SHOR 16 REPORT on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch IN THE COUNTY OF LONDON, FOR THE YEAR 1905, by LEWIS T. FRASER BRYETT, M.D. (LOND ), Medical Officer of Health; Diplomate 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. SHoie CONTENTS. page. Artizans' dwellings 43 Appendicitis, mortality from 7 Bacteriological examinations 36 Bakehouses 52 Barbers' shops 54 Births in sub-districts 2 Birth rates 3 Cancer 7 Cerebro-spinal fever 33 Cholera 33 Coffee-houses 53 Cook-shops 53 Conscientious objection certificates granted 17 Cow-houses 48 Customs and Inland Revenue Acts 46 Dairies 48 Deaths in sub-districts 3 Death rate 4 Deaths, ages at 5 Deaths, causes of 6 Deaths in public institutions 7 Deaths in out-lying institutions 8 Diarrhoea 29 Diphtheria 20 Disinfection 36 Drainage bye-laws 46 Enteric fever 22 Erysipelas 28 Factories and Workshops Act, 1901 49 Factories, workshops and workplaces—sanitary work 51 Food condemned and destroyed 55 Food and Drugs Acts 56 Fried fish shops 53 Houses closed 41 Houses let in lodgings 43 Houses occupied by working classes, demolition of 42 Ice cream shops 53 Infectious cases, number certified 10 Infectious cases, number removed to hospitals 11 Infectious diseases, age periods 9 Infectious diseases, deaths from 9 Infectious diseases, death rate 9 Infectious diseases, number of cases notified from schools 34 Influenza 31 Institutions, deaths in 8 Legal proceedings 40 Margarine Act, proceedings under 58 Marriages 3 Measles 30 Milk-shops 48 Milk premises, cowsheds, etc., on register 48 Mortality, infant 4 Mortuary 37 Offensive business 48 Outworkers 51 Population 1 Puerperal fever 28 Sanitary work 39 page. Scarlet fever 18 Scarlet fever at Catherine Street School 35 Scarlet fever, return cases of 12 Schools, closure for infectious disease 35 Shelter 36 Sickness amongst the poor 8 Slaughterhouses 47 Smallpox 17 Smoke nuisance 47 Street markets and food 55 Tuberculosis 32 Vaccination returns 17 Verminous houses 47 Violence, mortality from 7 Water supply 37 Whooping cough 31 Workshops, summary of principal trades carried on 49 Workshops on register 49 Zymotic diseases, deaths from 10 Zymotic death rate 10 APPENDIX. Statistical Tables : — For whole district during 1905 and previous years (Table I.) 62 For separate localities in 1905 (Table II.) 63 Cases of infectious disease notified during 1905 (Table III.) 64 Causes of, and ages at, death during year 1905 (Tables IV. and VI.) 65,67 Infantile mortality during 1905 (Table V.) 66 Comparison of London and Shoreditch birth and death rates in 1905 (Table VII.) 73 Cases treated by the District Medical Officer in 1905 (Table VIII.) 74 Summary of proceedings under the Public Health (London) Act, 1891 (Table IX.) 75 Factory and Workshop Act—Summary of work (Tables I., II. and III.) 76,77 Sewer ventilation and intercepting traps—Report 84 Bye-laws—Houses let in lodgings 84 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. HEALTH DEPARTMENT, TOWN HALL, OLD STREET, E C., January, 1906. 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 for the year ending December 31st, 1905. POPULATION. In past annual reports the separate localities taken for statistical purposes have been the registration sub-districts, but owing to the rearrangement and alteration resulting in there being now three such sub-districts instead of four, which were made during the latter part of 1904, fresh localities for the purposes of statistical tabulation have had to be decided on. The three new registration sub-districts are Shoreditch South, comprising Moorfields, Church, and Hoxton Wards, having a census population of 46,362, Shoreditch North-West comprising 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. stem and Acton Wards, having a census population of 36,148. The 1901 census populations of the eight wards mentioned are as set out below:— Ward. Population. Ward. Population. Moorfields 6,431 Whitmore 18,825 Church 20,823 Kingsland 11,663 Hoxton 19,108 Haggerston 12,034 Wenlock 17,302 Acton 12,451 For statistical purposes it appears advantageous to adopt the wards as separate localities. Statistics as to the registration sub-districts may be readily obtained from those relating to the wards, 2 The number of persons in Shoreditch for the year under consideration is estimated at 116,939, as compared with 117,360 in 1904, 117,740 in 1903, and 117,948 in 1902. This population is distributed in the eight wards of the Borough as follows: Ward. Population (estimated). Ward. Population (estimated). Moorfields 5,831 Whitmore 18,461 Church 20,103 Kingsland 11,281 Hoxton 18,216 Haggerston 12,314 Wenlock 18,342 Acton 12,391 The population of Wenlock Ward includes the inmates of the Holborn Union Workhouse, which is situate in this locality. These, estimated at 1,375, are not regarded, for certain statistical purposes, as persons belonging to Shoreditch, and are accordingly for these purposes not reckoned in the population of the Borough, which therefore becomes reduced to 115,564, whilst that of the ward becomes 1G,9G7. BIRTHS. As intimated in my report for last year, during the year under consideration weekly returns of births have been supplied by the registrars in the same manner as the death returns. These returns are of great value, as they enable a proper distribution of the births in the several localities of the Borough, and in any particular parts of the localities to be made, and also enable greater accuracy being obtained than hitherto in ascertaining the number of births amongst the people belonging to the Borough. The number of births registered in the Borough was 3,894, of which 1,927 were of males and 1.967 of females. The number corrected by the inclusion of the births occurring in public institutions outside Shoreditch, the parents being residents of the Borough, and the exclusion of those occurring in public institutions within the Borough, the parents not being residents of Shoreditch, was 3,953, of which 1,962 were of males and 1,991 of females. The distribution of the corrected births in the eight wards into which the Borough is divided is shown below:— Ward. Males. Females. Totals. Moorfields 71 66 137 Church 372 355 727 Hoxton 337 337 674 Wenlock 254 267 521 Whitmore 332 315 647 Kingsland 207 213 420 Haggerston 197 216 413 Acton 192 222 414 Totals 1,962 1,991 3,953 2 The birth-rate for the Borough was 34.2 per 1,000 inhabitants. The birth-rate for the several wards are contained in table VII. (appendix). The births for the whole of England and Wales during 1905 were at the rate of 27.2 per 1,000 population; for rural England and Wales 26.3; for 76 great towns, 28.2; and for 141 smaller towns the rate was 26.9 per 1,000 population. The birth-rate of the metropolis was 27.1 per 1,000 inhabitants. MARRIAGES. The marriages in Shoreditch during 1905 numbered 1,068, as compared with 1,066 in 1904, 1,146 in 1903, 1,156 in 1902, 1,073 in 1901, 1,157 in 1900, and 1,295 in 1899. The number of persons married was at the rate of 18.4 per 1,000, as compared with 16.9 for the whole of London. DEATHS. The deaths numbered 2,296, as compared with 2,392 for 1904. They were distributed amongst males and females in the eight wards of the Borough, as shown in the following table :— Ward. Males. Females. Totals. Moorfields 46 38 84 Church 222 208 430 Hoxton 209 180 389 Wenlock 187 139 326 Whitmore 239 207 446 Kingsland 109 96 205 Haggerston 115 93 208 Acton 102 106 208 Totals 1,229 1,067 2,296 The deaths of males were 162 in excess of those of females. The Shoreditch deathrate for 1905 was 19.8* per 1,000 inhabitants, as compared with 20.6 in 1904 and 19.6 in 1903. The rate was markedly below the average for the previous ten years. The London death-rate for 1905 was 15.1, that of England and Wales 15.2, rural England and Wales 14.9, 76 great towns 15.7, and that of 141 smaller towns 14.4 per 1.000 inhabitants. *Corrected for age and sex distribution, the death-rate was 20.7 per 1.000. 4 Tables giving the death-rates and the causes of death at various age periods in Shoreditch and its eight wards, with other information bearing upon the mortality in the Borough, are contained in the Appendix. (Tables I., II., IV., V., VI., VII.) The death-rate varied within very considerable limits as a comparison of the rates in the several wards will show. It was highest in Whitmore Ward and lowest in Moorfields, being 24.1 per 1,000 in the former and 14.4 in the latter. The density of the population per acre is very much greater in Whitmore than in Moorfields Ward, which doubtless plays an important part in determining a higher rate of mortality in the former locality. The death-rate for the Borough was subject to considerable fluctuations during the first quarter of the year, but on the whole was fairly low. During the second quarter it was steadier, showing a gradual decline until the fourth week of June, when the lowest point for the year was reached, the rate for that week being 11.6 per 1,000. The rate ran up sharply after the first week of July, and in the fourth week reached nearly 32 per 1,000. In the following week it dropped suddenly to 20, but in the second week of August again ran up to 31. During the next five weeks it came down to 14.8 per 1,000, and for seven weeks, from the middle of September until the end of October the rate was steadily about 15 per 1,000. During the last fortnight of November the rate went up sharply, touching the highest point for the year, 35 per 1,000, in the last week of the month. The rate came down as sharply as it went up, and remained fairly low for the rest of the year. The high rate during July and August resulted from the heavy mortality from summer diarrhoea, and that at the latter end of November was largely due to a high mortality from diseases of the respiratory organs. The deaths of infants under the age of one year numbered 652, of which 352 were of males and 300 of females. The mortality amongst infants under one year amounted to a little over 28 per cent. of the total mortality in the Borough. The proportion of infants under one year dying during the year to the total number of births belonging to Shoreditch registered during the same period was at the rate of 165 per 1,000, which is very considerably below the average for the previous twelve years. The chief causes of death in infants under one year old were diarrhoea, enteritis, and other disorders of the stomach and intestines, whooping cough, bronchitis, pneumonia, tuberculous diseases, atrophy, debiiitv and marasmus, prematurity and congenital defects, and suffocation in bed. In Table V. '(Appendix), which' is a form of tabulation required for the first time during the year under review by the Local Government Board, is contained a statement of the causes of deaths of infants under one year, the ages in weeks and months being given for the whole Borough. year, the ages in weeks and months being given for the whole Borough. In the subjoined table the deaths from the same causes amongst infants under one year of age are given for the eight wards of the Borough:— 5 Cause of Death. Moorfields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingslaud Ward. Haggersfcon Ward. Acton Ward. Totals. Measles ... 2 5 3 1 2 ... 2 15 Scarlet Fever 1 ... ... 1 ... ... 1 ... 3 Whooping Cough 1 9 9 2 4 ... 1 2 28 Diarrhoea (all forms) ... 22 29 17 20 6 17 10 121 Enteritis ... 5 6 5 8 4 ... 3 31 Gastritis and Gastro Intestinal Catarrh ... 4 3 3 7 4 5 3 29 Premature Birth 4 16 17 8 6 6 10 5 72 Congenital Defects ... 3 2 3 1 2 4 3 18 Want of Breast Milk ... 2 1 ... ... 2 ... ... 5 Atrophy, Debility and Marasmus 4 17 18 12 18 10 7 8 94 Tuberculous Meningitis 1 2 1 1 1 1 1 2 10 Tuberculous Peritonitis and Tabes Mesenterica ... 4 1 3 4 1 3 ... 16 Other Tuberculous Diseases ... 1 2 ... ... ... 1 1 5 Erysipelas ... ... ... ... ... ... 1 ... 1 Syphilis ... 4 ... 2 1 2 ... ... 9 Rickets ... 1 ... 1 2 ... ... ... 4 Meningitis (not Tuberculous) ... 2 3 ... 2 1 2 3 13 Convulsions 1 1 3 5 2 ... 1 4 17 Bronchitis 1 8 11 6 12 6 9 2 55 Pneumonia 3 14 7 5 5 9 9 3 55 Suffocation, overlaying ... 4 7 8 5 4 2 ... 30 Other causes 1 4 5 3 6 ... 1 1 21 Totals 17 125 130 88 105 60 75 52 652 A comparison of the infant mortalities in the wards is contained in Table VII. (appendix). The mortality was highest in Hoxton Ward and lowest in Moorfields. The deaths of children aged between ore and five years numbered 363, the chief cruses being measles, which accounted for 45, whooping cough for 56; tuberculosis for 55, pneumonia for 63, and diarrhoea, which resulted in 22 deaths. Through accident or negligence 15 children met their deaths, in eleven of these from burns or scalds. Altogether 1,015, or a little over 44 per cent, of the total number of deaths were of children under the age of five years. The deaths of children between the ages of five and fifteen numbered 88, including 21 from tuberculosis and .15 from other infectious diseases. Accident or negligence resulted in 9 deaths, four of which were caused by burns or scalds. Of persons aged between fifteen and twenty-five years 73 died, 30 of the deaths being due to tuberculosis, including 24 from consumption, 6 The deaths of persons aged between twenty-five and thirty-five years numbered 108, the chief causes being consumption, which accounted for 33, diseases of the respiratory organs, heart disease and Bright's disease. Cancer was given as the cause of 4 deaths, alcoholism of 3, and accident or negligence of 2 deaths. There were two instances of homicidal death, and three of suicidal. There were 172 deaths of persons between thirty-five and forty-five years of age, of which 67 were attributed to consumption. 6 to alcoholism. 12 to cancer, 6 to disorders of the nervous system, 5 to valvular heart disease, 10 to bronchitis, 20 to pneumonia, 5 to Bright's disease, 5 to accident or negligence, and 4 were suicidal. The deaths of persons aged between forty-five and fifty-five years numbered 228, of which 49 resulted from consumption, 8 alcoholism, 20 cancer, 24 from diseases of the nervous system, including 11 from apoplexy, 10 valvular heart disease, 19 bronchitis, 22 pneumonia, 11 cirrhosis of the liver, 12 Bright's disease, 10 accident or negligence, and 4 from malignant disease. Of 220 deaths amongst persons aged between fifty-five and sixty-five years, 19 were attributed to consumption, 4 to alcoholism, 20 to cancer, 4 to old age, 21 to diseases of the nervous system, including 11 from apoplexy, 10 to valvular heart disease; 23 to other and ill-defined diseases of the heart and circulatory system, 40 bronchitis, 17 pneumonia, 7 cirrhosis of the liver, 12 Bright's disease, 4 accident or negligence, and 7 to malignant disease. There was one suicide by poison. There were 223 deaths of persons aged from sixty-five to seventy-five years. Of these 4 were due to influenza, 3 to diarrhoea, 5 to consumption, 15 to cancer, 33 to old age, 19 apoplexy, 10 valvular heart disease, 13 other and ill-defined diseases of the heart and circulatory system, 57 bronchitis, 17 pneumonia, 3 cirrhosis of the liver, 17 Bright's disease, 6 to accident or negligence, five of which were the result of falls, and one to suicide by drowning. Of 138 deaths amongst persons between seventy-five and eighty-five years 10 were caused by cancer, 59 old age, 7 apoplexy, 1 valvular heart disease, 11 other and illdefined diseases of the heart and circulatory organs, 17 bronchitis, 7 pneumonia, 1 cirrhosis of the liver, 6 Bright's disease, and 2 by accident or negligence. Of the 31 persons who died at ages over 85 years, 22 succumbed to the effects of old age, 3 to apoplexy, 1 to disease of the circulatory system, 2 to chronic bronchitis, 2 to accident or negligence, and 1 to malignant disease. The chief causes of death in Shoreditch during the year were: tuberculosis, which accounted for 321 deaths, including 215 from consumption, bronchitis, which caused 225, pneumonia, causing 223, diseases of the heart and blood vessels 161, diarrhoea 121, enteritis 66, whooping cough 85, measles 60, cancer 82, malignant disease 20, Bright's disease 64, alcoholism and cirrhosis of the liver 45, apoplexy 53, atrophy, debility and marasmus 89, prematurity 72, and old age 118. 7 Of the 82 deaths from cancer, 37 were of males and 45 of females. The death of one person under 25 years was attributed to this cause, but the great majority were of persons aged between 35 and 75 years. There were 8 deaths of males and 12 of females attributed to malignant disease. The majority of these were probably due to cancer. The death-rate due to cancer was 0.70 per 1,000 inhabitants, as compared with 0.69 in 1904, 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. The deaths from malignant disease have not been included in estimating the cancer death-rate. The above figures indicate that the death-rate from cancer in Shoreditch shows a tendency to increase. Deaths attributed to appendicitis numbered 4, as compared with 7 in 1904, 5 in 1903, 4 in 1902, and 2 in 1901. The various forms of violence resulted in 103 deaths, of which 66 were of males and 37 of females. Accident or negligence occasioned 89 deaths, the chief causes being through accidents from vehicular traffic, which resulted in 10 deaths, burns and scalds, mainly in children, 17, falls, chiefly old people, 18, and suffocation of infants, mainly through overlaying, which caused 30 deaths. Two deaths were homicidal, and 12 persons committed suicide, 11 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 the public institutions situate in Shoreditch, are as set out in the subjoined table:— Institution. Persons belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Union Workhouse 10 307 317 Shoreditch Workhouse 455 31 486 Royal Chest Hospital 11 49 60 Convent Hospital — 4 4 Total 476 391 867 It may be mentioned that one public institution in Shoreditch, viz., Hoxton House Asylum, has ceased to exist as such. Elsewhere than in public institutions fourteen persons not belonging to Shoreditch died within the Borough. 8 In the subjoined table are set forth the various public institutions outside Shoreditch with the numbers of persons belonging to the Borough dying therein:— Asylums. No. of Deaths. General Hospitals—continued. No. of Deaths. Banstead 4 Italian 1 Cane Hill 2 King's College 2 Caterham 1 London 23 City of Birmingham 1 Metropolitan 72 Claybury 8 Middlesex 1 Colney Hatch 9 Mildmay 7 Dartford Heath 9 North Eastern (Children) 63 Frien Barnet 1 Royal Free 4 Grove Hall 1 St. Bartholomew's 106 Horton 3 St. George's 1 Leavesden 8 Westminster 1 Manor 1 Hospitals for Special Diseases,Etc. Metropolitan Benefit Society's 2 Hospital for Women, Soho 1 Norwood 1 Lying-in, City of London 3 Tooting Bec 11 Queen Charlotte's 1 Hospitals for Infectious Disease. St. Mark's 1 Eastern 2 Infirmaries and Workhouses. Long Reach, Dartford 1 Bethnal Green Infirmary and Workhouse 3 North Eastern 33 North Western 2 Camberwell Infirmary 1 General Hospitals. Holborn Infirmary 1 Charing Cross 1 Hackney infirmary 3 East London 1 Paddington Infirmary 1 Evelina (Children) 2 St. George's Infirmary 2 German 7 Whitechapel Infirmary 1 Gt. Northern 4 Other Institutions. Gt. Ormond Street (Children) 21 St. Joseph's Hospice 6 Guy's 2 St. Luke's House 2 Friedenheim 1 Hostel of God 1 Homoeopathic 2 Hospice of St. John and St. Elizabeth 1 Infants', Hampstead 1 Of 451 persons belonging to Shoreditch dying in public institutions situate beyond the limits of the Borough, 323 died in general hospitals including 86 in hospitals for children; 38 died in the fever hospitals of the Metropolitan Asylums Board; 62 died in asylums; 6 in hospitals for special diseases; 12 in workhouses and infirmaries, and 10 in other institutions. Elsewhere than in public institutions 16 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 927 persons belonging to Shoreditch died in public institutions. Including the sixteen persons Who did not die in public institutions 943 persons belonging to the Borough died elsewhere than in their homes. SICKNESS AMONGST THE POOR. The cases of illness coming under the treatment of the district medical officers in connection with the poor law dispensary were not quite so numerous as in 1904, the number being 4,014 as compared with 4,168 in 1904, 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 9 VIII. (appendix). The diseases classed as infectious accounted for 668 of the cases, and included 220 of consumption, 99 diarrhoea, 46 whooping cough, 84 influenza, 70 measles, and 24 of scarlet fever. There was an increase in the number of cases of diarrhcea and decreases in the numbers of cases of measles and influenza as compared with the figures for 1904. Diseases of the respiratory system, which to a very large extent result from infection, were responsible for 1,083 cases, as compared with 1,150 in 1904, the cases of bronchitis numbering 951, and of pneumonia 60. The cases of rheumatic fever, which is now pretty generally held to> be a disease due to microbic infection, were 32 in number, as compared with 28 for the previous year. There were 308 cases of rheumatism and 62 of gout. Disorders of the digestive organs were sources of trouble in 425 cases, of which the major proportion were cases of dyspepsia. There were 88 cases of enteritis or gastro-enteritis as compared with 73 for the previous year. This disorder was almost entirely confined to infnats. Alcoholism was recorded as the cause of illness in 16 cases, but as stated in previous reports alcohol directly or indirectly causes much more ill-health amongst the poor than would appear to be indicated by the actual number of cases stated to be due to alcoholism. The cases of cancer were more numerous than in previous years, being 37, as compared with 27 in 1904, 30 in 1903, 12 in 1902, 31 in 1901, 33 in 1900, 18 in 1899, 9 in 1898, 15 in 1897, 21 in 1896, 15 in 1895, 27 in 1894, and 23 in 1893. Diseases of the locomotive system were causes of trouble in 165 cases, of the skin in 96 cases, of the brain and nervous system in 253 caess, and heart disease with other troubles of the circulator)' system in 149 cases. In 149 instances the patients were simply suffering from the effects of old age. In 108 cases the patients attended the dispensary on account of injuries. In 295 cases the patients were suffering from marasmus, debility, and other causes not classified in the table. INFECTIOUS DISEASES. Infectious diseases included under the headings numbered 1 to 35 in Table VI. '(Appendix) resulted in 717 deaths as compared with 791 in 1904, 762 in 1903, 767 in 1902, and 762 in 1901. During 1905 the deaths from these diseases were therefore decidedly less numerous. They amounted to about 31 per cent, of the deaths from all causes as compared with 33 per cent. in 1904. There is the same tale with respect to the mortality from tuberculosis. Something approaching half of the deaths from the infectious diseases referred to resulted from consumption, and the other forms of disease due to the tubercle bacillus. With respect to the remainder, diarrhoea, measles and whooping cough accounted for a very large proportion. The death-rate due to these infectious diseases was 6.2 per 1,000 inhabitants as compared with 6.8 in 1904 and 6.5 in 1903. with 6.8 in 1904 and 6.5 in 1903. In the subjoined table the deaths have been grouped according to ages: — Age period Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 No. of deaths 211 217 20 15 14 20 44 73 57 28 14 4 10 As can readily be seen from the above figures, considerably more than half of the deaths from infectious diseases were of children under five years of age, and taking the total mortality of children under this age from all causes over 42 per cent. of the deaths resulted from infectious diseases. In infants under one year old. diarrhoea, and in children aged between one and five years, whooping cough, measles and tuberculosis were the chief causes of the mortality from infectious diseases. The deaths from infectious diseases were fewest during the age periods between 5 and 25 years. They become more numerous during the periods 25 to 45 years, after which there is a marked decrease. The percentages of the deaths from infectious diseases with respect to deaths from all causes during these age periods, however, averaged about the same as for the deaths of children under the age of five years. After the 35 to 45 age period the percentage rapidly declines. The chief cause of the mortality from infectious disease between the ages of 20 and 65 was consumption. Deaths from small-pox, measles, scarlet fever, diphtheria, including membranous croup, whooping cough, enteric fever, and diarrhoea are grouped as the deaths from the principal zymotic diseases, and the death-rate due to them is termed the zymotic death-rate. The deaths from these diseases during 1905 numbered 344, and the zymotic death-rate was 2.8 per 1,000 inhabitants as compared with 3.2 in 1904, 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, 3.8 in 1895, 2.8 in 1894, and 4.7 in 1893. On the whole, the foregoing figures show that there is a tendency to a decline in the zymotic death-rate of the Borough. A comparison of the zymotic death-rates of London and Shoreditch and the eight wards of the Borough is contained in Table VII. (Appendix). Amongst the wards the zymotic death-rate varied very considerably, being as low as 1.0 and 1.2 in Moorfields and Kingsland respectively, and as high as 4.3 in Hoxton. The cases of notifiable infectious disease certified during the year under conr sideration amounted to 1,151, a very marked rise as compared with the figures for the previous two years, the increase being due to the prevalence of scarlet fever. previous two years, the increase being due to the prevalence of scarlet fever. The number 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 1000 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 1905 1151 9.8 11 The cases of notifiable infectious disease, excluding chicken-pox, certified in the metropolis numbered some 32,880, which gives an attack-rate of 7.0 per 1,000 population. The rate for Shoreditch. therefore, was considerably higher than that of the metropolis as a whole during the year under consideration. Subjoined is a list of the infectious diseases which are notifiable to the Medical Officer of Health, showing the numbers of cases certified in the Borough for each of the four quarters of the year, and the numbers and percentages of such cases which were removed to hospital for treatment:— Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox 1 1 ... ... 