SHOR 24 REPORT ON THE Health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON FOR THE YEAR 1913, 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 darling and son, ltd,, bacon street, london, e. CONTENTS. Page. Anthrax 30 Artizans' dwellings 43 Appendicitis, mortality from 8 Bacteriological examinations 32 Bakehouses 49 Births in sub-districts 2 Birth rates 3 Cancer 7 Cerebro-spinal fever 29 Cholera 30 Coffeehouses 50 Cookshops 50 Cow-houses 46 Customs and Inland Revenue Acts 45 Dairies 46 Deaths in sub-districts 4 Death rate 4 Deaths, ages at 6 Deaths, causes of 5 Deaths in public institutions 8 Deaths in outlying Institutions 9 Demolition of houses 40 Diarrhœa 22 Diphtheria 17 Disinfection 32 Enteric Fever 19 Erysipelas 21 Factories and Workshops Act, 1901 47 Factories, workshops and workplaces—sanitary work 47 Food condemned and destroyed 51 Food and Drugs Act 51 Fried fish shops 51 Glanders 30 Housing and Town Planning Act, 1909 41 Houses closed 39 Houses let in lodgings 45 House to house inspection 39 Hydrophobia 30 Ice cream shops 50 Infantile mortality 4 Infectious cases, number certified 13 Infectious cases, number removed to hospitals 13 Infectious diseases, age periods 11 Infectious diseases, deaths from 10 Infectious diseases, death rate 11 Infectious diseases, isolation 13 Infectious diseases, number of cases notified from schools 30 Influenza 24 Legal proceedings 35 Margarine Act, proceedings under 54 Marriages 3 Measles 23 Milk-shops 46 Milk and Cream Regulations, 1912 55 (174)—100—D & S. Sch. 201. a Page. Milk premises, cowsheds, etc., on register 16 Mortuary 33 Notification of Births Act 3 Offensive business 46 Ophthalmia neonatorum 29 Outworkers 48 Polio-myelitis 30 Population 1 Puerperal fever 22 Rag Flock Act, 1911 46 Return cases 14 Sanitary work 33 Scarlet fever 15 Scarlet fever, return cases of 14 Schools, exclusions of children for infectious disease 32 Shelter 32 Sickness amongst the poor 10 Slaughter-houses 46 Small-pox 14 Smoke nuisance 37 Staff 55 Street markets and food 51 Tuberculosis 25 Typhus fever 24 Vaccination 14 Verminous houses 37 Violence, mortality from 8 Water supply 33 Whooping cough 24 Workshops on register 47 Zymotic diseases, deaths from 11 Zymotic death rate 11 APPENDIX. Statistical Tables :— For whole district during 1913 and previous years (Table I.) 58 Cases of Infectious disease notified during 1913 (Table II.) 59 Causes of, and ages at, death during year 1913 (Tables III. and V.) 60, 64 to 71 Infantile mortality during 1913 (Table IV.) 61 Notes to Table III. 62 Comparison of London and Shoreditch birth and death rates in 1913 (Table VI.) 72 Cases treated by District Medical Officer in 1913 (Table VII.) 73 Summary of proceedings under Public Health (London) Act, 1891 (Table VIII.) 74 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 75 to 78 Report on Infantile Mortality 79 to 81 Milk and Cream Regulations —Report 85 Report on tuberculosis dispensary 86 to 89 Report of Health Visitors 92 to 101 Metropolitan Borough of Shoreditch* ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. January, 1914. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. Sir and Gentlemen, I have the honour to submit the subjoined Report on the Health and Sanitary Condition of the Borough of Shoreditch for the Year ending December 31st, 1913. POPULATION. The estimated population for 1913 is 110,410, distributed in the Wards of the Borough as set out below : Ward. Population. Ward. Population. Moorrields 4,672 Whitmore 18,815 Church 18,835 Kingsland 10,736 Hoxton 16,430 Haggerston 11,220 Wenlock 17,342 Acton 12,360 The estimated populations of the Registration Sub-Districts of the Borough are as follows ;—Shoreditch South, comprising Moorfields, Church and Hoxton Wards, 39,937 ; Shoreditch North-West, comprising Wenlock and Whitmore Wards, 36,157, and Shoreditch North-East, which comprises Kingsland, Haggerston and Acton Wards, 34,310, (174)—100. A 2 Included in the population of the Wenlock Ward is that of the Holborn Union Workhouse, which is situate in this Ward. The number in this institution on the night of the Census 1911 was 1,328. 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 109,082, whilst the estimated population of the Ward is reduced to 16,014, and that of the Registration Sub-District, Shoreditch North-West, to 34,729. 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 66 Whitmore 76 247 Church 106 177 Kingsland 72 149 Hoxton 78 210 Haggerston 66 170 Wenlock 90 177 Acton 83 147 In estimating the above figures, the population and the area of the Holborn Union Workhouse premises, and also the area covered by water in the Borough, have not been included. BIRTHS. The births registered in the Borough numbered 3,283, of which 1,691 were of males and 1,592 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 3,393, of which 1,744 were of males and 1,649 of females. The distribution of the corrected births in the eight Wards of the Borough is given below :— Ward. Males. Females. Total. Moorfields 56 44 100 Church 297 315 612 Hoxton 302 274 576 Wenlock 241 209 450 Whitmore 295 300 595 Kingsland 180 165 345 Haggerston 184 167 351 Acton 189 175 364 Totals 1,744 1,649 3,393 3 Outside the Borough 158 births were registered—79 of males and 79 of females —the parents being residents of Shoreditch. In the Shoreditch Infirmary 101 births were registered, of which 55 were of males and 46 of females. In five of these (3 male and 2 female) the parents did not belong to Shoreditch. In the Holborn Union Workhouse there were 47 births, 25 of males and 22 of females. In 43 of these (23 male and 20 female) the parents were not resident in Shoreditch. Of the births registered as occurring in the Shoreditch Infirmary 42 (20 of males and 22 of females) were illegitimate. In the Holborn Workhouse 27 (16 male and 11 female) were illegitimate, and elsewhere in the Borough 28, of which 17 were male and 11 female. The birth-rate was 31.1 per 1,000 inhabitants, as compared with 32.l in 1912, 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 23.9 ; for 96 Great Towns, including London, it was 25.1, and for 146 smaller towns it was 23'9 per 1,000 living. The London birth-rate was 24.8 per 1,000 population. NOTIFICATION OF BIRTHS ACT, 1907. The births notified under the above Act during 1913 numbered 3,018, as compared with 3,230 in 1912, 3,228 in 1911, and 3,277 in 1910. Taking the number of births belonging to Shoreditch registered during the year, the percentage of notifications was 90 as compared with 91 per cent, in 1912, 92 per cent, in 1911 and 91 per cent, in 1910. The greater proportion of the notifications were by registered midwives. In addition there were 158 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 95 per cent, of the number of births registered during the year. MARRIAGES. The marriages in Shoreditch during 1913 numbered 1,028, as compared with 1,077 in 1912, 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 18.8 per 1,000 population, as compared with 19.6 in 1912, 18.4 in 1911, 18'0 in 1910, and 16.9 in 1909. The marriage-rate for the Metropolis during 1913 was 18.3 per 1,000 population. DEATHS. The deaths during 1913 numbered 2,008, as compared with 2,017 in 1912, 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. (174) A 2 4 The distribution of the deaths amongst males and females in the eight Wards of the Borough is as shown in the following table : — Ward. Males. Females. Total. Moorfields 35 28 63 Church 226 173 399 Hoxton 199 172 371 Wenlock 131 127 258 Whitmore 205 171 376 Kingsland 84 99 183 Haggerston 96 86 182 Acton 89 87 176 Totals 1,065 943 2,008 The deaths of males were 122 in excess of those of females. The death-rate for the year was 18.4 per 1,000 inhabitants, as compared with 18.3 in 1912, 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, and 19.6 in 1903. The death-rate for 1913 was therefore again below the average for the previous ten years. The London death-rate during 1913 was 14.2 per 1,000 population, for England and Wales it was 13.4, for 96 great towns including London 14.7, and for 145 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. The death-rate was lowest in Moorfields and highest in Hoxton Ward. The death-rate for the Borough was above the mean rate for the year during the first eleven weeks ; it fell about the middle of March and was below the mean until about the middle of August when the rate began to rise, gradually mounting until a maximum was attained during the first fortnight of October after which it fell again and for the remainder of the year it averaged somewhat below the mean rate. The highest rate recorded was that for the first week of February when it was 33.3, the lowest was for the first week of August, when it was only 8'5 per 1,000 population. The elevation during the early part of the year was the result of the mortality due to measles, bronchitis and pneumonia ; the rise in August was caused by the prevalence of summer diarrhoea. The deaths of infants under the age of one year numbered 530, 312 being of males and 218 of females, the deaths amounting to 26.3 per cent, of the total number of deaths at all ages as compared with 22.3 for 1912, 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 1913 was at the rate of 157 per 1,000 births belonging to Shoreditch registered during the year. Amongst males the infantile mortality was 179 whilst amongst females it was 132 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, measles and tuberculosis. Corrected for age and sex distribution the death-rate was 19.0 per 1,000 population. 5 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. This table also gives the nett deaths and births during the year amongst legitimate and illegitimate infants. Comparison with the table for 1912 shows that the increase in the infantile mortality for 1913 is mainly the result of increases in the numbers of deaths from diarrhoea, pneumonia and bronchitis. In the subjoined table the causes of death amongst infants under one year fo each of the eight Wards of the Borough are given :— Cause of Death. Moorfields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals. Small-pox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... 1 1 3 3 1 1 2 12 Scarlet Fever ... ... ... ... ... ... ... ... .... Whooping Cough ... 3 3 1 1 1 1 1 11 Diphtheria and Croup ... ... 1 ... 1 ... ... ... 2 Erysipelas .... 1 2 l 1 .... ... ... 5 Tuberculous Meningitis ... 3 ... ... 2 2 l ... 8 Abdominal Tuberculosis ... ... 1 1 4 ... ... l 7 Other Tuberculous Diseases ... 2 3 l 1 ... ... ... 7 Meningitis (not Tuberculous) ... ... ... 3 ... 3 ... ... 6 Convulsions 1 4 2 1 4 3 l 2 18 Laryngitis ... ... ... 1 ..... ... ... .... 1 Bronchitis 3 8 9 3 6 5 1 ... 35 Pneumonia (all forms) 1 18 14 5 10 10 7 7 72 Diarrhœa ... 22 22 13 15 7 8 7 94 Enteritis .... 12 8 4 7 4 2 5 42 Gastritis ... ... ... ... ... ... ..... ... .... Syphilis ... 2 ... ... ... ... 1 ... 4 Rickets ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 7 1 1 6 4 3 2 25 Injury at Birth ... ... 1 ... ... ... 1 ... 2 Atelactasis ... ... ... ... ... ... ... 1 1 Congenital Malformations 1 1 2 1 ... ... ... ... 5 Premature Birth 6 11 16 10 9 2 3 8 65 Atrophy, Debility and Marasmus ... 19 13 6 16 9 13 4 80 Other causes ... 6 8 2 4 2 3 3 28 Totals 13 120 107 57 91 53 46 43 530 6 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 196, and lowest in Acton, where it was 118 per 1,000 births. For England and Wales the infantile mortality during 1913 was 109 and for London 104. Generally throughout the country the infantile mortality was higher than in 1912. During the year attention was directed by Dr. Addison, M.P., to the marked difference between the infantile mortalities of London and Shoreditch. The subject is dealt with in a special report which is appended (p. 79). The work carried out by the Health Visitors is dealt with in their reports. (Appendix, page 92.) Some 3,557 visits were paid by the Council's Health Visitors in connection with 2,141 infants born during the year and 138 were visited by Miss Child during the last six weeks of the year. Miss Child is a fully qualified Health Visitor appointed by the Committee of the Shoreditch School for Mothers. Attention may be directed to the weighing centres which were established in the Borough during the year, where mothers can attend and receive advice and instruction from the Health Visitors as regards the care and nurture of their infants. Of these centres one is at the Town Hall, where the meetings take place every Wednesday afternoon under Miss Charlesworth, one is at the Haggerston baths, meeting on Thursday afternoons under Miss Jacocks, and the third, the Shoreditch School for Mothers, holds its meetings at the Church Room in Vestry Street under Miss Childs. The sphere of activity of the last is limited to that portion of Hoxton lying to the west of East Road and New North Road. There is every reason for believing that most useful work is being carried out in connection with these centres. The deaths of children aged from 1 to 5 years numbered 257, of which 27 were attributed to measles, 17 to whooping cough, 10 to diphtheria, 28 to various forms of tuberculosis, 10 to bronchitis, 53 to pneumonia, 74 to diarrhoea and enteritis, and 7 to various forms of violence, of which 6 were the results of burns or scalds. Altogether 787 or 38'6 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 38*4 for 1912. Of children from 5 to 15 years of age, 74 died. The chief causes of death were tuberculosis which accounted for 21, other infectious diseases which resulted in 12, pneumonia which caused 7, and various forms of violence which accounted for 9 deaths, 3 of which resulted from street accidents. Of persons aged between 15 and 25 years there died 67, of whom 14 were the victims of consumption, 12 of diseases of the heart and circulatory organs, and 9 of pneumonia. Of persons aged between 25 and 35 years there died 92, the chief causes of death being consumption, which accounted for 35; diseases of the circulatory organs, 7 which resulted in 9 ; pneumonia, which caused 7, and Bright's disease, which ended in 5 deaths. One death was attributed to cancer and 3 were due to violence, 2 of which were suicidal. Of persons aged from 35 to 45 years there died 149, of which 41 resulted from consumption, 8 from cancer, 17 from diseases of the nervous system, 3 of which were due to general paralysis of the insane, 14 from diseases of the heart and circulatory organs, 10 from bronchitis, 13 from pneumonia, 7 from diseases of the digestive organs, 12 from Bright's disease, and 6 from violence, 2 of which were the result of suicide and 1 of homicide. The deaths of persons aged from 45 to 55 years numbered 214, of which 36 were due to consumption, 19 to cancer, 11 to apoplexy, 5 to general paralysis of the insane, 22 to diseases of the heart and circulatory organs, 23 to bronchitis, 16 to pneumonia, 23 to diseases of the digestive organs, of which 13 resulted from cirrhosis of the liver, 15 to Bright's disease, and 11 to violence, 2 of which were due to suicide. Of 213 deaths amongst persons aged from 55 to 65 years, 34 were attributed to consumption, 18 to cancer, 3 to old age, 21 to apoplexy, 2 general paralysis of the insane, 27 to diseases of the heart and circulatory organs, 35 to bronchitis, 15 to pneumonia, 2 to cirrhosis of the liver, 13 to Bright's disease, and 8 to violence, of which 3 were the results of suicidal acts. Of 235 deaths amongst persons aged from 65 to 75 years, 6 were due to consumption, 15 to cancer, 23 to old age, 27 to apoplexy, 30 to diseases of the heart and circulatory organs, 56 to bronchitis, 