SHOR 15 REPORT on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shorrditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1904, by LEWIS T. FRASER BRYETT, M.D. (Lond.), Medical Officer of Health; Diplomats in Public Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health, &c. [Printed by Order of the Health Committee.] printed by a. t. roberts, son and co., ltd., hackney road, n.e. 1905. CONTENTS. page. Alcoholism 6 Appendicitis, mortality from 6 Bacteriological examinations 34 Bakehouses 48 Births and birth rates 2 Births in sub-districts 2 Cancer 5 Chicken pox 9, 60 Coffeehouses 49 Cookshops 49 Conscientious objection certificates granted 19 Cowhouses 44 Customs and Inland Revenue Acts 43 Dairies 44 Deaths, ages at 4 Deaths, causes of 5 Death rate 3 Deaths number of 3 Deaths in outlying institutions 7 Deaths in public institutions 6 Diarrhoea 29 Diphtheria 20 Disinfection 34 Enteric fever 24 Erysipelas 26 Factories and Workshops Act, 1901 45 Factories, workshops and workplaces—sanitary work 46 Food condemned and destroyed 50 Food and Drugs Acts 52 Fried fish shops 49 Glanders 27 Houses closed 39 Houses let in lodgings 41 Houses occupied by working classes—demolition of 41 Ice cream shops 48 Infectious cases, number certified 9 Infectious cases, number removed to hospitals 10 Infectious diseases, age periods 8 Infectious diseases, deaths from 8 Infectious diseases, death rate 8 Infectious diseases, number of cases notified from schools 32 Influenza 7 31 Institutions, deaths in 7 Legal proceedings 38 Margarine Act. proceedings under 54 Marriages 3 Measles 30 Milkshops 44 Milk premises, cowsheds, etc., on register 44 Mortality, infant 4 Mortuary 36 Offensive businesses 44 Outworkers 47 Population 1 Puerperal fever 29 Sanitary work 36 Scarlet fever 19 Scarlet fever at Catherine Street School 34 Scarlet fever, "return" cases of 11 Schools, closure for infectious disease 34 page. Shelter 35 Sickness amongst the poor 7 Slaughterhouses 43 Smallpox 16 Smoke nuisance 43 Street markets and food 50 Swine, keeping of 38 Tuberculosis 31 Vaccination returns 19 Violence, mortality from 6 Water supply 36 Whooping cough 30 Workshops—summary of principal trades carried on 45 Workshops on register 45 Zymotic diseases, deaths from 9 Zymotic, death rate 9 APPENDIX. Statistical Tables :— For whole district during 1904 and previous years (Table I.) 58 For separate localities in 1904 and previous years (Table II.) 59 Cases of infectious disease notified during 1904 (Table III.) 60 Causes of, and ages, at death during year 1904 (Tables IV. and V.) 61,62 Comparison of London and Shoreditch birth and death rates in 1904 (Table VI.) 68 Cases treated by the District Medical Officer in 1904 (Table VII.) 69 Summary of proceedings under the Public Health (Lond.) Act, 1891 (Table VIII.) 70 Factory and Workshop Act—Summary of work (Tables I., II. and III.) 71 Summary of return cases of scarlet fever, 1893-1904 73 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF the MEDICAL OFFICER of HEALTH. HEALTH DEPARTMENT, TOWN HALL, OLD STREET, E.C. January, 1905. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. SIR and GENTLEMEN, This report deals with the public health, sanitary condition and vital statistics of the Borough of Shoreditch for the year ending December 31st, 1904. POPULATION. The number of persons in the Borough is estimated at 117,360, as compared with 117,740 in 1903, and 117,948 in 1902. The population is distributed in the four registration sub-districts as follows:—Shoreditch South, 15,650; Hoxton New Town, 29,400; Hoxton Old Town, 26,330; Haggerston, 45,980. The population of the New Town registration sub-district includes the inmates of the Holborn Union Workhouse, which is situate in that sub-district. These, which numbered at the 1901 census 1,375, are not regarded for certain statistical purposes as persons belonging to Shoreditch, and are accordingly excluded for these purposes; the population of the New Town district becoming 28,125, and the population for the whole of the Borough 115,985. The demolition of dwelling houses occupied by persons of the working class was not so extensive as in 1903. The registration sub-districts were altered and re-arranged during the year, being reduced from, four to three in number. The new arrangement came into operation on September 1st. The new sub-districts are as follows:-—Shoreditch South, consisting of Moorfields, Church, and Hoxton Wards, having a population at the last census of 46,362; Shoreditch North-West, consisting of Wenlock and Whitmore Wards, with a population of 36,127; and Shoreditch North East, consisting of Kingsland, Haggerston, and Acton Wards, having a census population of 36,148. For statistical purposes the old arrangement of the registration sub-districts was adhered to until the end of the 2 year. It was inconvenient for the Health Department that the change should have taken place when it did. It would have been better if it had come into operation at the beginning of 1904. Most difficulty was experienced in connection with the statistics as to the births. BIRTHS. It was necessary for a clerk to search the registers at the offices of the Registrars every fortnight, in order to make the necessary distribution of births amongst the old subdistricts. He was enabled to do this through the courtesy of the Registrars. For the year 1905 the Health Committee have entered into an arrangement with the Registrars to supply the Birth Returns weekly in the same manner as the Death Returns are supplied. The number of births in 1903 was 3,763 as compared with 3,932 in 1902. The males born numbered 1,877, and the females 1,886. In the Shoreditch Infirmary and Workhouse the births numbered 83, of which 41 were of males and 42 females. Of these 40 were believed to be legitimate and 43 illegitimate. In the Holborn Union Workhouse there were 91 births, of which 42 were male and 49 female, 33 being legitimate and 58 illegitimate. The distribution of the births in the four Registration sub-districts of the Borougl is shown in the subjoined table:— Registration Sub-District. Males. Females. Total. Shoreditch South 192 180 372 Hoxton New Town 499 500 999 Hoxton Old Town 422 415 837 Haggerston 764 791 1,555 Total 1,877 1,886 3,763 Deducting the births in the Holborn Workhouse, the mothers not being persons belonging to Shoreditch, the birth-rate was 31.6 per 1,000 inhabitants. The birthrate in the Registration sub-districts are contained in table VI. (appendix). A marked decline in the birth-rate is observable this year, the rate being 1.3 per 1,000 lower than that of last year. There has been a steady decline since 1883. From 1865 to 1883 (inclusive) the Shoreditch birth-rate was every year above 40 per 1,000, and occasionally it mounted to 42 per 1,000. The rate for 1904 was more than 20 per cent. lower than that for 1883. The decline in the birth-rate is, however, not a feature confined to Shoreditch. A similar steady decline is observable in that for the Metropolis. In 1880 the London birth-rate was 36.2, in 1904 it was 27.9 per 1,000. The births for the whole of England and Wales during 1904 were at the rate of 27.9 per 1,000; for rural1 England and Wales, 26.8; for 76 great towns, 29.1; and for 142 smaller towns the rate was 27.5 per 1,000. The Shoreditch birth-rate, therefore, although, markedly less than it used to be, still remains higher than the average for the Country. 3 MARRIAGES. The number of marriages registered1 in the Borough during the year was 1,066, as compared with 1,146 in 1903, 1,156 in, 1902, 1,073 in 1901, 1,157 in 1900 and 1,295 in 1899. It was the smallest number during the past six years. The number of persons married was at the rate of 18.3 per thousand, as compared witn 17.0 per 1,000 for the whole of London. DEATHS. The deaths numbered 2,392, as compared with 2,280 last year. They were distributed amongst males and females in the four Registration sub-districts as shewn in the following table:— Registration Sub-District. Males. Females. Total. Shoreditch South 209 154 363 Hoxton New Town 263 290 553 Hoxton Old Town 283 236 519 Haggerston 498 459 957 Total 1,253 1,139 2,392 The deaths of males were 114 in excess of those of females. The death-rate was 20.6 per thousand inhabitants*, as compared with 19.6 for last year. Although showing an increase on that of 1903 it was, nevertheless, below the average for the previous ten years. The London death-rate was 16.1, that of England and Wales 16.2, Rural England and Wales 15.3, 76 great towns 17.2, and that of 142 smaller towns was 15.6 per 1,000. Tables giving the death-rates and the causes of death at various age-periods in Shoreditch and its four Registration sub-districts, together with other information bearing upon the subject, are contained in the appendix (Tables I., II., IV., V., VI.). The death-rate was highest in Shoreditch South, and lowest in Hoxton New Town, being 23.2 in the former Registration sub-district and 19.3 in the latter. The deathrate remained low and fairly steady for the first six months of the year. Towards the end of July there was a rapid rise, the rate increasing week by week until a maximum was reached in the third week of August, when the death-rate mounted to between 37 and 38 per 1,000. In the fourth week of August there was a drop to 24.0, and in the following week to 16.2 per 1,000. The rate remained low until the beginning of December, when a rapid rise to 34.8 per 1,000 took place. The next week there was a fall, but the death-rate remained above the average during the closing weeks of the year. The high rate of August resulted from the prevalence of summer diarrhoea and measles, and that of December was mainly due to measles and diseases of the respiratory organs, chiefly bronchitis and pneumonia. *Corrected for age and sex distribution the death-rate was 21.6 per 1,000. 4 The deaths of infants under the age of one year numbered 706, of which 380 were of males and 326 of females. They formed nearly 30 per cent. of the deaths during the year. The proportion of infants under one year dying during the year to the total number of births registered in the year was at the rate of 190 per 1,000. This infant mortality is greatly in excess of that of the Metropolis, and is higher than that of any of the other London Boroughs. The chief causes of the mortality amongst infants in Shoreditch in 1904 were diarrhoea, enteritis, whooping cough, bronchitis, pneumonia, and tuberculosis, which are all more or less infectious, and wasting, disorders of digestion, prematurity and weakness at birth, and suffocation in bed, which largely result through want of knowledge or lack of means or through carelessness on the part of those in charge of infants in respect to their feeding and management, or through debilitating influences which affect the mothers during pregnancy. The main conditions which result in high infant mortality are poverty and overcrowding, with their attendant evils intemperance in the parents, want of cleanliness in person and dwelling, insufficiency of fresh air. and lack of proper precautions as to infant feeding. Debilitating influences, more or less affect the health of persons of all ages, but the health of young infants suffers especially and in many instances, although they manage to survive, they grow up to be but stunted and feeble specimens of humanity. It would be a great step in the mitigation of these evils if a knowledge of the essential principles of hygiene as affecting the person and dwelling was more widely spread amongst the people. Hygiene ought to be made a subject to receive special attention in all schools, and measures should be taken to urge upon mothers the great importance of rearing infants naturally upon the breast. Infants so reared have a much better chance of surviving the vicissitudes of the first year of life than those fed artificially by hand. The deaths of children aged between one and five years numbered 358, chiefly attributable to measles, whooping cough, tuberculosis, pneumonia, bronchitis, and diarrhoea. Violence resulted in 8 deaths, four of which were due to burns or scalds, and one to homicide. Altogether 1,064, or a little over 44 per cent. of the total number of deaths during the year were of children under the age of five years. The deaths of children between the ages of five and fifteen numbered 72, and included 33 due to infectious disease—chiefly tuberculosis. Violence, through accident or negligence, resulted in seven deaths. Of persons aged from fifteen to twenty-five 80 died, including 47 from infectious disease of which 33 were caused by consumption. The deaths of persons aged from 25 to 35 years numbered 143, the chief causes being consumption, which accounted for 58, heart disease, and diseases of the respiratory organs. Alcoholism caused 3 deaths, Bright's disease 4 deaths, and violence 10 including one homicidal and four suicidal. Of persons aged between 35 and 45 years there were 175 deaths, of which 58 were attributed to consumption, ,10 to alcoholism-, 7 to cancer, 11 to various nervous disorders, 6 to aneurism, 10 to heart disease, 12 to bronchitis, 19 to pneumonia, 7 to cirrhosis of the liver, and 3 to Bright's disease. Violence resulted in 10 deaths, of which 2 were suicidal. 5 Of 221 deaths of persons aged between 45 and 55 years, 46 were attributed to consumption, 7 to alcoholism, 20 to cancer, 18 to diseases of the nervous system, 28 to heart disease, 22 to bronchitis, 15 to pneumonia, 11 to Bright's disease, and 5 to cirrhosis of the liver. Violence caused 7 deaths, including two through suicide. Of 243 deaths of persons aged from 55 to 65 years, 21 were attributed to consumption, 5 to alcoholism, 32 to cancer, 36 to diseases of the nervous system, including 23 from apoplexy, 25 to heart disease, 33 to bronchitis, 12 to pneumonia, 8 to cirrhosis of the liver, and 26 to Bright's disease. Violence resulted in 15 deaths, including 4 through suicide. Of persons aged from 65 to 75 years, 227 died, the chief causes given were cancer, which resulted in 16 deaths, old age in 31, apoplexy in 23, heart disease in 24, bronchitis in 52, pneumonia in 15, and Bright's disease in 13 deaths. Violence ended in 7 deaths, three of which were suicidal. Of 137 persons who died aged from 75 to 85 years, 52 succumbed to the effects of old age, 7 to heart disease, and 29 to bronchitis. Six deaths were attributed to the effects of violence, through accident or negligence. Of the 30 persons who died aged 85 years and upwards, 22 succumbed to the effects of age, one to paralysis, one to influenza, two to heart disease, two to bronchitis, one to pneumonia, and one committed suicide by hanging. The chief causes of death in Shoreditch during the year were: tuberculosis, which accounted for 365 deaths, including 247 from consumption; bronchitis, which caused 230 deaths; pneumonia, causing 197; diarrhoea, 186; prematurity and debility at birth, 97; atrophy, debility and marasmus, the result of injudicious feeding in infants, 101; old age, 107; measles, 81; whooping cough, 60; heart disease, 130; cancer, 80; apoplexy 64; and Bright's disease, 73 deaths. Cancer was given as the cause of 80 deaths of which 31 were of males and 49 of females. The whole of the deaths were amongst persons aged 35 years and upwards, the great majority occurring between the ages of 45 and 75 years. The cancer deathrate was 0.69 per 1,000 inhabitants as compared with 0.66 in 1903, 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 9 were attributed to malignant disease. Four of these were of males and five females. These have not been included in estimating the cancer death-rate but it is probable that several of them were due to cancer. The prevalence of cancer in Shoreditch judging from the death-rates given above has somewhat increased during the past three or four years. No specific cure has as yet been discovered, but the sooner treatment is begun the more likely is it to be successful. Persons who suspect cancer should lose no time in obtaining the advice of their doctors as to treatment. It is well to remember, however, that slight ailments 6 may give rise to the- suspicion of cancer and thus cause anxiety. In men the lips and tongue, gullet, stomach and intestines; and in women the breast and womb are most frequently affected with cancer. The breast and womb in women are especiaJly liable to be attacked, and it is the frequency with which they are the seat of the disease which accounts for the preponderance of cancer cases amongst women. The increase in the number of deaths attributed to appendicitis is worthy of note. In 1901 the number registered was 2; in 1902 it was 4; in 1903, 5; and for the year under consideration it has risen to seven. Alcoholism was given as the cause of 30 persons dying, but there were 27 deaths attributed to cirrhosis of the liver, a disorder which is practically always associated with the excessive use of alcohol. Many other deaths during the year were without doubt more or less directly attributable to the effects of alcoholic excess. The various forms of violence resulted in 111 deaths, of which 77 were of males and 34 of females. Accident or negligence occasioned 91 deaths, the chief causes being the suffocation in bed of infants, mainly through being overlaid, which accounted for 32, falls, which caused 25, burns and scalds, and the results of accidents with horses and vehicles. Two deaths were homicidal, and 18 persons committed suicide, 15 of whom were males. DEATHS IN PUBLIC INSTITUTIONS. The numbers and distribution of the deaths of persons, belonging and not belonging to the Borough, 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 2 271 273 Shoreditch Workhouse 431 19 450 Hoxton House Asylum 1 21 22 Eoyal Chest Hospital 11 51 62 Convent Hospital — 4 4 Total 445 366 811 Elsewhere than in public institutions seven 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:— 7 Asylums. No. of Deaths. General Hospitals—continued. No. of Deaths. Banstead 7 North Eastern (Children) 43 Cane Hill 3 Poplar 1 Caterham 1 Queen Charlottes 1 City of London Stone 1 Royal Free 3 Claybury 6 St. Bartholomew's 76 Colney Hatch 7 St. George s 1 Darenth 3 St. Mary's 1 Dartford Heath 6 St. Peter s 1 Friern Barnet 1 Shadwell (Children) 1 Grove Hall 1 University 2 Hanwell 4 Victoria, Southend 1 Horton 4 Hospitals for Special Diseases. Leavesden 11 Cancer 1 Licensed Victuallers,Peckham 1 Epileptic Colony, Epsom 1 London County, Ilford 2 Heart Hospital, Soho 1 Manor 1 Lying-in, City of London 5 Metropolitan Benefit Society 1 Mount Vernon Consumption 1 Tooting Bee 15 Royal London Ophthalmic . 1 Hospitals fob Infectious Disease Victoria Park, Chest 2 Eastern 3 Infirmaries and Workhouses. Bethnal Green Infirmary and Workhouse 5 Joyce Green 2 North Eastern 24 South Western 1 General Hospitals. Holborn Infimary 7 Charing Cross 1 Hackney Infimary 1 German 9 St. George's Infirmary 6 Gr. Ormoud Street (Children) 24 St. Pancras Workhouse 1 Guy's 2 Wood Green 1 Friedenheim 4 Whitechapel Infirmary 2 Homœopathic 1 Other Institutions. Infants', Hampstead 1 King's College 5 H.M. Prison, Wormwood Scrubbs 1 London 18 London Temperance 1 St. Anne's House 1 Metropolitan 77 St. Luke's House 2 Middlesex 1 Hostel of God 2 Mildmay 9 Salvation Army Maternity Home 1 National 1 Of 434 persons belonging to Shoreditch dying in public institutions situate beyond the limits of the Borough, 286 died in general hospitals including 68 in hospitals for children; 30 died in the fever hospitals of the Metropolitan Asylums Board; 75 died in asylums; 12 in hospitals for special diseases; 24 in workhouses and infirmaries and 7 in other institutions. Elsewhere than in public institutions 16 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 879 persons belonging to Shoreditch died in public institutions. Including the sixteen persons who did not die in public institutions 895 persons belonging to the Borough died elsewhere than in their homes. SICKNESS AMONGST THE POOR. The number of cases of illness coming under the treatment of the district medical officers in connection with the public dispensary shows a marked increase on the figures 8 for recent years, being 4,168 as compared with 3,527 in 1903, 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 685 of the cases, and included 212 of consumption, 116 of measles, 81 of diarrhoea, and 92 of influenza. Diseases of the respiratory system, mainly the result of infection, accounted for 1,150 cases, including 1,037 of acute and chronic bronchitis, and 45 of pneumonia. Rheumatism was the cause of trouble in 307 cases, and gout in 69 cases. Diseases of the organs of digestion gave rise to 399 cases, a large proportion of which were dyspepsia. Enteritis or gastro-enteritis afflicted some 73 infants. In 23 instances alcoholism was recorded as the cause of illness. There is no doubt, however, that alcohol, directly or indirectly, was the cause of a far greater amount of illness amongst the poor than is indicated by this figure. The cases of cancer numbered 27 as compared with 30 in, 1903, 12 in 1902, 31 in 1901, 33 in 1900, 18 in 1889, 9 in 1898, 15 in 1897, 21 in 1896, 15 in 1895, 27 in 1894 and 23 in 1893. Diseases of locomotive system were the cause of trouble in 192 cases and in 95 various forms of skin eruptions required treatment. Diseases of the brain and nervous system gave rise to 177 and diseases of the circulatory system to 195 cases. In 137 cases the cause of trouble was old age. In 109 cases persons sought relief on account of violence. In 434 cases the illnesses were described as debility, marasmus and other causes not classified in the table. INFECTIOUS DISEASES. The infectious diseases numbered 1 to 35 in Table V (appendix) resulted in 791 deaths as compared with 762 in 1903, 767 in 1902 and 762 in 1901. The deaths; from these diseases were a little over 33 per cent. of the deaths from all causes. Nearly half of these deaths were attributed to consumption and the other forms of tuberculosis, and a large proportion of the remainder to infantile diarrhoea. The death-rate due to the infectious diseases referred to above amounted to 6.8 per 1,000 inhabitants as compared with 6.5 for last year. 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 55-6565-75 75-85 No. of deaths 259 209 17 16 24 23 75 67 53 25 12 6 Considerably more than half the deaths from infectious disease in the Borough were of children under five years of age, and taking the total mortality of children under five years from all causes 43 per cent. of the deaths resulted from infectious diseases, mainly diarrhoea, tuberculosis, whooping cough and measles. After the 1 to 5 years age period there is a rapid decline in the mortality from infectious diseases. Between 25 and 65 years the deaths become more numerous again, the increase being chiefly the result of consumption. 