SHOR 23 REPORT on the HEALTH AND SANITARY CONDITION of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1912, by LEWIS T. FRASER BRYETT, M.D. (Lond.), Medical Officer of Health; Diplomate in Public Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health, &c. [Printed by Order of the Health Committee.] printed by ohas. straker and sons, ltd., bishopsgate aventje, london, b.c. CONTENTS. Page. Anthrax 33 Artizans' dwellings 46 Appendicitis, mortality from 10 Bacteriological examinations 35 Bakehouses 54 Births in sub-districts 3 Birth rates 4 Cancer 9 Cerebro-spinal fever 33 Cholera 33 Coffeehouses 55 Cookshops 55 Cow-houses 49 Customs and Inland Revenue Acts 49 Dairies 50 Deaths in sub-di6tricte 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 44 Diarrhoea 24 Diphtheria 19 Disinfection 35 Enteric fever 21 Erysipelas 23 Factories and Workshops Act, 1901 51 Factories, workshops and workplaces—sanitary work 52 Food condemned and destroyed 56 Food and Drugs Act 56 Fried fish shops 55 Glanders 33 Housing and Town Planning Act, 1909 45 Houses closed 42 Houses let in lodgings 49 Hydrophobia 33 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 33 Influenza 27 Page. Institutions, deaths in 10 Legal proceedings 39 Margarine Act, proceedings "under 59 Marriages 4 Measles 25 Milk-shops 50 Milk premises, cowsheds, etc., on register 50 Mortuary 33 Notification of Births Act 4 Offensive business 50 Ophthalmia neonatorum 52 Outworkers 53 Polio-myelitis 33 Population 1 Puerperal fever 24 Bag Flock Act, 1911 50 .Return cases 16 Sanitary work 37 Scarlet fever 18 Scarlet fever, return cases of 16 Schools, exclusions of children for infectious disease 34 Shelter 36 Sickness amongst the poor 12 Slaughter-houses 49 Small-pox 16 Smoke nuisance 41 Staff 61 Street markets and food 56 Tuberculosis 28 Typhus Fever 27 Vaccination 16 Verminous houses 41 Violence, mortality from 10 Water supply 36 Whooping cough 27 Workshops on register 51 Zymotic diseases, deaths from 13 Zymotic death rate 13 A PPENDIX. Statistical Tables:— For whole district during 1911 and previous years (Table I.) 66 Cases of infectious disease notified during 1911 (Table II.) 67 Causes of, and ages at, death during year 1911 Tables III. and V.) 68 & 72 to 77 Infantile mortality during 1911 (Table IV.) 69 Notes to Tables III. and IV 70 & 71 Comparison of London and Shoreditch birth and death rates in 1911 (Table VI.) 78 Cases treated by District Medical Officer in 1911 (Table VII.) 79 Summary of proceedings under Public Health (London) Act, 1891 (Table VIII.) 60 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 81 to 84 Report on Sanitary Staff 85 to 97 Report of Health Visitor 100 to 104 Metropolitan Borough of Shoreditch ANNUAL REPORT of the MEDICAL OFFICER of HEALTH. Town Hall, Old Street, E.C. January, 1913. 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, 1912. POPULATION. In my Annual Report for 1911 are contained provisional figures relating to the number of persons returned as living in Shoreditch at midnight on Sunday, April 2nd, 1911, which were obtained from the Preliminary Report and Abstract of the Twelfth Census, dated June 10th, 1911. In the Report of the Census, published during the year 1912, the population of the Borough is given as being 111,390, consisting of 54,842 males and 56,548 females. The number of separate families or occupiers was 24,801, as compared with 27,031 at the Census of 1901. The figures for the Wards are contained in the subjoined table:— Ward. Families or Separate Occupiers. Population 1911. Population 1901. Males. Females. Persons. Moorfields 1,151 2,469 2,521 4,990 6,431 Church 4,250 9,562 9,682 19,244 20,823 Hoxton 3,930 8,114 8,282 16,396 19,108 Wenlock 3,687 8,547 8,785 17,332 17,302 Whitmore 3,936 9,288 9,520 18,808 18,825 Kingsland 2,561 5,293 5,590 10,883 11,663 Haggerston 2,386 5,582 5,795 11,377 12,034 Acton 2,900 5,987 6,373 12,360 12,451 2 From these figures it will be seen that, with the exceptions of Wenlock and Whitmore Wards, where the populations have remained practically stationary, and Acton, where there has been a decrease of approximately 0.7 per cent., marked decreases have taken place in the populations between the Census of 1901 and that of 1911. The decrease amounted to no less than 224 per cent. in Moorfields and 14.2 in Hoxton, while it was 7.5, 7 and 5.3 in Church, Kingsland and Haggerston Wards respectively. Doubtless a very considerable proportion of the decreases in Moorfields and Hoxton Wards has been due to the demolition of houses which were occupied by persons of the working class to make way for the erection of warehouses, factories and other business premises. Based upon the revised Census figures, the estimated population of the Borough for 1912 is 111,067, which includes 567 persons, ascertained to be newcomers into the Borough during the year when the Sutton Dwellings came into occupation. The estimated populations in the various Wards of the Borough are as follows:— Ward. Population. Ward. Population. Moorfields 4,813 Whitmore 18,808 Church 19,053 Kingsland 10,790 Hoxton 16,628 Haggerston 11,290 Wenlock 17,332 Acton 12,353 The estimated populations of the Registration Sub-Districts of the Borough are as follows:—Shoreditch South, comprising Moorfields, Church and Hoxton Wards, 40,494; Shoreditcli North-West, comprising Wenlock and Whitmore Wards, 36,140, and Shoreditch North-East, which comprises Kingsland, Haggerston and Acton Wards, 34,433. Included in the population of the Wenlock Ward is that of the Holborn Union Workhouse, which is situate in this Ward. The number on the night of the Census 1911 was 1,323. For certain statistical purposes this 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 109,739, whilst the estimated population of the Ward is reduced to 16,004, and that of the Registration Sub-District, Shoreditch North-West, to 34,712. In the following table are given the areas of the Wards in acres, and the estimated populations per acre:— Ward. Area in acres. Population per acre. Ward. Area in acres. Population per acre. Moorfields 71 68 Whitmore 76 248 Church 106 180 Kingsland 72 150 Hoxton 78 213 Haggerston 66 171 Wenlock 90 177 Acton 83 149 3 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. The following figures obtained at the 1911 Census may be recorded: there were 11,535 inhabited houses in the Borough, including 9,470 ordinary dwellinghouses, 110 blocks of flats, 1,528 shops, 246 hotels, inns and public-houses, 96 offices, warehouses, workshops and factories, 38 institutions and 47 others; of the population 87,082 were in ordinary dwelling-houses, 9,344 in blocks of flats occupying 2,031 flats, 8,941 were in shops, 1,477 in hotels, inns and public-houses, 560 in offices, warehouses, workshops and factories, 3,701 in institutions, and 274 in others. The uninhabited houses numbered 822, of which 641 were ordinary dwelling-houses, 172 shops, 1 public house, 6 offices and other business premises. Of buildings not used as dwellings there were 27 places of worship, 15 Government and municipal buildings, 632 shops, 31 offices, 1,447 warehouses, workshops and factories, and 4 theatres and other places of amusement. BIRTHS. The births registered in the Borough numbered 3,375, of which 1,711 were of males and 1,664 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 3,529, of which 1,793 were of males and 1,736 of females. The distribution of the corrected births in the eight Wards of the Borough is given below:— Ward. Males. Females. Total. Moorfields 52 68 120 Church 339 299 638 Hoxton 258 282 540 Wenlock 275 257 532 Whitmore 299 274 573 Kingsland 186 192 378 Haggerston 191 201 392 Acton 193 163 356 Totals 1,793 1,736 3,529 Outside the Borough 228 births were registered—115 of males and 113 of females —the parents being residents of Shoreditch. In the Shoreditch Infirmary 141 births were registered, of which 69 were of males and 72 of females. In four of these (2 male and 2 female) the parents did not belong to Shoreditch. A 2 4 In the Holborn Union Workhouse there were 77 births, 36 of males and 41 of females. In 70 of these (31 male and 39 female) the parents were not resident in Shoreditch. Of the births registered as occurring in the Shoreditch Infirmary 62 (29 of males and 33 of females') were illegitimate. In the Holborn Workhouse 47 (20 male and 27 female) were illegitimate, and elsewhere in the Borough 21, of which 10 were male and 11 female. The birth-rate was 32.1 per 1,000 inhabitants, as compared with 31.8 in 1911, 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 birth-rates for the eight Wards of the Borough are contained in Table VI. (Appendix). The birth-rate for England and Wales during 1912 was 24.4; for 95 Great Towns, including London, it was 24.9, and for 146 smaller towns it was 23.8 per 1,000 living. The London birth-rate was 24.7 per 1,000 population. NOTIFICATION OF BIRTHS ACT, 1907. The births notified under the above Act during 1912 numbered 3,230, as compared with 3,228 in 1911, and 3,277 in 1910. Taking the number of births belonging to Shoreditch registered during the year, the percentage of notification was a little over 91 per cent., as compared with 92 percent. in 1911 and 91 per cent. in 1910. The greater proportion of the notifications were by registered midwives. In addition there were 156 births occurring in public institutions outside the Borough, which were notified by the London County Council, lists of the same being sent in weekly. Including these, the births notified were approximately 96 per cent. of the number of births registered during the year. MARRIAGES. The marriages in Shoreditch during 1912, numbered 1,077, as compared with 1,015 in 1911, 1,025 in 1910, 967 in 1909, 972 in 1908, 1,109 in 1907, 1,074 in 1906, 1,068 in 1905, 1,066 in 1904, 1,146 in 1903, 1,156 in 1902, and 1,073 in 1901. The persons married were at the rate of 19.6 per 1,000 population, as compared with 18.4 in 1911, 18.0 in 1910, and 16.9 in 1909. The marriage-rate for the Metropolis during 1912 was 18'6 per 1,000 population. DEATHS. The deaths during 1912 numbered 2,017, as compared with 2,227 in 1911, 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. The distribution of the deaths amongst males and females in the eight Wards of the Borough is as shown in the following table:— 5 Ward. Males. Females. Total. Moorfields 36 29 65 Church 220 164 384 Hoxton 164 145 309 Wenlock 157 149 306 Whitmore 229 185 414 Kingsland 93 83 176 Haggerston 97 67 164 Acton 106 93 199 Totals 1,102 915 2,01'7 The deaths of males were 187 in excess of those of females. The death-rate for the year was 18.3* per 1,000 inhabitants, as compared with 20.2 in 1911, 16.8 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 1912 was therefore below the average for the previous ten years. The London death-rate during 1912 was 14.3 per 1,000 population, for England and Wales it was 13.3, for 95 great towns, including London 14.6, and for 146 smaller towns it was 13.0 per 1,000 population. 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 forms required by the Local Government Board. As compared with the figures for 1911 the death-rates were lower for all the Wards of the Borough, except Wenlock. As for last year the rate was lowest in Moorfields and highest in Whitmore Ward being 13.5 and 22.0 respectively.† The death-rate for the Borough was above the mean rate for the year for the first seven weeks of the year. At the end of February there was a marked fall, and the rate was below the average almost continuously until the beginning of October, when it rose and remained above the mean during the remainder of the year. The highest point touched was during the second week of November, when the rate was 27.2 per 1,000, the lowest in the second week of June when the death-rate was only 8.2 per 1,000 population. The elevation of the rate during the last quarter of the year was mainly the result of the mortality from measles, bronchitis and pneumonia. The * Corrected for age and sex distribution the death-rate was 19.2 per 1,000 population. † 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. 6 mortality from diarrhoea affected the curve of the death-rate but slightly. The summer was cooler than usual, and this circumstance doubtless played an important part in keeping down the death-rate during the summer months. The deaths of infants under the age of one year numbered 451, 281 being of males and 170 of females, the deaths amounting to 22.3 per cent. of the total number of deaths at all ages as compared with 26.8 for 1911, 27.6 in 1910, 23 in 1909, and 25.4 in 1908. The number of infants under one year dying during 1912 was at the rate of 128 per 1,000 births belonging to Shoreditch registered during the year. This rate is by far the lowest recorded for over 40 years. The infantile mortality during the year amongst males was 156, whilst amongst females it was only 98 per 1,000 births. The chief causes of death amongst infants under the age of one year were atrophy debility and marasmus, prematurity, diarrhoea and enteritis, pneumonia, suffocation in bed, whooping cough, bronchitis, measles and tuberculosis. With regard to these causes, atrophy debility and marasmus may be said to be largely the result of improper or insufficient feeding, mostly due either to ignorance or want of means. The premature births of infants depend upon adverse conditions affecting the health of the mothers during pregnancy, such as insufficient food, alcoholism, excessive work, besides certain constitutional maladies. Suffocation of infants in bed is mainly due to want of forethought or negligence. The remainder are the results of infections. It is only in a comparatively small proportion of cases of these infectious diseases that isolation can be carried out, and the consequence is that in districts like Shoreditch, densely populated with poor people, there is a greater tendency for these diseases to spread than in more sparsely populated districts, which is an important factor to be noted in considering the infantile mortality of the Borough. In table IV. (Appendix) is contained a statement showing the various causes of death amongst infants under the age of one year, the ages in weeks and months being given. The table also shows the nett deaths and births during the year amongst legitimate and illegitimate infants. Comparing this table with the table for 1911 the reduction in the infantile mortality for the year under consideration would mainly seem to be the result of a greatly reduced mortality from diarrhoea and enteritis, together with smaller numbers of deaths from pneumonia and bronchitis. 7 In the subjoined table the causes of death amongst infants under one year for cach 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. Small pox .. .. .. .. .. .. .. .. .. Chicken pox .. .. .. 1 .. .. .. .. 1 Measles .. 2 6 4 2 3 .. 2 19 Scarlet Fever .. .. .. .. .. .. .. .. .. Whooping Cough 1 6 4 1 2 3 2 1 20 Diphtheria and Croup .. .. 1 .. 1 .. .. 1 3 Erysipelas .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. 2 2 2 4 1 .. 2 13 Abdominal Tuberculosis .. .. .. .. 1 2 .. .. 3 Other Tuberculous Diseases 1 .. .. 1 .. .. .. .. 2 Meningitis (not Tuberculous) .. 1 1 1 .. 1 1 .. 5 Convulsions 1 2 .. 3 1 .. 2 .. 9 Laryngitis .. .. .. .. 1 .. .. .. 1 Bronchitis 1 2 3 5 2 2 4 1 20 Pneumonia (all forms) 1 14 5 6 6 4 4 5 45 Diarrhœa .. 7 7 5 9 1 .. 2 31 Enteritis 1 10 1 4 15 6 2 3 42 Gastritis 1 .. .. .. .. .. .. .. 1 Syphilis .. 2 3 1 .. 1 1 1 9 Rickets .. .. .. .. 1 .. .. 1 2 Suffocation, overlying .. 10 6 2 1 .. 6 1 26 Injury at Birth .. 1 .. .. .. .. .. .. 1 Atelactasis .. 1 1 .. .. 2 1 .. 5 Congenital Malformations .. 3 1 3 3 1 2 2 15 Premature Birth 1 17 5 16 14 11 5 7 76 Atrophy, Debility and Marasmus 4 23 10 10 12 5 13 4 81 Other causes .. 3 6 2 3 3 3 1 21 Totals 11 107 62 67 78 46 46 34 451 The infantile mortalities of the eight wards of the Borough are contained in Table VI. (Appendix). The mortality was highest in Church Ward, where it amounted to 152, and lowest in Moorfields, where it was only 91 per 1,000 births. In Acton Ward the infantile mortality was also low, only amounting to 95 per 1,000 births. The infantile mortality was during 1912 markedly below the average throughout the country, being only 95 per 1,000 births for England and Wales, and 90 for London, 8 figures which are considerably below that of Shoreditch. The marked difference between the figures for Shoreditch and London has been noticeable for many years past, and the conditions causing the same have been referred to in previous reports. The work done by the Health Visitor with a view to mitigating the results of these conditions are dealt with in her report (page 100 Appendix). Towards the end of the year the Health Visitor had the assistance of Miss Meses, a fully qualified Health Visitor who volunteered her services for three full days each week for a period of three months. This lady rendered some very valuable assistance, especially in connection with the work under the Notification of Births Act. Towards the end of the year the health visiting staff was increased by the appointment of Miss Jacocks, as Health Visitor for the Borough. This is referred to later in the report (page 62). The deaths of children aged from 1 to 5 years numbered 326, of which 102 were attributed to measles, 21 to whooping cough, 13 to diphtheria, 44 to various forms of tuberculosis, 12 to bronchitis, 63 to pneumonia, 21 to diarrhoea and enteritis, and 15 to various forms of violence, of which 4 were the results of burns or scalds. Altogether 777 or 38.4 per cent. of the total number of deaths at all ages during the year were of children under 5 years of age, as compared with 44.7 for 1911. Of children from 5 to 15 years of age, 78 died. The chief causes of death were tuberculosis, which accounted for 16, other infectious diseases which resulted in 16, pneumonia, which caused 10, and various forms of violence which accounted for 9 deaths, 4 of which resulted from street accidents. Of persons aged between 15 and 25 years there died 69, of whom 23 were the victims of consumption, 11 of diseases of the heart and circulatory organs, and 7 of pneumonia. Of persons aged between 25 and 35 years there died 101, the chief causes of death being consumption, which accounted for 37, diseases of the circulatory organs, which resulted in 18; pneumonia, which caused 7, and Bright's disease, wnich ended in 4 deaths. Three deaths were attributed to cancer and 5 were due to violence, 2 of which were suicidal. Of persons aged from 35 to 45 years there died 174, of which 66 resulted from consumption, 11 from cancer, 12 from diseases of the nervous system, 6 of which were due to general paralysis of the insane, 19 from diseases of the heart and circulatory organs, 13 from bronchitis, 20 from pneumonia, 6 from diseases of the digestive organs, 10 from Bright's disease, and 4 from violence, two of which were from suicide. 9 The deaths of persons aged from 45 to 55 years numbered 190, of which 43 were due to consumption, 14 to cancer, 8 to apoplexy, 2 to general paralyses of the insane, 26 to diseases of the heart and circulatory organs, 18 to bronchitis, 20 to pneumonia, 17 to diseases of the digestive organs, of which 10 resulted from cirrhosis of the liver, 17 to Bright's disease, and 5 to violence, 3 of which were due to suicide. Of 235 deaths amongst persons aged from 55 to 65 years, 26 were attributed to consumption, 24 to cancer, 5 to old age, 19 to apoplexy, 4 general paralyses of the insane, 38 to diseases of the heart and circulatory organs, 37 to bronchitis, 20 to pneumonia, 5 to cirrhosis of the liver, 25 to Bright's disease, and 6 to violence, of which 4 were the results of suicidal acts. Of 222 deaths amongst persons aged from 65 to 75 years, 8 were due to consumption, 18 to cancer, 28 to old age, 17 to apoplexy, 30 to diseases of the heart and circulatory organs, 53 to bronchitis, 12 to pneumonia, 21 to Bright's disease, and 6 to violence through falls. Of 145 persons who died aged from 75 to 85 years, in 8 instances death was attributed to cancer, in 74 to old age, 11 to apoplexy, 20 to bronchitis, 3 to Bright's disease, and 6 to violence through falls. Of the persons who died 85 years and upwards, 1 died from cancer, 21 from old age, 1 from valvular heart disease, and 3 from bronchitis. The chief causes of death during the year were: tuberculosis which accounted for 290 deaths, including 217 attributed to consumption or phthisis, pneumonia which caused 208, bronchitis 184, old age 128, diseases of the heart and circulatory organs 166, measles 126, diarrhoea and enteritis 99, cancer 79, prematurity 76, Bright's disease and acute nephritis 83, apoplexy 61, atrophy debility and marasmus 68, whooping cough 42, alcoholism and cirrhosis of the liver 27, and violence 88 deaths. Of the 79 deaths from cancer 35 were of males and 44 of females. Fourteen persons under 45 years and 9 over 75 were certified to have died from cancer. In addition 9 deaths, 3 of males and 6 of females, were certified as being due to malignant disease or sarcoma. Probably some of those attributed to malignant disease were the result of cancer. The death-rate from cancer was 0.72 per 1,000 population and was again above the average. The rates for previous years arc as follows:—0.72 in 10 1911, 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, 0.58 in 1898, 0.51 in 1897, 0.45 in 1896, 0.50 in 1895, 0.65 in 1984 and 0.54 in 1893. Of the deaths attributed to alcoholism and cirrhosis of the liver 13 were of males and 14 of females. The deaths attributed to appendicitis numbered 8 as compared with 6 in 1911, 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 1912, 5 were of males. The deaths from peritonitis numbered 3, two of which were of males. Taking the deaths from appendicitis and peritonitis together they were somewhat below the average in point of number for the past 10 years. Of the 88 deaths from violence 49 were of males and 39 of females. Through accident or negligence 77 persons lost their lives. In 11 instances street accidents in connection with vehicular traffic were the cause of death; in 8 of these the persons killed were males. In 7 instances death was due to burns or scalds; all of these were females. In 25 instances falls of various kinds were the cause of death. The number of infants who lost their lives through being suffocated in bed was 26 as compared with 22 in 1911 and 35 in 1910. Eleven persons committed suicide; with one exception they were all males. DEATHS IN PUBLIC INSTITUTIONS The number and distribution of the deaths of persons belonging and not belonging to the Borough in the public institutions situate in Shoreditch are as set out in the subjoined table:— Institution. Persons belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Union Workhouse 7 237 244 Shoreditch Workhouse 542 30 572 Royal Chest Hospital 10 44 54 Convent Hospital — 1 1 Home of Good Shepherd 18 6 24 Babies' Home, Brunswick Place 27 10 37 Totals 604 328 932 Elsewhere than in public institutions, 5 persons not belonging to Shore ditch 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 4 Mildmay 6 Cane Hill 2 Queen's (Children) 63 Caterham 2 St. Bartholomew's 85 Claybury 10 Seaman's Hospital 1 Colney Hatch 14 Westminster 1 Darenth 1 Special Hospitals. Dartford Heath 5 Horton 2 Brompton 1 Hanwell 1 Cancer Hospital 3 Leavesden 7 Chest Hospital, Bethnal Green 3 Long Grove 9 City of Loudon Lying-in 9 Manor 2 Hospital for Women 1 Tooting Bec 3 Queen Mary's Hospital 5 Hospitals for Infectious Disease. Orthopedic Hospital 1 Eastern 22 Infirmaries and Workhouses. North Eastern 24 Belmont Workhouse 5 NorthWestern 4 Bermondsey Workhouse 1 Park 1 Bethnal Green Infirmary 3 South Eastern 4 Bethnal Green Workhouse 1 Western 1 Camberwell Infirmary 1 General Hospitals. Hackney Infirmary 3 East London (Children) 7 Hammersmith Infirmary 1 Freidenheim 2 Holborn Infirmary 1 French 1 Southwark infirmary 1 German 3 Whitechapel Infirmary 1 Gt. Ormond Street (Children) 26 Other Institutions. Great Northern 1 Guy's 2 Bethnal House 1 Hampstead General 1 Home for Sick Children, Sydenham 1 King's College 1 London 15 St. Joseph's Hospice 5 London Temperance 1 St. Luke's House 2 Metropolitan 67 Pentonville Prison 1 Middlesex 2 Wormwood Scrubbs Prison 1 Of 455 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 285 died in general hospitals, 62 in asylums, 56 in fever hospitals, 18 in workhouses and infirmaries, 24 in hospitals for special diseases, and 11 in other institutions. Elsewhere than in public institutions 19 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 1,059 or 52.5 per cent. of the deaths of persons belonging to Shoreditch took place in public institutions. 12 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 1912 numbered 5,201 as compared with 5,209 in 1911, 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. An analysis of the cases treated is recorded in Table VII. (Appendix). The diseases classed as infectious accounted for 991 as compared with 924 in 1911, 923 in 1910, 945 in 1909, 707 in 1908, and 763 in 1907. Consumption, measles, influenza, and whooping cough were responsible for more than two-thirds of the infectious cases. As compared with the figures for 1911 there was a marked increase in the number of cases of influenza, and there were also increases in the numbers of cases of consumption, measles and whooping cough. The cases of diarrhoea were greatly decreased, doubtless to be accounted for by the cool summer. Diseases of the respiratory organs, which are also in the main to be regarded as infectious, numbered 1,461 cases as compared with 1,458 in 1911, 1,344 in 1910, 1,444 in 1909 and 1,268 in 1908. Of the cases during 1912, bronchitis caused 1,292 and 110 were due to pneumonia. Rheumatism was given as the diagnosis in 458 cases as compared with 408 in 1911 and 398 in 1910. Cases of rheumatic fever were below the average in point of number, there being only 28 as compared with 53 in 1911, 53 in 1910, 47 in 1909 and 32 in 1908. Cases diagnosed as gout numbered 57 as compared with 95 in 1911, 100 in 1910 and 104 in 1909. Dyspepsia and other disorders of the digestive system accounted for 463 of the cases as compared with 546 in 1911 and 688 in 1910. The cases diagnosed as cancer numbered 25 as compared with 31 in 1911, 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 247 cases, chiefly of ulcerated legs, as compared with 240 in 1911 and 263 in 1910, and diseases of the skin for 148 as compared with 163 in 1911 and 236 in 1910. INFECTIOUS DISEASES. The infectious diseases included under the headings numbered 1 to 35 and 170 in Table V. (Appendix), resulted in 589 deaths as compared with 673 in 1911, 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 was therefore markedly below the average for the previous 10 years. They amounted to 29.0 per cent. of the total number of deaths from all causes as compared with 30.2 per cent. in 1911. 13 20.7 in 1910, 30.8 in 1909, and 30.7 in 1908. As compared with the figure for 1911, the decrease in 1912 is to be accounted for by the markedly few deaths from diarrhoea. Deaths from consumption show an increase on the figure for 1911, otherwise there is nothing of importance to comment upon as regards the mortality from the other infectious diseases. The deaths from consumption and the other forms of tuberculosis amounted to nearly 50 per cent. of the total number of deaths from infectious diseases, and of the remainder measles, whooping cough, and diarrhoea accounted for the greater number. The death-rate from these infectious diseases was 5.3 per 1,000 inhabitants as compared with 6.1 in 1911, 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. The rate was therefore markedly below the average for previous years. 