26 of these bylaws provides that the occupier of any premises, shall once at least in every week cause every receptacle for dung belonging to such premises to be emptied and thoroughly cleansed. The breach of the bylaws was proved but the magistrate did not think it was, in any of the cases, necessary to inflict any penalty, nor to allow costs to the Borough Council. It appears that the summonses which were taken out by Inspector Langstone, referred to a period which included a bank holiday, a time when it would have been difficult, under any circumstances, to have got the dung removed. In the case of No. 41, St. John's Eoad, premises let as workshops, the summons was taken out by Inspector Langstone. The waterclosets were without water supply, the premises generally were dirty and delapidated, and the main roof was very defective, and leaked badly, rendering the walls and flooring very damp. The owner consented to an order being made by the magistrate for the abatement of the nuisance existing in connection with the premises, and subsequently closed them. The steps taken in respect to the seven houses in Watson's Place, so far as they relate to the year 1902, are referred to in my report for that year. At the end of the year the orders made by the magistrate had not been complied with. The 3 months allowed by the magistrate for the work to be carried out in having elapsed, and nothing of a satisfactory character having been done the owner was again summoned before the magistrate by the late Inspector Quelch, and was, as stated above, fined £5, with costs in each case for disobedience of the magistrate's orders. It was then thought advisable to commence de novo, and fresh statutory notices were served upon the owner for non-compliance with which he was again summoned, but when the cases came before the magistrate, it appeared that negotiations were in progress for the transfer of the property to another owner, it being stated that the property had 35 been sold. As there appeared to be some doubt as to who actually was the owner at the time the summonses came on for hearing the magistrate declined to make any nuisance orders, but allowed the Council the costs of the summonses. No further proceedings in the police court were necessary, as the new owner, on the property coming into his possession, complied with the requirements of the Borough Council, and under the supervision of the chief sanitary inspector an excellent sanitary improvement was effected, including general repairs and cleansing, new flooring, and staircases where required, painting, papering and white washing, repairs to waterclosets and other matters. In three instances it was necessary to close the houses altogether, and in the others it was necessary to get some of the people out. The houses were dealt with in turn, and the people that remained were transferred from house to house as occasion required, so as to obviate the necessity of emptying the houses altogether. The proceedings under the London County Council bylaws, made under Section 39 (1) of the Public Health (London) Act, 1891, were taken in respect to the construction of a water-closet. Two summonses were taken out by Inspector Jordan against the offender—a builder. One was for not giving notice to the sanitary authority of his intention to do the work as required by one byelaw, and the other was for doing the work in such a manner as to contravene the requirement of another bylaw. When the case came before the magistrate the defendant pleaded ignorance, and stated that he had done the work over again, under the supervision of the sanitary Inspector, in a proper manner. Under the circumstance the magistrate thought that it would be sufficient to allow the Borough Council 2s. costs on each summons. HOUSES CLOSED. The following is a list of the houses closed during the year in consequence of the service of sanitary notices, either on account of being unfit for habitation or in order that the works necessary to put them in a satisfactory sanitary condition could be carried out in an efficient manner:— Alma Street, No. 3. Axe Place, Nos. 7 and 9. Britannia Street, No. 80. Byng's Buildings, No. 4. Clifton Street, No. 16. Ebenezer Buildings, No. 2. Gifford Street, No. 41. High Street, No. 189. Hoxton Street, No. 128a. Loanda Street, No. 56 Philip Street, Nos. 2 and 4 Provost Street, No. 109. St. John's Road, No. 41. Shepherdess Walk, No. 40. Ware Street, No. 41. Watson's Place, Nos. 2, 3 and 5. No. 3, Alma Street was closed by the owner on receipt of a sanitary notice from Inspector Langstone, the drain was relaid and the house cleaned throughout. The houses in Axe Place, Nuttall Street, consisting of 3 rooms each, were closed by the owner on receipt of sanitary notices from the Chief Inspector, in order that 36 they might be dealt with in an effectual manner, which was impossible whilst they were in occupation. An excellent sanitary improvement was effected. The water closets and sanitary arrangements generally were seen to, but it was not considered necessary to touch the drains, the brickwork was pointed, the paving of the yard in the front of the houses was re-constructed, and the yard properly drained, proper hearths were provided for the front rooms, and sills for the front doors, all delapidations were made good and the houses were cleansed and painted. Nos. 5, 11,13 and 15 Axe Place, although not closed, were also thoroughly dealt with in the manner above referred to at the same time. The house in Britannia Street, in the rear of which was a workshop, was dealt with by Inspector Lear, and was closed by the owner upon receipt of a statutory notice under the Public Health (London) Act, 1891. The house was in an extremely dirty and delapidated condition, and the walls of the workshop were in a dangerous condition and had been condemned by the District Surveyor. No. 4, Byng's Buildings was closed by the owner, on receipt of a sanitary notice from the Chief Inspector; the back wall of the house was sodden from top to bottom so as to render the house unfit for habitation. No. 16, Clifton Street was closed by the owner on receipt of a sanitary notice from Inspector Jordan. The house, which was occupied by members of more than one family, was in a very dirty and delapidated condition, and it was impracticable to proceed in a satisfactory manner with the work necessary until the premises had been evacuated. No. 2, Ebenezer Buildings was dealt with upon a sanitary notice from Inspector Langstone. The house was overcrowded, and in a very dirty and delapidated condition, and it was deemed necessary for the house to be emptied to get the work carried out in satisfactory manner. The house in Gifford Street was closed in order to allow of sanitary work including the reconstruction of the drain, being carried out in an effectual manner which would have been a difficult job whilst the house was inhabited. No. 189, High Street includes a bakehouse. The premises had been allowed to get into a very unsatisfactory sanitary condition, and on receipt of a statutory notice, under the Public Health (London) Act, 1891, the premises were vacated. With regard to No. 128a, Hoxton Street, which was dealt with by the Chief Inspector, this house has been during recent years, on several occasions, under the notice of the Council's sanitary officers, and efforts have been made to get it kept in a satisfactory sanitary condition. The house consists of some ten rooms, and when it again came under observation, during the early part of the year, it was found to be occupied by several families of Italians, numbering about thirty persons. The premises are very old, and it was found, on inspection, that they had again been allowed to get into a very dirty and also an extremely delapidated condition, and the genera . condition of the house was such as to render it quite unfit for habitation. Che owner was communicated with, and a statutory notice was served with a view to 37 obtaining a closing order under the Public Health Act. On the case coming before the magistrate, the owner agreed to a closing order being made. The house was vacated, and has since remained unoccupied. The house in Loanda Street was in such a dirty and delapidated condition that the owner, on receipt of a sanitary notice from Inspector Firth, thought it better to close it, in order to more effectually carry out the necessary work. The houses, Nos. 2 and 4, Philip Street were closed on receipt of sanitary notices from Inspector Clements. They were in a very dirty condition ; there was no light nor ventilation to the W.C., the flooring was defective, the walls damp, and the drains were very defective. It was impracticable to satisfactorily deal with the premises whilst they were in occupation, so the owner was advised to close them. No. 109, Provost Street was dealt with by the Chief Inspector, and on receipt of a statutory notice, under the Public Health Act, the owner decided to close the house. The walls were damp, and the premises generally were in a very dirty, delapidated and insanitary condition. The house in St. John's Road has already been referred to. With respect to No. 40, Shepherdess Walk, this house was in a delapidated and dirty condition, the roof leaked, and the water supply was defective. On receipt of a sanitary notice from Inspector Lear, the owner thought it advisable, in view of the fact that the premises were old and likely to be demolished in the near future, to close the house. It was closed for a time, but subsequently cleansed and generally repaired, and re-let. The house in Ware Street was closed on receipt of a sanitary notice from Inspector Clements. The drains and sanitary arrangements generally were bad, and the house required cleansing and repairing. The steps taken in connection with the houses in Watson's place, have already been mentioned. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. Subjoined are notes of cases of demolition, or intended demolition, of houses occupied by persons of the working class which came under observation during the year under consideration. Nile Street, Nos. 1, 3, 5, and 7. These are six roomed houses, and were pulled down in the early part of the year. Warehouses are in course of erection on the sites. Nile Street, Nos. 9, 11, 13, 15 and 17. It is understood that these houses, each of which consists of 6 rooms, are to be demolished at no distant date and that the site is to be occupied by warehouses. Underwood Place, Nos. 10, 12, 14, 16 and 18. These six-roomed houses were demolished early in the year, and warehouses are being erected on their sites. 38 Underwood Street, Nos. 26, 27, 28, 29, 30 and 31. These six-roomed houses have been demolished, and warehouses are to be built. Shepherdess Walk, 6 Almshouses. Each consisted of one room. They were demolished in the early part of the year. At the time of demolition they were occupied by persons of the working class. Warehouses are being built on their sites. Shepherdess Walk, No. 16, 18, 20, 22 and 24. These were shops, the upper portions of the houses, each consisting of 5 rooms, being let to persons of the working class. These houses have been closed and are shortly to be pulled down to make way for warehouses. East Road, Nos. 4 and 6. These were shops, with the upper parts of the houses occupied by persons of the working class. They have been pulled down to make way for warehouses. Underwood Street, Nos. 15, 16, 17, 18, 19, 20, 21, 22, 23 and 24. These sixroomed houses are to be demolished to make way for warehouses. The date of demolition is not fixed. Underwood Row, Nos. 4, 5 and 6. These houses, also six-roomed, are being demolished to make way for warehouses. Earl Street, Nos. 19, 21, 23, 25, 27, 29 and 31. These houses have been emptied, and are believed to be shortly coming down for the erection of warehouses. Each of these houses consists of seven rooms with a wash-house. Clifton Street, Nos. 25, 27, 29 and 31. These are shops with seven rooms and wash-house. They are empty, and are to be pulled down for the erection of warehouses. Scrutton Street, Nos. 