SHOP 18 REPORT on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1907, 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 chas. straker and sons, ltd., bishopsgate avenue, london, e.c. CONTENTS. Page. Artizans' dwellings 42 Appendicitis, mortality from 9 Bacteriological examinations 35 Bakehouses 49 Births in sub-districts 2 Birth, rates 3 Cancer 9 Cerebrospinal fever 29 Coffeehouses 50 Cookshops 50 Cow-houses 45 Customs and Inland Revenue Acts 44 Dairies 45 Deaths in sub-districts 3 Death rate 4 Deaths, ages at 7 Deaths, causes of 9 Deaths in public institutions 10 Deaths in outlying institutions 10 Diarrhoea 26 Diphtheria 18 Disinfection 33 Enteric fever 21 Erysipelas 25 Factories and Workshops Act, 1901 46 Factories, workshops and workplaces—sanitary work 47 Fish offal 46 Food condemned and destroyed 51 Food and Drugs Act 53 Fried fish shops 51 Houses closed 40 Houses let in lodgings 44 Houses occupied by working classes, demolition of 41 House refuse, removal of 36 Ice cream shops 50 Infectious cases, number certified 13 Infectious cases, number removed to hospitals 14 Infectious diseases, age periods 12 Infectious diseases, deaths from 12 Infectious diseases, death rate 12 Infectious diseases, number of cases notified from schools Influenza 28 Institutions, deaths in 10 Legal proceedings 38 Margarine Act, proceedings under 55 Marriages 3 Measles 27 Milk-shops 45 Milk premises, cowsheds, etc., on register 45 Mortality, infant 4 Mortuary 34 Offensive business 46 Outworkers 43 Population 1 Puerperal fever 25 Sanitary work 36 Scarlet fever 17 Scarlet fever, return cases of 15 Schools, closure for infectious disease 33 Shelter 34 Sickness amongst the poor 11 Slaughter-houses 44 Small-pox 16 Page. Smoke nuisance 39 Staff 58 Street cleansing 36 Street markets and food 51 Tuberculosis 28 Vaccination returns 16 Verminous houses 40 Violence, mortality from 9 Water supply 34 Whooping cough 27 Workshops on register 46 Zymotic diseases, deaths from 12 Zymotic death rate 12 APPENDIX. Statistical Tables:— For whole district during 1907 and previous years (Table I.) 62 For separate localities in 1907 (Table II.) 63 (Janes of infectious disease notified during 1907 (Table III.) 64 Causes of, and ages at, death during year 1907 (Tables IV. and VI.) 65, 68 Infantile mortality during 1907 (Table V.) 66 Notes to Tables IV. and V 67 Comparison of London and Shoreditch birth and death rates in 1907 (Table VII.) 74 Cases treated by District Medical Officer in 1907 (Table VIII.) 75 Summary of proceedings under Public Health (London) Act, 1891 (Table IX.) 76 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4 and 5) 77-79 Metropolitan Borough of Shoreditch. ANNUAL REPORT of the MEDICAL OFFICER of HEALTH. Health Department, Town Hall, Old Street, E.C. January, 1908. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. Sir and Gentlemen, This report deals with the public health, sanitary condition and vital statistics of the Borough of Shoreditch for the year ending December 31st, 1907. POPULATION. The number of inhabitants is estimated at 116,073, as compared with 116,506 for 1906, 116,939 for 1905, 117,360 for 1904, and 117,740 for 1903. The estimated populations in the registration sub-districts are as follows:—Shoreditch South, comprising Moorfields, Church, and Hoxton Wards, 43,022; Shoreditch North-West, comprising Wenlock and Whitmore Wards, 37,141 ; and Shoreditch North-East, comprising Kingsland, Haggerston and Acton Wards, 35,910. The estimated populations in the eight wards of the Borough are as follows: — Ward. Population. Ward, Population. Moorfields 5,531 Whitmore 18,279 Church 19,743 Kingsland 11,095 Hoxton 17,748 Haggerston 12,454 Wenlock 18,862 Acton 12,361 The population of Wenlock Ward includes that of the Holborn Union Workhouse, situate in this locality, which is estimated at 1,373. For certain statistical purposes the inmates of the Holborn Union Workhouse are not regarded as persons belonging to Shoreditch, and are for these purposes excluded in estimating the population of the Borough, which therefore becomes 114,700, whilst that of the ward is reduced to 17,489. A 2 The chief decrease in the population is taking place in the Shoreditch South registration sub-district; the decrease is very slight in Shoreditch North-East, whilst in the North-West registration sub-district there is an, increase. The net result, however, is an estimated decrease of between four and five hundred persons as compared with the population for the previous year. In the following table are given the areas of the wards in acres, and the estimated populations per acre : — Ward. Area in acres. Population per acre. Ward. Area in acres. Population per acre. Moorfields 71 78 Whitmore 76 240 Church 106 186 Kingsland 72 154 Hoxton 78 227 Haggerston 66 188 Wenlock 90 194 Acton 83 149 In the above table the areas of the water-ways of the Regent's Canal and of the site occupied by the Holborln Union Workhouse have not been taken into account. BIRTHS. The number of births registered in the Borough was 3,636, of which 1,850 were of males and 1,786 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 3,720, of which 1,877 were of males, and 1,843 of females. The distribution of the corrected births in the eight wards of the Borough is given below:— Ward. Males. Females. Total. Moorfields 73 66 139 Church 340 306 646 Hoxton 315 301 616 Wenlock 267 274 541 Whitmore 305 309 614 Kingsland 190 186 376 Haggerston 177 187 364 Acton 210 214 424 Totals 1,877 1,843 3,720 3 Outside the Borough there were registered 173 births, 82 of males and 91 of females, the parents being residents of Shoreditch. In the Shoreditch Infirmary 100 births occurred, of which 54 were of males and 46 of females; in 11 of these the parents did not belong to Shoreditch. In the Holborn Workhouse there: were 89 births, of which 54 were of males and 35 of females; in 78 of these the parents were not residents in Shoreditch. Of the births in the above institutions 93 were illegitimate. Elsewhere in the Borough 42 illegitimate births were registered. From information supplied by the Medical Officer of Health of the London County Council, 804 of the births during 1907 belonging to Shoreditch were attended by registered midwives, and of these 39 were hospital confinements. The birth-rate for the Borough was 32.4 per 1,000 inhabitants, as compared with 33.6 in 1906 and 34.2 in 1905. The birth-rates for the eight wards of the Borough are contained in Table VII. (Appendix). The births for the whole of England and Wales during 1907 were at the rate of 26.3; for 76 great towns the rate was 27.0, and for 142 smaller towns it was 25.7 per 1,000. The birth-rate of the Metropolis was 25.8 per 1,000 inhabitants. The birth-rates are all lower than for 1906. MARRIAGES. The marriages in Shoreditch during the year 1907 numbered 1,109, as compared with 1,074 in 1906, 1,068 in 1905, 1,066 in 1904, 1,146 in 1903, 1,156 in 1902, 1,073 in 1901 and 1,157 in 1900. The persons married were at the rate of 19.3 per 1,000 population, as compared with 17.0 for the whole of London. DEATHS. The deaths numbered 2,365, as compared with 2,289 in 1906, 2,296 in 1905 and 2,392 in 1904. Their distribution amongst males and females in the eight wards of the Borough is as shown in the following table:— Ward. Males. Females. Total. Moorfields 43 46 89 Church 201 200 401 Hoxton 207 184 391 Wenlock 175 169 344 Whitmore 258 268 526 Kingsland 83 111 194 Haggerston 95 101 196 Acton 111 113 224 Totals 1,173 1,192 2,365 A 2 4 This year the deaths of females were 19 more than the deaths of males. The death-rate for 1907 was higher than the rate for 1906, being 20.6* per 1,000 inhabitants, as compared with 19.8 in 1906, 19.8 in 1905, 20.6 in 1904 and 19.6 in 1903. It was, however, below the average for the previous ten years. The death-rate of the Metropolis for 1907 was 14.6, that of England and Wales 15.0, of 76 great towns 15.4, and of 142 smaller towns 14.7 per 1,000 population. In tables I., II., IV., V., VI. and VII. (see Appendix) are given the causes of death and the death-rates for the whole Borough and for its eight wards and other information bearing upon the mortality amongst the inhabitants of Shoreditch during the year. The death-rates in the wards varied within considerable limits, being as high as 28.7 in Whitmore and as low as 15.7 in Haggerston Ward. In connection with this it is to be noted that Whitmore Ward is the most densely populated portion of the Borough, and, moreover, contains a large proportion of the poorest section of the population. The death-rate of the Borough was above the mean-rate for the year during the first five months January to May. At the end of May there was a fall and the rate was below the mean until the end of November, when it again rose and was above the mean for three weeks, falling again during the last three weeks of the year. The highest point reached in any one week was during the first week of January, when the rate was as high as 33.1 per 1,000, and it was almost as high the following week. The cause of this high rate of mortality was doubtless the prevalence of influenza and diseases of the respiratory organs. The lowest death-rate in any one week was that for the second week of September, when it was only 12.8 per 1,000, but it was almost as low in the third week of June. Usually the effect of the diarrhoea season upon the death-rate in Shoreditch is very marked. This year it was comparatively insignificant. The number of infants who died aged under one year was 569, 286 being males and 283 females, the deaths amounting to a little over 24 per cent. of the total number of deaths at all ages. The proportion of infants under one year dying during 1907 was at the rate of 153 per 1,000 births belonging to Shoreditch registered during the year. This infantile mortality is lower than in any year since 1881, and is one of the lowest rates recorded in Shoreditch during the past 40 years. The reduction in the infantile mortality during the year under consideration resulted from the diminution in the prevalence of summer diarrhoea, which is especially fatal in young infants and babies under a year old. The infantile mortality in the Borough is usually higher amongst males than females, the average for the six years ending 1906 being 193 per 1,000 births in * Corrected for age and sex distribution, the death-rate was 21.6 per 1,000 population. 5 the case of the former and 167 for the latter. For 1907 the mortalities were almost equal, being slightly in excess of 153 in the case of the females and slightly under that number in the case of males. The chief causes of death amongst infants under the age of one year were diarrhoea, enteritis and other disorders of the stomach and intestines, prematurity, congenital defects and weakness at birth, wasting, measles, whooping cough, pneumonia, bronchitis, various forms of tuberculosis, and suffocation in bed. In table V. (Appendix) is contained a statement of the causes of death of infants under one year, the ages in weeks and months being given. In the subjoined table the causes of death among infants under one year of age are given for each of the eight wards of the Borough: — Cause of Death. Moorfields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals. Measles 2 9 3 4 9 1 1 .. 29 Scarlet Fever .. .. .. .. .. 1 .. 1 2 Diphtheria .. .. 1 1 .. .. .. 1 3 Whooping Cough 3 5 4 7 8 2 8 4 41 Diarrhoea (all forms) .. 8 15 8 9 5 3 9 57 Enteritis 1 9 6 5 11 1 1 2 36 Gastritis and Castro Intestinal Catarrh .. 1 1 .. 1 1 .. 1 5 Premature Birth 3 6 10 15 7 4 6 9 60 Congenital Defects .. 7 6 2 4 3 .. 1 23 Injury at Birth .. .. 1 .. .. .. .. .. 1 Want of Breast Milk .. 1 1 1 1 .. .. 1 5 Atrophy, Debility and Marasmus 2 9 6 11 12 9 8 8 65 Tuberculous Meningitis .. 1 2 1 2 2 1 1 10 Tuberculous Peritonitis and Tabes Mesenterica .. .. 1 1 3 .. 1 2 8 Other Tuberculous Diseases .. 2 2 .. 3 .. 2 .. 9 Erysipelas .. .. .. .. .. .. 1 .. 1 Syphilis 1 1 3 .. 1 2 2 .. 10 Rickets .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. 2 1 1 2 1 3 .. 10 Convulsions .. 6 3 .. 3 2 1 2 17 Bronchitis .. 10 16 11 12 4 5 5 63 Pneumonia 1 9 9 9 7 11 6 4 56 Suffocation, overlying 1 5 3 8 3 1 1 4 26 Other causes 2 6 6 5 9 .. 1 3 32 Totals 16 97 100 90 107 50 51 58 569 6 The infantile mortalities for the eight wards of the Borough are contained in Table VII. (Appendix). The mortality was lowest in Moorfields, where it amounted to 115 per 1,000 births, and highest in Whitmore, where the mortality was 174 per 1,000 births. In connection with this it is to be noted that Moorfields Ward is the least densely populated locality in the Borough. The density in this ward, however, is about 25 per cent, higher than that of the Metropolis as a whole. In Whitmore Ward the density of the population is three times as great as in Moorfields Ward and about four times as great as that of London. Whilst upon the subject of the infantile mortality of the Borough, attention may be directed to the Notification of Births Act, 1907, a piece of legislation which can hardly be stated to have been received with general enthusiasm, although the reason for its enactment is one which must commend itself to all right-thinking persons. The object of this Act is to afford local authorities a means, if they choose to take advantage of it, for obtaining early information of births with a view to advice and instruction as to the rearing of infants being given where deemed necessary to mothers and other persons having charge of infants, and it is hoped that such advice and instruction will result in a saving of infant life and so lead to a decrease in the infantile mortality. The Act is an adoptive one, and the expense of carrying it out would be defrayed as part of the expenses of the Council in the execution of the Acts relating to public health. Upon the question of the adoption of the Act it may be remarked that the Local Government Board, in their circular letter of September 27th last, bringing under the notice of the Councils of the Metropolitan Boroughs the provisions of this Act, observe " that in their opinion there is no occasion for imposing upon parents and others the obligation of notifying births unless steps are taken to carry out the ultimate object of the measure, viz., the giving of advice and instruction to those who have charge of the infants, and in ordinary circumstances they would not be prepared to consent to the adoption of the Act unless it appeared that arrangements had been made for this purpose." The Board are of opinion that local agencies under the Medical Officer of Health would usually be best for carrying out these arrangements, and they express the hope that the Council will consider the question of adopting the Act and of co-operating with any agency that may exist so as to make the Act successful. The question of the adoption of the Act was referred to me to report on, and I pointed out that in the event of the Borough Council resolving to adopt the Act in Shoreditch, it would be necessary to arrange and, provide for giving the advice and instruction to mothers above referred to. Such work being beyond the scope of the duties of a sanitary inspector, the way to secure it being done in the 7 most efficient manner would be through the medium of a properly qualified and trained female health visitor employed by the Council and possessing the requisite knowledge, experience, judgment and tact. Shoreditch is a district which has a high infantile mortality. As compared with that of the Metropolis its infantile mortality is very high, and during the past five years has averaged higher than that of any of the Metropolitan Boroughs. That a densely populated Borough like Shoreditch, containing as it does a large proportion of very poor inhabitants, should have such a mortality above the average for the Metropolis is perhaps only what might be expected. It is, nevertheless, a circumstance to be regretted, and any measures likely to lessen this high mortality should receive the serious attention of the Sanitary Authority. The point for consideration is whether by action on the part of the Sanitary Authority in the manner already foreshadowed the high infantile mortality of the Borough is likely to be reduced. Without doubt it is; although it would not perhaps be wise to venture an opinion as to the extent of: the reduction. This would largely depend upon the efficiency with which the work under the Act, if adopted, was carried out. One very important factor in the production of a high infantile mortality is undoubtedly the ignorance which is so frequently to be met with in respect to the elementary principles of rearing infants. It is against this that the Act is more particularly directed. The mortality amongst infants resulting from this cause alone is a very considerable item in the total amount of infantile mortality, but it is an item which could be reduced if the mothers only had a proper knowledge of the needs of their offspring and acted upon it. Such being my belief, it was my duty to advise that the Act be adopted ini the Borough, and that a health visitor be appointed to carry out the necessary duties arising thereunder. The personal qualifications of a health visitor for this purpose have already been briefly touched upon. There is one point in connection with her experience and training, however, to which great importance is to be attached, and that is the possession of a good experience as a professional midwife. Such professional knowledge would undoubtedly give the health visitor a locus standi1 amongst mothers she would not otherwise possess, a matter of no small importance for securing the successful operation of the Act. The consideration of the question of the adoption of the Act camel before the Council in November, but was deferred for six months, so that it will not come before the Council again until May of the current year. The deaths amongst children aged from one to five years numbered 423. Of these 83 were attributed to measles, 56 to whooping cough, 19 to scarlet fever, 14 to diphtheria, 50 to various forms of tuberculosis, 11 to diarrhoea, 7 to rickets, 9 to meningitis, 25 to bronchitis, 94 to pneumonia and 8 to enteritis. Accident or negligence resulted in 18 deaths, 5 of which were due to burns or scalds and three to vehicular traffic. 8 Altogether 992, or nearly 42 per cent. of the total number of deaths during the year, were of children under five years of age. Of children aged between five and fifteen years 94 died. The chief causes of death at this age period were tuberculosis, which accounted for 24 deaths, other infectious diseases, which caused 22, diseases of the heart and circulatory organs 16, and accident or negligence, which resulted in 10 deaths. Of persons aged between fifteen and twenty-five years there were 86 deaths, of which 34, including 29 from consumption, were due to tuberculosis. Violence resulted in 7 deaths, including one homicidal and three suicidal. Of persons aged between twenty-five and thirty-five years there were 107 deaths, the chief causes being consumption, which resulted in 39, diseases of the heart and circulatory organs, which accounted for 10, and pneumonia, which was the cause of 14 deaths. Three deaths were due to kidney disease, one to alcoholism, and three, including one homicidal, to violence. Between the ages of thirty-five and forty-five years there died 198 persons. Of these 62 died from consumption, 8 from cancer, 22 from diseases of the nervous system, including 7 from general paralysis of the insane, 8 from valvular heart disease, and 20 from heart disease not stated to have been due to valvular trouble, 13 from bronchitis, 10 pneumonia, 10 cirrhosis of the liver, 8 Bright's disease and 5 alcoholism. Three deaths were the result of suicide. Of persons from forty-five to fifty years of age 231 died. Of these 46 succumbed to consumption, 22 to cancer and 4 to malignant disease, 5 to alcoholism, 25 to diseases of the nervous system, including 14 from apoplexy, 11 to valvular disease, and 22 to heart disease not stated to have been valvular, 26 to bronchitis, 15 to pneumonia, 6 to cirrhosis of the liver, 10 to Bright's disease, 9 to accident, 1 to homicide and 1 to suicide. Of 247 deaths among persons aged from fifty-five to sixty-five years 26 were attributed to consumption, 34 to cancer, and 7 to malignant disease, 3 to alcoholism, 16 to diseases of the nervous system, including 6 from apoplexy, 9 to valvular heart disease, and 28 to heart disease not stated to have been valvular, 37 to bronchitis, 18 pneumonia, 19 to Bright's disease, 8 cirrhosis of the liver, 9 accident and 1 to suicide. Of persons aged from sixty-five to seventy-five years there died 229, the chief causes of death being cancer, which accounted for 14, malignant disease for 3, old age 36, influenza 7, apoplexy 12, other nervous disorders 6, valvular heart disease 9, disease of the heart not stated to be valvular 23, bronchitis 48, pneumonia 12, cirrhosis of the liver 3, Bright's disease 17, accidents 5 and suicide 2 deaths. 9 Of 140 deaths of persons aged from seventy-five to eighty-five years, 4 were the result of cancer, 5 influenza, 79 old age, 7 diseases of the nervous system including 4 from apoplexy, 4 valvular heart disease, 7 heart disease not stated to have been valvular, 17 bronchitis and 5 accident. Of the 41 persons who died aged eighty-five years and upwards, 1 died from cancer, 29 from old age, 1 diabetes, 1 influenza, 1 disease of the nervous system. 1 from heart disease, 1 bronchitis, 1 intestinal obstruction, 1 Bright's disease, 3 from accidental falls, and 1 from malignant disease. The principal causes of death in the Borough during the year were: Tuberculosis, which accounted for 327, including 232 due to phthisis or consumption, pneumonia 232, bronchitis 236, diseases of the circulatory organs 183, measles 114, whooping cough 99, diarrhoea 74, enteritis 52, cancer, 83, Bright's disease 63, apoplexy 39, prematurity 60, atrophy debility and marasmus 50, cirrhosis of the liver and alcoholism 47, and old age, which was given as the cause of 148 deaths. Of the 83 deaths from cancer 35 were of males and 48 of females. The great majority of these deaths were of persons aged between 45 and 75 years. Eight persons under forty-five years and 5 over seventy-five years were certified to have died from cancer. In addition to the deaths attributed to cancer there were 19 deaths certified as due to malignant disease. In some of these cancer was probably the cause of death. Fourteen of the deaths from malignant disease were of males and 5 of females. The death-rate from cancer was 0.72 per 1,000 population, which is considerably above the average. The rates for previous years are as follows:— 0.64 in 1906, 0.70 in 1905, 0.69 in 1904, 0.66 in 1903, 0.74 in 1902, 0.63 in 19: , 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 above rates. Of the deaths from alcoholism and cirrhosis of the liver 24 were of males and 23 of females. These, however, are far from representing the actual number of deaths directly or indirectly the result of the abuse of alcohol. Only one death was certified as being caused by appendicitis, as compared with 19 in 1906, 4 in 1905, 7 in 1904, 5 in 1903, 4 in 1902 and 2 in 1901. There were 6 deaths attributed to peritonitis. Taken together the deaths from peritonitis and appendicitis were fewer than in any year since 1889. Violence in its various forms resulted in 115 deaths, of which 73 were of males and 42 of females. Through accident or negligence 84 persons met their deaths, the chief causes being vehicular traffic 7, burns or scalds 10, falls, chiefly in persons over forty-five years of age, 24, and suffocation in bed, mainly through overlying, which resulted in 28 deaths. There were 5 instances of homicide, and 16 persons, 9 of whom were males, committed suicide. 