SHOR 20 REPORT on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1909, by LEWIS T. FRASER BRYETT, M.D. (Lond.), Medical Officer of Health; Diplomate in Public Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health,&c. Printed by Order of the Health Committee printed by chas. straker and sons, ltd., bishop sgate avenue, london, e.c. CONTENTS. Page. Anthrax 34 Artizans' dwellings 43 Appendicitis, mortality from 9 Bacteriological examinations 36 Bakehouses 51 Births in sub-districts 2 Birth rates 3 Cancer 8 Cerebrospinal fever 34 Cholera 34 Coffeehouses 52 Cookshops 52 Cow-houses 47 Customs and Inland Revenue Acts 46 Dairies 47 Deaths in sub-districts 4 Death rate 4 Deaths, ages at 7 Deaths, causes of 6 Deaths in public institutions 9 Deaths in outlying institutions 10 Diarrhoea 30 Diphtheria 17 Disinfection 36 Enteric fever 20 Erysipelas 28 Factories and Workshops Act, 1901 48 factories, workshops and workplaces—sanitary work 49 Food condemned and destroyed 53 Food and Drugs Act 53 Fried fish shops 52 Glanders 34 Housing and Town Planning Act, 1909 46 Houses closed 42 Houses let in lodgings 45 Hydrophobia 34 Ice cream shops 51 Infantile mortality 6 Infectious cases, number certified 13 Infectious cases, number removed to hospitals 13 Infectious diseases, age periods 12 Infectious diseases, deaths from 11 Infectious diseases, death rate 11 Infectious diseases, number of cases notified from schools 35 Influenza 31 Institutions, deaths in 9 Legal proceedings 39 Margarine Act, proceedings under 56 Marriages 4 Measles 30 Milk-shops 47 Milk premises, cowsheds, etc., on register 47 Mortuary 37 Notification of Births Act 3 Offensive business 48 Outworkers 50 Population 1 Puerperal fever 29 Return cases 14 Sanitary work 37 Scarlet fever 16 Scarlet fever, return cases of 14 Schools, closure for infectious disease 36 With the Medical Officer of Health's Compliments. Shoreditch Town Hall, Old Street, London, E. C. Page. Shelter 36 Sickness amongst the poor 11 Slaughter-houses 47 Small-pox 15 Smoke nuisance 41 Staff 58 Street markets and food 52 Tuberculosis 32 Vaccination returns 15 Verminous houses 41 Violence, mortality from 9 Water supply 37 Whooping cough 31 Workshops on register 48 Zymotic diseases, deaths from 12 Zymotic death rate 12 APPENDIX. Statistical Tables :— For whole district during 1908 and previous years (Table I.) 62 For separate localities in 1908 (Table IX.) 63 Cases of infectious disease notified during 1908 (Table III.) 64 Causes of, and ages at, death during year 1908 (Tables IV. and VI.) ... 65 & 68 to 73 Infantile mortality during 1908 (Table V.) 66 -Notes to Tables IV. and V 67 Comparison of London and Shoreditch birth and depth rates in 1908 (Table VII.) 74 Cases treated by District Medical Officer in 1908 (Table VIII.) 75 Summary of proceedings under Public Health (London) Act, 1891 (Table IX.) 76 Factory and Workshop Act—Summary of work (Tables 1, 2, ?, 4, 5 and 6 ... 77 to 80 Metropolitan Borough of shoreditch ANNUAL REPORT of the MEDICAL OFFICER of HEALTH. Health Department, Town Hall, Old Street, E.C. January, 1910. 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 the vital statistics of the Borough of Shoreditch for the year ending December 31st, 1909. POPULATION. The persons resident in the Borough are estimated at 115,285, as compared with 115,042 in 1908, 116,073 in 1907, 110,506 in 1906, 116,939 in 1905, 117,360 in 1904, and 117,740 in 1903. In the registration sub-districts the estimated populations are as follows:-—Shoreditch South, comprising Moorfields, Church and Hoxton Wards, 42,083 ; Shoreditch North-West, comprising Wenlock and Whitmore Wards, 37,372; and Shoreditch North-East, which comprises Kingsland, Haggerston and Acton Wards, 35,830. The estimated populations in the eight wards of the Borough are set out below:— Ward. Population. Ward. Population. Moorfields 5,306 Whitmore 18,100 Church 19,463 Kingsland 10,910 Hoxton 17,314 Haggerston 12,590 Wenlock 19,272 Acton 12,330 Included in the population of Wenlock Ward is that of the Holborn Union Workhouse, which is situate in this ward. This is estimated at 1,373. For certain statistical purposes this population is not regarded as belonging to Shoreditch and is excluded in estimating the population of the Borough, which becomes for these purposes therefore 113,912, whilst that of Wenlock Ward is reduced to 17,899. The population of Shoreditch has been decreasing since 1861. In that year the census showed that there were 129,364 persons resident in the Borough; in 1871 the number was 127,164; in 1881 it was 126,591; in 1891 it fell to 124,009; the census taken in London in 1896 gave 122,358 as the a 2 population; whilst the census of 1901 showed the number to be 118,637. The decrease in the last decennial period was therefore much more marked than in the previous ones. The decrease is largely the result of the erection of warehouses and business premises upon sites formerly occupied by dwelling houses. This is especially the case in the southern portion of the Borough. Another important factor are the facilities afforded by the railway companies and tramways which enable people to reside at a greater distance from their work than formerly. 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 76 238 Church 106 183 Kingsland 72 151 Hoxton 78 222 Haggerston 66 190 Wenlock 90 198 Acton 83 148 For the Borough as a whole the density of the population per acre is estimated at 177. In estimating these figures the population and the area of the Holborn Union Workhouse and also the waterways of the Regents Canal have not been taken into account. BIRTHS. The births registered in the Borough numbered 3,560, of which 1,782 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 3,692, of which 1,860 were of males and 1,832 of females. The distribution of the corrected births in the eight wards of the Borough is given below :— Ward. Males. Females. Total. Moorfields 62 71 133 Church 347 316 663 Hoxton 291 287 678 Wenlock 284 272 556 Whitmore 297 297 594 Kingsland 183 182 365 Haggerston 191 202 393 Acton 205 205 410 Totals 1,860 1,832 3,692 3 Outside the Borough 219 births were registered, 119 of males and 100 of females, the parents being residents of Shoreditch. In the Shoreditch infirmary 143 births were registered, of which 73 were of males and 70 of females. In eight of these (three of males and five of females) the parents did not belong to Shoreditch. In the Holborn Union Workhouse there were 83 births, 40 of males and 43 of females. In 78 of these (38 male and 40 female) the parents were not resident in the Borough. A birth also occurred in Ware Street, the parents being non-residents. Of the births in the Shoreditch Infirmary 50 (26 male and 24 female) were given as illegitimate. In the Holborn Infirmary 46 were returned as such. Elsewhere in the Borough 35 (16 of males and 19 of females) were so returned. Information was supplied by the London County Council as to 671 births belonging to Shoreditch which were attended by registered midwives during the year. Of these 156 were in lying-in hospitals. The birth-rate for the Borough was 32.4 per 1,000 inhabitants, as compared with 32.2 for 1908, 32.4 for 1907, 33.6 for 1906, and 34.2 for 1905. The birthrates for the eight wards of the Borough are contained in Table VII. (Appendix). The births for the whole of England and Wales during 1909 were at the rate of 25.6; for 76 great towns the rate was 25.7 ; and for 143 smaller towns it was 24.8 per 1,000 inhabitants. The birth rate for the Metropolis was 24.2 per 1,000 inhabitants. NOTIFICATION OF BIRTHS ACT, 1907. Upon the recommendation of the Health Committee, the Borough Council adopted the above Act on July 6th, which came into operation in the Borough with the consent of the Local Government Board on August 23rd, and the necessary steps were taken to bring its provisions to the attention of the medical practitioners and midwives practising in Shoreditch and others concerned. The act makes it the duty of the father of the child if he is actually residing in the house where the birth takes place at the time of its occurrence and of any person in attendance upon the mother at the time of, or within six hours after, the birth to notify the birth in writing to the Medical Officer of Health. This notice has to be given by posting a prepaid letter or post-card to the Medical Officer of Health, giving the necessary information of the birth within 36 hours after its occurrence or by delivering a written notice to the Medical Officer of Health. Addressed and stamped post-cards for this purpose have to be supplied free of charge by the sanitary authority. The births notified during the period from August 23 until the end of the year numbered 979. There were 1,204 births registered during the same period. a 2 4 MARRIAGES. The marriages in Shoreditch during 1909 numbered 967, as compared with 972 in 1908, 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 16.9 per 1,000 population, as compared with 15.8 for the whole of London. DEATHS. The deaths during 1909 numbered 2,189, as compared with 2,006 in 1908, 2,365 in 1907, 2,289 in 1906, 2,296 in 1905, and 2,392 in 1904. The number, although higher than that for 1908, was below the average. 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 55 32 87 Church 185 197 382 Hoxton 141 155 296 Wenlock 148 151 299 Whitmore 268 234 502 Kingsland 111 114 225 Haggerston 111 85 196 Acton 106 96 202 Totals 1,125 1,064 2,189 The deaths of males were 61 more than those of females. The death rate of the Borough for 1909 was 19.2* per 1,000 inhabitants as compared with 17.5 in 1908, 20.6 in 1907, 19.8 in 1906, 19.8 in 1905, 20.6 in 1904, and 19.6 in 1903. Although considerably higher than that of last year, the rate was nearly 7 per cent below the average for the previous ten years. The death rate of the Metropolis for 1909 was 14.7 the rate of England and Wales 14.5, that of 76 great towns 15.5, and of 143 smaller towns 13.9 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, and other information bearing upon the mortality amongst the inhabitants * Corrected for age and sex distribution the death-rate was 20.l per 1,000, 5 of Shoreditch during the year. As compared with those of last year, decreases in the death rates of Hoxton and Haggerston Wards may be noted, but the rates of the other six wards are all more or less increased. The death rate in the Borough was lowest in Haggerston and highest in Whitmore, being 15.5 and 27.7 per 1,000 respectively. The death rate of the Borough was markedly above the mean rate for the year from the middle of January until the middle of May. During June, July, and August the rate was well below the mean. Although there was a rise in the rate towards the end of August, it nevertheless remained below the mean during the rest of the year. The rate was highest during the month of March, when it averaged slightly over 30 per 1,000; it was lowest during the period extending from the first week of June to the fourth week of July, the average being 11 per 1,000 inhabitants. The highest rate for any one week occurred in the third week of March, when it reached 34.2 per 1,000; the lowest was in the third week of July, when the rate was only 9.2 per 1,000 inhabitants. The weather during March was cold below the average, and measles, influenza and diseases of the respiratory organs were prevalent. These were to a large extent accountable for the high death rate during the month. The rise towards the end of August was due mainly to the onset of summer diarrhoea which, however, did not affect the death rate this year so markedly as usual. The number of infants who died under one year of age was 512, 297 being males and 215 females, the deaths amounting to a little over 23 per cent. of the total number of deaths at all ages as compared with 25.4 per cent. for last, year. The number of Shoreditch infants under one year dying during 1909 was at the rate of 138 per 1,000 births belonging to Shoreditch registered during the year. This rate is the same as that for 1908, which was the lowest recorded since 1870. The comparatively low infantile mortality this year is to a considerable extent to be accounted for by the deaths from whooping cough, bronchitis, and diarrhoeal diseases not being so numerous as usual. The infantile mortality is higher amongst males than females, the average for the eight years ending 1908 being 183 in the case of the former, and 159 in that of the latter. For 1909 the mortalities were 160 for males and 117 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 6 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 .. 8 4 4 8 3 3 4 34 Scarlet Fever .. .. .. .. .. .. .. .. .. Diphtheria 1 1 1 .. 1 .. .. .. 4 Whooping Cough . . .. 5 4 8 3 5 2 1 28 Diarrhoea (all forms) 1 12 6 6 16 10 3 5 59 Enteritis 1 6 6 4 8 1 1 27 Gastritis and Gastro Intestinal Catarrh.. .. .. .. .. 1 .. .. 1 2 Premature Birth .. 19 9 8 15 7 12 8 78 Congenital Defects .. 6 4 3 3 1 5 1 23 Injury at Birth .. .. .. .. .. 1 .. .. 1 Want of Breast Milk .. .. .. .. 2 1 .. .. 3 Atrophy, Debility and .. .. .. .. .. .. .. .. .. Marasmus 2 14 8 8 20 6 11 6 75 Tuberculous Meningitis .. 3 1 1 .. 1 1 .. 7 Tuberculous Peritonitis and Tabes Mesenterica .. 1 .. 3 1 1 .. .. 6 Other Tuberculous Diseases .. 2 2 1 .. 1 .. .. 6 Erysipelas .. 1 .. .. 3 1 .. 1 6 Syphilis 1 1 2 1 2 1 .. .. 8 Pickets .. 1 .. .. 1 .. .. .. 2 Meningitis (not Tuberculous) .. 1 .. .. 1 .. .. .. 2 Convulsions , , 2 2 2 2 .. .. .. 8 Bronchitis 1 .. 7 6 8 2 4 3 31 Pneumonia 4 6 9 10 8 8 7 4 56 Suffocation, over- tying 3 2 2 1 1 2 5 2 18 Other causes 1 5 4 2 4 3 3 6 28 Totals 15 96 71 68 108 55 57 42 512 7 lated district. It is hoped that the adoption of the Notification of Births Act, already mentioned, and the appointment of a health visitor referred to later in this report, will have the effect of saving the lives of some of the infants who otherwise would perish during the first year of their existence. The deaths amongst children, aged from one to five years numbered 354; of these 86 were attributed to measles, 41 to whooping cough, 3 to scarlet fever, 14 to diphtheria, 18 to diarrhoea, 43 to various forms of tuberculosis, 11 to meningitis, 16 to bronchitis, 69 to pneumonia, and 14 to enteritis. Accident cr negligence was the cause of 13 deaths, 6 of which were the results of burns or scalds. Altogether 866, or a little over 39 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, 80 died. The chief causes were tuberculosis, which accounted for 17 deaths, other infectious diseases which resulted in 27, diseases of the heart and circulatory organs in 10, and accident or negligence which caused 5 deaths. Of persons aged from fifteen to twenty-five years there died 81, of whom 24 fell victims to consumption, 16 to diseases of the heart and circulatory organs, and 3 resulted through accident or negligence. Of persons aged between twenty-five and thirty-five years, there died 104, the chief causes being consumption, which resulted in 37, diseases of the heart and circulatory organs which accounted for 5, pneumonia for 14, and Bright's disease of the kidneys, which caused four deaths. Three deaths were the result of accidents or negligence, and one was homicidal. Between the ages of thirty-five and forty-five years 177 persons died. Of these 46 resulted from consumption, 9 from cancer, 11 from diseases of the nervous system, including 7 from general paralysis, 9 from diseases of the heart and circulatory organs, 33 from pneumonia, 17 from diseases of the organs of digestion, including 7 the result of cirrhosis of the liver, and 10 from Bright's disease. Six were the results of accident or negligence, and two were suicidal. Of persons from forty-five to fifty-five years of age 230 died. Of these 45 succumbed to consumption, 21 to cancer, 16 to apoplexy, 25 to heart disease and diseases of the circulatory organs, 22 to bronchitis, 27 to pneumonia, 12 to cirrhosis of the liver, 11 to kidney disease, and 6 to the results of accidents or negligence. Seven committed suicide. 8 There were 334 deaths amongst persons aged from fifty-five to sixty-five years. Of these 23 were attributed to consumption, 24 to cancer, 15 to apoplexy, 27 to diseases of the heart and circulatory organs, 41 to bronchitis, 33 to pneumonia, 9 to cirrhosis of the liver, 23 to disease of the kidneys, 3 to accident or negligence, and one to suicide. Of persons aged from sixty-five to seventy-five years there died 228, the chief causes being cancer, which resulted in 17, old age 29, diseases of the nervous system 22, including 12 due to apoplexy, diseases of the heart and circulatory organs, which caused 29, bronchitis 47, pneumonia 24, cirrhosis of the liver 6, disease of the kidneys 11, and accident or negligence 6, four of which were caused by vehicles. Of 150 persons who died aged between seventy-five and eighty-five years, in 59 instances death was attributed to the results of old age, in 10 to apoplexy, in 16 to diseases of the heart and circulatory organs, in 22 to bronchitis, in 12 to pneumonia, in 7 to Bright's disease, and in 10 to cancer. Two deaths were attributed to accident or negligence. Of the 39 persons who died, aged 85 years and upwards, 1 died of cancer, 17 old age, 1 apoplexy, 4 diseases of the heart and circulatory organs, 5 of bronchitis, 2 pneumonia, 1 of an affection of the liver, 5 of Bright's disease, 1 from poison and 2 through falls, all three the result of accident or negligence. The chief causes of death in the Borough during the year were:—Tuberculosis, which accounted for 277, including 194 attributed to phthisis or consumption, pneumonia 281, bronchitis 198, diseases of the heart and blood vessels 154, measles 127, old age 105, violence 85, cancer 82, diarrhoea 79, prematurity 78, atrophy, debility, marasmus 71, Bright's disease and other diseases of the kidneys 74, apoplexy 58, whooping cough 73, cirrhosis of the liver and alcoholism 46, and enteritis which was given as the cause of 46 deaths. Of the 82 deaths from cancer 37 were of males and 45 of females. Nine persons under 45 years and 11 persons over 75 years of age were certified to have died of cancer, the remaining 62 deaths were of persons aged between fortyfive and seventy-five years. In addition there were 10 deaths, 5 of males, and 5 of females, which were attributed to malignant disease. In some of these it is probable that cancer was the cause of death. The cancer death rate was 0.72 per 1,000 population. This is markedly above the average. The rates for previous years are as follows:—0.64 in 1908, 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, 9 0.56 in 1900, 0.63 in 1899, 0,58 in 1898, 0.51 in 1897, 0.45 in 1896, 0.50 in 1895, 0.65 in 1894, and 0.54 in 1893. The deaths from malignant disease have not been included in estimating the above rates. Of the deaths attributed to alcoholism and cirrhosis of the liver, a disease which is generally accepted as due to the consumption of alcoholic drink in excess, 28 were of males and 18 of females. The actual number of deaths, however, which were directly or indirectly the result of the abuse of alcohol, in all probability considerably exceeds these figures. Three deaths were certified as due to appendicitis, as compared with 5 in 1908, 1 in 1907, 19 in 1906, 4 in 1905, 7 in 1904, 5 in 1903, 4 in 1902, and 2 in 1901. Three deaths were attributed to peritonitis. Of the 85 deaths from violence, 50 were of males and 35 of females. Through accident or negligence 74 persons met their deaths, the chief causes being burns and scalds, mostly in young children, which accounted for 11, falls chiefly in persons 35 years of age and upwards, which resulted in 22, suffocation in infants through overlaying in bed, which caused 18 deaths, a number considerably lower than that of last year, and vehicular traffic which was the cause of 9 deaths. There was 1 case of homicide in a man, and 10 persons committed suicide, 8 of whom were males and 2 females. 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 4 265 269 Shoreditch Workhouse 527 38 565 Royal Chest Hospital 6 38 44 Convent Hospital 2 2 4 Home of Good Shepherd 15 1 16 Babies' Home 3 2 5 Total 557 346 903 Elsewhere than in public institutions, seven persons not belonging to Shoreditch died within the Borough. 