18 to pneumonia, 19 to Bright's disease, and 10 to violence, 2 of which were suicidal. Of 135 persons who died aged from 75 to 85 years, in 2 instances death was attributed to consumption, in 55 to old age, 13 to apoplexy, 14 to diseases of the circulatory organs, 27 to bronchitis, 4 to Bright's disease, and 3 to violence through falls. Of the persons who died 85 years and upwards, 1 died from cancer, 23 from old age, I from senile gangrene, 9 from bronchitis, 2 from pneumonia, 3 from apoplexy, and 3 from falls. The chief causes of death during the year were : tuberculosis which accounted for 248 deaths including 185 attributed to consumption or phthisis, pneumonia which caused 219, bronchitis 209, old age 104, diseases of the heart and circulatory organs 139, measles 40, diarrhoea and enteritis 217, cancer 63, prematurity 65, Bright's disease and acute nephritis 72, apoplexy 83, atrophy debility and marasmus 58, whooping cough 28, alcoholism and cirrhosis of the liver 30, and violence 91 deaths. Of the 63 deaths from cancer 32 were of males and 31 of females. Ten persons under 45 years and 1 over 75 were certified to have died from cancer. In 8 addition 14 deaths, 8 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 059 per 1,000 population and was below the average, being lower than in any year since 1900. The rates for previous years are as follows:—0.72 in 1912, 0.72 in 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 1894 and 0.51 in 1893. Of the deaths attributed to alcoholism and cirrhosis of the liver 13 were of males and 17 of females. The deaths attributed to appendicitis numbered 6 as compared with 8 in 1912, 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 1913, 4 were of males. The deaths from peritonitis numbered 5, 4 of which were of females. Taking the deaths from appendicitis and peritonitis together they were below the average in point of number for the past 10 years. Of the 91 deaths from violence 48 were of males and 43 of females. Through accident or negligence 75 persons lost their lives. In 9 instances street accidents in connection with vehicular traffic were the cause of death ; in 5 of these the persons killed were males. In 12 instances death was due to burns or scalds ; 8 of these were of females. In 19 instances falls of various kinds were the cause of death. The number of infants who lost their lives through being suffocated in bed was 25, as compared with 26 in 1912 and 22 in 1911. Thirteen persons committed suicide ; 10 of these were males. There were 3 cases of homicide. 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 6 209 215 Shoreditch Workhouse 544 43 587 Royal Chest Hospital 6 36 42 Convent Hospital — 5 5 Home of Good Shepherd 10 3 13 Babies' Home, Brunswick Place 16 15 31 Totals 582 311 893 9 Elsewhere than in public institutions, 8 persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various institutions outside Shoreditch with the numbers of persons belonging to the Borough dying therein Asylums. No. of Deaths. General Hospitals— continued. No. of Deaths. Banstead 2 London 18 Cane Hill 2 London Temperance 2 Caterham 5 Metropolitan 67 Claybury . 22 Middlesex 5 Colney Hatch . 12 Mildmay 9 Darenth 1 National 1 Dartford Heath 2 Queen's (Children) 82 Horton 3 Royal Free 6 Hanwell t 3 St. Bartholomew's 96 Leavesden . 11 Seamen's Hospital 1 Long Grove 2 University College 4 Manor 2 Vincent Square (Infants 1 Tooting Bee 5 Hospitals for Infectious Disease. Special Hospitals. Chest Hospital, Bethna Green I 1 Eastern . 13 Grove 1 City of London Lying-in 13 North Eastern . 14 Mount Vernon 1 North Western 2 Royal Hospital for Incurables 1 Northern 3 Park 2 South Eastern 3 Infirmaries and Work houses. Belmont Workhouse 6 Western 1 General Hospitals. Bethnal Green Infirmary 2 Belgrave 1 Holborn Infirmary 6 Charing Cross 1 Islington do. 2 East London (Children) 5 Lambeth do. 1 Freidenheim 1 Shoreditch Branch Workhouse 1 German 3 Gt. Ormond Street (Child ren) 12 Other Institutions. Guy's 1 St. Joseph's Hospice 2 Hampstead General 1 St. Luke's House 2 Home Hospital 1 Pentonville Prison 1 King's College 1 Downs Sanatorium 2 10 Of 471 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 319 died in general hospitals, 72 in asylums, 39 in fever hospitals, 18 in workhouses and infirmaries, 16 in hospitals for special diseases, and 7 in other institutions. Elsewhere than in public institutions 13 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 1,053 or 52*4 per cent, of the deaths of persons belonging to Shoreditch took place in public institutions. SICKNESS AMONGST THE POOR. The cases coming under the treatment of the district medical officers in connection with the Poor Law Dispensary in Hoxton Street during 1913 numbered 4,836 as compared with 5,201 in 1912, 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 679 as compared with 991 in 1912, 924 in 1911, 923 in 1910, 945 in 1909, 707 in 1908, and 763 in 1907. As compared with the figures for 1912 there were marked decreases in the numbers of cases of influenza, consumption, measles and whooping cough. The cases of diarrhoea shew an increase. Diseases of the respiratory organs, which are also in the main to be regarded as infectious, numbered 1,539 cases as compared with 1,461 in 1912, 1,458 in 1911, 1,344 in 1910, 1,444 in 1909 and 1,268 in 1908. Of the cases during 1913, bronchitis caused 1,375 and 100 were due to pneumonia. Rheumatism was given as the diagnosis in 345 cases as compared with 458 in 1912, 408 in 1911 and 398 in 1910. Oases of rheumatic fever were again below the average in point of number, there being 28 as compared with 28 in 1912, 53 in 1911, 53 in 1910, 47 in 1909 and 32 in 1908. Cases diagnosed as gout numbered 49 as compared with 57 in 1912, 95 in 1911,100 in 1910 and 104 in 1909. Dyspepsia and other disorders of the digestive system accounted for 464 as compared with 463 in 1912, 546 in 1911 and 688 in 1910. The cases diagnosed as cancer numbered 34 as compared with 25 in 1912, 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 185 cases, chiefly of ulcerated legs, as compared with 247 in 1912, 240 in 1911 and 263 in 1910, and diseases of the skin for 167 as compared with 148 in 1912,163 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 562 deaths as compared with 589 in 1912, 673 11 in 1911, 511 in 1910, 676 in 1909, 622 in 1908, 717 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 again markedly below the average for the previous 10 years. They amounted to 279 per cent, of the total number of deaths from all causes as compared with 29.0 in 1912, 30.2 per cent, in 1911, 26.7 in 1910, 30.8 in 1909, and 30.7 in 1908. Deaths from consumption show a decrease compared with the figure for 1912, 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 44 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 5.1 per 1,000 inhabitants as compared with 5.3 in 1912, 6T 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 again 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 158 149 25 8 11 16 44 47 47 42 13 2 ... The above shows a majority of deaths amongst children under 5 years of age. Of the total number of deaths of children under 5 years of age from all causes, 39 per cent, resulted from the infectious diseases referred to as compared with 40 per cent, in 1912, 42 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, diarrhoea was the most active cause of death, but measles, 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 diarrhœa—numbered 245 as compared with 235 in 1912, 349 in 1911 and 217 in 1910. The death-rate due to these diseases, which is termed the zymotic death-rate, was 2.2 per 1,000 population as compared with 2.1 in 1912, 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, 31 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. 12 The zymotic death-rate was, therefore, again markedly below the average for previous years. A comparison of the zymotic death-rates of London and Shoreditch and the 8 wards of the Borough is given in Table VI. (Appendix). The rate was highest in Hoxton Ward and lowest in Moorfields, being 3.0 and 0.6 per 1,000 population respectively. Excluding the 4 cases of cerebro-spinal fever, 8 of acute anterior poliomyelitis, 22 of ophthalmia neonatorum and the cases of tuberculosis, 696 cases of infectious disease were notified, an increase of 236 on the figure for 1912. 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 1913 696 6.3 The cases of notifiable infectious disease certified in the Metropolis during 1913 number some 30,484,excluding cases certified as anthrax, glanders, pulmonary tuberculosis, ophthalmia neonatorum, measles, cerebro-spinal fever, and acute poliomyelitis. The attack-rate was 6.7 per 1,000 inhabitants as compared with 5.2 in 1912, 5.3 in 1911 and 4.4 in 1910. The attack-rate for Shoreditch therefore was somewhat lower than that of the Metropolis during 1913. 13 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:— Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox ... ... ... ... ... ... Scarlet Fever or Scarlatina 30 42 92 176 340 3 Diphtheria and Membranous Croup 18 42 69 52 181 14 Typhus ... ... ... ... ... ... Cholera ... ... ... ... ... ... Enteric Fever (Typhoid) 5 2 4 3 14 1 Continued Fever ... ... 1 ... 1 ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever ... 1 3 5 9 4 Erysipelas 21 22 47 61 151 9 Plague ... ... ... ... ... ... Cerebro-Spinal Fever 3 ... ... 1 4 3 Glanders ... ... ... ... ... ... Anthrax ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... Acute Anterior Poliomyelitis ... 1 5 2 8 1 Ophthalmia Neonatorum 8 1 5 8 22 ... Totals 85 111 226 308 730 35 Numbers and percentages of cases removed to hospitals. 56 89 172 247 564 ... 65.8% 80% 76% 80% 77% ... As compared with the figures for 1912 there was a marked increase in the numbers of cases of scarlet fever and diphtheria, the former being more than twice as numerous. The deaths from the principal zymotic diseases which are notifiable, namely, small pox, scarlet fever, diphtheria and enteric fever were at the rate of 016 per 1,000 population, whereas the rate for the principal zymotic diseases which are not notifiable, namely measles, whooping cough and diarrhoea was 2'81 or more than twelve times as great. Although the cases of notifiable infectious disease were more numerous than in 1912, they were none the less below the average. 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 14 Shoreditch Infirmary or into the general hospitals in the neighbourhood. Under 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 now receivable into the hospitals of the Board, are small pox, scarlet fever, diphtheria, enteric fever, typhus fever, poliomyelitis, puerperal fever, and cerebro-spinal fever. The number of cases of these diseases certified (Table II. (Appendix)) was 556, and the number removed to hospital (not necessarily to hospitals of the Metropolitan Asylums Board) was 531, which gives a percentage of 95.5 as compared with 96.1 in 1912, 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 scarlet fever followed on the return home of a patient who had been suffering from the disease and treated in hospital. The facts are briefly as follows :—Leonard Charles C, aged 18, was certified to have scarlet fever on June 4th and removed to hospital. He had been ill at home for several days. He returned home on July 23rd and on the 26th Rosie G, aged 2½, of the same address, was taken ill and certified to have scarlet fever on July 28th. There was nothing about Leonard Charles C to indicate that he was likely to convey the disease and it is not free from doubt that he did so, for it was noted that Julia G, aged 11, sister to Rosie, had had a "sore throat," about which she saw a doctor on July 18. The mother looked for a rash in this case but none was noticed, nor was there any evidence of desquamation. SMALL POX. There were no cases of small pox in Shoreditch during the year, and only about 4 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 1912-13, and relate to the year 1911. Of the births registered during that year, in 40.9 per cent, vaccination was successfully performed and 35.5 per cent, were not finally accounted for, the latter figure including postponed cases. Altogether 48.6 per cent, of the children whose births were registered in 1911 were unvaccinated at the end of the year. The last figure includes those exempted by conscientious objection 15 certificates, who numbered 447 or 13.1 per cent, of the births registered as compared with 12.6 per cent, in 1910, 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 1911 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 1902 36.1 21.3 10.0 1892 10.8 18.4 14.3 1903 36.0 20.7 9.1 1893 16.2 18.2 15.7 1904 34.2 19.1 8.7 1894 33.9 20.6 19.0 1905 35.9 18.9 8.6 1895 47.5 24.9 19.8 1906 32.6 21.2 9.5 1896 55.5 26.4 22.3 1907 31.2 22.7 10.3 1897 67.4 29.1 21.6 1908 34.5 21.5 9.4 1898 68.4 33.0 19.6 1909 35.6 20.6 9.2 1899 54.2 27.7 15.4 1910 34.4 20.5 8.8 1900 52.8 25.8 13.9 1911 35.5 20.8 8.9 1901 44.4 24.1 11.2 To the foregoing should be added the percentages of those for whom conscientious objection certificates were granted to obtain the percentage of unvaccinated. Taken together the figures show further decrease in the amount of vaccination in the Borough. SCARLET FEVER. The cases certified during 1913 numbered 340 as compared with 151 in 1912, 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. In 8, or 2.3 per cent. of 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 daring the year numbered 332 as compared with 150 in 1912, 212 in 1911, 181 in 1910, 321 in 1909, 573 in 1908, 822 in 1907, 599 in 1906, 776 in 1905, 326 in 1904, and 237 in 1903. 16 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 :— Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 6 6 12 ... ... ... Church 22 38 60 ... ... ... Hoxton 32 20 52 ... ... 1 Wenlock 21 28 49 ... ... ... Whitmore 14 25 39 ... ... 1 Kingsland 7 14 21 ... ... ... Haggerston 14 24 38 ... 1 1 Acton 32 37 69 ... ... ... Totals for Borough... 148 192 340 2 1 3 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified 332 or 97.6 per cent, were removed to hospital as compared with 98 per cent, in 1912, 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 3.0 per 1,000 inhabitants as compared with 1.3 in 1912, 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 Acton Ward and lowest in Kingsland, being 5.6 in the former as compared with 1.9 per 1,000 population in the latter. The deaths numbered 3 as compared with 4 in 1912, 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 0.02 per 1,000 population as compared with 0.03 in 1912, 0.06 in 1911, 0.03 in 1910, 00.6 in 1909, 0.24 in 1908, 0.24 in 1907, 0.17 in 1906, 0.23 in 1905 and 0.11 in 1904. There were no deaths from scarlet fever during the year in Moorfields, Church, Wenlock, Kingsland, and Acton Wards. The severer types of scarlet fever have become much less common of late years, and the mortality has very greatly decreased. The case mortality was at the rate of 0.8 per cent, of the cases certified as compared with 2.6 per cent, in 1912, 3 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 17 children under 5 years there were 90 cases with 1 death, the case mortality (allowing for errors in diagnosis) being 1.1 per cent, as compared with 5 per cent, in 1912, 8 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. Amongst persons over 5 years there were 250 cases with 2 deaths. The case mortality was therefore 0.8 per cent, (allowing for errors in diagnosis) as compared with 1.1 in 1912, 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 17,552, the attack-rate being 3.8 per 1,000 inhabitants as compared with 2.5 in 1912, 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 188, the death-rate being 0.04 per 1,000 as compared with 0.03 in 1912, 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 181 as compared with 137 in 1912, 171 in 1911, 127 in 1910, 183 in 1909, 202 in 1908 and 211 in 1907. Intimations were received from the Metropolitan Asylums Board that 12 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 4 5 9 ... ... ... Church 16 17 33 1 ... 