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 110 198 25 7 15 20 44 72 51 31 11 5 .. The above shows that the majority of the deaths were of children under 5 years of age. Of the total number of deaths of children under 5 years of age from all causes, nearly 40 per cent. resulted from the infectious diseases referred to as compared with 42 per cent. in 1911, 35 in 1910, 43 in 1909, 40 in 1908 and 42 in 1907. In infants under the age of 1 year, measles, whooping cough, diarrhoea, and tuberculosis accounted for most of the deaths. Amongst children aged from 1 to 5 years, measles was the most active cause of death, but whooping cough, diphtheria, and tuberculosis also caused many deaths. The chief cause of the mortality from infectious diseases amongst persons aged 20 years and upwards was consumption. The deaths from the principal zymotic diseases—namely, small pox, measles scarlet fever, diphtheria, including membranous croup, whooping cough, enteric fever and diarrhoea—numbered 235 as compared with 349 in 1911 and 217 in 1910. The death-rate due to these diseases, which is termed the zymotic death-rate, was 2.1 per 1,000 population as compared with 3.2 in 1911, 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 was therefore markedly below the average for previous years. A comparison of the zymotic death-rates of London and Shoreditch and the 14 eight wards of the Borough is given in Table VI. (Appendix). The rate was highest in Whitmore Ward and lowest in Haggerston Ward, being 2.9 and 0.8 per 1,000 population respectively. Excluding cases of cerebro-spinal fever, which numbered 6, and ophthalmia neonatorum which numbered 17, also the cases of phthisis, 460 cases of infectious disease were notified, a decrease of 134 as compared with the number for 1911. The number of cases annually certified since 1889, when notification became compulsory, and the attack-rate per 1,000 population are set out below:— 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 1912 460 4.2 The cases of notifiable infectious disease certified in the Metropolis during 1911 number some 23,660, excluding cases certified as anthrax, glanders, pulmonary tuberculosis, ophthalmia neonatorum, measles, cerebro-spinal fever, and acute polio-myelitis. The attack-rate was 5.2 per 1,000 inhabitants as compared with 5.3 in 1911 and 4.4 in 1910. The attack-rate for Shoreditch therefore was markedly lower than that of the Metropolis during 1912. Subjoined is a list of the infectious diseases which are notifiable, excluding pulmonary tuberculosis, showing the numbers of cases certified in the Borough for each of the four quarters of the year, and the numbers and percentage of the cases removed to hospital:— 15 Disease. First Quarter. Second Quarter. Third Quarter. F ourth Quarter. Total. Deaths. Small Pox .. .. .. .. .. .. Scarlet Fever or Scarlatina 32 29 40 50 151 4 Diphtheria & Membranous Croup 33 30 47 27 137 18 Typhus .. .. .. 1 1 1 Cholera .. .. .. .. .. .. Enteric Fever (Typhoid) 2 8 4 .. 14 4 Continued Fever .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. Puerperal Fever 1 4 2 1 8 4 Erysipelas 40 40 30 39 149 6 Plague .. .. .. .. .. .. Cerebro-Spinal Fever .. 3 2 .. 5 3 Glanders .. .. .. .. .. .. Anthrax .. .. .. .. .. .. Hydrophobia .. .. .. .. .. .. Acute Anterior Poliomyelitis .. .. .. .. .. .. Ophthalmia Neonatorum 8 3 2 4 17 .. Totals 116 117 127 122 482 40 Numbers and percentages of cases removed to hospitals 70 75 95 81 321 60% 64% 75% 67% 66% As compared with the figures for 1911, the cases of scarlet fever, diphtheria, enteric fever, erysipelas, and ophthalmia neonatorum all show decreases. There were no cases of small pox nor of acute anterior polio myelitis. There was 1 more case of cerebro-spinal fever and 3 of puerperal fever than for last year. The deaths from the principal zymotic diseases which are notifiable, namely small pox, scarlet fever, diphtheria and enteric fever, were at the rate of 0.23 per 1,000 population whereas the rate from the principal zymotic diseases which are not notifiable, namely measles, whooping cough and diarrhoea, was 1.87, or eight times as great. Generally it may be stated that the year 1912 in respect to the prevalence of notifiable infectious diseases in Shoreditch, excluding pulmonary tuberculosis, was most distinctly satisfactory, the cases being smallest in number and the attackrate the lowest so far recorded for the Borough. ISOLATION OF INFECTIOUS CASES. Cases of small pox, scarlet fever, and diphtheria removed to hospital, with very few exceptions, are taken to the hospitals of the Metropolitan Asylums Board. Cases of enteric fever, puerperal fever, and erysipelas not infrequently go into the Shoreditch Infirmary or into the general hospitals in the neighbourhood. Under 16 the Metropolitan Asylums (Measles) Order, 1911, and the Metropolitan Asylums (Whooping Cough) Order, 1912, persons not paupers reasonably believed to be suffering from measles or whooping cough may be admitted into the hospitals of the Metropolitan Asylums Board. A similar order, dated 1912, applies in like manner to puerperal fever. The notifiable infectious diseases, cases of which are receivable into the hospitals of the Board, are small pox, scarlet fever, diphtheria, enteric fever, typhus fever and cerebro-spinal fever. The number of cases of these diseases certified Table II. (Appendix) was 308, and the number removed to hospital (not necessarily to hospitals of the Metropolitan Asylums Board) was 296, which gives a percentage of 96.1 as compared with 97.0 in 1911, 97.7 in 1910, 97 in 1909, 97.3 in 1908, 97.5 in 1907, and 96 in 1906. The percentages for previous years are contained in the report for 1905. RETURN CASES. One instance came under observation in which a recurrence of scarlet fever followed on the return home of a patient who had been suffering from scarlet fever and treated in hospital. The facts are briefly as follows:— Edith H—, aged 3, was removed to hospital, certified to have scarlet fever, on July 12, returning home on August 22nd. On the day of her return it was noticed that she had a discharge from her nose, but this ceased about September 8th. The following cases subsequently occurred in the family:—Mrs. H, the child's mother, had a "sore" throat on September 15th; Alice H—, aged 15, a sister, fell ill on September 16th and was certified to have scarlet fever on September 18th, the rash showing on that date; Louisa H—, aged 17, fell ill on September 21st, the rash showing on the same date, and she was certified to have the disease on September 22nd. So far as the mother was concerned, she stated that she had had no rash, and subsequently no evidence of desquamation was observed. SMALL POX. There were no cases of small pox in Shoreditch during the year, and only about 6 cases were certified in the whole of London. VACCINATION. The last official figures as to vaccination in the Borough are those published with the report of the Medical Officer of the Local Government Board for 1911-12, and relate to the year 1910. Of the births registered during that year, in 43.6 per cent. vaccination was successfully performed and 34.4 per cent. were not finally 17 accounted for, the latter figure including postponed cases. Altogether 47.0 per cent. of the children whose births were registered in 1910 were unvaccinated at the end of the year. The last figure includes those exempted by conscientious objection certificates, which numbered 439 or 12.6 per cent. of the births registered as compared with 6.8 per cent. in 1909, 4.7 per cent. in 1908, 2.1 per cent. in 1907, 0.7 in 1906, 0.8 in 1905, 0.5 in 1904, 0.6 in 1903 and 0.3 in 1902. In the following table are contained the percentages of children born not finally accounted for as regards vaccination, including postponed cases, each year from 1891 to 1910 for Shoreditch, the Metropolis, and the rest of England:— Year. Shoreditch. Metropolis. Rest of England. Year. Shoreditch. Metropolis. Rest of England. 1891 8.8 16.4 12.9 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 33.9 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 1910 34.4 20.5 8.8 To the foregoing should be added the percentages of those for whom conscientious objection certificate were granted to obtain the percentage of unvaccinated. Taken together the figures show a further decrease in the amount of vaccination in the Borough. SCARLET FEVER. The cases certified during 1912 numbered 151 as compared with 234 in 1911, 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. The number for 1912 was the smallest so far recorded for any year in Shoreditch since the disease was made notifiable in 1889. In 1, or 0.6 per cent. of the cases certified, intimations were received from the Metropolitan Asylums Board that the patient had not been suffering from the disease. Corrected for errors in diagnosis, the cases during the year numbered 150 as compared with 212 in 1911, 181 in 1910, 321 in 1909, 573 in 1908, 822 in 1907, 599 in 1906, 776 in 1905, 326 in 1901 and 237 in 1903. The distribution of the cases certified, and the deaths amongst males and females in the Borough and its eight wards during the year were as shown in the subjoined table:— B 18 Wards. SCARLET FEVER. Notifications. Fatal Casks. Male. Female. Total. Male. Female. Total. Moorfields 2 1 3 .. 1 1 Church 8 12 20 .. .. .. Hoxton 16 16 32 .. 1 1 Wenlock 13 16 29 .. .. .. Whitmore 10 14 24 .. .. .. Kingsland 8 7 15 .. .. .. Haggerston 6 7 13 1 .. 1 Acton 8 7 15 1 .. 1 Totals for Borough 71 80 151 2 2 4 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified 146 or 98 per cent. were removed to hospital as compared with 98.3 in 1911, 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 1.3 per 1,000 inhabitants as compared with 2.1 in 1911, 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, 2.1 in 1902, 4.7 in 1901 and 2.7 in 1900. The attack-rate in the Borough was highest in Hoxton Ward and lowest in Moorfields, being 1.9 in the former as compared with 0.6 per 1,000 population in the latter. The deaths numbered 4 as compared with 7 in 1911, 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 0.03 per 1,000 population as compared with 0.06 in 1911, 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 mortality from scarlet fever has very greatly decreased during recent years. The mortality of fifty years ago if compared with that of the past few years would be found to be something like thirty times as great. The severer types of scarlet fever have become much less common of late years. The case mortality was at the rate of 2.6 per cent, of the cases certified as compared with 3 per cent. in 1911, 1.9 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. The case mortality and the death-rate were therefore below the average. Amongst children under 5 years there were 60 cases with 3 deaths, the case mortality being 5 per cent. as compared with 8 per cent. in 1911, 2'3 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. 19 Amongst persons over 5 years there were 91 cases with 1 death. The case mortality was therefore 1.1 per cent. (allowing for the error in diagnosis) as compared with 1.6 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 1902. There were no deaths from scarlet fever amongst persons over 5 during 1911. The cases of scarlet fever in the Metropolis numbered 11,328, the attack-rate being 2.5 per 1,000 inhabitants as compared with 2.3 in 1911, 2.1 in 1910, 3.5 in 1909, 4.6 in 1908, 5.6 in 1907, 4.3 in 1906, 4.1 in 1905, 2.8 in 1904, 2.7 in 1903, 3.9 in 1902, 4.4 in 1901 and 3.0 in 1900. The deaths numbered 159 the death-rate being 0.03 per 1,000 as compared with 0.03 in 1911, 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 (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 149 as compared with 171 in 1911, 127 in 1910, 183 in 1909, 202 in 1908 and 211 in 1907. No intimations were received from the Metropolitan Asylums Board that any of these cases were other than diphtheria. The numbers of cases and the deaths amongst males and females in the Borough and its eight wards are given in the subjoined table:— Ward. DIPHTHERIA (Including Membranous Croup.) Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 1 1 2 .. .. .. Church 13 5 18 3 1 4 Hoxton 15 10 25 2 .. 2 Wenlock 12 7 19 .. 3 3 Whitmore 12 6 18 2 .. 2 Kingsland 10 9 19 .. .. .. Haggerston 6 6 12 .. .. .. Acton 12 12 24 5 1 6 Totals for Borough 81 56 137 12 5 17 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified, 96 per cent. were removed to hospital as compared with 95 per cent. in 1911, 97 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. B 2 20 The cases certified were at the rate of 1.2 per 1,000 inhabitants as compared with 1.5 in 1911, 1.1 in 1910, 1.5 in 1909 and 1.7 in 1908. The attack-rate was highest in Acton Ward and lowest in Moorfields, being 1.9 per 1,000 in the former and 0.4 in the latter ward. The deaths numbered 18, the death.rate being 0.18 per 1,000 as compared with 0.20 in 1911, 0.12 in 1910, 0.18 in 1909, 0.11 in 1908, 0.17 in 1907, 0.12 in 1906, 0.14 in 1905, 0.16 in 1904, 0.18 in 1903, 0.18 in 1902, 0.23 in 1901, 0.45 in 1900 and 0.52 in 1899. The diphtheria death-rates in the wards of the Borough are contained in Table VI. (Appendix). The rate was highest in Acton Ward where it was 0.48 per 1,000 population. There were no deaths from diphtheria during the year in either Moorfields, Kingsland or Haggerston Wards. The case mortality was 13.1 per cent. of the cases certified as compared with 12.7 in 1911, 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, 16 were of children under 5 years of age, the mortality being at the rate of 20.8 per cent. of the cases certified amongst children at that age period as compared with 20.6 in 1911, 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 two deaths of children aged from 5 to 10 years. The mortality amongst persons over 5 years of age was at the rate of 3.3 per cent. of the cases certified. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough With respect to 126 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 8 2 10 From 1 to 2 years 13 3 16 „ 2 „ 3 „ 9 3 12 „ 3 ,, 4 „ 9 5 14 4 „ 5 „ 8 7 15 5 „10 „ 15 18 33 „ 10 „ 13 „ 9 6 15 Over 13 years 2 9 11 Totals 73 53 126 21 In 62 of the cases the patients were children attending school, and in 52 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 45 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 8 instances the histories showed that there had been cases of "sore throat" amongst the inmates of the houses in which the patients resided. In 9 instances there was evidence pointing to infection from previous cases in the Borough. In 86 instances the houses were occupied by members of more than one family, in 32 by single families, and in 8 instances the cases occurred in artisan's dwellings of the block type. With regard to the sanitary condition of the dwellings, in 85 this was satisfactory, in 16 fairly so, and in 25 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 7,109, as compared with 7,378 in 1911, 5,508 in 1910, 6,783 in 1909, 7,840 in 1908 and 8,585 in 1907, the attack-rates being 1.5, 1.6, 1.1, 1.4, 1.6 and 1.8 per 1,000 population for the 6 years respectively. The deaths from the disease in the Metropolis numbered 452 as compared with 612 in 1911, 434 in 1910, 605 in 1909 and 724 in 1908, the deathrate for the five years respectively being 0.10, 0.11, 0.09, 0.12 and 0.15 per 1,000 population. ENTERIC OR TYPHOID FEVER. The cases numbered 14 as certified, but 2 were subsequently not regarded as cases of enteric fever at the hospitals to which they were removed, and a third which was not removed to hospital was probably not a case of enteric fever. 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 1902 149 1891 111 1903 101 1892 91 1904 48 1893 111 1905 36 1894 85 1906 39 1895 99 1907 34 1896 114 1908 101 1897 107 1909 49 1898 91 1910 49 1899 171 1911 22 1900 122 1912 14 1901 96 22 In my annual report for 1911, I directed attention to the small number of cases for that year as compared with the numbers for previous years. The number for 1912 is still smaller, and a glance at the above table will show how greatly enteric fever has decreased in the Borough during recent years. The attack-rate was a little over 0.1 per 1,000 population as compared with 0.2 in 1911, 0.4 in 1910, 0.4 in 1909, 0.8 in 1908, 0.3 in 1907, 0.3 in 1906, 0.3 in 1905, 0.4 in 1904 and 0.8 in 1903. The deaths numbered 4, the death-rate being 0.03 per 1,000 population as compared with 0.00 for 1911, 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 and 0.20 for 1902. The rate although higher than for last year was, however, markedly below the average. The case-mortality was at the grate of 28.5 per cent. of the cases certified (33 per cent, deducting the cases not regarded as having been enteric fever) as compared with 4.5 in 1911, 16 in 1910 and 12.2 in 1909. The case mortality for the 19 years ending 1911 averaged 14.0 per cent, of the cases certified. The distribution of the cases certified and deaths amongst males and females in the Borough and its eight wards during 1912 are shown in the subjoined table :— Wards. ENTERIC FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields .. .. .. .. .. .. Church 4 2 6 1 .. 1 Hoxton 1 .. 1 .. .. .. Wenlock 1 1 2 .. 1 1 Whitmore .. 2 2 1 .. 1 Kingsland 1 .. 1 .. .. . . Haggerston .. .. .. .. .. Acton .. 2 2 .. 1 1 Totals for Borough 7 7 14 2 2 4 The cases are grouped according to ages in Table II. (Appendix). All the cases except one, which terminated fatally at home, were removed to hospital. In 4 cases there was no history obtained which threw any light upon the source of infection, in 2 the patients were away at Southend about the time they might have been infected. Shellfish had been eaten in 2 instances. In 2 instances the patients were new arrivals in the Borough and were ailing when they came to Shoreditch. 23 The following cases are connected :—On April 1st, Mrs. W—, aged 31, of 126, St. Johns Road, began to ail and she was certified on April 26 to have enteric fever and removed to hospital. Three cases in children, viz., S. J—, a male aged 4, W. J—, a male aged 11, and R. J—, a female aged 14 were certified on May 11th. They were taken ill between May 1st and 4th at 13, Gloucester Row. From the history obtained it appeared that Mrs. W—, who was a connection of the J— family by marriage, visited their home at 13, Gloucester Row, on several occasions during the first fortnight or so of her illness ; moreover, the grandmother of the children, who resided at 13, Gloucester Row, visited Mrs. W— when she became too ill to get about, and Mrs. W—'s infant, aged 8 months, was taken to 13, Gloucester Row for a day or two about April 19th when its mother became too ill to look after it. This infant was ailing and was removed to hospital but from the information obtained it did not appear to have enteric fever. On May 15th, A. J—, aged 1½ years, was noticed to be unwell and was certified as a case of enteric fever, and removed to hospital on 23rd May from 13, Gloucester Row. There seems very little doubt that the cases at 13, Gloucester Row were secondary to that of Mrs. W—, who it is to be noted was ill for some 26 days before she was recognised to have enteric fever. The last case was probably infected through one or other of the children certified on May 11th. Two typhoid carriers were reported as having been discharged from the Army from the Royal Victoria Hospital, Netley, and proceeding to addresses in Shoreditch, one in April and one in June. They both appeared to be in perfect health, and seemed to have been thoroughly instructed as to the precautions to be taken to prevent risk of infection to those with whom they may be brought in contact. Up to the end of the year no case had occurred which could be connected with them in Shoreditch. The cases certified in the Metropolis show a marked decrease on the numbers for previous years, being but 702 as compared with 1,022 in 1911, 1,298 in 1910, 1,049 in 1909, 1,350 in 1908, 1,396 in 1907 and 1,608 in 1906. The attack-rate was 0.15 per 1,000 population, and somewhat higher therefore than that of Shoreditch. The deaths numbered 117 as compared with 144 in 1911, 196 in 1910, 146 in 1909 and 225 in 1908. The death-rate was 0.02 per 1,000 inhabitants. ERYSIPELAS. The cases certified as erysipelas numbered 149, as compared with 159 in 1911, 127 in 1910, 143 in 1909, 124 in 1908, 133 in 1907, 144 in 1906, 138 in 1905, 183 in 1904, 147 in 1903 and 172 in 1902. There were 6 deaths from the disease, as compared with 4 in 1911, 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. 24 The cases and deaths amongst males and females in the Borough and its eight wards were distributed as set out below:— Ward. ERYSIPELAS. Cases Certified. Fatal, Casks. Male. Female. Total. Male. Female. Total. Moorfields 2 2 4 . . . . . . Church 12 20 32 1 . . 1 Hoxton 9 9 18 1 . . 1 Wenlock 11 14 25 . . . . Whitmore 12 15 27 2 . . 2 Kingsland 9 6 15 . . . . . . Haggerston 7 8 15 . . . . . . Acton 4 9 13 1 1 2 Totals lor Borough 66 83 149 5 1 6 The death-rate was 0.05 per 1,000 inhabitants, as compared with 0.03 in 1911, 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 4.0 per cent. of the cases certified, as compared with 2.5 per cent, in 1911, 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 14 instances, 7 of males and 7 of females. Infective endocarditis caused the deaths of 8 males and 1 female. PUERPERAL FEVER. Eight cases were certified, with four deaths. The attacks were at the rate of 2.2 per 1,000 births, as compared with 1.4 in 1911, 2.2 in 1910, 3.5 in 1909, 1.3 in 1908, 0.8 in 1907, 1.5 in 1906, 2.2 in 1905, 1.3 in 1904, 1.7 in 1903, 2.2 in 1902, 1.7 in 1901 and 2.5 in 1900. The death-rate, calculated per 1,000 births, was 1.1 as compared with 0.6 in 1911, 0.5 in 1910, TO 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. The mortality was 50 per cent, of the cases notified during the year. DIARRHŒA. The deaths numbered 40, and there were besides 59 attributed to enteritis. The numbers of deaths from diarrhoea in previous years were 162 in 1911, 66 in 1910, 79 in 1909, 112 in 1908, 74 in 1907 and 191 in 1906. The deaths were 25 fore much below the average, being in fact the smallest number recorded in any one year for over 50 years. Most of them occurred during the months of August and September. The deaths from enteritis were also most numerous during these months. Of infants under 1 year there were 31 deaths. Seven were of children aged from 1 to 5 years, 1 of a person aged from 2.5 to 35 years, and 1 of a person aged from 45 to 55 years. Of the deaths from enteritis, 42 were of infants under 1 year, 14 of children aged between 1 and 5 years, and the remainder of persons over 45 years of age. The diarrhoea death-rate was, excluding deaths from enteritis, 0-37 per 1,000 population, as compared with 1.47 in 1911, 0.58 in 1910, 0.69 in 1909, 0.82 in 1908, 0.64 in 1907 and 1.68 in 1906. Taking the deaths from diarrhoea and enteritis amongst children under 2 years, which together numbered 94, the mortality was at the rate of 0.85 per 1,000 population, as compared with 2.1 for 1911. The deaths from diarrhoea amongst infants under one year in Shoreditch during 1912 were at the rate of 8.8 per 1,000 births registered during the year, as compared with 30.8 in 1911, 15.0 in 1910, 15.9 in 1909, 23.3 in 1908, 15.3 in 1907, 40.3 in 1906, and 30.6 in 1905. In contrast with the summer of 1911, which was exceptionally hot and dry, the summer of 1912 was cool and wet, which doubtless was the principal factor in determining the comparatively small amount of diarrhoea prevalent during the summer. The usual steps were taken for checking the spread of infection. Enquiries made by the Health Visitor show, as in previous years, that the mortality is much greater in young infants amongst those who are not fed solely upon the breast. The deaths from diarrhoea and enteritis amongst children under 2 years in the Metropolis numbered 1,371, giving a death-rate of 0.30 per 1,000 population, which is less than half of that for Shoreditch MEASLES. The deaths from measles numbered 126, as compared with 125 in 1911, 80 in 1910 and 127 in 1909. The cases coming under the treatment of the Poor Law medical officers during 1912 were more numerous than in 1911, and there was also a marked increase in the number of cases reported through the school authorities. During the first eight months of the year only 3 deaths from this disease occurred. In September there were 6, in October 21, in November 26 and in December 60 deaths. All the deaths were amongst children under 10 years of age; under 1 year 19 died, between 1 and 5 years 102, and from 5 to 10 years 5 died; 76 of the deaths were of females and 50 of males. The measles death-rate was 1.14 per 1,000 population, as compared with 1.13 in 1911, 0.70 in 1910, 1.11 in 1909, 26 0.44 in 1908, 0.99 in 1907, 0.64 in 1906, 0.52 in 1905, 0.69 in 1904, 0.85 in 1903, 0.72 in 1902 and 0.64 in 1901. The rate was highest in Whitmore and lowest in Haggerston, being 1.80 in the former and 0.35 in the latter ward. On September 13th, the Douglas Nursery, a creche in Shepherdess Walk, came under notice on account of the exclusion of about a dozen children who were suspected of having measles. It appeared that about August 28th there were 2 children who had been attending the creche absent with what was believed at the time to have been influenza. No medical man saw the cases, but there were grounds for suspecting measles. They may have been the source of infection in the cases excluded in September. The cases were confined to children in one room, and there were none amongst the babies. A watch was kept, and on the occurrence of 2 further cases it was thought advisable to close the creche on September 16th. The number of instances in which houses were brought to the notice of the Health Department as having measles therein was 847, as compared with 602 in 1911 and 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 86 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 754. Intimations were received from the Metropolitan Asylums Board as to the removal of 286 cases of measles to the hospitals of the Board, from Shoreditch during the year. The majority of these would be cases treated by the Poor Law Medical Officers. As already mentioned, however, 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, and a considerable number were so admitted. 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; 583 rooms were sprayed, and the usual steps were taken as to bedding and textile articles. Altogether some 546 beds, 609 mattresses, 962 pillows, 339 bolsters, and 8,197 other articles were removed for disinfection at the disinfecting station. In 26 instances disinfection was carried out by the occupiers of the dwellings where the cases had occurred. This was done 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 1,799, as compared with 2,570 in 1911, 1,980 in 1910 and 2,324 in 1909, the death-rate being 0.39, as compared with 0.57 in 1911, 0.40 in 1910 and 0.48 in 1909. 