SHOR 22 Metropolitan Borough of Shoreditch, on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1911, by LEWIS T. FRASER BRYETT, M.D. (Lond.), Medical Officer of Health; Diplomate in Puilie Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health, &c. [Printed by Order of the Health Committee.] PRINTED BY CHAS STRAKER AND SONS, LTD., BISHOPSGATE AVENUE, LONDON, E.C. CONTENTS. Page. Anthrax 35 Artisans' dwellings 48 Appendicitis, mortality from 10 Bacteriological examinations 37 Bakehouses 64 Births in sub-districts 3 Birth rates 4 Cancer 9 Cerebro spinal fever 34 Cholera 35 Coffeehouses 55 Cookshops 55 Cow-houses 51 Customs and Inland Revenue Acts 50 Dairies 51 Deaths in sub-districts 4 Death rate 5 Deaths, ages at 8 Deaths, causes of 5 Deaths in public institutions 10 Deaths in outlying institutions 11 Demolition of houses 48 Diarrhœa 26 Diphtheria 20 Disinfection 37 Enteric fever 22 Eiysipelas 25 Factories and Workshops Act, 1901 52 Factories, workshops and workplaces—sanitary work 52 Food condemned and destroyed 56 Food and Drugs Act 56 Fried fish shops 55 Glanders 35 Housing and Town Planning Act, 1909 45 Houses closed 44 Houses let in lodgings 50 Hydrophobia 35 Ice cream shops 54 Infantile mortality 6 Infectious cases, number certified 15 Infectious cases, number removed to hospitals 15 Infectious diseases, age periods 13 Infectious diseases, deaths from 12 Infectious diseases, death rate 13 Infectious diseases, isolation 15 Infectious diseases, number of oases notified from schools 35 Influenza 28 Page. Institutions, deaths in 10 Legal proceedings 41 Margarine Act, proceedings under 59 Marriages 4 Measles 27 M ilk-shops 51 Milk premises, cowsheds, etc., on register 51 Mortuary 38 Notification of Births Act 4 Offensive business 51 Ophthalmia neonatorum 33 Outworkers 48 Polio-myelitis 35 Population 1 Puerperal fever 26 Return cases 16 Sanitary work 39 Scarlet fever 18 Scarlet fever, return cases of 16 Schools, exclusions of children for infectious disease 37 Shelter 38 Sickness amongst the poor 11 Slaughter-houses 51 Small-pox 16 Smoke nuisance 43 Staff 69 Street markets and food 56 Tuberculosis 29 Vaccination 18 Verminous houses 43 Violence, mortality from 10 Water supply 38 Whooping cough 28 Workshops on register 52 Zymotic diseases, deaths from 13 Zymotic death rate 13 APPENDIX. Statistical Tables:— For whole district during 1911 and previous years (Table I.) 64 Cases of infectious disease notified during 1911 (Table II.) 65 Causes of, and ages at, death during year 1911 (Tables III. and V.) 66 & 70 to 75 Infantile mortality during 1911 (Table IV.) 67 Notes to Table III 68 Comparison of London and Shoreditch birth and death rates in 1911 (Table VI.) 76 Cases treated by District Medical Officer in 1911 (Table VII.) 77 Summary of proceedings Tinder Public Health (London) Act, 1891 (Table VIII.) 78 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 79 to 82 Report of Health Visitor 83 to 90 Metropolitan Borough of Shoreditch ANNUAL REPORT of the MEDICAL OFFICER of HEALTH. Town Hall, Old Street, E.C. January, 1912. 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, for the year ending December 31st, 1911. POPULATION. The twelfth census was taken on April 3rd of the year under consideration. The figures here given relate to the number of persons returned as living at midnight on Sunday, April 2nd. They are provisional, being subject to correction, and have been obtained from the preliminary report and abstract addressed to the President of the Local Government Board, and dated June 10th, 1911. The number of persons living in Shoreditch on the night of April 2nd, was 111,463 as compared with an estimate of 114,627 made prior to the Census. There has been a marked decrease in the number of people resident in the Borough as the subjoined figures show:— Population. Decrease. 1891. 1901. 1911. Between 1891 and 1901. Between 1901 and 1911. 124,533 118,637 111,463 4.7 per cent. 6 per cent. 2 Between 1891 and 1901 the population decreased by 5,896 ; between 1901 and 1911 the decrease amounted to 7,174. The density of the population has decreased from 180 persons per acre in 1901 to 170 in 1911, taking the area of the Borough at 658 statute acres land and water. The number of families or separate occupiers was returned as 24,817. In the Hoxton Parliamentary Division there were 12,795 families or separate occupiers, with 57,026 persons, whilst the figures for the Haggerston Division were 11,865 and 53,904 respectively. The particulars as regards the population in the registration sub-districts are set out below:— Registration sub-district. Area in statute acres. Families or separate occupiers. Population. Increase or decrease of population between 1901 and 1911. Census density of Population per acre 1911. 1901. 1911. Increase. Decrease. Shoreditch South 256 9,330 46,362 40,658 — 5,704 159 Shoreditch North West 176 7,630 36,127 36,153 26 — 205 Shoreditch North East 226 7,847 36,148 34,652 — 1,496 153 The populations of the sub-districts estimated for statistical purposes during 1911, were as follows: Shoreditch South comprising Moorfields, Church and Hoxton Wards, 41,417, Shoreditch North West, comprising Wenlock and Whitmore Wards, 37,462, and Shoreditch North East which comprises Kingsland, Haggerston and Acton Wards, 35,748. Comparison of these figures with those of the census show that for each of the sub-districts the decrease in the population had been greater than estimated, in the case of the first by 759, of the second by 1,309, and of the third by 1,096. The estimated population of the Borough for the middle of the year, 1911, based on the census of 1911, is 111, 285. The census populations of the eight wards of the Borough have not yet been published. The estimated populations are as set out below:— Ward. Population. Ward. Population. Moorfields 5,040 Whitmore 16,908 Church 18,882 Kingsland 10,400 Hoxton 16,594 Haggerston 12,315 Wenlock 19,237 Acton 11,909 3 Included in the population of the Wenlock Ward is that of the Holborn Workhouse which is situate in this ward. The number on the night of the census in this institution was 1,334 For certain statistical purposes the workhouse population is not regarded as belonging to Shoreditch and is excluded from the estimated population of the Borough which becomes for these purposes, therefore, 109,951, whilst that of Wenlock Ward is reduced to 17,903. In the following tabic 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 71 Whitmore 76 222 Church 106 178 Kingsland 72 144 Hoxton 78 211 Haggerston 66 186 Wenlock 90 199 Acton 83 143 In estimating the above figures the population and the area of the Holborn Union Workhouse premises have not been taken into account nor has the area covered by water in the Borough been included. BIRTHS. The births registered in the Borough numbered 3,398, of which 1,733 were of males and 1,665 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 3,497, of which 1,782 were of males and 1,715 of females. The distribution of the corrected births in the eight wards of the Borough is given below:— Ward. Males. Females. Total. Moorfields 49 51 100 Church 330 286 616 Hoxton 263 285 548 Wenlock 256 249 505 Whitmore 326 308 634 Kingsland 172 193 365 Haggerston 196 161 357 Acton 190 182 372 Totals 1,782 1,715 3,497 4 Outside the Borough 177 births were registered, 92 of males and 85 of females the parents being residents of Shoreditch. In the Shoreditch Infirmary 144 births were registered, of which G5 were of males and 79 of females. In three of these (females) the parents did not belong to Shoreditch. In the Holborn Union Workhouse there were 79 births, 45 of males and 34 of females. In 74 of these (43 male and 31 female) the parents were not resident in the Borough. Of the births registered as occurring in the Shoreditch Infirmary, 52 (23 male and 29 female) were entered as being illegitimate. In the Holborn Workhouse, 42 (23 male and 19 female) were so returned. Elsewhere in the Borough there were 42 births (18 of males and 24 of females) which were illegitimate. In the case of one of these—a female—the mother was not a resident in the Borough. The birth-rate was 31.8 per 1,000 inhabitants as compared with 31.6 in 1910, 32-4 in 1909, 32.2 in 1908, 32.4 in 1907, 33.6 in 1906 and 34.2 in 1905. The birthrates for the eight wards of Ihe Borough are contained in Table VI. (Appendix). The birth-rate for the whole of England and Wales during 1911 was 24'4, for 77 great towns it was 25.6, and for 136 smaller towns it was 23.4 per 1,000 living. The London birth-rate was 25.0 per 1,000 population. NOTIFICATION OF BIRTHS ACT, 1907. The births notified under the above Act numbered 3,228 as compared with 3,277 in 1910. Taking the number of births belonging to Shoreditch registered during the year, the percentage of notifications was 92 as compared with 91 in 1910. The great majority of the births were notified by registered midwives. There were in addition 158 births occurring in public institutions outside the borough which were notified by the London County Council, lists of the same being sent to me weekly. There is not much doubt therefore that the births not reported were comparatively few. MARRIAGES. The marriages in Shoreditch during 1911 numbered 1,015 as compared with 1,025 in 1910, 967 in 1909, 972 in 1908, 1,109 in 1907, 1,074 in 1906, 1068 in 1905, 1066 in 1904, 1,146 in 1903, 1,156 in 1902 and 1,073 in 1901. The persons married were at the rate of 18.4 per 1,000 population as compared with 18.0 in 1910 and 16.9 in 1909. The marriage rate for the Metropolis during 1911 was 17.7 per 1,000 population. DEATHS. The deaths during 1911 numbered 2,227 as compared with 1,913 in 1910, 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. 5 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 39 35 74 Church 230 181 411 Hoxton 170 147 317 Wenlock 155 136 291 Whitmore 255 211 466 Kingsland 111 98 209 Haggerston 113 113 226 Acton 128 105 233 Totals 1,201 1,026 2,227 The deaths of males were 175 in excess of those of females. The death-rate for the year was 20.2 *per 1,000 inhabitants as compared with 168 in 1910, 19.2 in 1909, 17 5 in 1908, 20.6 in 1907, 19.8 in 1906, 19.8 in 1905, 20.6 in 1904, 19.6 in 1903, 20.9 in 1902 and 22.1 in 1901. The death-rate for 1911 was somewhat above the average for the previous ten years The London death-rate during 1911 was 15.8 per 1,000 population, for England and Wales it was 14.6, for 77 great towns it was 16.4 and for 136 smaller towns it was 14.4. As compared with the figures for 1910 there was a marked increase in the death-rates. In tables I, III, IV, V, and VI (Appendix) are given the causes of death and the death-rates for the whole borough and for its eight wards, together with other particulars as to the mortality amongst the inhabitants of Shoreditch during the year. Tables I, III and IV are required by the Local Government Board and are modifications of those given in former reports. The alterations have been made at the request of the Board and have resulted from the Register-General's decision to publish from the commencement of 1911 statistics of causes of death for administrative, instead of, as hitherto, for registration (or poor law) areas. His statistics will in future relate to the same areas as those for which statistics are compiled by Medical Officers of Health. The alterations have been deemed necessary in order to minimise the risk of serious discrepancy between the two sets of figures. As compared with the figures for last year, marked elevations of the death-rates are noticeable for all the Wards of the Borough. The rate was lowest in Moorfields *Corrected for age and sex distribution the death-rate was 21.1 per 1,000 population. 6 and highest in Whitmore, being 14.6 and 27.5 per l,000 respectively* The deathrate for the Borough was above the mean rate for the year from the middle of January to the middle of April, when it fell and remained below until the end of July. During August, September and October it was above the mean but during November and December it was markedly below the mean rate for the year, which is very unusual for Shoreditch, in fact, the lowest weekly rate for the year was for the third week of November, when the death-rate only amounted to 7.8 per 1000. It may also be noted as a very unusual circumstance that the death-rate for the Borough was during November lower than the rate for the Metropolis during the month. The death-rate was highest above the mean at the end of March, when during the 12th week of the year it nearly touched 30 per 1000. It was also high during the second and fourth weeks of August, being over 28 per 1000 for those weeks. The high rate for the first quarter of the year was mainly the result of the prevalence of measles, bronchitis and pneumonia. The elevation during August and September was the result of summer diarrhoea. The temperature during these two months was considerably above the average, the weather being very hot, which without doubt helped to raise the death-rate. The deaths of infants under the age of one year numbered 598, 340 being of males and 258 of females, the deaths amounting to 26.8 per cent, of the total number of deaths at all ages as compared with 27.6 in 1910, 23 per cent, in 1909 and 25.4 in 1908. The number of infants under one year dying during 1911 was at the rate of 171 per 1000 births belonging to Shoreditch registered during the year. The infantile mortality was somewhat above the average for the previous ten years, and as is usually the case it was higher amongst males than females being 191 for the former as compared with 150 for the latter. The chief causes of death amongst infants under the age of one year were as stated for previous years; diarrhoea and other disorders of the stomach and intestines, prematurity, weakness and wasting, bronchitis, pneumonia and suffocation in bed. In Table IV (Appendix) is contained a statement showing the causes of death amongst infants under the age of one year, the ages in weeks and months being given. The table also shows the net deaths and births during the year amongst legitimate and illegitimate infants. * The Shoreditch Workhouse which is situate in Whitmore Ward is in the cases of some of the deaths in outlying institutions the last known place of residence in the Borough. This Ward is therefore in all probability credited with some of the deaths rightly belonging to other Wards in the Borough. This is a point to be borne in mind in connection with the high rate for this Ward. 7 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. Moorfields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals. Measles 1 7 3 1 3 2 7 3 27 Scarlet Fever .. .. .. .. 1 .. .. .. 1 Diphtheria and Croup .. .. .. 1 .. .. .. 1 2 Whooping Cough .. 1 .. 1 3 2 3 4 14 Diarrhæa 2 20 17 22 18 9 9 11 108 Enteritis .. 17 5 5 18 4 2 6 57 Tuberculous Meningitis 1 4 .. .. 1 2 1 1 10 Abdominal Tuberculosis .. .. .. 2 4 .. .. 2 8 Other Tuberculous Diseases .. 2 3 1 1 1 .. .. 8 Congenital Malformations .. 2 2 5 .. 1 2 2 15 Premature Birth .. 14 19 13 17 3 6 7 79 Atrophy, Debility and Marasmus .. 14 11 16 13 8 12 3 77 Atelactasis .. 1 .. .. .. 2 2 .. 5 Injury at Birth .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. Syphilis .. .. .. 3 3 1 1 .. 9 Rickets .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. 1 1 1 1 .. .. 2 6 Convulsions .. .. 2 1 3 3 2 3 16 Gastritis .. .. 1 .. 1 .. .. .. 2 Laryngitis .. .. 1 .. .. .. .. .. 1 Bronchitis 1 8 11 6 10 3 2 3 44 Pneumonia (all forms) Suffocation, 1 10 8 7 9 3 8 12 58 lying 3 4 4 2 5 1 2 1 22 Other causes 2 5 4 4 10 2 1 1 29 Totals 13 112 92 91 121 47 60 62 598 The infantile mortalities of the eight wards of the Borough are contained in Table VI. (Appendix). It was highest in Whitmore Ward where it amounted to 190 and lowest in Kingsland where it was 129 per 1000 births. The high rate of the infantile mortality in Shoreditch is as has been pointed out in previous reports chiefly due to the large proportion of the poorer working class resident in the Borough and the great density of the population which is something approaching three times that of London as a whole. This great density of the 8 residential population, in many parts of the Borough varying from 200 to 350 or 400 persons to the acre, means the existence of conditions which tend to lower the general standard of health and favour the prevalence of infectious disease. These conditions affect more or less all ages of the population, but especially infants who are liable to succumb more readily to deleterous influences and they need great and ever increasing effort on the part of the Sanitary Authority to counteract them. The work of Miss Charlesworth, the Health Visitor, directed towards mitigating some of the evil results of these conditions is dealt with in her report which is appended (p. 84). What has been accomplished in this direction during the year is so far as it goes of a very satisfactory character, but it is evident that the amount of work in the field of health visiting in the Borough is far greater than one health visitor can adequately cope with and that there is plenty of scope for an additional whole time worker. A perusal of the Health Visitor's report will convey a good idea of the nature and of the importance of the work of health visiting so far as Shoreditch is concerned. Early in the year the question of the employment of voluntary Health visitors came under the consideration of the Health Committee in connection with a communication on the subject from the Shoreditch Public Welfare Association. Enquiries were made as to the value of such voluntary assistance in other Boroughs. The conclusion arrived at was that valuable assistance could be rendered by voluntary workers provided they were properly trained, carried out their duties under the instruction of a responsible officer of the Borough Council and were able to give an adequate amount of time regularly on fixed days during each week. Towards the end of the year the Health Visitor had the assistance of Miss Stiff, a fully qualified health visitor who volunteered her services for four full days each week during a period of three months. This lady gave some most valuable help in connection with the work as to infants under the notification of Births Act. The deaths of children aged from 1 to 5 years numbered 399. Of these 94 were attributed to measles, 18 to whooping cough, 43 to diarrhoea, 31 to enteritis, 17 to diphtheria, 6 to scarlet fever, 12 to bronchitis, 82 to pneumonia, and 13 to violence, 4 of which were the results of burns or scalds. Altogether 997 or 44'7 per cent, of the total number of deaths at all ages during the year were of children under 5 years of age. Of children aged between 5 and 15 years 75 died. The chief causes of death were tuberculosis which accounted for 16, other infectious diseases which resulted in 13, pneumonia 11, and various forms of violence which caused 15 deaths, 6 of which were through street accidents and 5 from burns and scalds. Of persons aged between 15 and 25 years, there died 69, of whom 25 were victims of consumption and 11 of diseases of the heart and circulatory organs. 9 Of persons aged between 25 and 35 years there died 102, the chief causes of death being consumption which accountcd for 46, diseases of the heart and circulatory organs which resulted in 10, pneumonia which caused 7, and diseases of the nervous system which resulted in 7 deaths. One death was due to cancer, and 5 to violence of which 1 was homicidal. The deaths of persons aged from 35 to 45 years numbered 171, of which 40 resulted from consumption, 7 from cancer, 14 from diseases of the nervous system, 5 of which were due to general paralysis of the insane, 24 from diseases of the heart and circulatory organs, 16 from bronchitis, 25 from pneumonia, 12 from diseases of the digestive organs, 8 of which were attributed to cirrhosis of the liver, 5 from Bright's disease, and 5 from violence, 1 of which was suicidal. Of persons from 45 to 55 years of age 211 died, of these 38 succumbed to consumption, 16 to cancer, 18 to apoplexy, 4 to general paralysis of the insane, 16 to diseases of the heart and circulatory organs, 28 to bronchitis, 19 to pneumonia, 9 to cirrhosis of the liver 12 to disease of the kidneys and 13 to violence, 4 of which were suicidal. Of the 217 deaths amongst persons aged from 55 to 65 years, 17 were attributed to consumption, 26 to cancer, 12 to apoplexy, 32 to heart disease and disorders of the circulatory organs, 37 to bronchitis, 24 to pneumonia, 5 to cirrhosis of the liver, 13 to Bright's disease and 7 to violence, 3 of which were cases of suicide. Of 231 deaths amongst those aged between 65 and 75 years, 23 were the result of cancer, 36 of old age, 18 of apoplexy, 29 of heart disease and disorders of the circulatory organs, 44 of bronchitis, 21 of pneumonia, 13 of Bright's disease and 9 of violence. Of 117 persons who died aged from 75 to 85 years, in 55 instances death was attributed to old age, in 6 to heart disease and disorders of the circulatory organs, in 19 to bronchitis, in 6 to pneumonia, in 4 to Bright's disease, and in 5 to violence. Cancer was given as the cause of 6 deaths. Of the persons who died age 85 years and upwards, 29 died from old age, 6 from bronchitis, 1 from pneumonia and 1 through a fall. The chief causes of death during the year were: tuberculosis which accounted for 266, and included 183 attributed to consumption or phthisis, pneumonia which caused 259, bronchitis 210, diarrhoea 162 and enteritis 92, diseases of the heart and blood vessels 139, measles 125, old age 121, violence 108, cancer 79, prematurity 79, atrophy, debility and marasmus 65, Bright's disease and other diseases of the kidneys 53, apoplexy 59, alcoholism and cirrhosis of the liver 38, and whooping cough 32. 10 Of the 79 deaths from cancer 43 were of males and 36 of females. Eight persons under 45 years of age and six over 75 years were certified to have died from cancer. In addition 11 deaths, 7 of males and 4 of females, were certified as being due to malignant disease. It is probable that in some of these cancer was the cause of death. The death-rate from cancer during the year was 0.72 per 1,000 population and was again above the average. The rates for previous years are as follows: 0.71 in 1910, 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, 05.8 in 1898, 0.51 in 1897, 0.45 in 1896, 0.50 in 1895, 0.65 in 1894 and 0.54 in 1893. The deaths from malignant disease have not been included in estimating the above rates. Of the deaths attributed to alcoholism and cirrhosis of the liver, 20 were of males and 18 of females Six deaths were attributed to appendicitis as compared with 8 in 1910, 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. Of the deaths during 1911 5 were of males. The deaths from peritonitis number 8, of which 6 were of females. Of the 108 deaths from violence 63 were of males and 45 of females. Through accident or negligence 100 persons met their deaths. Street accidents resulted in 16 of these deaths, burns and scalds in 12, and falls of various kinds in 32. The number of infants who died through suffocation in bed was 22 as compared with 35 in 1910. There were 2 cases of homicide, and 8 persons committed suicide, of the latter 7 were males. DEATHS IN PUBLIC INSTITUTIONS. The number and distribution of the deaths of persons belonging and not belong ing to the Borough in the public institutions situate in Shoreditch are as set out in the subjoined table:— Institution. Persons belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Union Workhouse 10 246 256 Shoreditch Workhouse 560 18 578 Royal Chest Hospital 12 44 56 Convent Hospital 1 7 8 Home of Good Shepherd 11 2 13 Babies' Home 11 17 28 Totals 605 334 939 Elsewhere than in public institutions, 10 persons not belonging to Shoreditch died within the Borough. 