10 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 14 263 277 Shoreditch Workhouse 530 23 553 Royal Chest Hospital 15 54 69 Convent Hospital 3 10 13 Total 562 350 912 Elsewhere than in public institutions, twelve persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various public institutions outside Shore< 1 itch with the numbers of persons belonging to the Borough dying therein: — Asylums. No. of Deaths. General Hospitals—continued. No. of Deaths. Banstead 3 Great Northern 2 Cane Hill 4 Gt. Orrnond Street (Children) 22 Caterham 5 Guys 2 Claybury 10 King's College 1 Colney Hatch 16 London 17 Darenth 1 Metropolitan 96 Dartford Health 8 Mildmay 6 Hanwell 2 Middlesex 3 Horton 5 National 2 Leavesden 10 North Eastern (Children) 49 Long Grove 2 Royal Free 2 Manor 1 St. Bartholomew's 115 St. Luke's 1 Queen Alexandra's Tooting Bee 11 Military Hospital 1 Peckham House 1 Royal Free Hospital, Bath 1 Hospitals for Infectious Disease. Hospitals for Special Diseases, &c. Consumption Hospital, Eastern 16 North Eastern 35 Brompton 1 South Eastern 5 Queen Charlotte's Lying-in 1 South Western . . 1 Lying-in, City of London 5 General Hospitals. Chest Hospital, Bethnal Green 1 Epileptic Colony, Epsom 1 Evelina(Children) 1 St. Mark's 1 Freidenheim 1 St. Peter's 1 French 2 Hospital for Women, Soho 2 German 9 Heart Hospital, Soho 1 11 Infirmaries and Workhouses. No. of Deaths. Other Institutions. No. of Deaths. Bethnal Green Infirmary 3 St. Joseph's Hospice 5 Bishop Stortford Workhouse 1 Aged Pilgrim's Asylum 1 Islington Infirmary 2 Holborn Infirmary, Mitcham 2 Central London Sick Asylum 1 Hackney Infirmary 4 Sick Asylum, Bromley 1 Kensington Infirmary 1 H.M. Prison, Holloway 1 St. George's in the East Infirmary 2 Jews' Home, Paddington 1 St. George's Workhouse Southwark 1 St. Luke's House 1 St. Peter's House 2 Strand Infirmary 1 Lewisham Infirmary 1 City Infirmary 2 Of 516 persons belonging to Shoreditch dying in public institutions situate beyond the limits of the Borough, 332 died in general hospitals, including 72 in hospitals for sick children, 80 in asylums for those mentally diseased, 57 in the fever hospitals of the Metropolian Asylums Board, 20 in workhouses and infirmaries, 14 in hospitals for special diseases, and 13 in other institutions. Elsewhere than in public institutions 16 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 1,078, or nearly half of the deaths of persons belonging to Shoreditch, took place in public institutions. Including the 16 persons who did not die in public institutions, 1,094 persons, belonging to the Borough died elsewhere than in their own homes, a number which shows a marked increase on that for last year, the increment being chiefly due to the large number of persons dying in the Shoreditch Workhouse and Infirmary. SICKNESS AMONGST THE POOR. The cases coming under the treatment of the district medical officers in connection with the poor law dispensary during 1907 numbered 4,380, as compared with 4,107 in 1906 and 4,014 in 1905. An analysis of the cases is contained in Table VIII. (Appendix). The diseases classed as infectious accounted for 763 of the cases. They were mainly consumption, measles, influenza, whooping cough, diarrhoea, erysipelas and scarlet fever, in the order given. The cases of consumption numbered the same as in the preceding year. The cases of diarrhoea were in point of number markedly below the average, whilst those of measles were much above the average1— in fact, more numerous than; in any year during the past 15 years. Cases of erysipelas were more numerous than in any year since 1892, and more cases of scarlet fever were under the notice of the district medical officers than in any year since 1894. Diseases of the respiratory system, largely the result of infection, were responsible for 1,168 of the cases, a number above the average for the past 15 years. Of these 1,030 were cases of bronchitis and 65 of pneumonia. There were 12 282 cases of rheumatism and 77 of gout. The latter disorder, although lower in point of number than in the preceding year, was above the average for the past 15 years. Dyspepsia and other disorders of the digestive system accounted for 506 cases. Cases of cancer were below the average for the past 15 years, numbering 20, as compared' with 43 in 1906, 37 in 1905, 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 skin were more numerous than in any year since 1892, and diseases of the urinary system, including Bright's disease of the kidneys, were more numerous than usual. INFECTIOUS DISEASES. The infectious diseases included under the headings numbered 1 to 35 inclusive in Table VI. (Appendix) resulted in 747 deaths, as compared with 776 in 1906, 717 in 1905, 791 in 1904, 762 in 1903, 767 in 1902 and 762 in 1901. The deaths from these diseases were, therefore, below the average for the previous six years. They amounted to 31.5 per cent, of the deaths from all causes. The decrease in the number of deaths from these diseases mainly resulted from the comparatively small number of deaths from diarrhoea. Deaths from consumption and other forms of disease caused by the tubercle bacillus amounted to 44 per cent, of the whole. Of the remainder measles, whooping cough and diarrhoea in the order named were responsible for the greater number. The death-rate from these infectious diseases was 6.5 per 1,000 inhabitants, as compared with 6.7 in 1906, 6.2 in 1905, 6.8 in 1904 and 6.5 in 1903. In the subjoined table the deaths from the infectious diseases referred to above have been grouped according to age: — 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 85 and upwards No. of deaths 178 240 29 17 23 24 53 72 53 31 18 8 1 It will be noticed that more than half of these deaths were of children under the age of five years. Taking the total mortality amongst children under five years of age, over 42 per cent. of the deaths resulted from these infectious diseases. In infants under one year diarrhoea and whooping cough were the most fatal of these diseases, whilst amongst children aged from one to five years measles and whooping cough claimed most of the victims. Tuberculosis was also a common cause of death amongst children under five years of age. Consumption was the chief cause of the mortality from these diseases between the ages of 20 and 65 years. 13 The deaths from small pox. measles, scarlet fever, diphtheria, including membranous croup, whooping cough, enteric fever and diarrhoea, which are the principal epidemic diseases, numbered 341, the death-rate due to them being 2.9 peT 1,000 inhabitants, as compared with 3.1 in 1906, 2.8 in 1905, 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. The zymotic death-rate was, therefore, considerably below the average. A comparison of the zymotic death-rate of London and Shoreditch and the eight wards of the Borough is given in Table VII. (Appendix). The death-rate due to the principal zymotic diseases was highest in Whitmore and lowest in Acton and Moorfields Wards, in connection with which it may be noted that the population in Whitmore is of much greater density to the acre than is the case with the other two wards. The cases of notifiable infections disease numbered 1,265, being over 300 more than in 1906. The number of cases annually certified since 1889, and the attackrates per 1,000 inhabitants, are contained in the following table: — Year. Number of cases. Attack-rate per 1,000 inhabitants. 1890 1158 9.4 1891 862 7.0 1892 1478 12.0 1893 1987 16.2 1894 1104 9.0 1895 1157 9.4 1896 1473 12.1 1897 1331 10.9 1898 960 7.8 1899 1116 9.2 1900 989 8.1 1901 1146 9.8 1902 1239 10.5 1903 664 5.6 1904 776 6.6 1905 1151 9.8 1906 951 8.2 1907 1265 10.8 The cases of notifiable infectious disease certified in the Metropolis during 1907 amounted to 41,000, the attack-rate being 8.6 per 1.000 population, as compared with 7.5 for 1906. 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 14 of the four quarters of the year, and the numbers and percentages of such case which were removed to hospital for treatment: — Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox 1 .. .. .. 1 .. Scarlet Fever or Scarlatina 129 181 241 325 876 28 Diphtheria & Membranous Croup 54 60 40 57 211 20 Typhus Fever .. .. .. .. .. .. Cholera .. .. .. .. .. .. Enteric (Typhoid) Fever 7 5 8 14 34 6 Continued Fever .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. Puerperal Fever 1 1 .. 1 3 1 Erysipelas 28 30 30 45 133 6 Plague .. .. .. .. .. .. Cerebro Spinal Fever 1 2 2 2 7 2 Totals 221 279 321 444 1,265 63 Numbers and percentages of cases removed to hospitals 186 242 286 389 1,103 84% 87% 90% 87% 87% As compared with the figures for 1906, there were marked increases in the numbers of cases of scarlet fever and diphtheria. Slight decreases are noticeable in respect to the other diseases. Cerebro-spinal fever appears in the list for the first time. The deaths from notifiable diseases show a marked increase, being 20 more than for the previous year. The deaths from the principal zymotic diseases which are notifiable, namely small pox, scarlet fever, diphtheria and enteric fever, were at the rate of 0.47 per 1,000 population, whilst the rate for the principal zymotic diseases which are not notifiable, namely, measles, whooping cough and diarrhcea, was 2.5 per 1,000 population. METROPOLITAN ASYLUMS BOARD. Most of the cases of infectious disease removed to hospital were taken to the hospitals of the Metropolitan Asylums Board. The infectious diseases of which cases are receivable into the Board's hospitals are small pox, scarlet fever, diphtheria and enteric fever. The number of cases of these diseases removed was 1,122, giving a percentage of 97.5, which is the highest recorded for any year. In 1906 the percentage was 96. The percentages of removals for previous years are contained in the report for 1905. Efficient isolation of cases of infectious disease in the homes of the people in a densely crowded locality like Shoreditch is practically impossible. It is, therefore, a matter for congratulation that the inhabitants of the Borough have learnt to realise the value of, and the benefits to be derived from, the magnificent system of hospital isolation which has been organised and is being carried out bv the Metropolitan Asylums Board. 15 RETURN CASES. During the year 17 instances where "return" cases of scarlet fever occurred came under observation. The particulars are briefly as follows: — Number of Cases. 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 cases resulting from Primary case. Remarks. 1 108 days 9 days Discharge from nose and ears 1 Primary case, a male. Discharges came on after return home. 2 59 „ 14 „ 1 Primary case, a male. 3 108 „ 2 „ Scab on one nostril 3 ,, ,, 4 121 „ 21 „ Discharge from nose 1 Primary case, a male. Discharge was observed the day of his return home. 5 40 „ 4 „ 1 Primary case, a male. Doubtful as to case being Scarlatina. 6 47 „ 13 „ Chronic enlarged tonsils 1 Primary case, a female. 7 47 „ 2 „ Desquamation noticed 1 ,, male. 8 118 „ 17 „ Onychia right big toe, discharge from nose, Eczema behind right ear 1 ,, male. 9 104 „ 23 „ Sore nostrils, discharge from nose 1 ,, female. 10 48 „ 19 „ Slight desquamation on feet 2 Primary case, a female. Had Psoriasis on return from hospital. 11 54 „ 7 „ Discharge from right ear 1 Primary case, a male. 12 49 „ 4 ,, Discharge from nose 1 ,, ,, 13 50 ,, 16 „ 1 ,, ,, 14 96 „ 4 „ 1 ,, ,, 15 60 „ 12 „ Discharge from left ear 1 ,, ,, 16 42 „ 6 „ Slight discharge from nose 1 Primary case, a female. Discharge from nose came on after return home. 17 71 „ 9 „ Slight desquamation, discharge from nose, with soreness 1 Primary case, a male. Sore nose noticed about two days after return home, discharge subsequent to it. 16 The percentage of return cases in respect to the cases removed was 1.9, as compared with 1.5 for last year. It will be noticed that in 13 of the 17 instances lesions of one sort or another were observed, the commonest being a discharge from the nose. SMALL POX. Early in the year a case of illness was certified as small pox, but the patient proved to be suffering from a skin affection known as erythema multiforme. Later in the year a second case was brought to my notice as being possibly one of small pox. It was not certified, and proved also to be one of erythema multiforme. There were only three or four cases certified as small pox in the whole of the Metropolis, including the one in Shoreditch. No deaths were registered as due to this disease. VACCINATION. The latest official figures as to vaccination in the Borough are those published in the last report of the Medical Officer of the Local Government Board for the year 1905-6. They relate to the year 1904. It appears that of the children born in Shoreditch during that year 34.2 per cent, were not finally accounted for as regards vaccination. The cases in which vaccination was postponed are included in calculating this percentage. Certificates of conscientious objection were received by the vaccination authority in respect to 21 children, or 0.5 per cent, of the births for the year, as compared with 0.6 in 1903 and 0.3 in 1902. In the following table are contained the percentages of children born not finally accounted for as regards vaccination, including postponed cases, each year from 1890 to 1904 for Shoreditch, the Metropolis, and the rest of England: — Year. Shoreditch. Metropolis. Rest of England. Year. Shoreditch. Metropolis. Rest of England. 1891 8.8 16.4 12.9 1898 68.4 33.0 19.6 1892 10.8 18.4 14.3 1899 54.2 27.7 15.4 1893 16.2 18.2 15.7 1900 52.8 25.8 13.9 1894 33.9 20.6 19.0 1901 44.4 24.1 11.2 1895 47.5 24.9 19.8 1902 36.1 21.3 10.0 1896 55.5 26.4 22.3 1903 36.0 20.7 9.1 1897 67.4 29.1 21.6 1904 34.2 19.1 8.7 The above figures indicate that during the years 1904 to 1899 there has been a distinct improvement as regards the state of vaccination in the Borough, and an improvement in this respect appears to have been general throughout the country. 17 SCARLET FEVER. The cases of the above disease certified during 1907 numbered 876, as compared with 629 in 1906, 789 in 1905, 343 in 1904 and 255 in 1903. They were more numerous than in any year since 1893, when the highest number was recorded since the notification of the disease became compulsory. In 62, or 7 per cent., of the cases notified intimations were received from the Metropolitan Asylums Board that the patients had not been suffering from scarlet fever. In 59 of these the intimations simply stated that the diseases were not notifiable or not scarlet fever, and in the other three in one instance the disease was measles, in another diphtheria, and in the third tonsillitis. The corrected number of cases of scarlet fever was therefore 814, as compared with 595 in 1906, 771 in 1905, 320 in 1904 and 237 in 1903. 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 14 16 30 1 5 6 Church 86 89 175 5 6 11 Hoxton 46 58 104 1 .. 1 Wenlock 52 37 89 4 1 5 Whitmore 92 106 198 3 2 5 Kingsland 36 58 94 .. 2 2 Haggerston 27 39 66 1 .. 1 Acton 58 62 120 .. 2 2 Total for Borough 411 465 876 14 14 28 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified, 864, or 98.6 per cent., were removed to hospital, as compared with 97.4 per cent, in 1906, 97 per cent, in 1905 and 96 in 1904. The percentages for previous years are given in the report for 1903. The cases certified were at the rate of 7.5 per 1,000 inhabitants, as compared with 5.3 in 1906, 6.7 in 1905, 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 Whitmore, Acton and Church Wards, and lowest in Wenlock and Haggerston. In Whitmore Ward the attack-rate was nearly 11 per 1,000 inhabitants. The deaths from scarlet fever numbered 28, as compared with 20 in 1906, 27 in 1905 and 13 in 1904, the death-rate being 0.24, as compared with 0.17 in 1906, 0.23 in 1905, 0.11 in 1904 and 0.05 in 1903. The case-mortality was at the rate of 3.1 per cent. B 18 of the cases certified, as compared with 3.1 in 1906, 3.4 in 1905, 3.8 in, 1904, 2.7 in 1903, 3.5 in 1901 and 54 in 1900. It was therefore below the average. Amongst children under five years of age there weret 291 cases, with 21 deaths, the casemortality being 7.2 per cent, (allowing for cases not regarded as scarlet fever at the hospitals, 8 per cent.), as compared with 6 per cent, in 1906, 7.7 in 1905, 7.8 in 1904, 2.7 in 1903, 5.3 in 1902, 6.8 in 1901 and 12.0 in 1900. Among persons over the age of five years there were 585 cases,, with 7 deaths, the mortality being 1.2 per cent, of the cases certified (allowing for cases not regarded as scarlet fever, nearly 1.3), as compared with 1.3 in 1906, 1 in 1905, 1.8 in 1904, 2.7 in 1903 and 1.7 in 1901. These figures indicate how much more fatal scarlet fever is during early life. Of the 28 deaths during 1907, 26 were of children under the age of ten years. Mention may be made of a small localised outbreak of scarlet fever which attracted attention during the year. On August 12th it was noticed that an unusual number of cases were being certified from houses situate in Caesar and Long Streets. During the course of the week ending August 12th 11 cases were certified in seven houses in these streets. The existence of a common source of infection was suspected, and enquiry was made in the neighbourhood where the cases were occurring, which resulted in information being obtained that a child resident at a house in Caesar Street had been unwell and that it had been noticed going about with hands rough and peeling. The house was visited and the child was examined, and was found to be desquamating and otherwise presenting evidence of a recent attack of scarlet fever. The history was that the child was taken with sickness on July 29th, and a sore throat was noticed on the following day. No rash was, however, observed, and scarlet fever was not suspected. This child had been playing with children from the houses invaded, and there is little doubt that it was the source of infection in most of the cases. On the removal of this case to hospital the occurrence of the cases in these streets at once came to an end. The cases of scarlet fever certified in the Metropolis numbered 25,936, the attackrate being 5.6 per 1,000 inhabitants, as compared with 4.3 in 1906, 4.1 in 1905, 2.8 in 1904, 2.7 in 1903, 3.9 in 1902, 4.4 in 1901 and 3.0 in 1900. ihe deaths in the Metropolis from this disease numbered 644, as compared with 533 in 1906, 549 in 1905, 365 in 1904, 361 in 1903, 560 in 1902, 584 in 1901, and 361 in 1900, the death-rate being 0.13 per 1,000, as compared with 0.11 in 1906, 0.11 in 1905, 0.08 in 1904, 0.07 in 1903, 0.12 in 1902, 0.13 in 1901, and 0.08 in 1900. The above figures indicate that scarlet fever during 1907 was more than usually prevalent in the Metropolis. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 211, as compared with 133 in 1906. Of these, 46, or nearly 22 per cent., were not regarded as diphtheria cases at the hospitals of the Metropolitan Asylums Board, the diagnosis 19 being in one instance cerebro-spinal fever, in one laryngitis, one measles, one influenza with pneumonia, one pneumonia, five tonsilitis, eight scarlet fever, and in 28 instances the cases were simply stated to have not been diphtheria or not notifiable. 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 5 6 .. .. .. Church 15 19 34 2 2 4 Hoxton 11 18 29 1 4 5 Wenlock 12 14 26 2 2 4 Whitmore 15 20 35 1 2 3 Kingsland 14 7 21 1 .. 1 Haggerston 10 18 28 .. .. .. Acton 15 17 32 1 2 3 Total for Borough 93 118 211 8 12 20 These cases are grouped according to ages in Table III. (Appendix). Of the cases certified, nearly 94 per cent. were removed to hospital, as compared with 91 per cent. in 1906, 93 per cent. in 1905, 94 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. The cases certified were at the rate of 1.8 per 1,000 inhabitants, as compared with a rate of 1.1 for the previous year. The attack rate, according to the cases certified, was lowest in Moorfields Ward and highest in Acton, being 1.0 per 1,000 inhabitants in the former and 2.5 in the latter. The deaths numbered 20, the death-rate being 0.17 per 1,000, as compared with 0.12 in 1906, 0.14 in 1905, 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. The rate, although higher than that of 1906, was considerably below the average for the period covered; by the years given. The death-rates due to this disease in the wards of the Borough are contained in Table VII. (Appendix). The rate was highest in Hoxton. No deaths from diphtheria occurred amongst the inhabitants of Moorfields and Haggerston Wards. The case-mortality was lower than in 1906, being 9.5 per cent, of the cases certified (12.1 allowing for cases not regarded as diphtheria at the fever hospitals). In 1906, the case mortality was 10.5, in 1905 it was 15.2, and in 1904 it was 10.3 per cent. The case mortalities for previous years are contained in the report for 1906. The lowest so far recorded for Shoreditch was 8.8 per cent, in 1901. B 2 20 Of the 20 deaths in 1907, 17 were of children under five years of age, the mortality being at the rate of 15.6 per cent. of the cases certified amongst children belonging to that age period (18.2 per cent. allowing for cases not regarded as diphtheria at the hospitals), as compared with 16 per cent. in 1906, 14.7 in 1905, 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. These figures show the great reduction in the mortality per cent, of the cases certified in the Borough which has taken place during recent years. The case mortality amongst persons over five years of age amounted to just under 3 per cent, of the cases certified, but, deducting the cases not regarded as diphtheria, the mortality was 4.3 per cent. The whole of the deaths from diphtheria were of children under the age of 10 years. As in the case of scarlet fever, diphtheria is most fatal in early life. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 170 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 3 6 9 From 1 to 2 years 9 10 19 ,, 2 ,,3 ,, 11 12 23 „ 3 „ 4 „ 8 15 23 4 ,, 5 „ 13 8 21 5 ,, 10 „ 17 26 43 ,, 10 „13 „ 5 8 13 „ 13 years 7 12 19 Total 73 97 170 In 78 of the cases the patients were children attending school, and in 60 of these they were at school within a week of being certified to* have the disease. In several instances the histories obtained leave no doubt that the children were at school and mixing with their fellow school children whilst actually suffering from diphtheria before the nature of their disorder was recognised. In 82 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 20 instances the histories, showed that there had been cases of " sore throat" amongst the inmates of the houses in which patients resided, and in 22 instances evidence was forthcoming pointing to infection from previous cases in the Borough. In 122 instances, the houses were occupied by members of more than one family, in 38 by single families, and in 10 instances the cases were in artizans' dwellings of the block type. With regard to the sanitary condition of the dwellings, 21 in 91 this was satisfactory, in 36 it was fairly so, whilst in 43 it was unsatisfactory. In eight of the houses invaded, more or less dampness was noticeable. In connection with the foregoing figures, in respect to the sanitary condition of the houses, it should he observed that although more houses which were in a satisfactory sanitary condition were invaded by the disease, the conclusion is not warranted that this satisfactory sanitary condition favoured the occurrence of the cases in the houses. The probability is that the sanitary condition or otherwise of the houses played but a minor part in connection with the incidence of the cases. Approximately the same figures would have been obtained if 170 houses in which no cases of diphtheria had occurred had been visited promiscuously during the year. The cases certified as diphtheria in the Metropolis numbered 8,585, as compared with 7,916 in 1906 and 6,482 in 1905, the attack-rates being 1.8, 1.6, and 1.3 per 1,000 population respectively. The deaths numbered 781, as compared with 691 in 1906, and 546 in 1905, the death-rate being 0.16, 0.14, and 0.12 per 1,000 population respectively. During the past three years, the proportion of attacks per thousand inhabitants in Shoreditch has differed but little from that of London as a whole. If anything, it has been a little under the average for the Metropolis. ENTERIC OR TYPHOID FEVER. The cases certified during 1907 numbered 34; five of these were subsequently not regarded as having been cases of enteric fever and intimations to that effect were received from the hospital authorities. The numbers of cases certified year by year since 1889 are set out in the subjoined table :— Year. Number of Cases. Year. Number of Cases. 1890 202 1899 171 1891 111 1900 122 1892 91 1901 96 1893 111 1902 149 1894 85 1903 101 1895 99 1904 48 1896 114 1905 36 1897 107 1906 39 1898 91 1907 34 The cases certified, which were fewer in number than in any year since the notification of infectious diseases became compulsory, were at the rate of 0.3 per 1,000 population, as compared with 0.3 in 1905, 0.4 in 1904, and 0.8 in 1903. The cases certified were all of patients over five years of age. The deaths during the year numbered six, and the death-rate was 0.05 per 1,000 inhabitants, as compared with 22 0.03 in 1906, 0.01 in 1905, 0.07 in 1904, 0.11 in 1903, 0.20 in 1902, 0.08 in 1901, and 0.11 in 1900. The death-rate from this disease was, therefore, below the average for the years mentioned. The case-mortality was at the rate of 17.6 per cent, of the cases certified, but, deducting the cases which were not regarded as enteric fever, the mortality amounted to 20.6 per cent The case-mortality for 1906 was 10 per cent., and those for previous years are given in the annual report for 1905. During the past fifteen years the mortality has averaged 14.5 per cent. of the cases certified in the Borough. The distribution of the cases certified, and deaths amongst males and females in the Borough and the eight wards thereof during 1907 is shown in the subjoined table:— Wards. ENTERIC FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields .. 1 1 .. .. .. Church 3 1 4 1 .. 1 Hoxton 3 3 1 .. 1 Wenlock 2 2 4 .. 1 1 Whitmore 3 4 7 .. 1 1 Kingsland 2 6 8 . . 1 1 Haggerston .. 4 4 .. 1 1 Acton 1 2 3 .. .. .. Total for Borough 14 20 34 2 4 6 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified, 32, or 94 per cent., were removed to hospital for treatment. The usual enquiries were made with a view to tracing the sources of infection of the cases. The following instances came under observation in which infection appeared to have resulted from previous cases in the Borough:— May S-, aged 24, a nurse in the Shoreditch Infirmary, was taken ill about January 14th, and certified to be suffering from enteric fever on February 1st. She was nursing a patient who was admitted to the infirmary on December 22nd and certified to have enteric fever on December 30th of last year. It is not an uncommon thing for nurses to contract the disease from patients suffering from enteric fever. The following cases occurred at No. 9, P- Street, a house in a fair sanitary condition generally, but having defects in connection with the drains. 23 Henry P-, aged 14, was noticed ailing about February 17th; he was admitted to the Metropolitan Hospital on February 26th and certified to be suffering from enteric fever on February 28th. Ellen P-, aged 12, sister of above was taken ill about February 20th and certified to have enteric fever on March 2nd. The history obtained in connection with these cases pointed to the mother of the children having been the source of infection. It appears she was taken ill about the middle of November, 1906, with what was thought at the time to be influenza accompanied by constipation. There was fever with nocturnal delirium during part of the time she was ill, and she was confined to her bed during December. 1906, and part of January, 1907. During the latter month she began to get about again. The story of her illness was very suggestive of that of a case of enteric fever, and I have very little doubt that she really had an attack and passed infection on to her children. The following cases occurred at No. 4, J- Street, a house in a satisfactory sanitary condition:— Harriet D-, aged 11, was taken ill about February 8th and was admitted to the North-Eastern Hospital for Children on February 18th. She was certified to have enteric fever on February 23rd. May D-, aged 10, sister to the above, was taken ill about March 14th, was admitted to the North-Eastern Children's Hospital on March 16th, and certified to have enteric fever on March 21st. She slept with her sister before the latter's removed to hospital. Moreover, the mother was frequently at the bedside of Harriet whilst she was in the hospital, as her condition was serious for a time. The following cases occurred at No. 4a, H- Street, a house which was somewhat dirty, but otherwise presented no marked sanitary defects:— Mary C-, aged 40, was taken, ill about September 9th. She attributed her illness to mussels which she ate about September 1st. She took to her bed on September 21st, and was certified to be suffering from enteric fever on the 22nd, and removed to hospital. Daisy E. C-, aged 6, daughter of above, was taken ill about October 30th, and was certified to have enteric fever on November 14th. There was probably a connection between these cases, although the evidence is not very conclusive. The husband of Mrs. C- and her daughters visited her from time to time whilst she was in the hospital, but Daisy does not appear to have gone with them. These visits may, however, have been the means of her being infected. 24 The following cases are interesting:— Eleanor S. W-, aged 27, residing at No. 36, T-Street, a house in a satisfactory sanitary condition, was taken ill about September 17th, and was certified to have enteric fever and removed to hospital on October 15th. Thomas D. W-, aged 30, husband of the above patient, residing at 65, A- Street, where he had been living since the removal of his wife to hospital, was taken ill about November 6, certified to have enteric fever on December 6th, and died of perforation the following day. He may have been infected by his wife before her removal to hospital, but he was in the habit of paying her frequent visits whilst she was lying in a dangerous condition in the hospital. The following cases occurred at No. 63, N- Street, a house in a satisfactory sanitary condition:— Alice B-, aged 25, was taken ill about September 20th, and was certified to be suffering from enteric fever on October 11th. About the time she was likely to have been infected it is stated that she had some mussels to eat. Charles R. B—, aged 5, son of the above, was taken ill about October 10th, and certified to be suffering from enteric fever on October 17th. Of the 34 cases certified as enteric fever during the year, in 7, or 20 per cent., there were grounds for believing that infection was contracted from previous cases within the Borough. In the majority of instances, however, nothing definite throwing light upon the source of infection was ascertained. In one instance the patient, a plumber, attributed his illness to drinking water which had an unpleasant taste whilst on a job in Surrey. In five instances mussels had been eaten prior to the commencement of the illnesses, and in two cockles were mentioned. Watercress was noted in one instance, and ice-cream in two, but there was nothing to indicate that these delicacies were likely to have conveyed infection, although it is quite possible they may have done so. With respect to the sanitary condition of the houses in which the cases occurred, in the great majority of instances this was satisfactory. In one instance the drains required attention, in two the houses were generally dirty or otherwise unsatisfactory, and in one instance some overcrowding was found to exist. The cases of enteric fever certified in the metropolis numbered 1,396, as compared with 1,608 for 1906. The attack-rate was not quite 0.3 per 1,000 inhabitants. The deaths numbered 194, as compared with 260 for 1906, the death-rate being 0.04 per 1,000 inhabitants. 25 ERYSIPELAS. The cases certified as erysipelas numbered 133, as compared with 144 in 1906, 138 in 1905, 183 in 1904, 147 in 1903, and 172 in 1902. They were, therefore, fewer in number than usual. The deaths numbered 6, as compared with 2 in 1906, 3 in 1905, 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 deaths —although more numerous than for the last three years—were below the average for the last 15 years. 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 5 7 12 .. .. .. Church 0 11 16 .. .. .. Hoxton 2 5 7 .. .. .. Wenlock 9 12 21 .. 2 2 Whitmore 10 15 25 .. 1 1 Kingsland 7 7 14 I . . I Haggerston 9 11 20 1 .. 1 Acton 3 15 18 .. 1 1 Total for Borough 50 83 133 2 4 6 The death-rate was 0.05 per 1,000 inhabitants, as compared with 0.01 in 1906, 0.02 in 1905, 0.04 in 1904, 0.06 in 1903, 0.06 in 1902, 0.05 in 1901, and 0.08 in 1900. The deaths were at the rate of 4.5 per cent. of the cases certified, as compared with 1.3 per cent. in 1906, 2.1 in 1905, 2.6 in 1904, 4.7 in 1903, 4.6 in 1902, 4.2 in 1901, and 5.8 in 1900. Pyemia and Septicemia (blood-poisoning) were given as the cause of death in 13 instances, 5 of males and 8 of females. Infective endocarditis caused the deaths of 5 males and 4 females. There were three deaths attributed toi other septic diseases allied to the foregoing. PUERPERAL FEVER. Three cases were certified, one of which proved fatal. The attacks per 1,000 births were at the rate of 0.8, as compared with 1.5 in 1906, 2.2 in 1905, 1.3 in 1904, 1.7 in 1903, 2.2 in 1902, 1.7 in 1901, and 2.5 in 1900. The death-rate from puerperal fever calculated per 1,000 births was 0.2, as compared with 0.8 in 1906, 1.0 in 1905, 0.5 in 1904, 0.2 in 1903, 0.7 in 1902, and 0.5 in 1901. 26 DIARRHOEA. The mortality from diarrhoea in Shoreditch during 1907 was much below the average, the deaths being fewer than in any year since 1895. Doubtless, the absence of prolonged hot dry weather during the summer months, the average temperature being lower than usual, together with flies being less numerous than ordinarily, had a good deal to do in connection with this low mortality. During recent years observers have been directing attention to the importance of the part played by flies in the propagation of infectious diseases, especially those diseases which are accompanied by diarrhoea. The usual breeding places of flies are accumulations of certain waste pro-ducts, especially those which generate heat, such as manure heaps. The hotter the weather, the more quickly are flies produced. They feed upon various kinds of matter, and also upon certain articles in common use for human food. It is through visits paid by flies to infectious matter and then to human food stuffs, such as milk, butter, sugar, and the like, that infection is likely to be conveyed. The main steps, therefore, to prevent flies acting as agents foT the transmission of disease is, firstly, to endeavour to reduce their numbers to a minimum by the frequent removal of manure heaps and other accumulations in which they are likely to breed: secondly, to protect food from their visits, and, thirdly, to give particular attention to general sanitary measures for preventing their access to excrementitious matters. In respect to this latter, the frequent flushing of courts, alleys, and other places which are liable to be contaminated with excrement, especially during the summer months, is a public health measure of great importance for the prevention of diarrhoea. A large number of courts and alleys in the Borough are flushed and cleansed at regular intervals by the officers of the Borough throughout the year. Many of them, however, ought to be flushed daily during the diarrhoea season, that is, during the hot summer months. The deaths from diarrhoea were distributed during the year as follows:—In January 2 were registered, in February 2, in May 1, June 3, July 6, August 8, September 23, October 26, and November 3. The diarrhoea season was later than usual this year, most deaths occurring during September and October instead of during August and September. Altogether the deaths from diarrhoea numbered 74, not including 52 deaths, chiefly of infants under one year, attributed to enteritis or gastro-enteritis, as compared with 194 in 1906. Of the deaths during 1907, 57 were of infants under one year and 11 were of children aged between one and five years. The death-rate was 0.64 per 1,000, as compared with 1.68 in 1906. The mortality from diarrhoea amongst infants under one year in Shoreditch during 1907 was at the rate of 15.3 per 1,000 births registered during the year, as compared with 40.3 for 1906 and 30.6 for 1905. The figures for the metropolis were 9.2, 27.3 and 20.7 respectively for the three years. A table giving a comparison of these rates for previous years is contained in the report for the year 1905. The deaths from diarrhoea amongst young infants were in the great majority of those investigated of infants being brought up otherwise than at the breast. 27 The deaths from diarrhoea in the metropolis in 1907 numbered 1,563, as compared with 1,507 in 1906. The deaths were most numerous during the months of September and October. The death-rate from diarrhoea for the metropolis was 0.32 per 1,000 population, as compared with 0.93 in 1906, 0.72 in 1905, 1.07 in 1904, 0.64 in 1903, and 0.53 in 1902. The death-rate of the metropolis was, therefore, much lower than usual for diarrhoea. MEASLES. Measles was prevalent in the Borough during the year, especially during the first eight months. Deaths from the disease were registered in every month of the year. Most occurred during the months of February, March, April, November and December. Those during the latter two months were chiefly in the Shoreditch Infirmary, where there was an outbreak amongst the children, with a mortality amounting to 47 per cent of those attacked, 17 out of 36 cases terminating fatally. Measles caused 114 deaths, of which 112 were of children under 5 years of age, and the other two of children aged between 5 and 10 years. Of the deaths 67 were of males and 47 of females. The deaths were most numerous in Church, Hoxton, Wenlock and Whitmore Wards. The mortality was highest in Whitmore and lowest in Acton Wards, being 2.07 and 0.48 respectively. The death-rate for the Borough amounted to 0.99 per 1,000 population, as compared with 0.64 in 1906, 0.52 in 1905, 0.69 in 1904, 0.85 in 1903, 0.72 in 1902, and 0.64 in 1901. It was, therefore, considerably above the average of recent years The deaths from measles in the metropolis numbered 1,801, as compared with 1,909 in 1906 and 1,715 in 1905, the death-rate being 0.38 per 1,000, as against 0.40 in 1906 and 0.36 in 1905. The houses brought to the notice of the Health Department as being infected through measles numbered 674, as compared with 449 in 1906, 470 in 1905, and 454 in 1904. Information as to these houses was in the great majority of instances supplied by the school authorities. In 204 of the houses on enquiry it appeared that the illness was not measles. Altogether 494 rooms in 459 houses were disinfected and the usual steps were taken by the officers of the Sanitary Authority in respect to bedding and textile articles which had been exposed to infection In 11 instances the measures as to disinfection were carried out by the occupiers of the premises to the satisfaction of the medical practitioners in attendances on the cases. WHOOPING COUGH. This disease was the cause of 99 deaths, 42 of males and 57 of females. With two exceptions the whole of them were of children under 5 years of age. The death-rate was 0.86 per 1,000 inhabitants, as compared with 0.51 in 1906, 0.73 in 1905, 0.51 in 1904, 0.35 in 1903, 0.63 in 1902, and 0.49 in 1901. The rate was, 28 therefore, higher than usual. A comparison of the death-rates in the eight wards of the Borough is given in Table VII. (Appendix). The rate was highest in Moorfields and lowest in Acton Ward. Deaths from whooping cough were registered in every month of the year except November, and they were most numerous during March, April, May and June. The deaths from whooping cough in the metropolis numbered 1,786, as compared with 1,226 in 1900 and 1,507 in 1905, the death-rate being 0.37, as against 0.26 in 1906 and 0.32 in 1905. INFLUENZA. Influenza was given as the cause of 23 deaths, as compared with 17 in 1906, 11 in 1905, 14 in 1904, 19 in 1903, 14 in 1902, 16 in 1901, 52 in 1900, and 35 in 1899. The figures for previous years are contained in the annual report for 1901. The disease was most prevalent during the month of January, when more than half the total number of deaths for the year occurred. During the last six months of the year there was only one death certified as due to this disease; that occurred in September. The deaths attributed to influenza in the metropolis numbered 967, as compared with 895 in 1906, 664 in 1905, 707 in 1904, 644 in 1903, 1,036 in 1902, 664 in 1901, and 1,950 in 1900. The deaths were most numerous during the first three months of the year. TUBERCULOSIS. Tuberculosis (Appendix Table V., Nos. 29 to 34 inclusive) was given as the cause of 327 deaths, as compared with 347 in 1906, 321 in 1905, 365 in 1904, 376 in . 1903, 295 in 1902, 363 in 1901, and 343 in 1900. The deaths from tuberculosis amounted to nearly 14 per cent, of the total number of deaths from all causes during the year. Last year it was 15 per cent. The death-rate was 2.8 per 1,000 population, as compared with 3.0 in 190'6, 2.7 in 1905, and 3.1 in 1904. The rate was lowest in Moorfields Ward, where it only amounted to 1.2 per 1,000, and highest in Whitmore, where it reached 4.2 per 1,000 population. In connection with this it may be mentioned that the population in Whitmore Ward is three times as dense to the acre of space as it is in Moorfields, and, taking the population generally, that of Moorfields is in better circumstances than that of Whitmore. These are, without doubt, important factors in determining the difference between the tuberculosis mortalities of these localities. Tuberculosis of the lungs, that is to say, consumption or phthisis, resulted in 232 deaths, as compared with 233 in 1906. Of these 145 were of males and 87 of females. The great majority of these deaths were of persons in the wage-earning period of life. The death-rate from consumption was 2.0 per 1,000 inhabitants, 29 being highest in Whitmore, where it amounted to 3.0, and lowest in Moorfields, where it was 1.2 per 1,000 inhabitants. Disinfection in connection with phthisis cases is undertaken by the Sanitary Authority whenever they may be called upon to disinfect. This, however, is but seldom. Efforts are also made to get the necessary measures as to disinfection carried out by the Sanitary Authority after all deaths in private houses in the Borough, but not always with success. A large proportion of the deaths from phthisis occur in public institutions. In such the measures to be taken are matters for the authorities of the institutions, but in the case of institutions within the Borough bedding has been disinfected by the Sanitary Authority at the request of the authorities. During the year measures were taken for the disinfection of 79 houses in which cases of phthisis occurred. The deaths from tuberculosis in the metropolis numbered 9,312 yielding a deathrate of 1.9 per 1,000 inhabitants. Of these some 6,854 were attributed to consumption, the death-rate being 1.4 per 1000 inhabitants. From these figures it will be seen that the mortality from tuberculosis was 47 per cent. higher in Shoreditch than in the metropolis, whilst for phthisis it was 40 per cent. higher. CEREBRO SPINAL FEVER. In March of the year under consideration the above disease, which is also known under the names of epidemic cerebro spinal meningitis and spotted fever, was made a notifiable disease in the metropolis by the London County Council under the provisions of Section 56 of the Public Health (London) Act, 1891, for a period of six months, which period was further extended for another 18 months in September. Cases classed as basal meningitis, when not due to tubercle or ear disease, are also notifiable. The specific micro organism of the disease is here referred to as the meningococcus. The following are, briefly, particulars as to the cases certified as cerebro spinal fever during the year:— (1) A child, female, aged 4½, daughter of a journeyman baker, residing at 21, L— Street, certified March 12, removed to hospital, died. Postmortem examination revealed tuberculous meningitis. The meningococcus was not found. The house in which this case occurred was in a satisfactory sanitary condition. (2) A child, female, aged 9 years, father of no occupation, residing at 20, T—Place, certified April 2nd, removed to hospital, died. Postmortem showed pneumonia and meningitis, but there was no statement as to the presence of the meningococcus. The house occupied was dirty and verminous. (3) A child, female, aged 4 years, daughter of a labourer of 45, M— Street, certified April 8th, not removed to hospital, died. No postmortem examination and no bacteriological examination made. A sister died a few weeks before from pneumonia and convulsions following measles. The house occupied was