SHOR 21 REPORT on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch. in the county of london, FOR THE YEAR 1910, by LEWIS t. FRASER BRYETT, M.d. (Lond.), Medical Officer of Health; Diplomate in Public Health, Royal Colleges of Physicians and Surgeont; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health, frc. [Printed by Oreder of the Health Committee.] printed by chas. st raker and sons, ltd., bishopsgate avenue, london, E.c. CONTENTS. Page. Anthrax 30 Artizans' dwellings 42 Appendicitis, mortality from 8 Bacteriological examinations 3 <2 Bakehouses 49 Births in sub-districte 2 Birth rates 3 Cancer 7 Cerebro-spinal fever 30 Cholera 29 Coffeehouses 50 Cookshops 50 Cow-houses 46 Customs and Inland Bevenue Acts 45 Dairies 46 Deaths in eub-districts 3 Death rate 4 Deaths, ages at 6 Deaths, causes of 5 Deaths in public institutions 9 Deaths in outlying institutions 9 Diarrhœa 25 Diphtheria 17 Disinfection 33 Enteric fever 20 Erysipelas 24 Factories and Workshops Act, 1901 46 Factories, workshops and workplaces—sanitary work 47 Food condemned and destroyed 51 Food and Drugs Act 52 Fried fish shops 51 Glanders 30 Housing and Town Planning Act, 1909 39 Houses closed 38 Houses let in lodgings 45 Hydrophobia 30 Ice cream shops 50 Infantile mortality 5 Infectious cases, number certified 12, 13 Infectious cases, number removed to hospitals 13, 14 Infectious diseases, age periods 11 Infectious diseases, deaths from 10 Infectious diseases, death rate 10 Infectious diseases, number of cases notified from schools: 30 page. Influenza 27 Institutions, deaths in 9 Legal proceedings 36 Margarine Act, proceedings under 5» Marriages 3 Measles 26 M ilk-shops 46 Milk premises, cowsheds, etc., on register <6 Mortuary 33 Notification of Births Act 3 Offensive business 46 Outworkers 48 Population 1 Puerperal fever 25 Return cases 14 Sanitary work 34 Scarlet fever 16 Scarlet fever, return cases of 14 Schools, closure for infeotious disease 36 Shelter 33 Sickness amongst the poor 10 Slaughter-houses 45 Small-pox 14 Smoke nuisance 37 Staff 56 Street markets and food 51 Tuberculosis 28 Vaccination returns 15 Verminous houses 37 Violence, mortality from 8 Water supply 33 Whooping cough 27 Workshops on register 46 Zymotic diseases, deaths from 11 Zymotic death rate 11 APPENDIX. Statistical Tables :— For whole district during 1909 and previous years (Table I.) 58 For separate localities in 1909 (Table II.) 59 Cases of infectious disease notified during 1909 (Table III.) 60 Causes of, and ages at, death during year 1909 (Tables IV. and VI.) 64 to 69 Infantile mortality during 1909 (Table, V.) 62 Notes to Tables IV. and V 63 Comparison of London and Shoreditch birth and death rates in 1909 (Table VII.) 70 C.iscs treated by District Medical Officer in 1909 (Table VIII.) 71 Summary of proceedings under Public Health (London) Act, 1891 (Table IX.) 72 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6 73 to 76 Report of Health Visitor 77 to 87 Metropolitan Borough of Shorditch ANNUAL REPORT of the MEDICAL OFFICER of HEALTH. Town Hall, Old Street, E.C. January, 1911. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. Sir and Gentlemen, This report refers to the public health, sanitary condition and the vital statistics of the Borough of Shoreditch during the year ending December 31st, 1910. POPULATION. The persons resident in the Borough are estimated at 114,935, as compared with 115,285 in 1909, 115,642 in 1908, 116,073 in 1907, 116,506 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, 41,708 ; Shoreditch North-West, comprising Wenlock and Whitmore Wards, 37,441 ; and Shoreditch North-East, which comprises Kingsland, Haggerston and Acton Wards, 35,786. The estimated populations in the eight wards of the Borough are set out below :— Ward. Population. Ward. Population. Moorfields 5,231 Whitmore 18,019 Church 19,363 Kingsland 10,818 Hoxton 17,114 Haggerston 12,654 Wenlock 19,422 Acton 12,314 Included in the population of Wenlock Ward is that of the Holborn Union Workhouse, which is situate in this ward. This is estimated at 1,372. 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 113,653, whilst that of Wenlock Ward is reduced to 18,050. The above figures are based upon the census of ten years ago. The census which is to be taken during the current year will once again afford accurate figures for our calculations. 2 1 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 73 Whitmore 76 237 Church 106 183 Kinersland 72 150 Hoxton 78 219 Haggerston 66 191 Wenlock 90 200 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 3,485, of which 1,767 were of males and 1,718 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 3,575, of which 1,808 were of males and 1,767 of females. The distribution of the corrected births in the eight wards of the Borough is given below :— Ward. Males. Females. Total. Moorfields 50 61 111 Church 334 320 654 Hoxton 298 258 556 Wenlock 249 275 524 Whitmore 290 302 592 Kingsland 194 197 391 Haggerston 169 185 354 Acton 224 189 413 Totals 1,808 1,787 3,595 Outside the Borough 192 births were registered, 93 of males and 99 of females, the parents being residents of Shoreditch. In the Shoreditch Infirmary 154 births were registered, of which 69 were of males and 85 of females. In six of these (three of males and three of females) the parents did not belong to Shoreditch. In the Holborn Union Workhouse there were 109 births, 53 of males and 56 of females. In 96 of these (49 male and 47 female) the parents were not resident in the Borough. SHOR 3 Of the births in the Shoreditch Infirmary 54 (23 male and 31 female) were given as illegitimate. In the Holborn Workhouse 65 (28 male and 37 female) were returned as such. Elsewhere in the Borough 34 (16 of males and 18 of females) were so returned. According to information supplied by the London County Council 175 births belonging to Shoreditch took place in lying-in hospitals. The birth-rate was 31.6 per 1,000 inhabitants, as compared with 32.4 in 1909, 32.2 in 1908, 32.4 in 1907, 33.6 in 1906, and 34.2 in 1905. The birth-rates for the eight wards of the Borough are contained in Table VII. (Appendix). The Shoreditch birth-rate shows a steady decrease, but it is still high as compared with birth-rates elsewhere. The birth-rate for the whole of England and Wales during 1910 was 24.8, for 76 great towns it was 25.0 and for 136 smaller towns it was 23.7 per 1,000 living. The London birth rate was 23.9 per 1,000 population. NOTIFICATION OF BIRTHS ACT, 1907. The births notified under the above Act numbered 3,277, or 91 per cent, of the number registered during the year. Under the circumstances this may be considered satisfactory. Of the 3,277 some 2,135 were notified by registered midwives. In addition to the above 175 births occurring in institutions outside the Borough were notified during the year by the London County Council, lists of the same being sent to me weekly. It will therefore be seen that the great majority of the births belonging to Shoreditch were duly reported during the year. MARRIAGES. The marriages in Shoreditch during 1910 numbered 1,025, as compared with 967 in 1909, 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 18.0 per 1,000 population, as compared with 16.9 for 1909. The marriage rate for London as a whole during 1910 was 16.0 per 1,000 population. DEATHS. The deaths during 1910 numbered 1913, as compared with 2,189 in 1909, 2,006 in 1908, 2,365 in 1907, 2,289 in 1906, 2,296 in 1905, and 2,392 in 1904. The number is the smallest recorded during the past sixty years. The distribution of the deaths amongst males and females in the eight wards of the Borough is as shown in the following table :— Ward. Males. Females. Total. Moorfields 30 26 56 Church 164 144 308 Hoxton 145 188 283 Wenlock 124 142 266 Whitmore 243 209 452 Kingsland 106 96 202 Haggerston 92 76 168 Acton 93 85 178 Totals 997 916 1,913 4 The deaths of males were 81 in excess of those of females. The death-rate for 1910 was the lowest so far recorded for Shoreditch, being 16.8 per 1,000 inhabitants, as compared with 19.2 in 1909, 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. The rate for 1910 was nearly 18 per cent, below the average death-rate for the previous ten years. It is a point of interest to compare the death-rate of Shoreditch of to-day with that of fifty years ago. Taking the ten years ending 1865, the average was 25.0 per 1,000 population ; during the ten years ending 1910 the rate averaged 19.7 per 1,000, the decrease, as shown by the difference between these two rates, amounting to just over 21 per cent, or in other words for every 80 persons dying during the last ten years, over a hundred died during the first ten years above mentioned. The Metropolitan death-rate for 1910 was 12.7, the rate for England and Wales 13.4 for 77 great towns it was 14.3, and for 136 smaller towns it was 12.9 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 particulars as to the mortality amongst the inhabitants of Shoreditch during the year. As compared with the figures for 1909, decreases are noticeable in the death-rates of all the wards of the Borough. There was a general lowering of the death-rate, but the decrease was most marked in the southern portion of the Borough, comprising Moorfields and Church Wards. The rate was lowest in Moorfields, and highest in Whitmore being 10.5 and 25.0 per 1,000 respectively.f The death-rate of the Borough was above the mean rate for the year until the second week of March. It was again above from the end of March until the middle of April from which time, with the exception of the second week of May, it was below the mean until the latter end of September. During the last three months of the year the rate was above the mean. The highest weekly death-rate was that of the last week of the year, 27.1 ; the lowest was that of the last week of June, 8.5 per 1,000. The prevalence of chest complaints was probably the chief factor in determining the elevations of the death-rate during the earlier and latter portions of the year. The deaths of infants under one year of age numbered 528, 298 being of males and 230 of females, the deaths amounting to 27.6 per cent, of the total number of deaths at all ages, as compared with 23 per cent, in 1909 and 25.4 in 1908. The number of Shoreditch infants under one year dying during 1910 was at the rate of Corrected for age and sex distribution the death-rate was 17.6 per 1,000 population. The Shoreditch Workhouse is in Whitmore Ward ; this institution in the case of some of the deaths in outlying institutions is the last known place of residence in the Borough, and Whitmore Ward accordingly is, probably, credited with a certain number of deaths belonging rightly to other wards which however it is impossible to trace. This is a point to be borne in mind in connection with the high rate for this Ward, 5 147 per 1,000 births belonging to Shoreditch registered during the year. This infantile mortality although higher than those of the years 1909 and 1908 is none the less below the average of the past ten years. As is usual, the infantile mortality was higher amongst males than females, being 165 for the former as compared with 128 for the latter. The chief causes of death amongst infants under the age of one year were :— diarrhoea and other disorders of the stomach and intestines, prematurity, weakness and wasting, bronchitis, pneumonia and suffocation in bed. In Table V. (Appendix) is contained a statement showing the causes of death of infants under the age of one year, the ages in weeks and months being given. In the subjoined table the causes of death amongst infants under one year for each of the eight wards of the Borough are given :— Cause of Death. Moor fields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals. Measles .. 1 2 9 7 2 .. .. 21 Scarlet Fever .. .. .. .. 1 .. .. .. 1 Diphtheria .. 1 .. .. .. 1 .. .. 2 Whooping Cough .. 2 5 2 6 3 .. 3 21 Diarrhoea (all forms) .. 11 5 8 11 7 3 9 54 Enteritis .. 4 3 4 5 2 1 4 23 Gastritis and Gastro Intestinal Catarrh .. .. .. .. 1 1 .. .. 2 Premature Birth .. 12 10 9 15 8 1 9 64 Congenital Defects .. 5 1 7 5 1 3 3 25 Injury at Birth .. .. .. .. .. .. .. 1 1 Want of Breast Milk .. .. .. .. .. 1 .. .. 1 Atrophy, Debility and Marasmus 1 23 10 7 13 14 8 8 84 Tuberculous Meningitis .. 1 4 2 3 1 .. 1 12 Tuberculous Peritonitis and Tabes Mesenterica .. 1 .. .. 4 .. 1 .. 6 Other Tuberculous Diseases .. 4 1 1 2 .. .. 1 9 Erysipelas .. .. .. .. .. 1 .. .. 1 Syphilis .. 1 2 2 3 1 1 1 11 Rickets .. .. 1 .. .. .. .. .. 1 Meningitis (not Tuberculous) .. 3 2 5 2 4 .. .. 16 Convulsions 1 2 1 1 4 3 .. 1 14 Bronchitis 1 11 8 4 2 .. 1 2 29 Pneumonia .. 9 13 8 11 7 11 10 69 Suffocation, over- ling 1 7 10 5 8 2 3 1 37 Other causes 1 9 3 4 3 .. 2 2 24 Totals 5 107 81 78 106 59 36 56 528 6 The infantile mortalities of the eight wards of the Borough are contained in Table VII. (Appendix). It was highest in Whitmore Ward, where it amounted to 177 and lowest in Moorfields, where it was only 45 per 1,000 births. The latter figure is exceptionally low, and in connection with this it is to be noted that the birth-rate was also very low in Moorfields Ward. Haggerston Ward also has a birthrate and infantile mortality markedly below the average rates for the Borough. As pointed out in previous reports the infantile mortality in Shoreditch is one of the highest in London. This high rate is doubtless mainly the result of the large proportion of persons belonging to the poorer sections of the working-class resident in the Borough and the great density of the population, which is about three times that of the metropolis as a whole. The high birth-rate of the Borough as compared with that of London as a whole may also possibly not be without some effect as a contributing cause. The efforts of Miss Charlesworth, the Health Visitor, as indicated in her report (Appendix, p. 78) are directed towards mitigating some of the evil effects resulting from these influences and good work has been accomplished during the year. The field however is a large one, and there is ample scope for the energies of other health visitors. It may be pointed out that the services of voluntary health visitors are being utilised in a number of the sanitary districts in London and elsewhere in ameliorating the conditions which tend to the destruction of infant life. Much useful work in this direction could also be done in Shoreditch by voluntary workers acting under the supervision of the Borough Health Visitor. It is to be hoped that before long the services of such voluntary workers may be available in the Borough for a large amount of work is necessary. With well sustained effort, however, there is every reason for expecting that tangible results in the saving of infant lives will in due time become apparent. The deaths amongst children aged from one to five years numbered 257 ; of these 57 were attributed to measles, 24 to whooping cough, 12 to diphtheria, 8 to diarrhoea, 39 to various forms of tuberculosis, 9 to bronchitis, and 67 to pneumonia. Accident or negligence resulted in 8 deaths, 4 of which were through vehicular traffic. Altogether 785 or 41 per cent, of the total number of deaths at all ages during the year were of children under five years of age. Of children aged between five and fifteen, 55 died ; the chief causes being tuberculosis, which accounted for 14 deaths, other infectious diseases, which resulted in 12, diseases of the heart and circulatory organs in 8 and accident or negligence, which caused 8 deaths. There died 59 persons aged from fifteen to twenty-five years, of whom 12 were the victims of consumption, 7 of other infectious diseases, 8 of diseases of the heart and circulatory organs, and 4 of accident or negligence. 7 Of persons aged between twenty-five and thirty-five years, there died 104, the chief causes being consumption, which resulted in 40 deaths, diseases of the heart and circulatory organs which accounted for 13, pneumonia which caused 5 deaths, and Bright's disease which resulted in 5 deaths. Cancer was given as he cause of 3 deaths, and there were 3 deaths through suicidal poisoning. t The deaths of persons aged from thirty-five to forty-five years numbered 156, of which 36 resulted from consumption, 5 from cancer, 14 from diseases of the nervous system, 4 of which were due to general paralysis of the insane, 14 from diseases of the heart and circulatory organs, 21 from pneumonia, 15 from diseases of the digestive organs, 10 of which were attributed to cirrhosis of the liver, 5 from Bright's disease and 4 from accident or negligence. Six deaths were the result of suicidal acts. Of persons from forty-five to fifty-five years of age 203 died. Of these 40 succumbed to consumption, 24 to cancer, 7 to apoplexy, 6 to general paralysis of the insane, 25 to diseases of the heart and circulatory organs, 22 to bronchitis, 19 to pneumonia, 6 to cirrhosis of the liver, 12 to kidney disease, and 4 to the results of accident or negligence. Five committed suicide, and there was one case of homicide, Of the 202 deaths amongst persons aged from fifty-five to sixty-five years, 18 were attributed to consumption, 27 to cancer, 4 to old age, 16 to apoplexy, 32 to heart disease and disorders of the circulatory organs, 35 to bronchitis, 15 to pneumonia, 5 to cirrhosis of the liver, 14 to Bright's disease, and 2 to accidental causes. There was one case of suicide. Of persons aged between sixty-five and seventy-five years there died 209, the chief causes being cancer, which resulted in 19, old age in 18, apoplexy 18, diseases of the heart and circulatory organs 29, bronchitis 57, pneumonia 15, diseases of the digestive system 14, including 3 attributed to cirrhosis of the liver, and Bright's disease, which resulted in 15 deaths. Five deaths were the result of accident or negligence and one of suicide. Of 112 persons dying who were aged between seventy-five and eighty-five years in 54 instances death was attributed to old age, in 15 to diseases of the heart and circulatory organs and in 28 to bronchitis. Cancer was given as the cause of 3 deaths and accident or negligence of two. Of the 28 persons who died aged eighty-five years and upwards 19 died from old age, 1 from senile gangrene, 1 from disease of the heart and circulatory organs, 4 from bronchitis, 2 from pneumonia, and 1 from the result of a fall. The chief causes of death in the Borough during the year were : tuberculosis, which accounted for 241, including 169 attributed to phthisis or consumption ; pneumonia, 223 ; bronchitis, 199 ; diseases of the heart and blood vessels, 146 ; old age, 95 ; violence, 97 ; cancer, 81 ; measles, 80 ; diarrhoea, 66 ; atrophy, debility and marasmus, 79 ; prematurity, 64 ; Bright's disease and other diseases 8 of the kidneys, 57 ; apoplexy, 48 ; whooping cough, 45 ; alcoholism and cirrhosis of the liver, 30 ; and enteritis, which was given as the cause of 30 deaths. Of the 81 deaths from cancer 36 were of males and 45 of females. Eight persons under forty-five years and three over seventy-five years of age were certified to have died from cancer, the remaining 70 deaths were of persons aged between forty five and seventy-five years. In addition 10 deaths, 4 of males and 6 of females, were attributed to malignant disease not definitely stated to have been cancer, but in some of these cancer was probably the cause of death. The cancer death rate, which was 0.71 per 1,000 population, was again above the average. The rates for previous years are as follows : 0.72 in 1909, 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, 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 taken into account in estimating the above rates. Of the deaths attributed to alcoholism and cirrhosis of the liver, the latter being a disease generally held to be due to the habitual consumption of alcoholic drinks in excess, 20 were of males and 10 of females. The number this year was lower than usual. As pointed out in previous reports, the actual numbers of deaths directly or indirectly the result of alcoholism in all probability considerably exceed the figures given. Eight deaths were certified as due to appendicitis, as compared with 3 in 1909, 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. Five deaths were attributed to peritonitis. It is worthy of note with respect to the mortality from peritonitis in Shoreditch that there has been a very marked reduction in the number of deaths attributed to it during recent years. Taking the ten years ending 1900 the average number of deaths annually was 16.4, whilst during the ten years ending 1910 the number averaged only 7.2. During the former period deaths from appendicitis were included under peritonitis, whilst during the last ten years they have been classed separately. The number from appendicitis has averaged 5.8 annually. Taking peritonitis and appendicitis together they have been given as the cause of 13 deaths on an average annually during the ten years ending 1910, a marked reduction as compared with the deaths from peritonitis during the former period after allowing for the decreasing population of the Borough during the periods taken. This reduction may possibly be to some extent attributed to the more general recognition of the nature of appendicitis and of the value of the remedial measures available for dealing with it during recent years, so that cases which formerly terminated fatally from peritonitis now survive. Of the 97 deaths from violence 59 were of males and 38 of females. Through accident or negligence 77 persons met their deaths. Street accidents in connection with vehicular traffic accounted for 14 deaths, falls for 18, and burns and scalds for 3 ; suffocation in bed of infants resulted in 35 deaths or nearly double the number for last year. There was one case of homicide in a man and 19 persons committed suicide 15 of whom were males and 4 females. 9 DEATHS IN PUBLIC INSTITUTIONS. The number 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. Persona belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Union Workhouse 2 244 246 Shoreditch Workhouse 511 20 531 Royal Chest Hospital 11 44 55 Convent Hospital .. 