REPORT on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1908, by LEWIS T. FliASER 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, Sfe. [Printed by Order of the Health Committee.] printed by chas. straker and sons, ltd., bishopsgate avenue, london, b.c. CONTENTS. Page. Anthrax 34 Artizans' dwellings 42 Appendicitis, mortality from 8 Bacteriological examinations 36 Bakehouses 50 Births in sub-districts 2 Birth rates 3 Cancer 8 Cerebro-spinal fever 34 Cholera 34 Coffeehouses 50 Cookshops 50 Cow-houses 46 Customs and Inland Revenue Acts 45 Dairies 46 Deaths in sub-districts 3 Death rate 4 Deaths, ages at 7 Deaths, causes of 7 Deaths in public institutions 8 Deaths in outlying institutions 9 Diarrhoea 31 Diphtheria 16 Disinfection 36 Enteric fever 19 Erysipelas 30 Factories and Workshops Act, 1901 47 Factories, workshops and workplaces—sanitary work 48 Food condemned and destroyed 51 Food and Drugs Act 53 Fried fish shop6 51 Glanders 34 Houses closed 41 Houses let in lodgings 45 Ice cream shops 50 Infantile mortality 5 Infectious cases, number certified 12 Infectious ca6es, number removed to hospitals 12 Infectious diseases, age periods 11 Infectious diseases, deaths from 10 Infectious diseases, death rate 11 Infections diseases, number of cases notified from schools 35 Influenza 33 Institutions, deaths in 8 Legal proceedings 39 Margarine Act, proceedings under 55 Marriages 3 Measles 32 Milk-shops 46 Milk premises, cowsheds, etc., on register 46 Mortuary 37 Offensive business 47 Outworker's 49 Population 1 Puerperal fever 31 Return cases 13 Sanitary work 37 Scarlet fever 14 Scarlet fever, return cases of 13 Schools, closure for infectious disease 36 Shelter 37 Sickness among6t the poor 10 Slaughter-houses 76 Small-pox 14 Page. Smoke nuisance 40 Staff 56 Street markets and food 51 Tuberculosis 33 Vaccination returns 14 Verminous houses 40 Violence, mortality from 8 Water supply 37 Whooping cough 30 Workshops on register 47 Zymotic diseases, deaths from 11 Zymotic death rate 11 APPENDIX. Statistical Tables :— For whole district during 1908 and previous years (Table I.) 58 For separate localities in 1908 (Table II.) 59 Cases of infectious disease notified during 1908 (Table III.) 60 Causes of, and ages at, death during year 1908 (Tables IV. and VI.) 61 & 64 Infantile mortality during 1908 (Table V.) 62 Notes to Tables IV. and V 63 Comparison of London and Shoreditcli birth and death rates in 1908 (Table VII.) 70 Cases treated by District Medical Officer in 1908 (Table VIII.) 71 Summary of proceedings under Public Health (London) Act, 1891 (Table IX.) 72 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6 73 to 76 Metropolitan Borough of Shoreditch ANNUAL REPORT of the MEDICAL OFFICER of HEALTH. Health Department, Town Hall, Old Street, E.C. January, 1909, 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, 1908. POPULATION. The number of persons resident in the Borough is estimated at 115,642, as compared with 116,073 in 1907, 116,506 in 1906, 116,939 in 1905, 117,360 in 1904, and 117,740 in 1903. The estimated populations in the registration sub-districts are as follows: —Shoreditch South, comprising Moorfields, Church, and Hoxton Wards, 42,458; Shoreditch North-West, comprising Wenlock and Whitmore Wards, 37,310 ; and Shoreditch North-East, comprising Kingsland, Haggerston, and Acton Wards, 35,874. The estimated population in the eight Wards of the Borough are set out below: — Ward. Population. Ward. Population. Moorfields 5,381 Whitmore 18,188 Church 19,563 Kingsland 11,002 Hoxton 17,514 Haggerston 12,526 Wenlock 19,122 Acton 12,346 The population of Wenlock Ward includes that of the Holborn Union Workhouse, situate in this locality, estimated at 1,373. For certain statistical purposes the inmates of this workhouse are not regarded as persons belonging to Shoreditch, and are, for these purposes, excluded in estimating the population of the Borough, which becomes, therefore, 114,269, whilst that of the Ward is reduced to 17,749. Shoreditch has a decreasing population, the chief decrease taking place in the southern part of the Borough, where there is a displacement of the inhabitants owing to the erection of warehouses and other business premises cn sites formerly occupied by dwelling houses. 2 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 75 Whitmore 76 239 Church 106 185 Kingsland 72 153 Hoxton 78 224 Haggerston 66 190 Wenlock 90 197 Acton 83 148 In the above table the areas of the water-ways of the Regent's Canal and of the site occupied by the Holborn Union Workhouse have not been taken into account. BIRTHS. The births registered in the Borough numbered 3,553, of which 1,775 were of males and 1,778 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 3,678, of which 1,841 were of males and 1,837 of females. The distribution of the corrected births in the eight wards of the Borough is given below : — Ward. Males. Females. Total. Moorfields 51 73 124 Church 327 324 651 Hoxton 317 311 628 Wenlock 274 257 531 Whitmore 294 316 610 Kingsland 187 221 408 Haggerston 201 180 381 Acton 190 155 345 Totals 1,841 1,837 3,678 Outside the Borough 204 births were registered, 99 of males and 105 of females, the parents being residents of Shoreditch. In the Shoreditch Infirmary 174 births occurred, of which 82 were of males and 92 of females. In five of these (three of males and two of females) the parents did not belong to Shoreditch. In the Holborn Union Workhouse there were 82 births, 33 of males and 49 of females. In 74 of these (30 male and 44 female) the parents were not resident in the Borough. 3 Of the births in the Shoreditch Infirmary 67 (28 male and 39 female) were returned as illegitimate; in the Holborn Workhouse 41 were returned as such. Elsewhere in the Borough 36 (10 of males and 26 of females) were given as illegitimate. Information was supplied by the London County Council relating to some 537 births during the year belonging to Shoreditch which were attended by registered midwives. Of these 71 were hospital confinements. It may also be mentioned that notifications as required under the Notification of Births Act were received relating to 38 births belonging to the Borough. The birth-rate for the Borough was 32.2 per 1,000 inhabitants, as compared with 32.4 in 1907, 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 1908 were at the rate of 26.5 ; for 76 great towns the rate was 27.0, and for 142 smaller it was 26.0 per 1,000 population. The birth-rate of the Metropolis was 25.2 per 1,000 inhabitants. The birth-rate for Shoreditch although decreasing still remains much above the average for the country generally. MARRIAGES. The marriages in the Borough during 1908 numbered 972, as compared with 1,109 in 1907, 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 16.8 per 1,000 population, as compared with 15.9 for the whole of London. These rates are the lowest so far recorded. DEATHS. The deaths during 1908 numbered 2,006, as compared with 2,365 in 1907, 2,289 in 1906, 2,296 in 1905, and 2,392 in 1904. The number is the smallest recorded for over fifty years. The distribution of the deaths amongst males and females in the eight wards of the Borough is as shown in the following table : — Ward. Males. Females. Total. Moorfields 51 28 79 Church 187 148 335 Hoxton 175 155 330 Wenlock 144 134 278 Whitmore 229 190 419 Kingsland 103 90 193 Haggerston 93 104 197 Acton 105 70 175 Totals 1,087 919 2,006 4 The deaths of males were 108 in excess of those of females. The death rate of the Borough for 1908 was 17.5* per 1,000 inhabitants, as compared with 20.6 in 1907, 19.8 in 1906, 19.8 in 1905, 20.6 in 1904, and 19.6 in 190:3. It was 17 per cent, below the average for the previous ten years, and the lowest recorded for Shoreditch for over fifty years. The death-rate of the Metropolis for 1908 was 13.8 that of England and Wales 14.7, of 76 great towns 15.8, and of 142 smaller towns 14.7 per 1.000 population. In Tables I., II., IV., V., VI., and VII. (Appendix) are given the causes of death, and the death-rates for the whole Borough, and for its eight wards together, with other information bearing upon the mortality amongst the inhabitants of Shoreditch during the year. A marked reduction in the deathrates for all the wards, except Kingsland and Haggerston, is noticeable. In the wards named the rates have remained practically the same as for 1907. The death-rate was lowest in Acton Ward, and highest in Whitmore, being 13.3 and 23.0 per 1,000 respectively. The latter ward is the most densely populated in the Borough. The death-rate of the Borough was above the mean rate for the year during the first four months, January to April. During May, June, July, and August it was well below the mean, and for the remainder of the year its average was about the mean rate for the year. The rate was highest during the month of January, averaging 23.7, and lowest for the two months, June and July, when it averaged 12.7 per 1,000. The highest rate for any one week in the year was that for the first week of May, being 25.6; the lowest was that of the last week of June, when the rate was only 10.1 per 1,000. The effect of the mortality due to summer diarrhoea became apparent during the last week of July. There was a gradual rise in the death-rate until a maximum was leached in the first week of September. There was then a gradual decline until the middle of October, when another slight rise began, which lasted until the middle of December. Then the rate again fell much below the average. The second elevation of the death-rate was due to an increase in the mortality from diseases of the respiratory organs. The weekly death-rates only rose above 20 per 1,000 on four occasions during the year. The number of infants who died aged under one year was 510, 292 being males and 218 females, the deaths amounting to between 25 and 26 per cent, of the total number of deaths of all ages. The proportion of infants under one year dying during 1908 was at the rate of 138 per 1,000 births belonging to Shoreditch, registered during the year. This rate is the lowest recorded for Shoreditch since 1870, and is probably to be accounted for very largely by the comparatively low mortality from measles, whooping cough, and acute bronchitis. * Corrected for age and sex distribution the death-rate was 18.3 per 1,000 population. 5 The infantile mortality in the Borough is higher amongst males than amongst females, the average for the seven years ending 1907 being 187 in the case of the former and 165 in the case of the latter. For 1008 the mortalities were 158 for males and 118 for females. 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, weakness, wasting, bronchitis, pneumonia, tuberculosis, and suffocation in bed. In Table V. (Appendix) is contained a statement showing the causes of death of infants under the age of one year, the ages in weeks and months being given. In the subjoined table the causes of death among infants under one year 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 2 3 .. 1 3 .. 11 Scarlet Fever .. .. .. .. .. .. .. .. .. Diphtheria .. 1 .. .. 1 1 .. .. 3 Whooping Cough .. 1 4 1 2 .. 2 .. 10 Diarrhoea (all forms) .. 20 13 16 14 8 13 2 86 Enteritis .. 7 7 3 7 1 1 .. 26 Gastritis and Gastro Intestinal Catarrh .. 1 1 1 2 1 1 1 8 Premature Birth 3 9 7 14 10 4 8 6 61 Congenital Defects 1 3 1 5 4 2 2 5 23 Injury at Birth .. .. .. .. .. .. .. .. .. Want of Breast Milk .. .. .. .. .. .. .. 2 2 Atrophy, Debility and Marasmus 1 17 15 10 11 7 9 8 78 Tuberculous Meningitis 1 1 4 1 3 2 1 .. 13 Tuberculous Peritonitis and Tabes Mesenterica 2 .. .. 1 2 2 .. .. 7 Other Tuberculous Diseases .. 3 1 1 4 1 2 .. 12 Erysipelas .. .. .. 2 .. .. .. .. 2 Syphilis .. 2 1 .. 2 .. .. .. 5 Pickets .. .. .. .. .. 1 .. .. 1 Meningitis (not Tuberculous) 1 5 2 .. 3 1 1 1 14 Convulsions 1 1 .. .. .. 3 1 1 7 Bronchitis .. 2 5 6 9 1 2 2 27 Pneumonia .. 11 6 3 10 7 10 5 52 Suffocation, overlying .. 6 4 9 7 2 5 .. 33 Other causes 3 1 7 1 6 4 5 2 29 Totals 13 93 80 77 97 49 66 35 510 6 The infantile mortalities of the eight wards of the Borough are contained in Table VII. (Appendix). The mortality was higher in Haggerston, where it amounted to 173 per 1,000 births, and lowest in Acton, where it was 101. The next lowest infantile mortality was that of Moorfields ward, where it was 105 per 1,000 births. The latter two wards are the least densely populated parts of the Borough. Shoreditch is a district with a high infantile mortality, the mortality being one of the highest in the Metropolis. In connection with this attention must again be directed to the Notification of Births Act, 1907 This Act is an adoptive one, and its object is to afford Local Authorities the means for obtaining early information of births with a view to advice and instruction as to the rearing of infants being given, where necessary, to mothers and other persons responsible for the care of infants. There is no doubt that if the Act were put into effective operation in the Borough many infants would be likely to survive who now die. The question of the adoption of the Act was twice under the consideration of the Council during the year but on each occasion it was deferred for six months. The deaths amongst children aged from one to five years numbered 257 as compared with 423 for 1907, which is a very marked decrease. Of these 39 were attributed to measles, 11 to whooping cough, 20 to scarlet fever, 7 to diphtheria, 44 to various forms of tuberculosis, 20 to diarrhoea, 13 to bronchitis, 5G to pneumonia, and 7 to enteritis. Accident or negligence resulted in 14 deaths, seven of which were due to scalds or burns. Altogether 767, or a little over 38 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 77 died. The chief causes were tuberculosis, which accounted for 24 deaths, other infectious diseases which caused 15, diseases of the heart and circulatory organs 8, and accident or negligence which resulted in six deaths. Of persons aged from fifteen to twenty-five years there died G7, of whom 29 succummed to tuberculosis; 26 being the victims of consumption. Accidence or negligence resulted in three deaths, and there was one from suicidal poisoning. Of persons aged between twenty-five and thirty-five years there were 114 deaths,, the chief causes being consumption which resulted in 50, diseases of the heart and circulatory organs which accounted for 9, kidney disease for 8, and pneumonia which was the cause of 7 deaths. Five deaths were due to violence, two of which were suicidal. 7 Between the ages of thirty-five and forty-five years there died 174 persons. Of these 51 died from consumption, 10 from cancer, 12 from diseases of the nervous system,, 12 from valvular heart disease, and 10 from heart disease not stated to have been due to valvular mischief, 5 from bronchitis, 22 pneumonia, 11 cirrhosis of the liver, 7 kidney disease, and 2 alcoholism. There were two cases of suicidal poisoning. Of persons from forty-five to fifty-five years of age 202 died. Of these 41 succumbed to consumption, 14 to cancer, 9 to alcoholism, 18 to diseases of the nervous system, including 6 from apoplexy, 10 to valvular heart disease and 12 to diseases of the heart not stated to be valvular, 17 to bronchitis, 18 to pneumonia, 8 cirrhosis of the liver, 13 to Bright's disease, 5 to accident, and 5 to suicidal poisoning. Of 238 deaths among persons from fifty-five to sixty-five years, 29 were attributed to consumption, 23 to cancer, 7 to malignant disease, 4 to alcoholism, 33 to diseases of the nervous system, including 22 from apoplexy, 13 to valvular heart disease, and 21 to diseases of the heart not stated to be due to valvular trouble, 4 to influenza, 34 to bronchitis, 16 to pneumonia, 5 to cirrhosis of the liver, 12 to Bright's disease, 5 to accident and 4 to suicide. Of persons aged from sixty-five to seventy-five years there died 221, the chief causes of death being cancer which accounted for 19, malignant disease lor 4, old age 18, disease of the nervous system 30, including 16 from apoplexy, valvular heart disease 10, heart disease not stated to be valvular 18, influenza 8, bronchitis 50, pneumonia 16, cirrhosis of the liver 6, Bright's disease 17, and accident 4 deaths. Of 113 deaths of persons aged from seventy-five to eighty-five years 4 were the result of influenza, 6 cancer, 38 old age, 5 diseases of the nervous system, 6 heart disease not stated to be valvular, 12 bronchitis, 15 pneumonia, 4 Bright's disease, and 6 accident. Of the 33 persons who died aged 85 years and upwards 1 died from a form of septic disease, 1 from cancer, 17 from old age, 4 from heart disease not stated to be valvular, 4 from chronic bronchitis, 2 from pneumonia, 2 from other diseases of the respiratory organs, and 2 from accident. The chief causes of death in the Borough during the year were: tuberculosis which accounted for 311 including 232 due to phthisis or consumption, pneumonia 222, bronchitis 163, diseases of the heart and blood vessels 159, diarrhoea 112, violence 108, cancer 74, old age 74, atrophy, debility and marasmus 71, prematurity 61, Bright's disease and other diseases of the kidneys 64, apoplexy 50, cirrhosis of the liver and alcoholism 50, and enteritis which was given as the cause of 36 deaths. 8 Of the 74 deaths from cancer 32 were of males and 42 of females. Most of these deaths were of persons aged from 45 to 75 years. Eleven persons under 45 and seven over 75 years were certified to have died from cancer. In addition to the deaths attributed to cancer there were 17 deaths certified as due to malignant disease, and in some of these cancer was probably the cause of death. Six of the deaths from malignant disease were of males and 11 of females. The cancer death-rate was 0.64 per 1,000 population, which is a little above the average for the previous fifteen years. The rates for previous years are as follows:—0.72 in 1907, 0.64 in 1906, 0.70 in 1905, 0.69 in 1904,, 0.66 in 1903, 0.74 in 1902, 0.63 in 1901, 0.56 in 1900, 0.63 in 1899, (J.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 are not included in estimating the above rates. Of the deaths attributed to alcoholism and cirrhosis of the liver 28 were of males and 22 of females. These, however, are far from representing the actual number of deaths directly or indirectly the result of the abuse of alcohol. Five deaths were certified as caused by appendicitis as compared with 1 in 1907, 19 in 1906, 4 in 1905, 7 in 1904, 5 in 1903, 4 in 1902 and 2 in 1901. Seven deaths were attributed to peritonitis. Of the 108 deaths from violence, 66 were of males and 42 of females. Through accident or negligence 91 persons met their deaths, the chief causes being burns and scalds, which accounted for 15, falls, chiefly in persons aged 45 years and upwards, which resulted in 24, and suffocation, mainly in infants through overlaying, which was the cause of 33 deaths. Seventeen persons, 12 of whom were males, committed suicide. DEATHS IN PUBLIC INSTITUTIONS. The numbers and distribution of the deaths of persons belonging and not belonging to the Borough in the public institutions situate in Shoreditch are as set out in the subjoined table: — Institution. Persons belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Union Workhouse 10 257 267 Shoreditch Workhouse 479 54 533 Royal Chest Hospital 12 50 62 Convent Hospital 2 3 5 Medical Mission of Good Shepherd 14 3 17 Total 517 367 884 9 Elsewhere than in public institutions, eight persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various institutions outside Shoreditch with the numbers of persons belonging to the Borough dying therein : — No. of Asylums. Deaths. Banstead 8 Belmont 1 Cane Hill 1 Caterham 2 City of London 1 Claybury 8 Colney Hatch 6 Dartford Heath 4 Hanwell 3 Horton 8 Leavesden 11 Lung Grove 7 Manor 1 Tooting Bee 8 Hospitals tor Infectious Disease. Eastern 9 North Eastern 25 South Eastern 4 South Western 1 General Hospitals. Evelina (Children) 2 Freidenheim 1 French 1 German 9 Great Northern 1 Gt. Ormond Street (Children) 21 Vincent's Square (Infants) 2 Italian 1 King's College 2 London 26 Metropolitan 85 Mildmay 8 General Hospitals—continued, No of Deaths Middlesex 2 Queen's (Children) 67 St. Bartholomew's 103 Hospitals for Special Diseases, &c. Cancer Hospital, Chelsea 1 Lying-in, City of London 7 Chest Hospital, Bethnal Green 2 Homcepathic 2 Infirmaries and Workhouses. Bethnal Green Infirmary 8 Bishop Stortford Workhouse 1 Camberwell Workhouse 1 Islington Infirmary 1 Holborn Infirmary, Mitcham 4 Hackney Infirmary 2 St. Pancras Infirmary 1 St. George's Infirmary 2 St. George's Workhouse 2 Whitechapel Infirmary 2 Other Institutions. Bethnal House, Bethnal Green 1 St. Joseph's Hospice 3 St. Anne's House 1 Central London Sick Asylum 2 Metropolitan Benefit Society Asylum 1 Brooke House 1 H.M. Prison, Holloway 1 Of 485 persons belonging to Shoreditch dying in public institutions situate beyond the limits of the Borough 331 died in general hospitals including 92 in hospitals for sick children, 69 in asylums for those mentally unsound,, 39 in the fever hospitals of the Metropolitan Asylums Board, 24 in workhouses and infirmaries, 12 in hospitals for special diseases, and 10 in other institutions. Elsewhere than in public institutions 13 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 1,002, or nearly fifty per cent, of the deaths of persons belonging to Shoreditch, took place in public institutions. 