verminous, 30 (4) An infant, male, aged 6 months, son of an upholsterer, of 23, B— Dwellings, certified August 8th, removed to hospital, died. Post-mortem examination and bacteriological examination revealed cerebro-spinal fever, the meningococcus being present. The dwelling occupied was in a satisfactory sanitary condition. ( 5) An infant, male, aged 8 months, son of a window cleaner, of 12, B— Street, certified August 30th, removed to hospital, recovered, no bacteriological examination made. The case was regarded as one of posterior basic meningitis. The house occupied was in a satisfactory sanitary condition. (6) An infant, male, aged 8 months, son of a picture frame maker, of 74, A— Street, certified September" 4th, not removed to hospital, died. No post-mortem and no bacteriological examination made. House occupied in a fair sanitary condition. (7) A child, female, aged 3 years, daughter of a labourer, an inmate of the Shoreditch Infirmary, certified September 25th, removed to hospital, died. Post-mortem and bacteriological examinations were negative as to the case having been one of cerebrospinal fever. The following case was brought under my notice in consequence of the result of a post-mortem examination :— A female, aged 5 months, of 10, S— Chambers, daughter of a baker, was admitted to St. Bartholomew's Hospital and died there. The cause of death was basal meningitis, due to the meningococcus. The dwelling occupied was in a satisfactory sanitary condition. Enquiries were made during the year in respect to the subjoined deaths, which were suspected as possibly having been the result of cerebro-spinal fever:— (1) That of a child, female, of No. 37, E—Street. The post-mortem examination which was made sho-wed the presence of meningitis, but the meningococcus was not found. The case was regarded as having been one of meningitis due to the pneumococcus, or micro-organism of pneumonia. (2) That of a child, female, of 47, N— Street. No post-mortem examination was made. There were no good grounds for believing this child to have died from cerebro-spinal fever. (3) That of a child, female, of 61, H— Road. No post-mortem tion was made, and death was believed to have been the result of tuberculous meningitis. (4) That of a lad, aged 15 years, of 21, N— Street. The post-mortem examination made revealed no signs of tubercle. Basal meningitis was present, more particularly in respect to the left hemisphere of the brain, the appearance being such as to suggest the probability of abscess formation had the patient lived longer. Nothing definite was found in respect to the upper part of the spinal cord, which was 31 examined. Although there appears to have been an element of doubt about the case, death was not believed by the medical practitioner to have been the result of cerebro-spinal fever. No bacteriological examination was made. (5) That of a child, aged 13 months, of 122, C— Street. No post-mortem examination was made. The case was believed to have been one of tuberculous meningitis. The following cases were brought to my notice by the medical attendants early in the year before the disease was notifiable as possibly being cases of cerebro-spinal fever:— (1) A child, male, aged 2, of 99, B— Road, a house in a satisfactory sanitary condition, died with symptoms suggestive of cerebro-spinal fever. Fluid from the spinal cord was examined by the bacteriologist, but found to be sterile. (2) An infant, male, aged 6 months, of 16, H— Street, a house in a satisfactory sanitary condition, died with signs and symptoms suggesting to the medical attendant the possibility of cerebro-spinal fever. Death occurred after a few days' illness, and was preceded by the appearance of purpuric spots about the face and scalp, with a few scattered over the trunk and limbs. A post-mortem examination was negative as to the case having been one of cerebro-spinal fever, nor did the bacteriologist ascertain the presence of the meningococcus. The eruption, on close examination, was extremely suggestive of that of chicken pox. There had been chicken pox in the house within a month of the infant's fatal illness. An inquest was held, and a verdict of bronchitis and chicken pox was returned. Of the seven cases which were certified to be cerebro-spinal fever, in one the specific micro-organism of the disease was found, thereby proving that the case was a genuine one of cerebro-spinal fever; one was not positively shown to have been a genuine case, but was a case of basal meningitis; the remaining five were not proved to be cases of the disease. With regard to the other cases enquired into, in one only was positive evidence obtained as to the presence of the specific microorganism of cerebro-spinal fever. The deaths certified from cerebro-spinal fever numbered 4, all of children under five years, of whom three were males and one female, the death-rate being 0.03 per 1,000 inhabitants. The deaths from meningitis not stated to have been tuberculous numbered 22, of which 19 were of children under five. Including the deaths attributed to cerebro-spinal fever, they were rather below the average for the previous six years in point of numbers. In the whole of London less than 140 cases were notified, and some 25 deaths were certified as due to cerebro-spinal fever. 32 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. Aldersgate Ward .. .. .. .. .. 4 .. .. .. 4 Arlington Street .. .. .. .. .. .. .. 1 .. 1 Bath Street .. .. .. 1 .. 3 .. .. .. 4 Canal Road .. .. .. 5 97 12 9 .. 7 130 Catherine Street .. .. .. 13 24 14 9 24 14 98 Central Street .. .. 1 .. .. .. .. .. 1 2 Chatham Gardens .. .. 1 13 13 1 3 28 11 70 Coleman Street Ward .. .. .. .. 2 8 2 .. .. 12 Curtain Road .. .. 1 17 43 6 12 5 28 112 Ecclesbourne Road .. .. .. 1 .. .. .. .. .. 1 Enfield Road .. .. .. .. .. 1 .. .. .. 1 Fellows Street 1 .. .. 15 26 21 25 4 4 96 Gopsall Street 1 .. 11 50 107 69 68 54 67 427 Haggerston Road. .. .. 12 25 93 15 12 47 79 283 Hammond Square .. .. 1 2 89 43 19 79 33 266 Hanover Street .. .. .. 2 1 .. .. • • .. 3 Hoxton House .. .. .. .. .. .. 1 .. .. 1 The Laurence .. .. .. 1 .. .. .. .. .. 1 Maidstone Street 2 .. 32 41 53 15 31 1 51 226 Napier Street .. .. 25 20 99 39 15 40 39 277 Queen's Road .. .. .. .. .. .. .. .. 1 1 Redvers Street .. .. 5 29 12 2 8 2 o 23 81 St. Columba .. .. .. .. 9 .. .. 2 .. 11 St. John's Lane .. .. .. .. .. .. .. .. 5 5 St. John's National .. .. .. 13 2 3 .. .. .. 18 St. John's Road 1 .. 10 82 77 39 11 7 21 248 St. Mark's .. .. .. .. .. .. 1 1 1 3 St. Monica's .. .. .. .. 11 .. .. • • .. 11 St. Paul's .. .. 2 11 .. .. .. .. .. 13 Scawfell Street .. .. 15 56 71 47 108 106 90 493 Scrutton Street .. .. .. 8 10 4 3 1 8 34 Shap Street .. .. 4 49 87 15 12 25 66 258 Shepperton Road .. .. .. 2 .. 2 .. .. 1 5 Trinity Place .. .. .. .. 15 16 2 18 8 59 Virginia Road .. .. .. .. 1 .. .. • • 2 3 Wenlock Road .. .. 8 11 53 24 17 22 6 141 Total 5 .. 128 467 995 403 368 467 566 3399 The exclusions were much more numerous for all the diseases given in the foregoing table except enteric fever, the total number exceeding that for 1906 by over 1,200, and was the highest so far recorded. 33 The following schools came under my notice in connection with the prevalence of infectious disease amongst the scholars:— Shap Street School.—Class-room A of the infants' department was closed by the Medical Officer (Education) on account of the prevalence of measles amongst the children. There was a large percentage of absentees chiefly on account of the disease mentioned. The usual steps as to disinfection were taken by the Sanitary Authority. Canal Road School.—Attention was directed to the infants' department by reason of the number of cases of measles amongst the children, but after enquiry no action appeared necessary. Scawfell Street School.—A child whilst suffering from scarlet fever was found to have been attending the infants' department. The necessary measures for disinfection were taken. Redvers Street School.—Class-room E of the boys' department was closed by the Medical Officer (Education). There were some cases of scarlet fever discovered amongst the boys in this room, and it was thought advisable for the room and its contents to be disinfected. St. John's Road School.—Class-rooms F, G, H and I of the infants' department were closed shortly before the Christmas holidays and disinfected. Cases of scarlet fever were occurring amongst the children, more especially amongst those in room H. BACTERIOLOGICAL EXAMINATIONS. Bacteriological examinations were made by Dr. Bulloch at the London Hospital Medical School in 31 cases of suspected infectious disease. In 18 the disease suspected was diphtheria, in 8 it was typhoid fever, in 3 consumption, and in 2 cerebro-spinal fever. The results were positive as to the presence of1 the specific micro-organism in 1 case of enteric or typhoid fever, in 4 cases of diphtheria, and in 1 case of consumption. Two samples of tinned condensed milk were also examined, one of which was found to contain enormous numbers of micro-organisms likely to be injurious to health. DISINFECTION. During 1907 disinfection was carried out at 1,688 premises, a considerable increase on the number for last year. The articles removed and disinfected at the Borough disinfecting station numbered 34,095, as compared with 26,693 in 1906, 33,745 in 1905, 14,063 in 1904, 8,911 in 1903, 55,025 in 1902, and 17,226 in 1901. The articles disinfected included 1,906 beds, 2,349 mattresses, 3,697 pillows, 1428 bolsters, and 24,715 miscellaneous articles, including clothing, linen, carpets, curtains, and the like. In some cases infected bedding was found to be so contaminated and in such a worn and filthy state that it had to be destroyed. Articles so destroyed were replaced to the extent of 5 beds, 13½ mattresses, 1 bolster and 2 pillows. C 34 No complaints were received of a serious character in respect to the measures as to disinfection. In one instance a quilt was damaged, for which compensation was paid. Disinfection is carried out by the Sanitary Authority after all cases of notifiable infectious disease except erysipelas. In the case of erysipelas disinfection is carried out by the Sanitary Authority if called upon to do so. Disinfection is also performed after measles and after phthisis or consumption if the Sanitary Authority are so permitted. THE SHELTER. The following are the particulars as to the use of the shelter during 1907:— Date of Admission to Shelter. Length of Slay therein. Number of Persons. Address from which the persons were admitted. Disease. January 3 1 Day 2 21, Salisbury Street Smallpox March 22 ½ Day 2 65, Newton Street Scarlet Fever August 1 1 Night 2 251, Hoxton Street Diphtheria Altogether six persons used the shelter on account of infectious disease. Once during the year a family of seven persons had the use of the baths at the shelter for purposes under the Cleansing of Persons Act. PUBLIC MORTUARY. During 1907 the dead bodies received into the public mortuary, which is situate in the rear of Shoreditch Church, numbered 349, as compared with 405 in 1906, 417 in 1905, and 460 in 1904. The bodies of three persons dead of infectious disease were removed to the mortuary by the Sanitary Authority, as compared with 5 in 1906, and 3 in 1905. A specially constructed and ventilated iron shell has been provided for the reception of infectious or offensive bodies. The marked falling off in the number of bodies deposited in the mortuary during the year under consideration probably resulted to a large extent from the absence of prolonged hot weather during the summer. Bodies which would otherwise have been removed to the mortuary to await burial were retained at home. The inquests held numbered 298, as compared with 295 in 1906, 290 in 1905, and 336 in 1904. The post-mortem examinations made in the post-mortem room at the mortuary numbered 229, as compared with 226 in 1906, 223 in 1905, and 251 in 1904. The figures as to the use of the mortuary in years previous to 1904 are contained in the annual report for 1903. WATER SUPPLY. The rainfall for the year measured at Oxford amounted to 27 inches. Taking the mean rainfall for 35 years, there was an excess of about 1 inch. The last quarter 35 of the year was the rainiest, nearly 11½ inches fell, the fall exceeding the average by over 4 inches. The wettest month was October, when 5.34 inches fell, and the dryest was January, when the fall only amounted to 0.61 of an inch. No complaints were received as to the quality of the water supplied in the Borough either in the East London or in the New River district, and there was no reason for suspecting the occurrence of any water-borne disease. In accordance with Section 49 of the Public Health (London) Act, 1891, communications were received from the Metropolitan Water Board as to water-supplies to houses being cut off in respect to 113 premises, 81 in the New River district and 32 in the East London district. The area of the latter district in Shoreditch is about a quarter of the area of the Borough. In many of the intimations the premises referred to had been vacated. Arising out of a resolution of the Islington Borough Council asking the Metropolitan Water Board to adopt legal proceedings instead of cutting off the water as a means of recovering the rates, there was some correspondence between the Board and the Metropolitan Borough Councils upon the subject. In consequence thereof in the early part of the year the Board sent for the information of the Borough Councils an extract from a report of their Finance Committee dealing with the withdrawal of supplies. From this it appears that by far the greater number of cutting off cases have no connection whatever with the payment of the water rates, but are the results of defective or irregular water fittings and waste of water, requiring the attention of the Board's engineering department. The power of cutting off for non-payment of rates is now very sparingly used, and arrangements were being made whereby summary proceedings for the recovery of arrears are to be taken in the great majority of cases. The Board point out that the effect of their operation has been to considerably reduce the number of cutting-off notices issued, and. that the process of reduction will be continued as rapidly as circumstances permit. With reference to this it may be stated that the intimations as to the withdrawals of supplies in Shoreditch have been considerably reduced in number during the past four years as compared with the previous four years, when the water companies were in existence. The Board suggest that if at any time the local authorities find that the disconnection of a supply is likely to occasion the slightest danger to the public health, they should direct their officials to communicate with the Board's officials, who would promptly act in concert with them in order to obviate the possibility of the danger referred to. Dealing with the present procedure, the facts are stated to be as follows:— No supply is cut off for the non-payment of rates— (a) Without an order of the Committee after a full enquiry into the whole of the circumstances. (b) Where the premises are known to be occupied Ivy more than one family. (c) Where inability to pay by reason of real poverty is established. (d) Where the owner and not the occupier is responsible by law or agreement for the payment of the water rate. C 2 36 The Board further state— (1) That notice to "cut off" is sent to both the Clerk and the Medical Officer of Health of the Local Authority concerned, instead of only to one of those officers as formerly. (2) That during the half-year ending Michaelmas, 1906, with 1,100,000 supplies, only 214 were withdrawn for non-payment of water rate, and of these only about 150 were inhabited houses. (3) That with a view to giving the Local Authority information as to the reason of disconnection, we have arranged that the notices sent to them shall in future declare in all cases the reason for the withdrawal. STREET CLEANSING AND REMOVAL OF HOUSE REFUSE. Prior to 1891 the work of cleansing the streets and removing house refuse was done by a contractor. In that year the late Vestry undertook to carry out the work by direct labour, and it has since so been done by the Sanitary Authority. For the following brief note as to the system in operation 1 am indebted to Mr. T. L. Hustler, the Borough Surveyor, under whose supervision the work is executed. When first undertaken the whole of the work of cleansing the streets was done by day, but after a trial of three months this was found to bei unsatisfactory, and a system of partial day and night was adopted and is the one now in operation. The whole of the main thoroughfares and most of the paved streets are cleansed at night, and the remaining macadamised and secondary streets by day, all the streets in the Borough, including courts and passages, being cleansed daily at least. Principal roads are also cleared if required by an orderly gang which is set on according to the state of the weather. All gullies are emptied and cleansed by night once a week. A special gang of men is engaged to sweep the principal macadamised roads on Saturday nights to make them tidy for Sunday. The slop picked up from the roads is taken to the Council's wharf to be barged away by a contractor. On an average about 17,000 tons are thus disposed of per annum. Dry sweepings and market refuse are taken to the destructor and burned whenever possible. The refuse from the whole of the houses in the Borough is called for and removed once a week, but in many cases where special request has been made practically a daily collection is in vogue. All house refuse is taken to the dust destructor and burnt. About 30,000 tons are so disposed of during the year. From the end of March to the end of September the whole of the main roads, when required, are watered three times and the bye-roads twice in the course of the day. Special attention is directed to keeping roads well watered where food is exposed for sale in dry and dusty weather, two additional vans being employed to assist in carrying out this watering efficiently. SANITARY WORK. Preliminary notices as to insanitary conditions were served in respect to 3,341 premises, of which 348 were dealt with under the supervision of the Chief Inspector, 37 599 under that of Inspector Lear, 540 under Inspector Firth, 757 Inspector Jordan, 528 Inspector Langstone, and 569 under Inspector Pearson, In connection with the work arising out of these notices 932 letters were sent to owners of property, builders, and other parties concerned. Some 27,700 visits of inspection were made during the year, exclusive of those made by the Medical Officer of Health and Chief Sanitary Inspector. The premises inspected included milks hops, cowsheds, slaughter-houses, cookshops and eating-houses, factories, workshops, outworkers' premises, and others, including dwelling-houses and tenement buildings (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. Langstone. Insp. Pearson. Total New drains constructed 5 3 2 8 1 .. 19 Drains re-constructed or repaired 24 20 76 38 54 70 282 Sink waste pipes trapped and disconnected .. 13 95 99 15 57 279 Stack pipes re-instated 70 51 119 22 48 81 391 Eaves gutters re-instated 71 55 124 24 41 58 373 Stack pipes disconnected from drains .. 4 40 14 3 17 78 Accumulations of sewage dealt with 11 5 4 14 22 40 96 Cesspools abolished .. .. 2 .. .. .. 2 New water closets constructed 9 2 18 61 3 8 101 Old water closets re-construeted or repaired 2 46 92 126 98 99 463 Water closets cleansed and white-washed 40 322 81 358 66 163 1030 Water closet flushing apparatus repaired 53 80 28 147 78 69 455 Obstructions in water closets removed 3 49 18 33 20 51 174 Overcrowding in houses abated 6 11 19 4 15 25 80 Damp courses in houses provided .. 3 8 1 .. 2 14 Walls pointed 59 8 36 1 6 37 147 Roofs repaired 64 103 94 45 94 58 458 Stairs repaired 94 59 42 19 15 14 243 Floors repaired 90 117 32 34 27 55 355 Ventilation under floors provided .. .. 10 2 22 .. 34 Doors repaired 86 15 10 18 16 3 148 Door cills provided 87 9 35 24 20 17 192 Sashes repaired 56 239 7 10 18 9 339 Houses cleansed throughout 173 56 36 72 42 52 431 Houses cleansed in part 68 132 323 39 216 202 980 Total number of rooms cleansed 1083 1023 957 765 718 618 5164 Yards or areas lime-washed 52 367 20 194 60 135 828 Yards paved 58 74 96 58 76 108 470 Areas of forecourts paved 16 11 23 .. 4 18 72 New areas constructed .. .. .. 1 .. 1 2 Sculleries paved 21 10 31 4 5 13 84 Dust receptacles provided 35 87 66 44 102 109 443 Dung receptacles provided 16 .. 9 .. 1 .. 26 Insanitary cisterns removed .. 3 3 .. 