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22 and 24. Each of these houses consists of four rooms. No. 6 is already empty, and it is understood that the rest will shortly be closed. They are to be demolished for the erection of warehouses. Paul Street, Nos. 22 and 24. These seven-roomed houses are empty, and are to be demolished to make way for warehouses. Clifton Street, No. 107. This house, which contains six rooms, is also empty, and is to be demolished in connection with the erection of warehouses. Vandy Street, No. 15. This house consists of six rooms and a basement. It is to be pulled down for business premises to be erected on its site. Brunswick Street, No. 4, 6, 8, 10, 12 and 14. These seven-roomed houses have been demolished, and the London School Board are going to erect a building on the site. 39 Hay Street. Some eight small three-roomed houses were pulled down in connection with an improvement which is being carried out for widening Goldsmith Row. Shepherdess Walk, Nos. 106 and 108, have been demolished, and the site is occupied by a Hostel now in course of erection. The number of persons displaced, when all the houses above referred to have been demolished, will probably not be less than 600, and a considerable proportion of them will have been obliged to seek dwellings elsewhere than in Shoreditch. SMOKE NUISANCE. The various shafts and chimneys, other than those of private dwellings, were kept under observation by the sanitary inspectors during the year, with a view to preventing the emission of black smoke. Some 14 communications on the subject respecting 10 premises were received from the London County Council, and two respecting three premises from the Coal Smoke Abatement Society. In each instance the existence of the nuisance was brought to the notice of the person responsible, and steps were taken to abate the same. It was not necessary to bring any of the eases under the notice of the Health Committee. FACTORY AND WORKSHOP ACT, 1901. The number of workshops on the register at the end of 1902 was 1,081 ; during 1903 there were 95 added to, and 43 removed from the register, and at the end of the year there were 1,133 registered. The following is a classification of the workshops registered according to the various trades for which they are used: (1) Furniture, woodwork, fittings, decorations and other branches of the furniture trade:— (a) Cabinet making 393 (c) Upholstery 65 (b) French polishing 68 (d) Other work in the trade 128 (2) Dress:— (a) Tailoring 77 (e) Boot and Shoe Trade 60 (b) Millinery 20 (f) Artificial flower 8 (c) Dressmaking 36 (g) Other workers 27 (d) Shirtmaking 5 (3) Skins, leather, hair and feather trades:— (a) Furriers 10 (c) Feathers 5 (b) Saddlery and harness 23 (d) Other workers 16 (4) Paper, printing, book, stationery and fancy goods trades:— (a) Box and bag makers 50 (b) Other workers 11 40 (5) Laundry and washing 33 (6) Chemicals, oil, grease and soap 5 (7) Pood Manufacturers 8 (8) Metals, machines, implements and conveyances 39 (9) Precious metals, jewels, etc 1 (10) Other trades than those mentioned above 35 In point of numbers the various workshops in connection with the furniture trade head the list with 654; those in which various articles of dress are made come next with 233, and the third on the list are those connected with the printing, stationery and fancy goods trades. Every workshop on the register was inspected once during the year. Those found to be in a satisfactory sanitary condition were not visited a second time. Those found to be in an unsatisfactory state were kept under observation until the necessary improvement in their condition was satisfactorily effected. A number of the workshops required inspection at frequent intervals, and in connection with these a large number of visits of inspection were made during the year. (See Appendix). The communications received from the Factory Inspector as to the establishment of new workshops within the Borough, numbered 33 and referred to 101 workshops of which 40 were used for various branches of the furniture trade, 32 for the making of various articles of wearing apparel, and 4 for laundry work, 5 for work in connection with leather and feathers, and the remainder, with the exception of 6, for stationery, book, fancy goods, and other work. 'In regard to the 6 excepted, in 3 the premises were not to be found, in 1 they were empty, in 1 they had been demolished and in 1 no work was carried on. On inspection, 58 of these workshops were found to be in a satisfactory sanitary condition. The remainder more or less required the attention of the sanitary officers for the rectification of sanitary defects. The written intimations received from the Factory Inspector, respecting insanitary conditions and infringements of the law relating to Public Health numbered 118 and referred to 179 workshops and workplaces. The chief insanitary conditions mentioned by the Factory Inspector were: want of cleansing in 97 instances, delapidations and dirt in 21, defective or insufficient watercloset accommodation in 36, absence of watercloset accommodation in 1, want of proper separate sanitary conveniences for the sexes in 8, overcrowding in 4, and other defects in 6. The premises thus brought under observation were all visited and inspected by the officers of the Borough Council. The insanitary conditions referred to, besides others 41 brought to light through the visits of the Sanitary Inspectors, were all dealt with, and the Factory Inspector was informed of the steps taken to remedy the conditions to which attention was drawn, in accordance with statutory requirements. The whole of the sanitary work in regard to these workshops and workplaces was satisfactorily completed within a few weeks after the close of the year. In addition to those brought under the notice of the Sanitary Authority by the Factory Inspector, some 224 factories, workshops and work places—mostly workshops—were dealt with during the course of the year. The bakehouses are not included in the above figures. The defects and insanitary conditions remedied were similar in character to those referred to in the preceding paragraph. Special attention was given to cleanliness, air space and ventilation, drainage of floors in cases where wet processes are carried on, and the provision of suitable and sufficient sanitary conveniences. Altogether, 392 notices were served by the Sanitary Inspectors with respect to 446 factories, workshops and workplaces. In some cases several workshops were included on a single notice. The following is an abstract of the sanitary work done in connection with factories, workshops and work places in the Borough during the year 1903. Drains relaid 14 New drains constructed 1 Stack pipe3 disconnected 14 Stack pipes reinstated 27 Eaves gutters reinstated 24 Sink water pipes disconnected 15 Yards paved 18 Forecourts paved 1 Areas paved 3 Water closets re-constructed 33 New water closets constructed 37 Water closets cleansed and limewashed 287 Light and ventilation provided or improved in water closets 27 Obstructions removed from water closets 29 Water closets repaired 10 Water closets disconnected from workshops 18 Urinals repaired and cleaned 11 Urinals constructe 1 1 Water supply restored 19 Leaking water pipes repaired 21 Rooms cleansed & whitewashed 637 Yards „ „ „ 131 Areas „ „ „ 24 Roofs repaired 66 Floors 21 Stairs 15 Doors 15 Sashes 6 Ventilation under floors provided 1 Ventilation of workshops improved 3 Dust receptacles provided 23 Foul accumulation removed 19 Overcrowding abated 5 Included in the above abstract is the work done under the supervision of the Chief Sanitary Inspector in connection with three warehouses erected during the year, which afford accommodatian for between two and three hundred persons. 42 In most instances the insanitary conditions were rectified on the receipt of notices from the sanitary inspectors, but in a certain number of cases there was delay in the execution of the work required, and it was necessary to bring 30 of the workshops under the notice of the Health Committee, by whose orders statutory notices under the Public Health (Lond.) Act, 1891, were served upon the parties responsible. In most of these cases the default was in respect to cleansing and general repairs for delapidations. Altogether 30 statutory notices were served, but in no case did police court proceedings become necessary. In connection with the provision of the Act relating to home-work, it may be mentioned that 21 lists of addresses of out-workers were received referring to some 357 persons. On examination it was found that 213 of these were not resident in Shoreditch. Their addresses were duly forwarded to the Authorities of the districts in which they were situate. Communications were received from other Sanitary Authorities relating to some 807 out-workers. Of these 769 resided in Shoreditch. The addresses of the remainder were sent on to the Authorities in whose districts they were situate. Where necessary, enquiries were made into the conditions under which home-work was being carried on. Although, in some cases, home-work had to be stopped for a time on account of infectious disease in the dwelling, no action was found to be required under sections 108-110 of the Act. It is necessary to enter somewhat into particulars with regard to the action taken this year by the Borough Council in respect to the BAKEHOUSES. Those above ground, i.e., in which the floor is less than 3 feet below the surface of the footway of the adjoining street or of the ground adjoining or nearest to the baking room, are situate at the addresses set out below:— Bridport Place, No. 65 Broadway, London Fields, No. 33 Brunswick Place, No. 13 City Road, No. 183 East Boad, No. 52 Goldsmith Bow, Nos. 117 and 136 Hackney Boad, Nos. 55 and 151 Haggerston Boad, Nos. 9 and 48 Harwar Street, No. 42 High Street, No. 189 Holms Street, No. 38 Hows Street, No. 48 Hoxton Street, Nos. 167 and 221 Kingsland Road, No. 41 Mansfield Street, No. 43 Newton Street, No. 46 Nile Street, No. 65 Pitfield Street, No. 30 Queen's Road, No. 59 Rushton Street, No. 7 Shepherd's Walk, Nos. 5, 28, 96 Sun Street, No. 37 Union Street, No. 7 Whiston Street, No 44. Whitmore Road, Nos. 2 and 42 Of the above 32 bakehouses, 26 were found on inspection to be in a clean and satisfactory sanitary condition, 3 required limewashing, in one the ventilation of the bakehouse needed improvement, and the water-closet accommodation provided was 43 not in accordance with legal requirements, in one the drainage arrangements required amendment, and in one instance, viz., the bakehouse at 189, High Street, the general sanitary condition of the premises was very unsatisfactory. This bakehouse was disused for a time; the steps taken in connection with it have already been referred to. It was relet as a