10 SICKNESS AMONGST THE POOR. The cases coming under the treatment of the district medical officers in connection with the poor law dispensary during 1908 numbered 4,453, as compared with 4,380 in 1!)()7, 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 707 of the cases, as compared with 763 for 1907. Consumption, influenza, diarrhoea, measles, scarlet fever and erysipelas accounted for most of the infectious cases. The number treated for consumption was practically the same as for the previous two years. As compared with the figures for 1907 there were increases in the numbers of cases of influenza and diarrhoea, and marked decreases in those of measles and erysipelas. The cases of scarlet fever were also fewer. Diseases of the respiratory organs, which are largely the result of infection, were responsible for 1,268 of the cases, this number being one hundred more than for 1907, and considerably above the average for the past 16 years. Bronchitis caused 1,143 and pneumonia 79 of these cases. Rheumatism was given as the cause of illness in 335 and gout in 90 of the cases, the latter number being considerably above the average for the previous 16 years. Dyspepsia and other disorders of the digestive system accounted for 448 of the cases. Cases of cancer were below the average for the previous 16 years, numbering 14, as compared with 20 in 1907, 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. There was a considerable increase in the number of cases of diseases of the locomotive system. Diseases of the skin and of the urinary organs remained about the same in point of numbers as in 1907. INFECTIOUS DISEASES. The infectious diseases included under the headings numbered 1 to 35 inclusive and 171 in Table VI. (Appendix) resulted in 622 deaths as compared with 747 in 1907, 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, much below the average for the previous 7 years. They amounted to 30.7 per cent, of the deaths from all causes, as compared with 31.5 per cent for 1907. The marked decrease in the number of deaths from these infectious diseases mainly resulted from the comparatively small number of deaths from measles and whooping cough. The deaths from diarrhoea were also below the average. The deaths from consumption and other forms of disease caused by the tubercle bacillus amounted to 50 per cent, of the whole. Of the remainder, 11 diarrhoea, measles and scarlet fever, in the order named, were responsible for the greater number. The death-rate from these infectious diseases was 5.4 per 1,000 inhabitants, as compared with 6.5 in 1907, 0.7 in 1906, 6.2 in 1905, C.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 163 150 24 16 14 22 65 63 47 38 14 5 1 It will be noticed that half of these deaths were of children under the age of five years. Taking the total mortality amongst children under five years of age, about 40 per cent, resulted from these infectious diseases, as compared with 42 per cent, in 1907. In infants under one year diarrhoea and tuberculosis were the most fatal of these diseases, whilst amongst children aged from one to five years measles, tuberculosis, diarrhoea, and scarlet fever claimed most of the victims. Consumption was the chief cause of the mortality from these diseases between the ages of 20 and 65 years. The deaths from small pox, measles, scarlet fever, diphtheria including membranous croup, whooping cough, enteric fever and diarrhoea, which are the principal zymotic diseases, numbered 219, the death-rate due to them being 1.9 per 1,000 inhabitants, as compared with 2.9 in 1907, 3.1 in 1906, 2.S 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, greatly below the average, and is one of the lowest, if not the lowest recorded for Shoreditch during the past fifty years. 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 Church and Whitmore and lowest in Acton and Moorfields Wards, in connection with which it may be noted that the population in the latter two wards is of considerable less density to the acre than is the case with the other two wards. 12 The cases of notifiable infectious disease numbered 1,028, being 237 less than in 1907. The number of cases annually certified since 1889,| and the attack-rates per 1,000 inhabitants, are contained in the following table : — Year. Number of cases. Attack-rate per 1,000 inhabitants. 1890 1158 9.4 1891 862 7.0 1892 1478 12.0 1893 1987 16.2 1891 1104 9.0 1 89.5 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 1908 1028 8.8 The cases of notifiable infectious disease certified in the Metropolis during 1908 amounted to 35,900, the attack-rate being 7.5 per 1,000 population, as compared with 8.6 for 1907. Subjoined is a list of the infectious diseases which are notifiable to the Medical Officer of Health, showing the number of cases certified in the Borough for each of the four quarters of the year, and the numbers and percentages of such cases which were removed to hospital for treatment: — Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox .. .. .. .. .. .. Scarlet Fever or Scarlatina 119 99 173 199 590 28 Diphtheria & Membranous Croup 45 45 48 64 202 13 Typhus .. .. .. .. .. .. Cholera .. .. .. .. .. .. Enteric Fever (Typhoid) 4 11 34 52 101 11 Continued Fever .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. Puerperal Fever 2 3 .. .. 5 2 Erysipelas 23 34 21 46 124 5 Plague .. .. .. .. .. .. Cerebro Spinal Fever 1 3 1 1 6 5 Totals 194 195 277 362 1,028 64 Numbers and percentages of cases removed to hospitals 167 156 251 309 883 86% 80% 90% 85% 86% 13 As compared with the figures for 1907 there was a marked decrease in the number of cases of scarlet fever, and a very marked increase in the number of enteric fever cases. The deaths from notifiable infectious disease show an increase of one on the figure for 1907. The deaths from the principal zymotic diseases which are notifiable,, namely, smallpox, scarlet fever, diphtheria and enteric fever were at the rate of 0.45 per 1,000 population, whilst the rate from the principal zymotic diseases which are not notifiable, namely, measles, whooping cough and diarrhoea was 1.4 per 1,000 population". This latter rate it may be mentioned is very much below the average for previous years. METROPOLITAN ASYLUMS BOARD. Most of the cases of infectious disease removed to hospital were taken to the hospitals of the Metropolitan Asylums Board, but a number of the cases of enteric fever were treated in general hospitals, and some in the Shoreditch Infirmary. The infectious diseases, cases of which are receivable into the Board's hospitals, are smallpox, scarlet fever, diphtheria,, enteric fever and cerebrospinal fever. The number of cases of these diseases certified was 899, and the number removed to hospital was 875, giving a percentage of 97.3, which is practically the same as for 1907. The percentage of removals for 1906 was 96. The percentages for previous years are contained in the report for 1905. It is satisfactory to have to record such high percentages of removals. Efficient isolation of cases of infectious disease in the homes of the people in a densely crowded locality like Shoreditch being practically impossible. RETURN CASES. During the year 10 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 Primar)' case. Remarks. 1 83 days 11 days Discharge from nose. Right eye inflamed. 1 Primary case, a female. 2 52 „ 8 „ Scab on one nostril 1 Primary case, a female. Developed ''cold and sore throat" 3 days after return. 3 92 „ 4 ,, Discharge from nose 3 Primary case, a female. 4 47 „ 14 „ Discharge from nose; scaling from feet 1 Primary case, a male. Discharge came on after return. 5 47 „ 7 „ 1 Primary case, a male. 6 56 „ 8 „ Discharge from nose 2 „ male. 7 49 „ 13 „ Discharge from nose. Sore nostrils. 1 Primary case, a male. Discharge came on 4 days after arrival home. 8 61 „ 3 „ 1 Primary case, a male. 9 67 „ 19 „ 1 Primary case, a female. 10 76 „ 3 „ 1 Primary case, a male. Stated to have had nephritis. 14 The percentages of return cases in respect to the number of cases removed to hospital was 1.7, as compared with 1.9 in 19(37 and 1.5 in 1900. In four instances it will be noticed that nothing was discovered in respect to the patients returning from hospital to indicate that they were likely to convey infection; in five instances a discharge from the nose was observed, but in two of these it made its appearance subsequent to the return of the patient. SMALLPOX. No case of smallpox was certified in Shoreditch, and only one appears to have been notified in the whole of London during the year. Five intimations were received from port sanitary authorities relative to persons off ships, on which smallpox had occurred, who were proceeding to addresses in the Borough. The usual enquiries were made in each case. VACCINATION. The official figures as to vaccination in the Borough are those published in the reports of the Medical Officer of the Local Government Board. The latest are for the year 1900. It appears that of the children born in Shoreditch during that year 32.6 per cent. were not finally accounted for as regards vaccination. This is a slight decrease on the percentage for 1905. The cases in which vaccination was postponed are included in making this calculation. Certificates as to conscientious objection were obtained in 25 instances or 0.7 per cent, of the births, as compared with 0.8 in 1905, 0.5 in 1904, 0.6 in 1903, and 0.3 in 1902. SCARLET FEVER. The cases certified during 1908 numbered 590, as compared with 876 in 1907, 629 in 1906, 789 in 1905, 343 in 1904, and 255 in 1903. In 23, or 4 per cent., of the cases notified intimations were received from the Metropolitan Asylums Board that the patients had not been suffering from scarlet fever. Adding six cases of scarlet fever notified as diphtheria, the corrected number of cases of scarlet fever was 573, as compared with 822 in 1907, 599 in 1906, 778 in 1905,, 326 in 1904, and 237 in 1903. 15 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 : — Ward SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 17 11 28 .. 1 1 Church 52 62 114 5 3 8 Hoxton 44 41 85 2 3 5 Wenlock 36 33 69 2 2 4 Whitmore 39 41 80 3 2 5 Kingsland 40 30 70 3 .. 3 Haggerston 41 29 70 .. .. .. Acton 38 36 74 1 1 2 Total for Borough 307 283 590 16 12 28 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified, 377, or 97.8 per cent., were removed to hospital, as compared with 98.6 per cent, in 1907, 97.4 per cent, in 1906, 97 per cent, in 1904 and 96 per cent, in 1904. The percentages for previous years are given in the report for 1903 The cases certified were at the rate of 5.1 per 1,000 inhabitants, as compared with 7.5 in 1907, 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 attack-rates were highest in Acton and Kingsland Wards, and lowest in Wenlock and Hoxton. In Kingsland Ward the attack-rate was 6.3; in Wenlock it was 3.6 per 1,000 inhabitants. The deaths from scarlet fever numbered 28, as compared with 28 in 1907, 20 in 1906, 27 in 1905 and 13 in 1904, the death-rate being 0.24, as compared with 0.24 in 1907, 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 4.7 per cent, of the cases certified, as compared with 3.1 per cent, in 1907, 3.1 in 1906, 3.4 in 1905, 3.8 in 1904, 2.7 in 1903, 3.3 in 1902, 3.5 in 1901, and 5.4 in 1900. It was, therefore, above the average. Amongst children under five years of age there were 221 cases with 20 deaths, the case-mortality being 8.9 per cent, (allowing for corrections 9.4 per cent.), as compared with 7.2 per cent, in 1907, 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. Amongst persons over five years of age there were 365 cases with 8 deaths, the mortality being 2.2 per cent, of the cases certified (allowing for corrections 2.1 per cent.), as compared with 1.2 in 1907, 1.3 in 1906, 1.0 in 1905, 1.8 in 1904, 2.7 in 1903, 16 and 1.7 in 1901. The mortality from scarlet fever is heaviest during the early years of life. During 1908 23 of the 28 deaths were of children under the age of ten years, 4 were of children aged from 10 to 15 years, and one person died aged between 20 and 25 years. For the whole of London some 22,060 cases were certified, the attack-rate being 4.6 per 1,000 inhabitants, as compared with 5.6 in 1907, 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 m 1900. The deaths numbered 548, the death-rate being 0.11 per 1,000, as compared with 0.13 in 1907, 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 foregoing figures indicate, both for London and Shoreditch, that scarlet fever during 1908 was less prevalent than in the previous year, but that its prevalence was above the average for the previous eight years. DIPHTHERIA. The cases certified numbered 202, as compared with 211 in 1907 and 133 in 1906. Of these 35, or a little over 17 per cent., were not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board. In six of these the cases, subsequent to removal to hospital, proved to be cases of scarlet fever. 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 9 11 20 1 .. 1 Oliurch 11 20 31 2 1 3 Hoxton 15 10 25 1 1 2 Wenlock 10 15 25 2 1 3 Whitemore 18 18 36 .. 3 3 Kingsland 6 13 19 .. 1 1 Haggerston 7 6 13 .. .. .. 15 18 33 .. .. .. Total for Borough 91 111 202 6 7 13 These cases are grouped according to ages in Table III. (Appendix). 17 Of the cases certified, over 96 per cent, were removed to hospital, as compared with 94 per cent, in 1907, 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 1.7 per 1,000 inhabitants,, as compared with a rate of 1.8 for the previous year. The attack-rate, according to the cases certified, was highest in Moorfields Ward and lowest in Acton, being 3.7 per 1,000 inhabitants in the former and 1.0 in the latter. The deaths numbered 13, the death-rate being 0.11 per 1,000, as compared with 0.17 in 1907, 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 for 1908 is one of the lowest, if not the lowest, recorded during the past fifty years. The death-rates due to this disease in the wards of the Borough are contained in Table VII. (Appendix). The rate was highest in Moorfields Ward. No deaths from diphtheria occurred amongst the inhabitants of Acton and Haggerston Wards. The case-mortality was 6.4 per cent, of the cases certified (7.8 allowing for cases not regarded as diphtheria at the fever hospitals). In 1907 the casemortality was 9.5, in 1906 it 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 rate for 1908 is the lowest so far recorded for Shoreditch. Of the 13 deaths in 1908„ 10 were of children under five years of age, the mortality being at the rate of 9.5 per cent, of the cases certified amongst children belonging to that age period (11 per cent, allowing for cases not regarded as diphtheria at the hospitals), as compared with 15.6 per cent, in 1907, 16 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. The contrast between the mortality of 1908 and that of 1893 is very striking. The case-mortality amongst persons over five years of age was a little over 3 per cent, of the cases certified, but deducting cases not regarded as diphtheria the mortality was 4 per cent. The whole of the deaths from diphtheria were of children under the age of ten years. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 184 of the cases b 18 certified during the dear, they were distributed amongst males and females a' certain age periods as set out in the subjoined table: — Age Period. Male. Female. Total Under 1 year 4 3 7 From 1 to 2 years 12 14 26 „ 2 „ 3 „ 9 14 23 „ 3 ,, 4 „ 11 12 23 4 „ 5 „ 8 9 17 5 „ 10 „ 30 29 59 „ 10 ,, 13 „ 2 11 13 „ 13 years 5 11 16 Total 81 103 184 In 82 of the cases the patients were children attending school, and in 67 of these they were at school within a week of being certified as having the disease. In some instances the children were at school whilst actually suffering from diphtheria before the nature of their illness was recognised. In 78 other cases, although the patients themselves were not school-going children there were other children in the houses who were. In 28 instances the histories showed that there had been cases of sore throat " amongst the inmates of the houses in which the patients resided. In 30 instances there was evidence pointing to infection from previous cases in the Borough. In 132 instances the houses were occupied by members of more than one family, in 26 by single families, and in 26 instances the cases occurred in artizans' dwellings of the block type. With regard to the sanitary condition of the dwellings, in 108 this was satisfactory, in 36 fairly so, and in 40 it was unsatisfactory, but these figures must not be taken as an indication that a satisfactory sanitary condition is favourable to the occurrence of diphtheria in houses. Similar proportions have been obtained in inspecting houses in which no diphtheria cases were notified. The cases certified as diphtheria in the Metropolis numbered 7,840, as compared with 8,585 in 1907, 7,916 in 1906, and 6,482 in 1905, the attack-rates being 1.6,, 1.8, 1.6, and 1.3 per 1,000 population respectively. The proportion of attacks per thousand inhabitants in Shoreditch during the past four years lias averaged about the same as that for London as a whole. The deaths in London numbered 724, as compared with 781 in 1907, 691 in 1906, and 546 in 1905, the death-rates being 0.15, 0.16, 0.14, and 0.12 per 1,000 population respectively. 19 ENTERIC OR TYPHOID FEVER. The cases certified during 1908 numbered 101, of which 0 were subsequently not regarded as having been cases of enteric fever. The numbers of cases certified year by year since 1889 are set out in the following table: — Year. Number of Cas es. Year. Number of Cases. l890 202 1900 122 1891 111 1901 96 1892 91 1902 149 1893 111 1903 101 1894 85 1904 48 1895 99 1905 36 1896 114 1906 39 1897 107 1907 34 1898 91 1908 101 1899 171 During 1907 the cases of enteric fever in the Borough were fewer than in any year since the notification of infectious diseases became compulsory. For the year 1908, however, the number was between two and three times greater than the average for the previous four years. The cases certified were at the rate of 0.8 per 1,000 population, as compared with 0.3 in 1907, 0.3 in 1900, 0.3 in 1905, 0.4 in 1904, and 0.8 in 1903. Although there was such a marked increase on the numbers for the previous four years the cases certified during 1908 did not materially exceed the average for the previous eighteen years. The deaths during the year numbered 11, and the death-rate was 0.09 per 1,000 inhabitants as compared with 0.05 in 1907, 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 for 1908 was, therefore, a little above the average for the years mentioned. The case-mortality was at the rate of 10.9 per cent, of the cases certified, or deducting the cases not regarded as having been enteric fever, the mortality amounted to 11.6 per cent. The case-mortalities for 1907 and 1906 were 17.6 and 10 per cent, respectively. Those for previous years are given in the Annual Report for 1905. During the past sixteen years the mortality from typhoid fever has been on an average 16 per cent, of the cases certified. b 2 20 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 2 .. 