1 1 8 38 In connection with the above it may be mentioned that 12 old brick drains were removed, and in 44 instances nuisances and annoyance from the presence of rats on premises mainly through defects in drains or sewers were dealt with. In 97 instances water was restored to premises, the supplies having been cut off for various reasons, and on 129 premises leaking water pipes were repaired. Urinals were constructed or reconstructed in 13 instances, and 33 were cleansed, repaired, or otherwise dealt with. Seven of these urinals were dealt with by the Chief Inspector under the London County Council (General Powers) Act, 1904, four being remodelled, and three removed'. Foul accumulations which were causing or likely to cause nuisance were dealt with on 85 premises. On 32 premises animals were found to be stabled so as to give rise to nuisance, and in 16 instances stables were repaved under the supervision of the sanitary officers. The foregoing summary includes the work performed in dealing with matters under the Factory and Workshops Act, 1901, and also that done in connection with the drains of new buildings. The bulk of the work was carried out in compliance with preliminary notices; in 274 instances, however, it was necessary to specially direct the attention of the Health Committee to the circumstances connected with the cases, and in these statutory notices under the Public Health (London) Act, 1891, were served by the Sanitary Authority upon the parties responsible with a view to enforcing the abatement of the nuisances existing. For non-compliance with the requirements of the Sanitary Authority and for breaches of the Public Health (London) Act, 1891, and by-laws made thereunder, police court proceedings were taken as set out below:— Premises. Result of Proceedings. Angrave Street, No. 34 Order, with 8/- costs. Halcombe Street, No. 9 Order, with 2 guineas costs. Laburnum Street, No. 40 Summons withdrawn 3/- costs. „ „ „ 46 „ „ „ „ „ „ „ 48 „ „ „ „ „ „ „ 50 „ „ „ „ „ „ „ 52 „ „ „ „ „ „ „ 54 „ „ „ „ New Norfolk Street, No. 25 „ „ 2/- „ „ „ „ „ 26 „ „ „ „ „ „ „ „ 27 „ „ „ „ ,, ,, ,, ,, 28 „ „ „ „ „ „ „ „ 29 „ „ „ „ Pitfield Street, No. 112 Summons not proceeded with. St. John's Road, Nos. 33, 35, 37 Conviction-Fined £50, with 25 guineas costs. Wilmer Gardens, No. 47 Fined 5/- for 10 days, with 2 guineas costs. The summons in respect to No. 34, Angrave Street was taken by Inspector Firth against the owner for failing to provide a proper supply of water for flushing the w.c. 39 With respect to No. 9, Halcombe Street, proceedings were taken by Inspector Pearson on account of the defective condition of the drain. This drain formed part of a combined system. It was not disputed that the drain was defective and required reconstruction. The owner, however, contended that the combined drain was a sewer. The Council were in possession of a plan and record showing that the combination had been approved by the Local Authority, and was, therefore, a drain. The owner, however, was not satisfied, and decided that an appeal should be made to a magistrate, the chief point raised by him being that the application to lay the drain in question was undated. The magistrate decided in the Council's favour. The summonses in respect to the houses in Laburnum Street were taken by the Chief Inspector against the owner for failing to supply the houses with proper dust receptacles. The dust receptacles were, however, provided before the summonses came on for hearing, and it was decided to withdraw them on1 the owner paying the costs of the same. With respect to the houses in New Norfolk Street, the summonses were taken against the landlord by the Chief Inspector for neglecting to make the returns necessary for registration under the by-laws as to houses let in lodgings. The returns having been made before the summonses came on for hearing, it was decided in these cases also not to proceed further, and the summonses were withdrawn upon the costs being paid by the landlord. The proceedings in respect to Nos. 33, 35 and 37, St. John's Road and 112, Pitfield Street, relate to the seizure of unsound food, and are dealt with later in the report (vide p. 51-53). With regard to No. 47, Wilmer Gardens, this was a house without a proper receptacle for house refuse. The necessary notices were served, but no steps were taken, and when the case came on for hearing the owner failed to appear. The magistrate inflicted the penalty as above, that is, five shillings for every day the house was without a proper receptacle after the period stated on the statutory notice, seven days having been allowed for the period during which the necessary provision should have been made. SMOKE NUISANCE. During the year nuisances from the emission of black smoke were dealt with in 27 instances. Seventeen communications were received from the London County Council relating to black smoke issuing on ten premises. In all cases the necessary steps were taken with a view to obtaining the abatement of the nuisances. In one instance the facts were reported to the Health Committee, and a statutory notice was ordered to be served upon the person responsible under the Public Health (London) Act, 1891, but it was not necessary to take police court proceedings. 40 VERMINOUS HOUSES. The houses dealt with for vermin numbered 111, as compared with 103 for last year. The walls of the rooms affected, which numbered 181, were stripped of paper, stopped and thoroughly cleansed. The work was carried out upon the service of intimation notices, and it was not necessary to take any legal action for enforcing the provisions of the London County Council (General Powers) Act, 1904, which enable sanitary authorities in the metropolis to take steps for freeing houses from vermin. HOUSES CLOSED. The following houses were closed during the year upon 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 proper and efficient manner:— Alfred Terrace, No. 4. Barton Court, Nos. 6, 8, 9, 10, 11, 12, 13, 14, 15, and 16. Britannia Street, Nos. 114, 115, 116, 117, 118, 119, and 120. Cottons Gardens, No. 33. East Road, No. 95. Heam Street, No. 3. Kingsland Road, Nos. 12. 14, and 253. Maria Street, Nos. 53 and 57. Nichol Street, Nos. 4 and 6. Pearson Street, No. 9. Redvers Street, No. 55. Salisbury Street, No. 20. The house in Alfred Terrace was in a dirty and dilapidated condition and was closed under statutory notice. The necessary works to put the premises into a habitable condition were carried out under Inspector Firth's supervision. The houses in Barton Court were in a very dirty, dilapidated and insanitary condition. It was necessary to close them as the work of renovation could not be carried out whilst they were in occupation. They were dealt with under the supervision of the Chief Inspector. A great deal of work was required, and amongst other items it was necessary to take the front walls down and rebuild them. Extensive structural alterations were carried out, and in the end a very satisfactory improvement was effected in the condition of this court. The houses in Britannia Street were in a very dirty, dilapidated and insanitary condition. They were occupied by a very rough class of people, and several complaints had been received as to the insanitary conditions existing in them. They were closed by the owner upon receipt of sanitary notices from the Chief Inspector, and the works necessary to render them fit and proper for habitation are now in progress. The house in Cottons Gardens was in a very dirty and dilapidated condition, and was closed by the owner upon receipt of a statutory notice. The premises were dealt with under the supervision of Inspector Jordan. 41 The house in East Road was rinsed by the owner upon receipt of a sanitary notice from Inspector Lear. It was dealt with in a satisfactory manner, and subsequently re-occupied. No. 3, Hearn Street was closed under sanitary notice served by Inspector Jordan. The drains and sanitary arrangements generally were in a very defective condition, and the owner decided to close the house to facilitate the work of reconstruction. Nos. 12 and 14, Kingsland Road, were occupied by Italians and were used for the manufacture of ice-cream. The premises were very old, dirty and dilapidated, and a good deal of structural work was required to put them in a satisfactory sanitary condition. They were closed by the owner upon receipt of a sanitary notice from Inspector Jordan, and were subsequently demolished. A new building is now in course of erection upon this site. No. 253, Kingsland Road, was in a very dirty condition, and the drains were very defective. It was occupied in the lower part by Italians who manufactured ice-cream. The premises were closed and thoroughly dealt with under sanitary notice served by Inspector Pearson, the work being in progress at the end of the year. The two houses in Maria Street were in a dirty and dilapidated condition, and were closed by the owner upon receipt of a sanitary notice from Inspector Pearson. It was not thought advisable to spend the money on them to put the houses in a sanitary condition, as it was probable that they were to be demolished in connection with a building scheme. At Nos. 4 and 6, Nichol Street, and 9, Pearson Street, the drains were in a very defective condition. In order that the works required might be carried out in a speedy and efficient manner the owner closed the houses. The house in Redvers Street was in a very dirty and dilapidated condition, and was closed by the owner on receipt of a sanitary notice from Inspector Jordan, being dealt with under his supervision. The house in Salisbury street was in a very dilapidated and dirty state and generally insanitary. A statutory notice was served, and the premises were vacated to permit of the works required being executed in a satisfactory manner. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. The following houses came under my notice during the year as being closed for demolition:— Clifton Street, No. 29. A nine-roomed house with a basement; was demolished. Clifton Street, Nos. 109, 111, 113, 115, 117, 119, 121, and 123. These houses each consisted of seven rooms with a scullery; they were closed for demolition. Dysart Street, No. 10. A three-roomed house; was demolished. 42 Scrutton Street, Nos. 23 and 25. Seven-roomed houses with sculleries; they were closed for demolition. These houses were occupied as dwellings by persons of the working class, between 120 and 130 persons residing in them. Their sites are being, or are going to be, used for business premises. ARTIZANS' DWELLINGS. These comprise some 46 separate blocks, including an additional block in connection with Broad Street Dwellings. Particulars in respect to them are contained in my reports for 1905 and 1906. They were under observation during the year, and their sanitary condition may be described generally as satisfactory. As in previous years, for the purposes of comparison they have been divided into two classes, A including those occupied by persons who on the whole are in comfortable or fairly comfortable circumstances, and B including those occupied by people in very poor circumstances. Class B includes the same dwellings as in previous years. The number of tenements, rooms, and persons in the dwellings estimated for the year 1907 are contained in the subjoined table:— N umber of blocks. Number of tenements. Number of rooms. Number of persons. Class A 31 1514 3912 6010 Class B 15 383 917 1780 Total for the whole 46 1897 4829 7790 The conditions associated with residence in the class A are, from a sanitary point of view, superior to those in the class B dwellings. The births registered during the year, and the birth-rates in the dwellings as a whole, and the two classes into which they have been divided are shown below:— The whole of the Dwellings. Class A. Cass B. Number. Rate per 1,000 Inhabitants. Number. Rate per 1.000 Inhabitants. Number. Rate per 1,000 Inhabitants. 249 31.9 191 31.7 58 32.6 The number of births was the same as in 1906. The proportion of deaths attributed to prematurity remained the same as for 1906, namely, 12 per 1,000 births, as compared with 27.5 in 1905. In class A the deaths from prematurity amounted to 15.7 per 1,000 births, whilst in class B they were nil. For the whole Borough the deaths from prematurity amounted to 16.1 per 1,000 births. 43 The infantile mortality for the whole of the dwellings was 124 per 1,000 births, as compared with 97 in 1906 and 140 in 1905. For the class A dwellings it was 99, as compared with 84 in 1906 and 134 in 1905. For class B the mortality was 207, as compared with 133 in 1906 and 166 in 1905. 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. N umber of deaths. Rate per 1,000 inhabitants. Number of Deaths. Kate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants. Kate per 1,000 inhabitants. All causes 117 15.0 77 12.8 40 22.4 20.6 Principal Zymotic diseases 19 2.4 14 2.3 6 2.8 2.9 All forms of Tuberculosis 12 1.5 9 1.5 3 1.6 2.8 Phthisis 9 1.1 6 0.9 3 1.6 2.0 Bronchitis 9 1.1 4 0.6 5 2.8 2.0 Pneumonia 12 1.6 5 0.8 7 3.9 2.0 The deaths of residents of the dwellings in public institutions numbered 43, being 26 for the class A and 17 for the class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 36.7, being 33.7 for class A and 42.5 for class B. The percentages For previous years are contained in my last annual report. Those for the Borough and for the wards are contained in Table VII. (Appendix). These figures are higher than those for 1906. They are, however, below the average for the Borough. The cases of notifiable infectious disease numbered 79, of1 which 68 were in the class A and 11 in the class B dwellings. The attack-rates per 1,000 population were respectively 10.1, 11.3, and 6.1, as compared with 10.8 for the whole Borough. The cases included 52 of scarlet fever, 14 diphtheria, 1 enteric fever, 10 erysipelas, 1 cerebro-spinal fever, and 1 puerperal fever. The numbers of cases and the attack-rates per 1,000 inhabitants with respect to scarlet fever, diphtheria, enteric fever, and erysipelas are set out below:— Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Cases. Rate. Cases. Rate. Cases. Rate. Cases. Rate. Class A 46 7.6 11 1.8 1 0.1 8 1.3 Class B. 6 3.3 3 1.7 — — 2 1.1 The whole of the dwellings 52 6.6 14 1.8 1 0.1 10 1.2 44 For the whole Borough the attack-rates per 1,000 population were as follows: — 7.5 for scarlet fever, 1.8 for diphtheria, 0.3 for enteric fever, and 1.1 for erysipelas. To summarise, the foregoing figures indicate that, taking the artizans' dwellings as a whole during 1907, the mortality from all causes was markedly lower than that of the Borough. The death-rate in the class A dwellings was very low. That of the class B dwellings was distinctly higher than that of the Borough. The infantile mortality was markedly lower than that of the Borough, taking the dwellings as a whole, but whilst in class A it only amounted to 99 per 1,000 births, in class B it was 207, a very notable difference. The incidence of attacks of notifiable infectious disease was somewhat below the average for the Borough, taking the whole of the dwellings, but it will be noticed that, whilst the attack-rate is a little above the average for the class A dwellings, it is markedly below it for the class B dwellings. HOUSES LET IN LODGINGS. The following houses were registered during the year under the by-laws as to houses let in lodgings or occupied by members of more than one family: — Britannia Street. Nos. 97, 98, 99, and 100. New Norfolk Street, Nos. 25, 26, 27, 28, and 29. Hackney Road, Nos. 219 and 221. The number placed upon the register during the year was 11, making a total of 314 since the by-laws came into operation. The actual number on the register, after making deductions for duplication consequent upon change of ownership, was at the end of the year 272. The houses on the register were under observation dusing the year, and some 419 visits were made in connection with them. CUSTOMS AND INLAND REVENUE ACTS. Applications for certificates under the above Acts as to the sanitary fitness of dwellings for the purpose of obtaining exemption from payment of inhabited house duty were received in respect of the following:—Nos. 15, 16, and 17, Napier Street, each containing three tenements. Certificates were given after some necessary work had been executed in connection with the yard paving of the houses. SLAUGHTER-HOUSES. The number of licensed slaughter-houses in the Borough at the end of the year was 8, as compared with 9 in 1906 and 12 in 1905. They are situate at the addresses as set out below:— Broadway, London Fields, No. 7. Hackney Road, No. 135. Haggerston Road, No. 4. Haggerston Road, No. 76. Hoxton Street, No. 184. New North Road, No. 179. Shepherdess Walk, No. 92. Whitmore Road, No. 1, 45 The slaughter-house situate at No. 134, Goldsmith Row, was closed at Easter and the license lapsed. The slaughter-houses were inspected from time to time during the year, and except in respect to a few minor matters their general sanitary condition may be said to be satisfactory. COW-HOUSES. The number of licensed cow-houses in the Borough at the end of 1907 was seven, remaining the same as for the previous three years. They are situate at the following addresses:— Bracklyn Street, No. 22. Dunstan Street, No. 33. Hoxton Street, No. 274. Mintern Street, No. 7. Moye Street, No. 47. Nile Street, No. 38. St. John's Road, No. 76. The cowsheds afford accommodation for 108 cows, but the number kept in the Borough was found at an inspection made a short time before the licensing session in October to be 57, as compared with 74 in 1906, 86 in 1905, 95 in 1904, and 101 in 1903. If the decrease which is manifest from the figures given continues, cow-keeping in Shoreditch will in the course of a few more years have become a thing of the past. The cowhouse premises were periodically inspected during the year, and their general sanitary condition may be reported upon as satisfactory. On one of the premises the drainage system was reconstructed, the work being carried out to the satisfaction of the Sanitary Authority. The number of dairymen and milk purveyors on the register at the end of the year was 284, as compared with 288 in 1906, 289 in 1905, 294 in 1904, 300 in 1903, and 304 in 1902. As in the case of the cowsheds, the number of premises upon which milk is sold is decreasing. This is doubtless owing to the necessity of registration and to the premises being subject to periodic inspection. At many of the shops milk is only sold in small quantities, and the conditions under which it is often kept are from a health point of view far from satisfactory. During the session of 1908 the London County Council purpose introducing a Bill for obtaining power from Parliament to enable Local Authorities amongst other things to exercise their discretion as to the registration of premises for the sale of milk. Such power would undoubtedly help to prevent the sale of milk upon undesirable premises. During the year the sale of milk was discontinued at 22 and was commenced at 18 premises, the necessary applications being duly received. In 61 instances milk purveyors' premises changed hands and the necessary corrections were made in the register. The cowsheds, dairies, and milk shops in the Borough were under inspection by the sanitary staff, and some 3,410 visits of inspection were made to them during the year. In three instances warnings as to lack of proper cleanliness in respect to milk 46 utensils were necessary. In ten instances sanitary notices were required; in one on account of the dirty condition of the premises, in one for the dirty and dilapidated state of the premises, in five for defective drains and sanitary arrangements, in two instances on account of obstructions in the drains, and in one instance for a defective roof. The necessary works were carried out, and it was not necessary to bring any of the premises under the notice of the Health Committee. Foui cases of scarlet fever occurred in connection with milk purveyors' premises, and the usual steps were taken, the sale of milk being discontinued until it was considered safe for it to be resumed. OFFENSIVE BUSINESS. The tripe-boiling establishment situate at No. 69, Haggerston Road was under inspection from time to time during the year. No complaints were received in respect to it. FISH OFFAL NUISANCE. During the year, some three or four complaints were received owing to nuisances arising during the removal of fish offal from fish shops. In all cases the necessary investigations were made by the sanitary staff, and steps were taken to prevent the recurrence of the nuisances complained of. In one instance it was necessary to lay the facts before the Health Committee with a view to steps being taken under the bye-laws of the London County Council dealing with offensive or noxious matters. It was not required to take proceedings, however. FACTORY AND WORKSHOPS ACT, 1901. The number of workshops, exclusive of bakehouses, which are dealt with separately later in the report, on the register at the end of 1907 was 1,254, 147 having been added and 171 removed. The numbers for previous years were 1,278 in 1906, 1,218 in 1905, 1,133 in 1904, 1,133 in 1903, and 1,081 in 1902. A classification of the workshops registered is contained in the summary of proceedings under the above Act which is appended to this report The workshops were inspected by the officers of the Borough Council during the year, attention being more especially directed to those which were not found in a satisfactory sanitary condition. These had to be visited until the necessary sanitary improvements had been effected. Some 3,398 visits of inspection were made in connection with workshops and 103 to factories wherein insanitary conditions came under our notice. Nine communications were received from the Factory Inspector relating to the establishment of 128 new workshops in the Borough. A large proportion of these were for the purposes of the cabinet-making and tailoring trades. On inspection 92 were found to be in a fair or satisfactory sanitary condition, 47 8 were found to be unoccupied when visited, 2 were already on the register, and 2 were in an adjoining Borough. The remainder were more or less unsatisfactory from a sanitary point of view, and required the attention of the sanitary officers. Some 32 written intimations were received from the Factory Inspector referring to insanitary conditions and infringements of the law relating to public health in connection with 61 workshops and workplaces. The chief insanitary conditions to which the Factory Inspector directed attention were:—Dirty conditions of walls and ceilings in 33 instances, dirty and dilapidated state of the workshops in 11, defective or insufficient water-closet accommodation in 14, want of proper separate and sanitary accommodation for the sexes in 2, and overcrowding in one instance. These workshops were all 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 a number of others which came under the observation of the Sanitary Inspectors when visiting the premises. The results of the action thus taken upon these intimations were reported to the Factory Inspector from time to time during the year. Including those brought under our notice by the Factory Inspector, 402 workshops were dealt with and 366 sanitary notices were served upon the parties responsible for keeping them in a proper sanitary condition. In a number of instances more than one workshop was dealt with on the same notice. The following is an abstract of the sanitary work carried out to comply with notices served in connection with the workshops referred to above during the year 1907 : — New drains constructed 4 Urinals repaired and cleaned 6 Drains relaid 9 Urinal constructed 1 Stack pipes disconnected 5 Water supply laid on or restored 4 Stack pipes reinstated ... 15 Leaking water-pipes repaired 5 Eaves gutters reinstated 14 Rooms cleansed and whitewashed 383 Sink waste pipes disconnected ... 11 Yards „ „ „ 129 Yards paved 15 Areas „ „ „ 12 Sculleries paved 3 Roofs repaired 35 Water-closets re-constructed 42 Floors ,, 12 New water-closets constructed 10 Stairs „ 9 Water-closets cleansed and limewashed 242 Doors ,, 11 Sashes ,, 9 Obstructions removed from water-closets 34 Dust receptacles provided 18 Foul accumulations removed 13 Water-closets' flushing apparatus repaired 82 Overcrowding abated 1 Ventilation improved 2 In 29 instances statutory notices under the Public Health (London) Act, 1891, were served by order of the Health Committee, but there was no necessity for policecourt proceedings. 