1 Hoxton 10 11 21 2 ... 2 Wenlock 5 11 16 2 1 3 Whitmore 13 23 36 2 2 4 Kingsland 11 8 19 1 ... 1 Haggerston 11 17 28 ... 3 3 Acton 8 11 19 ... ... ... Totals for Borough 78 103 181 8 6 14 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified, 95 per cent, were removed to hospital as compared with 95 per cent. (174) B 18 in 1912, 95 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. The cases certified were at the rate of 1.6 per 1,000 inhabitants as compared with 1.2 in 1912, 1.5 in 1911,11 in 1910, 1.5 in 1909 and 1.7 in 1908. The attackrate was highest in Haggerston Ward and lowest in Acton, being 2.5 per 1,000 in the former and l.5 in the latter ward. The deaths numbered 14, the death-rate being 0.12 per 1,000 as compared with 0.18 in 1912, 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 Haggerston Ward where it was 0.26 per 1,000 population. There were no deaths from diphtheria during the year in Moorfields and Acton Wards. The case mortality was 7.7 per cent, of the cases certified as compared with 13.1 in 1912, 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 1913, 12 were of children under 5 years of age, the mortality being at the rate of 15.4 per cent, of the cases certified amongst children at that age period (16.2 allowing for errors in diagnosis) as compared with 20.8 in 1912, 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 1.9 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 161 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 7 2 9 From 1 to 2 years 6 5 11 „ 2 „ 3 „ 7 6 13 „ 2 „ 4 „ 12 10 22 „ 4 „ 5 „ 10 6 16 „ 5 „ 10 „ 13 26 39 „ 10 „ 13 „ 10 11 21 Over 13 years 8 22 30 Totals 73 88 161 19 In 77 of the cases the patients were children attending school and in 60 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 60 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 21 instances the histories showed that there had been cases of "sore throat" amongst the inmates of the houses in which the patients resided. In 28 instances there was evidence pointing to infection from previous cases in the Borough. In 119 instances the houses were occupied by members of more than one family, in 33 by single families, and in 9 instances the cases occurred in artisan's dwellings of the block type. With regard to the sanitary condition of the dwellings, in 93 this was satisfactory, in 27 fairly so, and in 41 it was unsatisfactory, but these figures must not be taken as an indication that a satisfactory sanitary condition is favouable 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 7,654 as compared with 7,109 in 1912, 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 1.7, 1.5, 1.6, 1.1, 1.4, 1.6 and 1.8 per 1,000 population for the 7 years respectively. The deaths from the disease in the Metropolis numbered 431 as compared with 452 in 1912, 612 in 1911, 434 in 1910, G05 in 1909 and 724 in 1908, the deathrate for the six years respectively being 0.09, 0.10, 0.11, 0.09, 0.12 and 0.15 per 1,000 population. ENTERIC OR TYPHOID FEVER. The cases including one of continued fever numbered 15 as certified, but 5 were subsequently not regarded as cases of enteric fever at the hospitals to which they were removed, one proving to be a case of Typhus fever. (174) The numbers of cases certified yearly since 1889 are set out in the following able:— 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 1913 15 B 2 20 Attention may again be directed to the small number of cases. Deducting the cases wrongly diagnosed the actual number of persons belonging to Shoreditch who suffered from enteric fever during the year was only 10. A glance at the foregoing table will shew how the disease has decreased in the Borough during recent years. The attack-rate was 0.1 per 1,000 population as compared with 0.1 in 1912, 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. There was only one death during the year, the rate being O'OO per 1,000 inhabitants as compared with 0.03 in 1912, 0.00 in 1911, 0.07 in 1910, 0.05 in 1909, 0.09 in 1908, 0.05 in 1907, 0.03 in 1906, 0.01 in 1905, 0.07 in 1904, 0.11 in 1903 and 0.20 in 1902. The case mortality was at the rate of 6.6 per cent. of the cases certified (10 per cent. deducting the cases not regarded as having been enteric fever) as compared with 28.5 in 1912, 4.5 in 1911 and 16 in 1910. The case mortality for the 20 years ending 1912 averaged 13.6 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 1913 are shown in the subjoined table:— Wards. ENTERIC FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 2 2 4 ... ... ... Church 1 1 2 ... ... ... Hoxton ... 1 1 ... ... ... Wenlock ... ... ... ... ... ... Whitmore ... 1 1 ... ... ... Kingsland 1 1 2 ... 1 1 Haggerston 1 4 5 ... ... ... Acton ... ... ... ... ... ... Totals for Borough 5 10 15 ... 1 1 The cases are grouped according to ages in Table II. (Appendix). With one exception the cases were removed to hospital for treatment. In six cases nothing definite was ascertained as to the source of infection. In one the patient was stated to be partial to ice cream and fried fish. In three instances the cases were secondary to previous cases in the Borough. The cases certified in the Metropolis numbered 758 as compared with 702 in 1912, 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. 21 The attack-rate was 0.16 per 1,000 population being Somewhat higher than that of Shoreditch. The deaths numbered 114 as compared with 117 in 1912, 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 151 as compared with 149 in 1912, 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 9 deaths from the disease as compared with 6 in 1912, 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, and 10 in 1900. The figures for previous years are contained in the report for 1908. Five of the deaths during the year were of infants under 12 months and 4 of these were under 3 weeks old. The attack-rate per 1,000 population was above the average for the previous ten years. The cases and deaths amongst males and females in the Borough and its eight wards were distributed as set out below:— Ward. ERYSIPELAS. Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 1 1 2 ... ... ... Church 8 13 21 ... 1 1 Hoxton 10 13 23 3 1 4 Wenlock 10 7 17 ... 1 1 Whitmore 21 25 46 ... 1 1 Kingsland 7 5 12 ... ... ... Haggerston 9 12 21 ... ... ... Acton 2 7 9 1 l 2 Totals for Borough 68 83 151 4 5 9 The death rate was 0.08 per 1,000 inhabitants, as compared with 0.05 in 1912, 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 5.9 per cent. of the cases certified, as compared with 4 per cent. in 1912, 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. 22 Pyaemia and Septicaemia (blood-poisoning) were given as the cause of death in 16 instances, 7 of males 9 of females. Infective endocarditis caused the deaths of two females. PUERPERAL FEVER. Nine cases were certified with 4 deaths. The attacks were at the rate of 2.6 per 1,000 births, as compared with 2.2 in 1912, 1.4 in 1911, 2.2 in 1910, 3.5 1909, 1.3 in 1908, 0.8 in 1907, 1.5 in 1906, 2.2 in 1905, 13 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 1.2 as compared with 1.1 in 1912, 0.6 in 1911, 0.5 in 1910, 1.0 in 1909, 0.5 in 1908, 0.2 in 1907, 0.8 in 1906. 1.0 in 1905, 0.5 in 1904, 0.2 in 1903, 0.7 in 1902 and 0.2 in 1901. The mortality was at the rate of 44 per cent. of the cases notified during the year. DIARRHOEA. The deaths numbered 159, and there were besides 58 attributed to enteritis. The numbers of deaths from diarrhoea in previous years were 40 in 1912, 162 in 1911, 66 in 1910, 79 in 1909, 112 in 1908, 74 in 1907 and 194 in 1906. The deaths were therefore markedly above the average for the previous seven years. They mostly occurred during the months of September and October. The deaths from enteritis were also most numerous during those months. Of the deaths from diarrhoea 94 were of infants under one year, 61 of children aged from one to five years, one of a person aged between fifteen and twenty years and the others were of persons aged between thirty-five and fifty-five years. Of the deaths from enteritis 39 were of infants under one year, 13 of children aged from one to five years, 2 of children aged from 5 to 10 years and the rest were of persons over sixty-five years. The diarrhoea death-rate was excluding deaths from enteritis T4 per 1,000 population as compared with 0.37 in 1912, T47 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 including those from enteritis amongst children under two years together numbering 207 the mortality was at the rate of T89 per 1,000 population as compared with 0.85 for 1912 and 2.1 for 1911. The deaths from diarrhoea amongst infants under one year were at the rate of 39.2 per 1,000 births registered during the year as compared with 8.8 in 1912, 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. The usual enquiries were made by the Health Visitors and as far as practicable steps were taken for checking the spread of infection. 23 The deaths from diarrhoea and enteritis amongst children under 2 years in the Metropolis numbered 3,098 as compared with 1,371 for 1912 giving a death-rate of 0.68 as against 030 per 1,000 population for 1912. MEASLES. The deaths from measles numbered 40 as compared with 126 in 1912, 125 in 1911, 80 in 1910 and 127 in 1909. The cases coming under the treatment of the poor law medical officers during the year were far less numerous than in 1912 and there was also a great decrease in the number of cases reported through the school authorities so there is no doubt that the disease was much less prevalent than in 1912. During January there were 23 deaths, February 12, March 4, April 8, and May 2 ; there were no more deaths until November when 3 were recorded and there were no deaths in December. All the deaths were of children under 10 years of age ; under one year 12 died, between 1 and 5 years 27 and from 5 to 10 there was one death, the deaths were equally divided between males and females. The measles death-rate was 0'36 per 1,000 population as compared with 1.14 in 1912, 1.13 in 1911, 0.70 in 1910, 1.11 in 1909, 0.44 in 1908, 0.99 in 1907, 0.64 in 1906, 0.52 in 1905, 0.69 in 1904, 0.85 in 1903, 0.72 in 1902 and 0.64 in 1901. The rate was lower than in any year since 1889. Relatively it was highest in Church and lowest in Kingsland Ward being 0 57 for the former and 0.09 for the latter ward. The number of instances in which houses were brought to the notice of the Health Department as having measles therein was 251, as compared with 847 for 1912, 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 was received through the school authorities. From the inquiries made in 38 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 170. Eight cases were notified from other sources. Intimations were received from the Metropolitan Asylums Board as to the removal of 73 cases of measles to the hospitals of the Board from Shoreditch during the year. The majority of these were cases treated by the Poor Law Medical Officers. Disinfection in the majority of cases coming under notice was carried out by the officers of the Borough Council; 168 rooms were sprayed, and the usual steps were taken as to bedding and textile articles. Altogether some 120 beds, 110 mattresses, 221 pillows, 73 bolsters, and 1,184 other articles were removed for disinfection at the disinfecting station. In 12 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 other dangerous infectious diseases. 24 The deaths from measles in London numbered 1,570, as compared with 1,799 in 1912, 2,570 in 1911, 1,980 in 1910 and 2,321 in 1909, the death-rate being 0.34, as compared with 0.39 in 1912, 0.57 in 1911, 0.40 in 1910 and 0.48 in 1909. WHOOPING COUGH. The deaths from whooping cough numbered 28, 13 of males and 15 of females. Of these 11 were of infants aged under 1 year and 17 of children aged between 1 and 5 years. Deaths were fairly evenly distributed throughout the year. There were none during the month of June. The whooping cough death-rate was 0.25 per 1,000 population, as compared with 0.38 in 1912, 0.29 in 1911, 0.39 in 1910 and 0 64 in 1909. The death-rate was considerably below the average for recent years. The rate was highest in Hoxton and lowest in Whitmore being 0.36 in the former and 0.10 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 1913. Some 19 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 800, the death-rate being 0.17 per 1,000 population. INFLUENZA. The deaths attributed to influenza numbered 22, as compared with 12 in 1912, 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 863 as compared with 537 in 1912, 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 1901, 661 in 1903, 1,036 in 1902, 664 in 1901 and 1,950 in 1900. The deaths were most numerous during the months of March, April and December. No deaths were registered in Shoreditch during the months of June, July and August. TYPHUS FEVER. In the report for the year 1912 a case which may have been one of typhus fever was mentioned. Another case came under observation during the year under 25 consideration which there is no doubt was a case of typhus fever. The patient, aged 28, a married woman, residing at No.55, Grange Street, was taken ill about May 12th. She was admitted to the Metropolitan Hospital, Kingsland Road, on the 10th and certified to have enteric fever on the 23rd. Enquiry elicited the fact that she had been visiting at No. 75, Ocean Street, Stepney, where there had occurred over a period of two months five cases of illness amongst her relatives residing there. The Medical Officer of Health for Stepney was communicated with and information was received from him that two of the five cases which had been removed to hospital as being enteric fever were regarded at the fever hospital as cases of typhus fever. Thereupon the Metropolitan Hospital Authorities were communicated with and an examination of the patient was made in the light of the information supplied. The patient's face was flushed, her eyes injected, and there was a dusky eruption of spots and subcuticular mottling more or less visible over the trunk and limbs. The aspect of the case was suggestive of typhus fever and the patient was removed to a fever hospital where the diagnosis was confirmed. Disinfection was carried out in the usual way and the residents of No. 55, Grange Street were kept under observation, but no further cases of illness suggestive of typhus fever occurred in the house. TUBERCULOSIS. Tuberculosis (Appendix, Table V., Nos. 29 to 31 inclusive) was given as the cause of 248 deaths as compared with 290 in 1912, 266 in 1911, 241 in 1910, 277 in 1909, 311 in 1908, 327 in 1907, 347 in 1906, 321 in 1905, 365 in 1904, 370 in 1903, 295 in 1902, 363 in 1901 and 343 in 1900. The number was considerably below the average for the past 12 years. The deaths from tuberculosis amounted to 11.8 per cent. of the total number of deaths from all causes, as compared with 14.3 in 1912, 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 2.2 per 1,000 population, as compared with 2.6 in 1912, 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 2.5, and lowest in Moorfields Ward, where it amounted to 1.5 per 1,000 inhabitants. Tuberculosis of the lungs or phthisis, or consumption as it is commonly named, caused 185 deaths, as comparer with 217 in 1912, 183 in 1911, 169 in 1910, 194 in 1909, 224 in 1908, 232 in 1907 and 233 in 1906. The majority of deaths were of persons aged from 25 to 65 years. The deaths of males numbered 121 as compared with 64 for females. The consumption death-rate was 1.7 per 1,000 population as 26 compared with 1.9 in 1912, 1.7 in 1911, 1.4 in 1910 and 1.7 in 1909. The rate was highest in Whitmore and lowest in Acton Ward, being 2.1 per 1,000 in the former and 1.3 in the latter. The deaths from tuberculosis in London numbered 7,390, giving a death-rate of l.63 per 1,000 population. The deaths attributed to consumption numbered 5,981, the death-rate being 1.30 per 1,000 as compared with l.34 in 1912. By the Public Health (Tuberculosis) Regulations, 1912, which came into operation on February 1st of the year under consideration, the previous regulations, viz., the Public Health (Tuberculosis) Regulations, 1908, dealing with Poor Law cases, the Public Health (Tuberculosis in Hospitals) Regulations, 1911, and the Public Health (Tuberculosis) Regulations, 1911, dealing with cases under the care of medical men in private practice were revoked. The new regulations make all forms of tuberculosis notifiable. From February 1st to December 31st, 858 notifications were received referring to 722 cases certified by medical practitioners, 36 relating to 30 children certified by School Medical Inspectors, 151 certified by Medical Officers of Poor Law Institutions, and 17 referring to inmates of sanatoria. A summary of the notifications is contained in the subjoined table:— — Number of Notifications on Form A. Number of Notifications on Form B. Number of Notifications on Form C. Primary Notifications. Total Notifications (i.e., including cases previously notified by other doctors). Primary Notifications. Total Notifications (i.e., including cases previously notified by other doctors). Poor Law Institutions. Sanatoria. Pulmonary— Males 337 397 2 2 103 11 Females 223 265 4 6 42 5 Non-Pulmonary— Males 88 104 13 16 3 1 Females 74 92 11 12 3 — Totals 722 858 30 36 151 17 Of the 920 cases certified 42 had been previously certified prior to 1913. 