2 2 Scarlet Fever or Scarlatina 92 162 318 217 789 27 Diphtheria and Membranous Croup 55 55 41 26 177 17 Typhus ... ... ... ... ... ... Cholera ... ... ... ... ... ... Enteric Fever (Tyhoid) 3 8 12 13 36 2 Continued Fever ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever 4 1 2 2 9 4 Erysipelas 36 35 30 37 138 3 Totals 191 262 403 295 1151 55 Numbers and percentages of cases removed to Hospitals. 142 216 364 215 967 74% 82% 90% 83% 83% As compared with the figures for 1904, the cases of scarlet fever during 1905 were more than doubled. There was also a marked increase in the number of cases certified as puerperal fever. The cases of the other notifiable infectious diseases were not so numerous as in 1904. The deaths from notifiable infectious disease numbered 55, as compared with 50 in 1904, 49 in 1903, 144 in 1902, 72 in 1901, 99 in 1900, 121 in 1899, 96 in 1898, 136 in 1897, 135 in 1896, and 117 in 1895. The marked increase in the number of deaths in 1902 was due to the small-pox outbreak of that year. The deaths from the principal infectious diseases which are notifiable, namely, small-pox, scarlet fever, diphtheria, and enteric fever, were at the rate of 0.3 per 1,000 population, as compared with 2.5 for the principal infectious diseases which are not notifiable, namely, measles, whooping cough, and diarrhoea. METROPOLITAN ASYLUMS BOARD. As mentioned in former reports, the great majority of the cases of infectious disease removed Ic hospital for treatment were taken to the various hospitals of the 12 Metropolitan Asylums Board, comparatively few being treated in other institutions. The exceptions in 1905 were a few cases of typhoid fever treated in general hospitals, three or four cases of erysipelas removed to the Shoreditch Infirmary, and one or two of scarlet fever and diphtheria taken to the Liverpool Road Fever Hospital. The infectious diseases, cases of which are receivable into the hospitals of the Board, are smallpox, scarlet fever, diphtheria, and typhoid fever. The number of cases of these diseases certified was 1,003, and the number removed to hospital 960, which gives a percentage of 95.6, as compared with 95 5 in 1904, 90.7 in 1903, 93.1 in 1902, 86.3 in 1901, 84.7 in 1900, 82.4 in 1899, 81.4 in 1893, 71.4 in 1897, 65 in 1896, 57 in 1895, and 61 in 1894. Less than 5 per cent. of the cases referred to were treated at home during 1905, and in several of these1 the patients were not removed because they were too ill or because they had died, the nature of their illness being only recognised shortly before death. The results of the investigations made on behalf of the Metropolitan Asylums Board by Dr. A. G. R. Cameron into the circumstances attending the occurrence of RETURN CASES of scarlet fever and diphtheria between July, 1901, and July, 1902, have been published in a report which contains much valuable information in respect to such cases. The observations of the medical superintendents of the Board's Fever Hospitals upon the report accompany it, and as a result of their examination of the facts contained therein, and of other sources of information known to them, they made the following recommendations with respect to scarlet fever:— (1.) "That, as far a:s practicable, every patient, as soon as he is in a fit condition and without regard to age or sex, be transferred from the acute to the - convalescent hospitals. (2.) " That a discharge ward for scarlet fever be established at each hospital into which the patient could be admitted and bathed not later than the day before discharge. (3.) " As we are of opinion that harm has resulted from the abrupt transition from hospital to home conditions undergone by patients immediately on discharge, we recommend that every endeavour should be made to- prepare patients for this change, especially by providing facilities for their being in the open air. At some of the hospitals this will involve the erection of verandahs or other forms of shelter. (4.) " That the following notice be printed and a copy sent with the notice of discharge to the parent or guardian of every discharged scarlet fever patient " Although every endeavour is made to send out patients free from infec" tion, it is advisable, as an additional precaution, that they should, as far " as possible, be kept away from other children, including attendance at 13 " school for the first three weeks after their return home. They should cer" tainly not sleep in the same bed, and, if possible, not in the same room " with children who have not had the disease. " It is also advisable that articles used by the patients such as cups, " plates, spoons, handkerchiefs, towels, and toys should, during this period, be " kept distinct from those used by other children. " The above precautions are specially important in the case of those " patients suffering from discharge of either nose or ears. (5.) " That at one hospital, say the South-Eastern, now in course of re-building, two or more wards be divided by glass partitions into' separate rooms,, and that scarlet fever patients be treated therein on the system of complete isolation during the whole period of detention so far as may be found practicable; and that the effect of this procedure on the occurrence of return cases should be carefully observed. (6.) " That similar rooms be erected at two other acute hospitals in which scarlet fever patients may be isolated for at least three weeks after admission. The patients being afterwards drafted into convalescent wards, the complicated and uncomplicated cases being kept separate. The structural arrangements of the rooms mentioned in this and the preceding recommendations to be carefully considered by the medical superintendents. (7.) " That inquiry into the subject of return cases should be continued, on lines to be suggested by the medical superintendents. (8.) " That arrangements be made to notify each return case to the superintendent of the hospital from which the infecting patient was discharged. With respect to diphtheria, return cases being less common, the medical superintendents make no recommendations as to any special systems of isolation, but they suggest that the question whether a bacteriological examination before discharge gives any additional security should be further investigated. Doubtless giving effect to the foregoing recommendations is likely to be attended with beneficial results, but so far as can be foreseen with a disease like scarlet fever, there will always remain even with the very best of regulations and the utmost precautions, some risk of the occurrence of return cases. 14 During the year under consideration 24 instances in which return cases of scarlet fever occurred came under observation in Shoreditch. This is equivalent to 3.1 per cent. of the cases removed to hospital. The particulars relating to them are briefly shown in the subjoined table:— Number of Case. Length of time in Hospital Interval between the return of the primary (infecting) case and the occurrence (invasion) of the secondary or return case Lesions observed in the primary case on return from hospital. Number of eases resulting from Primary case. Remarks. 1 90 days 3 days Discharge from ear and nose. 1 Primary case, a female 2 70 „ 8 „ Discharge from nose ; tonsils enlarged and ragged. 1 Primary case, a female 3 70 „ 12 „ Discharge from nose 1 Primary case, a female 4 50 „ 21 „ Discharge from nose; scurfy head. 2 Primary case, a male. The discharge from nose came on three days after return of primary case from hospital. The same was not apparent four days after secondary cases were certified 5 44 „ 16 „ Discharge from nose; enlarged tonsils. 1 Primary case, a female 6 58 „ 10 „ Discharge from nose; slight discharge from ears (mother's statement). 1 Primary case, a male 7 43 7 „ Discharge from nose; spots about body (mother's statement). 1 Primary case, a male 8 45 „ 7 „ Spots about body and soro nose (mother's statement). 1 Primary case, a female, was removed from an address in Hackney and returned to Shoreditch, the family having moved in the interval. 9 30 „ 28 „ Desquamation on hands and feet for about 14 days (mother's state ment). 1 Primary case, a female. There were several cases of scarlet fever at the school attended by return case—probable source of infection. 10 59 „ 15 „ 1 Primary case, a female. Dress worn on return bad not been disinfected. 11 42 „ 10 „ Enlarged tonsils. 1 Primary ca e, a male. 12 43 „ 3 „ Sore finger nail —discharging. 3 Primary case, a female. 13 59 „ 7 „ Discharge from nose. 1 Primary case, a male, played with secondary case, but did not reside in same house. 15 Number of Case. Length of time in Hospital. Interval between the return of the primary (infecting) case and the occurrence (invasion) of the secondary or return case Lessons observed in the primary case on return from hospital. Number of cases resulting from Primary case. Remarks. 14 67 „ 46 „ Discharge from nose and ears. 2 Primary case, a male. Improbable that there was any transmission of infection from primary case. Discharge came on two days after return. 15 41 „ 7 „ Discharge from nose; tonsils enlarged and ragged; glands enlarged. 1 Primary case, a male. Secondary case, resided in adjoining house. 16 56 „ 13 „ Discharge from nose; enlarged tonsils. 2 Primary case, a male. Clothing worn on return not disinfected, discharge from nose came on after return from hospital. 17 45 „ 6 „ Discharge from nose; desquamation on feet (mother's statement) 2 Primary case, a female. Discharge came on after return from hospital. 18 48 „ 11 „ Discharge from nose; skin crack behind right ear; peeling between toes; nostrils became sore a day or two after return. 3 Primary case, a male. 19 48 „ 16 „ Discharge from nose and sore behind right ear (mother's statement). 1 Primary case, a male. 20 58 „ 8 „ Slight discharge from nose. 1 Primary cas», a male. Secondary case resided in adjoining house which formed, however, practically one premises with house of primary case. 21 42 „ 5 „ Nasal discharge; sore nostrils; enlarged tonsils, 1 Primary case, a male. 22 57 „ 7 „ Discharge from nose (mother's statement). 1 Primary case, a male. 23 50 „ 8 „ 2 Primary case, a female. Infection was probably from another source. 24 35 „ 8 „ Discharge from nose; feet desquamating. 1 Primary case, a female. Discharge came on six days after return. 16 With respect to cases 9, 14 and 23, there is a very considerable element of doubt as to whether the recurrences of the disease were really due to the return of the primary cases from hospital or in any way connected with them. Excluding these the average length of stay in hospital of the primary cases was 52.5 days or 7½ weeks, whilst the intervals between the return of the primary cases and the occurrence of the secondary or return cases averaged 9½ days. In the majority of instances the primary cases presented evidence of nasal trouble, the children having discharges from the nose which were noticed when they came home. In three instances these discharges were not noticed until from two to six days after they reached home. It is important to note that both discharges from the nose and enlarged tonsils are very common amongst children, and the fact that such are present in convalescents from scarlet fever is far from being conclusive as to their being able to convey infection. In two instances the primary cases on their return wore clothing which had not been delivered up for disinfection, having been put away in a drawer and overlooked. It is not improbable that this may have been the cause of the recurrence of the disease in these two instances. A few instances came under notice in which recurrences of scarlet fever occurred in houses from which cases had been removed to hospital, not after the return of such cases from hospital, but a day or two before they came home. The following are illustrations:— George T——, aged 6, of No. 61, C- Street, was certified to have scarlet fever on March 16th, and removed to hospital. The patient returned home on June 16th. On June 15th Arthur T——, aged 8, was certified to have the same disease, and removed to hospital. Olive R-, aged 8, of No. 148, S- Road, was certified to have scarlet fever and removed to hospital on October 10th, returning home on November 30th. Stanley R-, aged 7, was certified on November 28th to have the same disease and removed to hospital. It need only be remarked that had the recurrences of the disease taken place after instead of before the return of the convalescents from hospital, they would have been included amongst the return cases. Such instances indicate, however, that careful enquiry is necessary in connection with the occurrence of return cases before assuming that the recurrence is due to infection from convalescents returning from fever hospitals. There was one instance of a return case of diphtheria, but there is a considerable element of doubt as to whether the recurrence of the disease was due to infection from the returning patient who was under treatment at the North-Eastern Hospital for Children. 17 SMALL-POX. Some 74 cases were certified as small-pox in the metropolis during 1905. They were most numerous in Stepney, Camberwell, Lewisham, and Woolwich. The deaths numbered 10, the death-rate being 0.002 per 1,000 population. In Shoreditch 2 cases were certified. The first was that of an infant about a year old. It was taken ill towards the end of January and died after about ten days' illness, during the course of which an eruption appeared which was thought to be that of small-pox. The notification certificate was not received until after the child's death. The body was removed to the mortuary, where, after a careful examination, it became clear that the cause of death was not small-pox. The child had probably been the victim of a variety of chicken-pox which is occasionally met with, in which the eruption assumes a bullous character, the vesicles being considerably larger than those ordinarily met with in chickenpox, looking, in fact, like small blisters. Just before the child was taken ill another child in the house had had a slight attack of chicken-pox. The second case was a genuine one of small-pox. The patient, a young man, 21 years of age, employed at a pork butcher's in Hoxton, was taken ill on June 12th, the eruption showing itself on June 14th. The patient was unvaccinated. The disease assumed the confluent type and terminated fatally. The usual precautions as to removal to hospital, disinfection, vaccination and re-vaccination were taken. . Persons resident in three households in Shoreditch had been more or less exposed to infection, but no secondary cases occurred. Nothing could be ascertained to throw light upon the source of infection. VACCINATION. The latest official figures published with the supplement containing the report of the Medical Officer of the Local Government Board for 1903-04 are for the year 1902. In Shoreditch the number of children not finally accounted for as regards vaccination during that year amounted to 36.1 per cent. of the children born during the year as compared with 44.4 in 1901. The cases in which vaccination was postponed are included in calculating this percentage. The number in respect to which conscientious objection certificates were granted by magistrates was twelve, being 0.3 per cent., which was the same as in 1901. During the last two years (1901 and 1902) there appears to have been a marked increase in the number of vaccinations performed in Shoreditch. Small-pox was, however, prevalent in the Borough during the early part of 1902. which doubtless accounts for the very considerable increase in the number of vaccinations during that year. The figures as to vaccination in Shoreditch for previous years are contained in my annual report for 1903. 18 SCARLET FEVER (SCARLATINA). The cases of scarlet fever certified during 1905 numbered 789, as compared with 343 in 1904 and 255 in 1903. In 18 of these or 2.3 per cent., intimations were received from the Metropolitan Asylums Board that the patients were suffering not from the disease certified, but from some complaint which was not scarlet fever, the diagnosis in 7 being erythema, in 3 tonsillitis, in 2 pneumonia, in 4 it was influenza, bronchitis, measles, and diphtheria respectively, and in 2 no obvious disease was recognised. The corrected number of cases was therefore 771, as compared with 320 in 1904 and 237 in 1903. The disease was more prevalent in Shoreditch in 1905 than in any year since 1893. The distribution of the cases certified and the deaths amongst males and females during the year in the Borough and its eight wards is as shown in the subjoined table:— Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 6 8 14 2 ... 2 Church 44 63 107 1 2 3 Hoxton 85 90 175 ... 2 2 Wenlock 77 75 152 2 2 4 Whitmore 63 65 128 4 1 5 Kingsland 34 33 67 3 1 4 Haggerston 38 29 67 2 1 3 Acton 31 48 79 2 2 4 Total tor Borough 378 411 789 16 11 27 Of the cases certified, 766 or 97 per cent. were removed to hospital for treatment as compared with 96 per cent. in 1904. The percentages for previous years are given in the report for 1903. Notwithstanding the high percentage of cases removed for isolation and the measures taken as to disinfection, the disease throughout the year until the beginning of October, manifested a marked tendency to spread from family to family in the Borough. This was more apparent than for several years past, and undoubtedly one of those years when scarlet fever tends to become markedly epidemic has been passed through. It is impossible to say what proportions the epidemic would have assumed if there had not been such a large amount of isolation effected, but it is highly probable that the cases would have been more numerous by several hundreds. An important factor in the dissemination of infection was missed cases. Thirteen such cases in the peeling stage of the disease were certified by myself, having come under notice whilst making enquiries where local prevalence of the disease had attracted attention. In these eases no medical men had been called in, the friends appeared to 19 have been quite unaware of the nature of the disease, and the children were thought to have had " colds." In a few instances children with scarlet fever were found attending school, and there is no doubt that the schools played an important part in spreading the disease. This point is touched upon later in the report (page 19). The first signs of an undue prevalence of scarlet fever in the Borough made their appearance towards the end of February. Through March, April and the first half of May the weekly numbers of cases certified remained above the average. They then rose rapidly with one or two intermissions reaching a maximum in the first week of July, after which they declined gradually, though still remaining much above the average. In the first week in September there was another abrupt rise in the number of cases and a second maximum, higher than the first, was reached in the middle fortnight of September, during which period some 72 cases were certified. Through October, November and December there was a gradual fall in the number of cases until the end of the year, when the signs of undue prevalence were no longer apparent in the Borough. During the last quarter of the year, however, the weekly numbers of cases certified were markedly above the average. The cases certified were at the rate of 6.7 per 1,000 inhabitants, as compared with 2.9 in 1904, 2.1 in 1903, 2.1 in 1902, 4.7 in 1901, and 2.7 in 1900. The cases were most numerous and the attack-rates highest in Hoxton and Wenlock Wards and lowest in Moorfields, the rates being 9.6 and 8.2 respectively in the former, and 2.5 per 1,000 in the latter. The deaths numbered 27, as compared with 13 during 1904, and the death-rate due to the disease was 0.23 per 1,000, as compared with 0.11 in 1904, 0.05 in 1903, 0.06 in 1902, and 0.17 in 1901. The case-mortality was at the rate of 3.4 per cent. of the cases certified, as compared with 3.8 in 1904, 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 five years of age there were 286 cases with 22 deaths, the mortality being 7.7 per cent. (or allowing for cases not regarded as scarlet fever at the hospitals, 8 per cent.), as compared with 7.8 in 1904, 2.7 in 1903, 5.3 in 1902, 6.8 in 1901, 12 in 1900, and 9.1 in 1899. Among persons aged five years and upwards there were 503 cases with 5 deaths, the mortality being barely 1 per cent. (allowing for cases not regarded as scarlet fever, just over 1 per cent.), as compared with 1.8 per cent. in 1904, 2.7 in 1903, 2 in 1902, and 1.7 in 1901. The cases of scarlet fever certified in the metropolis during 1904 numbered 19,460, or about 6.000 more than in 1904, the attack-rate being 4.1 per 1,000 inhabitants, as compared with 2.8 in 1904, 2.7 in 1903, 3.9 in 1902, 4.4 in 1901, 3.0 in 1900, and 3.9 in 1899. Comparing these with the Shoreditch attack-rates given above, it is evident that scarlet fever was unusually prevalent in Shoreditch during 1905. The deaths from scarlet fever in London numbered 549, as compared with 365 in 1904, 361 in 1903, 560 in 1902, 584 in 1901, and 361 in 1900, the death-rate being 0.11 per 1,000', as compared with 0.08 in 1904, 0.07 in 1903, 0.12 in 1902, 0.13 in 1901, and 0.08 in 1900, 20 DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 177, but of these, 55, or 31 per cent. were not regarded as cases of diphtheria at the hospitals of the Metropolitan Asylums Board, the diagnosis of the Board's medical officers being in 42 instances tonsillitis, in 7 scarlet fever, 3 Vincent's angina, 1 stomatitis, 1 laryngitis, and in 1 measles. To those who are not familiar with the difficulties attending the diagnosis of cases of diphtheria it might seem somewhat extraordinary that in such a large number of the cases removed to hospital as diphtheria there should be difference of opinion as to the nature of the disease. The explanation is that there are several affections of the throat which upon examination at the bedside of the patient may appear to be diphtheria, and the true nature of the disease only becomes manifest after careful and oftentimes prolonged observation combined with the help of the bacteriologist. It would obviously be dangerous to keep patients for this purpose in the homes of the poor, where isolation is impossible and the medical attendants in the vast majority of cases base their diagnosis upon the results of inspection of their patients' throats, and in more than two out of three they are correct as to the disease being diphtheria. The cases certified as diphtheria in 1904 numbered 183, including 47 which were not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board. Deducting the cases not regarded as diphtheria, the cases were distinctly less numerous in 1905. The numbers of cases and the deaths amongst males and females in the Borough and its eight wards are given in the subjoined table:— Ward. DIPHTHERIA (Including Membranous Croup.) Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 1 3 4 ... ... ... Church 17 9 26 1 3 4 Hoxton 16 11 27 1 ... 1 Wenlock 15 10 25 . . . 