bakehouse after being thoroughly dealt with. The bakehouse, situate at No. 183 City Road, is not at present in use; it was in a satisfactory state when inspected. The underground bakehouses in Shoreditch which were certified during the year in accordance with the requirements of Section 101 of the Factory and Workshop Act, 1901, number 46. They are situate at the addresses set out below:— Bevenden Street, No. 2 Bridport Place, No. 2 Bristow Street, No. 2 Britannia Street, No. 94 Brunswick Street, No. 126 Clifton Street, Nos. 32, 63, and 94 Cropley Street, No. 17 Dunloe Street, No. 41 Dunstan Street, No. 25 East Road, Nos. 82 and 103 Essex Street, No. 25 Hackney Road, No. 305 Haggerston Road, No. 78 Hoxton Street, Nos. 61, 74, 192, and 271 Hyde Road, Nos. 2, 63 and 73 Kingsland Road, Nos. 77, 164 and 200 Leonard Street, No. 91 Lee Street, No. 33 Marlborough Road, No. 36 Murray Street, No. 92 New North Road, Nos. 59 and 93 Paul Street, Nos. 16 and 26 Pearson Street, Nos. 7 and 78 Pitfield Street, Nos. 2, 17 and 76 Pownall Road, No. 102 Shaftesbury Street, No. 87 St. John's Road, Nos. 16, 39, 86 and 169 Sturt Street, No. 12 The underground bakehouses which were not certified at the end of the year 1903 numbered 7. They are situate as follows: — Bridport Place, No. 88 Cropley Street, No. 53 Great Cambridge Street, No. 36 Hoxton Street, Nos. 141 and 179 Kingsland Road, No. 273 Phillip Street, No. 86 No applications for certificates were received in respect to these bakehouses. Those situate at Nos. 88 Bridport Place and 273 Kingsland Road could be put into condition to merit certificates without much expense. That at No. 58, Cropley Street is a small unsatisfactory bakehouse, and has been disused as a bakehouse for about 18 months. No baking has been done at No. 35, Great Cambridge Street for several months past, and the premises have been converted into a general shop. The bakehouse in Phillip Street has been disused for 12 months ; the premises are empty and partly demolished. In my report for last year I mentioned that the question of the requirements to be complied with, as to construction, light, ventilation, and in all other respects, in order that underground bakehouses might be certified as suitable, was at the close of that 41 year under the consideration of the Health Committee. The subject subsequently came before the Council, and in April, 1903, the following regulations were adopted as being reasonable requirements to be complied with: (1). No underground bakehouse shall be less than 7 feet in height throughout, measured from the floor vertically to the under side of the joists of the ceilings, nor shall have a cubic capacity, clear of the oven, of less than 1,000 feet. (2). The floor shall be constructed of hard, smooth, durable and impervious material. (3). The walls shall be constructed of a material which is hard, smooth, and durable, and shall be free from damp. (4). The ceiling shall be impermeable to damp and dust, and durable. (5). Every underground bakehouse shall be approached by a suitable staircase, adequately lighted and ventilated. (6). The underground bakehouse shall be adequately lighted with daylight throughout, to the satisfaction of the sanitary authority, and the lighting maintained shall be such that an official copy of the Abstract of the Factory Act may ordinarily be read in all parts of such bakehouse, between the hours of 11 a.m. and 3 p.m. (7). Ventilation shall be adequate, that is to say, an abundance of fresh clean air shall be supplied constantly during working hours; it shall be so arranged that the circulation of air is confined to the underground bakehouse; and where, in the opinion of the sanitary authority such is necessary, mechanical power shall be used for the purpose of securing efficient ventilation. Where mechanical power is used, the fresh air shall be taken from a height above the level of the adjoining ground of not less than 6 feet, and be distributed to different parts of the underground bakehouse in such a manner as to change the air of such bakehouse in all parts. Note—This will generally require the provision of a fan. Foul air may also be abstracted by means of a fan with any aid available from gas and ventilating shafts. (8). Proper provision shall be made for the storage of flour elsewhere than in the underground bakehouse itself. (9). There shall be no opening into the underground bakehouse, for any purpose, which will tend unduly to the admission of dust from the adjoining street. 45 (10). Conveniences for personal abiution shall be provided in a suitable position, and include a water tap, and a sink or lavatory basin of an approved character. Note—These conveniences should be outside the underground bakehouse, Free access shall be provided to suitable sanitary conveniences suitably situated. (11). All troughs, tables, or other furniture standing on the floor of the underground bakehouse shall be so constructed as to be readily movable. (12). Proper provision shall be made for the depositing of wearing apparel outside the underground bakehouse. (13). An underground bakehouse shall not be in communication with a wash-house, nor with any room, cellar or area containing objectionable materials. (14). An underground room, not entirely separated from the underground bakehouse, shall be well lighted throughout, shall be sufficiently protected against the entrance of ground air, shall be properly ventilated and shall be at all times clean. (15). All statutory obligations shall be fulfilled. (16). Before making any structural alterations with a view to meeting these requirements, the owners or occupiers of underground bakehouses shall submit to the sanitary authority a specification (and plans) of the alterations which they purpose making. Copies of the above regulation and of section 101 of the Factory and Workshop Act, 1901, were sent to the occupiers of the underground bakehouses in the Borough, in the month of May, so that plenty of time was given for the execution of the work necessary in connection with them. All the underground bakehouses were inspected with a view to ascertaining how far they were in accordance with the regulations, each inspector dealing with those on his district. Inspector Lear had 13 to look after; Inspector Firth, 8; Inspector Jordan, 8 ; Inspector Langstone, 15; and Inspector Clements, 9. A statement was furnished to the occupier of each bakehouse showing in what respects his bakehouse failed to comply with the Council's requirements, and pointing out what was necessary to be done. Work was proceeding during the last six months of the year in those bakehouses for which application was made for certificates, and as the bakehouses were finished the certificates were granted from time to time by the Council. The last batch of certificates was recommended by the Health Committee on the last day of the year. The following is an analysis showing the character of the work carried out in the Borough to comply with the Council's regulations:— 46 In 16 instances the height of the bakebouse was increased to 7 feet, measuring from the floor to the undersurface of the ceiling or joists, and in 4 the capacity of the bakehouse was increased to 1,000 cubic feet or more to meet with the requirements of the first regulation. The floors were relaid or repaired so as to be hard, smooth, durable and impervious in 27 instances. In most cases concrete was the material used. In 17 the walls were rendered hard, smooth and durable, and in 9 instances dampness had to be dealt with. In most cases the walls were rendered in concrete, brought to a smooth surface and whitewashed. In one or two cases it was necessary to construct inner walls so as to form dry areas. In 22 the ceilings needed more or less attention. In some of these the floor of the shop above was rendered impervious, being match-boarded and painted on the under surface, and in some ceilings were constructed of wood, grooved and tongued and painted on the under surface. Suitable staircases, adequately lighted and ventilated, were provided in 7 cases. The light and ventilation of the bakehouse required improvement in 28 instances. Windows were hinged at the bottom and made to open inwards so as to throw the entering air towards the ceiling. Glass and wire screens were resorted to, to prevent, as far as practicable, dust and dirt being blown into the bakehouse, and areas in front of windows were covered over the surface of the walls with white tiles or glazed bricks with a view to facilitating cleansing and throwing additional light into the bakehouse. Hayward's lights were also employed in some cases to increase the amount of light. The object aimed at with respect to ventilation was to secure the means of obtaining a free current of air through the bakehouse when necessary. In one instance only was it considered necessary to resort to mechanical power for securing proper ventilation, and that was in the case of a very large bakery. In 13 cases flour stores, separated from the bakehouses, were provided. Suitable means for personal ablution in accordance with the requirements of the tenth regulation were provided in 19 instances. In 33 cases the troughs and other furniture standing on the floor of the bakehouse were made readily movable ; in most instances the troughs were put on wheels or castors. In 29 instances provision was made for keeping clothing outside the bakehouse. In 8 instances doors were provided to shut off coal cellars. In 2 instances dust receptacles were provided, in 2 the drains had to be amended, and in 9 cases the sinks in the bakehouses were disconnected from the 47 drains or abolished altogether in order to comply with Section 97 (1) of the Act, which requires that a drain or pip9 for carrying off fæcal or sewage matter must not have an opening within the bakehouse. From the foregoing particulars it may be gathered that a great deal of work was carried out during the year with a view to improving the sanitary condition of the underground bakehouses in the Borough. Owing to the amount of the work done the bakehouses were in several instances completely remodelled. No serious difficulty was experienced in getting the bakehouses brought into compliance with the Council's regulations. In one or two instances some reluctance was displayed to do what was necessary to satisfy the requirements of one or other of the regulations, but by the end of the year, in all cases where certificates were applied for, the necessary work was satisfactorily accomplished. With a few exceptions, the Health Committee visited and inspected the whole of the underground bakehouses in the Borough, upon it being reported that the work done to bring them into conformity with the regulations was completed, and on the recommendation of the Committee the certificates under the Act were granted by the Council. Whilst in several instances but little work was necessary to enable the certificate to be granted, such was not the case with the great majority of the underground bakehouses. On the whole a large amount of work had to be done, and it may be fairly claimed that Section 101 of the Factory and Workshop Act, 1901, has been the means of bring about a very marked and most satisfactory change in their condition from a sanitary point of view. SLAUGHTER-HOUSES. The number of licensed slaughter-houses in the Borough remains the same as for last year, namely, 14. From enquiries made it would appear that oxen are only slaughtered very occasionally in the 3 or 4 slaughter-housess which are adapted for the purpose. Moreover it does not seem that at so many sheep are killed as was the case a few years ago. The usual inspection took place during the year, and the condition in which the slaughter-houses were kept was found generally to be satisactory. COWSHEDS, DAIRIES AND MILKSHOPS. The number of cowhouses on the register for 1903 was 8, as compared with 9 for 1902. The number of cows kept in the Borough is 101, as compared with 103 in 1902. 