9 In addition to the above there are other diseases annually claiming many victims, which although not usually regarded by the public as being infectious nevertheless are so. Amongst such diseases may be mentioned pneumonia and bronchitis. Deaths from smallpox, measles, scarlet fever, diphtheria including membranous croup, whooping cough, enteric fever and diarrhoea are grouped, and the death-rate due to them is termed the zymotic death-rate. In 1904 the deaths from these diseases numbered 370 and the zymotic death-rate was 3.2 per 1,000 inhabitants as compared with 2.8 in 1903, 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. These figures show that the tendency is for a decline of the zymotic death-rate of the Borough. A comparison of the zymotic death-rates of London and Shoreditch, with its Registration sub-districts, is contained in Table VII. (Appendix.) The cases of notifiable infectious disease certified during 1904, excluding 302 casesof chickenpox, numbered 776. The numbers of cases certified since 1889 and the attack-rates per 1,000 inhabitants are contained in the following table:— Year. Number of cases. 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 1904 776 6.6 The cases of notifiable infectious disease, excluding chickenpox, certified in the Metropolis, numbered 28,311, which give a rate of attack of 6.0 per 1,000 population. Considering the great density of the population in Shoreditch it is satisfactory to note that the attack-rate for the Borough shows but a slight excess over that of the Metropolis as a whole. Subjoined is a list of the infectious diseases which are required to be notified tc 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:- 10 Disease First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox 1 6 7 ... 14 2 Scarlet Fever or Scarlatina 51 105 82 105 343 13 Diphtheria & Membranous Croup 24 45 58 56 183 19 Typhus ... ... ... ... ... ... Cholera ... ... ... ... ... ... Enteric Fever (Typhoid) ... 9 15 16 48 9 Continued Fever ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever 1 1 1 2 5 2 Erysipelas 34 41 51 57 183 5 Totals 119 207 214 236 776 50 Numbers and percentages of cases removed to hospitals 85 156 153 177 575 71% 75% 71% 75% 74% As compared with the figures of 1903 cas-is of scarlet fever, erysipelas and diphtheria were increased in number during 1904, whilst there was a very marked decrease in the number of cases of enteric fever. Puerperal fever cases were less by two. Fourteen cases of smallpox were certified as against none in 1903. The deaths from notifiable infectious disease numbered 50 as compared with 49 in 1903, 144 irr 1902, 72 in 1901, 99 in 1900, 121 in 1899, 96 in 1898, 136 in 1897, 135 in 1896, and 117 in 1895. The marked increase in the number of deaths noticeable for 1902 was the result of the smallpox outbreak that year. Otherwise of late years there has been a marked decline in the number of deaths resulting from notifiable infectious disease in Shoreditch. The deaths from the principal infectious diseases which are notifiable, namely smallpox, scarlet fever, diphtheria and enteric fever were at the rate of 0.3 per 1,000 population as compared with 2.8 for the principal infectious diseases which are not notifiable, namely, measles, whooping cough and diarrhoea. METROPOLITAN ASYLUMS BOARD. The great majority of the cases of infectious disease removed to hospital for treatment were taken to the various hospitals of the Metropolitan Asylums Board. The exceptions were certain cases of typhoid fever which were treated at general hospitals, cases of erysipelas taken into the Shoreditch Infirmary and one or two cases of scarlet fever and diphtheria treated at the Liverpool Road Fever Hospital. The infectious diseases which are received at the hospitals of the Board are smallpox, scarlet fever, diphtheria, and typhoid fever. The number of cases of these diseases certified was 588 and the number removed to hospital was 562; the percentage of cases 11 removed being 95.5 as compared with 90.7 in 1903, 93.1 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 percentage of removals to hospital from Shoreditch for the year 1904 was, therefore, higher than it has ever been before. The percentage of removals has been gradually increasing year by year since 1889, and this increase has been associated with a gradual decrease in the total number of cases of scarlet fever, diphtheria and enteric fever as the following figures show: Period. Years. Average Percentages of cases removed. Average number of cases certified annually. 1 1890—1894 41% 1082 2 1895—1899 70% 975 3 1900—1904 88% 670* Comparing the 1st and 3rd periods the percentage of removals per annum is more than double in the latter what it was in the former, whilst the average number of cases annually certified has decreased by 400 or 38 per cent. Doubtless there may be influences at work other than hospital isolation. It is, however, not unreasonable to hold that the reduction in the amount of notifiable infectious disease to which attention is directed has been to a considerable extent due to the increased use of the isolation hospitals by the people of Shoreditch. Smallpox has not been included with the other notifiable infectious diseases for the purposes of the above table as it is only occasionally met with now. All cases of this disease, save those which end fatally before they can be removed, are taken to hospital. Arising out of an alleged premature discharge of a patient to Poplar from one of the Board's hospitals a communication dated June 17th was addressed to the Borough Councils of the Metropolis on the subject of RETURN CASES OF SCARLET FEVER, directing attention to the following facts:— "At the present time there is an entire want of precise knowledge, both as to the causation of scarlet fever and also as to the period of infectivity of patients suffering from the disease and in the absence of definite scientific knowledge it is impossible for anyone to assert positively that infection has or has not ceased in any given case. Until recently there was a concensus of opinion that the desquamation which occurs in such cases was coincident with the infectivity of the, patient and that the cessation of desquamation could therefore be taken as an indication to determine this latter point; but the Board *Not including 170 cases of scarlet fever directly traceable to infected milk which occurred in 1901. 12 understands that this opinion; has undergone considerable modification during recent years, it being held by many of the more prominent physicians, medical officers of health, superintendents of fever hospitals and other medical authorities that desquamation, especially that in the latter stages, cannot be taken as evidence of infectivity." "The Board have long been aware that so-called return cases have from time to time occurred, and with the object of obtaining the fullest information as to their cause and with the view of adopting (if practicable) further precautions they, three years since, appointed a medical officer to conduct investigations into1 the circumstances of all such alleged cases, and the report of this officer will shortly be in print. As the result of this and other steps which the Board are taking they trust that they may be enabled to throw much light upon this at present obscure subject.'' "Notwithstanding this absence of scientific knowledge the Board are confident that the most careful judgment is exercised in every case by the medical officers whom they have placed in charge of their hospitals. The Board are of course alive to the responsible duties which rest upon them, and they can assure the Council that they are taking every means rightly to discharge these, both as regards the patients and the public.'' During the year under consideration seven cases of the nature referred to in the Board's letter came under observation in Shoreditch. The particulars relating to them are briefly as follows:— (1.) Sarah W-was removed from No. 22, D- Road, Kingsland, about the end of August 1903. She was discharged from hospital to 34, N- Street on January 11th, 1904. That night she slept in same bed as Leonard W-who was certified to have scarlet fever on January 14th. Sarah on her return was noticed to have a discharge from her right ear. (2.) Ernest P-, aged 5, was removed from 27, H- Place on April 16th, and returned home on July 9th. He was stated to have had a discharge from his nose whilst in hospital. The mother noticed that the discharge came on again the day after his return home. Lily P—, aged 1 year and 8 months sickened with scarlet fever on July 15th. (3.) Albert G-, aged .10 months, was removed with scarlet fever of Sept 10th and returned home on November 2nd to 26, G- W- Place. He had on his return a discharge from his ears which was present before his removal to hospital. Alice M-, aged 5, residing in the same dwelling, sickened with scarlet fever on November 14th. She was attending school up to November 13th. (4.) Reginald J-, aged 7, was removed from No. 18, C- Road, on September 15th and returned home on November 17th. He slept in same bed as Fred M-, aged 9, who was certified to have scarlet fever 13 on November 28th. In this instance there was no evidence as to the primary case (that of Reginald J-) having been infectious on return. There was a history of " sore throat" in the house during the interval between the return of the primary case and the occurrence of the secondary or return case. (5.) Elsie G-, aged 6, was removed to hospital on October 9th, and returned home to 77, P- Street, on November 26th. Ada G-, aged 10, who slept in same bed as Elsie, fell ill on November 29th with scarlet fever. Nothing was observable in connection with Elsie to indicate she was infectious. (6.) Alfred B-, aged 2 and 4 months, was removed from 21, Forston Street, on August 17th, and returned home on November 7th. He is stated to have had a discharge from his ears when he returned. On December 5th: Edward O'N-, aged 2 and 8 months, belonging to another family residing in the house, fell ill and was certified to have scarlet fever. (7.) Andrew H-, aged 9, was removed on October 23 and returned home to 99, C-Street, on December 17th. He was noticed to have a discharge from' his nose when he returned. On December 25 Johanna H-was taken ill with scarlet fever. She last attended school on December 23. In none of the above cases was there any reason for believing that the measures as to disinfection were insufficient. With the exception of the case of Elsie G——, who was taken to the Liverpool Road Hospital, the patients were removed to the fever hospitals of the Metropolitan Asylums Board. Assuming that in all the above instances the return cases resulted through infection from the patients coming back from the hospitals the percentage of recurrences due to this cause was 2.18, allowing for cases erroneously diagnosed. Appended to this report is a summary of the return cases of scarlet fever noted in Shoreditch during the years 1893 to 1903 inclusive. By a "return" case is meant a case occurring after and presumably due to the release of a patient suffering from the same disease from isolation, whether in hospital or at home. The person returning from hospital (which is practically the only means of isolation for a district like Shoreditch) is here referred to as the primary case, and the case or cases occurring after the return of the primary case are referred to as secondary or return cases. From the Summary it can be seen that the total number of instances in which return cases have been observed amounts to 54, in 20 of which the primary cases were in males and in 34 females. The incidence of attacks of scarlet fever in the Borough is greater amongst females than males, but making allowance for this the primary cases were more frequentlv in females. The secondary or return cases numbered 71, of which 34 were in males and 37 in females. The percentage of instances in which return cases occurred was approximately 1.4 of the discharges from hospital. The duration of the detention of the primary cases in hospital varied from 4 to 15 weeks, the average being 9 14 weeks. The intervals between the return of the primary cases and the occurrence of the secondary cases varied from one day to one month. In the majority of instances it was seven days and under In 25 of the primary cases there is no record of any lesion having been noticed. The statements of the friends of the patients have been taken that at the time of return from hospital they appeared quite well. In some of these cases considerable intervals elapsed between the time of the discharge from hospital and the time the primary case was examined by the Medical Officer of Health. Slight lesions may, therefore, possibly have disappeared. In the rest of the cases, 29 in number, lesions were observed. These lesions may be classified as follows:— Discharges from the nose in 12 instances Discharges from nose and ears in 1 instance. Discharges from ears in 2 instances. Unhealthy conditions of the tonsils in 7 instances. Discharging sores in 4 instances. Other lesions in 3 instances. In one of the above cases the discharge from the nose was stated to have been accompanied by redness in the groins and spots behind the ears. This patient also had an attack of herpes about the mouth not long after return from hospital. In another instance the discharge from the nose was accompanied by a rough state of the skin, and in a third instance attention was drawn to a "sore" nose. In a fourth the discharge from the nose was associated with a red and scurvy condition of the face. In one or two instances the patients were said to have had discharges from the nose whilst in hospital. These had ceased when they left hospital, but came on again shortly after their arrival home. It is noteworthy that with one doubtful exception in none of the primary cases was there any true scarlatinal desquamation observed. Lesions such as those indicated above afford good grounds for suspicion, but they are not conclusive evidence as to patients being infectious. From observation of the cases which ha ve come under notice in Shoreditch the following appear to be the most important factors in connection with the occurrence of return cases: (1) The existence of lesions in the primary cases when they are released from isolation. The lesions which are to be regarded as especially liable to convey infection are those which are accompanied by discharges from the nose and ears and unhealthy condition of the tonsils. Lesions may be so slight or persist for such a short time as to be overlooked. They may, nevertheless, have been sufficient to result in secondary cases.- (2) The primary cases may be perfectly healthy and free from infection but may be carriers of infection from hospital in clothing or by some other means, the result of oversight or lack of proper care. (3) Imlperfect measures as regards disinfection. These may result through articles or playthings which have been handled or used by the primary case prior to removal being put aside and forgotten when the measures as to disinfection were taken and1 being brought into use again on the 15 turn of the primary case without having been disinfected. Although suspected on more than one occasion no evidence was obtainable with respect to playthings. As regards clothing, however, it will be seen from the remarks in the summary on cases 14 and 39 that clothing worn by a patient when ill before removal to hospital may be put away and may be brought into use again on the return of the patient from hospital without it having been disinfected. (4) The possibility of coincidence must not be forgotten. It is to be noted that in a considerable proportion of the instances of return cases the secondary cases were attending school at the time they were taken ill. It is possible they may, in some instances, have been infected whilst at school. Then there is the possibility of a mild case of scarlet fever in the family having been overlooked; another member of the family not being infected until shortly after the return from hospital of the primary case, this is looked upon as the cause of the recurrence of the disease, though the actual source of infection may have been the unrecognised case. Again, it is possible for the secondary case to have actually received infection from the primary case before removal to hospital and to have harboured the same, the infection not taking root, so to speak, as to produce the disease until after the return of the primary case from hospital. Or, possibly both may have received infection from the same source, the secondary case not developing until after the return from hospital of the primary case. Some authorities believe it possible to harbour the germs of a disease like scarlet fever in the throat for months without an attack of the disease supervening. The following cases may be quoted to show that the possibility of coincidence ought not to be overlooked : On December 5th., 1900, a child was removed with scarlet fever from No. 61, C- Street. Whilst it was still in hospital another child belonging to the same family fell ill on January 24th, 1901, and was removed to hospital suffering from the same disease. Enquiry showed that the measures for disinfection had been carried out satisfactorily. The mother of the child had been particularly careful as to playthings and clothing being destroyed or disinfected. There had been no communication with the hospital to which the first child had been sent and no evidence could be obtained as to any connection direct or indirect between the two cases. There was no history of any illness indicating that there had been any case in the family which had been overlooked. The second child attacked was attending school until January 22nd. The interval between the two cases was 50 days. Had the first case returned home before the occurrence of the second case the latter would have been included in the list of "return'' cases. On April 27th, ,1903, Charles B-, aged 4, was removed from 41, D- Street suffering from scarlet fever. On May 22nd following, 16 Henry E-, aged 8, belonging to another family residing in the same house, was removed suffering from the same disease. Charles B-did not return from hospital until June 17. There was no reason to suspect that the precautions as to disinfection were ineffective. On July 3rd, 1903, Florence T-, aged 10, was removed from No. 18, W- Street with scarlet fever returning home on August 5, 1903. Two days before the return of this patient a brother, aged 3, was certified and removed suffering from the same disease. The measures taken as to disinfection appeared to have been satisfactory. Other instances of a similar character could be given and they indicate the necessity of exercising care before arriving at the conclusion that when a case of scarlet fever occurs in a household after the return from isolation of a patient who has been ill with that disease, the recurrence of the disease has resulted through infection from the returning patient. However, there is no doubt that in the majority of instances given in the summary appended the recurrence of the disease in a household following upon the return of a patient from hospital has resulted therefrom. Doubtless the steps practicable for preventing as far as possible the occurrence of return cases will be fully dealt with in the report of the Medical Officer referred to in the Board's letter of June last. Meanwhile there appears no reason to doubt the Board's statement that they are taking every means rightly to discharge their responsible duties, both as regards the patients and the public. SMALLPOX. Smallpox was somewhat more prevalent in London during 1904 than in the previous year. Altogether some 500 cases were certified, mostly in Bethnal Green where there was a considerable outbreak in the early part of the year, in Stepney and in Poplar. The deaths from smallpox in the Metropolis numbered 25, the death-rate being 0.01 per 1,000 population. The first case during the year in Shoreditch occurred in February. Subsequently four cases occurred in April, one in May and seven in July. Altogether fourteen cases were certified; 13 of these were smallpox, and two of them ended fatally. Both the fatal cases were in unvaccinated infants. The numbers of cases certified and the deaths amongst males and females in the Borough and its four Registration Sub-districts, are given in the subjoined table:— Su b-District. Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 2 3 5 ... ... ... Hoxton New Town 2 ... 2 ... ... ... Hoxton Old Town 1 ... 1 ... ... ... Haggerston 5 1 6 1 1 2 Total 10 4 14 1 1 2 The cases are grouped according to ages in Table III. (appendix). 17 The particulars as to the Small pox cases in the Borough during 1904 are contained in the subjoined table:— ef. No. Sex. Age. Address Date of Invasion. Date of Eruption. Date of Removal to Hospital. Occupation. As to Vaccination Source of Infection. Sanitary condition of dwelling. Remarks. 