2 2 Whitmore 10 12 22 3 1 4 Kingsland 5 10 15 ... ... ... Haggerston 14 18 32 2 2 4 Acton 13 13 26 1 1 2 Total for Borough 91 86 177 8 9 17 The cases are grouped according to ages in Table III. (Appendix). Slightly over 93 per cent. of the cases certified were removed to hospital as compared with 94 per cent. in 1904, 88 in 1903, 84 in 1902, 83 in 1901, 86 in 1900, 80 in 1899, 77 in 1898, 67 in 1897, and 65 in 1896. 21 The weekly numbers of cases certified remained fairly steady throughout the year. They were fewest during the last quarter. The cases were most numerous in Acton and Haggerston Wards, and least so in Moorfields, the attack-rates being 2.1 and 2.6 per 1,000 inhabitants respectively in the former two wards, and 0.7 in the latter ward. For the Borough as a whole, 1he attack-rate was 1.5 per 1,000 inhabitants. The deaths numbered 17, the death-rate being 0.14 per 1,000, as compared with 0.16 in 1904, 0.18 in 1903, 0.18 in 1902, 0.23 in 1901, 0.45 in 1900, and 0.52 in 1899. (Appendix, Table VII.) The case mortality was higher than in 1904, the attacks proving fatal in 15.2 per cent. of the cases certified (22.1 per cent., allowing for cases not regarded as diphtheria at the fever hospitals) as compared with 10.3 per cent in 1904. The mortalities for previous years were 10.7 per cent. of the cases certified 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 17 deaths in 1905, thirteen were of children aged 1 to 5 years, the mortality being 14.7 per cent. of the cases certified (19.4, allowing for cases not regarded as diphtheria at the hospitals) as compared with 16.3 in 1904, 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 three deaths of children aged between five and ten years, and one of an adult aged between twenty-five and thirty-five years. The mortality amounted to 4.5 per cent. of the cases certified amongst persons over five years of age, but deducting the cases stated not to have been diphtheria, the mortality was 7.2 per cent. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 127 of the cases certified during the year, they were distributed amongst males and females at certain age periods as set out in the subjoined table:— Age Period. Male. Female. Total. Under 1 year 4 1 5 Prom 1 to 2 years 4 6 10 „ 2 „ 3 „ 4 5 9 „ 3 „ 4 „ 11 9 20 „ 4 „ 5 „ 12 5 17 „ 5 „ 10 „ 19 21 40 „ 10 „ 13 „ 4 4 8 Over 13 years 7 11 18 Total 65 62 127 In 58 of these cases the patients themselves were children attending school, and in 46 of them they were at school within one week of being certified to have diphtheria. As has been remarked in previous reports, there were cases in which no doubt 22 existed that the children were at school and mixing with their schoolfellows whilst actually suffering from the disease before the nature of their illness was recognised. In 47 other instances, although the patients themselves were not school-going children, other children, either members of the same families as the patients or dwelling under the same roofs, were attending school at the time the case wa.s certified. In 13 instances there were histories of cases of " sore throat'' in the families of the patients or amongst the people dwelling in the same houses as the patients. In 12 instances evidence pointing to infection from previous cases was obtained. In 90 instances the houses in which the cases occurred were occupied by members of more than one family, in 26 the houses were occupied by single families, and in 11 the cases occurred in artizans dwellings. As to how far these figures are proportionate to the numbers of persons dwelling as classed above, it is impossible at present to say. In 74 instances the houses in which the cases occurred were satisfactory from a sanitary point of view. There was nothing in connection with them which required action on the part of the sanitary authority. In many the drains and sanitary arrangements were of modem construction. In 26 the houses were fairly satisfactory, that is, minor defects existed, but nothing serious required attention. In 27 the houses were in an insanitary condition, some being dirty and overcrowded, and in others the drains were found to be in a bad state, and there were other defects in connection with the sanitary arrangements. As to how far these figures are proportionate to the numbers of houses in the Borough classified according to their sanitary condition being satisfactory, fairly so, or unsatisfactory, it is impossible to say. It may, however, reasonably be conjectured that diphtheria is more likely to be met with in houses which are insanitary than in those which are not, but the evidence upon this point is by no means conclusive. ENTERIC OR TYPHOID FEVER. The cases certified as enteric fever were most numerous during the latter four months of the year. The total number for the year was 36, including five which turned out not to be cases of enteric fever. There was also one other case included in the total, which terminated fatally, but there was such a very doubtful history in connection with it that I am unable to regard it as having been a case of enteric fever. The number of cases certified is the smallest so far recorded. The numbers of cases yearly certified since 1889 are shown in the subjoined table:— Year. Number op Cases. Year. Number of Cases. 1890 202 1898 91 1891 111 1899 171 1892 91 1900 122 1893 111 1901 96 1894 85 1902 149 1895 99 1903 101 1896 114 1904 48 1897 107 1905 36 23 The cases certified were at the rate of 0,3 per 1,000 population, as compared with 0.4 for 1904 and 0.8 for 1903. With two exceptions, one of which was not a case of enteric fever, the cases certified were all amongst persons over five years of age. The deaths certified as due to the disease numbered 2, including the one not regarded as having been due to enteric fever. The death-rate was 0.01 per 1,000 inhabitants, as compared with 0.07 in 1904, 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. This is the lowest deathrrate from enteric fever so far recorded in Shoreditch. The mortality was at the rate of nearly 6 per cent. of the cases certified, but deducting those not regarded as being enteric fever, the case mortality was only 3.3 per cent., which is a very low mortality for this disease. The case mortalities for previous years are as follows:—20.4 per cent. in 1904, 14.2 in 1903, 17.2 in 1902, 11.3 in 1901, 12.7 in 1900, 16.1 in 1899, 18.6 in 1898, 17.7 in 1897, 15.7 in 1896, 21.2 in 1895, 14.1 in 1894, and 15.8 in 1893. A glance at these figures shows how much the mortality from enteric fever was below the average in Shoreditch during 1905. In connection with this, however, it is to be remembered that the number of cases during the year was comparatively few, a point of importance in considering the significance of this low case mortality. The distribution of the cases certified and deaths amongst males and females in the Borough and the eight wards thereof during 1905 is shown in the subjoined table:— • Ward. ENTERIC FEVER. Cases Cebtipied. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 1 ... 1 ... ... ... Church 4 2 6 1 ... 1 Hoxton 1 2 3 ... ... ... Wen lock 1 4 5 ... ... ... Whitmore 2 2 4 ... ... ... Kingsland 3 4 7 1 ... 1 Haggerston 2 5 7 ... ... ... Acton 2 1 3 ... ... ... Total for Borough 16 20 36 2 ... (1 XI A grouping of the cases according to ages is shown in Table III. '(Appendix). Of the cases certified, 28, or nearly 78 per cent., were removed for treatment chiefly to the hospitals of the Metropolitan Asylums Board. The results of the enquiries made as to the circumstances attending the occurrence of enteric fever cases in the Borough during the year are set out in the annexed summary:— 24 No. of Case. Sex. Age. Probable date of beginning of illness. Date of Certification. Result. As to Sanitary Condition of Dwelling. Remarks—Source of infection, etc. 1 M 26 Jan. 1st Jan. 16th R Fair condition. Patient said to have been fond of fried fish. Otherwise nothing discovered throwing light upon the source of infection. 2 F 11 Jan. 4th Jan. 18th Dirty and insanitary house ; a filthy water cistern. The father of these children was taken ill about the middle of October with an indefinite illness, of which the symptoms resembled those of enteric fever. He was treated in Manchester, and returned home about the middle of December last. He probably infected his children. 3 M 4 Jan. 4th Jan. 18th R 4 F 37 ... Apl. 14th ... ... Not enteric fever. 5 M 2½ ... Apl. 15th ... ... Not enteric fever. 6 M 16 May 12 th May 25th R Satisfactory. No information to throw light upon source of infection. 7 M 19 May 10th May 25th R Fair condition. No information throwing light upon source of infection—was away at his work ail day and not in Shoreditch—place of work near Chiswell Street. 8 F 40 May 9th June 1st R Satisfactory. No information throwing light upon source of infection—worked at a place of business off Chiswell Street—patient fond ot Shell Pish. 9 M 31 ... June 3rd ... ... Not enteric fever. 10 M 51 ... June 8th ... ... From the history given at the house, it is very doubtful as to this having been a case of enteric fever. 11 M 6 June 10th June 19th R Drains defective. No history throwing light upan source of infection. 12 M 33 ... July 7th ... ... Not enteric fever. 25 13 F 17 July 15th Aug. 2nd E Fair condition. No history throwing light upon source of infection; a girl who was employed at the place where she worked, near Golden Lane, is said to have had fever. 14 F 24 Aug. 1st Aug. 19th E Satisfactory. Nothing to throw light upon source of infection. Patient seems to have been very fond of strawberries. 15 M 29 Aug. 13th Aug. 23rd D Satisfactory. Nothing to throw light upon source of infec'ion. 16 F 18 Aug. 20th Sept. 2nd E Fair condition. Nothing to throw light upon source of infection. 17 F 7 Aug. 25th Sept. 7th E Satisfactory. Nothing to throw light upon source of infection. 18 M 10 Aug. 28th Sept. 9th E Satisfactory. Nothing to throw light upon source of infection. 19 F 13 Aug. 18th Sept. 12th E Satisfactory. Was at Oleethorpes from August 4th to August 19th She first had sickness and diarrhoea on August 18th was ailing but able to go back to School on August 28th, complained of headache September 3rd, spots first noticed September 11th; was infected at Cleethorpes. 20 F 25 Aug. 28th Sept. 14th E Satisfactory. Patient a nurse in Shoreditch Infirmary and assisted in nursing case 13, from whom she probably coniracted the disease. She however returned from a holiday on August 18th, it is possible, therefore, she may have contracted infection from some other source. 21 F 33 Sept. 9th Sept. 16th E Satisfactory. Patient a nursing sister at City Eoad Chest Hospital. She volunteered the information that she swallowed a fly, about August 28th—nothing further to indicate source of infection. 22 M 6 Sept. 6th Sept. 19th E Dirty house. No history as to source of infection. In the Summary R=recovered, D=died. 26 No. of case. Sex. Age. Probable date of beginning of illness. Date of Certification. Result. As to Sanitary Condition of Dwelling. Remarks— Source of infection, etc. 23 F 7 Sept. 11th Sept. 25th R Fair condition. No history as to source of infection. 21 M 10 Sept. 27th Oct. 9th R Satisfactory. Brother to case 19 which was probably the source of infection. 25 M 35 Sept. 3rd Oct. 6th R Fair condition. No history as to source of infection. 26 M 34 Sept. 22nd Oct. 12th R Fair condition. No history as to source of infection, patient was a hawker. 27 M 39 Sept. 15th Oct. 16th R Dirty house. No history as to source of infection. 28 F 10 Oct. 3rd Oct. 23rd R Fair condition. Nothing to indicate source of infection. 29 F 6 Oct. 28th Nov. 11th R Dirty house. Probably infected by case 27. 30 F 25 Nov. 11th Not enteric fever 31 F 41 Nov. 4th Nov. 28th R Satisfactory. Was not infected in Shoreditcb—she only came to reside in the Borough on November 22nd. 32 F 7 Nov. 18th Nov. 30th R Satisfactory. Nothing throwing light upon source of infection. 33 F 14 Nov. 14th Dec. 5th R Satisfactory. Nothing to indicate source of infection. 34 F 29 Nov. 22nd Dec. 13th R Fair condition. Wife to case 27, nursed case 29 from which she probably contracted infection. After removal to hospital of case 27, she changed her address. 35 M 21 Nov. 20th Dec. 14th R Fair condition. Patient, a soldier returned from Bermuda on October 26th—stated there had been deaths in the Company to which he belonged, from typhoid fever. It is probable may have brought infection home with him. 36 F 13 Dec. 10th Dec. 29th D Dirty house. The family eat shell fish occasionally. Last time they had mussels, about December 5th, otherwise no history indicating source of infection. In the Summary R=recovered, D=died. 27 In six instances, viz., cases 2, 3, 20, 24, 29, and 34, in the foregoing summary, infection was undoubtedly taken from previous cases within the Borough. One of the patients, it will be noticed, was a nurse, who was nursing a case of enteric fever. With respect to cases 29 and 34, the probable sequence was that the father infected the child, who, in its turn, passed the infection on to the mother. In a few cases there were reasons for believing that the patients contracted the disea.se elsewhere than in Shoreditch, and it is highly probable that several others did also. In most of the cases nothing definite was ascertained to throw light upon the source of infection. Shellfish and fried fish were mentioned as having been eaten by a few of the patients, and in one case attention was directed to strawberries, but whether they were in any way instrumental in causing the disease it was impossible to say. The fact that in one case (No. 21) the patient swallowed a fly may be noted. It was mentioned by the patient herself, who attached some importance to it, and it may possibly have been the means of infecting her. The period elapsing between the time the patient was noticed to be ailing and the date of certification as to the case being one of enteric fever, was in one case as short as five days, and in another as long as 33 days. The average for the 30 cases of enteric fever (excluding those not of that disease) was 17 days, and this is about the usual time that elapses before a case of enteric fever is notified. The disease is ordinarily recognised about the end of the second or the beginning of the third week of illness. Where cases come under the notiice of medical men as soon as a deviation from health is observed and can be kept under close observation, as happens sometimes in hospitals, the nature of the illness may be recognised quite early. In ordinary circumstances, however, the ailing patient goes about his usual avocation until the gradually increasing debility forces him to seek medical advice, and oftentimes it happens that the doctor is not called in until two or three weeks or more from the beginning of the illness. All the time such a patient is going about—it is unnecessary to dwell upon it—he is a source of danger, a danger all the greater because unsuspected. The majority of the houses in which the cases occurred were found to be in a satisfactory or fairly satisfactory sanitary condition, that is, no sanitary defects or only those of a minor character were ascertained to exist. It is not to be concluded from this that enteric fever is more likely to occur in a house in good sanitary condition, for the majority of the houses in the Borough would be found on inspection to be in a satisfactory or fairly satisfactory sanitary condition. It is highly probable that multiple cases are more likely to be met with in insanitary houses, especially in those which are dirty and overcrowded, and where the people are poor and without proper means for nursing the patients. In such instances the risks of personal infection are greatly increased, but multiple cases occur even where the sanitary condition of the dwelling is exceptionally good, a great deal in connection with the occurrence of these cases depending upon the habits of the people. 28 ERYSIPELAS. The cases certified as erysipelas numbered 138, as compared with 183 in 1904, 147 in 1903, and 172 in 1902. The numbers for previous years are contained in the report for 1901. The deaths numbered 3, as compared with 5 in 1904, 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. The cases and deaths amongst males and females in the Borough and its eight wards were distributed as set out below:— Ward. ERYSIPELAS. Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 2 6 8 ... ... ... Church 12 15 27 ... ... ... Hoxton 3 8 11 ... ... ... Wenlock 17 11 28 ... ... ... Whitmore 10 14 24 ... ... ... Kingsland 6 6 12 ... 1 1 Haggerston 6 8 14 ... 1 1 Acton 7 7 14 ... 1 1 Total for Borough 68 75 138 ... 3 3 The cases were pretty equally distributed throughout the year. The death-rate was 0.02 per 1,000 inhabitants, as compared with 0.04 in 1904, 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 2.1 per cent. of the cases certified, as compared with 2.6 in 1904, 4.7 in 1903, 4.6 in 1902, 4.2 in 1901, 5.8 in 1900, and 8 in 1899. Pyaemia and Septicaemia (blood poisoning) were given as the cause of 15 deaths, 10 of males and 5 of females. Infective endocarditis (a form of heart disease) resulted in three deaths. There were two deaths attributed to other septic diseases allied to the foregoing. PUERPERAL FEVER. Nine cases, four of which occurred during the first quarter of the year, were certified, the attacks per 1,000 births being at the rate of 2.2, as compared with 1.3 in 1904, 1.7 in 1903, 2.2 in 1902, 1.7 in 1901, and 2.5 in 1900. The death-rate due to puerperal fever calculated per 1,000 births was 1.0, as compared with 0.5 in 1904, 0.2 in 1903, 0.7 in 1902, and 0.5 in 1901. The fatality may be judged of by the fact that four of the nine women certified to have puerperal fever died. 29 DIARRHŒA. The deaths from diarrhoea in Shoreditch during the year were distributed as follows:—In April 2, May 2, June 4, July 49, August 70, September 19, October 3, and in November 2, the disease being prevalent in the Borough during July, August and September, and the deaths most numerous from about the middle of July to the middle of August. The death returns show that in the second week of July 4 deaths were registered, in the third week the number rose to 15, in the fourth week to 27, in the first week of August it was 23, in the second 24, in the third 16, and the number fell to 7 in the fourth week. The deaths from diarrhoea, numbered 151, including deaths registered as due to epidemic or zymotic enteritis. There were also 66 deaths attributed to enteritis or gastro enteritis, chiefly amongst infants. Of the deaths from diarrhoea 121 were of infants under one year, 22 of children under five years, 2 of children between 5 and 10 years, and the remainder were of persons aged 55 years and upwards. The death-rate from diarrhoea was 1.30 per 1,000 inhabitants, as compared with 1.63 in 1904, 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 therefore below the average for the previous eight years. The distribution of the deaths from diarrhoea in the wards of the Borough and the death-rates are shown in Tables VI. and VII. (Appendix). There were no deaths in Moorfields Ward. The death-rates in the other wards varied from 0.53 per 1,000 inhabitants in Kingsland to 2.08 in Hoxton. Generally it may be stated that the deaths were most numerous in those parts of the Borough where the density of the population was greatest. The deaths from diarrhoea in the metropolis numbered 3,410, of which 2,706 were registered during the months of July, August and September. They were at the rate of 0.72 per 1,000 inhabitants, as compared with 1.07 in 1904, 0.64 in 1903, 0.53 in 1902, and 0.85 in 1901. Judging from the death-rate, therefore, diarrhoea was not so prevalent as in 1904. 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 1904 inclusive: — Year 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 Shoreditch 30.5 28.7 38.2 38.9 39.7 35.7 31.5 27.0 30.5 40.8 London 20.7 18.9 24.2 26.1 25.0 21.8 24.1 14.5 16.5 28.7 During 1905 the mortality from diarrhœa amongst infants under one year in Shoreditch was at the rate of 30.6 per 1.000 births registered during the year as compared with 20.79 for the whole metropolis. 30 The great difference which is apparent between the figures for London and Shoreditch given above is, without doubt, mainly determined by two factors, firstly, the very great density of the population per acre in Shoreditch, which is about thrice that of the metropolis, and secondly, the large proportion of poor persons resident in the Borough. Poverty and overcrowding, it may be mentioned, are conditions favourable not only to the prevalence of diarrhœa, but of other diseases which result in a high morality amongst infants. During the diarrhoea season this year special enquiries were made with respect to 132 of the deaths certified to have been caused bv diarrhoea or zymotic enteritis amongst children under two years of age. Attention was particularly directed to the manner of feeding and the sanitary condition under which they were being reared. The chief forms of food used were cows' milk with water or barley water, or cows' milk mixed with something to thicken it, such as boiled crusts, rice, bread, or some patent infants' food, or condensed milk with water or barley water and with bread, oatmeal, or some patent food to thicken. In a number of cases the infants were too young for the form of food administered to them. It is noteworthy that in eighteen instances the mothers went out to work and the children were left to the care of others during their absence. With regard to the sanitary surroundings, in nearly all the houses in which the deaths occurred the drainage arrangements were satisfactory, or no serious defects were found in connection with them. In eleven instances exception was taken to the paving of the ground in the vicinity of the dwellings which was defective. The majority of the houses were in a cleanly condition, some more so than others, but in only nine were they stated to be unsatisfactory in this respect. The infection of diarrhœa, a disease well known as being very fatal in young infants, is conveyed through the medium of their food. If infants received. as they ought to, nothing but the breast for the first seven months of the;r existence, their food is not likely to contain the germs of diarrhoea during that period, as is liable to happen when artificial feeding is resorted to. It follows, therefore, that the mortality from diarrhoea amongst infants fed naturally upon the breast is likely to be low. This assumption is borne out by the results of the enquiries. For of 61 infants under 7 months old who died from diarrhoea, 54, or 88 per cent., were being brought up . by hand, that is, otherwise than at the breast, whilst it is not free from doubt that the remainder were solely fed upon the breast. After weaning, the risk of exposure to the infection of diarrhoea becomes a matter for serious consideration. This risk can only be obviated1 when diarrhoea is prevalent by strictest precautions in matters of detail in respect to the quality and purity of the children's food, its preparation and its administration. Above all things, the utmost possible cleanliness is absolutely necessary, both in person and dwelling. MEASLES. The deaths from measles numbered 60, all of children under five years of age, of whom 35 were males and 25 females. The deaths were most numerous in Hoxton 31 Ward, and least in Moorfields, the death-rates verying from 0.17 per 1,000, the rate in Moorfields to 1.07 the rate in Hoxton. The death-rate for the whole Borough was 0.52, as compared with 0.69 in 1904, 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 death-rate due to measles during 1905 was therefore lower than usual. The deaths were most numerous in the Borough during the first five months of the year, especially during the five weeks from the end of January to the end of February. Ten deaths only were registered during the last six months of the year. During the nine weeks from the fourth week in September to the third week in November no deaths from this disease were registered. The deaths from measles in the metropolis during 1905 numbered 1,715, the death-rate being 0.36 per 1,000 inhabitants, as compared w.ith 0.49 for 1904. The number of houses brought to the notice of the Health Department as being infected through measles having occurred therein was 470, as compared with 454 for 1904. In the great majority of these the information was supplied by the various school authorities within the Borough. On investigation it was found that in 112 instances the information as to the complaint being measles was erroneous. According to the statements made by the patients' friends, the disease was something other than measles. In all the houses where it was ascertained that measles existed, measures as to disinfection were taken, and with few exceptions they were carried out by the Sanitary Authority. Altogether some 371 infected rooms were dealt with and the usual steps were taken with bedding and textile articles which had been exposed to infection. WHOOPING COUGH. This disease was given as the cause of 85 deaths, 45 of males and 40 of females. With one exception they were all amongst children under five years of age. The death-rate was 0.73 per 1,000 inhabitants, as compared with 0.51 in 1904, 0.35 in 1903, 0.63 in 1902, and 0.49 in 1901. The rate was therefore considerably above the average for the past few years. A comparison of the death-rates in the eight wards of the Borough is shown in Table VII. (Appendix). There were no deaths from whooping cough in Kingsland Ward. As to the remainder, the death-rate was highest in Church and lowest in Acton Ward. The deaths were most numerous in the Borough during the months of February, March, April and May. The heaviest mortality during any one month was in April, when 19 deaths were attributed to this disease. The deaths from whooping cough in the metropolis during 1905 numbered 1,507, the death-rate being 0.32, which is about the same as that for 1904. INFLUENZA. Influenza was given as the cause of 11 deaths, as compared with 14 in 1904, 19 in 1903, 14 in 1902, 16 on 1901, 52 in 1900, and 35 in 1899. The figures for previous years are contained in my annual report for 1901. No deaths from this disease were registered in Shoreditch during the months of January, April, July, August, September and December. The deaths were most numerous during the month of February. 