110 in 1901, 114 in 1900, and 135 in 1899. The license of the cow-house situate at No. 3, Rufus Street was not renewed by the London County Council. Its renewal was opposed by the Borough Council on the grounds that the cowsheds were used for purposes other than cow-keeping, and were generally dirty and unfit for the purpose of cow-keeping. There was also opposition by the Council's Inspector to its renewal. The cowhouses were subject to periodical inspection throughout the year, and the condition in which they were kept may be described as satisfactory. 48 The number of dairymen and purveyors of milk on the register for the year was 300, as compared with 304 in 1902. In 24 instances, 4 of which where on account of rebuilding on the premises, the sale of milk was discontinued, in 47 the shop changed hands, and there were 16 fresh applications for registration. The premises upon which milk is sold were kept under observation during the year by the sanitary inspectors. Generally, the condition in which they were found was satisfactory. In 6 instances warnings were required an account of dirty utensils. In 3 cases sanitary notices were necessary. In 2 of these the premises were in an insanitary condition generally: the drains, water-closets, yard-paving, eaves, gutters, roofs and floors being defective, and in the third case the premises were dirty. OFFENSIVE BUSINESS. The premises situate at No. 69, Haggerston Road, upon which tripe is boiled were under observation during the year. There were no complaints in respect to them. HOUSES LET IN LODGINGS. The following is a list of the houses registered under the bylaws as to houses let in lodgings or occupied by members of more than one family:— Alfred Terrace, Nos. 1, 2, 3, 4 and 5 Barton's Court, Nos. 2, 3, 4 and 5 Britannia Street, Nos. 113,114, 115, 116,117, 118, 119, 120 and 121 Clifton Street, Nos. 37, 39 and 49 Earl Street, Nos. 36 and 38 Myrtle Street, Nos. 4, 6, 8, 40 & 40a Watson's Place, Nos. 1, 3, 6, 13, 14, 15, 16, 21, 27, 28 and 29 Westmoreland Place, No. 70 Wilmer Gardens, Nos. 87 and 89 The number of houses on the register was increased by 42 during the year, the number now registered being 233. Early in the year the Borough Council received a communication from the London County Council, enclosing a report from their Medical Officer of Health, shewing the extent to which bylaws as to houses let in lodgings were enforced in the districts of the Metropolitan Boroughs. The County Council in their letter pointed out that although there were, according to the Census returns of 1901, no fewer than 27,031 tenements in Shoreditch, of which 22,940 were tenements of less than five rooms, only 190 houses were registered under the bylaws of the Borough Council, and stated that they attached the greatest importance to the proper execution of the duties imposed upon sanitary authorities by section 94 of the Public Health (London) Act, 1891. The Council expressed the hope that the number of houses registered and regulated under the bylaws would be largely increased. The Borough Council in their reply informed the County Council that special instructions had been given to the sanitary staff with a view to securing the speedy registration of such houses as required to be brought under the bylaws. At the same time it was pointed out that the figures as to the number of tenements within the Borough contained in the Council's letter were misleading in respect to the number of houses 49 registerable under the bylaws, because of the numerous blocks of artizans' dwellings which are to all intents and purposes blocks of separate houses, and the number of tenement buildings belonging to the same class which have been excluded from the sphere of operation of the bylaws by a decision of the Divisional Court. There are, however, without doubt, a very large proportion of houses in the Borough which are occupied by members of more than one family, and the Borough Council pointed out that a large amount of the sanitary work done in the Borough was carried out in connection with such houses, although it was not thought necessary to register them. In November an intimation was received from the County Council, that their Medical Officer of Health had received instructions to have enquiries made in Shoreditch on the subject of houses let in lodgings. In connection with the correspondence above referred to, it may be mentioned that the London County Council have been advised by Mr. C. A. Cripps. K.C., that section 94 of the Public Health (London) Act, 1891, which requires bylaws to be made and enforced, is imperative, and that there is no provision as to a power to exempt from the operation of the bylaws such houses as come within the definition of a lodging house. When the Shoreditch bylaws were made, in 1894, an exemption clause was allowed by the Local Government Board. By this clause a lodging house is exempt from the operation of the bylaws, until the .landlord of such lodging house shall have been required to furnish the statement of particulars which is set forth in the fifth bylaw. These particulars have to be furnished by the landlord within fourteen days of the receipt of a notice in writing from the Clerk to the Sanitary Authority. This notice is sent only when it has been decided by the Borough Council to register a lodging house. In view of the exemption clause, there appears to be a discretionary power as to what lodging houses are to be registered in Shoreditch. The subject of the registration of lodging houses was considered by the late Shoreditch Vestry, in 1896, and aft9r a good deal of discussion it was decided to register houses which are occupied by members of more than one family, in which the landlord does not reside on the premises and which are not kept in a proper sanitary condition, and the Inspectors were accordingly instructed to report such houses for registration. In carrying out their instructions, the attention of the Sanitary Inspectors is more especially directed to those houses which are observed to be recurrent sources of sanitary trouble. CUSTOMS AND INLAND REVENUE ACTS. Applications for certificates as to the sanitary fitness of dwellings for the purpose of obtaining exemption from inhabited house duty were received in respect to 72 tenements. They were inspected in accordance with statutory requirement, and in 42 instances the certificates were granted after a good deal of work, including the reconstruction of the drains, repairing of the yards and general cleansing and repairing had been carried out. The remaining applications were not entertained. 50 STREET MARKETS AND POOD. The usual supervision was exercised by the sanitary officers over the street markets and the food exposed for sale. Frequent examinations were made with a view to the detection of unsound food. With few exceptions the quality of the various foods exposed for sale was excellent. The following articles of food were destroyed during the year as being unfit for the use of man:—Pigs plucks, 1 barrel; rabbits, cwt.; ducks, 2; geese, 3; fowls, 2; poultry, 2 cwt.; conger eel, 3Jlbs.; plaice, 4 trunks; haddocks, 38; skate, 841bs.; escallops, 5 boxes ; tomatoes, 36 boxes ; apples, 2 barrels. The ducks, fowls and haddocks were seized and carried before police magistrates who condemned them and ordered their destruction. In the case of the ducks and fowls, the person exposing them for sale, a boy in the street, absconded and could not be found. With regard to the haddocks, it was not deemed necessary to take further proceedings before a magistrate, but the person to whom they belonged was cautioned by the Health Committee. ICE CREAM SHOPS. The following summarises the results of the inspection of the ice-cream shops in the Borough during the year:—On Inspector Lear's district, seven were under inspection; their condition generally was satisfactory; in one instance a notice was required for cleansing. Inspector Pirth had thirteen under observation; their condition on the whole was fairly satisfactory; in six, notices as to cleansing were required. On the district of Inspector Jordan sixteen came under observation; their condition was generally satisfactory; four notices were served with respect to cleansing. On Inspector Langstone's district, nineteen were under inspection; their condition was generally satisfactory; in one case it was necessary to serve a notice on account of ice-cream being prepared in a room used for sleeping purposes, and in a second case a notice was required to remedy defects in connection with a water-closet. Inspector Clements had nine under observation; with the exception of one, they were in a very satisfactory condition, only a few small matters needing attention. The exception was a shop at 128a, Hoxton Street, which was situate on premises in a very unsanitary state. These premises were closed by order of a magistrate. Altogether, 64 places where ice-cream was manufactured and sold were under inspection. Of these 49 were found to be kept in a satisfactory condition. In the remaining, 15 sanitary notices were required chiefly on account of cleansing. As compared with last year, there is a general improvement in the conditions under which ice-cream is made in the Borough. 51 COFFEEHOUSES, COOKSHOPS AND FRIEDFISH SHOPS. The coffeehouses and cookshops and other premises of a similar character, upon which food is sold or prepared for sale, were subject to inspection during the year, and the results may be briefly summarised as follows : — Inspector Lear visited 34, including 8 friedfish shops. Of these 14, including 3 friedfish shops, were found in a clean and satisfactory condition. The remainder all more or less required attention, mostly in respect to the limewashing and cleansing of walls and ceilings. In a few cases dust receptacles were defective, and water supply apparatus of the water closets were out of order. Of 19, including 7 friedfish shops, visited by Inspector Firth, 14, 5 of which were friedfish shops, were in a satisfactory condition. Of the remainder, in 5 the kitchens were not in a cleanly condition, and in 1 there was no dust receptacle. Inspector Jordan visited 77, 8 of which were friedfish shops. Of these, 58, including 5 of the friedfish shops, were in a clean and satisfactory condition. With respect to the remainder, there were dirty rooms and kitchens in 17, the walls of the yards and water-closets were dirty in 3, dust receptacles were required in 8, water flushes to th6 water-closets were defective in 2, the yard paving was defective in one instance, and in another the sink was not properly trapped. Inspector Langstone visited 35, 7 of which were friedfish shops. Of these, 28, including 6 of the friedfish shops, were in a clean and satisfactory condition. The others required more or less attention; in 4 the kitchens were not in a cleanly condition, and in 3 there were delapidated dust receptacles. Of 22, including 9 friedfish shops, visited by Inspector Clements, 13, of which 6 were friedfish shops, were in a. clean and satisfactory condition. With respect to the remainder, in 5 the water-closets were out of order, in 2 the kitchens required cleansing, in 2 the yard paving was defective, and in 4 instances the dust receptacles were delapidated or wanting. Altogether, 148 cookshops and eating houses, and 39 fried fish shops were under inspection during the year, as compared with 138, and 38 for 1902. They were all visited once, but where the premises were not found to be kept in a satisfactory condition they were visited at frequent intervals until a better state of things was ascertained to exist. As the result of the inspection 102 cookshops and eating houses, and 25 friedfish shops were found to be kept in a satisfactory and cleanly condition. With regard to the remainder, want of proper attention to cleanliness was the predominant evil. Some 59 sanitary notices were served upon the parties responsible! and the necessary steps were taken to remedy the defects found existing. In no instance were police court proceedings necessary. 