1 M 25 7, Bridport Place Feb. 18 Feb. 20 Feb. 22 Printer's Labourer Infancy Bethnal Green Satisfactory 2 M 30 53, Eagle Wharf Boad Apr. 6 Apr. 8 Apr. 9 Carman Unvaccinated Unknown Satisfactory 3 M 39 277, Kingsland Boad Apr. 7 Apr. 12 Apr. 14 Wood Carver Infancy Unknown Fair 4 M 23 277, Kingsland Boad Apr. 24 Apr. 27 Apr. 27 French Polisher Infancy Case 3 Fair 5 M 30 13, Appleby Street Apr. 24 Apr. 27 Apr. 27 Timber Carter Infancy Case 3 Fair 6 M 43 277, Kingsland Boad Apr. 29 May 2 May 2 Boot Repairer Infancy Pobably Case 3 Fair 7 F 8 5, Hoxton Place July 9 July 12 July 15 School Unvaccinated Unknown Fair Confluent 8 F 36 5, Hoxton Place July 10 July 14 July 15 Domestic Infancy Unknown Fair Mother to Case 7 9 M 6 2, Hoxton Place July 14 July 15 July 15 School Unvaccinated Unknown Fair 10 M 4 5, Hoxton Place July 22 July 23 July 24 School Vaccinated July 16 Previous cases in Hoxton Place Fair 11 F 20 4, Crooked Billet Yard July 22 July 23 July 27 Wood Cutter Infancy Cases in HoxPlace, No.5 Dirty house 12 M 6 weeks 97, Wilmer Gardens.. Indefinite July 24 July 27 Vaccinated unsuccessfully on July 16 Cases at No. 5, Hoxton Place Dirty house Belonged to same family as Cases 7, 8 & 10-died 13 F 10 weeks 70, Phillip Street July 27 July 29 July 30 Unvaccinated Probably cases in Hoxton Place Fair Died An unvaccinated infant was certified to have small-pox, but was subsequently found to have chicken-pox. 18 The first case was that of a young man residing at No. 7, Bridport Place, a house in a clean and satisfactory sanitary condition. He was in the habit of visiting friends residing at No. 399, Corfield Street, Bethnal Green. On the same staircase in the house in Corfield Street, at No. 395, a man had died from what was at the time considered to be purpura haemorrhagica. It was subsequently believed that the cause of his death was black smallpox. An outbreak of smallpox followed, and there is very little doubt that the case in Bridport Place was connected with this outbreak. The young man was removed to hospital and the usual precautions were taken to prevent infection spreading and no further cases resulted from this source of infection in Shoreditch. The second case was that of a carman residing at 53, Eagle Wharf Road, a common lodging house. He was removed to hospital on April 9th. Nothing definite was obtainable as to the source of infection in this case. The man's occupation took him into various districts of the Metropolis and he could give no information as to how he became infected. The usual steps were taken and the lodging house was kept under observation. No further cases were traceable to this man. The third case was that of a wood carver, out of work, who was removed from, the common lodging house at 277, Kingsland Road. The history of his movements during the three or four weeks prior to his illness was indefinite; he appears to have been on the tramp in the neighbourhood of Walthamstow and came to No. 277, Kingsland Road on April 12th. He then had the eruption out on him, but the nature of his illness was not detected until April 14th, when he was at once removed to hospital. He therefore slept at the common lodging house on the nights of the 12th and 13th of April whilst suffering from smallpox. The usual steps were taken, and the lodging house was kept under observation. So far as could be ascertained three cases resulted from this patient. Two of them were inmates of the lodging house and the third resided at No. 13, Appleby Street. It was, however, found on enquiry that this third patient had also been an inmate of the common lodging house, having, indeed, slept in the bed next to the man suffering from smallpox. The cases which occurred in July were connected. On July 15th three cases were removed from Hoxton Place which together with a case which occurred in the City of Westminster about the same date were, without doubt, infected from the same source. This source of infection was not discovered. Hoxton Place is connected with Hoxton Street by a narrow passage, which probably in hot weather is made use of for sleeping purposes. It is conjectured that it may have been so used by a person suffering from or infectious from smallpox. The three cases in Hoxton Place gave rise to four other cases. So far as could be ascertained there were no other cases from this source of infection. The following case may be mentioned as having possibly been one of smallpox without eruption. On April 7th at the request of her medical attendant I saw a Mrs. N-, then residing at No. 30, Weymouth Terrace, where she was staying whilst her 19 husband was in hospital with smallpox. He was removed on March 23rd from Bethnal Green. Mrs. N—— was exposed to infection from about March 17th to March 23rd whilst attending to her husband before he was removed. On April 1st or 2nd Mrs. N—was taken ill with general malaise and pains in limbs and about her body. On April 3rd the medical attendant observed an eruption of a measly character on her arms but none was noticed elsewhere. On the 7th there were no signs of any eruption of any description resembling smallpox and the patient appeared quite well. VACCINATION. The latest official figures as to vaccination are for the year 1901. The number of children not finally accounted for as regards vaccination during that year amounted to 44.4 per cent. of the Children born in Shoreditch during the year. The percentage exempted by Conscientious Objection Certificates was 0.3, the number of certificates granted by the Magistrates being thirteen. As compared with the figures for the previous year there would appear to have been a marked increase in the number of vaccinations in 1901. The percentages for previous years are contained in the Annual Report for 1903. SCARLET FEVER (SCARLATINA). The cases of scarlet fever certified during the year numbered 343 as compared with 255 for the previous year. Intimations were received from the Metropolitan Asylums Board Authorities that in 23 of these the patients were not suffering from scarlet fever, the diagnosis being erythema in six, German measles in five, measles in three, diphtheria in one, nephritis in one and tonsilitis in one; whilst in six instances the diagnosis was not stated. The actual number of scarlet fever cases, after deducting these, was, therefore, 320, as compared with 237 in 1903. 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 shown in the subjoined Table:— Sub-District. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 23 32 55 1 1 2 Hoxton New Town 43 36 79 1 1 2 Hoxton Old Town 33 36 69 5 1 6 Haggerston 63 77 140 2 1 3 Total for the whole Borough 162 181 343 9 4 13 20 Of the cases certified 332 or 96 per cent. were removed to hospital for treatment. The percentages of removals for previous years are given in the Report for 1903. The proportion of removals in recent years has greatly increased. It is more than double what it was ten years ago. This increase has been associated with a marked decline in the prevalence of scarlet fever in the Borough as the following table shows:— Period. Years. Average Percentages of cases removed. Average number of cases annually certified. 1 1890—1894 44% 667 2 1895—1899 75% 541 3 1900—1904 91% 312* The average number of cases for the last five years has been less than half what it was for the first five years in the above table. The deaths during the year numbered 13, and the death-rate was 0.11 per 1,000 as compared with 0.05 in 1903, 0.06 in 1992 and 0.17 in 1901. The cases certified were at the rate of 2.9 per 1,000 population as compared with 2.1 in 1903, 2.1 in 902, 4.7 in 1901 and 2.7 in 1900. The mortality was at the rate of 3.8 per cent. of the cases certified as compared with 2.7 in 1903, 3.3 in 1902, 3.5 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 the age of five years there were 115 cases certified with 9 deaths, the mortality amounting to 7.8 per cent. (or allowing for the cases not regarded as scarlet fever at the hospitals 8.2 per cent.) as compared with 2.7 in 1903, 5.3 in 1902, 6.8 in 1901, 12 in 1900 and 9.1 in 1899. Amongst persons over the age of five years there were 217 cases certified with 4 deaths, the mortality being 1.8 per cent. (2 per cent. allowing for cases not regarded as scarlet fever) as compared with 2.7 in 1903, 2 in 1902, and 1.7 in 1901. From these figures it will be seen that not only were the cases more numerous than in 1903 but the mortality was also somewhat heavier. The cases of scarlet fever certified in the Metropolis in 1904 numbered 13,435, or about 900 more than in 1903, the attack-rate being 2.8 per 1,000 inhabitants as compared witth 2.7 in 1903, 3.9 in 1902, 4.4 in 1901, 3.0 in 1900 and 3.9 in 1899. In respect to the incidence of scarlet fever attacks Shoreditch does not compare unfavourably with the Metropolis as a whole, notwithstanding the fact that it is three times as thickly populated. The deaths from scarlet fever in London numbered 365 as compared with 361 in 1903, 560 in 1902, 584 in 1901, and 361 in 1900, the death-rate being 0.08 per 1,000 as compared with 0.07 in 1903, 0.12 in 1902, 0.13 in 1901, and 0.08 in 1900. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 183, of which 47 or 25 per cent. were not regarded as cases of diphtheria at the Hospitals of the Metropolitan Asylums Board. Of these *In obtaining this figure 170 cases which were directly traceable to milk infection in 1901 have not been taken into account. 21 47 cases according to information from the Board, in 30 tonsilitis was the illness from which the patients were suffering, in 6 it was scarlet fever, in 3 laryngitis, in 2 measles, in 2 bronchitis, 1 pharyngitis, 1 incipient whooping cough, and in 2 instances the patients were simply said not to have had diphtheria. In connection with the above it may be remarked that cases of throat illness are frequently met with in which, whilst there is reason to suspect diphtheria, it is impossible to say off hand that such positively is the case. The only thing in such cases is for them to be isolated and kept under observation. The cases certified as diphtheria in 1903 numbered 154 including 13 which were wrongly diagnosed as such. Deducting the cases not regarded as diphtheria there would appear to have been fewer cases in 1904 than in 1903. The deaths numbered 19, the death-rate being 0.16 per 1,000 as compared with 0.18 in 1903, 0.18 in 1902, 0.23 in 1901, 0.45 in 1900, and 0.52 in 1899 (appendix Table VI). The mortality during 1904 was less than in 1903, the attacks proving fatal in 10.3 per cent. of the cases certified (13.9 allowing for cases not regarded as diphtheria at the fever hospitals) as compared with 13.6 for 1903. The case mortalities for previous years were 10.7 in 1902, 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. Of the nineteen deaths, sixteen were of children under five years of age, the mortality being 16.3 percent, of the cases certified (19.5 per cent. allowing for cases not regarded as diphtheria at the hospitals) as compared with 23.8 in 1903, 20.5 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. There were two deaths of children aged between five and ten years and one between ten and fifteen years. The mortality amounted to 3.5 per cent of the cases certified amongst persons over five years of age, but deducting the cases which were subsequently stated not to have been diphtheria the mortality was nearly double this figure. 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 able: Sub-District. DIPHTHERIA (Including Membranous Croup.) Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 16 14 30 1 1 2 Hoxton New Town 19 21 40 2 4 6 Hoxton Old Town 17 14 31 1 2 3 Haggerston 42 40 82 4 4 8 Total for the whole Borough 94 89 183 8 11 19 22 The cases are grouped according to ages in Table III. (appendix). The cases certified were at the rate of 1.5 per 1,000 inhabitants as compared with 1.3 in 1903, 2 in 1902, 2.6 in 1901 and 3 in 1900. The cases certified as diphtheria in the Metropolis numbered 7,079, about five hundred less than in 1903, the rate being 1.5 per 1,000 inhabitants or about the same as that in Shoreditch. The deaths in the Metropolis numbered 723, the death-rate being 0.16 per 1,000 inhabitants, which is again the same as that of Shoreditch. Of the cases certified in the Borough during 1904 slightly over 94 per cent were removed to hospital for treatment as compared with 88 per cent. in 1903, 84 in 1902, 83 in 1901, 86 in 1900, 80 in 1899, 77 in 1898, 67 in 1897, and 65 in 1896. The increase in the percentage of removals of cases of diphtheria has not been associated with such a marked decline in the yearly average number of cases certified as has happened with respect to scarlet fever as the following figures show: Period. Years. Average Percentages of cases removed. Average number ot cases annually certified. 1 1890—1894 27% 294 2 1895—1899 65% 317 3 1900—1904 87% 246 It is probable that the above figures, however, are somewhat wide of the mark as to the actual amount of diphtheria prevalent. The disease is not so distinctively marked as scarlet fever and mild cases may more readily escape detection. Cases not diphtheria are removed to hospital whilst probably quite as many which are diphtheria are left unrecognised to spread infection. The following series of cases of throat illness, which came under observation during the year, may be mentioned as illustrating this:- About August 1st a girl aged 14 years, residing at No. 45, O- Street, went to stay for a week with a relative living at Clapton. Whilst there she played with children belonging to a family, a member of which had been recently removed to hospital with diphtheria. The girl returned home to O-Street about August 8th, and on August 13th she was ill with a severe "0sore throat" She appears to have been ill for about three or four weeks. Between August 13th and October 2nd, besides the patient mentioned, a brother, her mother, two sisters and then another brother successively developed more or less severe "sore throats." The last case was that of a brother, a young man; employed in the General Post Office. He was taken ill with a "sore throat" about October 2nd. The appearance of his throat seems not to have presented1 the aspect of diphtheria, l.ut the result of a bacteriological examination was that the bacillus of diphtheria was present. The case was brought under my notice by the Medical Officer of the Post Office, with a view to such steps being taken as might be thought necessary. On October 10th, beyond an appearance of past inflammation, there were no signs of diphtheria so far as the aspect of the throat went. The necessary precautions as to isolation were taken pending the result of a second bacteriological examination, 23 which was carried out by the Council's Bacteriologist. This also was positive as to the presence of the diphtheria bacillus. A week later, a third examination having failed to reveal the presence of the bacillus and the aspect of his throat being normal, the patient was released from isolation. That the whole of these cases of " sore throat" were really cases of diphtheria there is very little reason to doubt. There is a history of exposure to infection in the case of the girl first affected which is a reasonable one, the sequence of cases pointing to infection, and the isolation of the bacillus of diphtheria in the last of the series of cases. In connection with enquiries made as to 132 of the cases certified during the year their distribution amongst males and females at certain age periods was found to be as follows: Age Pebiod. Male. Female. Total. Under 1 year 5 3 8 From 1 to 2 years 16 7 23 ,, 2 „ 3 ,, 10 5 15 ,, 3 ,, 4 ,, 10 4 14 ,, 4 ,, 5 ,, 7 6 13 „ 5 ,, 10 ,, 11 18 29 „ 10 ,, 13 7 6 13 Over 13 years 2 15 17 Total 68 64 132 Of these 132 cases in 58 the children certified to have diphtheria were attending school and in 46 they were at school within a week of being certified to have the disease. In a few of the cases children were actually in school whilst suffering from the disease before the nature of their illness was recognised. In 60 other instances, although the patients themselves were not school-going children, other children either members of the same family as the patients or dwelling under the same roof, were attending school at the time the cases were certified. In 17 instances there were histories of "sore throats" in the patients' families or amongst the people dwelling in the same houses as the patients. In 27 instances evidence was obtained pointing to infection from previous cases in the house or elsewhere within the Borough. In 87 instances the houses in which the cases occurred were occupied by members of more than one family, in 22 the houses were occupied by single families, and in 23 instances the cases occurred in artizan dwellings. In 76 instances the houses in which the cases occurred were in a satisfactory sanitary condition and in 29 others the condition was fairly satisfactory, minor matters only requiring attention. In 27 instances the sanitary condition of the houses was unsatisfactory; some were dirty and overcrowded, and in others more or less serious defects were ascertained to exist in connection with the drains and sanitary arrangements generally. 24 ENTERIC OR TYPHOID FEVER. The majority of the cases were certified during the latter half of the year but the total number for the whole year only amounted to 48, including four cases which were subsequently found at the hospitals to which they were removed to be suffering from pneumonia. A table showing the numbers of cases yearly certified since 1889 is contained in last year's Report. The number for 1904 is the smallest yet recorded. The cases certified were at the rate of 0.4 per 1,000 population, which is about half of what it was for ]903. All the patients were over five years of age. The deaths numbered 9, and the death-rate was 0.07 per 1,000 inhabitants, as compared with 0.11 in 1903, 0.20 in 1902, 0.08 in 1901, 0.11 in 1900, 0.20 in 1899, 0.14 in 1898, 0.15 in 1897, 0.14 in 1896 and 0.17 in 1895. The rate is the lowest recorded in Shoreditch for typhoid fever. Deducting the cases not regarded as being enteric fever the attacks proved fatal in 20.4 per cent. of the cases, a mortality which is above the average as a comparison with the mortalities for previous years will show. The figures for previous years are given in the Report for 1903. The distribution of the cases certified and deaths amongst males and females in the four registration sub-districts during 1904 is as shown in the subjoined Table:— Sub-District. TYPHOID FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 4 5 9 1 1 2 Hoxton New Town 5 4 9 1 1 2 Hoxton Old Town 4 2 6 — 1 1 Haggerston 15 9 24 3 1 4 Total for the whole Borough 28 20 48 5 4 9 A grouping of the cases according to ages is shown in Table III. (appendix). Of the caises certified 43, or close upon 90 per cent., were removed to hospital for treatment. The cases certified as enteric fever in London during 1904 numbered 1902 as compared with 2,337 in 1903, 2,405 in 1902, 3,193 in 1901, 4,309 in 1900 and 4,460 in 1899. The attack-rate was 0.41 per 1,000 population as compared with 0.50 in 1903, 0.74 in 1902, 0.70 in 1901, 0.93 in 1900 and 0.97 in 1899. The deaths for the whole of London numbered 286, and the death-rate was 0.06 per 1,000 as compared with 0.08 in 1903, 0.11 in 1902, 0.12 in 1901 and 0.17 in 1900. These figures show that both the amount of and the mortalicv from enteric fever have greatly declined during recent years in London. 25 The usual enquiries were made as to the circumstances attending the occurrence of the cases of enteric fever in the Borough. The subjoined may be mentioned as indicating the danger of the disease spreading in a household by personal infection: (1) Frank M , aged 15, working at a saw mill in the Cambridge Heath Road, and residing at No. 16, W— Gardens, was first observed to be ill about January 14th. He kept at his work, however, until January 28th when he was sent home on account of illness. The case was certified to have been one of enteric fever on February 3rd and the patient was removed to hospital. (2) Elizabeth M—, aged 12, attending school, sister of above, was first observed to be ailing about January 28th. She was certified to have enteric fever also' on Feb. 3rd and same date removed to hospital. Case 1 was probably ailing for several days prior to January 14th. The mother stated that the lad was heavy and complained of headache in the morning especially. No. 16, W Gardens is a tenement house, each tenement consisting of three rooms with separate watercloset and a tap direct from the main: for water for domestic purposes. The general condition of the tenement in which the cases occurred was good. The drains are all outside and have recently been reconstructed. The inhabitants of the tenement were the parents and two other children besides the patients. The following case is interesting: Sarah P, aged 23, a nurse at the Shoreditch Infirmary, was certified to have enteric fever on March 17th. She was employed at the Sittingbourne Isolation Hospital until February 19th when she left to take up her duties at the Shoreditch Infirmary. At the time she left Sittingbourne she was engaged nursing a severe case of typhoid fever. She appears to have been taken ill sometime during the first week of March. It is highly probable that this nurse contracted infection from the patient at Sittingbourne. It is not an uncommon thing for nurses to become infected whilst nursing typhoid patients. It is perhaps hardly necessary to remark that the risk of contracting the disease must be markedly greater in the cases of unskilled persons who attend to patients suffering from typhoid fever. The following cases occurred at No. 10, H Place, a house occupied by one family in a fair sanitary condition: '(1) Mrs. Annie C, aged 27, and Edwin C, aged 5, her son, were admitted to the Metropolitan Hospital on October 18th suffering from typhoid fever. Mrs. C appears to have been ailing from about the first of October, or possibly a day or two before. She was not seen by a medical mam until October 15th. Edwin C seems to have been taken ill somewhat suddenly about October 9th. There is an ind&finite history of a previous illness, lasting for about a fortnight during the end of August and the beginning of September somewhat suggestive of the possibility of a mild attack of typhoid fever in the case of the boy. Widals reaction, however, was negative on October 19th, though a positive result was obtained on October 21st. In the case of Mrs. C the result was positive on October 19th. The connection between these 26 cases is not clear but the probability is that the mother infected the child. The cases were not certified until October 28th. (2) Daniel C, aged 29, husband of Mrs. C, labourer, sleeping at No. 10, H Place, but having all his meals out, was certified to have enteric fever on November 23rd. He first complained of being unwell about November 8th but was probably ailing for a few days prior to that date. He sought medical advice first on November 20th and took to his bed the same day. This patient was in the habit of visiting his wife in the hospital. In connection with the following cases there is the poss:bility of infection in the first instance through the consumption of cockles: About th2 end of the first or beginning of the second week of September it appears that a Mrs. B, resid'ng in Hackhvy, n the Shoreditch Boundary, visited Southend for the day. She returned with a Mrs. E and her children, who resided at No. 149, G Street, a public house. They had cockles at Southend, and brought some home with them. About October 2nd Mrs. B fell ill, took to her bed on October 6th and died from typhoid fever on November 13th. The case was treated at home, the husband helping in the nursing, attending to the patient at night. Mr. B— was employed during the day as General Manager at the public house at No. 149, G- Street, of which Mr. Thomas E, husband of Mrs. E-, was proprietor. Towards the end of October, during the last week of the month, Thomas E- fell ill. He took to his bed on November 6th, was certified to be suffering from typhoid fever on November 12th and was removed to hospital on November 14th. On November 20th Stanley John B—, aged eleven months, son of Mrs. B, died from an illness apparently lasting about 8 days, which was regarded as being " consumptive bowels " Widal's test in this case is said to have been negative. . The drains at No. 149 G— Street, were in a defective state and had to be reconstructed. There was no history of any previous illness in the house likely to have been typhoid fever, and Mr. E-had not been away for months previous to his illness. With regard to the above cases it is possible that Mrs. B- received infection through the consumption of cockles and indirectly, through the medium of her husband who was nursing her infection was conveyed from her to Mr. E-, at 149 G—Street. The possibility that Stanley John B- may have died from typhoid fever, having been directly infected through the mother, may be mentioned, but it is very doubtful that such was the case. ERYSIPELAS. The cases certified as erysipelas numbered 183 as compared with 147 last year and 173 for 1902. The numbers for previous years are contained in the Report for 1901. The deaths numbered 5 as compared with 7 in 1903, 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. 