27 including the cases of pulmonary tuberculosis notified during the month of January, 905 persons were certified for the first time during the year as suffering from various forms of tuberculosis, principally of the lungs, and of these some 557 were males and 348 females. The distribution of the cases notified according to age periods and localities is shown in Table II. (Appendix). The cases were most numerous in proportion to population in Whitmore Ward, where they amounted to 10.2 per 1,000 inhabitants, and least in Moorfields Ward, where the rate was 5.1 per 1,000 population. Where the patients were not inmates of public institutions in the Borough, and also where patients were not attending the tuberculosis dispensary, the addresses given on the certificates were visited by the Sanitary Inspectors and Health Visitors. In a number of instances the patients were brought under the Tuberculosis Dispensary, being referred thereto by the Council's officers. 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 as appeared necessary. Inquiries by the Sanitary Inspectors and Health Visitors were made as regards some 525 of the cases certified. In 326 the patients were males, their occupations being as follows:—Horses and vehicles, such as carmen and coachmen 27, bottles and glass 6, packers 10, porters in various trades 18, bootmaking 10, metal and machinery G, labourers in various trades 27, building trades 15, barmen and potmen 5; furniture, cabinet-making, upholstery, &c., 41; hawkers and street sellers 15, warehousemen 8, rag and bone dealers 4, cardboard box making 5, leather workers 8, municipal employees 5, printing and stationery 20; clerks, travellers, and agents, 7; packing-case and wooden box making 8, walking-sticks 2, dress and tailoring 5, wheelwrights 2, soldiers 2, employed in connection with food 8, school boys 31, police force 1, liftman 1, church verger 1, toymaker 1, tobacco-pipe maker 1, window cleaner 1, bone worker 1, hairdressers 2, picture-frame maker 1, gold beater 1, opera glass maker 1, wood carver 1, street organist 1, pugilist 1, horsehair dresser 1, tea blender 1, stoker 1 and gilder 1; seven gave no occupation, and five were children under school age. Of 199 female patients 61 were housewives, 28 school-girls, 8 were under school age, 8 worked in leather, 13 paper-bag and box-making, 4 laundries, 3 were street sellers, 19 were employed in tailoring and dressmaking, 9 were machinists, 7 charwomen and office cleaners, 4 domestic service, 3 were packers, 5 factory hands, 4 were engaged in printing and stationery trades, 3 were waitresses, 3 gave no occupation, 1 was an optician's assistant, 1 a warehouse assistant, 1 a nurse, 28 1 feltworker, 2 made fancy confectionery, 1 was a french polisher, 1 a hospital cleaner, 1 an errand girl, 1 hairbrush maker, 1 a tent stitcher, 1 an umbrella stitcher, 1 a shop assistant, 1 a cork sorter, 1 a rope spinner, 1 a shuttlecock maker and 1 a book-keeper. In the inspections of the dwellings of the patients the points to which attention was specially directed were the amount of cubic space available for the patient, the means for securing efficient ventilation, the amount of light, dryness of the dwelling and the general conditions as regards cleanliness. As a result of the inspections made, in 331 instances the dwellings were satisfactory or fairly so ; in the remaining 194 they were unsatisfactory. In 176 of the cases family histories of tuberculosis were obtained, and in 148 there was evidence more or less strong pointing to infection from previous cases either in the dwellings or where the patients worked. Disinfection was carried out by the Sanitary Authority in connection with 212 rooms at 201 premises and the usual steps were taken as regards textile articles exposed to infection. In a number of cases institutional treatment was obtained for uninsured patients through the agency of charitable societies at work in the Borough. From the reports received from the Insurance Committees for the County of London 134 insured persons, 93 male and 41 female, received institutional treatment in sanatoria or hospitals during the year. The periods of stay in the institutions varied from one or two days to eight or nine months in a few instances, the usual length of time being from six weeks to three months. With regard to the males 41 can be said to have improved whilst in the institutions, 17 were still in the institutions at the end of the year, and the remainder must be regarded as cases in which there was no improvement or in which improvement was doubtful. Five of the cases were not considered as cases of phthisis at the institutions they were sent to. As regards the females, in 26 instances improvement took place, 7 were away at the end of the year, and in the rest improvement was doubtful or absent. One was not regarded as being phthisis. Most of the male patients were sent to Downs Sanatorium, and of the females most of them went to Winchmore Hill. The accommodation for consumptives at the Shoreditch Infirmary was largely made use of during the year, mainly by advanced cases. About 49 per cent, of the deaths from phthisis in the Borough occurred at this institution. Upwards of 62 per cent. of the persons belonging to Shoreditch who died from consumption during the year died in public institutions within or without the Borough. At the end of last year, as mentioned in my report for that year, negotiations were in progress between Borough Council and the authorities of the Royal 29 Hospital for Diseases of the Chest in the City Road with a view to the settlement of a provisional scheme for the tuberculosis department of the hospital to be the tuberculosis dispensary for the Borough. These were brought to a successful conclusion and a provisional agreement sanctioned by the Local Government Board was entered into between the Borough and the hospital authorities whereby a tuberculosis dispensary for the Borough under a committee of management of representatives of the Borough Council and the hospital was established in connection with the out-patient department of the hospital. Particulars as to the work of the dispensary during the year are contained in the Report of Dr. Lytton Maitland, the Tuberculosis officer, which is appended (page 86). Some 413 persons attended the dispensary during the year, making 2,948 attendances, and 1,205 visits were made to the homes of patients by the Tuberculosis officer and the dispensary nurse in connection with the hygienic conditions of the dwellings, the discovery of contact cases, and for advice and instruction as to the precautionary measures to be taken in the homes for the prevention of the disease. In a number of instances insanitary conditions in the homes of phthisical patients were reported to the health department by the Tuberculosis officer, and dealt with. OPHTHALMIA NEONATORUM. The cases notified numbered 32 as compared with 17 in 1912 and 32 in 1911. The notifications were at the rate of 9.4 per 1,000 births as compared with 4.8 for 1912 and 9.1 for 1911. Of the cases notified 22 were certified by medical practitioners. The cases were inquired into by the Health Visitors and are referred to in their reports (Appendix, pp. 96 and 100), some 73 visits being made in connection with them. Eight of the cases were severe and one was admitted into hospital. All recovered satisfactorily without so far as is known the sight being in any case injured. The cases certified in London during the year numbered 641, the rate being 5.7 per 1,000 births. EPIDEMIC CEREBRO-SPINAL MENINGITIS. Four cases were certified with three deaths. All were removed to hospital. One of the deaths was of an infant under 12 months, one of a child aged 13 months and the third of a child aged four years. In none of the cases was the meningococcus of cerebro-spinal fever found. Of the deaths one was certified as posterior basic meningitis, one as being acute purulent meningitis, and the third as tuberculous meningitis. There were also 17 deaths attributed to meningitis, 12 of which were of children under five years, but so far as could be ascertained there was no reason for concluding that any of these were the result of epidemic cerebro-spinal meningitis. The cases certified in the metropolis numbered 92 with six deaths, and some 380 deaths in London were attributed to meningitis, 30 ACUTE POLIOMYELITIS. Eight cases were certified during the year with one death. They were all certified by medical officers of hospitals to which the patients had been taken for treatment. They occurred at houses situate one in Wenlock Ward, two in Hoxton, one in Whitmore, two in Acton and two in Haggerston Ward. The streets where these houses are may be described as satisfactory as regards the condition of their roadways, space, light and air. The houses were found to be satisfactory generally from a sanitary point of view as regards light, air, open space, water supply and sanitary arrangements. No two of the houses invaded were in close proximity to each other. The families in which the cases occurred all belonged to the working class. In five instances they appeared to be in comfortable circumstances, in the rest they were poorer but not amongst the poorest. On the whole the homes were fairly clean; in five instances there was evidence of bugs in the dwellings, but with one exception they were not markedly infested with them. In one instance it was noted that the patient had been bitten by these insects. In four instances animals were kept on the premises, but there was no history of illness amongst them. So far as could be ascertained there was no connection between the cases, nor was there any reason for believing that any other cases had occurred amongst the 63 persons who were resident in the houses. With regard to the cases that recovered six showed signs of paralysis remaining. In all cases such steps as seemed necessary for disinfection were taken. In the metropolis 145 cases were certified during the year. GLANDERS, ANTHRAX AND HYDROPHOBIA. No cases of either of the above diseases were certified in Shoreditch during the year amongst human beings. In the whole of London there were certified four cases of anthrax and one of glanders. One intimation was received from the Veterinary Inspector of the London County Council as to the presence of glanders amongst horses in the Borough. The usual inquiries 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 localities abroad where cholera was present. INFECTIOUS DISEASES AND SCHOOLS. In the following table are set forth the numbers of children belonging to Shoreditch who were suffering from infectious diseases or were residing in homes in which infectious diseases existed concerning whom intimations of exclusion from school were received from the head teachers of the schools they attended in accordance with the requirements of the school management code of the London County Council;— 31 School. Enteric Fever. Small Pox. Diphtheria. Scarlet Fever. Measles. Chicken Pox. Whooping Cougti. Mumps. Other Causes. Total. Aldersgate ... ... ... ... ... ... ... ... 4 4 Bath Street ... ... ... ... ... ... ... ... 2 2 Bay Street ... ... ... ... ... ... 2 ... ... 2 Brunswick Street (special) ... ... ... ... ... 1 4 ... 2 7 Canal Road ... ... 7 7 5 11 3 14 27 74 Catherine Street ... ... 1 12 ... 22 9 17 35 96 Central Street ... ... ... ... ... 6 ... ... ... 6 Chatham Gardens ... ... 8 ... 5 18 3 4 32 70 Coleman Street Ward ... ... ... 1 ... 1 ... ... ... 2 Curtain Road ... ... 8 11 4 7 3 29 52 114 Daniel Street ... ... ... 1 ... ... ... ... ... 1 Enfield Road ... ... ... 1 ... ... ... 1 2 4 Gopsall Street ... ... 21 29 22 44 16 93 71 296 Gravel Lane ... ... ... ... ... 1 ... ... ... 1 Haggerston Road ... ... 8 11 16 15 23 43 27 143 Hamond Square ... ... 13 9 22 10 5 22 109 190 Hoxton Central ... ... 3 8 1 ... ... 1 15 28 Hoxton House ... ... 26 37 10 23 20 23 63 203 Laburnum Street ... ... 19 8 10 4 8 16 16 81 Maidstone Street ... ... 11 24 44 65 45 60 124 373 Napier Street ... ... 29 34 14 35 25 40 113 290 Pritchards Road ... ... ... 7 9 3 ... ... ... 19 Queen's Road ... ... ... ... ... ... ... ... 3 3 Redvers Street ... ... 5 5 2 5 2 2 22 43 Rochelle Street ... ... 1 ... 2 ... ... ... ... 3 Rothertield Street ... ... ... ... ... ... ... ... 1 1 Saffron Hill ... ... ... ... ... ... ... 1 ... 1 St. John's Church ... ... 2 4 2 2 ... 15 10 35 St. John's Road ... ... 11 25 23 33 11 50 22 175 Sir John Cass Foundation ... ... ... ... ... 1 ... ... ... 1 St. John the Baptist ... ... ... ... ... ... 1 ... ... 1 St. Mark's ... ... 3 3 ... ... ... 1 ... 7 St. Monica's ... ... ... 13 6 6 ... 4 6 35 St. Paul's, Broke Road ... ... 8 33 30 3 3 4 15 96 St. Peter's ... ... 2 ... ... 1 ... ... ... 3 Scawfell Street ... ... 20 39 51 7 14 43 67 241 Scrutton Street ... ... 13 18 4 28 14 80 24 187 Shap Street ... ... 12 7 6 7 2 11 61 106 Shepperton Road ... ... ... 1 ... ... 1 ... 2 4 Shoreditch Technical ... ... ... 1 ... ... ... ... ... 1 Teesdale Street ... ... ... 6 ... ... ... ... ... 6 Trinity Place ... ... 21 19 4 24 ... 4 39 111 Virginia Road ... ... ... ... 2 ... ... ... ... 2 Wenlock Road ... ... 3 ... 10 12 11 10 27 73 Totals 7 ... 