2 2 Home of Good Shepherd 26 3 29 Babies' Home 13 9 22 Totals 562 323 885 Elsewhere than in public institutions, twelve persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various institutions outside Shoreditch with the numbers of persons belonging to the Borough dying therein :— Asylums. No. of Deaths. General Hospitals—continued, Banstead7 Royal Free 3 Cane Hill 1 Royal 1 Caterham 3 St. Bartholomew's 82 City of London 3 St. George's 2 Claybury 7 St. Thomas's 1 Colney Hatch 13 University College 4 Dartford Heath 1 Hospitals for Special Diseases, &c. Hanwell 1 Lying-in, City of London 5 Horton 5 Chest Hospital, Bethnal Green 2 Leavesden 6 Cancer 1 Long Grove 3 Heart Hospital, Soho 1 Tooting Bee6 Central London Throat and | Ear 1 Hospitals for Infectious Disease. Grove 1 Infirmaries And Workhouses. Eastern 7 Bethnal Green Infirmary 4 North Eastern 8 Belmont Workhouse 9 London Fever 1 Children'sInfirinary,Carshalton 4 Horborn Infirmary 3 General Hospitals. Hackney Infirmary 5 East London (Children) 4 St. George's Infirmary 1 German 6 Gt. Ormond Street (Children) 10 Other Institutions. Guy's 5 St. Peter's House 1 King's College 1 St. Joseph's Hospice 3 London 28 St. Anne's House 1 London Temperance 1 Home for Invalids, Highbury 1 Metropolitan 61 Hostel of God, Clapham 1 Mildmay 3 Hospital of St. John and National 1 Elizabeth1 Poplar 1 St. Luke's House 1 Queen's (Children) 89 H.M. Prison, Brixton 2 10 Of 428 persons belonging to Shoreditch dying in public institutions situate teyond the limits of the Borough 306 died in general hospitals, including 103 in hospitals for sick children, 58 died in asylums for those mentally unsound, 17 in fever hospitals, 26 in workhouses and infirmaries, 9 in hospitals for special diseases, and 11 in other institutions. Elsewhere than in public institutions 25 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 990 or 51.7 per cent, of the deaths of persons belonging to Shoreditch took place in public institutions. SICKNESS AMONGST THE POOR. The cases coming under the treatment of the district medical officers in connection with the Poor Law Dispensary in Hoxton Street during 1910 numbered 5,445, as compared with 5,261 in 1909, 4,453 in 1908, 4,380 in 1907, 4,107 in 1906, and 4,014 in 1905. During the last few years the numbers have shown a marked increase. An analysis of the cases is contained in Table VIII. (Appendix). The diseases classed as infectious accounted for 923 of the cases as compared with 945 in 1909, 707 in 1908, and 763 in 1907. Measles, consumption, diarrhoea, whooping cough and influenza were responsible for most of these cases. As compared with the figures for 1909 the number of cases of measles and consumption show increases, whilst for influenza and whooping cough the numbers are decreased. The cases of erysipelas were only half as numerous as in 1909. Diseases of the respiratory organs, which are mainly the results of infection, show a decrease numbering 1,344 as compared with 1,444 in 1909, and 1,268 for 1908. Of these bronchitis accounted for 1,176 and pneumonia for 93. Rheumatism was given as the cause of illness in 398 cases, as compared with 355 in 1909. The cases of rheumatic fever numbered 53, as compared with 47 in 1909 and 32 in 1908. The cases of gout numbered 100, as compared with 104 for last year. Dyspepsia and disorders of the digestive organs numbered 688, as compared with 629 in 1909. The cases diagnosed as cancer numbered 37, as compared with 36 in 1909, 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. There is a further increase in the number of cases classed under the heading Diseases of the Locomotive System, and a very marked increase is also noticeable in the number of cases of skin disease coming under treatment as compared with the figures for the previous year. INFECTIOUS DISEASES. The infectious diseases included under the headings numbered 1 to 35 and 171 in Table VI. (Appendix) resulted in 511 deaths, as compared with 676 in 1909, 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 reduction in the number of deaths from these diseases during the year under consideration is therefore very marked, and it may be stated that 11 they are the smallest number so far recorded for any year in respect to Shoreditch. They amounted to 26.7 per cent, of the total number of deaths from all causes, as compared with 30.8 for 1909 and 30.7 for 1908. As compared with the figures for 1909 the decrease was most marked as regards measles, whooping cough, tuberculosis, especially consumption, diphtheria and diarrhoea. The deaths from consumption and the other forms of tuberculosis amounted approximately to 47 per cent, of the total number of deaths from infectious diseases, and of the remainder, measles, diarrhoea, and whooping cough, in the order given accounted for the greater number. The death rate from these infectious diseases was 4.5 per 1,000 inhabitants, as compared with 5.9 in 1909, 5.4 in 1908, 6.5 in 1907, 6.7 in 1906, 6.2 in 1905, 6.8 in 1904, and 6.5 in 1903. The death-rate for infectious diseases during 1910 is the lowest so far recorded for Shoreditch. In the subjoined table the deaths from the infectious diseases referred to above have been grouped according to age :— Age period. No. of deaths Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 85 and upwards 141 145 20 6 12 7 52 46 44 26 9 3 .. It will be noticed that more than half of these deaths were of children under the age of five years. Taking the total number of deaths of children under five years of age from all causes, 35 per cent, resulted from the infectious diseases referred to as compared with 43 per cent, in 1909, 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 infectious 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 217, the death-rate due to them, which is termed the zymotic death-rate, being 1.9 per 1,000 inhabitants, as compared with 2.7 in 1909, 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, was again markedly 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. 12 (Appendix). The rate was highest in Whitmore and lowest in Moorfields Ward, being 2.5 per 1,000 in the former and nil 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 fact that no deaths from any of the principal zymotic diseases occurred in the latter ward happens for the first time, and is of course an exceptional circumstance. The cases of notifiable infectious disease numbered 528, being 201 less than in 1909. The numbers of cases annually certified since 1889, and the attack-rates per 1,000 inhabitants, are contained in the following table :— Year. Number of cases. Attack-rate per 1,000 inhabitants. 1890 1158 9.4 1891 862 7.0 1892 1478 12.0 1893 1987 16.2 1891 1104 9.0 1895 1157 9.4 1896 1473 12.1 1897 1331 10.9 1898 960 7.8 1899 1116 9.2 1900 989 8.1 1901 1146 9.8 1902 1239 10.5 1903 664 5.6 1904 776 6.6 1905 1151 9.8 1906 951 8.2 1907 1265 10.8 1908 1028 8.8 1909 729 6.3 1910 528 4.5 The cases during 1910 were less numerous than in any year since the notification of infectious diseases became compulsory. The cases of notifiable infectious disease certified in the Metropolis during 1910 amounted to 21,777, including cases notified as cerebro-spinal fever which has been a notifiable disease since March, 1907, the attack-rate being 4.4 per 1,000 population, as compared with 6.0 for 1909. 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 13 of the four quarters of the year, and the numbers and percentages of such cases which were removed to hospital for treatment :— Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox .. 1 1 .. 2 .. Scarlet Fever or Scar- latina 35 70 57 48 210 4 Diphtheria & Membra- nous Croup 42 20 24 41 127 14 Typhus .. .. .. .. .. .. Cholera .. .. .. .. .. .. Enteric Fever (Typhoid) 8 2 20 19 49 8 Continued Fever .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. Puerperal Fever 2 1 2 3 8 2 Erysipelas 30 30 28 39 127 1 Plague .. .. .. .. .. .. Cerebro Spinal Fever .. .. 2 3 5 2 Glanders .. .. .. .. .. .. Anthrax .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. Totals 117 124 134 153 528 31 Numbers and percentages ) of cases removed to > hospitals ) 83 71? 93 , 75 % i 105 119 78% 78* 400 76 % The cases of scarlet fever were fewer in number by 129 as compared with the number for 1909, and there was a marked decrease in the number of cases of diphtheria, and also in the number of cases of erysipelas and puerperal fever. The deaths from notifiable infectious disease were less in point of numbers than in any year since notification became compulsory and compared with the average of fifteen to twenty years ago the decrease is very striking. The deaths from the principal zymotic diseases which are notifiable, namely—smallpox, scarlet fever, diphtheria and enteric fever were at the rate of 0"23 per 1,000 inhabitants, whereas the rate for the principal zymotic diseases, which are not notifiable, namely—measles, whooping cough and diarrhoea was 1 '68, or more than seven times as great. ISOLATION OF INFECTIOUS CASES. Most of the cases of notifiable infectious disease removed to hospital are received by the hospitals of the Metropolitan Asylums Board. Cases of enteric fever, puerperal fever and erysipelas not infrequently go to the Shoreditch infirmary and general hospitals in the neighbourhood of the Borough. The infectious diseases cases of which are receivable into the hospitals of the Metropolitan Asylums Board are :— smallpox, scarlet fever, diphtheria, enteric fever and cerebro spinal fever. The number of cases of these diseases certified (Appendix, Table III.) was 393, and the 14 number removed to hospital 384, giving a percentage of 97.7, as compared with 97 in 1909, 97.3 in 1908, 97.5 in 1907, and 96 per cent, in 1906. The percentages for previous years are contained in the report for 1905. In a densely populated district like Shoreditch removal to hospital for the purposes of isolation is of the utmost importance for controlling the spread of infection, and it is satisfactory therefore to again have to report such a high percentage of removals. 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. The facts were briefly as follows (1) George W, aged 5, was certified to have scarlet fever on January 14th, and removed to hospital, returning on April 6th, after 82 days' absence from home. His mother stated that on his return she noticed he had a " sore place " on his left ear, and also one or two on his back. Sidney W, aged 2 years and 8 months, sickened with scarlet fever on April 28th, and was certified to have the disease on April 30th. (2) May H.——aged 2i years, was certified and removed to hospital on June 9th, and returned home on September 5th after 88 days in hospital. Three days after her return a discharge from her nose and ears was observed, and her face became " scurfy." On September 13th, Rose H, aged 5, who was attending school, sickened and her case was certified to be one of scarlet fever. SMALLPOX. After an interval of six years, smallpox once again made its appearance in the Borough. On June 15th, a man aged 42, residing in Clarissa Street, fell ill, an eruption was noticed on the 18th, and on the 20th he walked to a hospital, where the case was recognised to be one of smallpox and the patient was forthwith removed to the smallpox hospital. The usual enquiries were made with a view to ascertaining the source of infection, but nothing definite was obtained to throw light upon the manner in which the man contracted the disease. He worked in Shoreditch as a handy man at a drug grinders, and no history was obtained as to him having been away from Shoreditch for some considerable time prior to his illness. It is possible however, that he may have handled an infected bale from abroad. The patient was stated to have been vaccinated in infancy and re-vaccinated at the age of 15 years. The customary steps were taken as regards disinfection, vaccination and revaccination, and as to the observation of those persons who had been in contact with the patient of whom there were members of several families. All escaped the disease except the wife of the patient, aged 35, who stated she had been vaccinated in infancy, but refused to be re-vaccinated. She fell ill about mid-day on July 3rd, according to what she told me, but it subsequently came to my knowledge that 15 she complained of not feeling well when she woke up in the morning. I saw her a 10 a.m. on that date; she then assured me that she was feeling quite well, and she had no appearance of being ill. At 11 p.m. the same date, I saw her again at the hospital, to which she went in the evening, where she informed me that she felt very ill about 2 p.m. On examination a scarlatinaform prodromal eruption was present and the true eruption of the disease was beginning to appear on the backs of the wrists The history of the case, signs and symptoms were sufficient to warrant a diagnosis of smallpox, and she was certified and removed to the smallpox hospital, the removal being effected within 24 hours of the first symptoms becoming manifest. Unlike the previous case this patient had comparatively small opportunity for spreading infection, and no subsequent cases occurred in Shoreditch. Both cases turned out to be smart attacks, but the patients made good recoveries. Seven cases of smallpox were certified in the Metropolis during the year. VACCINATION. The last official figures as to vaccination are those published with the report of the Medical Officer of the Local Government Board for 1909-10 and relate to the year 1908. Of the births registered during that year in 51.5 per cent, vaccination was successfully performed and 34.5 per cent, were not finally accounted for, the latter figure including postponed cases. Altogether 39.2 per cent, of the children whose births were registered in 1908 were unvaccinated at the end of the year. The last figure includes those exempted by conscientious objection certificates, which numbered 169 or 4.7 per cent, of the births registered as compared with 2.1 per cent, in 1907, 0.7 in 1906, 0.8 in 1905, 0.5 in 1904, 0.6 in 1903 and 0.3 in 1902. In the following table are contained the percentages of children born not finally accounted for as regards vaccination, including postponed cases, each year from 189C to 1908 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 47.5 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 19H6 32.6 21.2 9.5 1898 68.4 330 19-6 1907 31.2 22.7 10.3 1899 54.2 27-7 15-4 1908 34.5 21.5 9.4 The above figures show that during 1908 there was a definite set back as regards vaccination in the Borough. 16 SCARLET FEVER. The cases certified during 1910 numbered 210, as compared with 339 in 1909, 590 in 1908, 876 in 1907, 629 in 1906, 789 in 1905, 343 in 1904, and 255 in 1903. It may be mentioned that the number for the year under consideration is the smallest so far recorded. In 29, or 13.8 per cent, of the cases certified, intimations were received from the Metropolitan Asylums Board that the patients had not been suffering from scarlet fever. Making the necessary correction for errors in diagnosis the cases of scarlet fever during the year numbered 181, as compared with 321 in 1909, 573 in 1908, 822 in 1907, 599 in 1906, 776 in 1905, 326 in 1904, and 237 in 1903. The distribution of the cases certified and the deaths amongst males and females during the year in the Borough and its eight wards is as shown in the subjoined table :— Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 6 3 9 .. .. .. Church 15 18 33 1 .. .. Hoxton 13 12 25 .. .. .. Wenlock 10 15 25 .. .. .. Whitmore 17 23 40 1 1 2 Kingsland 23 16 39 .. .. .. Haggerston 11 12 23 .. .. .. Acton 8 8 16 1 • • 1 Totals for Borough 103 107 210 3 1 4 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified 208, or 99 per cent., were removed to hospital as compared with 97.9 in 1909, 97.9 in 1908, 98.6 in 1907, 97.4 in 1906, 97 in 1905, and 96 in 1904. The percentage for the year under consideration is the highest so far noted. The percentages for previous years are given in the Report for 1903. The cases certified were at the rate of 1.8 per 1,000 inhabitants, as compared with 2.9 in 1909, 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 lowest in Wenlock and highest in Kingsland Ward, being 1.2 per 1,000 in the former, as compared with 3.6 in the latter. 17 The deaths numbered 4, as compared with 7 in 1909, 28 in 1908, 28 in 1907, 20 in 1906, 27 in 1905, and 13 in 1904, the death rate being 0.03 per 1,000 population as compared with 0.06 in 1909, 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 1.9 per cent, of the cases certified as compared with 2.0 in 1909, 4.7 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 in 1910 lower than in any year for which they have been recorded. Amongst children under five years there were 86 cases, with 2 deaths, the case mortality being 2.3 per cent, (allowing for mistakes in diagnosis 2.7 per cent.), as compared with 2.3 in 1909, 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 124 cases, with 2 deaths, the mortality being at the rate of 1.6 per cent, of the cases certified (allowing for errors in diagnosis 1.8), as compared with 1.9 in 1909, 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 were of children below fifteen years of age. Throughout the Metropolis some 10,542 cases were certified, the attack-rate being 2.1 per 1,000 inhabitants, as compared with 3.5 in 1909, 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 214, the death rate being 0.04 per 1,000, as compared with 0.08 in 1909, 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 in London generally scarlet fever during 1910 was again below the average, both as regards prevalence and mortality, and it may also be remarked that the attack-rate and death-rate from this disease in Shoreditch were again below the average for the Metropolis. It may also be pointed out that during the past eleven years the attack-rate in Shoreditch has averaged 3.9 per 1,000, as compared with 3.7 for the Metropolis as a whole. In a poor working class district with a density of population per acre approximately three times the average for the Metropolis a greater difference than this might be expected. That such is not the case is, I believe, very largely to be attributed to the high percentage of the cases certified in the Borough removed to hospital for isolation. DIPHTHERIA. The cases certified, including 5 of membranous croup, numbered 127, as compared with 183 in 1909, 202 in 1908, and 211 in 1907. Of these 15 or 11.8 per cent., were not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board. b 18 The number 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 3 12 .. .. .. Church 14 12 26 .. 2 2 Hoxton 6 11 20 .. 4 4 Wenlock 7 12 19 .. 2 2 Whitmore 10 10 20 3 1 4 Kingsland 3 .. 6 .. 1 1 Haggerston 6 9 15 .. 1 1 Acton 6 3 9 .. .. .. Totals for Borough 61 66 127 3 11 14 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified 97 per cent, were removed to hospital, as compared with 96 per cent, in 1909, 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 65 in 1896. The cases certified were at the rate of 1.1 per 1,000 inhabitants, as compared with 1.5 in 1909 and 1.7 in 1908. As last year the attack-rate was highest in Moorfields, where it was 2.3 per 1,000 inhabitants. It was lowest in Kingsland Ward, where it only amounted to 0.5 per 1,000. The deaths numbered 14, the death rate being 0.12 per 1,000, as compared with 0.18 for 1909, 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). As last year, the rate was highest in Hoxton Ward. There were no deaths from diphtheria in Moorfields Ward, although the attack-rate was highest, and for the third year in succession there were no deaths from the disease certified in Acton Ward. The case mortality was 11.0 per cent, of the cases certified, as compared with 11.5 in 1909, 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 1910 all were of children under five years of age, the mortality being at the rate of 17.2 percent, of the cases certified amongst children of that age period (19.7 per cent, allowing for errors of diagnosis) as compared with 19 15.7 in 1909, 9.5 in 1908, 15.6 in 1907, 16 in 1906, 14.7 in 1905, 16.3 in 1904, 23.8 in 1903, 20.5 in 1902, 15.4 in 1901, 22.7 in 1900, 34.2 in 1899, 29.5 in 1898, 36.0 in 1897, 31.8 in 1896, 47.5 in 1895, 43.0 in 1894, and 61.0 in 1893. None of the cases amongst persons over five years of age terminated fatally. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 120 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 6 5 11 From 1 to 2 years 0 4 9 13 „ 2 ,, 3 „ 10 9 19 „ 3 ,, 4 „ 9 7 16 „ 4 ,, 5 „ 11 8 19 „ 5 ,, 10 „ 11 17 28 „ 10 ,, 13 „ 2 o 4 Over 13 years 2 8 10 Totals 55 65 120 In 47 of the cases the patients were children attending school, and in 31 of these they were at school within a week of being certified as having the disease. As noted in previous years, there were instances in which the children were at school whilst suffering from diphtheria before the nature of their illness was recognised. In 66 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 17 instances the histories showed that there had been cases of " sore throat " amongst the inmates of the houses in which the patients resided. In 22 instances there was evidence pointing to infection from previous cases in the Borough. In 90 instances the houses were occupied by members of more than one family, in 18 by single families, and in 12 instances the cases occurred in artisan's dwellings of the block type. With regard to the sanitary condition of the dwellings, in 69 this was satisfactory, in 25 fairly so, and in 26 it was unsatisfactory, but these figures must not be taken as an indication that a satisfactory sanitary condition is favourable to the occurrence of diphtheria in houses. Similar proportions have been obtained in inspecting houses in which no diphtheria cases were notified. The cases certified as diphtheria in London numbered 5,508 as compared with 6,783 in 1909, 7,840 in 1908, and 8,585 in 1907, the attack rates being 1.1, 1.4, 1.6 and 1.8 per 1,000 population for the four years respectively. The deaths in London numbered 434 as compared with 605 in 1909, 724 in 1908 and 787 in 1907, the death- B2 20 rates being 0.09, 0.12, 0.15 and 0.16 per 1,000 population respectively. The figures show that whilst the attack-rate in Shoreditch during the year was about the same as that for the Metropolis generally, the mortality from the disease was somewhat higher. ENTERIC OR TYPHOID FEVER. The cases certified during 1910 numbered 49, of which 3 were subsequently not regarded as cases of enteric fever at the hospitals to which they were removed. The figures for twenty years previously are given in the report for 1909. The number of cases in 1910 was the same as for the previous year. The attack-rate was 0.4 per 1,000 population, as compared with 0.4 in 1909, 0.8 in 1908, 0.3 in 1907, 0.3 in 1906, 0.3 in 1905, 0.4 in 1904, and 0.8 in 1903. The deaths numbered 8, the death-rate being 0.07 per 1,000 inhabitants as compared with 0.05 in 1909, 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 although higher than in 1909 was below the average for the previous ten years. The case-mortality was at the rate of 16.3 per cent, of the cases certified or deducting cases not regarded as having been enteric fever the mortality was 17.3 per cent. The case mortalities for 1909, 1908, 1907, and 1906 were 12.2, 10.9, 17.6 and 10 per cent, respectively. Taking the case mortalities for the seventeen years ending 1909, the average is 14.5 per cent, of the cases certified ; the mortality during 1910 was therefore higher than usual. The distribution of the cases certified, and deaths amongst males and females in the Borough and the eight wards thereof during 1910, is shown in the subjoined table:— ENTERIC FEVER. Wards. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. M oorfields 1 .. 1 .. .. .. Church 2 3 5 .. 1 1 Hoxton 4 3 7 1 .. 1 Wenlok 4 6 10 .. 2 2 Whitmore 4 4 8 .. .. .. Kingsland 2 3 5 1 .. 1 Haggerston 2 2 4 .. 1 1 Acton 5 4 9 1 1 2 Totals for Borough 24 25 49 3 5 8 The cases are grouped according to ages in Table III. (Appendix). Of the cases certified, 46, or approximately 94 per cent., were removed to hospital for treatment. 21 Below are set out briefly particulars as to the age and sex of the patient, date of invasion and certification, the sanitary condition of the dwellings and the probable source of infection. Cases certified but subsequently regarded as not having been 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 V.L.B. F. 22 2, Parr Street Dec. 4, '09 Dec. 31, '09 Fail Case 3. 