27 WHOOPING COUGH. The deaths from whooping cough numbered 42, 23 of males and 19 of females. Of these 20 were of infants aged under 1 year, 21 of children aged between 1 and 5 years, and one of a child aged from 5 to 10 years. Deaths were most numerous during the months of April and May. The whooping cough death-rate was 0.38 per 1,000 population, as compared with 0.29 in 1911, 0.39 in 1910 and 0.64 in 1909. The death-rate, although higher than for 1911, was below the average for recent years. The rate was highest in Church and lowest in Wenlock, being 0.68 in the former and 0.18 in the latter ward. Under the Metropolitan Asylums (Whooping Cough) Order, 1912, the Managers of the Metropolitan Asylums Board may admit into any of their hospitals persons not paupers who are reasonably believed to be suffering from whooping cough, subject to the regulations and restrictions prescribed by the Order. There were no applications for cases to be sent to hospital under this Order during 1912. Some 54 Poor Law cases were admitted to the Board's hospitals, mostly from the Poor Law institutions in the Borough. The deaths from whooping cough in London numbered 970, the death-rate being 0.21 per 1,000 population. INFLUENZA. The deaths attributed to influenza numbered 12, as compared with 12 in 1911, 16 in 1910, 23 in 1909, 22 in 1908, 23 in 1907, 17 in 1906, 11 in 1905, 14 in 1904, 19 in 1903, 14 in 1902, 16 in 1901 and 52 in 1900. The figures for previous years are contained in the annual reports for 1900 and 1901. The deaths attributed to influenza in the Metropolis numbered 537 as compared with 496 in 1911, 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 the months of January, February, March and December, and least during tha months of July and August. TYPHUS FEVER. For the first time in Shoreditch for over 20 years a case was certified as being one of typhus fever. The patient was a man of 50 years of age, whose place of residence was given as being at 13, Gifford Street. He was a commercial traveller by occupation, but from information obtained had had very little employment for some time previous to his illness. He was taken suddenly unwell on October 14th, the onset of symptoms being marked by a severe shivering fit. He was 28 admitted to the Shoreditch Infirmary on October 16th, delirium was noticed on the 17th, a rash appeared on the 18th, he became unconscious and had a series of fits of convulsions, and died on October 19th. His temperature whilst under observation in the infirmary was continuously between 104 and 105 degrees Fahrenheit. The eruption in appearance resembled that of measles. It was distributed generally over the trunk and limbs, and was also to be seen on the face. It was a dusky purplish red in colour, disappearing mostly on pressure, but there were some spots which persisted and which were petechial in character. The case was seen by several medical men, for it was felt that there was a considerable element of doubt about it. One physician of great experience in typhus fever, who saw the body shortly after death was of opinion that the case had not been one of that disease. He suggested that the eruption was to be associated with the convulsions which were such as are sometimes met with in persons with disease of the kidneys. At the post mortem examination it was found that some of the eruption was distinctly petechial in character and persisted after death. There was marked evidence of chronic kidney disease, otherwise nothing of importance was noted. All necessary precautions were taken as to disinfection, and the patient's wife and two children were kept under observation at the shelter in Reeves Place until the period of incubation of the disease had elapsed. No history was obtained to throw light upon the source of infection. Two cases had been previously certified in the Metropolis during the year as being cases of typhus fever, one on June 8th in Finsbury, and the other on October 5th in Bermondsey. TUBERCULOSIS. Tuberculosis (Appendix, Table V., Nos. 29 to 34 inclusive) was given as the cause of 290 deaths as compared with 266 in 1911, 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, although higher than those for the 3 years previously, was below the average for the past 12 years. The deaths from tuberculosis amounted to 14.3 per cent. of the total number of deaths from all causes, as compared with 11.9 in 1911, 12.6 in 1910, 12.6 in 1909, 15.5 in 1908, 14 in 1907 and 15 in 1906. The death-rate was 2.6 per 1,000 population, as compared with 2.4 in 1911, 2.1 in 1910, 2.4 in 1909, 2.7 in 1908, 2.8 in 1907, 3.0 in 1906, 2.7 in 1905, and 3.5 in 1904. Comparing the wards, the rate was highest in Whitmore, where it was 3.2, and lowest in Haggerston and Acton, where it amounted to 17 per 1,000 inhabitants. Tuberculosis of the lungs or phthisis, or consumption as it is commonly named, caused 217 deaths, as compared with 183 in 1911, 169 in 1910, 194 in 1909, 224 in 1908, 232 in 1907 and 233 in 1906. The majority of the deaths were of persons aged 29 from 25 to 55 years. Of males there died 160, as compared with only 57 of females. The consumption death-rate was 1.9 per 1,000 population, as compared with 1.7 in 1911, 1.4 in 1910 and 1.7 in 1909. The rate was highest in Hoxton Ward and lowest in Haggerston, being 4.8 per 1,000 in the former and 1.1 in the latter ward. The deaths from tuberculosis in the Metropolis numbered 7,451, giving a death-rate of 1.64 per 1,000 inhabitants. Of these 6,069 were attributed to con. sumption, the death-rate being 1.34 per 1,000, as compared with 1.34 for 1910. In accordance with the requirements of the Public Health (Tuberculosis) Regulations, 1908, during the year, 311 certificates were received as to consumptive inmates of Poor Law institutions, 161 from the district medical officers as to consumptive patients upon whom they were in attendance as officers of the guardians, and 136 relating to the discharges of consumptives from Poor Law institutions. Altogether some 608 certificates were received relating to 343 persons suffering from consumption. Of these, 32 were persons who had been previously certified in 1911, so that 311 were certified for the first time in Shoreditch during the year. The numbers certified in 1911, 1910 and 1909 were 292, 241, and 313 respectively. Altogether some 1,157 persons therefore have, been certified as suffering from consumption under the above-mentioned regulations during the past 4 years. Under the Public Health (Tuberculosis in Hospitals) Regulations, 1911, there were, excluding duplicates, some 857 certificates as compared with 1,100 for 1911. Of these 197 were passed on from the medical officers of health of the sanitary authorities to whom they had been sent in the first place, in accordance with the requirements of the regulations. Most of the certificates came from medical officers at the Royal Hospital for Diseases of the Chest, which is situate in the Borough, and the City of London Hospital for Diseases of the Chest in Bethnal Green, but numerous certificates came from other institutions in London and elsewhere, including most of the great general hospitals of the Metropolis. Of the certificates received, 615 were in respect of patients not resident in Shoreditch. These were forwarded in accordance with the regulations to the medical officers of health of the sanitary authorities concerned, from 50 to 60 in number, mostly in or near London. The remaining 242 certificates related to persons who were resident in Shoreditch. On January 1st of the year under consideration a third series of Regulations made under a General Order of the Local Government Board, dated November 15th, 1911, came into operation. These are known as the Public Health (Tuberculosis) Regulations, 1911, and make cases of pulmonary tuberculosis occurring in the private practices of medical practitioners notifiable. Under these regulations some 270 persons were notified. 30 In the subjoined table are shown the numbers of persons, male and female, certified in the Borough under each of the three sets of regulations:— Public Health (Tuberculosis) Regulations, 1908. Public Health (Tuberculosis in Hospital) Regulations, 1911. Public Health (Tuberculosis) Regulations, 1911. Males. Females. Males. Females. Males. Females. 233 110 150 92 145 125 From the above figures it would appear that 855 persons, 528 males and 327 females, were certified as suffering from consumption during the year. In a considerable proportion of the cases, however, there were notifications under more than one of the regulations of the same person. In a number of instances the same case was certified under all three sets of regulations. When the necessary corrections were made, the actual number of persons certified during the year as suffering from consumption was found to be 703, of whom 432 were males and 271 females. The distribution of the cases notified according to age-periods and localities is shown in Table II. (Appendix). The cases certified were most numerous, in proportion to the population, in Hoxton and Wenlock Wards, where they amounted to 8.3 per 1,000 inhabitants. They were least numerous in Haggerston Ward, where the rate was 3.3 per 1,000 population. In the great majority of the cases where the patients were not inmates of public institutions in the Borough, the addresses given on the certificates were visited by the sanitary inspectors and health visitors, and, as far as practicable steps, were taken with a view to preventing the spread of infection and for securing such measures for the disinfection of dwellings and the removal of insanitary conditions, prejudicial to the health of consumptive persons, as appeared necessary. Enquiries were made as regards some 423 of the cases certified. In 249 of these the patients were males and 174 females. With respect to the males, their occupations were as follows:—various branches of the furniture trade in 22 instances, labourers 17, warehouse porters 15, hawkers and general dealers 13, schoolboys 13, printing 12, carmen 11, french polishing 10, metal working 10, boot trade 10, building trades 7, walking stick mounters and dressers 7, glass workers 5, packers 5, porters in various trades 5, clerks 5, book trade 5, tailors 4, beer and spirit trades 4, scavengers 4, furriers 3, postal service 3, wood sawyers 2, tobacco trade 2, picture frame makers 2, marble workers 2, horsekeepers 2, railway workers 2, waiters 2, commercial travellers 2, police service 2, packing case makers 2, and errand boys 2. In 9 instances no occupation could be ascertained, and in one case the patient was 31 a marine pensioner. The remainder were occupied in selling newspapers, in the tea and cocoa trade, feather working, box making, book edge gilding, copper plate printing, pianoforte tuning, fish trade, coffee shop keeping, silk spinning, butchering business, horse collar making, leather cutting, mat mending, hot water fitting, surgical pad making, electrical engineering, trunk making, fish frying, sugar boiling and marquetry cutting ; 1 was a coachman, 1 a lift man, and 1 a tram conductor. In the cases of the females, 72 of the patients were house wives, 28 were school children, 22 were employed in making various articles of wearing apparel, 9 were box makers, 5 domestic servants, 5 were employed in the printing and stationery trades, 4 were packers, 2 french polishers, 2 factory hands, 2 laundresses, and 8 were respectively a saddle stitcher, a charwoman, a card bronzer, a wire worker, a barmaid, a ward maid in a hospital, a button coverer and a waitress. With respect to the sanitary condition of the dwellings occupied by the patients, the chief points to which attention was specially directed were the amount of cubic space available, the means for securing proper ventilation, the amount of light, dryness, and the general conditions as regards cleanliness of the dwelling. As a result of the inspections made in 278 instances the dwellings were satisfactory or fairly so ; in the remaining 145 they were more or less unsatisfactory. In 160 of the cases, family histories of tuberculosis was obtained, and in 143 instances evidence more or less strong was forthcoming pointing to infection from previous cases, either at home or at the places where patients were employed. Disinfection was carried out by the Sanitary Authority in connection with 204 rooms at 178 premises, and the usual steps were taken as regards textile articles exposed to infection. In several instances, through the agency of charitable societies at work in the Borough, institutional treatment was obtained for a few of the patients, and some 7 patients were sent into sanatoria by the London Insurance Committee. The accommodation at the Shoreditch infirmary was largely used mostly by advanced cases, some 209 persons being admitted. Approximately 49 per cent. of the deaths of inhabitants of the Borough from consumption during the year occurred in this institution as compared with something over 40 per cent. for 1911. Altogether 59 per cent. of the deaths of persons belonging to Shoreditch dying from consumption took place in public institutions within or beyond the limits of the Borough. In my last annual report I referred to the subject of a tuberculosis dispensary for the Borough, and I mentioned that steps had been taken with a view to the establishment of a joint one for Shoreditch and Finsbury, but that difficulties had arisen which had resulted in a suspension of proceedings for the time being. The matter remained in abeyance for several months, but during this time the outpatient department of the Royal Hospital for Diseases of the Chest was reconstructed, special attention being given to the accommodation provided with the object of 32 establishing a tuberculosis department in connection therewith. In September the Borough Council were informed by the hospital authorities that they had established a department for the prevention of consumption, that a consulting officer and two nurses had been specially appointed for the work, that the department could undertake tuberculosis work for Shoreditch, and that the department would be under the management of a committee upon which the Shoreditch Borough Council would have due representation. The new buildings and the equipment of the department were subsequently inspected by members of the Shoreditch Borough Council. The premises provided and the arrangements made are of a most satisfactory character. There are well equipped consulting rooms with dressing rooms attached, large central waiting hall with electric light and modern heating, and the department is linked up with observation beds in the hospital and with the special sub-departments of the hospital, including X-ray, bacteriological, dental, throat and surgical. The work of the dispensary is to be diagnostic, consultative, bacteriological, X-ray and statistical, and otherwise on lines similar to those of tuberculosis dispensaries elsewhere. For the consultative work of the dispensary, two of the physicians of the hospital are to be elected annually in rotation. On October 29th. the Borough Council passed a resolution approving of the department provided by the hospital as a tuberculosis dispensary for the Borough, subject to satisfactory arrangements being made whereby the officers appointed by the dispensary shall be officers of the Borough Council under the supervision of the Medical Officer of Health for the purposes which are set forth in Articles XI. and XII. of the Public Health (Tuberculosis) Regulations, 1912. At the end of the year negotiations were in progress between the Borough Council and the hospital with a view to the settlement of a provisional scheme for a working arrangement. Meanwhile, the tuberculosis department commenced operations at the end of October, and up to the close of the year some 80 tuberculosis patients had been treated as dispensary patients. OPHTHALMIA NEONATORUM. The cases certified numbered 17, as compared with some 32 for last year. The notifications were at the rate of 4.8 per 1,000 births, as compared with 9.1 for 1911. Ten of the cases occurred in the practices of medical men and 7 in those of midwives. The cases were enquired into by the Health Visitor, and are referred to in her report (Appendix). Three of them were removed to hospital for treatment. Four other cases of inflammation of the eyes in infants came under notice as occurring in the practices of midwives, but they apparently were not considered as cases of ophthalmia neonatorum by the medical practitioners called in to examine them. The cases notified as ophthalmia neonatorum in London during the year numbered 699, the rate being 6.2 per 1,000 births. 33 CEREBRO-SPINAL FEVER. Five cases were certified, with 3 deaths. Two of the deaths were of infants under 1 year, the other being of a child aged from 1 to 5 years. Of the cases certified, in 2, the meningococcus or micro-organism causing cerebro-spinal fever was found. One of these cases recovered. In the other 3 cases the meningococcus was not found ; one turning out to be a case of tuberculous meningitis, one a case of generalised suppurative meningitis, and the other, there were grounds for believing, was not a case of cerebro-spinal fever. The cases certified in the Metropolis numbered 103, and some 4 deaths were attributed to the disease. The above disease was permanently added to the list of diseases notifiable under Section 55 of the Public Health (London) Act, 1891, by order of the London County Council, taking effect from and including March 13th, 1912. ACUTE POLIO-MYELITIS. This disease was also permanently added to the list of notifiable infectious diseases from and including March 13th, 1912, by order of the London County Council, duly approved by the Local Government Board. There were no cases certified in Shoreditch during the year. In the whole of London 136 cases were notified. GLANDERS, ANTHRAX AND HYDROPHOBIA. No cases of either of the above diseases were certified in Shoreditch during the year amongst human beings, nor do there appear to have been any in London. Eight intimations were received from the Veterinary Inspector of the London County Council as to the presence of glanders amongst horses on seven premises within the Borough, and 1 intimation as to a case of anthrax in a horse. The steps as to disinfection were taken under the supervision of the Veterinary Inspector, and the usual enquiries were made by the sanitary officers in view of the possibility of human beings becoming infected. CHOLERA. No intimations under the cholera regulations were received during the year as to persons arriving in the Borough from localties 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 c 34 were received from the head teachers of the schools they attended in accordance with the requirements of the school management code of the London County Council:— School. Enteric Fever. Small Pox. Diphtheria. Scarlet Fever. Measles. Chicken Pox. Whooping Cough. Mumps. Other Causes. Total. Bath Street .. .. 1 .. 3 .. 1 .. .. 5 BrunswickSt. (special) .. .. 1 1 .. .. 1 .. .. 3 Canal Road .. .. 3 18 132 29 26 5 33 246 Catherine Street .. .. 5 4 48 .. .. 10 8 75 Central Street .. .. 3 .. .. .. .. .. .. 3 Chatham Gardens .. .. 5 2 32 12 2 5 19 77 Coleman Street Ward .. .. .. .. 3 3 .. 2 .. 8 Columbia Road .. .. .. .. 1 .. .. .. 1 Curtain Road .. .. 7 2 62 18 28 9 70 196 Daniel Street .. .. .. .. 2 .. .. .. .. 2 Enfield Road .. .. 1 .. 1 .. .. .. 1 3 Gopsall Street .. .. 14 22 133 22 184 9 100 484 Haggerston Road .. .. 7 3 70 46 26 10 69 231 Hamond Square .. .. 6 16 62 25 49 19 113 290 Hoxton Central .. .. .. 1 .. .. .. .. .. 1 Hoxton House .. .. 5 19 52 36 33 28 70 243 Laburnum Street .. .. 30 9 55 15 17 .. 11 1.57 Maidstone Street .. .. 14 11 71 8 18 7 245 374 Napier Street .. .. 24 18 82 20 33 4 95 274 Popham Road .. .. .. .. 2 .. .. .. .. 2 Pritchards Road .. .. 1 .. 5 3 .. .. 2 11 Queen's Road .. .. 1 .. .. 1 .. .. .. 2 Queen's Head Street .. .. .. .. .. 1 .. .. .. 1 Redvers Street 2 .. 1 5 23 3 1 1 46 82 Risinghill Street .. .. 1 .. .. .. .. .. 3 4 Rotherfield Street .. .. .. .. .. .. .. 1 .. 1 St. John's Church .. .. 6 13 20 14 l .. 19 73 St. John's Road 2 .. 14 13 62 71 47 1 39 249 St. Joseph's, Gun Street .. .. .. 2 .. .. .. .. .. 2 St. Joseph's, Bunhill Bow .. .. .. .. 1 1 .. .. 1 3 St. Mark's .. .. .. .. 22 3 14 .. .. 39 St Monica's .. .. .. 1 14 .. 9 .. 5 29 St. Paul's, Broke Road .. .. 1 2 4 3 6 8 10 34 St. Peter's .. .. .. .. 1 .. .. .. 1 2 Scawfell Street .. .. 2 11 54 58 32 1 40 198 Scrutton Street .. .. 2 1 29 8 19 .. 44 1(16 Shap Street .. .. 3 6 25 6 2 .. 42 84 Shepperton Boad .. .. .. .. .. .. .. .. 1 1 Teesdale Street .. .. .. .. .. 1 .. .. .. 1 Trinity Place .. .. 3 12 71 4 8 25 23 146 Virginia Boad .. .. .. 1 1 2 .. .. .. 4 Wenlock Road .. .. 6 4 51 9 20 1 25 116 Totals 4 .. 167 197 1194 422 577 149 1133 3843 35 The numbers of children excluded during 1911 and 1910 were 3,292 and 3,293 respectively. The increase in the number for 1912 was due to the increased numbers of children excluded on account of measles and whooping cough. The exclusions for scarlet fever and also for ophthalmia, ringworm, eczema, &c., which are included under the head of " Other causes" were less numerous than in 1911. On account of the occurence of cases of measles, children under the age of 5 years who had not had the disease were ordered by the School Medical Officer to be excluded from the following schools:—Wenlock Road, St. Monica's, Shap Street, Curtain Road, Napier Street, Canal Road, St. John's Church School, Hamond Square, Laburnum Street, Catherine Street, Gopsall Street, St. John's Road, Chatham Gardens, Scrutton Street, Hoxton House, Maidstone Street, Haggerston Road, Trinity Place, Scawfell Street and Redvers Street. The exclusions commenced in June, the first being from Wenlock Road School, and with the exception of the month of August they increased in number every month until a maximum was reached in November. The numbers were as follows: June, 13; July, 20; September, 95; October, 277; November, 471; and December, 135. The exclusions during this period totalled 1,111 from 73 class rooms. In May, 125 children under 5 were excluded from the infants department, Gopsall Street School, on account of whooping cough. BACTERIOLOGICAL EXAMINATIONS. Dr. Bulloch at the London Hospital Medical School made 80 examinations in cases of suspected infectious diseases in the Borough. In 45 the examinations were for sore throats suspected of being diphtheria, in 18 of these the results were positive as to the presence of the diphtheria bacillus. In three instances Widal's tests were made in suspected cases of enteric fever ; they were all negative. In 32 instances the sputum of persons suspected to have consumption was examined with positive results as to the presence of the tubercle bacillus in 7. DISINFECTION. During 1912 disinfection was carried out by the Sanitary Authority at 1,179 premises, as compared with 1,147 in 1911, 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 24,497, as compared with 25,295 in 1911, 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 1,277 beds, 1,522 mattresses, 2,322 pillows, 855 bolsters, and 18,521 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. Included are 240 beds, 366 mattresses, 395 pillows, 140 bolsters c 2 36 and 1,897 other articles disinfected on account of vermin. It was necessary to destroy 1 bed, 4 bed ticks, and 14½ palliasses which were so torn and contaminated as to render it inadvisable to return them. These were replaced with new. In 1 instance in which a quilt sustained some damage during disinfection, compensation was paid to the owner. That was the only case in which any complaint was made on account of measures taken for disinfection. THE SHELTER. The Shelter was in use on two occasions during the year: by a man on account of vermin on February 3rd, whilst his clothing was being disinfected; and by a family of 3 persons from October 19th to 29th, on account of disinfection for typhus fever. THE PUBLIC MORTUARY. The bodies of 373 persons dying during the year were received into the Public Mortuary, as compared with 379 in 1911, 382 in 1910, 392 in 1909, 367 in 1908, 349 in 1907, 405 in 1906, 417 in 1905 and 460 in 1904. In only one instance 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 approximately 3 annually during the past 9 years. A specially constructed iron shell is provided for the reception of such bodies. The inquests numbered 294, as compared with 303 in 1911, 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 218, as compared with 226 in 1911, 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 previous years are contained in the report for 1903. With few exceptions, only the bodies of persons belonging to Shoreditch are received into the mortuary. The exceptions are in a certain number of inquest cases where persons not belonging to Shoreditch die within the Borough. WATER SUPPLY. The rainfall for the year measured at Oxford amounted to 32.796 inches. Taking the mean rainfall for 35 years, there was an excess of approximately 7 0 inches. Most rain fell during the first quarter of the year, the rainfall for that period amounting to 9 796 inches. The rainfall daring the months of July, August and September was 9.136 inches, the summer being cold and wet. The rainiest month was August when 4.866 inches fell. Least rain fell in April, the fall only amounting to 0.020 inch. The general rainfall for the Thames Valley above Teddington amounted to 35'65 inches, and for the Lee Valley 29.91 inches (Dr. Mill's Returns). 37 In accordance with Section 49 of the Public Health (London) Act, 1981, conmunications were received from the Metropolitan Water Board as to water supplies being cut off in respect to 40 premises as compared with 80 in 1911, 82 in 1910, 83 in 1909, 65 in 1908 and 113 in 1907. Of these 26 were in the New River District and 14 in the East London. The grounds for cutting the water off were as follows : on account of defective water pipes in 6 instances, premises being demolished in 12, waste on empty premises 6, on unoccupied premises 12, by request of the consumer 1, and in 3 instances for arrears in the rate. There were no complaints received as to the quality of the water supplied in the Borough, nor was there any 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 83 dwelling-houses occupied by members of more than one family. In most instances the water was supplied to one of the floors above the ground floor. In a few instances taps were provided on more than one floor. Sinks were provided as well, but, there is no statutory authority under the Act for insisting on these. It was not necessary this year to take any legal proceedings to secure effect being given to the requirements above referred to. SANITARY WORK. Intimation notices under the Public Health (London) Act, 1891, as to insanitary conditions were served in respect to 3,887 premises. In 581 instances the premises were dealt with under the supervision of Inspector Firth, in 525 under Inspector Jordan, 455 Inspector Langstone, 555 Inspector Pearson, 973 Inspector Stokes, 678 Inspector Wright, 43 Inspector Pratt and 77 under the supervision of Inspector Chapman. The two last named were newly appointed and commenced work in the Borough as inspectors at the beginning of December. In connection with the work arising out of the sanitary notices served, some 943 letters were sent to owners of property, builders, and others concerned. Some 34,266 visits of inspection were made by the sanitary inspectors during the year. The premises under inspection included dwelling houses, artisans' dwellings, houses let in lodgings, outworkers premises, factories, workshops, laundries and bakehouses under the Factory and Workshops Act, cowsheds and milk vendors premises, ice cream shops, slaughter houses, and places where food is prepared and sold. Towards the end of the year some special house to house inspections were made, and a large number of visits were made to houses brought to our notice by the school authorities as being the residences of children who had been reported as being in a verminous state. The latter are specially referred to later in this report (page 41). 