10 In the subjoined table are set forth the various institutions outside Shore ditch with the numbers of persons belonging to the Borough dying therein:— Asylums. No. of Deaths. General Hospitals—continued. No. of Deaths. Banstead 6 St. Bartholomew's 05 Cane Hill 1 West End 1 Caterham 1 Hospitals for Special Diseases, &c. City of London 1 Claybury IV Lying-in, City of London 5 Colney Hatch 9 Chest Hospital, Bethnal Green 1 Darenth 5 Homoepathic 1 Dartford Heath 3 Heart Hospital, Soho 1 Hanwell a Maternity, Hackney 1 Horton 1 Infirmaries and Workhouses. Leavesden 8 Long Grove 5 Bethnal Green Infirmary 8 Manor 3 Belmont Workhouse 6 Tooting Bee 6 Bishop Stortt'ord Workhouse 2 Hospitals for Infectious Disease. Children's infirmary,Carishalton 7 Islington Infirmary 3 Eastern 20 Holborn Infirmary 5 North Eastern £> Hackney Infirmary 5 General Hospitals. St. Pancras Infirmary 1 St. George's Infirmary 3 Charing Cross 1 City Infirmary 1 East London (Children) 5 Whitechapel Infirmary 3 Evelina (Children) 2 German 5 Shoreditch Additional Workhouse 2 Great Northern 1 Wandsworth Infirmary 1 Gt. Ormond Street (Children) 19 Other Institutions. Guy's 2 Vincent's Square (Infants) 1 Italian 1 Aged Pilgrims Asylum 1 King's College 3 Deaf Asylum, Homerton 1 London 32 St. Joseph's Hospice 1 Metropolitan 44 St. Anne's House 1 Mildmay 9 Central London Sick Asylum 1 Paddington (Children) 1 Hostel of God, Clapham 1 Poplar 1 St. Mark's House 1 Queen's (Children) 66 St. Luke's House 3 Royal Free 2 H.M. Prison, Brixton 1 Of 492 persons belonging to Shoreditch dying in public institutions situate beyond the limits of the Borough 331 died in general hospitals including 124 in hospitals for sick children, 69 died in asylums for those mentally unsound, 25 in the fever hospitals of the Metropolitan Asylums Board, 47 in workhouses and infirmaries, 9 in hospitals for special diseases, and 11 in other institutions. Elsewhere than in public institutions 11 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 1,049, or nearly 48 per cent, of the deaths of persons belonging to Shoreditch, took place in public institutions. 11 SICKNESS AMONGST THE POOR. The cases coming under the treatment of the district medical officers in connection with the poor law dispensary during 1909 numbered 5,261, as compared with 4,453 in 1908, 4,380 in 1907, 4,107 in 190G, and 4,014 in 1905. The number, therefore, is markedly above the average for the previous four years. An analysis of the cases is contained in Table VIII. (Appendix). The diseases classed as infectious accounted for 945 of the cases, as compared with 707 in 1908 and 763 in 1907. Measles, influenza, whooping cough, diarrhoea, erysipelas, and consumption caused most of these cases. As compared with the figures for 1908, there are marked increases in the numbers of cases of measles, whooping cough, diarrhoea, and erysipelas. Decreases are noticeable as regards scarlatina, diphtheria and influenza. Diseases of the respiratory organs, which are largely the results of infection, were responsible for 1,444 of the cases as compared with 1,268 for 1908, a very notable increase. Of these bronchitis was credited with 1,279, whilst 102 were attributed to pneumonia. Rheumatism was given as the cause of illness in 355 cases, an increase of 20 on the figure for 1908. The cases of rheumatic fever numbered 47, as compared with 32 for last year. The cases of gout numbered 104, which is also an increase on the number for last year. Dyspepsia and other disorders of the digestive system numbered 629, an increase of 180 on the figures for the previous year. The cases of cancer numbered 36, as compared with 14 in 1908, 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. A marked increase in the number of cases of disease of the locomotive system is noticeable, and the same may also be said as regards diseases of the skin. INFECTIOUS DISEASES. 1 he infectious diseases included under the headings numbered 1 to 35 inclusive and 171 in Table VI. (Appendix) resulted in 676 deaths as compared with 622 in 1908, 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, although more numerous than in 1908, considerably below the average for the previous eight years. They amounted to 30.8 per cent. of the deaths from all causes as compared with 30.7 for 1908, and 31.5 per cent. for 1907. As compared with the figures for 1908 there was a marked increase in the number of death's from measles, whooping cough, and diphtheria, whilst the number of deaths from scarlet fever, diarrhoea, and consumption show a decrease. The deaths from consumption and other forms of tuberculosis amounted to approximately 41 per cent. of the deaths from infectious disease, 12 whilst of the remainder measles, diarrhoea and whooping cough in the order given were responsible for the greater number. The death rate from these infectious diseases was 5.9 per 1,000 inhabitants as compared with 5.4 in 1908, 6.5 in 1907, 0.7 in 1906, 6.2 in 1905, 6.8 in 1904, and 6.5 in 1903. Although higher than for the previous year, it was considerably below the average. 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 52 35-45 45-55 55-65 65-75 75-85 85 and upwards No. of deaths 167 207 33 13 16 20 57 54 31 19 7 It will be noticed that more than half of these deaths during the year were of children under the age of live years. Taking the total number of deaths of children under five years of age from all causes, 43 per cent, resulted from the infectious diseases referred to as compared with 40 per cent, in 1908, and 42 per cent, in 1907. In infants under one year, diarrhoea, measles, whooping cough, and tuberculosis were the most fatal. Amongst children aged from one to five years, measles, tuberculosis, and whooping cough claimed most victims. The chief cause of the mortality from these diseases amongst persons aged from twenty to sixty-five years was consumption. The deaths from the principal zymotic diseases, namely, smallpox, measles, scarlet fever, diphtheria including membranous croup, whooping cough, enteric fever and diarrhoea numbered 314, the death-rate due to them, which is termed the zymotic death-rate, being 2.7 per 1,000 inhabitants, as compared with 1.9 in 1908, 2.9 in 1907, 3.1 in 1906, 2.8 in 1905, 3.2 in 1904, 2.8 in 1903, 3.6 in 1902, 2.9 in 1901, 3.1 in 1900, 3.6 in 1899, 4.1 in 1898, 4.2 in 1897, 4.3 in 1896, 3.8 in 1895, 2.8 in 1894 and 4.7 in 1893. The zymotic death-rate therefore although higher than that of 1908 was nevertheless considerably below the average. A comparison of the zymotic death rates of London and Shoreditch and the eight wards of the Borough is given in table VII. (Appendix). The rate was highest in Whitmore and lowest in Moorfields Ward, being 4.1 per 1,000 in the former and 0.5 in the latter. In connection with this it should be noted that the density of the population per acre in Whitmore Ward is more than three times as great as that in Moorfields. The cases of notifiable infectious disease numbered 729, being 299 less than in 1908. The number of cases annually certified since 1889, and the attackrates per 1,000 inhabitants, are contained in the following table:— Year. Number of cases. Attack-rate per 1,000 inhabitants. 1890 1158 9.4 1891 862 7.0 1892 1478 12.0 1893 1987 16.2 1891 1104 9.0 1895 1157 9.4 1896 1473 12.1 1897 1331 10.9 1898 960 7.8 1899 1116 9.2 1900 989 8.1 1901 1146 9.8 1902 1239 10.5 1903 664 5.6 1901 770 6.6 1905 1151 9.8 1906 951 8.2 1907 1265 10.8 1908 1028 8.8 1909 729 6.3 The cases of notifiable infectious disease certified in the Metropolis during 1909 amounted to 29,618, including cases notified as Cerebro Spinal Fever which has been a notifiable disease since March, 1907, the attack-rate being 6.0 per 1,000 population, as compared with 7.5 for 1908. 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 Scar- latina 108 65 106 60 339 7 Diphtheria & Membra- nous Croup 60 57 26 40 183 21 Typhus .. .. .. . . .. .. Cholera .. .. .. .. .. .. Enteric Fever (Typhoid) 32 7 5 5 49 6 Continued Fever .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. Puerperal Fever 5 4 2 2 13 4 Erysipelas 37 27 25 54 143 16 Plague .. .. .. .. .. .. Cerebro Spinal Fever 2 .. .. .. 2 3* Totals 244 160 164 161 729 57 Numbers and percentages of cases removed to hospitals 201 125 138 104 568 82% 78% 84% 65% 78% * In one case of Cerebro Spinal Fever, which proved fatal, the disease was not recognised until after death. 14 As compared with the figures for 1908 the cases of scarlet fever were 241 fewer than for that year. There was also a marked decrease in the number of cases of enteric fever, and there were not so many cases of diphtheria and cerebro-spinal fever certified. The cases of erysipelas were more numerous and there was a marked increase in the number of cases of puerperal fever. The deaths from notifiable infectious disease were fewer than in 1908. The deaths from the principal zymotic diseases which are notifiable, namely, smallpox, scarlet fever, diphtheria and enteric fever were at the rate of 0.29 per 1,000 population, whilst the rate from the principal zymotic diseases which are not notifiable, namely, measles, whooping cough and diarrhoea was 2.44 per 1,000 population. ISOLATION OF INFECTIOUS CASES. Most of the cases of infectious disease removed to hospital were taken to hospitals of the Metropolitan Asylums Board. Many of the cases of enteric fever, puerperal fever and erysipelas were treated in the Shoreditch Infirmary and several cases of enteric fever in General Hospitals. The infectious diseases, cases of which are receivable into the Board's Hospitals are smallpox, scarlet fever, diphtheria, enteric fever, and cerebro-spinal fever. The number of cases of these diseases certified was 573 and the number removed to hospital 554, giving a percentage of nearly 97, which is slightly below that of last year, which was 97.3, as compared with 97.5 in 1907 and 96 per cent. in 1906. The percentages for previous years are contained in the report for 1905. It is satisfactory to again have to report such a high percentage of removals, for as has been pointed out on previous occasions, efficient isolation of cases of .lfectious disease in the homes of the people in a densely populated locality like Shoreditch is practically impossible. RETURN CASES. Two instances came under observation where there were recurrences of scarlet fever in houses subsequent to the return of scarlet fever convalescents from hospital : — Rose T-aged 13, was removed to hospital with scarlet fever on March 11th, and returned home on April 22nd, having been in hospital 42 days ; Constance T-, aged 5, was also removed on March 11th with the same disease, returning on April 30th after 50 days in hospital; and Violet T-, aged 9, was removed with scarlet fever on March 23rd, and returned home on May 5th after being in hospital 43 days; Frederick T-, aged 9, was taken ill with scarlet fever on May 9th, four days after the return of his sister Violet. It was noticed that Violet had adenoids, otherwise nothing was observed about h er to indicate her being infectious. 15 Caroline G-, aged 4, was removed to hospital with scarlet fever on August 13th, and returned home on September 28th, after being in hospital 4G days. Florence G-, aged 2, was taken ill with scarlet fever on October 1st, and removed to hospital. The mother stated that she noticed nothing particular in respect to Caroline on her return from hospital except a small reddish patch on her upper lip beneath her nose. This patch increased in size, and when the child came under observation on October 4th she had sore nostrils and scabbing places on her head, besides a discharge from her nose. As another child, Sarah C-, a relative of Caroline's, was, a day or two later, certified to have scarlet fever, it was thought advisable for Caroline to be again isolated. The following instance of recurrence of diphtheria occurred:—Agnes B-, aged 10, of 49, M-Row, was removed to hospital on April 21st, and returned home on June 14, after isolation in hospital for 54 days. On her return she is stated to have embraced Matilda H-, of No. 51, M-Row. The latter was taken ill with diphtheria on June 19th, and certified to have the disease on June 24th. The following is an instance of the recurrence of diphtheria in the same patient: —Colin C-, aged 5, was removed to hospital on March 13th with diphtheria. He returned home on June 7th, after having been in hospital for 86 days. On June 9th, two days after his return he was again certified and removed to hospital with diphtheria. The percentage of return cases in respect to the number of cases of scarlet fever removed to hospital was 0.9, as compared with 1.7 in 1908, 1.9 in 1907 and 1.5 in 1906. It was, therefore, considerably below the average. SMALLPOX. There were no cases of smallpox certified in Shoreditch during 1909. In London some 23 were certified, most of them during the latter part of the year. There were also cases in other parts of the country. It is now nearly five years since the last case of smallpox occurred in Shoreditch. VACCINATION. The official figures as to vaccination are those published in the annual reports of the Medical Officer of the Local Government Board. The latest relate to the year 1907. Of the births registered during that year 56.8 per cent, were successfully vaccinated and 31.2 per cent. were not finally accounted for. The last figure includes postponed cases. Excluding those dying un-vaccinated 33.3 per cent. of the children whose births were registered during 1907 remained unvaccinated at the end of the year. Certificates as to conscientious objection were received by the vaccination authorities in respect to 77 children, or 2.1 per cent. of the births registered, as compared with 0.7 per cent. in 1906, 0.8 in 1905, 0.5 in 1904, 0.6 in 1903, and 0.3 in 1902. 16 In the following table are contained the percentages of children born not finally accounted for as regards vaccination, including postponed cases, each year from 1890 to 1907 for Shoreditch, the Metropolis, and the rest of England: — Year. Shoreditch. Metropolis. Rest of England. Year. Shoreditch. Metropolis. Rest of England. 1891 8.8 16.4 12.9 1900 52.8 25.8 13.9 1892 10.8 18.4 14.3 1901 44.4 24.1 11.2 1893 16.2 18.2 15.7 1902 36.1 21.3 10.0 1894 33.9 20.6 19.0 1903 36.0 20.7 9.1 1895 4 7.5 24.9 19.8 1904 34.2 19.1 8.7 1896 55.5 26.4 22.3 1905 35.9 18.9 8.6 1897 67.4 29.1 21.6 1906 32.6 21.2 9.5 1898 68.4 33.0 19.6 1907 31.2 22.7 10.3 1899 54.2 27.7 15.4 The above figures indicate that since 1898 there has been a marked improvement as regards the state of vaccination in the Borough. SCARLET FEVER. The cases certified during 1909 numbered 339, as compared with 590 in 1908, 876 in 1907, 629 in 1906, 789 in 1905, 343 in 1904, and 255 in 1903. In 29, or 8.5 per cent, of the cases certified, intimations were received from the Metropolitan Asylums Board that the patients had not been suffering from scarlet fever. Adding one case of scarlet fever, which was notified as diphtheria the corrected number of cases was 321, as compared with 573 in 1908, 822 in 1907, 599 in 1906, 778 in 1905, 326 in 1904, and 237 in 1903. The distribution of the cases certified and the deaths amongst males anc females during the year in the Borough and its eight wards is as shown in the subjoined table:— Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 10 8 18 .. .. .. Church 25 30 55 .. 3 3 Hoxton 25 35 60 .. 1 1 Wenlock 19 25 44 .. 1 1 Whitmore 21 35 56 1 .. 1 Kingsland 11 14 25 .. .. .. Haggerston 12 21 33 .. .. .. Acton 24 24 48 .. 1 1 Total for Borough 147 192 339 1 6 7 17 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified 332, or 97.9 per cent, were removed to hospital, as compared with 97.9 in 1908, 98.6 in 1907, 97.4 in 1906, 97 in 1905, and 90 in 1904. The percentages for previous years are given in the report for 1903. The cases certified were at the rate of 2.9 per 1,000 inhabitants, as compared with 5.1 in 1908, 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 rate was highest in Acton Ward and lowest in Wenlock, being 3.9 in the former and 2.2 per 1,000 inhabitants in the latter ward. The deaths numbered 7, as compared with 28 in 1908, 28 in 1907, 20 in 1906, 27 in 1905, and 13 in 1904, the death-rate being 0.06 per 1,000 population, as compared with 0.24 in 1908, 0.24 in 1907, 0.17 in 1906, 0.23 in 1905 and 0.11 in 1904. The case-mortality was at the rate of 2.0 per cent, of the cases certified as compared with 4.7 per cent, in 1908, 3.1 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. Both the death-rate and case-mortality were this year considerably below the average. Amongst children under five years of age there were 130 cases, with 3 deaths, the case mortality being 2.3 per cent, (allowing for mistakes in diagnosis 2.6 per cent.), as compared with 8.9 in 1908, 7.2 in 1907, 6 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 209 cases with 4 deaths; the mortality being at the rate of 1.9 per cent, of the cases certified (allowing for errors in diagnosis 2.0), as compared with 2.2 in 1908, 1.2 in 1907, 1.3 in 1906, 1.0 in 1905, 1.8 in 1904, 2.7 in 1903, and 1.7 in 1901. The whole of the deaths from scarlet fever were amongst children under 10 years of age. Throughout the Metropolis some 17,272 cases were certified, the attack rate being 3.5 per 1,000 inhabitants, as compared with 4.6 in 1908, 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 in 1900. The deaths numbered 383, the death-rate being 0.08 per 1,000, as compared with 0.11 in 1908, 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 above figures indicate that in Shoreditch and London generally scarlet fever during 1909 was below the average, both in respect to prevalence and mortality. It may also be remarked that the attack-rate and death-rate in Shoreditch were below the average for the Metropolis. DIPHTHERIA The cases certified, including 4 of membranous croup, numbered 183, as compared with 202 in 1908 and 211 in 1907. Of these 25 or 13.5 per cent, were not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board. In one instance a case after removal to hospital certified to be scarlet fever proved to be diphtheria. b 18 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 10 19 .. 1 1 Church 19 9 28 2 2 4 Hoxton 14 11 28 3 3 6 Wenlock 15 12 27 2 .. 2 Whitmor 13 21 34 1 4 5 Kuigsland 12 7 19 .. 1 1 Haggerston 6 8 14 .. 2 2 Acton 5 9 14 .. .. .. Total for Borough 93 90 183 8 13 21 These cases are grouped according to ages in Table III. (Appendix). Of the cases certified, 96 per cent, were removed to hospital, as compared with 90 per cent, in 1908, 94 in 1907, 91 in 1906, 93 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 6.5 in 1896. The cases certified were at the rate of 1.5 per 1,000 inhabitants, as compared with 1.7 in 1908. The attack rate was highest in Moorfields, and lowest in Acton and Haggerston Wards, being 3.5 per 1,000 inhabitants in the former and 1.1 in the latter wards. The deaths numbered 21, the death rate being 0.18 per 1,000, as compared with 0.11 in 1908, 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 diphtheria death rates in the wards of the Borough are contained in Table VII. (Appendix). The rate was highest in Hoxton Ward. For the second year in succession no deaths from diphtheria occurred amongst the inhabitants of Acton Ward. The case mortality was 11.5 per cent, of the cases certified, as compared with 6.4 in 1908, 9.5 in 1907, 10.5 in 1906, 15.2 in 1905, and 10.3 in 1904. The case mortalities for previous years are contained in the report for 1906. Of the deaths during 1909, 18 were of children under five years of age, the mortality being at the rate of 15.7 per cent of the cases certified amongst children belonging to that age period (17.6 per cent., allowing for errors in diagnosis), as compared with 9.5 in 1908, 15.6 in 1907, 16 in 1906, 14.7 in 19 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 case mortality amongst persons over five years of age was 4.3 per cent, of the cases certified. Deducting the cases not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board, the mortality was 5.3 per cent. The whole of the deaths from diphtheria were of children under the age of 10 years. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 158 of the cases certified during the year, they were distributed amongst males and females at certain age periods as set out in the subjoined table:— Age Period. Male. Female. Total. Under 1 year 4 7 11 From 1 to 2 years 11 11 22 „ 2 ,,3 ,, 11 10 21 „ 3 ,, 4 ,, 16 11 27 4 „ 5 ,, 16 4 20 5 ,, 10 ,, 12 23 35 „ 10 „13 „ 1 7 8 Over 13 years 7 7 14 Total 78 80 158 In 58 of the cases the patients were children attending school, and in 39 of these they were at school within a week of being certified as having the disease. There were instances in which the children were at school whilst actually suffering from diphtheria before the nature of their illness was recognised. In 91 other cases, although the patients themselves were not schoolgoing children, there were other children in the houses who were. In 24 instances the histories showed that there had been cases of "sore throat" amongst the inmates of the houses in which the patients resided. In 28 instances there was evidence pointing to infection from previous cases in the Borough. In 109 instances the houses were occupied by members of more than one family, in 29 by single families, and in 20 instances the cases occurred in artizans' dwellings of the block type. With regard to the sanitary condition of the dwellings, in 89 this was satisfactory, in 25 fairly so, and in 44 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. B 2 20 The cases certified as diphtheria in London numbered 6,783, as compared with 7,840 in 1908 and 8,585 in 1907, the attack rates being 1.4, 1.6, and 1.8 per 1,000 population respectively. The deaths in London numbered 605, as compared with 724 in 1908 and 781 in 1907, the death rate being 0.12, 0.15, and 0.16 per 1,000 population respectively. The figures show that in Shoreditch during 1909 diphtheria was slightly more prevalent, and that the mortality was a little higher than in the Metropolis as a whole. ENTERIC OR TYPHOID FEVER. The cases certified during 1909 numbered 49, of which 5 were subsequently not regarded as enteric fever by the Metropolitan Asylums Board Authorities, and there was also one other, a fatal case, which was in all probability not one of enteric fever. The numbers of cases certified year by year since 1889 are set out in the following table:— Year. Number of Cafes. Year. Number of Cases 1890 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 1909 49 A marked reduction in the number of cases certified as compared with the number for 1908 is noticeable. The majority of the cases occurred during the first four months of the year. They were certified at the rate of 0.4 per 1,000 population as compared with 0.8 in 1908, 0.3 in 1907, 0.3 in 1906, 0.3 in 1905, 0.4 in 1905, and 0.8 in 1903. The deaths during the year numbered 6, the deathrate being 0.05 per 1,000 inhabitants as compared with 0.09 in 1908, 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 enteric fever death rate for 1909 was therefore below the average for the previous nine years. The case-mortality was at the rate of 12.2 per cent. of the cases certified, or, deducting the cases not regarded as having been enteric fever, the mortality was 11.6 per cent. The case-mortality for 1908, 1907, and 1906 were 10.9, 17.6, and 10 per cent. respectively. 