2 F.M. M. 14 2, Parr Street Dec. 19, '09 Jan. 1 Fair Case 3. 3 M.M. F. 31 2, Parr Street Nov. 13,'09 Jan. 1 Fair 4 E.M. F. 30 2, Parr Street Jan. 3 Jan. 7 Fair Case 3 or possibly Cases 1 or 2. 5 W.J. M. 7 64, Gopsall Street Jan. 2 Jan 15 Satisfactory Infected in Hackney, where he was resident until 9th January, 1910. 6 A.K. F. 6 116, Britannia Street Dec. 26, '09 Jan. 21 Fair 7 W.C. M. 21 5, Avebury Street Feb. 10 Feb. 23 Fair This patient is cousin to Case 1 whose husband with 2 children moved from 2, Parr Street about 14th January, 1910 to 5, Avebury Street. It was noticed that Violet B, aged 2½, was not well at the time and she became worse. Her illness suggested enteric fever and she may have been the link between Cases 1 and 7. 8 E.S. F. 16 Shoreditch Infirmary Feb. 20 Mar. 5 Satisfactory 9 M.A.L. F. 24 5, Avebury Street Mar. 5 Mar. 9 Fair Case 7. Possibly the child mentioned in the note to Case 7. 10 S.B. M. 4½ 32, Gopsall Street Apr. 17 Mav 3 Fair 11 F.N. F. 22 15, Broke Road May. 5 May 27 Satisfactory 12 C.M.C. F. 15 101, Queen's Road Aug. 12 Aug. 14 Unsatisfactory 13 E.A.C. M. 17 101, Queen's Road Aug. 12 Aug. 14 Unsatisfactory 14 J.T C. M. 21 101, Queen's Road Aug. 12 Aug. 14 Unsatisfactory 15 W.C.C. M. 20 101, Queen's Road Aug. 13 Aug. 18 Unsatisfactory 16 C.L. F. 22 45, Harman Street Jul}' 14 Aug. 25 Satisfactory This patient (a nurse) came from Feridenheim-a hospital on 14th July, 1910. She is stated to have been ailing then. 17 M.F. F. 8 139, Goldsmith Row Aug. 17 Aug. 26 Satisfactory 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. 18 A.P. M. 16 44, Broke Road Aug. 7 Aug. 27 Satisfactory Mussels eaten about 28th July, 1910, believed by his relatives to have caused his illness. 19 E.G. F. 37 27, Wilmer Gardens Aug. 14 Aug. 29 Unsatisfactory Had mussels on 13th August, 1910, was sick on 14th August, 1910, and continued ill. His friends attributed illness to the mussels. 20 A.C. F. 24 5, Felton Street Sept. 2 Satisfactory Mussels eaten about 17th August, 1910. 21 E.E. M. 22 7, Dove Row Aug. 19 Sept. 3 Unsatisfactory Fried fish eater. 22 S.W. F. 15 13, Gorsuch Street Sept. 4 Sept. 10 Unsatisfactory Fried fish eater. 23 J L. M. 8 8 Pearson Street Aug. 28 Sept. 16 Satisfactory Fried fish eater. Mussels during first week of August. 24 J.W. F. 38 16, Red Lion Street Aug. 28 Sept. 16 Unsatisfactory Fried fish eater. Was in the habit of eating mussels. 25 E.W.B. M. 40 20, Bachas Street Aug. 28 Sept. 19 Satisfactory Fried fish eater. Was at Southend during first week of August, had cockles also mussels there. 26 J.R.B. M. 16 207, Chatham Avenue Aug. 28 Sept. 19 Satisfactory Fried fish eater, fond of ice cream, had mussels before his illness. 27 w.r. M. 30 49, Buttesland Street Sept. 2 Sept. 19 Satisfactory Was at Ramsgate August 20th to 28th. Oysters on 20th and 22nd, also mussels, was sick on 21st August. Sickness thought to be due to oysters. No fried fish. 28 A.C. M. 33 26, Hoxton Square Sept. 1 Sept. 20 Unsatisfactory' Fried fish eater. 29 D.M. F. 16 7, Pownall Road Sept. 2 Sept. 24 Satisfactory Fried fish eater. Was at Hastings on August 21st. Mussels said to have been eaten during the week ending August 28th. 30 M. F. 40 65, Buttesland Street Sept. 10 Sept. 28 Satisfactory Was at. Folkestone August 27th, Gravesend August 20th, had mussels and winkles. Fried fish eater. 31 J.W. A. M. 30 69, Buttesland Street Sept. 17 Oct. 1 Unsatisfactory Mussels on 16th September, 1910, and ou several occasions previously. Worked in Stratford. Fried fish eater. 32 J.G. M. 16 27, Wilmer Gardens Sept. 21 Oct. 1 Unsatisfactory Son to case 19, whence infection was probably derived. 33 A.Y. F. 35 29, Aske Street Sept. 1 Oct. 5 Satisfactory Fried fish eater. 34 S.W. F. 40 11, Dorchester Street Oct. 5 Satisfactory No fried fish nor shell fish. Was at Yarmouth during August, and has not been well since—took to bed 1st October, 1910. 35 A.K. F. 58 80, Wenlock Street Sept. 21 Oct. 7 Unsatisfactory No fried fish nor shell fish. 36 M.S. F. 26 24, Broke Road Sept 21 Oct. 8 Satisfactory Mussels about September 19th. This patient was a resident in Bethnal Green at the time she was taken ill. 37 E.B. F. 42 47, Taplow Street Sept. 14 Oct. 8 Satisfactory 38 J.R. M. 21 2, Hamilton Buildings .. Sept. 24 Oct. 10 Satisfactory 39 F.S. M. 32 101, Boston Street Aug. 19 Oct. 13 Fried fish eater. 40 J.G. M. 29 55, Essex Street Oct. 8 Nov. 5 Satisfactory No shell fish or fried fish. 41 M.P. F. 27 48, Scawfell Street Oct. 22 Nov. 12 42 J.G.B. M. 15 47, Taplow Street Oct. 18 Nov. 23 Satisfactory No fried fish. Case 37 was mother to this patient, and probably infected him. 43 R.L. M. 21 65, OrnSaby Street Nov. 10 Dec. 1 Satisfactory 44 E.B L. F. 12 65, Ormsby Street Nov. 24 Dec. 12 Satisfactory Sister to case 43, whence infection was probably derived. 45 H.A.C. M. 31 17, Kent Street Nov. 20 Dec. 12 Unsatisfactory 46 M.D. F. 4 22, York Row Dec. 2 Dec. 15 Unsatisfactory Fried fish eater—no shell fish. 22 23 24 The usual enquiries were made as to the circumstances connected with the occurrence of enteric fever cases in the Borough during the year. With respect to the cnses certified during the first half of the year, six were in all probability connected, one was without doubt infected whilst resident in an adjoining Borough, and nothing definite was obtained to throw light upon the source of infection in the others. With regard to the cases during the second half of the year, in three instances there was evidence as to infection from previous cases in the Borough. In the majority, however, nothing definite was obtained, but some evidence was forthcoming to indicate the probability of some article of food being the means by which infection was conveyed. It will be noticed that in several instances shell fish had been eaten prior to the onset of the disease, and in several cases fried fish is mentioned, and may possibly have been the vehicle of infection. Eight of the cases or approximately 17 per cent, were secondary to previous cases in the Borough. The cases certified in the Metropolis numbered 1,298, as compared with 1,049 in 1909, 1,350 in 1908, 1,396 in 1907 and 1,608 in 1906. The attack-rate for the Metropolis was 0.2 per 1,000 population. The deaths numbered 196 as compared with 146 in 1909, and 225 in 1908, and the death-rate was 0.04 per 1,000 inhabitants. ERYSIPELAS. The cases certified as erysipelas numbered 127, as compared with 143 in 1909, 121 in 1908, 133 in 1907, 144 in 1906, 138 in 1905, 183 in 1904, 117 in 1903 and 172 in 1902. There was only one death from the disease, as compared with 16 in 1909, 5 in 1908, 6 in 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 contained in the report for 1908. 25 The cases and deaths amongst males and females in the Borough and its eight wards were distributed as set out below Ward. ERYSIPELAS. Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 6 4 10 .. .. .. Church 6 21 27 .. .. .. Hoxton 9 9 18 .. .. .. Wenlock 12 12 24 .. .. .. Whitmore 5 10 15 .. .. .. Kingsland 7 3 10 1 .. 1 Haggerston 5 4 9 .. . . .. Acton 6 8 14 .. .. .. Totals for Borough 56 71 127 1 .. 1 The death-rate was 0.00 per 1,000 inhabitants, as compared with 014 in 1909, 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, 005 in 1901, and 0.08 in 1900. The deaths were at the rate of 0'8per cent, of the cases certified, as compared with 112 per cent, in 1909, 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 Septicæmia (blood-poisoning) were given as the cause of death in 9 instances, 3 of males and 6 of females. Infective endocarditis caused the deaths of 1 male and 5 females. PUERPERAL FEVER. Eight cases were certified, with two deaths. The attacks were at the rate of 2'2 per 1,000 births, as compared with 3.5 in 1909, 1.3 in 1903, 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 0.5, as compared with 10 in 1909, 0.5 in 1908, 0.2 in 1907, 0.8 in 1906, 1.0 in 1905, 0'5 in 1904, 02 in 1903, 0.7 in 1902 and 0.2 in 1901. DIARRHCEA. The deaths numbered 66, not including 30 attributed to enteritis chiefly in infants under one year as compared with 79 in 1909, 112 in 1908, 74 in 1907, and 194 in 1906. Deaths occurred in every month throughout the year, but were most 26 numerous during September ; 42 of the 66 deaths occurred during August, September and October Amongst infants under one year there were 54 deaths ; eight were of children aged from one to five years, one of a child aged between five and ten years, two were of persons aged between 25 and 45 years, and one was of a person over 75 years of age. The diarrhoea death-rate was 0.58 per 1,000 inhabitants, as compared with 0.69 in 1909, 0.82 in 1908, 064 in 1907, and 1.68 in 1906. The mortality from diarrhoea was therefore much lower than usual, probably largely to be accounted for by meteriological conditions, the summer being on the whole, favourable to a low prevalence of diarrhoea. The mortality from diarrhoea amongst infants under one year in Shoreditch during 1910, was at the rate of 15.0 per 1,000 births registered during the year, as compared with 15.9 in 1909, 23 3 in 1908, 15 3 in 1907, 40.3 in 1906, and 306 in 1905. Similar rates for the Metropolis were 8.0 in 1910, 9'9 in 1909, 14.4 in 190S, 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 enquiries made by the Health Visitor during the year as regards deaths of infants under the age of eight months (vide Appendix, p. 82) show, as noted in previous years that the great majority are of infants artificially fed. The deaths from diarrhoea in London numbered 1,368, as compared with 1,577 in 1909, 2,592 in 1908, 1,563 in 1907. and 4,507 in 1906. The deaths were most numerous in August, September and October. The diarrhoea death-rate for the Metropolis was 0'28 per 1,000, as compared with 0.32 in 1909, 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. The deaths from measles numbered 80, as compared with 127 in 1909. It is however to be noted, that the number of cases coming under treatment by the Poor Law Medical Officers considerably exceeded that of 1909, moreover, a far larger number of cases came under our notice through the school authorities; there is, therefore, reason for believing that, notwithstanding the smaller number of deaths n 1910, the disease was really more prevalent than in 1909. The cases seem to have been fairly equally distributed throughout the year, but were above the average for the year during May, August and November. The deaths were most numerous during the months of March, April, May, June, July, November and December, The whole of the deaths from measles were of children under 10 years of age; 21 were under one year, 57 were aged between one and five years, and two were aged from five to ten years; 38 were of males and 42 of females. The measles death-rate 27 was 0.70 per 1,000 population as compared with 1.11 in 1909, 0.44 in 1908, 0 99 in 1907, 0.64 in 1906, 0.52 in 1905, 0.69 in 1901, 0.85 in 1903, 0.72 in 1902, and 0.61 in 1901. The death-rate from the disease was highest in Whitmore, and lowest in Acton Ward. For the second year in succession no deaths were recorded from measles in Moorfields Ward. The number of instances in which houses were brought to the notice of the Health Department owing to the alleged presence of measles therein numbered 736 ; in some of these the houses were reported more than once. In the great majority of the cases they came under our notice through information received from the school authorities. On enquiring, it appeared that the illness was not measles in 151 instances. Disinfection was carried out in connection with 497 rooms by (he officers of the Borough Council, and the usual steps were taken with bedding and textile articles for their disinfection. Since the inclusion of measles amongst the dangerous infectious diseases, it has been the practice in this Borough to deal with it as far as possible as with the other dangerous infectious diseases. In ten instances disinfection was carried out by the occupiers of the infected premises to the satisfaction of the medical practitioners in attendince on the cases. The deaths from measles in London numbered 1,980, as compared with 2,324 in 1909, the death rate being 0.40, as compared with 0.48 per 1,000 population in 1909. WHOOPING COUGH. This disease was the cause of 45 deaths, 17 of males and 28 of females. Of these, 21 were of infants under 12 months' old, and 24 of children aged from one to five years. The deaths were most numerous during the months of March, April, May and June. The disease appears to have been most prevalent during March and April. The death-rate due to whooping cough was 0.39 per 1,000 as compared with 064 for 1909. The rate was highest in Kingsland and lowest in Haggerston Ward. For the second year in succession no deaths from this disease were certified in .Moorfields Ward. The deaths from whooping cough in the metropolis numbered 1,363, the death rate being 0'28 per 1,000 inhabitants. INFLUENZA. The deaths attributed to influenza numbered 16, as compared with 23 in 1909, 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 28 Annual Report for 1901. Most of the deaths occurred during the first half of the year. During the second half only one death was recorded, that occurred in December. The deaths attributed to influenza in the metropolis numbered 723, as compared with 1,231 in 1909, 1,334 in 1908, 967 in 1907, 895 in 1906, 664 in 1905, 707 in 1904, 664 in 1903, 1,036 in 1902, 664 in 1901 and 1,950 in 1900. The deaths were most numerous during the months of January, February, March and December, and least so during June, July and August. TUBERCULOSIS. Tuberculosis (appendix Table V., Nos. 29 to 34 inclusive) was given as the cause of 241 deaths, as compared with 277 in 1909, 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 again considerably below the average for recent years, and was, in fact, the smallest number so far recorded for any year in Shoreditch. The deaths from tuberculosis in the Borough amounted to 12'6 per cent. of the total number of deaths from all causes, as compared with 12.6 in 1909, 15.5 in 1908, 14 in 1907 and 15 in 1906. The death-rate was 2.l per 1,000 population, as compared with 2.4 in 1909, 2 7 in 1908, 2.8 in 1907, 3.0 in 1906, 27 in 1905 and 3.5 in 1904. Since the year 1856 the mortality from tuberculosis has gradually decreased in Shoreditch. With the lapse of time, the difference between the mortality of fifty years ago and of the present day has become very marked. Taking the nine years, 1856 to 1864, the tuberculosis death-rate for that period averaged 4 2 per 1,000 population ; for the nine years ending 1910, the average has been 2.7 per 1,000; the difference between these two figures represents a decrease of 35 per cent. Although during recent years some efforts have been made, more especially with a view to checking the spread of consumption or tuberculosis of the lungs in the Borough, which may not, perhaps, have been without some effect, the decrease above indicated must in the main be ascribed to the general improvement which has gradually been effected in the sanitary condition of the Borough and the measures which have been instituted generally with a view to that object. With increased efforts specially directed against the disease itself a further and marked decrease in its mortality may with good reason be expected and the establishment of a tuberculosis dispen sary in the Borough would go a long way towards achieving this object. Comparing the Wards the tuberculosis death-rate was highest in Whitmore where it amounted to 3.5 per 1,000 and lowest in Moorfields where it was only 0.2 per 1,000 which is exceptional; the next lowest was 1.4 for Acton Ward. Tuberculosis of the lungs or consumption was the cause of 169 deaths, as compared with 194 in 1909, 224 in 1908, 232 in 1907, and 233 in 1906. Most of the deaths were of persons aged from 25 to 55 years ; 110 were of males, and 59 of females. The consumption death-rate was 1.4 per 1,000 inhabitants, as compaied 29 with 17 for 1909. The rate was highest in Whitmore Ward where it was 2.3 per 1,000; no deaths from consumption were recorded as having occurred during the year in Moorfields Ward. The deaths from tuberculosis in the Metropolis numbered 7,236 giving a deathrate of 15 per 1,000 inhabitants. Of these, some 5,555 were attributed to consumption, the death-rate being l.l per 1,000 inhabitants, as compared with T3 for 1909. In accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1908, during the year, 202 certificates were received as to consumptive inmates of poor law institutions, 121 from the district medical officers as to consumptive patients upon whom they were attending as officers of the guardians, and 150 relating to the discharge of consumptives from poor law institutions. In six instances, changes of address of consumptives were notified by relieving officers. Altogether, 479 certificates were received referring to 272 persons suffering from consumption. Of these persons, 31 were certified previously in 1909, leaving 241 certified for the first time in Shoreditch during the year. The number certified in 1909 was 313. The addresses given on the certificates were visited in the great majority of cases by the sanitary inspectors, and as far as practicable such steps were taken as appeared necessary for the prevention of the spreading infection. Houses in which deaths from the disease occurred were also visited, with a view to securing measures being taken for their disinfection. In addition to the poor law notifications a number of others were received from the medical officer (Education) relating to school children, from certain hospitals, from the charity organisation society and also voluntarily from patients themselves. The circumstances in connection with these cases together with those referring to some 35 female patients notified by the poor law officers were investigated by the Health Visitor and are dealt with in her interesting report to which attention is directed (appendix p. 84). The evidence obtained throwing light upon the sources of infection in a number of the cases is worthy of note and also the fact that in 14 of the cases sanatorium or open air treatment was obtained through the Charity Organisation Society, the Invalid Children's Aid Association or otherwise. Disinfection was carried out by the Sanitary Authority in connection with a large number of the houses in which cases came under our notice. Altogether 122 rooms in 121 houses were disinfected, bedding and textile articles being dealt with in the usual way in the great majority of the cases. CHOLERA. Only one intimation under the cholera regulations was received during the year. It was from the port sanitary authority of Folkestone and referred to five persons from Salermo, in Italy, in the neighbourhood of which cholera cases had been occurring. The usual enquiries were made and the persons concerned duly kept under observation. 30 GLANDERS, ANTHRAX, HYDROPHOBIA. No cases of the above diseases in human beings were certified in Shoreditch during the year. In London six cases of anthrax and one of hydrophobia occurred. Six intimations were received from the veterinary inspector of the London County Council as to the presence of glanders amongst horses at five premises and one intimation as to a case of anthrax in a horse. The necessary steps as to disinfection are taken under the supervision of the veterinary inspector. Visits are made by the sanitary officers in all cases with a view to getting information as to the existence of any illness there may be of a suspicious character amongst those who have had to deal with the infected animals, Nothing was ascertained during the year which afforded any reason to believe that there had been any transmission of infection to human beings. CEREBRO SPINAL FEVER. Five cases were certified with two deaths. In three the meningococcus was stated to have been found in fluid from the spinal cord. The fatal cases were in infants under one year. There were 21 deaths attributed to meningitis, 16 being of children under the age of one year. Enquiries were made as to the cause of the meningitis in these cases. In most of them it was stated that there were no grounds for suspecting cerebro spinal fever. In two or three the pneumococcus was given as the cause and in two or three post mortem examinations and bacteriological results obtained after death shewed the presence of the meningococcus. The cases of cerebrospinal fever certified in the Metropolis numbered 115 and 10 deaths were attributed to the disease. 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 scnool management code of the London County Council:— 31 School. Enteric Fever. Small Pox. Diphtheria. Scarlet Fever. Measles. Chicken Pox. Whooping Cough. Mumps. 1 Other Causes. Total. Arlington Square .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 .. .. 3 Bath Street .. .. .. 1 .. .. .. .. . . 1 Canal Road .. .. .. 2 62 28 5 4 70 171 Catharine Street .. .. 2 .. 3 .. .. .. 1 6 Central Street .. .. .. .. .. 2 .. .. .. 2 Chatham Gardens .. .. 1 2 12 5 8 6 6 40 Coleman Street Ward. .. .. .. .. 1 .. .. . . .. 1 Curtain Road .. .. 14 7 18 13 13 45 46 156 Daniel Street .. .. 1 1 1 . . .. .. 2 5 Enfield Road .. .. .. .. .. 1 1 .. .. 2 Gayhurst Road .. .. .. .. .. .. .. .. 1 1 Gopaall Street .. .. 3 21 146 19 8 61 93 352 Haggerston Road .. .. .. 10 145 48 36 5 26 274 Hammond Square .. .. 12 21 113 21 46 39 103 356 Hoxton House .. .. 6 4 7 .. .. 4 12 38 Jews Free .. .. .. 1 .. .. .. .. .. 1 Laburnum Street .. .. 2 9 70 30 10 6 .. 154 Maidstone Street .. .. 8 13 58 27 23 76 131 337 Mowlem Street .. .. .. 1 .. .. .. .. .. 1 Napier Street .. .. 20 14 90 23 41 20 .. 246 Pritchards Road .. .. .. .. 3 1 .. .. .. 4 Queen Head Street .. .. .. .. 2 .. .. .. .. 2 Queen's Road .. .. .. .. 1 .. .. .. .. 1 Redvers Street .. .. 6 2 14 .. 2 .. 16 45 Rochelle Street .. .. .. .. .. 1 .. .. .. 1 Rotherfield Street .. .. .. .. .. .. .. .. 1 1 St. John's Lane .. .. .. .. .. .. .. .. .. 2 St. John's National .. .. 5 4 4 1 .. .. .. 15 St. John's Road .. .. 4 22 61 19 l 20 11 138 St. Joseph's .. .. .. .. 4 .. .. 4 .. 8 St. Luke's Parochial .. .. .. .. 1 .. .. 1 .. 2 St. Marks .. .. .. 1 1 .. .. 1 .. 3 St. Monica's .. .. .. .. 15 1 .. .. .. 16 St. Paul's .. .. 4 11 13 10 16 12 13 79 St. Phillip's .. .. .. .. .. 1 .. 2 .. 3 Scawfell Street .. .. 6 42 75 17 33 28 46 251 Scrutton Street .. .. 17 13 .. 1 1 6 19 78 Shap Street .. . 3 31 72 .. .. 10 13 1 70 Shepperton Road .. .. .. .. 6 4 6 .. 3 19 Trinity Place .. .. 6 6 4 7 16 25 12 55 167 Virginia Road .. .. .. 2 1 2 .. .. .. 5 Wenlock Road .. .. 