11 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. No. of Deaths Banstead 7 Middlesex 1 Cane Hill 5 Mildmay 12 Caterham 2 Queen's (Children) 89 City of London 1 Royal Free 1 Claybury 12 St. Bartholomew's 115 Colney Hatch 11 University College 1 Darenth 1 Special Hospitals. Dartford Hoath 4 Hanwell 1 Chest Hospital, Bethnal Green 4 Leavesden 10 Hospital for Women 1 Long Grove 5 Queen Mary's Hospital 7 Manor 1 Infirmaries and Workhouses. Tooting Bee 8 Hospitals for Infectious Disease. Belmont Workhouse 1 Botlmal Green Infirmary 8 Eastern 27 Bethnal Green Workhouse 2 London Fever 1 Camberwell Infirmary 1 North Eastern 29 City of London Infirmary 1 North Western 1 Fulham Workhouse 1 Park 2 Hackney Infirmary 2 South Eastern 6 Hackney Workhouse 1 General Hospitals. Holborn Infirmary 1 Islington Infirmary 1 Charing Cross 1 St. Pancras Infirmary 1 East London (Children) 3 Shoreditch Additional Work house 3 Freiden Heim 1 German 12 Whitechapel Infirmary 1 Gt. Ormond Street (Children) 15 Guy's 1 Other Institutions. Itatian Hospital 1 St. Joseph's Hospice 3 King's College 3 St. Anne's House 2 London 18 St. Luke's House 7 Metropolitan 86 Hostel of God 1 Of 543 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 360 died in general hospitals, 68 in asylums, 66 in fever hospitals, 24 in workhouses and infirmaries, 12 in hospitals for special diseases, and 13 in other institutions. Elsewhere than in public institutions 13 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 1 148 or 51 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 1911 numbered 12 5,209, as compared with 5,445 in 1910, 5,261 in 1909, 4,453 in 1908, 4,380 in 1907, 4,107 in 1906 and 4,014 in 1905. It must, however, be stated that the figures for 1911 do not include the cases which were treated in the practice of the medical practitioner who was temporarily engaged by the Guardians during August to November whilst a vacancy existed in one of the districts. These cases numbered several hundreds, so that the actual number of patients treated must have exceeded the number for 1910. An analysis of the cases recorded is contained in Table VII. (Appendix). The diseases classed as infectious accounted for 924, as compared with 923 in 1910, 945 in 1909, 707 in 1908 and 763 in 1907. Measles, influenza, whooping cough, diarrhoea, and consumption were responsible for most of these cases. The cases of diarrhoea and consumption shew a considerable increase as compared with the numbers for 1910, whilst cases of whooping cough were not so numerous. Diseases of the respiratory organs which are mainly the results of infections numbered 1,458 cases as compared with 1,344 in 1910, 1,444 in 1909 and 1,268 in 1908. Of these 1,303 were cases of bronchitis and 97 of pneumonia. Rheumatism was given as the cause of illness in 408 cases as compared with 398 in 1910. The cases of rheumatic fever numbered 53 as compared with 53 in 1910, 47 in 1909, and 32 in 1908. The cases diagnosed as gout numbered 95 as compared with 100 in 1910 and 104 in 1909. Dyspepsia and other disorders of the digestive system accounted for 546, as compared with 688 in 1910. The cases diagnosed as cancer numbered 31 as compared with 37 in 1910, 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. Diseases of the locomotive system accounted for 240 cases as compared with 263 in 1910, and diseases of the skin for 163 as compared with 236 for the previous year. INFECTIOUS DISEASES. The infectious diseases included under the headings numbered 1 to 35 and 171 in Table V. (Appendix), resulted in 673 deaths as compared with 511 in 1910, 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 number although considerably higher than in 1910 was none the less below the average for the previous 10 years. They amounted to 30.2 per cent, of the total number of deaths from all causes as compared with 26.7 per cent, in 1910, 30.8 in 1909 and 30 7 in 1908. As compared with the figures for 1910 the increase in the numbers of deaths is most marked in respect to diarrhoea and measles. There are also increases in the numbers of deaths from consumption, scarlet fever and diphtheria. The deaths from consumption and the other forms of tuberculosis amounted to approximately 38 per cent, of the total number of deaths from infectious diseases and of the remainder 13 diarrhoea, measles and whooping cough accounted for the greater number. The death-rate from these infectious diseases was 61 per 1,000 inhabitants as compared with 4.5 in 1910, 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. In the subjoined table the deaths from the infectious diseases referred to above have been grouped according to age:— Age period. Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 85 and upwards No. of deaths 195 225 19 10 17 15 54 50 47 26 11 4 .. Nearly two-thirds of the deaths were of children under five years of age. Of the total number of deaths of children under five years of age from all causes 42 per cent, resulted from the infectious diseases referred to as compared with 35 per cent, in 1910, 43 in 1909, 40 in 1908, and 42 per cent, in 1907. In infants under one year diarrhoea was the chief cause of death, more than half resulting from this disease. Measles, tuberculosis and whooping cough accounted for most of the other deaths during this age period. Amongst children aged from one to five years, measles was the most active cause of death, but diarrhoea, tuberculosis, whooping cough and diphtheria also caused many deaths. The chief cause of the mortality from infectious diseases amongst persons aged from 20 to 65 years was consumption. Amongst persons over 65 years diarrhoea was the chief cause. The deaths from the principal zymotic diseases namely small-pox, measles, scarlet fever, diphtheria and membranous crop, whooping cough, enteric fever and diarrhoea numbered 349 as compared with 217 for 1910. The death-rate due to these diseases which is termed the zymotic death-rate was 3'2 per 1,000 inhabitants as compared with 1.9 in 1910, 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 although markedly higher than for 1910, none the less did not exceed the average for the years given. A comparison of the zymotic death-rate of London and Shoreditch and the eight Wards of the Borough is given in Table VI. (Appendix). The rate was highest in Kingsland Ward and Church Ward, and lowest in Moorfields, beine 3.8 for each of the former and 1.8 for the latter. Excluding cases of cerebro-spinal fever and polio-myelitis which together numbered 6, ophthalmia neonatorum 32, and phthisis, the cases of notifiable infectious disease numbered 594, an increase of 66 on the number for 1910. The numbers of 14 cases annually certified since 1889, when notification was made compulsory, 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 1894 1104 9.0 1895 1157 9.4 1896 1473 12.1 1897 1331 10.9 1898 960 7.8 1899 1116 9.2 1900 989 8.1 1901 1146 9.8 1902 1239 10.5 1903 664 5.6 1904 776 6.6 1905 1151 9.8 1906 951 8.2 1907 1265 10.8 1908 1028 8.8 1909 729 6.3 1910 528 4.5 1911 594 5.3 The cases of notifiable infectious disease certified in the Metropolis during 1911 numbered some 24,300 excluding cases certified as anthrax, glanders, ophthalmia neonatorum, measles, which was notifiable in one of the Boroughs, cerebro-spinal fever and acute polio-myelitis, the latter having been a notifiable disease in London since September. The attack-rate was 5.3 per 1,000 as compared with 4/4 during 1910. Excluding the diseases mentioned, the incidence of cases of notifiable infectious disease in Shoreditch during 1911, and the increase therein as compared with the figure for 1910, did not materially differ from those of the Metropolis. Subjoined is a list of the infectious diseases which are notifiable to the Medical Officer of Health, showing the number of cases certified in the Borough for each of the four quarters of the year, and the numbers and percentages of such cases which were removed to hospital for treatment 15 Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox 3 .. .. .. 3 .. Scarlet Fever or Scar- latiua 28 27 83 96 234 7 Diphtheria & Membra- nous Croup 27 39 46 59 171 22 Typhus .. .. .. .. .. .. Cholera .. .. .. .. .. .. Enteric Fever (Typhoid) 1 2 6 13 22 1 Continued Fever .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. Puerperal Fever 1 2 2 .. 5 2 Erysipelas 31 22 36 70 159 4 Plague .. .. .. .. .. .. Cerebro-Spinal Fever 2 .. 1 1 4 4 Glanders .. .. .. .. .. .. Anthrax .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. Acute Anterior Poliomyelitis .. .. .. 2 2 .. Ophthalmia Neonatorum 1 13 8 10 32 .. Totals 94 105 182 251 632 38 Numbers and percentages of cases removed to hospitals 63 71 141 171 446 67% 67 % 77% 68% 70% Chicken-pox was notifiable for a part of the first and during the second quarter of the year. Some 87 cases were certified. As compared with the figures for 1910 the numbers of cases of scarlet fever, diphtheria, erysipelas and puerperal fever were increased. There were 3 cases of small pox as against 2 in 1910. Cases of enteric fever show a marked decrease, the reduction in the number being over 50 per cent. Acute anterior polio-myelitis became a notifiable infectious disease in the County of London from September 1st, and ophthalmia neonatorum from March 13th, 1911. The deaths from the principal zymotic diseases which are notifiable, namely, small pox, scarlet fever, diphtheria and enteric fever were at the rate of 0'27 per 1000 inhabitants, whereas the rate from the principal zymotic diseases which are not notifiable, namely—measles, whooping cough and diarrhoea was 2'9 or more than ten times as great. ISOLATION OF INFECTIOUS CASES. The cases of small pox, scarlet fever and diphtheria removed to hospital are all taken to the hospitals of the Metropolitan Asylums Board. Cases of enteric fever, puerperal fever, and erysipelas not unfrequently go to the Shoreditch Infirmary and general hospitals in the neighbourhood of the Borough. The notifiable infectious diseases, cases of which are receivable into the hospitals of the Metropolitan Asylums Board are:—Smallpox, scarlet fever, diphtheria, enteric fever andcerebro- 16 spinal fever. The number of cases of these diseases certified (Table II Appendix) was 434, and the number removed to hospital 421, which gives a percentage of 97.0 as compared with 97.7 in 1910, 97 in 1909, 97.3 in 1908, 97.5 in 1907, and 96 in 1906. The percentage for previous years are contained in the report for 1905. As stated in previous reports, in a densely populated working class district such as Shoreditch, where the great majority of the population are dwellers in tenements of less than five rooms, the removal of infectious cases to hospital is the only efficient way to secure isolation; it is a factor of the utmost importance in controlling the spread of infection, and it is satisfactory therefore to again have to report such a high percentage of cases removed to hospital. RETURN CASES. Two instances came under observation in which recurrences of the disease followed the return home of patients who had been treated in hospital. In one instance the disease was scarlet fever and in the other diphtheria. The facts were briefly as follows:— (1) On Angust 8th, Louisa M—, aged 4, was removed to hospital certified to be suffering from scarlet fever, she returned home on October 6th. A few days after her return a discharge from her nose appeared together with a " breaking out " on her face. On October 21st her brother, George M—, aged 7, fell ill and on October 23rd he was certified and removed to hospital also suffering from scarlet fever. He last attended school on October 20th. There were no grounds for believing disinfection was at fault. (2) Ruby C—, aged 2, was certified to have diphtheria on September 19th, and was removed to hospital the following day. She returned home on November 23rd, and had a discharge from her nose which lasted until December 1st. Thomas C—, aged 4, her brother was taken ill with diphtheria on December 3rd and Arthur C—, aged 2, on December 16th. SMALL POX. In February owing to an unrecognised case there was a serious outbreak of small pox in the Mile End Infirmary. Infection was spread through the medium of friends of the inmates of the institution with the result that a number of cases followed in the East End of London, and a few elsewhere in the Metropolis. In Shoreditch 3 cases occurred which were without doubt connected with the outbreak. The particulars are briefly as follows: on March 9th information was received that a girl named Ethel F—, aged 10, residing in D Block, White Cross Place, was being attended by a medical man for influenza. As intimation had been received that she had in all probability been exposed to small pox infection in connection with a case which had occurred in Hackney the medical man was apprised of the 17 fact. This resulted in a careful examination being made and the patient was found to have a very mild attack of small-pox. She was duly certified and removed to hospital the same day. The usual steps were taken as regards disinfection and the patients mother and a sister named Rose F—, aged 21, were accommodated at the Council's shelter whilst their clothing, &c., were undergoing disinfection. On visiting the shelter the following day to ascertain whether everything was correct before they returned to their dwelling, spots were noticed on the girl's arms—just one or two small scabs. A careful examination placed it beyond doubt that she had had small pox and was still infectious, and this was confirmed by Dr. Wanklyn who saw the case. The patient was accordingly certified as having small pox and removed to hospital. From the history obtained it appears that Rose F– – had been to see a young man who was subsequently found to be suffering from small pox and who was removed from an address in Hackney on February 27th, having been ill from about February 2nd. On February 18th Rose was not well and spots were noticed on February 21st. Feeling better after a few days she returned to her work as a box hand, and for several days she must have been in contact with a number of persons where she worked whilst she had small pox. Probably from 30 to 40 persons were more or less exposed to infection from her. Many of these, mostly girls were resident in Bethnal Green, Stepney and elsewhere in the Metropolis. The Medical Officers of Health of the respective sanitary authorities were duly notified as to the names and addresses of these contacts. The principal of the establishment where the patient had been working was warned as to the danger and all precautions which could be taken by the sanitary authority were adopted. The employes were kept under observation during the period that further cases might be expected, and careful enquiries were made but no other cases occurred notwithstanding the fact that Rose F— had been working amongst them for a week whilst actually suffering from the disease. Both patients were said to have been vaccinated but there were no scars observable. So far as could be traced no other cases arose through infection from these two cases in Shoreditch, nor was there any reason for believing that there were any elsewhere. The third case was that of a man, Thomas S—, aged 43, residing in Ebor Street. He fell ill on March 9th, and the eruption was noticed on the 11th. He was certified and removed to hospital on March 12th. This patient is said to have been vaccinated. The usual precautions were taken as regards vaccination and disinfection. So far as could be ascertained no further cases accurred which were traceable to infection from this source. All made good recoveries. There were also two other cases certified as small pox but on arrival at the wharf, the patients were found not to be suffering from the disease. It may also be mentioned that during February and March several cases were brought to my notice by Medical Practitioners as being of a doubtful character and possibly small pox, but they all proved not to be cases of the disease. The cases of small pox certified in the Metropolis numbered some 73 and the deaths 9, the mortality being a little over 12 per cent, of the cases notified. B 18 VACCINATION. The last official figures as to vaccination are those published with the report of the Medical Officer of the Local Government Board for 1.910.11, and relate to the year 1909. Of the births registered during that year in 48"6 per cent, vaccination was successfully performed and 35'6 per cent, were not finally accounted for, the latter figure including postponed cases. Although 42.4 per cent, of the children whose births were registered in 1909 were unvaccinated at the end of the year. The last figure includes those exempted by conscientious objection certificates, which numbered 237 or 68 per cent, of the births registered as compared with 4'7 per cent, in 1908, 2T 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 1890 to 1909 for Shoreditch, the Metropolis, and the rest of England:— Year. Shoreditch. Metropolis. Best of England. Year. Shoreditch. Metropolis. Rest of England. 1891 8.8 16.4 129 1901 44.4 24.1 11.2 1892 10.8 18.4 14.3 1902 36.1 21.3 10.0 1893 16.2 18.2 15.7 1903 36.0 20.7 9.1 1894 339 20.6 19.0 1904 34.2 19.1 8.7 1895 47.5 24.9 19.8 1905 35.9 18.9 8.6 1896 55.5 26.4 22.3 1906 32.6 21.2 9.5 1897 67.4 29.1 21.6 1907 31.2 22.7 10.3 1898 68.4 33.0 19.6 1908 34.5 21.5 9.4 1899 54.2 27.7 15.4 1909 35.6 20.6 9.2 1900 52.8 25.8 13.9 The above figures indicate a decreasing amount of vaccination in the Borough since 1907. SCARLET FEVER. The cases certified during 1911 numbered 234 as compared with 210 in 1910 339 in 1909, 590 in 1908, 876 in 1907, 629 in 1906, 789 in 1905, 343 in 1904, and 255 in 1903. In 22 or 9.4 per cent, of the cases certified intimations were received from the Metropolitan Asylums Board that the patients had not been suffering from scarlet fever. Corrected for errors in diagnosis, the cases during the year numbered 212 as compared with 181 in 1910, 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 are as shown in the subjoined table:— 19 Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 6 3 9 .. .. .. Church 12 17 29 .. .. .. Hoxton 10 13 23 .. .. .. Wenlock 13 22 35 .. .. .. Whitmore 24 42 66 2 .. 2 Kingsland 20 13 33 1 2 3 Haggerston 5 14 19 1 .. 1 Acton 12 8 20 1 .. 1 Totals for Borough 102 132 234 5 2 7 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified 230 or 98.3 per cent, were removed to hospital as compared with 99 in 1910, 97.9 in 1909, 97.9 in 1908, 98 6 in 1907, 97.4 in 1906, 97 in 1905, and 96 in 1904. The percentages for previous years are given in the Report for 1903. The cases certified were at the rate of 2.1 per 1,000 inhabitants as compared with 1.8 in 1910, 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.l in 1902, 4.7 in 1901 and 2.7 in 1900. The attack-rate in the Borough was highest in Whitmore Ward and lowest in Hoxton, being 3.9 per 1,000 in the former as compared with 1.3 in the latter ward. The deaths numbered 7, as compared with 4 in 1910, 7 in 1909, 28 in 1908, 28 in 1907, 20 in 1906, 27 in 1905, and 13 in 1904, the death rate being 0.06 per 1,000 population as compared with 0.03 in 1910, 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 3 per cent, of the cases certified, as compared with 19 in 1910, 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. Although considerably higher than for 1910, the case mortality and also the death-rate were below the average. Amongst children under five years there were 88 cases, with 7 deaths, the case mortality being a shade under 8 per cent, (allowing for mistakes in diagnosis 9.4 per cent.), as compared with 2.3 per cent, in 1910, 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 in 1900. Amongst persons over five years of age there were 146 cases, but no deaths, the case mortality for previous years were 16 in 1910, 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 cases of scarlet fever in the Metropolis numbered 10,462, the attack-rate being 2.3 per 1,000 inhabitants, as compared with 2.1 in 1910, 3.5 in 1909, 4.6 in B2 20 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 172, the death-rate being 0.03 per 1,000, as compared with 0.04 in 1910, 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. DIPHTHERIA. The cases certified, including 2 of membranous croup, numbered 171, as compared with 127 in 1910, 183 in 1909, 202 in 1908, and 211 in 1907. Of these 17 or 9.9 per cent., were not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board. 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 5 5 10 1 1 2 Church 19 19 38 2 1 3 Hoxton 15 15 30 3 3 6 Wenlock 10 12 22 2 2 4 Whitmore 10 11 21 1 .. 1 Kingsland 4 8 12 .. 2 2 Haggerston 7 15 22 1 1 2 Acton 9 7 16 2 .. 2 Totals for Borough 79 92 171 12 10 22 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified, 95 per cent, were removed to hospital, as compared with 97 per cent, in 1910, 96 in 1909, 96 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 1.5 per 1,000 inhabitants, as compared with 11 in 1910, 1.5 in 1909 and 1.7 in 1908. The attack-rate was highest in Hoxton Ward, where it was 2.0 per 1,000 inhabitants. It was lowest in Kingsland and Wenlock Wards, where it amounted to 11 per 1,000 for each of these wards. The deaths numbered 22, the death rate being 0.20 per 1,000, as compared with 0.12 in 1910, 018 in 1909, 0.11 in 1908, 0.17 in 1907, 0.12 in 1906, 0.14 in 1905, 21 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 VI. (Appendix). The rate was highest in Moorfields and lowest in Whitmore Ward, being 0.39 per 1,000 for the former and only 0.06 for the latter. The case mortality was 12.7 per cent, of the cases certified, as compared with 11.0 in 1910, 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 from diphtheria during 1911, 19 were of children under five years of age, the mortality being at the rate of 20.6 per cent, of the cases certified amongst children at that age period (21.8 per cent, allowing for errors of diagnosis) as compared with 17.2 in 1910, 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. There were three deaths of children aged from five to ten years. The mortality amongst persons over five years of age was at the rate of 3.8 per cent, of the cases certified, or allowing for errors in diagnosis 4.4 per cent. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 137 of the cases certified during the year, they were distributed amongst males and females at certain age periods as set out in the subjoined table:— Age Period. Male. Female. Total. Under 1 year 3 3 6 From 1 to 2 years 8 4 12 „ 2 „ 12 12 24 „ 3 „ 4 „ 7 7 14 4 „ 5 „ 6 13 19 5 „ 10 „ 16 16 32 „ 10 „13 „ 3 5 8 Over 13 years 6 16 22 Totals 61 76 137 In 51 of the cases the patients were children attending school, and in 44 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 22 62 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 20 instances the histories showed that there had been cases of "sore throat" amongst the inmates of the houses in which the patients resided. In 23 instances there was evidence pointing to infection from previous cases in the Borough. In 105 instances the houses were occupied by members of more than one family, in 15 by single families, and in 17 instances the cases occurred in artisan's dwellings of the block type. With regard to the sanitary condition of the dwellings, in 90 this was satisfactory, in 18 fairly so, and in 29 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 7,378 as compared with 5,508 in 1910, 6,783 in 1909, 7,840 in 1908, and 8,585 in 1907, the attack-rates being 1.6, 1.1, 1.4, 1.6 and 1.8 per 1,000 population for the five years respectively. The deaths from the disease in the Metropolis numbered 612, as compared with 434 in 1910, 605 in 1909, 724 in 1908 and 787 in 1907, the death-rate for the five years respectively being 0.11, 0.09, 0.12, 0.15 and 0.16 per 1,000 population. ENTERIC OR TYPHOID FEVER. The cases numbered 22 as certified, but two were subsequently not regarded as cases of enteric fever at the hospitals to which they were removed. The numbers of cases certified yearly since 1889 are set out in the following table:— Year. Number of Cases. Year. Number of Cases. 1890 202 1901 96 1891 111 1902 149 1892 91 1903 101 1893 111 1904 48 1894 85 1905 36 1895 99 1906 39 1896 114 1907 34 1897 107 1908 101 1898 91 1909 49 1899 171 1910 49 1900 122 1911 22 The cases certified during 1911 were more than fifty per cent. below the number for the preceding year, and it may be stated that there has not been any year during modern times, or at all events during the last sixty years, when the 23 cases of enteric fever have been so few in Shoreditch. The attack-rate was not quite 0.2 per 1,000 population, as compared with 0.4 in 1910, 0.4 in 1909, 0.8 in 1908, 0.3 in 1907, 03 in 1906, 0.3 in 1905, 0.4 in 1904, and 0.8 in 1903. There was only one death from the disease during the year, the death-rate being 0.00 per 1,000 population, as compared with 0.07 for 1910, 0.05 for 1909, 0.09 for 1908. 