32 In London the deaths from influenza numbered 664, as compared with 707 in .1904, 644 in 1903, 1036 in 1902, 664 in 1901, and 1950 in 1900. The deaths in the metropolis during 1905 were most numerous during the first three months of the year, and least so during July, August and September. TUBERCULOSIS. Tuberculoslis (see Appendix, Table VI., Nos. 29 to 34 inclusive) resulted in 321 deaths, as compared with 365 in 1904, 376 in 1903, 295 in 1902, 363 in 1901, and 343 in 1900. The deaths from tuberculosis amounted to 14 per cent. of the total number of deaths for the year. The death-rate due to tuberculosis for 1905 was 2.8 per 1,000 inhabitants, as compared with 3.1 for 1904. Phthisis, or consumption, which is the form of the disease affecting the lungs, alone accounted for 215 deaths, yielding a death-rate of 1.8 per 1,000 inhabitants. Of the persons who died from consumption 131 were males and 84 females, over two hundred of them were in the wage earning period of life, and many of them breadwinners. Upwards of 6,600 persons died from consumption in the metropolis, yielding a death-rate of 1.4 per 1,000 population. The figures show that the mortality from phthisis in Shoreditch during 1905 was nearly 30 per cent. higher than that of London as a whole. As is well known, consumption is a contageous malady due to the growth in the lungs of a minute organism—the tubercle bacillus—which at times swarms in the material coughed up by persons suffering from the disease. The conditions which favour the propagation of the disease and the manner in which infection is spread are now generally recognised amongst those who have made a study of it. It has been pointed out by high authorities upon the subject that the disease is to a very large extent one which can be prevented. There is not the least doubt that such is really the case, and that if the necessary action were taken by the public authorities, an immense amount of good would result and the suffering poor amongst whom the disease commits its greatest ravages would be afflicted with far less hardship and distress. In Shoreditch the voluntary notification of the disease has not yet been adopted so that the death returns are at present the only indications given as to prevalence of the disease in the Borough. In all cases where information is received as to deaths in dwelling houses from consumption, the friends of the deceased are communicated with, and disinfection is advised. It is to be noted that the larger proportion of deaths from consumption takes place in public institutions, where there are responsible medical officers able to take the necessary precautions. In some cases, however, the disinfection after phthisis cases has been undertaken by the Borough at the request of the hospital authorities. During the year 1905 disinfection was carried out by the officers of the Borough Council in connection with 50 dwelling houses in whlich persons suffering from consumption had resided before death. In 30 other houses more or less efficient precautions were taken by the residents themselves rather than permit the officers of the 33 Council to do what was necessary. There is no power to insist on disinfection in connection with cases of tubercle in the Borough. CEREBROSPINAL FEVER. This disease, which is also known as epidemic cerebro-spinal meningitis, spotted fever, and also by other less known names, has during the last year or two been somewhat more prevalent than usual, and has been attracting attention in Central Europe and in the United States of America. Local outbreaks have occurred at a number of places in this country during recent years, and in several instances such outbreaks have been the subject of investigation on behalf of the Local Government Board. In August a communication was received from the Board with respect to this disease, pointing out that whiilst it was probable that it was not more prevalent in this country than it has been from time to time during the last quarter of a century, nevertheless it behoved sanitary authorities to be watchful for the disease in their districts with a view to ascertaining whether any increased prevalence existed or not. To this end a memorandum was prepared by the Medical Officer of the Board, dealing generally with the characteristiic symptoms of the disease, and especially with, minor and anomalous manifestations. The Board's communication came under the notice of the Health Committee of the Borough, who gave instructions for copies of the memorandum to be distributed amongst the medical practitioners resident in Shoreditch. The mortality returns showed that during the year a few deaths were certified as being the result of cerebro-spinal meningitis, but there was nothing to indicate any prevalence of the disease in the Borough. Moreover, from enquiries made of medical practitioners, nothing unusual in this respect appears to have been noticed. CHOLERA. There were one or two small outbreaks of cholera in Germany which attracted attention in this country. In v!iew of the possibility of cases occurring in the Metropolis, arrangements were made by the Metropolitan Asylums Board for the reception and treatment of cholera cases, should any occur. Dining the year some 23 intimations were received from the Medical Officer of the Port of London relating to 46 foreigners landed from vessels arriving from Bremen, Hamburg, Libau, and Rotterdam, who were ostensibly proceeding to addresses in Shoreditch. At first, on enquiry at the addresses given, it was found in several instances that no such persons as those mentioned on the intimations from the Port Medical Officer, had arrived or were expected to arrive. Evidently false information as to their destination was being given. The matter was taken in hand by the Public Health Department of the London County Council, which secured correct addresses being given. Enquiries made in Shoreditch, however, shewed that in many instances the immigrants were only remaining at the addresses given for a short rime. In some cases only amounting to a few hours. None of the persons visited whilst they were in Shoreditch manifested any signs or symptoms suggestive of cholera. 34 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 residing 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:— School. Enteric Fever. Small Pox. Diphtheria. Scarlet Fever. Measles Chicken Pox. Whooping Cough. Mumps Other diseases Total. Baltic Street ... ... ... ... 4 ... ... ... ... 4 Bath Street ... ... ... 1 8 ... 2 1 3 15 Canal Road ... ... 2 ... 22 38 6 ... 5 73 Catherine Street ... ... 8 6 4 1 1 3 23 Central Street ... ... ... ... 1 ... ... ... ... 1 Chatham Gardens ... ... 2 5 10 2 ... 2 12 33 Chequer Street ... ... ... 1 ... ... ... ... ... 1 Christ Church ... ... 2 27 17 3 12 61 Colman Street Ward ... ... ... ... 1 ... 1 ... ... 2 Curtain Road ... ... ... ... 52 12 11 5 44 124 Fellows Street ... 1 3 13 9 13 7 1 4 51 Gopsall Street ... ... 1 38 89 41 22 29 43 263 Haggerston Road 6 ... 10 24 61 36 ... 3 17 157 Hammond Square 1 ... 9 28 19 20 37 10 48 172 Maidstone Street 2 ... 3 15 100 43 7 15 103 288 Moreland Street ... ... ... ... ... 1 ... ... ... 1 Napier Street 1 ... 21 186 149 41 32 26 4 460 Queen's Head Street ... ... ... ... 1 ... ... ... ... 1 Queens Road ... ... ... 3 1 ... ... ... ... 4 Red vers Street ... ... 2 10 19 25 40 8 27 131 Rochelle Street ... ... ... ... ... 2 ... ... ... 2 St. Columba ... ... ... ... 1 1 2 ... ... 4 St. John's Evangelist R. C. ... ... ... ... 1 ... ... ... ... 1 St. John's National ... ... ... 34 30 22 6 1 5 98 St. John's Road 1 ... 3 11 106 35 26 4 12 198 St. Joseph's ... ... ... ... ... ... ... ... 1 1 St. Mark's ... ... ... ... 3 ... ... ... 2 5 St. Mary's ... ... ... 9 13 4 ... ... 6 32 St. Monica's ... ... ... 8 ... ... ... ... 4 12 St. Paul's ... ... ... ... 8 3 ... ... 2 13 St. Saviour's ... ... 2 2 4 18 ... ... ... 26 Scawfell Street ... ... 10 41 39 24 10 11 62 197 Scrutton Street ... ... ... 3 18 13 2 3 2 41 Shap Street ... ... 3 37 19 16 2 7 34 118 Trinity Place ... ... ... 5 56 21 1 1 84 Turin Street ... ... ... ... 1 ... ... ... ... 1 Virginia Road ... ... 1 ... 1 15 3 9 29 Wenlock Road ... ... ... 2 13 2 1 2 20 Total 11 1 82 509 380 452 213 129 467 2747 35 The number of exclusions during 1905 on account of infectious illness shows an increase of over a thousand as compared with that for 1904. The increase is manifest in connection with all the diseases except mumps. The chief cause, however, of the increase of the number of exclusions was the prevalence of scarlet fever. During the year attention was specially required in connection with the following schools:— Catherine Street School.—This school, which was under our notice during October and November, 1904, on account of the unusual number of scarlet fever cases amongst the scholars, again came under observation during February, March, and April of the year under consideration for the same reason. The cases were chiefly amongst the children in the infants' department, the heaviest incidence appearing to be amongst those in class rooms D and E of that department. The cases occurred as follows:—Four in February, one being on the 5th, 9th. 14th, and 19th respectively; 11 fin March, one being certified on March 2nd, three on March 6th, and single cases on the 8th, 10th, 17th, 19th, and 20th respectively; after an interval of ten days, another case was certified on March 30th, and that was followed after twelve days by a case on April 12th. The school holidays then intervened, and after the re-opening of the school on May 1st the incidence of scarlet fever amongst the scholars ceased to attract attention. There is not the least doubt that there was a source of infection in the infants' department, and some suspicion was attached to a little boy who returned to school on February 13 after having been away in hospital with scarlet fever. He was the subject of a discharge from his nose, which he had had since his return from hospital. He came under notice on March 21st, and under the circumstances it was thought advisable to exclude him. Another child was found to be peeling whilst attending the department. He was a little boy about 5 years old, who was taken ill on March 6th. He returned to school on March 12th for a few days and was then absent agalin unitil March 20th, when he finally returned to school as being well. It was thought by his mother that he had had a "cold." He was found to be peeling freely on March 30th, when he was removed to hospital. As to whether this child was the source of infection in any of the cases during the latter half of March it is impossible to say with certainty, but it is not improbable. Trinity Place School.—Class room E in the infants' department was closed on account of measles by the Medical Officer (Education) of the London County Council. The necessary steps as to disinfection were taken by the Sanitary Authority. Napier Street School. —This school came under observation in June on acoount of an unusual number of scarlet fever cases which suddenly made their appearance amongst the scholars. The cases were more especially amongst the girls. The Medical Officer, Dr. Kerr, was communicated with, and class room G in the girls department, from which most of the cases appeared to be coming, was closed for a fortnight, during which appropriate measures as to disinfection were carried out. 36 BACTERIOLOGICAL EXAMINATIONS. Bacteriological examinations were made by Dr. Bulloch at the London Hospital Medical School in 32 cases of suspected infectious disease. In 21 instances the disease suspected was diphtheria, in 8 typhoid fever, in 2 paratyphoid fever, and in one consumption. The results were positive in 5 of the cases suspected to be diphtheria and in one of the cases suspected to be typhoid fever. All the rest were negative. DISINFECTION. During 1905 some 1,472 premises were disinfected. The number of articles removed and disinfected1 at the Borough Disinfecting Station amounted to 33,745, as compared with 14,063 in 1904, 8,911 in 1903, 55,025 in 1902 (the year of small-pox outbreak), and 17,226 in 1901. The. articles disinfected included 1,780 beds, 2,330 mattresses, 3,527 pillows, 1,361 bolsters, and 24,747 miscellaneous articles, including clothing, linen, carpets, curtains, and the like. In some instances bedding is found, besides being infectious, so contaminated with discharges, or in such a wornout and filthy condition, that it is necessary for it to be destroyed. During the year eight beds and twenty-eight mattresses were so destroyed, being burnt in a furnace at the Di.-infecting Station. All bedding destroyed was replaced with new. Besides disinfecting in cases of scarlet fever, small-pox, diphtheria and typhoid fever, a large amount of disinfection is now arried out in connection with cases of measles and phthisis. Moreover, in a number of cases clothing from verminous houses was disinfected during the year. The large amount of disinfection carried out in 1905 was mainly the result of the prevalence of scarlet fever. No complaints were received as to any damage caused by the measures taken for 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 1905:— Date of Admission to Shelter. Length of stay therein. Number of Persons. Address from which the persons were admitted to the Shelter. Disease. Jan. 28th ½ day 8 131, Boston Street Small-pox Mar. 30th 1 night 2 10, Rodney Buildings Scarlet Fever Aug. 22nd 3 hours 2 30, Hyde Road Scarlet Fever Oct. 5th 4 hours 3 48, Rushton Street Scarlet Fever Oct. 21st 3 hours 3 26, Salisbury Street Scarlet Fever Dee. 1st 4 hours 2 9, Upper John Street Scarlet Fever The Shelter was in use on six occasions by 20 persons belonging to 8 families, 3? THE PUBLIC MORTUARY. The dead bodies received into the Public Mortuary in St. Leonard's Church Yard during 1905 numbered 417, as compared with 460 in 1904. The bodies of three persons dead of infectious disease were removed to the mortuary by the sanitary authority, as compared with four in 1904. A specially constructed iron shell is used at the mortuary for the reception of infectious or decomposing and very offensive bodies. The inquests held numbered 290, as against 336 in 1904, and the post-mortem examinations made in the post-mortem room at the mortuary numbered 223, as compared with 251 for last year. The figures relating to the use of the mortuary in years previous to 1904 are contained fin the report for 1903. WATER SUPPLY. According to the figures contained in the reports of Sir W. Crooks, F.R.S., and Sir James Dewar, F.R.S., and of Dr. Houston, the Director of Water Examinations to the Metropolitan Water Board, the rainfall for the year 1905, measured at Oxford, amounted to a little under 21 inches. Talcing the mean rainfall for 35 years, there was a deficit of about four inches, the rainfall being approximately 17 per cent. below the average. Most rain fell in June and least in July, the amounts being 4.15 and 0.16 inches respectively. Towards the end of March complaint was received as to the colour of the water supplied to the Haggerston Baths, which are situate in the East London water district. The water was of an olive green colour, and when viewed in bulk as in the swimming bath, the coloration was very apparent, and caused persons using the bath to complain of its dirty appearance. A sample was taken from a tap direct from the main upon the premises and submitted to the public analyst. His report was to the effect that the water was of doubtful purity, there being an excess of vegetable matters, that it resembled the London companies' filtered waters at their worst, was not a satisfactory water for drinking purposes, and was too highly coloured for bath use. It soon regained its normal tinge, and no further complaints were received. In the Autumn of 1903 there was a similar complaint in respect of the water supplied to the Pitfeld Street baths, which are situate on the New River area. Doubtless, the coloration of the water was associated with heavy rainfalls, whiich caused the solution of considerable amounts of vegetable matter. Taking the monthly reports on the condition of the Metropolitan water supply for 1905 by the Water Examiner appointed under the Metropolis Water Act, 1871, they shew that on the whole the waters supplied during the year both on the New River and East London districts were of good quality, but that of the New River was somewhat superior to that on the East London. Some of the water supplied on the East London district during part of March was unsatisfactory in quality, as the following passage from the Water Examiner's report for that month shews:— "With regard to the East London supply, all the samples taken in the districts supplied with filtered Lea water were of good quality; but on the relatively small area partly supplied with water taken from the Thames at Sunbury certain samples taken on the 20th and1 21st were found to contain 38 excessive quantities of organic impurity and were of very bad quality. The inferior character of the samples mentioned evidently resulted from the want of adequate storage at the Sunbury works.'' These samples were taken about the time the highly-coloured water was supplied to the Haggerston Baths. There was no reason to suspect 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 60 premises on the New River district and 82 on that of the East London. In many of these the intimations referred to premises which had been vacated. The subject of the water supply of tenement houses was considered by the Health Committee in connection with a communication! from the London County Council directing attention to certain police- court proceedings in 1894 taken by the Sanitary Authority of Woolwich in respect to the water supply of a tenement house in that Borough, and expressing a hope that the Borough Council of Shoreditch would take all possible steps to secure the provision of a proper and sufficient supply of water for the tenants of every floor of a tenement house. The decision of the magistrate in the case alluded to> was that a water supply from a tap situate in the yard of this particular tenement house was not a proper and sufficient supply within the meaning of section 48 of the Public Health (London) Act 1891, and an order was n.ade for the abatement of the nuisance, with five guineas costs. The information afforded in the Council's letter is useful, because it goes to show that the mere fact of there being a tap upon the premises from whrch a supply of water is obtainable does not always mean that a tenement house has a proper and sufficient supply within the meaning of the Act. The magistrate's decision, however, only appllied to a particular house, and is not binding in respect to tenement houses generally, and in the matter of the water supply of tenement houses each case will have to be dealt with on its merits. So far as this Borough /is concerned, the Health Committee, after enquiry, were satisfied as to what was being done to secure a proper and sufficient water supply for tenement houses, and it may be added that the matter of the water supply to all premlises is one which has received a great deal of attention on the part of the Sanitary Authority in the Borough. Shoreditch possesses many tenement houses in which every floor has a water supply of its own, the houses having been specially built or adapted for the purpose of being let /in tenements. There are, however, numbers of small houses of from four to six rooms each which were built to accommodate single families, but which have come to be occupied by members of more than one family. To lay water on to floors above the ground floor in many of these houses would involve considerable structural alterations. Sinks and waste pipes would have to be provided, otherwise the necessity would be /continually arising of having to deal wiith houses flooded owing to taps being left running. Moreover, in many of the houses the only possible situations to be found for the sinks withiin the dwellings, without radical structural alterations, would be within the dwelling rooms 39 themselves, and sinks in dwelling rooms are not altogether free from objection on sanitary grounds, especially where there are children. The practice in the Borough is to require additional water taps where the circumstances appear to render the provision of such necessary in connection with tenement houses, but there is no hard and fast rule on the subject. SANITARY WORK. Preliminary notices as to insaniitary conditions were served in respect to 2,877 premises, of which 297 were dealt with by the chief inspector, 649 by Inspector Lear, 441 by Inspector Firth, 515 by Inspector Jordan, 432 by Inspector Langstone, and 543 by Inspector Clements. In connection with the work carried out, 909 letters were written to owners of property, builders and other parties concerned. Over 24,000 visits of inspection were made during the year, not including those made by the Medical Officer of Health and Chief Inspector. The premises inspected included milkshops, cowsheds, slaughterhouses, places where food is prepared for consumption by the public, such as cookshops and eating houses, factories, workshops, including bakehouses, places where home work is carried on, and other premises, including dwelling houses. (Appendix.) In the subjoined table is contained a summary giving an idea as to the nature of the work done for the abatement of nuisances and for improving the dwellings of the people in Shoreditch, which has been compiled from the abstracts of their work prepared by the sanitary inspectors:— Chief Insp. Insp. Lear. Insp. Firth. Insp. Jordan Insp. Lang- stone. Inspg. Clements. Tolal. New drains constructed 5 5 2 9 7 27 55 Drains re-oonstructed or repaired 67 31 48 23 36 27 232 Sink waste pipes trapped and disconnected 1 64 66 80 20 61 292 Stack pipes re-instated 26 49 47 21 27 105 275 Eaves gutters re-instated 25 51 47 17 26 144 311 Stack pipes disconnected from drains 2 14 30 22 2 37 107 Accumulations of sewage dealt with .. 8 7 19 23 9 66 Cesspools abolished .. .. .. .. 1 .. 1 New water closetis constructed 39 23 6 41 17 1 127 Old water closets re-constructed or repaired 17 58 53 53 55 98 334 Water closets cleansed and White-washed 48 399 66 231 96 196 1036 Water restored or newly laid on to water closets 6 36 50 20 31 135 278 Obstructions in water closets removed 12 46 17 27 11 70 183 Overcrowding in houses abated .. 11 15 5 23 27 81 Damp courses in houses provided 3 4 6 3 2 23 41 Walls pointed 10 5 15 1 8 50 89 Roofs repaired 15 80 78 21 82 108 384 Stairs repaired 41 18 75 8 21 65 228 Floors repaired 14 34 42 25 47 88 250 Ventilation under floors provided 3 3 J6 9 24 12 67 Doors Tepaired 34 10 26 15 14 40 119 Door cills provided 33 31 19 18 32 17 150 Sashes repaired 14 60 22 2 20 54 172 Houses cleansed throughout 95 22 39 23 30 109 318 Houses eleaused in part 58 173 272 28 163 166 860 Total number of rooms cleansed 469 858 925 554 599 932 4337 Yards or areas lime-washed 26 380 16 181 45 72 720 Yards paved 21 72 66 28 65 54 306 Areas or forecourts paved 11 19 16 3 1 39 89 New areas constructed .. .. .. .. .. 10 10 Sculleries paved 3 1 14 2 17 26 63 Dust receptacles provided 3 83 60 36 49 89 320 Dung receptacles provided .. .. 