21 The distribution of the cases certified, and deaths amongst males and females in the Borough and the eight wards thereof during 1909 is shown in the subjoined table: — Wards. ENTERIC FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfielda 1 2 3 .. ] 1 Church 2 6 8 1 .. 1 Hoxton 2 1 3 .. .. .. Wenlock 1 2 3 .. .. Whitmore 10 8 18 2 2 4 Kingsland 2 2 4 .. .. .. Haggerston .. 1 1 .. .. .. Acton 6 3 9 .. .. .. Total for Borough 24 25 49 3 3 6 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified, 44, or approximately 90 per cent., were removed to hospital for treatment. The majority of the cases were connectable with previous cases in the Borough, and a continuation of the series commented on in my Annual Report for 1908. Although in one or two instances shellfish had been eaten, nothing of any value was forthcoming as a result of the enquiries made to show that any common vehicle of infection such as water, milk, shellfish, ice cream, or fried fish, played a part in connection with the spread of infection, nor was there any reason for believing the drains or sanitary arrangements responsible. The particular streets which were more especially affected in 1908, namely, Ware Street, Louisa Street, Nancy Street, Watson's Place, and Wilmer Gardens were practically free from the disease in 1909. Cases occurred at two houses in Wilmer Gardens, otherwise they would have been entirely free. Although Whitmore Ward was again most heavily invaded, the cases were more evenly distributed throughout the Borough than in 1908. 22 23 Below are set out briefly particulars as to the age and sex of the patients, dates of invasion and notification, the sanitary condition of the dwellings and the probable source of infection. The list includes one case which was not certified. One or two other uncertified cases are referred to in the remarks as to the probable source of infection. Cases certified but subsequently not regarded as enteric fever are excluded : 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 A.L. M. 15 35, Ivy Lane Dec. 17 Jan. 1 Satisfactory 2 A.C. M. 48 41, Ashford Street Dec. ? Jan. 4 Satisfactory Disinfecting officer in service of Borough Council. Handling bedding from enteric fever patients. 3 A.R. F. 22 Chest Hospital, City Road Dec. 23 Jan. 4 Satisfactory A probationer nurse in the Ward where case 63 {vide report for 1908) was being treated. 4 F.W. M. 4 10, Hertford Street Jan. 1 Jan. 9 Satisfactory Case 100 {vide report for 1908). 5 F.W. F. 15 69, Granville Buildings Dec. 26 Jan. 14 Satisfactory S.F.C. aet 25/12 son to case 16 (below), and nephew to case 5, was ill with diarrhoea, sickness, and wasting, from the end of November. Was in Great Ormonde Street Hospital with inflammation of bowels, December 10th to 24th. History suggests enteric. His mother use to take him shopping in Hoxton Street in neighbourhood where cases had been. 6 J. W. F. 27 10, Hertford Street Jan. 9 Jan, 14 Satisfactory Case 100 (vide report for 1908). 7 T. L. M. 21 35, Ivy Lane Jan. 4 Jan. 16 Satisfactory Case 1 (above), patients were brothers. 8 A. P. F. 10/2 26, Hoxton Square Jan. 16 Fair Case 9 (below), who is her mother. 9 F. P. F. 34 26, Hoxton Square 6, Hertford Street Dec. 1 Jan. 18 Fair Case 15, who is her son. 10 W.P. M. 40 Jan. 9 Jan. 16 Fair Case 11 (below), or Case, 100 {vide report for 1908). This patient's wife was aunt to Case 11 and nursed her when she became ill. 11 E.S. F. 28 10, Hertford Street Jan. 1 Jan. 18 Satisfactory Case 100 (vide report for 1908). 12 B.H. F. 29 24, Wilmer Gardens Nov. 18 Jan. 18 Fair This patient was a friend of Case 48 {vide report for 1908). Case 48 was treated in the Shoreditch Infirmary, and left that Institution about January 1st, 1909. B.F. visited her from time to time when she was in the Infirmary. See remarks to cases 18 and 19. 13 S.B. F. 21 10, Hertford Street Jan. 9 Jan. 19 Satisfactory Case 100 (vide report for 1908). This patient was sister to Case 6 and resided with her. 14 E.B. F. 26 48, Essex Street Dec. 12 Jan. 25 This patient resided at 41, Wilmer Gardens until December 2nd, 1908. A Mrs. C. residing with E.B., 48, Essex Street, was sister to Case 12, and looked after her when she was first taken ill. 15 H.P. M. 7 26, Hoxton Square Nov. 15 Not certified. Fair 16 F.C. M. 30 69, Granville Buildings Jan. 12 Jan. 22 Satisfactory Case 5 or possibly same source of infection as Case 5, viz., J.F.C. 17 T.C. F. 3 191, Hoxton Street Jan. 23 Satisfactory Patient appears to have contracted infection whilst in Eastern Fever Hospital whither she was moved with Scarlatina on December 10th, 1908. (James S. aet 44, father of these patients, was ailing from about November 10th. He died on December 15th from "Congestion of the Lungs." History of illness suggested enteric fever. 18 E.T.S. M. 9 6/19 71, Wilmer Gardens Jan. 12 Jan. 28 Unsatisfactory Sarah A. S. aet 8, was ailing from about 19 s.s. F. 17 71, Wilmer Gardens Jan. 20 Feb. 1 Unsatisfactory December 29th, 1908, admitted to Shoreditch Infirmary as a case of Phthisis, recovered and was discharged January 28th. History suggests, Enteric Fever. James S. appears to have been an intimate friend of Case 12. 24 25 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. 20 F.T. M. 29 71, Nicholas Street Jan. 21 Feb. 4 Satisfactory 21 W.H.C.W. M. 34 11, Clarissa Street Jan. 28 Feb. 8 Satisfactory 22 P.F. F. 2 4, Eleanor House Jan. 24 Feb. 7 Satisfactory 23 W.W. M. 9 22, Harvey Street Jan. 26 Feb. 14 Unsatisfactory This case is probably connected with the cases in the N. family (vide cases 99, 101 and 102, Annual Report, 1908). Two children belonging to case 99 (vide Annual Report, 1908) were taken cave of by Mrs. W. These children were poorly at the time. 24 H.K. M. 16 6, Lee Street Jan. 24 Feb. 15 Satisfactory 25 L.M.B. F. 22 29, Gt. James Street Jan. 20 Feb. 16 Satisfactory 26 E.H. F. 36 4, Crooked Billet Yard Jan. 15 Feb. 19 Unsatisfactory 27 E.A.P. F. 25 Shoreditch Infirmary Feb. 3 Feb. 19 Satisfactory Nurse in the Shoreditch Infirmary—was nursing enteric fever patients amongst others cases 101 and 102 (vide Annual Report for 1908). 28 L.F. F. 11 97, St. John's Road Jan. 24 Feb. 20 Satisfactory The mother of this patient appears to have been a friend of case 12. 29 H.W. M. 1/1 0/2 24, Harvey Street Feb. 10 Feb. 22 Satisfactory This child is a relative of Case 23. Was in the room and on the bed in which Case 23 was lying ill. 30 A.E.L. F. 5 40, Ivy Street Feb. 19 Feb. 22 Unsatisfactory The mother of this patient appears to have been an acquaintance of Case 12. A.E L. also appears to have been in contact with Case 28. 31 H.W. M. 22 9, Penn Street Feb. 26 Mar. 7 Satisfactory This patient is father to Case 29 and probably was infected through his child. 32 M.S. F. 49 71, Nicholas Street Feb. 7 Mar. 13 Satisfactory Case 20. 33 E.W. F. 25 22, Harvey Street March 1 Mar. 21 Fair This patient was sister to Case 23. Helped wait on him before his removal. She was also with H.W. Case 31 at 9, Penn Street—her brother. She visited her relatives whilst they were ill with enteric fever in hospital. 34 F.B. F. 24 Shoreditch Infirmary April 1 April 15 Satisfactory A nurse in the Shoreditch Infirmary— Assisted in the nursing of Case 27, who was probably the source of infection in her case. 35 G.N. M. 6 43, Hemsworth Street April 7 May 5 Satisfactory Possibly connected with Case 28. The patients are cousins and the mother of Case 28 is now living at 43, Hemsworth Street. She was visiting her daughter in the Fever Hospital. 36 T.B. M. 72 10, Norris Street April 30 June 15 Fair 37 R.D. F. 23 28, Cæsar Street May 21 June 17 Satisfactory Not infected in Shoreditch. 38 H.T. F. 17 22, Fleming Street May 24 July 1 Satisfactory This patient's mother was ill with what was, in all probability, enteric fever for several weeks during March and April. The mother's case may have been connected with cases in Hertford Street. 39 W.E.R. M. 12 42, Lee Street Aug. 23 Sept. 22 Satisfactory Was at Banwell in Somerset, August 5th-19th, probably infected there. 40 F.M. M. 11 4, Gifford Street Aug. 25 Sept. 24 Satisfactory Was at Banwell in Somerset, August 5th-19th, probably infected there. 41 J.H. M. 27 56, Weymouth Terrace Sept. 18 Oct. 9 Satisfactory At the time of infection was a resident of Austin Street, Bethnal Green. Stated to have had cockles about September 9th. 42 B.W. M. 21 89, Westmoreland Place Oct. 8 Oct. 22 Unsatisfactory 43 M.A.M. F. 29 12, Alexandra Buildings.. Dec. 11 Dec. 30 Satisfactory 26 The last case in which there was reason for suspecting connection with previous cases in the Borough was case 38 in the foregoing list. It will be noticed that this patient although ailing from the end of May was not certified until July 1st. Five cases only were certified during the latter half of the year. There was no reason for believing that these were associated with previous cases in Shoreditch. With regard to cases.39 and 40 information was received that there had been cases of enteric fever in the neighbourhood where the boys were residing at Banwell whilst staying there on a holiday. Case No. 2, that of the disinfecting officer may be noted. There had been no illness suggestive of enteric fever in the house in which he resided nor in the immediate neighbourhood. He had for months been handling bedding and textile articles from cases of enteric fever, and there is little doubt that he contracted the disease whilst following his occupation. It may be mentioned that he was in the habit of chewing tobacco whilst at work. It is possible that he may have infected some of the tobacco whilst putting it into his mouth. With regard to the cases at 69, Granville Buildings, the probability is that J. F. C. was the source of infection in the dwelling (see note to case 5). No history was obtained to throw light on the source of infection in his case. It may be mentioned, however, that the family before moving to No. 69, Granville Buildings, resided in the neighbourhood where a number of cases of enteric fever occurred, and it is not improbable that the mother had friends and acquaintances in some of the infected families. It is possible that the child may have received infection whilst with its mother shopping in the neighbourhood where these infected families were. With respect to the cases at 71, Wilmer Gardens, it may be noted that from November 10th, 1908, until January 28, 1909, when the first case was certified, a period extending over eleven weeks, there was in all probability the infection of enteric fever in the house. There have been other instances also in connection with this series of cases, in which long periods have elapsed before the nature of the illness has been recognised, notably the cases at No. 2, Nancy Street, and 30, Ware Street (cases 7 and 70 Annual Report for 1908). It may be mentioned too that in other series of cases which have been investigated in Shoreditch during the past 12 years similar instances have been observed. They indicate the facility with which enteric fever may escape recognition, and the consequent danger of infection to the other inmates of the infected household and the friends and relatives of the infected family. Attention may be directed to the probable dates of invasion and the dates of notification. There is practically in all the cases a considerable interval between the date the patient becomes unwell and the date of removal to hospital. This interval is rarely less than 10 days, and frequently amounts to three weeks or a month, or sometimes even longer. Occasionally it has been 27 noted that the patient has undergone an attack of enteric fever without the disease having been recognised at the time at all. During the early stages of the illness before its recognition, every case of enteric fever is a danger, and remains so until it is isolated and properly dealt with. It is, in fact, a carrier of infection. Instances have been recorded of outbreaks of enteric fever attributable to what are termed "carrier" cases. Such cases are persons who, having had an attack of enteric fever and recovered therefrom, nevertheless, from time to time, pass the micro-organisms of enteric fever with their dejecta. The evidence which has been put forward leaves little doubt as to such cases resulting in outbreaks as described in the reports published about them. In like manner every case of enteric fever so long as the patient is able to go about is liable to infect those with whom he comes in contact. They are, in fact, carriers of the disease. Even after isolation and with all the precaution of modern nursing some risk still remains. Nurses take the disease from the patients. Case 27 is an instance of this which occurred this year. This nurse had been nursing cases of enteric fever in the infirmary for several months. She, unfortunately, lost her life. Case 34 is another instance. This nurse in all probability took the disease whilst assisting in the nursing of case 27. She made a good recovery after a long illness. Altogether, it came to my knowledge that seven persons whose duty brought them into contact with enteric fever cases either in connection with nursing or disinfection took the disease during the years 1908 and 1909, whilst following their avocations with respect to the cases in Shoreditch. According to the probable dates of invasion, the monthly numbers of cases of enteric fever occurring in the Borough during 1908 and 1909 were as set out below:— 1908. 1909. Month. No. of Cases. No. of Cases. 2 19 February 3 5 March 4 1 April 2 3 May 4 2 June 9 — July 16 — August 9 2 September 14 1 October 12 1 November 23 1 December 13 3 28 Included in the above table are the cases which were not certified as enteric fever and also three cases which were not notified until the current year, but which were taken ill in November and December, 1909. It will be noted that the numbers were steady, month by month, until June, 1908. From June to November, 1908, they varied somewhat, but were markedly increased. The maximum was reached in November, but the cases were numerous in January, 1909, after which they rapidly decreased. The figures do not suggest the explosive character of an outbreak due to any common cause, such as water or milk or other common vehicle of infection. To sum up the results of the investigations made with respect to the prevalence of enteric fever in Shoreditch during the past two years: the majority of the cases were connectable with previous cases in the Borough. With few exceptions, such as those who contracted the disease in the execution of their duty in connection with the sick, the cases were practically confined to very poor people in the Borough. Their habits and the conditions generally under which they dwelt were such as to favour contamination of food in the household, and in all probability such infected food was usually the vehicle for the transference of infection from person to person in the same house. The close relationship which existed in several instances between families resident in different houses favoured the transference of infection from house to house. The presence of unrecognised cases, especially in infants and children, materially assisted in the dissemination of infection, and in this respect it is also to be noted that in the majority of the cases which were eventually certified very appreciable periods of time, amounting in some instances to three weeks or a month, elapsed before the cases were isolated. There was no evidence that defective drains or sanitary arrangements played any conspicuous part in favouring the prevalence of the disease, nor as the result of the enquiries made was there any reasons for suspecting contamination of any common food supply. Nothing was obtained to indicate that milk, shellfish, fried fish, ice cream or water were concerned in the prevalence of the disease. The cases of enteric fever certified in the Metropolis numbered 1,049, as compared with 1,350 in 1908, 1,390 in 1907, and 1,608 in 190G. The attackrate was 0.2 per 1,000 population. The deaths numbered 146, as compared with 225 in 1908, the death-rate being 0.03 per 1,000 inhabitants. ERYSIPELAS. The cases certified as erysipelas numbered 143 as compared with 124 in 1908, 133 in 1907, 144 in 1906, 138 in 1905, 183 in 1904, 147 in 1903, and 172 in 1902. The deaths numbered 16 as compared with 5 in 1908, 6 in 29 1907, 2 in 1906, 3 in 1905, 5 in 1904, 7 in 1903, 8 in 1902, 6 in 1901, 10 in 1900, and 16 in 1899. The figures for previous years are given in last year's report. The deaths during 1909 were more numerous than usual. The cases and deaths amongst males and females in the Borough in its eight wards were distributed as set out below:— Ward. ERYSIPELAS. Cases Certified. Fatai. Cases. Male. Female. Total. Male. Female. Total.[/##] Moorfields 5 1 6 .. .. .. Church 12 23 35 1 2 3 Hoxton 6 14 20 1 .. 1 Wenlock 14 12 26 1 1 2 Whitmore 11 11 22 2 3 5 Kingsland 6 6 12 2 1 3 Haggerston 5 6 11 .. .. .. Acton 5 6 11 .. 2 2 Total for Borough 64 79 143 7 9 16 The death-rate was 0.14 per 1,000 inhabitants, as compared with 0.04 in 1908, 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 11.2 per cent. of the cases certified, as compared with 4 per cent, in 1908, 4.5 per cent. in 1907, 1.3 per cent. in 1906, 2.1 in 1905, 2.6 in 1904, 4.7 in 1903, 4.6 in 1902, 4.2 in 1901, and 5.8 in 1900. Pyaemia and Septicaemia (blood-poisoning) were given as the cause of death in 15 instances, 11 of males and 4 of females. Infective endocarditis caused the deaths of 3 males and 2 females. There were four deaths attributed to other septic diseases allied to the foregoing. PUERPERAL FEVER. Thirteen cases were certified with four deaths. The attacks were at the rate of 3.5 per 1,000 births, as compared with 1.3 in 1908, 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 puerperal fever death-rate calculated per 1,000 births was 1.0, as compared with 0.5 in 1908, 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 0.2 in 1901. Both the attacks and deaths were, therefore, more numerous than usual. 