0.05 for 1907, 0.03 for 1906, 0.01 for 1905, 0.07 for 1904, 0.11 for 1903, 0.20 for 1902, 0.08 for 1901 and 0.11 for 1900. The rate for 1911 was the lowest so far recorded for enteric fever in Shoreditch. The case-mortality was at the rate of 4.5 per cent. of the cases certified (five, deducting the cases not regarded as having been enteric fever) as compared with 163 for 1910 and 12.2 for 1909. The case-mortality for the eighteen years ending 1910 averaged 14.6 per cent. of the cases certified. The distribution of the cases certified, and deaths amongst males and females in the Borough and the eight wards thereof during 1911, are shown in the subjoined table:— Wards. ENTERIC FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Hoorfields .. 1 1 .. .. .. Church .. 3 3 .. .. .. Hoxton 2 2 4 . . . . .. Wenlock 1 3 4 .. .. .. Whitmore .. 4 4 .. .. .. Kingsland .. .. .. .. .. .. Haggerston 1 4 5 .. .. .. Acton 1 .. 1 1 .. 1 Totals for Borough 5 17 22 1 .. 1 The cases are grouped according to ages in Table II. (Appendix). The whole of the cases of enteric fever certified during the year were removed to hospital. Removal to hospital is a factor of the greatest importance for controlling this disease, especially in a district like Shoreditch. Not only is it in the patient's interest so far as nursing is concerned, but it means the removal of a centre of infection in every case. Unfortunately, owing to the nature of the disease, it is not usually recognised until the patient has been ill for at least a fortnight, and sometimes for a considerably longer period. It is during this period that the patient is most likely to spread infection and endanger the health of the community. 24 Below are set out briefly particulars as to the ages and sex of the patients, dates of invasion and certification, the sanitaryconditions of the dwellings and the probable source of infection. Cases certified but subsequently not regarded as having been enteric fever have been excluded: No. of case. Patients initials. Sex. Age. Address. Probable date of invasion. Date of Certification. Sanitary condition of dwelling. Remarks.—Probable source of infection 1911 1911 1 M.A.K. F. 3 25, Mill Row Jan. 14 Jan. 24 .. This patient had been an inmate of a hospital at Hampstead from 8th Dec., 1910. Was not infected in Shoreditch. 2 E.J. F. 7 75, Provost Street May 6 June 15 Satisfactory 3 A.J. F. 17 30, Taplow Street 21, Granville Buildings Aug. 5 Aug. 29 Unsatisfactory 4 B.H.B. F. 39 Aug. 30 Sept. 6 Satisfactory Fried fish eater, but no shell fish. 5 N.McG. F. 17 17, Boston Street Aug. 25 Sept. 9 Satisfactory Fond of shell fish. Last had shell fish on 7th August. 6 A.F. M. 14 42, Herbert Street Aug. 21 Sept. 14 Satisfactory Was at a holiday camp in the New Forest until 13th August. Probably infected at the camp. 7 L.B. F. 13 43, New North Road Sept. 6 Sept. 15 Satisfactory Cockles and ice cream at Bamsgate between 20th August and 3rd Sept. 8 E.J. F. 9 50, Moye Street .. Sept. 23 Fair Fried fish two or three times a week. 9 J.H. M. 9 43, Buckland Street Sept. 13 Sept. 23 Fair Cockles and ice cream at Bamsgate between 20th August and 3rd Sept. 10 A.C. M. 19 21, Goldsmith Bow Sept. 14 Oct. 2 Unsatisfactory A fried fish eater. Oysters about 2nd September. 11 C.C. F. 23 21, Goldsmith Bow Sept. 25 Oct. 6 Unsatisfactory Probably infected by case 10. Both were in the same family. 12 K.C. F. 37 49, Holms Street.. Sept. 16 Oct. 16 Satisfactory This patient only came to reside in Shoreditch on 3rd October, 1911. Fond of mussels, fried fish. 13 E.A.M. F. 23 Shoreditch Infirmary Oct. 1 Oct. 17 Satisfactory Nurse in the infirmary. 14 F.K. F. 30 91, Rushton Street Oct. 4 Oct. 25 Satisfactory This patient was not infectedin Shoreditch. 15 O.A.B. F. 14 69, Crondall Street Oct. 12 Oct. 23 Satisfactory Fried fish eater. 1(5 L.L.W. F. 7 77, Felton Street.. Oct. 18 Oct. 25 Satisfactory 17 F.B.B. F. 11 69, Crondall Street Nov. 1 Nov. 6 Satisfactory Probably case 15. Members of same family and slept in same bed. 18 E.H. M. 10 44, Crondall Street Oct. 15 Nov. 14 Satisfactory 19 J.W.J. M. 33 50, Brownlow Eoad Oct. 20 Nov. 14 Satisfactory Said to have eaten mussels about 14th October, 1911, which made him ill. 20 E.M. M. 19 4, George Square Dec. 2 Dec. 28 Satisfactory Fried fish eater. 25 From the enquiries made as to the circumstances in connection with the occurrence of the cases in the Borough it was ascertained that fried fish had been eaten by several of the patients, but fried fish being a very common article of diet, this fact, so far as Shoreditch was concerned, did not appear to have any particular value as throwing light upon the source of infection during the year. In several instances also shell fish had been consumed and it is possible that such may have been the vehicle of infection in some cases. In four of the cases the patients did not contract the disease in Shoreditch, and in two others it is highly probable that it was not contracted in the Borough. In two instances, in all probability the cases were secondary to previous cases in the Borough. The cases certified in the Metropolis numbered 1,022, as compared with 1,298 in 1910, 1,049 in 1909, 1,350 in 1908, 1,396 in 1907 and 1,608 in 1906. The attackrate was somewhat above that of Shoreditch, being 0.2 per 1,000 population. The deaths numbered 144, as compared with 196 in 1910, 146 in 1909, and 225 in 1908, the death-rate being 0.03 per 1,000 inhabitants. ERYSIPELAS. The cases certified as erysipelas numbered 159, as compared with 127 in 1910, 143 in 1909, 121 in 1908, 133 in 1907, 144 in 1906, 138 in 1905, 183 in 1904, 147 in 1903 and 172 in 1902. There were 4 deaths from the disease, as compared with 1 in 1910, 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. The cases and deaths amongst males and females in the Borough and its eight wards were distributed as set out below:— Ward. ERYSIPELAS. Cases Ceiitified. Fatai, Cases. Male. Female. Total. Male. Female. Total. Moorfields 4 1 5 1 .. 1 Church 13 14 27 1 .. 1 Hoxton 8 6 14 .. .. .. Wenlock 11 18 29 .. .. .. Whitmore 10 16 26 .. 1 1 Kingsland 6 7 13 1 .. 1 Haggerston 6 15 21 .. .. .. Acton 9 15 24 .. .. .. Totals for Borough 67 92 159 3 1 4 26 The death-rate was 0.03 per 1,000 inhabitants, as compared with 0.00 in 1910, 0.14 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, 0 05 in 1901, and 0.08 in 1900. The deaths were at the rate of 2.5 per cent. of the cases certified, as compared with 0.00 per cent in 1910, 11.2 per cent. in 1909, 4 per cent. in 1908, 4.5 per cent. in 1907, 1.3 per cent. in 1906, 2.1 per cent. in 1905, 2 6 in 1904, 4.7 in 1903, 4.6 in 1902, 4.2 in 1901, and 5.8 in 1900. Pyaemia and Septicaemia (blood-poisoning) were given as the cause of death in 13 instances, 6 of males and 7 of females. Infective endocarditis caused the deaths of 1 male and 3 females. PUERPERAL FEVER. Five cases were certified, with two deaths. The attacks were at the rate of 1.4 per 1,000 births, as compared with 2.2 in 1910, 3.5 in 1909, 1.3 in 1903, 0.8 in 1907, 1.5 in 1906, 2.2 in 1905, 1.3 in 1904, 17 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 0.6 as compared with 0.5 in 1910, 1.0 in 1909, 0.5 in 1908, 0.2 in 1907, 0.8 in 1906, 1.0 in 1905, 0.5 in 1904, 0.2 in 1903, 0.7 in 1902 and 0.2 in 1901. DIARRHŒA. The deaths numbered 162, not including 92 attributed to enteritis. The numbers of deaths from diarrhoea for previous years were 66 in 1910, 79 in 1909, 112 in 1908, 74 in 1907, and 194 in 1906. The mortality was therefore above the average for recent years. The great majority of the deaths occurred during the third quarter of the year. The mortality was especially heavy during the months of August and September, the number of deaths during these months being 128, and there were besides numerous deaths attributed to enteritis. Of infants under one year, there were 108 deaths. Amongst children aged from one to five years, 43 deaths occurred. Of the remainder, one was of a person aged between 35 and 45 years, three of persons aged from 55 to 65 years, and seven of persons over 65 years of age. The death-rate due to diarrhoea was 1.47 per 1,000 population, as compared with 0.58 in 1910, 0.69 in 1909, 0.82 in 1908, 0.64 in 1907, and l.68 in 1906. Taking the deaths from diarrhoea with the deaths from enteritis amongst children under two years, which together numbered 239, the mortality was 2.1 per 1,000. The deaths from diarrhœa amongst infants under one year in Shoreditch during 1911, were at the rate of 30'8 per 1,000 births registered during the year, as compared with 15.0 in 1910, 159 in 1909, 23.3 in 1908, 15.3 in 1907, 40.3 in 1906, and 30.6 in 1905. For the Metropolis the rates were in 1911, 8'0 in 1910, 9.9 in 1909, 14.4 in 1903, 9.2 in 1907, 27.3 in 1906, and 20.7 in 1905. The figures for previous years are given in the Annual Report for 1905. The summer was exceptionally hot and dry. Doubtless this may have had a good deal to do with the markedly increased prevalence of diarrhoea in 1911. In a 27 densely populated working-class district, such as Shoreditch is, where three-fourths of the population reside in tenements of less than five rooms, and a large proportion of these in tenements of only one or two rooms there are consequent conditions which facilitate the spread of the infection of diarrhoea in families and generally predispose to prevalence of the disease. With a view to mitigating the effects of these influences, efforts are made each summer to specially deal with all nuisances and other conditions which may tend to favour excessive mortality amongst children. Leaflets giving advice as to the feeding and management of children and for preventing the exposure of food to contamination are distributed. This is supplemented by personal visits made by the Health Visitor with a view to giving practical advice to mothers of infants who have been born within the twelve months. Special attention is paid to the prevention of accumulations in the vicinity of houses of decomposing animal and vegetable refuse. Courts and alleys are flushed out regularly by a special gang of men. Through the almoners of the hospitals in the neighbourhood of the Borough, information is obtained by the Health Visitor as to the existance of cases of diarrhoea in infants, and this information is taken advantage of to impress upon parents the serious character of diarrhoea amongst young children and the importance of prompt steps as to treatment. The steps taken by the Health Visitor in connection with the summer epidemic of diarrhoea in the Borough are stated in her report (Appendix, p. 87). The enquiries she has made again shew, as has been noted in previous years, that the mortality is much greater in young infants amongst those who are not naturally fed, that is, amongst those who are not fed solely upon the breast. The deaths from diarrhœa and enteritis amongst children under two years numbered 5,313 for the whole of the Metropolis, which give a death-rate of 117 per 1,000 population. MEASLES. The deaths from measles numbered 125, as compared with 80 in 1910 and 127 in 1909. It may be noted, that the cases coming under the treatment of the Poor Law Medical Officers during 1911 were not so numerous as in 1910, moreover, there was also a decrease in the number of cases reported through the school authorities. Deaths from measles occurred throughout the year except during the month of October. They were; however, most numerous in February and March, during which period close upon two-thirds of the total number of deaths for the year took place. All the deaths were amongst children under 10 years of age; under one year 27 died, between one and five 94. and from five to ten, 4; 68 were of males and 57 of females. The death-rate from measles was 1.13 per 1,000 population as compared with 0 70 in 1910, 1.11 in 1909, 0'44 in 1908, 0.99 in 1907, 0.64 in 1906, 0.52 in 1905, 0 69 in 1904, 0.85 in 1903, 0.72 in 1902, and 0.64 inl901. The deathrate was highest in Kingsland and lowest in Moorfields Ward, being 1.82 in the former and 0.39 in the latter. 28 The number of instances in which houses were brought to the notice of the Health Department as having measles therein was 602, as compared with 736 for 1910. Some of the houses were reported more than once. In the great majority of the cases the information as to the houses was received through the school authorities. From the inquiries made in 142 instances the illness did not appear to have been measles. The number of children brought to our notice by the school authorities as suffering from measles was 367. Intimations were received from the Metropolitan Asylums Board as to the removal of 146 cases of measles to the hospitals of the Board, from Shoreditch during the year. The great majority of these would be cases treated by the poor law Medical Officers. It may be mentioned, however, that persons who are not paupers and who are reasonably believed to be suffering from measles may be admitted to the hospitals of the Metropolitan Asylums Board. The conditions associated with their admission are laid down in the Metropolitan Asylums (Measles) Order, 1911. Disinfection in the majority of cases coming under notice was carried out by the officers of the Borough Council; 465 rooms were sprayed, and the usual steps were taken as to bedding and textile articles. Altogether some 455 beds, 347 mattresses, 847 pillows, 458 bolsters and 6,572 other articles were removed for disinfection at the disinfecting station. In 15 instances disinfection was carried out by the occupiers of the dwellings where the cases had occurred to the satisfaction of the medical practitioners in attendance. Since the inclusion of measles amongst the dangerous infectious diseases, it has been the rule in this Borough to deal with it as far as practicable on the same lines as with the other dangerous infectious diseases. The deaths from measles in London numbered 2,570, as compared with 1,980 in 1910 and 2,324 in 1909, the death-rate being 0.57 as compared with 0.40 in 1910 and 0.48 in 1909. WHOOPING COUGH. The deaths from whooping cough numbered 32, 14 of males and 18 of females. Of these, 14 were of infants under one year and, the rest, of children aged from one to five years. Most of the deaths occurred during the months of February, March, April and May. The death-rate was 0.29 per 1,000 as compared with 0.39 in 1910 and 0.64 in 1909. The deaths were considerably below the average for recent years. The death-rate was highest in Acton and lowest in Hoxton Ward. During the year 165 children were brought to our notice by the school authorities as suffering from whooping cough. The deaths from whooping cough in London numbered 1,038, the death-rate being 0.23 per 1,000 inhabitants. INFLUENZA. The deaths attributed to influenza numbered 12, as compared with 16 in 1910, 23 in 1909, 22 in 1908, 23 in 1907, 17 in 1906, 11 in 1905, 14 in 1904, 19 in 1903, 29 14 in 1902, 16 in 1901, 52 in 1900 and 35 in 1899. The figures for previous years are contained in the Annual Report for 1901. The deaths attributed to influenza in the Metropolis numbered 496, as compared with 723 in 1910 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 January, February, March and December, and least during June, July, August and September. TUBERCULOSIS. Tuberculosis (Appendix Table V., Nos. 29 to 34 inclusive) was given as the cause of 266 deaths, as compared with 241 in 1910, 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 below the average for recent years. They amounted to 1T9 per cent. of the total number of deaths from all causes, as compared with 12.6 in 1910, 12.6 in 1909, 15.5 in 1908, 14 in 1907 and 15 in 1906. The death-rate was 2'4 per 1,000 population, as compared with 2T in 1910, 2.4 in 1909, 2.7 in 1908, 2.8 in 1907, 3.0 in 1906, 2.7 in 1905 and 35 in 1904. Comparing the Wards, the rate varied from 3.5 in Whitmore to 1.8 in Haggerston. In my last annual report I commented on the gradual decline which is evident in the mortality from tuberculosis in the Borough when the figures extending over a series of years are compared. Tuberculosis of the lungs, commonly called consumption, caused 183 deaths, as compared with 169 in 1910, 194 in 1909, 224 in 1908, 232 in 1907, and 233 in 1906. As noted in previous years the majority of the deaths were of persons aged between 25 and 55 years. Of males there died 100 as against 83 of females. The death-rate due to consumption was 1.7 per 1,000, as compared with 1.4 in 1910 and 1.7 in 1909. The rate was highest in Whitmore where it was 2.3 per 1,000 and lowest in Wenlock Ward, where it was somewhat less than 1.3 per 1,000. The deaths from tuberculosis in the Metropolis numbered giving a death- rate of per 1,000 inhabitants. Of these, 6,084 were attributed to consumption the death-rate being 1.34 per 1,000, as compared with 1.1 for 1910. In accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1908, during the year, 249 certificates were received as to consumptive inmates of poor law institutions, 155 from the district medical officers as to consumptive patients upon whom they were in attendance as officers of the guardians, and 186 relating to the discharges of consumptives from poor law institutions. Altogether some 590 certificates were received relating to 331 persons suffering from consumption. Of these, 39 were persons who had been previously certified in 1910, so that 292 were certified for the first time in Shoreditch during the year. The 30 numbers certified in 1910 and 1S09 were 241 and 313 respectively. Some 846 persons therefore have been certified as suffering from phthisis or consumption under the regulations above-mentioned during the past three years. Under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, which came into operation on May 1st of the year under consideration, the number of certificates received was, excluding duplicates, 1,100. Of these, 193 were received from the medical officers of health of various sanitary authorities to whom they had been sent in the first place in accordance with the requirements of the regulations. The majority of the certificates came from medical officers at the Royal Hospital for Diseases of the Chest which is situate in the Borough, and from the Victoria Park Hospital, Bethnal Green, but certificates were received from some 30 institutions altogether in London or elsewhere, including most of the great general hospitals of the Metropolis. Of the certificates received, 813 were in respect to patients not resident in Shoreditch. These were forwarded in accordance with the regulations to the medical officers of health of the various sanitary authorities, some 74 in number, in whose districts the patients were resident. Most of these patients lived in Islington, Finsbury, Stepney, Hackney, Bethnal Green, Tottenham, Poplar, West and East Ham, Southwark and Camberwell, but some of them resided far away from London, in Gloucester, Wales and elsewhere. The remaining 287 certificates related to persons suffering from consumption who were resident in Shoreditch. In the subjoined table are shewn the numbers of persons, male and female, certified under both sets of regulations during the year who were resident in various localities of the Borough, the Poor Law institutions being taken as separate localities:— Localities. Males. Females. Tuberculosis Regulalations, 1908. Tuberculosis (Hospital) Regulations, 1911. Total. Tuberculosis Regulations, 1908. Tuberculosis (Hospital) Regulations, 1911. Total. Total. Moorfields Ward 4 19 23 2 3 5 28 Church ,, 29 25 54 7 10 17 71 Hoxton ,, 30 33 63 9 13 22 85 Wenlock ,, 23 27 50 13 9 22 72 Whitmore ,, 34 32 66 22 21 43 109 Kingsland ,, 17 27 44 15 11 26 70 Haggerston ,, 17 23 40 9 11 20 60 Acton „ 11 12 23 9 11 20 43 Shoreditch Workhouse 7 – 7 11 – 11 18 Holborn ,, 40 — 40 22 — 22 62 Totals, Borough 212 198 410 119 89 208 618 31 The certificates were most numerous in proportion to the population in Kingsland and Whitmore Wards, being at the rate of 6.7 and 6.4 per 1,000 inhabitants respectively. They were least numerous in Acton and Church Wards where the rates were 36 and 3 7 per 1,000 respectively. In the subjoined table the age periods at which the cases were certified are given:— Age Period. Years. Males. Females. Total Males and Females. Tuberculosis Regulations, 1908. Tuberculosis (Hospitals) Regulations, 1911. Total. Tuberculosis Regulations, 1908. Tuberculosis (Hospitals) Regulations, 1911. Total. 0-5 4 2 6 4 1 5 11 5-15 7 7 14 7 5 12 26 15-25 25 45 70 21 22 43 113 25-35 41 56 07 26 25 51 148 35-45 45 51 96 23 23 46 142 45-55 52 28 80 21 11 32 112 55-65 24 8 32 14 2 16 48 65- 14 1 15 3 .. 3 18 In the great majority of the cases where the patients were not in public institutions the addresses given on the certificates were visited by the sanitary inspectors and health visitor, and as far as possible steps were taken with a view to preventing the spread of infection, and securing such measures being taken for the disinfection of dwellings and the abatement of nuisances, and the removal of insanitary conditions prejudicial to the health of consumptive persons as appeared necessary. Enquiries were made in connection with 253 cases. In 184 of these the patients were males and in 69 females. With respect to the males their occupations were as follows:—Carmen in 16 instances, printing trade 15, labourers 13, French polishers 7, cabinet makers 6, cigar makers and tobacco trade 3, fancy goods 3, fishmongers 2, school boys 13, building trades 9, glass blowers 4, glass bevellers and cutters 5, hawkers and general dealers 6, packers 3, porters (warehouse) 7, newsvendors 3, boot trade 5, tailors 3, packing case makers 3, stokers 2, metalworkers 4, tea and cocoa trade 2, wood sawyers 2, feather workers 2, window cleaners 2, cooks and kitchen porters 4, and box makers 2. In 18 instances the occupations were those of a revenue teller, blacksmith, errand boy, horsekeeper, clerk, policeman, silk cord spinner, saddle padmaker, railway porter, motor engineer, dustman, fur worker, chaff cutter, farrier's boy, photographer, butcher, wire frame maker and carpet cleaner. In 11 of the cases no occupation was stated. 