2 .. 1 3 6 Insanitary cisterns removed 4 2 .. 1 1 5 13 40 In connection with the above, it may be mentioned that 20 old brick drains were removed, and in 48 cases nuisances and annoyance caused through rats infesting premises were dealt with. As a rule, the presence of rats indicates defects in connection with drains or sewers. In 146 instances water was restored to premises, the supplies having been cut off for various reasons, and on 159 premises leaking water pipes were repaired. Urinals were constructed on nine premises, and on 32 they were cleansed and repaired. Foul accumulations of various descriptions, 96 in number, were removed on requisition by the sanitary officers. On 16 premises animals were found to be kept under conditions causing nuisances. They were chiefly horses improperly stabled. In 60 instances stables were properly paved under the supervision of the inspectors. The summary of the sanitary work given above includes that done in connection with the drains and sanitary arrangements of new buildings, and also the work carried out in pursuance of the Factory and Workshop Act, 1901. In the great majority of instances the preliminary notices setting forth the insanitary conditions to be remedied were complied with by the parties responsible. In 257 cases, however, it was necessary to specially direct the Health Committee's attention to the circumstances connected with them and in these statutory notices under the Public Health (London) Act, 1891, were served by the sanitary authority with a view to enforcing the abatement of the nuisances existing. For non-compliance with the requirements of the sanitary authority in five instances police-court proceedings were taken under the Public Health (London) Act, 1891, and bye-laws made thereunder. The results briefly were as follows:— Laburnum Street, No. 92.—The owner was summoned by Inspector Firth Sn consequence of not complying with the requirement of a statutory notice to remove an obstruction in the drain on the premises. The obstruction having been removed before the case came on for hearing, the summons was withdrawn, 3s. costs being paid by the defendant. Essex Street, No. 1.—The owner was summoned by Inspector Clements for not complying with the requirement of a statutory notice to provide additional water closet accommodation. The summons was withdrawn, as the owner was taking steps to provide the additional accommodation when the case came before the magistrate, the defendant paying 2s. costs. Rufus Street, No1. 3.—The stables and the drainage arrangements on these premises were in such a state as to be a nuisance. A summons was taken out by Inspector Langstonie, and the magistrate made an order for the necessary work to be carried out in fourteen! days. There was no order as to costs. Essex Street, Nos. 35, 37, 39, and 41.—Police-court proceedings were taken by the Town Clerk under the bye-laws as to houses let in lodgings, the landlord having neglected to make the returns required by the bye-laws for registration thereunder. 4i One summons only was taken out, viz., in respect to No. 37. It was withdrawn on payment of 2s. costs, the landlord having made the necessary return before the case came on for hearing. Brougham Road, No. 17.—The owner was summoned by Inspector Firth for not complying with a statutory notice as to the provision of a proper dust receptacle. The summons was withdrawn, as when the case came into court the receptacle had been provided. The defendant paid 10s. costs. 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 be carried out in a speedy and efficient manner:— Bernales Buildings, Nos. 1 and 2. Byng's Buildings, Nos. 3, 4, 7, 8 and 9. Holt Place, No. 17. Hoxton Street, No. 286. Mill Row, Nos. 69 and 71. Weymouth Terrace, Nos. 78 and 112. Scawfell Street, No. 104. Talavera Place, No. 26. The houses Nos. 1 and 2, Bernales Buildings, were in a dirty and dilapidated condition, and unfit for habitation. They were closed under sanitary notice from the Chief Inspector, and remained closed at the end of the year. The five houses at Byng's Buildings were all in a very dirty and dilapidated condition, and were closed upon the service of statutory notices under the Public Health (London) Act, 1891, except No. 7, which was in a very dirty and insanitary condition, besides having one of its flank walls in a structurally dangerous state. The Health Committee, who viewed the buildings, gave instructions for steps to be taken under the Housing of the Working Classes Act in connection with this house. Notice was accordingly served under the Act upon receipt of which the owner closed the house, which was partially demolished. The flank wall was re-built, the roof was repaired, new flooring was provided, the walls were cleansed and repaired, and the house generally dealt with so as to render it fit for habitation. The work in connection with these houses was carried out under the supervision of Inspector Clements. The house in Holt Place was in a very dirty and dilapidated state. The walls of the back addition v. were falling, and the drains were in a very defective condition. As the work of rendering the house habitable could not satisfactorily be carried out whilst it was occupied, the premises were closed by the owner. The house was dealt with under sanitary notice from Inspector Langstone. The back addition was re-built, the sanitary arrangements reconstructed, the yard was paved, and the house stripped, cleansed, painted and papered throughout. 42 The house in Hoxton. Street was old and very dirty and dilapidated. It was also structurally dangerous so as to require the attention of the District Surveyor. The house was closed under statutory notice, and the necessary steps were taken to put the premises into a habitable condition under the supervision of Inspector Clements. The two houses in Mill Row adjoin one another, and were in a very defective, dirty and dilapidated state. A good deal of sanitary work was necessary to render them fit for habitation. They were closed by the owner upon receipt of statutory notices, and were dealt with under the supervision of Inspector Clements. No. 78, Weymouth Terrace, was in a dirty and overcrowded condition, and was closed by the owner upon the service of a statutory notice. No. 112, Weymouth Terrace, was in a dirty and dilapidated state, and the drains and sanitary arrangements were found to be defective. The house was closed early in the year by the owner upon receipt of a statutory notice, and at the end of the year remained closed. The houses in Scawfell Street and Talavera Place were both in a very dirty and dilapidated' condition, and were closed by the owners upon receipt of sanitary notices from Inspector Firth, under whose supervision they were thoroughly cleansed and repaired throughout. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. The following houses came under our notice during the year as being closed for demolition: — Hackney Road, Nos. 33, 35, and 37. These were 8-roomed houses, and have been demolished. Sun Street, Nos. 26 and 28. These each contained seven rooms and a shop. They have been demolished. Mill Court, Nos. 16, 17, and 18. These were small houses consisting of four rooms with a scullery each. They have been demolished. Charlotte Street, Nos. 55 and 56. Small houses, which have been demolished. Craven Street, Nos. 10, 11, and 12. These are 6-roomed houses, which have been shut up by the owner, who states that they will not be again let for occupation as dwellings. These houses were occupied by persons of the, working class. It is intended to utilise their sites for warehouses or other business premises. 43 HOUSES LET IN LODGINGS. The following houses were registered during the year under the bye-laws as to houses let in lodgings or occupied by members of more than one family:— Underwood Place, Nos. 1, 2, 3, 4, 5, 6, 7, and 8. Essex Street, Nos. 14, 16, 18, 22, 26, 32, 35, 37, 39, 40, 41, 45, 49, 50, 51, 53, 55, 57. The number placed upon the register was 26, making a total of 283 since the bye-laws came into operation. As stated in my report for 1904, at the end of that year the amendment of the bye-laws as to houses let in lodgings was under consideration, amendment being necessary in consequence of the decisions of the judges in the cases of Nokes v. Islington Borough Council and Styles v. Galinski. At the same time the question of amending the existing exemption clause which is contained in the Shoreditch bye-laws came under consideration. After a conference at the offices of the Local Government Board it was thought best not to alter the exemption clause. A copy of the bye-laws amending the bye-laws of 1894 is appended to this report. The amending bye-laws received the sanction of the Local Government Board on August 5th, 1905. Their effect is to render it obligatory upon the sanitary authority to serve a written notice upon a landlord of a lodging house giving him due warning of any breach of certain of the bye-laws and a reasonable time to comply with the same before legal proceedings may be taken against him. ARTTZANS DWELLINGS. During the year under 'consideration attention was directed to the Artizans Dwellings in the Borough which have been specially constructed for the accommodation of the workiing classes, and are commonly called model dwellings. These dwellings comprise some 44 blocks, the majority of which are situate in the southern part of the Borough, and the following is a list of them :— Alabaster Buildings. Albert Buildings. Alexandra Buildings. Allen's Buildings. Bleyton's Buildings (3 blocks). Britannia Dwellings. Broad Street Dwellings. Chapel Buildings. Chichester Houses. Cleeves Buildings. Citizens Dwellings. Hoxton Market Dwellings. Kossuth Buildings. Langbourne Buildings. L.C.C. Dwellings, Goldsmith Row (2 blocks). McKay's Buildings. Moore's Buildings. Norfolk Buildings. Penny Bank Chambers. Provost Buiildings. Red Lion Buildings. 44 Council's Dwellings. Derby Houses. Enfield Buildings. George's Square. Gladstone Buildings. Goldsmith Buildings. Granville Bulildings. Great Eastern Buildings. Hamilton Buildings. Rodney Buildings. Singer Street Chambers. St. Agatha Square. Stanley Houses. Victoria Chambers. Vinegar Ground Models (4 blocks). Willow Chambers. Eleanor House. As the result of inspection for the purpose of comparison, the dwellings have been divided into two classes, which may be designated as A and B. Class A includes all those which from the general aspect of the dwellings and the appearance of the dwellers, are occupied by persons of the working class in comfortable or fairly comfortable circumstances. In class, B the people are not in comfortable circumstances, and a large proportion of them are extremely poor. With a few exceptions the dwellings are structurally satisfactory, and save in one instance their sanitary condition was generally satisfactory also. In a number of them the standard of sanitation is high, and leaves l5ttle to be desired. With regard to the rest, although sanitary defects of minor importance were observed, so far as light, ventilation, water supply, sanitary accommodation, drainage, paving of open spaces in connection with the dwelling's, provision for the washing of clothes and disposal of house refuse are concerned, they cannot be classed otherwise than satisfactory. The great drawback from a health point of view with respect to artizans' dwellings, 'is the aggregation of population on the areas covered by the buildings. Ini some cases the density of the population per acre is very great. The numbers of tenements, rooms, and persons in the dwellings estimated from the results of enquiries made during the latter part of 1904 and the early part of 1905 are set out below:— Number of blocks. Number of tenements. Number of rooms. Number of persons. Class A 29 1483 3827 5920 Class B 15 383 917 1849 Totals for the whole 44 1866 4744 7769 The blocks of dwellings in class B are as a rule of smaller size than' those in class A. The average number of persons per tenement for the whole of the dwellings is 4.1, being at the rate of 1.6 persons per room. In class A the averages were 3.9 persons per tenement, and 1.5 per room, in class B 4.8 and 2.0 respectively. For the whole of the dwellings the number of rooms per tenement averages 2.54, being 2.58 for class A, and 2.39 for class B. 45 The rooms are of very fair size, and the amount of accommodation is ample when compared with the standards contained in the Council's bye-laws as to houses let in lodgings. The room space is, however, more abundant in class A than in class B, and on the whole the conditions associated with residence in the former class of dwellings are, from a health point of view, distinctly superior to those of the latter. A few remarks may now be made in respect to the statistical information available bearing upon the health of the inhabitants of these dwellings. The births registered during the year together with the birth-rates, are set out below:— The whole of the Dwellings. Class A. Class B. Number. Rate per 1,000 Inhabitants. Number. Rate per 1,000 Inhabitants. Number. Rate per 1,000 Inhabitants. 327 42.0 267 45.1 60 32.4 The birth-rate for these dwellings is high, especially so in class A. In class B, however, it is lower than that for the whole Borough, although considerably above the average for the metropolis. A point which may be noted in connection with the births is the proportion of deaths attributed to prematurity. For the whole of the dwellings these deaths were at the rate of 27.5 per 1,000 births. In classes A and B the rates were 22.4 and 50 respectively, whilst for the whole Borough it was only 18.1 per 1,000 births. The deaths of infants under one year of age per 1,000 births were as follows: 140 for the whole of the dwellings, 134 for class A, and 166 for class B. The infantile mortality was in class A, greatly below that of the Borough as a whole, and only a little above that of the metropolis. In class B it was a little above the average for the Borough. In the subjoined table are given the deaths and death-rates from certain causes for the dwellings and the corresponding death-rates for the whole Borough, so that they may be compared:— Cause of Death. The whole of the Dwellings. Class A. Class B. The Borough. Number of deaths. Rate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants. Rate per 1,000 inhabitants. All causes 147 18.9 105 17.7 42 22.7 19.8 Principal Zymotic diseases 22 2.8 15 2.5 7 3.7 2.8 All forms of Tuberculosis 21 2.7 16 2.7 5 2.7 2.7 Phthisis 16 2.0 11 1.8 5 2.7 1.8 Bronchitis 16 2.0 11 1.8 5 2.7 1.9 Pneumonia 13 1.6 7 1.1 6 3.2 1.9 46 The cases of notifiable infectious disease certified in the whole of the dwellings numbered 82, of which 50 were in class A, and 32 in class B, the attack-rates per 1,000 inhabitants being 10.5, 8.4, and 17.3 respectively, as compared with 9.8 for the Borough. There were 56 cases of scarlet fever, 12 of diphtheria, 13 of erysipelas, and one of puerperal fever. The numbers of cases and the attack-rates per 1,000 inhabitants with respect to scarlet fever, diphtheria, and erysipelas are set out below:— Scarlet Fever. Diphtheria. Erysipelas. Cases. Bate. Cases. Bate. Cases. Rate. Class A 39 6.5 4 0.6 7 1.1 Class B 17 9.1 8 4.3 6 3.2 The whole of the dwellings 56 7.2 12 1.5 13 1.6 The attack-rates for the whole Borough were 6.7 per 1,000 inhabitants for scarlet fever, 1.5 for diphtheria, and 1.2 for erysipelas. In drawing conclusions from the foregoing figures, it is necessary to bear in mind that they only relate to a particular year. To sum up briefly: During the year 1905 the mortality amongst the residents in the artizans' dwellings in Shoreditch was lower than that of the Borough as a whole; it was markedly lower amongst the residents in the class A dwellings, but amongst those in the B class it was markedly higher than that of the Borough; taking them as a whole, attacks of notifiable infectious disease were somewhat more frequent in the dwellings than in the Borough generally ; whilst the attacks were less frequent lira the class A dwellings, in the class B they were much more frequent than in the Borough as a whole, the incidence being nearly twice as great. 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. DRAINAGE BYE-LAWS. Arising out of a communication from the Borough of Lewi sham on the subject of sewer ventilation, enclosing a report from the surveyor of that Borough, in which it was suggested that the London County Council should be approached with the object of obtaining the repeal of the bye-law under the provisions of Section 202 of the Metropolis Management Act, 1885, which deals with the use of intercepting traps in connection with drains, the question of the use of such traps came under the consideration of the Council, 47 The Borough Surveyor of Shoreditch (Mr. J. Rush Dixon) reported in favour of co-operating with the Lewisham Council in approaching the London County Council as to repealing the bye-laws, and this report was adopted by the Highways Committee. The Medical Officer of Health and Chief Sanitary Inspector (vide Appendix) were of opinion that the repeal of the bye-law would be a retrograde step, and on public health grounds ought not to be advocated, and their opinion was endorsed by the Health Committee. A Joint Health and Highways Committee were in favour of supr porting the Lewisham Borough Council in approaching the London County Council on the subject of the repeal of the bye-law, and they recommended the Borough Council accordingly. The Coundil, however, did not adopt the recommendation. SMOKE NUISANCE. Some 16 complaints as to the emission of black smoke were received from the London County Council in respect to 11 premises. There was one complaint from the Coal Smoke Abatement Society, and two from other sources. In all cases the complaints were brought under the notice of the parties responsible, and steps were taken to secure the abatement of the nuisances. In three instances it was necessary to bring the facts under the notice of the Health Committee with a view to legal proceedings. Statutory notices under the Public Health (London) Act, 1891, were served upon the responsible persons, but it was not necessary to take the cases before the magistrate. VERMINOUS HOUSES. Under section 20 of the London County Council (General Powers) Act, 1904, which enables steps being taken to free houses from vermin, some 22 houses more or less infested by bugs were dealt with during the course of the year, the walls of the rooms being stripped, stopped, and cleansed. A number of houses were reported as verminous owling to the verminous condition of children residing in them. In the great majority of these, however, it was found on investigation that so far as the house and the rooms therein were concerned, it could not be said that they were infested with vermin; in fact, a number of them appeared particularly clean. In some of these it was thought advisable to disinfect clothing and bedding which appeared specially filthy, but it is of very little use to take measures in respect to the rooms to get rid of vermin whose natural habitat is the person or clothing. SLAUGHTERHOUSES. The slaughterhouses registered in the Borough were at the end of the year 12 in number, being one less than in 1904, that at No. 35, Hackney Road, ceasing to exist, the premises having been demolished to make way for the erection of a warehouse. In several instances the slaughterhouses in the Borough are but little used, and the amount of slaughtering done is now but small as compared with what was 48 formerly the case. The slaughterhouse premlises were periodically inspected during the year, and their general condition from a sanitary point of view may be reported upon favourably. COWSHEDS, DAIRIES, AND MILKSHOPS. The number of cowhouses on the register at the end of 1905 was seven, being the same as that for the previous year. The number of cows kept in the Borough was found at the inspection made a short time prior to the hearing of applications for licenses in October to have undergone a further decrease, there beling 86, as compared with 95 in 1904, 101 in 1903, 103 in 1902, 110 in 1901, 114 in 1900, and 135 in 1899. No complaints were received in respect to the cowhouse premises; they were subject to periodical inspection during the year, and thair general sanitary condition may be reported as satisfactory. The number of dairymen and milk purveyors on the register at the end of the year was 289, as compared with 294 in 1904, 300 in 1903, and 304 in 1902. In 35 instances the sale of milk was discontinued at shops where it was formerly sold, in 30 instances the sale of milk was commenced, in connection with which applications were duly received and the premises registered, and in 77 instances the premises of milk purveyors changed hands. At many of the milk purveyors' premises, which are little general shops, only small quantities of milk are sold, perhaps not more than a quart or two daily. From enqueries made by the sanitary inspectors on their several districts, it would appear that something like 1,800 imperial gallons of milk are sold daily in Shoreditch, amounting in the course of the year to something approximating seven hundred thousand gallons. The premises upon which milk is sold were kept under pretty close observation by the sanitary staff, some 3,152 visits of inspection being made to them. Warnings as to lack of proper attention to cleanliness in connection, with milk utensils were necessary in six instances. In ten cases notices as to insanitary conditions tin connection with the premises were required, in six instances on account of the premises being dirty and dilapidated, and in three owing to defective drains. In another case there was an accumulation of dung which was being kept longer than necessary. Seven cases of infectious disease occurred in connection with milk purveyors' premises, and the usual steps were taken. In one instance (No. 3, Rufus Street) police-court proceedings were taken owing to a defective drain on the premises, and an abatement order was obtained with respect to the nuisance. (Ante p. 40.) OFFENSIVE BUSINESS. The premises at No. 69, Haggerston Road, where tripe-boiling is carried on, were kept under observation during the year. There were no complaints in respect to them. 49 Early in the year attention was called to a soap-making business which had recently been commenced at No. 36a, Albion Road. Upon enquiry it was found that a small quantity of soap only was being manufactured ais samples, the premises having been taken temporarily for the purpose pending the completion of permanent works situate outside the Metropolitan area. The process of manufacture having been explained, in view of the small1 quantity of soap being made, and there not being any likelihood of nuisance arising therefrom, the sanitary authority raised no objection to the proprietors manufacturing the samples during the three or four weeks they occur pied the premises. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1905 was 1,218, some 268 having been added and 183 removed. The numbers for previous years were 1,133 in 1904, 1,133 in 1903, and 1,081 in 1902. 