255 374 304 396 224 588 993 3,141 32 On account of the occurrence of cases of measles amongst those attending, the children under five years who had not had the disease were by order of the school medical officer excluded from class rooms of the infants' departments of the following schools: Gopsall Street, Haggerston Road, Hamond Square, Laburnum Street, Maidstone Street, St. John's Road, Shap Street, Chatham Gardens, Catherine Street, Scawfell Street, and Napier Street. At Scawfell Street the exclusions were from four classrooms, at Chatham Gardens and Maidstone Street from three, and at Hamond Square and Haggerston Road from two classes at each school. The exclusions were in continuation of those which commenced in June, 1912, and they lasted until June of the year under consideration. Thus, in January 47 children were excluded, in February 31, March 11, April 8, May 84, and June 17. Altogether during the year some 201 children were excluded from 20 classrooms. BACTERIOLOGICAL EXAMINATIONS. Dr. Bulloch at the London Hospital Medical School made 205 examinations in cases of suspected infectious diseases in the Borough. In 51 the examinations were for sore throats suspected of being diphtheria ; in 10 of these the results were positive as to the presence of the diphtheria bacillus. In five instances Widal's tests were made in suspected cases of enteric fever; they were all negative. In 149 instances the sputum of persons suspected to have consumption was examined, with positive results as to the presence of the tubercle bacillus in 26. In addition 247 specimens were examined for tubercle bacilli at the Tuberculosis Dispensary. DISINFECTION. During 1913 disinfection was carried out by the Sanitary Authority at 1,139 premises, as compared with 1,179 in 1912, 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 22,937, as compared with 24,497 in 1912, 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 1,112 beds, 1,331 mattresses, 2,004 pillows, 817 bolsters, and 17,673 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. Included are 187 beds, 267 mattresses, 254 pillows, 103 bolsters and 1,450 other articles disinfected on account of vermin. It was necessary to destroy 3 beds, 2 bed ticks and 11 palliasses which were so dilapidated and contaminated as to render it inadvisable to return them. These were replaced with new. THE SHELTER. The Shelter was not in use during the year, 33 THE PUBLIC MORTUARY. The bodies of 362 persons dying daring the year were received into the Public Mortuary as compared with 373 in 1912, 379 in 1911, 382 in 1910, 392 in 1909 and 367 in 1908. There was only one instance in which the body of a person dead of infectious disease was placed in the mortuary. A special shell is provided for the reception of such bodies. The inquests numbered 304 as compared with 294 in 1912, 303 in 1911, 322 in 1910, 317 in 1909 and 302 in 1908. The post mortem examinations carried out at the post-mortem room attached to the mortuary numbered 214 as compared with 218 in 1912, 226 in 1911, 214 in 1910, 241 in 1909 and 298 in 1908. The figures for previous years are contained in the reports for 191] and 1903. Save in some inquest cases only the bodies of persons belonging to Shoreditch are received into the mortuary. WATER SUPPLY. The rainfall for the year measured at Oxford amounted to 25.413 inches. Taking the mean rainfall for 35 years, it was about the average. Most rain fell during the last quarter of the year, the rainfall for that period amounting to 8.196 inches. The rainiest month was October when 4.755 inches fell. Least rain fell in June, the fall amounting to 0.567 inch. The general rainfall for the Thames Valley above Teddington amounted to 27.39 inches, and for the Lee Valley 22.42 inches (Dr. Mill's Returns). In accordance with Section 49 of the Public Health (London) Act, 1891, communications were received from the Metropolitan Water Board as to water supplies being cut off in respect to 42 premises as compared with 40 in 1912, 80 in 1911, 82 in 1910, 83 in 1909, 65 in 1908, and 113 in 1907. Of these 38 were in the New River District and 4 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 20, waste on empty premises 8, by request of the consumer 2, and in 6 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 illnes 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 19 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. SANITARY WORK. Intimation notices under the Public Health (London) Act, 1891, as to insanitary conditions were served in respect to 4,366 premises. In 553 instances the premises were dealt with under the supervision of Inspector Firth, in 747 under (174) c 34 Inspector Jordan, 457 Inspector Langstone, 517 Inspector Pearson, 463 Inspector Stokes, 510 Inspector Wright, 592 Inspector Pratt and 527 under the supervision of Inspector Chapman. In connection with the work arising out of the sanitary notices served, some 1,113 letters were sent to owners of property, builders, and others concerned. Some 44,022 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 were food is prepared and sold. The house to house inspection carried out during the year is referred to later in the report (page 39). In the subjoined table is contained a summary giving an idea at 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. Langstone. Inap. Pearson. Insp. Stokes. Insp. Wright. Insp. Pratt. Insp. Chapman. Total. New drains constructed 4 5 ... 3 28 22 2 14 78 Drains re-constructed or repaired 36 23 23 32 120 28 63 30 355 Sinks trapped and disconnected 37 87 ... 25 83 23 28 12 295 Stack pipes reinstated 71 25 70 101 152 26 26 57 528 Eaves gutters reinstated 75 5 43 108 142 57 38 69 537 Stack pipes disconnected 25 17 ... 5 59 2 1 1 110 Accumulations of sewage removed ... 12 30 40 43 1 8 ... 134 Soil pipes ventilated ... 1 1 ... 2 ... ... 9 13 New water closets constructed 2 32 ... 7 44 2 1 ... 88 W.c.'s re constructed or repaired 46 72 33 54 118 15 39 10 387 VV.c.'s cleansed and white-washed 62 369 73 149 210 90 28 121 1,105 W.c.'s flushing apparatus repaired Obstructions in w.c.'s removed 41 71 72 94 141 50 75 78 622 36 20 26 54 38 30 58 43 305 Overcrowding in houses abated 62 6 27 47 64 30 49 15 300 Damp courses in houses provided 5 1 4 ... 22 3 13 1 49 Walls pointed 49 ... 7 29 65 10 13 4 177 Roofs repaired 74 17 104 111 120 65 110 133 734 Stairs repaired 67 10 8 8 56 27 5 16 197 Floors repaired 43 12 19 55 67 30 17 81 324 Ventilation under floors provided 27 ... 4 13 9 5 ... 3 61 Doors repaired 20 25 19 12 55 42 6 25 204 Door sills provided 38 1 3 10 ... 1 ... 3 56 Sashes repaired 13 18 23 65 49 42 12 59 281 Houses cleansed throughout 24 161 33 124 78 51 15 14 500 Houses cleansed in part 289 47 254 160 75 198 279 116 1,318 Total number of rooms cleansed 776 950 513 968 582 998 485 1,057 6.329 Yards or areas lime-washed 145 88 57 81 348 170 146 81 1,116 Yards paved 114 12 29 55 125 66 38 46 485 Areas and forecourts paved 7 2 2 6 43 6 1 1 68 New areas constructed ... ... ... ... 2 ... ... ... 2 Sculleries paved 2 1 6 ... 10 1 5 2 27 Dust receptacles provided 83 32 67 31 27 40 63 78 421 Dung receptacles provided 10 4 ... ... 1 1 1 ... 17 Insanitary cisterns removed ... ... ... 1 1 ... ... ... 2 35 In connection with the foregoing 13 old brick drains were abolished, and in 77 instances nuisances and annoyance due to rats on premises were dealt with. In 127 instances water supplies were restored to premises, and in 178, leaky water pipes were repaired. In 20 instances urinals were constructed or reconstructed, and in 25 instauces they were cleansed and repaired. Foul accumulations causing or likely to cause nuisances were dealt with on 161 premises. Nuisances through the improper stabling of animals were remedied in 40 instances, and in four instances stables were paved or repaired 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 549 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. Branch Place, No. 17 Adjourned 14 days for work to be done ; 10s. 6d. costs. Brunswick Street, No. 89 Fined 20s., with 2s. costs. Cavendish Street, No. 15 Summons withdrawn. „ No. 15 Order to do work in 7 days. Charles Square, No. 3 Summons withdrawn; 10s. 6d. costs. Custance Street, No. 31 Adjourned seven days for necessary work to be done ; 12s. 6d. costs. Dereham Place, No. 9 Summons withdrawn ; 10s. 6d. costs. „ „ No. 10 Order made ; 12s. 6d. costs. „ No. 17 „ ; 2s. costs. „ No. 18 Adjourned for work to be done; 12s. 6d. costs. „ No. 19 „ „ „ 27s. costs. „ „ No. 20 „ „ „ Grantham Terrace, No. 2 Order to do work in 14 days. No. 3 „ „ „ No. 5 „ „ „ „ „ No. 2 Closing Order. „ „ No. 3 „ „ ,, No. 5 „ Little Essex Street, No. 10 Summons withdrawn; 10s. 6d. costs. Livermere Road, No. 9 Ordered to pay 10s. 6d. costs. Napier Street, No. 15 Order to do work in seven days. St. John's Road, No. 131 „ „ „ Sun Street, No. 20 „ „ 14 days. (174) C 2 36 With respect to the house in Branch Place, the owner was summoned for not complying with a statutory notice requiring the abatement of a nuisance owing to the drains being defective. The case was adjourned for the notice to be complied with, which was done. The proceedings in respect to No. 89, Brunswick Street, were taken against a builder for fixing a new w.c. pan in contravention of the London County Council by-laws, no notice having been given to the Clerk to the Sanitary Authority as required by the by-laws. The two summonses in respect to the house in Cavendish Street were : one for not providing a proper dust receptacle and the other for not complying with a statutory notice requiring certain work to be executed in connection with the roof of the scullery. The dust receptacle was provided when the case came before the magistrate, but the work required to be done to the roof had not been carried out and an order was therefore made. The drains were defective at No. 6, Charles Square. When the case came on for hearing the statutory notice served on the owner in respect thereto had been complied with. The proceedings as regards No. 31, Cunstance Street, were against a builder for contravening the London County Council by-laws by improperly fixing a new w.c. pan without giving due notice of his intention to fix a pan to the Sanitary Authority. The hearing of the summons was adjourned to enable the builder to rectify certain errors in his work, which he did. The summons in respect to No. 9, Dereham Place, was taken against the owner for not complying with a statutory notice under the Public Health (London) Act, 1891, requiring the abatement of a nuisance due to the roof being defective and the w.c. not being in proper order and condition. With regard to Nos. 16, 17, 18, 19 and 20, Dereham Place, eight summonses were taken against the owner for non-compliance with statutory notices under the Public Health (London) Act, 1891. When the cases came on for hearing some of the work required had been clone and the magistrate adjourned the hearing for the completion of the work, which was duly effected. Generally the premises were dirty and dilapidated. The proceedings in respect to the houses in Grantham Terrace were against the owner for not complying with statutory notices requiring the abatement of nuisances due to defective drains and sanitary arrangements, the premises also being more or less dirty and dilapidated and without proper dust receptacles. Nuisance orders made by the magistrate not being complied with, further proceedings were instituted and closing orders were made. There was some difficulty in taking action owing to the fact that no owner was forthcoming at the 37 time. The houses were inspected under the Housing and Town Planning Act, 1909 (page 41), but the Health Committee, after considering the reports made on them, thought it advisable to proceed under the Public Health (London) Act, 1891. The owner of No. 10, Little Essex Street would not provide a proper dust receptacle until a summons had been taken out. In the case of No. 9, Livermere Road, a builder was summoned for not complying with the London County Council by-laws ; he failed to give the required notice to the Sanitary Authority of his intention to fix a new w.c. pan. The proceedings in respect to No. 15 Napier Street, were against the owner for non-compliance with a statutory notice under the Public Health (London) Act, 1891, requiring the abatement of a nuisance, the premises being generally dirty and dilapidated and the sanitary arrangements defective. No. 131, St. John's Road, was in a dirty and dilapidated state and the owner was summoned for not complying with a statutory notice under the Public Health (London) Act, 1891. With regard to No. 20, Sun Street, the summons was for not complying with the requirements of a statutory notice, the kitchen being dirty and the sink defective. The Magistrate made an order for the owner to comply with the requirements of the notice in fourteen days as stated. 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 14 factories and work-places. In all cases the necessary steps were taken for obtaining the abatement of the nuisances. Sixteen intimation notices were served, and in two instances statutory notices under the Public Health (London) Act, 1891, were required. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 440 as compared with 452 in 1912, 275 in 1911, 197 in 1910, 99 in 1909, 127 in 1908, 111 in 1907 and 103 in 1906. The rooms dealt with numbered 601 as compared with 910 in 1912, 518 in 1911, 386 in 1910 and 187 in 1909. Sanitary notices were served and 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 32. In a large proportion of the cases, the steps taken were the result of information received from the school authorities. 38 During the year the homes of some 1,315 children, 747 boys and 568 girls, notified by the School Medical Officer as being verminous were visited with a view to steps being taken by the Sanitary Authority under the London County Council (General Powers) Act, 1901, Part IV., for dealing with the homes, bedding and clothing where necessary, the children themselves having been cleansed at the County Council's Cleaning Stations in the neighbourhood of the Borough. In many instances the same children were notified more than once as being verminous. Intimations as to the service of statutory notices on parents to cleanse the persons of the children within 21 hours were received in respect to 151, and farther intimations as to the institution of police court proceedings in respect to 75 children under Section 122 of the Children Act, 1908. In consequence a number of the homes were dealt with by the Sanitary Authority on more than one occasion. In all cases the houses were visited by the Sanitary Officers and the following summarises the results of the inspections made In 958 the rooms occupied were clean or in fair condition, in 150 they were dirty, in 81 they were buggy, and in 123 they were both dirty and infested with bugs. In 879 the bedding was clean or fairly so, in 336 it was dirty, in 33 it was buggy and in 67 it was dirty and buggy. In 122 instances the bedding showed evidence of lice, i.e., the lice or nits being observed. Where lice were found the bedding was usually dirty and otherwise verminous, but this was not always the case as in a few instances the bedding appeared clean. In 10 cases mothers attributed the presence of lice to the use of second hand clothing which had been purchased for the children. In 197 instances the home was markedly infested with fleas. Overcrowding was nosed in 68 cases and in 105 evidence of poverty was markedly apparent in the home. In 181 instances there was evidence of recent efforts to cleanse, probably in most cases in expectation of the visit of the Sanitary Inspector. In 41 there was difficulty in gaining admission to inspect, in some cases as many as six or seven visits had to be made before inspection could be carried out, and in 9 instances twenty-four hour notices had to be given of the Sanitary Inspector's intention to apply to a Magistrate for an order to enter the dwelling. Altogether the Inspectors had to make 155 visits before they were able to satisfy themselves as to the conditions of these 41 homes when 41 visits should have sufficed. It is also to be mentioned that there were 207 children notified whose addresses were erroneous ; in 92 they were not known at the addresses stated on the intimations, in 72 they had left the addresses, in 16 there were no such addresses in the Borough and in 27 the addresses were those of unoccupied houses. It may be noted that evidence of lice was found in the bedding in about 9 per cent. of the cases notified. The visits of the Sanitary Inspectors resulted in a large amount of cleansing and disinfection both of bedding, clothing and homes being carried out and also brought to light a number of insanitary conditions which were remedied. Altogether some 363 sanitary notices were served in connection with the work arising from the visits made by the Inspectors in consequence of the intimations received from the School Medical Officer. 