2 .. .. .. Church 4 1 5 2 .. 2 Hoxton 3 7 10 1 1 2 Wenlock 3 4 7 1 .. 1 Whitmore 32 40 72 2 4 6 Kingsland .. 3 3 .. .. .. Haggerston 1 .. 1 .. .. .. Acton .. 1 1 .. .. .. Total for Borough 45 56 101 6 5 11 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified, 98, or 97 per cent., were removed to hospital for treatment. As may be gathered from the above table the disease was most prevalent in Whitmore Ward, chiefly in Ware Street, Louisa Street, Nancy Street, Watson's Place, Reeves' Place, and Wilmer Gardens, which are occupied by some of the poorest persons in the Borough. A large proportion of the cases certified were infected from previous cases in the Borough. Inquiry failed to reveal any common vehicle of infection such as water,, milk, shellfish, ice cream, or fried fish. In a few instances the patients were said to have eaten mussels about the time they were infected. There was nothing to indicate that drainage, and sanitary arrangements generally, were connected with the prevalence of the disease. The chief factor undoubtedly appeared to be personal infection. Below are set out brief particulars as to the age and sex of the patients, the dates of invasion and notification, the sanitary condition of the dwellings and the probable source of infection. The list includes 8 cases which were not certified. It will be noted that other uncertified cases are referred to iu the remarks as to the probable source of infection. The cases certified but subsequently not regarded as enteric fever have not been included : No. of case. Patients initials. Sex. Age. Address. Probable date of invasion. Date of Certification. Sanitary condition of dwelling. Probable source of infection—Remarks. 1 E.G. F. 8 77, Mansfield Street Jan. 17 Jan. 27 Satisfactory *2 A.P. F. 21 6, Ware Street Jan. 7 Jan. 31 Unsatisfactory 3 F.A. F. 18 43, Grange Street Feb. 12 Feb. 24 Satisfactory 4 A.P. M. 18 102, Clifton Street Mar. 11 Mar. 23 Satisfactory Not infected in Shoreditch. 5 A.P. M. 28 49, Paul Street Mar 10 April 3 Satisfactory 6 F.C.Tl. F. 13 25, Norris Street April 3 April 8 Satisfactory *7 - .T. F. 20 2. Nancy Street Feb. 10 Not certified Unsatisfactory Case 2. *8 S.C. F. 18 2, Nancy Street Feb. 20 Not certified Unsatisfactory Case 7 but possibly case 2. *9 E.C. M. 30 2, Nancy Street Mar. 1 April 10 Unsatisfactory Cases 7 or 8. *10 B.C. M. 17 2, Nancy Street Mar. 20 April 11 Unsatisfactory Case 9. 11 O.T. M. 10 20, Fairbank Street May 2 May 14 Satisfactory *12 EB. F. 6 4, Nancy Street May 7 May 18 Satisfactory Cases 7 to 10 through an unrecognised case. *13 A.D. F. 11 28, Ware Street May 24 June 3 Fair Cases 7 to 10 through an unrecognised case. *14 B.H. M. 4 75, Wilmer Gardens May 10 June 4 Fair Cases 7 to 10 through an unrecognised case. *15 F.C. F. 22 4, Ware Street April 24 June 20 Fair 1 Cases 9 or 10. F.C. is a relative and visited them in hospital. *16 L.A.W. F. 4 39, Ware Street June 15 June 24 Fair Case 13. *17 S.N. F. 20 4, JEutley Place June 12 July 3 Unsatisfactory Cases 7 to 10 through an unrecognised case S N. is a relative. *18 M.H. F. 28 75, Wilmer Gardens June 20 July 6 Fair Case 14. M.H. was his mother and nursed him before removal to hospital. *19 P.P. F. 6 4, Nancy Street June 27 July 7 Satisfactory Cases 7 to 10 through an unrecognised case. Possibly case 12. *20 A.W. F. 5 1, Nancy Street June 20 Not certified Fair Same source of infection as case 19—the children were playmates. *21 E.P. F. 26 11, Louisa Street.. July 1 July 10 Unsatisfactory Cases 7 to 10 through an infected family in Islington. 22 C.M. M. 19 26 Holms Street July 1 July 18 Satisfactory Not infected in Shoreditch. 21 No of case. Patient's initials. Sex. Age. Address. Probable date of invasion. Date of Certification. Sanitary condition of dwelling. Probable source of infection. Remarks. *23 A.E.C, M. 14 32, Watson's Place July 7 July 21 Unsatisfactory Cases 7 to 10 through an infected family in Islington. These boys are cousins and shared the same bed. Possibly case 24 infected case 23. *24 H. J.L. M. 13 32, Watson's Place June 28 July 21 Unsatisfactory *25 A.W. M. 15 237, Ivingsland Eoad July 16 July 24 Fair The mother of this patient was ill from the middle of May to the middle of July. She had typhoid fever and her case was connected with previous cases in Ware Street and Nancy Street. She probably infected her son. *26 —.W. F. 25 1, Nancy Street J ulv 13 Jufy 25 Fair This patient was mother to case 20 and slept in the same bed with her when she was ill *27 A.C. F. 36 32, Watson's Place July 20 July 27 Unsatisfactory Case 23. A.C. is his mother and nursed, him for a time. *28 E.P. F. 4 6, Watson's Place June 22 Not certified Fair Cases 7 to 10 through an unrecognised case, *29 W.H.P M. 28 6, Watson's Place July 7 Aug. 6 Fair Case 28. W.H.P. was her father. *30 M.A.P. P. 2½ 6, Watson's Place July 1 Aug. 6 Fair Case 28. Sister to case 28. *31 M.A.S. P. 54 6, Watson's Place July 16 Aug. 8 Fair Cases 29 or 30. M.A.S. is aunt to cases 28 and 29. *32 J.D. M. 16 22, Wilmer Gardens July 24 Aug. 8 Unsatisfactory Nothing definite to show connection with previous cases. *33 K.P. F. 35 49, Grange Street July 3 Aug. 9 Fair Case 33 is mother to cases 34-37, and probably infected them. Nothing definite to show how case 33 contracted the disease. She was, however, in the habit of shopping in Hoxton Street in the neighbourhood of Wilmer Gardens, from stalls. *34 M.P. F. 14 49, Giange Street Aug. 3 Aug. 9 Fair *35 A.P. M. 1 49, Grange Street Aug. 3 Aug. 10 Fair *36 A.P. M. 9 49, Grange Street Aug. 2 Aug. 10 Fair *37 W.P. M. 11 49, Grange Street Aug. 2 Aug. 10 Fair *38 C.M. M. 2 237, Ivingsland Eoad June 15 Aug. 15 Fair Same source of infection as case 25. *39 J.M. F. 28 237, Kingslmd Eoad July 20 Aug. 15 Fair Case 38, who was brother to these patients. Case 39 did washing for the family, to which case 25 belonged. *40 A.M. F. 6 237, Kingslrind Eoad July 27 Aug. 15 Fair *41 F.M. F. 8 237, Kingsland Eoad June 15 Not certified Fair Same source of infection as case 25. *42 E.W. F. 44 58, Wilmer Gardens July 16 Aug. 15 Unsatisfactory Nothing definite to show connection with previous cases. 43 A.E. M. 29 42, Hai-man Street July 20 Aug. 19 Fair *44 G.R. F. 29 51, Wilmer Gardens Aug. 10 Aug. 26 Fair Nothing definite to show connection with previous cases. *45 A.J. F. 21 Shoreditch Infirmary Aug. 14 Aug. 27 Satisfactory Maid in Nursing home at Shoreditch infirmary, where some of the cases were treated. Case possibly connected with the cases in Nancy Street. *46 P.P. M. 16 94, Wilmer Gardens Aug. 15 Sept. 1 Fair Was a friend of case 32, and was possibly infected by him. *47 J.S. M. 24 17, Herbert Street Aug. 19 Sept. 2 Satisfactory Nothing d^nite to connect with previous cases. Patient at the time he was infected was a potman in a public house close to the infected neighbourhood. *48 H.P. F. 26 58, Wilmer Gardens July 20 Sept. 15 Unsatisfactory Nothing definite to connect with previous cases. *49 W.P. M. 47 94, Wilmer Gardens Sept. 4 Sept. 17 Fair Case 46, who was son to this patient. *50 A.W. M. 30 3, Eeeves Place Sept. 7 Sept. 19 Fair Possibly connected with previous cases in Nancy Street. A baby belonging to case 50 was kept during the daytime at a house in Nancy Street. 51 A.C. M. 16 86, Crondall Street Sept. 14 Sept. 22 Unsatisfactory *52 E:P. F. 10 58, Wilmer Gardens Sept. 10 Sept. 24 Unsatisfactory Case 48, who is her mother. *53 A.J. F. 10 63, Wilmer Gardens Sept. 21 Sept. 30 Played with children from 94 and 58, Wilmer Gardens (cases 46, 48, and 49). *54 A.A.S. F. 11 50, Pearson Street Sept. 20 Oct. 1 Satisfactory Nothing definite to connect with previous cases. Her mother sometimes took her marketing in Hoxton Street, close to infected neighbourhood. 55 G.L M. 23 11, Drysdaie Place Sept. 20 Oct. 3 Fair 56 A.J.W. F. 19 22, Bristow Street Sept. 23 Oct. 5 Fair 57 H.W. M. 3S 8, Britannia Dwellings Sept. 4 Oct. 6 Satisfactory *58 S.W. F. 25 3, Eeeves Place Sept. 21 Oct. 6 Fair Case 50, who is her husband. *59 N.E. F. 13 2, Shaftesbury Street Sept. 1 Oct. 6 Satisfactory Nothing definite to connect with previous cases, but was employed in infected neighbourhood at time of infection. *60 L.H. F. 9 17, Shaftesbury Street Sept. 25 Oct. 10 Satisfactory Possibly case 59, but nothing definite was obtained. 61 J.G. M. 37 51, Provost Street Sept. 16 Oct. 10 Satisfactory *62 M.N. F. 28 Shoreditch Infirmary Oct. 11 Oct. 20 Satisfactory Nurse in ward where cases 29 and 47 were treated. 22 23 No. of case. Patient's initials. Sex Age. Address. Probable date of invasion. Date of Certification. Sanitary condition of dwelling. Probable source of infection. Remarks. 63 E.M.A.I. F. 47 23, Buttesland Street Oct. 9 Oct. 21 Satisfactory *64 G.S. M. 12 85, Wilmer Gardens Oct. 2 Oct. 21 Satisfactory Was a playmate of children from infected houses. 65 E.F. F. 17 49, Haberdasher Street Oct. 13 Oct. 22 Satisfactory 66 J.E.B. F. 16| 23, Wimbourne Street Oct. 1 Oct. 22 Sati sfactory *67 A.M. M. 17 14, Louisa Street Aug. 30 Not certified. Fair Previous cases in neighbourhood, but nothing definite to connect. *68 A.M. M. 43 14, Louisa Street Oct. 6 Oct. 26 Fair- Case 67. who was his son. He nursed his son during his illness; no medical man was called in. *69 L.H.S. F. 5 50, Pearson Street Oct,. 17 Oct. 26 Satisfactory Case 54, who was her sister. *70 E.W. M. 23 30, Ware Street Sept. 7 Not certified. Satisfactory Previous cases in the neighbourhood, but nothing definite to show connection. *71 J.W. M. l-A 30, Ware Street Oct. 1 Not certified. Satisfactory Case 70. *72 J.W. F. 23 30, Ware Street Oct. 6 Oct. 29 Satisfactory 73 F.B. M. 16 18, Bristow Street Oct. 28 Nov. 12 Satisfactory Possibly connected with Case 56. *74 C.M. F. 4 14, Louisa Street.. Oct. 22 Nov. 13 Fair Case 68, her father, possibly Case 67, her brother. 75 E.D. F. 29 13, Stratford Place Nov. 12 Nov. 25 Fair 76 G.D. M. 12 13, Stratford Place Nov. 20 Nov. 2b Fair Possibly case 75. *77 E.L. M. 7 31, Ware Street Nov. 18 Nov. 26 Fair Case 71. Eelatives of Cases 70-72. 78 M.O. F. 11 120, Britannia Street Oct. 16 Nov. 26 Fair 79 EE. F. 27 120, Britannia Street Nov. 13 Nov. 27 Fair Case 78. *60 A.L. F. 15 31, Ware Street Nov. 12 Nov. 27 Fair Case 71. Eelatives of Cases 70-72. *81 J.C. M. 10 29, Ware Street Nov. 15 Nov. 29 Fair *82 H.M. M. 14 206, Hoxton Street Nov. 17 Nov. 29 U nsatisf actory Nothing definite to connect with previous cases iu the neighbourhood. *83 C.L. F. 20 31, Ware Street .. Nov. 20 Nov. 30 Fair Case VI. Eelatives of Cases 70-72. 84 L.Q. F. 35 10, Henson House Nov. 10 Nov. 30 Fair *85 L.M. F. 4 4, Watson's Place Nov. 23 Dec. 2 Fair Case 81. During the daytime L.M. was kept at No. 29, Ware Street. Possibly casft 93. *86 S.E. F. 8 4, Watson's Place Nov. 23 Dec. 2 Fair Case 93. 87 J.W. M. 20 30, Hyde Eoad Nov. 19 Dec. 3 Fair *88 G.H. M. 20 73, Phillip Street.. Nov. 10 Dec. 3 Fair Nothing definite to connect with previous cases but the mother of this patient resided in Wilmer Gardens and knew several of the families in which cases occurred. She left Wilmer Gardens on Oct. 12th. *89 D.S. F. 12 9, Louisa Street Nov. 16 Dec. 4 Unsatisfactory Nothing definite to connect with previous cases. Case 74. *90 J.H. M. 18 14, Louisa Street Nov. 14 Dec. 5 Fair *91 A.E. F. 6 9, Louisa Street Nov. 13 Dec. 7 Unsatisfactory Nothing definite to connect with previous cases. *92 C.H. M. 11 55, Wilmer Gardens Nov. 15 Dec. 8 Fair Nothing definite to connect with previous cases, but the mother of this patient knew several of the families in which cases occurred. *93 F.F. M. 25 5, Watson's Place Nov. 8 Dec. 9 Fair Nothing definite to connect with previous cases. *94 J.L. M. 24 31, Ware Street Nov. 26 Dec. 9 Fair Vide cases 77 and 80-81. 95 MC. F. 37 5, Great Chart Street Dec. 11 Satisfactory Tliis patient was removed with Scarlatina on November 25th. *96 J.L. M. 19 31, Ware Street . Nov. 23 Dec. 14 Fair See note to cases 77 and 80-81. *97 G.H.H. M. 22 16, Ware Street Dec. 8 Dec. 15 Fair Probably connected with cases 94 and 96. Friends of the infected family were living in this house. 98 Y.E.B. F. 8 55, Harman Street Dec. 5 Dec. 16 Fair 99 J.Y. F. 28 22, Harvey Street Dec. 4 Dec. 19 Unsatisfactory D.Y., age 5, daughter of J.Y., was ill for a month before her mother, J.Y., was taken ill, the history was that of enteric fever, her case was not certified. *100 J.W. F. 7 10, Hertford Street Dec. 16 Dec. 24 Unsatisfactory Probably connected with cases in Ware Street. A Mis. S., oi No. 11, Ware Street, visited No. 10, Hertford Street about December 1st. Mrs. S. knew several of the infected families. 101 H.Y. M. 28 22, Harvey Street Dec. 18 Dec. 28 Unsatisfactory | Case 99, who was wife to case 101. 102 A.Y. M. 22 22, Harvey Street Dec. 18 Dec. 28 Unsatisfactory *103 L.M. F. 9 245, Kingsland Eoad Dec. 18 Dec. 28 Satisfactory This patient was a playmate of case 86. 24 25 In the above list the cases believed to have been connected are indicated by an asterisk. Towards the end of December, the neighbourhood of Ware Street and Watson's Place was free from the disease, but families in HertfordStreet, and elsewhere in the Borough, became infected. Cases belonging to the series continued during the early part of the current year and did not cease until well on in April. One of the last to contract the disease was a Nurse in the Shoreditch Infirmary, who was infected whilst nursing another Nurse who probably took the disease whilst nursing cases 101 and 102. 26 The following is a note as to the way in which the disease became prevalent in the Ware Street neighbourhood:— Amelia P-, aged 21, of No. (J, Ware Street, employed at a paper-box factory in Pear Tree Street, Finsbury, began to ail about the beginning of January. She became unable to work on January 14, and was certified and removed to hospital on January 31. Mrs. T-, aged 20, married, of No. 2, Nancy Street, was ill from about February 10 until the end of March ; her case was not certified, but the history leaves little doubt that it was one of enteric fever. Sarah C-, aged 18, of No. 2, Nancy Street, sister to Mrs. T-, was ailing from about February 20. She went into the Shoreditch Infirmary on March 11, and left that institution on April 8. Widal's test was negative, but there is no doubt that this case was one of enteric fever. Edward C-, aged 30, of No. 2, Nancy Street, a wood and coal seller at a store kept by the C- family, at No. 40, Ware Street, nearly opposite No. 6, was ailing from about March 1, admitted to the Shoreditch Infirmary on April 2, and certified to have enteric fever on April 10. Richard C-, aged 17, of No. 2, Nancy Street, a glass blower, unemployed, was ailing from March 20, and was certified to have enteric fever on April 11, and was removed to the Shoreditch Infirmary. Florence C-, aged 22, of No. 4, Ware Street, sister-in-law to the above patients, was taken ill about April 24, admitted to St. Bartholomew's Hospital on May 19, and certified to have enteric fever on June 20. This person visited the C- family at No. 2, Nancy Street, and also visited Edward and Richard C-, whilst they were lying ill in the infirmary. Nos. 4 and 6, Ware Street, are next door, and No. 2, Nancy Street, is about forty yards away. No. 4, Ware Street was in a fair sanitary condition, the other two houses were dirty. There was nothing amiss with the drains. The C- family appeared to be well known, their wood and coal store being patronised by people in Ware Street, Watson's Place, Louisa Street, and Nancy Street. Mrs. C-, the mother of the family, also appeared to have a large connection of friends and acquaintances amongst her neighbours. Her husband di^d from the effects of a fall on March 20. He sold shellfish from a stall at the corner of Nancy Street. The stall was not kept on after his death. Amelia P- knew the C-s. The information obtained was somewhat contradictory as to the extent of the intimacy, but I believe she was the source of infection, so far as the C family were concerned. From about February 10 until April 10, a period of two months, infection was in the family at No. 2, Nancy Street, before the first case was certifie'd. The first two cases in the family were, without doubt, enteric fever, and the two 27 cases which were subsequently certified were cases secondary to them. There were several children belonging to the family in the house, and although no positive evidence was forthcoming it is not improbable that one or more mild unrecognized cases occurred amongst them. The fact that infection was in the house for such a long period before the nature of the disease was recognized exercised an important influence in spreading infection in the neighbourhood during the early part of the year. The following cases are worth noting:— On May 14th a Mr. and Mrs. R- with their three children, one of whom was a baby about nine months old, removed from No. 31, Watson's Place, which is within a few yards of No. 2, Nancy Street, to No. 62, Queensbury Street, Islington. Two of the R- children appear to have been playmates of some of the children from No. 2, Nancy Street. On May 28th one of the R- children was noticed ill, and on June 3rd and 7th respectively another child and the mother sickened. They were all removed to St. Bartholomew's Hospital on June 10th, and were certified to have enteric fever on June 15th. Elizabeth P-, aged 26, married, of No. 11, Louisa Street, visited the R- family when they were ill, and also when they were removed to hospital she washed clothing belonging to the family. Mrs. P-'s husband was a brother of Mrs. R-. About July 1st Mrs. P- began to ail and was certified to be suffering from enteric fever on July 10th. When Mrs. R-was removed to hospital her baby was brought to No. 32, Watsons Place to be taken care of by a Mrs. C- (not the same name as that of the family at No. 2, Nancy Street) whilst its mother was in hospital. The following cases then occurred at No. 32, Watson's Place:—Henry J. L-, aged 13£ began to ail about June 25th, was admitted to the Metropolitan Hospital on July 25th and certified to have enteric fever on July 21st; Alfred E. C-, aged 14, cousin to above-mentioned patient, and shared the same bed, was ailing from about July 6th, admitted to the Metropolitan Hospital on July 15th and certified to have enteric fever on July 21st; Ann C-, aged 36, mother of the above patient, was ailing from about July 20th, and certified to be suffering from enteric fever on July 27th. That these cases were infected through Mrs. R-'s baby appears highly probable. When seen on July 28th, although the infant was stated to be well and to be putting on flesh, it looked pallid and thin, and there was a history of wasting with feverishness and diarrhoea lasting over a month. I have little doubt that this infant had enteric fever, and was the source of infection in the house. Ann C- may have been directly infected from her son or nephew. The following cases may be mentioned as also affording evidence of a young child being a source of infection:— 28 Robert W-, aged 23, of No. 30, Ware Street, was taken ill with what was believed to be an attack of influenza and bronchitis about September 7th; he was ill for nearly 8 weeks and confined to his bed for five; he had diarrhoea and lost a good deal of flesh. He was getting about again at the end of October. He was nursed by his wife Julia W-, aged 23. She began to ail about October Gth, and was certified to have enteric fever on October 29th and removed to hospital. About October 1st, John W-, aged 1 year and 4 months, was taken ill. He had attacks of diarrhoea and feverishness and lost flesh. He seems to have been ailing for about a month. On the removal of his mother to hospital he was taken care of during the day time at No. 29, Ware Street, by a family named C—, and at night he was looked after at No. 31, by a family named L—, these two families being relatives of the W—'s. As shown in the list one case subsequently developed in the C— family at No. 29, and five cases in the L— family at No. 