52 SALE OF FOOD AND DRUGS ACTS. Thereports of the public analyst, Dr. Stevenson, show that 707 samples were submitted to him for analysis during the year. This number works out at the rate of one for every 166 persons in the Borough. Of the samples submitted, 154 were taken by Inspector Lear, 129 by Inspector Firth, 142 by Inspector Jordan, 135 by Inspector Langstone, 51 by Inspector Clements, and 96 by the late Inspector Quelch. Inspector Clements began to take samples during the fourth quarter of the year. The results of the work for the year are summarised in the following Table:— Quarter for the year 1903. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of successful Prosecutions. Pines and Costs. Amounts paid to Analyst for samples analysis. £ s. d. £ s. d. 1st. 111 20 18% 9 2 7 7 41 3 6 55 10 0 2nd. 147 23 15.6% 17 2 15 14 49 7 0 73 10 0 3rd. 186 34 18.2% 26 — 26 24 65 16 6 93 0 0 4th. 263 35 13.3% 8 1 7 6 17 4 6 131 10 0 Year 707 112 15.8% 60 5 55 51 173 11 6 353 10 0 The samples included 345 of milk, 254 of butter, 54 of lard, 27 of spirits, 10 of Demarara sugar, 6 of coffee, 6 of cheese, 3 of cod-liver oil, and one each of margarine and oil of lemon. Of the milk samples 76, or 22.0 per cent., were found not to be genuine. A marked decline in the percentage of adulterated samples of milk is noticeable during the year on comparing the figures for the four quarters, as is seen from the following Table:— Quarter of the year. Number of Samples. Number not genuine. Percentage not genuine. 1st 48 14 29.1% 2nd. 52 13 25.0% 3rd 80 17 21.2% 4 th 165 32 19.4% 53 In 41 of the samples not genuine, water had been added to the milk; in 29 the amount was less than 5 per cent., and in the remaining 12 it was over 5 per cent. In 30 fat had been abstracted, in 21 to the extent of more than 5 per cent., and in 9 less than 5 per cent. In 5 instances both water had been added and fat abstracted. Preservatives were found to have been addad in 14 of the samples analysed. In 12 instances the preservative was formic aldehyde, and in the other 2 boric acid or some preparation thereof. Legal proceedings were instituted in 29, or 38 per cent., of the cases of adulteration, and the defendants were convicted in 21 of them. It is not considered advisable to prosecute in cases where the adulteration does not exceed 5 per cent, as shown by analysis. The standards fixed by the Board of Agriculture in respect to milk (3 per cent, of fat and 8.5 per cent, of solids not fat) upon which the analyst bases his certificates, are regarded by authorities upon the subject aa being exceptionally low for genuine milk. Taking into consideration the frequency with which small percentages of adulteration with water occur, it is highly probable that in the great majority of these cases the actual amounts of water added are considerably greater than the analyst's figures indicate. In the cases in which convictions were obtained, the penalties (not including costs) inflicted for milk adulteration amounted to £37 10s., averaging 8 per cent, of the maximum penalties to which the defendants were liable under the Acts, as compared with 13.5 per cent, in 1902. The costs allowed the Council were heavier in 1903 than in 1902, but, taking the fines and costs together, the average was only £1 18s. 6d. for each conviction in 1903, as compared with £2 18s. in 1902. Of the butter samples, 25, or 9.8 per cent., were not genuine. A marked decline in the percentage of the samples found adulterated was observable during the year, as the subjoined figures show:— Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st. 32 5 15.6% 2nd 75 8 10.6% 3rd 75 9 12.0% 4th 72 3 4.1% In all the cases of adulterated butter, margarine had been sold as a substitute for butter except in three instances, in which the samples were found to contain a small amount of water in excess of 16 per cent. Ten of ihe butter samples contained traces 54 of boric acid or a preparation thereof. Legal proceedings were taken in 22, or 88 per per cent., of the cases of adulteration, in all of which convictions were obtained. In one case margarine was exposed for sale without being duly labelled, and the defendant was fined £2. The penalties inflicted in the cases in which convictions were obtained for infringments of the Acts in respect to butter and margarine amounted to £84 5s., which gives an average of a little over 18 per cent, of the maximum penalty per case as compared with 17 per cent, for 1902. Including costs the amount imposed for each conviction averaged about £4 10s., as compared with £4 Is. in 1902. . Two of the samples of lard were adulterated. In each case proceedings were taken, and a conviction was obtained in one of them. All the samples of cheese were genuine as were also the samples of cod liver oil. Of the 27 samples of spirits, 26 were genuine, and in the case of the other it was not deemed advisable to prosecute. The sample contained excess of water, but there was a warning tablet as to the water contained in the spirits exposed in the place where the sample was purchased. The sample of oil of lemon was not as prescribed by the British Pharmacopoea, but it was not thought advisable to prosecute. Six of the samples of Demerara sugar were not genuine, and proceedings were successfully instituted in each case. One of the 6 samples of coffee was not genuine, but proceedings were not taken there being only about 1 per cent, of chicory present which was regarded as an accidental admixture. With respect to the prosecutions which did not succeed, in 5 instances the summonses were withdrawn. In 2 on account of the production of warranties, in two because the reserve samples had become useless for the purpose of evidence, and in the remaining one because there were good grounds for believing that the milk was sold to the purchaser in the same state as supplied by the contractor. In 2 cases of milk prosecution the summonses were dismissed, in one case with one guinea costs against the Council; the defence being a warranty in each case. In one instance in which his certificate was questioned, the analyst gave evidence, but the magistrate thought it would be sufficient to allow the Council the costs of the analysis and summons and no penalty was inflicted. It is to be noted that all the above were in respect to milk samples. The unsuccessful prosecution in the case of one of the samples of adulterated lard, resulted from there being some doubt in the mind of the magistrate as to whether the article in question was exposed for sale as lard. At the meeting of the Borough Council on December 15th last, Mr. Alderman Sawell drew attention to certain statistics relating to food and drugs adulteration contained in a report which was adopted by the London County Council, on December 8th. They refer to the year 1902, and from them the subjoined figures are quoted to shew the position of Shoreditch for that year in this respect. 55 Borough. Percentage of the total number of samples taken found to be adulterated. Percentage of the number cl milk samples taken found to be adulterated. Lowest. St. Marylebone 3.9 6.9 Woolwich 4.1 4.8 Hampstead 5.4 4.4 Hammersmith 6.0 5.0 Highest. Shoreditch 25.3 29.9 Hackney 23.8 33.2 Stepney 21.9 30.4 St. Pancras 20.7 32.1 Of the total number of samples taken in the Metropolis 11.9 percent, were found to be adulterated. These figures show that Shoreditch, in 1902, occupied the unenviable position of being the district in the Metropolis in which adulteration of food generally appeared to be most rampant. The samples taken in Shoreditch during 1902 numbered 281, and were at the rate of 1 for every 420 persons living in the Borough, as compared with an average of 1 for every 253 persons in the Metropolis. The following figures compare the results of the work during 1902 and 1903 :— Year. Number of Samples. Number of persons in the Borough to each sample. Number of samples adulterated. Percentage of samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties. Prosecutions proceeded with. Number of successful prosecutions. Pines and Costs. Amounts paid to Public Analyst. £ s. d £ s. d 1902 281 420 71 25.3 54 2 52 48 117 9 0 140 10 0 1903 707 166 112 15.8 60 5 55 51 173 11 6 353 10 0 With regard to the samples of milk, whereas 154 taken in 1902 showed 29.9 per oent, adulterated, those taken in 1903 showed 22.0 per cent., a substantial reduction, 56 not so marked, however, as in the case of butter, for of 94 samples taken in 1902, 24.2 per cent, were adulterated, whilst of 254 samples taken in 1903,9.8 per cent, were not genuine. A comparison of the results of the work under the Food and Drugs Acts for the years 1902 and 1903 shows that the increased activity during the latter year has been associated with a considerable reduction in the number of samples found adulterated, and presumably the amount of adulteration in the Borough has been diminished. This is very noticeable in respect to butter, but less so as regards milk. It is to be regretted that the average amount of the penalty inflicted for adulteration of milk was so much less in 1903 than it was in 1902, for the results of the analyses during 1903 afford good grounds for believing that a large amount of tampering with the milk still goes on in the Borough. The large percentage of the samples found not to be genuine is, as has been pointed out elsewhere by the Town Clerk, sufficient testimony as to the skilful discretion, ability and success with which the inspectors concerned take the samples, and it may be added the small percentage of summonses dismissed indicates the care and skill which is exercised by the Council's legal advisers in conducting the oase before the magistrates. An improvement is manifest with respect to the amount of adulteration carried on in the Borough, and it is satisfactory to note it; but it is advisable that the activity under the Food and Drugs Acts, which characterised the past year should be continued. SANITARY STAFF. Owing to the decrease in the notifiable infectious disease the sanitary work arising therefrom was less than in previous years, but this was counter-balanced by the additional work in connection with measles, which has already been referred to, and the increased duties under the Factory and "Workshop and Sale of Food and Drugs Acts, so that the time of the sanitary staff has been fully occupied during the year. With