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 736 (a) Cabinet making 456 (b) French polishing 71 (d) Other work in the trade 151 (e) Upholstery 58 (2) Dress: 226 (a) Tailoring 70 (b) Mantles 10 (c) Millinery 17 (d) Dressmaking 31 (e) Shirtmaking 3 (f) Boot and Shoe Trade 57 (g) Artificial flower 8 (h) Other workers 30 (3) Skins, leather, hair and feather trades:— 62 (a) Furriers 12 (b) Saddlery and harness 21 (c) Feathers 2 (d) Other workers 27 (4) Paper, printing, book, stationery and fancy goods trades: 56 (a) Box and bag makers 37 (b) Other workers 19 (5) Laundry and washing 32 (6) Food Manufacturers 6 (7) Metals, machines, implements and conveyances 50 (8) Precious metals, jewels, etc. 2 (9) Other trades than those mentioned above 48 All the workshops on the register were inspected during the course of the year, but attention was more especially directed to those which were unsatisfactory. These were kept under observation until the necessary improvement had been effected in their 50 saniitary condition. Some 2,838 visits of inspection were made in. connection with the registered workshops, and 34 in connection with factories where insanitary conditions were reported. The communications received from the Factory Inspector as to the establishment of new workshops within the Borough numbered 34, and referred to 81 workshops mainly for the purposes of the various branches of the furniture trade, and for dress, leather and feather work. On inspection 54 were found to be in a satisfactory sanitary condition, three could not be found or the addresses were not in Shoreditch, and in the remainder, insanitary conditions more or less serious required attention. Written intimations were received from the Factory Inspector numbering 84, referring to insanitary conditions and infringements of the law relating to public health in connection with 132 workshops and workplaces. The chief insanitary conditions mentioned on the intimations from the Factory Inspector were: want of proper attention to cleanliness, walls and ceilings being in a dirty state in 79 instances, dirty and dilapidated state of the workshop in 15, defective or insufficient water closet accommodation in 22, want of proper separate sanitary accommodation for the sexes in one, overcrowding in two, and in 12 other defects. In one instance the workshop mentioned was empty and about to be demolished. These workshops were all duly inspected by the officers of the Borough Council, and the necessary steps were taken to remove the insanitary conditions to which attention was directed as well as others which came under observation when the premises were visited by the sanitary inspectors. The results of the action taken upon the intimations of the factory inspectors were reported to them in accordance with the requirements of the Factory and Workshop Act. In addition to those brought under the notice of the sanitary authority by the factory inspector some 379 workshops, workplaces and factories, exclusive of bakehouses, places where food is prepared, and other workplaces which are referred to later in this report, were dealt with during the year. The defects and insanitary conditions were similar in character to those already mentioned. In the inspection of workshops and workplaces attention is particularly directed to cleanliness, ventilation, drainage, and the provision of sufficient and suitable accommodation in the way of sanitary conveniences. Including the premises brought under the notice of the sanitary authority by the factory inspectors, 511 factories, workshops and workplaces, exclusive of bakehouses, and places where food is prepared for sale, were dealt with, and altogether some 463 sanitary notices were served upon the parties responsible by the sanitary (inspectors. In some instances defects common to more than one workshop were dealt with on 51 a single notice. a single notice. The following is an abstract of the sanitary work done in connection with the notices served during the year 1905:— Drains relaid 6 Water closets disconnected from workshops 1 New drains constructed 5 Stack pipes disconnected 16 Urinals repaired and cleaned 5 Stack pipes reinstated 23 Water supply laid on or restored 36 Eaves gutters reinstated 33 Leaking water pipes repaired 20 Sink waste pipes disconnected 20 Rooms cleansed and whitewashed 668 Yards paved 11 Yards „ „ „ 172 Forecourts paved 1 Areas „ „ „ 13 Areas paved 4 Roofs repaired 71 Water closets re-constructed 34 Floors „ 19 New water closets constructed 6 Stairs „ 10 Water closets cleansed and limewashed 352 Doors „ 8 Sashes „ 5 Light and ventilation provided or improved in water closets 17 Ventilation under floors provided 1 Ventilation of workshops improved 1 Obstructions removed from water closets 39 Dust receptacles provided 1 Foul accumulations removed 12 Overcrowding abated 3 The foregoing only relates to the work carried out in connection with factories, and in the workshops and workplaces on the register. In the great majority of instances the work required was performed upon the receipt of official intimations from the sanitary inspectors. In 24 cases it was necessary for the Health Committee to order the service of statutory notices under the Public Health (London) Act, 1891, upon the parties responsible, whereupon what was required was done, and it was not necessary in any instance to appeal to a magistrate. With respect to home work, 31 lists of outworkers were received from employers in Shoreditch, 19 during the first half-year, and 12 in the second. These lists referred to 629 outworkers, of whom 494 were not resident in Shoreditch, and their addresses were forwarded to the authorities of the sanitary districts to which they belonged. Communications were received from other sanitary authorities as to some 1,305 outworkers who were residents in the Borough, and 98 who were residents of other sanitary districts. The addresses of the latter were forwarded to the authorities concerned. The number of outworkers brought to our notice during the year amounted to 1,440, of whom 1,342 were residents of Shoreditch, and some 743 visits of inspection were made to places where home work was carried on. The sanitary notices served in connection with them numbered 94, and the works done in consequence thereof included, amongst others, the construction or reconstruction of drains in 8 instances, the removal of other defects in the sanitary arrangements in 12 instances, and the whitewashing and cleansing of 171 workrooms. 52 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 an 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 9 106 5 94 95 81 207 189 Mantles 1 3 2 18 3 8 14 28 Underclothing 1 19 ... ... 13 ... 27 24 Blouses & Costumes ... ... 2 120 ... 118 46 32 Boots 3 78 2 20 61 11 124 156 Millinery 1 13 ... ... 10 ... 43 25 Fur pulling ... ... ... ... ... ... 5 3 Other work 4 125 1 23 75 19 270 210 Total 19 344 12 275 257 237 736 667 The objects aimed at in requiring lists of outworkers to be sent to the sanitary authority are the prevention of home work being done in unsuitable and insanitary dwellings to the detriment of the workers themselves and on premises where dangerous infectious disease exists so as to safeguard the interests of the public. The classes of work in connection with which lists of out workers are required are set forth in the Home Work Order of 15th August, 1905, which revokes the previous Home Work Orders of 1901 and 1902. During the year 75 cases of infectious disease were notified on premises where home work was carried on. The necessary steps were taken to prevent infection being spread by the work. In most instances the temporary cessation of work was necessary. No action was required under Sections 108-110 of the Factory and Workshop Act. BAKEHOUSES. The number on the register at the end of the year was 77, including two factory bakehouses. Of these 32 are above ground, and 45 underground. Their general sanitary condition may be described as satisfactory. In 14 instanoes the bakehouses required limewashing, and the necessary notices were served and complied with, 53 The bakehouse situate at No. 55, Hackney Road, which was closed in June, 1904, came into use again early in 1905. The underground bakehouse at No. 63, Clifton Street, being no longer used for baking, the premises having been let as a milk shop and refreshment rooms, has been removed from the register. The underground bakehouse at No. 273, Kingsland Road, which has not been certified as fit for baking in, has also been removed from the register, the premises having been let for purposes other than baking. ICE CREAM SHOPS. The following summarises the results of the inspection of the above premises made in 1905: Inspector Lear had 13 under observation, of which eight required more or less cleansing. On Inspector Firth's district 11 were inspected, which were found, with three exceptions, to be in a clean and satisfactory condition. Inspector Jordan had 20 under inspection; fourteen were in a clean condition, in two cleansing was necessary, in one cleansing and defective yard paving required attention, in one there was an insufficient water supply to the water closet, tin one there was an absence of a proper dust receptacle, and in one instance eaves guttering was defective. Inspector Langstone had 24 under observation; in one case the vendor did not keep his utensils as clean as they ought to have been, in one instance the place for the preparation of the ice-cream was not in accordance with the regulations, in one instance the drains were obstructed, and in a fourth case the premises generally required cleansing; the remaining 20 premises were found to be kept in a clean condition. On Inspector Clements' diistrict 11 were inspected, of which eight were found to be kept in a cleanly condition; writh respect to the others, two required cleansing, and in one the drains were defective. Altogether 79 places where ice-cream was manufactured or sold came under observation during the year, as compared with 69 for 1904. In seven instances ice-cream was not being sold when the premises were visited. Of the premises inspected, 54 were found in a satisfactory condition. With respect to the remainder, sanitary defects of the nature indicated above were found, and in 21 instances sanitary notices were necessary. On the whole, the results of the inspection show some improvement as compared with those of the previous year. COOK-SHOPS, COFFEE-HOUSES, AND FRIED FISH SHOPS. The usual inspection of premises of the above description, upon which food is sold, was made during the year, and the results may be summarised as follows:— follows:— Inspector Lear visited 40, of which 11 were fried-fish shops. In 34 instances, 7 of which were fried-fish shops, sanitary notices were required, chiefly on account of cleansing being necessary. In a few some minor sanitary defects were dealt with. 54 On Inspector Firth's district 20, including 7 fried-fish shops, were under observation. Of these 7, including 1 fried-fish shop, were in a satisfactory sanitary condition. The remainder all more or less required attention, chiefly on account of want of sufficient cleanliness on the premises. In one case overcrowding was found. Inspector Jordan had 99 premises under observation, including the kitchens of 13 public-houses, where dinners are provided, and 9 fried-fish shops. Of these, 75 were found to be in a satisfactory sanitary condition, 11 being kitchens of public houses and 7 fried-fish shops. The rest all more or less required attention, chiefly on account of insufficient attention to the cleanliness of the premises. In a few cases there was an absence of proper receptacles for house refuse, and in one or two instances defects were observed in connection with the sanitary arrangements. On Inspector Langstone's district 43 premises were under inspection, 31 of which were found in a satisfactory sanitary condition, including 9 out of 10 fried-fish shops. The remainder mostly required cleansing. In one or two cases the sanitary arrangements were defective. Inspector Clements had 28 premises under observation, including a jam factory, a brawn factory, a kitchen of a public-house where dinners are provided, and 9 friedfish shops. Of these 15, including the jam and brawn factories, the public-house kitchen and 4 fried-fish shops were in a satisfactory sanitary condition. The remainder mostly required cleaning. At one of the fried-fish shops the drains had to be reconstructed. The rest of the defects were of a minor character. Altogether 182 cook-shops and eating-houses (including 14 public-houses), 46 fried-fish shops and two other premises where food is prepared, were under inspection as compared with 161 (including 12 public-houses), and 40 fried-fish shops for 1904. Some 655 visits of inspection were made in connection with them, and 77 sanitary notices were served. The results indicate that a larger proportion of these premises required attention on account of insanitary conditions than was the case in 1904. BARBERS' SHOPS. The results of an inspection made during the year of the premises in the Borough where barbers' businesses are carried on are summarised below:— On Inspector Lear's district 17 premises were visited. In 15 of these the general sanitary condition was satisfactory, a few minor defects only requiring attention. In the other two the sanitary condition was unsatisfactory. In one of them a water-closet was found without ventilation, opening directly into the shop. Inspector Firth had 14 under observation. In 8 the general sanitary condition was satisfactory. The rest all more or less needed attention on account of sanitary defects. In one instance the premises were exceedingly dirty, and in another the sanitary arrangements generally were defective. 55 Inspector Jordan had 28 premises under inspection. With 8 exceptions theirgeneral sanitary condition was satisfactory, minor defects only being apparent. With regard to the exceptions in some, the premises were dirty, in others sinks were untrapped, and in several the sanitary arrangements were defective. On Inspector Langstone's district 22 premises were inspected. With one or two exceptions their sanitary condition was satisfactory. In one case the shop was dirty, and in another the drains were so defective as to require reconstruction, otherwise the defects found were of minor importance. On Inspector Clement's district 11 premises came under observation. With one or two exceptions their sanitary condition was satisfactory, minor defects only being noticeable. In one instance there was a foul accumulation in the cellar below the shop, and in two others the water-closets were without water. Altogether 92 premises were inspected, of which 74 were satisfactory sanitary defects of minor importance only being observed, and 18 were unsatisfactory. In all cases where necessary sanitary notices were served. A defect which was noted by the inspectors in connection with 49 of the shops was the absence of traps beneath the lavatory basins. The waste pipes discharged over gullies or sinks and were therefore disconnected from the drains, but there remained a liability to smells from the untrapped waste pipes themselves, especially in cases where the waste-pipes were common to several basins. Where this defect was observed the advisability of providing proper traps close up under the lavatory basins was pointed out, and in many instances this advice was acted on. In some cases the common waste-pipes were dispensed with, enamelled iron pails being provided to receive the discharges from the basins. STREET MARKETS AND FOOD. The usual supervision was exercised by the sanitary officers in connection with the street markets and the foodstuffs sold in the Borough, and frequent inspections were made with a view to the detection of food unfit for human consumption. Some instances of coccidiosis in rabbits, the existence of which was confirmed by examinations made by Dr. Bulloch at the London Hospital Medical School, came under observation. The organ affected was the liver. In this disease the bile ducts become infested with a parasite—the coccidium oviforme—which gives rise to the formation of nodules, appearing on the surface of the liver as slightly raised yellowish-white patches. In some cases the bile ducts become occluded by the growth and little sacs containing bile are formed. Coccidiosis of the liver is said to have been observed in man. In the cases of the rabbits above referred to the affected organs were destroyed. The following articles were destroyed as unfit for food:— About 40lbs. of mutton, three-quarters and 181bs. of pork, 3¾cwt. of rabbits, 5½lbs. of corned beef, 2 cases of herrings, 3 barrels and a case of plaice, 2 trunks of 56 soles, 2 trunks and about 100lbs. of skate, 3 barrels and 1 case of haddocks, 2 barrels of escalops, 1 box of rock salmon, 1 case of mixed fish, 6 sacks of greens, 2 barrels of apples, 1 crate of bananas, 2 barrels of grapes, and 16 boxes of tomatoes. There were no instances in which police-court proceedings were necessary. SALE OF FOOD AND DRUGS ACTS. The reports of the public analyst, Sir Thomas Stevenson, show that during the year 536 samples were submitted to him for analysis under the above acts. This number works out at the rate of one sample for every 215 persons belonging to the Borough, or 4.6 samples per 1,000 inhabitants per annum. Of the samples, 108 were taken by Inspector Lear, 119 by Inspector Firth, 108 by Inspector Jordan, 89 by Inspector Langstone, and 110 by Inspector Clements. Two samples of butter were taken by a private person in the third quarter of the year. The results of the year's work are summarised in the following table:— Quarter of the year 1905. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions Instituted. Prosecutions withdrawn because of Warrantees, &c. Prosecutions proceeded with Number of successful Prosecutions. Fines and Costs. Amount paid to Analyst for samples analysed. £ s. d. £ s. d. 1st. 135 24 17.7% 17 ... 17 14 114 17 0 67 10 0 2nd. 115 34 29.5% 19 2 17 17 71 0 6 57 10 0 3rd. 102 17 16.6% 11 ... 11 9 34 12 6 50 0 0 4th. 184 23 12.5% 10 ... 6* 6 18 10 0 92 0 0 Total for Year 536 98 18.2% 57 2 51 46 239 0 0 267 0 0 The samples taken comprised 332 of milk, 180 butter, 6 lard, 5 sausages, 4 coffee, 2 margarine, 2 bread and butter, 2 golden syrup, 2 treacle, and 1 of almond oil. Of the milk samples 69 or 20.8 per cent. were found not to be genuine, as compared with 23.5 in 1904, and 22.0 per cent. in 1903. In the subjoined table are shown the numbers of samples of milk taken during the four quarters of the year with the numbers and percentages of those found not to be genuine. *Four summonses in respect to boric acid in sausages were not proceeded with by order of the Council. 57 Quarter of the year. Number of Samples. Number not genuine. Percentage not genuine. 1st. 75 17 22.6% 2nd. 76 24 31.5% 3rd. 73 11 15.0% 4th. 108 14 12.9% The percentage of samples found adulterated was highest in the second and lowest in the fourth quarter of the year. In 32 of the samples water was stated to have been added. In 18 of these the amount was over, and in 14 it was under 5 per cent. In 21 of the samples the milk was deficient in fat, the deficiency being over in 13 instances and under 5 per cent. in eight. In 6 samples it was found that the fat was deficient and the water in excess. In three instances boric acid or a preparation thereof as an added preservative was found without any other adulteration. In two others in addition: to the milks not being in conformity with the Board of Agriculture's standard, boric acid was also, found. The largest amount in any of the samples was at the rate of grains to the pint. Formic aldehyde to the extent of 1 part in 10,000, was found in one instance. In three the samples besides being below standard, also showed traces of artificial colouring matter, and in six instances the presence of traces of such colouring matters was the only thing noted by the analyst. Legal proceedings were taken in 28, or a little over 40 per cent. of the cases in which the milks were below standard. In 21 of these convictions were obtained. In 2 cases the production of warranties rendered the prosecutions unsuccessful, and the summonses were dismissed, but the defendants were in each instance ordered to pay two guineas costs to the Council. In two cases the summonses were withdrawn on the production of warranties, in one the defendant paying 12s. 6d. costs to the Council. In one case the summons was dismissed, as the wrong party had been summonsed, the business having changed hands prior to the samples being taken. In the second case the summons was dismissed, the magistrate having been satisfied that the milk, the sample of which on analysis was found to be deficient in fat to the extent of 7 per cent., was sold in the same condition as received from the wholesale dealer and as taken from the cow. In a third case the summons was dismissed, the magistrate objecting to the form and wording of the analyst's certificate. A case was asked to be stated, and the matter remains at present unsettled. In the remainder of the cases in which the analysis showed that the milks were below the standard, it was not deemed advisable to prosecute, in most instances the percentages of abstraction of fat or addition of water not exceeding five per cent. In seven instances in which the analyst's certificates showed the presence of 5 per cent. of water added, letters cautioning the vendors were sent. 58 In the cases in which convictions were obtained the penalties for milk adulteration amounted to £45 2s., which is equivalent to 7.8 per cent. of the full amount of the penalties to which the defendants were liable, as compared with 6 per cent. in 1904, 8 in 1903, and 13.5 per cent. in 1902. Taking the fines and costs, which together amounted to £60 15s. 8d., the average amount paid by a defendant upon conviction was £2 19s. 3d., as compared with £2 6s. 10d. in 1904, £1 18s. 6d. in 1903, and £2 18s. Od. in 1902. Of the samples of butter taken, 25, or nearly 14 per cent., were not genuine. Of the samples of butter taken, 25, or nearly 14 per cent., were not genuine. The numbers of samples and percentages of those found adulterated during the four quarters of the year are shown below:— Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st. 51 7 13.9% 2nd. 35 8 22.8% 3rd. 27 5 18.5% 4th. 67 5 7.4% Of the adulterated samples 21 of the 25 were stated by the analyst to have been margarine, and in 23 of the 25 samples traces of boric acid were found. Legal proceedings were taken in 24 instances, or 96 per cent. of the cases where the samples were found adulterated, and in each case a conviction was obtained. Two samples were taken under the Margarine Act. In the case of one of these the vendor was summonsed for selling margarine without a properly stamped wrapper. The case was proved, but the magistrate did not regard the offence as a serious one, and imposed no penalty, only allowing the Council 2s. costs. The penalties inflicted in the cases in which convictions were obtained with respect to the samples of butter and margarine amounted to ,£163 1s. 0d., which was equivalent to 17 per cent. of the full penalties to which the defendants were liable, as compared with 10 per cent. in 1904, 18 in 1903, and 17 in 1902. Including costs, the amounts imposed by the magistrates for each conviction averaged £7 1s. 0d., as compared with £3 1s. Od. in 1904, £4 10s. Od. 1903, and £4 10s. 0d. in 1902. In, several of the cases in which proceedings were taken during 1905 there had been previous convictions. Five samples of sausages, one of German and four of beef, were submitted for analysis. The German sausage contained 11 grains of boric acid per pound, and three of the beef 7, 18 and 35 grains per pound respectively. In the cases of these sausages containing boric acid, summonses were applied for against the vendors. In granting the summonses, however, the magistrate intimated that he would not hear the cases, until an appeal against a conviction obtained by a neighbouring sanitary authority in a similar case had been settled. In view of the long delay likely to ensue before 59 this appeal would come on for hearing, and having regard to a communication from the London Butchers and Pork Butchers' Trade Society submitting to the Council that in all fairness, some notification ought to be given before the institution of legal proceedings, the summonses were ordered to be withdrawn by the Council. With regard to the use of boric acid in food, its employment as a preservative appears to be very common. In their report (1901) the Departmental Committee of the Board of Agriculture recommended that the amount of boric acid allowable as a preservative in cream should not exceed 0.25 per cent., and in the case of butter 0.5 per cent. The latter amount is equivalent to about 38 grains per pound. Butter, however, is not under ordinary circumstances likely to be consumed by a single person at the rate of one pound for a meal or anything like such an amount, consequently, butter containing that amount of boric acid is not likely to occasion any appreciable injurious results in a healthy individual. With sausages containing 35 grains of boric acid per pound, the case is different. A pound of sausages may be consumed at a single meal by a hungry man. There is, therefore, the possibility of an excessive amount of boric acid being taken with sausages containing as much as 35 grains to the pound, which is more than two full doses, and might give rise to unpleasant symptoms even in a healthy man. Boric acid is used internally as medicine in epilepsy sometimes, and also for its local action on the bladder in some forms of disease of that organ. It is largely eliminated from the system by the kidneys, and if these organs are unsound it is a question for very careful consideration, whether it is advisable for boric acid to be taken even in the smallest of doses. Cases of accidental poisoning by boric acid have been recorded, the chief symptoms noted being vomiting, diarrhoea, feebleness of the heart s action, collapse, increased frequency of passing water, bloody urine, skin eruptions, and a stur perous condition ending in death. No cases of fatal poisoning through the use of boric acid as a food preservative have, so far as I am aware, attracted attention, but in the opinion of many eminent authorities the use of boric acid as a food preservative is not free from risk. The samples of lard, coffee, bread and butter, golden syrup, treacle, and almond oil were all reported upon by the analyst as genuine. The subjoined table snows a comparison of the results of the work under the Food and Drugs Acts during the years 1902-5 inclusive:— Year. Number of Samples. Number of persons in the Borough to each sample. Number of samples adulterated. Percentage of samples adulterated. Number ef prosecutions instituted. Summonses withdrawn on account of warranties, &c. Prosecution 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 0 1904 612 189 110 17.9 55 6 50 46 128 5 0 306 0 0 1905 536 215 98 18.2 57 2 51 47 233 18 0 267 0 0 60 It is noticeable that the reduction of the number of samples taken in 1904 as compared with the number taken in 1903 was associated with an increase in the percentage of samples found adulterated in 1904, and the same is noticeable in respect to the reduction in the number of samples in 1905. The last increase, however, is small. SANITARY STAFF. As mentioned in my report for 1904, at the close of that year, the question of adequacy of the sanitary staff was receiving the attention of the Health Committee. The advisability of appointing a female sanitary inspector for special duties, and also of an additional inspector specially qualified as to meat inspection to take over all work under the sale of Food and Drugs Acts and food inspection generally, including the inspection of slaughterhouses, cowhouses, and premises upon which milk is sold and food prepared for consumption by the public was considered by tne Committee. In the end the Committee decided that it was unnecessary to make any addition to the existing sanitary staff, and reported to the Council accordingly, who adopted their report. At the end of the year the Council lost the services of a very capable sanitary inspector in the person of Mr. J. H. Clements, who left on December 31st, to take up a similar position under the Borough Council of Lambeth. His place in Shoreditch was filled by Mr. J. H. Pearson, who was for several years sanitary inspector at Broadstairs. Mr. Pearson was appointed by the Council on January 16th of the current year. In conclusion, I have to thank the various officers of the Health Department for the assistance they have afforded me in connection with the work of the department during the year under review and to express my satisfaction as to the manner in which they have discharged their duties. I have also to acknowledge my indebtedness to the chairman and members of the Health Committee for the consideration and help which 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 OF HEALTH. CONTAINING Statistical Tables, a Summary of Sanitary Proceedings under the Public Health and Factory and Workshop Acts, during the Year 1905, and other Information. Tables I., II., III., IV. and V. are forms required by the Local Government Board. 