30 DIARRHŒA. The deaths numbered 79, not including 46 attributed to enteritis chiefly in infants under one year, as compared with 112 in 1908, 74 in 1907 and 194 in 1906. During the first seven months of the year there were seven deaths from diarrhœa. No deaths occurred during the months of February, June and July. In August there were 13, in September 40, and in October 8 deaths. Eleven deaths occurred during the last two months of the year. The disease was most active and fatal from the third week in August until the end of September. Amongst infants under one year there were 59 deaths, whilst 18 were of children between the ages of one and five years, one was of a child aged between 5 and 10 years and one was of a person over 75 years of age. The diarrhoea death-rate was 0.69 per 1,000, as compared with 0.82 in 1908, 0.64 in 1907 and 1.68 in 1906. The amount of diarrhoea was less than usual in Shoreditch. In connection with this it may be noted that the temperature during the summer months was not so high as it is sometimes, and the summer on the whole was cool. Moreover, there were a good many rainy days. The mortality from diarrhoea amongst infants under one year in Shoreditch during 1909 was at the rate of 15.9 per 1,000 births registered during the year as compared with 23.3 in 1908, 15.3 in 1907, 40.3 in 1906, and 30.6 in 1905. Similar rates for the Metropolis were 9.9 in 1909, 14'4 in 1908, 9.2 in 1907, 27.3 in 1906, and 20.7 in 1905. The figures for previous years are contained in the Annual Report for 1905. The usual enquiries were made as regards a number of deaths from diarrhœa of infants under eight months old. In nearly all of them the deaths were of those being fed otherwise than naturally. Only two or three perished from diarrhoea whilst they were at the breast, and it is not free from doubt that these were solely breast fed. The deaths in London from diarrhoea numbered 1,577, as compared with 2,592 in 1908, 1,563 in 1907, and 4,507 in 1906. Most of the deaths occurred during September and October. The death-rate from diarrhœa for the Metropolis was 0.32, as compared with 0.54 in 1908, 0.32 in 1907, 0.98 in 1906, 0.72 in 1905, 1.07 in 1904, 0.64 in 1903, and 0.53 in 1902. MEASLES. Measles was more prevalent during the year than for several years past in Shoreditch. Most cases occurred during February, March, April, May and June. The deaths were most numerous during those months, 105 of the 127 deaths for the year due to this disease occurring within the five months. The 31 whole of the deaths were of children under 10 years of age; 34 were under one, 86 were aged between one and five, and the remaining 7 between five and 10 years. The deaths were fairly equally distributed between the sexes, 65 being of males and 62 of females. The death-rate from this disease was considerably above the average for recent years, being 1.11 per 1,000 population, as compared with 0.44 in 1908, 0.99 in 1907, 0.64 in 1906, 0.52 in 1905, 0.69 in 1904, 0.85 in 1903, 0.72 in 1902, and 0.64 in 1901. The mortality was proportionately highest in Whitmore ward. There were no deaths from measles in Moorfields ward. The houses brought to the notice of the Health Department as being infected through the presence of measles numbered 479. Most of them came under notice through information received from the school authorities. On enquiry it was found that the illness was not measles in 114 instances. Disinfection was carried out in connection with 341 rooms by the officers of the Sanitary Authority, and the usual steps were taken with bedding and textile articles. In 15 instances disinfection was carried out by the occupiers of the infected premises to the satisfaction of the medical practitioners in attendance on the cases. The deaths from measles in London numbered 2,324, the death rate being 0.48 per 1,000 population. WHOOPING COUGH. Whooping cough caused 73 deaths, 28 of males, and 45 of females. Of these 28 were of infants under 12 months' old, 41 of children aged from 1 to 5 years, and 4 of children aged from 5 to 10 years. The disease was most prevalent in the Borough during the first 5 months of the year. March, April, and May were the months during which the deaths were most numerous. The whooping cough death rate was 0.64 per 1,000 population. The death rate from this disease, comparing the different wards was highest in Hoxton. No death was certified from this disease in Moorfields Ward. The deaths from whooping cough in the Metropolis numbered 1,246, the death-rate being 0.25 per 1,000 population. INFLUENZA. The deaths attributed to this disease numbered 23, as compared with 22 in 1908, 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 the first three months of the year. During the months of June, July, August, September, October and November, only one death attributed to this disease was certified. 32 The deaths attributed to influenza in the Metropolis numbered 1,231, as compared with 1,334 in 1908, 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. March and April were the months when the deaths were most numerous, and August when they were least so. TUBERCULOSIS. Tuberculosis (Appendix Table V., Nos. 29 to 34 inclusive) was given as the cause of 277 deaths, as compared with 311 in 1908, 327 in 1907, 347 in 1906, 321 in 1905, 365 in 1904, 376 in 1903, 295 in 1902, 363 in 1901, and 343 in 1900. The number was, therefore, considerably below the average for recent years. Deaths from tuberculosis in Shoreditch amounted to 12.6 per cent. of the total number from all causes during the year as compared with 15.5 per cent. in 1908, 14 in 1907 and 15 in 1906. The death-rate was 2.4 per 1,000 population, as compared with 2.7 in 1908, 2.8 in 1907, 3.0 in 1906, 2.7 in 1905, and 3.5 in 1904. The rate was highest in Whitmore and Kingsland Wards, where it amounted to 2.9, and lowest in Haggerston Ward, where it was 1.7 per 1,000 population. Tuberculosis of the lungs, or phthisis, or consumption as it is commonly named, was the cause of 194 deaths, as compared with 224 in 1908, 232 in 1907, and 233 in 1906. Most of the deaths from consumption were of persons in the wage-earning period of life ; 120 were of males, and 74 of females. The deathrate from consumption was 1.7 per 1,000 inhabitants being highest in Whitmore Ward, where it was 2.2 and lowest in Haggerston, where it was 1.1 per 1,000 population. The deaths from tuberculosis in the Metropolis numbered 8,370 giving a death rate of 1.7 per 1,000 inhabitants. Of these some 6,337 were attributed to consumption, the death-rate being 1.3 per 1,000 inhabitants. A conparison between the figures for Shoreditch, and those for the Metropolis indicates a markedly heavier mortality in Shoreditch than in London as a whole An important step has been taken by the local Goverment Board for affording facilities to extend administrative action for the prevention of tuberculosis by issuing regulations with this object. These regulations, known as the Public Health (Tuberculosis) Regulations, 1908, came into operation on January 1st, 1909. They apply, and have effect throughout England and Wales. Medical officers of poor law institutions and district medical officers are required within 48 hours of recognition of pulmonary tuberculosis (consumption) in poor persons upon whom they may be in attendance as medical officers of the poor law guardians to notify The medical officers of health of the areas in which the residences of the poor persons are situate. Superintending officers of poor law institutions are required to notify the medical officers of health of the districts in which are situate the intended places of destination of consumptive persons leaving the institutions and relieving officers have to notify medical officers of health of changes in the addresses of consumptive persons. 33 With a view to the prevention of the spread of infection from cases of consumption, sanitary authorities may : (i) "Take all such measures, or do all such things as are authorised in any case of infectious disease or of dangerous infectious disease, by any enactment relating to public health, and as have reference to the destruction and disinfection of infected articles or the cleansing or disinfection of premises." (ii) "Take all such measures or do all such things as are appropriate and necessary for the safe disposal or destruction of infectious material produced and discharged as a result of pulmonary tuberculosis; and otherwise for the prevention of the spread of infection from any such material." (iii) "Afford or supply all such assistance, facilities or articles as, within such reasonable limits as the circumstances of the case require, and allow, will obviate, or remove, or diminish the risk of infection arising from the conditions affecting the use or occupation of any room, when used or occupied by the poor person as a sleeping apartment; and " (iv) "furnish, for the use of the poor person, on loan, or otherwise any appliance, apparatus, or utensil which will be of assistance for the purpose of any precaution against the spread of infection." The sanitary authority may also provide, publish, or distribute in the form of placards, hand-bills, or leaflets, suitable summaries of information and instruction, respecting pulmonary tuberculosis and the precautions to be taken against the spread of infection. An important point to be noted is that neither sanitary authorities nor their officers are directly or indirectly authorised to put in force as regards any poor consumptive person, who may have been notified in pursuance of the regulations, any enactment rendering the poor person or any one in charge of the poor person liable to penalty, restriction, prohibition or disability affecting himself or his employment means of livelihood or residence on the grounds of his suffering from consumption. In accordance with the requirements of these regulations during the year 217 certificates were received as to consumptive inmates of poor law institutions, 178 from the district medical officers as to consumptive patients upon whom they were attending as officers of the guardians, and 1G3 relating to the discharge of consumptives from poor law institutions. There was also one instance in which a relieving officer notified the change of address of a poor person with consumption. Altogether 559 certificates were received referring to 313 persons suffering from consumption. The addresses given on the certificates were visited by the sanitary inspectors, and as far as practicable such steps C 34 were taken as appeared necessary for the prevention of the spread of infection. Disinfection was carried out by the sanitary authority in connection with 102 premises, including 107 rooms. CEREBROSPINAL FEVER. Two cases were certified. The deaths certified as due to this disease numbered three. In one of these the cause of death was not ascertained until after a post mortem examination. There were 16 deaths attributed to meningitis, 13 of which were of children under five years of age. Enquiries were made as to whether there were grounds for believing the meningitis to have resulted from the presence of the meningococcus but so far as could be ascertained there appeared to have been no reason for believing such to have been the case. The cases of cerebro-spinal fever certified in the Metropolis numbered 111, and 13 deaths were attributed to this disease. GLANDERS, ANTHRAX AND HYDROPHOBIA. Adopting a suggestion in a letter from the Local Government Board dated December 2, 1908, in which it was intimated that if the Borough Council should wish to extend, pursuant to Section 56 (i) of the Public Health (London) Act, 1891, the provisions of Section 55 of that Act with respect to the notification of infectious disease to glanders, anthrax and hydrophobia, the Board would be prepared to favourably entertain an application to add these diseases to the list of those notifiable, the Borough Council resolved to make them so in Shoreditch. The usual steps were taken, and application in. due course was made to the Board for that purpose. The proposed order as to the notification of these diseases in Shoreditch which was submitted to the Board for their approval was, however, deferred pending the consideration of the London County Council as to taking steps to make them notifiable throughout the Metropolis. The necessary steps having been taken by the London County Council, the diseases became notifiable throughout London on April 26th. No cases were notified in Shoreditch during the year. With respect to glanders, 16 notices were received from the veterinary inspector of the London County Council relative to glanders in horses existing on premises in the Borough. The usual enquiries were made by the officers of the Borough Council, but no evidence was obtained as to the spread of infection to human beings. CHOLERA. There were several outbreaks of cholera reported in Russia, Holland and elsewhere on the Continent, during the year. Intimations, in accordance with the cholera regulations, were received from the Port of London and the Port of Harwich Sanitary Authorities as to nine persons from Rotterdam, one from 35 Riga, and one from Bremen, who were proceeding to addresses in Shoreditch. In all cases the usual enquiries were made at the addresses given, and the persons concerned kept under observation. 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 Causes. Total. Bath Street .. .. 2 2 1 .. .. 3 8 Brunswick Street .. .. .. .. 1 .. .. .. 1 Canal Road 1 2 8 90 .. 23 24 2 12 .. 162 Central Street .. .. .. 3 3 .. 6 Chatham Gardens .. 1 13 2 .. 1 .. 14 31 Coleman Street Ward. .. .. .. 2 .. .. 1 1 4 Curtain Road .. 5 11 77 7 24 l 84 209 Gopsall Street .. 22 15 62 35 56 13 121 324 Haggerston Road 1 .. 6 46 6 18 6 7 90 Hammond Square 1 1 13 68 29 39 3 59 213 Hanover Street .. . . .. 2 .. .. .. .. 2 Hoxton House .. 2 2 4 .. .. .. 7 15 Italian School .. .. .. 1 .. .. .. .. 1 Laburnam Street .. 7 5 11 3 3 1 1 31 Maidstone Street Molem Street .. .. 9 .. 20 .. 68 .. 58 .. 34 .. 4 .. 98 1 291 1 Napier Street .. 18 36 48 12 8 14 48 184 Pritchards Road .. 2 4 4 4 .. .. 1 15 Redvers Street 2 11 16 8 .. 15 5 91 148 Rotherfield Street .. .. 1 .. .. .. .. .. 1 St. John's National .. 1 7 .. .. .. .. .. 8 St. John's Road .. 7 23 47 20 21 3 22 143 St. Monica's .. 1 4 .. .. .. .. .. 5 St. Paul's .. 4 18 8 39 4 3 7 83 St. Phillip's .. .. .. 3 .. .. .. .. 3 Scawfell Street 1 13 35 23 18 24 9 54 177 Scrutton Street .. 23 14 24 1 5 4 21 92 Shap Street .. 3 4 36 5 .. 4 16 68 Shepperton Road .. 1 1 5 .. .. .. .. 7 Trinity Place .. 5 8 62 30 32 2 31 170 Wenlock Road .. .. 8 9 50 13 24 6 43 153 .. Total 6 146 275 753 308 335 81 742 2646 36 The number of children excluded in 1908 was 2,146. The increase during 1909 was due to increased prevalence of measles, chicken-pox, and whooping cough. There was also a larger number of exclusions for skin affections and minor ailments. During the year intimations were received from the school authorities as to the exclusion of children who had not had measles from class rooms in the infants' departments of the following schools: Chatham Gardens, Trinity Place, on two occasions in February and May, St. John's Road, Maidstone Street, Scawfell Street, Scrutton Street, Canal Road, Wenlock Road, Hoxton House, Shap Street and Napier Street. The practice of excluding the younger children who have not had measles when the disease is prevalent, is now being tried in place of closure of class rooms. BACTERIOLOGICAL EXAMINATIONS. During the year 35 examinations were made by Dr. Bulloch at the London Hospital Medical School in cases of suspected infectious disease. In 20 the examinations were for enteric fever, in five of these Widals test was positive, in nine negative and in three instances doubtful. Thirteen examinations were made in cases of suspected diphtheria; in seven of these the micro-organism of the disease was found. In two instances the examinations were for the bacilli of tuberculosis; in one of these they were present. DISINFECTION. During 1909 disinfection was carried out at 1,103 premises as compared with 1,208 in 1908 and 1,688 in 1907 The articles removed and disinfected at the Borough disinfecting Station numbered 26,544, as compared with 22,056 in 1908, 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 1,247 beds, 1,065 mattresses, 2,425 pillows, 934 bolsters and 20,878 other articles including sheets, blankets, quilts, curtains, carpets, cushions, clothing and the like. The figures for 1909 include 564 articles disinfected on account of vermin. It was necessary to destroy infected beds in three and mattresses in ten instances. These were replaced by new. No complaints of a serious character! were received in respect to the measures taken by the Sanitary Authority for the purposes of disinfection. In one instance compensation was allowed for damage to a table-cloth. THE SHELTER. The shelter was in use on two occasions: on April 26th for one night by a family of four persons, and on August 10th for one night by a family of five, in both instances on account of scarlet fever. 37 THE PUBLIC MORTUARY. The dead bodies received into the public mortuary, which is situate in rear of the east end of the parish church of St. Leonard, Shoreditch, numbered 392, as compared with 367 in 1908, 349 in 1907, 405 in 1906, 417 in 1905 and 460 in 1904. The bodies of five persons dead of dangerous infectious disease were removed to the mortuary by the Sanitary Authority as compared with 6 in 1908, 3 in 1907, 5 in 1906, 3 in 1905 and 4 in 1904. The inquests held numbered 317, as compared with 302 in 1908, 298 in 1907, 295 in 1906, 290 in 1905, and 336 in 1904. The post-mortem examinations made in the post-mortem room attached to the mortuary numbered 241, as compared with 208 in 1908, 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 27.730 inches. Taking the mean fall for 35 years there was an excess of about 2 inches. The wettest quarter was the third, when 8.823 inches fell. Most rain fell in June, and least in February, the amounts being 3,990 and 0.425 inches respectively. August, September, October, and December were all wet months. 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 83 premises, as compared with 65 in 1908 and 113 in 1907. Of these 45 were on the New River and 38 on the East London district. In 20 instances the houses had been vacated, in 29 there were broken water pipes, in 11 the water rates had not been paid, in 12 the water was cut off at the request of occupiers, and in 11 instances no reasons were given. No complaints were received as to the quality of the water supplied in the Borough, and there was no reason for suspecting the occurrence of any waterborne illness. SANITARY WORK. Preliminary notices as to insanitary conditions were served in respect to 2,585 premises. Of these 567 were dealt with under the supervision of Inspector Lear, 445 under Inspector Firth, 517 under that of Inspector Jordan, 471 under Inspector Langstone, 490 under Inspector Pearson, and 95 under Inspector Stokes. The last-named commenced work in Shoreditch on November 1st. In connection with the work arising from the notices some 38 747 letters were sent to owners of property, builders and others concerned. Some 28,983 visits of inspection were made by the sanitary inspectors during the year. 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: — Insp. Lear. Insp. Firth. Insp. Jordan. Insp. Langstone. Insp. Pearson. Insp. Stokes Total. New drains constructed 1 11 7 13 18 .. 50 Drains re-constructed or repaired 10 84 45 38 64 2 243 Sink waste pipes trapped and disconnected 14 93 53 5 21 3 189 Stack pipes re-instated 62 84 29 74 84 .. 333 Eves gutters re-instated 68 75 20 51 69 12 295 Stack pipes disconnected from drains 1 53 13 8 5 .. 80 Accumulations of sewage dealt with 6 17 22 21 25 5 96 Cesspools abolished 1 5 1 .. 2 .. 9 New water closets constructed 53 7 21 15 10 .. 106 Old water closets re-constructed or repaired 29 72 68 73 95 2 339 Water closets cleansed and white-washed 302 39 154 75 150 18 738 Water closet flushing apparatus repaired 61 44 101 94 115 32 447 Obstructions in water closets removed 40 42 31 21 22 7 163 Overcrowding in houses abated 15 28 10 20 20 2 95 Damp courses in houses provided 2 18 7 .. 1 .. 28 Walls pointed 9 37 5 5 18 .. 74 Roofs repaired 95 73 44 100 105 15 432 Stairs repaired 33 40 9 8 9 2 101 Floors repaired 63 37 32 19 30 10 191 Ventilation under floors provided 1 18 2 7 3 .. 31 Doors repaired 23 8 14 14 5 1 65 Door cills provided 10 21 2 10 9 1 53 Sashes repaired 178 11 4 14 3 .. 210 Houses cleansed throughout 59 39 12 15 17 2 144 Houses cleansed in part 120 187 13 222 161 14 717 Total number of rooms cleansed 978 636 374 641 485 56 3170 Yards or areas lime-washed 324 38 119 39 119 4 643 Yards paved 49 116 54 56 120 5 400 Areas and forecourts paved 8 13 .. 4 7 .. 32 New areas constructed .. 1 .. .. .. .. 1 Sculleries paved .. 21 .. 7 7 .. 35 Dust receptacles provided 57 76 50 57 51 15 306 Dung receptacles provided 2 2 .. .. 1 .. 5 Insanitary cisterns removed 1 .. .. .. 2 .. 3 In connection with the works enumerated above 12 old brick drains were removed, and in 47 instances nuisances and annoyance through the presence of rats on premises were dealt with. In most cases the rats came from 39 tive drains or sewers. In 126 instances water supplies were restored to premises, and on 105 premises leaky water pipes were repaired. Urinals were constructed or reconstructed in 11 instances, and 22 were cleansed and repaired Foul accumulations, causing, or likely to give rise to nuisance were dealt with on 65 premises. In 14 instances animals were found to be stabled so as to give rise to nuisance, and in 12 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. The great bulk of the sanitary work carried out in the Borough was done in compliance with the requirements of intimation notices. With a view to enforcing the abatement of nuisances, statutory notices under the Public Health (London) Act, 1891, were served upon the parties responsible in 265 instances. For non-compliance with statutory notices and for other infringements of the statute and the byelaws made thereunder, police court proceedings were taken as set out below : — Premises. Result of Proceedings. Alfred Place, No. 8 Summons withdrawn, 2/- costs ,, Terrace, No. 2 „ „ Curtain Road, No. 133 Fined 10/- with 3 guineas costs Crondall Street, No. 29 Summons withdrawn, 1 guinea costs Essex Street, No. 13 ,, ,, 10/6 costs Flower and Dean Street, No. 2 Fined 4 0'- with 2/- costs Gifford Street, No. 5 2 guineas costs allowed Goldsmith Row, No. 144 Order made with 1 guinea costs Hare Walk, No. 19 Bound over, 23/- costs allowed „ „ No. 8 Fined 12/- with 2/- costs Phillip Street — Fined 40/- Kenning Terrace, No. 4 Summons withdrawn, 2/- costs Railway Arch, No. 405 Order made with 10/- costs ,, ,, No. 408 Summons withdrawn, 2/- costs ,, Arches, Nos. 405, 406, 407, 408 Order made with 10/6 costs Salisbury Street, No. 28 Summons withdrawn, 10/6 costs Wilkes Place, No. 18 Fined £2 5/- with 2/- costs The proceedings in respect to the house in Alfred Place were taken against the owner on account of the defective state of the roof; those in respect to No. 2, Alfred Terrace were for absence of a proper water supply. The summonses were withdrawn, the statutory notices having been complied with before the cases came before the magistrate. 