38 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:— Insp. Firth. Insp. Jordan. Insp. LangBtone. Insp. Pearson , Insp. Stokes. Insp. Wright. Insp. Pratt. Insp. Chapman. Total. New drains constructed 2 5 3 3 116 27 .. .. 156 Drains re-constructed or repaired 67 41 32 59 117 30 .. .. 346 Sinks trapped and disconnected 95 36 6 46 51 45 1 .. 280 Stack pipes reinstated 130 39 60 121 120 98 .. 7 565 Eaves gutters reinstated 102 14 43 119 113 75 2 7 475 Stack pipes disconnected 83 31 1 5 23 8 .. .. 280 Accumulations of sewage removed .. 17 16 40 106 3 2 .. 184 Cesspools abolished .. 1 .. 1 .. .. .. .. 2 New water closets constructed 7 60 .. 10 130 10 1 • • 218 W.c.'s re-constructed or repaired 91 60 36 100 91 29 3 4 414 W.c.'s cleansed and white-washed 58 197 50 207 447 173 1 30 1163 W.c.'s flushing apparatus repaired 66 88 74 144 186 66 8 5 637 Obstructions in w.c.'s removed 33 20 25 49 108 36 2 1 274 Overcrowding in houses abated 52 8 18 12 48 46 .. 2 186 Damp courses in houses provided 27 .. 7 2 1 6 4 2 49 Walls pointed 78 4 14 28 10 23 .. 8 165 Roofs repaired 105 46 134 157 116 145 10 15 728 Stairs repaired 51 17 13 14 95 43 .. .. 233 Floors repaired 33 22 49 62 108 65 9 23 371 Ventilation under floors provided 17 2 9 20 100 .. 1 .. 149 Doors repaired 18 14 13 16 97 51 1 2 212 Door cills provided 40 9 1 12 .. 1 .. .. 63 Sashes repaired 13 7 31 27 96 46 .. 3 223 Houses cleansed throughout 49 54 53 79 84 135 .. 2 456 Houses cleansed in part 208 28 206 213 74 62 28 57 876 Total number of rooms cleansed 668 567 846 946 1047 1364 54 211 5703 Yards or areas lime-washed 70 146 39 135 432 179 7 25 1033 Yards paved 89 40 31 95 71 61 .. 3 390 Areas and forecourts paved 15 .. 2 6 14 1 1 .. 39 New areas constructed 10 1 .. 2 .. .. .. .. 13 Sculleries paved 6 5 5 13 .. 1 .. .. 30 Dust receptacles provided 112 38 79 74 81 57 7 12 460 Dung receptacles provided 7 .. .. .. 2 .. .. .. 9 Insanitary cisterns removed .. .. .. 1 .. 1 .. .. 2 In connection with the above 2 old brick drains were abolished, and in 91 instances nuisances and annoyance due to rats on premises were dealt with. In 230 instances water supplies were restored to premises, and in 162, leaky water pipes were repaired. In 10 instances urinals were constructed or reconstructed, and in 23 instances they were cleansed and repaired. Foul accumulations causing 39 or likely to cause nuisances were dealt with on 95 premises. Nuisances in connection with the stabling of animals were dealt with in 30 cases, and in 12 instances 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 the drains and sanitary arrangements of new buildings. The great bulk of the sanitary work carried out was in compliance 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 and for otherwise complying with the requirements of the Act in 469 instances. For non-compliance with statutory notices and for breaches of by-laws proceedings were taken before a Magistrate with the results stated below:— Premises. Result of Proceedings. Aske Street, No. 8 Fine 20/- with 2/- costs. ,, ,, ,, Fine 40/- with 2/- costs. Croker's Buildings, No. 2 Order made, with 10/6 costs. Dereliam Place, No. 17 Summons withdrawn, 10/6 costs. ,, ,, ,, ,, ,, ,, Kingsland Poad, No. 85 ,, ,, ,, New North Koad, No. 129 Summons dismissed, £3 3s. costs against Council. Shepherdess Walk, No. 98 Fine 20/- with £1 1s. costs. Wellington Place, No. 1 Order made, with 10/6 costs. ,, ,, No. 4 ,, ,, ,, ,, ,, No. 6 ,, ,, ,, Wellington Place Courtway ,, ,, ,, Windsor Terrace, No. 5 Fine 1/- without costs. Wilmer Gardens, No. 85 Summons withdrawn, 10/6 costs. ,, ,, No. 91 Order made, with 23/- costs. With respect to No. 8, Aske Street, two summonses were taken against a builder ; one under the London County Council by-laws for fixing a water closet pan without giving the prescribed notice to the Sanitary Authority before proceeding with the work, and the other under the Public Health (London) Act, 1891, for executing the work in such a manner as to be dangerous to health. The proceedings in respect of No. 2, Croker's Buildings, were for non-compliance with a statutory notice under the Public Health (London) Act, 1891, the premises being in such a state as to be a nuisance by reason of the roof, eaves guttering, and drains being defective, and the premises being generally dirty and dilapidated. The Magistrate's order was in due course complied with. 40 Two summonses were taken against the owner of No. 17, Dereham Place, one for not providing a proper dust receptacle, and the other for not complying with a statutory notice requiring the abatement of a nuisance due to the dirty condition of the premises. The notices being complied with before the cases came into Court the summonses were withdrawn. The summons as regards No. 85, Kingsland Road, was for non-compliance with a statutory notice requiring the abatement of a nuisance due to the defective condition of the roof of a workshop in rear. The necessary work having been completed before the case came on for hearing the summons was withdrawn. The summons in respect to No. 129, New North Road, was for non-compliance with a statutory notice requiring the owner to reconstruct a defective drain, which was in such a state as to be a nuisance. The defence was that the drain receiving the drainage of No. 131, next door, was a combined drain, and there being no record of its construction with the sanction of the proper authority was therefore a sewer, and as such was repairable by the Borough Council. In 1904 application was made to the Borough Council for permission to reconstruct the drain of No. 131 by the owner of that house (not the owner of No. 129), the drain from 131 joining that of No. 129. The application was granted, and the combination of the drainage of the two houses was at that date approved by the Borough Council. The Magistrate held that there being no evidence that the combination of the drains which existed prior to 1904 had been sanctioned by the proper authority, the combined drain remained a sewer vested in the Borough Council and dismissed the summons accordingly. The summons in respect to No. 98, Shepherdess Walk, was taken against a builder for failing to comply with the requirements of the London County Council by-laws as to the construction of water-closets. He neglected to give the prescribed notice to the Sanitary Authority of his intention to construct one at that address. The proceedings in respect to the premises at Wellington Place were taken against the owner for not complying with the requirements of statutory notices as to the abatement of nuisances due to defective water-closets and defective roofs, the premises also being generally dirty and dilapidated. With respect to No. 5, Windsor Terrace, proceedings were taken against the person who was responsible for a breach of the London County Council by-laws through causing a rainwater pipe to be constructed as to receive the discharge from a sink waste pipe. The proceedings in respect of No. 85, Wilmer Gardens were for non-compliance with a statutory notice requiring the abatement of a nuisance due to the watercloset being obstructed and otherwise defective. The work having been carried out for the abatement of the nuisance before the case came on for hearing, the summons was withdrawn. 41 With regard to No. 91, Wilmer Gardens, the roof was defective and the premises generally dilapidated. SMOKE NUISANCES. During the year some 9 complaints were received from the London County Council relating to the emission of black smoke from shafts belonging to factories and workplaces at 11 premises. In all cases the necessary steps were taken for obtaining the abatement of the nuisances. Sixteen intimation notices were served, but it was not necessary to bring any of the cases under the notice of the Health Committee. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 452 as compared with 275 in 1911, 197 in 1910, 99 in 1909, 127 in 1908, 111 in 1907 and 103 in 1906. The rooms dealt with numbered 910 as compared with 518 in 1911, 386 in 1910 and 187 in 1909. The usual steps were taken with the rooms, the walls being stripped, stopped, and cleansed where necessary, sprayed with lysol or fumigated with sulphur fumes as required. Bedding and textile articles were removed and disinfected by the officers of the Borough Council. The number of articles disinfected are stated on page 35. In a large proportion of the cases, the steps taken were the result of information received from the school authorities. During the year the homes of 1,249 children, namely 613 boys and 636 girls were notified by the School Medical Officer, 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, bedding and clothing if necessary, the children themselves having been cleansed at the County Council Cleansing Stations in the neighbourhood of the Borough. It may be mentioned that in a number of the cases the same children were notified more than once; in some instances several times. In a number of cases also, intimations were received to the effect that statutory notices under section 122 of the Children Act, 1908, had been served by the school authorities upon the parents, requiring that steps should be taken to cleanse the persons of the children within 24 hours. There were also several intimations that police court proceedings were being instituted against parents who had failed to keep the children in a proper state of cleanliness. In all cases the houses were visited by the sanitary officers, and the following summarises the results of the inspections made:— In 649 the rooms were clean, or fairly so; in 72 they were dirty; in 80 they were buggy, and in 131 they were both dirty and infested with bugs. In 598 the bedding was clean, or fairly so ; in 210 it was dirty ; in 42 bugs were present; 42 in 80 it was dirty and buggy, and in 106 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 also otherwise verminous. In 3 instances clothing worn by the children was noticed as showing evidence of lice*. In 17 instances mothers attributed the alleged presence of lice to the fact that the clothing of the children had been bought second-hand. In 351 instances the homes were markedly infested with fleas. In 37 instances overcrowding was observed, and in 83 instances the Sanitary Inspectors remarked on the evidences of extreme poverty which were noticeable. It is necessary again to refer to the numbers of erroneous addresses received : in 74 instances the children named were not known at the addresses stated, in 40 instances they had left the addresses, in 24 there were no such addresses in the Borough, and in 11 instances the addresses given were those of unoccupied houses. In 30 instances there was difficulty in obtaining admission for the purpose of making the necessary inspection, and in several instances multiple visits had to be made to the same address before the inspectors were allowed to enter. In a few cases intimations had to be given that application would be made to a Magistrate for an order to enter the premises before an inspection was allowed. Without doubt, in a number of cases, admission was denied until the homes had been cleansed, and in some 76 instances there was evidence of recent cleansing, probably in most instances in preparation for the inspectors' visits. It may be noted that evidence of lice was found in the bedding at a little over 11 per cent. of the homes visited. As the results of the visits made a large amount of cleansing was done in the homes, and a number of insanitary conditions were dealt with. Altogether some 350 notices were served. 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 allow 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 occupied:— Bracklyn Street, No. 26. Crondall Street, Nos. 22, 24, 26, 28, 30, 34 & 36. Dereham Place, No. 18. Eagle Wharf Road, No. 7. Gorsuch Street, Nos. 10 and 16. Grange Street, No. 71. Goldsmith Row, No. 96. Hows Street, No. 39. Kingsland Road, No. 192. Mill Row, Nos. 60 and 67. Reeves Place, No. 8. Staff Street, No. 13. Welch Street, No. 15. Wimborne Street, No. 46. *It should be noted that the parsons and clothing of the children are not examined by the Sanitary Officers. This examination is carried out by the School Authorities. 43 The house in Bracklyn Street, which contains 6 rooms, was generally in a dilapidated state, the roof and eaves gutters also being defective. It was closed by the owner on receipt of a statutory notice under the Public Health (London) Act, 1891, with a view to the necessary work being carried out. The work required was done and the house reoccupied. The houses in Crondall Street, each containing 8 rooms, were generally in a dirty, dilapidated and verminous condition, some of the brickwork was defective, the roofs were in a bad state, and the yard paving more or less required attention. Sanitary notices were served by Inspector Stokes, and the houses were closed by the owner. They remained closed at the end of the year. The house in Dereham Place, containing 6 rooms, was in a dirty and dilapidated state, and was closed by the owner upon the service of a statutory notice under the Public Health (London) Act, 1891. It was subsequently dealt with under the supervision of Inspector Jordan and reoccupied. The house in Eagle Wharf Road, containing 8 rooms, was in a dirty, dilapidated, and verminous condition. It was closed by the owner on receipt of a statutory notice under the Public Health (London) Act, 1891, to enable it to be dealt with in a thorough and efficient manner. The house was reoccupied after being dealt with. The houses in Gorsuch Street, each containing 6 rooms, were closed by the owners upon receipt of sanitary notices from Inspector Jordan. They were in a dirty, dilapidated and verminous condition. They were reoccupied after being dealt with. The house in Grange [Street, containing 6 rooms, was in a dilapidated state, and was closed by the owner upon the service of a sanitary notice by Inspector Langstone. Subsequently the work was carried out and the house reoccupied. The house in Goldsmith Row, containing 6 rooms, was generally dilapidated and in a dangerous condition owing to the state of the brickwork. The drains and sanitary arrangements were also defective. The house was closed upon the service of a statutory notice under the Public Health (London) Act, 1891, with a view to its demolition. It remained closed at the end of the year. The house in Hows Street, containing 7 rooms, was closed by the owner upon receipt of a statutory notice under the Public Health (London) Act, 1891, the roof being defective and the premises generally dirty, dilapidated, and damp. The house in Kingsland Road, containing 8 rooms, was without a water supply, and was closed by the owner on receipt of a sanitary notice from Inspector Pearson. The house was subsequently reoccupied, the water being restored. 44 No. 67, Mill Row, a 4-roomed house, was in a dilapidated state, and the watercloset and eaves guttering were defective. The house was closed by the owner upon receipt of a sanitary notice from Inspector Pearson. No. 60, Mill Row, also containing 4 rooms, was generally dirty and dilapidated, the roof was defective and leaky, and the drains also required attention. It was closed by the owner upon receipt of a statutory notice under the Public Health (London) Act, 1891. Both the houses in Mill Row were dealt with and subsequently reoccupied. The house in Reeves Place, containing 5 rooms, was generally dirty and dilapidated, and the water supply was unsatisfactory. It was closed by the owner upon receipt of a statutory notice, and subsequently dealt with under the supervision of Inspector Pearson and reoccupied. No. 13, Staff Street, containing 2 rooms, was overcrowded, and there were also a number of minor sanitary defects; the owner closed the house on receipt of a sanitary notice from Inspector Stokes. It was subsequently dealt with and reoccupied. The house in Welsh Street, containing 4 rooms, was closed by the owners on being served with a statutory notice, the premises being dirty and dilapidated. It was dealt with under the supervision of Inspector Stokes and subsequently reoccupied. The house in Wimbourne Street was closed by the owner upon the service of a statutory notice under the Public Health (London) Act, 1891, the premises being generally dirty and dilapidated. It was dealt with under the supervision of Inspector Wright and re-occupied. 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:— Axe Place, No. 12, a four-roomed cottage. It was closed and demolished for the erection of a place of amusement on the site. Browns Buildings, Nos. 1, 2, 3, 4, 5, 6, 7 and 8, three-roomed cottages. Closed for demolition. Clifton Street, No. 16, an eight-roomed house. Closed for demolition. 45 Dysart Street, Nos. 1, 2, 3, 4, 5 and 6, eight-roomed houses, demolished in consequence of notices from the District Surveyor. Site has been cleared for erection of warehouses. Earl Street, No. 32, an eight-roomed house, was closed and demolished to make way for business premises. Westmoreland Place, No. 16, an eight-roomed house, was demolished for the erection of business premises. Wilson Street, No. 68, a four-roomed cottage, was closed and demolished to make way for business premises. 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 :— Barretts Buildings, Nos. 1, 3, 6 and 7.—These two-roomed cottages were inspected by order of the Health Committee on January 2nd, when it was found that the roofs were defective, there was evidence of dampness, no proper ventilation under the floors, and the premises were generally dilapidated, dirty and verminous. Intimations as to their insanitary state were sent to the owner, who proceeded to carry out the works necessary to comply with the requirements to render the houses fit for habitation. No. 1 was closed to enable the work to be done in an efficient manner. The results were reported to the Health Committee, and no further action was required. Byngs Buildings, Nos. 2, 3, 4, 5, 6, 8 and 9.—These two-roomed cottages were inspected by order of the Health Committee on January 2nd, when it was found that the roofs generally were defective, there was no proper through ventilation under the floors, and the premises were more or less dilapidated and dirty. Intimations as to the conditions found were sent to the owner, who proceeded to deal with them in order to render them habitable. Nos. 6, 8 and 9 were closed to enable the work required to be properly carried out. The results were reported to the Health Committee, and no further action was required. Alfred Place, Nos. 2, 3, 4, 5, 6, 7, 8, 9 and 10.—The first 6 of these houses each contains 4 rooms and a scullery, the last three have had back additions constructed and contain 8 rooms each. They were inspected by order of the Health Committee on April 29th, and their general condition was as follows: all more or less dilapidated, dirty and verminous, no proper ventilation under floors, in some instances there was overcrowding, insufficient light as regards back additions of Nos. 8 and 9, 45 and the drains were defective. Intimations as to their condition were sent to the owners, who proceeded to take steps to comply with the requirements to render the houses habitable. Progress was, however, slow, and the Health Committee visited and inspected the houses on October 8th, after which more active steps were taken. By the end of the year most of the work required had been done. Nos. 2, 6, 7 and 9 were closed to facilitate the execution of the work. The steps with respect to Nos. 8 and 9 were still under the consideration of the Committee at the end of the year. 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 20 (2) The number of houses considered unfit for habitation — (3) Representations made to the Local Authority with a view to Closing Orders — (4) Number of Closing Orders made — (5) The number of dwelling-houses, the defects of which were remedied without Closing Orders 18 (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 have already been mentioned. Since the Act came into operation some 60 houses have been inspected in accordance with its provisions by order of the Health Committee, with the following results: 13 have been represented as unfit for habitation, closed in consequence, and demolished without demolition orders; 5 others were closed without representations being made, and of these 2 have been demolished and one has ceased to be used as a dwelling house; 42 have been dealt with to the satisfaction of the Sanitary Authority, 9 of them having been closed to facilitate the work required to render the houses fit for habitation, and two are still subjudice. ARTISANS' DWELLINGS. The artisans' dwellings in the Borough were under observation throughout the year, and their sanitary condition may be stated as being generally satisfactory. As in previous years they have been classed as A and B; A including those occupied by persons in comfortable circumstances, and B those occupied by very poor persons. During the year a block of dwellings with eight entrances and containing 48 tenements, in Haberdasher Street, constructed for the Haberdashers' Company, came into occupation. They are situate on the south side of the street at the Pitfield Street end. Each of the dwellings possesses its proper w.c. accommodation, water supply and bath, and is fitted with all modern conveniences. They 47 have been erected on the sites of houses which were occupied by persons of the working class, and are a decided improvement in the neighbourhood. As dwellings they are in every respect most satisfactory. The numbers of tenements, rooms and persons in the artisans' dwellings in the Borough, estimated for 1912, are contained in the subjoined table :— N umber oi blocks. Number of tenements. Number of rooms. Number of persons. 43 1884 4595 6230 Class B 15 379 919 1750 Total for the whole 58 2263 5514 7980 A decrease was noticeable in the number of unoccupied tenements during the year. Taking the figures in the above table, the number of rooms per tenement averages 2.4 for both classes of dwellings, but the number of persons per room for the Class A is approximately 1.3, as compared with 1.9 for Class B, which may be taken as an indication of the greater amount of crowding in the Class B as compared with the Class A dwellings. The births registered during the year, and the birth-rates in the dwellings as a whole, and the two classes into which they have been divided, are shown below :— The whole of the Dwellings. Class A. Class B. Number. Eate per 1,000 Inhabitants. Number. Eate per 1,000 Inhabitants. Number. Eate per 1,003 Inhabitants. 275 34'4 184 29-5 91 52 The number of births was 70 more than in 1911. The proportion of deaths attributed to prematurity was at the rate of 7.2 per 1,000 births as compared with 24.4 in 1911, 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 10.8 per 1,000 births, whilst in Class B they were nil. For the whole Borough the deaths from prematurity amounted to 21.5 per 1,000 births. The infantile mortality for the whole of the dwellings was 84 per 1,000 births as compared with 131 in 1911, 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 76 as compared 48 with 125 in 1911, 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 99, as compared with 147 in 1911, 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 :or the dwellings and the corresponding death-rates for the whole Borough, so that they may be compared :— Cause of Death. The whole of the Dwellings. Class A. Class B. The Borough. Number of deaths. Rate per 1,000 inhabitants. Number of Deaths. Hate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants Kate per 1,000 inhabitants. All causes 106 133 73 11.7 33 18.8 18.3 Principal Zymotic diseases 14 1.7 11 1.7 3 1.7 2.1 All forms of Tuberculosis 16 2.0 13 2.1 3 1.7 2.6 Phthisis 13 1.6 10 1.6 3 1.7 1.9 Bronchitis 7 0.9 5 0.8 2 1.1 1.6 Pneumonia 10 1.3 5 0.8 6 2.8 1.9 The deaths of residents of the dwellings in public institutions numbered 51, being 32 for the Class A and 19 for the Class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 48.1, being 43.8 for Class A and 57.5 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 38, of which 28 were in the Class A dwellings and 10 in the Class B. The attack-rates per 1,000 population were 4.7 for the whole of the dwellings, 44 for Class A, and 5.7 for Class B, as compared with 4.2 for the whole Borough. The cases included 1 of puerperal fever, 17 of scarlet fever, 7 of diphtheria and 13 of erysipelas. The number of cases and the attack-rates per 1,000 inhabitants are set out below :— Scarlet Fever. Diphtheria. Puerperal Fever. Erysipelas. Cases. Rate. Cases. Rate. Cases Rate. Cases. Rate. Class A 13 20 6 0.9 9 1.4 Class B 4 2.3 1 0.5 1 0.5 4 2.3 The whole of the dwellings 17 2.1 7 0.9 1 0.1 13 1.6 49 For the Borough as a whole, the attack.rates for the above diseases were as follows : 1.3 for scarlet fever, 1.2 for diphtheria, 0.07 for puerperal fever and 1.3 for erysipelas. HOUSES LET IN LODGINGS. During the year 6 houses let in lodgings or occupied by members of more than one family were placed on the register, namely, Nos. 53, 55, 57, 59, 61 and 63, Fanshaw Street. The number on the register at the end of the year was 272. Sanitary notices were served in connection with 95 and statutory notices in 53 instances. During the year 379 visits of inspection were made to houses registered under the by.laws. The by.laws as to houses let in lodgings which were made in 1894 and 1905 were repealed by by.laws which were allowed by the Local Government Board on October 22nd of the year under consideration. The new by.laws differ from the old ones chiefly in the interpretation of terms and in containing no exemption Clause. CUSTOMS AND INLAND REVENUE ACTS. No applications for certificates under the above Acts as to the sanitary fitness of dwellings for the purpose of obtaining exemption from payments of inhabited house duty were received during the year. SLAUGHTER HOUSES. The licensed slaughter houses in the Borough at the end of the year numbered 5 as compared with 6 in 1911, 6 in 1910, 7 in 1909, 7 in 1908, 8 in 1907, 9 in 1906 and 12 in 1905. The slaughter house premises, at 4 Haggerston Road, when visited in October were found unoccupied. The slaughter.houses were inspected from time to time during the year, and their general sanitary conditions may be reported as being satisfactory. COWHOUSES. The number of cowhouses at the end of the year was 7 ; there has been no alteration in their number during the past nine years, but the number of cows kept has been gradually dwindling. The cowhouses afford accommodation for about 100 cows. The number of cows kept, however, was found at an inspection made in October, to be 37 only. The numbers for previous years were 41 in 1911. 