27 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 Cases. Male. Female. Total. Male. Female. Total. Shoreditch South 19 13 32 1 1 2 Hoxton New Town 23 27 50 — 2 2 Hoxton Old Town 14 28 42 — — — Haggerston 29 30 59 1 — 1 Total for the whole Borough 85 98 183 2 3 5 The death-rate was 0.04 per 1,000 inhabitants as compared with 0.06 in 1903, 0.06 in 1902, 0.05 in 1901, 0.08 in 1900, and 0.13 in 1899. The deaths were at the rate of 2.6 per cent, of the cases certified as compared with 4.7 in 1903, 4.6 in ,1902, 4.2 in 1901, 5.8 in 1900 and 8 in 1899. Blood poisoning (pyaemia and septicaemia) was given as the cause of 8 deaths, 5 of males and 3 of females. Infective endocarditis (a form of heart disease) resulted in 3 deaths. Other septic diseases allied to the foregoing caused 2 deaths. Included amongst the deaths from blood poisoning or pyaemia was a death which was, subsequent to registration, ascertained to have been due to GLANDERS. According to Professor J. McFadyean, of the Royal Veterinary College, the Reports of the Registrar General show that on an average four persons die annually from glanders. The symptoms and lesions of the disease are by no means pathognomonic and it may readily be confounded with morbid conditions usually classed as pyaemia. It is, therefore, quite possible that the official returns considerably understate the mortality from glanders.* The facts of the case referred to are briefly as follows: Daniel C-, aged 25 years, employed as a farrier at stables, near Broad Street Station, where some 400 horses are kept, fell ill about July 28th and was admitted to the Shoreditch Infirmary on August 9th. His symptoms at first resembled those met with in certain forms of influenza ; then when his left ankle and right wrist became swollen and painful acute rheumatism suggested itself. As the case proceeded it presented characters suggestive of typhoid fever, then acute septicaemia, and when the eruption appeared the possibility of it being an anomalous case of smallpox presented itself. About a week after admission to the *Harben Lectures for 1904. Glanders Lecture HI. 28 Infirmary a pustule on his scalp in the region above the left ear began to attract attention. This discharged and an ulcer formed which gradually increased in size until it attained the size of a five shilling piece. The margins of the ulcer were irregular and it increased in depth towards the central portion, the floor of which was down on the bone. On August 23rd and 24th, pustules were observed making their appearance on the face, neck, shoulders, chest, arms and legs. On August 25th the Medical Superintendent of the Infirmary kindly afforded me the opportunity of seeing the case. The pustules presented an appearance somewhat resembling boils, and the aspect of the patient with respect to the eruption bore some resemblance to that of smallpox when the pocks have become pustular. The pustules were of varying size, but few exceeded that of a large pea. In places they formed groups or patches. On the right shoulder there was an irregular raised mass of them covering an area of about the size of a two shilling piece. Those on the legs were few in number and were in an early stage, presenting the aspect of slightly reddish papules with a light yellowish centre giving the impression of flattened vesicles. No enlargement of the lymphatic glands was noticeable. The patient was obviously extremely ill. His respirations were hurried and the fever was high, his temperature being between 105 deg. and 106 deg. The temperature in the early stage of the disease ranged from two to two-and-a-half degrees higher in the evening than in the morning. Later this difference between the morning and evening temperatures hardly amounted to a degree. During the last few days the temperature remained pretty steadily at about 105 deg. In order to clear up the diagnosis which rested between typhoid fever with septic complications, septicaemia and glanders, a specimen of the patient's blood and specimens of the discharge from the ulcer on the scalp and the pustules were submitted to the bacteriologist at the London Hospital. On August 27th an interim report was received that the result of Widal's test for typhoid fever was negative but that the specimens of the discharge contained a bacillus of a, suspicious nature. Four days later a further report was received stating that the bacilli isolated proved to be those of glanders as shown by their morphology, staining reaction, culture characters, and inoculation experiment. The case terminated fatally on August 25th and a post mortem examination was made by order of the Coroner on August 29th. The general character of the ulcer of the scalp and the cutaneous abscesses have already been referred to. The most noteworthy feature in connection with the ulcer was the presence of brownish, semitranslucent flattened tubercles on the bone forming its floor. There were no signs of internal abscesses. The viscera were gorged with blood and their general appearance was such as is met with after death fromi a severe febrile disorder. An inquest was held on August 30th. According to the evidence it appeared that a horse stabled where deceased was employed was slaughtered for glanders on July 18th. 1 his horse was shod by deceased on May 25th. It was then to all appearances well. No history was obtainable as to the man having been brought in contact with the horse in any way after May 25th. The horse seems to' have been suspected of being glandered for some time before it was killed, and was kept in a loose box from 29 about the middle of June until the date it was slaughtered. The Jury on the medical evidence (the presence of the glanders bacillus not having been then confirmed) returned a verdict of death from acute septicaemia, but as to whether the same resulted from glanders or no the evidence was not sufficiently conclusive. Man is usually infected through pus or discharge from a glandered horse obtaining access to a wound or abrasion of the skin. In the foregoing case the seat of inoculation was without doubt the site of the ulcer on the scalp. PUERPERAL FEVER. Five cases were certified, the attacks per 1,000 births being at the rate of 1.3 as compared with 1.7 in 1903, 2.2 in 1902, 1.7 in 1901, and 2.5 in 1900. The death-rate due to puerperal fever was 0.5 per 1,000 births as compared with 0.2 in 1903, 0.7 in 1902 and 0.5 in 1901. DIARRHCEA. Diarrhoea was prevalent in Shoreditch during the months of July, August and September. It was most fatal during the last week of July and the first three weeks of August. The number of deaths from diarrhoea in the third week of July was 9, in the fourth week it rose to 23, and was 23 and 24 in the first and second weeks of August. In the third week of August the maximum was reached, the number for that week being 31. The next week the number fell to 14,and after that the weekly numbers of deaths due to the disorder gradually declined. The monthly records of the deaths from diarrhoea during the summer months were 8 in June, 39 in July, 92 in August, and 23 in September. The number of deaths from diarrhoea during the year, including the deaths registered as due to diarrhoea and epidemic or zymotic enteritis was 186. In addition to these there were 54 deaths attributed to enteritis and gastro-enteritis, chiefly in infants which have not been included. Of the deaths from' diarrhoea, 150 were of infants under one year, 30 were of children under five years and the remainder were of adults of thirty-five years of age and upwards. The death-rate from.diarrhoea was 1.63 per 1,000 inhabitants as compared with 1.23 in 1903, 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 lowest in Shoreditch South and highest in Hoxton Old Town, being 0.63 and 2.01 respectively. The deaths fromi diarrhoea in the Metropolis numbered 4,801, of which 3,968 occurred during the months of July, August, and September. The deaths from diarrhoea were at the rate of 1.07 per 1,000 inhabitants as compared with 0.64 in 1903, 0.53 in 1902 and 0.85 in 1901. 30 Diarrhoea was, therefore, more prevalent throughout the Metropolis generally during 1904 than during the last few years as judged of from the number of deaths recorded. In the subjoined Table is contained a comparison of the mortalities from diarrhoea amongst infants under one year per 1,000 births in Shoreditch and London during the years 1895 to 1903 inclusive:— Year 1895 1896 1897 1898 1899 1900 1901 1902 1903 Shoreditch 30.5 28.7 38.2 38.9 39.7 35.7 31.5 27.0 30.5 London 20.7 18.9 24.2 26.1 25.0 21.8 24.1 14.5 16.5 During 1904 the mortality from diarrhoea amongst infants under one year in Shoreditch was at the rate of 40.8 per 1,000 births, as compared with 28.7 for the whole of London. MEASLES. The deaths fromi measles numbered 81, 50 of males and 31 of females, and all of children under five years of age. Ten of the deaths belonged to Shoreditch South, 13 to Hoxton New Town-, 9 to Hoxton Old Town and 49 to Haggerston. The disease was most fatal in the Haggerston registration sub-district. The deaths in the Borough were at the rate of 0.69 per 1,000 inhabitants as compared with 0.85 in 1903, 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 deaths from this disease were fairly equally distributed throughout the year, but taking the months they were most numerous in August and December, and least so in February, September and November. No deaths were registered from measles in September. The deaths from measles in the Metropolis during 1904 numbered 2,256 and the death-rate was 0.49 per 1,000 population. The number of houses brought under the notice of the Health Department as being infected with measles was 454. Of these 432 were notified by the authorities of the various schools, 20 by private persons, and in 2 instances the information was received anonymously. On investigation in 138 instances the information was found to be erroneous, the complaints from which the children were suffering being returned as something other than measles. Some 330 rooms were fumigated, and the bedding and texile articles exposed to infection were removed and disinfected in the usual way. WHOOPING COUGH. Whooping cough was given as the cause of 60 deaths, 21 of males and 39 of females. All were of children under five years of age. In 24 the age was under one 31 year. The death-rate from the disease was 0.51 per 1,000 inhabitants as compared with 0.35 in 1903, 0.63 in 1902 and 0.49 in 1901. The deaths were most numerous during the first half of the year, the heaviest mortality being in March, when 16 deaths occurred. There were no deaths from whooping cough during the months of October and November. The deaths from whooping cough in the Metropolis during 1903 numbered 1,495 and the death-rate was 0.32 per 1,000 population. INFLUENZA. Influenza was given as the cause of 14 deaths as compared with 19 in 1903, 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. No deaths from influenza in Shoreditch were registered during the months of February, June, July, August and November. The deaths fromi influenza in London during 1904 numbered 709, as compared with 644 in 1903, 1,036 in 1902, 664 in 1901, and 1,950 in 1900. The deaths were most numerous during the last three months of the year and least so during June, July, August and September. TUBERCULOSIS. Tuberculosis (Appendix Table V. Nos. 29 to 34) resulted in 365 deaths as compared with 376 in 1903, 295 in 1902, 363 in 1901 and 343 in 1900. Of the total number of deaths during the year in Shoreditch between 15 and 16 per cent. resulted from tuberculosis. The great majority of the deaths from tuberculosis resulted from phthisis or consumption, which is, as is well-known, the form of the disease affecting the lungs. The death-rate from tuberculosis in Shoreditch amounted to 3.1 per 1,000 inhabitants. The deaths from consumption numbered 247 of which 153 were of males and 94 of females, and the death-rate due to this form of the disease was 2.12 per 1,000 as compared with an average rate of 2.07 for the previous ten years. The death-rate due to consumption during 1904 for the Metropolis was 1.63 per 1,000 inhabitants. The above figures show what a fruitful cause of death tuberculosis is in Shoreditch. The common form of the disease—consumption—is so well known that it is unneccessary to dwell upon its characteristics. Tuberculosis is spread by infection and is, unfortunately, very common in densely populated working class communities. During recent years, since the infectious character of consumption has become generally recognised various measures have been adopted with a view to coping with it, such as the establishment of sanatoria, and the distribution of literature containing instructions as to preventing infection and as to disinfection. In various parts of the country Sanitary Authorities have adopted systems of voluntary notification of the disease, and similar systems have been established in more than half of the London Boroughs. 32 Voluntary notification leaves it to the discretion of the medical men attending on cases of consumption to notify such cases as in their opinion should be brought under the notice of the Sanitary Authority in the interests of the public health. The usual notification fee is paid by the Sanitary Authority. There is no official interference with the freedom of the patient, only such measures are suggested as are likely to be of service in respect to. the sanitary environment of the patient and the prevention of the spread of infection. The question of establishing such a system of notification in Shoreditch was considered by the Health Committee, who., early in the year, recommended the Council to adopt the voluntary notification of consumption for the period of one year with a view to ascertaining what beneficial results might be expected from it. The Council, however, did not adopt the Committee's recommendation. In all cases where information is received as to deaths from consumption in dwelling houses in the Borough, communications are sent to the friends of the deceased 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. A larger proportion of the deaths from tuberculosis., more especially consumption, occur in public instiutions where there are responsible Medical Officers able to take all necessary precautions. During the year disinfection was carried out by the officers of the Borough Council in connection with 55 houses in wrhich persons suffering from tuberculosis (in nearly all cases of the lungs) had resided before death. In some 64 houses more or less efficient measures were taken by the people resident in preference to allowing the officers of the Council to do what was necessary. The question of the provision of sanatoria for consumptive persons belonging to the Metropolis, which was referred to in my Report for 1903, appears to be in statu quo. The proposal is that the Managers of the Metropolitan Asylums Board, with their unrivalled experience in Hospital Management, are the proper authorities to provide sanatoria for London and should undertake the duty of doing so. The Managers have referred to the Local Government Board for an authoritative expression of opinion and at the time of writing there the matter rests. 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 or living in houses in which infectious diseases existed, concerning whom intimations of exclusion from school were received from the head-teachers of the schools they attended in accordance with the requirements of the school management code of the London County Council:— 33 School. Enteric Fever. Small Pox. Diphtheria. carlet Fever. Measles. Chicken Pox. Whooping fiough. Mumps Other diseases. Total. Bath Street ... ... ... ... 1 ... 1 ... ... 2 Baltic Street ... ... ... ...... c ... ... ... ... 2 Canal Road 1 ... 2 2 50 10 ... 7 3 75 Catherine Street ... ... ... 15 ... ... ... ... 1 16 Chatham Gardens ... ... 1 3 11 6 ... ... 4 25 Coleman St ... ... ... ... 1 ... ... ... ... 1 Curtain Road ... ... ... 4 7 6 5 2 9 33 Daniel Street ... ... ... ... 1 ... ... ... ... 1 Fellows Street ... ... ... 5 80 40 14 ... 2 141 Gayhurst Road ... ... ... 1 ... ... ... ... ... 1 Gopsall Street ... ... 5 12 50 25 17 16 34 159 Haggerston Road. ... ... 8 8 43 25 11 ... 4 99 Hammond Square. ... ... 8 4 72 15 25 1 9 134 Hanover Street ... ... ... ... ... ... ... 1 1 Hugh Road ... ... ... ... ... ... ... ... 1 1 Maidstone Street ... ... 7 3 123 12 2 2 47 196 Napier Street 1 ... 5 19 55 52 18 14 4 168 Pritchards Road ... ... ... ... 2 ... ... ... ... 2 Queens Road ... ... ... ... 4 ... ... ... ... 4 Redvers Street ... ... ... 10 1 ... ... ... 11 St. John's Church. ... ... ... 2 9 l ...... 20 1 33 St. John's Road 1 ... 1 6 16 44 2 47 4 121 St. Joseph's, Bun ... ... ... hill Row ... ... ... ...... 2 ... ... 2 4 St. Mark's, Old St. ... ... ... 2 5 1 ... ... ... 8 St. Mary's ... ... ... 1 ... ... ... ... ... 1 St. Paul's, Haggerston ... ... ... ... ... 2 ... 2 St. Saviour's, Felton Street ... ... ... ... ... ... 2 ... ... 2 Scawfell Street 1 ... 14 8 69 32 42 14 50 230 Scrutton Street ... ... ... 2 26 2 1 5 6 42 Shap Street ... ... ... 5 76 26 12 1 4 124 Shepperton Road ... ... ... ... ... 1 ... ... ... 1 Trinity Place ... ... ... ... 29 25 7 1 2 64 Virginia Road ... ... ... 5 2 ... ...... 1 9 Wen lock Road ... ... 2 ... 9 ... ... ... ... 11 Wood Close ... ... ... ... 1 ... ... ... ... 1 Total 4 ... 53 103 757 330 159 130 189 1725 The schools in the foregoing table are more numerous than hitherto owing to the increase in the number of schools which are now required to comply with the provisions of the School Management Code of the London County Council in consequence of the coming into operation of the recent Education Act. The number of exclusions on account of infectious illness in the aggregate show an increase as compared with that of the previous year, but taking into consideration the number of schools added to the list it is probable that less time was lost on account of infectious illness in 1904 than in 1903. Measles, whooping cough and chickenpox were the chief causes of exclusion. 34 During the year attention was especially required in connection with the following schools:— Catherine Street School.—During October and the early part of November a series of fourteen cases of scarlet fever occurred amongst the children attending or residing in houses from which children attended this school. It appears that towards the end of August a case of scarlet fever was removed from a house in a street in close proximity to the school, and on the 29th September following a case of scarlet fever was discovered amongst the children living next door to this house. The patient in this case had had what was considered to be a "cold." He was not seen by a medical man for more than a fortnight after his illness began, and consequently no precautions as to isolation had been taken and other children from the house in which he resided were attending the school. Whether this focus of infection was the origin of the cases in connection with the school is uncertain but I am inclined to believe that it was. The first case of the series was certified on October 3rd, and with intervals of a few days between them cases were certified until November 9th. The cases then ceased. On December 6th three cases occurred in a family, children fromi which were attending the school, but it is improbable that these were connected with the cases during October and November. The school was kept under observation. The cases were mostly amongst the children attending the infants' department. A watch was kept for children exhibiting suspicious symptoms, particularly discharges from nose and ears and signs of throat trouble, and a few were discovered and excluded. It was impossible, however, to say definitely that any particular scholar was the source of infection. The usual instructions were given as to precautions for ventilation and disinfection in the class rooms. Canal Road School.—The babies' room in the infants' department was closed in November under the advice of the Medical Officer (Education) of the London County Council, on account of measles, and the necessary steps were taken as to' disinfection by the Sanitary Authority. BACTERIOLOGICAL EXAMINATIONS. In connection with 43 cases of suspected infectious disease bacteriological examinations were made by Dr. Bulloch at the London Hospital Medical School. In eleven the disease suspected was consumption, in seven typhoid fever, in twenty-three diphtheria, in one anthrax and in one case glanders. The results were positive in five of the suspected cases of consumption, in two of the suspected cases of typhoid fever, in six of the cases in which diphtheria was suspected and in the case of glanders. DISINFECTION. During the year 957 premises were disinfected. The number of articles removed and disinfected at the Borough Disinfecting Station was 14,063 as compared with 8,911 in 1903, 55,025 in 1902 and 17,226 in 1901. The disinfected articles included 1,029 beds, 769 mattresses, 2,241 pillows, 735 bolsters and 9,289 miscellaneous articles, 35 including clothing, linen, carpets, curtains and the like. Sometimes bedding is found to be, besides being contaminated with infection, in such a worn-out and filthy condition that it is necessary to destroy it. During the year seven beds and ten mattresses were so destroyed, being burnt in a furnace at th Disinfecting Station. In the Report for 1903 it was mentioned that the use of sulphur for fumigating infected rooms had been discontinued save in exceptional cases, formalin as a spray being substituted. A 2 per cent solution of formalin was tried for several months, but whilst there is no reason to be dissatisfied with the results of its use as a disinfecting agent, it was found to be very trying to the eyes and especially the skin of the officer manipulating the spraying apparatus. In the course of a few months he was the victim of a dermatitis affecting the face, neck, hands and fore-arms, which persisted although he wore a mask and used india-rubber gloves. Formalin had, therefore, to be given up and during the latter part of the year a 2-per-cent. solution of Betalysol in the form of a spray was used instead. This agent has not an unpleasant smell, and it has not been complained of either by the officers using it or the people whose rooms have been sprayed, and so far as can be judged it has proved satisfactory for the purpose for which it is used. The use of sulphur is retained for smallpox cases. Rooms infected with smallpox are kept for 24 hours under fumigation with sulphur fumes and are then sprayed, being subsequently cleansed by the occupants. No complaints were received as to any damage caused by the measures taken for the purpose of disinfection during the year. THE SHELTER. The following are the particulars as to the use of the Shelter in Reeve's Place during the year 1904:— Date of Admission to Shelter. Length of stay therein. Number of Persons. Address from which the persons were admitted to the Shelter. Disease. Feb. 22nd 1 day 4 7, Bridport Place Small-pox July 15th 1 day & night 7 2, Hoxton Street Small-pox July 16th 1 day 6 5, Hoxton Place Small-pox July 24th 1 day 5 2, Hoxton Place Small-pox July 27th 1 day 4 4, Crooked Billet Yard Small-pox July 28th 1 day 13 97, Wilmer Gardens ... Small-pox July 30th 1 night 4 57, Phillip Street Small-pox The Shelter was used on seven occasions by 43 persons belonging to 9 families. Its use is of very great value in enabling efficient measures as to disinfecting in dangerous cases of infectious disease being properly carried out, and it has undoubtedly had a very beneficial action in controlling the spread of smallpox in the Borough during recent years. 