32 In the cases of the females, 20 of the patients were housewives, 18 school girls, 3 were employed in laundries, 3 in the making of wearing apparel, 2 in box making, 1 was a hospital cleaner, 1 worked in the tobacco trade, 1 was a factory worker, 1 worked at a printers, 1 worked in leather, 1 was a servant in a restaurant, 1 was a domestic servant, and in the cases of 11 no occupation was mentioned. With respect to the sanitary condition of the dwellings occupied by the patients, the chief points to which attention was directed were the amount of cubic space available, the means for securing light and fresh air, the dryness of the premises and their general condition as regards cleanliness. As a result of the inspections made in 145 instances the dwellings were satisfactory or fairly so; in the remaining 98 they were more or less unsatisfactory. In 74 of the cases there were family histories of the disease, that is information was elicited that members of the families to which the patients belonged had suffered or died from consumption either on the fathers' or mothers' side. In 69 of the cases evidence more or less strong was forthcoming, pointing to infection from previous cases either at home or at work. Had the time at the disposal of the officers permitted of their enquiries being pushed, there is no doubt these figures would in all probability have been higher. As it is they are not without significance. Disinfection was carried out by the Sanitary Authority in connection with 104 rooms, and the usual steps were taken as regards textile articles exposed to infection. Instruction was given both verbally and by means of leaflets as to the precautions to be taken to prevent the spread of infection, and there is no doubt that the public realise the dangers associated with the disease to a far greater extent than was the case a few years ago. Efforts were made in suitable cases to obtain sanatorium treatment for those suffering from the disease and otherwise to assist patients so as to place them under better conditions to resist the disease and lessen the risk of infection to others. The health visitor reports that six had sanatorium treatment, of whom four were away at the end of the year, and two had returned, one stated to be cured and one to be incurable. In the cases of three other patients who applied for sanatorium treatment, long periods of inpatient treatment were obtained with a view to sanatorium benefits later if suitable cases on leaving hospital. Three patients had long periods in convalescent homes. Three applications for sanatorium were refused as the cases were too advanced. Three withdrew their applications, and six were under consideration at the end of the year. In 23 cases beds and bedding were supplied to ensure separate sleeping accommodation for consumptive patients These benefits were obtained through the agency of various charitable societies at work in the Metropolis. The Sanitary Authority has so far made no provision for cases in which there are prospects of cures being effected. In the Shoreditch Infirmary there are wards 33 specially assigned to consumptives where as far as circumstances permit the principles underlying sanatorium treatment are carried out. The accommodation here available is very largely used. Most of the cases admitted are, however, in an advanced stage. Over 40 per cent. of the deaths of inhabitants of the Borough from consumption during the year occurred in this institution, and altogether between 50 and 60 per cent. of the deaths of persons belonging to Shoreditch. who died from consumption, took place in public institutions either within or beyond the limits of the Borough. Early in the year the question of the establishment of a Tuberculosis Dispensary on the lines of those existing elsewhere came under the consideration of the Health Committee. In my report on the subject I suggested the establishment of a joint voluntary dispensary for Shoreditch and Finsbury to be worked as a department of, or otherwise closely identified with, the Royal Hospital for Diseases of the Chest in the City Road which is conveniently situated for such purpose. Upon the report of the Health Committee the Borough Council approved of the suggestion and communicated with the Hospital Authorities and the Finsbury Borough Council, On July '24th, there was a meeting in the Board Room of the Chest Hospital at which there were present representatives from the Central Tuberculosis Dispensary Fund, the local branches of the Charity Organisation Society, the Royal Chest Hospital, and others interested in the Health and Social Welfare of the two Boroughs. The meeting was unanimously of opinion that a joint Dispensary should be established in as close association with the hospital as practicable, on a voluntary basis, under the management of a Committee representative of the hospital and the two Boroughs. Subsequently steps were taken to proceed with the establishment of the dispensary, and considerable progress was made. A hitch, however, arose which resulted in the suspension of proceedings for the lime being. The responsibilities of the Sanitary Authority have been markedly increased during the last two or three years in consequence of the Regulations made by the Local Government Board relative to consumption, and every effort has been made by the sanitary staff to cope with the necessary work which has arisen therefrom. During the year under consideration a great deal of useful work has been done in the Borough under the Regulations mentioned, a far larger amount than in any preceeding year, but it is relatively insignificant when compared with what ought to be done in a Borough like Shoreditch, and which will undoubtedly have to be done to give effect to the important provisions contained in the National Insurance Act, 1911, relating to tuberculosis. OPHTHALMIA NEONATORUM. This is an inflammation of the eyes of an infectious nature which attacks infants shortly after birth. If promptly and efficiently dealt with it usually yields to treatment without permanent injury to the eyes. Delay in securing proper treat- c 34 ment, carelessness or neglect may, however, result in more or less lasting damage to the eyes, in some cases involving loss of sight. This disease, which is a common cause of blindness, became notifiable under the Public Health (London) Act, 1891, in the County of London in March. The object of making the disease notifiable is to ensure that cases shall receive proper treatment with as little loss of time as possible. It was very necessary as a large proportion of the births in the Borough are not attended by medical practitioners, and on that account delay in obtaining proper treatment was very likely to occur. The cases certified since the notification became compulsory numbered 32. The notifications were at the rate of 9.1 per 1000 births. This number includes the cases of 2 children aged 8 months and 14 weeks, respectively. In each case the eye trouble appeared only a few days before notification. In the first instance the attack came on whilst the child was suffering from acute bronchitis; in the second there was evidence of infection from the child of a neighbour who was suffering from Ophthalmia. The cases were all enquired into by the health visitor who has dealt with them in her report (Appendix). Excluding the two cases mentioned above, 17 of them were under the care of medical practitioners and 12 occurred in the practice of registered midwives. There was also one other case certified by the Medical Officer of a Hospital, but no information was obtainable about it as the parents were not traced in this Borough. Of the cases in midwives' practices 10 had prompt treatment and made satisfactory recoveries. With regard to the other two, in one the attack at first mild, only affecting one eye, became very severe and the child had to be taken to hospital. It recovered, however, without the sight being injured. In the other case, owing to want of knowledge on the part of the infants relatives valuable time was lost before efficient treatment was provided. They thought it was simply a "cold" in the eyes. When eventually the infant was taken to hospital the sight of one eye was said to be lost and vision in the other seriously impaired. Three other cases came under our notice through the Midwives Inspector of the London County Council. Two were slight and one moderately severe. They all made good recoveries. The cases notified as Ophthalmia Neonatorum in London numbered 690, the rate being 54 per 1,000 births. cerebro-spinal fever. Four cases were certified all of which terminated fatally. Three were in infants under 12 months and the other was in a young man aged between 20 and 25 years. There were ten other deaths certified from meningitis, but, so far as our enquires went, they were not regarded as having been due to cerebro-spinal fever. The cases certified in London numbered 102, and some 9 deaths were attributed to this disease. 35 ACUTE POLIO-MYELITIS. The above disease was made notifiable in London by order of the London CountyCouncil duly approved by the Local Government Board. The order came into operation for six months as from and including 1st September, 1911. This disease is an affection of the nervous system, of an infectious nature, but it is not yet definitely understood how infection is disseminated. An attack may be mild ending in complete recovery. It may be rapidly fatal. In many cases, however, the patients recover, but with permanent injury to the nervous system resulting in more or less paralysis of the muscles. The legs and arms are usually affected, and the disease is the common cause of paralysis in children. It is, however, not confined to childhood, and cases may be met with amongst persons well on in life. Two cases were certified, one in a child a year old, and the other in a woman, the wife of a carman, 31 years old. There were, however, grounds for believing that the latter was not a case of the disease. In the Metropolis some 69 cases were certified. GLANDERS, ANTHRAX, HYDROPHOBIA. No cases of the above diseases in human beings were certified in Shoreditch during the year. In London there were two or three cases of anthrax certified. Three intimations were received from the veterinary inspector of the London County Council as to the presence of glanders amongst horses on three premises in the Borough. The steps as to disinfection are taken under the supervision of the veterinary inspector. The usual enquires were made by the sanitary officers. No evidence was obtained affording any reason for believing that there had been any transmission of infection to human beings. CHOLERA. No intimations under the cholera regulations were received during the year relative to persons arriving in this Borough from localities abroad where cholera was present. INFECTIOUS DISEASES AND SCHOOLS. In the following table are set forth the numbers of children belonging to Shoreditch who were suffering from infectious diseases or were residing in houses in which infectious diseases existed, concerning whom intimations of exclusion from school were received from the head teachers of the schools they attended in accordance with the requirements of the school management code of the London County Council:— c 2 36 School. Enteric Fever. Small Pox. Diphtheria. Scarlet Fever. Measles. Chicken Pox. Whooping Cough. Mumps. Other Causes. Total. Ann Street .. .. .. .. .. .. .. .. 1 1 Bath Street .. .. 5 3 .. .. .. 1 10 19 Bay Street .. .. .. .. .. .. .. 1 1 2 Brunswick St. (special) .. .. .. 1 .. 1 .. .. .. 2 Canal Road .. .. 1 8 27 7 2 3 48 96 Catharine Street .. .. 6 1 24 1 .. .. 10 42 Central Street .. .. . . .. .. 1 .. .. 2 3 Chatham Gardens .. .. 2 .. 45 8 4 14 12 85 Coleman Street Ward .. .. .. .. 5 .. .. .. .. 5 Columbia Road .. .. .. .. 3 .. .. .. .. 3 Curtain Road 1 1 1 2 29 29 3 .. 96 167 Ecclesbourne Road .. .. .. 1 .. .. .. .. .. 1 Enfield Road .. .. .. .. 2 2 .. 1 1 6 Gopsall Street .. .. 13 64 31 19 16 28 138 309 Haggerston Road .. .. 2 4 52 34 16 30 61 199 Hammond Square 2 .. 4 32 67 53 20 28 193 399 Hanover Street .. .. .. .. 1 1 .. .. .. 2 Hilldrop Road .. .. .. 1 .. .. .. .. .. 1 Hoxton House .. .. 6 13 40 .. 1 1 109 179 Jews Free .. .. .. .. .. 1 .. .. .. 1 Laburnum Street .. .. 8 26 21 11 6 5 25 102 Maidstone Street .. .. 21 27 56 15 13 15 143 290 Mansford Street .. .. .. .. .. .. .. .. 1 1 Mowlem Street .. .. .. .. .. .. .. 1 .. 1 Napier Street .. .. 9 24 17 31 12 11 62 166 Oldfield Road .. .. .. 1 .. .. .. .. .. 1 Pritchards Road .. .. .. .. 1 .. .. .. .. 1 Queen's Road .. .. .. 1 .. .. .. .. .. 1 Redvers Street .. .. 15 16 54 .. 11 11 214 327 Rotherfield Street .. .. 2 .. .. .. .. .. 1 3 St. John's National .. .. 2 2 1 1 1 .. 4 11 St. John's Road .. .. 17 25 .. .. 7 .. 19 79 St. Joseph's .. .. .. .. .. .. .. .. .. 4 St. Mark's .. .. .. .. 5 .. .. .. .. 5 St. Monica's .. .. 2 7 4 2 .. 1 5 21 St. Paul's .. .. 1 5 32 .. 6 .. 6 58 St. Peter's .. .. .. 1 1 .. .. .. .. 2 St. Phillip's .. .. .. .. .. 2 .. .. .. 2 Scawfell Street .. .. 3 9 95 15 20 14 40 196 Scrutton Street .. .. 1 9 9 6 1 11 12 49 Shap Street .. .. 13 14 89 8 2 .. 55 185 Shepperton Road .. .. .. 2 .. 2 2 .. 4 10 South Grove (special) .. .. 1 .. .. .. .. .. 1 2 Trinity Place .. .. 14 2 23 31 24 .. 23 126 Virginia Road .. .. .. .. 2 1 .. .. .. 3 Wenlock Road .. .. 5 8 45 6 10 11 39 124 Totals 4 2 154 309 785 314 177 211 1336 3292 37 The number of children excluded during 1911 was practically the same as for 1910, being 3,292, as compared with 3,293. The exclusions on account of measles were 328 less than in 1910, while the exclusions under the head of other causes, such as ophthalmia, ringworm, eczema, etc., were 1,336, as compared with 791 in 1910. During the first six months of the year a number of intimations were received from the Medical Officer (Education) relative to the exclusion of children from the classes in the infants departments on account of measles. The following were the schools concerned:—Shap Street, Catherine Street, Trinity Place, Redvers Street (classrooms D in February, and E and C in March), Chatham Gardens (classroom D on two occasions in February and July), Scawfell Street, Maidstone Street, Canal Road (classroom A in April and B in May), Wenlock Road, Laburnum Street and Hoxton House. The children excluded were those under five years stated not to have had measles. The fatality of measles is greatest amongst children under five years. If, therefore, the exclusion of the children referred to helps to postpone the age of attack it is a reasonable step to take and may help to lessen the heavy mortality from the disease. The disadvantage of closing classrooms or departments is that numbers of children who have had measles and therefore not likely to be attacked again are prevented from attending school. The weak point in connection with exclusion is the difficulty in being sure that children stated to have had measles have really had the disease. BACTERIOLOGICAL EXAMINATIONS. During the year 52 examinations were made by Dr. Bulloch at the London Hospital Medical School in cases of suspected infectious disease. In 36 the examinations were for sore throats suspected of being diphtheria; in 8 of these the results were positive as to the presence of the diphtheria bacillus, and in 28 negative. In 6 instances Widal's tests were made in cases suspected to be enteric fever; positive results were obtained in two. Ten examinations of sputum from persons suspected to have consumption were made, with positive results in three. DISINFECTION. During 1911 disinfection was carried out by the Sanitary Authority at 1,147 premises, as compared with 1,131 in 1910, 1,103 in 1909, 1,208 in 1908, and 1,688 in 1907. The articles removed and disinfected at the Borough Disinfecting Station numbered 25,295, as compared with 24,788 in 1910, 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 during the year included 1,214 beds, 1,211 mattresses, 2,391 pillows, 895 bolsters and 19,584 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. Included are 118 beds, 138 mattresses, 190 pillows, 66 bolsters and 774 other articles disinfected on 38 account of vermin. It was necessary to destroy 2 beds and 9½ palliasses which were so torn and contaminated as to render it inadvisable to return them. These were replaced with new. No complaints were received in respect to the measures taken. THE SHELTER. The Shelter was in use on four occasions during the year: by a family of three persons on account of vermin on February 4th, whilst dwelling and clothing were being disinfected; on March 2nd by two persons for one night, on March 9th by two persons for one day, and on March 12th by one person for a night, all three occasions on account of disinfection for small pox. THE PUBLIC MORTUARY. The bodies of 379 persons who died during the year were received into the public mortuary, as compared with 382 in 1910, 392 in 1909, 367 in 1908, 349 in 1907, 405 in 1906, 417 in 1905, and 460 in 1904. In one instance only was the body of a person dead of infectious disease removed to the mortuary by the Sanitary Authority. The number of infectious bodies so removed has averaged three annually during the eight years ending 1911. Special arrangements are made for the reception of such bodies. The inquests numbered 303, as compared with 322 in 1910, 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 226, as compared with 214 in 1910, 241 in 1909, 208 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 21.165 inches. Taking the mean fall for 35 years there was a deficiency of approximately 4 6 inches. Most rain fell during the last quarter of the year, the rainfall for that period amounting to 9.892 inches. The wettest month was December when 5.0 inches were recorded. Least rain fell in July, when only 0.422 of an inch was measured. The general rainfall in the Thames Valley above Teddington amounted to 26.02 inches, and in the Lee Valley 24.13 inches (Dr. Mills' 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 80 premises, as compared with 82 in 1910, 83 in 1909, 65 in 1908, and 113 in 1907. Of these 48 were in the New River District and 33 in the 39 East London. The grounds for cutting off the water were as follows : on account of defective water pipes in 23 instances, premises being demolished in 20, waste on empty premises 20, waste on occupied premises 8, by request of consumer 3, and because water was not required in two instances. There were no complaints received as to the quality of the water supplied in the Borough and there was no reason for suspecting the occurrence of any illness due to the water. In accordance with the requirements of Section 78 of the London County Council (General Powers) Act, 1907, additional water taps were provided at 78 dwelling houses occupied by members of more than one family. In most instances a water supply was provided on one of the floors above the ground. In a few on more than one floor. Sinks were provided as well, but there is no statutory authority for insisting on these. In several instances which are referred to later (page 41) it was necessary to take legal proceedings before the provision of the additions to the water supplies were secured. SANITARY WORK. Preliminary notices as to insanitary conditions were served in respect to 3,178 premises. Of these 412 were dealt with under the supervision of Inspector Firth, 674 under Inspector Jordan, 404 Inspector Langstone, 557 Inspector Pearson, 563 Inspector Stokes, and 568 under the supervision of Inspector Wright. Inspector Wright commenced his duties on February 23rd. Inspector Jordan was absent for a month during November and December owing to illness. In connection with the work arising out of the services of the notices, some 791 letters were sent to owners of property, builders and others concerned. Some 31,735 visits of inspection were made by the sanitary inspectors during the year. The premises under inspection included dwelling houses, artisans dwellings of which a special inspection was made, houses let in lodgings, outworker's premises, factories, workshops, laundries and bakehouses under the Factory and Workshop's Acts, cowsheds and milk vendors' 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 the Borough, which has been compiled from the abstracts of their work prepared by the sanitary inspectors:— 40 Insp. Firth. Insp. Jordan. Insp. Langstone. Insp. Pearson. Insp. Stokes. Insp. Wright. Total. New drains constructed 4 3 1 4 73 19 104 Drains re-constructed or repaired 71 19 48 33 144 29 344 Sink waste pipes trapped and disconnected 57 47 14 20 70 22 230 Stack pipes re-instated 84 18 44 87 106 99 438 Eaves gutters re-instated 96 16 34 74 112 55 387 Stack pipes disconnected from drains 31 22 9 8 171 1 242 Accumulations of sewage dealt with 3 37 26 26 77 3 172 Cesspools abolished 2 .. .. 3 .. .. 5 New water closets constructed 4 38 8 4 320 1 375 Old water closets re-constructed or repaired 76 74 53 52 126 39 420 Water closets cleansed and white-washed 26 193 37 171 240 170 838 Water closet flushing apparatus repaired 39 93 74 77 24 106 413 Obstructions in water closets removed 25 49 15 37 88 40 254 Overcrowding in houses abated 32 1 33 9 51 22 148 Damp courses in houses provided 10 .. 2 12 .. 1 25 Walls pointed 34 6 2 15 10 40 107 Roofs repaired 69 27 83 109 103 111 502 Stairs repaired 40 11 6 22 51 67 197 Floors repaired 19 31 22 49 67 91 279 Ventilation under floors provided 3 .. 6 17 5 .. 31 Doors repaired 17 20 14 11 55 104 221 Door cills provided 21 6 .. 13 5 .. 45 Sashes repaired 10 3 15 12 49 98 187 Houses cleansed throughout 22 97 15 46 64 70 314 Houses cleansed in part 165 53 169 222 34 14 657 Total number of rooms cleansed 428 719 565 720 620 952 4004 Yards or areas lime-washed 15 111 41 95 107 196 565 Yards paved 93 26 21 75 89 41 345 Areas and forecourts paved 4 4 4 .. 11 1 24 New areas constructed .. .. .. 1 10 .. 11 Sculleries paved 6 1 1 9 4 .. 21 Dust receptacles provided 83 35 66 80 36 58 358 Dung receptacles provided 2 1 1 3 1 2 10 Insanitary cisterns removed 3 .. .. .. 2 .. 5 In addition to the above 4 old brick drains were abolished, and in 93 instances nuisances and annoyance due to rats on premises were dealt with. In 146 instances water supplies were restored to premises, and in 141 leaky water pipes were repaired. In 6 instances urinals were constructed or reconstructed, and in 33 instances they were cleansed and repaired. Foul accumulations causing or likely to cause nuisances were dealt with on 63 premises. Nuisances in connection with the stabling of animals were dealt with in 23 cases, and in 4, stables were paved or repaved under the supervision of the sanitary officers. The foregoing summary includes the work carried out under the Factory and Workshops' Act, 1901, and also that done in connection with drains and sanitary arrangements of new buildings. 41 The great bulk of the sanitary work carried out in the Borough was done to comply with the requirements of intimation notices. Statutory notices, under the Public Health (London) Act, 1891, were served, by order of the Sanitary Authority, upon parties responsible for the abatement of nuisances in 396 instances. For non compliance with statutory notices proceedings were taken as set out below:— Premises. Result of Proceedings. Aske Street, No. 27 Order made to do work in 14 days—10/6 costs ,, ,, No. 28 ,, ,, ,, ,, ,, ,, No. 29 ,, ,, ,, ,, ,, „ No. 30 ,, ,, ,, ,, ,, „ No. 30 Order made to do work in 3 days—10/6 costs. ,, „ No. 39 Summons withdrawn, 10/6 costs paid by defendant. Bernales Buildings, No. 1 Summons withdrawn, 2/- costs paid by defendant. Crondall Street, No. 26 Order made to do work in 7 days—£1 1s. costs ,, ,, No. 22 Owner fined £1 with £2 2s. costs allowed. ,, „ No. 28 ,, £1 ,, £1 1s. ,, ,, ,, No 30 ,, £1 ,, £1 1s. ,, Fanshaw Street, No. 55 Order made to do work in 14 days—10/6 costs ,, ,, No. 57 ,, ,, ,, ,, ,, ,, No. 59 ,, ,, ,, ,, ,, ,, No. 61 ,, ,, ,, ,, ,, ,, No. 63 ,, ,, ,, ,, Lee Street, No. 34 Summons withdrawn, 10/6 costs paid by defendant. Loanda Street, No. 5 Order made to do work forthwith—10/6 costs allowed. Newton Street, No. 25 Work done—defendant to pay 10/6 costs. St. John's Road, No. 153 ,, ,, ,, ,, Westmoreland Place, No. 37 Order made to do work in 7 days—10/6 costs allowed. ,, ,, No. 37 ,, ,, ,, ,, Wilmer Gardens, No. 87 Summons withdrawn on defendant paying 10/6 costs. ,, ,, No. 87 Defendant ordered to pay 10/6 costs. Pearson Street, No. 7 Order made to prevent recurrence of nuisance. In the cases of Nos. 27, 28, 29 and 30, Aske Street; 22, 26, 28 and 30, Crondall Street, and 55, 57, 59, 61, and 63, Fanshaw Street, proceedings were taken against the respective owners by Inspector Stokes for noncompliance with statutory notices under Section 48 of the Public Health (London) Act, 1891, as amended by Section 78 of the London County Council (General Powers) Act, 1907, for failing to supply means for obtaining water on one of the floors above the ground floor, the houses being tenement houses. The second summons in respect to No. 30, Aske Street, was for failure to render the roof watertight. The summons in respect to No. 1, Bernales Buildings was taken by Inspector Jordan against the owner, there being no water for the house. It was withdrawn, as when the summons came on for hearing the water had been restored. 