7 5 46 18 16 12 31 135 Total 13 4 128 246 1113 330 294 374 791 3293 32 The number of children excluded in 1909 for infectious diseases was 2,646. The increase during 1910 was mainly due to the larger number of exclusions for measles and mumps. With respect to the numbers excluded on account of scarlet fever and diphtheria some reduction is noticeable in 1910, as compared with the previous year. During the year intimations were received from the Medical Officer (Education) as to the exclusion of children who had not had measles from the infants departments or from classrooms in the infants departments of the following schools:— In February, Laburnum Street, classroom G; in April, Trinity Place School, classroom E; in June, Chatham Gardens School, classroom D; in July, Napier Street School, classroom C; in September, Hamond Square, classroom C, and Shap Street, classroom B; in October, Gopsall Street, classrooms A, B and C, Shap Street, classroom C, Redvers Street, classroom A, Catherine Street, infants department, Canal Road, classrooms A and B, Hoxton House, classroom K, Chatham Gardens, classroom D, and Haggerston Road, infants department; in November, Shap Street, infants department, Gopsall Street, classroom A, Scrutton Street, classroom A, Scawfell Street classroom, M, St. John's Road, classroom F, Catherine Street, classroom F, and Napier Street, classroom C; in December, Trinity Place, classroom E, Shap Street, classroom B, Napier Street, classrooms A and B, and St. Monica's School, classroom C. In June it was necessary to visit Scawfell Street and Hamond Square Schools in connecton with the occurrence of cases of scarlet fever certified in children attending the infants departments, the incidence of the cases suggesting the probability of an undetected source of infection. A watch was kept, but the cases ceased without anything definite being ascertained. BACTERIOLOGICAL EXAMINATIONS. During the year 69 examinations were made by Dr. Bulloch at the London Hospital Medical School in cases of suspected infectious disease. In 45 the examinations were for sore throats suspected of being diphtheria; in 18 the results were positive, and in 27 negative. In 17 instances Widal's tests were made for enteric fever, with positive results in nine. Seven examinations were made for the tubercle bacillus, with positive results in three. Throughout the year specimens were collected from persons who had been inmates of the Metropolitan Asylums Board Hospitals suffering from enteric fever in connection with an investigation undertaken by Dr. Theodore Thomson, of the Local Government Board as regards "carrier" cases. The results of the examinations made by Dr. Ledingham, of the Lister Institute, where the specimens were sent, were negative so far as those collected in Shoreditch went. 33 DISINFECTION. During 1910 disinfection was carried out at 1,131 premises, as compared with 1,103 in 1909, 1,208 in 1903 and 1,688 in 1907. The articles removed and disinfected at the Borough disinfecting station numbered 24,788. as compared with 26,544 in 1909, 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 1,222 beds. 1,157 mattresses, 2,356 pillows, 816 bolsters and 19,237 other articles, including sheets, blankets, quilts, curtains, carpets, clothing and the like. Included are 1,092 articles disinfected on account of vermin, as compared with 564 for 1909. It was necessary to destroy 9 infected beds, 14 palliasses, 3 bolsters and 5 pillows, which were so torn and contaminated that it was not advisable to return them. These were replaced with new. No complaints of a serious nature were received in respect to the measures taken by the Sanitary Authority, but in one instance compensation was allowed for damage done to a quilt. THE SHELTER. The Shelter was in use on three occasions during the year: on June 20th, for one night, by a family of three persons; on July 4th, for one night, by three persons; in both instances for smallpox; and on December 8th, for 3 hours, by a single person whilst his clothing was being disinfected. THE PUBLIC MORTUARY. The dead bodies received into the public mortuary numbered 382, as compared with 392 m 1909, 367 in 1908, 349 in 1907, 405 in 1906, 417 in 1905, and 460 in 1904. No bodies of persons dead of infectious disease were removed to the mortuary by the Sanitary Authority. The numbers for previous years were 5 in 1909, 6 in 1908, 3 in 1907, 5 in 1906, 3 in 1905, and 4 in 1904. There is a special iron shell at the mortuary which is used for the reception of infected bodies. The inquests numbered 322, as compared with 317 in 1909, 302 in 1908, 298 in 1907, 295 in 1906, 290 in 1905, and 336 in 1904. The post mortem examinations at the post mortem room attached to the mortuary numbered 214, as compared with 241 in 1909, 203 in 1908, 229 in 1907, 226 in 1906, 223 in 1905, and 251 in 1904. The figures for years previous to 1904 are contained in the Report for 1903. WATER SUPPLY. The rainfall for the year measured at Oxford amounted to 29.178 inches Taking the mean fall for 35 years there was an excess of approximately 3'4 inches Most rain fell during the last quarter of the year, the rainfall during that period amounting to 11767 inches. The wettest month was December, when 4.958 inches were 9 34 recorded. Least rain fell in September, when only 0.439 of an inch was measured. The general rainfall in the Thames Valley above Teddington amounted to 32.45 inches, and in the Lee Valley 27.80 inches. (Dr. Mill's Returns). 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 82 premises, as compared with 83 in 1909, 65 in 1908, and 113 in 1907. Of these 48 were in the New River District and 34 in that of the East London. In 37 of these the houses had been vacated, in 19 water pipes were broken or leaky, in 6 the water rates had not been paid, in 3 the supplies had been cut off by request, in 9 there was waste, and in 8 no reasons were given as to why the supply had been stopped. 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 water-borne illness. SANITARY WORK. Preliminary notices as to insanitary conditions were served in respect to 2,886 premises. Of these 462 were dealt with under the supervision of Inspector Lear. 254 under Inspector Firth, 431 under that of Inspector Jordan, 419 under Inspector Langstone, 534 under Inspector Pearson, and 786 under Inspector Stokes. The figures of Inspector Lear relate to the first ten months of the year. Inspector Firth was absent for nearly six months owing to the results of an accident. In connection with the work arising from the notices, some 746 letters were sent to owners of property. builders and others concerned. Some 28,626 visits of inspection were made by the sanitary inspectors during the year. The premises under inspection included dwelling houses, artizan's dwellings, houses let in lodgings, outworker's premises, factories, workshops, laundries, bakehouses, cowsheds, milk-vendor's premises, ice-cream shops, slaughter-houses, and premises where food is prepared and sold. 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:— 35 Insp. Lear. Insp. Firth. Insp. Jordan. Insp. LangBtone. Insp. Pearson. Insp. Stokes. Total. New drains constructed 1 4 7 6 3 9 30 Drains re-constructed or repaired 15 22 55 35 55 53 235 Sink waste pipes trapped and disconnected 2 40 61 3 11 6 126 Stack pipes re-instated 31 47 30 18 93 33 252 Eaves gutters re-instated 62 41 29 34 94 39 299 Stack pipes disconnected from drains 1 29 20 3 .. 1 54 Accumulations of sewage dealt with 3 6 28 25 63 37 162 Cesspools abolished 2 .. .. .. .. .. 2 New water closets constructed 20 2 32 2 5 292 353 Old water closets re-constructed or repaired 13 37 107 46 64 68 335 Water closets cleansed and white-washed 208 27 175 46 169 213 838 Water closet flushing apparatus repaired 58 23 93 55 92 116 437 Obstructions in water closets removed 43 20 34 21 36 63 217 Overcrowding in houses abated 13 13 19 17 16 26 104 Damp courses in houses provided 1 16 7 .. 2 3 29 Walls pointed 20 12 1 4 3.1 2 70 Roofs repaired 07 29 31 84 100 99 410 Stairs repaired 46 22 16 8 14 5 111 Floors repaired 59 14 16 23 43 34 189 Ventilation under floors ptovided 1 3 3 14 18 2 41 Doors repaired 18 6 14 19 9 20 86 Door cills provided 11 17 4 1 14 1 48 Sashes repaired 98 6 12 13 6 9 144 Houses cleansed throughout 51 12 47 27 41 43 221 Houses cleansed in part 72 113 40 153 212 87 677 Total number of rooms cleansed 730 320 393 527 720 700 3390 Yards or areas lime-washed 230 6 148 33 128 168 713 Yards paved 42 43 48 36 91 29 289 Areas and forecourts paved 4 5 6 6 13 .. 34 New areas constructed 1 .. .. .. .. 1 2 Sculleries paved 1 6 4 4 7 1 23 Dust receptacles provided 61 41 50 81 82 77 392 Dung receptacles provided .. 1 .. .. .. • • 1 Insanitary cisterns removed •• .. .. .. •• .. .. In addition to the above 5 old brick drains were removed and in 51 instances nuisances and annoyance resulting from the presence of rats on premises were dealt with. Where rats are complained of it is most frequently found that there are defects in drains on the premises or near at hand which have to be remedied in order to get rid of them. Rats are known to be closely associated with the dissemination of the infection of plague, the importance of having sound drains so as to exclude rats from dwellings as a precaution against plague, therefore, is not to be overlooked. The attention of the sanitary staff was specially directed to the point towards the latter end of the year in consequence of the occurrence of several cases of plague in one of the Eastern Counties of England. 2 36 In 173 instances water supplies were restored to premises, and on 106 premises leaky water pipes were repaired. Urinals were constructed or reconstructed in 6 instances and 33 were cleansed and repaired. Foul accumulations causing or likely to cause nuisance were dealt with on 56 premises. In 19 instances animals were found to be stabled so as to give rise to nuisance, and in 26 instances stables were properly paved or re-paved 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 and sanitary arrangements 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 318 instances. Act, 1891, were served upon the parties responsible in 318 instances. For noncompliance 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. Crondall Street, No. 75 20/- fine with 2/- costs, or in default 17 days imprisonment. Harwar Street, No. 86 40/- fine with 2/- costs. Louisa Street, No. 12 7/- fine with 23/- costs. Pitfield Street, No. 15 £3 fine with 2/- costs. St. John's Road, No. 155 Summons withdrawn on payment of 21/- costs. Wilmer Gardens, No. 51 Order made with 21/- costs. With regard to the houses in Crondall Street, Pitfield Street, Louisa Street and Harwar Street persons resident at these addresses were proceeded against for exposing unsound foods for sale (page 51). In the case of No. 155, St. John's Road a summons was taken against the owner by Inspector Langstone for neglecting to comply with a statutory notice requiring certain repairs necessary to prevent rain coming through the roof. The summons was withdrawn on payment to the Borough Council of the costs mentioned, the owner giving an undertaking to do the work required in forty-eight hours. With respect to No. 51, Wilmer Gardens, the owner was summoned by Inspector Pearson for failing to comply with a statutory notice under the Public Health (London) Act, 1891, as amended by the London County Council (General Powers) Act, 1907, Section 78, by neglecting to provide a means for obtaining water on one of the floors above the ground floor. There were three floors and the water tap for the house was in the yard. A tap was subsequently provided on the second floor. 37 SMOKE NUISANCES. Nuisances through the emission of black smoke were dealt with in 16 instances. Twenty-four communications were received from the London County Council respecting 15 premises, and one was received from the Coal Smoke Abatement Society. There were also three complaints relative to smoke nuisances in connection with private premises. In all cases the necessary steps were taken to obtain the abatement of the nuisances complained of. Seven intimation notices were served by the sanitary inspectors, 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 197, as compared with 99 in 1909, 127 in 1908, 111 in 1907, and 103 in 1906. The rooms dealt with numbered 386, as compared with 157 in 1909. The usual steps were taken to strip, stop and cleanse walls where required. In 94 of the rooms situate in 72 of the bouses referred to above the steps taken arose through information from the school authorities. During the year numerous intimations were received from the Medical Officer (Education) as to children attending school in a verminous state, presumably suffering from body lice. Others also from the same source were received through the Medical Officers of Health of adjoining boroughs. These intimations, which numbered over one hundred, related to some 355 homes in Shoreditch, in which dwelt 424 children alleged to have been attending school in a verminous state. Intimations were also received respecting a number of other homes in which there were verminous children situate in adjoining boroughs. These were duly forwarded to the respective medical officers of health. In a few cases the same house and children were brought under our notice more than once. The intimations were accompanied by requests for the homes to be dealt with under the London County Council (General Powers) Act, 1904. Part IV., Section 20, of that Act giving the sanitary authority power to cleanse houses infested with vermin. In all cases the addresses at which the children reported resided were visited by the sanitary inspectors, and the dwelling, bedding, clothing and the like inspected with a view more particularly to ascertaining whether lice were present or not. Special attention was paid to seams and folds in clothing, &c., with the object of detecting nits. The general condition of the dwelling as regards cleanliness, the presence or absence of bugs and fleas was also noted. Where necessary the requisite steps were taken by disinfection and cleansing to free the dwellings, bedding and the like from vermin. A very appreciable amount of the inspector's time was occupied in the work and in numerous instances multiple visits had to be made before the dwellings could be inspected. Much tact is necessary in connection with visits of this character, but notwithstanding great care in this respect on the part of the inspectors in numerous instances the visits were greatly resented by parents and others in charge of the 38 children alleged to be verminous. Inasmuch as there was no evidence of lice in the sreat majority of the dwellings visited, it cannot but be admitted that in many instances there were grounds for the resentment manifested. The following are the results of the visits in 260 instances which were specially noted : In 30 cases there was evidence of the existence of lice in the bedding or clothing found in the dwelling; in the remaining 230 no such evidence was obtained. In 186 the dwelling-rooms were described as being clean or fairly so, in 35 as being dirty in 22 there was marked evidence of bugs, and in 17 instances the rooms were both dirty and infested with bugs. In 160 instances the bedding was described as clean or fairly so; in 60 it was dirty; in 23 evidence of lice was observed; in 3 it was dirty and also contained lice; in 10 it was dirty and contained bugs, and in 4 instances lice were observed in both bedding and clothing. In 18 instances the dwellings were markedly infested with fleas, and in 8 cases overcrowding was noted. It may be mentioned that in several cases evidence of extreme poverty was manifest. HOUSES CLOSED. The following houses were closed upon the service of sanitary notices, either no account of being unfit for habitation or in order to enable the works necessary to put them in a satisfactory sanitary condition to be carried out in a proper and efficient manner, which would have been difficult or impossible whilst the houses were in occupation:— Avebury Street, No. 9. Earl Street, No 30. Barrett's Buildings, No. 7. Holywell Place, Nos 2, 4 and 5 Bevenden Street, No. 27. Westmoreland Place, Nos. 45 and 70. Dereham Place. Nos. 16 and 20. Walmer Gardens. No. 77. Devizes Street. Nos 3. 6, 7 and 11. No. 9, Avebury Street, a 4.-roomed dwelling, was in a very dirty and dilapidated state, the roof, eaves, guttering, stairs, window frames and flooring wore defective the yard paving was also in a defective condition, and there was an absence of a proper receptacle for house refuse. The house was brought to the notice of the Health Committee, who gave instructions for it to be inspected under the Housing and Town Planning Act, 1909, and an intimation notice was served by Inspector Langstone upon the owner setting forth the existing defects and calling upon him to remedy them. The house became empty, and in a few days was stripped of its sanitary fittings, so that it became totally unfit for human habitation. Nothing was done to deal with it, and it remained closed at the end of the year, the windows having been boarded up. No. 7, Barrett's Buildings, a two-roomed dwelling-house, was dirty, dilapidated, overcrowded and verminous. It was closed by the owner on receipt of a statutory 39 notice under the Public Health (Loud.) Act, 1891, in order to enable the necessary work to be carried out in an efficient manner, which was done under the supervision of Inspector Pearson. The house in Bevenden Street was in a dirty and dilapidated state, the roof was leaky, and there were other matters requiring attention. A statutory notice was served upon the owner who, however, did not think it worth while to comply with its requirements and closed the house. It has since been demolished and the site cleared for rebuilding on. The houses in Dereham Place were dirty, dilapidated and verminous. No. 20 was also very damp. Statutory notices were served upon the owner under the Public Health (Lond.) Act, 1891, and they were closed in order to facilitate the necessary measures for dealing with them. The necessary work as regards No. 16 was carried out under the supervision of Inspector Jordan, but No. 20 remained closed at the end of the year. With respect to the houses in Devizes Street. Nos. 3 and 11 were closed by the owner on receipt of statutory notices under the Public Health (Lond.) Act, 1891; they were in a very dirty and dilapidated state. Nos. 6 and 7 were represented under the Housing and Town Planning Act, 1909 as being unfit for human habitation; they were generally dirty and very dilapidated and without proper and sufficient water supplies, the water fittings having been removed, and there were no proper dust receptacles. As regards the house in Earl Street, an eight-roomed dwelling, the basement was very damp. A statutory notice was served upon the owner, who deemed it necessary to close the house in order that it might be speedily and effectively dealt with. The necessary steps were taken with a view to correcting the dampness. The houses in Holywell Place were closed in consequence of the service of statutory notices under the Public Health (Lond.) Act, 1891, they were dirty, dilapidated, damp, and some of the brickwork required attention. The necessary work was carried out under the supervision of Inspector Jordan. The brickwork was repaired and pointed, damp courses and new flooring were provided, and the houses were generally cleansed and the dilapidations made good. No. 45, Westmoreland Place was generally dirty and dilapidated, and No. 70 was without a proper and sufficient water supply. Both were closed by the owner on receipt of statutory notices under the Public Health (Lond.) Act, 1891. HOUSING AND TOWN PLANNING ACT, 1909. Under Section 17 subsection (1) of the above Act, it is the duty of the Borough Council to cause to be made from time to time inspection to ascertain whether any 40 dwelling-house within the Borough is in such an insanitary state as to be unfit for human habitation. For this purpose the Borough Council and its officers are to comply with such regulations and to keep such records as may be prescribed by the Local Government Board. Under the powers given them the Local Government Board have made regulations bearing date, September 2, 1910. The purport of these regulations is as follows:— The Borough Council shall provide for a thorough inspection to be carried out from time to time, according to the varying needs and circumstances of the dwelling houses or localities of the Borough; the Medical Officer of Health is made responsible for the preparation of lists of dwelling houses the early inspection of which is in his opinion desirable (Article I.). For the purpose of these inspections the state of the dwelling houses in relation to the following matters shall be examined:— (1) The arrangements for preventing the contamination of the water supply. (2) Water closet accommodation. (3) Drainage. (4) The condition of the dwelling house in regard to light, the free circulation of air, dampness and cleanliness. (5) The paving, drainage and sanitary condition of any yard or out-houses belonging to or occupied with the dwelling house. (G) The arrangements for the deposit of refuse and ashes. (7) The existence of any room which would in pursuance of sub section (7) of Section 17 of the Act of 1909 be a dwelling house so dangerous or injurious to health as to be unfit for human habitation. (8) Any defects in other matters which may tend to render the dwelling house dangerous or injurious to the health of the inhabitants (Article II.). The Medical Officer of Health is made responsible for the preparation of the records of the inspections made and they shall be kept by the officer of the sanitary authority appointed for the purpose. These records must contain information under appropriate headings, namely:— (1) The situation of the dwelling-house and its name or number. (2) The name of the officer who made the inspection. (3) The date of the inspection. (4) The date of the last previous inspection and a reference to the record thereof. (5) The state of the dwelling-house in regard to each of the matters mentioned above, in relation to the inspection of the house as to its sanitary condition. (G) Action taken by the Medical Officer of Health or other officer of the local authority, either independently or on the directions of the Local Authority. 41 (71 Results of any action so taken. (8) Any further action which should be taken in respect of the dwelling-house (Article III.) The Local Authority shall so far as may be necessary take into consideration at each of their ordinary meetings the records above mentioned, and shall act thereon as may be necessary or desirable in regard to any dwelling-house to which the records relate (Article IV.). The Medical Officer of Health shall include in his Annual Report information and particulars in tabular form in regard to the number of dwelling-houses inspected under and for the purposes of Section 17 of the Act of 1909. the number of dwelling houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation, the number of representations made to the Local Authority with a view to closing orders being made, the number of closing orders made, the number of dwelling-houses, the defects in which were remedied without the making of closing orders, the number of dwelling-houses which after the making of closing orders were put in a state fit for human habitation, and the general character of the defects found to exist. He shall also include any other information and particulars which he may consider desirable in regard to the work of inspection under the said section (Article V.). The regulations were considered by the Health Committee, and upon the recommendation of the Committee the Borough Council gave the necessary instructions to the officers of the Health Department to comply with the requirements of the regulations. In accordance with the provisions of Article V. of the regulations, the subjoined information and particulars are given with respect to the action taken up to the end of the year 1910:— (1) The number of houses inspected under Section 17 27 (2) The number considered to be unfit for habitation 3 (3) The number of representations made to the Local Authority, with a view to closing orders 2 (4) The number of closing orders made 2 (5) The number of dwelling-houses, the defects of which were remedied without the making of closing orders (6) The number of dwelling-houses, which after the making of closing orders were put in a fit state for human habitation (7) The general character of the defects found to exist were: dampness, defective roofs, general dilapidations and want of cleanliness, want of ventilation beneath flooring, defective yard paving, defective water-closets, eaves, guttering and rainwater pipes and want of proper dust receptacles. 