36 THE PUBLIC MORTUARY. The dead bodies received into the Public Mortuary in St. Leonard's Church-yard during 1904 numbered 460, including the bodies of four persons removed by the Sanitary Authority on account of infection or to prevent nuisance. The number of inquests held was 336. The number of postmortem examinations made in the postmortem room at the Mortuary was 251. The figures for previous years are contained in the Report for 1903. WATER SUPPLY. According to the figures of the reports to the Water Examiner on the London Water Supply by Sir W. Crooks, F.R.S., and Sir James Dewar, F.R.S.. for the year 1904, the rainfall as measured at Oxford amounted to 22.67 inches. The mean for 35 years is given at 25.29 inches. There was, therefore, a deficit amounting to 2.62 inches, which means that the rainfall was 10.3 per cent. below the average for thirty-five years. The wettest months were January, February, May and July. Least rain fell ira April and October. Taken as a whole the purification of the London water by the combined action of storage and filtration during the year, is stated to have been highly satisfactory. The average microbic impurity of the supplies derived fromi the Thames, the New River and the River Lea was much less than in 1903. No complaints were received by the Health Department in Shoreditch either as to the quality or the quantity of the water supplied in the Borough, and there was nothing to 'suggest the occurrence of any water-borne disease during the year. In accordance with the requirements of Section 49 of the Public Health (London) Act, 1891, Communications relative to water supplies to houses being cut off were received in respect to 27 premises on the East London District and 41 on that of the New River. In many of these the intimations referred to empty premises. SANITARY WORK. Preliminary notices as to insanitary conditions were served in respect to 2,599 premises, the Chief Inspector dealing with 285, Inspector Lear with 465, Inspector Firth with 469, Inspector Jordan with 467, Inspector Langstone with 401, and Inspector Clements with 512. In connection with the work carried out 886 letters were written to owners of property, builders, and other parties concerned. Nearly 25,000 visits of inspection were made during the year, exclusive of those made by the Medical Officer of Health and Chief Inspector. In the subjoined Table is contained a summary giving an idea of the nature of the work done for the abatement of nuisances and for the improvement of the dwellings of the inhabitants of Shoreditch which has been compiled from the abstracts of their work prepared by the Sanitary Inspectors:— 37 Chief Insp. Insp. Lear. Insp. Firth. Insp. Jordan. Insp. Langstone. Insps. Clements. Total New drains constructed 6 5 2 16 44 31 104 Drains re-constructed or repaired 21 36 73 31 4 46 211 Sink waste pipes trapped and disconnected — 46 63 82 8 46 245 Stack pipes re-instated 8 74 73 16 29 77 277 Eaves gutters re-instated 4 73 63 19 18 112 289 Stack pipes disconnected from drains 4 17 51 22 7 41 142 Accumulations of sewage dealt with 2 8 9 13 25 2 59 Cesspools abolished — — — — — 1 1 New water closets constructed 40 21 3 104 4 14 186 Old water closets re-constructed or repaired 9 64 75 64 65 81 358 Water closets cleansed and white-washed 47 279 85 257 67 229 964 Water restored or newly laid on to water closets 4 73 55 14 11 80 237 Obstructions in water closets removed 4 35 61 27 14 68 209 Overcrowding in houses abated — 16 18 10 37 32 113 Damp courses in houses provided 17 2 5 — — 11 35 Walls pointed 79 7 2d — 7 46 167 Roofs repaired 41 74 81 20 06 105 377 Stairs repaired 64 15 64 6 21 55 225 Floors repaired 64 42 49 9 30 89 283 Ventilation under floors provided 1 12 29 1 13 18 74 Doors repaired 52 15 29 6 18 32 152 Door cills provided 89 46 39 9 25 41 249 Sashes repaired 52 81 23 — 31 43 230 Houses cleansed throughout 89 26 38 51 42 58 304 Houses cleansed in port 123 152 277 24 112 223 911 Total number of rooms cleansed 559 685 856 599 561 766 4026 Yards or areas lime-washed 45 311 8 137 54 119 674 Yards paved 19 89 111 29 55 79 382 Areas or forecourts paved 13 28 13 5 1 25 85 New areas constructed 4 — 4 — — 2 10 Sculleries paved 10 20 23 21 18 18 110 Dust receptacles provided 38 88 66 37 66 49 344 Dung receptacles provided — — 4 — — 3 7 Insanitary cisterns removed 1 3 — — — 4 It may also be mentioned that 4 old defective brick drains were removed and in 65 instances nuisances and annoyance caused by the presence of rats on premises were dealt with. In most of the cases where rats were found infesting premises the drains were defective and had to be reconstructed or repaired. The number SO' dealt with are included in the figures given above. In 137 instances water was restored to premises where the supply had been cut off for various reasons, and on 174 premises leaking water-pipes were repaired. Urinals were constructed on eight premises, and on 25 they were repaired or cleaned. Foul accumulations of various descriptions were removed in 14 instances on requisition from the sanitary officers. On 11 premises animals were found not to be kept under proper conditions. They were mainly horses improperly stabled. In 22 instances stables were properly paved under the supervision of the sanitary officers. 38 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 Factory and Workshop Act 1901. In most instances the preliminary notices setting forth the insanitary conditions to be dealt with which were served upon the parties responsible by the Sanitary Inspectors were complied with. In 202 cases, however, it was necessary to report the circumstances specially to the Health Committee, and in these cases statutory notices under the Public Health (Lond.) Act 1891 were served by the Sanitary Authority with a view to enforcing the abatement of nuisances. For non-compliance with the requirements of the Sanitary Authority or for infringements of bylaws and regulations made under the Act in three instances only were police-court proceedings necessary. The results are briefly set out below:— The owner of Nos. 51 and 53, Moye Street, was summoned for non-compliance with statutory notices in respect to the dirty and dilapidated condition of the houses. The Magistrate made orders for the work to be done in fourteen days with £1 3s. Od. costs in one instance, and 3s. in the other. A builder was summoned for contravening the bylaws of the London County Council by connecting the wastepipe from a sink with a soil pipe at No. 10, Motley Street. The work having been altered to comply with the bylaws the summons was withdrawn on payment of 2s. costs. A milk vendor at No. 7, Coronet Street after being warned to comply with the regulations as tO registration neglected to do so until after he had been summoned. . He was ordered to pay £1 3s. Od. costs by the Magistrate. A case of keeping swine in contravention of the Public Health Act came under notice in the early part of the year. It was the first instance of the kind for many years. A pig was found to be kept on premises used as stables in Eagle Wharf Road. Section 17 of the Public Health (Lond.) Act, 1891, provides that a person shall not feed or keep any swine in any locality, premises or place which is unfit for the keeping of swine, or in which the feeding or keeping of swine may create a nuisance or be injurious to health. The same section provides that any premises within forty yards of any street or public place shall be deemed for the purposes of this section to be a place unfit for keeping swine. If any person contravenes this Section he becomes liable to a penalty of forty shillings and to forfeit the swine and to a further fine, not exceeding ten shillings, for every day during which he continues such offence after notice from the Sanitary Authority to discontinue the same. In the particular instance referred to the place where the pig was kept was within forty yards of the street. The occupier of the premises to whom the pig belonged was accordingly communicated with and an intimation of the offence against the provisions of the Section was given him, and he at once disposed of the pig. It appears that the pig had been sent up from the couniry about a week before as a present and was being kept for killing. 39 The facts were reported to the Health Committee who directed that the person in whose possession the pig was found should be cautioned against a repetition of the offence. 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 to enable the works necessary to put them in a satisfactory sanitary condition to te carried out in a speedy and efficient manner:—• Barretts Buildings, Nos. 1, 2, 3, 4, 5, 6 and 7. Moneyer Street, No. 62. Devizes Street, No. 5. New Norfolk Street, No. 12. Foundry Place, Nos. 1, 3, 4, 5, 6, 7, 8, 9 Norfolk Gardens, No. 25. and 15. Royal Oak Walk, No. 9. Foundry Row, Nos. 1, 2, 3, 4, 7, 11, 14 and Westmoreland Place, No. 53. and 16. Weymouth Terrace, Nos. 128 and 130. Gopsall Street, No. 75. Wilmer Gardens, Nos. 85, 87 and 93. Mansfield Street, No. 5a. Wiltshire Row, No. 1. Mintern Street, No. 29. Barretts Buildings—these are small 2-roomed houses. They were dealt with under the supervision of the Chief Inspector in a very satisfactory manner. They were in a very dirty and dilapidated condition and were generally insanitary. The walls of the lower rooms were damp and the front walls in some of the houses were bulged and dangerous. Their condition was brought under the notice of the owner who was advised to close them as. not being fit for habitation. The owner took this advice and as a result of the work carried out the general condition of Barretts Buildings was vastly improved. No. 5, Devizes Street—this house consisting of 4 rooms with a, scullery, was in a very insanitary condition, being very dirty and dilapidated throughout. The flooring was defective, the sanitary arrangements were bad, the roof was defective and leaky, and the house was overcrowded. A statutory notice was served with a view to obtaining a Closing Order under the Public Health Act. The owner closed the house which was then dealt with in a satisfactory manner under the supervision of Inspector Langstone. Foundry Row, Foundry Place and Royal Oak Walk—the whole of the houses in these courts, together with those in Foundry Walk and Royal Oak Place, were receiving attention at the hands of the Chief Inspector throughout the year. At the end of the year there still remained some in which the necessary work had not been completed. The houses altogether numbered 66; of these 17 were closed. In 56 the work required was completed and in 9 it was in progress at the end of the year. The houses were generally dirty and dilapidated, the flooring was bad, the sanitary arrangements in many instances were defective, the yard-paving was bad in a number of cases and in some 40 cases ventilation needed improvement. In one instance there was an obstructive building in the rear of a house, which was removed—a measure which greatly increased the amount of light and air for the dwelling. The houses mentioned on the above list were closed by the owner in order that the work could be more efficiently carried out. No. 16, Foundry Row was demolished to increase the amount of light and air for the adjoining houses. The work carried out has been of a very satisfactory character and the condition of the houses has been greatly improved. No. 75, Gopsall Street was closed by the owner on receipt of a sanitary notice from Inspector Langstone. The house was in a damp, dirty and dilapidated condition. No. 5a, Mansfield Street—this house was closed by the owner on receipt of a sanitary notice from Inspector Clements. It consisted of three rooms and was found to be overcrowded. The drains were defective, the eaves guttering and rainwater pipes were defective, as was also the case with the roof of the scullery and the paving of the yard. The walls of the rooms were damp, the floors were rotten and the rooms were generally dirty and dilapidated. The house was dealt with satisfactorily and put into a habitable condition. No. 29, Mintern Street was closed by the owner on receipt of a sanitary notice from Inspector Langstone, in order to facilitate the necessary works being carried out in an efficient manner. The drains and sanitary arrangements were defective and the house required cleansing throughout. No. 62, Moneyer Street was closed by the owner on receipt'of a sanitary notice from the Chief Inspector. The house throughout was in a very dirty and dilapidated state. No. 12, New Norfolk Street was closed by the owner under statutory notice. This house was in a, very dirty and dilapidated condition and was overcrowded. It was dealt with under the supervision of Inspector Jordan. No. 25, Norfolk Gardens, a six-roomed house, was closed by the owner on receipt of a sanitary notice from Inspector Jordan. The premises were generally dirty and dilapidated. No. 53, Westmoreland Place, an eight-roomed house, was closed by the owner on receipt of a sanitary notice from Inspector Lear. The premises were in a very dirty and dilapidated condition and required very thorough measures being taken to render it fit for habitation. Nos. 128 and 130, Weymouth Terrace were closed by the owner upon receipt of a sanitary notice from Inspector Clements. The houses were generally dirty and dilapidated. With respect to the houses in Wilmer Gardens—Nos. 85 and 87 were in a very dirty and dilapidated state generally, the rainwater pipes and eaves guttering were defective 41 and there was, having regard to the numbers of persons in the houses, insufficient water-closet accommodation. The houses were closed upon receipt of sanitary notices by the owner, and were dealt with under the supervision of the Chief Inspector. No. 93 was closed under statutory notice and dealt with under the supervision of Inspector Clements. The house was in a dirty and dilapidated state, the eaves, gutters and rainwater pipes were defective, the drains were out of order and there were other insanitary conditions. It was thought advisable for the owner to close the house in order to more effectually carry out the work required. No. 1, Wiltshire Row was generally dirty and dilapidated and the roof was in a bad state. It was closed under statutory notice and dealt with under the supervision of Inspector Langstone. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. The following houses came under notice during the year as being closed for demolition:— Clifton Street, Nos. 33, 35 and 37—these were eight-roomed houses. They have been demolished. Paul Street, No. 22, 24 and 26—these are eight-roomed houses. They were empty at the close of the year. Vandy Street, Nos. 15 and 16—these are also eight-roomed houses and were empty at the close of the year. These houses were let off to persons of the working class. They were situated in the southern part of the Borough in close proximity to the City and it is intended to occupy their sites with warehouses or business premises. HOUSES LET IN LODGINGS. The following houses were registered during the year under the bylaws as to houses let in lodgings or occupied by members of more than one family:— Branch Place, No. 15. Scrutton Street, No. 49. Huntingdon Street, No. 41. St. John's Road, No. 53. Long Street, Nos. 67, 71 and 73. Westmoreland Place, Nos. 70, 71, 81, Moneyer Street, Nos. 52, 72 and 75. 89 and 53. Nancy Street, Nos. 4 and 6. Wilmer Gardens, Nos. 91 and 99. Newton Street, No. 25. Underwood Street, Nos. 7, 8, 10 and 12. The number placed upon the register was 24, making a total of 257 since the bylaws came into operation. In view of the decisions in the cases of Nokes v. Islington Borough Council J20 T.L.R. 95 (1904)] and Styles v. Galinski and Nokes v. Islington 42 Boorugh Council [20 T.L.R. 219] the Local Government Board caused their model bylaws as to houses let in lodgings to be revised, and in a letter dated May 17th, 1904, the Board expressed the desire that the Shoreditch Borough Council would consider the desirability of amending the Bylaws in force in the Borough in a corresponding manner. The main alteration in the model bylaws of the Board is the insertion of a new clause which reads as follows:—“Where a duty imposed upon or a prohibition applied to the landlord of a lodging-house is by any bylaw expressly imposed or applied subject to the provisions of these bylaws proceedings shall not be taken against the landlord for an offence against the bylaw unless and until the landlord, after service upon him of a notice in writing by the Council requiring him within such reasonable time as is specified in the notice to comply with the bylaw, has failed to comply with the bylaw within the time so specified.” The matter was considered by the Health Committee and the Borough Council amended the bylaws on the lines indicated, and a copy of the bylaws as amended was submitted for the approval of the Local Government Board. In December a further communication was received from the Board directing attention to the terms, of the exemption clause in the Shoreditch bylaws and pointing out the desirability of the bylaws making definite provision as to what houses are to be subject to their operation. The Board suggested the adoption of a clause for the purpose of fixing the rental limits of the houses to which such bylaws shall apply. The Board, however, stated that if, owing to the varying conditions under which houses are let in lodgings in the Borough, the Borough Council found a difficulty in fixing rental limits which would work satisfactorily they would be glad to be informed of the nature of such difficulty and to. be furnished with same detailed information as to the conditions under which houses are let in lodgings in the Borough. The Borough Council, after consideration of a joint report of the Town Clerk and Medical Officer of Health, sent a reply to the Local Government Board pointing out that the varying conditions under which houses are let in lodgings in the Borough make it very difficult, if not impossible, to fix rental limits which would be likely to work satisfactorily for the following reasons:— (a) A number of houses which are now registrable and which it is desirable should be registered in the Borough would be excluded from the operation of the bylaws unless a high rental limit were fixed. Not infrequently it has been found necessary, on account of the recurrence of insanitary conditions to place upon the register houses let in lodgings for which lodgers pay from 7s. to 13s. 6d. per week. There are houses on the register in the Borough in which lodgers pay for their lodgings 7s. per week in 30 instances, 7s. 6d. in 14, 8s. in 6, 8s. 6d. in 3, 9s. in 3, 9s. 6d. in 2, 10s. in 3, 10s. 6d. in 2, l1s. in 2, 12s. in 6 and 13s. 6d. in one instance. At the same time the fixing of a high rent limit would compel the registration of a number of houses which are not of a class usually requiring registration, and where great dissatisfaction and friction would not, without reason, be generated. In short, the rents paid by lodgers are a most unreliable guide as to the sanitary condition or otherwise of houses let in lodgings in Shoreditch. 43 (b) A rental limit is likely to be a source of difficulty in cases where .some of the rents paid by lodgers are above and others in the same house are below such limit. In such cases the house would be only partly registrable, a condition of things to be avoided for administrative purposes. As an alternative to a rent limit exemption clause the Borough Council suggested that the exemption clause in the Shoreditch Bylaws should read as follows:—“Where the landlord resides in a lodging-house which is in the opinion of the Sanitary Authority kept in a satisfactory sanitary condition such lodging-house shall be exempt from the operation of the bylaws.” At the time of writing the matter is under the consideration of the Local Government Board.* CUSTOMS AND INLAND REVENUE ACTS. No applications were received for certificates under the above Acts as to the sanitary fitness of dwellings for the purpose of obtaining exemption from inhabited house duty. SMOKE NUISANCE. The shafts and chimneys, other than those of dwelling houses, were kept under observation by the Sanitary Inspectors with a view to preventing the emission of black smoke. Some 16 complaints were received from the London County Council in respect to five premises, 5 complaints from the Coal Smoke Abatement Society in respect to five premises and from other sources complaints respecting three premises. In all cases the complaints were brought under the notice of the persons responsible and the necessary steps were taken to secure the abatement of the nuisances. In one instance it was necessary to bring the facts of the case especially under the notice of the Health Committee with a view to legal proceedings. It was not necessary, however, to1 take the case before a Magistrate. SLAUGHTER-HOUSES. The slaughter-houses registered in the Borough at the end of the year numberd 13, being one less than in 1903. They are mostly used for the slaughtering of sheep. Few oxen are now killed in Shoreditch, nearly all the beef eaten in the Borough is killed elsewhere. The licence of the slaughter-house situate at No. 60, Shepherdess Walk was allowed to lapse. The slaughter-houses were subject to periodical inspection throughout the year and the general condition in which they were kept from a sanitary point of view was satisfactory. As the result of a conference with the Local Government Board early in the current year it was agreed to leave the existing exemption clause as it is. 44 COWSHEDS, DAIRIES AND MILKSHOPS. The number of cowhouses on the register at the end of 1904 was 7 as compared with 8 in 1903 and 9 in 1902. The number of cows kept in the Borough was found at the inspection made prior to the hearing of applications for licences in October to be 95 as compared with 101 in 1903, 103 in 1902, 110 in 190.1, 114 in 1900 and 135 in 1899. As pointed out in previous reports the number of cows kept in the Borough has gradually dwindled. At the present time it is less than one sixth of what it was forty years ago. The licence of the cowhouse situate at No. 31, Taplow Street, was allowed to lapse, the proprietor transferring his business as cowkeeper to the licensed premises situate at No. 22, Bracklyn Street, where he was permitted to put in order and make use of a shed which had not been used for several years. Other improvements were also at the same time carried out in connection with the cow-keeping establishment at No. 22, Bracklyn Street. The cowsheds were periodically inspected throughout the year and the condition in which they were kept may be described as satisfactory. The number of dairymen and purveyors of milk on the register at the end of the year was 294 as compared with 300 in 1903 and 304 in 1902. In 33 instances the sale of milk was discontinued at shops where it was formerly sold, in 72 instances milk shops or general shops at which milk was sold changed hands and the sale of milk was commenced at 27 shops, in connection with which applications were duly received. The premises, upon which the sale of milk is carried on were kept under observation by the sanitary staff, and some 3,199 visits were paid to them, by the Sanitary Inspectors. Warnings as to want of proper attention to cleanliness in connection with milk utensils were given im five instances, in one instance the shop was cleansed and in four cases notices as to insanitary conditions in respect to the drains and sanitary accommodation were required. One case of notifiable infectious disease occurred at a milk shop and the usual steps were taken. In one instance legal proceedings were taken for nonregistration which have already been referred to. OFFENSIVE BUSINESS. The premises at No. 69, Haggerston Road, upon which tripe is boiled, weie under observation during the year. No complaint was received in respect to this business. An order made by the London County Council on March 29th, 1904, declaring the business of a dresser of fish skins to be an offensive business within the meaning of Section 19 (!) (b) of the Public Health (Lond.) Act 1891 was confirmed by the Locail Government Board later in the year and is now in force. The consent of the London County Council must now be obtained before such a business may be established anew. So far as is known at present there is no business of this description carried on in Shoreditch. 