40 The summons in respect to No. 133, Curtain Road was taken out against the owner by Inspector Jordan for non-compliance with a statutory notice requiring the abatement of a nuisance owing to the defective condition of the drains. As the work was practically finished when the case came on for hearing, the Council made an offer to the owner to withdraw the summons on payment of one guinea costs. This offer, however, was refused by the owner. The case was heard, and he was convicted with the fine and costs above mentioned. The summons in respect to the house in Crondall Street was taken against the owner by Inspector Langstone for failure to comply with a statutory notice requiring the abatement of a nuisance arising through the defective state of the roof and of the drains. It was withdrawn on payment of the Council's costs, the necessary work having been completed before the case was heard by the magistrate. The summons as regards the house in Essex Street was taken against the owner by Inspector Pearson for non-compliance with a statutory notice to abate a nuisance in connection with a water-closet. It was withdrawn as the nuisance was abated before it came on for hearing. The summons in respect to the house in Felton Street, which was to secure the provision of a proper dust receptacle, was withdrawn, as the receptacle was provided before the case came into court. As regards the house in Flower and Dean Street, which is not in Shoreditch, this was the place of residence given by a man who was convicted for selling pieces of decomposing poultry. This case is mentioned later in this report (p. 53). The summons in respect to No. 5, Gifford Street was taken by Inspector Pearson against the owner for not complying with a statutory notice requiring the provision of sufficient water-closet accommodation for the people resident in the house. The bye-laws of the London County Council, under the Public Health (London) Act, 1891, lay down a proportion of one water-closet for every 12 persons in houses occupied by members of more than one family. The Act also requires that dwelling houses shall have sufficient accommodation of the nature mentioned. In this particular case there were 25 persons in the house and only one w.c. for their use. The defendant was convicted, and ordered to pay the Council's costs. The summons in respect to No. 144, Goldsmith Row was taken against the owner by Inspector Firth for not complying with the requirements of a statutory notice to abate a nuisance arising from a water-closet without a proper and sufficient flush. 41 As regards the houses in Hare Walk, persons residing at these addresses were convicted for exposing for sale rotten oranges in Hoxton. A man was also convicted for a similar offence in Phillip Street (p. 53). The summons in respect to the house in Kenning Terrace was taken by Inspector Langstone against the owner for failure to comply with a statutory notice to abate a nuisance due to the dirty, dilapidated, and verminous state of the premises, the roof also being defective. The necessary work was carried out before the case came on for hearing, and the summons was withdrawn. The summonses in respect to the railway arches were taken by Inspector Jordan against the owner for failing to provide a proper water supply. In the case of arch 408 the water was provided before the summons was heard. The summons as regards the house in Salisbury Street was to secure the provision of a proper dust receptacle. As regards the house in Wilkes Place, this was the residence of a man who was convicted for exposing stinking fish for sale (p. 53). SMOKE NUISANCES. Nuisances from the emission of black smoke were dealt with in 13 instances. Sixteen communications were received from the London County Council, relating to the emission of black smoke pn 12 premises, and one was received from a private source. There were also five complaints respecting smoke nuisances in connection with private premises, and one owing to smoke from fish curing. In all cases the necessary steps were taken to obtain the abatement of the nuisances complained of. Five intimation notices were served but no statutory notices were required. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 99 as compared with 127 in 1908, 111 in 1907 and 103 in 1906. The rooms dealt with numbered 157, the walls being stripped of paper, stopped and thoroughly cleansed. In seven houses bedding, clothing and other textile articles had to be removed to the disinfecting station, and were there dealt with. It was not necessary to take steps for enforcing the provisions of the London County Council (General Powers) Act, 1904, which gives sanitary authorities compulsory powers in respect to the cleansing of houses infested with vermin. 42 HOUSES CLOSED. The following houses were closed upon the service of sanitary notices, either on account of being unfit for habitation or in order to enable the works necessary to put them into a satisfactory sanitary condition to be carried out in a proper and efficient manner:— Ely Place, No. 51 Falkirk Street, No. 41 Gifford Street, No. 5 Hearne Street, No. 3 New Inn Street, No. 6 Red Lion Street, No. 3 St. John's Road, No. 136 Wickham Street, No. 6 The house in Ely Place was closed by the owner on receipt of a statutory notice. The drains were defective, and the house was infested with rats ; it was necessary for the premises to be vacated in order that the work could be carried out in a speedy and efficient manner. The house in Falkirk Street was closed by the owner on receipt of a sanitary notice from Inspector Jordan. The house was generally in a very dirty state and was overcrowded, being occupied by no less than eight families. The house in Gifford Street was in a dirty and dilapidated state and there was insufficient water-closet accommodation. It was closed by the owner in March following on the receipt of a statutory notice, and was dealt with under the supervision of Inspector Pearson. It was re-occupied, but later in the year again came under notice on account of insufficient water-closet accommodation. The house in Hearne Street was dirty and dilapidated and the drains and sanitary arrangements generally were very defective. It was closed upon the service of a sanitary notice by Inspector Jordan. The house in New Inn Street was in a dirty and dilapidated state besides being very old. It was closed for demolition on receipt of a sanitary notice from Inspector Jordan. No. 3, Red Lion Street was dirty, dilapidated, and the roof was defective. It was closed by the owner on receipt of a statutory notice in order to facilitate the execution of the necessary works. No. 136, St. John's Road consisted of premises part of which was let as a workshop and part as a dwelling house. The portion occupied as a dwelling was in a dirty and dilapidated state generally, the roof was defective, also the rain-water pipes and yard paving, moreover, the water-closet accommodation 43 was insufficient. On receipt of a statutory notice the house was closed as a dwelling. The premises were dealt with under the supervision of Inspector Langstone, and have since been used entirely for business purposes. The house in Wickham Street was closed by the owner on receipt of a sanitary notice from Inspector Langstone, in order to facilitate the reconstruction of the drains and the general cleansing and repairing of the premises. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. The following houses came under my notice during the year as being closed for demolition:— Earl Street, Nos. 34, 36 and 38. These houses each consist of 7 rooms with a scullery. They were occupied by persons of the working class. The number of inhabitants was, approximately, 40. Their sites will be used for business premises. ARTIZANS' DWELLINGS. There are some 48 blocks of artizans dwellings in the Borough. Particulars in respect to them are contained in previous Annual Reports. They were under observation during the year, and their sanitary condition may be described generally as satisfactory. As in previous years, for the purposes of comparison they have been divided into two classes, A including those occupied by persons who on the whole are in comfortable or fairly comfortable circumstances, and B including those occupied by people in very poor circumstances. Class B includes the same dwellings as in previous years. The number of tenements, rooms, and persons in the dwellings estimated for the year 1909 are contained in the subjoined table: — Number of blocks. Number of tenements. Number of rooms. Number of persons Class A 33 1532 3966 5920 Class B 15 383 917 1780 Total for the whole 48 1915 4883 7700 The conditions associated with residence in the class A are, from a sanitary point of view, superior to those in the class B dwellings. 44 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. Number. Rate per 1,000 Inhabitants. 255 33.0 198 33.4 57 30.9 The number of births was 22 more than in 1908. The proportion of deaths attributed to prematurity was at the rate of 11.7 per 1,000 births as compared with 4.3 in 1908, 12 in 1907, 12 in 1906 and 27.5 in 1905. In class A the deaths from prematurity amounted to 5.0 per 1,000 births, whilst in class B they were 35.0. For the whole Borough the deaths from prematurity amounted to 21.1 per 1,000 births. The infantile mortality for the whole of the dwellings was 113 per 1,000 births, as compared with 103 in 1908, 124 in 1907, 97 in 1906, and 140 in 1905. For the class A dwellings it was 101, as compared with 75 in 1908, 99 in 1907, 84 in 1906, and 134 in 1905. For class B the mortality was 158, as compared with 213 in 1908, 207 in 1907, 133 in 1906, and 166 in 1905. In the subjoined table are given the deaths and death-rates from certain causes for the dwellings and the corresponding death-rates for the whole Borough, so that they may be compared :— Cause of Death. The whole of the Dwellings. Class A. Class B. The Borough. Number of deaths. Rate per 1,000 inhabitants. Number of Deaths. Rate per 1,000 inhabitants. N umber of deaths. Rate per 1,000 inhabitants. Rate per 1,000 inhabitants. All causes 117 15.1 92 15.5 25 14.0 19.2 Principal Zymotic diseases 24 3.1 16 2.7 8 4.4 2.7 All forms of Tuberculosis 13 1.7 11 1.8 2 1.1 2.4 Phthisis 9 1.1 8 1.3 1 05 1.7 Bronchitis 3 0.4 3 0.5 — — 1.7 Pneumonia 11 1.4 10 1.6 1 0.5 2.4 The deaths of residents of the dwellings in public institutions numbered 49, being 39 for the class A and 10 for the class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 41.0, being 42.3 for class A and 40 for class B. The percentages for the Borough and for the wards are contained in Table VII. (Appendix). 45 The cases of notifiable infectious disease numbered 5G, of which 50 were in the class A and G in the class B dwellings. The attack-rates per 1,000 population were respectively 7.2, 8.4, and 3.4, as compared with 6.3 for the whole Borough. The cases included 23 of scarlet fever, 18 diphtheria, 4 enteric fever, 9 erysipelas, and 2 of puerperal fever. The numbers of cases and the attack-rates per 1,000 inhabitants with respect to scarlet fever, diphtheria, enteric fever, and erysipelas are set out below : — Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Cases. Rate. Cases. Rate. Cases Rate. Cases. Rate. Class A 23 3.8 16 3.7 3 0.5 7 1.2 Class B — -- 2 11 1 0.5 2 1.1 The whole of the dwellings 23 2.9 18 2.3 4 0.5 9 1.1 For the whole Borough, the attack-rates were as follows:—2.9 for scarlet fever, 1.5 for diphtheria, 0.4 for enteric fever, and 1.2 for erysipelas. From the foregoing figures it will be seen that amongst the inhabitants of the artizans dwellings in the Borough during 1909 the mortality from all causes was markedly lower than amongst the inhabitants of the Borough generally. It is to be noted that the death-rate this year was higher in the class A than in the class B dwellings. The infantile mortality, taking the dwellings as a whole, was lower than that of the Borough. The contrast between the mortalities amongst infants in the class A and class B dwellings is very striking. Whilst in the class A the mortality was markedly lower than that of the Borough, that in class B was considerably higher. The birth-rate, both in the class A and class B dwellings were slightly higher than in the Borough generally. The incidence of attacks of notifiable infectious disease was higher in the class A dwellings than in the Borough as a whole, whilst in the class B dwellings it was considerably lower. HOUSES LET IN LODGINGS. No houses let in lodgings or occupied by members of more than one family were placed on the register during the past year. The register was revised, 28 were removed therefrom, so that at the end of the year the number of houses registered was 258. Sanitary notices were served in connection with 63, and 293 visits of inspection were made. 46 CUSTOMS AND INLAND REVENUE ACTS. Applications for certificates under the above Acts in respect to the sanitary fitness of dwellings for the purpose of obtaining exemption from the payment of inhabited house duty were received relating to 26 dwellings. In 22 instances certificates were given, and in 4 they were refused. HOUSING AND TOWN PLANNING ACT, 1909. The above Act is now in force. It gives sanitary authorities much extended powers for dealing with dwelling houses unfit for habitation, or which are not kept reasonably fit for habitation. A brief reference to some of the principal sanitary provisions having effect in the administrative Counties of London may here be made. In any contract now made for letting for habitation a house or part of a house at a rent not exceeding £40, there is an implied condition that the house is and shall be kept by the owner in all respects reasonably fit for human habitation. There is a proviso exempting houses let on lease for not less than three years under certain conditions. If it appears to the local authority that the implied condition in the case of any such house is not complied with the local authority shall require the landlord within a reasonable time, not less than 21 days specified in a notice to execute such works as the authority shall require as being necessary to make the house in all respects reasonably fit for human habitation. On receipt of such a notice, the landlord may within 21 days do the work, or close the house, or the local authority may at the expiration of the time specified in the notice given by them to the landlord in the event of him not taking action, do the work required to be done and recover the expenses from the landlord as a civi debt, and in the manner laid down in the Act. The landlord has the right of appeal to the Local Government Board (Sections 14 and 15). The power of making byelaws with respect to lodging houses for the working classes is extended (section 16). The procedure for the closure and demolition of houses is amended. Where a local authority is satisfied that a dwelling house is unfit for human habitation it is their duty to make an order prohibiting its use as a dwelling house. Any owner aggrieved by such an order may appeal to the Local Government Board. The local authority may determine a closing order when satisfied that the dwelling house has been made fit for habitation. If on the application of any owner of a dwelling house the local authority refuse to determine a closing order, the owner may appeal to the Local Government Board. In the case of a room habitually used as a sleeping place the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room certain conditions as to height, light, 47 and ventilation will have to be complied with, otherwise the room is to be deemed a dwelling house so dangerous or injurious to health as to be unfit for human habitation (Section 17). If the local authority are of opinion that a house which has been closed has not been rendered fit for habitation, or that proper steps are not being taken to render it so fit, or that the continuance of the building being or being part of a dwelling house is a nuisance or dangerous or injurious to health, they shall order the demolition of the building (section 18). It is also to be noted that under section 35 of the Act exemption from payment of inhabited house duty may be claimed in the case of any house occupied for the sole purpose of letting lodgings to persons of the working class at a charge of not exceeding sixpence a night for each person upon production of a certificate to the effect that the house is solely constructed and used to afford suitable accommodation for the lodgers and that due provision is made for their sanitary requirements. SLAUGHTERHOUSES. The number of licensed slaughterhouses in the Borough at the end of the year were 7, as compared with 7 in 1908, 8 in 1907, 9 in 190G, and 12 in 1905. In two slaughtering did not appear to be carried on. They were inspected from time to time during the year, and their general sanitary condition may be reported upon as being satisfactory. COWHOUSES. The number of licensed cowhouses in the Borough at the end of 1909 was 7, remaining the same as for the past five years. The cowsheds afford accommodation for about 100 cows. The number of cows kept in the Borough was found at an inspection made shortly before the licensing session in October to be 44, as compared with 52 in 1908, 57 in 1907, 74 in 190G, 8G in 1905, 95 in 1904, and 101 in 1903. The premises were subject to periodical inspection and their general sanitary condition may be reported as satisfactory. The number of dairymen and milk purveyors on the register at the end of the year was 302 as compared with 292 in 1908, 284 in 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 18 and commenced at 28 premises, and in 70 instances there were changes in the names of the persons registered as milk vendors. It may also be mentioned that 14 vendors are registered for the sale of milk in Shoreditch whose places of business or shops are outside the Borough. These are not included in the number on the register given above. The cowsheds, dairies and milk shops were under inspection by the 48 sanitary staff throughout the year, and some 8,404 visits were made in connection with them. In nine instances sanitary notices were served ; in one on account of the absence of a dust receptacle, in four for dirty conditions of rooms, in two on account of defects as regards the sanitary arrangements, in one for want of proper attention to the milk measures, and in one by reason of a defective roof. In all cases the notices were complied with, and it was not necessary to report any of them specially to the Health Committee. There was one case in which a milk vendor not resident in Shoreditch was summonsed for selling milk in the Borough without being duly registered in Shoreditch, although he was registered in an adjoining Borough. The magistrate allowed the Council 2s., the cost of the summons. OFFENSIVE BUSINESSES. The tripe boiling establishment in the Haggerston Road, which comes under the above heading, was under inspection from time to time during the year. It was so conducted as not to give rise to complaint. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1909 was 1,226, 234 having been placed on and 191 taken off during the year. The numbers for previous years were : 1,183 in 1908, 1,254 in 1907, 1,278 in 1906, 1,218 in 1905, 1,133 in 1904, 1,133 in 1903, and 1,081 in 1902. A classification of the workshops registered is contained in the summary of proceedings under the Act which is appended. The increase in the number of workshops was chiefly in those used for the purposes of the cabinet making and furniture trades. Some 3,694 visits of inspection were made in connection with workshops and 192 to factories. Six communications were received from the Factory Inspector relative to the establishment of 136 new workshops in the Borough. On inspection 98 were found to be in a satisfactory condition, 13 were not in occupation at the time of visit, 5 were already on the register, and at one it was found that the work carried on had been discontinued. The remainder were more or less unsatisfactory from a sanitary point of view and required the attention of the sanitary officers. Some 30 written intimations were received from the factory inspector referring to insanitary conditions and infringements of the law relating to public health in connection with 55 workshops and workplaces. The chief insanitary conditions to which the factory inspector directed attention were: dirty conditions of walls and ceilings in 10 instances, defective or insufficient watercloset accommodation in 32, want of proper separate sanitary accommodation 49 for the sexes in 8, absence of water-closet accommodation in 1, insanitary state of urinals in 1, overcrowding in 1, and other insanitary conditions in 2 instances. These workshops were all inspected by the officers of the Borough Council and the necessary steps were taken to deal with the insanitary conditions to which attention had been directed, as well as a number of others which came under the observation of the sanitary inspectors when visiting the premises. The results of the action 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 348 workshops were dealt with, and 333 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 1909:— New drains constructed 3 Drains relaid or repaired 32 Stack pipes disconnected 10 Stack pipes reinstated 25 Eaves gutters reinstated 14 Sink waste pipes disconnected 23 Yards paved 15 Water-closets reconstructed 30 New water-closets constructed 20 Water-closets cleansed and lime- washed 162 Obstructions removed from water-closets 21 Urinals repaired and cleaned 7 Water-closets' flushing apparatus repaired 56 Water supply laid on or restored 7 Leaking water-pipes repaired 8 Rooms cleansed and whitewashed 383 Yards „ „ „ 93 Areas „ „ „ 9 Roofs repaired 46 Floors „ 7 Stairs „ 4 Doors „ 7 Sashes „ 2 Dust receptacles provided 18 Foul accumulations removed 5 Ventilation improved 8 In 10 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 30. In 18 instances sanitary notices were served in connection with them. The works carried out in compliance with the notices served included amongst others the provision of 3 new water-closets, and the remedying of defects in 12 others, the cleansing of 10 rooms, 2 yards and 9 water-closets, and the disconnection and ventilation of three sink waste pipes. In one instance a statutory notice was served but no police court proceedings were necessary. D 50 During the year 112 lists of outworkers were received from employers in the Borough, 53 in the first half-year, and 59 in the second. These lists contained the names of 1,823 outworkers of whom 1,113 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the authorities of the sanitary districts to which they belonged. Communications were received from a number of sanitary authorities relating to 2,958 out-workers, 267 of whom were residents of other boroughs and their addresses were forwarded to the authorities concerned. A table is appended which gives the numbers of addresses of outworkers received from the sanitary authorities referred to during 1909. The number of out-workers brought to our notice during 1909 was 4,781 as compared with 4,185 in 1908, 4,578 in 1907, and 2,975 in 1906. Of these 3,401 were residents in Shoreditch as compared with 2,985 in 1908, 3,431 in 1907, and 2,259 in 1906. In respect to these figures it is to be noted that in many instances names and addresses of out-workers are duplicated owing to lists being sent in twice a year and in a number of instances the same outworkers are employed by more than one firm. As mentioned in previous reports the numbers given above are far from representing the actual numbers of individual outworkers. Tables are appended showing the distribution of out-workers as regards trades in the Borough. Most of them are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags, and boxes, and brushes. During the year some 2,325 visits of inspection were made to places where home-work was carried on and sanitary notices were served in respect to 177 out-workers' premises. The work carried out to comply with these notices included the construction, reconstruction, or repair of drains in 5 instances, the disconnection from the drains of sink waste pipes in 4, the disconnection of stack pipes in 2, the reinstatement of stackpipes in 23, and of eaves gutters in 26, the paving of yards in 18, of sculleries in 3 and areas in 2, the reconstruction of water-closets in 5 and the repair of flushing apparatus in 31 and other work in connection with the water supplies in 14 instances ; 282 rooms, 36 yards, and 45 water-closets were cleansed and whitewashed, repairs were effected in connection with roofs in 32 instances, floors in 7, stairs 4, doors 4, and window sashes 4, and in 26 instances dust receptacles were provided. Four cases of overcrowding were dealt with in connection with out-workers' premises, and in 6 instances works for the improvement of light and ventilation were carried out. 51 Three cases of infectious disease were certified at houses where home-work was carried on during the year. They were all cases of scarlet fever. Two occurred at addresses where articles of clothing were being made and 1 where paper bags and boxes were being manufactured. The usual steps were taken to prevent the work carried on being a means of spreading infection. No difficulties were experienced in connection with this, and there was no necessity for action to be taken under sections 108-110 of the Factory and Workshops Act, 1901. BAKEHOUSES. The number of bakehouses on the register is 77, of which 44 are underground, and 33 above ground. Four of these, 1 underground and 3 above ground were not in occupation at the end of the year. At 4 mechanical power is employed thereby constituting the bakehouses factories. As the result of inspection in 29 instances, lime washing, and cleansing were more or less required, and the necessary sanitary notices were served, and complied with except in one case which had to be reported to the Health Committee. In this instance the premises were allowed to get into a very dirty state by the person occupying the bakehouse and a statutory notice under the Public Health (London) Act, 1891, became necessary. ICE CREAM SHOPS. The following is a summary of the work in connection with ice cream shops during 1909 : Inspector Lear had 20 under observation two of which required cleansing. Inspector Firth had 12, four of which required cleansing, and in two others there were defects in the drains. Inspector Jordan had 17, in 2 of which the roofs were defective and in one other there was no dust receptacle, Inspector Langstone had 25 under observation, 5 of which were not used for the sale of ice cream at the time, in one of them the water closet was defective, in one there was no dust receptacle, and in one the premises generally were dirty and dilapidated. Inspector Pearson had 15 under observation, two of which required cleansing, and in 2 others there were defects in connection with the water closet and yard paving. Altogether 89 premises whereon ice cream was manufactured or sold were under the observation of the sanitary officers during the year. Of these some 66 were found in a satisfactory sanitary condition, and five were not in use for the sale of ice cream. In 18 instances sanitary notices were served. d 2 52 COOKSHOPS, COFFEE SHOPS, AND EATING HOUSES. On Inspector Lear's district 29 were visited ; in 21 of them more or less cleansing was found necessary. Inspector Firth had 12 under his observation in 4 of which cleansing was required. Inspector Jordan had 97 under observation as well as the kitchens of 15 public-houses at which dinners are provided for customers. In 14 instances sanitary notices were served. In two instances water closets were defective, in 3 flushing cisterns were out of order, in two drains were defective, in one the yard paving was defective, in 1 the sink was defective, and in 3 instances there were no proper dust receptacles. In 7 instances the kitchens required general cleansing and repairs. In 4 instances the premises were found closed. Inspector Langstone had 34 under observation, 5 of which were not in use. Notices were served in two instances on account of the premises generally being dirty and dilapidated, and in one because the drain was obstructed. Inspector Pearson had 17 under observation, including the kitchens of 2 public-houses, and sanitary notices were served in connection with 6 of them. Three required cleansing, in 1 an area was flooded, and in 2 others there were defects in connection with the sink and eaves' guttering. Altogether some 204 cook-shops, coffee-shops, and eating houses, including the kitchens of 17 public-houses, were under inspection during the year, as compared with 197 in 1908, 188 in 1907, 178 in 1906, and 182 in 1905. In 48 instances, sanitary notices were served in connection with them, chiefly on account of want of proper attention to cleanliness. FRIED FISH SHOPS. Inspector Lear had 11 under observation, in 8 of which more or less cleansing was necessary, Inspector Firth 6, in 3 of which cleansing was required, Inspector Jordan 10, in 2 of which the yard paving was defective, in 1 the roof, and in 1 a rainwater pipe needed attention, and one required cleansing. Inspector Langstone had 12 under observation, in 1 of which the roof and eaves' guttering were defective, and Inspector Pearson had 10, 7 of which required more or less cleansing. Altogether 49 fried fish shops were under inspection curing the year, and 22 sanitary notices were served in connection with them, chiefly for cleansing STREET MARKETS AND FOOD. The usual supervision was exercised throughout the year 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 the detection 53 of unsound or unwholesome food. A sanitary inspector was on duty every evening for this and other purposes in accordance with the instructions of the Borough Council. The following articles were destroyed as unfit for the food of man: — Herrings, 4 cases ; plaice, 9 boxes ; smoked filleted haddocks, 7 lbs.; codlings, 1 trunk and 45 separate fish ; haddocks, 1 box ; whiting, 5 stones ; escallops ½ bag; poultry, 2 qrs. 13 lbs., besides a number of gizzards, heads, necks, and other parts of fowls ; rabbits, 15; sheeps' livers, 28 lbs. ; brussel sprouts, 4 tons 4 cwt. 1 qr. ; greens, 22 cwt. ; tomatoes, 7 cases ; strawberries, 10 pecks ; bananas, 13 ; apples, 4 lbs. ; chestnuts, 2¾ lbs. ; onions, 38 lbs. ; and G37 oranges. With respect to the oranges, they were all more or less rotten, and were seized by the sanitary inspectors under the Public Health (London) Act, 1891, and ordered to be destroyed by the magistrate ; 337 were being exposed for sale cn a stall in Hoxton by a woman residing at No. 8, Hare Walk, 159 on a stall in Hoxton by a woman residing at 19, Hare Walk, 81 on a barrow in Phillip Street by a man residing at 16, Station Buildings, Acton Street, and 61 on a barrow in Whiston Street by a man who gave a false address and could not be traced. Proceedings were taken before the magistrate in the first 3 cases with the results already stated (p 39). The gizzards, heads, necks, and other parts of fowls mentioned above were in a stinking condition, and were being offered for sale on a stall in Hoxton by a man residing at No. 2, Flower and Dean Street. They were seized by the sanitary inspector, and ordered to be destroyed by the magistrate, who fined the defendant. He was unable to pay the fine and went to prison. Of the codlings mentioned 45 were seized on a stall in Hoxton and ordered to be destroyed by the Magistrate as being unfit for the food of man. The man to whom they belonged, who resided at 18, Wilkes Place, was prosecuted with the result already stated. The onions, chestnuts, apples, and one rabbit were also seized as unfit for food. In the case of the onions proceedings were taken before the Magistrate against the woman who was exposing them for sale. She was the same referred to as residing at 8, Hare Walk, who was convicted for selling rotten oranges earlier in the year. On this occasion the Magistrate did not inflict a fine but ordered her to pay 23s. costs. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that during the year 570 samples were submitted for analysis under the above acts. This number was at the rate of approximately five samples per 1,000 estimated population. 54 The results of the year's work are summarised in the following table Quarter of the year 1909. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. N umber of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of successful Prosecutions. Fines and Costs. Amount paid to Analyst for samples analysed £ s. d. £ s, d. 1st. 138 21 15.2% 15 — 15 15 65 5 6 69 0 0 2nd. 134 25 18.6% 19 1 18 14 95 10 0 67 0 0 3rd. 132 16 12.1% 10 1 9 8 23 15 6 66 0 0 4th. 166 30 18.0% 30 — 30 30 59 4 6 74 5 0 Total for Year 570 92 16.1% 74 2 72 67 243 15 6 276 5 0 The samples taken included 297 of milk, 137 of butter, 56 coffee, 31 margarine, 19 cocoa, 13 golden syrup, 10 lard, two pepper, one cheese, one separated milk, one mustard, one tea dust and one dripping. Of the milk samples 50 or 16.8 per cent. were found not to be genuine as compared with 17.8 per cent. in 1908, 23.2 in 1907, 27.9 in 1906, 20.8 in 1905, 23.5 in 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 73 15 20.5 2nd 87 20 22.9 3rd 69 7 10.1 4th 68 8 11.7 In 32 of the samples of milk water was certified to have been added. In two the amount was more than five per cent. in excess of the standard of the Board of Agriculture, and in 30 it was less than five per cent. In 11 the samples were deficient in milk fat, the deficiency being over five per cent. below the standard in eight and less than five per cent. in the remainder. In three of the samples both fat had been abstracted and water added. In one sample traces of artificial colouring matter were present, otherwise the milk appeared genuine. Boric acid not exceeding ¼ grain to the pint with traces of colouring matter were present in one sample. Traces of artificial colouring matter were present in four of the samples which were adulterated with 55 water. In two instances in which the total solids were slightly below the Board of Agriculture's standard the Public Analyst remarked that the samples may possibly have been genuine. Legal proceedings were instituted in 10 or 20 per cent. of the cases in which the samples of milk were not up to the Board's standard, and in nine, convictions were obtained. In one instance the summons was dismissed, a warranty being produced by the vendor. In the remainder, amounting to 80 per cent., in which the samples were not up to the standard, prosecutions were not considered advisable, the percentages of abstraction of fat and additions of water being regarded as too small to render convictions likely. The percentages in which it was not considered advisable to prosecute in previous years were as follows : 66 in 1908, 65 in 1907, 66 in 1906, 60 in 1905, 55 in 1904, and 62 in 1903. These figures afford some indication that greater care is now being taken to sell milk in accordance with the standard fixed by the Board of Agriculture. In the cases in which convictions were obtained the penalties for milk adulteration amounted to £95 11s. 0d., which is equivalent to 28 per cent. of the full amount of the penalties to which the defendants were liable as compared with 11.25 per cent. in 1908, 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 £110 17s. 6d., the average amount paid by a defendant on conviction was £12 6s. 4d. as compared with £3 1s. 4d. in 1908, £1 13s. 7d. in 1907, £2 9s. 6d. in 1906, £2 19s. 3d. in 1905, £2 6s. l0d. in 1904, £1 18s. 6d. in 1903, and £2 18s. 4d. in 1902. The great increase in the figures for 1909 as compared with those for previous years is due mainly to the fact that in two instances there had been previous convictions under the Sale of Food and Drugs Acts. In one there had been five previous convictions and the Magistrate fined the defendant £30 with one guinea costs. In the other case, the vendors—a company—against whom two previous convictions were proved, were fined £50 with 10 guineas costs. In both these cases the maximum penalties to which the defendants were liable were each £100. Of the samples of butter taken, 13, or 9.5 per cent. were not genuine, as compared with 12.2 in 1908, 63 in 1907, 11 in 1906, and 14 in 1905. The numbers of samples and the percentages of those found adulterated during the four quarters of the year are as shewn in the subjoined table :— Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st. 42 4 9.5 2nd. 21 2 9.5 3rd. 37 4 10.8 4th. 37 3 8.1 56 Of the samples sold for butter, which were not returned as genuine by the Analyst, six were samples of margarine, four contained water in excess of the 16 per cent. standard and the remainder were samples of butter containing foreign fats in large amounts. Legal proceedings were taken in 12 instances and were successful in 11. In one the summons was dismissed, the person summoned being proved in court not to have been at the time of sale the proprietor of the business. The penalties inflicted in the cases in which convictions were obtained for the sale of adulterated butter amounted to £33, or 9.4 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 which amounted to £11 8s. 6d., the amounts imposed by the Magistrates averaged £4 0s. 9d. as compared with £4 6s. 10d. in 1908, £4 6s. 7d. in 1907, £5 3s. 0d. in 1906, £7 1s. 0d. in 1905, £3 1s. 0d. in 1904, £4 10s. 0d. in 1903, and £4 10s. 0d. in 1902. In one instance the defendant had been three times previously convicted under the Acts and was, therefore, liable to a penalty of £100. The amount of the penalty inflicted in this case was £10 with 12s. 6d. costs. Thirty-one samples of margarine were taken and in 26 proceedings were instituted under Section 6 of the Margarine Act 1887 for selling margarine in a wrapper not bearing the word " Margarine " legibly imprinted upon it as required by law. In 25 convictions were obtained and in one the summons was withdrawn upon payment of 2s. costs. The fines inflicted for these breaches of the Margarine Act amounted to 4.7 per cent. of the maximum penalties to which the defendants were liable. Including costs the amounts paid averaged £1 12s. 5d. as compared with £1 4s. 6d. for 1908. Of the 56 samples of coffee taken 22 were mixtures of coffee and chicory in varying amounts, which were sold without any disclosure being made of the fact that they were mixtures, which is contrary to the statute. These samples were obtained from regular grocers shops and from general shops. At the former it appears to be the practice to sell such mixtures in packages properly labelled and a sufficient disclosure is made at the time of purchase as to the article being a mixture. In the general shops, more especially the smaller ones, however, it does not appear to be the practice either to make a disclosure or use a wrapper containing any notice to the effect that the article is sold as a mixture. Of the 19 samples of cocoa two were adulterated. One contained 40 per cent. of sugar and 25 per cent. of starch, which had been added, and the other 5 per cent. of foreign starch. In the case of the former proceedings were taken and the vendor was fined £2. Of the 13 samples of golden syrup three were adulterated with glucoseproceedings were taken against the vendors, but unsuccessfully. In two instances 57 the summonses were dismissed with three guineas costs in each case against the Borough Council. In the third instance the summons was withdrawn. Of the ten samples of lard, one contained 7.1 per cent. of added water— proceedings were taken against the vendor, but a warranty was produced and the case was dismissed. The sample of separated milk contained 3 per cent. of added water and traces of artificial colouring matter. No proceedings were taken. The samples of pepper, cheese, mustard, tea dust and dripping were returned as genuine. During the year there were two cases of obstruction, and proceedings were instituted in the one case for refusal to sell milk and in the other for refusing to serve margarine which were asked for. In each case the defendants were convicted and fined £10 in the case of the former and £1 with 23s. costs in the latter. The subjoined table shows a comparison of the results cf the work under the Food and Drugs Acts during the years 1902-9 inclusive:— Year. Number of Samples. Number of persons in the Borough to each sample. Number of samples adulterated. Percentage of samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties. Prosecutions proceeded with. Number of successful prosecutions. Fines and Costs. Amount paid to Public Analyst. £ s. d. £ s. d. 1902 281 420 71 25.3 54 2 52 48 117 9 0 140 10 0 1903 707 166 112 15.8 60 5 55 51 173 11 6 353 10 0 1904 612 189 110 17.9 56 6 50 46 128 5 0 306 0 0 1905 536 215 98 18.2 57 2 51 47 233 18 0 267 0 0 1906 520 224 122 23.4 44 2 42 34 106 12 6 260 0 0 1907 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 1908 580 200 92 15.8 45 .. 