31, Ware Street. I think an infant or young child with unrecognised enteric fever, owing to contamination of clothing, bedding, etc., with excreta, must be regarded as a very potential source of infection. Although there was nothing to indicate that infected food or drink was a common cause in connection with the prevalence of the disease I have not much doubt that contamination of the food in a household may have been frequently the means by which infection was conveyed. Take for instance cases 33 to 37 on the list: here we have a mother ill with enteric fever for nearly a month and looking after her domestic affairs, preparing food and handling the loaf from which she cuts the bread for her children. It is impossible to gainsay the risk run by a family under such circumstances. Another instance where a person suffering from the disease handled food, was case 18 on the list. This person was selling fruit from a barrow in the street for aBout 10 days whilst she was suffering from enteric fever which she contracted through nursing her child. Here was undoubtedly risk to the public, but I was not able to trace any cases to this source. The main characteristics of the cases during the year were infectivity above and severity somewhat below the average. Early during the prevalence it became apparent that unrecognised cases would have to be traced, and the enquiries made resulted in a number being brought to light, some of which might have escaped recognition altogether, whilst others would certainly have dragged on for several days longer before medical advice was sought. Notwithstanding the efforts made, however, cases did escape recognition and without doubt played their part in the chain of infection. As a matter of fact it came to my knowledge towards the end of the year that there had been three cases of illness in a house in Ware Street during the months of June and July. The history obtained leaves no doubt in my mind as to the illness having been 29 enteric fever. Two of these children who were ailing for about a month were undoubtedly in contact with other children in the neighbouring houses whilst they were ill, for they were not confined to bed and used to sit on the front door steps. It may be mentioned that our enquiries were hampered, especially during the early stages of the prevalence, by reticence on the part of the patient's friends as to the information they were willing to give about the cases. In a number of instances poverty, with its attendant evils, a lack of proper attention to domestic cleanliness, and want of sufficient accommodation in the dwellings, undoubtedly helped to spread infection in households. There is, however, always some risk of secondary cases, even when patients are treated under the best of conditions. In connection with these cases this is exemplified by the fact that a nursing sister in one hospital, a nurse in another, and two nurses and a maid in the Shoreditch Infirmary, in which institution some of the patients were treated contracted the disease. Moreover it may be mentioned that one of the disinfecting officers of the Borough also took the disease and unfortunately died. If persons trained in nursing, who are aware of the risks of infection, who are dealing with patients under the best conditions possible nevertheless do acquire enteric fever from their patients, how much more liable to take infection are those who have to look after cases in the homes of the poor, where proper accommodation is lacking, where the conditions as to ventilation and cleanliness are most unfavourable, where there is ignorance as to nursing, and a want of knowledge as to the patient suffering from an infectious complaint ? There can be no doubt as to the answer. In connection with this it is to be noted that cases of enteric fever are not usually certified much under a fortnight from the commencement of the illness. It is highly probable that infection is frequently spread during this period. It may be mentioned with regard to the results of Widal's test that in several of the cases, negative results were obtained where clinically the cases were clearly enteric fever. On the other hand, in one or two instances in which the illness was not marked, instantaneous positive results were obtained. Cases 23 and 24 on the list may be instanced : the former was typically enteric fever but Widal was negative ; in the latter case there were no signs of the disease beyond slight continued pyrexia, the patient being bright and cheerful, yet Widal's test was positive at once. Case 48 may also be referred to. The patient in this case was ill from the end of July until the end of October; there was a relapse but the temperature was never very high. Widal's tests were made on September 9th, 14th and 21st, with negative results; on October 4th a positive result was obtained but only in high concentrations of serum. A further test made on November 17th, when the patient was convalescent, gave a positive result. A daughter of this patient, who was 30 taken ill about September 10th, gave negative results with the test on September 14th and 21st, positive with strong concentrations of serum on September 27th, and positive but slow on November 10th when she was convalescent. It is also worthy of note that a case which was certified to be enteric fever, and which closely resembled one of that disease, and gave a positive resuli with Widal's test, was found after death to have been one of tuberculous meningitis. The cases of enteric fever certified in the Metropolis numbered 1,350, as compared with 1,396 for 1907 and 1,608 for 1906. The attack-rate was somewhat under 0.3 per 1,000 inhabitants. The deaths numbered 225, as compared with 194 in 1907, the death-rate being 0.04 per 1,000 inhabitants. ERYSIPELAS. The cases certified as erysipelas numbered 124, as compared with 133 in 1907, 144 in 1906, 138 in 1905, 183 in .1904, 147 in 1903, and 172 in 1902. They were fewer than in any year since notification was made compulsory. The deaths numbered 5„ as compared with 6 in 1907, 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 were below the average for the last 15 years. The cases and deaths amongst males and females in the Borough and its eigRt wards were distributed as set out below: — Ward. ERYSIPELAS. Cases Certified. Fatal. Cases. Male. Female. Total. Male. Female. Total. Moorfields o o 7 10 1 .. 1 Church 4 14 18 .. .. .. Hoxton 5 6 11 .. 1 1 Wenlock 7 14 21 2 .. 2 Whitmore 5 24 29 .. 1 1 Kingsland 6 7 13 .. .. .. Haggerston 8 4 12 .. .. .. Acton 6 4 10 .. .. .. Total for Borough 44 80 124 3 2 5 The death-rate was 0.04 per 1,000 inhabitants, as compared with 0.05 in 1907, 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 4.0 per cent, of the cases certified, as compared with 4.5 per cent, in 1907, 1.3 per cent, in 31 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. Pyaemia and Septicemia (blood-poisoning) were given as the cause of death in 19 instances, 9 of males and 10 of females. Infective endocarditis caused the deaths of 3 males and 1 female. There was one death attributed to another septic disease allied to the foregoing. PUERPERAL FEVER. Five cases were certified, two of which proved fatal. The attacks per 1,000 births were at the rate of 1.3, as compared with 0.8 in 1907, 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 0.5, as compared with 0.2 in 1907, 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. DIARRHCEA The deaths from diarrhoea numbered 112, not including 36 attributed to enteritis, chiefly of infants under one year, as compared with 74 in 1907 and 194 in 1906. The deaths were distributed during the year as follows:—In January 2, February 1, March 2, April 1, May 2, June 2, July 7, August 34, September 48, October 10, November 3, and December 1. As is usually the case August and September were the months when the disease was most active and fatal. Of the deaths from diarrhoea during 1908, 86 were of infants under one year and 23 were of children aged between one and five years. The remainder were of persons over fifty-five years of age. The death-rate was 0.82 per 1,000, as compared with 0.64 in 1907 and 1.68 in 1906. The mortality from diarrhoea amongst infants under one year in Shoreditch during 1908 was at the rate of 23.3 per 1,000 births registered during the year, as compared with 15.3 for 1907, 40.3 for 1906 and 30.6 for 1905. The figures for the Metropolis were 14.4, 9.2, 27.3 and 20.7 respectively for the four years. A table giving a comparison of these rates for previous years is contained in the report for the year 1905. In nearly all of those investigated the deaths of young infants were of those being brought up otherwise than at the breast, and condensed milk was largely used in their feeding. The deaths from diarrhoea in the Metropolis in 1908 numbered 2,592, as compared with 1,563 in 1907 and 4,507 in 1906. The deaths were most numerous during August and September. The death-rate from diarrhoea for the Metropolis was 0.54 per 1,000 population, as compared with 0.32 in 1907, 0 93 in 1906, 0.72 in 1905, 1.07 in 1904, 0.64 in 1903 and 0.53 in 1902. 32 MEASLES. Deaths from measles were most numerous during the months of March, April and May,, but the disease was much less prevalent than in 1907. The deaths numbered 51, of which 50 were children under 5 years of age, and one was of a child aged between five and ten years; 31 of the-children who died were males and 20 females. The mortality was proportionately highest in Haggerston and lowest in Moorfields Wards, being 0.71 and 0.18 per 1,000 respectively. The death-rate for the Borough due to measles was 0.44 per 1,000 population as compared with 0.99 in 1907, 0.(54 in 190G, 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 be low the average of recent years, and is the lowest recorded during the past 20 years. The deaths from measles in the Metropolis numbered 1,524, as compared with 1,801 in 1907, 1,909 in 190G and 1,715 in 1905; the death-rate being 0.31 per 1,000, as against 0.38 in 1907, 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 311, as compared with 674 in 1907, 449 in 190G, 470 in 1905 and 454 in 1904. These houses were mostly brought to our notice by the School Authorities. On enquiry during the year in 85 instances it appeared that the illness was not measles. Disinfection was carried out in connection with 228 rooms by the officers of the Sanitary Authority, and the usual steps were taken as regards bedding and textile articles. In three instances the measures as to disinfection were carried out by the occupiers of the infected premises to the satisfaction of the medical practitioners attending on the cases. WHOOPING COUGH. This disease caused 21 deaths, 3 of males and 18 of females, all of whom were under five years of age. The death-rate was only 0.18 per 1,000 inhabitants, as compared with 0.86 in 1907, 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 death-rate due to whooping cough for 1908 is the lowest recorded for fifty yea is. A comparison of the death-rates in the eight wards of the Borough is given in Table VII. (Appendix). There were no deaths in Moorfields Ward. The rate was highest in Hoxton Ward. No deaths from whooping cough were registered during January, March, May and July. 33 The deaths from whooping cough in the Metropolis numbered 984, as compared with 1,786 in 1907, 1,226 in 1906 and 1,507 in 1905 ; the deathrate being 0.20, as against 0.37 in 1907, 0.26 in 1906 and 0.32 in 1905. INFLUENZA. Influenza was given as the cause of 22 deaths, as compared with 23 in 1907, 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 February and March when 15 deaths occurred. No deaths from influenza were registered during July, August, October and December. The deaths attributed to influenza in the Metropolis numbered 1,334, as compared with 967 in 1907, 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 February and March and least so in August and September. TUBERCULOSIS. Tuberculosis (Appendix Table V., Nos. 29 to 34 inclusive) was given as causing 311 deaths, as compared with 327 in 1907, 347 in 1906, 321 in 1905, 365 in 1904, 37B in 1903, 295 in 1902, 363 in 1901, and 343 in 1900. The number was therefore below the average for recent years. The deaths from tuberculosis amounted to 15.5 per cent, of the total number of deaths from all causes during the year, as compared with 14 per cent, in 1907 and 15 per cent, in 1906. The death-rate was 2.7 per 1,000 population, as compared with 2.8 in (1907, 3.0 in 1906, 2.7 in 1905, and 3.1 in 19041 The rate was lowest in Hagggerston Ward and highest in Whitmore, being 1.9 and 3.5 per 1,000 respectively. Tuberculosis of the lungs, or phthisis, or consumption as it is commonly called, resulted in 224 deaths, as compared with 232 in 1907 and 233 in 1906. Of these 140 were of males and 84 of females. The great majority of these deaths were of persons in the wageearning period of life. The death-rate from consumption was 1.9 per 1,000 inhabitants, being highest in Hoxton, where it amounted to 2.6, and lowest in Haggerston where it was 1.1 per 1,000 population. Dicing the year measures as to disinfection were taken in connection with 71 houses in which cases of phthisis occurred. The deaths from tuberculosis in the Metropolis numbered 9,176 giving a death-rate of 1.9 per 1,000 inhabitans. Of these some 6,647 were attributed to consumption, the death-rate being 1.32 per 1,000 inhabitants. Comparing these figures with those of Shoreditch it will be seen how much higher proportionately the mortality from tuberculosis is in this Borough. 34 CEREBRO SPINAL FEVER Six cases were certified with five deaths. Four of these cases were in infants under 12 months, one patient was 2 years and the other six years of age. In three of the cases there was positive evidence as to the presence of the micro-organism of the disease, in two the evidence was doubtful, and in one the micro-organism was not found. Inquiries were made as to two deaths from meningitis. One was due to the micro-organism of pneumonia and the other was stated by the medical practioner attending the case not to have been cerebro spinal fever. The cases certified as cerebro spinal fever in the Metropolis numbered 85, and 12 deaths were attributed to this disease. ANTHRAX A case of anthrax came under my notice during the year in the person of the wife of a caretaker employed at a horse hair factory. Drawn hair is manufactured, the work being in tail hair, which is obtained practically from all parts of the world, but more especially from Russia, Siberia, South America, and China. Most of it comes from Siberia. The patient first noticed a pimple on her neck about April 20th ; it was thought to be a boil up to the 26th, when she was beginning to feel ill and went to the London Hospital. It was then recognised to be malignant pustule, the seat of innoculation of the micro-organism of anthrax, and the patient was admitted and operated on at once. She made a good recovery. The patient was not employed in working with horse hair, but she cleaned the offices and did washing and doubtless washed the blouses used by her employer in the business, and also washed her husband's clothing. GLANDERS. In accordance with Article 2 of the London (Notification of Glanders) Order, 1907, some 21 intimations were received from the Veterinary Inspector of the London County Council as to the existence of glanders amongst horses on premises within the Borough. The necessary steps in connection with the cases, and the cleansing and disinfection of the infected premises were carried out by the officers of the London County Council. Enquiries were made by the officers of the Borough Council in each instance, but no evidence was obtained as to the existence of any case of human glanders CHOLERA. In connection with the occurrence of cholera in Russia intimations were received from the Port of London Sanitary Authority as to the arrival of six persons from Russia who were proceeding to addresses in Shoreditch. One intimation was also received from the Hull and Goole Port Sanitary 35 Authority as to a person from a ship upon which a case of cholera occurred, who was proceeding to this Borough. In all cases the usual enquiries were made. 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. Arlington Square .. .. .. 1 2 .. .. .. 1 4 Bath Street .. .. .. 1 .. .. .. 1 1 3 Canal Road 1 .. 3 5 2 1 .. .. 4 11 Catherine Street, 1 .. .. 2 .. 2 .. .. .. 5 Central Street .. .. .. .. .. .. .. .. 1 1 Chatham Gardens .. .. .. .. 1 2 .. .. 24 28 Coleman Street Ward .. .. .. .. 5 .. .. 6 .. 11 Curtain Road .. .. 1 13 18 4 .. 26 27 89 Enfield Road .. .. 1 1 .. .. .. .. .. 2 Fellows Street .. .. .. 10 12 7 .. .. 5 34 Gopsall Street 2 .. 21 12 7 10 11 22 74 189 Haggerston Road .. .. 14 35 69 24 15 2 10 169 Hammon d Square 7 .. 7 26 46 27 41 13 48 215 Hanover Street .. .. 1 .. .. .. .. .. .. 1 Hoxton House .. .. .. 2 .. 2 5 .. .. 9 Maidstone Street 1 .. 9 62 62 10 16 15 72 247 Napier Street .. .. 34 74 49 28 6 9 44 244 Pritchards Road .. .. .. 2 .. .. .. .. .. 2 Queen's Road .. .. .. .. 6 .. .. 1 1 8 Redvers Street .. .. 3 12 2 3 3 11 33 67 St. John's Lane .. .. .. .. .. 5 .. .. .. 5 St. John's National .. .. .. 4 .. 3 .. .. .. 7 St. John's Road .. .. 3 53 9 7 15 10 15 112 St. Joseph's .. .. .. .. 1 .. .. .. .. 1 St. Monica's .. .. 3 7 .. .. .. .. .. 10 St. Mary's .. .. .. 1 .. .. .. .. .. 1 St. Paul's .. .. .. 1 21 2 6 15 6 54 St. Peter's .. .. .. 2 .. .. .. .. .. 2 Scawfell Street .. .. 8 46 63 28 21 21 59 251 Scrutton Street .. .. 4 11 3 5 .. 4 12 39 Shap Street .. .. 12 33 40 12 2 5 69 174 Shepperton Road .. .. 2 .. .. .. 6 .. 8 Trinity Place .. .. 1 1 21 3 7 1 30 64 Virginia Road .. .. 1 .. 2 2 1 .. 2 8 Wenlock Road .. .. 1 9 27 8 4 2 20 71 Total 18 .." 129 452 471 195 153 170 558 2146 c 2 36 The number of children excluded in 1907 was 3,399. The decrease during 1908 was due to the comparative fewness of the cases of measles, chickenpox, whooping cough and mumps. There was a considerable increase in the number of children away from school through enteric fever. The following schools came under my notice in connection with the prevalence of infectious disease amongst the scholars:— Fellows Street School.—Class-room B of the infants' department was closed by the Medical Officer (Education) on account of the prevalence of measles amongst the children The usual steps as to disinfection were taken by the Sanitary Authority. Shap Street School.—Class-room C of the infants' department was visited on account of the prevalence of measles but no action appeared necessary on the part of the Sanitary Authority Curtain Road School.—There was measles amongst the scholars in Class-room A of the infants' department, but it was not necessary to take any action; children who had not had measles were being excluded. Class-room E later in the year also came under notice in connection with the exclusion of some of the children on account of measles, but no action on the part of the sanitary authority was necessary. Scrutton Street School.—Class-room B of the boys' department was visited in connection wth the occurrence of certain cases of diphtheria in the neighbourhood of the school, but it was not necessary to take any special action as regards the scholars. BACTERIOLOGICAL EXAMINATIONS. During the year 65 bacteriological examinations were made by Dr. Bulloch at the London Hospital Medical School in cases of suspected infectious disease. In 26 the examinations were for diphtheria, with positive results in six instances. For tuberculosis of the lungs six examinations were made, and in one the tubercle bacillus was found. The remaining 33 were for enteric fever, with positive results in 14 instances. DISINFECTION. During 1908 disinfection was carried out at 1,208 premises, as compared with 1,688 in 1907. The articles removed and disinfected at the Borough disinfecting station numbered 22,0-56, as compared with 34,095 in 1907, 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 1,311 beds, 1,229 mattresses, 2,649 pillows, 971 bolsters, and 15,896 other articles, including sheets, blankets, clothing, carpets, curtains, and the like. In some instances infected beddingwas destroyed, and was replaced with new to the extent of 2 beds and 6½ mattresses. No complaints of a serious character were received in respect of the measures taken by the sanitary authority for disinfection. In one instance compensation was paid for damage to an article of dress. 