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. d 50 The number of dairymen and milk purveyors on the register at the end of the year was 291, as compared with 292 in 1911, 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 16 and commenced at 15 premises, and in 33 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 3,157 visits were made in connection with them. In 14 instances sanitary notices were served ; in 6 for general cleansing. With regard to the others, the matters requiring attention were the absence of water supply, an accumulation of rubbish, absence of a dust receptacle, a defective w.c., a defective roof, a defective dust receptacle and yard paving, a nuisance through the presence of rats, and a defectively drained area. In all cases the necessary steps were taken to comply with the notices. One case of scarlet fever occurred in connection with a milk vendor's premises, and the usual measures were taken in connection therewith. OFFENSIVE BUSINESS. The tripe boiling establishment in Haggerston Road was under observation during the year. There were no complaints in connection with it. RAG FLOCK ACT, 1911. This Act came into operation on July 1st, 1912, and prohibits the sale and use for the purpose of the manufacture of certain articles, of unclean flock manufactured from rags. The standard of cleanliness is prescribed in regulations made by the Local Government Board. The amount of soluble chlorine in the form of chlorides removed by thorough washing with distilled water at a temperature not exceeding 25 degrees Centigrade from not less than 40 grammes of a well mixed sample of the flock must not exceed 30 parts of chlorine in 100,000 parts of the flock. Any person contravening this Act is liable on summary conviction to a fine not exceeding, in the case of a first offence, ten pounds, or in the case of a second or subsequent offence, fifty pounds. If a person charged with an offence under the Act can prove that he purchased the flock under a warranty from a person in the United Kingdom that it complied with the prescribed standard of cleanliness, and that he took reasonable steps to ascertain the accuracy of the warranty, he may, have the person who gave the warranty brought before the Court, and that person may be summarily convicted of the offence and also be liable to pay any costs incidental to the proceedings in the discretion of the Court. Where a person is charged with having flock in his possession, the some is deemed to be intended for sale or use in the manufacture of articles mentioned in the Act unless the contrary is proved. 51 It is the duty of the Sanitary Authority and their officers to enforce the provisions of the Act within their district, and if so authorised by the Sanitary Authoi'ity, the officers are to institute and carry on any proceedings which the Sanitary Authority is authorised to institute 2nd carry on under the Act, and they are empowered to enter on premises, examine and take samples of flock for analysis. The occupier of the premises may require the officer taking the sample to divide it into two parts, and to mark, seal and deliver to him one part. The expenses under the Act are to be defrayed, in the case of a Metropolitan Borough Council, as part of the expenses incurred in the execution of the Public Health (London) Act, 1891, and all fines imposed in any proceedings instituted by the Sanitary Authority under the Act are to be paid to the Sanitary Authority and carried to the credit of the fund out of which the expenses under the Act are defrayed. The Sanitary Inspectors having been duly authorised by the Borough Council and the necessary arrangements made with the Public Analyst of the Borough, the first samples under the Act were taken in October, and down to the end of the year 32 samples were obtained. Of these, in 11, or just over 34 per cent., the amounts of soluble chlorine were found by the analyst to exceed the standard. In 5 of the samples the amounts of soluble chlorine were found to vary from 5 to 12 times the standard amount, 1 sample containing as much as 352.5 parts per 100,000, and another 379.6 parts. In 10 instances proceedings were taken with the following results :—in 1 case the person in possession of the flock was fined £1 with £2 2s. costs, in another 5s. with 2s. costs, and in a third the summons was withdrawn ; in 4 cases the summonses were dismissed against the persons who possessed the flock, and proceedings were taken against persons giving warranties, who were convicted and fined in 3 instances, £2 with 2 guineas costs, and in the fourth, £1 with 2 guineas costs ; in 3 instances the summonses were dismissed, in 2 cases with £1 Is. costs against the Council. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1912 was, 1,143, 170 having been placed on and 163 taken off during the year. The numbers for previous years were : 1,136 in 1911, 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 2,778 visits of inspection were made in connection with workshops, and 384 to factories. Seven communications were received from the Factory Inspector relative to the establishment of 80 new workshops in the Borough. On inspection 66 were found D 2 52 to be in a satisfactory sanitary condition, and 1 was not in occupation at the time when visited. The remainder were all more or less unsatisfactory from a sanitary point of view, and some 13 notices were served. From the Factory Inspector 32 written intimations were received relating to insanitary conditions and infringements of the law as to public health in connection with 60 workshops and 19 factories. The chief insanitary conditions to which the Factory Inspector directed attention were : dirty conditions of walls and ceilings in 42 instances, defective and insufficient water closet accommodation in 28, want of proper separate accommodation for the sexes in 5, absence of sanitary accommodation in 7, overcrowding in 2, want of proper ventilation in 1, dampness of walls in 1, and in 2 instances accumulation of rubbish. Including those brought under our notice by the Factory Inspector, 300 workshops were dealt with and 278 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 3 Drains relaid or repaired 13 Stack pipes disconnected 7 Stack pipes reinstated 19 Eaves gutters reinstated 10 Sink waste pipes disconnected 12 Yards paved 13 Areas 2 Door sills provided 6 Water-closets reconstructed 29 Water-closets cleansed and lime- washed 171 Obstructions removed from water-closets 35 Urinals repaired and cleaned 2 „ newly constructed 1 New water-closets constructed 8 Water-closets' flushing apparatus repaired 79 Water supply laid on or restored 29 Leaking water-pipes repaired 8 Rooms cleansed and whitewashed 198 Yards „ „ 87 Areas „ „ 8 Roofs repaired 49 Floors „ 14 Stairs „ 4 Doors „ 7 Sashes „ 3 Dust receptacles provided 9 Foul accumulations removed 2 It may also be added that in 18 instances nuisances owing to flooding with sewage had to be dealt with, and in 3 cases overcrowding. In 24 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. 53 The number of factories under observation during the year was 24, and in connection with them some 24 sanitary notices were served. The works carried out to comply with these notices included the construction, reconstruction or repair of drains in 7 instances, the disconnection of stackpipes in 5, of sink waste pipes in 8, the repair of water-closets in 17, of the flushing apparatus in 4, the removal of obstructions from water-closets in 2, the construction of new water-closets in 9 instances, besides a number of other items connected with cleansing and repairing. In 2 instances flooding with sewage required dealing with. 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 105 lists of out workers were received from employers in the Borough, 53 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 1,830 out-workers, of whom 1,296 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the sanitary authoities of the districts to which they belonged. Communications were received from various sanitary authorities relating to some 2,385 out-workers, and of these 82 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 out-workers received from the sanitary authorities referred to during 1912. The number of out-workers brought to our notice during 1912 was 4,215, as compared with 4,325 in 1911, 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 1912, some 2,837 were residents in Shoreditch, as compared with 2,977 in 1911, 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 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 2,645 visits of inspection were made to places where homework was being carried on, and sanitary notices were served in 95 instances. The work carried out to comply with these notices included the disconnection of sink waste pipes in 1 instance, the reinstatement of stack pipes in 3, of eaves gutters in 4 ; various works in connection with the water-closet accommodation in 28, with the water supply in 1 ; the cleansing of 158 rooms, 34 yards, 2 areas, and 39 water-closets ; the repair of roofs in 21, floors in 15, stairs in 10, sashes in 13 54 and doors in 7 instances ; the provision of 16 dust receptacles besides other work. In 1 instance overcrowding was found, in 25 cases the rooms required to be dealt with on account of vermin, in 5 instances drains were relaid, in 3 repaired, and in 3 instances accumulations of sewage were dealt with. No cases of notifiable infectious disease occurred at out-workers' premises during the year. In connection with the lists of out-workers it was necessary to write to employers in 35 instances on account of delay in sending in the lists relating 1o out-workers employed in making wearing apparel, in 26 relating to paper bag and box making out-workers, in 3 relating to artificial flower making, in 2 instances as to employers in the fur trade, and in 1 in respect to cabinet making. There was no necessity for further action as the lists were forthcoming when the letters were sent. BAKEHOUSES. The bakehouses on the register at the end of the year numbered 75, of which 43 are below and 32 above ground. Six, namely, those at 88, Bridport Place ; 82, East Road ; 189, High Street ; 249, Old Street ; 30, Pitfield Street ; and 55, Hackney Road, were not in use as bakehouses at the end of the year. At 5 of the bakehouses mechanical power is used, so that they are factories within the meaning of the Factory and Workshop Acts. Generally the sanitary condition of the bakehouses may be stated to be satisfactory. In 23 instances limewashing was required, in 3 there was some dampness which needed attention, in 2 dust receptacles were required, and in 1 case a urinal required cleansing. On the whole the sanitary defects found were of a minor character. The necessary sanitary notices were served and complied with. In 1 instance a bakehouse was used as a sleeping place contrary to the law ; the case was reported to and dealt with by the Health Committee. Otherwise 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 during 1912 : Inspector Firth had 12 under observation, 6 of which required more or less cleansing. Inspector Jordan had 16, in 7 of which sanitary notices were necessary, chiefly for cleansing and repairs. Inspector Langstone visited 23, and sanitary notices were served in 3 instances, in 1 for cleansing, 1 for a defect in the W.C., and 1 for absence of a proper dust receptacle. Inspector Pearson had 12 and notices were served in respect to 4, of which 2 were for cleansing, 1 for defective yard paving, and 1 for absence of a proper dust receptacle. Inspector Stokes had 16 under inspection ; he served 1 sanitary notice for general cleansing. Inspector Wright had 14 under observation and served 3 sanitary notices, 2 for cleansing and 1 for overcrowding. 55 Altogether 93 premises whereon ice cream was made or sold were under inspection during the year. In 69 of them the general sanitary condition was satisfactory. In 24 instances sanitary notices were served, mostly for cleansing. COOKSHOPS, COFFEE HOUSES AND EATING HOUSES. Inspector Firth had 13 under inspection, in 4 of which more or less cleansing was required, and in 1 case it was necessary for the drains to be reconstructed. Inspector Jordan had 85 under observation and also the kitchens of 17 public houses where dinners are provided. In 42 instances sanitary notices were served ; in 2 instances flushing cisterns were defective, in 11 dust receptacles were required, in 1 a roof required repairing, in 2 sinks needed to be properly trapped, in 1 the drain was obstructed, in 5 yard paving required attention, in 2 floors were defective, and 6 W.C.'s, 23 kitchens, 2 sculleries, 2 staircases, and in 1 instance the house throughout required cleansing. Inspector Langstone had 12 under inspection ; in 1 instance a proper dust receptacle was required. Inspector Pearson had 13, and in 2 instances notices were necessary for cleansing, in 1 for defective eaves guttering, and in 1 for the provision of a proper dust receptacle. Inspector Stokes had 36 under inspection, in connection with which 2 sanitary notices were served, 1 for defective drains and general cleansing and the other for cleansing. Inspector Wright had 18 under observation and 7 notices were served for cleansing ; in one of these there were also defective drains, and in another there was a nuisance due to the presence of rats. Altogether 194 cookshops, coffee houses, eating houses and kitchens of public houses were under observation during the year, as compared with 202 in 1911, 198 in 1910, 204 in 1909, 197 in 1908, 188 in 1907, 178 in 1906 and 182 in 1905. In 60 instances sanitary notices were served. FRIED FISH SHOPS. On Inspector Firth's district 7 were under inspection and 3 sanitary notices were served, mainly for cleansing. On Inspector Jordan's district 8 were inspected, and 1 sanitary notice was served on account of defective yard paving. On Inspector Langstone's district 7 were under observation, and 1 sanitary notice was necessary for the abatement of nuisance due to rats. Inspector Pearson had 18 under inspection, and 6 sanitary notices were required for cleansing. Inspector Stokes had 14, and 7 sanitary notices were necessary, chiefly for cleansing. Inspector Wright had 9, and in connection with these 5 sanitary notices were served for cleansing. Altogether 63 fried fish shops were under inspection during the year, and some 23 sanitary notices were required, mainly for cleansing. 56 STREET MARKETS AND FOOD. The usual supervision was exercised by the sanitary officers in the street markets, and as regards food exposed for sale in the Borough, and inspectors were on duty 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:— Skate, 10 stone ; dog fish, 6 ; eels, 18 lbs. ; mackerel, 28 lbs. ; conger eels, 6 ; salmon, 7 tins ; whelks, 1 cwt. 2 qrs. ; herrings, 500 ; poultry, 6 baskets ; rabbits, about 2 cwt. ; offal, 2 cwt. ; ox liver, 2 lbs. ; ox tails, 3 ; lemons, 102 ; oranges, 4,621 ; tomatoes, 84 boxes and 56 lbs. ; other fruit, 1 cwt. 10 lbs. ; and cabbages, 16 cwts. 2 qrs. The subjoined proceedings were taken :— A hawker, of No. 19, Hare Walk, was summoned for not removing a barrow from the carriageway when called upon to do so by Inspector Pearson. The summons was withdrawn on payment of 2s. costs. A hawker, of No. 10, Louisa Street, was fined 40s. or 3 days imprisonment for exposing 280 rotten oranges for sale, which were seized by Inspector Stokes in Mundy Street. A hawker, of No. 75, Crondall Street, was fined £3 or 21 days imprisonment for exposing for sale 405 rotten oranges in Crooked Billet Yard, which were seized by Inspector Stokes. A hawker, of 38 Hanbury Street, Stepney, was fined 13s., with 5s. costs, or 5 days imprisonment, for exposing for sale a quantity of rotten tomatoes, which were seized by Inspector Wright in Hoxton. A hawker, of 26, Brunswick Street, was fined 5s. with 5s. costs for not removing a barrow when warned to do so by Inspector Wright in Hoxton Street. A hawker, of 47, Grifford Street, was fined 5s. with 5s. costs for not removing a barrow in Hoxton Street when warned to do so by Inspector Wright. The occupier of No. 67, Nile Street, was fined 20s. with 2s. costs for not removing a stall from the footway when required to do so by Inspector Pearson. The offences as regards the non-removal of barrows and stalls occurred on Sunday mornings whilst the inspectors were engaged in clearing the street markets. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 584 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 1912. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of succeseful Prosecutions. Fines aad Costs. Amount paid to Analyst for samples analysed. £ s. d. £ s. d. 1st. 139 26 17.9% 13 — 13 13 51 11 0 69 10 0 2nd. 146 31 21.2% 9 1 9 8 34 14 0 73 0 c 3rd. 116 24 20.6% 15 — 15 13 56 3 0 58 0 0 4th. 183 19 10.32% 11 — 11 11 30 3 0 81 0 0 Total for Year 584 100 17.1% 48 1 48 45 172 11 0 281 10 0 The samples taken included 35G of milk, 149 of butter, 6 coffee, 9 margarine, 4 lard, 2 pepper, 1 separated milk, 9 sausage (4 beef, 2 pork and 3 German), 9 vinegar, 4 cocoa, 5 jam, 6 rum, 8 jelly, 2 jelly cuttings, 3 honey, 2 ground ginger, 2 self raising flour, 2 salmon, and 1 each of arrowroot, baking powder, whiskey, beef dripping and rice. Of the samples of milk, 80 or 22.2 per cent, were found to be below the standard fixed by the Board of Agriculture, as compared with 34.2 in 1911, 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 1912, therefore, were somewhat below the average. It is, however, to be mentioned that 6 of the samples were only below standard to a very slight extent, and the Public Analyst noted them as being possibly genuine. If these be deducted the percentage of adulteration is reduced to 20-8. 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 62 19 30.6 2nd. 93 22 23.6 3rd. 69 20 28.9 4th. 132 19 14.4 58 In 36 of the samples water was certified to have been added; in 14 the amount was more and in 22 it was less than 5 per cent., taking the standard of the Board of Agriculture. In 34 the samples showed deficiencies in milk fat; in 14 the deficiency was more, and in 20 it was less than 5 per cent. In 4 instances both fat had been abstracted and water added. Four of the samples contained traces of artificial colouring matter. None showed the presence of Formic Aldehyde. Legal proceedings were instituted in 31 or 38.7 per cent, of the cases in which the samples of milk were below standard, and in 29 of these convictions were obtained. In one instance the summons was dismissed, a warranty being proved, and in one case the defendant was ordered to pay 2s., the cost of the summons. 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 five 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 61, as compared with 65 in 1911, 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 £77 10s., which is equivalent to about 6.9 per cent, of the full amount of the penalties to which the defendants were liable as compared with 6'6 per cent, in 1911, 4.4 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 £109 7s. 6d., the average amount paid by the defendants on conviction was £3 15s. 5d., as compared with £2 8s. 3d. in 1911, £1 lis. 6d. in 1910, £12 6s. 4d. in 1909, £3 Is. 4d. in 1908, £1 13s. 7d. in 1907, £2 9s. 6d. in 1906, £2 19s. 3d. in 1905, £2 6s. 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 6.7 per cent, were not genuine, as compared with 7.9 per cent, in 1911, 6.9 in 1910, 9.5 in 1909, 12.2 in 1908, 6-3 in 1907, 11 in 1906, and 14 in 1905. The numbers of samples and the percentages of those found adulterated during the four quarters of the year are as shown in the subjoined table Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st. 51 5 9.8% 2nd. 31 .. 3rd. 30 3 10% 4th. 37 2 5.4% 59 Of the samples sold as butter which were not genuine, 3 were samples of margarine, 2 contained foreign fats in large amounts and were probably mixtures of butter and margarine, and 5 contained water in excess of the 16 per cent, standard. Prosecutions were instituted in 6 instances, and in all of them the defendants were convicted. As regards those in which proceedings were not taken, in 2 instances there were small amounts of water in excess of the standard, not sufficient to justify prosecutions, in 1 case the defendant absconded and could not be traced, and in 1 case the Magistrate refused to grant a summons as he was of opinion that the fact of the sample containing 17 per cent, of water instead of the standard 16, which is equivalent to an excess of nearly 6 per cent., was not sufficient to justify a summons. The penalties inflicted amounted to £22, or approximately 85 per cent, of the maximum penalties to which the defendants were liable, as compared with 23 in 1911, 7'9 in 1910, 9*4 in 1909, 163 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 £7 8s. 6d., the amounts defendants were ordered to pay averaged £4 18s. Id., as compared with £8 Is. lOd. in 1911, £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 Is. in 1904, £4 10s. in 1903 and £4 10s. in 1902. Eight samples of margarine were taken, the samples being sold in wrappers not bearing the word " Margarine " legibly stamped thereon as required by the Margarine Act. Proceedings were taken and convictions obtained in 7 of the cases. In 1, proceedings were not advised. The fines amounted to £7 and £4 14s. costs were allowed the Council. The fines under the Margarine Act amounted to a little over 1 per cent, of the maximum penalties to which the defendants were liable. Including costs, the amounts paid by defendants averaged £1 13s. 5d. as compared with £1 16s. Id. in 1911, 15s. in 1910, £1 12s. 6d. in 1909 and £1 4s. 6d. in 1908. Of 6 samples purchased as coffee, 1 was found to be a mixture of coffee and chicory. No proceedings were, however, deemed advisable. One of the samples of pork sausage contained 0 52 per cent, or 36'4 grains per pound of boric acid as an added preservative. This amount being excessive, proceedings were taken, and the defendant was fined 10s., with £1 3s. costs allowed the Council. One of the samples of beef and 2 of the samples of German sausage contained small amounts of boric acid, in neither case exceeding 9 grains per pound. Five of the samples of vinegar contained excess of water varying from 3 to 28 per cent, calculated on the basis of 4 grammes of acetic acid per 100 cubic centimetres as the minimum for genuine vinegar. It was, however, not thought advisable to take proceedings in any of the cases. 60 Two of the samples of rum contained water in excess, in 1 case to the extent of 86 per cent. No proceedings were taken as it was found that notices to the effect that the spirits sold were diluted were exhibited in the bars. One of the samples of jelly cuttings contained 0'7 grains per pound of salicylic acid as an added preservative. Of the 2 samples of tinned salmon, 1 was genuine fish free from injurious ingredients, but containing very little salmon. The other sample contained 0 32 grains of tin per pound. The sample of baking powder contained 17-27 per cent, of sulphate of calcium, being 15'81 per cent, of the sample in excess of the maximum recommended by the Local Government Board as being allowable. It was, however, not deemed advisable to take proceedings. The samples of lard, pepper, separated milk, cocoa, jam, whisky, jelly, honey, ground ginger, self-raising flour, arrowroot, beef dripping, and rice were all genuine. The subjoined table shows a comparison of the results of the work under the Sale of Food and Drugs Acts during the years 1902-12 inclusive :— Year. Number of Samples. Number of persons in the Borough to each sample. Number of samples adulterated. Percentage of sampler 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 11 6 353 10 0 1904 612 189 110 17.9 56 6 50 46 128 5 0 306 0 0 1905 536 215 98 18.2 57 2 51 47 233 18 0 267 0 0 1906 520 224 122 23.4 44 2 42 34 106 12 6 260 0 0 1907 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 1908 580 200 92 15.8 45 .. 45 39 117 10 0 290 0 0 1909 570 200 92 16.1 76 2 74 69 255 18 6 276 5 0 1910 578 200 133 23.0 65 .. 60 49 93 17 6 279 5 0 1911 577 200 149 25.8 64 .. 62 58 180 0 6 278 17 6 1912 584 190 100 17.1 48 1 48 45 172 11 0 281 10 0 The percentage of samples found adulterated was somewhat below the average. With reference to the convictions under the Acts during 1912, in 10 instances the defendants had been once, in 4 instances twice, in 1 three times, and in 2 nstances five times previously convicted 61 SANITARY STAFF. In my Annual Report for 1911, mention was made of the increase in the work of the Health Department and of the necessity of providing for coping with it. Early in the year under consideration in this report, the matter came before the Health Committee upon a reference from the Borough Council, and the Committee instructed me to specially report to them upon the whole subject. My report, copy of which is appended (page 85), was in due course considered by the Committee, who recommended to the Council the appointment of two additiona sanitary inspectors, another health visitor, and an additional clerk. These recommendations were adopted by the Council, and the necessary steps were taken to give them effect. The Borough was divided into eight sanitary sub-districts, which are numbered 1 to 8 as shown upon a map submitted to and approved by the Health Committee. The particulars as regards these sub-districts may be briefly stated as follows :— No. 1 : situate in the north-east of the Borough, having an area of 98 acres, a population of 14,665, and containing 129 buildings not used as dwellings, was assigned to Inspector Firth. No. 2 : in the south of the Borough, with an area of 113 acres, a population of 8,382, and 1,068 premises not used as dwellings, was assigned to Inspector Jordan. No. 3 : in the north, with an area of 65 acres, a population of 15,187, and 118 buildings not used as dwellings, was assigned to Inspector Langstone. No. 4 : situated centrally in the Borough, with an area of 68 acres, a population of 13,840, and 370 buildings not used as dwellings, was allotted to Inspector Pearson. No. 5 : situate to the west of No. 4, with an area of 69 acres, 14,485 people, and 245 buildings not used as dwellings, was allotted to Inspector Stokes. No. 6 : in the north-west of the Borough, with an area of 89 acres, a population of 14,734, and 178 premises not used as dwellings, was assigned to Inspector Wright. No. 7 : situate towards the north-east of the Borough, with an area of 69 acres, a population of 14,029, and 119 buildings not used as dwellings, was assigned to Inspector Pratt. He was appointed Sanitary Inspector on October 29th, and at the time of his appointment was senior clerk in the Health Department, having been for over ten years employed in the clerical work of the Department. No. 8 : situate to the north of No. 7, with an area of 87 acres, a population of 13,378, and 147 premises not used as dwellings, was allotted to Inspector Chapman, who was appointed Sanitary Inspector for the Borough on October 29th. He was at the time of his appointment Assistant Inspector of Nuisances under the Cheltenham Sanitary Authority. Each inspector is responsible for the due performance of all the duties of a sanitary inspector in the sub-district to which he is appointed. For the purposes of the Sale of Food and Drugs and Rag Flock Acts, and the inspection of food in the street markets on evening duty the inspectors are not confined to their particular sub-districts. For the purposes of Health Visiting, the Borough was divided into two districts, viz., Hoxton, including Moorfields, Church, Hoxton, and Wenlock Wards, with a population of 57,962 ; and Haggerston, including Whitmore, Kingsland, Haggerston, and Acton Wards, with a population of 53,428. The former was assigned to Miss Charlesworth and the latter to Miss Jacocks, who was appointed Health Visitor on October 29th. Miss Jacocks has had previous experience as a Health Visitor, besides many years practical experience as a nurse and a midwife. The clerical staff was increased in September by the promotion of Mr. Harris to the position of clerk and the appointment of Mr. H. Ansell as messenger in his place. In consequence of the appointment of Mr. Pratt to be Sanitary Inspector Mr. Abbott became senior clerk and Mr. Hayes second, and the vacancy in the Department was filled by the transference of Mr. E. C. Martin to the Health from the Borough Surveyor's Office. The clerical staff now includes four clerks and a messenger, who also assists with the clerical work. It is hoped that this increase together with certain changes made with a view to lightening the work, will enable the increased duties referred to in the report on the Sanitary staff being coped with in a satisfactory manner. During the year some 15,749 communications, written and printed, were dispatched from the Health Department as compared with 16,520 in 1911, and 13,639 in 1910. These included 4,751 notices and summonses, 3,123 letters, cards, and other documents, mainly on matters under the Public Health and Sa'e of Food and Drugs Acts, 2,117 communications relating to cases of pulmonary tuberculosis, 654 in connection with the work under the Factory and Workshops Acts, 4,320 communications of various kinds relating to infectious disease and disinfection, and 784 agendas and reports relating to the work of the Department. 