45 FACTORY AND WORKSHOP ACT 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1902 was 1,081, at the end of 1903 it was 1,133 and at the end of 1904 it was 1,133, some 147 having been added to, and 147 removed from the register. 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 666 (a) Cabinet making 417 (c) Upholstery 62 (ib) French polishing 66 (d) Other work in the trade 121 (2) Dress: 237 (a) Tailoring 65 (e) Shirtmaking 6 (b) Mantles 11 (f) Boot and Shoe Trade 62 (c) Millinery 19 (g) Artificial flower 8 (d) Dressmaking 35 (h) Other workers 31 (3) Skins, leather, hair and feather trades:-59 (a) Furriers 12 (c) Feathers 4 (b) Saddlery and harness 23 (d) Other workers 20 (4) Paper, printing, book, stationery and fancy goods trades:52 (a) Box and bag makers 33 (b) Other workers 19 (5) Laundry and washing 32 (6) Food Manufacturers 1 (7) Metals, machines, implements and conveyances 40 (8) Precious metals, jewels, etc.4 (9) Other trades than those mentioned above 42 More than half of the workshops on the register are used in connection with the various branches of the furnishing trade and next to these in point of numbers are the workshops in which articles of dress are made. All the workshops on the register were visited once during the year. Those found to be kept in a satisfactory sanitary condition were not visited a second time. Those found in an unsatisfactory condition were kept under observation until an improvement was effected, and in connection with these a considerable number of visits were made during the year. Altogether some 4,681 visits of inspection were made in connection with the workshops on the register (Appendix). The communications received from the Factory Inspector as to the establishment of new workshops within the Borough numbered 33 and referred to 73 workshops. The chief purposes for which these workshops are used are for various branches of the furniture trade in 35 instances, for dress in 13 instances, and for leather and feathers in 5 instances. On inspection 54 were found in a satisfactory sanitary condition, 17 required attention for the removal of sanitary defects, in one instance the occupier was found' to have gone elsewhere and in one instance the workshop could not be found. 46 The written intimations received from the Factory Inspector as to insanitary conditions and infringements of the law relating to public health numbered 122, and referred to 151 workshops or workplaces. In 55 instances the intimation referred to dirtiness of workshops, in 23 to dirty and dilapidated workshops, in 25 to defective conditions of the water-closet arrangements, in 5 to overcrowding, in 3 to defective drains, in 3 to the waterclosets being without water supplies, in 2 to absence of proper separate sanitary accommodation for women, in 2 to insufficiency of the water-closet accommodation, in one instance to there being an entire absence of sanitary accommodation, in one instance to an accumulation of manure on the premises and in two1 cases to the existence of foul smells at the workshops. These workshops were all duly inspected by the officers of the Borough Council and the necessary steps were taken for the removal of the insanitary conditions mentioned on the written intimations of the Factory Inspectors as well as others which were found when the workshops were visited by the Sanitary Inspectors. In addition to those brought under the notice of the Sanitary Authority by the Factory Inspector, some 306 workshops, workplaces and factories—mostly workshops and workplaces—were dealt with during the year, not including bakehouses, which are specially referred to later. The defects and insanitary conditions were similar in character to those already mentioned. In the inspection of workshops and workplaces special attention is given to the duties the Sanitary Authority is called upon to perform, as to cleanliness, air space and ventilation, drainage of floors in cases where wet processes are carried on, and as to the provision of sufficient and suitable accommodation in the way of sanitary conveniences. Altogether 454 sanitary notices were served by the Sanitary Inspectors with respect to 474 factories, workshops and workplaces. In some cases more than one workshop were included on a single notice. The following is an abstract of the sanitary work done in connection with factories, workshops and workplaces in the Borough in compliance with the sanitary notices served during the year 1904: — Drains relaid 14 Water closets disconnected fromi workshops 4 New drains constructed 6 Stack pipes disconnected 8 Urinals repaired and cleaned 13 Stack pipes reinstated 12 Water supply laid on or restored 32 Eaves gutters reinstated 22 Leaking water pipes repaired 14 Sink waste pipes disconnected 22 Work rooms cleansed and whitewashed 629 Yards paved 15 Yards 143 Forecourts paved 1 Areas ,, ,, „ 17 Areas paved 1 Roofs repaired 52 Water closets re-constructed 50 Floors ,, 19 New water closets constructed 21 Stairs ,, 19 Water closets cleansed and limewashed 292 Doors ,, 12 Sashes ,, 26 47 Light and ventilation provided or improved in water closets 17 Obstructions removed from water closets 24 Water closets repaired 7 Ventilation under floors provided 2 Ventilation of workshops improved 3 Dust receptacles provided 20 Foul accumulations removed 20 Overcrowding abated 7 The above does not include the work done in respect to two new warehouses which were dealt with during the year nor that carried out in the bakehouses. With 30 exceptions the insanitary conditions were rectified upon the receipt of official intimations from the Sanitary Inspectors. The exceptions were brought under the notice of the Health Committee and statutory notices under the Public Health (Lond.) Act 1891 were served upon the parties responsible. The work was, however, in all these cases carried out without it being necessary to appeal to a Magistrate. With respect to home work 42 lists of out-workers were received from employers, 17 in the first half year and 25 in the second, referring to 791 out-workers. On examination it was found that 601 were not resident in Shoreditch. Their addresses were duly forwarded to the Authorities of the Sanitary Districts to which they belonged. Communications were received from other Sanitary Authorities relative to some 680 outworker's, the great majority of whom resided in the Borough. In the cases of the remainder, 36 in number, their addresses were forwarded to the Sanitary Authorities of the districts- in which they were situate. Alogether some 651 visits of inspection were paid in Connection with places where home work was done. The following table will serve to convey an idea of the distribution of the outworkers in the several classes of home work according to the lists sent in during the year: Class of Homework. Number of Lists received. Number of Addresses of Outworkers. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1st. Due August 1st. Due Feb. 1st. Due August 1st Tailoring 4 42 7 126 40 118 50 28 Mantles 1 12 1 17 6 6 14 17 Underclothing 1 22 1 14 12 8 31 16 Blouses & Costumes 1 8 2 125 7 124 7 4 Boots 3 60 6 80 50 68 91 93 Millinery 1 14 1 17 12 15 9 10 Fur pulling ... ... ... ... ... ... 4 2 Other work 6 135 7 119 73 62 155 149 Total 17 293 25 498 200 401 361 319 48 The object aimed at by the law in requiring that lists of outworkers shall be sent to the Sanitary Authority every six months is the prevention of home work being done in dwellings which are injurious or dangerous to the health of the workers themselves, e.g. through overcrowding and other insanitary conditions, or on premises where dangerous infectious disease exists. During the year 45 cases of infectious disease were notified on home workers premises. In all cases the necessary steps were taken to prevent infection being spread by the work. In most instances the temporary cessation of the work carried on was required, but no action was found necessary under Sections 108-110 of the Factory and Workshop Act. With respect to the BAKEHOUSES in the Borough, the number on the register at the end of the year was 78, including two factory bakeries. Of these 32 were above ground and 46 under ground. The condition in which they were found to be kept generally was satisfactory. Cleansing and limewashing were required in 10, dust receptacles in 3 and some minor matters in two others. The necessary sanitary notices were served and complied with. No. 88, Bridport Place, an underground bakehouse, was made to comply with the requirements of the Borough Council, and was accordingly certified and added to the register. A new bakehouse, constructed above ground, was brought into use at 179, Hoxton Street in place of an old disused underground one which has not been certified. The bakehouse formerly existing at No. 28, Shepherdess Walk has been demolished. A bakehouse at No. 2, Pitfield Street, above ground, has been rebuilt. The bakehouses situate at No. 63, Scrutton Street, 55, Hackney Road, and 189, High Street were not in use at the end of the year. No application was received for the certification of the bakehouse at 273, Kingsland Road which remains disused. ICE CREAM SHOPS. The following is a summary of the results of the inspection of premises whereon ice cream is prepared or sold in the Borough:—On Inspector Lear's district 11 were under observation. Generally they were kept in a very fair condition. In four instances the premises required more or less cleansing, and in one case notice was required on account of the defective state of the sanitary arrangements. On Inspector Firth's district seven were under observation. Their condition generally was satisfactory, but in two or three some cleansing was necessary. Inspector Jordan had twenty under observation. Of these fifteen were found to be kept in a satisfactory state. Sanitary notices were required in respect to the other five premises, in one instance on account of the defective condition of the yard paving, in two instances on account of defective drain and sanitary arrangements, and in two instances chiefly on account of the dirty condition of the premises. Inspector Langstone visited 22 premises. They may be described as being generally in a satisfactory sanitary condition. Notices as to cleansing were required in three instances, as to the provision of a dust receptacle in one 49 case and as to the provision of proper storage for ice cream materials in one instance. Inspector Clements had nine premises under observation. Generally they were in very fair condition. In three instances cleansing was necessary, and in three instances some minor sanitary defects required attention. Two cases of scarlet fever occurred on premises upon which ice cream was sold. The necessary steps were taken to obviate risk of the spread of infection. Altogether 69 places where ice cream was manufactured or sold were under inspection during the year. It is to be noted that the sale of ice cream mainly takes place in the summer time, and that it is not necessary to give the Sanitary Authority any intimation when the sale of ice cream is to be commenced upon any premises. It is probable, therefore, that places upon which it is manufactured or sold escape inspection. Of those inspected some 46 were found to be in a satisfactory condition. In the remainder sanitary notices were required mainly on account of lack of proper attention to cleanliness. COFFEE-HOUSES, COOK-SHOPS AND FRIED-FISH SHOPS. Premises of the above description upon which food is sold or prepared for sale were subject to inspection during the year. The results may be summarised as follows : Inspector Lear visited 30, including 8 fried-fish shops. Of these 24, including 6 friedfish shops were found in a cleanly and satisfactory sanitary condition. The remainder required the service of sanitary notices, chiefly for the purpose of securing the limewashing and cleansing of walls and ceilings. Inspector Firth had 19, including 7 fried-fish shops, under observation. Of these 15, including 5 fried-fish shops were in a satisfactory sanitary condition. In the remainder notices were required on account of lack of proper attention to cleanliness and the existence of minor sanitary defects. Inspector Jordan, visited 71 cook-shops and coffee-houses, 53 of which may be said to have been in a satisfactory sanitary condition. In 18 sanitary notices were required, in 10 instances on account of want of proper attention to cleanliness and in the remainder for minor sanitary defects. The number of fried-fish shops visited was 10, seven of which were in a satisfactory sanitary condition. In three instances notices were served, in one case for defective drains, in one case for general cleansing, and in one case on account of the presence of offensive smells from the basement where the fish was cut up. Inspector Jordan also visited the kitchens of 12 public-houses where dinners are provided for customers. In 8 of these the conditions were satisfactory. In three instances notices were served as to dirty conditions of the ceilings and walls of the kitchens, and in one case the drain was found to be obstructed and defective. Inspector Langstone visited 30 coffee-houses and cook-shops and 7 fried-fish shops. Of these 27 were in a satisfactory condition. Notices were required as to cleansing in 6 instances, as to drains in 2 instances, for overcrowding in one case, and to secure the provision of a proper dust receptacle in one case. 50 Inspector Clements visited 14 cook-shops and coffee-houses and 8 fried-fish shops. Eleven of them were in a satisfactory sanitary condition. In the remainder sanitary notices were necessary, in five instances for securing cleanliness of premises, in five instances for more or less serious defects in connection with the drains and sanitary arrangements, and in one case for defects in the yard paving with absence of a proper dust receptacle. Inspector Clements also had under observation a place where jam is manufactured, and a brawn factory from which retail shops are supplied. The former was in a clean condition but a sanitary notice was required in connection with the latter establishment, which had to be visited at frequent intervals for a time in order to secure the necessary attention to matters of cleanliness. Altogether 161 cook-shops and eating-houses, including 12 public-houses and 40 fried-fish shops, were under observation during the year, as compared with 148 and 39 respectively for 1903. Some 635 visits of inspection were made in connection with these premises. Where they were not found to be kept in a satisfactory condition they were visited at frequent intervals until the necessary improvement had taken place. As the result of inspection 118 cook-shops and eating-houses and 27 fried-fish shops were found to be in a satisfactory and cleanly condition. With regard to the remainder want of proper attention to cleanliness was the chief evil met with. In all cases sanitary notices were served upon the parties responsible and the necessary steps were taken to remedy the defects found existing. STREET-MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers over the street markets and the foodstuffs exposed for sale generally in the Borough. Frequent inspections were made with a view to the detection of unsound food. On the whole it may be stated that the quality of the various articles of food exposed for sale was excellent. The folowing were destroyed during the year as being unfit for the food of man :— One carcase of a calf, 21 sheeps' hearts, 41bs. of salt beef, one barrel containing 80 pigs' plucks, about 3 cwt. of rabbits, 2 hampers of pigeons and one of chickens; half a barrel of conger eels, 3 boxes of eels, 17 trunks of plaice and dabs, 2 trunks of plaice and haddocks, 3 boxes of skate, 1 trunk of cod, 9 boxes of haddocks and 30 soles; condensed skimmed milk in tins 21 cases, each case containing six dozen tins; 2½ boxes of oranges, 6 crates of bananas, 5 baskets of grapes, 1 box of onions, 1 case of olives and pears, and 15 sacks of pota' oes. One box of oranges was seized by Inspector Clements as being unfit for the food of man. A part of this box was destroyed by the owner. The remainder contained 120 oranges, was taken before a Magistrate, who condemned and ordered 70 of the oranges to be destroyed. The remainder were restored to the owner. The owner claimed that the whole of the 120 oranges were fit for food. No proceedings were thought advisable. 51 With regard to the tinned condensed milk, said to have been machine skimmed prepared in Holland, this was brought under our notice by the person to whom it belonged. It was found after careful examination that with the exception of' about 4 dozen tins the whole was bad and quite unfit for food. All the tins appeared to be more or less blown, and in many instances had given way at one end where circular pieces of tin had been soldered over the places at which the tins had been filled. This gave rise to a suspicion that the same had been tampered with. The manner in which they have been sealed, however, appears to be a recognised one in the trade. The stuff which was bad was seized by Inspector Lear and taken before a Magistrate, who made an order condemning it, and it was accordingly destroyed. The question as to taking legal proceedings then arose. The person on whose premises it was seized brought the stuff under our notice. As soon as he found that it was bad he had no intention of selling it. The party who sold it to him carried on his business in West Ham. This same party was previously in business in Stepney, He left there after being prosecuted, convicted, and imprisoned for selling tinned food unfit for human consumption. Enquiries were made in West Ham and Stepney as to the nature of the business carried on by the party in question. It appears that he was in the habit of buying damaged stocks of tinned foods of various descriptions, such as meat, fish, fruits, etc., with a view to separating what was fit for food and rejecting what was unfit. Although this may be a legitimate business it is, nevertheless, one which from its nature is very readily open to abuse and is consequently to be regarded with suspicion. In the case under consideration the goods had been on the hands of the person on whose premises they were seized for several months, and it was impossible to obtain reliable evidence as to the condition of the tins at the time the sale took plaice. Moreover, every tin bore a printed label upon which was a caution to the effect that any unsound tins were not to be sold but to be returned when full price would be allowed. Under the circumstances it was not deemed advisable to take legal proceedings. In September a circular letter was received from the Local Government Board pointing out the desirability of uniformity in the practice of meat inspection, in respect to the carcases of cattle, and urging the observance of the principles laid down by the Royal Commission on Tuberculosis in their report for 1898 with respect to the degree of tuberculous disease which should cause the seizure of a carcase or part thereof. The principles referred to are as follows:— The entire carcase and all the organs may be seized (a) when there is miliary tuberculosis of both lung's, (b) when tuberculous lesions are present on the pleura and peritoneum, (c) when the lesions are present in the muscular system or in the lymphatic glands embedded in or between the muscles, and (d) when tuberculous lesions exist in any part of an emaciated carcase. The carcase if otherwise healthy shall not be condemned, but every part of it containing tuberculous lesions shall be seized (a) when the lesions are confined to th<. lungs and the thoracic lymphatic glands, (b) when the lesions are confined to the liver, 52 (c) when the lesions are confined to the pharyngeal lymphatic glands, and (d) when the lesions are confined to any combination of the foregoing but are collectively small in extent. With respect to tuberculous meat in Shoreditch it may be remarked that, owing to the great bulk of the meat consumed in the Borough which is liable to be infected with tuberculosis, being slaughtered elsewhere than in Shoreditch and being sub ject to examination before it reaches: the Borough, it is only very rarely that meat suspected of being tuberculous comes under observation. There is no record of a tuberculous carcase having been found exposed for sale or in a place under conditions giving rise to the supposition that it was intended for sale for the food of man during recent years in Shoreditch. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Sir Thomas Stevenson, show that during the year 612 samples of food and drugs were submitted to him for analysis. This number works out at the rate of one sample for every 189 persons in the Borough or slightly more than 5 samples per 1,000 inhabitants. Of the samples submitted 128 were taken by Inspector Lear, 130 by Inspector Firth, 129 by Inspector Jordan, 97 by Inspector Langstone and .128 by Inspector Clements. The results of the year's work are summarised in the following table:— Quarter for the year 1904. 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 analysed. 1st. 238 46 19.3% 21 1 20 20 £ 52 s. 6 d. 0 £ 119 s. 0 d. 0 2nd. 116 25 21.5% 12 5 7 5 15 3 0 58 0 0 3rd. 104 25 24.0% 15 — 15 14 37 14 6 52 0 0 4th. 154 14 9.0% 8 — 8 7 23 1 6 77 0 0 Year 612 110 17.9% 56 6 50 46 128 5 0 306 0 0 The samples included 365 of milk, 181 butter, 20 lard, 8 coffee, 6 seidlitz powder, 5 cheese, 4 cocoa, 4 pepper, 2 jam, 2 whisky, 2 flour, 2 arrowroot, 2 dripping, 2 brandy, 2 cod liver oil, 1 milk and water, 1 margarine, 1 tea, 1 mustard and 1 of almond oil. Of the milk samples 86 or 23.5 per cent. were found not to be genuine as compared with 22.0 per cent. for 1903. This increase in the percentage of adulteration has taken place notwithstanding there were 20 more samples taken in 1904 than in 1903. In the 53 subjoined table are shown the numbers of samples of milk taken during the four quarters of the year and the numbers and percentages of the samples found not to be genuine:— Quarter of the year. Number of Samples. Number not genuine. Percentage not genuine. 