39 HOUSE-TO-HOUSE INSPECTION. House-to-house inspection on a considerable scale was carried out during the year by the Sanitary Inspectors in their respective districts. Attention was especially paid to those streets which appeared more particularly to require such inspection. Altogether 2,162 houses situate in 97 streets, including blocks of artizans' dwellings as streets, were inspected and sanitary notices were served in connection with 1,126 of these houses. In the great majority, however, the defects found were of minor importance. 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:— Branch Place, No.22. Britannia Street, No.120. Clifton Street, No.11. Cavendish Street, Nos.15 and 50. Drysdale Street, Nos.21, 23, 25, 27 and 29. Essex Place, Nos.9, 13, 20, 22 and 24 Rivington Street, No.12. Windsor Terrace, No.5. Sylvia Street, Nos.8 and 12. The house in Branch Place contains seven rooms and scullery. It was dirty and dilapidated and the sanitary arrangements generally were defective. It was closed upon the service on the owner of a statutory notice under the Public Health (London) Act, 1891. It was subsequently dealt with and re-let for occupation. The house in Britannia Street, containing eight rooms with scullery, was dirty and overcrowded. It was closed by the owner on receipt of a sanitary notice from Inspector Wright, under whom it was subsequently dealt with. With regard to No. 15, Cavendish Street, containing six rooms and scullery, a magistrate's order was obtained against the owner for not complying with a statutory notice, the premises being generally dirty and dilapidated, the roof being defective and also the sanitary arrangements. The owner closed the house which remained closed at the end of the year. No. 50, Cavendish Street, containing seven rooms and a scullery, was generally dirty and dilapidated and the roof was also defective. It was closed by the owner on the service of a statutory notice under the Public Health (London) Act, 1891, and remained closed at the end of the year. 40 The five houses in Drysdale Street, each containing eight rooms, were closed by the owner on receipt of sanitary notices from Inspector Pearson. They were dirty and dilapidated and the sanitary accommodation was insufficient. They remained closed at the end of the year. The five houses in Essex Place, each containing three rooms, were generally dirty and dilapidated and verminous. They were closed by the owner on receipt of sanitary notices from Inspector Firth in order to enable the work required to be efficiently carried out. They were subsequently re-let. The house in Rivington Street, comprising three rooms with a workshop, was generally dirty and dilapidated. It was closed by the owner on receipt of a sanitary notice from Inspector Jordan in order to facilitate the execution of the work required. The house in Windsor Terrace, containing eight rooms, was in a very dirty condition and was closed by the owner on receipt of a sanitary notice from Inspector Wright and subsequently dealt with. The houses in Sylvia Street, each containing five rooms with a scullery, were closed by the owner on receipt of sanitary notices from Inspector Stokes. The basements were illegally occupied as cellar dwellings and the houses were dirty and dilapidated and generally required a good deal of attention. They were subsequently dealt with 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:— Dysart Street, No.7—an eight-roomed house. It was demolished ; the site is to be used for the erection of a warehouse. Craven Street, Nos. 6, 7, 8 and 9, each containing 7 rooms with scullery were demolished for the extension of adjoining business premises. East Road, Nos. 90, 92, 94, 96, 98,100,102,104,106, 108, 110,112, 114, 116 and 118, each containing 6 rooms and shops, the upper parts being let for occupation by persons of the working class were demolished in connection with the widening of the thoroughfare. Bevenden Street, Nos. 31, 33 and 35—eight-roomed houses, were demolished for the erection of a warehouse on these sites. Wellington Place, Nos.1, 2, 3, 4, 5, and 6, each containing five rooms, and Britannia Street, No. 101, containing eight rooms, were closed by the owner with a view to demolition for the erection of business premises on their sites. 41 HOUSING AND TOWN PLANNING ACT, 1909. The following is a brief account of the work clone 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 : Alfred Place, Nos. 8 and 9. These houses were under the consideration of the Health Committee at the end of the year 1912 in consequence of insufficient light as regards their back additions. The light was much improved by the provision of additional windows, and the notices served were complied with. Grantham Terrace, Nos. 1, 2, 3, 4 and 5, were inspected under the Act and their condition was reported to the Health Committee in March. Their roofs were in some instances defective and they were all more or less dirty, dilapidated and damp; the yard paving and sanitary arrangements were also defective. Intimations as to the works required were addressed to the owner but there was difficulty and likely to be delay in ascertaining to whom the houses belonged. The Health Committee after visiting and inspecting the houses decided to proceed under the Public Health (London) Act, 1891. Statutory notices addressed to the owner were served on the premises. Nothing having been done further proceedings were taken and Closing Orders obtained in respect to Nos. 2, 3 and 5 in July, the other two houses having been vacated some time previously. They remained closed at the end of the year. Britannia Street, No. 104, a six-roomed house, was inspected by order of the Health Committee in May. The sanitary accommodation was defective and the drain obstructed, the main roof was leaky and the premises generally were dirty and dilapidated. An intimation as to the defects existing was given to the owner, but no steps were taken to remedy them. A representation was made by the Medical Officer of Health that the state of the house was such as to render it unfit for human habitation and the house was closed under the Act. It remained closed at the end of the year. It is understood that it is to be demolished and the site used for business premises. Wilmer Gardens, Nos. 85, 87, 89, 91, 93, 95, 97 and 99. These houses are occupied by very poor people and each contains four rooms and scullery. They were inspected by order of the Health Committee in October. The sanitary accommodation was defective, there were defects in the drains, and the houses generally were more or less dirty and dilapidated. Intimations were given to the owner indicating the works required and at the end of the year these had been practically carried out. No further action, therefore, appeared necessary. Wilmer Gardens, Nos. 102, 104, 106, 108 and 110. These are large houses which have been adapted to some extent for the purpose of being let in separate 42 tenements. They had, however, been allowed to get into a very dirty and dilapidated state and were inspected by order of the Health Committee in October. Several of the tenements were found unoccupied. Intimations were sent to the owner as to what was necessary to be done. He thereupon closed the houses and they remained closed at the end of the year. Halcombe Place, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11. These houses, each containing three rooms, were inspected by order of the Health Committee in December. They were, with few exceptions, dirty and verminous and dampness was observable in some of the walls. On the whole the sanitary defects were of minor importance. Intimations were served upon the owner, who lost no time in dealing with the houses. 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 1913 :— (1) The number of houses inspected under Section 17 30 (2) The number of houses considered unfit for habitation 1 (3) Representations made to the Local Authority with a view to Closing Orders 1 (4) Number of Closing Orders made 1 (5) The number of dwelling-houses, the defects of which were remedied without Closing Orders 10 (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—these have already been mentioned. The results for the year may be briefly summarised as follows:—The work in respect to 2 houses outstanding at the end of 1912 was completed; of 30 houses inspected during the year 1 was closed after representation by the Medical Officer of Health, 5 were closed without such representation, 5 were ordered to be dealt with under the Public Health (London) Act, 1891, and of these 3 were closed by order of the Magistrate and 2 without such orders. These 11 houses remained closed at the end of the year; 6 of them will probably be demolished. Of the remaining 19, in 8 the works required were practically completed, and in the case of the rest the inspections were made so near the end of the year that there was no time for the necessary works to be commenced before the close of the year. Since the Act came into operation some 90 houses have been inspected in accordance with its provisions by order of the Health Committee. Of these 14 have been represented as unfit for habitation and closed; 13 have been demolished without demolition orders; 15 have been closed without representations being made under the Act and of these 2 have been demolished, one has ceased to be 43 used as a dwelling house, 2 have been dealt with satisfactorily and reoccupied as dwelling houses and the rest remained closed at the end of the year. With the exception of the 11 which were under consideration at the end of the year the remainder were dealt with to the satisfaction of the Sanitary Authority and no further steps were therefore necessary under the Act. 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 another block of dwellings with nine entrances and containing 51 tenements, in Haberdasher Street, constructed for the Haberdashers' Company, came into occupation. These dwellings are situate on the north side of the street at the Pitfield Street end. Each of them possesses its proper w.c. accommodation, water supply and bath, and is fitted with all modern conveniences. They have been erected on the sites of houses which were occupied by persons of the working class, and add to the improvement in the neighbourhood effected by the block opened last year. 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 1913, are contained in the subjoined table:— Number of blocks. Number of tenements. Number of rooms. N umber of persons. Class A 44 1,935 4,775 6,550 Class B 15 379 919 1,750 Total for the whole 59 2,314 5,694 8,300 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 more crowded condition of the Class B as compared with the Class A dwellings. 44 The births registered during the year, and the birth-rates in the dwellings as a whole, and the two classes into which they have been divided, are shown below:— The whole of the Dwellings. Class A. Class B. Number. Rate per 1,000 Inhabitants. Number. Rate per 1,000 Inhabitants. Number. Rate per 1,000 Inhabitants. 245 29.5 184 29.5 61 34.8 The proportion of deaths attributed to prematurity was at the rate of 36.7 per 1,000 births as compared with 7.2 in 1912, 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 27.1, whilst in Class B they were 65.5 per 1,000 births. For the whole Borough the deaths from prematurity amounted to 19.1 per 1,000 births. The infantile mortality for the whole of the dwellings was 143 per 1,000 births as compared with 84 in 1912, 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 152 as compared with 76 in 1912, 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 115, as compared with 99 in 1912,147 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 for the dwellings and the corresponding death-rates for the whole Borough, so that they may be compared:— Cause of Death. The whole of the Dwellings. Class A. Class B. The Borough. Number of deaths. Rate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants. Rate per 1,000 inhabitants. All causes 113 13.6 86 13.1 27 14.8 184 Principal Zymotic diseases. 14 1.7 10 1.5 4 2.3 22 All forms of Tuberculosis 14 1.7 12 1.8 2 1.1 2.2 Phthisis 8 0.9 8 1.2 ... ... 1.7 Bronchitis 12 1.4 11 1.7 1 0.5 1.9 Pneumonia 18 2.1 14 2.1 4 2.2 2.0 45 The deaths of residents of the dwellings in public institutions numbered 36, being 25 for the Class A and 11 for the Class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 31.8, being 29.0 for Class A and 40.7 for Class B. The percentages for the Borough and for the wards are contained in Table VI. (Appendix). The cases of notifiable infectious disease numbered 52, of which 44 were in the Class A dwellings and 8 in the Class B. The attack-rates per 1,000 population were 6.2 for the whole of the dwellings, 6.2 for Class A, and 4.3 for Class B, as compared with 6.3 for the whole of the Borough. The cases included 1 of puerperal fever, 23 of scarlet fever, 9 of diphtheria and 13 of erysipelas, 4 of enteric fever, and 2 of poliomyelitis. The number of cases and the attack-rates per 1,000 inhabitants are set out below:— — Scarlet Fever. Diphtheria. Puerperal Fever. Erysipelas. Enteric Fever. Cases. Rate. Cases. Rate. Cases. Rate. Cases. Rate. Cases. Rate. Class A 20 3.0 8 1.2 — — 11 1.6 4 0.6 Class B 3 1.7 1 0.5 1 0.5 2 1.1 — — The whole of the dwellings 23 2.7 9 1.0 1 0.1 13 1.5 4 0.5 For the Borough as a whole the attack-rates for the above diseases were as follows:—3"0 for scarlet fever, 1.6 for diphtheria, 0.08 for puerperal fever, 1.3 for erysipelas and 0-1 for enteric fever. HOUSES LET IN LODGINGS. During the year eight houses let in lodgings or occupied by members of more than one family were placed on the register, namely, Nos. 61, 63 and 65, Rushton Street, and 3, 5, 7, 9 and 11, New North Road. The number on the register at the end of the year was 280. There were 449 visits of inspection made, and 261 intimations, followed by 55 statutory notices were served in connection with these houses. CUSTOMS AND INLAND REVENUE ACTS. Two blocks of dwellings situate respectively on the north and south sides of Haberdasher Street were inspected, and certificates granted as to sanitary fitness for exemption from inhabited house duty in respect to the 91 dwellings contained therein, 46 SLAUGHTER HOUSES. The licensed slaughter houses in the Borough at the end of the year numbered 5 as compared with 5 in 1912, 6 in 1911, 6 in 1910, 7 in 1909, 7 in 1908, 8 in 1907, 9 in 1906, and 12 in 1905. The slaughter-houses were inspected from time to time during the year, and their general sanitary conditions may be reported 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 ten 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 32 only. The numbers for previous years were 37 in 1912, 41 in 1911, 39 in 1910, 44 in 1909, 52 in 190S, 57 in 1907, 74 in 1906, 86 in 1905, 95 in 1904, and 101 in 1903. Generally the sanitary condition of tile cowhouses was found to be satisfactory. The number of dairymen and milk purveyors on the register at the end of the year was 290, as compared with 291 in 1912, 292 in 1911, 292 in 1910, 302 in 1909, 292 in 1908, 284 in 1907, 288 in 1906, 289 in 1905, 291 in 1904, 300 in 1903, and 304 in 1902. Daring the year the sale of milk was discontinued at 18 and commenced at 17 premises, and in 41 instances there were changes in the names of the persons registered as milk vendors. The premises where milk is sold were under observation throughout the year, and some 2,997 visits were made in connection with them. In 15 instances sanitary notices were served; in 4 for general cleansing, in 4 for defective sanitary arrangements, in 3 for defective roofs, in one for dirty utensils, and in one for the provision of a proper dust receptacle. One case of scarlet fever and two of diphtheria occurred on premises where milk was sold and the usual steps were taken by the Sanitary Authority. OFFENSIVE BUSINESS. The tripe boiling establishment in Haggerston Road was under observation but there were no complaints respecting it during the year. RAG FLOCK ACT, 1911. Under the above act 34 samples of rag flock were taken. In one instance proceedings were necessary the sample containing 40.4 parts per 100,000 of soluble chlorine in excess of the 30 parts allowed. The summons was dismissed against the party selling the flock but guarantors of the same were fined £2 with five guineas costs. 