63 I have again to express my satisfaction with the way in which the officers of the Health Department discharged their duties during the year, and also my appreciation of the assistance rendered by them in connection with my work, and in conclusion I have to express my thanks for the kind consideration and help which I have received from the Chairman and members of the Health Committee in connection with the work of the Department during the year. I have the honour to be, Mr. Mayor and Gentlemen, Your obedient servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. APPENDIX TO THE REPORT of the MEDICAL OFFICER OF HEALTH. containing Statistical Tables and a Summary of Sanitary Proceedings under the Public Health and Factory and Workshop Acts, during the year 1912, together with a copy of a special Report on the Sanitary Staff of the Borough made during the Year, and the Report of the Health Visitor for the Year. Tables II, III. and IV. are forms required by the Local Government Board. 66 TABLE I. Vital Statistics of the Borough of Shoreditch during 1912 and previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in tub District. Transferable Deaths Nbtt Draths belonging to the District. of Nonresident s registered in the District. of residents not regis tered in the District Under 1 Year of Age. At all Ages. Uncorrected Number. Nett. Number Eate. Number. Kate per 1,000 net Births. Number. Eate. Number Rate. ] 2 3 4 5 6 7 8 9 10 11 12 13 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 15.6 353 453 528 147 1913 16.8 1911 111285 3393 3497 31.8 2015 18.1 341 566 598 171 2227 20 .2 1912 111067 3375 3529 32.1 1878 16.9 335 474 451 128 2017 18.3 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) Total population at all ages, Number of inhabited houses, 642.5 Average number of persons per house 111,390 11,535 9.6 At Census of 1911. 67 TABLE II. Cases of infectious disease notified during the Year 1912 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 Ages-Years. 1. 3. 4. 5. 6. 7. 8. Under 1. l to 5 5 to 15 15to25 25to45 45to65 65 and upwards. Moorfields. Church Hoxtor Wenlock. Whitmore. Kingsland. Haggerston Acton. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 137 11 66 51 6 3 .. .. ,2 18 25 19 18 19 12 24 Erysipelas 149 3 9 10 18 39 48 22 4 39, 18 25 27 15 15 13 132 Scarlet fever 151 3 57 77 12 2 3 20 39! 29 24 15 13 15 .. Typhus fever 1 .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. Enteric fever 14 .. 2 2 3 6 1 .. .. 6 1 .. 0 1 .. .. .. Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 8 .. .. .. 3 5 .. .. .. 1 1 .. 2 .. 3 1 .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Oerebro-spinal Meningitis 5 2 1 1 1 .. .. .. .. .. .. 2 1 1 .. 1 4 Polio-myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 703 6 21 64 94 324 158 36 29 118 138 145 117 60 38 58 216‡ Ophthalmia Neonatorum 17 17 * * • • * * • • .. .. .. 4 4 2 1 3 3 5§ Totals 1185 42 156 205 137 379 208 58 38 200 219 224 192 144 84 114 540 * This number includes the cases of consumption notified in the Holborn Union Workhouse. ‡ This includes the cases of consumption in the Shoreditch Workhouse. | Removed to the Shoreditch Infirmary or Moorfields Eye Hospital. + Removed to the Shoreditch Infirmary, except seven removed to Sanatoria. There were in addition a few removed to other Institutions. E2 63 TABLE III. Causes of, and ages at death during the Year 1912 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 ok "NonResidents " in Institutions in the District (b). 11. All Ages. Under 1. 1 and under 2. 2 and inder 5. 5 and inder 15. 15 and under 25. 25 and under 45. 45 and under 65 65 and up wards. 2 3 4 5 6 7 8 9 10 All causes Certified (c) 2017 451 188 138 78 69 275 425 393 932 Uncertified .. .. .. .. .. .. .. .. .. .. 1 Enteric Fever 4 1 1 1 ] 1 2 Small Pox .. .. .. .. .. .. .. .. .. .. 3 Measles 126 19 54 48 5 .. .. .. .. 13 4 Scarlet Fever 4 2 1 .. 1 .. .. .. .. 5 Whooping-cough 42 20 17 4 1 .. .. .. .. .. 6 Diphtheria and Croup 18 3 4 9 2 .. .. .. .. .. 7 Influenza 12 3 1 1 .. 1 1 3 2 .. 8 Erysipelas 6 .. .. .. .. .. 1 2 3 .. 9 Phthisis (Pulmonary Tuberculosis) 217 1 5 3 3 23 103 69 10 127 10 Tuberculous Meningitis 46 13 12 10 9 2 .. .. .. 7 11 Other Tuberculous diseases 27 4 7 .. 4 I 1 2 1 7 12 Cancer, malignant disease 88 .. .. .. 2 1 14 41 30 32 13 Pheumatic Fever 3 .. .. .. 2 .. .. 1 .. .. 14 Meningitis (See note (d)) 9 5 3 .. .. .. .. .. .. 1 15 Organic Heart Disease 61 , , .. .. 4 5 18 20 12 26 16 Bronchitis 184 20 10 .. 1 3 17 55 76 154 17 Pneumonia (all forms) 208 45 38 25 10 7 27 40 lrt 50 1 8 Other diseases of Pespiratory organs 18 2 1 1 2 1 6 5 6 19 Diarrhoea and Enteritis (See note (e) ) 99 73 16 5 .. .. 1 3 1 48 20 Appendicitis and Typhlitis. . 8 .. .. .. 5 1 2 .. . . 1 21 Cirrhosis of Liver 19 .. .. .. .. .. 3 15 1 11 22 Alcoholism 8 .. .. .. .. .. 3 4 1 6 23 Nephritis and Bright's Disease 83 .. .. 1 2 .. 14 42 24 66 24 Puerperal Fever 4 .. .. .. .. 1 3 .. .. 1 25 Other accidents and diseases of Pregnancy and Parturition 4 .. .. .. .. .. 3 1 .. 2 26 Congenital Debility and .. .. .. .. .. .. .. .. .. .. formation, including .. .. .. .. .. .. .. .. .. .. mature birth 179 172 7 .. .. .. .. .. .. 47 27 Violent deaths, excluding suicide 77 27 8 7 9 5 6 3 12 17 28 Suicides 11 .. .. .. .. .. 4 7 .. 1 29 Other defined diseases 444 41 3 10 17 16 53 107 197 304 30 Diseases ill-defined or unknown 8 3 .. .. .. .. .. 3 2 2 2017 451 188 138 78 69 275 425 393 932 69 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH during the year 1912. Nett deaths from stated causes at various ages under One Year of Age (see note (a)). CAUSE OF DEATH. Under Week. 1-2 Weeks 2-3 Weeks. 3- 4 Weeks Total under 1 1 Month 1-3 Mont hp 3-6 Months 6-9 Months 9-12 Months Total Deaths under 1 year. All causes Certified 86 22 91 10 139 912 78 77 65 451 Uncertified .. .. .. .. .. .. .. .. .. .. Smallpox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. 1 .. .. 1 Measles .. .. .. .. .. .. 1 9 9 19 Scarlet fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. 4 .. 7 5 20 Diphtheria and Croup .. .. .. .. .. .. 1 .. 2 3 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. 3 .. 5 2 13 Abdominal Tuberculosis (b) .. .. .. .. .. 1 .. .. 2 3 Other Tuberculous Diseases. .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 2 2 5 Convulsions 3 .. .. .. .. 1 .. .. .. 9 Laryngitis .. .. .. .. .. .. 1 .. .. 1 Bronchitis .. .. .. .. .. 7 .. 7 4 20 Pneumonia (all forms) .. .. .. .. .. 9 11 11 11 45 Diarrhœa .. .. .. .. .. 3 11 11 6 31 Enteritis .. .. .. .. .. 9 15 10 8 42 Gastritis .. .. .. .. .. .. 1 .. .. 1 Syphilis .. .. .. .. .. 4 .. 1 1 9 Rickets .. .. .. .. .. , , 1 .. 1 2 Suffocation, overlying 5 .. .. .. 8 12 5 .. 1 26 Injury at birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 5 .. .. .. 5 .. .. .. .. 5 Congenital Malformations (c) 5 5 2 .. 12 1 1 .. 1 15 Premature birth 50 5 10 2 67 7 .. 1 1 76 Atrophy, Debility and Marasmus 14 5 4 4 27 27 16 5 6 81 Other causes 3 2 .. .. 5 4 3 7 2 21 86 22 21 10 139 92 78 77 65 451 Nett Births in the year—Legitimate 3,443, illegitimate 86. Nett Deaths in the year of legitimate infants 443, illegitimate infants 8. 70 NOTES TO TABLE III. The classification and numbering of Causes of Death are those of the " Short List" on page xxv. of the manual of the International List of Causes of Death. (a) 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 or Wales who have died in the district, have been in like manner 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 being regarded as " Uncertified." (d) Exclusive of " Tuberculous Meningitis " (10), but inclusive of Cerebro-spinal Meningitis. (e) Title 19 has been used for deaths from Diarrhoea and Enteritis at all ages. (In the " Short List" deaths from Diarrhoea and Enteritis under 2 years are included under 19 ; those at 2 years and over being placed under Title 29.) 71 NOTES TO TABLE IV. (a) The total in the last column of Table IV. equals the total in column 10 of Table I. and in column 3 of Table III. (b) Under Abdominal Tuberculosis have been included deaths from Tuberculous Peritonitis, Enteritis, and from Tabes Mesenterica. (c) The total deaths from Congenital Malformation, Premature Birth, Atrophy, Debility, and Marasmus equal the total in Table III under the heading Congenital Debility and Malformation, including Premature Birth. 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. TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1912. Note.—The deaths of persons not belonging to Shoreditch occurring in hospitals and other institutions in the Borough are excluded; deaths of persons belonging to Shoreditch occurring in public institutions in London beyond the limits of the Borough are included. CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 5. 5 to 10. 10 to 16. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 86. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kings'and. Haggerston. Acton. Male. Female. Total. 1Small Pox vaccinated Unvaccinated No statement .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 19 102 5 .. .. .. .. .. .. .. .. .. .. 2 22 27 19 34 12 4 6 7 6 50 126 3 Searlet fever .. 3 .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 .. • • .. 1 1 2 2 4 4 Typhus fever .. .. .. .. .. .. .. 1 .. .. .. .. .. I .. .. .. .. .. .. 1 .. 1 5 Epidemic influenza 3 2 .. .. 1 .. .. 1 2 1 2 .. .. 2 2 1 1 5 1 .. .. 4 8 12 6 Whooping cough 20 21 1 .. .. .. .. .. .. .. .. .. 2 13 9 3 6 3 4 2 23 19 42 7 Diphtheria, membranous croup .. 3 13 2 .. .. .. .. .. .. .. .. .. .. 4 2 3 3 .. .. 6 12 6 IN 8 Enteric fever .. 1 .. .. .. 1 1 .. .. 1 .. .. .. .. 1 .. 1 1 .. .. 1 2 2 4 9 Asiatic cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Diarrhoea, dysentery 25 6 .. .. .. .. 1 .. 1 .. .. .. .. .. 9 5 3 11 2 .. 3 10 23 33 11 Epidemic or zymotic enteritis 6 1 .. .. .. .. .. .. .. .. .. .. .. 1 2 1 1 1 .. 1 6 1 7 12 Other allied diseases 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 13 Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14 Glanders, farcy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 15 Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 16 Anthrax, splenic fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 17 Cow-pox, accidents of vaccination .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 18 Syphilis 9 1 .. .. .. .. .. .. .. .. .. .. .. 2 3 1 1 1 1 1 5 5 10 19 Gonorrhoea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 20 Phagedoena, hospital gangrene 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 21 Erysipelas .. .. .. .. .. .. 1 .. 1 1 .. 3 .. .. I 1 .. 2 .. .. 2 5 1 6 22 Puerperal fever .. .. .. .. .. 1 2 1 .. .. .. .. .. .. 1 1 1 .. .. .. 1 .. 4 4 23 Pyemia, septicemia 1 2 4 2 .. 1 1 1 1 1 .. .. .. 2 1 5 .. 3 1 .. 7 7 14 24 Infective endocarditis 2 .. .. .. 3 1 .. 3 .. .. .. .. .. .. .. .. 3 9, .. 1 3 8 1 9 25 Other allied diseases .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 26 Malarial fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 27 Rheumatic fever .. .. .. 2 .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. 1 .. 2 1 3 28 Rheumatism of the heart Tubeuculosis : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 29 Brain or meninges, acute hydrocephalus 1 3 22 8 1 .. .. .. .. .. .. .. .. 8 10 9 7 5 4 3 21 95 46 30 Larynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 31 Lungs 1 8 2 1 9 14 37 66 43 26 8 2 .. 12 44 31 28 48 23 13 18 160 57 217 32 Intestines, tabes mesenterica 3 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 3 2 .. .... 4 1 5 33 General, position undefined 1 10 3 1 .. .. 1 .. .. .. .. .. 4 5 1 8 1 2 .. 8 8 16 34 Other forms, scrofula .. 2 .. .. .. 1 1 .. I 1 .. .. .. .. 1 .. 1 2 I 1 2 4 6 35 Other infevtive diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 36 Thrush .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 37 Actinomycosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 38 Hydatid diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 39 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 40 Other diseases due to altered food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 41 Acute alcoholism, delirium tremens .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 42 Chronic alcoholism .. .. .. .. .. .. 3 2 2 1 .. .. .. 2 3 2 1 .. .. 4 4 8 43 Chronic industrial poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 44 Other chronic poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 45 Osteo- arthritis, rheumatoid arthritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 46 Gout .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. 1 1 47 Cancer .. .. .. .... .. .. 3 11 14 24 18 8 1 7 12 10 13 13 5 8 11 35 44 79 48 Diabetes mellitus .. .. .. .. 1 .. 1 .. 1 2 1 . • .. 2 1 1 I .. .. 1 3 3 6 49 Purpura hemorrhagica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 50 Hemophilia .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. 51 Anemia, leucocythemia .. .. .. .. .. .. 1 .. .. .. .. .. .. .... .. .. .. .. .. 1 1 1 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 5. 5 to 10. . 10 to 16. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 76. 75 to 85. 85 and upwards. Moorfiulds. Church. Iloxton. Wenlock. Whitmore. Kings'and. Ilugg rston. Acton. Male. Female. Total. 52 Lymphadenoma, Hodgkin's disease .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 53 Premature birth 76 .. .. .. .. .. .. .. .. .. .. .. l 17 5 16 14 11 5 7 | 44 32 76 54 Iniurv at birth 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 55 Debility at birth 15 1 .. .. .. .. .. .. .. .. .. .. .. 1 3 9 3 4 1 2 .. 9 7 1 6 50 Atelectasis 5 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 9 1 .. 4 1 5 57 Congenital defects 15 2 .. .. .. .. .. .. .. .. .. .. .. .. 3 1 3 3 1 3 3 10 7 1 7 58 Want of breast milk 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 1 2 59 Atrophy, debility, marasmus 64 4 .. .. .. .. .. .. .. .. .. .. .. 3 21 10 7 9 4 10 4 45 23 68 60 Dentition 3 9. .. .. .. .. .. .. .. .. .. .. .. .. 1 9, .. 1 .. .. 1 5 .. 5 61 Rickets 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 1 2 62 Old Age, senile decay .. .. .. .. .. .. .. .. .. 5 28 74 21 6 24 17 21 33 11 10 6 54 74 128 63 Convulsions 9 3 .. .. .. .. .. .. .. .. .. .. .. 1 4 .. 4 1 .. 9 .. 6 6 1 2 64 Meningitis 3 1 1 1 .. .. .. .. .. .. .. .. .. .. 2 1 1 .. 1 1 .. 6 .. 6 65 Encephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 66 Apoplexy .. .. , . .. . . .. 1 5 8 19 17 11 .. 5 8 7 9 14 3 5 10 24 37 61 67 Softening of brain .. .. .. .. .. .. .. .. .. 1 2 .. .. .. 1 .. .. 1 1 .. .. 1 2 3 68 Hemiplegia, brain paralysis . .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 1 .. .. .. .. .. 1 1 2 69 General Paralysis of insan .. .. .. .. .. .. .. 6 2 4 1 .. .. .. 1 .. 2 5 3 .. 2 9 4 13 70 Other forms of insanity .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 71 Chorea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 72 Cerebral tumour .. .. .. .. .. .. .. .. .. 2 1 .. .. .. 1 .. .. 1 .. .. 1 3 .. 3 73 Epilepsy .. .. .. .. 2 .. .. .. .. .. 1 .. .. .. .. .. .. 3 .. .. .. 1 2 3 74 Laryngismus Stridulu .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 5 Locomotor Ataxy .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 76 Paraplegia, diseases of spinal cord .. .. .. .. .. .. .. 1 .. 1 1 1 .. .. 2 .. .. 1 .. .. 1 2 2 4 77 Other diseases of brain or nervous system .. .. .. .. .. .. 1 .. 1 1 .. .. .. .. 1 .. 2 .. .. .. 1 2 3 78 Otitis, otorrhcea 1 3 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. 2 .. 4 1 5 79 Diseases of nose, epistaxis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 80 Diseases of eye, ophthalmia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 81 Pericarditis 1 1 .. 1 .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. 1 3 .. 4 1 5 82 Endocarditis, valvular diseases of the heart .. 9. .. 4 4 1 10 8 8 12 9 2 1 9 ..6 11 10 10 7 g 7 3 I 30 61 83 Hypertrophy of heart .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 84 Angina pectoris .. .. .. .. .. .. .. .. 1 4 .. .. .. .. .. 1 .. 1 1 1 1 3 2 5 85 Aneurism .. .. .. , , .. .. .. 2 2 3 1 .. .. .. 2 2 .. 1 2 1 .. 6 2 8 86 Senile gangrene .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 .. 1 .. 2 2 87 Embolism, thrombosis .. .. .. .. .. .. 1 .. .. 1 .. .. .. 1 1 .. .. .. .. .. .. .. 2 2 88 Phlebitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8y Varicose veins .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 90 Other and ill-dejined diseases of heart and circulatory system, including heart disease not stated to be valvular .. .. 3 3 1 5 8 9 14 17 19 3 .. 2 13 16 15 12 7 7 10 34 48 82 91 Laryngitis 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. 1 92 Crou .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 93 Oilier diseases of larynx and trachea 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 94 Acute bronchitis 19 12 .. 1 .. 1 1 2 2 6 8 1 .. 1 11 7 9 10 5 5 5 23 30 53 95 Chronic bronchitis 1 .. .. . . 2 .. 3 11 16 31 45 19 3 3 21 25 29 28 10 5 10 61 70 131 96 Lobar, croupous-pneumonia 4 7 1 .. .. 3 2 5 4 1 .. 3 .. .. 5 4 2 9 1 6 3 19 1 1 30 97 Lobular, broncho-pneumonia 29 46 3 .. .. 1 1 5 5 6 8 .. .. 3 21 9 22 22 6 12 9 53 51 104 98 Pneumonia, form not stated 12 10 4 2 .. 3 4 10 11 13 4 1 .. .. 14 11 16 9 10 4 10 45 99 74 99 Emphysema, asthma .. .. .. .. .. .. .. .. 1 .. 2 .. .. .. .. 1 1 .. .. .. 1 9 1 3 100 Pleuris 1 2 .. .. .. .. .. .. 1 9. 1 1 .. .. 1 s .. 1 1 1 .. 2 8 101 Other and ill-defined diseases of respiratory system 1 .. 2 . . .. 1 , , .. 1 1 1 .. .. 2 2 .... 1 .. .. 2 4 3 7 102 Diseases of mouth and annexa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 103 Diseases of pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 104 Diseases of oesophagus .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 105 Ulcer of stomach and duodenum .. .. .. .. .. .. 2 2 4 2 1 .. .. 1 2 2 2 1 .. 9 1 5 6 11 106 Other diseases of stomach .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. 107 Enteritis 42 14 .. .. .. .. .. .. 1 1 .. 1 .. 2 16 2 5 19 8 «> z, .. 59 108 Appendicitis .. .. 1 4 .. 1 1 1 .. .. .. .. .. 3 1 1 .. .. ] 9 20 8 109 Obstruction of intestine .. .. .. .. .. 2 .. 1 1 2 1 .. 1 .. 9. .. 2 .. .. 2 4 3 7 110 Other diseases of intestine. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .... .. .. .. 1 .. .. 3 1 Ill Cirrhosis of liver .. .. .. .. .. .. 1 2 10 5 1 .. .. .. 5 4 1 2 4 1 2 9 10 19 112 Other diseases of liver .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. 113 Peritonitis .. .. 1 .. .. .. 1 1 .. .. .. .. .. .. 2 .... .. .. .. 1 .. 9 1 3 114 Other and ill-defined diseases of digestive system 2 .. .. .. .. .. .. 1 •• 2 .. .. .. 1 9 1 .. .. .. 1 3 2 5 CAUSES OP DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 5. 5 to 10. 10 to 16. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 86. 85 and upwards. Moorfieldg. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. . 115 .Diseases of Lymphatic System and ductless glands .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 116Acute nephritis .. 1 1 .. .. .. 1 1 .. 2 .. .. .. .. .. 3 .. .. 1 .. 1 4 1 5 117 Bright's disease .. 1 1 .. .. .. 3 9 17 23 21 3 .. 2 3 13 8 19 5 6 17 40 38 78 118 Calculus .. .. .. .. .. .. .. .. 1 1 .. .. . .. .. 1 .. 1 .. .. .. 1 1 2 119 Diseases of bladder and prostate .. .. .. .. .. .. .. 1 .. .. 2 1 .. .. 1 1 1 1 .. .. 4 .. 4 120 Other and ill-defined diseases of urinary system .. .. .. .. 1 .. 1 2 .. .. .. .. .. .. .. 2 1 .. . . 1 1 3 4 121 Diseases of testis and penis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 122 Diseases of ovaries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 123 Diseases of uterus and appendages .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 124 Diseases of vagina and external genital organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 125 Diseases of breast .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 126 Abortion, miscarriage .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 127 Puerperal mania .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 1 128 Puerperal convulsions .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 129 Placenta prsevia, flooding .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 .. 1 .. .. .. .. 9, 2 130 Puerperal thrombosis .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 131 Other and ill-defined accidents and diseases of pregnancy and childbirth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 132 Arthritis, ostitis, periostitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 133 Other and ill-defined diseases of osseous system .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 134 Ulcer, bedsore .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 135 Eczema .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 136 Pemnhierus 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 137 Other and ill-defined diseases of integumentary system, By Accident or Negligence. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 138 In mines and quarries .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 139 In vehicular traffic .. 3 4 .. 9: 1 .. .. .. .. .. .. .. .. 1 3 2 2 .. 3 .. g 3 11 140 On railwavs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 141 On vessels and docks, excluding drowning" .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 142 In building operations .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 143 By machinery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 144 By weapons and implements .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 145 Burns and Scalds .. 4 2 .. .. 1 .. .. .. .. .. .. .. .. 2 .. .. 4 .. 1 .. .. 7 7 146 Poisons, poisonous vapours .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. 147 Sui-gical narcosis .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 148 Effects of electric shock .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 149 Corrosion bv chemicals .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 150 Drowning .. 2 .. .. .. .. 2 .. .. .. .. .. .. .. 1 1 2 .. .. .. .. 3 1 4 151 Suffocation, overlaid in bed 25 1 .. .. .. .. .. .. .. .. .. .. .. .. 10 6 9, 1 .. 6 1 12 14 26 152 Suffocation otherwise 1 1 .. .. .. .. .. .. .. .... .. .. .. .. 1 .. 1 .. .. .. .. .. 2 2 153 Palls, not specified 1 4 1 2 .. .. 1 1 1 2 6 6 .. ..1 3 3 7 5 2 1 3 15 10 25 154 Weather agencies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 155 Otherwise, and not stated .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 156 Homicide Suicides, all forms. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 157 By poison .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 158 By asphyxia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 159 By hanging and strangulation .. .. .. .. .. .. .. 1 1 1 .. .. .. ..1 1 .. 1 .. .. .. ..>> 1 3 160 By drowning .. .. .. .. .., , .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 161 By shooting .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 162 By cut or stab .. .. .. .. .. .. .. 1 1 1 .. .. .. .. 1 .. .. 1 .. 1 .. .. 3 163 By precipitation from elevate places .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 1 .. .. .. .. .. 1 .. 2 164 By crushing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 165 By other and unspecified methods .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 166 Execution .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 167 Sudden death .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 168 Other ill-defined and not speci fied causes 3 .. .. .. .. .. .. .. ..1 9. 2 .. .. .. 9 1 1 ..1 3 .. .. .. 7 .. 169 Malignant disease .. .. 1 1 1 .. .. .. 2 1 2 1 .. .. 1 1 1 1 .. 2 3 a 6 9 170 Cerebro Spinal Fever 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. •• 1 1 2 3 Total 451 326 51 27 29 40 101 174 190 235 222 145 26 65 384 309 306 414 176 164 199 1102 915 2017 TABLE VI.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1912. DISTRICTS. Estimated population 1912. ANNUAL KATE PER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. DEATII8 DURING THE YEARS: DEATHS DURING 1912 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Donthe. BIRTHS. 1 1909 1910 1911 1912 Principal I Zymotic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. i Whooping Cough. *Fever. -{•Diarrhoea. Tuberculous. Disease. Violence. London 4,519,754 24.5 14.0 12.7 15.8 13.6 1.7 o-oo 0.40 0.04 o.1o 0.22 0.03 0.30 1.6 0.5 91 10,6 43-4 o-1 Slioreditch §109,739 32.1 19.2 16.8 20.2 18.3 2.1 .. 1.14 0.03 0.18 0.38 0.03 0.83 2.6 0.8 128 13,8 53-1 .. Wards. Moorfields 4,813 24.9 16.4 10.5 14.6 13.5 1.0 .. 0.41 0.21 .. 0.41 .. 0.20 2.5 0.4 91 12.3 47.7 .. Church 19,053 33.4 19.5 15.9 21.7 20.1 2.6 .. 1.15 .. 0.20 0.68 0.10 1.0 2.9 1.2 152 15.6 57.8 .. Hoxton 16,628 32.4 17.0 16.5 19.1 18.5 2.7 .. 1.62 0.06 0.12 0.54 .. 0.54 2.8 0.8 115 15.8 51.8 .. W enlock §16,004 33.2 16.7 14.6 16.2 19.1 1.8 ... 1.18 .. 0.18 0.18 0.06 0.5f 2.3 0.9 125 14.0 48.3 .. Whitmore 18,808 30.4 27.7 25.0 27.5 22.0 2.9 .. 1.80 .. 0.15 0.31 0.05 1.63 3.2 0.7 136 10.6 54.6 .. Kingsland 10,790 35.0 20.6 18.7 20.1 16.3 1.6 .. 1.1l .. .. 0.27 .. 0.83 3.0 0.2 121 13.0 51.1 .. Haggerston 11,290 34.7 15.5 13.2 18.3 14.5 0.8 .. 0.35 0.09 .. 0.35 .. 0.17 1.7 1.0 117 17.7 54.8 .. Acton 12,353 28.8 16.3 14.4 19.5 16.1 1.6 .. 0.48 0.8 0.48 0.16 0.08 0.56 1.7 0.4 95 11.5 52.7 .. -Fever includes typhus, typhoid and continued fevers. |Diarrhcea includes Enteritis in children under two years. §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. 