1st. 119 30 25.2% 2nd. 81 22 27.1% 3rd 73 23 31.5% 4 th 92 11 11.9% The percentage of adulteration was highest in the third and lowest in the fourth quarter. In 45 of the milk samples water was found to have been added. In 21 instances the amount was over and in 24 it was under five per cent. In 22 of the samples fat had been abstracted, the amount being over 5 per cent in seventeen and under in five instances. In 14 samples both fat had been abstracted and water added. In the remaining samples returned as adulterated preservatives had been added. In several instances in addition to adulteration with water or abstraction of fat samples were found to contain traces of boric acid, and in one instance formic aldehyde. Altogether 10 of the samples of milk contained added preservatives, and in two instances traces of artificial colouring matter were also present- Legal proceedings were instituted in 39, or slightly over 45 per cent of the cases of milk adulteration. In 32 convictions were obtained. In 5 the summonses were withdrawn on account of the production of warranties. In 2 instances the summonses were dismissed. In 1 the defendant was able to convince the Magistrate that a sample of milk showing on analysis 6 per cent of abstraction of fat had not been tampered with and in the other that there had been a disclosure so that the purchaser was not prejudiced. In the remainder of the cases in which analysis showed that the milk had been tampered with it was not deemed wise to prosecute as the percentage of abstraction of fat or addition of water did not exceed five per cent. A good average milk will permit of the addition of from 6 to 10 per cent of water without exceeding the standard of the Board of Agriculture by more than 4 or 5 per cent., the standard, therefore, is not without its value to those who make a practice of adding water to milk. In the cases in which convictions were obtained the penalties for milk adulteration (excluding costs) amounted to £50 10s. Od.averaging 6 per cent of the maximum penalties to which the defendants were liable as compared with 8 per cent in 1903, and 13.5 per 54 cent in 1902. Taking the fines and costs together, however, the average amounts paid by the defendants on conviction were £2 6s. 10d. as compared with £1 18s. 6d. in 1903 and £2 18s. Od. in 1902. The question of warranties has lately been receiving attention at the hands of those who have to do with the administration of the Sale of Food and Drugs Acts. The law in this respect needs amendment. Of the butter samples 20, or a shade over 11 per cent. were not genuine. The number of samples and percentages of adulteration for the four quarters of the year are as shown in the following table : — Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated, 1st. 81 12 14.8% 2nd. 31 3 9.6% 3rd 27 2 7.4% 4th 42 3 7.1% Fifteen of the twenty samples which were not genuine were found to be margarine. In the remaining five there was water in excess of the 16 per cent. recognised as allowable in butter. Nineteen of the samples not genuine contained traces of boric acid or a preparation thereof. Legal proceedings Were taken in 14, or 70 per cent, of the cases of adulteration of butter and convictions were obtained in 12 instances. One summons was withdrawn at the suggestion of the Magistrate on the payment of costs amounting to 12s. 6d., and one summons was dismissed without costs on the grounds of conflicting evidence. One sample was taken under the Margarine Act. The vendor was summonsed for exposing margarine for sale without a label and also for selling margarine in contravention of Section 8 of the Sale of Food and Drugs Act 1899, which restricts the amount of butter-fat in margarine to 10 per cent. A fine of Is. was imposed by the Magistrate in each case without costs. The penalties inflicted in the cases in which convictions were obtained in respect to samples of butter and margarine amounted to ,£31 3s. 0d., which gives an average of 10 per cent. of the maximum penalty per case, as compared with 18 per cent. in 1903 and 17 per cent. in 1902. Including costs the amount imposed by the Magistrates for each conviction averaged £3 Is. Od. as compared with £4. 10s. Od. in 1903 and £4 Is. Od. in 1902. The samples of lard, seidlitz powder, cheese, cocoa, pepper, flour, arrowroot, dripping, brandy, cod liver oil, milk and water, tea, mustard and almond oil were all reported as genuine. 55 One of the samples sold as coffee contained 65 per cent. of chicory, but the vendor could not be prosecuted as it was found that the wrapper bore words printed upon it to the effect that the contents had been sold as a mixture. One sample of plum jam contained l/10th of a grain of salicylic acid to the pound, and one of the samples of whisky contained a very small excess of water over and above that contained in 25 per cent. u. p. whisky. The subjoined table shows a comparison of the results of the work under the Food and Drugs Acts during the years 1902-4 inclusive:— 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, &c. Prosecutions proceeded with. Number of successful prosecutions. Fines 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 o. 1904 612 189 110 17.9 56 6 50 46 128 5 0 306 0 0 It is noticeable that the reduction of the number of samples in 1904 as compared with the number taken in 1903 has been associated with an increase in the percentage of samples found adulterated in 1904. SANITARY LEGISLATION. Under Part IV. of the London County Council (General Powers) Act 1904 the Sanitary Authorities in the Metropolis have become possessed of some useful additional sanitary powers:—Section 19 enables a Sanitary Authority to secure the purification of filthy, dangerous or unwholesome articles which may be in any house or part thereof in its district; Section 20 gives power for the purpose of causing houses infested with vermin to be cleansed; Section 22 enables the Sanitary Authority of the district to require that any sanitary convenience now or hereafter erected in or accessible from any street in its district shall be so placed or constructed as not to be a nuisance or offensive to public decency, and for this purpose the owner may be required to remove such convenience or otherwise to reconstruct the same in such a manner and with such materials as may be required to abate the nuisance or remove the offence against public decency; any owner failing to comply with a notice under this Section may become liable on summary conviction to a fine of five pounds with a further fine of twenty shillings for every day during which he makes default in complying with the requirements of such, notice after conviction; Section 23 enables the Sanitary Authority to require the owner of a building to remove or fill up any fixed ashpit in or about such building and restore to a good and sanitary condition the site of such ashpit where a moveable ashpit shall have been provided in connection with, the building conforming with the requirements of any bylaw 56 or order made under any statutory authority or power in that behalf; Section 24 gives the Sanitary Authority the necessary powers of entry; and Section 25 makes it the duty of the Sanitary Authority for each Sanitary District to enforce within that district these new provisions and gives the Authority the necessary rights and powers for the purpose. The power in respect to sanitary conveniences is most useful. Although a good deal of beneficial work has already been done in this direction, the Sanitary Authority has hitherto been at a disadvantage whenever it was necessary to ask for matters in connection with them to be attended to which could not be remedied under the existing law relating to public health, but which it was necessary to deal with on the grounds of public decency. SANITARY STAFF. Towards the end of the year the question of the adequacy of the staff of Sanitary Inspectors was raised on the Health Committee. The responsibilities which have been thrown upon the Sanitary Authority by the London Government Act 1899, and the Factory and Workshop Act 1901, together with the increased amount of work under the Sale of Food and Drugs Acts which has been required of the Sanitary Inspectors by the Health Committee have taken up a very appreciable proportion of the time formerly available for sanitary inspection in connection with dwelling houses. The matter is now under investigation. Owing to injury through accident, the Chief Inspector was absent from duty for about a month in the summer, and Inspector Langstone wap absent during December of the year under consideration, and January and February of the current year owing to an attack of rheumatic fever. During their absences their duties were divided amongst the other Inspectors. Owing to ill-health and age H. J. Suffield, who was for nearly 20 years in charge of the disinfecting apparatus, was unable to fulfil his duties and W. S. Gilbert, who had been temporarily employed during the last smallpox outbreak was appointed to assist in disinfecting, F. J. Ford taking charge of the disinfecting apparatus in place of Suffield. I beg to express my satisfaction as to the manner in which the Officers of the Health Department have discharged their duties, and my recognition of the assistance I have received from them in connection with the work of the department during the year. I also have to acknowledge my indebtedness to the Chairman and Members of the Health Committee for the consideration and help they have rendered me in my official work for the year. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. APPENDIX TO THE REPORT of tHE MEDICAL OFFICER OP HEALTH. containing Statistical Tables and a Summary of Sanitary Proceedings under the public health and factory and workshop acts, during the Year 1904, also a Summary of the " Return Casfs " of Scarlet Fever in Shoreditch during the years 1893 to 1903 inclusive. Tables I., II, III. and IV. are forms required by the Local Government Board. 58 TABLE I. BOROUGH OP SHOREDITCH. Vital Statistics of whole District during 1904 and previous Years. Year. Population estimated to middle of each Year. Births. 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. Net 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 3 4 5 6 7 8 9 10 11 12 13 1893 123520 4446 35.5 807 186 3198 26.1 862 436 384 3146 25.7 1894 123520 4332 34.5 704 166 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 1903 117740 3932 33.3 676 176 2232 18.9 832 337 383 2280 19.6 Averages for years 1893tol903 121221 4208 34.4 780 188 2697 22.3 816 407 363 2657 22.1 1904 117360 3763 32.0 706 190 2315 19.6 811 366 434 2392 20.6+ * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. 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, corrected by the subtraction of the number in column 10 and the addition of the number in column 11. During 1904 seven persons not resident in Shoreditch died within the district, and 16 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 net 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 account of sickness or infirmity, and have died in public institutions elsewhere. The " public institutions ' taken into account for the purposes of these 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) 642.5 Total population at all ages, 118,637 Number of inhabited houses, 12,743 Average number of persons, per house 9.3 AtCensus of 1901. 59 TABLE II. BOROUGH OP SHOREDITCH. Vital Statistics of separate Localities in 1901 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 unoer 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. d. a. b. C. d. a. b. c. 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 1013 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 328 1902 117948 3992 2441 704 15927 467 355 74 29636 1023 580 159 26385 865 558 171 46000 1637 948 300 1903 117740 3932 2280 676 15800 421 341 66 29600 1026 591 192 26350 909 499 171 45990 1576 849 247 Averages of Years 1892 to 1903. 121416 4232 2671 778 17801 505 399 89 29588 1052 623 187 27592 962 600 185 46425 1711 1048 316 1904 117360 3763 2392 706 15650 372 363 78 29400 999 553 154 26330 837 519 184 45980 1555 957 290 Note.—(a) The 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 c 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. 60 TABLE III. BOEOUGH OP SHOREDITCH. Cases of infectious disease notified during the Year 1904. Notifiable Disease Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. 1. Shoreditch South. 2. Hox on New Town 3. Hoxton Old Town. 4. Haggerston. 1. Shoreditch South. 2. Hoxton New Town. 3. Hoxton Old Town. 4 Haggerston. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox 14 3 l 2 2 6 ... 5 2 l 6 5 2 1 6 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 180 11 85 60 17 7 ... 28 40 30 82 28 38 29 78 Membranous croup 3 ... 2 1 ... ... ... 2 ... 1 ... ... ... ... ... Erysipelas 183 7 ... 21 25 108 12 32 50 42 59 1 3 3 4 Scarlet fever 343 5 112 195 23 8 ... 55 79 69 140 52 78 67 135 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 48 ... ... 17 16 15 ... 9 9 6 24 7 9 5 22 Relapsing fever ... ... ... ... ... — ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 5 ... ... ... 3 2 ... ... 2 2 1 ... 1 ... 1 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *Chicken pox 302 30 160 109 3 ... ... 35 94 79 94 ... ... ... ... Totals 1078 56 307 405 89 146 12 166 276 230 406 93 131 105 246 * Chicken pox was notifiable in London from the first week of April until the first week of November, 1904. 61 TABLE IV. BOROUGH OP SHOREDITCH. Causes of, and ages at, death during Year 1904. 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 Hoxton New Town. Hoxton Old Town. Hagger ston. 1 2 3 4 5 6 7 8 9 10 11 12 13 Small-pox 2 2 ... ... ... ... ... ... ... ... 2 ... Measles 81 11 70 ... ... ... ... 10 13 9 49 11 Scarlet fever 13 ... 9 3 ... 1 ... 2 2 6 3 ... Whooping-cough 60 24 36 ... ... ... ... 6 17 9 28 1 Diphtheria and membranous croup 19 3 13 3 ... ... ... 2 6 3 8 Croup ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... Fever ( Enteric 9 ... ... 1 3 5 ... 2 2 1 4 2 Other contd. ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza ... 14 ... 2 1 ... 7 ... 4 3 ... 7 4 Cholera ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... 50 ... ... ... Diarrhoea (see notes below) 186 150 30 ... ... 3 3 10 53 73 6 Enteritis (see notes below) 54 38 8 ... ... 4 4 5 15 12 22 9 Puerperal lever 2 ... ... ... 1 1 ... ... 2 ... ... ... Erysipelas 5 3 ... ... ... 2 ... 2 2 ... 1 1 Other septic diseases 13 2 1 3 3 4 ... ... 5 2 6 5 Phthisis 247 3 13 6 33 183 9 36 60 58 93 131 Other tuberculous diseases 118 53 33 15 7 10 ... 15 36 17 50 19 Cancer, malignant disease 89 ... ... ... 1 65 23 18 17 27 27 39 Bronchitis 230 39 32 ... 1 75 83 27 58 52 93 133 Pneumonia ... 197 54 64 6 3 52 18 40 43 36 78 34 Pleurisy 5 1 2 ... ... 2 ... 3 1 ... 1 5 Other diseases of Respiratory organs ... 7 ... ... 1 ... 3 3 2 2 ... 3 2 Alcoholism ) Cirrhosis of liver j 57 ... ... ... 2 49 6 8 14 13 22 25 Venereal diseases ... 12 7 1 ... ... 4 ... 3 5 1 3 2 Premature birth 67 67 ... ... ... ... ... 9 16 20 22 1 Diseases and accidents of parturition 4 ... ... ... 1 3 ... 1 1 2 ... ... Heart diseases 130 1 2 10 9 75 33 24 34 22 50 66 Accidents 91 37 7 ... 7 30 10 15 17 19 40 17 Suicides 18 ... ... ... 2 12 4 4 2 6 6 4 All other causes 662 211 35 23 7 192 194 115 130 151 266 294 All Causes 2392 706 358 72 80 782 394 363 553 519 957 811 Notes.—(a) In this Table all deaths of "residents " occurring in public institutions, whether within or without the district, have been included with the other deaths in the columns for the several 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) see 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 note (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 diarrhoea ; 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 included under the latter. 62 63 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH REGISTRATION SUB-DISTRICT, DURING THE YEAR ENDING DECEMBER 31ST, 1904. Note.—The deaths of persons not belonging to Shoreditch occurring in Hospitals, &c., in the Borough are excluded; and the deaths of persons belonging to Shoreditch occurring in Hospitals, &c., situated in London beyond the limits of the Borough, are included. AGES. DEATHS REGISTERED IN EACH SUB-DISTRICT FROM ALL CAUSES. CAUSES OF DEATH. 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 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Small Pox ( Unvaccinated 2 ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... 2 1 1 2 No statement ... ... . . . ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 11 70 ... ... ... ... ... ... ... ... ... ... ... 10 13 9 49 50 31 81 3 Scarlet fever 9 3 ... ... ... 1 ... ... . . . ... ... 2 2 6 3 9 4 13 4 Typhus fever ... ... ... . . . . . . ... • . . ... ... ... ... ... . . . .. . ... . . . ... ... 5 Epidemic influenza 2 ... 1 ... ... 1 ... 2 2 2 3 I 4 3 ... 7 9 5 14 6 Whooping cough 24 36 ... ... ... ... ... ... ... ... ... . . . ... 6 17 9 28 21 39 60 7 Diphtheria, membranous croup 3 13 2 1 ... ... ... ... ... ... ... ... 2 6 3 8 8 11 19 8 Enteric fever ... ... ... 1 3 ... 2 2 1 ... ... ... ... 2 2 1 4 5 4 9 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 94 23 ... ... ... ... ... 1 1 ... 1 1 ... 8 27 37 49 b9 52 121 11 Epidemic or zymotic enteritis 56 7 ... ... ... ... ... ... 1 ... ... 1 ... 2 23 16 24 35 30 65 12 Other allied diseases 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 7 1 ... ... ... ... 1 2 1 ... ... ... • •• 3 5 1 3 8 4 12 19 Gonorrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedoena, hospital gangrene ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... 21 Erysipelas 3 ... ... ... ... ... 1 ... ... 1 ... ... ... 2 2 ... 1 2 3 5 22 Puerperl fever ... ... ... ... ... 1 i ... ... ... ... ... ... ... 2 ... ... ... ... 2 23 Pyaemia, septicaemia 2 ... 1 1 1 ... 2 ... 1 ... ... ... ... ... 2 2 4 5 3 8 24 Infective endocarditis ... ... ... 1 i ... I ... ... ... ... ... ... ... 3 ... ... 2 1 3 25 Other allied diseases ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 1 2 26 Malarial fever ... ... ... ... ... ... ... ... . . . ... ... . . . ... ... ... ... ... ... ... ... 27 Rheumatic fever ... ... ... 1 ... ... 3 1 2 1 ... ... ... ... 1 5 2 4 4 8 28 Rheumatism of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis : 29 Brain or meninges, acute hydrocephalus 18 19 5 3 2 1 1 ... ... ... ... ... ... 8 13 4 24 20 29 49 30 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 2 31 Intestines tables mesinterica 3 13 1 5 12 21 58 58 46 21 9 ... ... 36 60 58 93 153 94 247 32 Intestines, tabes mesinterica 14 2 ... 2 ... ... ... ... ... ... ... ... ... 1 9 3 5 8 10 18 33 General, position undefined 18 8 2 ... 2 ... 3 1 3 ... ... ... ... 4 9 8 16 20 17 37 34 Other forms, scrofula 3 4 3 ... 2 ... ... ... ... ... ... ... ... 2 5 2 3 6 6 12 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 ... 1 1 2 42 Chronic alcoholism ... ... ... ... ... 2 10 7 5 4 ... ... 2 8 7 11 13 15 28 43 Chronic industrial poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 Gout ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... 1 47 Cancer ... ... ... ... ... ... 7 20 32 16 5 ... 18 15 22 25 31 49 80 48 Diabetes mellitus ... ... ... ... ... 1 ... 3 2 ... ... ... ... 1 2 3 2 4 6 49 Purpura hoemorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anæmia, leucocythæmia ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 1 1 2 DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31ST, 1904. DEATHS REGISTERED IN EACH SUB-DISTRICT FROM ALL CAUSES. CAUSES OF DEATH. AGES. Shoreditch South. Hoxton New Town. Hoxton Old Town. Haggereton. Male. Female. Total. Under 1. 1 to 5. 6 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 53 Premature birth 67 ... . . . ... ... ... ... ... ... ... ... ... ... 9 16 20 22 37 30 67 54 Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 Debility at birth 26 ... ... ... ... ... ... ... ... ... ... ... ... 3 4 6 13 18 8 26 56 Atelectasis 8 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 4 7 1 8 57 Congenital defects 15 1 1 ... ... ... ... ... ... ... ... ... ... 5 1 1 10 6 11 17 58 Want of breast milk 1 ... ... . . . . . . ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 59 Atrophy, debility, marasmus 91 9 1 ... ... . . . ... ... ... ... ... ... ... 7 20 29 45 56 45 101 60 Dentition 7 5 ... ... ... ... ... ... ... ... ... ... ... 3 2 4 3 8 4 12 61 Rickets 1 1 ... ... ... . . . ... ... ... ... ... ... ... ... ... ... 2 2 ... 2 62 Old Age, senile decay ... ... ... ... ... ... ... ... ... 2 31 52 22 34 16 22 35 53 54 107 63 Convulsions 33 1 ... ... ... ... ... ... ... ... ... ... ... 2 7 11 14 17 17 34 64 Meningitis 13 8 1 1 ... ... ... ... ... ... ... ... ... 6 3 10 4 15 8 23 65 Encephalitis ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... . . . ... 66 Apoplexy ... ... ... ... ... ... 1 4 10 23 20 6 ... 10 18 12 24 21 43 64 67 Softening of brain ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 68 Hemiplegia brain paralysis ... ... ... ... ... ... 1 2 ... 4 3 1 1 1 ... 3 8 3 9 12 69 General paralysis of insane ... ... ... ... ... ... 2 2 5 2 ... ... ... 4 2 3 2 7 4 11 70 Other forms of insanity ... ... ... ... ... ... ... ... ... ... ... i ... ... ... ... 1 1 ... 1 71 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 1 1 1 2 73 Epilepsy ... 1 ... ... ... 1 4 1 1 1 1 ... ... 3 4 1 2 5 5 10 74 Laryngismus Stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 75 Locomotor Ataxy ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... 1 2 ... 2 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... ... ... ... 1 3 ... 1 2 1 3 1 4 77 Other diseases of brain or nervous system 1 ... ... ... 1 ... ... 2 ... 2 1 ... ... 3 ... 2 2 2 5 7 78 Otitis, otorrhoœa 1 2 1 1 ... 2 1 ... ... ... ... ... ... 1 2 1 4 3 5 8 79 Diseases of nose, enistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... 1 2 1 1 3 4 82 Endocarditis, valvular diseases of the ... ... ... 3 2 1 3 5 11 10 9 4 l 7 15 6 21 18 31 49 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 ... 2 ... 2 85 Aneurism ... ... ... ... ... ... ... 6 3 2 1 ... ... 1 2 2 7 10 2 12 86 Senile gangrene ... ... ... ... ... ... ... ... ... ... 1 4 ... ... 1 ... 4 2 3 5 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... 1 ... ... ...... ... ... ... ... 1 ... 1 1 90 Other and ill-defined diseases of heart and circulatory system, including heart disease ... ... 1 5 4 2 7 5 17 15 15 3 1 17 17 13 28 36 39 75 91 Laryngitis 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea ... •• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Acute bronchitis 38 32 ... ... ... ... 2 3 5 6 7 2 1 10 26 24 36 56 40 96 95 Chronic bronchitis 1 ... ... ... ... 1 6 9 17 27 45 27 1 17 32 28 57 61 73 134 96 Lobar, croupous pneumonia ... 2 1 ... ... ... ... 1 ... 1 1 ... ... ... 2 1 3 5 1 6 97 Lobular, broncho-pneumonia 35 34 4 ... ... ... 1 2 3 6 8 1 1 18 19 lb 42 40 55 95 98 Pneumonia, form not stated 19 28 ... 1 3 ... 5 16 12 5 6 1 ... 22 22 19 33 58 38 96 99 Emphysema, asthma ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 1 2 ... 2 100 Pleurisy 1 2 ... ... ... ... ... ... ... 