42 Those dwelling-houses which were considered to be in a state unfit for human habitations were very dilapidated, moreover the brickwork was defective and dangerous. One of these was closed by the owner before its condition was brought to the notice of the Health Committee, and no representation was made therefore. In connection with 24 of the above houses intimation notices were served by the sanitary inspectors and works were in progress at the end of the year to remedy the defects except in one instance. In this the house became unoccupied, and has not since been let. With regard to the houses closed, a good deal of brickwork has been demolished as being dangerous. The sites will probably be cleared for re-building. ARTIZANS' DWELLINGS. Particulars in respect to the artizans' dwellings in the Borough 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 Bincludes the same dwellings as in previous years. The number of tenements, rooms, and persons in the dwellings estimated for the year 1910 are contained in the subjoined table:— N umber of blocks. N umber of tenements. Number of rooms. Number of persons. ClassA 33 1532 3966 5920 Class B 15 383 917 1780 Total for the whole 18 1915 4883 7700 So far as can be ascertained, there is no reason for believing that the figures materially differ from those of the previous year. The conditions associated with residence in the class A are, from a sanitary point of view, superior to those in the class B dwellings. 45 The births registered during g 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. Kate per 1,000 Inhabitants. Number. Rate per 1,000 Inhabitants. 221 28.7 169 28 .5 52 29.2 The number of births was 34 less than in 1909. The proportion of deaths attributed to prematurity were at the rate of 13.5 per 1,000 births, as compared with 11.7 in 1909. 4.3 in 1908, 12 in 1907, 12 in 1906 and 27.5 in 1905. In class A the deaths from prematurity amounted to 11.8 per 1,000 births, whilst in class B they were 19.2. For the whole Borough the deaths from prematurity amounted to 17.8 per 1,000 births. The infantile mortality for the whole of the dwellings was 95 per 1,000 births, as compared with 113 in 1909, 103 in 1908, 124 in 1907, 97 in 1906, and 140 in 1905. For the class A dwellings it was 65, as compared with 101 in 1909, 75 in 1908, 99 in 1907, 84 in 1906, and 134 in 1905. For class B the mortality was 192, as compared with 158 in 1909, 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. Number of deaths. Rate per 1,000 inhabitants. Rate per 1,000 inhabitants. All causes 73 9.5 55 9.3 18 10.1 16.8 Principal Zymotic diseases 4 0.51 3 0.50 1 0.55 1.9 All forms of Tuberculosis 6 0.77 6 1.0 - - 2.1 Phthisis 3 0.4 3 0.5 — — 1.4 Bronchitis 7 0.9 4 0.7 1.6 1.7 Pneumonia 9 1.1 5 0.8 4 2.2 1.9 The deaths of residents of the dwellings in public institutions numbered 39, being 27 for the class A and 12 for the class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 53.4, being 49.0 for class A and 66.0 for class B. The percentages for the Borough and for the wards are contained in Table VII. (Appendix). 44 The cases of notifiable infectious disease numbered 35, of which 32 were in the class A and 3 in the class B dwellings. The attack-rates per 1,000 population were respectively 4.5, 5.4 and 1.7, as compared with 4.5 for the whole Borough. The cases included 11 of scarlet fever, 11 diphtheria, 2 enteric fever, and 8 of erysipelas. The number 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 11 1.8 11 1.8 2 0.3 8 1.3 Class B 1 0.5 2 11 — — — — The whole of the 12 1.5 13 1.7 2 0.2 8 l.0 For the whole Borough the attack-rates were as follows:1.8for scarlet fever, 1.1r diphtheria, 0.4for enteric fever, and 1.1r erysipelas. In connection with the artizan=' dwellings in the Borough a brief reference may be made to the Sutton model dwellings, which will be occupied during the current year These consist of 9 blocks of dwellings built by the Sutton Trust, which was founded under the will of the late William Richard Sutton, the carrier of Golden Lane E.C., whodied on 20th May, 1900. He left a large fund in Trust to his trustees to acquire sites in populous towns and places in England for the erection of model dwellings for the necessitous poor. The site of these dwellings is at the corner of Old Street and City Road, and is the second one purchased, the amount of superficial area being about 2 acres. The contract price for the buildings was approximately £70,000. The Dwellings contain 284 tenements. The number of rooms is 601, not including sculleries, of which there is one to each tenement. There are 65 one-room tenements with rents from 3s to 3s 6d per week, 123 two-room tenements, rents from 5s 6d to 6s. 6d., 94 three-room from 7s. 6d. to 8s. 6d., and 2 four-room tenements at 10s. per week rental. Each tenement, whether consisting of one or more rooms, has scullery, bath (with hot and cold water), water-closet, and provision for keeping food. It is estimated that these dwellings when fully occupied, and it is understood that they have already been all let, will contain about 1,200 persons. There are certain qualifications necessary for residence depending generally upon the number and total earnings of each family, but roughly the head of each family should not earn more than 20s. 25s , 30s., and 35s, for a one-, two-, three- or four-room tenement respectively. The general arrangement of the dwellings on the site, the structure of the buildings, the provision made for light, air, and ventilation, the internal arrangements 45 for the comfort, convenience and sanitary welfare of the tenants are of a most excellent character. The sanitary work and drainage was carried out under the supervision of Inspector Stokes, and to give an idea of the amount it may be stated that it involved the laying of something approaching 1½ miles of pipes. The dwellings may be regarded as models amongst the finest in the Metropolis. HOUSES LET IN LODGINGS. Five houses let in lodgings or occupied by members of more than one family were placed on the register during the year, namely—134, St John's Road and 3, 5, 7 and 9, Little Essex Street. The number on the register at the end of the year was 263. Sanitary notices were served in connection with 84, and in 18 instances statutory notices were served. Legal proceedings were instituted in one case, which resulted in an order being made for certain sanitary work to be carried out. During the year 637 visits of inspection were made. CUSTOMS AND INLAND REVENUE ACTS. Application 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 in respect to four dwellings, which were granted. Applications were received under the Housing and Town Planning Act, 1909, in respect to two common lodging houses. By Section 35 (1) of this Act the assessment to inhabited house duty of any house occupied for the sole purpose of letting lodgings to persons of the working classes at a charge of not exceeding sixpence a night for each person shall be discharged upon the house being certified by the Medical Officer of Health to be solely constructed and used to afford suitable accommodation for the lodgers and that due provision is made for their sanitary requirements. The provisions of sub-section 27 of Section 26 of the Customs and Inland Revenue Act, 1890, apply as regards the certificate to be produced under the section of the Housing and Town Planning Act quoted above. In both instances the certificates applied for were given on certain sanitary matters being attended to. SLAUGHTER-HOUSES. The licensed slaughter-houses in the Borough at the end of the year numbered 6 as compared with 7 in 1909, 7 in 1908. 8 in 1907, 9 in 1906 and 12 in 1905. The licence of the slaughter-house at 184, Hoxton Street was not applied for, and has therefore lapsed. Comparatively little slaughtering is now done in Shoreditch. The slaughter-houses were inspected from time to time during the year and their general sanitary condition may be reported as satisfactory. 46 COWHOUSES. The number of licensed cowhouses at the end of 1910 was 7, remaining the same as for the past six years. Accommodation for about 100 cows is afforded. Two of the cow-houses were empty. The number of cows kept in the Borough was found at an inspection in October to be 39 as compared with 44, in 1909, 52 in 1908, 57 in 1907, 74 in 1906, 86 in 1905, 95 in 1904 and 101 in 1903. One of the cow-houses required lime-washing but otherwise 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 292 as compared with 302 in 1909, 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 24 and commenced at 14 premises, and in 64 instances there were changes in the names of the persons registered as milk vendors. Premises where milk is sold were under inspection throughout the year, and some 2,949 visits were made in connection with them. In 23 instances sanitary notices were served; the chief insanitary conditions being want of proper attention to cleanliness in 15, defects in connection with w.c.'s in 6, with sinks in 5, rain-water pipes in 3, drains in 2, yard paving in 5, and absence of proper receptacles for refuse in 5 instances. In three instances the cases were brought to the notice of the Health Committee and statutory notices had to be served before the insanitary conditions were removed. OFFENSIVE BUSINESSES. The tripe-boiling establishment in Haggerston Road, which comes under the above heading, was inspected from time to time during the year. No complaints were received in connection with it. A notice was served as to cleansing. Certain premises situate at No. 9, Canal Road, where dripping is made, were brought under notice towards the latter part of the year as being an establishment where fat melting is carried on in contravention of the bye-laws of the London County Council dealing with such businesses. At the end of the year the matter was still under consideration. FACTORY AND WORKSHOP ACT. 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1910 was 1,173, 173 having been placed on and 229 taken off during the year The numbers for previous years were: 1,226 in 1909, 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 Some 3,061 visits of inspection were made in connection with workshops and 440 to factories. 47 Seven communications were received from the Factory Inspector relative to the establishment of 171 new workshops in the Borough. On inspection 122 were found to be in a satisfactory condition. 10 were not in occupation at the time of visit, at one it was found that no work was being carried on, and one was an outworkers premises. The remainder were more or less unsatisfactory from a sanitary point of view requiring the attention of the sanitary officers and some 37 notices were served. Some 37 written intimations were received from the factory inspector referring to insanitary conditions and infringements of the law relating to public health in connection with 66 workshops and workplaces. The chief insanitary conditions to which the sanitary inspector directed attention were: dirty condition of walls and ceilings in 7 instances, defective or insufficient water-closet accommodation in 45, want of proper separate sanitary accommodation for the sexes in 8, absence of water-closet accommodation in 2, insanitary state of urinals in 1, and overcrowding in 3 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 315 workshops were dealt with, and 270 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 1910:— New drains constructed 3 Drains relaid or repaired 12 Stack pipes disconnected 2 Stack pipes reinstated 12 Eaves gutters reinstated 10 Sink waste pipes disconnected 10 Yards paved 4 Water-closets reconstructed 25 New water-closets constructed 11 Water-closets deansed and lime- washed 175 Obstructions removed from water-closets 19 Urinals repaired and cleaned 9 Ventilation improved 6 Water-closets' flushing apparatus repaired 69 Water supply laid on or restored 4 Leaking water-pipes repaired 2 Rooms cleansed and whitewashed 231 Yards 96 Areas 9 Roofs repaired 30 Floors 1 Stairs 5 Doors 9 Sashes 2 Dust receptacles provided 9 Foul accumulations removed 6 48 In 14 instances statutory notice., under the Public Health (London) Act, 1891, were served by order of the Health Committee, but there was no necessity for policecourt proceedings. The number of factories under observation during the year was 62 in connection with which 28 sanitary notices were served, The works carried out to comply with these notices included the construction, reconstruction or repair of drams in 6 instances, the disconnection of stack pipes in 6, of sink waste pipes in 3, the reconstruction of 7 water-closets and works to remedy defects inconnection with 21 others, besides other items connected with cleansing and repairs. During the year 112 lists of outworkers were received from employers in the Borough, 57 in the first half-year and 55 in the second. These lists contained the names of 1,808 outworkers of whom 1,147 were nut 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 2,971 out-workers, 313 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 out-workers received from the sanitary authorities referred to during 1910. The number of out-workers brought to our notice during 1910 was 4,785 as compared with 4,781 in 1909, 4,185 in 1908, 4,578 in 1907, and 2,975 in 1906. Of these 3,333 were residents in Shoreditch as compared with 3,401 in 1909, 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 out-workers 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 out-workers. 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 2,040 visits of inspection were made to places where home-work was carried on and sanitary notices were served in respect to 102 outworkers' premises. The work carried out to comply with these notices included the repair of drains in 3 instances, the disconnection from the drains of sink waste pipes in 2, the reinstatement of stackpipes in 10, and of eaves gutters in 9, the paving of yards in 6, of sculleries in 3 and areas in 1, the reconstruction of water-closets in 1 and the repair of flushing apparatus in 13 and other work in connection with the water supplies in 8 instances ; 148 rooms, 26 yards, and 28 water-closets were cleansed and whitewashed; repairs were effected in connection with roofs in 15 instances, floors in 3, stairs 5, doors 5, and window-sashes 2, and in 23 instances dust receptacles 49 were provided. One case of overcrowding was dealt with in connection with outworkers' premises, and in 2 instances works for the improvement of ventilation were carried out. No cases of notifiable infectious disease occurred at out-workers' premises during the year BAKEHOUSES. The number of bakehouses on the register at the end of the year was 76, as compared with 77 for 1909, one bakehouse situate above ground at 17, Rushton Street, having been demolished. These include 5, three above and two below ground, which were not in use. Of the 76 bakehouses 32 are above and 44 below ground. At 5 mechanical power is employed so as to constitute the bakehouses factories within the meaning of the Act. As the results of the inspections made, eleven of these above ground required cleansing. In one a clust receptacle was wanted, and in one a sink was defective and needed attention. Of those below the ground level 12 required cleansing ; in one a dust receptacle was wanted, and in one a lavatory provided for the use of the men employed required attention. In all 27 sanitary notices were served upon the parties responsible, and complied with. There was no necessity to report any of the cases specially to the sanitary authority. Arising out of certain correspondence from the Local Government Board the London County Council and the Bermondsey and Rotherhithe Association of Master Bakers on the subject of the regulation of places where bread is sold, a special inspection was made of such places in Shoreditch, including many of the regular baker's shops, chandler's shops and dairies Altogether some 236 shops where bread is soM were visited by the sanitary inspectors with a view to ascertaining how far they complied with the requirements laid down in Section 8 of the London County Council (General Powers) Act, 1908, for regulating the sanitary condition of premises used for the sale, &c., of food for human consumption. The Section mentioned contains provisions (A) as to sanitary conveniences ; (B) as to cisterns for water supply; (C) as to drainage; (D) as to sleeping places ; (E) as to refuse and filth; (F) as to cleanliness. In every case the requirements of provision (A) were found to be complied with; (B) was complied with in 234 instances; in two the waste preventors for flushing w.c.'s were out of order. In 233 (C) was complied with ; in 3 instances sinks on the premises, although trapped, were not properly disconnected from the drains, but there were no openings to drains within any of the places where the bread was being sold. Provision (D) was found to be complied with in 235 instances ; (E) in all cases, and (F) in 233 instances. D 50 Enquiry was also made at the same time as to the practice of exchanging stale bread for new. In the great majority of instances this was repudiated. In 32 it was allowed that it was more or less a practice, but in most of these the exchanges took place between the regular bakers and the general shop3 supplied by them. Moreover, the exchanging appeared to be commoner between the regular bakers and their customers than between the general shops and theirs. On the whole, according to the information obtained so far as Shoreditch is concerned, exchanging bread does not appear to be practised to any great extent. ICE-CREAM SHOPS. The following is a summary of the work in connection with ice cream shops during 1910 : Inspector Lear had 20 under observation, 3 of which required cleansing. Inspector Firth had 12, in 5 of which cleansing was required. Inspector Jordan had 10 under observation, in 1 of which the drain was obstructed, in 1 the roof was defective, in 1 a dust receptacle was required and in 1 cleansing was necessary, Inspector I.angstone had 15 under observation ; in 4 cleansing was required, in 2 there was some overcrowding, in 1 repairs were necessary in connection with the water-closet, and in 1 the roof of a store room was defective and had to be repaired. Inspector Pearson had 13 under observation in 3 of which cleansing was required, in 1 the drains were defective, in 1 the roof was defective and in 3 others there were other matters requiring attention. Inspector Stokes had 19 under observation. 2 of which required cleansing. Altogether 89 premises whereon ice-cream was made or sold were under the observation of the sanitary officers during the year. Of these some 62 were found in a satisfactory sanitary condition. In 22 instances sanitary notices were served. COOKSHOPS, COFFEE-SHOPS AND EATING-HOUSES. On Inspector Lear's district 29 were under observation, in 14 of which cleansing more or less was required. Inspector Firth had 16 under observation, in 6 of which cleansing was required and in 4 instances the drains and sanitary arrangements, more or less, needed attention. On Inspector Jordan's district 82 were under inspection, also the kitchens of 16 public-houses, it which dinners are provided for customers. In 3 instances drains were found obstructed ; in 4 instances there were defects in connection with the water-closets ; in 1 case the drains were reconstructed to abate nuisance due to the escape of rats from the same ; in 3 instances dust receptacles were provided ; in 3 instances cleansing was required, and in 2 cases sinks required to be properly trapped. Inspector Langstone had 16 under observation, in two of which cleansing and repairs were carried out. Inspector Pearson had 12 under inspection, in 3 of which cleansing and repairs were necessary. Inspector Stokes had 43 under inspection, in 3 of which cleansing and other matters required attention. 51 Altogether 198 cookshops, coffee-shops and eating-houses, including the kitchens of 18 public-houses, were under inspection during the year, as compared with 204 in 1909. 197 in 1908, 188 in 1907, 178 in 1906 and 182 in 1905. In 44 instances sanitary notices were served, chiefly as regards cleansing and limewashing. FRIED FISH SHOPS. On Inspector Lear's district 11 were under inspection, of which in 4 instances more or less cleansing was required. Inspector Firth had 7 under observation, in 3 of which cleansing was necessary. On Inspector Jordan's district 9 were undes observation ; in 3 instances the yard paving was defective, in 2 dust receptacles were provided, in one case the drain was obstructed and in 2 instances cleansing was necessary. Inspector Langstone had 6 under observation, in 1 of which general repairs to the premises were required. Inspector Pearson had 11 under inspection; in 1 instance there was a slight defect in the drain and in 1 case some cleansing was necessary. Inspector Stokes had 16 under observation, 2 of which required some cleansing. Altogether 60 fried fish shops were under inspection during the year and 15 sanitary notices were served in connection with them mainly for cleansing and limewashing. STREET MARKETS AND FOOD. The usual supervision was exercised by the sanitary officers with respect to the food exposed for sale in the Borough, and frequent inspections were made for the detection of unsound or unwholesome food. A sanitary inspector was on duty every evening in accordance with the instructions of the Borough Council. The following articles were surrendered or seized and destroyed as unfit for the food of man:— Herrings, 1 barrel; skate, 14 lbs.; whiting, 26; haddocks, 2 trunks; kippers, 420 pairs; bloaters, 20; mackerel, 23; mussels, 1J bags; soles, 16 pairs; partridges, 3 cwt. 2 lbs.; geese, 1; turkeys, 1; Ostend rabbits, 281; beef, 50 lbs.; necks and breasts of mutton, 30; salt beef, 6 lbs. ; Spanish onions, f box; cauliflower heads, 1,149 baskets; oranges, 1,800; tomatoes, lli lbs.; lemons, 159; cabbages, 1 ton 13 cwt. ; cherries, 7 lbs.; pears, 12 lbs.; grapes, 30 lbs. A vendor was prosecuted for exposing 226 rotten oranges for sale on a barrow in George's Square; another for exposing 135 oranges which were unfit for the food of man on a stall in Pitfield Street; and a third vendor for exposing for sale on a barrow in Phillip Street 302 unsound oranges. Convictions were obtained in each case (page 36). In a fourth case 40 rotten oranges were seized on a barrow belonging to a man who gave his name as Arthur Huggins, and who was exposing them for d 2 52 sale in Scawfell Street. A summons was taken out, but the address given was a false one, so it could not be served. A warrant was subsequently issued but the man could not be traced. The 26 whiting were seized at No. 36, Harwar Street, where they were in course of preparation for sale by frying, the premises being used as a fried fish shop. The person in whose possession they were was convicted and fined, as previously stated. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that during the year 578 samples were submitted for analysis under the above Acts, a number which gives a rate of approximately 5 samples per 1,000 inhabitants. The results of the year's work are summarised in the following table:— Quarter of theyear 1910. Number of Samples taken. Number of Sample# Adulterated. Percentage Adulterated. N umber of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of succeseful Prosecutions. Fines and Costs. Amount paid to Analyst for samples analysed £ s. d. £ s. d. 1st. 134 43 32.0% 22 — 20 16 29 8 0 67 0 0 2nd. 131 30 22.1 % 8 — 8 6 20 5 0 65 10 0 3rd. 161 24 14.92% 12 — 12 9 17 18 6 80 10 0 4th. 152 36 23.6% 23 — 20 18 26 6 0 66 5 0 Total for Year 578 133 23.0% 65 — 60 49 93 17 6 279 5 0 The samples included 348 of milk, 130 of butter, 22 malt vinegar, 13 tea dust, 8 margarine, 20 coffee, 4 cocoa, 2 chicory, 4 pepper, 2 lard, 3 tea, 6 ale, 5 tinned salmon, 3 pickled cabbage and 1 each of piccallili, mixed pickles, cayenne pepper, olive oil, pork pie, steak pie, sausage and brawn. Of the samples of milk 89 or 25 5 per cent, were found to be below the standard of the Board of Agriculture, as compared with 16.8 per cent, in 1909, 17.8 in 1908, 23.2 in 1907, 27.9 in 1906, 20.5 in 1905, 23.5 in 1904, and 22.0 in 1903. In the sub- 5.3 joined table are shown the numbers of samples of milk taken during the four quarter 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 70 25 37.1 2nd. 84 25 29.7 3rd 112 19 16.9 4 th 82 20 24.4 In 52 of the samples water was certified to have been added. In 8 the amount was more than and in 41 it was less than 5 per cent., as indicated by the standard of the Board of Agriculture. In 27 the samples showed deficiences in milk fat; in 12 of these the deficiency was less than and in 14 it exceeded 5 per cent. In 10 instances both fat had been abstracted and water added, and one of these samples showed also the presence of traces of artificial colouring matter. None of the samples contained boric acid. In 11 instances not included in the foregoing the deviation from the standard was so slight that the analyst remarked they might possibly have been genuine, and they have been so regarded. Legal proceedings were instituted in 28, or about 31 per cent, of the cases in which the samples of milk were below standard, and conviction was obtained in 19 of them. In 7 instances the summonses were dismissed, warranties being proved ; m 1 case the defendant absconded and could not be traced, and in 1 instance the defendant died. In the remaining 69 per cent, of the samples below standard prosecutions were not considered advisable, as the small percentage of adulteration rendered it extremely unlikely that convictions could be obtained. The percentages in which it was not considered advisable to prosecute in previous years were 80 in 1909, 66 in 1908, 65 in 1907, 66 in 1906, 60 in 1905, 55 in 1904 and 62 in 1903. In the cases in which convictions were obtained the penalties for milk adulteration amounted to £18, which is equivalent to 4.4 per cent, of the full amount of the penalties to which the defendants were liable, as compared with 28 per cent, in 1909, 11.2 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 £30, the average amount paid by a defendant on conviction was £1 lis. 6d., as compared with £12 6s. 4d. in 1909, £3 Is. 4d. in 1908, £1 13s. 7d in 1907, £2 9s. 6d. in 1906, £2 19s. 3d. in 1905, £2 6s. lOd. in 1904 £1 18s. 6d. in 1903, and £2 18s. 4d. in 1902. The large amount for 1909 was due to two defendants being very heavily fined. 54 Of the samples of butter taken 9, or 6.9 per cent, were not genuine as compared with 9.5 per cent, in 1909, 12.2 in 1908, 6.3 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 shown in the subjoined table:— Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st 25 4 16 2nd. 35 2 5.7 3rd. 41 2 4.8 4 th 29 1 3.4 Of the samples sold as butter which were not genuine 4 were samples of margarine and 3 contained water in excess of the 16 per cent, standard ; the other 2 were samples of butter containing foreign fats in large amounts. Prosecutions were instituted in 8 instances and in 6 convictions were obtained. In 1 case the summons was dismissed, the defence proving a warranty, and in the second case the defendant absconded and could not be traced. The penalties inflicted amounted to £23, or 7.9 per cent, of the maximum penalties to which the defendants were liable, as compared with 9 4 per cent, in 1909, 16.3 in 1908, 15.6 in 1907, 12 in 1906, 17 in 1905, 10 in 1904, 18 in 1903, and 17 in 1902. Including the costs, which amounted to £3 13s., the amounts imposed by the magistrates averaged £4 18s., as compared with £4 0s. 9d. in 1909, £4 6s. in 1908, £4 6s. 7d. in 1907, £5 3s. in 1906, £7 Is. in 1905, £5 3s. in 1906, £7 Is. in 1905, £3 Is. in 1904, £4 10s. in 1903, and £4 10s. in 1902. Eight samples of margarine were taken, and in 5 instances proceedings were instituted for selling margarine in a wrapper not bearing the word "margarine" legibly stamped upon it. as required by the Margarine Act; in each case a conviction was obtained. In another case proceedings were not pressed, the defendant paying the Council £1 15s. 6d. costs. The fines under the Margarine Act amounted to less than 1 per cent, of the maximum penalties to which the defendants were liable. Including costs, the amounts paid averaged 15s., as compared with £1 12s. 5d. in 1909 and £1 4s 6d. in 1908. Of the 20 samples sold as coffee 7 were found to be mixtures of coffee with varying amounts of chicory. Proceedings were taken in each case, and in 6 convictions were obtained. One summons was dismissed, the magistrate being satisfied on the evidence that the purchaser had been informed at the time of purchase that the article was a mixture of coffee and chicory. Of the 13 symples of tea dust, 5 were found to contain sand and ferruginous matter in varying amounts up to 6 per cent. In the case of 1 sample which contained 6 per cent, of sand proceedings were taken and a conviction was obtained, but without fine or costs. 55 Of the 22 samples of malt vinegar 17 were returned as not malt vinegar. In 16 instances summonses were taken against the vendors, and in 12 convictions were obtained, the offence being the sale of vinegar other than malt vinegar when the latter was asked for. In three instances the summonses were withdrawn under instructions from the Health Committee, and in 1 case the summons was dismissed, the magistrate believing that vinegar and not malt vinegar had been asked for. Two of the samples of tinned salmon contained minute amounts of tin found on analysis in the salmon and the samples of pork pie, steak pie, sausage and brawn showed the presence of varying amounts of boric acid. The quantities were, however, not sufficient to render it likely that legal proceedings could be instituted with any prospect of success. The samples of cocoa, chicory, pepper, lard, tea, ale, pickle, cayenne pepper and olive oil were returned as genuine. The samples of ale were examined specially with a view to ascertaining whether arsenic was present, but no traces of it were found. In 2 cases in connection with the sampling of butter the vendors obtained possession of the samples purchased and refused to deliver them to the inspectors concerned. Proceedings were taken against the vendors for obstructing the inspectors, and they were fined 40s. with 23s. costs and 20s. with 12s. 6d. costs respectively. The subjoined table shows a comparison of the results of the work under the Sale of Food and Drugs Acts during the years 1902-10 inclusive:— Year. Number of Samples. Number of persons in the Borough to each sample. 'Number of samples adulterated. | Percentage of sampie>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 1910 578 200 133 23.0 65 .. 60 49 93 17 6 279 5 0 With reference to the convictions under the Sale of Food and Drugs Acts during 1910 may be mentioned that in one of the cases of milk adulteration the offender had been once previously fined; in 4 of the butter cases the offenders had been each 56 once and in one case twice previously convicted, and in the margarine cases the defendants had in one instance been once and in another instance twice previously convicted. None of the fines inflicted during the year were heavy, although doubtless, in proportion to the business carried on they may in some instances have been seriously felt by the defendants. SANITARY STAFF. The re-arrangement of the sanitary districts in the Borough referred to in my report for last year has worked satisfactorily. I have again to express my satisfaction as to the manner in which the officers of the Health Department have discharged their duties during the year and also my appreciation of their assistance in connection with my work. During the year the department lost the valuable services of Mr. A. Hayes, chief clerk and a reliable and experienced officer. He left to take up an appointment as Sanitary Inspector under the Hammersmith Borough Council. He was succeeded by Mr. G. H. Pratt, next in seniority, and Mr. E. J. Hayes was transferred from the Town Clerk's department to fill the vacancy. With regard to the clerical work, some 13,639 communications written and printed, were sent out from the Health Department during the year. These included 3,705 notices and summonses, 2,269 letters and cards, mainly on matters under the Public Health and Sale of Food and Diugs Acts, 728 as to work under the Factory and Workshops Acts, 6,247 communications of various kinds in respect to infectious disease and disinfection and 690 copies of agendas and reports relating to the work of the department. With great regret I have to record the death of Mr. J. W. Lear, a reliable and experienced sanitary officer, who passed away on November 7th after a short illness. He was appointed Assistant Sanitary Inspector in 1884 and subsequently Sanitary Inspector, and for upwards of twenty-six years discharged his duties as such in an able and efficient manner. In conclusion I beg to express my appreciation of the kind consideration and assistance which have been extended to me by the Chairman and Members of the Health Committee in connection with the work of the Department during the year. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient servant, LEWIS T. FRASER BRYETT, Medical Officer oj 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 workshops acts, during the Year 1910, and also a Repobt of the Health Visitor on her Work for the Year. Tables /., II, Ill, IV. and V. are forms required by the Local Government Hoard. TABLE I. BOROUGH OF SHOREDITCH. Vital Statistics of whole District during 1910 and previous Years. Yeah. I'opulation estimated to middle of each Year. Births. Total Deaths Registered in thk District. Total Deaths INPublic i institutions in thk District. Deaths of Nonr sident registered in Pubic Institutions in the District. Deaths of resident registered in Public Institutions beyond the District. Net Deaths at all agks belonging to the District. isdek one YearofAgi- at all Ages. Number Rate* Number. Rate per 1.000 Births regis- N" umber Rate* Number Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1900 121335 4023 32.9 741 187 2689 22.2 790 472 350 2576 21.4 19 J1 118550 4120 34.3 812 201 2652 22.6 883 427 365 2596 22.1 1902 117948 3992 33.3 704 18) 2383 20.2 B36 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 3S02 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 1909 115285 3692 32.4 5'2 138 2S92 20.7 903 316 492 2189 19.2 Averages for years 1900 to l909 117347 3853 32.7 653 169 2350 19.9 853 378 438 2343 20.1 1910 114935 3595 ‡ 31.6§ 528 147 1795 1 15.6 885 323 428 1913 16.8§ * 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 house. § 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 1910 twelve persons not resident in Shoreditch died within the district, and 25 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 1910. 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 habitua'ly 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 page 9 of the Report. Total popu'ation at all ages, 118,637 Area of District in acres Number of inhabited houses, 12,743 (exclusive of area 642.5 Average number of persons, covered by water per house 9.3 Atcensus of 1901. 59 TABLE II. BOROUGH OF SHOREDITCH. Vital Statistics of separate Localities in 1910, and in previous Years. Year. 1.— Moorfields Ward. 2.—Church Ward. 3.—Hoxton Ward. 4—Wenlock Ward. 5—Whitmore Ward. 6—Kingsland Ward. 7 - Hatigerstuu Ward. 8—Acton Ward. Population estimated to middle of year. Births registered. D-aths 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 middie of year. Births registered. Deaths at all ages. Deaths under 1 y^ar. Population estimated to middle of year. Hirths registered. Deaths at all ages. Deaths 1 under 1 year Population estimated to middle of year. Birtlis registered. Deatbs at all ages. Deaths ander 1 year. Population e*'i mater) to middle of year. Births regiftered. Deai lis at all ages. Deatns under 1 ^ ear. a. b c. d. a. b. e. 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 C6 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 68 1908 5381 124 7£ 13 19563 651 33o 93 17514 628 330 80 19122 531 278 77 18188 610 119 97 11002 408 193 49 12526 3S1 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 12590 393 196 57 12330 410 202 42 1910 5'>31 111 56 5 19363 654 1308 107 17114 556 283 8I 19422 524 266 78 18019 592 452 106 10818 391 202 59 12654 354 168 36 12314 413 178 56 (a) Owing to the alteration in respect to the registration sub-districts referred to on page 1 of the report for the year 3 005. it was necessary to select fresh localities for statistical purposes. The eight wards of the Borough were accordingly adopted as separate localities for the purposes<of this table. If required, the figures relating to the registration sub-districts may be obtained from this table, as Wards 1, 2 and 3 form the Shoreditch South Registration sub-district, 4 and 5 that of Shoreditch North-West, and G, 7 and 8 that of Shoreditch North-East. (b) Deaths of residents occurring beyond the district are included in sub-columns c of this table, and those of non-residents registered in the district excluded. (See note on Table I. as to meaning of terms " resident " and " non-resident. ') (c) Deaths of residents occurring in public institutions have been allotted to the respective localities according to addresses of the deceased. (d) The population of locality No. 4 includes the population in the Holborn Union Workhouse, estimated at 1,37'2. TABLE III. BOROUGH OF SHOREDITCH. Cases of infectious disease notified during the Year 1910. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital fkom kacu 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 Moorfields. Church, Hoxton Wenlock. Whitmore. Kingsland. Ha gerston Acton. Moorlields. Church. Hoxtoo. Wenlock. Whit- , more. Kings- , land. Haggerston. Acton. Small-pox 2 .. .. .. .. 2 .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 2 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 122 10 66 35 4 7 .. 12 25 20 18 20 4 14 9 12 25 20 17 20 4 12 8 Membranous croup 5 .. 5 •• .. .. .. .. 1 .. 1 1 2 1 .. .. 1 .. 1 .. 2 1 .. Erysipelas 17 7 8 9 16 69 18 10 27 18 24 15 10 9 14 .. 3 2 6 1 1 .. .. Scarlet fever 210 6 79 111 10 4 .. 9 33 25 25 40 39 23 16 9 33 24 25 39 39 23 16 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 49 .. 2 8 19 20 .. 1 5 7 10 8 5 4 9 1 5 7 8 7 5 4 9 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 8 .. .. .. 2 6 .. .. 1 2 1 3 .. 1 .. .. .. 1 .. 1 .. 1 .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever 5 3 1 1 .. .. .. .. .. 2 .. 2 .. •• 1 .. .. 2 .. 2 .. .. 1 Totals 528 26 161 164 51 108 18 32 92 74 79 88 60 52 51 22 67 56 57 70 51 41 36 60 TABLE IV. BOROUGH OF SHOREDITCH. Causes of, and ages at, death during Year 1910. Causes of Death. Deaths belonging to whole District at subjoined Ages. Deaths 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. 1-5 and under 25. 25 and ' under 65. | 65 and unwardp Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland Huggerstem. AC'on. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 80 21 57 2 .. .. .. .. 17 11 16 17 6 9 4 13 Scarlet fever 4 1 1 2 .. .. .. .. 1 .. .. 2 .. .. 1 .. Whooping-cough 45 21 24 .. .. .. .. .. 9 8 6 8 6 3 0 3 Diphtheria and membranous croup 14 2 12 .. .. .. .. .. 2 4 2 4 1 1 .. 2 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 8 .. .. 2 1 5 .. .. 1 1 .. .. 1 1 2 .. Other contd .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 16 .. 1 1 2 7 5 .. 1 1 2 8 .. 2 2 8 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea (see notes) 91 79 8 1 .. 2 1 .. 15 12 14 20 10 4 16 20 Enteritis (see notes) 7 .., 2 1 .. 2 2 .. .. .. 1 4 2 .. .. 1 Puerperal fever 2 .. .. .. 1 1 .. .. .. 1 .. 1 .. .. .. 1 Erysipelas 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Other septic diseases 15 2 2 2 3 6 .. .. 3 2 3 .. 3 2 7 Phthisis 169 3 12 2 12 134 6 .. 23 20 34 44 20 18 10 122 Other tuberculous diseases 72 23 27 .. 12 10 .. 1 16 7 7 21 7 5 8 16 Cancer, malignant disease 91 .. .. .. .. 67 24 5 11 22 14 17 9 7 6 38 Bronchitis 199 29 9 .. 1 71 89 12 33 28 21 62 16 8 19 129 Pneumonia 223 69 67 5 4 60 18 1 30 35 26 48 26 28 29 121 Pleurisy 6 .. 1 .. .. 4 1 .. .. 2 2 1 .. 1 .. 6 Other diseases of Pespiratory organs 9 1 1 .. 1 5 1 1 3 2 .. 2 .. 1 .. 2 Alcoholism 30 .. .. .. .. 27 3 2 2 4 2 11 4 2 3 18 Cirrhosis of liver Venereal diseases 13 11 .. .. .. 2 .. .. 2 2 2 4 .. 2 1 8 Premature birth 64 64 .. .. .. .. .. 1 12 10 9 13 9 1 9 16 Diseases and accidents of parturition 5 .. .. .. .. 5 .. .. .. 2 1 .. 1 .. 1 3 Heart diseases 133 1 1 7 8 77 39 7 22 17 1/ 29 10 7 19 46 Accidents 77 39 8 8 4 10 8 2 13 19 13 10 6 9 5 18 Suicides 19 .. .. .. 3 15 1 3 .. 1 3 3 5 3 1 2 All other causes 520 161 24 22 7 155 151 21 92 92 69 121 57 53 35 285 All causes 1913 528 257 55 59 665 349 56 308 283 266 452 202 168 178 885 C5 to Infantile Mortality during the year, 1910, showing deaths from stated causes in weeks and months under One Year of Age. CAUSE OF DEATH. Under 1 Wtek. 1-2 Weeks 1 2-3 j W-ekP. 3-4 Weeks Total under 1 Month. 1-2 Months 2-3 Months 3-4 Months 4-5 Months 5-6 Monti s 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 72 17 20 16 125 55 64 58 26 39 32 26 32 21 25 25 528 ( Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. i. Common Infectious Diseases. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 .. 2 0 1 1 2 3 3 5 21 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Diphtheria: Oroup .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. 2 Whooping Cough .. .. .. 1 1 .. .. 2 2 3 3 3 3 1 2 1 21 ii. Diarrhoeal Diseases. Diarrhoea, all forms .. .. .. .. .. 3 9 9 5 9 3 8 4 2 1 1 54 Enteritis, Muco-enteritis, Gastro-enteritis .. 1 .. 1 2 1 5 2 1 2 3 .. 2 2 .. 3 23 (See notes,) Tables iv. & v. Gastritis, Gastro-intestinal Catarrh .. .. .. 1 1 .. 1 .. .. .. .. .. .. .. .. .. 2 iii. Wasting . Diseases. Premature Birth 39 7 .. 4 56 4 2 1 .. 1 .. .. .. .. .. .. 64 Congenital Defects 14 1 1 .. 16 2 2 4 .. .. .. 1 .. .. .. .. 25 (See notes on Tables iv. & v.) Injury at Birth 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Want of Breast-milk,Starvation .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Atrophy, Debility, Marasmus 6 5 6 2 19 15 10 13 7 4 7 1 2 1 4 1 84 iv. Tuberculous. Diseases. Tuberculous Meningitis .. .. .. .. .. 1 .. 2 1 1 1 .. 2 1 1 2 12 (See notes on Tables iv. & v.) Tuberculous Peritonitis, Tabes Mesenterica .. .. .. .. .. .. 3 1 .. .. .. 1 1 .. .. .. 6 Other'tuberculous Diseases (dee notes on Tables iv. & v.) .. .. .. .. .. .. 2 .. 1 2 .. 1 .. 3 .. .. 9 v. Other causes Erj'sipelas .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Syphilis 1 .. 1 1 3 3 4 .. .. .. .. .. 1 .. .. .. 11 Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 2 1 2 2 1 .. 2 2 3 16 Convulsions 2 1 1 .. 4 1 .. 4 .. 1 .. 1 2 .. .. 1 14 Bronchitis .. 1 1 3 5 5 3 5 .. 2 1 1 4 .. .. 2 29 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. 2 1 3 10 8 4 3 7 7 2 8 .4 9 4 69 Suffocation, overlaying 6 .. 1 2 9 5 10 7 2 2 1 1 .. .. .. .. 37 Other Causes 3 1 1 .. 5 4 3 2 1 .. 3 3 1 .. 1 1 24 72 17 20 16 125 55 64 58 26 39 32 26 32 21 25 25 528 Births during the year—Legitimate 3,507, illegitimate 88. Population, estimated to middle of 1909, 113,653. Deaths from all Causes 1,913. 63 NOTES TO TABLES IV. AND V. (a) In Table IV., all deaths of "Residents" occurring in public institutions, whether within or without the district, are included with the other deaths in the columns for the several age groups (columns 2-8). They are also, in columns 9-16, included among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non-residents" occurring in public institutions in the district are in like manner excluded from columns 2-8 and 9-16 of Table IV.. (b) See notes on Table I. as to the meaning of "Residents" and 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. (f) 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 " Diarrhoea " are included deaths registered as due to Epidemic diarrhoea, Epidemic enteritis, Infective enteritis, Zymotic enteritis, Summer diarrhoea, Dysentery and Dysenteric diarrhoea, Choleraic diarrhoea, Cholera and Cholera Nostras. In addition, and as regards deaths of children under one year of age, under the heading "Diarrhoea" in column 3 (Table IV.) are included all deaths classified as "Diarrhoea diseases" in Table V. Under the heading of "Enteritis" in Table IV., are included only deaths over one year of age registered as due to Enteritis, Muco-enteritis, Gastro-enteritis, Gastric catarrh, Gastritis, and Gastro-intestinal catarrh. Deaths from diarrhoea secondary to some other well-defined disease have been included under the latter. (/) Under the headings of "Cancer" and "Puerperal fever" are included all registered deaths from causes comprised within these general terms. Thus: Under "Cancer" are included deaths from Cancer, Carcinoma, Malignant disease, Scirrhus, Epithelioma, Sarcoma, Villous tumour, Papilloma of bladder and Rodent ulcer. Under "Puerperal Fever" are included deaths from Pyasmia, Septicaemia, Sapraemia, Pelvic Peritonitis, Peri- and Endo-Metritis occurring in the Puerperium. (g) Under "Congenital Defects" in Table V. are included deaths from Atelectasis, Icterus neonatorum, Navel hemorrhage, Malformations and Congenital hydrocephalus. (.h) Under "Tuberculous Meningitis" are included deaths from Acute hydrocephalus. («) Under "Other Tuberculous Diseases" are included deaths from Tuberculosis, Tuberculosis of bones, joints and other organs, Lupus and Scrofula. (f) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified"; all other deaths are regarded as "Uncertified." TABLE VI. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1910. Note.—The deaths of persons not belonging to Shoreditch occurring in hospitals and other institutions in the Borough are excluded ; deaths of persons belonging to Shoreditch occurring in public institutions in London beyond the limits of the Borough are included. CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 5. 