42 The summons in respect to No. 34, Lee Street, was taken against the owner by Inspector Pearson for non-compliance with a statutory notice, requiring'the remedying of certain defects in the yard paving and the provision of a dust receptacle. When the summons came on for hearing, the notice had been complied with. With regard to No. 5, Loanda Street, it was necessary to obtain a magistrate's order before the owner would do what was required to make the roof watertight. In the case of No. 25, Newton Street, this was a tenement house with a workshop in the rear. The water-closet accommodation was insufficient, in view of the number of persons resident in the house, there being only one closet for the house and workshop. A statutory notice was served on the owner in May, and he thereupon reduced the number of residents in the house in order to comply with the notice. This meant that half the house was unoccupied. It remained unoccupied until November, when the owner again re-let it. A summons was taken by Inspector Langstone, but by the time it came on for hearing the work of constructing an additional closet was in progress. The case was adjourned, and the summons was subsequently withdrawn, the necessary sanitary accommodation having been provided. With regard to 153, St. John's Road, the roof was defective and the premises generally dilapidated. A summons was taken against the owner by Inspector Langstone for not complying with a statutory notice requiring the abatement of the nuisance. It was withdrawn, as the notice had been complied with when the case came before the magistrate. The proceedings in the case of No. 87, Wilmer Gardens were taken by Inspector Pearson for non-compliance with the requirements of a statutory notice relative to the provision of a dust receptacle, the premises also being in such a state as to constitute a nuisance. There were two summonses. In the first instance the dust receptacle having been provided, the summons was withdrawn ; in the second, the magistrate adjourned the case for the defendant to comply with the notice. When the case again came before the magistrate, the necessary work had been carried out, and the defendant was not fined, but ordered to pay the costs, as stated. The proceedings in respect of No. 7, Pearson Street, were the result of repeated complaints as to the emission of black smoke from the chimney of the bakehouse on the premises. Every effort was made by the sanitary officers to induce the proprietor of the bakehouse to take the necessary precautions to prevent the occurrence of the nuisance, but without effect. In the end, proceedings had to be taken. In two instances proceedings were instituted against persons for breaking the law relating to unsound food. Brief particulars as to these cases are given later in the report (page 56). 43 SMOKE NUISANCES. Complaints as to nuisances through the emission of black smoke from shafts belonging to factories or workshops were dealt with in twenty-eight instances. Twenty-eight communications were received from the London County Council respecting twelve premises: In thirteen they related to the same premises—No. 7, Pearson Street. In all cases the necessary steps were taken to obtain the abatement of the nuisances, and fourteen intimation notices were served. In one case a statutory notice was required, which was followed by the Police Court proceedings, already referred to. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 275, as compared with 197 in 1910, 99 in 1909, 127 in 1908, 111 in 1907, and 103 in 1906. The rooms dealt with numbered 518, as compared with 386 in 1910, and 157 in 1909. The usual steps were taken to strip the walls, stop and cleanse them where required, and fumigate with sulphur or spraying with Lysol when deemed necessary. Bedding and textile articles are removed and disinfected by the officers of the Borough Council in cases where it is expedient that they should be so dealt with. The numbers of articles disinfected for vermin during the year have already been stated (page 37). In the cases of 97 rooms, in 83 of the houses above referred to, the steps taken resulted through information from the School Authorities. During the year the homes of 729 children, viz., 422 boys and 307 girls were notified by the School Authorities, the children being verminous, with a view to the Sanitary Authority taking steps under the London County Council (General Powers) Act, 1904, Part IV., to deal with the homes, the children themselves having been cleansed at the County Council's Cleansing Station. In a number of instances the same children were notified more than once, in some instances three or four times. In a number of cases several children belonging to the same family were notified at the same time. The following are the results of the inspections made In 509 the rooms were clean, or fairly so; in 102 they were dirty; in 82 they were buggy, and in 36 they were both dirty and infested with bugs. In 482 the bedding was clean, or fairly so; in 160 it was dirty; in 32 bugs were present; in 16 it was dirty and buggy, and in 47 instances the bedding showed evidence of lice, i.e., the lice themselves, or the nits were found. Where lice were observed the bedding was, in most cases, dirty, and otherwise verminous. In six instances clothing worn by the children showed evidence of lice. In twelve instances mothers attributed the alleged presence of lice to the fact that the clothing of the children had been bought 44 second-hand. In 175 instances the homes were markedly infested with fleas. In 18 instances overcrowding was observed, and in 32 instances the sanitary inspectors remarked on the evidences of extreme poverty which were noticeable. In addition to the above there were numerous cases in which the notifications from the school authorities referred to addresses which were erroneous. Thus in 43 instances children were not known at the addresses given, in 18 the addresses were empty houses, in 13 the children had left and their addresses were unknown, and in 11 the addresses given did not exist in Shoreditch. It is also to be mentioned that in numerous instances there was more or less difficulty in obtaining admission for inspecting. In some cases as many as six or seven visits had to be made before an inspection was possible, owing apparently to the members of the families being out whenever the inspector called. In one instance admission was refused and it was necessary to give an intimation that application would have to be made to a magistrate for an order before an inspection could be made. Doubtless, in some instances, the inspectors were kept out of the houses until the homes had been cleansed and in several cases there was evidence of recent cleansing, probably in preparation for the inspector's visit. In a number of cases a good deal of indignation and in some cases great distress were manifested by parents on becoming aware of the object of the inspector's visits. This need not be viewed seriously in cases where the homes are dirty and the visits of the inspectors thereby justified, but it is another matter where the homes are clean, and one to which the school authorities should give their careful attention when notifying homes as verminous. In many cases the inspectors reported that the children were undergoing treatment for head lice. Vermin in the head may very easily be spread amongst children whilst at school notwithstanding the fact that the children are dwelling in homes which are clean. Doubtless a great many of the children were notified because of verminous heads, and this is probably the explanation of the large proportion of the homes reported clean or fairly so. It is to be noted that at the homes of 729 children reported as verminous, in the cases of 53, or about seven per cent. only, there was evidence of lice in the clothing or bedding. houses closed. The following houses were closed upon the service of sanitary notices, either on account of being unfit for habitation or in order to enable the works necessary to put them 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:— Aske Street, No. 39. Bernales Buildings, Nos. 4 and 5. Dereham Place, Nos. 4, 5, 6, 8, 9, 10, 11 & 12 Dunstan Road, No. 6. Dunstan Street, No. 22. Ely Place, No. 2. Hoxton Street, No. 119. Ware Street, No. 2. Weymouth Terrace, No. 118. 45 No. 39, Aske Street, an eight-roomed house with scullery, was in a dilapidated state, and the roof was very leaky. A statutory notice was served upon the owner under the Public Health (London) Act, 1891, but nothing was done. A summons was taken out upon which the owner closed the house, and it remained empty at the end of the year. Nos. 4 and 5, Bernales Buildings were closed by the owner on receipt of statutory notices, the houses, each consisting of five rooms, being without water supply. The water was subsequently restored and the houses re-let. The houses in Dereham Place, each consisting of six rooms and scullery, were in a dirty and dilapidated state. They were closed by the owner on receipt of statutory notices from inspector Jordan, and remained closed at the end of the year. The houses in Dunstan Road and Dunstan Street, the former consisting of six rooms, and the latter of four with scullery, were generally dirty and dilapidated, and were closed on receipt of sanitary notices from inspector Pearson. They were subsequently dealt with and re-occupied. No. 2, Ely Place, a two-roomed house, was generally dirty and dilapidated. It was closed by the owner on receipt of a statutory notice under the Public Health (London) Act, 1891, and was afterwards dealt with and again occupied. With regard to No. 119, Hoxton Street, the drains were in a defective and dangerous condition. The house was closed by the owner and remained closed at the end of the year. No. 2, Ware Street, a six-roomed house with back addition, was in a dirty and dilapidated state, and the roof was defective. The house was closed by the owner on receipt of a statutory notice under the Public Health (London) Act, 1891, and remained closed at the end of the year. The house in Weymouth Terrace, consisting of six rooms, was generally dirty and dilapidated, and was closed by the owner on receipt of a sanitary notice from inspector Pearson. It was subsequently dealt with throughout and again occupied. HOUSING AND TOWN PLANNING ACT, 1909. The following is a brief account of the work done under Section 17 (1) of the above Act, which makes it the duty of the Borough Council to cause to be made, from time to time, inspection to ascertain whether any dwelling-house within the Borough is in such an insanitary state as to be unfit for human habitation Nos. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12, Wiltshire Row.—These houses were ordered to be inspected by the Health Committee in September, 1910, and were 46 duly inspected, and intimations were sent to the owner by Inspector Langstone as to the sanitary defects found. These were: general dilapidations, want of cleansing, defective roofs (which were more or less leaky), defective eaves guttering and rainwater pipes, causing dampness of walls, and in several instances defective drains. The houses were practically worn out, and their condition was reported to the Health Committee on October 20th, 1910. Nothing of a satisfactory character was attempted by the owner for dealing with the houses. The Health Committee inspected them on December 15th, and again on February 3rd, 1911, and the owner was interviewed with a view to inducing him to take effective action to render the houses habitable, but with negative result. A formal representation by the Medical Officer of Health, under Section 17 of the Act, was made on March 2nd, and closing orders followed. The orders were served on April 4th, and the houses were closed on April 10th. They subsequently came into the hands of the ground landlord, and were demolished. Nos. 61, 63, 65, 67, 69, 71, 73, 75, 77, 79, 81 and 83, Wilmer Gardens.—These houses were generally dirty and dilapidated; in some the water-closets were defective, and also the yard paving; dampness and other sanitary defects were also observed. The Health Committee ordered that an inspection should be made. This was done on November 15th, 1910, by Inspector Pearson, and the owner was informed of the condition of the houses. Steps were at once taken to deal with the houses, and when the Health Committee visited them on December 15th the work required was in satisfactory progress. It was completed early during the current year, and the condition of the houses was much improved. There was then no further need for action under the Act. Nos. 37, 39, 51, 61 and 62, Westmoreland Place.—The Health Committee ordered these houses to be inspected under the Act, on June 15th, and they were inspected the following day by inspector Wright. The insanitary conditions found were general dilapidations, want of cleanliness and defective sanitary arrangements. Intimation notices were sent to the owner, and the conditions existing were reported to the Health Committee on July 6th. In the case of No. 61, the intimation notice was complied with. In the case of No. 62, the house was closed. Nos. 37, 39 and 51, the Committee decided to deal with under the Public Health (London) Act, 1891, and statutory notices were served accordingly. In the case of No. 37, a summons had to be taken, and an order was obtained on the owner to do the necessary work in seven days, which was complied with. In the case of No. 39, the statutory notice was complied with, and in the case of No. 51 the house was closed on October 27th. No. 191, City Road.—This house was ordered by the Health Committee to be inspected under the Act, on June 15th, and was inspected by Inspector Wright the following day. The house was dilapidated, dirty and damp. The condition of the house was reported to the Health Committee, and an intimation of the defects found was sent to the owner. Nothing was done. The Health Committee visited on October 47 5th, and then resolved to proceed under the Public Health (London) Act, 1891. A statutory notice was served, which resulted in the house being closed on November 29th. Nos. 1, 3, 5 and 7, Loanda Street.—These houses were inspected under the Act^ on June 26th. The insanitary conditions existing were defective roofs, guttering and yard paving, dampness, dirty walls and ceilings and general dilapidations. Their condition was reported to the Health Committee on July 5th, and the defects found were brought to the notice of the owner by inspector Pearson. Nos. 5 and 7 were closed to carry out the work, and in all cases the intimation notices served by the Inspector were complied with. Nos. 33, 34 and 35, Dunstan Road.—These houses were ordered to be inspected under the Act, and were duly inspected on June 26th. The conditions found to exist were defective drains and sanitary arrangements, damp walls, defective yard paving, defective roofs and general dilapidations. The houses were moreover dirty and verminous. Their condition was brought to the notice of the owner, and reported to the Health Committee. The owner at once proceeded to render the houses fit for habitation. They were closed and thoroughly dealt with throughout. In accordance with the provisions of Article V. of the regulations prescribed by the Local Government Board under the Act, the subjoined information and particulars are given with respect to the action taken during the year 1911 (1) The number of houses inspected under Section 17 13 (2) The number of houses considered unfit for habitation 4 (3) Representations made to the Local Authority with a view to Closing Orders11 (4) Number of Closing Orders made11 (5) The number of dwelling-houses, the defects of which were remedied without Closing Orders 22 (6) The number of dwelling-houses which, after the making of Closing Orders, were put in a fit state for habitation — (7) The general character of the defects found to exist were: ness, defective roofs, general dilapidations, want of cleanliness, defective drains, water-closets, eaves guttering and rain-water pipes, defective yard paving and want of proper dust receptacles. Since the Act came into operation some forty houses have been inspected under it, with the following results:—13 have been represented as unfit for habitation, and closed; 22 have been dealt with, and improved; of these five were closed in order to get the necessary work carried out, as this was practically impossible whilst the houses were in occupation; five others have been closed without representations, 48 and of these two have been demolished. Altogether of the 40 houses inspected, 23 have been closed, and of those closed, 15 have been demolished and their sites cleared. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. The following houses came under my notice during the year as being closed for demolition :— Nos. 11, 12, 13 and 14, New North Place.—Each of these houses consisted of four rooms, with scullery and was occupied by one family. They were closed and demolished in connection with the extension of the Scrutton Street School premises. Nos. 21 to 61, Maria Street.—21 houses, each consisting of four rooms, with scullery. They were demolished in connection with the laying-out of the Ironmongers' Almshouses' Open Space. ARTISANS' DWELLINGS. During the year the artisans' dwellings in the Borough were under inspection, and taking them as a whole, their condition may be described as satisfactory so far as the general principals governing the sanitation of dwellings are concerned. Numerous defects, mostly of a minor character, however, necessitated the service of some 295 sanitary notices (A 256, B 39), which were duly attended to. As in previous years, for the purposes of comparison, the dwellings have been divided into two classes: A, which includes those occupied by persons who appear to be in comfortable or fairly comfortable circumstances; and B, occupied by persons who appear to be in very poor circumstances. The dwellings included in class B remain as in previous years. The figures relating to class A have been altered in consequence of the inclusion of the dwellings built by the Sutton Trust, which came into occupation towards the end of the year. Special attention was given to ascertaining the numbers of tenements and rooms, and verifying the numbers of persons dwelling therein. The results for the year 1911 are as set forth in the subjoined table :— Number of blocks. Number of tenements. Number of rooms. Number of persons. Class A 42 1836 4421 5961 Class B 15 379 919 1743 Total for the whole 57 2215 5340 7704 49 It may be noted that 142 tenements belonging to class A and 35 to class B were found to be unoccupied at the time the dwellings were visited. Taking the figures as stated above the number of rooms per tenement is the same in both classes namely 2.4, but the number of persons per room averages a little over 1.3 for class A, as compared with nearly 1.8 for class B. This may be taken as a very fair indication that the conditions associated with residence in the class B dwellings arc not so favourable from a health point of view as in the case of the class A dwellings. The births registered during the year, and the birth-rates in the dwellings a 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. Bate per 1,000 Inhabitants. Number. Bate per 1,000 Inhabitants. Number. Bate per 1,000 Inhabitants. 205 25-3 114 24.1 61 35 The number of births was 16 less than in 1910. The proportion of deaths attributed to prematurity was at the rate of 24-4 per 1,000 births, as compared with 13.5 in 1910, 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 20.8 per 1,000 births, whilst in class B they were 32.8. For the whole Borough the deaths from prematurity amounted to 22.6 per 1,000 births. The infantile mortality for the whole of the dwellings was 131 per 1,000 births, as compared with 95 in 1910, 113 in 1909, 103 in 1908, 124 in 1907, 97 in 1906, and 140 in 1905. For the class A dwellings it was 125, as compared with 65 in 1910, 101 in 1909, 75 in 1908, 99 in 1907, 84 in 1906, and 134 in 1905. For class B the mortality was 147, as compared with 192 in 1910, 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. Bate per 1,000 inhabitants. Number of Deaths. Hate per 1,000 inhabitants. N umber of deaths. Bate per 1,000 inhabitants Bate per 1,000 inhabitants. All causes 131 17.0 99 16.6 32 18.3 20.2 Principal Zymotic diseases 24 3.1 17 2.8 7 4.0 3.2 All forms of Tuberculosis 19 2.4 17 2.8 2 1.1 2.4 Phthisis 17 2.2 15 2.5 2 1.1 1.7 Bronchitis 11 1.4 8 1.3 3 1.7 1.9 Pneumonia 13 1.7 7 1.2 6 3.4 2.3 D 50 The deaths of residents of the dwellings in public institutions numbered 56, being 39 for the class A and 17 for the class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 42.7, being 39.3 for class A and 53.1 for class B. The percentages for the Borough and for the wards are contained in Table VI. (Appendix) The cases of notifiable infectious disease numbered 52, of which 40 were in the class A dwellings and 12 in the class B. The attack-rates per 1,000 population were 6.7 for the whole of the dwellings, 6.7 for class A, and 6.9 for class B, as compared with 5.3 or the whole Borough. The cases included 2 of small pox, 19 of scarlet fever, 2 of enteric fever, 20 of diphtheria, and 9 of erysipelas. The numbers of cases and the attack-rates per 1,000 inhabitants are set out below :— Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Cases. Rate. Cases. Rate. Cases. Rate. Cases Rate. Cases. Rate. Class A. 2 0.3 16 2.7 15 2.5 1 0.1 6 1.0 Class B. — — 3 1.7 5 2.8 1 0.5 3 1.7 The whole of the dwellings 2 0.2 19 2.4 20 2.6 2 0.2 9 1.1 For the whole Borough the attack-rates were as follows:—0.02 for small pox, 2.1 for scarlet fever, 1.5 for diphtheria, 0.2 for enteric fever, and 1.4 for erysipelas. HOUSES LET IN LODGINGS. Three houses let in lodgings or occupied by members of more than one family were placed on the register during the year, namely—Nos. 14 Baches Street, 19 and 121 St. Johns Road. The number on the register at the end of the year was 266. Sanitary notices were served in connection with 102, and 'statutory notices in 67, instances During the year some 426 visits of inspection were made. CUSTOMS AND INLAND REVENUE ACTS. Applications for certificates under the above Acts as to the sanitary fitness of dwellings for the purpose of obtaining exemption from payment of inhabited house duty were received in respect to 62 dwellings. In the cases of 28, certificates were given. 