2 ... ... ... 3 1 ... 1 3 2 5 101 Other and ill-defined diseases of respiratory ... . . . 1 ... ... . . . ... 2 ... ... 2 ... ... 1 2 ... 2 3 2 5 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... 1 3 3 3 2 ... ... ... ... 2 3 7 4 8 12 106 Other diseases of stomach 2 1 ... ... ... ... 1 1 1 ... ... ... ... 2 1 2 1 2 4 6 107 Enteritis 38 8 ... ... ... ... ... ... 2 2 4 ... ... 5 15 12 22 26 28 54 108 Appendicitis ... ... ... 2 ... 2 ... 1 ... 1 1 ... ... 1 1 2 3 4 3 7 109 Obstruction of intestines 4 2 ... 2 1 1 ... ... ... 3 5 2 ... ... 5 2 9 12 8 20 110 Other diseases of intestines ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... 1 2 3 ... 3 1ll Cirrhosis of liver ... ... ... ... 1 1 3 7 5 8 1 1 ... 5 6 5 11 10 17 27 112 Other diseases of liver ... ... . ... ... ... ... 1 2 1 ... 1 ... ... 1 2 2 2 3 5 113 Peritonitis 1 ... ... ... ... ... 1 2 4 2 1 1 ... ... ... 5 7 5 7 12 114 Other and ill-defined diseases of digestive system ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 64 G5 66 67 DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31st, 1904. DEATHS REGISTERED IN EACH SUB-DISTRICT FROM ALL CAUSES. CAUSES OF DEATH. AGES. Shoreditch South. Hoxton New Town. 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 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards 115 Diseases of Lymphatic System and ductless glands ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 116 Actue nephritis ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Bright's disease ... ... 2 1 1 3 4 3 11 26 13 9 ... 18 21 10 24 35 38 73 118 Calculus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 119 Disease of bladder and prostrate ... ... ... ... ... ... ... ... 1 1 2 1 ... 1 2 1 1 4 1 5 120 Other and ill-defined diseases of urinary system ... ... ... ... ... ... ... ... 1 ... 2 1 ... 1 2 ... 1 3 1 4 121 Diseases of testis and penis ... ... ... ... ... ... ... ••• ... ... . . . ... ... ... . .. ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... 1 2 2 123 Diseases of uterus and appendages ... ... ... ... ... ... 1 1 ... 1 1 ... ... 2 ... ... 2 ... 4 4 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 127 Puerperal mania ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... . . . ... ... . . . 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 129 Placenta prævia, flooding ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 1 ... ... 2 2 130 Puerperal thrombosis ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 132 Arthritis, ostitis, periostitis ... ... 1 ... ... ... ... ... 1 . . . 1 ... ... ... 2 ... 1 2 1 3 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 134 Ulcer, bedsore ... ... ... . . . ... ... ... ... ... . . . ... ... ... . . . ... ... ... ... ... ... 135 Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 Pemphigus 2 . . . ... . . . . . . ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 137 Other and ill-defined diseases of integumentary system ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 By Accident or Negligence. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 138 In mines and quarries ... ... ... ... . . . . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In vehicular traffic ... 1 2 ... ... ... . .. 1 1 2 1 ... ... 2 3 1 2 7 1 8 140 On railways ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 On vessels & docks, excluding drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 142 In buildings operations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143 By machinery ... . . . ... ... ... . . . 1 ... ... ... ... ... ... ... ... ... 1 1 ... 1 144 By weapons and implements ... ... ... ... ... ... . .. ... ... ... ... ... ... ... ... ... ... ... ... ... 145 Burns and scalds 1 4 2 ... ... ... ... ... 1 1 ... ... ... ... 1 I 7 2 7 9 146 Poisons, poisonous vapours ... ... . . . ... ... ... ... ... ... ... ... ... ... . . . ... ... ... . . . ... ' ... 147 Surgical narcosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Effects of electric shock .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 Drowning 1 ... 2 ... ... ... 1 2 ... ... ... ... ... 1 ... 2 3 4 2 6 151 Suffocation, overlaid in bed 32 ... ... ... ... ... ... ... ... ... ... ... ... 5 4 7 16 21 11 32 152 Suffocation, otherwise 3 ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 2 ... 4 ... 4 153 Falls not specified ... ... ... 1 ... ... 2 3 3 8 3 5 ... 5 6 4 10 17 8 25 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 . .. ... ... 1 ... 1 155Otherwise,and not stated ... 2 ... ... ... ... 2 1 ... ... ... ... ... ... 2 2 1 4 1 5 156 Homicide ... 1 ... ... ... ... l ... ... ... ... ... ... ... 1 ... 1 1 l 2 Suicides, all forms. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 157 By poison ... ... ... ... ... ... ... 1 1 1 1 ... ... 1 2 1 ... 4 ... 4 158 By asphyxia ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... . . . ... ... ... ... 159 By hanging and strangulation ... ... ... ... ... ... l 1 ... 1 ... . .. 1 1 ... 2 1 4 ... ...4 ... ... ... ... ... 1 l ... ... 2 1 ... ... ... ... 2 3 4 1 5 161 By shooting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 162 By cut or stab ... ... ... . . . ... ... ... ... 1 . . . ... ... ... ... ... . . . 1 1 ... 1 163 By precipitation from elevated places ... ... ... ... ... ... 2 ... . . . ... ... ... ... 1 ... ... 1 1 I 2 164 By crushing ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... 1 ... 1 l 2 165 By other and unspecified methods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 168 Other ill-defined and not specified causes 2 1 ... ... ... ... ... ... 2 ... l 1 ... 1 3 ... 3 3 4 7 169 Malignant disease ... ... ... ... 1 ... ... 1 3 2 ... 2 ... ... 2 5 2 4 5 9 170 Abscess 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Totals 706 358 38 34 38 42 143 175 221 243 227 137 30 363 553 519 957 1253 1139 2392 68 TABLE VI. — ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1904. Districts. Estimated population 1904. births Annual Eate per 1000 persons living. Deaths under 1 year to 1000 Births. percentage to total deaths. deaths during the years: deaths during 1903 from Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Small.Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. *Fever. Diarrhoea. Tuberculous Disease. Violence. 1901. 1902. 1903. 1904, London 4,648,950 27.9 17.6 17.2 15.7 16.1 1.9 0.01 0.49 0.08 0.16 0.32 006 1.04 2.23 0.6 146 9.6 35.0 0.2 Shoreditch § 115,985 31.6 22.1 20.9 19.6 20.6 3.1 0.01 0.69 0.11 0.16 0 51 0.07 1.63 3.1 0.9 190 13.5 36.7 0.0 Sub.Districts. Shoreditch South 15,650 23.7 23.2 22.2 21.5 23.2 2.0 — 0.63 0.12 0.12 0.31 0.12 0.63 3.2 1.2 209 13.2 51.5 Hoxton New Town §28,025 35.6 21.6 20.5 20.9 19.3 3.2 — 0.46 0.07 0.21 0.60 0.07 1.78 3.4 0.7 170 12.6 35.0 Hoxton Old Town 26,330 31.7 22.0 21.1 18.9 19.7 3.0 — 0.34 0.22 0.11 0.34 0.03 2.01 2.8 0.9 220 13.1 29.8 Haggerston 45,980 33.8 22.1 20.6 18.4 20.8 3.6 00.4 1.06 0.06 017 0.60 0.08 1.58 3.1 1.0 186 14.2 35.8 * 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. 69 TABLE VII. ANALYSIS or the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31 st, 1904. Diseases Diseases. All Causes 4,168 38 Congenital malformations 1 Small-pox 2 39 Old age 137 2 Measles 116 40 Apoplexy 5 3 Scarlet fever 9 41 Epilepsy 27 4 Typhus — 42 Convulsions 2 5 Relapsing fever — 43 Other diseases of brain and 6 Influenza 92 nervous system 143 7 Whooping cough 41 8 Diphtheria 3 44 Diseases of organs of special sense 13 9 Simple, continued and illdefined fever 7 45 Diseases of circulatory system 195 10 Enteric fever 4 46 Laryngitis 1 11 Simple cholera — 47 Bronchitis 1037 12 Diarrhoea, dysentery 81 48 Pneumonia 45 13 Remittent fever - 49 Pleurisy 27 14 Hydrophobia - 50 Other respiratory diseases 40 15 Glanders - 16 Cow pox and effects of vaccination _ 51 Dentition 4 52 Quinzy, sore throat 36 17 Venereal affections 35 53 Enteritis 73 18 Erysipelas 42 54 Peritonitis 3 19 Pyæmia and septicaemia 10 55 Diseases of liver 49 20 Puerperal fever 3 56 Other diseases of digestive system 234 21 Tabes mesenterica 1 22 Tuberculous meningitis 1 23 Phthisis 212 57 Diseases of lymphatic system and ductless glands 1 24 Scrofula, tuberculosis 15 25 Other zymotic diseases 11 58 Diseases of urinary system 32 26 Thrush _ 59 Diseases of generative system 23 27 Worms and other parasitic diseases 2 60 Accidents of childbirth 15 61 Diseases of locomotive system 192 28 Starvation, want of breast-milk - 62 Diseases of integumentary system 95 29 Alcoholism 23 30 Rheumatic fever and rheumatism of heart 28 INJURIES.— 63 Fracture and contusion 23 31 Rheumatism 307 64 Gun shot wounds — 32 Gout 69 65 Cut, stab — 33 Rickets 1 66 Burns or scalds 2 34 Cancer 27 67 Poison 2 35 Other constitutional diseases 53 68 Drowning — 69 Suffocation — 70 Otherwise 82 36 Premature birth 37 Atelectasis — 71 Other causes 434 70 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1904.— Table VIII. PREMISES. NUMBER OP PLACES— Number of inspections, 1904. Number of notices, 1904. Number of prosecutions, 1904. On register at end of 1903. Added in 1904. Removed in 1904. On register at end of 1904. Milk premises 300 27 33 294 3199 4 1 Cowsheds 8 — 1 7 64 — — Slaughter-houses Other offensive 14 — 1 13 96 — — trade premises Ice cream 1 — — 1 — —. — premises Registered houses let in lodgings 64 233 11 24 6 69 257 196 272 23 29 — Overcrowding, 1904 :— Number of dwelling rooms overcrowded 132 Number remedied 132 Number of notices issued 113 Number of prosecutions - Underground rooms :— Number dealt with during year 7 Insanitary houses:— Number closed under the Public Health (London) Act, 189l 39 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891 :— Number of persons accommodated during the year 43 Customs and Inland Revenue Acts :— Number of houses for which applications were received during year — Number of prosecutions under By-laws u"der Public Health Act, 1891 :— "With respect to water closets, earth closets, etc. 1 Mortuary :— Total number of bodies removed 460 Total number of infections bodies removed 4 71 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 56 — — Workshops (Including Workshop Laundries.) 4681 454 — Workplaces Home workers'Premises 651 23 Total 5388 477 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred toH.M. Inspector. Nuisances under the Public Health Acts :—* Want of cleanliness 324 321 3 — Want of Ventilation 2 2 — — Overcrowding 7 7 — — Want of drainage of floors — — — — Other nuisances 67 67 — — insufficient 16 16 — — Sanitary accommodation ( unsuitable or defective 37 37 — — not, separate for sexes.. 4 4 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) — — — — Failure as regard lists of outworkers (S 107) 18 18 — — Giving out work to be done in unwholesome (S. 108) premises which are I infected — — — Allowiog wearing apparel to be made in premises infected by scarlet fever or smallpox (S. 109) — — — Other offences — — — — Total 475 472 3 — Including those specified in Sections 2, 3, 7 and 8 of the Factory Act as remediable under the Public Health Acts. • Letters sent in these cases, 72 3.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories: — Failure to affix Abstract of the Factory and Workshop Act (S. 133) 1 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under" the Factory Act (S. 5) 'Notified by H.M. Inspector 1221 (Referring to 151Workshops) Reports (of action taken) sent to H.M. Inspectors 16 (Referring to 151 Workshops) Other — Underground Bakehouses (S. 101):— In use during 1903 46 Certificates granted in 1903 46 tin 1904 1 In use at the end of 1904 46 (1 Bakehouse demolished) Homework: — Number of Lists of Outworkers' (S. 107):— Lists. Outworkers Lists received ., 42 791 Addresses of Outworkers .. forwarded to other Authorities .. 601 received from other Authorities .. 680 Homework in unwholesome or infected premises :— wearing Apparel; Other Notices prohibiting homework in unwholesome premises (S. 108) — — Cases of infecious disease notified in homeworkers'premises 45 — Orders prohibiting homework in infected premises (S. 110) — — Workshops on the Register (S. 131) at the end of 1904. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Workshop Laundries 32 Workshop Bakehouses 76 Other Workshops and Workplaces 1101 Total number of workshops on Register 1209 73 "RETURN CASES" OF SCARLET FEVER. In the following table is contained a summary of the return cases of Scarlet Fever which have come under observation in Shoreditch, during the years 1893 to 1903 inclusive, shewing the year, number of the case, length of time the primary case was in hospital, the number of days which elapsed between the date the primary case returned home and the date the secondary case or cases fell ill, the lesions observed in the primary cases when the same returned from hospital, the number and sex of the secondary cases resulting, indicated by the letters M and F, and other particulars:— Year. No. of case. Length of time the primary (infecting) case was detained in hospital. Number of days which elapsed between the date the primary (infecting) case return- ed home and the date the secondary (infected) case fell ill. Lesions observed in primary case when same returned from hospital. Number of cases resulting presumably from primary case, so far as could be traced. REMARKS. 1893 l 11 wks. 14 days Dirty scurfy condition of head, nits, — eczematous patch discharging behind one of the child's ears 1M & IF Primary case was a female. Secondary cases attending school at time they were taken ill. 2 6½ „ 12 „ Eczematous patch behind the right ear 1 M Primary case a male. 1895 3 7 „ 7 „ Dirty condition of head—nits 1 M Primary case,a female, slept with secondary case three days after arrival home. ,, 4 10 „ 4 „ A sore was present on the child's head, where it had been scalded before the attack of scarlet fever came on 2 M Primary case a male. Secondary cases attending school when attacked. ,, 5 6 „ 7 „ 1 M Primary case, a female, was regarded as infectious by mother and doctor. ,, 6 8 „ 8 „ 1 M Primary case a female. 74 Year. No. of case. Length of time the primary (infecting) case was detained in hospital. Number of days which elapsed between the date the primary (infecting) case returned home and the date the secondary (infected) case fell ill. Lesions observed in primary case when same returned from hospital. Number of cases resulting presumably from primary case, so far as could be traced. REMARKS. 1895 7 10 „ 14 „ Rhinorrhoea (nasal discharge) 1 f Primary case a male. Stated to have been ailing and poorly on return. Secondary case attending school when attacked. 77 8 7 „ 6 „ Rhinorrhoea— (nasal discharge) Sore nostrils 1 f Primary case a female. 7 7 9 8 „ 14 „ Tonsils enlarged and congested 1 M Primary case, a female, was kept by herself for a week after her arrival home. Secondary case attending school. 7 7 10 11 ,, 7 „ Tonsils enlarged and ragged looking 1 M Primary case, a male, slept with secondary case. ,, 11 11 „ 3 „ 1 f Primary case, a female; secondary case, attending school at date of attack. Mother states that primary case on return was free from spot or blemish. 1896 12 8 „ 5 „ 1 M Primary case, a female, was ill at home for a fortnight before removal to hospital. Mother states that when primary case returned home she was free from spot or blemish. 7 7 13 9 6 „ 1M&1F Primary case, a male on return home was according to mother quite well. 77 14 13 „ 4 „ 2 M Primary case, a female, wore on her return from hospital a dress which had only been worn two or three times. She was wearing it when taken ill and it was put away and escaped disinfection. The primary case was stated to have been quite well on return. 75 Year. No. of case. Length of time the primary (infecting) case was detained in hospital. Number of clays which elapsed between the date the primary (infecting) case returned home and the date the secondary (infected) case fell ill. Lesions observed in primary case when same returned from hospital. Number of cases resulting presumably from primary case, so far as could be traced. REMARKS. 1896 15 10 „ 6 „ Scar on one of his fingers. 1 M Primary case, a male, may possibly have had a sore finger on his return from hospital. " 16 11 „ 5 „ 1 F Primary case, a female, was according to mother free from any lesion on her return. " 17 7 „ 7 „ Rhinorrhoea (nasal discharge) 2 F Primary case, a male, was stated to have had a rough skin and to have been peeling on return. I observed nothing of this, but the child had chickenpox which developed after return from hospital. 1897 18 7½ „ 7 „ 1 F Primary case a male. " 19 12 „ 7 „ 1 F Primary case, a male, free from spots, sores or scaling. Two sisters of patient (secondary case) were attending school but no history of illness. " 20 9 „ 3 „ 1 M Primary case a female. Showed nothing to suggest her being infectious. " 21 8 „ 17 „ Tonsils enlarged 1F&1M Primary case a female. Mother stated patient returning has always had large tonsils. Secondary cases attending school when taken ill. There were two other cases at school about same time. Primary case slept by herself for first week after her return. " 22 9 „ 2 „ Throat presented suspicious appearance 1 F Primary case, a female. 76 Year. No. of case. Length of time ihe primary (infecting) case was detained in hospital. Number of days which elapsed between the date the primary (infecting) case returned home and the date the secondary (infected) case fell ill. Lesions observed in primary case when same returned from hospital. Number of cases resulting presumably from primary case, so far as could be traced. REMARKS. 1897 23 8 „ 1 „ Face 'red and scurfy.' Rhinorrhœa with sore nostrils 1 M Primary case a male. Secondary case attending school. " 24 9 „ 3 „ 1M & 1F Primary case a female. Mother stated she was free from spots &c., and looked well on her return. " 25 8 „ 2 „ 1 F Primary case a male. Appeared quite well. Secondary case attending school. " 26 12 „ 11 „ Rhinorrhoea, and Otorrhœa. (Nasal and aural discharges). 2 M Primary case a female. Discharges were observed by mother on return from hospital. When I saw her there was little or no discharge. 1898 27 11 „ 15 „ 1 F Primary case a female. According to enquiries made by sanitary inspector nothing was noticeable about the primary case on return from hospital. " 28 9 „ 16 „ 1 F Primary case a male, free from sores, discharges and peeling,according to mother's statement—secondary case attending school. " 29 5½ „ 4 „ Rhinorrhcea and sore nose 1 F Primary case a male. " 30 8 „ 8 „ 1 M Primary case a male— nothing definite about primary case observed. 77 Year. No. of case. Length of time the primary (infecting) case was detained in hospital. Number of days which elapsed between the date the primary (infecting) case returned home and the date the secondary (infected) case fell ill. Lesions observed in primary case when same returned from hospital. Number of cases resulting presumably from primary case, so far as could be traced. REMARKS. 1899 31 15 „ 20 „ Rhinorrhoea (Discharge from nose) 1 F Primary case a female. Mother warned by M.A.B authorities not to allow her too intimate relation with the rest of the children. Secondary case attending school up to onset of symptons. " 32 12 „ 4 „ 1 F Primary case a female. I examined primary case but could find no evidence of discharges, &c. Patient appeared quite well. " 33 10 „ 5 Rhinorrhcea— Skin rough 1 M Primary case a male. Mother's statement to sanitary inspector as to rhinornfea and rough skin. 1900 34 15 „ 7 „ 1 F Primary case, a female— Mother states she was peeling between toes when she came home. Vaseline used. Allowed to sleep with secondary case five days after return. I saw no sign of desquamation. 1901 35 7 „ 4 „ Rhinorrhoea (Nasal discharge) 1 M Primary case, a male. " 36 11 „ 7 „ Tonsils enlarged, also glands at angles of jaws. 3 M & 1 F Primary case, a male— Mothers statement as to lesions observed. Secondary cases may have resulted directly from primary case or the infection may have been passed on from one to the other. " 37 7 „ 9 „ Rhinorrhoea (Nasal discharge) 1 F Primary case a female 78 Y ear. No. of case. Length of time the primary (infecting) case was detained in hospital. Number of days which elapsed between the date the primary (infecting) case returned home and the date the secondary (infected) case fell ill. Lesions observed in primary case when same returned from hospital. Number of cases resulting presumably from primary case, so far as could be traced. REMARKS. 1901 38 8 „ 4 „ Rhinorrhoea— redness in groins, and some spots behind the knees 1M & IF Primary case, a female. After return bad an attack of herpes about the mouth. Slept with first of the secondary cases taken ill. 1902 39 7 „ 13 „ 1 M Primary case, a female. Mother stated that she seemed well on her return, but also stated that she was brought home in a frock which had been put away without disinfection, the same being worn at time child was taken ill. " 40 13 „ 2 „ 1M & 1F Primary case, a female. Mother stated that she was well and hearty on her return. Secondary cases attending school. " 41 10 „ 14 „ Otorrhoea left ear, discharge stated to have been offensive 3 F Primary case, a female. One of the secondary cases was certified to be scarlet fever and the other two diphtheria—probably all were scarlet fever. " 42 9 „ 9 „ Otorrhoea (Discharge f'm ears) 1 F Primary case, a female. " 43 6½ „ 31 „ 1 F Primary cases, females. Mother stated they were quite well on return. Secondary case attending school at time of invasion. 1903 44 7 „ 7 „ Tonsils, ragged appearance. Right nostril sore 1 F Primary case, a female. " 45 6 „ 10 „ Patch of Eczema discharging under the right arm 1 M Primary case, a female. Secondary case attending school. 7 9 Year. No. of case. Length of time the primary (infecting) case was detained in hospital. Number of days which elapsed between the date the primary (infecting) case returned home and the date the secondary (infected) case fell ill. Lesions observed in primary case when same returned from hospital. Number of cases resulting presumably from primary case, so far as could be traced. REMARKS. 1903 46 13 „ 11 „ Tonsils enlarged & ragged 2 F Primary case, a male, was certified diphtheria; there is no record of his case having been certified scarlet fever. The secondary cases were notified one diphtheria and one scarlatina, but from enquires both appeared to be scarlet fever. (A doubtful instance.) " 47 9 3 „ 1 F Primary case certified diphtheria, female—no sign of anything wrong with her. (Possibility of a connection with the secondary case which was notified scarlatina, both having been scarlatina) " 48 4 „ 4 „ Patch of rough skin on cheek 1 F Primary case, a female. Beyond the patch of rough skin the mother observed nothing wrong with the primary case on her return. " 49 10 „ 11 „ 1 M Primary case, a female. Nothing to indicate she was infectious on her return. Secondary case attending school. " 50 8 „ 4 „ 1 M Primary ease, a female. Nothing to indicate she was infectious on her return. " 51 8 „ 6 „ Rhinorrhoea (Discharge from nose) 1 F Primary case, a male. " 52 8 „ 7 „ 1 F Primary case, a male. Mother observed nothing wrong with him. Secondary case attending school. " 53 7½ „ 7 „ Rhinorrhoea (Discharge from nose) 1 M Primary case, a female. Secondary case attending school. " 54 9½ „ 16 „ 1M & 1F Primary case, a female.