5 to 10. 10 to 16. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kiugs'and. Ilaggerston. Acton. Male. Female. Total. 1 Small Pox Vaccomated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. No statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 21 57 2 .. .. .. .. .. .. .. .. .. .. .. 17 ii 16 17 6 9 4 38 42 80 3 Scarlet fever 1 1 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. 2 .. .. 1 3 1 4 4 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Epidemic influenze .. 1 1 .. 1 1 .. 1 2 4 3 2 .. .. 1 1 2 8 .. 2 2 6 10 16 6 Whooping cough 21 24 .. .. .. .. .. .. .. .. .. .. .. .. 9 8 6 8 6 3 5 17 28 45 7 Diphtheria, membranous croup 2 12 .. .. .. .. .. .. .. .. .. .. .. .. 2 4 2 4 1 1 .. 3 11 14 8 Enteric fever .. .. 2 .. 1 .. 3 1 .. 1 .. .. .. .. 1 1 .. .. 1 1 2 3 5 8 9 Asiatic cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Diarrhoea, dysentery 46 6 1 .. .. .. 1 1 .. .. .. 1 .. .. 11 9 9 12 4 3 8 34 22 56 11 Epidemic or zymotic enteritis 8 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 2 .. .. 4 7 3 10 12 Other allied diseases .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 13 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Glanders, farcy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15 Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 16 Anthrax, splenic fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 17 Cow-pox, accidents of vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 18 Syphilis 11 .. .. .. .. .. .. 1 .. 1 .. .. .. .. 2 2 2 4 .. 2 1 4 13 19 Gonorrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 20 Phagedcena, hospital gangrene .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 21 Erysiplas 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 22 Puerperal fever .. .. . . .. .. 1 1 .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. 2 2 23 Pyaemia, septicaemia 2 2 1 .. .. .. 2 1 .. 1 .. .. .. .. 3 .. 3 1 .. 1 1 3 6 9 24 Infective endocarditis .. .. .. 1 2 1 1 1 .. .. .. .. .. .. .. 2 .. 1 .. 2 1 1 5 6 25 Other allied diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 26 Malarial fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 27 Rheumatic fever .. .. 1 1 .. .. .. .. .. 1 .. .. .. .. 1 1 .. 1 .. .. .. 2 1 3 28 Rheumatism of the heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis : 29 Brain or meninges, acute hydrocephalus 12 17 6 2 .. .. 1 .. .. .. .. .. .. 1 8 5 4 9 3 3 5 17 21 38 30 Larynx .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 31 Lungs 3 12 1 1 8 4 40 36 40 18 6 .. .. .. 23 20 34 44 20 18 10 110 59 169 32 1 ntestines, tabes mesenterica 6 2 2 .. .. .. 1 .. .. .. .. .. .. .. 3 1 . . 5 .. 2 .. 8 3 11 33 General Position undefined 5 6 1 .. .. .. 1 2 .. .. .. .. .. .. 4 1 1 4 4 .. 1 6 9 15 34 Other forms, scrofula .. 2 1 .. .. .. 1 1 2 .. .. .. .. .. 1 .. 2 3 .. .. 1 5 2 7 35 Other Infective diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 36 Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 37 Actinomycosis .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 38 Hydatid diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 39 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 40 Other diseases due to altered food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 Acute alcoholism, delirium tremens .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 42 Chronic alcoholism .. .. .. .. .. .. 1 1 2 1 .. .. .. .. .. .. .. 4 .. .. 1 3 2 5 43 Chronic industrial poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 44 Other chronic poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 45 Osteo-arthritis, rheumatoid .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 46 Gout .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 47 Cancer .. .. .. .. .. .. 3 5 24 27 19 3 .. 4 9 20 13 15 8 7 45 36 81 48 Diabetes mellitus .. . . .. .. .. 1 .. 1 1 .. .. .. .. .. 1 .. 1 .. 1 .. .. 3 .. 3 49 Purpura hsemorrhagica .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 50 Hæmophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 51 Anaemia, leucocythsemia .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. 1 .. 1 .. .. .. 2 .. 2 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 tj 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 65 to 65. 65 to 76. 75 to 86. 85 and upwards. Moorfields. Church. Hoxton. "Wenlock. Whitmore. Kingsland. Haggeraton. Acton. Male. Female. 52 Lymphadenoma, Hodgkin's disease .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 53 Premature birth 64 .. .. .. .. .. .. .. .. .. .. .. .. 1 12 10 9 13 9 1 9 33 31 64 54 Injury at birth 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 55 Debility at birth 12 .. .. .. .. .. .. .. .. .. .. .. .. .. 3 2 2 .. 3 1 1 6 6 12 56 Atelectasis 10 .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 1 3 .. 2 1 8 2 10 57 Congenital defects 15 .. .. .. .. .... .. .. .. .. .. .. .. 1 2 1 5 2 1 1 5 10 15 58 Want of breast milk 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 59 Atrophy, debility, marasmus 73 6 .. .. .. .. .. .. .. .. .. .. .. 2 23 8 6 12 14 7 46 33 79 60 Dentition 4 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 .. 1 1 4 1 5 61 Rickets 1 4 .. .. .. .. .. .. .. .. .. .. .. .. 2 2 .. 1 .. .. .. 4 1 5 62 Old Age, senile decay .. .. .. .. .. .. .. .. .. 4 18 54 19 1 4 14 1 1 7 35 11 8 5 36 59 95 63 Convulsions 14 1 .. .. .. .. .. .. .. .. .. .. .. 1 2 2 .. 4 4 1 1 9 6 15 16 1 1 1 .. .. .. 1 1 .. .. .. .. .. 4 3 5 4 2 1 .2 13 8 21 65 Encephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 66 Apoplexy .. .. .. .. .. 1 .. 5 7 16 18 1 .. 3 7 6 8 11 4 .. 1 21 27 48 67 Softening of brain .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 68 Hemiplegia, brain paralysis .. .. .. .. .. .. .. 1 .. 2 .. .. .. .. .. .. .. 2 .. .. 1 1 2 3 69 General Paralysis of insane .. .. .. .. .. 1 1 4 6 .. .. .. .. 1 2 9 1 4 .. 2 .. 10 2 12 70 Other forms of insanity .. .. .. .. .. .. .. .. .. 1 1 1 .. .. 2 .. 1 .. .. .. .. 1 2 3 71 Chorea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 72 Cerebral tumour .. 1 .. .. .. .. 1 1 .. 1 .. .. .. 1 .. 2 .. .. .. .. .. .. 1 4 73 Epilepsy .. 1 .. .. 2 .. 2 .. 1 .. .. .. .. .. 1 .. 1 3 1 .. .. 5 1 6 74 Laryngismus Stridulus .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 1 75 Locomotor Ataxy .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 76 Paraplegia, diseases of spinal cord .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. 2 .. .. .. 2 .. 2 77 Other diseases of brain or nervous system 1 .. 1 1 .. .. .. 1 2 2 2 .. .. .. 1 3 1 2 .. 1 2 1 6 10 78 Otitis, otorrhœa 1 1 .. .. 1 2 .. .. 1 .. .. .. 1 .. 2 .. 1 1 1 .. 1 4 2 1 6 79 Diseases of nose, epistaxis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 80 Diseases of eye, ophthalmia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 81 Pericarditis .. 2 1 .. .. .. .. 1 1 1 .. .. .. .. .. 3 1 2 .. .. .. 3 3 6 82 Endocarditis, valvular diseases of the heart .. .. 3 1 5 .. 4 3 7 11 1 .. 1 11 4 5 8 5 1 5 20 ?0 40 83 Hypertrophy of heart .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 84 Angina pectoris .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 85 Aneurism .. .. .. .. .. .. .. 1 2 .. 1 .. .. 1 1 .. .. .. 1 .. 1 3 1 4 86 Senile gangrene .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 .. 1 .. .. .. 2 2 87 Embolism, thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 88 Phlebitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 89 Varicose veins .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular 1 1 3 .. 2 1 9 8 14 20 23 9 I | 6 11 13 12 20 10 6 14 34 58 92 91 Laryngitis .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 92 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 93 Other diseases of larynx and trachea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 94 Acute bronchitis 29 9 .. .. .. .. 3 4 4 2 .. 3 1 4 15 12 8 8 4 3 8 j 35 27 62 95 Chronic bronchitis .. .. .. .. .. 1 1 6 18 33 50 25 3 8 18 16 13 54 12 5 11 59 78 137 96 Lobar, croupous-pneumonia 5 4 .. .. .. 1 .. 3 2 .. 1 1 .. .. 2 .. 3 4 3 1 4 12 5 17 97 Lobular, broncho-pneumonia 46 52 2 .. .. .. 1 4 5 5 6 .. 1 .. 17 21 13 30 15 13 13 63 59 122 98 Pneumonia, form not stated 18 11 2 1 1 2 4 14 12 10 8 .. 1 1 11 14 10 1 1 8 14 12 48 36 84 99 Emphysema, asthma .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 1 1 .. .. .. .. .. 1 1 2 100 Pleurisy .. 1 .. .. .. .. .. .. .. 4 1 .. .. .. .. 2 2 1 .. 1 .. 3 3 6 101 Other and ill-defined diseases of respiratory system 1 1 .. .. .. 1 1 2 .. 1 .. .. .. 1 2 1 .. 2 ... . 1 .. 7 .. 7 102 Diseases of mouth and annexa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 103 Diseases of pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 104 Diseases of oesophagus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105 Ulcer of stomach and duodenum .. .. .. .. .. ..3.. ..1.. .. 1 2 2 .. .. .. 1 2 3 2 .. .. 1 6 3 9 106 Other diseases of stomach 2 .. .. .. .. .. .. 2 1 .. .. 1 .. .. 9 1 1 1 .. 1 .. 3 3 6 107 Enteritis 23 2 1 .. .. .. 1 .. 1 .. 2 .. .. .. 4 3 5 9 4 1 15 15 30 108 Appendicitis 1 .. .. .. 1 1 1 1 2 .. 1 .. .. 1 .. 1 2 2 1 .. 1 6 9, 8 109 Obstruction of intestine 2 .. .. 1 .. .. 1 1 ?, 1 1 1 .. .. 1 1 3 9: .. ? 1 4 6 10 110 Other diseases of intestine .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ill Cirrhosis of liver .. .. .. .. .. .. .. 10 6 5 3 .. .. 2 2 3 2 7 4 2 7 17 24 112 Other diseases of liver 1 .. .. .. .. .. 1 .. 1 9 9 .. .. .. .. .. 4 1 1 1 .. 4 3 7 113 Peritonitis 1 1 .. .. .. .. .. 1 .. .. 2 .. .. .. 2 1 .. 1 .. .. 1 5 .. 114 Other and ill-defined diseases of digestive system .. .. .. .. .. .. .. .. .. 2 1 .. .. .. 1 1 .. 1 .. .. .. 2 1 3 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 tj 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 115 Diseases of Lymphatic System and ductless glands .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 116 Acute nephritis .. .. 1 .. .. 1 .. .. 1 .. .. .. .. .. .. 2 .. .. .. 1 .. 2 1 3 117 Bright's disease .. .. .. .. 1 1 5 5 11 14 15 2 .. 5 7 7 7 12 6 9 1 25 29 54 118 Calculus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 119 Diseases of bladder and prostate .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 120 Other and ill-defined diseases of urinary system 1 .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 1 1 1 .. .. 2 1 3 121 Diseases of testis and penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 122 Diseases of ovaries .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 123 Diseases of uterus and appendages .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 124 Diseases of vagina and external genital organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 125 Diseases of breast .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 126 Abortion, miscarriage .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 2 127 Puerperal mania .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 128 Puerperal convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 129 Placenta prtevia, flooding .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 130 Puerperal thrombosis .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 131 Other and ill-defined accidents and diseases of pregnancy and childbirth .. .. .. .. .... .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 132 Arthritis, ostitis, periostitis .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. 1 1 133 Other ancl ill-defined diseases of osseoics system .. 1 .. .. .. 1 .. .. 1 .. .. .. .. .. 1 .. .. 1 .. 1 .. 3 .. 3 134 Ulcer, bedsore .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135 Eczema .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 136 Pemphigus 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 137 Other and ill-defined diseases of integumentary system .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 By Accident or Negligence. 138 In mines and quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 139 In vehicular traffic .. 4 2 .. 1 1 3 1 1 1 .. .. .. .. 2 4 2 2 1 2 1 10 4 14 140 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 .. 2 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. .. .. 3 3 146 Poisons, poisonous vapours .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 147 Surgical narcosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 148 Effects of electric shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 149 Corrosion by chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 150 Drowning .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 151 Suffocation overlaid in bed .. .. .. .. .. .. .. .. .. .. .. .. .. 1 6 9 5 7 3 3 1 20 15 35 152 Suffocation otherwise 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 2 .. 2 153 Ealls, not specified 1 2 1 2 1 .. .. 1 3 .. 4 2 1 1 2 4 4 .. 1 4 2 8 10 18 154 Weather agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 155 Otherwise, and not stated 1 .. .. 1 1 .. .. .. .. 1 .. .. .. .. 2 •• 1 .. .. .. 1 2 2 4 156 Homicide .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 Suicides, all forms. 157 By poison .. .. .. .. .. 1 3 1 3 1 .. .. .. 1 .. .. 1 .. 4 2 1 8 1 9 158 By asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 159 By hanging and strangulation .. .. .. .. .. 1 .. 3 2 .. 1 .. .. 2 .. 1 1 2 1 .. .. 6 1 7 160 By drowning .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 1 2 161 By shooting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 162 By cut or stab .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .... 1 1 163 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 3 .. .. .. .. 1 1 3 2 2 1 2 .. .. 3 1 2 4 2 1 2 8 7 15 169 Malignant disease .. .. .. .. .. .. .. 2 4 2 1 1 .. 1 2 2 1 2 1 .. 1 4 6 10 170 Abscess .. 1 1 .. 1 .. .. 1 .. .. .. .. .. 1 1 .. 1 .. .. .. ..1 2 2 4 171 Cerebro Spinal Fever 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 2 2 Total 528 257 40 15 30 29 104 156 203 202 209 112 28 56 308 283 266 452 202 168 178 997 916 1913 o TABLE VII.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1910. DISTRICTS. Estimated population 1910. BIRTHS. ANNUAL KATE PER 1.000 PERSONS LIVING. Violence. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. DEATHS DURING THE YEARS: DEATHS DURING 1910 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. 1907. 1908. 1909. I 1910. Principal Zymotic Diseases. Small Pox. Measles. Scailet Fever. Diphtheria. Whooping Cough. Fever. Diarrhcea. Tuberculous. Disease. London 4,872,702 239 14.1 13.8 14.0 12.7 1.14 .. 0.40 0.04 0.09 0.28 0.04 0.28 1.5 0.5 103 10.2 43.3 0.09 Shoreditch §1 13,653 31.6 20.6 17.5 19.2 16.8 1.9 .. 0.70 0.03 0.12 0.39 0.07 0.581 2.1 0.8 147 15.0 51.7 .. Wards. Moorfields 5,231 21.2 16.0 14.6 16.4 10.5 .. .. .. .. .. .. .. .. 0.2 0.9 45 19.6 50.0 .. Church 19,363 33.7 20.3 17.1 19.5 15.9 2.1 .. 0.87 0.05 0.10 0.46 0.05 0.56 2.0 0.7 163 16.8 51.6 .. Hoxton 17,114 32.4 22.0 18.8 17.0 16.5 1.9 .. 0.64 .. 0.23 0.46 0.05 0.51 1.5 1.1 145 15.5 53.7 .. W enlock §18,050 29.0 19.6 15.6 16.7 14.6 1.9 .. 0.88 .. 0.11 0.33 o.11 0.55 2.2 0.9 149 17.2 42.8 .. Whitmore 18,019 32.8 28.7 23.0 27.7 25.0 2.5 .. 0.94 0.11 0.22 0.44 0.ll 0.77 3.6 0.8 177 12.1 62.1 .. Kingsland 10,818 36.1 17.4 17.5 20.6 18.7 1.9 .. 0.55 .. 0.09 0.55 0.09 0.64 2.5 1.0 150 14.3 51.1 .. Haggerston 12,65 27.9 15.7 15.7 15.5 13.2 1.3 .. 0.71 .. 0.07 0.23 0.07 0.23 1.8 09 101 19.0 54.7 .. Acton 12,314 33.5 18.1 14.1 16.3 14.4 1.9 .. 0.32 0.08 .. 0.40 0.16 0.97 1.4 0.8 135 16.2 34.2 .. *Fever includes typhus, typhoid and continued fevers. §The inhabitants of the Holborn Union Workhouse, which is situate in Wenlock Ward, and the deaths occurring in that institution are excluded. Note.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, O'OO is inserted; where no deaths have occurred, dots are placed in the space under the heading. 71 TABLE VIII. ANALYSIS of the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31st, 1910. Diseases. Diseases. All Causes 5,445 37 Atelectasis .. 38 Congenital malformations .. 1 Small-pox .. 39 Old age 187 40 Apoplexy 6 2 Measles 270 41 Epilepsy 26 3 Scarlet Fever . . 18 42 Convulsions 7 -1 Typhus .. 43 Other diseases of brain and nervous system 282 5 Relapsing- fever .. 6 Influenza 67 44 Diseases of organs of special sense 27 7 Whooping Cough 88 8 Diphtheria 6 45 Diseases of circulatory system 212 9 Simple, continued and illdefined fever 8 46 Laryngitis 8 10 Enteric fever 2 47 Bronchitis 1176 11 Simple cholera .. 48 Pneumonia 93 12 Diarrhcea, dysentery 108 4 9 Pleurisy 35 13 Remittent fever .. 50 Other respiratory diseases 32 14 Hydrophobia .. 15 Glanders .. 51 Dentition 10 16 Cow pox and Effects of vaccination .. 52 Quinsy, sore throat 55 53 Enteritis 60 17 Venereal affections 35 54 Peritonitis 4 18 Erysipelas 23 55 Diseases of liver 24 19 Pyeemia and septicaemia 2 'JUX XX V vX • • • • 56 Other diseases of digestive system 535 20 Puerperal fever 4 21 Tabes mesenterica 1 57 Diseases of lymphatic system and ductless glands 10 22 Tuberculous meningitis .. 23 Phthisis 208 24 Scrofula, tuberculosis 33 58 Diseases of urinary system 42 25 Other zymotic diseases 50 59 Diseases of the generative system 34 26 Thrush .. 27 Worms and other parasitic diseases 5 60 Accidents of childbirth 24 61 Diseases of locomotive system 263 28 Starvation, want of breast-milk 1 62 Diseases of integumentary system 236 29 Alcoholism 13 30 Rheumatic fever and rheumatism of heart 55 63 Fracture and contusion 32 64 Gun shot wounds 31 Rheumatism 398 65 Cut, stab 1 32 Gout 100 66 Burns or scalds 5 33 Rickets 9 67 Poison 4 34 Cancer 37 68 Drowning .. 35 Other constitutional diseases 34 69 Suffocation .. 70 Otherwise 62 36 Premature birth 3 71 Other causes 377 72 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1910. Table IX. PREMISES. NUMBER OF PLACES— Number of inspections, 1910. Number of notices, 1910. Number of prosecutions, 1910. On register at end of 1909. Added ii 1910. Removed in 1910. On register at end of 1910. Milk premises 302 14 24 292 2949 23 1 Cowsheds 7 .. .. 7 47 .. .. Slaughter-houses 7 .. 1 6 22 .. .. Other offensive trade premises 1 .. .. 1 12 1 .. Ice Cream premises 89 5 5 89 186 22 .. Registered houses let in lodgings 258 5 .. 263 637 84 1 Number of intimation notices served for all purposes 2823 Overcrowding:— Number of dwelling rooms overcrowded 104 Number remedied 104 Number of prosecutions Nil Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 197 Underground rooms:— Number dealt with during year 4 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 14 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 7 Customs and Inland Revenue Acts:— Number of dwellings for which applications were received during year 4 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 382 Total number of infectious bodies removed Nil 73 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK, DURING THE YEAR 1910. 1.—Inspection. Inspection made by Sanitary Inspectors. Premises. Inspections. Number of Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 440 28 - Workshops (Including Workshop Laundries and Bakehouses.) 3182 297 - Workplaces (Excluding Outworkers' premises dealt with in Table 3.) 712 81 - Total 4334 406 - 2.—Dejects Found. Particulars. Number of Defects. Number Found. Remedied. Referred to H.M. Inspect'r cf Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:-* Want of cleanliness 248 248 1 — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage — — — — Other nuisances 23 23 — — Sanitary accommodation insufficient 8 8 — — unsuitable or defective 55 55 — — not separate for sexes 8 8 — — OJfenccs under the Factory and Workshop Act:— Illegal occupation of 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 343 343 1 — *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 LI8T8, 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 or 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) Makiug, &c. 54 79 832 10 ii 132 2149 1176 .. .. 1189 50 50 .. .. .. .. (2) Cleaning & washing .. .. .. .. .. .. 3 .. .. .. 1 .. .. .. .. .. .. Lace, lace curtains, and nets .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. Artificial flowers 4 .. 85 .. .. .. 130 53 .. .. 95 7 7 .. .. .. .. Tents .. .. .. .. .. .. 4 .. .. .. 2 .. .. .. .. .. .. Furniture and upholstery .. .. .. .. .. .. 15 .. .. .. 8 .. .. .. .. .. .. Fur pulling 2 .. 7 .. .. .. 17 8 .. .. 11 1 1 .. .. .. .. Feather sorting .. .. .. .. .. .. 2 .. .. .. 2 .. .. .. .. .. .. Umbrellas, &c .. .. .. .. .. .. 95 16 .. .. 44 4 4 .. .. .. .. Paper hags and boxes 38 .. 601 4 .. 61 420 196 .. .. 603 38 38 .. .. .. .. Brush making .. .. 11 .. .. .. 135 2 .. .. 85 2 2 .. .. .. .. Total 98 79 1525 14 11 193 2971 1452 .. .. 2040 102 102 •• .. .. .. (a) There were no names and addresses of outworkers received in respect to the following classes of work: Sacks, basket making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors and giapnels, cart gear, locks, latches and keys, and pea picking. (3) The figures in columns 2 and 4 are the total number of lists received from employers who sent them both for February and August, and of the entries of names of outworkers in those lists. They are therefore double the number of employers and approximately double the number of individual outworkers whose names are given, since in the February and August lists of the same employers, the same outworker's name will often be repeated. (c) There were no prosecutions, but letters were sent to employers in 45 instances of failures to send lists of outworkers employed in making wearing apparel, &c., in 38 instances for similar failures in respect to paper bag and box making, in 3 instances in respect to artificial florists and i in respect to furriers. 75 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) (I) Furniture, woodwork, fitting and other branches of the furniture trades 733 (a) Cabinet making 428 (b) French Polishing 76 | (c) Upholstery 56 (d) Other workers 173 (2) Dress 178 (a) Tailoring 78 (e) Shirt making 4 (b) Mantles 10 (f) Boot & Shoe trades 39 (c) Dress 9 (g) Artificial Flowers 7 (d) Millinery l5 (h) Other workers 16 (3) Skin, leather, hair and feather trades 54 (a) Furriers 5 (b) Saddlery & Harness 24 (c) Feathers 3 (d) Other workers 22 (4) l'aper, printing, book, stationery and fancy goods trades 55 (a) Box & bag makers 36 (b) Other workers 19 (o) Laundry and Washing 26 (6) Food 4 (7) Metals, machines, implements and conveyances 55 (8) Precious metals, jewels, &c o (9 Other trades than those mentioned above 66 Total number of workshops on Register 1173 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 71, including 6 factory bakehouses. 5.—Other Matters. Class. Number. (1) (2) Matters notified to II.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s. 133) 3 Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 37 (referring to 66 workshops) Reports (of action taken) sent to H.M. Inspector. 10 (referring to 66 workshops) Other 1 Underground Bakehouses (s. 101): — Certificates granted during the year Nil. In use at the end of the year 42 6.—Shewing the Numbers of Outworkers Received from other Districts During 1910. DISTRICT. Making Wearing Apparel. Cleaning and Washing. Lace Curtains. Artificial Flowers. Furniture and Upholstery Fur Pulling. Feather Sorting. Umbrellas, &c. Paper Bags and Boxes. Brush Making. Tents. Total. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb Aug. Feb. Aug. Feb. Aug. Feb. Aug. Battersea .. .