regard to the work under the Sale of Food and Drugs Acts, it may be mentioned that the subject of food adulteration in the Borough was brought under the notice of the Health Committee in May last by the Mayor (Mr. Councillor Bird) who was at the time Chairman of the Committee, and it was decided that greater activity was necessary in taking samples. The inspectors concerned were accordingly instructed to take not less than eight samples each every fortnight. It is hardly necessary to point out that a very appreciable portion of the time of the five inspectors engaged upon the work was taken up in this way. In a letter, dated February 20th, 1903, the London County Council drew attention to the fact that their legal adviser was of opinion that the original construction of drainage works was not a duty specified in the General Order of the Local Government Board of December 8th, 1891, and it was therefore not legal for the London County Council to refund half of the salaries of the sanitary inspectors engaged upon such work. The Town Clerk, after considering the point, was of opinion that such works were not outside the duties of sanitary inspectors as prescribed by the Order 57 and an appeal was therefore made to the Local Government Board. The Board, however, held the same opinion as the London County Council on the question, but they pointed out that if the Shoreditch Borough Council desired the sanitary inspectors to continue to supervise the construction of new drains they should be specially appointed for the purpose, and separate salaries should be assigned to them, no proportion of which would be repayable by the London County Council. Several other Boroughs in the Metroplis were in a similar position to Shoreditch in the matter, and as the result of a Conference, held at the Camberwell Town Hall, on July 13th, the Local Government Board were asked to amend the Order of December, 8th, 1901, so as to include the supervision of the.original construction of drainage works amongst the duties specified. The Local Government Board were, however, unable to accede to the request. The matter then came under the consideration of the Health Committee as to the steps to be taken under the circumstances, and the Committee, after due consideration, recommended that 1¼ per cent, of each sanitary inspector's salary should be allocated in respect to the duty of supervising the original construction of drainage work as being the amount to be deducted before the moiety of the remaining salary is claimed from the London County Council. The Borough Council adopted this recommendation, and the Local Government Board were informed accordingly. The Board offered no objection to this arrangement, but made a request to be furnished with particulars as to the arrangement, and a list of the sanitary inspectors affected, showing the exact scale of salary proposed to be paid to each for the work of supervising the original construction of drains. Eventually it was agreed that £2 10s. should be deducted in the case of the Chief Inspector, and £2 in the case of the other inspectors. During the year the Health Department lost the services of a valuable officer through the death of Mr. C. H. Quelch, who was for twelve years one of the Sanitary Inspectors of Shoreditch. He was a very able and efficient officer, and his loss is much regretted by his brother officers. During his illness and until his successor was appointed the work on his district was attended to by the Chief Inspector and Inspectors Firth and Langstone. Mr. J. S. Clements, for some two years assistant Inspector under the Willesden Urban District Council, was appointed to the vacant post on July 21st, and commenced his duties in Shoreditch, on August 31st. I desire to express my satisfaction as to the manner in which the officers of the Health Department have discharged their duties during the year, and my thanks are due to them for the assistance they have afforded me in connection with the work of the department. I also desire to express my indebtedness to the chairmen and members of the Health Committee for the consideration and help which I have received from them in respect to my official work during the year. I have the honour to be, Mr, Mayor and Gentlemen, Your obedient Servant, LEWIS T. FEASER BEYETT, Medical Officer of Health, APPENDIX TO THE REPORT of the MEDICAL OFFICER OF HEALTH. Containing Statistical Tables and a Summary of Sanitary Proceedings under the Public Health and Factory and Workshop Acts. Tables I., II., III., and IV. are forms required by the Local Government Board. 60 TABLE I. BOROUGH OF SHOREDITCH. Vital Statistics of whole District during 1903 and previous Tears. Year. Population estimated to middle of each Year. Bibths. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District Deaths of Nonresidents registered in Public Institutions in the District. Deaths of residents registered in Public Institutions beyond the District. Nett Deaths at all Ages Belonging to the District. Number Rate* under one Year of Age at all Ages. Number. Rate per 1000 Births registered. Number Rate* Number. Rate. * 1 2 8 4 5 6 7 8 9 10 11 12 13 1893 123520 4446 35.6 807 186 3198 26.1 862 436 384 3146 25.7 1894 123520 4332 34.6 704 166 2582 21.0 826 428 312 2466 20.1 1895 123190 4352 34.8 867 203 2968 24.3 813 434 326 2860 23.4 1896 122308 4364 36.0 786 183 2620 21.6 686 367 369 2622 21.6 1897 122058 4325 35.0 789 186 2662 21.8 783 392 356 2626 21.7 1898 121740 4281 35.1 846 199 2709 22.2 761 371 366 2704 22.4 1899 121530 4131 33.7 854 210 2982 24.5 905 429 358 2911 24.2 1900 121335 4023 32.9 741 187 2689 22.2 790 472 350 2576 21.4 1901 118550 4120 34.3 812 201 2652 22.6 883 427 365 2596 22.1 1902 117948 3992 33.3 704 181 2383 20.2 836 387 432 2441 20.9 Averages for years 1893tol902 121569 4236 34.8 791 186 2744 22.5 814 414 361 2694 22.1 1903 117740 3932 ‡ 33.3 676 176 1 2232 18.9 832 337 383 1 2280 19.6 § * Rates in (Jolumns 4, b, and Id calculated per 1,000 of estimated population. I Including the births in the Holborn Workhouse. § The population in the Holborn Workhouse is excluded in calculating this rate. Note.—The deaths included in column 7 of this table are the whole of those registered during the year as having actually occurred within the district. The deaths included in column 12 are the number in column 7, correoted by the subtraction of the number in column 10 and the addition of the number in column 11 Daring 1903 nine persons not resident in Shoreditch died wiihin the district, and 11 residents of Shoreditch died beyond the district, but not in public institutions, these have to be added to the figures in columns 10 and 11 respectively in order to get the nett deaths. By the term "non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there ; and by the term "residents" is meant persons who have been taken out of the district on 3-<s«ount of sickness or infirmity, and have died in public institutions elsewhere. The "public institutions" taken into account for the purposes of those Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have been made are given on pages 6 and 7 of the Report. Area of District in acres (exclusive of area ) covered by water) 642.50 Total population at all ages, 118,637 Number of inhabited houses, 12,743 Average number of persons per house 9.3} At Census of 1901. 61 TABLE II. BOKOUGH OP SHOREDITCH. Vital Statistics of separate Localities in 1903 and previous Years. Year 1.—Whole Borough. 2.--Shoreditch South. 3.—Hoxton New Town. 4.—Hoxton Old Town. 5.—Haggerston. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all ages. Deaths .under 1 year. Population estimated to middle of each year. Births registered. Deaths at | all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year- a. b. c. a. a. b. c. d. a. 5. e. d. a. b. . c. d. a. b. c. d. 1892 123563 4487 2828 760 19720 546 423 99 29410 1134 645 184 28803 1016 656 157 45530 1791 1104 320 1893 123520 4446 3146 807 19890 527 399 88 29380 1128 741 182 28850 999 719 196 45400 1792 1287 341 1894 123520 4332 2466 704 19890 524 317 66 29380 1133 574 170 28850 984 552 158 45400 1691 1023 303 1895 123190 4352 2860 867 19840 518 410 99 29300 1043 715 220 28700 989 645 198 45350 1802 1090 350 1896 122308 4364 2622 786 17900 501 380 80 29585 1109 591 192 27635 954 552 184 47188 1800 1099 330 1897 122058 4325 2626 789 17575 551 435 103 29630 1035 575 185 27505 990 610 188 47348 1749 1006 313 1898 121740 4281 2704 846 17100 522 400 88 29750 1007 611 202 27365 1018 621 216 47525 1734 1072 340 1899 121530 4131 2911 854 16950 497 507 119 29800 974 646 200 27165 947 673 218 47615 1713 1085 317 1900 121335 4023 2576 741 16755 497 443 105 29860 961 597 171 27020 929 536 160 47700 1636 1000 305 1901 118550 4120 2596 812 16276 489 379 87 29732 1060 615 193 26480 955 584 204 46062 1616 1018 326 1902 117948 3992 2441 704 15927 467 355 74 29636 1023 580 159 26385 865 558 171 46000 1637 94- 300 Averages of Years 1892 to 1902. 121751 4260 2707 788 17984 512 404 91 29587 1055 626 187 27705 967 609 186 46465 1723 1066 322 1903 117740 3932 2280 676 15800 421 341 66 29600 1026 591 192 26350 909 499 171 45590 1576 849 247 Note.—(a) lhe separate localities adopted for this table are the registration sub-districts. Block 1 has been used for the whole district. (6) Deaths of residents occurring beyond the district are included in sub-columns r of this table, and those of non-residents registered in the district excluded. (See note on Table I. as to meaning of terms " resident" and " non-resident.") (c) Deaths of residents occurring in public institutions have been allotted to the respective localities, according to addresses of the deceased. 62 BOROUGH OF SHOEBDITCH. Cases of infectious disease notified during the Year 1903. Notifiable Disease. Cases notified in Whole District. Total Cases Notifed in each Locality. No. of Cases removed to Hospi tal from each Locality. At all Ages. At Ages—Years. 1. 2. 3. 4. 1. 2. 3. 4. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Shoreditch South. Hoxlon New Town. Hoxton Old Town. Haggerston. Shoreditch South. Hoxton New Town. Hox on Old Town. Haggers' ton. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 151 7 79 47 13 5 ... 22 27 28 74 15 22 27 70 Membranous croup 3 ... 3 ... ... ... ... ... ... ... 3 ... ... ... 1 Erysipelas 147 5 10 13 13 88 18 23 45 26 53 1 ... 1 2 Scarlet fever 255 17 92 122 17 7 ... 29 75 55 96 27 71 54 86 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 100 ... 5 31 32 32 ... 13 31 27 29 12 28 24 24 Relapsing fever ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... Continued fever 1 ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... Puerperal fever 7 ... ... ... 2 5 ... ... 3 1 3 ... ... 1 1 Plague ... ... ... ... ... ... ... ... ... ... ... •• ... ... ... *Chicken pox 39 4 21 13 1 ... ... 12 17 3 7 ... ... ... ... Totals 703 33 211 226 78 137 18 99 198 141 265 55 121 108 184 * Chicken pox was notifiable in Shoreditch until the 28th February, 1903. TABLE IV. BOROUGH OF SHOREDITCH. Causes of, and ages at, death during Year 1903. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to localities at all Ages Total Deaths InPublic Institutions in the District All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards Shoreditch South Hox- ton New Town. Hox- ton Old Town. Hagger ston. 1 2 3 4 5 6 7 8 9 10 11 12 13 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 99 30 66 3 ... ... ... 7 50 17 25 11 Scarlet fever 7 ... 3 4 ... ... ... 