79 TABLE TIL ANALYSIS of ttte Cases Treated by tiie District Medical Officers of thb Borough during the Year ending December 31 st, 1912. Diseases. Diseases. All Causes 5,201 37 Atelectasis 38 Congenital malformations 1 39 Old age153 1 Small-pox 40 Apoplexy13 2 Measles ,263 41 Epilepsy84 3 Scarlet Fever 6 42 Convulsions 6 4 Typhus 43 Other diseases of brain and nervous system 269 5 Relapsing fever 6 Influenza 147 44 Diseases of organs of special sense 21 7 Whooping Cough 79 8 Diphtheria 4 9 Simple, continued and ill- defined fever 9 45 Diseases of circulatory system 190 46 Laryngitis 7 10 Enteric fever 11 Simple cholera 47 Bronchitis1,292 12 Diarrhoea, dysentery 50 48 Pneumonia 110 13 Remittent fever 4 9 Pleurisy 23 14 Hydrophobia 50 Other resoieators diseases 20 15 Glanders 51 Dentition 4 16 Cow pox and Effects of vaccination 52 Quinsy, sore throat 30 53 Enteritis 54 17 Venereal affections 47 54 'Peritonitis 3 18 Erysipelas 28 55 Discases of liver 16 19 Pyaemia and septicaemia 6 56 Other diseases of digestive system 356 20 Puerperal fever 22 Tuberculous meningitis 1 57 Diseases of lymphatic system and ductless glands18 23 Phthisis 292 24 Scrofula, tuberculosis. 27 58 Diseases of urinary system 54 25 Other zymotic diseases 31 26 Thrush.1 59 Dissoasos of the generative system 19 27 "Worms and other parasitic diseases 3 60 Accidents of childbirth 24 28 Starvation, want of breast-milk 1 61 Diseases of locomotive system 247 29 Alcoholism 4 62 Diseases of locomotive system system148 30 Rheumatic fever and rheumatism of heart 28 63 Fracture and contusion 42 64 Gun shot wounds 31 Rheumatism 458 65 Cut, stab 1 32 Gout 57 66 Burns or scalds 7 33 Rickets 67 .poison 2 34 Cancer 25 68 Drowning 35 Other constitutional diseases 25 69 Suffocation 70 Otherwise 60 36 Premature birth 2 71 Other causes 323 80 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1912. Table VIII. PREMISES. NUMBER OF PLACES— Number of inspections, 1912. Number of notices, 1912. Number of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Milk premises .. 292 15 16 291 3157 14 .. Cowsheds 7 .. .. 7 44 2 .. Slaughter-houses Other offensive 6 .. 1 5 15 •• .. trade premises Ice Cream 1 •• .. 1 6 1 .. premises Registered houses let in lodgings 95 7 9 93 154 24 .. 266 6 •• 272 379 95 .. Number of intimation notices served for all purposes 3887 Overcrowding: — Number of dwelling rooms overcrowded 186 Number remedied186 Number of prosecutions Nil Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 452 Underground rooms: — Number dealt with during year 7 Insanitary houses: — Number closed under the Public Health (London) Act, 1891 23 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891: — Number of persons accommodated during the year 4 Customs and Inland Revenue Acts: — Number of dwellings for which applications were received during year Nil Number of prosecutions under By-laws under Public Health (London) Act, 1891: — With respect to water closets, earth closets, etc. 3 Mortuary: — Total number of bodies removed 373 Total number of infectious bodies removed 1 81 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK, DURING THE YEAR 1912. 1.—Inspection. Inspection made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (i) (2) (3) (4) Factories (Including Factory Laundries.) 384 24 - Workshops (Including Workshop Laundries and Bakehouses.) 2924 278 - Workplaces (Excluding Outworkers' premises dealt with in Table 3.) 674 107 - Total 3982 409 - 2.—Defects Found. Particulars. (1) Number of Defects. Number Found. (2) Remedied. (3) Referred to H.M. [nspect'r (4) cf Prosecutions. (5) Nuisances under the Public Health Acts:—* Want of cleanliness 19S 198 1 — Want of ventilation — — — Overcrowding 3 3 — — Want ot drainage of floors — — — — Other nuisances 76 76 — — insufficient 18 18 — — Sanitary accommodation unsuitable or defective 123 123 — — not separate for sexes 8 8 — — Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (S. 101) — — — — Breach oi special sanitary requirements for bakehouses (Ss. 97 to 100) — — — — Other offences.. (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — Total 412 426 1 — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Au as remediable under the Public Health Acts. 3. Home Work. NATURE OF WORK. OUTWORKERS LISl'S, SECTION 107. 1 Outwork in unwholesome premises, 8tction 108. Outwork in infected premises, Sections 109 and 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Twice in the Year. Once in the Year. Failing to keep or permit inspection of lists. Hailing to send Lists. Instances. Notices served. Prosecutions. Instances. Orders made. (8. 109.) Prosecutions. (S. 109, 110.) Lists. Outworkers Lists. Outworkers. Con- Work- Con- Work- (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (ID (12) (13) (14) (15) (16) Wearing Apparel: (1) Making, &c. 68 73 1077 9 29 60 .. .. .. 41 41 .. .. .. .. (2) Cleaning & washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery 2 .. 6 1 .. 3 .. .. .. 1 1 .. .. .. .. Artificial flowers 4 .. 130 .. .. .. .. .. .. 10 10 .. .. .. .. Fur pulling .. .. . . 1 .. 4 .. .. .. .. .. .. .. .. .. Umbrellas, &c .. .. .. .. .. .. .. .. .. 2 2 .. .. .. .. Paper bags and boxes . . 28 .. 439 2 .. 9 .. .. .. 38 38 .. .. .. .. Brush making .. .. .. .. .. .. .. .. .. 3 3 .. .. .. .. Total 92 73 1652 13 29 76 .. .. .. 95 95 .. .. .." .. (а) 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. (б) 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. (r) There were no prosecutions, but letters were sent to employers in 35 instances of failure to send lists of outworkers employed in making wearing apparel, &c., in 26 instances for similar failures in respect to paper bag and box making, in 3 instances in respect to artificial flowers, 2 in respect to furriers and 1 in respect to cabinet making. 00 to «3 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 722 (a) Cabinet making 432 (b) French Polishing 79 (c) Upholstery .... 58 (d) Other workers 153 (2) Dress 189 (a) Tailoring 86 (0 Shirt making 8 (b) Mantles 12 (f) Boot & Shoe trades 35 (c) Dress 8 (g) Artificial Flowers 8 (d) Millinery 14 (h) Other workers 9 (3) Skin, leather, hair and feather trades 53 9 (b) Saddlery & Harness 23 (c) Feathers 3 (d) Other workers 18 (4) Paper, printing, book, stationery and fancy goods trades 49 (a) Box & bag makers 32 (b) Other workers 17 (5) Laundry and Washing 26 (6) Fool 3 (7) Metals, machines, implements and conveyances 51 (8) Precious metals, jewels, &c o (9) Other trades than those mentioned above 57 Total number of workshops on Register 1143 Note.—A separate register is kept for bakehouses. On the register there are 75, of which the number in use at the end of the 3*ear was 69, 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. Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector r referring to \ 32! 60 workshops j \ & 19 factories. / / referring to \ 151 KO workshops 1 \ & 19 factories. / Reports (of action taken) sent to H.M. Inspector. Underground Bakehouses (s. 101) : — Nil. 41 F 2 6.—Shewing the Numbers of Outworkers Received from other Districts During 1912. DISTRICT. Making Wearing Apparel. Cleaning and Washing. i .arc Curtains. Artificial Flowers. Furniture and TlnhoUterv Fur Pulling. Feather Sorting. Umbrellas, &c. Paper Bags and Boxes. Brush Making. Tents. Dolls and Toys. Total. Feb. Aug. Feb. Aug. Feb. Aug. Feb Aug. Keb. Aug. Feb. Aug. Feb. | Aug. Feb Aug. Feb. Aug. Feb. Aug Feb. Aug., Feb. | Aug. Battersea .. .. 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Bethnal Green . . 48 43 .. .. .. .. .. .. 2 ..3 .. .. .. .. 3 2 36 42 32 11 .. .. .. .. 222 ('amber well 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 4 City of London .. 384 387 .. .. .. 4 39 16 .. .. 2 9 .. .. 29 42 1 3 .. .. .. .. .. .. 916 Chelsea 4 4 .. .. .. 1 .. .., . .. 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12 Deptford.. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Knheld . . i 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Finsbury 119 100 .. .. .. .. 24 2 5 3 ..,. 4 7 10 8 5 60 77 i 9 .. .. .. .. 440 Hackney 180 167 .. .. .. .. 48 15 6 8 4 1 .. .. 5 3 22 18 26 10 3 .. 1 .. 517 Hampstead 1 9 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Holborn 6 5 .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. 11 Ilf.'.rd 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Islington.. 59 49 .. .. .. .. 2 2 1 .. .. .. .. .. .. 18 19 1 .. .. .. .. .. 151 Kensington 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 1 iambeth.. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 4 Lewisham 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Poplar 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8 1 .. .. .. .. .. .. 12 Southwark 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 4 St. Marylebone . . 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Stepney 13 18 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. .. 34 Stoke Newington 2 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 6 Tottenham .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 W estminster 12 16 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 28 West Ham 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 840 808 2 2 .. 5 114 35 15 18 6 14 7 10 45 52 150 160 68 30 3 •• 1 .. Total .. 1648 4 5 149 33 20 17 97 310 98 3 / 1 2385 85 METROPOLITAN BOROUGH OF SHOREDITCH, Report on the Adequacy of the Sanitary Staff, 1912, by THE MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. May Uth, 1912. To the Chairman and Members of the Health Committee. Gentlemen, I beg to report on the adequacy of the Staff of the Health Department in accordance with your instructions. In doing so it will be convenient to deal with the subject as briefly as possible under the following headings :— 1. The past history of the Department, with a view to showing where increases have taken place in the work and the provision made for coping with them. 2. Statistical information as to the Borough and the number of Sanitary Inspectors employed. 3. Health Visiting in the Borough. 4. The work of the Clerical Staff. 5. Summary. 6. Recommendations. 7. Financial considerations. There is no intention in this report of dealing in detail with the work of the Department. A full summary as to that is given every year in my annual report. Only such matters are here touched upon as appear to have a direct bearing upon the subject under consideration. 1.—PAST HISTORY. Prior to the year 1890, the number of sanitary inspectors employed in Shoreditch never exceeded two. In November of that year an additional inspector was appointed as the result of a public enquiry which was held by direction of the Secretary of State, in consequence of allegations as to the insanitary condition of certain premises in the district. In January, 1892, when the Public Health (London) Act, 1891, came into operation, another inspector was appointed, thus raising the number to four. In 1893, the staff of the Department consisted of a Medical Officer of 86 Health, a Public Analyst, four Sanitary Inspectors, a Clerk, and a Messenger for the office work, three Disinfecting Officers, a part time Mortuary Keeper and a Caretaker for the shelter, which was provided in that year for use in connection with infectious disease. About three years after the Act above-mentioned came into operation, a communication was addressed to the Vestry by the London County Council directing attention to the fact that from particulars given in a report of the Medical Officer of Health for the County, it appeared that the number of sanitary inspectors in Shoreditch in proportion to the population was much below the average for the Metropolis, and requesting the Vestry to take into consideration the advisability of increasing the staff of inspectors. I reported on the subject and ad\"ised that at least two additional inspectors were necessary. Early in 1896 two additional inspectors were appointed, thus raising the number to six, at which it has remained up to the present. At the same time another clerk was appointed for the office work. From 1896 to 1900 the sanitary staff may be stated to have been adequate for the average needs of the district. There was, however, during this period a gradual increase in the work the Department was called upon to perform, resulting partly from within through experience of the necessities of the district, and partly from without through the requirements of other bodies. In 1900 there was a marked increase in the amount of inspection the sanitary staff was called upon to carry out. This was due to the London Government Act, 1899, coming into operation. This Act transferred the registration of milk purveyors and the enforcement of the regulations as to dairies and milkshops from the London County Council tothe newly created Borough Councils, and meant that these premises had to be periodically inspected. The additional work entailed may be judged of by the fact that taking the three years ending 1910, on an average 295 milk purveyors premises were under regular inspection, and the number of visits paid to them averaged 3,290 annually. Soon after the Act became operative the Health Committee's attention was directed to the addition thus made to the work required of the staff, and the advisability of appointing another sanitary inspector was suggested, but the Committee were of opinion that no such increase was necessary. Two years later, in 1902, the Factory and Worshops Act, 1901, came into operation. This made another marked addition to the work of the Department. One of its results was to render a systematic inspection of workshops and out-workers premises necessary, besides involving a large increase in the clerical work. The following will serve to convey an idea as to the amount of the increase in the work brought about by this Act; excluding outworkers premises the average number of premises inspected under the Act during the three years ending 1910, was 1,660 ; the visits paid to them averaged 4,697 and the sanitary notices served 443 annually. It is to be noted that these premises are only visited once during the course of the year if found to be in a satisfactory condition at the time when visited. In many 87 instances, however, there is no doubt that more frequent inspections should be made but for this no time is available. To meet this increase of work an additional clerk was appointed. Since, with the exception of the appointment of a health visitor, no additions have been made to the staff of the department. In 1903, the Health Committee by resolution ordered each of the sanitary inspectors to take not less than eight samples every fortnight under the Sale of Food and Drugs Acts. Although this number was subsequently reduced, the effect of the Committee's resolution was to practically treble the amount of work under these Acts. This meant that a very appreciable amount of the time formerly available for sanitary inspection had to be used for the purposes of these Acts. The London County Council (General Powers) Act, 1894, may be mentioned as adding to the work about this time. It contains amongst others certain provisions dealing with verminous rooms. Arising out of a reference from the Council as to the appointment of a special inspector to carry out all the sanitary duties appertaining to food in the Borough, the question of the adequacy of the sanitary staff again came under the consideration of the Health Committee early in 1905. I reported on the subject and directed attention to the increases which had taken place in the work the sanitary staff was called upon to perform, pointing out that the six sanitary inspectors in the service of the Borough Council were not then sufficient in point of number to adequately perform all the duties required of them. I advised the appointment of an additional male inspector possessing special qualifications as regards food inspection, and also of a female sanitary inspector for special duties, including amongst others duties now performed by health visitors, such as giving instruction as to the rearing of infants and making enquiries as regards infantile mortality. The matter was considered by a sub-committee of the Health Committee who recommended the appointment of a male inspector qualified as suggested and reported to the Health Committee accordingly. Their recommendation was, however, not adopted by the Health Committee who were of opinion that the staff of sanitary inspectors was quite adequate to carry out the duties mentioned, and that an additional inspector was not necessary, and further, that a female sanitary inspector was not desirable. The Committee reported to the Council accordingly and the Council adopted their report The London County Council (General Powers) Acts of 1907 and 1908, may be alluded to as placing additional duties on the shoulders of the Borough Council in respect to water supplies of tenement houses and the sanitary regulation of premises used for the sale of food for human consumption, thereby increasing the work of the sanitary staff. The most marked increases, however, are those which have taken place as the result of the action of the school authorities in reporting the homes of children with verminous bodies and clothing, and through the orders made by the Local Government Board as to pulmonary tuberculosis or consumption. 88 The number of children reported as being verminous by the school authorities during 1910 was 424, and during 1911 the number rose to 729. In all cases the homes of the children were visited by the sanitary inspectors, and the necessary steps were taken for disinfection and cleansing. This work which must be regarded as very important and necessary has taken up a far larger part of the time of the sanitary inspectors than was the case before 1910. The orders of the Local Government Board as to pulmonary tuberculosis are three in number. The first embodies the Public Health (Tuberculosis) Regulations, 1908. These regulations make the notification of cases of consumption occurring amongst patients treated under the poor law compulsory. They have been in operation since January 1st, 1909. The number of cases which have been certified under these regulations were 313 in 1909, 241 in 1910, and 292 in 1911. Many of these were cases treated whilst residing at home. As far as practicable the homes were visited by the sanitary inspectors and health visitor, and steps taken in accordance with the regulations. The second of the orders embodies the Public Health (Tuberculosis in Hospitals) Regulations, 1911, which makes it compulsory to notify all patients suffering from consumption who are attending hospitals for treatment. These regulations came into operation on May 1st, 1911, and from that date to the end of the year some 289 persons resident in Shoreditch were notified to be suffering from the disease. The homes of these patients also have to be visited. It must, however, be pointed out that the work under these regulations is especially heavy in Shoreditch owing to the existence of a hospital for diseases of the chest within the Borough. The regulations provide that certificates as to cases have to be sent to the Medical Officer of Health of the district in which the hospital or hospitals are situate, and it is for him to send the certificates on to the Medical Officers of Health of the various sanitary districts in which the patients are resident. The Health Department of Shoreditch has consequently become a clearing house for certificates relating to cases which may be resident in any part of London or the Country. It need hardly be stated that this has greatly added to the amount of clerical work. The third set of regulations is the Public Health (Tuberculosis) Regulations, 1911, which make the notification of cases of consumption occurring amongst private patients of medical practitioners compulsory. This came into operation on January 1st of the current year, and made a further addition to the work to be undertaken. As far as practicable, houses where consumptive patients are resident are visited, and as far as existing means will permit of, advice and assistance are rendered. There have been tangible results in a small number of instances, but only a small number. The work, unfortunately, in this direction can only be looked upon as relatively insignificant when compared with what ought to be done. As a matter 89 of fact, the addition to the work of the department brought about by these regulations is such as to be quite beyond the power of the existing sanitary staff to adequately cope with. It is to be noted as a point of importance in connection with the work of the department that during the past two years the cases of notifiable infectious disease certified under the Public Health (London) Act, 1891, have been much below the average. This has, to some extent, lightened the work but it cannot be relied upon to continue. The number of cases might easily be doubled without greatly exceeding the average for the past ten years and an increase must be expected. When this happens the effects of the additions above-mentioned must be accentuated. From what has been stated it will, I think, be evident that since the staff of inspectors was increased, some 16 years ago, the work to be undertaken has been greatly added to. Regular inspections have become necessary in respect to milk purveyors premises, factories, workshops, outworkers premises, and premises where food is prepared and sold ; under the Sale of Food and Drugs Acts there has been a large increase ; more attention has had to be given to verminous homes, and lastly there has been a great addition owing to the compulsory notification of consumption. I have no desire to magnify what has been added to the work and am willing to admit that to a certain extent it has been possible to cope with it by systemization. The great bulk of it, however, has been added work in reality, and a very considerable portion of the time of the inspectors which was formerly available for the regular sanitary inspection of dwelling houses has had to be given up to it. II.—STATISTICAL INFORMATION. The Metropolitan Borough of Shoreditch, including the spaces covered by water, has an area of 658 acres. The population which was 124,533 in 1891, fell to 118,637 in 1901, and at the census of 1911 it was 111,463, showing a further decrease amounting to 6 per cent. The figures for the last census are provisional. The average number of persons resident on each acre of the Borough which was 189 in 1891, fell to 180 in 1901, and has since fallen to 170 in 1911. The number of inhabited houses which was 13,848 in 1891 and 12,743 in 1901 may be estimated at about 11,800, the figure for the last census being not yet available. The residential population is mainly working class, and there is a large and probably increasing proportion of very poor people amongst them. During the past 20 years numerous dwelling houses have been demolished to make way for factories, workshops, warehouses and other business premises. A steady change has been in progress as to the character of the house property in the Borough. In many ways there have been marked improvements, but the great majority of the houses remain such as to need more or less constant attention on the part of the sanitary authority. To some extent there has been change in the character of the premises to be inspected, but the amount of sanitary supervision to be cxercised by the sanitary staff has been 90 in no way diminished. The contrary is, in fact, the case. Consideration of the status of the people and the density of the population per acre should make this evident. As compared with the Metropolis, Shoreditch is almost three times as thickly populated. If the death-rates of the Borough for the past 20 years are considered, a steady decline is noticeable. The average rate for the five years, 1891-95, was 23.4 per 1,000 population ; for the five years ending 1911, the average was 18.8, the decrease amounting to a little short of 20 per cent. Without doubt this is satisfactory so far as it goes. When, however, it is compared with the decrease in the death-rate for London as a whole, which amounts to a little over 30 per cent., the average rates for the same periods being taken, it can hardly be claimed to be altogether satisfactory. The explanation, doubtless, lies in the character of the population and the great density per acre in Shoreditch as compared with London. This, however, can only be taken as an indication for greater sanitary supervision as compared with the average requirements of the Metropolis. Again, if we take the infantile mortalities for the same periods, the average for the years, 1891-95, was 179 deaths of infants under one year per 1,000 births; for the 5 years ending 1911 it was 149, the decrease amounting to approximately 17 per cent. Comparing the same periods for London as a whole, the decrease amounted to 27 per cent. Farther, there has been a steady decline in the mortality from consumption, which is, of course, satisfactory, but unfortunately the death-rate from this cause in Shoreditch is 30 per cent, higher than for the Metropolis. Generally, it may be stated that whilst the mortality statistics are markedly improved as compared with what they were 15 to 20 years ago they none-the-less remain much above the average for London, moreover they take their place amongst the highest rates in the Metropolis. In the subjoined table is a comparison of the mortality statistics of Shoreditch and London, averages for the 5 years ending 1911 being taken for the purpose :— DEATHS. Average Annual Rate per 1,000 persons for the 5 Years ending 1911. All Causes. Principal Zymotic Diseases. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Consump tion. Shoreditch 18. 8 2.5 0.87 0.12 0.15 C.47 0. 05 0.78 1.7 London 14.0 1.5 0.43 0.08 0.13 0.27 0.04 0.52 1.3 91 The figures show for Shoreditch a general death-rate nearly 35 per cent. higher than that of the Metropolis, whilst the death-rate due to the principal zymotic diseases, namely, smallpox, measles, scarlet fever, diphtheria, whooping-cough, enteric fever and diarrhoea was, in Shoreditch, 66 per cent. higher than the average for London. If the infantile mortalities for the 5 years ending 1911 are compared we find that for every thousand infants born in Shoreditch 14.9 have died during the first year of life, whilst the average for London has only been 113; that is, the infantile mortality in the Borough has averaged nearly 32 per cent. higher than that of London. To reduce the mortality rates in the Borough to the average for the Metropolis, which most certainly should be aimed at, must necessarily involve an increase in the work of sanitary inspection, and this means an increase in the existing staff of Sanitary Inspectors. Now, if the number of Sanitary Inspectors employed in Shoreditch be compared with the number employed in London, it will be seen that the Borough is markedly below the average for London in this respect. The following are the latest figures available upon the point and relate to the year 1911:— Enumerated Population, 1911. Families or Separate Occupiers. Number of Sanitary Inspectors. Population to each Sanitary Inspector. Families or separate Occupants to each Sanitary Inspector. Shoreditch 111,463 24,807 6 18,577 4,134 London 4,522,961 1,036,146 331 13,665 3,130 The above figures show that there are 4,912 persons more to each Sanitary Inspector in Shoreditch than the average per Sanitary Inspector in the Metropolis, an excess which amounts to nearly 36 per cent. Taking the sanitary districts adjoining Shoreditch, leaving out the City of London, Bethnal Green has one Sanitary Inspector for 12,828 persons, Hackney one for 13,093, Islington one for 14,8S3, Finsbury one for 9,775 and Stepney one for 15.557. The average for these 5, which may be said to be mainly working-class districts, is one Sanitary Inspector for 13,227 inhabitants, which is somewhat above the average for London Comparing Shoreditch with these 5 districts, each Sanitary Inspector in the Borough has 5,350 persons in excess of this average. 