45 39 117 10 0 290 0 0 1909 570 200 92 16.1 76 2 74 69 255 18 6 276 5 0 Included in the figures for 1909 in the above table are those relating to the two cases of obstruction mentioned. The marked increase as regards the number of prosecutions results from infringements of the law relating to the sale of margarine and mixtures of coffee with chicory. HAIRDRESSERS AND BARBERS' SHOPS. During the year some 77 premises occupied by barbers and hairdressers were under the observation of the Sanitary Inspectors. Sanitary notices were served in connection with 23 of them for defects in the sanitary arrangements and for other insanitary conditions existing on the premises. The notices were all complied with. 58 SANITARY STAFF. Some important changes have to be noted in respect to the personnel of the Sanitary Staff as taking place during the year. The chief sanitary inspector, Mr. Hugh Alexander, on account of advancing years and infirmity, was obliged to relinquish the position which he held with such conspicuous ability for so many years in the health service of Shoreditch. Under the late Vestry and the Borough Council he closely identified himself with the work of improving the sanitary conditions under which the people live in Shoreditch, and his name must most honourably be associated with the great sanitary improvement which has taken place in the Borough since the time of his appointment in 1873. He retired in June on a pension granted by the Borough Council in recognition of an honourable and meritorious service extending over 35 years. He was, however, spared but a short time to enjoy the retirement he had so well earned. He passed away on November 3rd deeply regretted by his numerous friends. The vacancy created by the retirement of Mr. Alexander necessitated a re-arrangement of the sanitary sub-districts in the Borough as it was not thought desirable to appoint another inspector with duties as laid down for the late chief inspector. The matter was considered by the Health Committee who decided with the approval of the Borough Council to divide the Borough into six sub-districts for the purposes of sanitary inspection in place of the five sub-districts then existing. In the new sub-division of the Borough the existing inspectors were retained as far as practicable in the localities they were accustomed to work in order to obviate disturbance as much as possible. As finally approved by the Borough Council, the re-arrangement was as follows:— No. 1 sub-district, having an area of 100 acres and a population of 20,943, was retained by Inspector Lear; No. 2, having an area of 135 acres and a population of 15,373, was retained by Inspector Jordan; No. 3, with an area of 126 acres and a population of 20,643, was retained by Inspector Firth; and No. 4 having an area of 85 acres and a population of 20,273, was retained by Inspector Langstone ; No. 5 sub-district, which was formed from the old Nos. 5 and 3 districts, with an area of 113 acres and a population of 20,420, was allotted to Inspector Pearson ; and No. 6 sub-district, with an area of 97 acres and a population of 20,451, was allotted to Mr. W. H. Stokes, who was appointed sanitary inspector on September 21st, and entered on his duties on November 1st. Mr. Stokes, at the time of his appointment, was a sanitary inspector under the Croydon Urban District Council. No. G sub-district was formed from portions of the former Nos. 1, 2, 4, and 5 59 sub-districts. Subject to slight modifications consequent upon the addition to their number, the existing arrangements as to the duties of the inspectors remains as heretofore. An important addition was made to staff of the Health department by the appointment of Miss E. J. Charlesworth as Health Visitor on September 21st. This appointment was made in accordance with the provisions of section 6 of the London County Council (General Powers) Act, 1908, and the regulations of the General Order made thereunder. She holds the certificates of the Sanitary Inspectors' Examination Board and the Central Midwives' Board, and was, previous to her appointment in Shoreditch, Health Visitor at Lincoln. She entered on her duties in the Borough on November 22nd. The purpose of the appointment is to afford inhabitants of the Borough advice as to the proper nurture, care, and management of infants, for the promotion of cleanliness, and for the discharge of such other duties as may be assigned to her in accordance with the provisions of section G of the Act mentioned. In Article VIII. of the General Order of September 4th, 1909, containing the regulations as to Health Visitors made by the Local Government Board, are set forth the duties additional to those specified in the Act as the purpose for which a Health Visitor may be appointed. These include the keeping of the necessary records as to her work as may be required, and the discharge of such duties, not being duties of a Sanitary Inspector, as may be assigned to her by the sanitary authority in connection with and for the purposes of the administration by the sanitary authority of any public and general Act or local and personal Act under which powers are conferred or duties imposed upon the sanitary authority with respect to matters relating to public health, the housing of the working classes, and the notification of births, or of any bye-laws or regulations made under any such Act. I regret to have to record the death of A. Cartiledge, which occurred on January 5th from enteric fever, contracted during his work as a disinfecting officer. He was for nearly twelve years in the service of the Council. The vacancy thus created was filled by the appointment of J. Wilson on January 21st. I also regret to record the death of T. Gilbert on May 27th. He was for several years a disinfecting officer. His place was filled by the appointment of J. Pearse on June 17th. I have to express my satisfaction with the way in which the officers of the Health Department have carried out their duties during the year, and also my appreciation of the assistance I have received from them in connection with my work in the department. As regards the work of the clerical staff, some 12,579 communications, written and printed, issued from the department 60 during the year. These included 2,982 notices and summonses and 2,140 letters and cards, mainly on matters under the Public Health and Sale of Food and Drugs Acts, 786 as to work under the Factory and Workshops Acts, 5,860 communications of various kinds in respect to infectious disease and disinfection, and 811 copies of agendas and reports relating to the work of the department. In conclusion, I desire to express my appreciation of the kind consideration and assistance extended to me by the Chairman and members of the Health Committee in connection with my official work during the year. I have the honour to be, Mr. Mayor and gentlemen, Your obedient servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. APPENDIX TO THE REPORT of the MEDICAL OFFICER OF HEALTH. containing Statistical Tables and a Summary of the Sanitary Proceedings under the Public Health and Factory and Workshop Acts, DURING THE YEAR 1909. Tables I., II, III., IV., and V. are forma required by the Local Government Board. TABLE I. BOROUGH OF SHOREDITCH. Vital Statistics of whole District during 1909 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 the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of residents registered in Public Institutions beyond the District. Net Deaths at all ages belonging to the District. Number Rate* under one Year of Age at all Ages. Number. Rate* Number. Rate per 1,000 Births regis. Number Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1899 121530 4131 33.7 854 210 2982 24.5 905 429 358 2911 24.2 1900 121335 4023 32.9 741 187 2689 22.2 790 472 350 2576 21.4 1901 118550 4120 34.3 812 201 2652 22.6 883 427 365 2596 22.1 1902 117948 3992 33.3 704 181 2383 20.2 836 387 432 2441 20.9 1903 117740 3932 33.3 676 176 2232 18.9 832 337 383 2280 19.6 1904 117360 3763 32.0 706 190 2315 19.6 811 366 434 2392 20.6 1905 116939 3894 33.3 652 165 2234 19.1 867 391 451 2296 19.8 1906 116506 3802 32.6 651 168 2158 18.5 816 343 473 2289 19.8 1907 116073 3636 31.3 569 153 2195 18.9 912 350 516 2365 20.6 1908 115642 3678 32.2 510 138 2258 19.0 884 367 485 2006 17.5 Averages for years 1889tol908 117962 3897 32.8 687 176 2409 20.3 853 387 424 2415 20.6 1909 115285 36921 32.4§ 512 138 2392 20.7 903 346 492 2189 19.2§ *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 1909 seven persons not resident in Shoreditch died within the district, and 11 residents of Shoreditch died beyond the district, but not in public institutions, these have to be added to the figures in columns 10 and 11 respectively in order to get the net deaths for 1909. It should also be noted that the net deaths for previous years have been similarly corrected for residents and non-residents who died elsewhere than in institutions. 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 9 and 10 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. TABLE II. BOROUGH OF SHOREDITCH. Vital Statistics of separate Localities in 1909, and in previous Years. Year. 1.—Moorfields Ward. 2.—Church Ward. 3.— Hoxton Ward. 4—Wenlock Ward. 5—Whitmore Ward. 6—Kingsland Ward. 7—Hapgerston Ward. 8—Acton Ward. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages Deaths under 1 year Population estimated to middle of year. Births registered. Deaths at, all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of year. Births registered. Deaths at all ages. Deaths 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 registered. Deaths at all aged. Deaths under 1 year. a. b c. d. a. b. c. d. a. b. c. d. a. b. c. d. a b. c. d. a b. c. d. a. b. c. d. a. b. c. d. 1905 5831 137 84 17 20103 727 430 125 18216 674 389 130 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 614 526 107 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 381 197 66 12346 345 175 35 1909 5306 133 87 15 19463 663 382 96 17314 578 296 71 19272 556 299 68 18100 594 502 108 10910 365 225 55 12690 393 196 57 12330 410 202 42 (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 6, 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. 63 TABLE III. BOROUGH OF SHOREDITCH. Cases of infectious disease notified during the Year 1909. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages —Years. 1. 2. 3. 4. 5. 6. 7. 8. 1. 2. 3. 4. 5, 6. 7. 8. Under 1. 1 to 5 5 to 15 15to25 25to65 65 and upwards. Moorlields. Church Hoxton Wenlock. Whitmore. Kingsland. Haggerston Acton. Moorlields. Church. Hoxton. Wen- lock. Whitmore. Kingsland. Haggerston. Acton. Small-pox • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Cholera • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Diphtheria 179 15 97 57 5 5 • • 19 28 28 27 33 18 14 12 19 27 27 24 31 18 14 12 Membranous croup 4 • • 2 2 • • • • • • • • • • • • • • 1 1 • • 2 • • • • • • • • 1 1 • • 2 Erysipelas 143 8 6 9 13 90 17 6 35 20 26 22 12 11 11 1 • • 2 • • 2 1 • • 1 Scarlet fever 339 5 125 172 23 11 1 18 55 60 44 56 25 33 48 17 55 60 42 56 24 32 46 Typhus Fever • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Enteric fever 49 1 5 9 16 17 1 3 8 3 3 18 4 1 9 2 8 3 2 16 4 1 8 Relapsing fever • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Continued fever • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Puerperal fever 13 • • • • • • 3 10 • • 1 2 1 2 2 2 2 1 • • 2 1 1 • • 1 1 1 Plague • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Cerebro-spinal fever 2 • • • • 2 • • • • • • • • 1 • • • • • • • • • • 1 • • 1 • • • • • • • • • • 1 Totals 729 29 235 253 60 133 19 47 129 112 102 132 62 61 84 39 93 93 69 106 49 48 71 64 65 TABLE IV. BOROUGH OF SHOREDITCH. Causes of, and ages at, death during Year 1909. Causes or Death. Deaths in or belonging to whole District at subjoined Ages. Dkaths 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. 2ft and under 65. 65 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Baggerston. Acton. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1 6 17 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 127 34 86 7 .. .. .. .. 25 28 15 33 10 11 5 10 Scarlet fever 7 .. 3 4 .. .. .. .. 3 1 1 1 .. .. 1 .. Whooping-cough . . 73 28 41 4 .. .. .. .. 13 15 18 12 8 3 4 7 Diphtheria and membranous croup 21 4 14 3 .. .. .. .. 4 6 2 5 1 2 .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 6 .. .. .. 2 3 1 .. 1 .. .. 4 .. .. .. 3 Other contd. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza . . 23 3 .. .. .. 11 9 .. 2 .. 5 6 5 .. 2 4 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea (see notes) 108 88 18 1 .. .. 1 2 25 14 11 29 11 7 9 26 Enteritis (see notes) 21 .. 14 2 .. 3 2 .. 5 .. 5 7 1 1 2 1 Puerperal fever 4 .. .. .. 1 3 .. .. 2 .. 1 .. 1 .. .. 1 Erysipelas 16 6 .. .. .. 7 3 .. 3 1 2 .. 3 .. 2 10 Other septic diseases 24 5 1 7 2 8 1 .. 6 5 3 3 3 3 .. 7 Phthisis 194 2 2 6 24 151 9 11 33 28 28 40 18 15 21 115 Other tuberculous diseases 83 17 41 11 6 8 .. 3 21 6 13 13 14 7 6 17 Cancer, malignant disease 92 .. 1 .. .. 60 31 6 17 7 22 15 12 5 8 38 Bronchitis 198 31 16 1 .. 76 74 6 21 27 31 65 20 15 13 120 Pneumonia 281 56 69 4 .. 107 38 17 47 27 38 61 28 32 31 136 Pleurisy 10 .. .. 1 .. 7 2 1 .. 3 .. 1 1 4 .. 7 Other diseases of Respiratory organs 4 .. 1 .. .. 2 1 .. 1 1 .. 2 .. .. .. 5 Alcoholism Cirrhosis of liver 46 .. .. .. .. 38 8 2 10 6 4 11 5 3 5 36 Venereal diseases 10 8 .. .. .. 2 .. 1 2 2 1 2 2 .. .. 4 Premature birth 78 78 .. .. .. .. .. .. 19 9 8 15 7 12 8 14 Diseases and accidents of parturition 8 .. .. .. 4 4 .. .. 1 1 2 .. .. 1 3 2 Heart diseases 141 .. .. 10 16 66 49 5 21 25 15 34 1 5 13 14 67 Accidents 74 24 13 5 3 18 11 8 13 14 4 6 1 12 10 18 Suicides 11 .. .. .. .. 11 .. .. 2 4 .. 2 1 1 1 1 All other causes 529 128 34 14 16 160 177 21 85 65 70 130 52 49 57 254 All causes 2189 512 354 80 81 745 417 87 382 296 299 502 225 196 202 903 E 66 TABLE V. BOROUGH OF SHOREDITCH. Infantile Mortality during the year, 1909, showing deaths from stated causes in weeks and months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks Total under 1 Month 1-2 Months 2-3 Months 3-4 Months 4-5 Months 5-6 Months 6-7 Months 7-8 Months 8-9 Months 9-10 Months 10-11 Months 11-12 Months Total Deaths under 1 Year. All causes Certified 92 11 24 23 150 46 39 33 29 28 27 33 22 31 36 28 512 Uncertified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i. Common Infectious Diseases. Small-pox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Chicken-pox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Measles . . . . . . . . . . . . . . . . 2 . . 3 3 5 6 1 8 34 Scarlet Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diphtheria: Croup . . . . . . . . . . . . . . . . . . . . 1 . . 1 1 1 . . 4 Whooping Cough . . . . 1 1 2 1 1 4 4 . . 5 4 . . 1 3 3 28 ii. Diarrhœal Diseases. (See notes, &c. Tables iv. & v.) Diarrhœa, all forms . . . . 1 . . 1 5 9 6 8 5 4 6 5 4 3 3 59 Enteritis, Muco-enteritis, Gastro-enteritis . . 1 2 . . 3 3 1 2 6 4 2 3 1 . . 1 1 27 Gastritis, Gastro-intestinal Catarrh . . . . 1 . . 1 . . . . 1 . . . . . . . . . . . . . . . . 2 iii. Wasting Diseases. Premature Birth 56 6 6 6 74 3 1 . . . . . . . . . . . . . . . . . . 78 Congenital Defects (See notes on Tables iv. & v.) 13 . . 3 4 20 . . 2 . . . . . . . . . . . . 1 . . . . 23 Injury at Birth 1 . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . 1 Want of Breast-milk, Starvation . . . . . . . . . . . . 2 1 . . . . . . . . . . . . . . . . 3 Atrophy, Debility, Marasmus 9 1 3 4 17 15 9 9 10 7 2 2 . . 2 1 1 75 iv. Tuberculous. Diseases. (See notes on Tables iv. & v.) . . . . . . . . . . . . . . . . . . 2 . . . . 1 2 . . 2 7 Tuberculous Peritonitis: Tabes Mesenterica . . . . . . . . . . 1 1 1 1 . . 2 . . . . . . . . . . 6 Other Tuberculous Diseases (See notes on Tables iv. & v.) . . . . . . . . . . . . . . . . . . . . . . 2 1 2 1 . . 6 v. Other causes Erysipelas . . . . 1 . . 1 . . . . . . 1 1 . . . . . . . . 2 1 6 Syphilis . . . . 1 . . 2 2 . . 1 . . 1 . . 1 1 . . . . . . 8 Rickets . . . . . . . . . . . . . . . . 1 . . . . 1 . . . . . . . . 2 Meningitis (not Tuberculous) . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . 1 2 Convulsions 1 . . . . . . 2 3 2 . . 1 . . . . . . . . . . . . . . 8 Bronchitis . . . . 2 1 3 4 4 . . 2 2 1 5 . . 4 3 3 31 Laryngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pneumonia 1 . . 1 2 5 2 4 5 2 3 3 5 6 6 10 5 56 Suffocation, overlaying 2 . . . . 3 5 3 3 2 . . 1 2 1 . . . . 1 . . 18 Other Causes 9 . . 2 2 13 4 . . 1 1 2 2 . . . . 2 3 . . 28 92 11 24 23 150 46 39 33 39 28 27 33 22 31 36 28 512 Births during the year—Legitimate 3,607, illegitimate 85. Population, estimated to middle of 1909, 115,285. Deaths from all Causes 2,189. 67 NOTES TO TABLES IV. AND V. (a) In Table IV., all deaths of "Residents" occurring in public institutions, whether within or without the district, are included, with the other deaths in the columns for the several age groups (columns 2-8). They are also, in columns 9-16, included among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non-residents" occurring in public institutions in the district are in like manner excluded from columns 2-8 and 9-16 of Table IV.. (b) See notes on Table I. as to the meaning of "Residents" and residents," and as to the "Public Institutions" taken into account for the purposes of these Tables. The "Localities" in Table IV. are the same as those in Tables II. and III. (c) All deaths occurring in public institutions situated within the district, whether of "Residents" or "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. (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 "Diarrhœa" are included deaths registered as due to Epidemic diarrhœa, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhœa, Dysentery and Dysenteric diarrhœa, Choleraic diarrhœa, Cholera and Cholera Nostras. In addition, and as regards deaths of children tinder one year of age, under the heading "Diarrhœa" in column 3 (Table IV.) are included all deaths classified as "Diarrhœa 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 diarrhœa 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, Papilloma of bladder and Rodent ulcer. Under "Puerperal Fever" are included deaths from Pyaemia, Septicæmia, 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 culosis, Tuberculosis of bones, joints and other organs, Lupus and Scrofula. (j) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified"; all other deaths are regarded as "Uncertified." e 2 TABLE VI. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31st DECEMBER, 1909. Note.—The deaths of persons not belonging to Shoreditch occurring in hospitals and other institutions in the Borough are excluded; deaths of persons 1 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. Total. Under 1. 1 to 5. 5 to 10. 10 to l5. 15 to 20. 20 to 25. 25 to 85. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whit more. Kingsland. Haggerston. Acton. Male. Female. 1 Small Pox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. No statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 34 86 7 .. .. .. .. .. .. .. .. .. .. .. 25 28 15 33 10 11 5 65 62 ??? 3 Scarlet fever .. 3 4 .. .. .. .. .. .. .. .. .. .. .. 3 1 1 1 .. .. 1 1 6 .. 4 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Epidemic influenza 3 .. .. .. .. .. 3 3 4 1 4 5 .. 1 2 2 5 6 5 .. 2 10 13 .. 6 Whooping cough 28 41 4 .. .. .. .. .. .. .. .. .. .. .. 13 15 18 12 8 3 4 28 45 .. 7 Diphtheria, membranous croup 4 14 3 .. .. .. .. .. .. .. .. .. .. 1 4 6 2 5 1 2 .. 8 13 .. 8 Enteric fever .. .. .. .. 1 1 2 1 .. .. 1 .. .. 1 1 .. .. 4 .. .. .. 3 3 .. 9 Asiatic cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Diarrhoea, dysentery 51 14 1 .. .. .. .. .. .. .. .. 1 .. 1 14 6 6 18 9 6 7 36 31 .. 11 Epidemic or zymotic enteritis 8 4 .. .. .. .. .. .. .. .. .. .. .. .. 5 2 1 2 1 .. 1 7 5 .. 12 Other allied diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 13 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Glanders, farcy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15 Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 16 Anthrax, splenic fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 17 Cow-pox, accidents of vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 18 Syphilis 8 .. .. .. .. .. 1 .. .. 1 .. .. .. 1 2 2 1 2 2 .. .. 5 5 ??? 19 Gonorrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 20 Phagedœna, hospital gangrene .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 21 Erysipelas 6 .. .. .. .. .. 1 1 2 3 3 .. .. .. 3 1 2 5 3 .. 2 7 9 ??? 22 Puerperal fever .. .. .. .. .. 1 .. 3 .. .. .. .. .. .. 2 .. 1 .. 1 .. .. .. 4 ??? 23 Pyaemia, septicaemia 2 1 3 2 1 .. 2 1 1 2 .. .. .. 1 3 4 2 2 2 1 .. 11 4 ??? 24 Infective endocarditis .. .. .. 2 .. 1 2 .. .. .. .. .. .. .. 1 .. 1 .. 1 2 .. 3 2 ??? 25 Other allied Diseases 3 .. .. .. .. .. .. .. .. .. 1 .. .. .. 2 1 .. 1 .. .. .. .. 4 ??? 26 Malarial fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 27 Rheumatic fever .. 1 .. 1 1 .. .. .. .. 1 1 1 .. .. 2 .. 1 .. 2 1 .. 5 1 ??? 28 Rheumatism of the heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis : 29 Brain or meninges, acute hydrocephalus 7 24 3 1 .. .. .. 1 .. .. .. .. .. 2 7 3 7 6 6 4 1 16 20 ??? 30 Larynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 31 Lungs .. 2 3 3 11 13 37 46 45 23 9 .. .. 11 33 28 28 40 18 15 21 120 74 ??? 32 Intestines, tabes mesenterica 6 4 2 .. .. 1 .. .. .. .. .. .. .. .. 1 1 4 3 3 .. 1 5 8 ??? 33 General, position undefined 3 12 1 2 1 3 3 .. 2 .. .. .. .. 1 10 .. 2 3 4 3 4 14 13 ??? 34 Other forms, scrofula 1 1 2 .. 1 .. 1 1 .. .. .. .. .. .. 3 2 .. 1 1 .. .. 3 4 ??? 35 Other Infective diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 36 Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 37 Actinomycosis .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 38 Hydatid diseases .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 39 Scurvy .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 40 Other diseases due to altered food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 Acute alcoholism, delirium tremens .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 ??? 42 Chronic alcoholism .. .. .. .. .. .. 2 3 1 3 1 .. .. 1 3 3 .. 1 .. .. 2 6 4 ??? 43 Chronic industrial poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 44 Other chronic poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 45 Osteo-arthritis, rheumatoid arthritis .