1 3 2 1 ... Whooping-cough 41 14 25 2 ... ... ... 3 12 8 18 1 Diphtheria and membranous croup 21 4 17 ... ... ... ... 4 3 3 11 ... Croup 1 ... 1 ... ... ... ... ... 1 ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric 13 ... ... 2 7 4 ... 2 4 2 5 2 Other contd. ... ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza 19 1 2 1 ... 12 3 2 9 3 5 4 Cholera ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Diarrhcea (see notes below) 143 117 23 ... ... 2 1 18 39 35 51 2 Enteritis (see notes below) 66 52 9 ... 1 2 2 4 27 18 17 8 Puerperal fever 1 ... ... ... ... 1 ... ... 1 ... ... ... Erysipelas 7 3 ... ... ... 3 1 2 2 1 2 ... Other septic diseases 22 3 4 3 4 8 ... 3 11 3 5 4 Phthisis 271 3 7 8 28 218 7 39 62 55 115 146 Other tuberculous diseases 105 39 37 14 2 12 1 12 26 25 42 19 Cancer, malignant disease 98 ... ... 1 2 68 27 17 20 26 35 83 Bronchitis 187 44 15 2 1 55 70 30 48 43 66 97 Pneumonia 179 40 53 3 4 60 19 22 43 37 77 37 Pleurisy 6 1 ... 1 ... 4 ... ... 1 1 4 3 Other diseases of Respiratory organs 8 ... ... ... 1 5 2 1 4 ... 3 4 Alcoholism 45 ... ... ... ... 39 6 11 11 9 14 22 Cirrhosis of liver Venereal diseases ... ... ... ... ... ... ... ... ... ... ... ... Premature birth 79 79 ... ... ... ... ... 7 21 20 31 18 Diseases and accidents of parturition 5 ... ... ... 1 4 ... ... 3 ... 2 ... Heart diseases 139 2 1 5 11 81 39 23 31 26 59 71 Accidents 92 37 13 5 1 25 11 12 19 21 40 15 Suicides 12 ... ... ... 1 10 1 4 5 ... 3 4 All other causes 614 207 31 17 12 174 173 117 135 144 218 330 All Causes 2280 676 307 71 76 787 363 341 591 499 849 832 Notes.—(a) In this Table all deaths o "residents" occurring in public institutions, whether within or without the district, have been included with the other deaths in the columns for the leveral age groups (columns 2-8). They have also, in columns 9-12, been included among the deaths in their respective "localities" according to the previous addresses of the deceased as given by the registrars. Deaths of "non-residents" occurring in public institutions in the district have been in like manner excluded from columns 2-8 and 9-12 of this Table. (b) bee notes on Table I. as to the meaning of "residents" and "non-residents," and as to the " Public Institutions" taken into account for the purposes of these Tables. (c) All deaths occurring in public institutions situated within the district, whether of "residents" or of " non-residents " have, in addition to being dealt with as in not« (a), been entered in the last column of this Table. (d) Under the heading of " diarrhoea " have been included deaths certified as from diarrhoea alone or in combination with some other cause of ill-defined nature ; and also deaths certified as from Epidemic enteritis; Zymotic enteritis; Epidemic diarrhoea. Summer diarrhœa; Dysentery and dysenteric diarrhoea; Choleraic diarrhoea, cholera, cholera nostras (in the absence of Asiatic cholera). Under the heading of " enteritis " have been included those certified as from gastroenteritis, muco-enteritis and gastric catarrh. Deaths from diarrhoea secondary to some other well-defined disease have been inoluded under the latter. 64 65 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH REGISTRATION SUB-DISTRICT, DURING THE YEAR ENDING DECEMBER 31ST, 1903. Note.—The deaths of persons not belonging to Shoreditch occurring in the Borough are excluded; and the deaths of persons belonging to Shoreditch in London beyond the limits of the Borough, are included. CAUSES OF DEATH. AGES. DEATHS REGISTERED IN EACH SUB-DISTRICT FROM ALL CAUSES. Shoreditch South. Hoxton New Town. Hoxton Old Town. Haggerston. Male. Female. Total. Under 1 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 46. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to upwards. 1 Small Pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 30 66 3 ... ... ... ... ... ... ... ... ... ... 7 50 17 25 48 51 99 3 Scarlet fever ... 3 4 ... ... ... ... ... ... ... ... ... ... 1 3 2 1 2 5 7 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza 1 2 ... 1 . . . ... 1 4 2 3 2 3 ... 2 9 3 5 10 9 19 6 Whooping cough 14 25 2 ... ... ... ... ... ... ... ... ... ... 3 12 8 18 18 23 41 7 Diphtheria, membraneous croup 4 17 ... ... ... ... ... ... ... ... ... ... ... 4 3 3 11 10 11 21 8 Enteric fever ... ... ... 2 4 3 3 ... 1 ... ... ... ... 2 4 2 5 10 3 13 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 75 11 ... ... ... ... ... 1 ... 1 1 ... ... 15 27 23 24 46 43 89 11 Epidemic or zymotic enteritis 12 12 ... ... . . . ... ... . . . ... ... . . . ... ... 3 12 12 27 31 23 54 12 Other allied diseases 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 1 2 3 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus 2 1 ... ... ... ... 1 ... ... 1 ... ... ... 1 2 ... 2 3 2 5 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 2 ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 ... 2 2 2 4 19 Gonorrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedcena, hospital gangrene ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas 3 ... ... ... ... ... ... 1 ... 2 1 ... ... 2 2 1 2 4 3 7 22 Puerperal fever ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 23 Pyamia, septicaemia 2 4 2 ... 1 2 2 1 1 2 ... ... ... 3 8 3 3 11 6 17 24 Infective endocarditis ... ... ... ... ... 1 1 1 ... ... ... ... ... ... 1 ... 2 1 2 3 25 Other allied diseases 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... 2 26 Malarial fever ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 27 Bheumatic fever ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 Rheumatism of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tubekculosis : 29 Brain or meninges, acute hydrocephalus 12 19 6 4 1 ... ... ... 2 ... ... ... ... 4 9 13 18 24 20 44 30 Larynx ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... 1 31 Lungs 3 7 1 7 14 14 51 70 68 29 6 1 ... 39 62 55 115 171 100 271 32 Intestines, tabes mesenterica 11 5 ... ... ... ... ... 1 ... ... ... ... ... 2 2 4 9 1U 7 17 33 General, position undefined 11 9 1 1 ... ... 3 1 2 ... ... ... ... 4 11 3 10 21 7 28 34 Other forms, scrofula 5 4 2 ... 1 ... ... 1 1 ... 1 ... ... 2 4 4 5 9 6 15 35 Other Infective diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 Hydatid diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Other diseases due to altered food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 41 Acute alcoholism, delirium tremens ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... 1 42 Chronic alcoholism ... ... ... ... ... ... ... 9 7 3 2 ... ... 5 6 4 6 9 12 21 43 Chronic industrial poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 46 Gout ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... 1 1 1 2 47 Cancer ... ... ... ... ... ... 1 9 27 17 18 5 ... 12 15 19 31 33 44 77 48 Diabetes mellitus ... ... ... ... ... ... 2 ... 1 ... 2 ... ... ... ... 2 3 2 3 5 49 Purpura hoemorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anaemia, leucocvthaemia ... ... ... ... ... ... ... ... ... ... ... ... ... I... ... ... ... ... ... ... 66 67 DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31st, 1903. DEATHS REGISTERED IN EACH SUB-DISTRICT FROM ALL CAUSES. CAUSES OF DEATH. AGES. Shoreditch South. Hoxton New Towd. Hoxton Old Town. Haggerston. Male. Female. Totai. Under 1 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 26 to 36. 36 to 45. 46 to 65. 56 to 65. 65 to 75. 75 to 85. 85 and upwards. 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 ... ... 2 ... 2 53 Premature birth 79 ... ... ... ... ... ... ... ... ... ... ... ... 7 21 20 31 43 36 79 54 Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 Debility at birth 22 ... ... ... ... ... ... ... ... ... ... ... 8 5 5 9 13 9 22 56 Atelectasis 6 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 3 3 6 57 Congenital defects 13 ... ... ... ... ... ... ... ... ... ... ... ... 1 3 b 3 7 6 13 58 Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Atrophy, debility, mararmus 87 7 ... ... ... ... ... ... ... ... ... ... ... 12 16 26 40 43 51 94 60 Dentition 7 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 3 3 4 4 8 61 Rickets ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 3 62 Old Age, senile decay ... ... ... ... ... ... 1 ... ... 4 34 51 16 43 12 23 28 39 67 106 63 Convulsions 33 1 ... ... ... ... ... ... ... ... ... ... ... 3 7 11 13 20 14 34 64 Meningitis 11 9 1 1 ... ... ... ... 3 ... ... ... ... 1 5 8 11 14 11 25 65 Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 66 Apoplexy ... ... ... ... ... 1 1 10 11 16 5 1 8 9 12 16 23 22 45 67 Softening of brain ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... 6 9 2 3 ... 2 5 2 8 8 9 17 69 General paralysis of insane ... ... ... ... ... ... 4 3 5 2 1 ... ... 3 4 3 5 11 4 15 70 Other forms of insanity ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... 1 71 Chorea ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 72 Cerebral tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73 Epilepsy ... I ... ... 1 1 1 2 2 ... ... ... ... 1 1 1 5 4 4 8 74 Laryngismus Stridulus 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 75 Locomotor Ataxy ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... 2 ... 2 76 Paraplegia, diseases of spinal cord ... ... ... ... 1 ... ... 1 3 2 2 1 ... 2 3 ... 5 4 6 10 77 Other diseases of brain or nervous system ... ... 1 3 ... ... ... 2 1 2 2 ... ... 2 5 ... 4 2 9 11 78 Otitis, otorrhoea ... ... 1 ... ... ... 4 ... ... 1 ... ... ... 1 2 ... 3 3 3 6 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 82 Endocarditis, valvular diseases of the heart ... ... 1 3 3 1 3 4 10 8 9 3 ... 6 6 11 22 19 26 45 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 85 Aneurism ... ... ... ... ... ... ... 1 2 1 1 ... ... ... 3 ... 2 5 ... 5 86 Senile gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 Embolism, thrombosis ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... 2 1 1 2 3 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 90 Other and ill-defined, diseases of heart and circulatory system, including heart disease not stated to be valvular 2 l 1 ... 4 2 8 12 13 23 16 9 2 17 24 15 37 47 46 93 91 Laryngitis 1 ... ... 1 1 1 1 1 2 22 Croup i ... ... ... ... ... ... 1 ... 1 1 93 Other diseases of larynx and trachea •• ... ... ... 94 Acute bronchitis 44 15 2 1 1 6 3 4 1 1 ... 9 27 20 22 35 43 78 95 Chronic bronchitis ... ... 1 10 y 21 47 20 1 21 21 23 44 54 55 109 96 Lobar, croupous pneumonia 3 ... ... 2 h a ... 2 ... 3 3 3 5 8 6 14 97 Lobular, broncho-pneumonia 27 29 ... 1 a V 4 1 ... 8 20 16 27 36 35 71 98 Pneumonia, form not stated 13 21 3 ... ... 3 7 11 14 10 9 3 11 20 18 45 56 38 94 99 Emphysema, asthma ... ... ... ... 2 1 3 3 3 100 Pleurisy 1 ... 1 ... i i 2 ... ... 1 i 4 2 4 6 101 Other and ill-defined diseases of respiratory system ... ... ... 1 ... ... ... 3 1 1 1 3 3 2 5 102 Diseases of mouth and annexa 1 ... ... ... .. . ... 1 1 1 103 Diseases of pharynx ... 104 Diseases of oesophagus ... ... ... 105 Ulcer of stomach and duodenum ... ... 1 i 1 ... 1 2 1 "3 2 1 5 6 106 Other diseases of stomach 5 i ... ... ... ... 4 ... ... 3 1 6 5 5 10 107 Enteritis 52 9 1 ... 1 1 1 1 ... 4 27 18 17 36 30 66 108 Appendicitis 109 Obstruction of intestine 3 i 2 1 2 ... i ... ... 5 2 ... ... "i 1 5 2 4 4 4 5 1 7 5 12 110 Other diseases of intestine 1 I ... i ... ... ... 2 ... 1 2 1 3 Ill Cirrhosis of liver ... ... ... 2 7 8 2 4 ... 5 5 5 8 11 12 23 112 Other diseases of liver • ... ... I 1 ... 1 ... ... 2 3 2 3 5 113 Peritonitis 2 1 ... ... ... 1 1 i 4 a 5 1 6 114 Other and ill-defined diseases of digestive system ... ... ... ... 