92 Whether the case be considered from the point of view of the additions which have been made to the work to be coped with, or from the point of view of the existing staff of Inspectors in the Borough, as compared with what has been deemed necessary for other working-class Boroughs differing from Shoreditch to no material extent as regards sanitary work required, it seems to me to be quite clear that an increase in the number of Inspectors is necessary. In coming to a conclusion as to the increase needed some allowance must be made for the small area of the Borough, which no doubt saves time as regards inspection. On the other hand, the area is very thickly populated and contains many very poor persons dwelling under conditions which render more than an average amount of the inspection necessary. After carefully considering the matter I am of opinion that not less than two additional Sanitary Inspectors are required. Two additional Inspectors would give the Borough 8 Inspectors, being an average of one Inspector to every 13,933 persons. This approaches fairly near, although it does not quite reach the average for the Metropolis. III.—HEALTH VISITING. Health visiting has been part of the work carried out by Sanitary Authorities in various parts of the country for several years past. In Shoreditch it has been in progress for between two and three years. Some excellent work has been done, so far as it goes, but experience shows that one Health Visitor is unable to deal with half that which is really necessary. A brief statement as to this branch of health work in the Borough will, I think, be helpful. In 1907 the Notification of Births Act was passed and the Act was adopted by the Borough Council on the recommendation of the Health Committee in 1909, and came into operation in August of that year. The object of this Act is to enable Sanitary Authorities to get early information of births, with a view to advice being given to mothers where necessary as to the rearing of infants, in order that the infantile mortality may be lowered. A Health Visitor was appointed, and entered on her duties in the Borough in November, 1909. The purposes of the appointment were to afford for inhabitants of the Borough advice as to the proper nurture, care and management of infants, for the promotion of cleanliness, and for the discharge of such other duties as may be assigned in accordance with the provisions of Section 6 of the London County Council (General Powers) Act, 1908, and the regulation of the General Order made thereunder. The duties discharged by the Health Visitor include the keeping of the necessary records as to her work, enquiries as to consumption cases in women and children, and investigation as regards cases of puerperal fever, ophthalmia neonatorum or inflammation of the eyes in infants newly born, and infantile diarrhoea. The Health Visitor also arranges for obtaining sanatorium or hospital treatment, for admissions to convalescent homes, and for other measures, as may be practicable, for alleviating suffering and affording relief or benefit in such cases. 93 It is perhaps hardly necessary to point out that in a district like Shoreditch there is an immense field for work of this description. Much of the work is of an educational character, such as the instruction of mothers as regards the care of infants. This, from a health point of view, is of great importance in the Borough, owing to the high infantile mortality, and most of the Health Visitor's time is taken up with it. The amount of work, however, is greater than can be dealt with, and a large proportion of the births have to go unvisited. The following is a brief synopsis of the work done by the health visitor for the year 1911, and will, I think, convey an idea as to the general character of the duties she performs :— (1) Visits in connection with births notified—1,347, of which 840 were first and 507 re-visits ; (2) Visits in respect of infants suffering from summer diarrhoea, 65 ; (3) Inquiries as to the deaths of infants caused by summer diarrhoea, 41 ; (4) Inquiries as to cases of opthalmia neonatorum, i.e., inflammation of the eyes occurring in newly-born children, 46 ; (5) Inquiries as regards cases of puerperal fever, 5 ; (6) Visits in connection with consumption cases notified in women and children—206, of which 144 were first and 62 re-visits ; (7) Inquiries as to deaths from consumption in women and children, 13 ; (8) Lectures on the Care of Infants, &c., 3; (9) Interview with various persons on matters relating to the work, 127 ; (10) The whole of the clerical work, which is no inconsiderable item, and includes keeping the necessary records and correspondence arising out of the work done : the number of letters written was 186. The total number of visits made during the year was 1,996 ; but there were a large number of futile visits, i.e., to persons who were not at home at the time or, from some other cause, could not be seen. The chief item of the work is that in connection with the notification of births. During the year 3,386 births were notified ; but of these only 840 were visited, leaving 2,546, in which no visits could be paid. Of the latter number 870 could be excluded as not requiring to be visited, the circumstances indicating that the infants were either under the care of medical practitioners or were being otherwise looked after at medical missions, or were in Poor Law Institutions. There were also still-born infants and those dying shortly after birth to be reckoned. Deducting these, there remained some 1,593 births in connection with which visits should have been made, but lack of time rendered it impossible. 94 In connection with the health visitor's work as regards consumption cases, it may be mentioned that during the past two years she was instrumental in obtaining sanatorium treatment for some 15 persons and for 6 others long periods of treatment in hospitals or convalescent homes. In 3 other cases private arrangements were made for open-air treatment, and in 23 cases beds and bedding were supplied so as to ensure separate sleeping accommodation. Since ophthalmia neonatorum became notifiable the health visitor has followed the notifications up, so as to make sure that the infants received proper and prompt treatment—a matter of great importance, as the disease not infrequently results in permanent loss of sight if not speedily and properly treated. Your Committee may perhaps be reminded that a health visitor has no statutory authority as regards entering houses. It depends upon the person visited whether admission to the home is given. A good deal of tact is necessary, therefore, in connection with the work. Visits cannot be hurriedly made if they are to be of service and be productive of good results. I hope the foregoing statement will be sufficient to show the character of the work now being done in the Borough by health visiting, and the need which, in my opinion, exists for more of it. I may add that I believe the work in this direction is already much appreciated amongst the people. 4.—CLERICAL STAFF. The staff includes three clerks and a general assistant. Each of these officers has assigned to him certain regular duties in the routine of the department, for the due performance of which he is held responsible. These duties may be briefly stated as follows:— The Senior Clerk (Mr. Pratt) attends to the general statistical work, most of the correspondence of the Medical Officer of Health, the preparation of the regular reports for the Health Committee and the registers which have to be kept as to milk purveyors, houses let in lodgings, the Housing and Town Planning Act, 1909, and others. He also does the clerical work relating to estimates, requisitions, material for use in the department, accounts, petty cash and the payment of wages. He is present in the office whenever the Health Committee meets, and is generally responsible for the supervision of the office. The Second Clerk (Mr. Abbott) has charge of all clerical work under the Factory and Workshops Acts, such as keeping the register of workshop, the outworkers' lists and the. correspondence with the Factory Department and the various employers of labour in the Borough. He prepares the major portion of Intimation and all the Statutory Notices under the Public Health (London) Act, 1891, and keeps the records as to houses dealt with under that Act. He also prepares summonses which may be taken under the Act, and does most of the correspondence relating to nuisances or insanitary conditions. He keeps the register as to combined drains and has the preparation of agendas for the Health Committee. 95 The Third Clerk (Mr. Hayes) is responsible for all the clerical work relating to infectious disease, such as keeping the various registers under the Public Health Act and the Tuberculosis Regulations, 1908-11, the index relating thereto, the disinfection records and the correspondence with the Metropolitan Asylums Boaid, the London County Council and the School Authorities in connection therewith. The General Assistant (Mr. Harris) acts as messenger, assists in drain testing, attends to complaint book, copies and indexes letters. He makes all the necessary preparations for sampling under the Sale of Food and Drugs Acts, and attends to most of the clerical work arising out of the administration of these Acts. He also does a portion of the work as regards sanitary notices and is in attendance at the office when the Health Committee meets. All the above officers assist as regards the Annual Report relating to the work of the Department. When necessary, they may be called upon to render assistance in respect to any portion of the clerical work of the Department. It need, perhaps, hardly be stated that there has been an enormous increase in the clerical work, as compared with what it was 15 to 20 years ago. It could then be done without effort by one clerk and a general assistant. Now, the existing staff have much difficulty in coping with the routine work of the Department, although, as has been pointed out, the amount oi notifiable infectious disease during the past 2 years has been markedly below the average. Last year a great and a permanent increase was made in the amount of clerical work, owing to the Tuberculosis in Hospitals Regulations. The extent of this may be gauged by the fact that, whereas the average number of communications, written and printed, sent out from the department was 13,293 annually for the 4 years ending 1910, it rose to 16,520 in 1911. This increase was due to the regulations mentioned almost entirely, and the regulations did not come into operation until May. The difficulty as regards the work has been engaging my attention during the past 2 years. Certain re-adjustments of the duties between the officers have had to be made to meet it. To the Health Visitor has been transferred the responsibility for the register of births notified. This was necessary to relieve Mr. Abbott, who had been doing part of this work. To relieve Mr. Hayes it was necessary to transfer all the clerical work under the Sale of Food and Drugs Acts to Mr. Harris. Notwithstanding there is still a marked tendency for some of the work to get in arrear. I have made a point of going very carefully into what each of the officers does, with a view to ascertaining, as far as practicable, how their time is taken up, and where economies, if possible, can be effected. There is no doubt that it takes them practically all their time to get through their work now. There is little or no margin for emergencies, and in the event even of an average prevalence of infectious disease, it would be impossible for the work to be done within the usual office hours. A material saving of time can, however, be effected by making an alteration in the existing system of copying intimation notices which are served under the Public 96 Health Act. At present the practice is for the sanitary inspectors to write out the requirements of the notices on the counterfoils in the notice books which are handed to the clerk to be copied. These copies signed by the inspectors are served, the counterfoils being retained in the books as the office records. If a carbon copying system, which is already for some purposes in use in the department, be substituted, the counterfoils and the notices for service could be written by the sanitary inspectors themselves. This would save a large part of the clerical work in connection with something like 3,000 notices during the course of the year without materially adding to the work of the sanitary inspectors. Such a change would perhaps, probably increase the cost of the notice books to some extent, and some of the notices would perhaps not bear the stamp of clerkly hands, but it does not seem to me that there need be any serious objection to it. The clerical work in connection with health visiting in the Borough is done by the health visitor herself as already pointed out. A good deal of the correspondence is of a confidential character, and as such must necessarily be conducted by the health visitor. There is, however, some in which clerical assistance would be helpful, and would moreover allow of more time for visiting. It is, however, impossible to give this with the existing staff. 5.—SUMMARY. Briefly, it may be stated that since the last increase in the number of sanitary inspectors, some 16 years ago, the dirties of the sanitary authority have been very greatly added to. A comparison of the mortality statistics of Shoreditch and London as a whole, shows that whilst there have been definite improvements for both, the improvement in the case of the Metropolis is markedly greater than Shoreditch. The general death-rate, the death-rates from the principal zymotic diseases and from consumption, and the infantile mortality are all considerably higher in Shoreditch than for the Metropolis. Taking the number of inhabitants as a basis, the number of sanitary inspectors employed in Shoreditch is markedly below the averages for London and for the Boroughs adjacent to Shoreditch. Health visiting is a work of great importance in a Borough like Shoreditch. The amount required, is, however, far greater than one health visitor can possibly accomplish. Consequent upon the increases in the duties devolving upon the department, more especially during the past two years, the work of the clerical staff has grown to such an extent that there is practically no margin for further work. Any additional work of a permanent character will render more clerical assistance absolutely necessary 97 6.—RECOMMENDATIONS. After reviewing the circumstances and the needs of the Borough, I beg to submit for your consideration the following recommendations. (1) That 2 additional sanitary inspectors be appointed, thus raising the number of inspectors in the Borough to 8. (2) That the inspectors so appointed be assigned to districts therein to perform the duties laid down for sanitary inspectors in accordance with the Sanitary Officers (London) Order, 1891, and that the Borough be divided into sanitary sub-districts accordingly. (3) That a second health visitor be appointed, and that the Borough be divided into two districts for health visiting, namely Hoxton and Haggerston (4) That the system of preparing the sanitary inspectors intimation notices be modified on the lines suggested in this report. (5) That an additional clerk be appointed. 7.—FINANCIAL CONSIDERATIONS. To give effect to the foregoing recommendations at the existing rates of pay will involve an additional expenditure which may be estimated as follows :— Two sanitary inspectors £290 One health visitor £100 One clerk £52 The total for the first year would be £442, rising by annual increments of say £20 to a maximum of about £590 per annum. It is to be noted, however, that approximately half of the salaries paid to the sanitary inspectors should be refunded to the Borough Council by the London County Council out of the exchequer contribution account. It may also be stated that the sum paid to Shoreditch under the Equalisation of Rates Act, 1894, was during the year ending March 31st, 1912, over one thousand pounds more than in the previous year. In as much as the expenses incurred by the sanitary authority under the Public Health (London) Act, 1891, are a first charge on every sum paid to the sanitary authority under the Equalisation of Rates Act, the point is one which should not be lost sight of in considering the expenditure involved in connection with the in creases in the sanitary staff as recommended. I am, Gentlemen, Your obedient Servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. g Metropolitan Borough of Shoreditch. REPORT ON THE WORK OF HEALTH VISITING (.During the Year ending December 31sf, 1913) IN THE BOROUGH OF SHOREDITCH, by Ethel J. Charlesworth, Health Visitor Certificates of the San. Insp. Exam. Board, London; Central Midwives Board-, National Health Society, &c. fc'2 100 Town Hall, Shore ditch, E.C. January, 1912. To the Medical Officer of Health. Sir, I have the pleasure to submit the following report on the work of health visiting in the Borough during the year 1912. 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 2,034. These may be divided into nine classes :— 1. Visits in connection with notifications under the Notification of Births Act, 1907 :— First visits 927 Re-visits 262 1,189 2. Visits in connection with certified cases of Ophthalmia Neonatorum 31 First visits 20 Re-visits 11 3. Enquiries into cases of Puerperal Septicaemia ... 10 First visits 8 Re-visits 2 4. Enquiries into deaths of infants from Summer Diarrhoea . 13 5. Lectures on Infant Care 2 6. Visits in connection with Notifications of Phthisis 433 First visits 285 Re-visits 148 7. Enquiries into Deaths from Phthisis 16 8. Interviews with various people connected with the Work 106 9. Miscellaneous visits 17 10. Futile visits 217 (1) Visits in connection with Notification of Births. The total number of notifications received during the year was :— Under the Notification of Births Act 3,230 Notified by London County Council 156 3,386 101 The total number of notifications followed up was 1,134, leaving 2,252 which have not been dealt with. Of these 2,252 notifications, 283 were excluded. This number is composed of:— 1. Seventy-six Notifications concerned births occuring in the Holborn Infirmary, the parents not being resident in this Borough. 2. 123 Notifications concerned those births occurring in families not so likely to require visits as others. 3. 84 Notifications related to still born children. The remaining 1,969, which were not followed up, include those cases where the infant died shortly after birth. In respect of this branch of the work there has been little which calls for comment other than that made in my two previous reports. The disadvantages attached to the endeavour to carry out the whole of the infant visiting in the Borough remained the same during the greater part of the year, but were removed in November, by the appointment of a second health visitor. This division of the Borough will give opportunity for better work, both in quality and quantity, for it will be possible to take a keener interest in a smaller number of people, and time will not be spent in traversing so large an area. This, in conjunction with the plans already made for the establishment of a weighing centre, leads me to believe that considerable progress can be made during the forthcoming year. The Problem of the Mentally Defective Parent. There still remains the extreme difficulty of dealing with the mentally defective parent who is often unable to respond to any form of education, and who has no idea of parental responsibility ; their children more often than not being in a more or less neglected state. Experience having shown me the unsatisfactory condition of the homes of mentally defective parents, I have redoubled my efforts to induce parents and guardians of mentally deficient children to allow them to be placed under permanent care, both for the happiness of the children and that of future generations. But my reasons have been met with sentimental prejudice, and only once in the course of my three years work have I been successful in this direction. Early in the year I came across a young adult woman, obviously mentally deficient, who was vainly trying to care for her illegitimate child, itself of a degenerate type. The girl lived with her married sister, for whose young children she was a most undesirable companion, and on this account alone she should have been removed. But though I several times urged the reasons for her removal, none of which her relatives could deny, they declined to part with her, and I was at last obliged to abandon the attempt. Nothing short of compulsory powers is likely to secure permanent care for such people. 102 Food for Nursing Mothers. Owing to the generosity of my former voluntary helper, Miss Stiff, I was enabled during the year to make an interesting experiment as to the value of supplying a nursing mother with adequate nourishment for a prolonged period. The two last babies in this family wasted and died in infancy. Knowing the parents to be thoroughly trustworthy, I provided the baby (who weighed less at one month than at birth) with some warm modern clothes, and arranged for the mother to have a pint of milk daily for some months. The baby steadily increased in weight, made satisfactory progress, and seems likely to grow into a strong child. Ophthalmia Neonatorum. 17 cases have been certified under Section 55 of the Public Health (London) Act. 1. Ten of these occured in cases attended by doctors, inclusive of six in the maternity wards of public institutions. 2. Seven occurred in the practice of midwives, of these, five were subsequently admitted to either a Hospital or Infirmary, In one such instance, where the child's eyes were severely affected, it was admitted to Moorfield's Hospital of the 16th day, and died there three days later, of convulsions. Another severe case was admitted to the Infirmary, where it was efficiently treated ; but the child died shortly after returning home ; both parents being of a very unsatisfactory type. The remainder have been treated at home ; various arrangements having been made in accordance with the needs of each case. There is little doubt that the majority of parents are becoming impressed with the seriousness of this disease, and I have not in this year experienced a single instance where the advice given has been disregarded, and all are more inclined than before to give themselves earnestly to the task of cure. In addition, four cases of "inflammation of the eyes," have been notified by the London County Council Medical Inspectors of Midwives. These occurred in cases attended by midwives, all were subsequently seen by a doctor, on account of their eyes, but were not certified by them as suffering from ophthalmia neonatorum. In one of these cases, it seemed possible that the mischief was caused by the condition of the eyes of the so-called " nurse " in attendance on the mother. The midwife was not summoned until 30 minutes after the child's birth ; the " nurse," an old woman, had sore eyes and a copious watery discharge, which she habitually wiped off with her finger or her apron ; under the pressure of questioning she admitted that she had used the corner of this apron to wipe the baby's eyes at birth. I pointed out to the "nurse" and to her employer that the condition of 103 her eyes rendered her a potential source of danger in maternity cases; and advised the " nurse " not to attend any more cases until her eyes were cured ; but I had no power to enforce this advice. This forms a striking illustration of the less conspicuous harm which frequently results from the employment by the poor of an untrained woman to act in the capacity of " monthly nurse." She attends the patients of both a doctor or a midwife, and whilst both of these are trained and registered, and the latter vigorously supervised, the " nurse " is a free lance, neither trained, registered or controlled, and is often ignorant and superstitious. Yet both the doctor and midwife have to accept the responsibility of the case, and are blamed if trouble arises as in the case quoted above, as the result of her incompetence. In the interests of both the patient and the responsible attendant, it should be illegal tor a woman to act in the capacity of " nurse " unless she has some recognised standard of efficiency. Puerperal Septicaemia. Eight cases have been certified. Three were attended by doctors, two of these patients died after a few days illness, the other, a severe case, recovered after an illness of some weeks duration. Five were attended by midwives; and of these, two died some days after their admission to hospital; the other three patients all recovered, two of these having only a slight illness. Summer Diarrhoea. The number of deaths of infants from summer diarrhoea was comparatively small, and there was no marked prevalence of the disease during the whole of the summer months. Enquiry was made into the circumstances attending 13 deaths from this disease, all the infants being less than eight months old. The main points of the information thus obtained are shown in the following table. Total. Condition of Home. Method of Feeding. Evidence of Infection. Cl ean and Fairly Clean. Dirty and Very Dirty. Proper Food Store. Natural. Natnral and Artificial. Artificial. Cases in same House. Cases in Neihbour's Children. No Evidence. 13 7 6 1 (Fairly sat- isfactory.) 1 5 7 3 1 9 It will be seen that only one baby was entirely naturally fed ; the mother stated that the baby had been ill with "brain disease" for many months and had suffered from chronic diarrhoea, which became acute, a few days previous to death. 104 There was no proper pantry in any of the houses, but one home had a fairly satisfactory cupboard for food. Lectures on Infant Care. These were given early in the year, in response to an invitation received from the organiser of the Women's Meetings in connection with S. John's Church, Hoxton. Phthisis. Owing to the fact that on and after January 1st, 1912, all cases of pulmonary tuberculosis became notifiable, there has been a large increase in the number of visits paid to those suffering from phthisis. As in former years, my work has, for the most part been limited to women and children. Many certificates have been received, relating to those previously known to me, but 285 of these were new cases and have been visited for the first time; 69 were children under 14 years of age. Sixteen women have been industrially employed, out of their home, and it has been necessary to visit in the evening, at or after 8 p.m. Voluntary Workers. Until January 27th, 1912, I was assisted by Miss Stiff, who then completed three months work here as a voluntary assistant health visitor. On October 9th, 1912, Miss Meses, with the permission of the Health Committee, began to assist me as a voluntary worker, and is still continuing in that capacity. In Conclusion, I should like to express my thanks to all those individuals and societies who have afforded me opportunites of co-operation to secure those reforms which we in common desire. I am, Sir, Your obedient servant, ETHEL J. CHARLESWORTH.