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. 1 1 .. .. .. .. 2 2 46 Gout .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 1 .. .. .. 2 .. 2 47 Cancer .. .. .. .. .. .. .. 9 21 24 17 10 1 5 16 6 21 14 10 4 6 37 45 82 48 Diabetes mellitus .. .. .. .. .. 1 2 .. 1 .. 1 .. .. .. 2 1 1 .. .. 1 .. 3 2 5 49 Purpura hœmorrhagica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 50 Hæmophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 51 Anæmia, leucocythæmia .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 1 1 1 2 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 5. 6 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 65 to 65. 66 to 76. 76 to 85. 85 and upwards. Moorfields. Chureh. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 52 Lymphadenoma, Hodgkin's disease .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 53 Premature birth 78 .. .. .. .. .. .. .. .. .. .. .. .. .. 19 9 8 15 7 12 8 45 33 ??? 54 Injury at birth 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 55 Debility at birth 7 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 1 1 1 1 4 3 .. 56 Atelectasis 11 .. .. .. .. .. .. .. .. .. .. .. .. .. 3 1 .. 2 1 3 1 6 5 1 57 Congenital defects 12 2 1 .. .. 1 .. .. .. .. .. .. .. .. 3 3 3 1 .. 3 3 11 5 1 58 Want of breast milk 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. 1 2 .. 59 Atrophy, debility, marasmus 67 4 .. .. .. .. .. .. .. .. .. .. .. 3 14 6 8 19 5 10 6 47 24 7 60 Dentition 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 1 .. 61 Pickets 2 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 .. .. .. 1 2 .. 62 Old Age, senile decay .. .. .. .. .. .. .. .. .. .. 29 59 17 5 10 13 17 25 17 8 10 44 61 10 63 Convulsions 8 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 2 2 3 .. .. 2 8 2 1 64 Meningitis 2 11 1 .. .. .. .. 1 .. 1 .. .. .. .. 5 1 1 6 2 .. 1 7 9 1 65 Encephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 66 Apoplexy 2 .. .. .. .. .. 1 1 16 15 12 10 1 4 11 6 11 16 4 1 5 24 34 5 67 Softening of brain .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 68 Hemiplegia, brain paralysis .. .. .. .. .. .. .. .. .. 1 6 2 .. .. 1 1 1 4 .. 2 .. 4 5 .. 69 General Paralysis of insane .. .. .. .. .. 1 2 7 2 1 .. .. .. .. .. 1 5 4 .. 1 2 8 5 1 70 Other forms of insanity .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. 1 .. .. .. 1 1 .. 71 Chorea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 72 Cerebral tumour .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 .. 2 .. 73 Epilepsy .. .. 2 1 1 1 1 .. 1 .. 1 .. .. .. .. .. 2 3 .. 3 .. 3 5 .. 74 Laryngismus Stridulus 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 .. 2 1 .. 75 Locomotor Ataxy .. .. .. .. .. .. .. 1 .. 2 .. .. .. .. 1 .. .. 1 .. 1 .. 3 .. .. 76 Paraplegia, diseases of spinal cord .. 1 .. .. .. .. 1 .. .. 1 1 .. .. .. 1 .. .. 1 1 1 .. 2 2 .. 77 Other diseases of brain or nervous system .. 1 1 .. 1 1 1 1 2 .. 1 .. .. 2 1 1 .. 1 2 1 1 5 4 .. 7 8 Otitis, otorrhœa .. 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. 2 1 .. 79 Diseases of nose, epistaxis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 80 Diseases of eye ophthalmia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 81 Pericarditis .. .. .. .. 1 .. 1 1 .. 1 .. .. .. .. .. .. .. 2 .. 2 .. 2 2 .. 82 Endocarditis, valvular diseases of the heart .. .. 1 3 5 4 3 2 9 6 9 4 1 2 9 10 4 10 6 4 2 22 25 4 83 Hypertrophy of heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 84 Angina pectoris .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 85 Aneurism .. .. .. .. .. .. 1 1 3 3 2 .. .. 1 2 2 .. 1 2 .. 2 8 2 1 86 Senile gangrene .. .. .. .. .. .. .. .. 1 .. 1 1 .. .. 1 .. .. 1 .. 1 .. 3 .. .. 87 Embolism, thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 88 Phlebitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 89 Varicose veins .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be .. .. .. 6 2 4 1 6 16 20 20 12 3 3 12 15 11 22 9 6 12 36 54 9 91 Laryngitis .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 92 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 93 Other diseases of larynx and trachea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 94 Acute bronchitis 31 15 .. .. .. .. 3 2 4 7 8 3 1 3 7 13 10 25 5 7 4 44 30 7 95 Chronic bronchitis .. 1 .. 1 .. .. 3 5 18 34 39 19 4 3 14 14 21 40 15 8 9 61 63 12 96 Lobar croupous-pneumonia 3 5 .. .. 1 2 4 9 11 7 7 3 .. 3 9 2 3 14 8 4 9 28 24 5 97 Lobular, broncho-pneumonia 38 46 1 1 1 .. 1 3 1 11 6 4 2 6 19 14 19 19 14 14 10 51 64 11 98 Pneumonia, form not stated 15 18 2 .. 1 2 9 21 15 15 11 5 .. 8 19 11 16 28 6 14 12 62 52 11 99 Emphysema, asthma .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. 1 .. .. .. 1 1 .. 100 Pleurisy .. .. .. 1 .. .. 1 3 2 1 2 .. .. 1 .. 3 .. 1 1 4 .. 4 6 1 101 Other and ill-defined diseases of respiratory system .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. 102 Diseases of mouth and annexa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 103 Diseases of pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 104 Diseases of œsophagus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105 Ulcer of stomach and duodenum .. .. .. .. .. 2 1 3 5 3 .. .. .. 1 .. 2 3 2 1 1 4 9 5 1 106 Other diseases of stomach 2 .. .. .. .. .. .. 1 .. .. 1 .. .. .. 1 .. .. 2 .. .. 1 4 .. .. 107 Enteritis 27 14 1 1 .. .. .. 2 .. .. 1 .. .. 1 10 6 9 14 2 2 2 24 22 4 108 Appendicitis .. .. .. .. .. .. 1 2 .. .. .. .. .. 1 1 1 .. .. .. .. .. 2 1 .. 109 Obstruction of intestine .. 1 .. .. .. .. .. .. 3 3 .. 1 .. .. 1 2 .. 1 2 .. 2 3 5 .. 110 Other diseases of intestine .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 111 Cirrhosis of liver .. .. .. .. .. .. .. 7 12 9 6 1 .. 1 6 3 4 10 5 3 3 22 13 3 112 Other diseases of liver .. .. .. .. 1 .. 1 2 2 .. 1 .. 1 .. 2 1 .. 2 .. 2 1 4 4 .. 113 Peritonitis 1 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. .. .. .. .. 3 .. 114 Other and ill-defined diseases of .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 76 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 115 Diseases of Lymphatic System and ductless glands 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. 2 .. 2 116 Acute nephritis .. 1 .. 1 .. .. .. .. 2 2 2 .. .. .. 1 1 .. 1 2 1 2 5 3 8 117 Briglit's disease .. .. .. .. .. 1 4 10 9 21 9 7 5 2 13 11 9 19 2 5 5 34 32 ??? 118 Calculus .. .. .. .. .. 1 1 1 .. .. .. .. .. 1 .. .. 1 .. 1 .. .. 1 2 ??? 119 Diseases of bladder and prostate .. .. .. .. .. .. .. .. .. 2 2 .. .. .. 1 .. 1 .. 1 1 .. 3 1 4 120 Other and ill-defined diseases of urinary system .. .. .. .. .. 1 .. 1 .. 2 .. .. .. .. .. 1 .. 1 2 .. .. 2 2 4 121 Diseases of testis and penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 122 Diseases of ovaries .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 ??? 123 Diseases of uterus and appen- dages .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 124 Diseases of vagina and external genital organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 125 Diseases of breast .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 126 Abortion, miscarriage .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 127 Puerperal mania .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 ??? 128 Puerperal convulsions .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 129 Placenta prævia, flooding .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. 2 2 130 Puerperal thrombosis .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 131 Other and ill defined accidents and diseases of pregnancy and childbirth .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 2 2 132 Arthritis, ostitis, periostitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 133 Other and ill-defined diseases of osseous system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 134 Ulcer, bedsore .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135 Eczema .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 136 Pemphigus 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 2 137 Other and ill-defined diseases of integumentary system By Accident or Negligence. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 138 In mines and quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 139 In vehicular traffic .. 2 .. 1 .. .. 1 .. .. 1 4 .. .. 1 2 1 1 1 1 2 .. 7 2 ??? 140 On railways .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 141 On vessels and docks, excluding drowning .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 142 In building operations .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 143 By machinery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 144 By weapons and implements .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 145 Burns and Scalds .. 6 1 .. .. 1 1 1 1 .. .. .. .. .. 3 3 .. .. 1 1 3 4 7 1 146 Poisons, poisonous vapours .. 1 .. 1 .. 1 1 .. .. .. .. .. 1 .. 1 1 .. 1 1 .. 1 3 2 ??? 147 Surgical narcosis 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. 1 .. 2 .. ??? 148 Effects of electric shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 149 Corrosion by chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 150 Drowning .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 151 Suffocation, overlaid in bed 18 .. .. .. .. .. .. .. .. .. .. .. .. 3 2 2 1 1 2 5 2 10 8 ??? 152 Suffocation otherwise 3 .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. .. .. .. .. 2 3 1 ??? 153 Falls, not specified 1 4 .. 1 .. 1 .. 5 4 2 1 1 2 2 4 6 2 2 1 3 2 11 11 ??? 154 Weather agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 155 Otherwise, and not stated 1 .. 1 .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. .. 1 .. .. 1 2 ??? 156 Homicide .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. ??? Suicides, all forms. 157 By poison .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 1 1 .. .. .. .. .. 1 1 ??? 158 By asphyxia .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 .. .. .. .. .. 2 .. ??? 159 By hanging and strangulation .. .. .. .. .. .. .. 1 3 1 .. .. .. .. .. 1 .. 2 1 .. 1 4 1 ??? 160 By drowning .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 161 By shooting .. .. .. .. .. .. .. .. 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 4 1 .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. 1 2 .. .. 2 4 2 ??? 169 Malignant disease .. 1 .. .. .. .. 1 1 3 1 3 .. .. 1 1 1 1 1 2 1 2 5 5 ??? 170 Abscess 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. ??? 171 Cerebro Spinal Fever 1 .. .. 2 .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 1 2 ??? Total 512 354 47 33 31 50 104 177 230 234 228 150 39 87 382 296 299 502 225 196 202 1125 1064 ??? 74 TABLE VII.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1909. DISTRICTS. Estimated population 1909. ANNUAL HATE PER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS: DEATHS DURING 1909 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Tuberculous. Disease. Violence. 1906. 1907. 1908. 1909. London 4,833,938 24.4 15.1 14.1 13.8 14.0 1.30 0.00 0.48 0.08 0.12 0.25 0.03 0.32 1.7 0.5 107 9.6 42.0 0.08 Shoreditch §113,912 32.4 19.8 20.6 17.5 19.2 2.7 .. 1.11 0.06 0.18 0.64 0.05 0.69 2.4 0.7 138 13.9 47.9 .. Wards. Moorfields 5,306 25.0 13.9 16.0 14.6 16.4 0.5 .. .. .. 0.18 .. 0.18 0.18 2.6 1.5 113 19.5 459 .. Church 19,463 34.0 20.2 20.3 17.1 19.6 3.3 .. 1.28 0.15 0.20 0.66 0.05 0.97 2.8 0.8 145 13.8 56.0 .. Hoxton 17,314 33.4 19.6 22.0 18.8 17.0 3.3 .. 1.61 0.05 0.34 0.86 .. 0.46 1.9 1.0 123 15.5 43.9 .. Wenlock §17,899 31.0 18.5 19.6 15.6 16.7 2.4 .. 0.83 0.05 0.11 1.00 .. 0.38 2.3 0.2 122 12.4 41.8 .. Whitmore 18,100 32.8 24.7 28.7 23.0 27.7 4.1 .. 1.82 0.05 0.27 0.66 0.22 1.10 2.9 0.4 182 12.3 55.9 .. Kingsland 10,910 33.4 19.6 17.4 17.5 20.6 2.6 .. 0.91 .. 0.09 0.72 .. 0.91 2.9 0.7 150 15.1 43.1 .. Haggerston 12,590 31.2 16.7 15.7 15.7 15.5 1.7 .. 0.87 .. 0.15 0.24 .. 0.47 1.7 1.0 145 16.3 46.9 .. Acton 12,330 33.2 18.9 18.1 14.1 16.3 1.4 .. 0.40 0.08 .. 0.32 .. 0.64 2.1 0.9 102 11.8 36.6 .. *Fever includes typhus, typhoid and continued fevers. §The inhabitants of the Holborn Union Workhouse, which is situate in Wenlock Ward, and the deaths occurring in that institution are excluded. Note.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, 0.00 is inserted ; where no deaths have occurred, dots are placed in the space under the heading. 75 TABLE VIII. ANALYSIS of the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31 st, 1909. Diseases. Diseases. All Causes 5,261 37 Atelectasis 38 Congenital malformations 39 Old age 155 1 Small-pox 40 Apoplexy 8 2 Measles 198 41 Epilepsy 38 3 Scarlet Fever 11 42 Convulsions 3 4 Typhus 43 Other diseases of brain and nervous system 233 5 Relapsing fever 6 Influenza 130 44 Diseases of organs of special sense 29 7 Whooping Cough 130 8 Diphtheria 4 9 Simple, continued and ill- defined fever 8 45 Diseases of circulatory system 202 46 Laryngitis 7 10 Enteric fever 5 47 Bronchitis 1279 11 Simple cholera 48 Pneumonia 102 12 Diarrhoea, dysentery 104 49 Pleurisy 30 13 Remittent fever 50 Other respiratory diseases 26 14 Hydrophobia 15 Glanders 51 Dentition 20 16 Cow pox and Effects of vaccination 52 Quinsy, sore throat 57 53 Enteritis 75 17 Venereal affections 38 54 Peritonitis 2 18 Erysipelas 46 55 Diseases of liver 26 19 Pyaemia and septicæmia 6 56 Other diseases of digestive system 449 20 Puerperal fever 6 21 Tabes mesenterica 57 Diseases of lymphatic system and ductless glands 17 22 Tuberculous meningitis 1 23 Phthisis 190 24 Scrofula, tuberculosis 40 58 Diseases of urinary system 58 25 Other zymotic diseases 28 26 Thrush 59 Diseases of the generative system 52 27 Worms and other parasitic diseases 1 60 Accidents of childbirth 25 61 Diseases of locomotive system 240 28 Starvation, want of breast-milk 4 62 Diseases of integumentary system 177 29 Alcoholism 4 30 Rheumatic fever and rheumatism of heart 47 63 Fracture and contusion 30 64 Gun shot wounds 65 Cut, stab 1 31 Rheumatism 355 66 Burns or scalds 7 32 Gout 104 67 Poison 4 33 Rickets 1 68 Drowning 34 Cancer 36 69 Suffocation 35 Other constitutional diseases 36 70 Otherwise 53 36 Premature birth 2 71 Other causes 322 76 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1909. Table IX. PREMISES. NUMBER OF PLACES- Number of inspections, 1909. Number of notices, 1909. Number of prosecutions, 1909. On register at end of 1908. Added in 1909. Removed in 1909. On register at end of 1909. Milk premises 292 28 18 302 3404 9 1 Cowsheds 7 .. .. 7 83 .. .. Slaughter-houses Other offensive 7 .. .. 7 32 .. .. trade premises Ice Cream 1 .. .. 1 3 .. .. premises Registered houses 90 4 5 89 161 18 .. let in lodgings 286 .. 28 258 293 63 .. Number of intimation notices served for all purposes 2283 Overcrowding:— Number of dwelling rooms overcrowded 95 Number remedied 95 Number of prosecutions Nil Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 99 Underground rooms:— Number dealt with during year 3 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 8 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 9 Customs and Inland Revenue Acts:— Number of dwellings for which applications were received during year 26 Number of prosecutions under By-laws under Public Health (London) Act, 1891:— With respect to water closets, earth closets, etc. Nil Mortuary:— Total number of bodies removed 392 Total number of infectious bodies removed 5 77 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK, DURING THE YEAR 1909. 1.—Inspection. Inspection made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 192 18 - (Including Workshop Laundries.) 3694 333 - Workplaces .. (Including Bakehouses and excluding Outworkers' premises dealt with in Table 3.) 818 117 - Total 4704 468 - 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspect'r (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 287 287 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 53 53 — — Sanitary accommodation 'insufficient 9 9 — — unsuitable or defective 43 43 — — not separate for sexes 11 11 — — Offences 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 403 403 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 3. Home Work. NATURE OF WORK. OUTWORKERS LISTS, SECTION 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises Sections 109 and 110. Lists received from Employers. Addresses of Outworkers. Prosecutions. Number of inspections of outworkers premises. 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 ot permit inspection of lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Wearing Apparel: (1) Making, &c. 57 57 975 6 3 74 2083 1123 .. .. 1426 69 69 .. 2 .. .. (2) Cleaning & washing .. .. .. .. .. .. 4 .... .. .. 2 .. .. .. s.. .. .. Lace, lace curtains, and nets .. .. .. .. .. .. 4 .. .. .. 2 .. .. .. .. .. .. Artificial flowers 2 .. 34 1 .. 24 137 35 .. .. 120 19 19 .. .. .. .. Furniture and upholstery .. .. .. 1 .. 8 19 6 .. .. 16 .. .. .. .. .. .. Fur pulling .. .. .. .. .. .. 25 5 .. .. 15 1 1 .. .. .. .. Feather sorting .. .. . . , . .. . . 5 1 .. .. 2 .. .. .. .. .. .. Umbrellas, &c .. .. .. .. .. .. 107 20 .. .. 65 4 4 .. .. .. .. Paper bags and boxes 44 .. 641 1 .. 7 440 187 .. .. 572 82 82 .. 1 Brush making .. .. .. .. .. •• 144 3 .. .. 105 2 2 .. .. Total 103 57 1650 9 113 2958 1380 . . 2325 177 177 . . 3 .. .. (a) There were no names and addresses of outworkers received in respect to the following classes of work: Tents, sacks, baske making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors anc 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 Februar and August, and of the entries of names of outworkers in those lists. They are therefore double the number of employers an< approximately double the number of individual outworkers whose names are given, since in the February and August lists of thi same employers, the same outworker's name will often be repeated. (c) There were no prosecutions, but letters were sent to employers in 28 instances of failures to send lists of outworker employed in making wearing apparel, &c., and in 3G instances for similar failures in respect to paper bag and box making. 79 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades (a) Cabinet making 446 (b) French Polishing 81 760 (c) Upholstery 55 (d) Other workers 178 (2) Dress (a) Tailoring 76 (e) Shirt making 4 178 (b) Mantles 5 (f) Boot & Shoe trades 41 (c) Dress 9 (g) Artificial Flowers 8 (d) Millinery 18 (h) Other workers 17 (a) Furriers 5 (b) Saddlery & Harness 27 62 (c) Feathers 4 (d) Other workers 26 (4) Paper, printing, book, stationerv and fancy goods trades (a) Box & bag makers 38 (b) Other workers 22 60 (5) Laundry and washing 27 (6) Food 4 (7) Metals, machines, inplement 58 (8) Precious metals, jewels , &c. o 75 Total number of workshops on Register 1226 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 73, including 4 factory bakehouses. 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshops Act (s. 133) Nil. Action taken in matterg 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 30 referring to 55 workshops - Reports (of action taken) sent to HM. Inspector. referring to 55 workshops — CInderground Bakehouses (s. 101) : — Nil. 43 6.—Shewing the Numbers of Outworkers Received from other Districts During 1909. DISTRICT. Making Wearing Apparel. Cleaning and Washing. Lace Curtains. Artificial Flowers. Furniture and Upholstery Fur Pulling. Feather Sorting. Umbrellas, &e. Paper 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 2 1 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 Bethnal Green 76 64 .. .. .. .. .. .. 3 3 .. 1 .. .. .. 2 22 21 26 20 238 Camberwell 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Chelsea 5 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 City of London 510 530 .. .. 1 2 42 14 .. .. 12 8 .. .. 56 38 5 1 .. .. 1219 Deptford 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Enfield 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Finsbury 125 146 .. .. .. .. 7 3 3 2 .. 1 3 2 2 .. 131 139 1 1 582 Hackney 176 205 .. .. .. .. .. 33 5 3 . . 1 . . 4 4 31 48 29 32 592 Hammersmith 6 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 Hampstead .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 4 Holborn 4 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 9 Ilford 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Islington 55 58 .. .. .. .. 8 4 .. .. 1 1 .. .. .. 1 18 20 9 .. 185 Lambeth 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Poplar 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 5 St. Marylebone 2 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 St. Pancras 4 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Southgate .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Southwark 4 3 .. .. .. .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. 10 Stepney 34 18 .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 54 Stoke Newington 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Tottenham 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Wandsworth .. 1 .. . . 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 West Ham 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Westminster • • 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 1026 1057 2 2 2 2 79 58 11 8 13 12 3 2 62 45 209 231 75 69 Total 2083 4 4 137 19 25 5 107 440 144 2958