48 The number of factories under observation during the year was 32, in connection with which 12 sanitary notices were served. The works carried out included the repairing of drains in 2 instances, of water-closets in 4, of flushing apparatus in 2, of urinals in 1, and of roofs in 1 instance, the reinstatement of stack-pipes and eaves guttering in 2 instances, the cleansing of water-closets in 5 instances, and other matters. It was not necessary to serve any statutory notices for the abatement of nuisances in connection with these factories. During the year 90 lists of outworkers were received from employers in the Borough, 44 during the first half-year and 46 in the second. I hese lists contained the names and addresses of 1,475 outworkers, of whom 944 were not resident in Shoreditch. The addresses of the non-residents were forwarded to the authorities of the sanitary districts to which they belonged. Communications were received from other sanitary authorities relating to 3,103 outworkers, 203 of which were residents of other Boroughs. The addresses of the latter were also forwarded to the authorities concerned. The number of outworkers brought to our notice in 1907 was 4,578, as compared with 2,975 in 1906. Of these 3,431 were residents in Shoreditch, as compared with 2,259 in 1906. With respect to these figures it is to be noted that in many instances the names and addresses of outworkers are duplicated owing to lists being sent in twice a year, and in a number of instances the same outworkers are employed by more than one firm of employers. The numbers given above, therefore, are, as was mentioned in the report for last year, far from representing the actual numbers of individual outworkers. The following are the classes of work specified in the Home Work Order made by the Secretary of State and dated May 23rd, 1907, in which the names and addresses of outworkers are required to be sent to the Sanitary Authority: — The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel; The making, ornamenting, mending, and finishing of lace and lace curtains and nets; Cabinet and furniture-making and upholstery work; The making of electro-plate; The making of files ; Fur-pulling; The making or iron and steel cables and chains; The making of iron and steel anchors and grapnels; The making of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds; The making of locks, latches, and keys; The making or repairing of umbrellas, sunshades, parasols, or parts thereof; The making of artificial flowers; 49 The making of nets other than wire nets; The making of tents; The making or repairing of sacks; The covering of racquet or tennis balls; The making of paper bags; The making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material; The making of brushes; Pea-picking; Feather sorting; The carding, boxing, or packeting of buttons, hooks and- eyes, pins, and hair pins; The making of stuffed toys; The making of baskets; And any processes incidental to the above. The bulk of the outworkers in Shoreditch are engaged in work connected with wearing apparel, artificial flower-making, paper-bag and box-making, and brushmaking. A table is appended to this report showing the distribution of outworkers as regards trades in the Borough. During the year some 2,242 visits of inspection were made to places where homework was carried on and in 195 instances sanitary notices were required. The works carried out in compliance therewith included the reconstruction or repair of drains in 6 instances, the disconnection of sink waste pipes in 15, the reinstatement of stack pipes in 14, and of eaves gutters in 13, the paving of yards in 16, repairs in connection with water-closets in 34, and with the water supply arrangements to the premises in 6 instances; in 13 instances houses were cleansed throughout, and in 82 thev were partly cleansed; altogether 308 rooms, 45 yards, 61 water-closets, and 8 areas were cleansed; repairs were carried out in connection with roofs in 27 instances, floors in 10, stairs in 9, doors in 2, and windows in 7 instances; ventilation was attended to in 2, and in 24 instances dust receptacles were provided. During the year 11 cases of scarlet fever were certified in houses at which home work was carried on; in 2 instances clothing was being made, in 8 paper bags and boxes, and in 1 artificial flowers. In all cases the usual steps were taken to prevent the work being a means of spreading infection. No difficulties were experienced in connection with this, and it was not necessary for any action to be taken under Section 108-110 of the Factory and Workshops Act, 1901. BAKEHOUSES. The number of bakehouses on the register at the end of the year which were in use was 73, including four factory bakehouses. Of these 31 are above ground . and 42 below ground. As the result of inspection 46 were found in a satisfactory sanitary condition, 22 required cleansing and lime-washing, in 1 a urinal required attention, in 2 there were defects in the water-closets, in 1 a sink was defective, and in I it was necessary to carry out the reconstruction of a portion of the drainage D 50 system. In all cases the usual sanitary notices were served and complied with, with one exception, in which the bakehouse required lime-washing. This was reported to the Health Committee, and a statutory notice was served, with the desired effect. The following bakehouses' in the Borough are not in use, the premises being unoccupied or used for some other purpose:—No. 183, City Road. 189, High Street, 30, Fitfield Street, and 37, Sun Street, which are above ground, and 88, Bridportplace, and 82, East Road, which are below ground. Some of these may be brought into use again. ICE-CREAM SHOPS. The following summarises the results of the work of the inspectors in connection with the above premises in 1907:—Inspector Lear had 14 under observation, of which 1 required cleansing. Inspector Firth visited 10; in 2 cleansing was required and in 1 the water-closet and sink were defective. Inspector Jordan had 23 under observation; in 2 the yard-paving, guttering, and the roofs were defective, and 1 was dirty throughout. Inspector Langstone visited 23, in 1 of which the watercloset was defective, and in 1 over-crowding was found. Inspector Pearson visited 14; 7 of these required cleansing, in 1 the water-closet was in a dirty condition, in 1 the sink waste pipe was defective, in 2 the drains were defective, and in 1 instance animals were found to be improperly kept upon the premises!. In 2 instances the conditions were so unsatisfactory that it was necessary to stop the sale of ice-cream. Altogether 84 premises whereon ice-cream was manufactured or sold were under the observation of the sanitary officers during the year. Of these 63 were in a satisfactory condition. The remainder all more or less required attention, chiefly on account of lack of proper attention to cleanliness. Sanitary notices were served in 21 instances. COOK-SHOPS AND COFFEE-HOUSES. Inspector Lear visited 31, of which 15 required cleansing. On Inspector Firth's district 13 were visited, 3 of which required cleansing, and in 1 some minor sanitary defects required attention. On Inspector Jordan's district 95 were under observation, including the kitchens of 13 public-houses at which dinners are provided. None of these kitchens were sanitarily defective. With respect to the other premises, 6 required cleansing, and in 3 defects of a more or less serious character were found in connection with the drains and sanitary arrangements. In 11 instances defects of minor importance existed. Inspector Langstone visited 31, 1 of which required cleansing and in another a dust receptacle was required. Inspector Pearson visited 18, of which 5 required cleansing, 3 dust receptacles, in 1 the water-closet was blocked, and in 2 animals were kept in an improper manner. Altogether 188 cook-shops and eating-houses, including 13 public-houses, were under inspection during the year, as compared with 178 in 1906 and 182 in 1905. and 52 sanitary notices were served in connection with them, chiefly on account of want of proper attention to cleanliness. 51 FRIED-FISH SHOPS. The number of fried-fish shops under observation was 49, in 7 of which cleansing was found to be required and sanitary notices were served, and in 1 the sanitary arrangements required attention. In connection with the above it may be mentioned that two fish-curers' premises were under inspection, and in each instance cleansing was required. STREET MARKETS AND FOOD. There was the usual supervision by the sanitary officers in connection with the street markets and the food-stuffs exposed for sale in the Borough, and frequent inspections were made with a view to the detection of food unfit for human consumption. The following articles were destroyed as unfit for food: — One hundredweight of ling, 1 box of mackerell, 2 trunks, 1 case and 7 stone of skate, 1 box and 1 trunk of whiting, 1 bushel of winkles and 3 boxes of hake, 28 lbs of beef, 89 rabbits, 10 pieces and 30 lbs. of bacon, 24 pigs' plucks, 5 hands of pork and 36 turkeys, 95 cases of condensed milk in tins, 5 sacks of condensed milk in tins, 6 cases and 2 sacks of meat in tins, 2 double crates of bananas, 3 tons 7 cwt. and 3 qrs. of cabbages, 2 sacks of potatoes, and 1 box of onions. Most of the articles mentioned were surrendered as unfit for food; the beef and tinned foods were seized, however, under circumstances which rendered it necessary for the Sanitary Authority to take proceedings before a magistrate. With respect to the unsound tinned foods, these were seized at a common lodging-house situate at Nos. 33, 35, and 37, St. John's Road. Upon information received from the Borough of Camberwell the premises were visited by Inspector Langstone on Saturday, June 8th, in the afternoon. A large number of cases of tinned condensed milk, tinned beef, and some other canned goods was found in an outhouse in rear of No. 33. The stuff, the bulk of which was condensed milk, appearing to be unsound and unfit for food, the Inspector took the necessary steps to keep it secure until it could be thoroughly examined. On the morning of June 10th further information was received over the telephone from the Medical Officer of Health for Stepney relative to the existence of the unsound goods at the common lodging-house. He was desirous of being present when the tins were examined, being interested in the matter, having recently had seizures of unsound tinned milks in Stepney. He was anxious to ascertain whether any of the milks we had taken possession of were of similar brands to those which he had seized. He was, therefore, present when I made a careful examination of the bulk of the condensed milk, and he was able to identify some of the brands as the same as those seized by him. Examination showed the cases to be filled with blown tins, and their contents were quite unfit for human consumption. I accordingly gave instructions for them to be submitted for inspection to a magistrate. The whole of the goods, which amounted to two D 2 52 van-loads, weighing about three tons, were taken to Old Street Police Court. They were examined by the magistrate (Mr. Cluer) on June 11th. After requiring and taking evidence to show that the presumption was that the articles were intended for human food, he made an order for their destruction on the following day. The facts of the case were laid before the Health Committee in due course, and instructions were given for police court proceedings to be taken against the proprietor of the common lodging-house upon whose premises the seizure was made. The case was heard at the Old Street Police Court on July 16th and 19th before Mr. Cluer. Two summonses were taken against the defendant, James Shuttleworth, the proprietor of the common lodging-house, one charging him with having had in his possession on March 1st, 1907, 250 cases of condensed milk which were unfit for food and liable to seizure, and the other for having had in his possession on June 8th, 95 such cases and five sacks of condensed milk which were unfit for food. The summonses were taken together. Dr. Mansfield Robinson, the Town Clerk, prosecuted on behalf of the Council, and Mr. Margetts, solicitor, defended. The defendant was described as an owner of house property in the district and as carrying on a registered common lodging-house in St. John's Road and a coffee-house in Pitfield Street. It was part of the Cooincil's case that the condensed milk was used for the purposes of his business and for sale in the common lodging-house. Evidence as to seizure was given by Inspector Langstone in respect to 95 cases and five sacks of condensed milk of various brands, the same being unsound and unfit for food. Evidence was also submitted which showed that there were not less than 250 cases of condensed milk in the shed in the rear of the common lodginghouse on March 1st, and that they were examined by a provision broker, to whom they were offered for sale on that date, and found to be quite unfit for food then. During the three months that elapsed before they came under the notice of the Sanitary Authority 150 of the cases had been disposed of. It was shown that the defendant bought the stuff from a provision dealer in White Horse Street, Stepney, in January, and paid two shillings per case for it. From what was stated it would appear that unsound condensed milk is sometimes sold as food for pigs. Evidence as to the stuff being unfit for human food was given by Dr. Thomas, the Medical Officer of Health for Stepney, and myself. The defence was that the shed was let to two of the lodgers residing at the common lodging-house, and that they were disposing of the condensed milk as pigs' food in the country. The truth of the suggestion as to it being used in the common lodging-house was denied. It was admitted by the defendant that he paid for the milk, but he said that he lent the money to the lodgers mentioned at interest for the purchase, and that the money had been partly repaid to him. He was, however, unable to produce the lodgers whom he described as the owners of the milk. In the end, after hearing other evidence on behalf of the defendant, Mr. Cluer said he had no doubt as to the defendant being the person responsible. He regarded the case as a very bad one, and accordingly fined him £50, with 25 guineas costs. The fine was at once paid. 53 There was a further summons against the same defendant in respect to two pieces of beef weighing 28 lbs. which were found in a brine tub in the basement at No. 112, Pitfield Street, and were unfit for human food. In view of the heavy penalty inflicted in respect to the condensed milk this summons was withdrawn. In connection with the above it may be mentioned that on June 12th and 13th two van-loads of tinned meats were removed from Not. 31, St. Join's Road, a house next to the common lodging-house, let off to' lodgers and belonging to the proprietor of the common lodging-house. The removal, which was effected during the early hours of the morning, was brought to the notice of the Health Department on June 13th. Inspector Langstone was not long in ascertaining that the stuff had been taken to certain premises situate in Montague Street, in the Borough of Southwark. The Health Department of that Borough was at once communicated with, and another large seizure, amounting to about three tons of tinned meats unfit for human food, was effected by the authorities in that Borough. The stuff was ordered to be destroyed by a magistrate, and the defendant was subsequently again heavily fined. A large amount of the tinned goods seized appeared to have made a voyage to South Africa and back before their disposal of was attempted in this country. SALE OF FOOD AND DRUGS ACTS. The reports of Sir Thomas Stevenson show that during the year 519 samples were submitted for analysis under the above Acts. The number was at the rate of one sample for every 223 persons in the Borough, and gives a rate of nearly 4.5 per 1,000 inhabitants for the year. Each of the five district inspectors takes on an average four samples every fortnight. The inspectors are not restricted to their particular districts for this duty, but may take samples anywhere within the limits of the Borough. The results of the year's work are summarised in the following table: — Quarter of the year 1907. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. N umber of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. N umber of successful Prosecutions. Fines and Costs. Amount paid to Analyst for samples analysed. 1st. 122 26 21.3% 10 2 8 7 £ 17 s. 2 d. 6 £ 61 s. 0 d. 0 2nd. 121 27 22.3 % 11 1 10 8 9 10 0 60 10 0 3rd. 103 15 14.5% 7 — 7 5 8 6 0 51 10 0 4th. 173 31 17.9% 8 1 7 7 32 5 6 86 10 0 Total for Year 519 99 19.0% 36 4 32 27 67 14 0 259 10 0 54 The samples taken comprised 331 of milk, 126 butter, 11 sausages, 8 brawn, 7 lard, 5 bread, 5 tea dust, 4 bread and butter, 4 cheese, 4 vinegar, 2 corned beef, 2 pork pie, 2 lemonade, 2 seidlitz powder. 2 cream of tartar, 1 tartaric acid, 1 mustard, 1 coffee, and 1 sugar. Of the milk samples 77, or 23.2 per cent., were found not to be genuine, as compared with 27.9 in 1906, 20.8 in 1905, 23.5 in 1904, and 22.0 in 1903. In the subjomea 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 : — Quarter of the year. Number of Samples. Number not genuine. Percentage not genuine. 1st 92 25 27.1 2nd. 72 22 30.5 3rd. 67 13 19.4 4 th. 100 17 17 In 37 of the samples of milk water was certified to have been added. In 12 the amount added was more than 5 per cent, in excess of the standard of the Board of Agriculture, and in 25 it was less than 5 per cent. In 26 of the samples the milk was deficient in butter fat, the deficiency being; over 5 per cent, below the standard in 7, and under that amount in the remainder. In 5 of the samples there was both an excess of water and a deficiency of fat, and 1 of the samples contained besides added water a trace of artificial colouring matter. Another of the samples containing added water also showed the presence of 1½ grains of boric acid per pint. In 7 samples traces of artificial colouring matter were the only adulteration found, and two contained boric acid, not exceeding 2½ grains to the pint. Where boric acid is found on analysis in milk it is the practice to send a written warning to the vendors pointing out that they are liable to be proceeded against under the Sale of Food and Drugs Acts. Legal proceedings were instituted in 27, or 35 per cent. of the cases in which the milk samples were below the standard of the Board of Agriculture'. In 19 convictions were obtained, 3 were withdrawn, and the remainder were dismissed, most of them on account of the production of warranties. In one instance in which the summons was dismissed the magistrate held that the person who served the milk which was purchased at a private house was not acting as the assistant of the defendant who was summoned, and in another case the summons was withdrawn owing to the death of the defendant. In the remaining 65 per cent., in which the samples were below standard, prosecutions were not advisable, the percentages of abstraction of fat and of added water being too small to make it likely for magistrates to convict. 55 In the cases in which convictions were obtained the penalties for milk adulteration amounted to £27 11s., which is equivalent to 5.6 per cent. of the full amount of the penalties to which the defendants were liable, as compared with 5.6 per cent. in 1906, 7.8 in 1905, 6 in 1904, 8 in 1903, and 13 in 1902. Taking fines and costs together, which amounted to £31 18s. 6d., the average amount paid by a defendant upon conviction was £1 13s. 7d., as compared with £2 9s. 6d. in 1906, £2 19s. 3d. in 1905, £2 6s. 10d. in 1904, £1 18s. 6d. in 1903, and £2 18s. 4d. in 1902. The decrease as regards the amounts of the penalties is probably mainly a result of a decrease in the number of persons summoned who have been previously convicted. In only two instances during the year had the defendants been previously fined. Of the samples of butter taken 8, or 6.3 per cent., were not genuine, as compared with 11 per cent, in 1906 and 14 per cent, in 1905. The numbers of samples and percentages of those found adulterated during the four quarters of the year are as shown in the subjoined table: — Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st. 22 1 4.5 2nd. 28 1 3.4 3rd. 32 2 6.4 4th. 37 4 10.8 Of the samples sold for butter which were found not to be genuine 7 were samples of margarine and 1 was butter containing 19.8 per cent. of water, or 3.8 per cent. of water over and above the recognised standard, which is 16 per cent. Legal proceedings were successfully taken on all the cases. In 5 instances the proceedings were under the Margarine Act; in 2 for failing to serve margarine in a properly stamped wrapper, and in 3 for exposing margarine for sale without having the same properly labelled. The penalties inflicted in the cases in which convictions were obtained for infringements of the Sale of Food and Drugs Acts in respect to butter and margarine amounted to £25, which was equivalent to 15.6 per cent. of the maximum penalties to which the defendants were liable, as compared with 12 per cent. in 1906, 17 in 1905, 10 in 1904, 18 in 190'3, and 17 in 1902. Including the costs, the amounts imposed by the magistrates averaged £4 6s. 7d., as compared with £5 3s, in 1906, £7 1s. in 1905, £3 1s. in 1904, £4 10s. in 1903, and £4 10s. in 1902. All the defendants were first offenders. Of the 11 samples of sausages taken in 6 boric acid was found. In 4 the amounts were small, not exceeding 3 grains per pound. Of the remaining two 1 contained 8½ grains and the other 22 grains per pound. In the latter case a 56 summons was taken out, but was not proceeded with, the cost of the analysis being paid by the defendant. Arising out of the question of the use of boric acid in sausages there was some correspondence during the year with the London Butchers' and Pork Butchers' Trade Society upon the subject. The Society urged that for trade purposes the use of a certain amount of boric acid as a preservative was indispensable. With the consent of the Health Committee the question was referred to Professor Klein, who was instructed by the Society to make investigations with a view to determining the smallest amount of boric acid which would be required to prevent putrifactive changes in sausages kept for three days at a temperature of 76 degrees F. The experiments were carried out as follows : —A sausage factory which appeared to Professor Klein to be suitable and satisfactory for the purpose was selected. The materials for making the sausages—veal, pork, and bread—looked in every way satisfactory. Preliminary experiments were made to exclude the skins used and to ascertain the bacteriological nature of the materials before adding the preservative. The essential experiments were of the following character:—Sample I.