62 TABLE 1. BOROUGH OP SHOREDITCH. Vital Statistics of whole District during 1905 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 Y ear 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 34.6 704 166 2582 21.0 826 428 312 2466 201 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 1904 117360 3763 32.0 706 190 2315 19.6 811 366 434 2392 20.6 Averages for years 1893 to 1904 120896 4171 34.5 774 185 2666 22.0 815 404 369 2635 21.7 1905 116939 3894‡ 33.3 652 165 2234 19.1 867 391 451 2296 19.6 § * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. ‡ Total registered in the Borough, 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 1905 fourteen 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 is given on pages 7 and 8 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 At Census of 1901. 63 TABLE II. BOROUGH OF SHOREDITCH. Vital Statistics of separate Localities in 1905. 1—Moorfields Ward. 2—Church Ward. 3—Hoxton Ward. 4—Wenlock Ward. 5—Whitmore Ward. 6—Kingsland Ward. 7—Haggerston Ward. 8—Acton Ward. Year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. De.it hs under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of 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. a. b. c. d. a. b. c. d. a. b. C. d. 1895 5831 137 84 17 20103 727 430 125 18216 674 389 130 18342 521 326 88 18461 647 446 105 11281 420 205 60 12314 413 208 75 12391 414 208 52 (a) Owing to the alteration in respect to the registration sub-districts referred to on page 1 of the report it has been necessary to select fresh localities for statistical purposes. The eight wards of the Borough have accordingly been adopted as separate localities for the purposes of this table. If required the figures relating to the new registration sub-districts may be obtained from this table, as Wards 1, 2 and 3 form the Shoreditch South Registration sub-district, 4 and 5 that of Shoreditch North-West, and 6, 7 and 8 that of Shoreditch NoTth-East. (b) 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.") (it) Deaths of residents occurring in public institutions have been allotted to the respective localities according to addresses of the deceased. (d) The population of locality No. 4 includes the population in the Holborn Union Workhouse, estimated at 1,375. 64 TABLE III. BOROUGH OF SHOREDITCH. Cases of infectious disease notified during the Year 1905. 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. 1. 2. s. 4. 5. 6. 7. 8. 1. 2. 3. 4. 5. 6. 7. 8. Under 1. 1 to 5 5 to 15 15 to 25 25 to 65 65 and up- wards Moorfields. Church. Hoxton Wenlock. Whitmore. Kirgsland. Haggerston Acton. Moorfields. Church Hoxton Wenlock. Whitmore. Kingsland. Haggerston Acton. Small-pox 2 ... 1 ... 1 ... ... ... ... ... ... 1 ... l ... ... ... ... ... 1 ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 176 6 82 67 12 9 ... 4 26 27 25 22 15 31 26 4 26 27 23 19 14 28 23 Membranous croup 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... Erysipelas 138 5 6 11 13 83 20 8 27 11 28 24 12 14 14 ... 1 ... 1 2 ... ... ... Scarlet fever 789 9 277 471 20 12 ... 14 107 175 152 128 67 67 79 13 104 173 150 123 65 63 75 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 36 ... 2 13 6 15 ... 1 6 3 5 4 7 7 3 1 5 3 4 2 6 5 2 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 9 ... ... ... 1 8 ... ... 2 1 1 1 3 ... 1 ... 1 ... ... ... 2 ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1151 20 368 563 53 127 20 27 168 217 211 180 104 121 123 18 137 203 178 147 87 97 100 65 TABLE IY. BOROUGH OF SHOREDITCH. Causes of, and ages at, death during Year 1905. Causes of Death. Deaths in or belonging to whole District at subjoined ages. Deaths in ok belonging to Localities at all Ages. Total Deaths InPublic Institu tions 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 Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Small-pox 2 ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... Measles 60 15 45 ... ... ... ... 1 9 20 9 7 3 4 7 3 Scarlet fever 27 3 19 5 ... ... ... 2 3 2 4 5 4 3 4 ... Whooping-cough 85 28 56 1 ... ... ... 3 27 19 9 11 ... 10 b 11 Diphtheria and membranous croup 17 ... 13 3 ... 1 ... ... 4 1 2 4 ... 4 2 ... Croup 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 2 ... ... ... ... 2 ... ... 1 ... ... ... 1 ... ... ... Other contd. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza 11 ... 1 ... ... 4 6 1 1 ... 1 4 1 2 1 5 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa (see notes below) 151 121 22 2 ... 2 4 26 38 23 28 6 19 11 9 Enteritis (see notes below) 66 51 12 ... ... 2 1 11 10 9 15 5 8 8 9 Puerperal fever 4 ... ... ... ... 4 ... ... 1 ... 1 ... 2 ... ... 3 Erysipelas 3 1 ... ... ... 1 1 ... ... ... ... ... 1 1 1 2 Other septic diseases 20 3 3 3 3 7 1 1 5 3 3 5 1 2 ... 5 Phthisis 215 1 10 6 24 168 6 9 45 24 30 43 20 18 26 136 Other tuberculous diseases 106 30 45 15 6 10 ... 4 18 15 19 19 12 11 8 16 Cancer, malignant disease 102 ... ... 2 2 70 28 6 13 17 12 19 1 1 8 16 48 Bronchitis 225 55 16 1 1 76 76 5 34 49 37 54 22 22 9 122 Pneumonia 223 55 63 6 7 68 24 9 48 36 25 46 22 16 21 64 Pleurisy 7 1 1 ... 1 3 1 1 1 3 2 4 Other diseases of Respiratory organs 4 ... ... 1 ... 3 ... ... 1 ... 2 1 ... ... ... 7 Alcoholism 45 ... ... ... ... 41 4 1 13 9 7 5 7 ... 3 31 Cirrhosis of liver Venereal diseases 11 9 1 ... ... 1 ... ... 4 1 3 1 2 ... ... 6 Premature birth 72 72 ... ... ... ... ... 4 15 18 8 6 6 10 5 7 Diseases and accidents of parturition 2 ... ... ... 1 1 ... ... 1 ... 1 ... ... ... ... 1 Heart diseases 144 1 4 16 9 77 37 8 25 16 16 96 17 13 23 61 Accidents 89 31 15 9 3 21 10 5 18 15 14 14 10 7 6 22 Suicides 12 ... ... 1 2 8 1 ... 2 2 4 3 1 ... ... 2 All other causes 590 175 35 17 13 158 192 25 103 100 84 129 51 49 49 298 All Causes 2296 652 363 88 73 728 392 84 430 389 326 446 205 208 208 867 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 9-16, 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 9-16 of this Table. (b) See notes on Table I. as to the meaning of "residents" and "non-residents," and as to the "Public Institutions," and on Table II. as to meaning of "localities," 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 diarrhœa; Dysentery and dysenteric diarrhœa; 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. 66 TABLE V. BOROUGH OF SHOREDITCH. Infantile Mortality during the year, 1905, showing deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OP DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 34 Weeks. Total under 1 Month. 1-2 MODtllS 2-3 Months 3-4 Months 4-5 Months 5-6 Months 6-7 Months 7-8 Months 8-9 Months 9-10 Months 10-11 Months 11-12 Months Total Deaths under 1 Year. All causes Certified 64 30 28 14 136 86 63 50 41 42 34 52 37 32 41 36 650 Uncertified 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 2 Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... 1 ... 3 3 3 1 4 15 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 3 Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 2 3 2 1 2 2 4 2 1 4 5 28 Diarrhoeal Diseases. Diarrhoea, all forms ... ... ... ... ... 5 16 13 6 15 11 19 8 7 15 6 121 Enteritis (not Tuberculous) ... ... ... ... ... 3 7 3 2 2 3 2 4 2 1 2 31 Gastritis, Gastro-intestinal Catarrh 1 ... ... 1 2 1 3 4 9 2 2 1 3 1 1 ... 29 Wasting Diseases. Premature Birth 35 8 10 7 60 7 2 1 2 ... ... ... ... ... ... ... 72 Congenital Defects 8 3 2 ... 13 5 ... ... ... ... ... ... ... ... ... ... 18 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... 1 1 2 1 ... 1 1 ... ... ... ... ... ... ... 5 Atrophy, Debility, Marasmus 11 8 4 2 25 23 10 10 2 8 3 6 2 2 1 2 94 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... 1 3 1 2 3 10 Tuberculous Peritonitis: Tabes Mesenterica ... ... ... ... ... 4 2 1 1 4 1 1 1 1 ... ... 16 Other Tuberculous Diseases ... ... ... ... ... ... 1 ... 1 ... 1 1 ... 1 ... ... 5 Erysipelas ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Syphilis 2 1 ... ... 3 4 1 1 ... ... ... ... ... ... ... ... 9 Rickets ... ... ... ... ... ... ... 1 ... ... 1 1 ... 1 ... ... 4 Meningitis (not Tuberculous) ... ... ... ... ... 1 1 1 3 1 2 ... ... 1 2 1 13 Convulsions 4 1 2 1 8 2 1 1 1 ... ... 2 1 ... 1 ... 17 Bronchitis ... 5 3 1 9 7 5 5 5 3 3 5 4 3 4 2 55 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 1 ... 2 1 4 6 6 3 1 2 3 3 5 6 7 9 55 Suffocation, overlaying 2 1 1 ... 4 11 5 3 4 2 ... 1 ... ... ... ... 30 Other Causes 1 2 3 ... 6 4 ... ... 2 ... 2 ... 1 3 2 1 21 65 30 28 14 137 86 63 50 41 42 34 52 37 33 41 36 652 Births in the year—Legitimate 3861, illegitimate 92. Population, estimated to middle of 1905, 116,939. Deaths from all Causes at all Ages 2,296. TABLE VI. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD, DURING THE YEAR ENDING 31st DECEMBER, 1905. 68 67 TABLE VI. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1905. 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. DEATHS IN EACH WARD FROM ALL CAUSES. CAUSES OF DEATH. AGES. Moorfields. Church. Hoxton Wenlock. Whitmore. Kingsland. Haggerston. Acton. 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. 00 ana upwards. 1 Small Pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 15 45 ... ... ... ... ... ... ... ... ... ... ... 1 9 20 9 7 3 4 7 35 25 60 3 Scarlet fever 3 19 5 ... ... ... ... ... ... ... ... ... ... 2 3 2 4 5 4 3 4 16 11 27 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza ... 1 ... ... ... ... ... ... 1 3 4 2 ... 1 1 ... 1 4 1 2 1 4 7 11 6 Whooping cough 28 56 1 ... ... ... ... ... ... ... ... ... ... 3 27 19 9 11 ... 10 6 45 40 85 7 Diphtheria, membranous croup ... 13 3 ... ... ... 1 ... ... ... ... ... ... ... 4 1 2 4 ... 4 2 8 9 17 8 Enteric fever ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 2 ... 2 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 82 11 1 ... ... ... ... ... ... 2 1 ... ... ... 19 20 12 22 5 12 7 48 49 97 11 Epidemic or zymotic enteritis 39 11 1 ... ... ... ... ... ... ... 2 1 ... ... 7 18 11 6 1 7 4 28 26 54 12 Other allied diseases ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 9 1 ... ... ... ... ... 1 ... ... ... ... ... ... 4 1 3 1 2 ... ... 5 6 11 19 Gonorrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedœna, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 1 ... 3 3 22 Puerperal fever ... ... ... ... ... ... 4 ... ... ... ... ... ... ... 1 ... 1 ... 2 ... ... ... 4 4 23 Pyaemia, septicaemia 3 2 ... 2 1 1 ... 2 2 1 1 ... ... 1 3 3 2 3 1 2 ... 10 5 15 24 Infective endocarditis ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... 2 25 Other allied diseases ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... 2 ... ... 1 ... ... ... 1 2 3 26 Malarial fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Rheumatic fever ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 2 28 Rheumatism of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis: 29 Brain or meninges, acute hydrocephalus 10 27 3 6 1 1 ... ... 1 ... ... ... ... 3 7 8 7 8 8 3 5 27 22 49 30 Larynx ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 1 2 ... 2 31 Lungs 1 10 ... 6 10 14 33 67 49 19 5 1 ... 9 45 24 30 43 20 18 26 131 84 215 32 Intestines, tabes mesenterica 16 1 2 ... ... 1 2 ... ... ... ... ... ... 1 3 3 4 4 5 2 14 8 22 33 General, position undefined 3 16 3 1 1 ... 3 1 1 1 ... ... ... ... 6 4 7 6 4 2 1 16 14 30 34 Other forms, scrofula 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 1 2 3 35 Other Infective diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . .. ... ... ... ... ... ... ... 36 Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 Hydatid diseases ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 39 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Other diseases due to altered food ... ... ... ... ... ... ... ... ... .. . ... ... ... ... ... ... ... ... ... ... ... ... 41 Acute alcoholism, delirium tremens ... ... ... ... ... ... 2 1 1 ... ... ... ... ... 1 2 ... ... 1 ... ... 4 ... 4 42 Chronic alcoholism ... ... ... ... ... ... 1 5 7 4 ... ... ... 1 7 1 2 2 3 ... 1 8 9 17 43 Chronic industrial poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . .. ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 1 46 Gout ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... l ... 1 47 Cancer ... ... ... ... ... 1 4 12 20 20 15 10 ... 5 11 13 12 18 7 7 9 37 45 82 48 Diabetes mellitus ... ... ... ... ... ... 2 1 2 1 ... ... ... ... 2 4 2 2 ... ... 6 4 10 49 Purpura hœmorrhagica ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 50 Hæmophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anæmia, lecucocythæmia ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 69 70 DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31ST, 1905. DEATHS IN EACH WARD FROM ALL CAUSES. CAUSES OF DEATH. AGES. Moorfields. Church. Hoxton. Wenlock. Whitmcre. Kingsland. Haggerston. Acton. 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 65. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 53 Premature birth 72 ... ... ... ... ... ... ... ... ... ... ... ... 4 15 18 8 6 6 10 5 46 26 72 54 Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 Debility at birth 9 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 6 ... ... 2 7 2 9 56 Atelectasis 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 2 5 ... 5 57 Congenital defects 18 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 4 1 2 4 1 10 8 18 58 Want of breast milk 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 2 ... ... 3 2 5 59 Atrophy, debility, marasmus 85 4 ... ... ... ... ... ... ... ... ... ... ... 4 15 21 12 13 11 7 6 45 44 89 60 Dentition 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... 1 2 2 4 61 Rickets 4 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 4 ... ... 1 b 1 7 62 Old Age, senile decay ... ... ... ... ... ... ... 4 33 59 22 6 17 18 16 37 4 10 10 46 72 118 63 Convulsions 17 3 ... ... ... ... ... ... ... ... ... ... 1 2 3 5 3 2 1 3 13 7 20 64 Meningitis 13 8 3 ... ... ... ... 1 1 . . . ... ... ... 8 5 1 4 1 4 3 14 12 26 65 Encephalitis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 66 Apoplexy ... ... ... ... ... ... ... 2 11 11 19 7 3 2 6 13 7 12 2 4 7 22 31 53 67 Softening of brain ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 1 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... 3 2 2 2 ... 1 1 ... 2 1 4 ... 5 4 9 69 General paralysis of insane ... ... ... ... ... 1 1 2 2 1 ... ... 1 1 2 2 1 ... ... ... 4 3 7 70 Other forms of insanity ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Chorea ... . . . ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 72 Cerebral tumour ... 1 ... ... ... ... ... ... 1 1 1 ... ... 1 ... 1 1 ... ... 1 ... 2 2 4 73 Epilepsy ... ... ... ... ... ... ... 2 2 ... ... ... ... 1 ... 1 1 ... ... 1 1 3 4 74 Laryngismus Stridulus ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 75 Locomotor Ataxy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 Paraplegia, diseases of spinal cord ... 1 ... . . . ... ... ... ... 1 1 ... ... ... 1 .. ... ... ... ... 2 ... 3 ... 3 77 Other diseases of brain or nervous system ... ... ... ... ... ... 1 ... 3 2 ... ... ... ... ... 1 2 1 ... ... 2 4 2 6 78 Otitis, otorrhœa 1 2 2 1 ... ... ... ... ... ... ... ... ... ... 3 1 1 1 ... ... ... 2 4 6 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... 3 ... 3 82 Endocarditis, valvular diseases of the heart ... 1 3 4 2 3 8 5 10 10 10 1 ... 3 8 7 7 7 8 5 12 31 26 57 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... 1 85 Aneurism ... ... ... ... ... ... 1 3 ... 2 2 ... ... 1 3 ... 3 ... 1 ... 7 1 8 86 Senile gangrene ... ... ... ... ... ... ... ... ... 1 2 4 ... 1 1 1 1 2 1 ... ... 6 1 7 87 Embolism, thrombosis ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 1 ... ... ... ... 1 1 2 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular ... 2 4 4 ... 4 2 9 10 23 13 11 1 5 15 8 9 19 8 8 11 35 48 83 91 Laryngitis ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 . .. ... ... ... ... ... 1 1 92 Croup ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 93 Other diseases of larynx and trachea ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 94 Acute bronchitis 55 16 ... ... ... 1 4 2 l 6 6 2 2 1 14 21 13 21 9 12 4 51 44 95 95 Chronic bronchitis ... ... ... 1 ... ... 3 8 18 34 51 15 ... 4 20 21 24 33 13 10 5 64 66 130 96 Lobar, croupous pneumonia 1 6 ... ... ... 1 3 6 3 6 2 1 ... 2 7 3 2 8 2 1 4 21 8 29 97 Lobular, broncho-pneumonia 39 36 2 ... 1 1 ... 1 3 2 6 4 ... 4 21 13 15 13 10 9 10 41 54 95 98 Pneumonia, form not stated 15 21 4 ... 1 3 6 13 16 9 9 2 ... 3 20 20 8 25 10 6 7 68 31 99 99 Emphysema, asthma ... ... ... ... . . . ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 100 Pleurisy 1 1 ... ... 1 ... ... 1 1 1 1 ... ... ... 1 1 3 ... ... ... 2 4 3 7 101 Other and ill-defined diseases of respiratory system ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 1 ... ... ... 3 ... 3 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... ... 2 3 3 3 ... ... ... ... ... 2 2 2 2 ... 3 7 4 11 106 Other diseases of stomach 9 4 1 ... ... ... 1 ... 3 3 ... ... ... ... 6 1 2 4 6 2 ... 7 14 21 107 Enteritis 51 12 ... ... ... ... 1 ... ... 1 1 ... ... ... 11 10 9 15 5 8 8 32 34 66 108 Appendicitis ... ... 1 ... ... 1 ... ... ... 2 ... ... ... ... 1 1 ... 2 ... ... ... 2 2 4 109 Obstruction of intestine 1 ... 3 ... ... ... ... ... ... 2 3 1 ... 1 1 ... 1 3 2 1 1 7 3 10 110 Other diseases of intestine ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... 1 111 Cirrhosis of liver ... ... ... ... ... ... ... 2 11 7 3 1 ... ... 5 6 5 3 3 ... 2 11 13 24 112 Other diseases of liver 1 ... ... ... 1 2 4 2 ... ... ... ... ... 3 1 3 3 ... ... ... 4 6 10 113 Peritonitis ... ... 2 ... ... ... 1 1 2 2 ... ... ... ... ... 3 3 2 ... ... ... 4 4 8 114 Other and ill-defined diseases of digestive system ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 1 ... 2 2 71 72 DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31ST, 1905. DEATHS IN EACH WARD FROM ALL CAUSES. CAUSES OF DEATH. AGES. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. 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 Acute nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Bright's disease 1 1 ... 2 ... 1 7 5 12 12 17 6 ... 1 18 9 8 12 11 2 3 30 34 64 118 Calculus ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... 2 119 Diseases of bladder and prostrate ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 1 ... ... ... 1 1 3 ... 3 120 Other and ill-defined diseases of urinary system ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 121 Diseases of testis and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Placenta prævia, flooding ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 130 Puerperal thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... ... 1 2 ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 3 3 132 Arthritis, ostitis, periostitis ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 2 133 Other and ill-defined diseases or osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 134 Ulcer, bedsore ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 1 135 Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 ... ... 1 1 ... 1 3 1 ... ... ... 2 2 ... 3 1 ... 2 ... 8 2 10 140 On railways ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 On vessels & docks, excluding drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 142 In building operations ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 143 By machinery ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 144 By weapons and implements ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 145 Burns and scalds ... 11 ... ... ... ... ... 1 ... ... ... 1 ... ... 2 3 1 2 5 2 2 4 13 17 146 Poisons, poisonous vapours ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 147 Surgical narcosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 150 Drowning ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 151 Suffocation, overlaid in bed 29 ... ... ... ... ... ... ... ... ... ... ... 4 7 7 5 4 2 ... 20 9 29 152 Suffocation, otherwise 1 ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... 2 1 3 153 Falls, not specified 1 3 ... ... ... ... ... 1 4 1 ... 1 ... 1 3 3 3 6 ... ... 2 11 7 18 154 Weather agencies ... ... ... ... ... . . . ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 2 1 3 155 Otherwise, and not stated ... ... ... ... ... ... ... 2 1 ... ... ... 1 1 3 ... ... ... ... ... ... 3 1 4 156 Homicide ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 2 Suicides, all forms. 157 By poison ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... 1 1 1 1 ... ... ... 3 1 4 158 By asphyxia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 159 By hanging and strangulation ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 ... ... ... ... 2 ... 2 160 By drowning ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 161 By shooting ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 162 By cut or stab ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 163 By precipitation from elevated places ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 By crushing ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 ... 2 165 By other and unspecified methods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 168 Other ill-defined and not specified causes 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... 1 1 ... ... ... 1 2 3 169 Malignant disease ... ... ... 2 ... 1 1 2 4 7 1 1 1 1 2 4 ... 1 4 1 7 8 12 20 170 Abscess 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 1 ... ... ... 1 2 3 171 Cerebro-spinal Meningitis ... 1 ... l ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 ... 2 Totals 652 363 52 36 24 49 108 172 228 220 223 138 31 84 430 389 | 326 446 205 208 208 1229 1067 2296 73 TABLE VII. — ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1905. Districts. Estimated population 1905. Annual Rate per 1000 persons living. Deaths under 1 year to 1000 Births. percentage to total deaths. Births deaths during the years: deaths during 1905 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. 1902. 1903. 1904. 