1 1 ... ... 2 ... ... 2 2 68 69 DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31st, 1903. DEATHS REGISTERED IN EACH SUB-DISTRICT FROM ALL CAUSES. CAUSES OF DEATH. AGES. Shoreditch South. Hoxton Hoxton Old Town. Haggereton. Males. Females. Total. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 36. 35 to 45. 45 to 65. 55 to 65. 65 to 75. 75 to 85. 85 and upwards 115 Diseast of symphatic eystern and ductless glands ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 116 Acute nephritis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 117 Bripht's disease 1 ... 1 ... 2 1 4 12 18 10 15 3 ... 8 21 17 21 38 29 67 118 Calculus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 119 Disease of bladder and postrate ... ... ... ... ... ... ... 1 ... 1 2 ... ... 1 1 ... 2 4 ... 4 120 Other and ill-defined diseases of urinary system ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 1 121 Diseases of testis and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 124 Diseases of vagina and external genita organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Placenta prcevia, flooding . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 130 Puerperal thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-denned accidents and diseases of pregnancy and childbirth ... ... ... ... ... 1 3 l ... ... ... ... ... ... 3 ... 2 ... 5 5 132 Arthritis, ostitis, periostitis ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... 1 3 ... ... 3 ... ... 1 2 2 4 134 Ulcer, bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Eczema 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... l ... 1 136 Pemphigus 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... l ... 1 137 Other and ill-defined diseases of integumentary svstem 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 By Accident ob Negligence. 138 In mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In vehicular traflic ... 4 ... ... 1 ... ... ... ... 1 ... ... ... 2 ... ... 5 6 1 7 140 On railways ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 ... 1 141 On vessels & docks, excluding drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 142 In buildings operations ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 1 143 By machinery ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 144 By weapons and implements ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 145 Burns and scalds 2 5 ... ... ... ... 2 1 1 2 3. ... ... 3 3 3 7 5 11 16 146 Poisons, poisonous vapours ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 147 Surgical narcosis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 Drowning 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 2 4 1 5 151 Suffocation, overlaid in bed 34 2 ... ... ... ... ... ... ... ... ... ... ... 4 8 10 14 17 19 36 152 Suffocation, otherwise ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 153 Falls, not specified ... ... 1 1 ... ... 1 1 6 3 4 2 2 ... 4 6 11 6 15 21 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... 155 Otherwise, and not stated ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 1 156 Homicide ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Suicides, all forms. 157 By poison ... ... ... ... ... 1 ... 3 1 1 ... ... ... 3 1 ... 2 2 4 6 158 By asphyxia ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 1 159 3y hanging and strangulation ... ... ... ... ... ... ... 3 1 ... ... ... ... 1 3 ... ... 2 2 4 160 By drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 161 By shooting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 162 By cut or stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 163 By precipitation from elevated places ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... 1 164 By crushing ... ... ... ... ... ... ... ... .. . ... ... ... ... ... ... ... ... ... ... ... 165 By other and unspecified methods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 168 Other ill-defined and not specified causes 5 2 ... ... ... ... ... 2 1 4 1 ... ... ... 8 3 4 5 10 15 169 Malignant disease ... ... 1 ... 2 ... 1 3 1 9 2 2 ... 5 5 7 4 10 11 21 170 Abcess ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... 1 ... 1 1 2 Totals 676 307 42 29 37 39 121 199 248 219 226 115 22 341 591 499 849 1183 1097 2280 70 TABLE VI- ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1903. Districts. Estimated population 1903 Annual Rate per 1000 persons living. Deaths under 1 year to 1000 Births. percentage to total deaths. births deaths during the years : deaths during 1903 from Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Small-Pox 1 Measles. Scarlet Fever Diphtheria Whooping Cough. *Fever. Diarrhcea. Tuberculous Disease. Violence. 1900 1901. 1902. 1903. London 4,613,812 28.5 18.8 17.6 17.2 15.7 1.7 0.00 0.44 0.07 0.16 0.35 0.08 0.64 131 Shoreditch § 116,865 32.9 21.4 22.1 20.9 19.6 2.7 — 0.85 0.05 0.18 0.85 0.11 1.28 3.2 0.9 176 36.8 Sub-Districts. Shoreditch South 15,800 26.6 26.4 23.2 22.2 21.6 2.2 — 0.44 0.06 0.25 0.19 0.12 1.14 3.2 1.0 156 Hoxton New Town §28,225 82.5 20.9 21.6 20.5 20.9 3.9 — 1.77 0.10 0.10 0.42 0.14 1.38 3.1 0.8 186 Hoxton Old Town 26,350 34.5 19.8 22.0 21.1 18.9 2.5 — 0.64 0.07 0.11 0.30 0.07 1.32 3.0 0.7 188 Haggerston 45,990 34.2 20.9 22.1 20.6 18.4 2.4 — 0.54 0.02 0.23 0.39 0.10 1.10 3.4 0.9 156 *Fever includes typhus, typhoid, and continued fevers. §The inhabitants of the Holborn Union Workhouse, which is situate in Hoxton New Town Sub-District, and the deaths occurring in that institution are excluded. Note.—Where the deaths under any heading are too few to express as a rate per 1000 within two places of decimals, 0.00 is inserted; where no deaths have occurred, a line is placed in the space under the heading. 71 TABLE VII. ANALYSIS of the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31,s<, 1903. Diseases. Diseases All Causes 3,527 38 Congenital malformations - 1 Small-pox — 39 Old age 99 2 Measles 106 40 Apoplexy 7 3 Scarlet fever 8 41 Epilepsy 26 4 Typhus 42 Convulsions 1 5 Relapsing fever — 43 Other diseases of brain and nervous system 151 6 Influenza 73 7 Whooping cough 13 44 Diseases of organs of special sense 8 8 Diphtheria 1 9 Simple, continued and illdefined fever 7 45 Diseases of circulatory system 164 10 Enteric fever 5 46 Laryngitis 5 11 Simple cholera — 47 Bronchitis 772 12 Diarrhoea, dysentery 75 48 Pneumonia 42 13 Remittent fever — 49 Pleurisy 21 14 Hydrophobia — 50 Other respiratory diseases 25 15 Glanders — 16 Cow pox and effects of vaccination 51 Dentition 5 52 Quinzy, sore throat 20 17 Venereal affections 22 53 Enteritis 54 18 Erysipelas 14 54 Peritonitis 2 19 Pyiemia and septicaemia 10 55 Diseases of liver 25 20 Puerperal fever — 56 Other diseases of digestive system 167 21 Tabes mesenterica — 22 Tuberculous meningitis — 23 Phthisis 209 57 Diseases of lymphatic system 24 Scrofula, tuberculosis 26 and ductless glands 25 Other zymotic diseases 13 58 Diseases of urinary system 41 26 Thrush 59 Diseases of generative system 23 27 Worms and other parasitic diseases 7 60 Accidents of childbirth 7 61 Diseases of locomotive system 157 28 Starvation, want of breast-milk 1 62 Diseases of integumentary 29 Alcoholism 12. system 93 30 Rheumatic fever and rheumatism of heart 13 INJURIES.— 63 Fracture and contusion 23 31 Rheumatism 287 64 Gun shot wounds — 32 Gout 53 65 Cut, stab — 83 Rickets 3 66 Burn or scald 4 34 Cancer 30 67 Poison 3 35 Other constitutional diseases 50 68 Drowning 69 Suffocation — 36 Premature birth - 70 Otherwise 86 37 Atelectasis - 71 Other causes 462 72 SUMMARY OP PROCEEDINGS DURING 1903.— Table VIII. PREMISES. NUMBER OP PLACES— Number of inspections, 1903. Number of notices, 1903. Number of prosecutions, 1903. On register at end of 1902. Added in 1903. Removed in 1903. On register at end of 1903. Milk premises 304 16 20 300 4 2803 3 — Cowsheds 9 — 1 8 90 — — Slaughter-houses 14 — — 14 110 — - Other offensive trade premises 1 - - 1 - - - Ice cream premises 63 5 4 64 148 15 - Registered houses let in lodgings 191 42 — 233 335 (a)* (a)* (b)*22 (b) * (a) For overcrowding. * (b) For other conditions. Overcrowding, 1903:— Number of dwelling rooms overcrowded 106 Number remedied 106 Number of notices issued 85 Number of prosecutions — Underground rooms:— Number closed during year 2 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 20 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 14 Customs and Inland Revenue Acts :— Number of houses for which applications were reoeived during year 24 Number of dwellings comprised therein 72 Number of certificates granted as to dwellings 42 Number of prosecutions under By-laws under Public Health Act, 1891:— As to cesspools and privies, removal and disposal of refuse, etc. 7 "With respect to water closets, earth closets, etc. 2 Mortuary:— Total number of bodies removed 450 Total number of infectious bodies removed 2 73 FACTORY AND WORKSHOP ACT, 1901. TABLE IX. INSPECTION OP FACTORIES, WORKSHOPS, AND WORKPLACES. CLASS OF WORKS. NOMBjSR OF Pj.ACES. Number of Inspections, 1903. Number of Notices, 1903. Number of Prosecutions, 1903. On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Premises Rooms. Factorie Factory Laundries ... ... ... ... ... ... Factory Bakehouses 2 ... ... 2 ... 2 Other Factories Work- shops Workshop Laundries 34 2 3 33 92 10 Workshop Bakehouses ... 82 ... 6 76 710 57 Other Workshops 1047 93 40 1100 3236 382 Work- places Outworkers' premises .. .. ... .. ... 56 Places where food is prepared for sale 176 12 1 187 317 65 Workplaces other than the above ... ... .. .. .. .. Total 2341 107 50 2398 4355 572 ✓ 74 TABLE X. MATTERS DEALT WITH IN CONNECTION WITH FACTORIES WORKSHOPS AND WORKPLACES. PARTICULARS. Number of Defects. Notices Issued Prosecutions. Found. Notified by Home Office. Remedied. Notified to Home Office. Matters under the Public Health (London) Act, 1891. Want of Cleanliness 194 97 291 97 291 Want of Ventilation ... 2 2 2 2 Want of Air Space : Overcrowding ... 1 4 4 4 Sanitary Accommodation' (s. 38,) Insufficient 1 5 6 5 6 Unsuitable 7 31 38 31 38 Not Separate for Sexes 2 8 10 8 10 Want of Drainage of Floors ... ... ... ... ... Other Nuisances 22 19 41 19 41 Contraventions of Factory and Workshop Act, 1901. Occupying underground Bakehouse without certificate ... ... ... ... ... Breach of Special Sanitary Requirements for Bakehouse (ss. 97 to 100) ... ... ... ... ... Failure as regards Lists of Outworkers (s. 107) 12 ... ... ... 12* Giving out , woi k to be done in premises which are Unwholesome (s. 108) ... ... ... ... ... Infected (s. 110) ... ... ... ... ... Allowing Wearing Apparel to be made in Premises infected by Scarlet Fever or Small-pox (s. 109 ... ... ... ... ... Other Contraventions ... ... ... ... ... Total 238 166 392 1 166 404 * Letters were sent in these cases. 75 TABLE XI. LIST OF OUTWORKERS (S. 107). Class of Homework. 1903. Number of Lists received. Number of Addresses of Outworkers. Up to Feb. 1st. Up to Aug. :st. Forwarded to other Authorities. Received from other Authorities. No. o£ Lists. No. of Outw'rkers No. of Lists. No. of Outw'rkers Wearing Apparel: Tailoring 1 68 4 17 80 492 Fancy Collar, Tunics, &c. 1 13 1 11 14 ... Pinafores, Pelisses, Millinery, &c. 1 26 ... ... 17 18 Mantles 1 8 1 14 Millinery ... ... 1 15 12 ... Boots ... ... 2 29 18 81 Blouses ... ... 1 53 16 22 Trimmings ... ... 1 37 34 ... Lace ... ... ... ... ... ... Cabinet Making ... ... ... ... ... ... Fur pulling ... ... ... ... ... 4 Other ... ... 7 80 43 41 Total 3 107 18 250 235 672