37 THE SHELTER. The Shelter was not in use during the year under consideration. PUBLIC MORTUARY. During 1908 the dead bodies received in the public mortuary numbered 367, as compared with 349 in l907, 405 in 1906, 417 in 1905, and 460 in 1904. The bodies of 6 persons dead of infectious disease were removed to the mortuary by the sanitary authority, as compared with 3 in 1907, 5 in 1906, 3 in 1905, and 4 in 1904. The decrease in the number of bodies deposited in the mortuary during the past two years probably resulted mainly from the absence of prolonged hot weather during the summer months, though it is also necessary to take into account the decrease in the total number of deaths in the Borough during 1908. The inquests held numbered 302, as compared with 298 in 1907, 295 in 1906, 290 in 1905, and 336 in 1904. The post-mortem examinations in the post-mortem room at the mortuary numbered 208, as compared with 229 in 1907, 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 23.725 inches. Taking the mean rainfall for 35 years there was a deficiency of about 2 inches. The rainiest quarter of the year was the second, when 7.470 inches fell, the fall exceeding the average of the four quarters of the year by 1.5 inches. The wettest month was April, when 4.309 inches fell, and the dryest February, when the fall only amounted to 0.872 inches. In accordance with Section 49 of the Public Health (London) Act, 1891, communications were received from the Metropolitan Water Board as to water supplies being cut off in respect to 65 premises, as compared with 113 in 1907. Of these 19 were on the East London District, and 46 on that of the New River. In a number of the intimations the premises referred to had been vacated, in 19 water pipes were broken and leaky, in 6 instances there was waste, and in 6 instances the water was cut off on account of non-payment of the water rate. No complaints were received as to the quality of the water supplied in the Borough, either on the East London or on the New River District, and there was no reason for suspecting the occurrence of any water-borne disease. SANITARY WORK. Preliminary notices as to insanitary conditions were served in respect to 3,026 premises, of which 264 were dealt with under the supervision of the Chief Inspector, 534 under that of Inspector Lear, 569 under Inspector Firth, 594 Inspector Jordan, 492 Inspector Langstone, and 573 under the supe vision 38 of Inspector Pearson. In connection with the work arising out of these notices some 823 letters were sent to owners of property, builders, and others concerned. Some 29,076 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 milkshops, cowsheds, slaughter-houses, cookshops, and eating houses, factories, workshops, outworkers' premises, schools, 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. Lang- stone. Insp. Pearson. Total. New drains constructed .. 5 1 11 10 6 33 Drains re-constructed or repaired 56 40 75 31 53 87 342 Sink waste pipes trapped and disconnected .. 21 102 94 14 45 276 Stack pipes re-instated 2 53 121 25 48 80 339 Eaves gutters re-instated 35 71 104 23 32 81 346 Stack pipes disconnected from drains .. 6 42 49 1 2 100 Accumulations of sewage dealt with .. 14 .. 15 38 37 104 Cesspools abolished .. 2 2 .. 1 6 11 New water closets constructed 1 39 2 19 35 9 105 Old water closets re-constructed or repaired 41 4'2 119 94 74 96 466 Water closets cleansed and white-washed 39 296 79 173 89 189 856 Water closet flushing apparatus repaired 3 67 38 134 76 80 398 Obstructions in water closets removed 1 33 23 19 22 50 148 Overcrowding in houses abated .. 16 39 8 26 28 117 Damp courses in houses provided .. 1 15 2 4 1 23 Walls pointed 33 6 19 2 5 48 113 Roofs repaired 29 71 79 56 77 86 398 Stairs repaired 13 24 35 26 6 15 119 floors repaired 14 49 17 30 13 72 195 Ventilation under floors provided 16 .. 6 1 7 28 58 Doors repaired 9 15 1 21 10 8 64 Door cills provided 28 29 53 8 9 13 140 Sashes repaired 13 150 2 12 11 18 206 Houses cleansed throughout 100 37 24 52 22 24 259 Houses cleansed in part 71 125 278 36 75 201 786 Total number of rooms cleansed 385 718 727 603 597 607 3637 Yards or areas lime-washed 35 299 59 170 40 120 723 Yards paved.. 31 72 117 64 67 128 469 Areas of forecourts paved .. 24 14 3 12 22 75 New areas constructed .. 3 .. .. .. 8 11 Sculleries paved 15 1 42 4 7 13 82 Dust receptacles provided 39 64 96 56 69 93 417 Dung receptacles provided .. .. 5 3 2 4 14 Insanitary cisterns removed .. 2 3 .. •• •• 5 39 In connection with the works enumerated above 3 old brick drams were removed, and in 38 instances nuisances and annoyance through the presence of rats on premises were dealt with. In most cases the rats came from defective drains or sewers. In 132 instances water supplies were restored to premises, and on 139 premises leaky water pipes were repaired. Urinals were constructed or reconstructed in 7 instances, and 30 were cleansed and repaired. In one of these the measures taken were under the London County Council (General Powers) Act, 1904. Foul accumulations, causing, or likely to give rise to nuisance were dealt with on 99 premises. In 22 instances animals were found to be stabled so as to give rise to nuisance, and in 27 stables were paved or repaved, under the supervision of the sanitary officers. The foregoing summary includes the work carried out in dealing with matters under the Factory and Workshops Act, 1901, and also that done in connection with the drains of new buildings. Most of the work was done to comply with the requirements of preliminary notices. In 273 instances statutory notices under the Public Health (London) Act, 1891, were served, by order of 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 lor other breaches of the Public Health Act, and the by-laws made thereunder, Police Court proceedings were taken, as set out below : — Premises. Result of Proceedings. Alfred Terrace, No. 2 Order made, 4 guineas costs. „ „ No. 3 Summons withdrawn. Bridport Place, No. 69 Fined 20/-, costs 12/-. Boston Street, No. 52 No fine, costs 42/-. Drysdale Street, No. 25 Fined 18/-, costs 2/-. Pearson. Street, No. 19 Fined 5/-, costs 2/-. Shrubland Road, No. 69 Summons -withdrawn. Tyssen Street, No. 12 Fined 20/-, costs 2/-. Tyssen Street, (vacant premises) Order made, 2 guineas costs. Watson's Place, No. 30 Summons withdrawn 7/- costs. „ „ „ 31 „ „ 7/- „ „ „ 32 „ „ 7/- „ „ „ 33 „ „ 7/- „ „ „ 34 „ „ 7/- „ „ „ 35 „ „ 7/- „ The summonses in respect to the houses in Alfred Terrace were taken out by Inspector Firth against the owner for failure to comply with statutory notices to abate nuisances in connection with the premises. The roofs were 40 leaky, the water-closets were defective, and the houses were dirty, and more or less dilapidated. With respect to Nos. 19, Pearson Street, and 09, Bridport Place, the occupiers of milkshops at these premises were proceeded against for carrying on business without being duly registered as milk purveyors. The proceedings in respect to No. -32 Boston Street, were taken against a builder under the by-laws of the London County Council as to the execution of sanitary work. Summonses were taken out firstly for failure to give notice of intention to execute the work, and secondly for doing work in contravention of the requirements of the by-laws. With respect to Nos. 25, Drysdale Street, and 12, Tyssen Street, occupiers of these houses were proceeded against for selling rotten oranges in Hoxton. The cases are referred to later (vide Page 51). At No. 69, Shrubland Road, the drains were defective. A statutory notice was served upon the owner requiring their reconstruction, and a summons followed. The system, now taking the drainage of more than one premises, was claimed by the owner of the premises to be a sewer repairable by the Borough Council, but it was open to question whether, originally, the whole of the premises drained did not formerly belong to the same curtilage. In the end a compromise was effected, the matter being settled by the Council doing the work, the other party contributing a very substantial part of the costs, and the summons was withdrawn. The summonses as to the six houses in Watson's Place were for failure to comply with statutory notices on the owner requiring the abatement of nuisances through defects in the drains and sanitary arrangements, and general dilapidations. The work was, however, completed before the summonses came on for hearing, and it was agreed to withdraw them upon the owner paying costs. SMOKE NUISANCE Nuisances from the emission of black smoke were dealt with in 20 instances. Eleven communications were received from the London County Council relating to black smoke issuing on seven premises, and one from the Coal Smoke Abatement Society. In all cases the necessary steps were taken to obtain the abatement of the nuisances complained of, and no statutory notices were served by order of the Health Committee. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 127, as compared with 111 in 1907, and 103 in 41 1906. The rooms dealt with numbered 207; the walls were stripped, stopped, and thoroughly cleansed. In a few instances bedding and clothing were also dealt with, being- removed to the disinfecting station for disinfection. It was not necessary to take steps for enforcing the provisions of the London County Council (General Purposes) Act, 1904, which provides for sanitary authorities in London taking steps to free houses from vermin. HOUSES CLOSED. The following houses were closed upon the service of sanitary notices, either on account of their unfitness for habitation, or in order to enable the works necessary to put them in a satisfactory sanitary condition being carried out in a proper and efficient manner:— Bartlett's Buildings, Nos. 1, 2, 3, 4, 5, Nancy Street, No. 2, 6, 7. Louisa Street, No. 9. Harvey Street, No. 7. Red Lion Street, No. 4. Holywell Lane, No. 8. Talavera Place, No. 14. Holywell Place, No. 5. Wenlock Street, No. 36. Ivy Street, No. 39. White Cross Place, No. 5. The houses at Bartlett's Buildings each contained three rooms. The lower rooms were basements, with insufficient light, and the premises generally were dirty and dilapidated. Six of the houses were dealt with satisfactorily, but the seventh house was so constructed that it was impossible to provide adequate light and ventilation for the lower room. It was, therefore, closed permanently as a dwelling. The work carried out included general cleansing and repairs, and the provision of means for obtaining more light and air for the basements. The brickwork of the houses also needed a good deai of attention. The work was executed under the supervision of the Chief Inspector. The house in Harvey Street was in a dirty and dilapidated condition throughout, and was closed by the owner on receipt of a sanitary notice from Inspector Langstone. The houses in Holywell Lane and Holywell Place were in a dirty and dilapidated condition. That in Holywell Lane required a good deal of attention, and it was necessary to reconstruct a portion of the brickwork. It was vacated upon the service of a statutory notice. The other house was closed by the owner on receipt of a sanitary notice from Inspector Jordan. The house in Ivy Street was closed by the owner on receipt of a statutory notice, and the necessary work was carried out under the supervision of Inspector Langstone. 42 The house in Nancy Street was in a very dirty and dilapidated condition. It was closed by the owner on receipt of a statutory notice, and was subsequently dealt with under the supervision of Inspector Pearson, the premises being stripped, cleansed, and repaired throughout. The house in Louisa Street was dirty and dilapidated throughout, and was closed under statutory notice. The premises were subsequently stripped, cleansed, and repaired, under the supervision of Inspector Pearson. The house in Red Lion Street was in a very insanitary state. The roof was leaky, the ceiling of several of the rooms defective, and the drains, eaves, guttering and sanitary arrangements generally needed reconstruction. The premises were closed under sanitary notice, and dealt with under the supervision of Inspector Jordan. The front wall of this house was defective. It was condemned by the District Surveyor, and had to be reconstructed. No. 14, Talavera Place was closed under sanitary notice from Inspector Firth. This house was generally dirty and dilapidated, and the drainage arrangements were very defective. The house in Wenlock Street was in a very dirty and dilapidated condition throughout. It was closed by the owner, upon receipt of a sanitary notice from Inspector Lear. At No. 5, Whitecross Place, the drainage arrangements were in a very defective condition, and were dealt with under sanitary notice from Inspector Jordan. The house had to be closed for the work to be carried out in a speedy and efficient manner, which was impossible whilst it was in occupation. ARTIZANS' DWELLINGS. Under the above heading are included 48 blocks of dwellings in the Borough. Particulars in respect to them are given in previous reports. During the year two new blocks of buildings—David and Pesman buildings— were opened for occupation. Each of these blocks contained nine dwellings of three rooms each. The population was ascertained to be (iO. The construction and sanitary arrangements of these buildings are of a most satisfactory description. The Artizans' Dwellings were under observation during the year, and a good deal of sanitary work was carried out in connection with several of the blocks. Their general sanitary conditions may be stated to be very satisfactory. As in previous years, for purposes of comparison, they have been divided into two classes, according to the general characters of the populations resident in them : A class including those dwellings occupied by persons who, on 43 the whole, appeared in comfortable or fairly comfortable circumstances ; and B including those occupied by people apparently in very poor circumstances. Class A has been increased by the addition of the new blocks mentioned above. Class B includes the same dwellings as in previous years. The number of tenements, rooms, and persons in the dwellings estimated for the year 1908 are contained in the subjoined table : — Number of blocks. Number of tenements. Num ber of roi ms. Number of pirsons Class A 33 1532 3966 6070 Class B 15 383 917 1780 Total for the whole 48 1915 4883 7850 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. Class B. Number. Rate per 1,000 Inhabitants. Number. Rate per 1,000 Inhabitants. N umber. Rate per 1,003 Inhabitants. 233 29.6 186 30.6 47 26.4 The proportion of deaths attributed to prematurity was 4.3 per 1,000 births, as compared with 12 in 1907, 12 in 1906, and 27.5 in 1905. In class A the deaths from prematurity amounted to 5.4 per 1,000 births, whilst in class B they were nil. For the whole Borough the deaths from prematurity amounted to 16.6 per 1,000 births. The infantile mortality for the whole of the dwellings was 103 per 1,000 births, as compared with 124 in 1907, 97 in 1906, and 140 in 1905. For the class A dwellings it was 75, as compared with 99 in 1907, 84 in 1906, and 134 in 1905. For class B the mortality was 213, as compared with 207 in 1907, 133 in 1906, and 166 in 1905. 44 In the subjoined table are given the deaths and death-rates from certain causes for the dwellings and the corresponding death-rates for the whole Borough, so that they may be compared :— Cause of Death. The whole of the Dwellings. Class A. Class B. The Borough. Number of deaths. Rate per 1,000 inhabitants. Number of Deaths. Rate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants. Kate per 1,000 inhabitants. All causes 122 15.4 85 14.0 37 20.8 17.5 Principal Zymotic diseases 19 2.4 9 1.4 10 5.6 1.9 All forms of Tuberculosis 17 2.1 13 2.1 4 2.4 2.7 Phthisis 15 1.9 11 1.8 4 2.4 1.9 Bronchitis 9 1.1 6 0.6 3 1.7 1.4 Pneumonia 17 2.1 14 2.3 3 1.7 1.9 The deaths of residents of the dwellings in public institutions numbered 04, being 40 for the class A and 14 for the class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 44.2, being 47.0 for class A and 37.8 for class B. The percentages for previous years are contained in my last annual report. Those for the Borough and for ihe wards are contained in Table VII. (Appendix). The cases of notifiable infectious disease numbered 90, of which 78 were in the class A and 18 in the class B dwellings. The attack-rates per 1,000 population were respectively 12.2, 12.8, and J 0.1, as compared with 8.8 for the whole Borough. The cases included 56 of scarlet fever, 29 diphtheria, 2 enteric fever, and 9 erysipelas. 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 7.5 23 3.7 1 0.1 8 1.3 Class B 10 5.6 6 3.3 1 0.6 1 0.5 The whole of the dwellings 56 7.1 29 3.6 2 0.2 9 1.1 For the whole Borough the attack-rates were as follows: 5.1 for scarlet fever, 1.7 for diphtheria, 0.8 for enteric fever, and 1.0 for erysipelas. 45 The foregoing figures indicate that amongst the inhabitants of the Artizans' Dwellings in the Borough during 1908, the mortality from all causes, although higher than in 1907, was markedly lower than that of the Borough generally. The death-rate in the class A dwellings was not so low as for 1907, but it was considerably below that of the Borough. The class B dwellings show a decreased death-rate, as compared with that of 1907, but it was markedly higher than that of the Borough. The infantile mortality, taking the dwellings as a whole, was much below that of the Borough, but the difference in the infantile mortalities of the two classes of dwellings is very striking, that of class B being considerably above the average for the Borough. It is also to be noted that the birth-rate in these dwellings is considerably lower than that of the Borough. The incidence of attacks of notifiable infectious disease was considerably higher than in the Borough generally. The attack-rate was lower in the class B dwellings than in the class A 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: — Gifford Street, Nos. 2, 3, 4, 5, 8, 9, 11. Crooked Billet Yard, Nos. 2, 3, 4, 5, 0, 7, 8. The number placed upon the register during the year was 14, making a total of 328 since the by-laws came into operation. The number on the register at the end of the year was 286. These houses were under observation during the year, and some 345 visits of inspection were made, attention being more particularly directed to the houses registered in Dereham Place, Laburnam Street, Wellington Place, Barton Court, Bernale's Buildings, George's Square, Myrtle Street, Collingwood Street, Essex Street, Westmoreland Place, and Britannia Street. The houses registered in the last-named street—Nos. 113 to 121—received a good deal of attention at the hands of the Chief Inspector, and a marked improvement was effected in their sanitary condition. CUSTOMS AND INLAND REVENUE ACTS. No 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 during the year. 46 SLAUGHTER-HOUSES. The number of licensed slaughter-houses in the Borough at the end of the year was 7, as compared with 8 in 1907, 9 in 1906, and 12 in 1905. The license of the slaughter-house at No. 135, Hackney Road, was not renewed by the London County Council, the premises not having been used for slaughtering for over six months. The slaughter-house premises were inspected from time to time during the year. In one instance limewashing was required. Their general sanitary condition was satisfactory. COWHOUSES. The number of licensed cowhouses in the Borough at the end of 1908 was 7, remaining the same as for the past four years. The cowsheds afford accommodation for about 100 cows. The number kept in the Borough was found, at an inspection made shortly before the licensing session, in October, to be 52, as compared with 57 in 1907, 74 in 1906, 86 in 1905, 95 in 1 !7T)4, and 101 in 1903. The premises were periodically inspected during the year. Limewashing was required in one instance, and in another structural alterations were carried out for the general improvement of the premises for cowkeeping, and the drainage system was reconstructed. The general sanitary condition of the cowsheds in the Borough may be reported upon satisfactorily. The number of dairymen and milk purveyors on the register at the end of the year was 292, as compared with 284 m 1907, 288 in 1906, 289 in 1905, 294 in 1904, 300 in 1903, and 304 in 1902. During the year the sale of milk was discontinued at 16 and was commenced at 24 premises. In 67 instances there were changes in the names of the persons registered, and the necessary corrections were made. The cowsheds, dairies, and milkshops in the Borough were under inspection by the sanitary staff, and some 3,590 visits of inspection were made during the year. In 4 instances milk utensils were found in an uncleanly condition. Verbal warnings were given in two of these, and written intimations in the other two. In 16 instances sanitary notices were required in respect to the premises where the milk business was being carried on : in 9 for general cleansing, in 2 for cleansing and minor sanitary defects, in 1 for the provision of a dust receptacle, 2 for a defect in connection with the w.c.'s, 1 for a defective drain, and in 1 for the absence of a water supply. The necessary steps were taken to comply with the notices served, and it was not necessary to bring any of the premises specially to the notice of the Health Committee. 