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Bethnal Green 56 78 .. .. .. .. 1 .. 5 .. .. .. .. .. 1 2 28 42 20 17 .. .. 250 Camberwell 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Chelsea 8 6 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 City of London 556 521 .. .. 1 . . 33 26 .. .. 4 4 .. .. 58 16 2 .. .. .. .. .. 1221 Deptford 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Enfield 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Finsbury 129 121 .. .. .. .. 4 10 .. .. 2 2 .. 2 3 2 130 118 8 8 .. .. 539 Hackney 172 207 .. .. .. .. 36 6 2 3 .. 2 .. .. 3 7 38 29 44 37 .. 4 590 Hammersmith 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Hampstead 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 5 Holborn 5 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9 Hford 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Islington 65 107 .. .. .. .. 2 8 2 3 1 2 .. .. .. 3 17 8 .. .. .. .. 218 Lambeth 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Lewisham 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Poplar 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 2 Rochester .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 St. Marylebone 3 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 St. Pancras 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Southgate 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Southwark 5 5 .. .. .. .. 2 2 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 15 Stepney 25 28 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. 55 Stoke Newington 1 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 7 Tottenham 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Wandsworth 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 West Ham 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Westminster 10 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Total 1054 1095 1 2 1 78 52 9 6 7 10 .. 2 65 30 219 201 72 63 4 2971 2149 3 1 130 15 17 2 95 420 135 4 76 Metropolitan Borough of Shoreditch, REPORT on the WORK OF HEALTH VISITING (January 1st—December 31st, 1910) in the Town Hali , Shoreditch, E. January, 1911, To the Medical Officer of Health. Sir — I have the pleasure to submit the following report on the work of Health Visiting in the Borough during the year 1910. The greater part of my time has been spent in paying visits to various people resident in Shoreditch. and the rest in the clerical work which the visiting involves. The total number of visits paid was 1,982. These may be divided into six classes:— (i.) Visits in connection with notifications under the Notification of Births Act, 1907 :— First visits 884 Re-visits 883 1,717 (ii.) Interviews with various persons connected with the work 100 (iii.) Enquiries into the causes of death among infants 39 (iv.) Lectures on Infant Care 10 (v:) Enquiries into cases of puerperal septicaemia 6 (vi.) Visits in connection with notifications of Phthisis:— First visits 86 Re-visits 20 — 106 Total 1,982 In addition to these I have paid 415 futile visits, i.e.—to persons who were absent, removed, or for some other reason could not be found. 1.— Notification of Births. The total number of notifications received during the year was :— Under the Notification of Births Act 3,277 Notified by the L.C.C 175 3,452 The total number of notifications followed up was 884. There remained, therefore, 2,568 notifications, which have not been followed up. 78 79 Of this number, 887 notifications were excluded from those to be visited, for the reasons given below:— (i.) 286 notifications sent in by the midwives of the Medical Mission, 45, Harman Street. In every case which these midwives attend, they invite the mother to call at the Home regularly, to have the baby weighed and examined ; the majority of these patients like to keep in touch with the Home, and go there frequently. (ii.) 306 notifications sent in from certain homes. In these cases the occupation of the father, and the general tone of the surroundings indicate that the standard of life, might reasonably be expected to be higher than in other parts of the Borough. I regret very much that this exclusion is necessary, for it is amongst people of this class, that the most satisfactory work can be done, and the results are most apparent; whilst such work might not affect the infantile mortality rate, it would certainly have a beneficial effect upon the health of the children. (iii.) 106 notifications of births occurred in the Holborn Infirmary, Shep herdess Walk, the parents not belonging to this Borough. (iv.) 63 notifications in cases when the death of the infant had occurred shortly after birth. (v.) 63 notifications, related to stillborn children. The remaining 1,641 notifications were not followed up, solely through lack of time. Interviews. This year I have spent much time in getting into touch with the Secretaries of local Associations for the relief of Distress, Almoners of Hospitals, and midwives, &c., all of whom have rendered me much help. I am now thoroughly acquainted with the Borough, and therefore I expect to be able to pay a larger number of visits to infants in the forthcoming year. General Remarks. If health visiting were merely a matter of teaching the ignorant it would be much simpler than it is ; but there are many other factors to be reckoned with: wages, unemployment, ill-health, housing conditions, drink and crime all have their influence on the health of the infant, before and after birth. This being considered it can easily be seen that it is hardly to be expected that the work of health visiting alone can effect any marked changes, especially in a short time. 80 Method of Work. In carrying out the work of health visiting among infants, I make it a practice not to call until 10 days after the birth. I do not find it either necessary or tactful to call before that time. For the first ten days, at least, the mother is a patient in the care of a doctor or a midwife ; it therefore seems superfluous to visit at this time ; moreover my visit might be resented by both doctors and midwives. It is after the 10th clay, when the mother lias, as a rule, to rely upon herself, that an inexperienced or anxious mother welcomes the help and advice of a health visitor. But it is not often, however, that 1 am able to visit until the infant is two or three weeks old ; and I could not visit every one unless little or no revisiting were done. A record of each visit is kept on the card index system, with a brief account of the family history, and of the condition of the infant, both at the first and subsequent visits. At the time of the first visit I decide whether it is advisable to revisit. Revisiting. It does not always seem necessary to revisit, but in the majority of cases it is desirable that further visits should be paid, at more or less frequent intervals, according to individual needs. In some cases, I have revisited weekly for several consecutive weeks, and have afterwards gradually increased the intervals between the visits as the infant's health improved. It may seem that such frequent revisiting should not be done when there are so many who are not visited at all ; but I consider that experience justifies me in spending a good deal of my time in dealing with a comparatively small number of cases thoroughly, rather than perfunctorily getting through a larger number less thoroughly. I do not hesitate to say that unless I could follow my first visit by others, the first would be an absolute waste of time, in most cases. Results of Work. I am pleased to be able to report that far from my visits being resented, I have always been treated with the greatest courtesy, and my advice has often been sought on other subjects, such as the health of elder children, and their prospects as wageearners after leaving school. In some cases in which the parents are intemperate and degraded, it seems a waste of time to revisit, but there are others in which I have had the satisfaction of seeing some definite results of my work. These have been cases in which the mother has been willing to do her best for the child, but did not know the right methods to adopt. The following is a typical illustration of a case of this kind:— 81 Mrs. X., living in one large room, very nicely kept, had, at the time of the first visit, two young children, besides an infant aged 3 weeks. The eldest child (aged 3½) had been "always ailing" ; the second child (aged 15 months) had ricketts. and could not walk. Both were said to have been healthy at birth, and to have made good progress for 3 months, when artificial feeding began, and wasting supervened. As the mother appeared to have been ignorant, rather than neglectful, and seemed teachable, I gave her careful instructions, and decided to revisit. This I did weekly for about 8 weeks, then fortnightly, and afterwards monthly ; when I last saw the child (at ten months old), it was in a normal state of health. It is unwise to predict what would have happened, but it seems probable that the third child would have suffered in the same way as the other two, if the mother had not received some advice. Regular visiting has also good effects on the promotion of cleanliness ; many people who have grown accustomed to having their homes dirty and untidy, will in response to an outsider's interest in them, make an effort to have their home as nice as possible, when they expect a visitor who has a higher standard than their own. Number of Deaths The number of deaths among the 884 infants visited was 39, which gives a mortality rate of 43.11 per 1,000 births. Of these deaths 16 were due to "wasting" diseases ; 10 to diseases of the respiratory tract; 1 to heart disease ; 1 to congenital malformation of heart; 1 to cerebrospinal fever ; 9 to summer diarrhoea. Wasting. Of the 16 dying from "wasting" diseases, 11 were apparently healthy at birth, but began to " waste " soon after, despite all efforts made to save them. In some cases the environment was fairly satisfactory but apparently the infants health was undermined by adverse influences brought to bear on it, during ante-natal existence. (I) Due to ante-natal conditions. I have chosen the following as an example of the loss of infant life, apparently due to adverse ante-natal conditions rather than to any want of, or misdirected care after birth. This child's father, a builder's labourer, was apparently quite well so long as he was able to earn enough to get sufficient food The mother, who had suffered very much from anaemia for a long while during her girlhood was a machinist. One r week after marriage, Mr. Y. lost his work, and Mrs. Y was obliged to support herself and her husband by working at her sewing-machine many hours daily right up to the time of her confinement. The infant seems to have been in a satisfactory condition at birth, but soon after began to deteriorate ; I visited frequently for a long while. The father had, a short time previously to the child's birth, obtained work, and the mother was at liberty to devote herself to the infant, on whom she lavished the greatest possible care ; the infant was taken regularly for medical advice, as an out-patient to a Babies' Home, and finally admitted to the Home, where it died when 5 months old. (II) Due to post-natal conditions. With the exception of cases of wasting caused by ante-natal conditions, there is little doubt that wasting whether it ends fatally or not, is largely produced by improper feeding, which is, in this Borough, to some extent due to poverty. Many nursing-mothers do not have a sufficiently generous diet to enable them to produce good milk ; many who employ artificial feeding are not able to afford as much fresh milk as is necessary, and dilute the milk too freely, or fall back on the use of machine skimmed condensed milk. There are also cases of improper feeding due to ignorance, and often to prejudice in favour of following time-honoured methods, regardless of the results produced. Summer Diarrhoea. The total number of infant deaths from Summer Diarrhoea was 54. Nine of these were infants whom I had visited, so that I have no doubt as to the method of feeding in these cases. Eight were entirely and one was partly artificially fed ; three of them occurred in clean, well-kept homes. I investigated in 29 of the 46 remaining cases. Twenty-five of these were said to be entirely artificially fed, and four entirely naturally fed. Of these four, one was a case in which the vomiting and diarrhoea appeared to be the result of brain disease. In the other three cases, although no artificial feeding was said to have occurred, the infants used "comforters," which probably acted as carriers of infection. In some cases the homes were clean and well kept, and in others they were dirty and untidy. In accordance with my usual practice I reported the insanitary condition of three of these houses to the Medical Officer of Health. Housing Conditions. Many of the houses visited, although not " insanitary " in a technical sense of the word, are by no means satisfactory as homes, and their condition must have a prejudicial effect on the health of both parents and children. The fault lies chiefly 82 83 in the fact that houses originally built for accommodating single families are now let out to two or three families, and therefore rooms intended to be used as bedrooms or parlours have now to serve for the entire accommodation of a whole family. Food Storage. In one or two-roomed homes where the only storage for food is a cupboard in the recess by the side of the fire, it is extremely difficult and sometimes almost impossible to keep milk in a fit state for an infant's food, especially in the summer. In this connection I may point out that there was proper pantry accommodation in only two of the thirty-seven homes where the above-mentioned deaths from Summer Diarrhoea had occurred. This want of proper pantries also tends to encourage the wasteful habit of buying food in small quantities, as it is required. Even when means permit it is impossible to economise by buying in larger quantities if there is no fit and proper place in which to store the food. Water Supply. In some of the larger houses now let out to more than one family, taps for water have been placed on the upper storey. This is a step in the right direction and the extension of this improvement should help to raise the standard of cleanliness in the home. It is not surprising that women who have to go up and down several stairs to fetch clean and dispose of dirty water should feel tempted to reduce the amount of cooking, cleaning and washing to a minimum. 1 V.— Lectures. These were given to members of women's meetings held in conjunction with various churches, chapels, clubs, &c., in the Borough. I attended in response to invitations from the workers in chaige, without regard to differing religious denominations. I have welcomed the opportunity of speaking at these meetings. In doing so it is easy to teach many things which cannot always be brought into a conversation with a mother in her home I have dealt especially with the necessity of employing hygienic methods during the ante-natal period, with the need for providing for the expenses attendent on a tirth ; on the value of providing suitable clothing for the infant, and on methods of feeding. Taking a prominent part in such meetings also brings me into touch with many women in the Borough and enables me to make their acquaintance before calling at their house. V—Puerperal Septicaemia. The cases into which I have enquired were all attended by midwives ; a record of each enquiry is kept, giving the circumstances of each case. One patient died, one appears to have been very ill; the other four recovered after a slight illness. No enquiry has been made in cases occurring in the practice of a medical man. F 2 84 V I.—Phthisis. 86 notifications have been received from various sources. 35 from Poor Law officials. 27 ,, L.C.C. officials. 16 ,, Hospitals. 2 the Charity Organisation Society. 3 voluntarily from patients. 3 discovered in the course of other work. 49 patients were women, 10 men. and 27 children under fourteen years of age. The Poor Law notifications above refer to women only, to whom my work in this connection has been limited. Six patients have been sent to sanatoria and 2 to invalid homes by the Charity Organisation Society ; 3 to sanatoria by the Invalid Children's Aid Association ; 3 have arranged privately for open-air treatment. Twelve have died ; 8 in the infirmary, 4 in their own homes. My aim in visiting phthisical patients is to teach them how to improve their health as far as possible and how to minimise the risk of infecting others. Frequently it is impossible for people to do all that they wish to in providing separate sleeping accommodation for a phthisical member of a family ; often they cannot afford to rent a separate room, or even to buy a separate bed. especially when the patient is or should be the wage earner. Some phthisical patients w ho are at an advanced stage enter the infirmary or a home for the dying ; but main' remain in their own homes for a long while, working when their health permits. Sources of Infection. In 45 of the 86 cases investigated it has been possible to some extent to account for the source of infection. Direct Contact. (i.) In 21 cases this appeared to be due to direct contact with other phthisical patients, 19 of these being members of The same family. Of the other two, one had nursed phthisical patients on two occasions ; the other had worked next to a man suffering from phthisis, who declined to take any precautions. It is satisfactory to report that sanatorium treatment has so far been successful in the last case. 85 Probable Contact. (ii.) In 19 cases the source of infection could not be definitely stated. Twelve had near relatives, who had died of phthisis ; but such a long time (in one case fifteen years) had elapsed since their deaths that it seemed unwise to trace the infection to this source, although no other was apparent. Seven had relatives known to be phthisical but who lived at some distance ; these patients said that they had no personal contact with these relatives. (iii.) In 5 cases there was no clue to the source of infection, but it seemed that circumstances had rendered the patient an easy prey to attacks of infection. Two widows had worked very bard for years on insufficient food. One man had had an accident, resulting in damage to the lungs. One woman was of confirmed intemperate habits. One child had been underfed and neglected, her mother having to go to work for many hours daily ; the child's condition had improved since having dinners provided at school Conditions favouring existence of Tuberculosis. The cases last mentioned indicate to some extent that the same influences which I have referred to as adversely affecting infant life, are also at. work, producing conditions favourable to the existence and spread of tuberculosis in all its forms. These may be spoken of with more certainty in their effect upon children than en adults ; for, with the latter, factors which may not necessarily affect the community in general, operate differently in individual instances ; thus, one adult works at an unhealthy trade, another frequents public-houses, and so on ; these constitute dangers to which children are not directly exposed, although indirectly affected by them. Rather more than one-third of the phthisical-patients whom I have visited have been children under 14 years, the youngest being 3 years old. A great many of these are children, who though they may have enough food to keep them from being hungry, do not have a sufficiently generous diet. These appear to suffer very much from want of fresh milk, its place being taken by tea. to which a little machine skimmed condensed milk (used for " economy's sake ") is added. Then there is the very harmful effect of the want of air and space in sleeping rooms ; frequently these children have been sleeping three together in a small bed in a stuffy room, often used as a living room during the day-time. Thus the children are not able, whilst growing, to build up constitutions fitted to resist the attacks of infection from phthisis to which they are frequently exposed, both at home, at school and in the streets. 86 An undoubted cause of the spread of phthisis in this Borough (especially among children, who play in the streets for many hours) is the fact that persons are allowed to misuse the streets, and among other uncleanly habits, to expectorate freely. If anything could be done to remedy this (e.g.—the frequent cleansing of all the streets with water), it would certainly tend to check the spread of infection from phthisis and other diseases. Sanatorium awl open-air treatment. Sanatorium treatment is difficult to procure and the problems both of providing and accepting it are complicated by the fact that, if the wage-earner goes away the rest of the family must be supported ; there is also the difficulty and expense of finding someone to look after the children if the mother has to go. Yet, various societies do assist admirably in sending phthisical patients away for open-air or for educational treatment ; but as far as I am aware, there are unfortunately no facilities for providing any special accommodation, such as " open-air shelters " for patients in their own home. Favourable results are said to have followed the use of such shelters in other parts of London ; it seems likely that in this Borough also, they would be of ereat service, both to those who return from sanatoria, and those who remain at home. The good effects of sanatorium and educational treatment are often very much lessened when the patient returns home, perhaps to share a sieeping room or to sleep in the living-room. The provision of shelters would tend to maintain the improve ment gained in the sanatorium ; it might also encourage the provision of sanatorium treatment, for at present charitable societies sometimes refuse to arrange this for an otherwise eligible patient, because the conditions to which he must return are so unfavourable that it would be useless to send him away. In the case of those who, for various reasons, must remain at home, the use of such shelters would reduce the risk of the patient infecting other members of his family, and might also assist to keep him in better health, and so to remain longer at work. It must be admitted that this branch of the work is often very discouraging, especially when one sees a patient becoming worse for the want of special nourishment, a light, airy home, change of air, and other such necessary aids to health. But sometimes one has the satisfaction of seeing progress made ; this generally occurs when the patient's illness is detected at an early stage and promptly treated, or, when a patient is suspected of having phthisis and is treated as though a definite diagnosis had been made. In these cases charitable agencies are often willing to assist (as by providing sanatorium treatment), and do so very thoroughly ; the 87 success of their efforts depends largely on the patient's power and willingness to adapt himself to treatment, and to an alteration of his environment, when necessary. In conclusion, I should like to express my thanks to all who have so kindly assisted me in various ways during the year. I am, Sir, Your obedient servant, ETHEL J. CHARI.ESWORTH.