47 FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of 1913 was 1,232, 264 having been placed on and 175 taken off during the year. The numbers for previous years were 1,143 in 1912, 1,136 in 1,911, 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 3,962 visits of inspection were made in connection with workshops, and 858 to factories. Six communications were received from the Factory Inspector relative to the establishment of 69 new workshops in the Borough. On inspection 48 were found to be in a satisfactory sanitary condition, and 6 were not in occupation at the time when visited. The remainder were all more or less unsatisfactory from a sanitary point of view, and some 14 notices were served. From the Factory Inspector 24 written intimations were received relating to insanitary conditions and infringements of the law as to public health in connection with 79 workshops and 7 factories. The chief insanitary conditions to which the Factory Inspector directed attention were: dirty conditions of walls and ceilings in 54 instances, defective and insufficient water-closet accommodation in 9, want of proper separate accommodation for the sexes in 5, overcrowding in 5, want of proper light and ventilation in 3, accumulation of rubbish 1, want of proper ventilation 2, roof defective 1, no lobby to w.c.'s 7, and w.c.'s and urinals dirty 8 instances. Including those brought under our notice by the Factory Inspector, 359 workshops were dealt with and 338 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 1913:— New drains constructed 2 Obstructions removed from water-closets 22 Drains relaid or repaired 17 Stack pipes disconnected 6 Urinals repaired and cleansed 9 Stack pipes reinstated 31 Eaves gutters reinstated 23 Urinals newly constructed 1 Sink waste pipes disconnected 9 New water-closets constructed 8 Yards paved 16 Water-closets' flushing apparatus repaired 96 Areas paved 2 Forecourts paved 1 Water supply laid on or restored 4 Door sills provided 1 Water-closets reconstructed 51 Leaky water pipes repaired 10 Water-closets cleansed and lime-washed 301 Rooms cleansed and whitewashed 451 48 Yards cleansed and whitewashed 132 Doors repaired 23 Sashes repaired 11 Areas cleansed and whitewashed 5 Dust receptacles provided 17 Foul accumulations removed 12 Roofs repaired 73 Floors repaired 12 Stairs repaired 11 It may also be added that in 9 instances nuisances owing to Hooding with sewage had to be dealt with, and in 2 cases overcrowding. In 46 instances statutory notices were served under the Public Health (London) Act, 1891, by order of the Health Committee, but the necessity for police court proceedings did not arise. The number of factories under observation during the year was 17, and in connection with them some 17 sanitary notices were served. The works carried out to comply with these notices included the construction, reconstruction or repair of drains in 2 instances, the disconnection of stack pipes in 2, of sink waste pipes in 5, the repair of water closets in 10, of the flushing apparatus in 4, the removal of obstructions from water-closets in 3, the construction of new water-closets in 4, and new urinals in 4 instances, besides a number of other items connected with cleansing and repairing. In 1 instance 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 110 lists of out-workers were received from employers in the Borough, 57 in the first and 53 in the second half-year. Those for the first halfyear are due in February, for the second in August. These lists contained the names of 1,602 out-workers, of whom 1,170 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the sanitary authorities of the districts to which they belonged. Communications were received from various sanitary authorities relating to some 2,330 out-workers, and of these 59 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 1913. The number of out-workers brought to our notice during 1913 was 3,932, as compared with 4,251 in 1912, 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 1913, some 2,703 were residents in Shoreditch, as compared with 2,837 in 1912, 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 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 49 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 1,963 visits of inspection were made to places where homework was being carried on, and sanitary notices were served in 117 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 15, of eaves gutters in 14; various works in connection with the water-closet accommodation in 33, with the water supply in 20; the cleansing of 195 rooms, 36 yards, 10 areas, and 42 water-closets; the repair of roofs in 20, floors in 9, stairs in 6, sashes in 7, and doors in 4 instances, the provision of 15 dust receptacles besides other work. In 4 instances overcrowding was found, in 27 cases the rooms required to be dealt with on account of vermin, in 1 instance drains were relaid, in 5 repaired, and in 3 instances accumulations of sewage were dealt with. 38 cases of notifiable infectious disease occurred at out-workers' premises during the year, and the necessary measures were taken in accordance with the requirement of the law. In connection with the lists of out-workers it was necessary to write to employers in 24 instances on account of delay in sending in the lists relating to out-workers employed in making wearing apparel, in 21 relating to paper bag and box making out-workers, in 1 relating to artificial flower making, and in 1 in respect to cabinet making. There was no necessity for further action as the lists were forthcoming on the letters being sent. BAKEHOUSES. The bakehouses on the register at the end of the year numbered 74, of which 42 are below ground and 32 above. The bakehouse at No. 82, East Road, ceased to exist as such, the oven having been demolished. Of the bakehouses on the register at the end of the year, 7 were unoccupied or the premises used for other purposes than baking—namely, those situate at 88, Bridport Place, 55, Hackney Road, 189, High Street, 46, Newton Street, 249, Old Street, 30, Pitfield Street, and 16, St. John's Road. In 5 of the bakehouses power is used and they are consequently factories within the meaning of the Factory Acts. As the result of inspection it was found that in one instance the drains were in a very defective state and required reconstruction, in 4 others there were some minor defects in the sanitary arrangements, in 1 a dust receptacle was required and in 26 the walls of the bakehouse more or less required limewashing. In all cases sanitary notices were served. It was not necessary to bring any of the premises specially to the notice of the Sanitary Authority, (174) D 50 ICE CREAM SHOPS. The following is a summary of the work during 1913:—Inspector Firth had 7 under observation, 5 of which required more or less cleansing. Inspector Jordan had 1.0, in 2 of which sanitary notices were necessary for cleansing and repairs. Inspector Langstone visited 17, which seem to have been in a satisfactory sanitary condition. Inspector Pearson had 21 under visitation, and sanitary notices were served in respect to 9, of which 6 were for cleansing, 1 for a defective roof, 1 for defective eaves guttering and 1 for absence of proper dust receptacle. Inspector Stokes had 13 under inspection, all of which appeared in a satisfactory sanitary condition. Inspector Wright had 11 under observation, one of which required cleansing. Inspector Pratt visited 8; 1 notice was required for cleansing and repairs. Inspector Chapman had 11 under observation and 1 notice for general cleansing was necessary. Altogether 98 premises whereon ice cream was made or sold were under inspection during the year. In 79 of them the general sanitary condition was satisfactory ; in 19 instances sanitary notices were necessary. COOKSHOPS, COFFEE HOUSES AND EATING HOUSES. Inspector Firth had 9 under observation, in 8 of which more or less cleansing was required. Inspector Jordan had 78 under observation, including the kitchens of 18 public houses; in 32 instances sanitary notices were necessary, in 3 instances flushing cisterns were defective, in 5 dust receptacles were required, in 2 roofs were defective, in 3 sinks required to be properly trapped, in one the yard paving was defective, in 3 instances light and ventilation were provided for w.c.'s, in 2 rain water pipes were repaired and in 3 instances obstructed drains had to be dealt with. A good deal of general cleansing was also carried out ; 21 kitchens, 9 other rooms and 8 basements being cleansed and whitewashed and the walls of yards and w.c.'s were limewashed in 4 instances. Inspector Langstone had 11 under inspection, one of which required to be dealt with on account of the presence of rats, the premises being, moreover, dirty and dilapidated. Inspector Pearson had 34 under observation; in 2 instances notices as to cleansing were necessary and in one the kitchen flooring was defective. Inspector Stokes visited 15 and in one instance a sanitary notice was required, the flooring and yard paving being defective, and there was the absence of a proper dust receptacle. Inspector Wright had 16 under inspection and in 14 instances sanitary notices were necessary, mainly for cleansing and repairs. Inspector Pratt visited 18 and in 5 instances notices were necessary for cleansing and repairs. Inspector Chapman had 12 under observation and one notice was necessary for general cleansing and a defective roof. Altogether 193 cookshops, coffee houses, eating houses, and kitchens of public-houses, were under observation during the year as compared with 194 in 1912, 202 in 1911, 198 in 1910, 204 in 1909, 197 in 1908, 188 in 1907, 178 in 1906, and 182 in 1905. In 65 instances sanitary notices were necessary. 51 FRIED FISH SHOPS. On Inspector Firth's district. 4 were under observation, and in 15 cases sanitary notices were required chiefly for cleansing. On Inspector Jordan's district, 6 were under inspection, and in 2 instances notices were necessary for cleansing and repairs. On Inspector Langstone's district, 5 were visited, at one of which overcrowding was found to exist. On Inspector Pearson's district, 10 were under observation, and in 4 instances sanitary notices were required for cleansing and repairs. Inspector Stokes visited 4 which seemed in a satisfactory sanitary condition. Inspector Wright had 5 under visitation, and 3 notices were served for cleansing. Inspector Pratt had 10, in two of which notices were necessary for cleansing and repairs. On Inspector Chapman's district, 11 were under observation, in connection with six of which sanitary notices were necessary for general cleansing and repairs. STREET MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers in the Street Markets as regards food exposed for sale in the Borough. The following were seized or surrendered and destroyed as unfit for the food of man:— Skate 79 lbs., plaice 39 stone, fresh haddocks 1 trunk, whiting 1 cwt., kippers 3 boxes; kidneys 1 cwt. 10 lbs., pigs' plucks 30, rabbits 67 lbs., neck of mutton 6 pieces, breast of mutton 3 pieces, beef 2 pieces; oranges 1,293 and 1 case, lettuce 35 bushels, dates 7½ cwt., tomatoes 8 cases and 18 lbs., and onions 1 bag. The occupier of No. 147, Hoxton Street was fined £2 with 2s. costs for not removing a stall board from the footway when requested to do so by Inspector Pratt, whilst the inspector was engaged in clearing the street markets on a Sunday morning. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 768 samples were submitted to him for analysis during the year. This number is at the rate of nearly 7 per 1,000 inhabitants. The results of the year's work are summarised in the following table :— Quarter of the year 1913. Number of Samples taker. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of successful Prosecutions. Fines and Costs. Amount paid to Analyst for Samples analysed. £ s. d. £ s. d. 1st 171 27 15.2% 11 — 11 10 18 11 0 85 10 0 2nd 207 45 21.2% 19 — 19 17 47 2 6 103 10 0 3rd 129 29 22.4% 7 — 7 6 12 7 6 63 12 6 4th 261 31 11.4% 10 — 10 9 16 1 6 97 17 6 Total for Year. 768 132 17.1% 47 — 47 42 94 2 6 350 10 0 (174) D 2 52 The samples taken included 498 of milk, 132 of butter, 13 coffee, 9 margarine, 8 lard, 9 pepper, 2 separated milk, 1 German sausage, 3 cocoa, 4 jam, 10 flour, 7 tapioca, 6 mustard, 5 citric acid, 4 sago, 4 bread, 4 cheese, 3 preserved cream, 3 camphorated oil, 3 Gregory's powder, 2 cream, 2 cod liver oil, 2 tincture of perchloride of iron, 2 linseed, 2 peas, 2 ground rice, 2 mustard pickles, 2 tincture of rhubarb, 2 honey, and one each of beef extract, brawn, glycerine, glycerine of borax, castor oil, custard powder, Demerara sugar, linseed meal, liquorice powder, arrowroot, mincemeal, sweet spirits of nitre, ham and chicken paste, ham and tongue paste, rice, salvolatile, beef suet, rice flour, sweetmeats and tartaric acid. Of the samples of milk 116 or 25.3 per cent. were found to be below the standard fixed by the Board of Agriculture as compared with 22.2 in 1212, 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 proportion of milk samples returned as adulterated during 1913 was above the average. It is, however, to be mentioned that 18 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 19.6 as compared with 20.8 for 1912. 