51 SLAUGHTER-HOUSES. The licensed slaughter-houses in the Borough at the end of the year numbered 6, as compared with 6 in 1910, 7 in 1909, 7 in 1908, 8 in 1907, 9 in 1906, and 12 in 1905. They were inspected from time to time during the year, and their general sanitary condition may be reported as satisfactory. COWHOUSES. The number of licensed cowhouses at the end of 1911 was 7, remaining the same as during the preceeding seven years. They afford accommodation for about 100 cows. The number of cows kept in the Borough was found at an inspection made in October to be 41, as compared with 39 in 1910, 44 in 1909, 52 in 1908, 57 in 1907, 74 in 1906, 86 in 1905, 95 in 1904, and 101 in 1903. Generally the sanitary condition of the cowhouses was found to be satisfactory. The number of dairymen and milk purveyors on the register at the end of the year was 292, as compared with 292 in 1910, 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 15 and commenced at 15 premises, and in 32 instances there were changes in the names of the persons registered as milk vendors. The premises where milk is sold were under observation throughout the year, and some 2,876 visits were made in connection with them. In seventeen instances sanitary notices were served. In seven instances there was want of proper attention to cleanliness at the premises, in six there were nuisances in connection with the drains and sanitary arrangements, in a few cases proper dust receptacles were required, in one case there was a nuisance in connection with a grain pit, and in one or two other cases there were some minor matters which required attention. The necessary steps were taken to comply with the notices in all cases. OFFENSIVE BUSINESSES. The tripe-boiling establishment in Haggerston Road was under inspection during the year. There were no complaints in connection with it. With reference to the premises at No. 9, Canal Road where dripping was being made by rendering down fat on a somewhat large scale, which was mentioned in my report for last year, after a good deal of correspondence the proprietor transferred the business elsewhere. The premises were not suitable for the business, and although it cannot be said that there was any nuisance to complain of, there is no doubt that fat melting was carried on in contravention of the by-laws. d 2 52 FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1911 was 1,136, 189 having been placed on and 226 taken off during the year. The number for previous years were: 1,173 in 1910, 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 2,720 visits of inspection were made in connection with workshops, and 298 to factories. Fifteen communications were received from the Factory Inspector relative to the establishment of 148 new workshops in the Borough. On inspection 108 were found to be in a satisfactory sanitary condition, 9 were not in occupation at the time they were visited, at one no work was being carried on, one was being cleansed at the time of visit, and in one the occupier could not be traced. The remainder were all more or less unsatisfactory from a sanitary point of view, and some 28 notices were served. From the Factory Inspector 29 written intimations were received relating to insanitary conditions and infringements of the law as to public health in connection with 52 workshops and 25 factories. The chief insanitary conditions to which the Factory Inspector directed attention were: dirty conditions of walls and ceilings in 20 instances, defective and insufficient water closet accommodation in 38, want of proper separate accommodation for the sexes in 6, absence of sanitary accommodation in 2, overcrowding in 5, no drinking water in one, want of proper ventilation in one, a defective soil pipe, gas heaters insufficiently ventilated, an insanitary urinal and a leaky gas pipe. Including those brought under our notice by the Factory Inspector, 242 workshops were dealt with and 227 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 1911 :— New drains constructed 6 Water-closets' flushing apparatus Drains relaid or repaired 34 repaired 62 Stack pipes disconnected 22 Water supply laid on or restored 12 Stack pipes reinstated 22 Leaking water-pipes repaired 1 Eaves gutters reinstated 21 Rooms cleansed and whitewashed 234 Sink waste pipes disconnected 20 Yards ,, ,, 41 Yards paved 23 Areas „ ,, 9 Water-closets reconstructed50 Roofs repaired 39 New water-closets constructed 15 Floors „ 22 53 Water-closets cleansed and limeStairs 11 washed 132 Doors „ 14 Obstructions removed from Sashes ,, 12 watcr-closets 36 Dust receptacles provided 10 Urinals repaired and cleaned 8 Foul accumulations removed 11 Ventillation improved 6 It may also be added that in 22 instances nuisances owing to flooding with sewage had to be dealt with, and in 7 cases overcrowding. In 20 instances statutory notices were served under the Public Health (London) Act, 1891, by order of the Health Committee, but the necessity for police court proceedings did not arise. The number of factories under observation during the year was 31, and in connection with them some 25 sanitary notices were served. The works carried out to comply with these notices included the construction, reconstruction or repair of drains in 6 instances, the disconnection of stackpipes in 2, of sink waste pipes in 4, the repair of water-closets in 7, of the flushing apparatus in 14, the removal of obstructions from water-closets in 8, the construction of new water-closets in 2 instances, besides a number of other items connected with cleansing and repairing. Limewashing of factories in accordance with the requirements of the Factory and Workshop Act is a matter with which the Factory Inspectors deal. Defects in connection with the sanitary arrangements in factories come within the province of the Sanitary Authority. During the year 104 lists of out-workers were received from employers in the Borough, 52 in the first and 52 in the second half-year. Those for the first half-year are due in February for the second in August. These lists contained the names of 1,570 out-workers, of whom 1,069 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the sanitary authorities of the districts to which they belonged. Communications were received from various sanitary authorities relating to some 2,755 out-workers, and of these 279 were residents in other Boroughs and their addresses were duly forwarded to the authorities concerned. A table is given in the appendix showing the numbers of addresses of outworkers received from the sanitary authorities referred to during 1911. The number of out-workers brought to our notice during 1911 was 4,325, as compared with 4,785 in 1910, 4,781 in 1909, 4,185 in 1908, 4,578 in 1907, and 2,975 in 1906. Of the number for 1911, some 2,977 were residents in Shoreditch, as compared with 3,333 in 1910, 3,401 in 1909, 2,985 in 1908, 3,431 in 1907, and 2,259 in 1906. As pointed out in previous reports it should be noted that in numerous instances names and addresses of out-workers are duplicated owing to lists being sent in twice a year, and in some cases the same out-workers are employed by more than one firm, so that the numbers given above must not be taken as representing the actual 54 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 2,735 visits of inspection were made to places where homework was being carried on, and sanitary notices were served in 107 instances. The work carried out to comply with these notices included the disconnection of sink waste pipes in 5 instances, the reinstatement of stack pipes in 15, of eaves gutters in 16; various works in connection with the water-closet accommodation in 23, with the water supply in 8; the cleansing of 198 rooms, 27 yards, 4 areas, and 27 water-closets; the repair of roofs in 25, floors in 9, stairs in 4, and sashes in 8 instances; the provision of 22 dust receptacles besides other work. There was one instance in which overcrowding was found, and in fifteen cases the rooms required to be dealt with on account of vermin. No cases of notifiable infectious disease occurred at out-workers premises during the year. There were no prosecutions in respect to out-workers premises. In connection with the lists of out-workers it was necessary to write to employers in 31 instances on account of delay in sending in the lists relating to out-workers employed in making wearing apparel, in 29 relating to paper bags and boxes, in 2 relating to artificial flower making, and in 1 instance to an employer in the fur trade for a similar delay. There was no necessity for further action as the lists were all forthcoming on the letters being sent. BAKEHOUSES. The number of bakehouses on the register at the end of the year was 76, remaining, the same as in the preceeding year. Of these 32 are above and 44 below ground. Six of them, namely, those situate at 88, Bridport Place; 82, East Road; 16, St, Johns Road; 189, High Street; 249, Old Street, and 30, Pitfield Street, were found when visited, not to be used as bakehouses. At five of the bakehouses mechanical power is used so as to constitute the bakehouses factories within the meaning of the Factory and Workshop Acts. Generally, the sanitary condition of the bakehouses may be stated to be satisfactory. In 25 lime-wasliing and cleansing were more or less required, and in five some minor defects in connection with the sanitary arrangements needed attention. Sanitary notices were served and duly complied with in all cases, and it was not necessary to bring any of the bakehouses specially under the notice of the sanitary authority. ICE CREAM SHOPS. The following is a summary of the work in connection with ice cream shops during 1911: Inspector Firth had 10 under observation; in one instance the shop 55 and yard was lime washed. Inspector Jordan had 16 under observation ; in three instances sanitary notices were necessary, in one case the yard paving was defective and in two the walls and ceilings of the basements, passages and shops required cleansing, and were lime-washed, and in two instances some minor sanitary matters required attention. Inspector Langstone had 21, in connection with which three sanitary notices were served. Inspector Pearson had 14, in connection with which 6 notices were served for cleansing and one for defective yard paving. Inspector Stokes had 18 under observation, and Inspector Wright 16, but no sanitary notices were required. Altogether 87 premises whereon ice cream was made or sold were under the inspection of the sanitary officers during the year. In 73 of them the general sanitary condition was satisfactory. In 14 instances sanitary notices were served, mostly for cleansing. COOKSHOPS, COFFEE-SHOPS AND EATING HOUSES. Inspector Firth had 12 under inspection, in five of which notices were required for cleansing and lime washing. Inspector Jordan had 85 under observation, as well as the kitchens of 16 public-houses, at which dinners are provided. In 30 instances sanitary notices were served. In 3 instances flushing cisterns were defective, in 2 the drains were re-laid; in 5 dust-bins were provided; in 2 the waterclosets were removed to positions where proper light and ventilation were secured; in 5 sinks were properly trapped; in 2 the kitchen floors were concreted, and in 1 the yard paving was repaired. In 5 of the premises the roofs were repaired, and 5 basements, 4 dining-rooms and staircases, and in 1 case the whole house were cleansed and white-washed where required. Inspector Langstone had 13 under observation, and one sanitary notice was served. Inspector Pearson had 13, and the kitchen of 1 public-house. Six sanitary notices were served: 1 for an obstructed water-closet; 2 for obstructed drains; 1 for defective rain-water pipe causing dampness and 2 for general cleansing of the premises. Inspector Stokes had 44 under inspection, in connection with which 3 sanitary notices were served. Inspector Wright had 18 under inspection, in connection with which 6 sanitary notices were required, chiefly for cleansing; in 3 instances waste pipes from sinks needed attention, and in 1 case the roof had to be repaired. Altogether 202 cookshops, coffee-shops, eating-houses and kitchens of publichouses were under observation during the year, as compared with 198 in 1910, 204 in 1909, 197 in 1908, 188 in 1907, 178 in 1906, and 182 in 1905. In 51 instances sanitary notices were served. FRIED FISH SHOPS. On Inspector Firth's district 7 were under inspection, and four sanitary notices were required, chiefly for cleansing and repairs. On Inspector Jordan's district 56 10 were under observation, and four sanitary notices were served, in two instances for defective yard paving, and in two for cleansing. Inspector Langstone had 8 under observation, and no sanitary notices were required. Inspector Pearson had 13, and three sanitary notices were required for cleansing. On Inspector Stokes's district 15 were under inspection, and two sanitary notices were required: the work done, including the reconstruction of drains, the paving of the yards and general cleansing, also the provision of proper arrangements for offal, and in one case the repairing of the roof. Inspector Wright had 9 under observation in connection with which one notice was served for cleansing. Altogether 62 fried fish shops were under observation during the year, and some 14 sanitary notices were required in connection with them, mainly for cleansing and lime-washing. STREET MARKETS AND FOOD. The usual supervision was exercised by the sanitary officers with respect to food exposed for sale in the Borough, and frequent inspections were made for the detection of unsound and unwholesome food. A sanitary inspector was on duty every evening throughout the year in accordance with the instructions of the Borough Council. The following were surrendered or seized and destroyed as unfit for the food of man :— Plaice, 18 stone; mackerel, 25; kippers, 3 boxes; eels, 1 cwt. 8 lbs.; whelks, 5 bags, and mussels 2 bags; heads, hearts, livers and lights, 1 cwt.; beef, 1 cwt. 34 lbs.; pigs' heads, 39 stone; sheeps' plucks, 37; chicken, 2 qrs. 10 lbs.; rabbits, 2 cases, and fowls 2; tomatoes, 49 boxes; onions, 3 bags and 69 lbs.; loose greens, 8 tons 14¾ cwts.; lettuces, 40 bushels; sauerkraut, 3¾ cwts.; oranges, 278; grapes, 2 cwts. 3 stone; pears, 10 boxes and 36 lbs.; walnuts, 70 lbs.; bananas, 1 case; pomegranates, 29 cases ; pears and pomegranates, 1 cwt., and apples, 14 boxes. The proprietor of a butcher's business which was situate at No. 133a, Hoxton Street, was fined £5, with 2s. costs, for being in possession of 10 pieces of brisket of beef found in pickle on the premises by Inspector Stokes. The beef was tainted and unfit for the food of man, and was seized and carried before a Magistrate. A man named John Potts was bound over at the Newington Sessions for exposing for sale rotten oranges, which were seized by Inspector Stokes, and ordered to be destroyed by the Magistrate. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 577 samples were submitted to him for analysis during the year. This number is at the rate of a little over 5 per 1,000 inhabitants. 57 The results of the year's work are summarised in the following table: — Quarter of the year 1911. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. N umber of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of successful Prosecutions. Fines and Costs. Amount paid to Analyst for samples analysed £ s. d. £ s. d. 1st. 139 37 26.6% 12 — 11 11 21 2 6 69 10 0 2nd. 152 43 28.3% 16 — 15 12 52 2 0 76 0 0 3rd. 140 32 22.82% 13 — 13 13 30 18 0 70 0 0 4 th. 146 37 25.3% 23 — 23 22 75 18 0 63 7 6 Total for Year 577 149 25.8% 64 - 62 58 180 0 6 278 17 6 The samples taken included 388 of milk, 127 of butter, 18 ice cream, 11 coffee, 5 margarine, 4 glycerine, 3 camphorated oil, 3 lard, 3 pepper, 2 separated milk, 7 sausage and 1 each of malt vinegar, cocoa, chocolate powder, brawn, dripping and cheese. Of the samples of milk, 133 or 34.2 per cent, were found to be below the standard fixed by the Board of Agriculture, as compared with 25.5 in 1910, 16.8 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. The samples returned as adulterated during 1911, therefore, were considerably above the average. It is, however, to be mentioned that 19 of the samples were only below standard to a very slight extent, and the Public Analyst noted them a being possibly genuine. If these be deducted the percentage of adulteration is reduced to 29.3. In the subjoined table are shown the numbers of samples of milk taken during the four quarters of the year, with the numbers and percentages of those found not to be genuine:— Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st. 100 33 33 2nd. 112 41 36.6 3rd. 92 28 30.4 4th. 84 31 36.9 58 In 64 of the samples water was certified to have been added; in 20 the amount was more and in 44 it was less than 5 per cent., taking the standard of the Board of Agriculture. In 3 the samples showed deficiencies in milk fat; in 23 the deficiency was more, and in 11 it was less than 5 per cent. In 16 instances both fat had been abstracted and water added. Four of the samples contained traces of artificial colouring matter, but none showed the presence of boric acid. Legal proceedings were instituted in 46 or 34.5 per cent. of the cases in which the samples of milk were below standard, and in 40 of these convictions were obtained. In four instances the summones were dismissed, warranties being proved, and in two cases the defendants absconded and could not be traced. With regard to the remainder of the samples below standard the small percentages of adulteration rendered it so very unlikely that convictions could be obtained, that prosecutions were not considered advisable. In seven instances letters of caution were sent to the vendors. The percentage of the adulterated samples in which it was not thought advisable to prosecute was 65, as compared with 69 in 1910, 80 in 1909, 66 in 1908, 65 in 1907, 66 in 1906, 60 in 1905, and 55 in 1904. In the cases in which convictions were obtained the penalties for milk adulteration amounted to £63, which is equivalent to about 6.6 per cent. of the full amount of the penalties to which the defendants were liable as compared with 4.4 per cent. in 1910, 28 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 fines and costs, which in the aggregate amounted to £96 l1s. 6d., the average amount paid by the defendants on conviction was £2 8s. 3d., as compared with £1 l1s. 6d. in 1910, £12 6s. 4d. in 1909, £3 1s. 4d. in 1908, £1 13s. 7d. in 1907, £2 9s. 6d. in 1906, £2 19s. 3d. in 1905, £2 6s. l0d. in 1904, £1 18s. 6d. in 1903, and £2 18s. 4d. in 1902. The marked excess of the figures for the year 1909 was due to two defendants being very heavily fined. Of the samples of butter taken 10 or 7.9 per cent. were not genuine, as compared with 6.9 per cent. in 1910, 9.5 in 1909, 12.2in 1908, 6.3in 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. 30 2 6.6 2nd. 20 2 10 3rd. 30 2 6.6 4th. 47 4 8.5 59 Of the samples sold as butter which were not genuine, 5 were samples of margarine, 2 contained foreign fats in large amounts and were probably mixtures of butter and margarine, 2 contained water in excess of the 16 per cent, standard, and one sample was reported by the analyst as being possibly genuine though somewhat abnormal. Prosecutions were instituted in 8 instances and in all of them the defendants were convicted. In one case the sample was taken inadvertently just beyond the limits of the Borough and no proceedings could therefore be taken. No proceedings were deemed advisable in the case of the abnormal sample above mentioned. The penalties inflicted amounted to £55 2s. or approximately 23 per cent. of the maximum penalties to which the defendants were liable, as compared with 7.9 in 1910, 9.4 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 £9 12s. 6d., the amounts the defendants were ordered to pay averaged £8 1s. 10d., as compared with £4 18s. in 1910, £4 0s. 9d. in 1909, £4 6s. in 1908, £4 6s. 7d. in 1907, £5 3s. in 1906, £7 Is. in 1905, £3 1s. in 1904, £4 10s. in 1903, and £4 10s. in 1902. The average was therefore the highest recorded since 1901. Five samples of margarine were taken, the samples being sold in wrappers which did not bear the word "Margarine" legibly stamped upon them as required by the Margarine Act. Proceedings were taken and convictions obtained in all the cases. The fines amounted to £6, and £3 0s. 6d. costs were allowed the Council. The fines under the Margarine Act amounted to 3 per cent. of the maximum penalties to which the defendants were liable. Including the costs, the amounts paid averaged £1 16s. 1d. as compared with 15s. in 1910, £1 12s. 6d. in 1909, and £1 4s. 6d. in 1908. Of eleven samples purchased as coffee, 4 were found to be mixtures of coffee and chicory. In all 4 instances proceedings were taken and convictions obtained, the fines in the aggregate amounting to £3 10s. and the costs to £4 1s. One of the samples of sausages contained 0.56 per cent. or 39.2 grains per pound of boric acid as an added preservative. This amount being excessive, proceedings were taken and the defendant was fined £1, with £1 3s. costs allowed the Council. One of the samples of separated milk contained 2 per cent. of added water and a trace of artificial colouring matter. The samples of ice cream were all reported by the analyst as genuine, none of the constituents being of a harmful character. The samples of glycerine and camphorated oil were found to be of the standard of the British Pharmacopoea, and the samples of lard, pepper, malt vinegar, cocoa, chocolate powder, brawn, dripping, and cheese were all reported as genuine. 60 The subjoined table shows a comparison of the results of the work under thi 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 samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties. Prosecutions proceeded with. Number of successful prosecutions. Fines and Costs. Amount paid to Public Analyst. £ s. d. £ s. d. 1902 281 420 71 253 54 2 52 48 117 9 0 140 10 0 1903 707 166 112 15.8 60 5 55 51 173 1 1 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 9,33 18 0 267 0 0 1906 520 224 122 23.1 44 2 42 34 106 1? 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 IS 6 276 5 0 1910 578 200 133 23.0 65 .. 60 49 93 17 6 279 5 0 1911 577 200 149 25.8 64 .. 62 58 180 0 6 278 17 6 The percentage of samples found adulterated, it will be noticed, was the highest since 1901. With reference to the convictions under the Sale of Food and Drugs Acts during 1911, in four instances the defendants had been once previously convicted and in two instances they had each been previously convicted four times. There were two instances in which rather heavy penalties were inflicted. In one case £15, with £1 15s. 6d. costs, and in the other £20, with 2 guineas costs. In each of these cases the offence was selling margarine as butter, and both the defendants had been previously convicted on several occasions. SANITARY STAFF. 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 past year the work of the department has been markedly increased largely owing to the Orders made by the Local Government Board as to pulmonary tuberculosis. Some provision is necessary with a view to coping with this increase, and the matter is now engaging the attention of the Health Committee. As already mentioned, Mr. C. J. Wright was appointed Sanitary Inspector by the Borough Council and took over the district of the late Mr. W. Lear in February of the year under consideration. With reference to the clerical work, some 16,520 communications, written and printed, were sent out from the Health Department during the year as compared with 13,639 in 1910. These included 3,841 notices and summonses, 2,533 letters and cards mainly on matters under the Public Health and Sale of Food and Drugs Acts, 61 2,8G0 communications in connection with cases of pulmonary tuberculosis which account for the increase in the figures as compared with those for 1910, 714 as to work under the Factory and Workshop Acts, 5,788 communications of various kinds in respect to infectious disease and disinfection, and 784 agendas and reports relating to the work of the department. In conclusion, I beg to express my hearty appreciation of the kind consideration and assistance which have been rendered 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 Officcr oj Health. APPENDIX TO THE EEPOET 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 1911, and also A Report of tiie Health Visitor on iier Work for the Year. Tables I., II., III. and IV. are forms required by the Local Government Board 64 TABLE I. Vital Statistics of the Borough of Shoreditch during 1911 and previous Years. Year. I'opulatior estimated to middle of each Y ear. Births,. Total Deaths Registered ix the District. Transferable Deaths. Nett Deaths belonging to the Distriot. Under 1 Year of Age. At all Ages. of Nonresidents registered in the District. of residents not registered in the District. Uncorrected Number. Nett. Number Rate. Number. Rate per 1,000 net Births. Number. Rate. Number Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 116506 3802 3870 33.6 2158 18.5 360 491 651 168 2289 19.8 1907 116073 3636 3720 32.4 2195 18.9 362 532 569 153 2365 20.6 1908 115642 3553 3678 32.2 1883 16.2 375 498 510 138 2006 17.5 1909 115285 3560 3692 32.4 2039 17.8 353 503 512 138 2189 19.2 1910 114935 3485 3595 31.6 1795 15.6 335 453 528 147 1913 16.8 1911 111285 3398 3497 31.8 2015 18.1 344 556 598 171 2227 20.2 Note.—The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn Union Workhouse has been deducted in calculating the rates. In column 6 are included the whole of the deaths registered during the year as having actually occurred within the Borough. In column 12 is entered the number in column 6 corrected by subtraction of the number in column 8 and by the addition of the number in column 9. Deaths in column 10 have been similarly corrected by subtraction of the deaths under 1 included in the number given in column 8 and by addition of the deaths under 1 included in the number given in column 9. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. Area of Borough in acres (exclusive of area covered by water) 642.5 Total population at all ages, 111,463 Number of inhabited houses, Average number of persons per house At Census of 1911. 65 TABLE II. Cases of infectious disease notified during the Year 1911 in the Borough of Shoreditch. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Total Cases Removed to Hospital. At all Ages. At Aees—Years. 1. u. 3. 4. 5. 6. 7. 8. Under 1. 1 to 5 5 to 15 15to25 25to45 45to65 35 and upwards. Moorfields. Church Hoxton Wenlock. Whitmore. Kingsland. Haggerston Acton. Small-pox 3 .. .. .. 2 1 .. .. 3 .. .. .. .. .. .. .. 3 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 171 8 84 60 13 6 .. .. 10 38 30 22 21 12 22 16 163 Erysipelas 159 5 9 14 16 52 50 13 5 9,7 14 28 25 14 23 23 23 Scarlet fever 234 9 79 133 13 .. .. .. 8 9,9 ?,4 35 66 33 19 20 930 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 22 1 10 6 5 .. .. .. 1 3 4 4 4 .. 5 1 92 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 5 .. .. .. 2 3 .. .. .. 1 1 1 .. .. .. 2 2 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis Under Tuberculosis egulations, 1908 331 1 7 14 46 135 111 17 6 36 39 98* 74† 32 16 20 .. Under Tuberculosis Regulations, 1911 287 .. 3 12 67 155 49 1 22 35 46 36 53 38 34 23 .. Others .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever 4 3 .. .. 