47 Four cases of scarlet fever, one of diphtheria, and two of erysipelas occurred in connection with milk purveyors' premises, and the usual steps were taken as to discontinuing the sale of milk until it was considered safe for it to be resumed. OFFENSIVE BUSINESSES. The tripe-boiling establishment which comes under the above heading was under inspection from time to time during the year, but there were no complaints received in connection with it FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1908 was 1,183, 140 having been added and 211 removed. The numbers for previous years were 1,254 in 1907, 1,278 in 1900, 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 Act, which is appended. The decrease in the number of workshops was chiefly in those used for cabinet making and the boot and shoe trades. The usual inspection of the workshops in the Borough was made during the year. Some 3,991. visits of inspection were made in connection with workshops, and 223 to factories. Five communications were received from the Factory Inspector relating to the establishment of 90 new workshops in the Borough. A large proportion of these were for the purposes of the cabinet making and tailoring trades. On inspection 77 were in a satisfactory sanitary state, 4 were unoccupied at the time visited, and 1 was a factory. The remainder were more or less unsatisfactory from a sanitary point of view, and required the attention of the sanitary officers. Some 33 written intimations were received from the Factory Inspector referring to insanitary conditions and infringements of the law relating to public health in connection with 48 workshops and work-places. The chief insanitary conditions to which the Factory Inspector directed attention were: -Dirty conditions of walls and ceilings in 18 instances, dirty and dilapidated states of the workshops in 5, defective or insufficient water-closet accommodation in 16, want of proper separate sanitary accommodation for the sexes in 6, absence of water-closet accommodation in 2, and an accumulation of manure which wjls a nuisance in 1 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 had been directed, as well as a number of others which came under the observation of 48 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 349 workshops were dealt with, and 332 sanitary notices were served upon the parties responsible for keeping them in a proper sanitary condition. In some 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 during the year 1907 : — New drains constructed 1 Drains relaid or repaired 15 Stack pipes disconnected 7 Stack pipes reinstated 17 Eaves gutters reinstated 11 Sink waste pipes disconnected 21 Yards paved 19 Sculleries paved 1 Water-closets reconstructed 29 New water-closets constructed 37 Water-closets cleansed and lime- washed 233 Obstructions removed from water-closets 12 Urinals repaired and cleaned 7 Water-closets' flushing apparatus repaired 76 Water supply laid on or restored 5 Leaking water-pipes repaired 6 Rooms cleansed and whitewashed 327 Yards „ „ „ 93 Areas „ „ „ 16 Roofs repaired 36 Floors „ 10 Stairs ,, 7 Doors „ 6 Sashes ,, 3 Dust receptacles provided 24 Foul accumulations removed 9 Ventilation improved 7 In 17 instances statutory notices under the Public Health (London) Act, 1891, were served by order of the Health Committee, but there was no necessity for police-court proceedings. The number of factories under observation during the year was 41, and 7 sanitary notices were served in connection with them. The works carried out in connection with them included the construction or reconstruction of drains in four instances, the disconnection of sink waste pipes in seven instances, the construction or reconstruction of water-closets in 10 instances, improvements as regards the ventilation of water-closets in two instances, and other matters. In two instances statutory notices were served but no police court proceedings were necessary During the year 94 lists of outworkers were received from employers in the Borough, 47 during each half year. These lists contained the names of 1,375 outworkers, of whom 1,037 were not resident in Shoreditch. The addresses of the non-residents were forwarded to the authorities of the sanitary 49 districts to which they belonged. Communications were received from other sanitary authorities relating to 2,810 outworkers, 163 of which were residents of other boroughs, and their addresses were forwarded to the authorities concerned. A table is appended giving the numbers of addresses of outworkers received from surrounding sanitary authorities during 1908. The number of outworkers brought to our notice in 1908 was 4,185, as compared with 4,578 in 1907 and 2,975 in 1906 Of these 2,985 were residents in Shoreditch as compared with 3,431 in 1907 and 2,259 in 1906. It is to be noted in respect to these figures that in many instances the names and addresses of outworkers are duplicated owing to lists being sent in twice a year; moreover, in a number of instances the same outworkers are employed by more than one firm. The numbers given above, therefore, as mentioned in previous reports, are far from representing the actual numbers of individual outworkers. Most of the outworkers in Shoreditch are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags and boxes, and brushes. Tables are appended showing the distribution of outworkers as regards trades in the Borough. During the year some 2,577 visits of inspection were made to places where homework was carried on. The work carried out in compliance with sanitary notices served in connection therewith included the construction or reconstruction of drains in 13, instances, the disconnection of sink waste pipes from drains in 14, the disconnection of stack pipes in 6, the reinstatement of stackpipes in 40, and of eaves gutters in 33, the paving of yards in 33, sculleries in 12, and areas 3, the reconstruction of water.closets in 23 instances, the repair of flushing apparatus in 22, and other work in connection with the water supplies in 23 instances; 342 rooms, 30 yards and 49 water.closets were cleansed and whitewashed; repairs were effected in connection with roofs in 28 instances, floors 16, stairs 11, doors 2, and window.frames 4; and in 45 instances dust receptacles were provided. Twelve cases of overcrowding came under observation in outworkers' premises and were abated. Altogether 219 sanitary notices were served in respect to these premises. During the year 17 cases of infectious disease were certified in houses where home work was carried on : five cases of scarlet fever were notified at addresses where clothing was being made, two where french polishing was being done, two where paper bags and boxes and two where brushes were being made; four cases of diphtheria, one of erysipelas, and one of epidemic cerebro spinal fever were certified at houses where paper bags and boxes were being made. 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 Sections 108.110 of the Factory and Workshop Act, 1901. D 50 BAKEHOUSES. The number of bakehouses on the register which were in use at the end of the year was 73, including four factory bakehouses where power is used. The number remains the same as for 1907. Of these 30 are above ground and 43 below ground level. As the result of inspection 51 were found in a satisfactory sanitary condition, 17 required cleansing and limewashing, in one there was defective ventilation, in two instances rain water pipes were defective, and in two instances other insanitary conditions required attention. In all cases the usual sanitary notices were served and complied with, and it was not necessary to specially direct the attention of the Health Committee to any of the bakehouses. ICE.CREAM SHOPS. The following is a summary of the work in connection with ice.cream shops during 1908:—Inspector Lear had 18 under observation; two of them required cleansing. Inspector Firth visited 14, of which 4 required cleansing. Inspector Jordan had 18 under observation; one required cleansing, and in another instance there was no dust receptacle. Inspector Langstone visited 25, of which 2 required cleansing; in two other cases the sale of ice.cream was discontinued, and in 4 instances the premises were found to be closed. Inspector Pearson had 15 under observation; in 7 instances notices were required as to cleansing. Altogether 90 premises whereon ice.cream was manufactured or sold were under the observation of the sanitary officers during the year. Of these 69 were in a satisfactory sanitary condition and 4 were found closed. The remainder required attention mainly on account of want of due care as to cleanliness. Sanitary notices were served in 17 instances. COOK.SHOPS AND COFFEE.HOUSES. On Inspector Lear's district 29 were visited and 22 of them required cleansing. On Inspector Firth's district 11 were visited and 3 required cleansing. Inspector Jordan had 92 under observation, also the kitchens of 13 public.houses at which dinners are provided In 28 instances sanitary notices were required; in two instances the soil pipes and water.closets were defective, in 3 sinks required attention, 3 flushing cisterns were out of order, in 1 the yard paving was defective, and in 6 proper dust receptacles were required. In 20 instances the kitchens required cleansing and repairs. In 6 the coffee.shops were closed when visited. On Inspector Langstone's district 34 were under observation, and notices as to cleansing were necessary in 51 nection with 6 of them. Inspector Pearson visited 18, including the kitchens of 2 public.houses. In 7 instances sanitary notices were necessary, chiefly for cleansing and in 1 case the drains were defective. Altogether 197 cook.shops and eating.houses, including the kitchens of 15 public.houses, were under inspection during the year, as compared with 188 in 1907, 178 in 1906 and 182 in 1905. In 66 instances sanitary notices were served in connection with them, chiefly on account of a lack of proper attention as regards cleanliness FRIED.FISH SHOPS. The number of fried fish shops under observation was 46; in 12 instances sanitary notices were required, in 9 for cleansing, in 1 for defective yard paving, and in 2 for other sanitary defects. Inspector Firth notes that there has been a great improvement in respect to the shops on his district since the introduction of hermetically sealed cylinders for the removal of fish offal. STREET MARKETS AND FOOD. The usual supervision was exercised by the sanitary officers in connection with the street markets and the food exposed for sale in the Borough, and frequent inspections were made with a view to detecting unsound or unwholesome food. An inspector is also on duty for this purpose during the evening in accordance with the instructions of the Council. The following articles were destroyed as unfit for food :— Two boxes of cod fish, 29 stone and 1 barrel of skate, 7 lbs. of turbot with roes, 18 lbs. of soles, 2 boxes of clabs, 2 sacks of whelks, 4 tons of sheep's tongues, 6 tons 8 cwt. of cabbages, 109 sacks of savoy greens, ¾ case of onions, 1 case of asparagus, 5 cases of bananas, 88 lbs. of apples, 3 cases and 116 oranges, 1½ bushels of cherries, ¾ bushel of plums, 31 barrels of raspberries, and 10 tins of condensed milk. Most of the articles destroyed were surrendered as unfit for food. In one instance some oranges were seized, and condemned, and ordered to be destroyed by the magistrate. No proceedings followed as the owner who had them for sale could not be traced. In 2 other cases rotten oranges exposed for sale were seized, and ordered to be destroyed by the magistrate. The persons who were offering them for sale were prosecuted, and convicted, and fined as stated on page 39. The turpot and roes mentioned were also seized at a fried.fish shop as being prepared for sale. They were ordered to be destroyed by the d 2 62 magistrate. There was, however, an element of doubt as to whether they were actually intended for the food of man. The case was reported to the Health Committee who did not think it advisable to order a prosecution. With regard to the sheep's tongues—these were brought under my notice by a firm of traders in the Borough on December 3rd, with a view of ascertaining my opinion as to whether the tongues were fit for food. It appears they were from South America per S.S. “ Orcoma.” There were 30 barrels, and the specification of their contents shewed that there were 25,500 tongues. On examination of the contents of two of the barrels they appeared satisfactory, being firm and free from any putrefactive odour, but a tallowy smell was noticed. Considering the circumstances, however, it was thought advisable to subject some of the tongues and the fluid in which they were pickled to a careful test. Six tongues were accordingly selected from the two barrels which were opened, and also some of the fluid. The latter was sent to the public analyst for a report as to its composition. The tongues were boiled until cooked. Upon splitting them open a very marked putrifactive odour was at once detected. It was then determined to subject samples of the tongues from each of the thirty barrels to a similar test. The result was the same, in every instance the cooked tongue on being split open had an offensive putrifactive odour. This test was carried out in the presence of a representative of the Firm. The tongues were taken possession of by the officers of the Borough Council and destroyed. With two exceptions there was nothing noticeable about the contents of the barrels before cooking to indicate that they were tainted. In the case of the exceptions the tongues had the appearance of putrifactive changes which was noticeable on opening the barrels. Analysis showed that the fluid in which the tongues were preserved contained boric acid. Doubtless this accounted to some extent for the absence of any appreciable tainted odour before cooking. Sheep's tongues are imported into the United Kingdom from several foreign countries and British possessions. They are usually sent in barrels containing brine or “sweet pickle,” a fluid impregnated with common salt and sugar and sometimes with saltpetre In some instances the liquor employed is a strong solution of boric acid, and tongues exposed to this preservative solution frequently are found to contain considerable quantities of boric acid or its compounds, which have gained access to the substance of the tongues. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analysts show that during the year 580 samples were submitted for analysis under the above Acts. This number was approximately at the rate of 5 samples per 1,000 inhabitants for the year. 53 The results of the year's work are summarised in the following table:— Quarter of the year 1908. 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 £ s. d. £ 8. d 1st. 132 27 20.8% 12 — 12 10 46 9 0 66 0 0 2nd. 127 19 14.9% 15 — 15 13 39 12 6 63 10 0 3rd. 102 12 11.7% 4 — 4 2 9 5 0 51 0 0 4th. 219 34 15.5% 14 — 14 14 36 16 6 109 10 0 Total) for Year ) 580 92 15.8% 45 — 45 39 132 3 0 290 0 0 The samples taken comprised 352 of milk, 180 of butter, 8 margarine, 6 mustard, 5 coffee, 5 cheese, 4 cocoa, 3 pepper, 3 sausage, 2 samples each of lard, arrowroot, olive oil, kidneys and flour, and one sample each of separated milk, ice.cream, carbonate of soda, and carbonate of potash. Of the milk samples 63, or 17.8 per cent., were found to be genuine, as compared with 23.2 per cent, in 1907, 27.9 in 1906, 20.8 in 1905, 23.5 in 1904, and 22.0 in 1903. 1904, and 22.0 in 1903. In the subjoined table are shown the numbers of samples of milk taken during the four quarters of the year, with the numbers and percentages of those found not to be genuine : — Quarter of the year. Number of Samples. Number not genuine. Percentage not genuine. 1st. 76 20 26.3 2nd. 90 14 15.5 3rd. 65 8 12.3 4th 121 21 18.1 In 33 of the samples of milk water was certified to have been added In 8 the amount was over 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 (he milk was deficent in butter fat, the deficiency being over 5 per cent, below the standard in 19 of the samples, and under that amount in the remainder. 54 In 3 samples there were both excess of water and deficiency of butter fat. Artificial colouring matter in traces was found in three of the samples, and boric acid in two. The amounts of boric acid in neither case exceeded 2 grains per pint, and the usual letters of warning were sent. Legal proceedings were instituted in 21 or 33 per cent, of the cases in which the milk samples were not up to the Board of Agriculture's standard. In IT convictions were obtained and in 4 instances the summonses were dismissed owing to the production of warranties. In the remaining 66 per cent, in which samples were not up to standard prosecutions were not considered advisable, the percentages of abstraction of fat and of added water being too small to make a conviction likely. In the cases in which convictions were obtained the penalties for milk adulteration amounted to £45, which is equivalent to 11.25 per cent, of the full amount of the penalties to which the defendants were liable, as compared with 5.6 in 1907, 5.6 in 1906, 7.8 in 1905, 6 in 1904, 8 in 1903, and 13 in 1902. Taking the fines and costs together, which amounted to £52 2s. 6d., the average amount paid by the defendant upon conviction was 1s. 4d., as compared with £1 13s. 7d. in 1907, £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. In two of the cases the defendants had been previously convicted for adulterating milk. For the second offence they were liable to penalties of £50, but the penalties inflicted were £4 in each instance. Of the samples of butter taken 22, or 12.2 per cent., were not genuine, as compared with 6.3 per cent, in 1907, 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 52 6 11.5 2nd 26 3 11.5 3rd 36 4 11.1 4 th 66 9 13.6 Of the samples sold for butter which were found not to be genuine 18 were samples of margarine and 2 were butter containing a small percentage of water over and above the recognised standard, which is 16 per cent. Legal proceedings were taken in 17 instances and were successful in 15; in two instances the defendant absconded and could not be traced. The penalties inflicted in the cases in which convictions were obtained for the 55 sale of adulterated butter amounted to £62, which was equivalent to 16.3 per cent, of the maximum penalties to which the defendants were liable, as compared with 15.6 per cent, in 1907, 12 per cent, in 1906, 17 in 1905, 10 in 1904, 18 in 1903, and 17 in 1902. Including the costs allowed, which amounted to £3 2s. 6d., the amounts imposed by the magistrate averaged £4 6s. 10d., as compared with £4 6s. 7d. in 1907, £5 3s. Od. in 1906, £1 1s. Od. in 1905, £3 Is. Od. in 1904, £4 10s. Od. in 1903, and £4 10s. Od. in 1902. In one instance the defendant had previously been convicted three times, he was, therefore, liable to a penalty of £100 ; £15 was the penalty inflicted. Eight samples of margarine were taken. Four were sold in unstamped wrappers in contravention of the Act. Proceedings were taken in these cases. In one case a fine of 10s. was imposed, and in the other three there were no fines but costs were allowed the Council. The fine amounted to 0.3 per cent, of the maximum penalties to which the defendants were liable. Including the costs the amounts recovered averaged £1 4s. 6d. Of the five samples of cheese one was found to be margarine cheese, which was sold in contravention of the Act. Proceedings were taken and the vendor was convicted, a penalty of £3 being inflicted. Of the four samples of cocoa one was adulterated, and the vendor was fined £3. Of the three samples of sausages two contained boric acid not exceeding 2 grains per pound. One of the samples of kidneys taken showed traces of boric acid. The sample of separated milk contained 16 per cent, of added water. The vendor was fined £4. The samples of mustard, coffee, pepper, lard, arrowroot, olive oil, flour, icecream, carbonate of soda, and carbonate of soda, and carbonate of potash were returned as genuine. The subjoined table shows a comparison of the results of the work under the Food and Drugs Acts during the years 1902.8 inclusive:— Tear. Number of Samples. Number of persons in the Borough to each sample. Number of samples adulterated. Percentage of samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties, &c. Prosecutions proceeded with. Number of successful prosecutions. Fines and Costs. Amount paid to Public Analyst. £ s. d. £ 8. 