1905 London 4,684,794 27.1 17.2 15.7 16.1 15.6 1.7 0.00 0.36 0.11 0.11 0.32 0.05 0.72 2.0 0.6 131 9.9 37.5 0.2 Shoreditch § 115,564 34.2 20.9 19.6 20.6 19.8 2.8 0.01 0.52 0.23 0.14 0.73 0.01 1.30 2.7 0.9 165 12.2 40.3 0.13 Wards. Moorfields 5,831 23.5 ... ... ... 14.4 1.0 ... 0.17 0.34 ... 0.51 ... ... 2.2 0.8 124 11.9 39.2 1.19 Church 20,103 36.1 ... ... ... 21.3 3.4 ... 0.44 0.14 0.19 1.34 0.04 1.29 3.1 0.9 172 14.6 39.0 0.46 Hoxton 18,216 37.0 ... ... ... 21.3 4.3 ... 1.09 0.10 0.05 1.04 ... 2.08 2.1 0.9 193 131 31.1 ... Wenlock §16,967 30.7 ... ... ... 17.7 2.7 ... 0.53 0.23 0.11 0.53 ... 1.35 2.9 1.0 169 19.0 34.6 ... Whitmore 18,461 35.0 ... ... ... 24.1 3.0 0.05 0.37 0.27 0.21 0.59 0.05 1.51 3.3 0.9 162 10.3 55.6 ... Kingsland 11,281 37.2 ... ... ... 18.1 1.2 ... 0.26 0.35 ... ... ... 0.53 2.8 0.9 143 15.6 41.4 ... Haggerston 12,314 33.5 ... ... ... 16.8 3.3 ... 0.32 0.24 0.32 0.81 ... 1.54 2.3 0.6 181 6.7 36.5 ... Acton 12,391 33.4 ... ... ... 16.7 2.4 ... 0.56 0.32 0.16 0.48 ... 0.89 2.7 0.4 125 11.0 38.4 ... * Fever includes typhus, typhoid, and continued fevers. § The inhabitants of the Holborn Union Workhouse, which is situate in Wenlock Ward, 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. 74. TABLE VIII. ANALYSIS of the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31st, 1905. Diseases. Diseases. All Causes 4,014 38 Congenital malformations ... 1 Small-pox ... 39 Old age 149 2 Measles 70 40 Apoplexy 9 3 Scarlet fever 24 41 Epilepsy 40 4 Typhus ... 42 Convulsions 2 5 Relapsing fever . . . 43 Other diseases of brain and nervous system 202 6 Influenza 84 7 Whooping cough 46 44 Diseases of organs of special sense 23 8 Diphtheria 3 9 Simple, continued and illdefined fever 13 45 Diseases of circulatory system 149 10 Enteric fever 3 46 Laryngitis 3 11 Simple cholera ... 47 Bronchitis 951 12 Diarrhœa, dysentery 99 48 Pneumonia 60 13 Remittent fever ... 49 Pleurisy 31 14 Hydrophobia ... 50 Other respiratory diseases 38 15 Glanders ... 16 Cow pox and effects of vaccination ... 51 Dentition 9 52 Quinzy, sore throat 31 17 Venereal affections 29 53 Enteritis 88 18 Erysipelas 29 54 Peritonitis 1 19 Pyæmia and septicæmia 4 55 Diseases of liver 26 20 Puerperal fever ... 56 Other diseases of digestive system 270 21 Tabes mesenterica 1 22 Tuberculous meningitis ... 57 Diseases of lymphatic system and ductless glands 10 23 Phthisis 220 24 Scrofula, tuberculosis 12 25 Other zymotic diseases 31 58 Diseases of urinary system 43 26 Thrush 1 59 Diseases of generative system 26 27 Worms and other parasitic diseases ... 60 Accidents of childbirth 12 61 Diseases of locomotive system 165 28 Starvation, want of breast-milk 2 62 Diseases of integumentary system 96 29 Alcoholism 16 30 Rheumatic fever and rheumatism of heart 32 INJURIES.- 63 Fracture and contusion 36 31 Rheumatism 308 64 Gun shot wounds ... 65 Cut, stab 2 32 Gout 62 66 Burns or scalds 2 83 Rickets 4 67 Poison 4 34 Cancer 37 68 Drowning ... 35 Other constitutional diseases 47 69 Suffocation ... 36 Premature birth ... 70 Otherwise 64 71 Other causes 295 37 Atelectasis ... 75 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1905.— Table IX. PREMISES. NUMBER OP PLACES— Number of inspections, 1905. Number of notices, 1905. Number of prosecutions, 1905. On register at end of 1904. Added in 1905. Removed in 1905. On register at end of 1905. Milk premises 294 30 35 289 3690 10 ... Cowsheds 7 ... ... 7 42 ... ... Slaughter-houses 13 ... 1 12 67 ... ... Other offensive trade premises 1 ... ... 1 ... ... ... Ice cream premises 69 10 7 72 172 21 ... Registered houses let in lodgings 257 26 ... 283 356 110 1 Number of intimation notices served for all purposes 2572 Overcrowding, 1904:— Number of dwelling rooms overcrowded 102 Number remedied 102 Number of prosecutions Nil Number of premises dealt with under Section 20 of the London County Council (General powers) Act, 1891 22 Underground rooms:— Number dealt with during year 5 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 14 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 20 Customs and Inland Revenue Acts:— Number of houses for which applications were received during year Nli Number of prosecutions under By-laws under Public Health (London) Act, 1891, other than those with respect to houses let in lodgings Nil Mortuary:— Total number of bodies removed 417 Total number of infectious bodies removed 3 FACTORY AND WORKSHOP ACT, 1901. SUMMARY OF PROCEEDINGS. 76 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 34 – – Workshops (Including Workshop Laundries.) 2932 477 – Workplaces 827 98 – Homeworkers' Premises 743 94 – Total 4536 669 – 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 501 501 — — Want of Ventilation 3 3 — — Overcrowding 5 5 — — Want of drainage of floors — — — — Other nuisances 109 109 — — Sanitary accommodation insufficient 7 7 — — unsuitable or defective 38 38 — — 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) 17† 17 — — Giving out work to be done in premises which are unwholesome (S. 108) — — — — infected — — — — Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S. 109) — — — — Other offences — — — — Total 680 680 — — * 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. 77 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) — 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 84 (Referring to 132VVorkshops) Reports (of action taken) sent to H.M. Inspectors 13 (Referring to l32 Workshops) Other — Underground Bakehouses (S. 101):— Certificates granted during 1905 — In use at the end of 1905 45 Homework:— Number of Lists of Outworkers* (S. 107):— Lists. Out- workers Lists received 31 | 629 Addresses of Outworkers forwarded to other Authorities 494 received from other Authorities 1305 Homework in unwholesome or infected premises:— Wearing Apparel; Other Notices prohibiting homework in unwholesome premises (S. 108) — — Cases of infectious disease notified in homeworkers' premises 62 13 Orders prohibiting homework in infected premises (S. 110) — — Workshops on the Register (S. 131) at the end of 1904. Workshop Laundries 32 Workshop Bakehouses 75 Other Workshops and Workplaces 1186 Total number of workshops on Register 1293 *The lists should be received twice in the year. The year's figures in the table are those obtained by adding together the two half-yearly totals. 76 METROPOLITAN BOROUGH OF SHOREDITCH. PUBLIC HEALTH DEPARTMENT. Shoreditch Town Hall, London, E.C., 10th February, 1905. To the Chairman and Members of the Health Committee. Gentlemen, SEWER VENTILATION AND INTERCEPTING TRAPS. We beg to submit for your consideration our views on the subjects dealt with in the reports of the Borough Surveyors of Lewisham and Shoreditcth, dated November 4th and December 22nd, 1904, respectively, and the recommendations contained therein. As instructed we have more especially directed attention to those portions of the reports attacking the use of interceptors. The Borough Surveyor of Lewisham, in his report, opens with the statement that "the whole question of the ventilation of sewers is surrounded by difficulties and unfortunately engineers hold very different opinions as to the best means of dealing with the matter." After referring to the unsatisfactory results which have apparently attended the use of columns erected for the purpose of ventilating sewers and preventing nuisance, he goes on to deal with the question of ventilating them through the house drains. If we do not misunderstand him he suggests as a partial mitigation of the nuisance that the sewer ventilators should be put much nearer together and that efforts should be made to obtain the repeal of the London County Council bye-law with reference to interceptors, his theory apparently being that if the numbers of openings in the roadways were increased, and the ventilation pipes of the house drains were used for ventilating the sewers, there would be fewer complaints of smells in the roadways. In the last paragraph but one of his report, he directs attention to the fact that although the interceptor was not made compulsory until the passing of the bye-laws in 1900, many of the local authorities of the Metropolis insisted on their use, whilst in Lewisham not only was their use not insisted on, but builders were advised not to use them, and he considers that this action has been justified over and over again by the low death rate in the Parish of Lewisham. The Borough Surveyor of Shoreditch, after discussing the question of sewer ventilation from a Shoreditch point of view, devotes some eight paragraphs to attacking the use of intercepting traps in connection with house drains. He concludes his report by advising that in regard to the placing of surfaoe ventilators, the communication from the Lewisham Borough Council be received, that is, he does not recommend that the number of openings in the roadways should be increased, but that as regards intercepting traps, efforts should be made to obtain the repeal of the bye-law referred to. 79 In considering these reports the first thing that strikes us is that the views of the two Surveyors do not agree. The suggestion of the Surveyor of Lewisham which may be regarded as the multiplication of the openings in the roadways and the abolition of interceptors differs most materially from the recommendation of the Surveyor of Shoreditch, which simply amounts to abolition of interceptors. The former, which provides for two sets of openings into the sewers, one to act as inlets and the other as outlets, is theoretically satisfactory, the latter is not so, as no provision is made for additional inlets. This difference is doubtless determined by the local knowledge possessed by the two gentlemen in question as to the existing conditions of the sewerage systems of their respective districts. We direct attention to it as it aptly illustrates the truth of the opening statement of the Borough Surveyor of Lewisham as to the divergence of opinion amongst Borough Engineers on the subject of sewer ventilation. We think it highly probable that the method suggested by the Surveyor of Lewisham would not be reliable and that the liability to smells in the roadways would remain. Indeed the Surveyor of Lewisham himself appears to hold a similar opinion, for he seems to refer to the mitigation of the nuisance as being a partial one. In theory the openings in the roadways should act as inlets to the sewers, whilst the ventilating shafts of the house drains should act as outlets. In practice, however, a variety of conditions affecting the flow of sewage, temperature and barometric pressure would undoubtedly come into play, and most seriously interfere with the proper action of the method suggested. Any method which simply depends upon the ventilating pipes of house drains, without increasing the number of openings in the roadways, such as appears to be in the mind of the Borough Surveyor of Shoreditch is hardly likely to satisfactorily ventilate the public sewers. It is difficult to understand how sufficient movement of air is going to be produced in the sewers under such a method. All that it can be relied upon to do is to allow of a certain amount of diffusion of the sewer gas from the outlets of the vent pipes of the house drains and this diffusion will again be very dependent upon meteorological conditions. Sanitarians hold that every possible step should be taken to prevent the impregnation of dwellings with sewer gas, and there is a very general impression in the public mind that sewer gas is much more dangerous in its effects than drain emanations. Certainly the effluvia from well-laid, properly ventilated and intercepted house drains are as a rule nothing in comparison with those commonly experienced in connection with public sewers. To dispense with intercepting traps and permit the emission of sewer gases from ventilation pipes on private premises, would, in our opinion, be a dangerous and possibly costly experiment. The smells from the sewer ventilators in the roadway are bad enough at times, but to have similar smells evolved in situations where they are much more liable to obtain access to dwellings by means of the windows or chimneys, as is very likely to be the case with the ventilation pipes of house drains which are not intercepted, is to our minds a short-sighted policy and one which is pretty certain to be associated with numerous complaints, and there is not much doubt that the air breathed in the dwellings in Shoreditch would be likely to be distinctly less pure than it is at present. 80 The reference of the Borough Surveyor of Lewisham to the low death-rate of the Parish of Lewisham, as justifying the non-use of intercepting traps will be dealt with later. It is alluded to by the Borough Surveyor of Shoreditch in his remarks deprecating the use of intercepting traps, which we will now proceed to comment on, taking the eight paragraphs he devotes to attacking them seriatim. In the first paragraph the Surveyor states that he strongly supports the idea of having no interceptors. From what he has seen "even in ShoTeditch, where they seem to be put in on every conceivable opportunity,'' his conviction is strengthened that they are more "a trouble and nuisance than anything else." With regard to this we would say that, so far as we are aware, in Shoreditch, interceptors are only used in connection with drains when the bye-laws require that they shall be used, and so far as our experience goes, their use does not materially add to the trouble and nuisance which is ordinarily associated with the construction and use of house drains. In the second paragraph the statement is made that the constant blocking and difficulty of clearing is a "prolific source of annoyance to all who have to do with them, and when placed under the public footway they are a frequent cause of obstruction to traffic when being attended to." This statement must be characterised as exaggerated and misleading. The Officers of the Health Department have most to do with the use of intercepting traps in Shoreditch and are best acquainted with the nuisances which from time to time are experienced in connection with them. Undoubtedly intercepting traps do become obstructed occasionally. All traps dependent upon a water seal for their effective action are liable to be blocked, but so far as our experience goes, the fact that a trap is used for intercepting house drains from the sewer does not materially add to this liability. From enquiries made for the purposes of this report we can say that obstructions in connection with intercepting traps have caused only a comparatively small proportion of the number of blockages in drains which have come under the notice of the Health Department during the past few years, as the following figures will show:— Inspector Lear reports that during the past four years, of 54 cases of obstructions in drains, or the pipes and apparatus in connection therewith, in six instances only was the. blockage in the intercepting trap. For the same period Inspector Firth reports six instances in 59 cases of drain obstruction, and Inspector Jordan nine in 44 cases. Inspector Langstone reports that from September, 1901, to December, 1904, he had 16 instances in which interceptors were blocked in 59 cases of obstructed drains, and Inspector Clements from September, 1903, to December, 1904, has not met with a single instance in which the interceptor was the cause of the blockage in some 28 cases of obstructed drains which have come under his notice during that period. In many of the obstructed drains there were no intercepting traps to become blocked. We estimate that about 14 per cent. of the obstructions in connection with drains which have come under the notice of the Health Department in recent years have been due to blockages in intercepting traps. In the great bulk of the cases the obstructions in the drains have had nothing to do with intercepting traps. 81 With respect to the point as to the interference with traffic, so far as we have been able to ascertain, the number of times it has been necessary to examine interceptors under footways has amounted to about sixteen during the past four years. The average has probably not exceeded four times a year, and even in these cases it has not always been found that the interceptors were at fault. With respect to the third paragraph, which deals with the flushing of drain traps, it is true that it usually requires more than one flush with an ordinary cistern to clear an intercepting trap. The trap has not only to be cleared, but also to be kept charged. It is therefore very probable that on inspection, an interceptor will be found to contain water contaminated with excreta. It is quite possible also that if left long enough the contents of the interceptor may make some very slight addition to the effluvia in a drain, but we very much question whether the use of the interceptor materially adds to the stink of a sewer. The whole of the drain along which fœcal and offensive matter and liquid are more or less constantly passing is contaminated and liable to be offensive. The interior of the drain, however, presents such a very much larger surface for the evolution of offensive gases than the comparatively small surface of the fluid in the interceptor and consequently bears such a much larger share in the production of drain effluvia, that the argument of the interceptor adding to the gases in a house drain does not appear to us to be of any weight against the use of interceptors. Moreover, even supposing the interceptor to make a material addition to the drain gases, no harm is done if the drain is efficiently ventilated as is required by the bye-laws. As a matter of fact, in ordinary use, the contents of the intercepting trap are renewed with sufficient frequency to prevent such fermentative changes as may be in progress, producing any marked effect in the evolution of drain gases. What is stated in the fourth paragraph as regards gas from sewers bubbling through the water in the intercepting traps is only likely to' happen during storms, when the sewers are charged with storm water. At such times a very limited amount of gas, chiefly generated in the portion of the drain between the interceptor and the sewer, is by the pressure of the contents of the sewer, liable to be forced through the interceptor. At such times, also, as is Well known, there may be, when the conditions are favourable, flooding of basements with sewage. Moreover, other traps in pipes leading to the sewers are liable to be forced, even the gullies in the roads. However, supposing the small quantity of gas above referred to be forced through the interceptor, the result can be of no practical significance if the drains are efficiently ventilated as they ought to be. That rats can dive through intercepting traps at will may be a fact, but experience shows that it is not the rule for them to do so. It has only occasionally been observed, and the use of the intercepting trap is one of the measures most relied upon for preventing rats infesting premises. 82 With respect to> the fifth paragraph, in view of the fact that intercepting traps are usually several feet below the surface of the ground and as a rule have a deeper seal than other forms of traps, we are unable to agree with the statement that "they are quickly affected and often unsealed by ordinary variations of temperature. Of course local warmth might evaporate the water in the trap, but as the water is, so long as the drain is in use, frequently being changed, it does not appear to us that the objection against the use of interceptors contained in this paragraph is worthy of serious consideration. We do not admit that the statement contained in the sixth paragraph as to the great majority of interceptors not being properly set, represents the truth, at least so far as Shoreditch is concerned. Even if it were true, it would not be a valid objection to the use of interceptors as such. It would rather indicate that better supervision was required on the part of the Sanitary Authority, to ensure that the bye-laws as to drain construction were properly complied with, With respect to the seventh paragraph, the statement that the majority of the Medical Officers in London are in favour of interceptors may be correct. Doubtless their opinion as to the utility of interceptors from a health point of view, carried some weight with the London County Council in framing their bye-laws. One of the objects of the bye-laws is to secure that the sanitary condition of the dwellings of the people, so far as house drainage is concerned, shall be as perfect as possible. Health officers naturally regard the use of intercepting traps from a health point of view, and as the use of such traps is regarded as the most reliable safeguard! against the emission of sewer gas on private premises, as such it has been advocated. A study of the bye-laws would, we think, make it impossible to believe that the London County Council, in framing them did not consider the opinions of engineers and other practical men who were well acquainted with the most modern views on the subject of house drainage. The eighth paragraph refers to a point to which the Borough Surveyor of Lewisham directs attention, viz.:—that the low death-rate of the Parish of Lewisham justifies the action taken in Lewisham against the use of interceptors, prior to the coming into operation of the bye-laws. We do not intend to discuss the nature of the connection assumed to exist between the low death-rate mentioned and the non-use of intercepting traps. All we desire to do is to direct attention to the following facts: (1) that of late years there has been a marked increase in the use of intercepting traps in the Metropolis, and that since the bye-laws were passed their use has become compulsory; and (2) the general death-rate of the Metropolis has of late years declined and since 1900, the year the bye-laws came into operation, it has been remarkably low. We think that inasmuch as the Borough Surveyor of Lewisham has put forward the low death-rate of the Parish of Lewisham in justification of the non-use of intercepting traps, we may with equal propriety point to the low death-rate of the Metropolis during recent years as justifying the use of such traps. 83 It is perhaps hardly necessary to point out that the repeal of the bye-law as to interceptors (No. 5) would also render nugatory bye-law No. 8 which provides for the ventilation of house drains. We venture to hope that what we have stated in defence of the use of interceptors will enable your Committee to arrive at the conclusion that neither of the Borough Surveyors has made out a good case against them. In our opinion the step advocated as to repealing the bye-law respecting intercepting traps is distinctly a retrograde one and on the grounds of public health we do not feel justified in recommending you to support it. We are, Gentlemen, Your obedient Servants, LEWIS T. FRASER BRYETT, Medical Officer of Health. H. ALEXANDER, Chief Sanitary Inspector. 84 METROPOLITAN BOROUGH OF SHOREDITCH. PUBLIC HEALTH (LONDON) ACT, 1891. BYELAWS. Made by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch with respect to Houses let in Lodgings or occupied by Members of more than one Family in the Metropolitan Borough of Shoreditch. 1. Throughout these Byelaws the expression "the Council" means the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. The expression "Byelaws of 1894" means the byelaws with respect to Houses let in lodgings or occupied by members of more than one family which were made by the Vestry of the Parish of St. Leonard, Shoreditch, on the 15th day of May, 1894, and were confirmed by the Local Government Board on the 20th day of July, 1894, and words and expressions which are defined in the byelaws of 1894 shall in these byelaws have the same meaning as in the byelaws of 1894. 2. Notwithstanding anything contained in the byelaws of 1894, proceedings shall not be taken against the landlord of a lodging house for an offence against any of the byelaws numbered 3 (three), 4 (four), 9 (nine), 10 (ten), 14 (fourteen), 15 (fifteen), 16 (sixteen), and 17 (seventeen), 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 byelaws has failed to comply with the byelaws within the time so specified. In pursuance of a resolution passed by the Sanitary Authority at their Meeting on the 4th day of July, one thousand nine hundred and five, the Common Seal of the Council of the Metropolitan Borough of Shoreditch, was hereunto affixed this 4th day of July, one thousand nine hundred and five, in the presence of H. BUSBY BIRD, Mayor. H. MANSFIELD ROBINSON, Town Clerk. Allowed by the Local Government Board this fifth day of August, 1905. S. B. PROVIS, Secretary, Acting on behalf of the said Board under the authority of their General Order, dated the twenty-sixth day of May, 1877.