1 .. .. .. .. 2 .. 1 1 .. .. .. 3 Acute polio-myelitis 2 .. 1 .. .. 1 .. .. .. 1 1 .. .. .. .. .. .. Ophthalmia neonatorum 32 32 .. .. .. .. .. .. .. 5 5 6 8 3 2 3 .. Totals 1250 59 193 239 165 353 210 31 55 177 164 231 252 132 131 108 446 * This number includes the cases of consumption notified in the Holborn Union Workhouse, t This includes the case of consumption in the Shoreditch Workhouse. E 66 TABLE III. Causes of, and ages at death during the Year 1911 in the Borough of Shoreditch. Causes of Death. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the District (a). Total Deaths whether of " Residents " or " Nonresidents " in Institutions in the District (b). All Ages. Under 1. 1 and under 2. 2 and vinder 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11. All causes Certified (c) 2227 598 244 155 75 69 273 428 385 939 Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. .. 1 .. Small Pox .. .. .. .. .. .. .. .. .. .. Measles 125 27 50 44 4 .. .. .. .. 12 Scarlet Fever 7 1 4 2 .. .. .. .. .. Whooping-cough 32 14 12 6 .. .. .. .. .. 4 Diphtheria and Croup (See note (d) ) 23 2 9 9 3 .. .. .. .. .. Influenza 12 2 .. .. 1 .. .. 7 2 .. Erysipelas 4 .. .. .. .. .. 2 1 1 4 Cerebro-spinal Fever 4 3 .. .. .. 1 .. .. .. .. Phthisis (Pulmonary Tuberculosis) 183 3 1 5 5 25 86 55 3 98 Tuberculosis Meningitis (See note (e) ) 87 10 8 10 8 1 .. .. .. 7 Other Tuberculous diseases 46 13 6 12 3 2 6 3 1 14 Rheumatic Fever 4 .. .. .. 1 1 1 1 .. .. Cancer, malignant disease (See note (/)) 90 .. .. .. .. 1 9 47 33 49 Bronchitis 210 44 9 3 .. 2 18 65 69 135 Broncho-pneumonia 119 39 40 20 4 1 2 7 6 25 Pneumonia (all other forms) 140 19 16 6 7 4 30 36 22 67 Other diseases of Respiratory organs 15 3 3 .. 1 .. 4 3 1 7 Diarrhœa and Enteritis (See note (g)) 254 165 59 15 2 .. 1 3 9 72 Appendicitis and Typhlitis 6 .. .. .. 2 1 2 1 .. .. Alcoholism (See note (h) ) 15 .. .. .. .. .. 5 9 1 9 Cirrhosis of Liver 23 .. .. .. .. .. 8 14 1 12 Nephritis and Bright's Disease 53 .. 1 1 .. 2 7 25 17 40 Puerperal Fever (See note(i)) 2 .. .. .. .. 1 1 .. .. 1 Other accidents and diseases of Pregnancy and Parturition 4 .. .. .. .. .. 4 .. .. 1 Congenital Debility and malformation, including premature birth (See note (j)) 177 171 6 .. .. .. .. .. .. 38 Violent deaths, excluding suicide 100 31 6 7 15 4 9 13 15 21 Suicides 8 .. .. .. .. .. 1 .. .. 2 Other defined diseases 532 50 14 15 19 23 76 131 204 319 Diseases ill-defined or unknown 1 1 .. .. .. .. .. .. .. 1 2227 598 244 155 75 69 273 428 385 939 67 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH during the year 1911. Nett deaths from stated causes at various ages under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 1 2-3 Weeks. 3-4 Weeks Total under 1 Month. 1-3 Months 3-6 Months 6-9 Months 9-12 Months Total Deaths under 1 Year. All causes Certified 94 21 17 22 154 98 152 104 90 598 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 2 10 15 27 Scarlet fever .. .. .. .. .. .. .. .. 1 1 Diphtheria and Croup .. .. .. .. .. .. .. 1 1 2 Whooping-cough .. .. .. .. .. 2 4 5 3 14 Diarrhœa .. .. 1 2 3 14 43 28 20 108 Enteritis.. .. 1 1 .. 2 11 l8 14 12 57 Tuberculous Meningitis .. .. .. .. .. 1 1 4 4 10 Abdominal Tuberculosis (b). .. .. .. 1 1 2 3 2 .. 8 Other Tuberculous Diseases .. .. .. .. .. .. 3 2 3 8 Congenital Malformations (e) 1 1 2 2 12 .. 3 .. .. 15 Premature birth 64 4 6 4 78 1 .. .. .. 79 Atrophy, Debility and Marasmus 11 9 3 4 27 17 25 7 1 77 Atelectasis 5 .. .. .. 5 .. .. .. .. 5 Injurry at birth .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Syphilis .. 1 .. 1 2 6 1 .. .. 9 Rickets .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. 1 2 2 1 6 Convulsions 2 1 1 1 6 3 5 2 .. 16 Gastritis .. .. .. .. .. 1 .. 1 .. 2 Laryngitis .. .. .. .. .. 1 .. .. .. 1 Bronchitis .. 3 1 2 6 9 14 5 10 44 Pneumonia (all forms) .. .. .. 1 1 15 17 11 14 58 Suffocation, overlying 4 .. .. 2 6 8 5 1 2 22 Other causes 1 .. 2 2 5 6 6 9 3 29 94 21 17 22 154 98 152 104 90 598 Nett Births in the year—Legitimate 3,404, illegitimate 93. Nett Deaths in the year of legitimate infants 578, illegitimate infants 20. e 2 68 NOTES TO TABLE III. (а) All " Transferable Deaths " of residents, i.e., of persons resident in the District who have died outside it, have been included with the other deaths in columns 2.10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who have died in the District, have been excluded from these columns. For the precise meaning of the term "transferable deaths" see footnote to Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, have been entered in the last column of Table III. (c) All deaths certified by registered Medical Practitioners and all Inquest cases have been classed as "Certified" ; all other deaths would be regarded as "Uncertified." (d) This heading includes all deaths from croup except those certified as due to "spasmodic," "stridulous," ''catarrhal," or " false " croup. (e) Under "Tuberculous Meningitis" have been included deaths from Acute Hydrocephalus. (f) Under "Cancer" have been included deaths under such headings as Carcinoma, Scirrhus, Epithelioma, Rodent ulcer, Sarcoma, Cancer, and Malignant Disease. 69 (g) Under this heading have been included deaths registered as due to Epidemic Diarrhoea, Epidemic Enteritis, Infective Enteritis, Zymotic Enteritis, Summer Diarrhoea, Choleraic Diarrhoea, Cholera (other than Asiatic), Gastro-Enteritis, Gastro-Intestinal Catarrh, Muco-Enteritis, Colitis, &c. Deaths from Diarrhoea secondary to some other well-defined disease have been included under the latter. (h) Under this heading have been included deaths from Delirium Tremens, acute and chronic alcoholism, &c., but not those certified as due to organic disease attributed to alcoholism. (i) Under " Puerperal Fever " have been included deaths under such headings as Pyaemia, Septicaemia, Sapraemia, Pelvic Peritonitis, Peri- and Endo-Metritis occurring in the Puerperium. (j) Under this heading have been included also deaths from Atrophy and Marasmus of Infants, and want of Breast-Milk, but not from Atelectasis. NOTES TO TABLE IV. (b) Under Abdominal Tuberculosis have been included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (c) Want of Breast-Milk has been included under Atrophy and Debility. (d) For references to the meaning of any other headings, see notes to Table III. 70 71 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH. AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1911. Notk. 1 he 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 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. Wenloek. Whitmore. Kings'nnd. Haggfrston. Acton. Male. Female. Total. 1 Small Pox Vaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvaccinated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. No statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 27 94 4 .. .. .. .. .. .. .. .. .. .. 2 31 18 10 22 19 16 7 68 57 1 25 3 Scarlet fever 1 6 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 3 1 1 5 2 7 4 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Epidemic influenza 2 .. 1 .. .. .. .. .. 4 3 .. 2 .. 1 2 3 2 3 1 .. 6 6 12 6 Wliooping cough 14 18 .. .. .. .. .. .. .. .. .. .. .. 1 5 2. 4 7 2 4 7 14 18 32 7 Diphtheria, membranous croup 2 17 3 .. .. .. .. .. .. .. .. .. .. 2 3 6 4 1 2 9, 2 19, 10 22 8 Enteric fever .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 9 Asiatic cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Diarrhœa, dysentery 80 34 .. .. .. .. .. 1 .. 3 7 .. .. 4 26 18 2 6 22 11 8 10 66 59 125 11 Epidemic or zymotic enteritis 28 9 .. .. .. .. .. .. .. .. .. .. .. .. 8 5 8 5 3 4 4 17 20 37 12 Other allied diseases 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 13 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Glanders, farcy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15 Tetanus .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 16 Anthrax, splenic fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 17 Cow-pox, accidents of vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 18 Syphilis 9 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 2 2 4 1 1 .. 7 4 11 19 Gonorrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 20 Phagedœna, hospital gangrene .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 21 Erysipelas .. .. .. .. .. .. 1 1 1 .. 1 .. .. 1 1 .. .. 1 1 .. .. 3 1 4 22 Puerperal fever .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 2 2 23 Pyemia, septicemia 2 4 2 1 .. .. 1 2 1 .. .. .. .. .. 3 1 3 2 .. 3 1 6 7 13 24 Infective endocarditis .. .. .. 1 1 .. 1 1 .. .. .. .. .. .. 1 1 .. .. 1 1 .. 1 3 4 25 Other allied diseases .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. .. 1 .. .. .. .. .. 2 2 26 Malarial fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 27 Rheumatic fever .. .. .. 1 .. 1 1 .. 1 .. .. .. .. .. 1 2 1 .. .. .. .. 3 1 4 28 Rheumatism of the heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis: 29 Brain or meninges, acute hydrocephalus 10 18 7 1 1 .. .. .. .. .. .. .. .. 2 11 4 2 7 4 2 5 19 18 37 30 Larynx .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 31 Lungs 3 6 .. 5 13 12 46 40 38 17 2 1 .. 7 37 22 9! 3 40 19 18 17 100 83 183 32 Intestines, tabes mesenterica 8 4 .. .. .. .. 1 .. .. .. .. .. .. .. 2 .. 2 ..5 .. 1 3 8 5 13 33 General, position undefined 4 10 1 1 2 .. 1 2 .. .. .. .. .. 1 2 7 2 3 2 2 1 14 7 21 34 Other forms, scrofula 1 4 1 .. .. .. .. 2 .. 2 1 .. .. 1 3 1 .. 5 1 .. .. 7 4 11 35 Other Infective diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 36 Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 37 Actinonycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 38 Hydatid diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 39 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 40 Other diseases due to altered food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 Acute alcoholism, delirium tremens .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. 2 2 42 Chronic alcoholism .. .. .. .. .. .. .. 4 3 5 1 .. .. .. 4 1 3 4 1 .. .. 10 3 13 43 Chronic industrial poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 44 Other chronic poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 45 Osteo-arthritis, rheumatoid arthritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 46 Gout .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. 47 Cancer .. .. .. .. .. .. 1 7 16 26 23 6 .. 2 13 19 11 11 3 9 11 43 36 79 48 Diabetes mellitus .. .. .. .. .. .. 1 2 3 1 .. .. .. .. 2 1 2 .. .. .. 2 5 2 7 49 Purpura hemorrhagica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 50 Hemophilia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 51 Anemia, leucocythemia .. .. .. .. .. .. 2 .. 1 1 .. .. .. 1 .. 1 1 .. .. .. 1 3 1 4 72 73 CAUSSS OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 66 to 65. 66 to 75. 76 to 86. 85 and upwards. Moorfields. Church. Iloxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total.[/#] 52 Lymphadenoma, Hodgkin's .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. 1 •• 1 •• .. .. 2 .. 2 53 Premature birth 79 . . .. .. .. .. .. .. .. .. .. .. .. 13 19 13 17 4 6 7 47 32 79 54 Injury at birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 55 Debility at birth 15 .. .. .. .. .. .. .. .. .. .. .. .. .. 2 2 3 4 1 3 .. 7 8 .. 56 Atelectasis 5 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 2 2 .. 1 4 15 57 Congenital defects 15 2 .. .. .. .. .. .. .. .. .. .. .. 1 2 3 5 1 1 2 .3 8 9 5 58 Want of breast milk 1 .. .. .. .. .. .. .. .. .. .. .. .. 13 10 8 10 4 40 1 17 59 Atrophy, debility, marasmus 61 4 .. .. .. .. .. .. .. .. .. .. .. 14 1 5 .. 1 6 25 65 60 Dentition 6 3 .. .. .. .. .. .. .. .. .. .. .. 2 1 2 1 1 3 3 9 61 Rickets .. 5 .. .. .. .. .. .. .. .. .. .. .. .. 16 28 12 12 14 69 2 5 62 Old Age, senile decay .. .. .. .. .. .. .. .. 1 36 55 29 8 .. .. .. .. 2 0 10 52 121 63 Convulsions 16 1 .. .. .. .. .. .. .. .. .. .. 1 1 \ C .. 3 5 2 3 6 7 17 10 64 Meningitis 3 1 3 .. 1 .. .. 1 .. 1 .. .. .. 2 .. .. 1 .. 1 .. 4 65 Encephalitis .. .. .. .. .. .. .. .. .. 18 3 .. 2 .. .. 11 .. 6 .. 32 27 59 66 Apoplexy .. .. .. .. .. 1 4 .. 12 .. .. .. .. 9 .. 1 7 .. 9 2 1 3 67 Softening of brain .. .. .. .. • • .. .. .. 2 4 1 .. 1 .. .. 1 .. .. .. 2 4 6 68 Hamiplegia,brain paralysis .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 .. 3 .. .. 2 .. 3 9 69 General Paralysis of insane .. .. .. .. .. .. .. 4 .. 1 .. .. .. 2 .. 3 2 .. .. 6 3 5 70 Other forms of insanity .. .. .. .. .. .. .. 2 1 1 1 .. .. .. .. .. .. 1 .. .. 2 1 1 71 Chorea .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. . . 3 72 Cerebral tumour .. .. .. .. .. .. 1 .. 2 2 .. .. 1 .. .. 5 1 .. .. 3 5 11 73 Epilepsy .. .. • • 1 1 2 2 1 1 1 2 .. .. .. .. .. .. 1 .. 6 74 Laryngismus Stridulus .. ... .. .. .. .. • • .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. 75 Locomotor Ataxy ... .. .. .. .. .. .. .. 2 2 .. .. .. 1 1 .. 1 1 .. .. .. 4 .. 4 76 Paraplegia, diseases of spinal cord .. .. .. .. .. .. .. 1 1 3 .. 1 .. 1 2 .. 1 2 .. .. .. 2 4 6 77 Other diseases of brain or nervous system 1 2 .. .. .. .. .. 1 2 1 2 1 .. 1 1 .. 1 I 2 22 1 5 5 10 78 Otitis, otorrhoea 2 1 .. .. 1 .. .. .. .. 1 .. ... 1 .. .. 1 .. 1 2 .. 1 4 5 79 Diseases of nose, epistaxis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..• .. .. 80 Diseases of eye, ophthalmia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 81 Pericarditis .. 3 .. .. .. .. 1 .. 1 1 .. .. .. .. 1 2 1 1 1 .. .. 3 3 6 82 Endocarditis, valvular diseases of the heart .. 1 .. 4 2 2 8 7 3 9 8 3 .. 3 7 5 10 7 7 3 1 l3 34 47 83 Hypertrophy of heart .. .. .. .. .. .. .. •• •• .. 1 .. .. .. .. .. .. .. .. .. 1 .. 1 1 84 Angina pectoris .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 85 Aneurism .. .. .. .. .. .. 1 2 2 1 .. .. .. .. 2 .. .. 3 1 .. .. 6 .. 6 86 Senile gangrene 1 1 .. 1 .. 1 87 Embolism, thrombosis .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 88 Phlebitis .. .. .. .. .. .. 2 .. .. .. ... .. .. .. .. .. 1 .. 1 .. 1 1 2 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 5 2 .. 13 10 22 19 2 .. 2 8 12 7 17 9 8 11 33 41 74 91 Laryngitis 1 1 .. .. .. .. .. .. .. .. .. .. .. .. l 1 .. .. .. .. .. 2 2 92 Croup .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 93 Other diseases of larynx and trachea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 94 Acute bronchitis 44 12 .. .. .. 1 1 2 1 3 3 5 1 1 16 13 10 21 3 2 7 43 3 0 73 95 Chronic bronchitis .. .. .. .. .. 1 1 14 27 34 41 14 5 4 21 18 12 35 14 15 18 68 69 137 96 Lobar, croupous-pneumonia 3 2 2 1 3 1 1 4 2 4 4 1 .. .. 5 5 2 7 1 4 4 18 10 28 97 Lobular, broncho-pneumonia 39 60 4 .. .. 1 1 1 3 4 3 2 1 1 24 19 13 22 8 12 20 63 56 119 98 Pneumonia, form not stated 16 20 2 2 .. .. 5 20 14 1G 14 3 .. 5 12 14 14 22 11 19 15 74 38 112 99 Emphysema,asthama .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 100 Pleurisy .. 2, .. .. .. .. .. 1 1 .. .. .. .. .. 1 1 .. 1 .. .. 1 2 2 4 101 Other and ill-defined diseases of respiratory system r 3 1 1 .. .. 1 2 .. 1 1 .. .. .. .. 2 1 2 3 .. 1 5 5 10 102 Diseases of mouth and annexa . .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 103 Diseases of pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 104 Diseases of œsophagus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 105 Ulcer of stomach and duodenum .. .. .. .. .. 2 1 1 3 .. .. .. .. 1 1 2 1 1 1 .. .. 4 3 7 106 Other diseases of stomach .. .. .. .. .. .. .. .. .. 1 . . .. .. .. .. .. .. .. .. .. 1 .. 1 1 107 Enteritis 57 31 2 .. .. .. .. .. .. .. 1 1 .. 1 27 12 6 23 8 9 6 49 43 92 108 Appendiictis .. .. .. 2 .. 1 2 .. 1 .. 2 .. 1 .. .. .. .. .. 3 1 2 5 1 6 109 Obstructions of intestine .. .. .. .. 1 1 .. 2 1 .. 2 .. .. .. 2 .. 2 2 2 .. 2 4 6 10 110 Other diseases of intestine .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 111 Cirrhosis of liver .. .. .. .. .. .. .. 8 9 5 1 .. .. .. 1 6 2 2 7 3 .. 10 13 23 112 Other diseases of liver .. .. .. .. .. .. 1 . 2 .. .. .. 1 1 1 .. .. .. 1 .. 4 4 113 Peritonitis .. 2 1 2 .. .. 1 .. 1 .. .. .. .. 1 .. .. 3 1 2 1 .. 2 6 8 114 Other and ill-defined diseases of digestive system 2 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 2 •• .. 1 • • .. 1 3 4 74 75 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. sex. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total. 115 Diseases of Lymphatic System and ductless glands .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 116 Acute nephritis .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 1 1 .. 1 .. 2 1 3 117 Briglit's disease .. 1 .. .. .. 2 2 4 11 13 13 4 .. .. 9 7 8 10 4 5 7 21 29 50 118 Calculus .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. 1 1 119 Diseases of bladder and prostate .. .. .. .. .. .. 1 .. .. 3 .. 2 .. .. 2 .. 2 1 .. .. 1 6 .. 6 120 Other and ill-defined diseases of urinary system .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 1 .. .. 1 1 2 121 Diseases of testis and penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 122 Diseases of ovaries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 123 Diseases of uterus and appendages .. .. .. .. .. .. 2 .. 1 1 .. .. .. .. 2 1 .. .. .. 1 .. .. 4 4 124 Diseases of vagina and external genital organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 125 Diseases of breast .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 126 Abortion, miscarriage .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 127 Puerperal mania .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 128 Puerperal convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 129 Placenta prævia, flooding .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. 2 2 130 Puerperal thrombosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 131 Other and ill-defined accidents and diseases of pregnancy and childbirth .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 132 Arthritis, ostitis, periostitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 133 Other and ill-defined diseases of osseous system .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 134 Ulcer, bedsore .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135 Eezema .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 136 Pemphigus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 137 Other and ill-defined diseases of intequmentary system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. By Accident or Negligence. 138 In mines and quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 139 In vehicular traffic 1 3 5 1 .. 1 2 2 .. .. 1 .. .. .. 2 1 1 8 1 2 1 12 4 16 140 On railways .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 141 On vessels and docks, excluding .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 142 In building operations .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. 2 .. 2 143 By machinery .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 144 By weapons and implements .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 145 Burns and Scalds 2 4 4 1 .. .. .. .. .. .. .. 1 .. .. 4 3 1 2 .. 1 1 3 9 12 146 Poisons, poisonous vapours .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. 2 1 .. .. .. .. .. 3 .. 3 147 Surgical narcosis .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 148 Effects of electric shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 149 Corrosion by chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 150 Drowning .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 151 Suffocation, overlaid in bed 22 .. .. .. .. .. .. .. .. .. .. .. .. 2 5 5 2 4 1 2 1 12 10 22 152 Suffocation otherwise 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. 2 2 153 Palls, not specified 2 5 1 .. 1 1 .. 1 7 3 6 4 1 .. 4 6 8 6 1 5 2 18 14 32 154 Weather agencies 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 155 Otherwise, and not stated .. .. 2 .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 2 .. 2 1 3 156 Homicide 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 2 2 Suicides, all forms, 157 By poison .. .. .. .. .. .. .. 1 3 2 .. .. .. .. 1 .. .. 2 2 .. 1 6 .. 6 158 By asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 159 By hanging and strangulation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 160 By drowning .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 .. .. 1 .. .. .. 1 1 2 161 By shooting .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 162 By cut or stab .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 163 By precipitation from elevated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 164 By crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 165 By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 166 Execution .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 167 Sudden death .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 168 Other ill-defined and not specified causes 8 1 .. .. .. .. .. 1 .. 1 3 .. .. 9 1 2 2 1 .. 1 .. .. 4 9 169 Malignant disease .. .. .. .. .. 1 1 .. 3 2 3 1 .. 2 2 2 1 2 1 .. 1 7 4 11 170 Abscess .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 171 Cerebro Spinal Fever 3 .. .. .. .. 1 .. .. .. .. .. .. .. .. 2 .. 1 1 .. .. .. 3 1 4 Total 598 399 49 26 32 37 102 171 211 217 231 117 37 74 411 317 291 466 209 226 233 1201 1026 2227 76 TABLE VI.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1911. DISTRICTS. Estimated population 1911. ANNUAL RATE PER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS: DEATHS DURING 1911 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. * Fever. Diarrhoea. Tuberculous. Disease. Violence. 1908. 1909. 1910. 1911. London 4,522,628 25.0 13.8 14.0 12.7 15.8 2.2 0.00 0.57 0.03 0.11 0.23 0.03 128 Shoreditch §109,951 31.8 17.5 19.2 16.8 20.2 3.2 • • 1.13 0.06 0.20 0.29 0.00 1.47 2.4 0.9 171 14-1 51-0 # # Wards. Moorfields 5,040 19.8 14.6 16.4 10.5 14.6 1.8 .. 0.39 .. 0.39 0.19 .. 0.79 2.2 0.6 130 17*5 43-2 .. Church 18,882 32.6 17.1 19.5 15.9 21.7 3.8 .. 1.64 .. 0.16 0.26 .. 1.80 2.9 1.1 182 13-8 62-0 Hoxton 16,594 33.0 18.8 17.0 16.5 19.1 2.9 '.. 1.08 .. 0.36 0.12 .. 1.38 2.0 1.1 168 14-5 48*2 Wenlock §17,903 28.2 15.6 16.7 14.6 16.2 2.9 .. 0.56 .. 0.22 0.22 .. 1.89 1.7 0.7 180 15-4 44 • • Whitmore 16,908 37.5 23.0 27.7 25.0 27.5 3.5 .. 1.30 0.12 0.06 0.41 .. 1.59 3.5 1.5 190 15-0 57*5 Kingsland 10,400 35.1 17.5 20.6 18.7 20.1 3.8 .. 1.82 0.28 0.19 0.19 .. 1.33 2.5 0.6 129 124 51-6 1 • Haggerston 12,315 28.9 15.7 15.5 13.2 18.3 2.8 .. 1.29 0.08 0.16 0.32 .. 0.96 1.8 1.0 168 13*7 50-9 • . Acton 11,909 31.2 14.1 16.3 14.4 19.5 2.7 .. 0.58 0.08 0.16 0.58 0.08 1.17 2.2 0.5 166 12*0 38-6 *Fever includes typhus, typhoid and continued fevers. §The inhabitants of the Holborn Union Workhouse, which is situate in Wenlock Ward, and the deaths occurring in that institution are excluded. Note.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, O'OO is inserted; where no deaths have occurred, dots are placed in the space under the heading. 77 TABLE VII. ANALYSIS of the Cases Treated by tiik District Medical Officers of the Borough during the Year ending December 31st, 1911. Diseases. Diseases. All Causes 5,209 37 Atelectasis .. 38 Congenital malformations .. 39 Old age 154 1 Small-pox .. 40 Apoplexy 8 2 Measles 213 41 Epilepsy 43 3 Scarlet Fever 13 42 Convulsions 4 4 Typhus .. 43 Other diseases of brain and nervous system 266 5 Relapsing fever .. 6 Influenza 56 7 Whooping Cough 46 44 Diseases of organs of special sense 52 8 Diphtheria 2 9 Simple, continued and illdefined fever 8 45 Diseases of circulatory system 183 10 Enteric fever 3 46 Laryngitis 7 11 Simple cholera .. 47 Bronchitis 1,303 12 Diarrhœa, dysentery 183 48 Pneumonia 97 13 Remittent fever .. 49 Pleurisy 26 14 Hydrophobia .. 50 Other respiratory diseases 25 15 Glanders .. 51 Dentition 9 16 Cow pox and Effects of vaccination .. 52 Quinsy, sore throat 54 53 Enteritis 58 17 Venereal affections 35 54 Peritonitis 3 18 Erysipelas 30 55 Diseases of liver 24 19 Pyaemia and septicaemia 4 56 Other diseases of digestive system 398 20 Puerperal fever .. 21 Tabes mesenterica .. 22 Tuberculous meningitis 3 57 Diseases of lymphatic system and ductless glands 18 23 Phthisis 264 24 Scrofula, tuberculosis 25 58 Diseases of urinary system 50 25 Other zymotic diseases 39 59 Diseases of the generative system 34 26 Thrush .. 27 Worms and other parasitic diseases 4 60 Accidents of childbirth 13 61 Diseases of locomotive system 240 28 Starvation, want of breast-milk .. 62 Diseases of integumentary system 163 29 Alcoholism 9 30 Rheumatic fever and rheumatism of heart 53 63 Fracture and contusion 35 64 Gun shot wounds .. 