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 520 224 122 234 44 2 42 34 106 12 6 260 0 0 190? 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 1908 580 200 92 15.8 45 .. 45 39 117 10 0 290 0 0 56 The increase in the number of samples during 1908, as compared with the previous year, is a result of the inspectors being on duty in the evening according to the arrangements made by the Council last year. SANITARY STAFF. The Staff of the Health Department includes the following officers:—A medical officer of health, public analyst, six sanitary inspectors, three clerks, a messenger and general assistant who helps in clerical work, three disinfecting officers, a mortuary keeper, and a keeper for the shelter house. Through the death of Sir Thomas Stevenson, M.D., which occurred on July 27th, the Borough was deprived of the valuable services of an eminent public analyst. He was Public Analyst for Shoreditch for 30 years, and his loss is much regretted by all who knew him in the Borough. His place was temporarily filled by Mr. Leo. Taylor, F.I.C., F.C.S., the Public Analyst for the Borough of Hackney until December 1st, when Mr. H. G. Harrison, M.A., F.I.C., F.C.S., was appointed Public Analyst for the Borough. Mr. Harrison was an assistant to the late Sir Thomas Stevenson. It was necessary to bring the unsatisfactory character of the work done by the keeper of the shelter house under the notice of the Health Committee, otherwise I have to express my satisfaction as to the manner in which the officers of the department have performed their duties during the year, and my appreciation of the help they have afforded me in the work of the department. As regards the work of the clerical staff it may be mentioned that some 13,205 communications written and printed were issued by the department during the year. These included 3,159 notices and summonses, 2,204 letters and cards, mainly on matters under the Public Health and Sale of Food and Drugs Acts, and 669 as to work under the Factory and Workshop Act, 6,297 communications of various kinds in respect to infectious diseases and disinfection, and 777 copies of reports and agendas relating to the work of the department. In conclusion I desire to thank the Chairman and members of the Health Committee for the consideration and assistance they have extended to me 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 57 APPENDIX TO THE REPORT OF THE MEDICAL OFFICER OF HEALTH. CONTAINING Statistical Tables and a Summary or Sanitary Proceedings UNDER THE FUBLIC HEALTH AND FACTORY AND WORKSHOP ACTS, during the year 1908. Tables I., II., III., IV., and V. are forms required by the Local Government Board. 58 TABLE I. BOROUGH OF SHOREDITCH. Vital Statistics of whole District during 1908 and previous Years. Year Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institu. tions in thk District. Deaths of Nonresidents registered in PubMc Institutions in the District. Deaths of residents registered in Public Institutions beyond the District. Net Deaths at Belonging TO THE District. N umber Rate* Under one year of Age at all Ages. Num. ber Kate per 1,000 Birth:. regis. N umber Rate* Number. Rate* 1 2 3 4 5 6 7 8 9 1C 11 12 13 1898 121740 4 281 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 117918 3992 33.1 704 181 2383 20.2 836 387 432 2441 20.9 1903 117740 3932 333 676 176 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 1906 11C 9 3 J 3894 33.3 652 165 2234 191 867 391 451 2296 19.8 1906 116506 3802 32.6 651 168 2158 185 816 343 473 2289 19.8 1907 116073 3636 31.3 569 153 2195 189 912 350 516 2365 20.6 Averages for years 1898tol907 118572 3957 331 721 183 2454 20.6 841 387 412 2485 21.1 1908 115642 3678‡ 32.2§ 510 138 2258 19.0 884 367 485 2006 17.5§ *Rates in Columns 4, 8, and 13 are calculated per 1,000 of estimated population. ‡Total registered for the Borough, excluding the births in the Holborn Workhonse. §The population in the Holborn Workhouse is excluded in calculating these rates. 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 1908 eights persons not resident in Shoreditch died within the district, and 13 residents of Shoreditch died beyond the district, but not in public institutions, these have to be added to the figures in columns 10 and 11 respectively in order to get the. net deaths. By the term “ non.residents” is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there ; and by the term “ residents ” is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The “ public institutions ” taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the institutions in respect of the deaths in which corrections have been made is given on pages 8 and 9 of the report Area of District in acres (exclusive of area covered by water) 642.5 Total population at all ages, 118,637 Number of inhabited houses, 12,743 Average number of persons, per house 9.3 At Census of 1901. 59 TABLE II. BOROUGH OF SHOREDITCH. Vital Statistics of separate Localities in 1908, and in previous Years. 1.—Moorfields Ward. 2.—Church Ward. 3.—Hoxton Ward. 4—Wenlock Ward. 5—Whitmore Ward. 6—Kingsland Ward. 7—Haggerstun Ward. 8—Acton Ward. Year. Population estimated to middle of year Births registered. Draths 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 registe-e«i. Deaths at all ape9 Deaths under 1 year Population estimated to Middle of year. Births registered. Deaths at. all ages. Deaths under 1 year. Papulation estimated to middle of year. Birt.ns 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 Milder 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 regitered. Deaths at all .ages Deatns 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 674 389 130 18342 521 326 88 18461 647 446 105 11281 420 205 60 12314 413 208 75 12391 414 208 52 1906 5681 130 79 11 19923 668 403 108 17982 664 354 107 18602 596 336 113 18370 586 454 119 11188 423 220 59 12384 386 208 68 12376 417 235 66 1907 5531 139 89 16 19743 646 401 97 17748 616 391 100 18862 541 344 90 18279 614 526107 11095 376 194 50 12454 364 196 51 12361 424 224 58 1908 5381 124 79 13 19563 651 335 93 17514 628 330 80 19122 531 278 77 18188 610 419 97 11002 408 193 49 12526 3S1 197 66 12346 345 175 35 (a) 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 G, 7 and 8 that of Shoreditch North-East. (b) Deaths of residents occurring beyond the district are included in sub-columns c of this table, and those of non-residents registered in the district excluded. (See note on Table I. as to meaning of terms " resident" and " non-resident.") (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. 60 TABLE III. BOROUGH OF SHOREDITCH. Cases of infectious disease notified during the Year 1908. Notifiable Disbasr. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital fkom each Locality. At all Ages. At Ages—Years. 1. 2 3. 4. 5. 6. 7. 8. 1. 2. 3. 4. 5, 6. 7. 8. Moorfields. Church. Hoxton Wenlock. Whitmore. Kingsland. Hasgerston Acton. Moorfields. Church. Hoxton. Wen- lock. Whitmore. Kingsland. Haggerston. Acton. Under 1. 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards Small-pox •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Cholera •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Diphtheria 200 7 96 77 11 9 20 31 24 24 36 19 13 33 20 30 24 23 34 19 12 32 Membranous croup 2 •• 2 •• •• •• •• •• •• 1 1 •• •• •• •• •• •• 1 •• •• •• •• •• Erysipelas 124 6 7 •• 17 63 22 10 18 11 21 29 13 12 10 •• •• •• 2 1 2 1 1 Scarlet fever 590 10 215 328 25 12 28 114 85 69 80 70 70 74 28 112 84 68 76 70 69 70 Typhus Fever •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Enteric fever 101 •• 7 34 30 30 •• 2 5 10 7 72 3 1 1 2 5 10 7 69 3 1 1 Relapsing fever •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Continued fever •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Puerperal fever 5 •• •• •• 1 4 •• •• 3 1 •• •• 1 •• •• •• •• 1 •• •• •• •• •• Plague •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Cerebro-spinal fever 6 4 1 1 •• •• •• •• 2 •• •• 1 1 1 1 •• 2 •• •• 1 1 1 •• Totals 1028 27 328 449 84 118 22 60 173 132 122 218 107 97 119 50 149 120 100 181 95 84 104 61 TABLE IV. BOROUGH OF SHOREDITCH. Causes of, and ages at, death during Year 1908. 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. Haggei-ston. Ac'on. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 51 11 39 1 .. .. .. 1 8 10 8 4 7 9 4 4 Scarlet fever 28 20 3 1 .. .. .. 8 5 4 5 3 .. 2 .. Whooping-cough 21 10 11 .. .. .. .. 1 6 3 4 6 1 1 .. 4 Diphtheria and membranous croup 13 3 7 3 .. .. .. 1 3 2 3 3 1 .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 11 .. .. .. 4 7 .. .. 2 2 1 6 .. .. .. 2 Other contd .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 22 .. .. .. 1 9 12 .. 6 3 4 6 1 1 .. 6 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea (see notes) 146 120 23 .. 1 2 34 23 24 30 12 18 3 18 Enteritis (see notes) 14 .. 7 .. .. 6 1 .. .. 6 4 1 .. 3 . . 2 Puerperal fever 2 .. .. .. .. 2 .. .. 2 .. .. .. .. .. .. 1 Erysipelas 5 2 .. .. .. 1 2 1 .. 1 2 1 .. .. .. 3 0flier septic diseases 24 10 3 2 1 7 1 2 3 3 3 4 3 3 8 Phthisis 224 4 9 11 26 171 3 11 31 47 32 43 24 14 22 132 Other tuberculous diseases 87 28 35 13 3 8 5 14 17 8 21 8 11 3 17 Cancer, malignant disease 91 1 .. .. .. 60 30 2 14 10 10 19 5 7 15 45 Bronchitis 163 27 13 .. 1 56 66 5 17 35 23 39 14 16 14 97 Pneumonia 222 52 56 7 3 66 38 9 36 33 24 49 25 27 19 113 Pleurisy 5 1 2 .. .. 1 1 .. .. 1 2 .. 1 1 .. 4 Other diseases of Respiratory organs 9 2 1 .. 1 4 1 1 1 1 .. 2 2 2 11 Alcoholism ) Cirrhosis of liver 50 .. .. .. .. 41 9 2 9 11 6 8 5 2 7 33 Venereal diseases 8 5 .. .. .. 3 .. .. 3 1 .. 2 1 .. 1 4 Premature birth 61 61 .. .. .. .. .. 3 9 7 14 10 4 8 6 3 Diseases and accidents of parturition 6 .. .. .. .. 6 .. .. 2 1 1 1 1 .. .. 2 Heart diseases 149 1 8 13 89 38 11 24 23 15 29 18 14 15 77 Accidents 91 41 14 6 3 15 12 1 21 14 17 19 6 8 5 27 Suicides 17 .. .. 1 1 15 .. .. 1 1 5 3 6 .. .. 2 All other causes 486 131 17 18 9 160 151 19 81 61 64 108 45 54 54 269 All causes 2006 510 257 77 67 72S 367 79 335 33U 278 419 193 197 175 884 62 TABLE V. BOROUGH OF SHOREDITCH. Infantile Mortality during the year, 1908, showing deaths from stated causes in weeks and months under One Year of Age. CAU3E OF DBATH Under 1 W« ek. 1-2 Weeks 1 2-3 Weeks 34 Weeks Total under 1 Month 1 - 2 Months 2-3 Months 3-4 Months 4- 5 Months 5-6 Mont l s 6-7 Months 7-8 J Months 8-9 Months 9-10 Months 10-11 Months 11-12 Months Total Deaths under 1 Year. All causes Certified 74 14 17 6 111 57 61 37 42 34 33 28 27 31 32 17 510 Uncertified i. Common Infectious Diseases. Small-pox Chicken-pox Measles 1 1 3 1 4 1 11 Scarlet Fever Diphtheria: Croup 1 1 1 . , 3 Whooping- Cough 1 3 1 1 1 1 2 10 ii. Diarrhoeal Diseases. (See notes &c. Tables iv. & v.) Diarrhoea, all forms 8 12 12 9 12 3 7 9 5 4 86 Enteritis, Muco-enteritis Gastro-enteritis .. .. .. 1 1 6 7 .. .. 2 2 2 1 1 1 26 Gastritis, Gastro-intestinal i Catarrh .. .. .. .. .. 3 2 1 1 .. .. .. .. .. .. .. 8 iii. Wasting Diseases Premature Birth 44 6 4 1 55 4 2 .. .. .. .. .. .. .. .. .. 61 Cougenital Defects (See notes on Tables iv. & v.) 10 4 3 17 .. 3 .. 1 .. 2 .. .. .. .. .. 23 Injury ar, Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast-milk,Starvation .. .. 1 1 9 .. .. .. .. .. .. .. .. .. .. .. 2 Atrophy, Debility, Marasmus 12 1 6 19 13 10 7 5 4 5 1 3 3 .. 78 iv. Tuberculous Diseases Tuberculous Meningitis (See notes on Tables iv. & v ) 1 1 1 3 1 2 1 1 2 13 Tuberculous Peritonitis Tabes Mesenterica .. .. .. .. .. 2 1 1 .. 1 1 .. 1 .. .. .. 7 Other Tuberculous Diseases (See notes on Tables iv. & v.) .. .. .. .. .. .. .. .. 1 2 .. 4 1 3 1 12 v. Other causes Erysipelas .. .. .. .. .. .. .. .. .. .. .. 2 2 Syphilis .. .. .. .. .. .. 4 1 .. .. .. .. .. .. .. .. 5 Rickets .. .. .. .. .. .. .. 1 .. .. .. .. .. • • .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. 2 1 2 1 1 2 .. 1 3 1 14 Convulsions 1 .. .. .. .. 1 1 1 1 .. .. .. .. .. .. .. 7 Bronchitis .. .. .. .. .. 7 2 .. 1 2 1 2 3 2 1 27 Lanngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. 1 1 3 6 1 4 5 3 3 9 3 9 5 52 Suffocation, overlaying 0 1 2 8 7 5 6 4 1 2 .. .. .. .. 33 Other Causes 2 1 2 .. 5 2 3 .. 5 2 2 1 1 4 2 2 29 74 14 17 6 111 .57 61 37 42 34 33 28 27 31 32 17 510 Births in the year—Legitimate 3,575, illegitimate 103. Population, estimated to middle of 1908, 115,642. Deaths from all Causes at all Ages 2,006. 63 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 "Nonresidents," 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 "Non-residents," are, in addition to being dealt with as in note (a), entered in the last column of Table IV. The total number in this column equals the figures for the year in column 9, Table I. 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., subcolumns c. The total deaths of 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 " Diarrhoea " are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Dysentery and Dysenteric diarrhoea, Choleraic diarrhoea, Cholera and Cholera Nostras. In addition, and as regards deaths of children under one year of age, under the heading "Diarrhoea" in column 3 (Table IV.) are included all deaths classified as "Diarrhoea 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, Muco-enteritis, Gastro-enteritis, Gastric catarrh, Gastritis, and Gastro-intestinal catarrh. Deaths from diarrhoea secondary to some other well-defined disease have been included under the latter. (/) Under the headings of "Cancer" and "Puerperal fever" are included all registered 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, Sapraemia, Pelvic Peritonitis, Peri- and Endo-Metritis occurring in the Puerperium. (g) Under "Congenital Defects" in Table V. are included deaths from Atelectasis, Icterus neonatorum, Navel 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." 64 TABLE VI. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31st DECEMBER.. 1908. 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. CAUSES OF DEATH. AGES. DEATHS IN EACH "WARD. SEX. . Under 1. 1 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. Moorfields. ( hurch. Iloxfon. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 1 Small Pox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. No statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 11 39 1 .. .. .. .. .. .. .. .. .. .. 1 8 10 8 4 7 9 4 31 20 51 3 Scarlet fever .. 20 3 4 .. 1 .. .. .. .. .. .. .. 1 8 5 4 5 3 .. 2 16 12 28 4 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Epidemic influenza .. .. .. 1 .. .. 3 2 4 8 4 .. 1 6 3 4 6 1 1 .. 8 14 22 6 Whooping cough 10 11 .. .. .. .. .. .. .. .. .. .. .. .. 3 5 4 2 2 3 2 3 18 21 7 Diphtheria, membranous croup .. 3 7 3 .. .. .. .. .. .. .. .. .. .. 1 3 2 3 .. 1 .. .. 6 7 13 8 Enteric fever .. .. .. . . 2 2 4 3 .. .. .. .. .. .. 2 2 1 6 .. .. 6 5 11 9 Asiatic cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Diarrhoea, dysentery 73 20 .. .. .. .. .. .. .. 1 .. 1 .. 2 21 13 15 1 6 15 2 56 39 95 11 Epidemic or zymotic enteritis 13 3 .. .. .. .. .. .. .. .. 1 .. .. .. 5 2 5 .. 4 1 .. 8 9 17 12 Other allied diseases .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 1 1 2 13 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Glanders, farcy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15 Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ] 6 Anthrax, splenic fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 17 Cow-pox, accidents of vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 18 Syphilis 5 .. .. .. .. 1 2 .. .. 1 .. .. .. .. 3 1 .. 2 1 1 6 2 8 19 Gonorrhoea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 20 Phagedcena, hospital gangrene .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 21 Erysipelas 2 .. .. .. .. .. .. .. .. 1 2 .. 1 .. 1 2 1 .. .. .. 3 2 5 22 Puerperal fever .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 2 2 23 Pyaemia, septicaemia 10 3 1 1 I 1 2 2 2 3 2 2 o 3 3 9 10 19 24 Infective endocarditis .. .. .. .. .. .. 3 1 .. .. .. .. .. .. 1 .. 1 1 1 .. .. 3 1 4 25 Other allied diseases .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 1 1 26 Malarial fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 27 Rheumatic fever 1 1 1 .. ... 1 2 1 .. .. .. .. 1 1 1 .. 0 .. .. 9 4 3 7 28 Rheumatism of the heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 29 Brain or meninges, acute hydrocephalus 13 23 4 1 .. 1 1 .. 1 .. .. .. .. 1 9 11 4 6 5 6 2 25 19 44 30 Larynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 31 Lungs 4 9 0 6 9 17 50 51 11 29 3 11 31 47 32 43 24 14 22 140 84 224 32 Intestines, tabes mesenterica 7 5 .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 1 5 2 1 .. 9 3 12 33 General, position undefined 7 7 5 2 1 2 2 .. .. .. .. .. 2 5 3 2 8 1 4 1 18 8 26 34 Other forms, scrofula 1 .. .. 1 .. 1 1 .. 1 .. .. .. .. .. .. 2 1 2 .. .. .. 3 2 5 35 Other In fective diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 36 Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 38 Hydatid diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• 39 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 40 Other diseases due to altered food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 Acute alcoholism, delirium tremens .. .. .. .. .. .. .. .. 3 .. .. .. 1 .. .. .. .. 1 .. 1 2 1 3 42 Chronic alcoholism .. .. .. .. .. .. 2 2 6 4 1 .. .. .. 5 1 3 3 2 1 .. 10 5 15 43 Chronic industrial poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 44 Other chronic poisoninas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. 45 Osteo-arthritis, rheumatoid arthritis .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 1 .. .. 1 .. .. .. .. 2 2 46 Gout .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 47 Cancer 1 10 14 23 19 6 i 1 10 15 10 16 4 6 12 32 42 74 48 Diabetes mellitus .. .. 1 .. 1 .. 3 2 .. 2 .. .. 3 1 1 .. 2 2 .. 5 4 9 49 Purpura hceinorrhagica 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 1 50 Haemophilia .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 51 Anaemia, lecucocythsemia .. 1 .. .. .. .. 2 .. .. .. .. .. .. .. 1 1 .. 1 .. 1 1 2 3 65 CAUSES OF DEA.TH. AGES. DEATHS IN EACH WARD. SEX.. Total. Under 1. 1 t> 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. Moorfields. Church. lloxton. Weill ock. Whitinore. Kings'and. rston. Acton. Male. Female. 