— The bacteriological analysis comprised analysis of the materials after mincing and mixing with the preservative, and Sample II., of the finished sausage. Sample I. on return to the laboratory was at once subjected to analysis in order to ascertain its character and to be able to compare it with Sample II. after this latter had been subjected to the required incubation. Sample II. was placed in a moist chamber in the incubator and kept at a temperature of 76 degrees F. Every evening the sausage was transferred to a refrigerator and kept there overnight to be replaced next morning in the incubator at 76 degrees F. This was repeated on three successive days, after which it was subjected to analysis thus:—The sausage was cut open with a sterile knife, and material was taken from the interior and cultures were made in order to ascertain whether any, and if so what, differences of a bacterial nature existed between Sample 1., composed of fresh sausage material, and Sample II., which had been kept for three days under the above conditions. As the result of these experiments Professor Klein expressed the opinion that, provided the conditions as to locality, general cleanliness, character of the meats and bread are satisfactory, 26.25 grains of boric preservative to the pound of sausages should be the minimum quantity. The report was considered by the Health Committee. It appeared to them that the object of the experiments—namely, to ascertain the smallest amount of boric acid that would keep a sausage sweet for three successive days at a temperature of 76 deg. F. had not been achieved. As carried out, the investigation indicated that, with the use of a refrigerator at night (for a length of time not stated), a sausage containing 26.25 grains of boric preservative per pound would have undergone no change when kept for three successive days during the daytime (length of time not stated) at a temperature of 76 deg. F. The Committee were of opinion that, had the experiments 57 been carried out in accordance with the conditions they agreed to, the result obtained would have shown that a larger quantity of the preservative per pound than, 26.25 grains would have been required, and that the amount so required would probably have been such as to indicate that the preservative was of very little use: except in dangerous quantities. Moreover, it appeared to the Committee that a greater use of the refrigerator would have rendered a smaller quantity of boric preservative efficacious, and the question, therefore, arises whether, if refrigerators were in general use for keeping sausages in, any preservatives would be required at all. It may also< be mentioned that, at the request of the trade society, Mr. J. Kear Colwell, F.I.C., made investigations with a view to ascertaining whether cooking had any effect upon the amount of boric preservative in sausages. The result obtained did not indicate that there was any material change. Sausages which before cooking contained 0.365 grains of boric acid per pound, were found after cooking to contain 0.364 grains per pound. Of the eight samples of brawn taken during the year, in four there were small quantities of boric acid in amounts not exceeding three grains per pound. Of the samples of bread and butter, in two margarine, or a mixture of margarine and butter was substituted for the butter, but it was not deemed advisable to prosecute. One of the samples of pork pie contained four grains of boric acid per pound. One of the samples of tea dust contained iron sand to the extent of 2 per cent., and other mineral matter 4 per cent. The soils upon which teas are grown are sometimes ferrugeous, and this was probably a sample of dirty tea dust. No proceedings were taken. The samples of lard, bread, cheese, vinegar, corned beef, lemonade, seidletz powder, cream of tartar, tartaric acid, mustard, coffee, and sugar were genuine. The subjoined table shows a comparison of the results of the work under the Food and Drugs Acts during the years 1902-7 inclusive : — Year. Number of Samples. Number of persons in the Borough to each sample. Number of samples adulterated. Percentage of sample adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties, &c. Prosecutions proceeded with. Number of successful prosecutions. Fines and Costs. Amount paid to Public Analist. £ s. d. £ s. d. 1902 281 420 71 253 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 1906 520 224 122 23.4 44 2 42 34 106 12 6 260 0 0 1907 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 58 Legal proceedings were instituted in 36 per cent, of the cases of adulteration, but, as has been already mentioned, a large proportion of the samples were of milk deviating but slightly from the Board of Agriculture's standard, or samples containing traces of artificial colouring matter or preservatives in such small quantities as to render proceedings inadvisable. BUTTER AND MARGARINE ACT, 1907. The above Act, which is construed as one with the Sale of Food and Drugs Act, 1899, and may be cited with the Sale of Food and Drugs Acts, as the Sale of Food and Drugs Acts 1875 to 1907, came into operation on the first day of January, 1908. This Act requires the registration of (a) butter factories, that is to say, any premises on which, by way of trade, butter is blended, reworked, or subjected to any other treatment, but not so as to cease to be butter; and (b) any premises on which there is manufactured any milk-blended butter, that is to say, any mixture produced by mixing or blending butter with milk or cream (other than condensed milk or cream), or on which there is carried on the business of a wholesale dealer in milkblended butter. Section 2 (2) enables an officer of the Local Authority, if duly authorised, to enter and inspect such premises and to procure samples under the Sale of Food and Drugs Acts. The district sanitary inspectors in Shoreditch have been authorised by the Borough Council for this purpose. Section 3 prohibits adulterants in butter factories, and Section 4 makes it an offence to have in any butter or margarine factory, butter or margarine containing more than 16 per cent, of water; and also to sell, expose, or offer for sale, or possess for the purpose of sale, milk-blended butter containing more than 24 per cent, of water. Section 5 contains a list of articles (butter, margarine, and milk-blended butter) importation of which is made an offence by Section 1 of the Sale of Food and Drugs Act, 1899. Section 7 enables the Local Government Board to make regulations as to the use of preservatives in butter, margarine, or milk-blended butter. Sections 8 and 9 deal with the marking of wrappers used in connection with the sale of margarine and milk-blended butter respectively. Any person guilty of an offence under this Act is liable to a penalty of £20 for a first offence, £50 for a second, and £100 for a third or subsequent offence, and in certain cases of imprisonment may be ordered. Margarine is defined in the Act as meaning any article of food, whether mixed with butter or not, which resembles butter, and is not milk-blended butter. SANITARY STAFF. During the year, the question of the adequacy of the sanitary staff again came under the consideration of the Council in connection with a report from the Health Committee recommending the appointment of an additional sanitary inspector. The recommendation was not adopted by the Council, but there was a feelling that additional work might with advantage be performed in connection with the supervision of the street markets and be food of the people in the Borough. On five evenings 59 of the week there was no sanitary inspector on duty after five o'clock, and the suggestion was made that it would be useful if the services of the sanitary inspectors were available not only on Saturday evenings, but on every week-day evening, it being pointed out that a great deal of traffic in food is carried on in the evenings. The matter was referred to me, and, the suggestion appearing a good one, I submitted the following proposals for giving effect to it : — (1) That the five district sanitary inspectors take it in rotation to be on duty on the five evenings of the week, as set out below: — Monday evenings, Inspector Lear. Tuesday evenings, Inspector Firth. Wednesday evenings, Inspector Langstone. 1 hursday evenings, Inspector Jordan. Friday evenings, Inspector Pearson. The arrangement as to Saturday evening duty will remain as heretofore. (~2) That the inspector on duty will make such inspections as may be necessary for ascertaining the quality of the foodstuffs exposed for sale and with a view to detecting any that may be unsound and unfit for the food of man, (3) That he will from time to time take samples under the Sale of Food and Drugs Acts. (4) That he will take the usual steps in respect to any nuisances that may come under his notice during his tour of duty. (5) That he will keep in touch with the Town Hall so as to be available in the event of any sanitary matter of special urgency arising and requiring attention after the usual office hours. It was also suggested that the maximum number of samples talcen in the Borough under the Sale of Food and Drugs Acts, which was approximately 500 per annum, be increased to 550 per annum. These proposals were considered by the Health Committee, who recommended thfm lor adoption by the Council. They received the approval of the Council, the hours for evening duty being fixed six to ten p.m., and the remuneration allowed tor the work being £'20' per annum for each of the five district inspectors. The arrangement was sanctioned by the Local Government Board, and came into' operation on January 8th of the current year. Towards the end of the year the question of the performance of the duties of the Medical Officer of Health during his absence came under the consideration of the Council in connection with a letter from the Local Government Board upon the subject. In order to place the matter upon a proper footing the Medical Officer of Health was authorised by the Council to arrange with Dr. Major Greenwood, of 243, Hackney Road, who possesses the requisite qualification in public health, and in 60 the event of him being unable to act, with the Medical Officer of Health of a neighbouring Borough to deal with any matters which might require attention during the absence of the Medical Officer of Health. This arrangement, which is similar to that which has been followed for many years past, was approved by the Local Government Board. It may be mentioned as conveying an idea of the amount of work done by the clerical portion of the sanitary staff that some 13,749 communications written and printed were sent out from the offices during the yeiar. These included 3333 notices and summonses and 2,488 letters and cards relating chiefly to matters under the Public Health (London) Act, 1891, and the Sale of Food and Drugs Acts, 651 letters as to the work under the Factory and Workshop Act, 1901, 6,772 communications of various descriptions in respect to infectious disease and disinfection and 505 reports and agendas relating to the work of the department. In conclusion, I desire to express my satisfaction as to the manner in which the officers of the Health Department have performed their duties during the year, and also my appreciation of the assistance which they have rendered me in connection with the work of the department. My thanks are also due to the Chairman and members of the Health Committee for the kind consideration and assistance I have received from them in connection with my official work during 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 and a Summary of Sanitary Proceedings under the Public health and factory and workshop Acts, during the Year 1907. Tables I., II., III., IV., and V. are forms required by the Local Government Board. 62 TABLE I. BOROUGH OF SHOREDITCH. Vital Statistics of whole District during 1907 and previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District Deaths of Nonresidents registered in Public Institutions in the District. Deaths of residents registered in Public Institutions beyond the District. Net Deaths At All Ages Belonging To The District. Number Rate under one Year of Age At all Ages. Number Rate N umber. Rate per 1,000 Births registered. Number Rate 1 2 3 4 5 6 7 8 9 11 11 12 13 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 1905 116939 3894 33.3 652 16 2234 19.1 867 391 451 2296 19.8 1906 116506 3802 32.6 651 168 2158 18.5 816 343 473 2289 19.8 Averages for years 1887tol906 119170 4026 33.5 743 186 2501 20.9 828 391 396 2511 21.2 1907 116073 3636 31.3 569 153 2195 J 18.9 912 350 516 2365 20.68 Rates in Columns 4, 8, and 13 are 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 1907 twelve 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 infirmitv, 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 nages 10 and 11 of the Report. Total population at all ages, 118,637 At Census of Area of District in acres Number of inhabited houses, 12,743 1901. (exclusive of area 642.5 Average number of persons, covered by water per house 9.3 TABLE II. BOROUGH OF SHOREDITCH. Vital Statistics of separate Localities in 1907, and in previous Years. 1—Moorfields War.i. 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. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to midole 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. 1905 5831 137 84 17 20103 727 430 125 18216 674 189 130 18342 521 326 88 18461 647 446 105 11281 420 205 60 12314 413 208 76 12391 414 208 52 1906 5081 130 79 11 19923 668 403 10S 17982 664 354 107 18602 596 336 113 18370 586 454 119 11188 423 22C 59 12384 386 208 68 12376 417 235 66 1907 5531 130 89 16 19743 646 401 97 17748 616 391 100 18862 541 344 90 18279 614 526 107 11093 376 194 50 12454 364 196 51 12361 424 124 58 (а) Owing to the alteration in respect to the registration sub-districts referred to on page 1 of the report for the year 1905, it was necessary to select fresh localities for statistical purposes. The eight wards of the Borough were accordingly adopted as separate localities for the purposes of this table. If required, the figures relating to the 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 North-East. (b) Deaths of residents occurring beyond the district are included in sub-columus c of this table, and those of non-residents registered in the district excluded. (See note on Table I. as to meaning of terms "resident" and " non-resident.") (c Deaths of residents occurring in public institutions have been allotted to the respective localities according to addresses of the deceased. (d) The population of locality No. 4 includes the population in the Holborn Union Workhouse, estimated at 1,373. 63 TABLE III. BOROUGH OF SHOREDITCH. Cases of infectious disease notified during the Year 1907. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from kack Locality. Notifiable Disease. At all Ages. At Ages -Years. 1. ji. 3. 4. 5. 6. 7. 8. 1. •i. 3. 4. 5, 6. 7. 8. Under 1. 1 to 5 5 to 15 15 to 25 25to65 65 and upwards. Moorfields Church Hoxton Wenlock. Whitmore. Kingsland. Haggerston Acton. Moorfields. Church Hoxton Wenlock. Whitmore. Kingsland. Hag. gerston. Acton. Small-pox .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 209 10 96 84 15 4 •• 6 34 29 26 34 21 28 31 5 32 27 25 31 21 27 28 Membranous croup .. 2 •• 2 .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. 1 Erysipelas 133 5 8 16 17 71 16 12 16 7 21 25 14 20 18 1 1 .. .. .. .. 1 .. Scarlet fever 876 12 280 504 59 21 .. 30 175 104 89 198 94 66 120 30 173 104 86 195 93 66 117 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 34 .. •• 17 6 11 .. 1 4 3 4 7 8 4 3 1 3 3 4 6 8 4 3 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 3 .. .. .. 1 2 .. 1 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever 7 3 3 1 .. .. .. .. .. 3 .. 1 1 .. 2 .. .. 1 .. 1 .. .. 2 Totals 1265 30 389 623 98 109 16 50 231 146 141 266 138 118 175 37 210 135 116 234 122 98 151 64 65 TABLE IV. BOROUGH OF SHOREDITCH. Causes of, and ages at, death during Year 1907. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities at all Ages. Total Deaths In Public Institutions in the District All Ages Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Moorfields. Church. Hoxton. Wenlock. Whit- more. Kingsland. Hagger- ston. Acon. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 114 29 83 9 .. .. .. 3 21 17 12 38 9 6 25 Scarlet fever 28 2 19 6 1 .. .. 1 11 1 5 .. .. .. 2 .. Whooping-cough 99 41 56 2 .. .. .. 8 18 17 14 14 6 1 5 16 Diphtheria and membranous croup 20 3 14 3 .. .. .. .. 4 5 4 3 1 .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 6 .. .. 1 2 3 .. .. 1 1 1 1 1 .. .. .. Other contd. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 23 1 1 .. 1 14 6 2 .. 5 3 9 1 .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa (see notes) 115 98 11 2 .. 3 1 1 20 29 14 26 7 4 14 19 Enteritis (see notes) 16 .. 8 1 .. 7 .. 1 1 2 2 4 .. 3 3 1 Puerperal fever 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 Erysipelas 6 1 1 .. .. 2 2 .. .. .. 2 1 1 .. 1 3 Other septic diseases 25 4 2 3 7 7 2 1 .. .. 7 4 1 .. 3 9 Phthisis 232 4 9 7 29 178 5 7 42 28 33 55 18 23 26 132 Other tuberculous diseases 95 23 41 17 5 8 1 .. 20 12 17 22 6 6 12 19 Cancer, malignant disease 102 .. 1 .. .. 77 24 5 20 14 10 28 6 6 13 42 Bronchitis 236 63 25 1 2 79 66 4 40 48 38 56 16 16 18 99 Pneumonia 232 56 94 5 7 57 13 6 44 49 38 34 23 20 18 67 Pleurisy 3 .. 3 .. .. .. .. .. .. 1 1 .. .. .. .. 2 Other diseases of Respiratory organs 7 1 1 1 .. 2 2 1 1 .. 2 2 1 .. .. 5 Alcoholism Cirrhosis of liver 47 .. .. .. 1 40 6 1 5 11 9 7 4 8 .. 27 Venereal diseases 12 11 .. .. .. 1 .. 1 1 3 .. 3 2 .. .. 1 Premature birth 60 60 .. .. .. .. .. 3 6 10 15 7 4 .. .. 8 Diseases and accidents of parturition 4 .. .. .. .. 4 .. .. 1 .. .. 1 2 .. .. 1 Heart diseases 179 .. 1 16 7 110 45 12 29 25 21 41 13 14 24 93 Accidents 94 31 18 19 2 20 13 4 13 16 21 23 5 4 8 29 Suicides 16 .. .. .. 4 10 2 2 4 3 3 1 2 .. 1 4 All other causes 593 141 35 17 18 160 222 26 93 94 72 141 63 51 54 308 All causes 2365 569 423 94 86 783 410 89 401 391 344 526 194 196 224 912 TABLE V. BOROUGH OF SHOREDITCH. Infantile Mortality during the year, 1907, showing deaths from stated causes in weeks and months under One Year of Age. CAUSE OF DEATH. U nder 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks Total under 1 Month. 1-2 Months 2-3 Months 3-4 Months 45 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 84 18 21 20 143 55 71 46 34 28 38 36 33 29 29 27 569 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Common Infectious Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. 1 .. .. .. .. .. 5 6 6 3 8 29 Scarlet Fever .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. 2 Diphtheria Croup .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. 3 Whooping Cough .. .. .. 2 2 4 4 3 2 4 6 2 4 3 1 6 41 ii. Diarrhoeal Diseases. (See notes, &c. Tables iv. & v.) Diarrhoea, all forms .. 1 1 .. 2 3 11 6 7 4 4 8 4 2 2 4 57 Enteritis, Muco-enteritis, Gastro-enteritis .. .. 1 1 2 6 4 5 5 2 2 4 4 2 .. .. 36 Gastritis, Gastro-intestinal Catarrh .. 1 .. .. 1 1 .. 1 .. .. 2 .. .. .. .. .. 5 iii. Wasting Diseases. Premature Birth 43 2 3 4 52 5 2 1 .. .. .. .. .. .. .. .. 60 Congenital Defects (See notes on Tables iv. & v.) 13 2 2 1 18 .. 2 .. .. .. .. 2 1 .. .. .. 23 Injury at Birth 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Want of Breast-milk, Starvation .. .. 1 .. 1 .. 2 .. 1 .. 1 .. .. .. .. .. 5 Atrophy, Debiliry, Marasmus 14 2 1 4 21 8 13 5 7 1 1 1 5 .. 1 2 65 iv. Tuberculous Diseases. Tuberculous Meningitis (See notes on Tables iv. & v ) .. .. .. .. .. 1 1 1 1 .. .. 1 1 .. 2 2 10 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. 1 1 2 3 .. .. .. 1 .. 8 Other Tuberculous Diseases (See notes on Tables iv. & v.) .. .. .. .. .. .. 1 1 .. 1 4 .. 1 .. .. 1 9 v. Other causes Erysipelas • • .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 Syphilis .. 1 .. .. 1 2 4 2 1 .. .. .. .. .. .. .. 10 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. 3 1 1 3 1 1 .. 10 Convulsions 3 2 2 1 8 1 1 1 1 .. 2 1 .. .. 2 .. 17 Bronchitis .. 2 4 4 10 11 9 9 1 5 3 4 2 5 2 2 63 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. 1 2 1 4 6 7 6 3 2 4 7 1 4 11 1 56 Suffocation, overlaying 3 4 1 .. 8 4 7 1 4 .. 1 .. .. 1 .. .. 26 Other Causes 7 .. 3 1 11 2 2 3 .. 3 4 2 .. 2 2 1 32 84 18 21 20 143 55 71 46 34 28 38 36 33 29 29 27 569 Births in the year—Legitimate 3,635, illegitimate 85. Population, estimated to middle of 1907, 116,073. Deaths from all Causes at all Ages 2,365. 66 67 NOTES TO TABLES IV. AND V. (a) In Table IV., all deaths of "Residents" occurring in public institutions, whether within or without the district, are included with the other deaths in the columns for the several age groups (columns 2-8). They are also, in columns 9-16, 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 are in like manner excluded from columns 2-8 and 9-16 of Table IV. (b) See notes on Table I. as to the meaning of "Residents" and "Non-residents," and as to the "Public Institutions" taken into account for the purposes of these Tables. The " Localities " in Table IV. are the same as those in Tables II. and III. (c) All deaths occurring in public institutions, situated within the district, whether of " Residents" or of " Non-residents," are, in addition to being dealt with as in note (a), entered in the Inst column of Table IV. The total number in this column equals the figures for the year in column 9, Table I. d) The total deaths in the several " Localities" in columns 9-16 of Table IV, equal those for the year in the same localities in Table II., sub-column9 c. The total deaths at all ages in column 2 of Table IV. equal the gross total of columns 9-16, and the figures for the year in column 12 of Table I. (e) Under the heading of " Diarrhœa" are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea., Dysentery and Dysenteric diarrhoea, Choleraic diarrhcea, Cholera and Cholera Nostras. In addition, and as regards deaths of children under one year of age, under the heading "Diarrhœa" in column 3 (Table IV.) are included all deaths classified as " Diarrhœal diseases " in Table V. Under the heading of " Enteritis " in Table IV., are included only deaths over one year of age registered as due to Enteritis, Mua>en.teritis, Gastro-enteritis, Gastric catarrh, Gastritis, and Gastrointestinal catarrh. Deaths from diarrhoea secondary to some other well-defined disease have been included under the latter. (f) Under the headings of "Cancer" and "Puerperal fever" are included all tered deaths from causes comprised within these general terms. Thus: Under " Cancer" are included deaths from Cancer, Carcinoma, Malignant disease, Scirrhus, Epithelioma, Sarcoma, Villous tumour, and Papilloma of bladder, Rodent ulcer. Under " Puerperal Fever" are included deaths from Pyaemia, Septicaemia, Saprsemia, Pelvic Peritonitis, Peri- and Endo-Metritis occurring in the Puerperium. (g) Under "Congenital Defects" in Table V. are included deaths from Atelectasis, Icterus neonatorum, Travel haemorrhage, Malformations and Congenital hydrocephalus. (h) Under "Tuberculous Meningitis " are included deaths from Acute hydrocephalus. (i) Under "Other Tuberculous Diseases" are included deaths from Tuberculosis, Tuberculosis of bones, joints and other organs, Lupus and Scrofula. (j) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified"; all other deaths are regarded as "Uncertified." E 2 TABLE VI. Deaths from all Causes in the Borough of Shoreditch, and in each ward during the year ending 31st December, 1907. Note.—The deaths of persons not belonging to Shoreditch occurring in hospitals and other institutions in the Borough are excluded ; deaths of persons belonging to Shoreditch occurring in public institutions in London beyond the limits of the Borough are included. DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31st, 1907. 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. 85 and upwards. Small Pox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. No statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 29 83 2 .. .. .. .. .. .. .. .. .. .. 