31 Rheumatism 408 65 Cut, stab 3 32 Gout 95 66 Burns or scalds 9 33 Rickets 6 67 Poison 1 34 Cancer 31 68 Drowning .. 35 Other constitutional diseases 17 69 Suffocation . . 70 Otherwise 55 36 Premature birth 1 71 Other causes 326 78 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1911. Table VIII. PREMISES. NUMBER OF PLACES— Number of inspections, 1911. Number of notices, 1911. Number of prosecutions, 1911. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. Milk premises 292 15 15 292 2868 17 .. Cowsheds 7 • • .. 7 16 .. .. Slaughter-houses 6 .. .. 6 12 .. .. Other offensive trade premises 2 .. • • 1 10 1 .. Ice Cream premises 89 11 13 87 115 14 .. Registered houses let in lodgings 263 3 .. 266 426 67 .. Number of intimation notices served for all purposes 3178 Overcrowding:— Number of dwelling rooms overcrowded 148 Number remedied 148 Number of prosecutions Nil Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 275 Underground rooms:— Number dealt with during year 8 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 17 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 8 Customs and Inland Revenue Acts:— Number of dwellings for which applications were received during year 62 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 397 Total number of infectious bodies removed 1 79 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK, DURING THE YEAR 1911. 1.—Inspection. Inspection made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 298 25 - Workshops (Including Workshop Laundries and Bakehouses.) 2862 252 - Workplaces (Excluding Outworkers' premises dealt with in Table 3.) 558 79 - Total 3718 356 - 2.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspect'r (4) Nuisances under the Public Health Acts:—* Want of cleanliness 193 193 — — Want of ventilation 1 1 — — Overcrowding 7 7 — — Want ot drainage of floors — — — — Other nuisances 52 52 — — Sanitary accommodation insufficient 5 5 — — unsuitable or defective 56 56 — — not separate for sexes 8 8 — — Offences under the Factory and Workshop Act — Illegal occupation of underground bakehouse (S. 101) — — — — Breach ot 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.) — — — — 322 322 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 80 3. Home Work. NATURE OF WORK. OUTWORKERS LISTS, SECTION 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 and 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made. (S. 109.) Prosecutions. (S. 109, 110.) Twice in the Year. Once in the Year. Failing to keep or permit, inspection of lists. Failing to send Lists. Li9ts. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel: (1) Making, &c. 56 74 878 8 •• 99 •• •• •• 43 43 •• •• •• •• (2) Cleaning & washing •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Furniture and upholstery •• •• •• 1 •• 3 •• •• •• 2 2 •• •• •• •• Artificial flowers 2 •• 29 1 •• 35 •• •• •• 15 15 •• •• •• •• Fur pulling 2 •• 8 •• •• •• •• •• •• •• •• •• •• •• •• Umbrellas, &c •• •• •• •• •• •• •• •• •• 3 3 •• •• •• •• Paper bags and boxes 28 •• 324 6 •• 120 •• •• •• 41 41 •• •• •• •• Brush making •• •• •• •• •• •• •• •• •• 3 3 •• •• •• •• Total 88 74 1239 16 •• 257 •• •• •• 107 107 •• •• •• •• (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 grapnels, cart gear, locks, latches and keys, pea picking, household linen, lace, lace curtains and nets, curtains and furniture hangings, brass and brass articles, tents, feather sorting, and carding, &c., of buttons. (b) The figures in columns 2, 3 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 31 instances of failure to send lists of outworkers employed in making wearing apparel, &c., in 29 instances for similar failures in respect to paper bag and box making, in 2 instances in respect to artificial flowers and 1 in respect to furriers. 81 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades 716 (a) Cabinet making 425 (b) French Polishing 78 (c) Upholstery 59 (d) Other workers 154 (2) Dress 174 (a) Tailoring 79 (e) Shirt making 6 (b) Mantles 11 (f) Boot & Shoe trades 37 (c) Dress 8 (g) Artificial Flowers 6 (d) Millinery 13 (h) Other workers. 14 (3) Skin, leather, hair and feather trades 52 (a) Furriers 8 (b) Saddlery & Harness 22 (c) Feathers 3 (d) Other workers 19 (4) Paper, printing, book, stationery and fancy goods trades 51 (a) Box & bag maker s 33 (b) Other workers 18 (5) Laundry and Washing 27 (6) Food 3 (7) Metals, machines, implements and conveyances 52 (8) Precious metals, jewels, &c. 2 (9) Other trades than those mentioned above 59 Total number of workshops on Register 1136 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 70, including 5 factory bakehouses. 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s. 133) Nil. ( referring to 29 52 workshops & 25 factories. ) 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). - Reports (of action taken) sent to H.M. Inspector. (referring to 9 52 workshops 25 factories. ) 2 Underground Bakehouses (s. 101):— Nil. 40 f 82 6.—Shewing the Numbers of Outworkers Received from other Districts During 1911. 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. Sacks. Total. Feb. Aug. Feb. Aug. Feb. Aug. Feb Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Battersea 1 1 2 1 •• •• •• •• •• •• •• •• •• •• ••-•• •• •• •• •• •• •• •• •• •• 5 Bermondsey •• 2 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 Bethnal Green 110 52 •• •• •• •• 1 •• •• •• •• •• •• •• 2 1 33 50 18 9 •• •• •• •• 276 Camberwell 2 2 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 4 City of London 504 388 •• 2 •• . 1 33 15 •• •• 1 13 •• •• 29 31 1 1 •• •• •• •• •• •• 1019 Chelsea 4 5 •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 1 •• •• •• •• •• •• 12 Croydon 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 Deptford 1 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 Entield 2 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 3 Finsbury 108 109 •• •• . 1 . . 6 17 . . •• 3 5 •• 6 1 3 111 99 11 9 •• •• •• •• 489 Hackney 175 172 •• . . . . •• 107 2 9 8 3 4 •• •• 3 8 32 32 38 31 •• 1 2 •• 627 Hammersmith 2 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 Hampstead 1 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 Holborn 4 6 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 10 Ilford 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 Islington 68 78 •• •• •• •• 5 1 . . •• •• •• •• •• •• 2 11 11 •• 3 •• •• •• •• 179 Kensington •• 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 Lambeth 2 •• •• •• •• •• •• . . •• •• •• •• •• •• •• •• •• 1 •• •• •• •• •• •• 3 Poplar 2 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 3 •• •• •• •• •• •• 7 Southwark 4 1 •• •• •• •• 1 1 •• 1 •• •• •• •• •• •• •• •• 1 •• •• •• •• 9 St. Marylebone 3 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 4 St. Pancras 2 2 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 •• •• •• •• 5 Stepney 20 33 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 53 Stoke Newington 4 3 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 7 Tottenham 3 7 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 7 •• 1 •• •• •• •• 18 Walthamstow 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 1 •• •• •• •• 3 Westminster • • 10 •• •• •• •• •• •• •• •• •• •• •• •• •• 1 •• •• •• •• •• •• •• •• 11 1025 877 2 3 1 1 153 36 9 9 7 22 •• 6 35 46 191 205 68 56 •• 1 2 •• Total 1902 5 2 189 18 29 6 81 396 124 1 2 2755 Metropolitan Borough of Shoreditch. REPORT ON THE WORK OF HEALTH VISITING (During the Year ending December 31st, 1911) IN THE BOROUGH OF SHOREDITCH, BY Ethel J. Charlesworth, Health Visitor, Certificates of the San. Iasp. Exam. Board, London; Central Midwives Board; National Health Society, &c. F 2 84 Town Hall, Shoreditch, E.C. January, 1912. To the Medical Ofjicer of Health. Sir, I have the pleasure to submit the following report on the work of Health Visiting in the Borough during the year 1911. 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 1,853. These may be divided into nine classes:— (i.) Visits in connection with notifications under the Notification of Births Act, 1907:— First visits 840 Re-visits 507 1,347 (ii.) Special visits with respect to Infants suffering from Epidemic Diarrhœa 65 (iii.) Enquiries into Deaths of Infants from Epidemic Diarrhoea 41 (iv.) Visits in connection with cases of Ophthalmia Neonatorum, certified under Section 55 of the Public Health (London) Act, 1891 46 (v.) Enquiries into cases of Puerperal Septicaemia 5 (vi.) Lectures on Infant Care 3 (vii.) Visits in connection with Notifications of Phthisis:— First visits 144 Re-visits 62 206 (viii.) Enquiries into Deaths from Phthisis 13 (ix.) Interviews with various People connected with the Work 127 In addition to these, I have paid a large number of futile visits—i.e., to persons who were absent, removed, or for some other reason could not be found. 85 The clerical work includes the writing of 186 letters, in addition to a number of postcards, and filling up of Forms of Application for help on behalf of those needing assistance. The writing of this number of letters, many of them long ones, has taken up much time that could with greater advantage have been spent in visiting. I consider that it would be to the advantage of my work in connection with home visiting if I could be given adequate clerical assistance ; at present I have none at all. The remainder of this report is divided into sections, consisting of observations on the work connected with each of the nine sections given above. (i.) Visits in Connection with Notifications of Births. The total number of Notifications received during the year was:— Under the Notification of Births Act 3,228 Notified by the London County Council 158 3,386 The total number of Notifications followed up was 840, leaving 2,546 Notifications which have not been followed up. Of these, 871 Notifications were excluded from those to be visited. This number is composed of:— (i.) 256 Notifications sent in by midwives of the Medical Mission in Harman Street. In every one of these cases the mothers are invited to bring the baby to the Home for periodic weighing and supervision. (ii.) 430 Notifications concerned those births occurring in families not so likely as others to require visits. (iii.) 87 Notifications concerned births occurring in the Holborn Infirmary, Shepherdess Walk, the parents not belonging to this Borough. (iv.) 82 Notifications related to still-born children. (v.) 16 Notifications concerned those resident in the Workhouse, or whose address was insufficient. The remaining 1,675 Notifications, which were not followed up, include those cases where the infant died shortly after birth. Remarks. Although it is possible to quote a number of instances in which good work has been done, yet, taken as a whole, this section of the work cannot be said to have been undertaken satisfactorily. 86 Amongst the 840 visited, a few did not require a second visit ; a certain proportion have been adequately re-visited, and the rest visited once only. There are also at least twice as many who have not been visited at all, solely on account of want of time. I think that this is much to be regretted, for if the work of infant visiting were carried out in a thoroughly efficient and comprehensive manner, and an adequate amount of time and trouble were given to each family, very much better results would be obtained than at present. Re-visiting is now only carried out in those cases where at the first visit the method of feeding or the condition of the mother or infant is distinctly unsatisfactory, and obviously requires immediate attention. To ensure a possibility of good results nearly every case should be visited periodically, because circumstances may arise which alter the case considerably and create a much less favourable environment than prevailed at the time of the first visit. For example:— A visit was paid to Mrs. X about a month after the birth of her third child. The mother was then quite well, the baby was healthy, clean, naturally fed, and as well cared for as the small and uncertain family income, and the inconveniences of a poor type of house would permit ; therefore no arrangement was made to re-visit. Several months later I saw this baby again ; it was then in a very unsatisfactory condition. The baby had made good progress until the 8th week, when the mother fell ill with blood poisoning, and was ordered by the doctor to wean the baby ; from that time onward it had been wrongly fed, and had gradually deteriorated. If the mother had, as a matter of routine, been re-visited at the end of about six weeks, she would at least have had an opportunity of knowing the right method of artificially feeding. Although I have much faitli in the efficacy of systematic re-visiting, at the same time, I have found that the education of the mother, although an important factor, is not in itself an all-sufficient remedy for the evils which militate against infant life in this Borough. Records of the visits during this year show that it has been comparatively easy to obtain improvements when the home has certain essential requirements. The housing conditions should at least afford convenient facilities for cleanliness, and decency and privacy in sanitary accommodation ; these essentials are often lacking, and their absence has a very demoralising effect on the family. Much more has been done when the father as well as the mother takes an intelligent interest in his home and children, and contributes a just proportion of his wages towards the upkeep of his home. When this co-operation between parents was lacking, progress was hindered, and sometimes entirely checked. Intemperance with its concomitant evils in either one or both of the parents was a serious drawback ; in some cases, either chronic or acute poverty, often not the fault of the individual, has made it impossible for the parents to provide as much food and material comforts as are necessary for health. 87 (ii.) Special Visits respecting Summer Diarrhoea. Owing to the number of cases of epidemic diarrhoea occurring in infants during the summer, and especially in August, it became necessary to make arrangements to ascertain the existence of such cases. In response to my request, the Almoners of the Great Ormond Street Hospital for Children, the Metropolitan Hospital, and the Queen's Hospital, kindly consented to send notices of the cases occurring in infants attending as out-patients. I received a great many, of which 41 related to those resident in this Borough. All these were specially visited, the mother informed of the dangerous and infectious nature of this illness, the home conditions investigated, and any sanitary defects reported. Advice was given as to special feeding, the need for careful food storage, and the precautions to be taken against the spread of this disease. The number of cases thus notified can be safely considered to be only a small proportion of the number which occurred, and the number of visits paid in connection with these notified, represents only a part of the educational work in this connection. The large amount of illness from this cause, and the attention drawn to its prevalence, created some alarm and quickened interest in the nature of the disease. When visiting a house, perhaps for ordinary routine work, I frequently found several people who were anxious to discuss this matter and who were in a very educable frame of mind, and I spent much time, which could not be definitely accounted for, in talking to these people. According to your instructions, special stress was laid on the necessity of the washing of hands before handling or eating food. It was, indeed, always necessary to give this advice, for this simple and effective precaution was nearly always neglected, and very few had any previous idea of the connection between the spread of infection and dirty hands. In many instances, however, this advice was much more easily given than carried out. There are so many families in this Borough whose so-called " homes " are just one or two rooms in a large house, with no facilities for cleanliness. In these circumstances, the frequent washing of hands entails a great deal of labour in the carrying to and fro of clean and dirty water. Again, in regard to the cleanly storage of food, few, if any, of these same people have any proper place for storing food ; an unventilated cupboard in the fireplace recess is all that is provided, and it is extremely difficult to keep milk in a fit state for a baby's food, especially in hot weather. Considering the housing conditions, the wonder is that there was not a greater mortality from epidemic diarrhoea during the exceptionally hot summer. It is a noteworthy fact that of the 65 cases referred to below as having died of epidemic diarrhoea, only three occurred in blocks of dwellings, which have facilities for cleanliness ; and no deaths among infants from this cause have occurred in the Sutton Model Dwellings, where even the one-room homes are entirely self-contained and there is every facility for cleanliness. 88 (iii.) Deaths from Epidemic Diarrhoea. I enquired into the circumstances preceding the deaths of 65 infants under eight months from epidemic diarrhoea. These enquiries covered a period from July 15th to September 16th. Forty-four satisfactory records were obtained ; in the remaining cases the parents had removed, or were out at work, and so no information worth recording was obtainable. The main points of the records thus obtainable are shown in the following table:— Condition of Home. Method of Feeding. Proper Food Storage. Mother out at work. Clean and Fairly Clean. Very Dirty. Natural. Natural and Artificial. Artificial. 27 17 3 10 31 1 18 With reference to the three deaths in the above table in connection with which it was stated that the infants had been naturally fed, the type of home in which they lived suggested that, though possibly no regular bottle meals were given, the infants were fed with "bits of food," and given dummy teats, which had been dipped into dirty milk or sugar. (iv.) Ophthalmia Neonatorum. Since this disease was made notifiable in March, 1911, 35 cases have been certified, 32 under § 55 of the Public Health (London) Act, 1891, and three by the London County Council Inspectors of Midwives. Of the whole 35 notifications— Two referred to children aged respectively fourteen weeks and eight months. These are not included in the Report given below, which relates to cases amongst the newly-born. One referred to an infant not ordinarily resident in the Borough, and 110 information respecting the attendance at birth was obtainable. Of the 32 remaining cases (five of which were admitted to hospitals)— Seventeen occurred in the practice of doctors, inclusive of five occurring in the lying-in wards of public institutions. Cases attended by doctors only are not visited until after the tenth day, when the patient is ordinarily not under a doctor's care. Very few in this Borough care to entail the expense of retaining the doctor's services after that date, and my advice is then of some service to the mother, especially as, although the baby's eyes have been well looked after by the doctor, the mother, as a rule, has received no information as to the nature of the disease, and requires education on this point. 89 Fifteen occurred in the practice of midwives. Of these seven cases were very slight, and eight were either severe or fairly severe. Provided that the baby's relatives will co-operate with the attendants, the care given in these cases is very satisfactory. The midwife not only calls in a doctor, but also notifies the London County Council Inspector of Midwives. The latter visits the home to see that the baby is receiving proper care, and visits the midwife to see that she is taking proper precautions to prevent the spread of infection amongst her patients. These cases are, as a rule, taken daily for treatment to the Royal Ophthalmic Hospital. In eight cases it has also been necessary to make arrangements with district nurses to attend once or twice daily to give skilled attention to the eyes. No advantage has been taken of the arrangements made by the London County Council for the admittance to certain hospitals in severe cases of both the mother and the infant to obviate the necessity of weaning. With two exceptions these have all made satisfactory progress ; (i.) This was a very severe case, and the midwife urged the mother to send the baby to a hospital; but neither the father nor his relatives would bestir themselves to do this, saying it was unnecessary; when, four days later, a fellow-lodger in the house, kindly volunteered to do it, the sight of one eye was lost and that of the other much impaired. (ii.) The mother had no relatives who could afford to spend time in attendance at a hospital, hut so sent the baby to a private doctor, when she had the money The case was a fairly severe one, and, although not neglected, required special lotions and skilled treatment, and got worse rather than better ; it improved when nurses were called in, and the mother was able to take the baby to the hospital. No permanent injury to the sight seems to have occurred. My own visits, consequent on the certificates received under Section 55 of the Public Health (London) Act, 1891, and the notifications sent by the London County Council Inspectors, are directed towards the education of the mother on the nature of the disease, and the supervision of the case after the midwife has ceased to attend. Notification and the consequent visiting has had a wholesome effect on the attitude which parents and untrained attendants take towards this disease. An attack of ophthalmia neonatorum has hitherto been regarded as a very insignificant matter, only " a bit of a cold " in the eyes. As the result of these official enquires, they now realise its importance, and are much more inclined to carry out the instructions of the doctor or midwife. (v.) Puerperal Septicaemia. Only five cases have been certified. Three were attended by doctors and very little enquiry was made into these. One patient died, another, who was confined in June at a lying-in hospital, was subsequently removed from there to an infirmary, and is still there as an in-patient ; the third recovered. 90 Two were attended by midwives. One patient died in the infirmary ; the other was reported to be a slight case making good progress at time of enquiry ; no further information has been obtained, the patient being resident in Poplar. (vi.) Lectures on Infant Care, etc. These were given at the Maurice Hostel, Hoxton Hall, and St. John's Hall, in response to invitations received from workers there. (vii.) Visits in connection with Notiiicaiions of Phthisis. Owing to the number of notifications received under the Tuberculosis (in Hospitals) Regulations, May, 1911, there is a considerable increase in the amount of work in this section. Since May, my work has been limited to women and children, previously I had visited a few men-patients notified by hospitals, Almoners and charitable agencies. (viii.) Phthisis Death Enquires. In visiting after a death has occurred, attention is paid to the need for disinfection, and enquiry is made amongst the relatives of the deceased to ascertain whether any of them have been infected, and advice given to secure treatment, in case of slight illnesses suggesting phthisis. (ix.) Interviews. I have spent some time in interviews with people connected in various ways with the work ; under this heading are included occasional attendances at the local committee meeting of the Charity Organisation Society ; when cases referred by me were being discussed ; also occasional attendances at the local committee meetings of the Invalid Dinner Kitchens. I am much indebted to the Almoners of certain hospitals for their kind cooperation ; to the Invalid Children's Aid Association, to the Charity Organisation Society, and to the East London Friendly Worker's Association. This last has given most valuable help in providing milk and other nourishment for mothers and infants, in providing holidays for mothers with young children, and in giving beds and beddings to phthisical patients who require separate accommodation. The other organisations have provided some with long periods of sanatorium treatment. Other societies that have helped are the Convalescent Dinners Association, and the Invalid Dinner Kitchen. I am, Sir, Your obedient servant, ETHEL J. CHARLESWORTH.