52 Lymphadenoma, Hodgkin's disease 1 1 1 1 2 2 53 Premature birth 61 g3 9 7 11 10 4 8 6 31 30 61 54 Injury at birth 55 Debility at birth 1 3 1 1 1 1 1 1 3 6 9 56 Atelectasis 6 2 1 2 1 4 2 6 57 Congenital defects 15 2 1 2 2 1 3 1 2 5 7 11 18 58 Want of breast milk 2 2 2 . . 2 59 Atrophy, debility, marasmus 69 2 1 15 12 9 11 6 9 8 44 27 71 60 Dentition 1 1 1 1 1 2 61 Rickets 1 2 1 1 1 1 2 3 62 Old Age, senile decay 1 18 38 17 3 10 8 15 22 6 2 8 32 42 74 63 Convulsions 7 1 1 1 1 3 1 1 6 2 8 64 Meningitis 11 1 1 4 2 1 1 1 5 7 12 65 Encephalitis 66 Apoplexy 1 1 o 6 22 16 1 2 10 6 6 12 6 6 2 18 32 50 67 Softening of brain 68 Hemiplegia, brain paralysis 1 3 8 3 2 1 2 2 i 9 6 15 69 General Paralysis of insane 2 3 7 3 1 3 2 2 6 1 2 15 1 16 70 Other forms of insanity 1 1 1 71 Chorea 72 Cerebral tumour 1 3 1 1 1 1 1 2 1 3 3 6 73 Epilepsy .. 1 1 2 1 1 1 2 1 1 1 1 5 4 9 74 Laryngismus, Stridulus 75 Locomotor Ataxy 76 Paraplegia, diseases of spinal cord 1 1 1 1 1 2 1 3 1 1 1 6 1 7 77 Other diseases of brain or nervous system 1 1 1 I 1 3 1 2 1 2 2 5 3 8 78 Otitis, otorrhcea 1 1 1 2 2 79 Diseases of nose, epistaxis 80 Diseases of eye, ophthalmia • • 81 Pericarditis 1 1 1 1 1 1 1 . . 1 2 3 82 Endocarditis, valvular diseases of the heart 3 5 2 6 12 10 13 10 4 11 7 7 16 7 6 3 32 29 61 83 Hypertrophy of heart 1 1 .. .. .. .. .. .. .. .. .. .. 2 .. 1 1 2 84 Angina pectoris .. .. .. .. .. .. .. .. .. 1 1 .. .. 1 .. 1 85 Aneurism .. .. .. .. .. .. .. .. 3 4 2 .. .. 1 3 2 1 1 1 .. .. .. 3 9 86 Senile gangrene .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 87 Embolism, thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 88 Phlebitis .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 89 Varicose veins .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 90 Other and ill-defined, diseases of heart and circulatory system, including heart disease not stated to be valvular .. .. 4 1 2 3 3 9 11 21 18 6 4 7 12 15 8 12 10 6 12 34 48 82 91 Laryngitis .. 2 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 .. 1 2 1 3 92 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 93 Other diseases of larynx and trachea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 94 Acute bronchitis 27 13 .. .. .. .. .. 3 6 6 9 2 .. 1 7 15 12 19 3 3 6 35 31 66 95 Chronic bronchitis .. .. .. .. 1 .. .. 2 11 28 41 10 4 4 10 20 11 20 11 13 8 46 51 97 96 Lobar, croupous-pneumonia 2 5 .. .. .. .. 5 12 5 3 3 3 1 5 2 10 / 1 6 29 9 38 97 Lobular, broncho-pneumonia 43 42 2 1 1 4 2 6 6 2 3 19 16 16 24 14 17 6 62 52 114 98 Pneumonia, form not stated 7 9 3 2 1 1 1 8 9 11 7 9 2 5 11 12 7 15 4 9 7 42 28 70 99 Emphysema, asthma 1 .. .. .. .. .. .. .. 1 .. .. .. 1 1 .. .. .. .. .. .. 2 .. 2 100 Pleurisy 1 2 .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 2 .. 1 1 .. 4 1 5 101 Other and ill-defined diseases of respiratory system 1 1 .. .. 1 .. • • 1 .. 2 1 .. .. .. .. 1 .. 2 2 .. 2 6 1 7 102 Diseases of mouth and annexa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1U3 Diseases of pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 104 Diseases of oesophagus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105 Ulcer of stomach and duodenum .. .. .. .. .. 1 .. 3 4 .. 1 .. .. 1 1 .. 2 2 1 2 .. 0 4 9 106 Other diseases of stomach 8 .. .. .. .. .. .. 1 2 1 .. .. .. .. 1 2 3 3 1 1 1 9 3 1? 107 Enteritis 26 7 .. .. .. .. .. .. .. 1 1 .. .. .. .. 12 5 7 1 4 .. 17 19 36 108 Appendicitis .. .. 3 .. .. .. 1 .. .. .. 1 .. .. 1 .. 2 .. .. 1 1 3 2 5 109 Obstruction of intestine 1 .. 1 3 2 2 2 1 3 2 2 3 4 7 11 110 Other diseases of intestine .. .. .. .. .. 1 1 .. .. .. 2 .. .. .. 1 .. 1 1 .. 1 1 3 4 Ill Cirrhosis of liver .. .. .. .. .. .. .. 11 8 5 6 2 .. 1 .. 10 3 5 2 1 6 16 16 32 112 Other diseases of liver 1 1 .. .. .. .. .. .. 1 .. 1 113 Peritonitis .. 1 1 1 1 .. 1 .. 1 1 .. .. .. .. 2 2 2 .. .. 1 .. 1 6 7 114 Other and ill-defined diseases of .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. digestive system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total Under 1. 1 t> 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 Hnd upwards. Moorfields. Church. Hoxton. Wenlock. 1 Whitmore. Kings'and. Hag£ r.ston. Acton. Male. Female. 115 Diseases of Lymphatic System and ductless glands .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 116 Acute nephritis .. .. .. .. .. 2 4 .. 2 .. .. .. .. 2 .. 1 1 1 2 1 5 3 8 117 Bright's disease .. .. 1 .. .. 6 3 13 12 17 4 .. 4 13 7 6 17 3 1 5 30 26 56 118 Calculus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 119 Diseases of bladder and prostrate .. .. .. .. .. .. 1 .. .. .. 1 2 .. .. 1 .. 1 1 .. .. 1 4 .. 4 120 Oth'r and ill-defined diseases of urinary system .. .. .. .. .. .. .. 1 1 .. .. 4 .. .. .. 1 .. 1 1 3 .. 2 4 6 121 Diseases of tenstis and penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 122 Diseases of ovaries .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 123 Diseases of uterus and appendages .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. 2 2 124 Diseases of vagina and external .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 125 Diseases of breast .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 126 Abortion, miscarriage .. .. .. .. . . . . 1 2 .. .. .. .. .. .. 1 1 .. .. 1 .. .. .. 3 3 127 Puerperal mania .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 128 Puerperal convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 129 Placenta prsevia, flooding .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 130 Puerperal thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 131 Other and ill defined accidents and diseases of pregnancy and childbirth .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 2 2 132 Arthritis, ostitis periostitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 133 Other and ill-defined diseases of osseous system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 134 Ulcer, bedsore .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135 Eczema 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 136 Pemphigus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 137 Other and ill-defined diseases of integumentary system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Accident or Negligence. I 138 In mines and quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 139 In vehicular traffic .. 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. .. 1 3 * * 3 140 On railways .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 141 On vessels and docks excluding drowning .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 142 In building poerations .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 143 By machinery .. .. .. .. .. .. 1 .. .. .. .. .. .. .... .. .. .. .. .. 1 .. 1 .. 1 144 By weapons and implements .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 145 Burns and Scalds 3 7 3 .. .. .. .. .. 1 .. .. .. 1 .. 3 1 1 4 2 1 3 8 7 15 146 Poisons, poisonous vapours .. .. .. .. 2 .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 2 147 Surgical narcosis .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. ..2 .. .. .. .. .. .. 2 .. 2 148 Effects of electric shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 149 Corrosion by chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 150 Drowning .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. 2 .. 2 151 Suffocation, overlaid in bed 33 .. .. .. .. .. .. .. .. .. .. .. .. .. 6 4 9 7 2 5 .. 23 10 33 152 Suffocation, otherwise 5 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 2 1 1 1 .. .. 4 2 6 153 Falls, not specified .. 3 1 .. .. 1 .. 1 3 4 4 6 1 1 6 5 4 7 .. 1 .. 9 15 24 154 Weather agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 155 Otherwise, and not stated .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 2 .. 2 156 Homicide .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Suicides, all forms. 157 By poison .. .. .. .. 1 .. .. 2 5 2 .. .. .. .. 1 1 4 2 2 .. .. 5 5 10 158 By asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 159 By hanging and strangulation .. .. .. 1 .. .. .. .. 1 2 .. .. .. .. .. .. 1 .. 2 .. 1 4 .. 4 160 By drowning .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. 1 1 .. .. 2 .. 2 161 By shooting .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 162 By cut or stab .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 163 By precipitation from elevated places .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 164 By crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 165 By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 166 Execution .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 167 Sudden death .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 168 Other ill-defined and not specified causes 1 1 1 .. .. .. .. 1 1 .. .. .. .. .. .. 1 1 1 .. 2 .. 3 2 5 169 Malignant disease 1 .. .. .. .. .. 1 2 2 7 4 .. .. 1 4 4 .. 3 1 1 3 6 11 17 170 Abscess 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 171 Cerebro Spinal Meningitis 3 1 1 .... .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 .. 1 1 3 2 5 Total 510 257 45 32 32 35 114 174 202 238 221 113 33 79 335 330 278 419 193 197 175 1087 919 2006 70 TABLE VII— ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1908. DISTRICT'S. Estimated population 1908. ANNUAL KATE PElt 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS DKATTTR DURING THE TEARS. DEATHS DURING 1908 FROM Inquest Cases. 1 Deaths m Public Institutions. Uncertified Causes of Death. 1905. 1906. 1907. 1908. Principal Z\ motic Deseases. SmMll Pox. Measles. Scarlet. Fev« r. Diphtheria. Whooping Cough. *Fever. Diarrhoea. Tuberculous. Dieease. Violence. London 4,795,757 25.4 15.6 15.1 14.4 13.8 1.37 .. 0.31 0.11 0.15 0.20 0.05 0.54 1.9 0.57 113 10.1 40.1 0.1 Slioreditch §114,269 32.2 19.8 19.8 20.6 17.5 1.9 .. 0.44 0.24 0.11 0.18 0.09 0.82 2.7 0.9 138 14.7 49.9 .. Wards. Mom-fields 5,381 23.0 14.4 13.9 16.0 14.6 0.9 .. 0.18 0.18 0.18 .. .. 0.37 2.9 0.1 105 13.9 48.1 .. Church 19,563 33.2 21.3 20.2 20.3 17.1 2.3 .. 0.40 0.40 0.15 0.15 0.10 1.07 2.3 1.1 143 18.8 54.0 .. Hoxton 17,514 35.8 21.3 19.6 22.0 18.8 2.1 .. 0.57 0.28 0.11 0.28 0.11 0.70 3.6 0.8 127 12.7 44.8 .. W enlock §17,749 29.9 17.7 18.5 19.6 15.6 1.9 .. 0.45 0.22 0.16 0.22 0.05 0.84 2.2 1.2 145 17.6 41.0 .. Whitmore 18,188 33.5 24.7 24.7 28.7 23.0 2.2 .. 0.22 0.27 0.16 0.11 0.32 1.15 3.5 1.2 159 13.8 51.8 .. Kingsland 11,002 37.0 18.1 19.6 17.4 . 17.5 1.7 .. 0.63 0.27 0.09 0.18 ... 0.54 2.9 1.0 120 16.0 47.1 .. Hnggerston 12,526 30.4 16.8 16.7 15.7 15.7 2.1 .. 0.71 .. .. 0.24 .. 1.19 1.9 0.6 173 10.6 42.6 .. Acton 12,346 27.9 16.7 18.9 18.1 14.1 0.8 .. 0.32 0.16 .. 0.16 .. 0.16 2.0 0.4 101 11.4 48.5 .. *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, O'OO is inserted; where no deaths have occurred, dots are placed in the space under the heading. TABLE VIII. ANALYSIS or the Oases Treated by tub District Medical Officers of the Borough during the Year ending December 31 st, 1908. Diseases. Diseases. All Causes 4,453 37 Atelectasis .. 38 Congenital malformations .. 1 Small-pox .. 39 Old age 155 40 Apoplexy 4 2 Measles 80 41 Epilepsy 38 3 Scarlet Fever 28 42 Convulsions 3 4 Typlius .. 43 Other diseases of brain and nervous system 229 5 Relapsing fever .. 6 Influenza 148 44 Diseases of organs of special sense 26 7 Whooping Cough 22 8 Diphtheria 8 9 Simple, continued and illdefined fever 9 45 Diseases of circulatory system 163 46 Laryngitis 1 10 Enteric fever 18 47 Bronchitis 1143 11 Simple cholera .. 48 Pneumonia 79 12 Diarrhoea, dysentery 85 49 Pleurisy 19 13 Remittent fever .. 50 Other respiratory diseases 26 14 Hydrophobia .. 51 Dentition 8 15 Glanders .. 16 Cow pox and Effects of vaccination .. 52 Quinsy, sore throat 48 53 Enteritis 46 17 Venereal affections 23 54 Peritonitis 2 18 Erysipelas 28 55 Diseases of liver 34 19 Pyaemia and septicemia 8 56 Other diseases of digestive system 310 20 Puerperal fever 1 21 Tabes mesenterica 1 57 Diseases of lymphatic system and ductless glands 16 22 Tuberculous meningitis 5 23 Phthisis 194 24 Scrofula, tuberculosis 31 58 Diseases of urinary system 57 25 Other zymotic diseases 17 26 Thrush .. 59 Diseases of the generative system 34 27 Worms and other parasitic diseases 2 60 Accidents of childbirth 24 61 Diseases of locomotive system 183 28 Starvation, want of breast-milk 1 62 Diseases of integumentary system 144 29 Alcohol inn 8 63 Fracture and contusion 36 30 Rheumatic fever and rheumatism of heart 32 64 Gun shot wounds 31 Rheumatism 335 65 Cut, stab 66 Burns or scalds 10 32 Gout 90 67 Poison 33 Rickets .. 68 Drowning 34 Cancer 14 69 Suffocation 35 Other constitutional diseases 51 70 Otherwise 63 36 Premature birth 1 71 Other causes 308 71 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1908. Table IX. PREMISES. NUMBER OF PLACES— Number of inspections, 1908. Number of notices, 1908. Number of prosecutions, 1908. On register at end of 1907. Added in 1908. Removed in 1908. On register at end of 1908. Milk premises 284 24 16 292 3513 18 2 Cowsheds 7 .. .. 7 77 1 .. Slaughter-houses 8 .. 1 7 39 1 .. Other offensive trade premises 1 .. .. 1 7 .. .. Ice Cream premises 84 12 6 90 200 17 .. Registered houses let in lodgings 272 14 •• 286 345 18 .. Number of intimation notices served for all purposes 2824 Overcrowding: — Number of dwelling rooms overcrowded 117 Number remedied 117 Number of prosecutions Nil Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1891 127 Underground rooms: — Number dealt with during year 5 Insanitary houses:- Number closed under the Public Health (London) Act, 1891 17 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891: — Number of persons accommodated during the year Nil Customs and Inland Revenue Acts: — Number of houses for which applications were received during year Nil Number of prosecutions under By-laws under Public Health (London) Act, 1891: — With respect to water closets, earth closets, etc. 1 Mortuary:— Total number of bodies removed 367 Total number of infectious bodies removed 6 73 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK, DURING THE YEAR 1908. 1.—Inspection. Inspection made by Sanitary Inspectors. emises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 223 7 - Workshops (Including Workshop Laundries.) 3991 332 - Workplaces (Including Bakehouses and excluding Outworkers' premises dealt with in Table 3.) 840 116 - Total 5054 455 - 2.—Defects Found. Particulars. Number of Defects. Number of Prosecu- Found. Remedied. Referred to H.M (1) (2) (3) (4) (5) Nuisances under the Publ c Health Acts:—* Want of cleanliness 296 296 — — Want of ventilation 2 2 — — Overcrowding.. — — — — Want of drainage of floors — — — — Other nuisances 73 73 — — Sanitary accommodation insufficient 6 6 — — unsuitable or defective 51 51 — — not separate for sexes 14 14 — — Offenccs under the Factory and Workshop Act: — Illegal occupation or 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 442 442 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. F 74 3. Home Work. NATURE OF WORK. OUTWORKERS LISTS, SECTION 107. Number of inspec tions of outworkers premises. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 and 110. Lists received from Employers. Addresses of Outworkers. Prosecutions. Instances. Notices served. Prosecutions. instances. Orders made. (8. 109.) Prosecutions. (S. 109, 110.) Twice in the Year. Once in the Year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send Lists. Lists. Outworkers. Lists. Outw arkers. Con- Work- Con- Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Wearing Apparel: (1) Making, &c. 46 57 810 8 .. 90 1964 1026 .. .. 1571 113 113 .. 5 .. .. (2) Cleaning & washing .. .. .. .. .. .. 6 .. .. .. 4 .. .. .. .. .. .. Lace, lace curtains, and nets .. .. .. .. .. .. 5 .. .. .. 3 .. .. .. .. .. .. Artificial flowers .. .. .. .. .. .. 135 2 .. .. 109 9 9 .. .. .. .. Furniture and upholstery .. .. .. .. .. .. 12 .. .. .. 12 3 3 .. 2 .. .. Fur pulling .. .. .. .. .. .. 26 1 .. .. 22 1 1 .. .. .. .. Feather sorting .. .. .. .. .. .. 2 .. .. .. 2 .. .. .. .. .. .. Umbrellas, &c .. .. .. .. .. .. 96 4 .. .. 62 4 4 .. .. .. .. Paper bags and boxes 32 .. 472 8 .. 103 424 164 .. .. 680 75 75 .. 8 .. .. Brush making .. .. .. .. .. .. 140 3 .. .. 112 14 14 .. 2 .. .. Total 78 57 1280 16 .. 193 2810 1200 .. .. 2577 219 219 .. 17 .. .. (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. (b) 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 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 27 instances of failures to send lists of outworkers employed in making wearing apparel, &c, and in 40 instances for similar failures in respect to paper bag and box making. 75 4.—Registered Workshops. Workshops oil the Register (s 131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades 728 (a) Cabinet making 424 (b) French Polishing 77 (c) Upholstery 52 (d) Other workers 175 (2) Dress 165 (a) Tailoring 67 (e) Shirt making 4 (b) Mantles 5 (f) Boot & Shoe trades "9 (c) Dress 9 (g) Artificial Flowers 7 (d) Millinery 18 (h) Other workers 16 (3) Skin, leather, hair and feather trades 59 (a) Furriers 5 (b) Saddlery & Harness 24 (c) Feathers 4 (d) Other workers. 26 (4) Paper, printing, book, stationery and fancy goods trades 59 (a) Box & bag makers 37 (b) Other workers 22 (5) Laundry and Washing 30 (6) Food 4 '7) Metals, machines, implements and conveyances 59 8) Precious metals, jewels, &c o (9) Other trades than those mentioned above 77 Total number of workshops on Register 1183 Note.—A separate register is kept for bakehouses, the number of which at the end of the year was 73, including 4 factory bakehouses. 5.—Other Matters. Class. (1) Number. (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 / referring to \ \48 workshops/ Reports (of action taken) sent to H.M. Inspector. g / referring to \ \4S workshops/ — Underground Bakehouses (s. 101) : — Nil. 43 76 6.—Shewing tiie Numbers of Outworkers Received from other Districts During 1908. DISTRICT. Making Wearing Apparel. Cleaning and Washing. Lace Curtains. Artificial Flowers. Furniture and Upholstery Fur Pulling. Feather Sorting. Umbrellas, &c. l'aper Bags and Boxes. Brush Making Total. Feb. Aug. Feb. Aug. Feb. Aug Feb Aug. Feb. Aug. Feb. Aug. Feb. Aug Feb Aug. Feb. Aug. Feb. Aug. Battersea .. 1 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Bethnal Green 52 78 .. .. .. .. .. 6 1 .. .. .. .. .. 1 3 31 25 45 34 276 Camberwell 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Chelsea 3 2 .. . . .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 11 City of London 544 43/ .. .. .. .. 34 17 .. .. 9 12 .. .. .. .. .. .. .. .. 1131 Deptford 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Enfield 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. • • 2 Pinsbury 125 161 .. .. .. .. 11 6 .. .. 1 .. .. 2 2 3 154 136 11 9 621 Fulham .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Hackney 107 172 .. .. .. .. 18 18 4 1 2 .. .. .. 5 4 24 25 19 21 480 Hammersmith 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 5 Hampstead .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 2 Holborn 4 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 10 Ilornsey 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Ilford 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Islington 49 61 .. .. .. .. 15 8 3 3 1 1 .. .. .. .. 12 9 .. .. 162 Kensington 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Lambeth 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Leyton 2 .. .. .. • • .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Poplar 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 St. Marylebone 3 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 7 St Pancras 3 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 Southwark 4 5 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 11 Stepney 17 28 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 1 1 .. 49 Stoke Newington 3 2 .. .. .. .. .. • • .. .. .. .. .. .. .. .. .. .. .. .. 5 Tottenham 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 WalthamHtow 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 West Ham 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Westminster 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Total 998 966 2 4 2 3 78 57 8 4 13 13 .. 2 46 50 224 200 76 64 2810 1964 6 5 135 12 26 2 96 424 140