3 21 17 12 38 9 8 6 67 47 114 3 Scarlet fever 2 19 5 1 1 .. .. .. .. .. .. .. .. 1 11 1 6 5 2 1 2 14 14 28 4 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Epidemic influenza 1 1 .. .. .. 1 1 4 2 .. 7 5 1 2 .. 5 3 9 1 1 2 10 13 23 6 Whooping cough 41 56 2 .. .. .. .. .. .. .. .. .. .. 8 18 17 14 14 6 17 5 42 57 99 7 Diphtheria, membranous croup 3 14 3 .. .. .. .. .. .. .. .. .. .. .. 4 5 4 3 1 .. 3 8 12 20 8 Enteric fever .. .. .. 1 2 .. 2 1 .. .. .. .. .. .. 1 1 1 1 1 1 .. 2 4 6 9 Asiatic cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Diarrhœa, dysentery 52 11 1 1 .. .. .. 1 .. .. 2 1 .. .. 9 19 8 14 5 3 11 32 37 69 11 Epidemic or zymotic enteritis 5 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 3 1 .. .. .. .. 3 2 5 12 Cerebro-Spinal Fever 2 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 2 1 .. 1 .. .. 3 1 4 13 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Ganders, farcy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15 Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 16 Anthrax, splenic fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 17 Cow-pox, accidents of vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. ..•.. .. 18 Syphilis 10 .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 3 .. 2 2 2 .. 5 6 11 19 Gonorrhœa 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 20 Phagedoena, hospital gangrene .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 21 ..Ervsipelas 1 1 .. .. .. .. .. .. 1 1 1 1 .. .. .. .. 2 1 1 1 1 2 4 6 22 Puerperal fever. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 23 Pyaemia, septicemia 3 2 .. .. 2 2 .. 1 .. 2 .. 1 .. .. 1 .. 4 3 .. 3 2 5 8 13 24 Infective endocarditis .. .. . . 3 2 .. 1 1 1 .. 1 .. .. 1 2 .. 2 1 1 1 1 5 4 9 25 Other allied diseases 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. 2 .. 1 .. .. .. .. .. 3 3 26 Malarial fever .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 27 Rheumatic fever .. 1 .. 2 2 .. .. .. .. .. 1 .. .. .. .. 2 1 .. 2 1 .. 1 5 6 28 Rheumatism of the heart •• .. •• 1 .. .. .. .. .. .. .. .. .. .. .1 .. .. .. .. .. .. .. 1 1 Tuberculosis : 29 Brain or meninges, acute hydrocephalus 10 20 4 1 .. 2 .. .. .. .. .. .. .. .. 6 2 8 9 3 3 6 16 22 37 30 Larynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 31 Lungs 4 9 4 3 13 16 44 62 46 26 5 .. .. 7 42 28 33 55 18 23 26 145 87 232 32 Intestines, tabes mesenterica 8 7 1 1 .. .. .. 1 .. 1 .. .. .. .. 3 2 1 8 1 1 3 8 11 19 33 General, position undefined 5 14 6 1 1 1 2 1 1 .. 1 .. .. .. 8 6 8 5 1 2 3 9 24 33 34 Other forms, scrofula .. .. 1 2 .. 1 1 .. 1 .. .. .. .. .. 3 2 .. .. 1 .. .. 5 1 6 35 Other Infective diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 36 Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 37 Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 38 Hydatid diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 39 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 40 Other diseases due to altered food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 Acute alcoholism, delirium tremens .. .. .. .. .. .. .. 1 3 .. .. .. .. .. .. 1 .. 1 .. 1 1 4 .. 4 42 Chronic alcoholism .. .. .. .. .. .. 1 4 4 3 3 .. .. .. 4 4 2 3 1 1 .. 8 7 15 43 Chronic industrial poisonings . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 45 Osteo-arthritis, rheumatoid arthritis .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. 1 .. 1 46 Gout .. .. .. .. .. .. .. .. .. 2 1 .. .. .. 1 .. .. 1 .. 1 .. 3 .. 3 47 Cancer .. .. .. .. .. .. .. 8 22 34 14 4 1 3 16 11 9 24 5 5 10 35 48 83 48 Diabetes mellitus .. .. .. .. .. 1 1 .. .. 2 1 1 1 .. .. 2 1 3 1 .. .. 2 5 7 49 Purpura hœmorrhagica .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 50 Hæmophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 51 Anremia lecrucocythremia .. 2 .. .. .. .. 2 .. 1 1 .. .. .. 2 1 .. .. 1 5 6 DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31ST, 1907. 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. 85 and upwards. 52 Lymphadenoma, Hodgkin's disease .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 1 2 53 Premature birth 60 .. .. .. .. .. .. .. .. .. .. .. .. 3 6 10 15 7 4 6 9 33 27 60 54 Injury at birth 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 55 Debility at birth 16 .. .. .. .. .. .. .. .. .. .. .. .. 2 3 2 3 3 .. 2 1 10 6 16 56 Atelectasis 11 .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3 1 3 1 .. .. 5 6 11 57 Congenital defects 12 1 .. .. .. .. .. .. .. .. .. .. .. .. 4 3 1 1 3 .. 1 6 7 13 58 Want of breast milk 5 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 1 .. .. 1 3 2 5 59 Atrophy, debility, marasmus 49 1 .. .. .. .. .. .. .. .. .. .. .. .. 5 4 8 10 9 7 7 25 25 50 60 Dentition 3 1 .. .. .. .. .. .. .. .. .. .. .. .1 1 .. .. 1 .. .. 1 3 1 4 61 Rickets .. 7 .. .. .. .. .. .. .. .. .. .. .. .. 4 .. .. 2 .. .. 1 4 3 7 62 Old Age, senile decay .. .. .. .. .. .. .. .. .. 4 36 79 29 1 20 14 16 60 11 10 13 58 90 148 63 Convulsions 17 1 .. .. .. .. .. .. .. .. .. .. .. .. 6 3 .. 3 3 1 2 11 7 18 64 Meningitis 10 9 .. 1 1 .. .. i .. .. .. .. .. 2 4 2 3 2 1 0 2 10 12 22 65 Encephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 66 Apoplexy .. .. .. .. .. .. .. 3 14 6 12 4 .. 1 6 9 6 8 5 3 1 16 23 39 67 Softening of brain .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 68 Hemiplegia, brain paralysis 1 .. .. .. .. .. 1 2 .. 3 3 1 .. 1 3 1 1 3 2 .. .. 3 8 11 69 General Paralysis of insane .. .. .. .. .. .. 4 7 2 2 .. 1 .. .. 4 4 1 .. 2 3 2 12 4 16 70 Other forms of insanity .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 71 Chorea .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 2 72 Cerebral tumour .. .. 1 .. .. .. .. 1 2 .. .. .. .. 1 1 1 .. .. .. .. 1 1 3 4 73 Epilepsy .. .. .. .. .. 2 1 2 1 .. 1 .. .. .. 2 1 .. 1 2 1 .. 3 4 7 74 Laryngismus, Stridulus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 75 Locomotor Ataxy .. .. .. .. .. .. .. 1 4 1 .. .. .. .. 1 2 1 .. 1 .. 1 6 .. 6 76 Paraplegia, diseases of spinal cord .. 1 .. .. .. .. 2 .. 1 1 1 .. .. 1 .. 1 2 .. 2 5 1 6 77 Other diseases of brain or nervous system .. .. .. .. .. .. .. 5 1 3 1 1 1 2 .. 3 2 2 2 1 .. 3 9 12 78 Otitis, otorrhœa 3 2 2 .. 1 2 .. .. 1 .. .. .. .. .. 1 5 .. 1 1 1 2 6 5 11 79 Diseases of nose, epistaxis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 80 Diseases of nose, epistaxis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 81 Pericarditis .. 1 1 .. .. .. .. .. .. 1 .. .. .. .. 1 2 .. .. .. .. .. 1 2 3 82 Endocarditis, valvular diseases of the heart .. .. 3 6 3 2 3 8 11 9 9 4 .. 5 9 7 6 13 5 3 10 23 35 58 83Hypertrophy of heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 84 Angina pectoris .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 .. 1 .. .. .. .. 1 1 2 85 Aneurism .. .. .. .. .. 1 .. 2 .. 1 .. .. .. .. 2 1 .. .. .. 1 .. 2 2 4 86 Senile gangrene .. .. .. .. .. .. .. .. .. .. 5 2 .. 1 1 1 1 1 .. .. 2 4 3 7 87 Embolism, thrombosis 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 88 Phlebitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 89 Vasricose viens .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular .. .. 2 4 1 1 7 20 22 28 23 7 1 7 18 16 14 28 8 11 14 55 61 116 91 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 92 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 93 Other diseases of larynx and trachea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 94 Acute bronchitis 95 Chronic bronchitis 63 23 2 1 .. 1 1 2 1 3 10 6 20 7 30 9 39 2 15 1 1 3 23 17 22 26 19 19 24 32 9 7 10 6 10 8 53 46 65 72 118 118 96 Lobar, croupous-pneumonia 3 4 .. .. 1 .. 6 3 4 3 .. .. .. .. 3 3 2 5 1 3 2 9 15 24 97 Lobular, broncho-pneumonia . 42 66 2 .. 1 .. 1 1 4 2 4 1 .. 2 21 28 22 20 10 11 10 74 50 124 98 Pneumonia, form not stated 11 24 2 1 4 1 7 6 7 13 8 .. .. 4 15 18 14 9 12 6 6 44 40 84 99 Emphysema, asthma .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 100 Pleurisy .. 3 .. .. .. .. .. .. .. 2 1 1 .. .. .. 1 1 .. .. 1 .. 2 1 3 101 Other and ill-defined diseases of respiratory system 1 1 •• 1 .. .. .. .. .. 2 1 1 .. 1 1 .. 2 2 1 .. .. 3 4 7 102 Diseases of mouth and annexa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 103 Diseases of pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 104 Diseases of oesophagus .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. 1 .. 1 105 Ulcer of stomach and duodenum .. .. .. .. .. 1 .. 3 2 4 .. .. .. 1 1 1 1 6 .. .. 1 0 5 10 106 Other diseases of stomach 5 1 .. .. .. 1 .. 1 2 .. 1 .. .. .. 2 2 .. 4 1 .. 2 7 4 11 107 Enteritis 36 8 .. 1 .. .. 1 3 1 2 .. .. .. 2 10 8 7 15 1 4 5 24 28 52 108 Appendicitis .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 109 Obstruction of intestine 1 1 1 .. .. .. 1 2 .. 2 3 .. 1 .. 4 2 3 2 .. 1 .. 4 8 12 110 Other diseases of intestine 1 .. 1 .. .. .. 1 .. .. 1 1 .. .. .. 1 1 .. 2 .. .. 1 2 3 5 1ll Cirrhosis of liver .. .. .. .. .. 1 .. 10 6 8 3 .. .. 1 1 6 7 3 3 6 1 12 16 28 112 Other diseases of liver .. 1 1 .. .. .. .. 2 .. 1 1 .. .. .. 2 1 1 1 .. 1 .. 3 3 6 113 Peritonitis .. 1 .. .. .. .. .. 2 2 1 .. .. .. 1 .. 2 .. 1 2 .. .. 3 3 6 114 Other and ill-defined diseases of digestive system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR ENDING DECEMBER 31st, 1907. 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. 85 and upwards. 115 Diseases of Lymphatic System and ductless glands .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 116 Acute nephritis .. 2 .. .. .. 1 1 1 .. .. .. .. .. .. .. 1 2 .. 1 1 .. 2 3 5 117 Briglit's disease .. 1 .. 2 .. 1 2 8 10 19 17 2 1 5 3 13 9 12 10 6 5 28 35 63 118 Calculus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 119 Diseases of bladder and prostrate .. .. .. .. .. .. .. .. 2 1 2 .. .. .. .. 2 .. 2 .. .. 1 5 .. 5 120 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 .. .. .. .. .. .. .. .. .. 2 .. 2 2 124 Diseases of vagina and external genital organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 125 Diseases of breast .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 126 Abortion, miscarriage .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 127 Puerperal mania .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 128 Puerperal convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 129 Placenta prævia, flooding .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 130 Puerperal thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 131 Other and ill defined accidents and diseases of pregnancy and childbirth .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 2 .. .. .. 2 2 132 Arthritis, ostitis, periostitis .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 . . 1 1 133 Other and ill-defined diseases of osseous system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 134 Ulcer, bedsore .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135 Eczema 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 2 .. .. .. .. 2 .. 2 136 Pemphigus 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 137 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 .. 3 1 .. .. .. .. .. .. 1 2 .. .. .. 2 .. 1 2 1 .. 1 7 .. 7 140 On railways .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 141 On vessels and docks, excludin drowning .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 142 In building operations .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 143 By machinery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 144 By weapons and implements .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 145 Burns and Scalds .. 5 2 .. .. .. .. .. 1 1 1 .. .. .. 2 l l .. 1 .. .. .. .. 10 146 Poisons, poisonous vapours .. 1 .. 1 .. .. 1 .. .. 1 .. .. .. 1 .. 2 1 2 .. .. .. 5 1 6 147 Surgical narcosis 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. .. 2 .. 2 148 Effects of electric shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 149 Corrosion bv chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 150 Drowning .. .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. 1 .. 1 .. .. 1 3 .. 3 151 Suffocation, overlaid in bed 26 2 .. .. .. .. .. .. .. .. .. .. .. 1 5 3 8 4 2 1 4 17 11 28 152 Suffocation, otherwise 1 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. 3 1 .. .. .. .. 1 3 4 153 Falls, not specified 1 3 1 1 .. 2 .. .. 6 3 1 3 3 9 2 4 7 5 1 1 2 15 9 24 154 Weather agencies 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 155 Otherwise, and not stated 1 2 2 1 .. .. 1 .. .. 1 .. 1 .. .. 2 1 1 4 .. 1 .. 4 5 9 156 Homicide 2 .. .. .. .. 1 1 .. 1 .. .. .. .. .. 1 .. .. 1 1 1 1 4 1 5 Suicides, all forms 157 By poison .. .. .. .. 1 2 .. .. 1 1 .. .. .. .. 3 2 .. .. .. .. .. 2 3 5 158 By asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 159 By hanging and strangulation .. .. .. .. .. .. .. 1 2 .. 1 .. .. 2 .. .. 1 .. .. .. 1 1 .. 4 160 By drowning .. .. .. .. .. 1 .. 1 1 .. .. .. .. .. .. 1 1 .. 1 .. .. 2 .. 3 161 By shooting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 162 By cut or stab .. .. .. .. .. . . .. .. 1 .. 1 .. .. .. 1 .. 1 .. .. .. .. 2 .. 2 163 By precipitation from elevated places .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 164 By crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 165 By other and unspecified methods .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 l66 Execution .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 167 Sudden death .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 168 Other ill-defined and not specified causes 2 •• 1 .. .. .. .. .. 1 .. .. .. .. .. 1 1 1 1 .. .. .. 2 2 4 169 Malignant disease .. 1 .. .. .. .. 1 1 4 7 3 1 1 2 4 3 1 4 1 1 3 14 5 19 170 Abscess 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. 2 .. 2 Total 569 423 57 37 39 47 107 198 231 247 229 140 41 89 401 391 344 526 194 196 224 1173 1192 2365 74 TABLE VII.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1907. DISTRICTS. Estimated population 1907. ANNUAL RATE PEK 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATH8. BIRTHS DEATII8 DURING THE YEARS: DEATHS DURING 1907 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. 1904. 1905. 1906. 1907. London 4,758,218 25.8 16.1 15.6 15.1 14.1 1.42 •• 0.38 0.14 0.16 0.38 0.04 0.32 1.9 0.55 116 9.8 38.0 0.1 Shoreditch §114,700 32.4 20.6 19.8 19.8 20.6 2.9 .. 0.99 0.24 0.17 0.86 0.05 0.64 2.8 1.0 153 12.6 45.5 .. Wards. Moorfields 5,531 25.4 .. 14.4 13.9 16.0 2.1 .. 0.54 0.18 .. 1.44 .. .. 1.2 1.0 115 15.7 49.9 .. Church 19,743 32.7 .. 21.3 20.2 20.3 3.2 .. 1.06 0.56 0.20 0.90 0.05 0.50 3.1 0.9 150 12.2 47.1 .. Hoxton 17,748 34.7 .. 21.3 19.6 22.0 3.5 .. 0.95 0.05 0.28 0.95 0.05 1.23 2.2 1.0 162 14.3 44.7 .. Wenlock §17,489 30.9 .. 17.7 18.5 19.6 2.5 .. 0.68 0.28 0.22 0.79 0.05 0.51 2.8 1.3 166 17.1 39.5 .. Whitmore 18,279 33.6 .. 24.1 24.7 28.7 4.1 .. 2.07 0.27 0.16 0.75 0.05 0.75 4.2 1.3 174 10.0 52.0 .. Kingsland 11,095 33.8 .. 18.1 19.6 17.4 2.1 .. 0.81 0.18 0.09 0.54 0.09 0.27 2.1 0.7 133 11.8 32.9 .. Haggerston 12,454 29.0 .. 16.8 16.7 15.7 2.4 .. 0.64 0.08 .. 1.36 0.08 0.24 2.3 0.4 140 9.1 42.3 .. Acton 12,361 34.3 .. 16.7 18.9 18.1 2.2 .. 0.48 0.16 0.24 0.40 .. 0.88 3.0 0.8 136 10.7 43.3 .. *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 1,000 within two places of decimals, 0.00 is inserted; where no deaths have occurred, dots are placed in the space under the heading. 75 TABLE VIII. ANALYSIS of the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31st, 1907. Diseases. Diseases. All Causes 4,380 37 Atelectasis 38 Congenital malformations 2 1 Small-pox 39 Old age 175 40 Apoplexy 6 2 Measles 144 41 Epilepsy 20 3 Scarlet Fever 36 42 Convulsions 2 4 Typhus 43 Other diseases of brain and nervous system 218 5 Relapsing fever 6 Influenza 97 44 Diseases of organs of special sense 19 7 Whooping Cough 63 8 Diphtheria 5 9 Simple, continued and ill- defined fever 15 45 Diseases of circulatory system 198 46 Laryngitis 2 10 Enteric fever 4 47 Bronchitis 1030 11 Simple cholera 48 Pneumonia 65 12 Diarrhoea, dysentery 50 4 9 Pleurisy 28 13 Remittent fever 50 Other respiratory diseases 43 14 Hydrophobia 15 Glanders 51 Dentition 10 16 Cow pox and Effects of vaccination 52 Quinsy, sore throat 57 53 Enteritis 30 17 Venereal affections 45 54 Peritonitis 2 18 Erysipelas 50 55 Diseases of liver 23 19 Pysemia and septicemia 2 56 Other diseases of digestive system 384 20 Puerperal fever 21 Tabes mesenterica 22 Tuberculous meningitis 57 Diseases of lymphatic system and ductless glands 8 23 Phthisis 194 24 Scrofula, tuberculosis 34 58 Diseases of urinary system 58 25 Other zymotic diseases 24 59 Diseases of the generative system 18 26 Thrush 27 Worms and other parasitic diseases 60 Accidents of childbirth 11 61 Diseases of locomotive system 155 28 Starvation, want of breast-milk 1 62 Diseases of integumentary system 148 29 Alcoholism 12 30 Rheumatic fever and rheuma- tism of heart 52 63 Fracture and contusion 33 64 Gun shot wounds 31 Rheumatism 282 65 Cut stab 3 32 Gout 77 66 Burns or scalds 2 33 Rickets 2 67 Poison 3 68 Drowning .. 34 Cancer 20 69 Suffocation .. 35 Other constitutional diseases 34 70 Otherwise 77 36 Premature birth 71 Other causes 307 76 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1907. Table IX. PREMISES. NUMBER OF PLACES— Number of inspections, 1907. Number of notices, 1907. Number of prosecutions. 1907. On register at end of 1906. Added in 1907. Removed in 1907. On register at end of 1907. Milk premises 288 18 22 284 3410 10 .. Cowsheds 7 •• •• 7 17 •• •• Slaughter-houses Otlier offensive 9 •• 1 8 37 •• •• trade premises lee Cream 1 •• •• 1 6 •• •• premises 69 17 2 84 158 21 •• Registered houses let in lodgings 266 11 5 272 419 140 5 Number of intimation notices served for all purposes 3032 Overcrowding: — Number of dwelling rooms overcrowded 80 Number remedied 80 Number of prosecutions Nil Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1891 111 Underground rooms: — Number dealt with during year Nil Insanitary houses : — Number closed under the Public Health (London) Act, 1891 31 Shelter provided under sec. 60 (4) of the Public Heialth (London) Act, 1891 : — Number of persons accommodated during the year 6 Customs and Inland Revenue Acts: — Number of houses for which applications were received during year 3 Number of prosecutions under By-laws under Public Health (London) Act,1891 : — With respect to water closets, earth closets, etc. Nil Mortuary : — Total number of bodies removed 349 Total number of infectious bodies removed 3 77 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Inspection made by Sanitary Inspectors. Premises. Inspections. Number of Written Notices. Prosecutions. 0) (2) (3) (4) Factories (Including Factory Laundries.) 103 12 - Workshops dncluding Workshop Laundries.) 3435 366 - Workplaces (Including Bakehouses and excluding Outworkers' premises dealt with in Table 3.) 818 108 - Total 4356 486 - 2.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Keferred to H.M. Inspect'r (4) Nuisances under the Public Health Acts:—* Want of cleanliness ,. 465 465 — — Want of ventilation .. 2 2 — — Overcrowding 2 2 — — Want of drainage of floors — — — — Other nuisances 39 39 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 61 61 — — not separate for sexes 2 2 — — Offences under the Factory and Workshop Act: — Illegal occupation oi underground bakehouse (S. 101) .. — — — — Breach of special sanitary requirements for bakehouses (Ss. 97 to 100) — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 573 573 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 3. Home Work. OUTWORKERS LISTS, SECTION 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 and 110. NATURE OF WORK. Lists received from Employers. Addresses of Outworkers. Prosecutions. Number of inspections of outworkers premises. Instances. Notices served. Prosecutions. Instances. Orders made. (S. 109.) Prosecutions. (S. 109, 110.) Twice in the Year. Once in the Year. Received from other Councils. Forward > d to other Councils. Failing to keep or permit, inspection of lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (i) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Wearing Apparel. (1) Making, &c. 22 27 801 8 . . 166 2157 980 . . . . 1428 . . 95 . . 2 . . . . (2) Cleansing andWashing Lace, Lace Curtains, and Nets . . . . . . . . . . . . 4 . . . . . . 3 . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . 2 . . . . . . . . . . . . Artificial Flowers . . . . . . . . . . . . 167 6 . . . . 103 . . 14 . . 1 . . . . Furniture and Upholstery . . . . . . . . . . . . 18 . . . . . . 12 . . 2 . . . . . . . . Fur pulling . . . . . . . . . . . . 30 3 . . . . 18 . . 4 . . . . . . . . Feather sortina . . . . . . . . . . . . 8 1 . . . . 7 . . . . . . . . . . . . Umbrellas. &c . . . . . . . . . . . . 60 3 . . . . 36 546 . . 4 . . . . . . . . Paper Bags and Boxes 16 . . 365 6 . . 116 514 151 . . . . . . 73 . . 8 . . . . Brush Making . . . . . . •• . . . . 142 3 . . . . 87 . . 3 . . . . . . . . Total 38 27 1166 14 . . 282 3103 1147 . . . .2242 . . 195 . . 11 . . . . (a) There were no names and addresses of outworkers received in respect to the following classes of work: Tents, sacks, basket making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors and grapnels, cart gear, locks, latches, and keys, and pea picking. (£) The figures in columns 2 and 4 are the total number of lists received from employers who sent them both for February and August, and of the entries of names of outworkers in those lists. They are therefore double the number of each employers and approximately double the number of individual outworkers whose names are given since in the February and August lists of the same employers, the same outworker's name will often be repeated. (c) There were no prosecutions, but letters were sent to employers in 37 instances of failures to send lists of outworkers employed in making wearing apparel, &c, and in 49 instances for similar failures in respect to paper bag and box making. 79 4.—Registered Workshops. Workshops on the Register (s 131) at the enil of the year. Number. (1) (2) (l) Furniture, woodwork, fitting and other branches of the furniture trades 783 (a) Cabinet making 491 (b) French Polishing 79 (c) Upholstery 44 (d) Other workers 169 (2) Dress 197 (a) Tailoring 73 (e) Shirt making 6 (b) Mantles 10 (f) Boot & Shoe trades 49 (c) Dress 13 (g) Artificial Flowers 6 (d) Millinery 15 (h) Other workers25 (3) Skin, leather, hair and feather trades 58 (a) Furriers 10 (b) Saddlery & Harness 21 (c) Feathers 2 (d) Other workers27 (4) Paper, printing, book, stationery and fancy goods trades 57 (a) Box & bag makers 38 (b) Other workers 19 (5) Laundry and Washing 34 (6) Food 7 (7) Metals, machines, implements and conveyances 55 (8) Precious melals, jewels, &c 2 (9) Other trades than those mentioned above 61 Total number of workshops on Register 1254 Note.—A separate register is kept for bakehouses, the number of which at the end of the year was 73. 5.—Other Matters. Class. N umber. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshops Act (s. 133) Nil. Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 32 referring to 61 workshops Reports (of action taken) tent to H.M. Inspector. 9 referring to 61 workshops Other — Underground Bakehouses (s. 101) : — Certificates granted during the year Nil. In use at the end of the year 42