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 112 25 22.3 2nd 135 42 31.1 3rd 102 27 26.4 4th 149 22 14.7 In 52 of the samples water was certified to have been added; in 11 the amount was more and in 41 it was less than 5 per cent., taking the standard of the Board of Agriculture. In 37 the samples showed deficiencies in milk fat; in 17 the deficiency was more, and in 20 it was less than 5 per cent. In 9 instances both fat had been abstracted and water added. Three of the samples contained traces of artificial colouring matter. None showed the presence of preservatives. Legal proceedings were instituted in 26 or 22.4 per cent. of the cases in which the samples of milk were below standard, and in 19 of these convictions were obtained. In two instances the summonses were dismissed, warranties being proved, and in three cases the defendants were ordered to pay 23s. costs. The summons was withdrawn in one instance on defendant paying 42s. costs. One summons was dismissed, the vendor having given notice to the Inspector that the milk was 53 scalded. With regard to the remainder of the samples below standard the small percentages of adulteration rendered it so very unlikely that convictions could be obtained, that prosecutions were not considered advisable. In seven instances letters of caution were sent to the vendors. The percentage of the adulterated samples in which it was not thought advisable to prosecute was 77 as compared with 61 in 1912, 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 £26, which is equivalent to 4.6 per cent. of the full amount of the penalties to which the defendants were liable as compared with 6.9 per cent. in 1912, 6.6 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 £52 3s. 0d., the average amount paid by the defendants on conviction was £2 14s. 1d., as compared with £3 15s. 5d. in 1912, £2 8s. 3d. in 1911, £1 11s. 6d. in 1910, £12 6s. 4d. in 1909, £3 1s. 4d. in 1908, £1 13s. 7d. in 1907, £2 9s. 6d. in 1906, £2 19s. 3d. in 1905, £2 6s. 10d. 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 3 or 2.2 per cent. were not genuine, as compared with 6.7 in 1912, 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 41 ... ... 2nd 35 2 5.7 3rd 19 ... ... 4th 37 1 2.7 Of the samples sold as butter which were not genuine one was a sample of margarine, one contained foreign fats in a large amount and was probably a mixture of butter and margarine, and one contained water in excess of the 16 per cent. standard. The summons taken in the case of the excess of water was dismissed, a warranty being proved. Proceedings were then taken against the person giving the warranty; the summons again was dismissed as this person sold under a warranty. A third summons was then taken in February of the current year against the person who gave this warranty, but this also was dismissed as the butter came from France under a warranty. 54 The penalties inflicted amounted to £12, or approximately 8.5 per cent. of the inaximum penalties to which the defendants were liable, as compared with 8.5 in 1912, 23 in 1911, 7.9 in 1910, 9.4 in 1909, 16.3 in 1908, 15.6 in 1907, 12 in 1906, 17 in 1905, 10 in 1904, 18 in 1903, and 17 in 1902. Including the costs, which amounted to £3 5s. 0d., the amounts defendants were ordered to pay averaged £5 1s. 8d., as compared with £4 18s. 1d. in 1912, £8 1s. 10d. 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 1s. in 1905, £3 1s. in 1904, £4 10s. in 1903 and £4 10s. in 1902. Twelve 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 9 of the cases. In 2 proceedings were not advised. One case was dealt with under the Probation of Offenders Act, 1907, and no fine was inflicted. The fines amounted to £7 10s. and £4 12s. costs were allowed the Council. The fines under the Margarine Act amounted to a little over 1.5 per cent. of the maximum penalties to which the defendants were liable. Including costs, the amounts paid by defendants averaged £1 6s. 10d. as compared with £1 13s. 5d. for 1912, £1 16s. 1d. in 1911, 15s. in 1910, £1 12s. 6d. in 1909 and £1 4s. 6d. in 1908. Of 13 samples purchased as coffee, 5 were found to be mixtures of coffee and chicory. Proceedings were taken in all cases, and in 4 convictions were obtained. In the fifth costs were allowed the Borough Council. The fines came to £6 and £4 3s. 6d. costs were allowed. The fines amounted to 6 per cent. of the maximum penalties to which the defendants were liable. Of 5 samples of citric acid 2 were not genuine. One contained 15.47 per cent. of boric acid, and the other was not citric but tartaric acid. In the former case the defendant was fined £1, with 23s. costs, and in the latter 23s. costs were allowed the Council. Of 3 samples of Gregory's powder 2 were genuine; the other contained 31.8 per cent. of rhubarb and 68.2 per cent. of carbonate of magnesia. Proceedings were taken, the defendant escaping a fine, but being ordered to pay 23s. costs. One sample of tincture of perchloride of iron was 18 per cent. deficient in iron; the sample of German sausage contained boric acid equivalent to 17.0 grains per lb; 2 samples of linseed meal were slightly adulterated, and 1 sample of peas (bottled) contained 0'37 grains of copper per lb. It was not deemed advisable to take proceedings in these cases. The samples of lard, pepper, separated milk, cocoa, jam, honey, flour, tapioca, mustard, sago, bread, cheese, preserved cream, camphorated oil, cream, cod liver oil, ground rice, mustard pickles, tincture of rhubarb, beef extract, brawn, glycerine, glycerine of borax, castor oil, custard powder, Demerara sugar, linseed meal, 55 liquorice powder, arrowroot, mince meat, sweet spirits of nitre, ham and chicken paste, ham and tongue paste, rice, sal volatile, beef suet and rice flour, sweetmeats and tartaric acid 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 1902-13 inclusive:— Year. Number of Samples. Number of persons in the Borough to each Sample. Number of Samples adulterated. Percentage of Samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties. Prosecutions proceeded with. Number of successful prosecutions. Fines and Costs. Amount paid to Public Analyst. £ s. d. £ s. d. 1902 281 420 71 25.3 54 2 52 48 117 9 0 140 10 0 1903 707 166 112 15.8 60 5 55 51 173 11 6 353 10 0 1904 612 189 110 17.9 56 6 50 46 128 5 0 306 0 0 1905 536 215 98 18.2 57 2 51 47 233 18 0 267 0 0 1906 520 224 122 23.4 44 2 42 34 106 12 6 260 0 0 1907 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 1908 580 200 92 15.8 45 ... 45 39 117 10 0 290 0 0 1909 570 200 92 16.1 76 2 74 69 255 18 6 276 5 0 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 1913 768 144 132 17.1 47 ... 47 42 94 2 6 350 10 0 The percentage of samples found adulterated was again somewhat below the average. With reference to the convictions under the Act during 1913, in 8 instances the defendants had been once, in 3 twice, in 1 three times, in 1 instance seven times, and in 1 eight times previously convicted. In one case the defendant was fined £2, with £2 costs, for refusing to serve the inspector. MILK AND CREAM REGULATIONS, 1912. During the year 498 samples of milk, 2 of cream, and 3 of preserved cream, were examined by the Public Analyst as to the presence of preservatives. The results are shown in a special report which is appended. SANITARY STAFF. No change has taken place in connection with the staff of the Health Department during the year. Some 17,602 communications, written and printed, were dispatched from the Department as compared with 15,749 in 1912, 16,520 in 1911 and 13,639 in 1910. 56 These included 5,371 notices and summonses; 2,893 letters, cards and other documents, mainly on matters under the Public Health and Sale of Food and Drugs Acts ; 1,374 communications relating to cases of pulmonary tuberculosis; 574 in connection with the work under the Factory and Workshops Acts; 6,422 communications of various kinds relating to infectious disease, verminous cases and disinfection; and 968 agendas and reports concerning the work of the Department. I have again to record my satisfaction as to the work done by the Officers of the Health Department and my appreciation of the assistance rendered by them in connection with my work during the year. My thanks also are due to the Chairman and Members of the Health Committee for their kind consideration and help in connection with the work of the Department throughout 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 1913; a copy of a Special Report on the Infantile Mortality of the Borough; a copy of a Report on the Proceedings under the Milk and Cream Regulations of 1912; the Report of the Tuberculosis Officer; the Reports of the Health Visitors for the Year. Tables II., III. and 1V. are forms required by the Local Government Board. 58 TABLE I. Vital Statistics of the Borough of Shoreditch during 1913 and previous Years. Year. Population estimated to middle of each Year. Births. Total deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Nonresidents registered in the District. of residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 net Births. Number. Rate. l 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 3398 3497 31.8 2015 18.1 344 556 598 171 2227 20.2 1912 111067 3375 3529 32.1 1878 16.9 335 474 451 128 2017 18.3 1913 110410 3283 3393 31.1 1831 16.5 313 490 530 157 2008 18.4 Note.—The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn Union Workhouse has been deducted in calculating the rates. In column 6 are included the whole of the deaths registered during the year as having actually occurred within the Borough. In column 12 is entered the number in column 6 corrected by subtraction of the number in column 8 and by the addition of the number in column 9. Deaths in column 10 have been similarly corrected by subtraction of the deaths under 1 included in the number given in column 8 and by addition of the deaths under 1 included in the number given in column 9. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. Area of Borough in acres (exclusive of area covered by water) 642.5 Total population at all ages, 111,390 At Census of 1911. Number of inhabited houses, 11,535 Average number of persons per house 9.6 59 TABLE II. Cases of infectious disease notified during the Year 1913 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. 2. 3. 4. 5. 6. 7. 8. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C), Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous group) 181 10 70 79 14 8 ... ... 9 33 21 16 36 19 28 19 172 Erysipelas 151 9 6 10 16 43 42 25 2 21 23 17 46 12 21 9 30 Scarlet Fever 340 4 88 218 26 4 ... ... 12 60 52 49 39 21 38 69 332 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 14 ... ... 8 2 3 1 ... 4 2 1 ... 1 2 4 ... 13 Relapsing fever (R), Continued fever (C) 1(C) ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Puerperal fever 9 ... ... ... 3 6 ... ... ... 3 ... ... 3 ... 1 2 7 Cerebro-spinal Meningitis 4 1 3 ... ... ... ... ... ... 1 ... 1 1 1 ... ... 4 Polio-myelitis 8 ... 7 1 ... ... ... ... ... 1 1 1 ... ... 2 3 3 Pulmonary Tuberculosis 719 5 23 88 109 810 162 22 22 115 134 120* 145† 79 53 51 278‡ Other forms of Tuberculosis 186 20 35 92 18 14 6 1 2 37 20 28 48 18 14 19 23‡ Ophthalmia Neonatorum 22 22 ... ... ... ... ... ... ... 4 4 1 4 5 2 2 1§ Totals 1,635 71 232 496 189 388 211 48 51 277 253 233 323 157 164 174 864 * This Number includes the cases of consumption notified from the Holborn Union Infirmary. Highgate. † This includes the cases of consumption in the Shoreditch Workhouse. ‡ Removed to the Shoreditch Infirmary, Hospitals and Sanatoria. § Removed to Moorfields Eye Hospital. 60 TABLE III. Causes of, and ages at death during the Year 1913 in the Borough of Shoreditch. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District (a). Total Deaths whether of " Residents " or "NonResidents" in Institutions in the District (b). All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 2008 530 178 79 74 67 241 427 412 893 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric Fever 1 ... ... ... ... 1 ... ... ... 1 2 Small-pox ... ... ... ... ... ... ... ... ... ... 3 Measles 40 12 19 8 1 ... ... ... ... 7 4 Scarlet Fever 3 ... ... 1 2 ... ... ... ... ... 5 Whooping-cough 28 11 8 9 ... ... ... ... ... l 6 Diphtheria and Croup 14 2 4 6 2 ... ... ... ... ... 7 Influenza 22 5 2 ... ... 3 1 8 3 4 8 Erysipelas 9 5 ... ... ... 2 ... 1 1 7 9 Phthisis (Pulmonary Tuberculosis) 185 2 3 4 8 14 76 70 8 119 10 Tuberculous Meningitis 34 10 7 7 9 1 ... ... ... 9 11 Other Tuberculous diseases 29 12 3 4 4 1 4 1 ... 11 12 Cancer, malignant disease 77 ... 1 ... 3 3 10 43 17 40 13 Rheumatic Fever 7 ... ... ... 3 1 3 ... ... 3 14 Meningitis (see note (d)) 17 5 4 3 2 1 2 ... ... 3 15 Organic Heart Disease 62 ... ... 1 5 8 12 21 15 29 16 Bronchitis 209 35 10 ... 2 ... 12 58 92 121 17 Pneumonia (all forms) 219 71 36 19 7 9 20 31 26 38 18 Other diseases of Respiratory organs 13 1 ... ... ... ... 4 4 4 14 19 Diarrhoea and Enteritis (see note (e)) 217 133 61 13 2 1 2 1 4 88 20 Appendicitis and Typhlitis 6 ... ... ... 3 1 1 1 ... 4 21 Cirrhosis of Liver 20 ... ... ... ... ... 4 15 1 12 22 Alcoholism 10 ... ... ... ... ... 4 5 1 10 23 Nephritis and Bright's Disease 72 ... ... ... 1 3 17 28 23 47 24 Puerperal Fever 4 ... ... ... ... ... 4 ... ... 2 25 Other accidents and diseases of Pregnancy and Parturition 8 ... ... ... ... 2 6 ... ... 2 26 Congenital Debility and malformation, including premature birth 155 152 3 ... ... ... ... ... ... 31 27 Violent deaths, excluding suicide 78 29 3 4 7 2 5 14 14 18 28 Suicides 13 ... ... ... ... 2 4 5 2 1 29 Other defined diseases 448 41 14 ... 13 12 48 120 200 271 30 Diseases ill-defined or unknown 8 4 ... ... ... ... 2 1 1 ... 2008 530 178 79 74 67 241 427 412 893 61 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHORED1TCH during the year 1913. Nett deaths from stated causes at various ages under One Year of Age (see note (a)). CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Monts. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All causes. Certified 70 23 24 8 131 Ill 105 99 84 530 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 5 6 12 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 2 5 2 2 11 Diphtheria and Croup ... ... ... ... ... ... ... ... 2 2 Erysipelas 1 1 2 ... 4 1 ... ... ... 5 Tuberculosis Meningitis ... ... ... ... ... ... 3 4 1 8 Abdominal Tuberculosis (b) ... ... ... ... ... 2 1 3 1 7 Other Tuberculous Diseases ... ... ... ... ... ... 1 4 2 7 Meningitis (not Tuberculous) ... ... ... ... ... ... ... 3 3 6 Convulsions 3 2 3 ... 8 4 2 1 3 18 Laryngitis ... ... ... ... ... ... 1 ... ... 1 Bronchitis ... 1 2 3 6 9 13 6 1 35 Pneumonia (all forms) ... 2 1 1 4 20 12 18 18 72 Diarrhoea ... ... 2 ... 2 16 25 25 26 94 Enteritis ... ... ... 1 1 10 12 10 9 42 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... ... ... 1 3 ... ... ... 4 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 5 2 2 ... 9 8 5 3 ... 25 Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis ... ... 1 ... 1 ... ... ... ... 1 Congenital Malformations (c) 3 1 ... ... 4 1 1 2 1 9 Premature birth 44 8 5 ... 57 6 2 ... ... 65 Atrophy, Debility and Marasmus 13 4 3 2 22 29 17 5 5 78 Other causes 4 2 3 1 10 4 8 4 26 76 23 24 8 131 111 105 99 84 530 Nett Births in the year—Legitimate 3,323, illegitimate 70. Nett Deaths in the year of legitimate infants 514, illegitimate infants 14. 62 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.) 63 NOTES TO TABLE IV. (a) The total in the last column of Table IV. equals the total of 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, 1913. 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. Total. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingslaud. Haggerston. Acton. Male. Female. 1 Small Pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 12 27 1 ... ... ... ... ... ... ... ... ... ... 1 11 9 5 8 1 2 3 20 20 40 3 Scarlet fever ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 2 1 3 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza 5 2 ... ... 1 2 1 ... 5 3 3 ... ... ... 3 5 2 5 1 5 1 14 8 22 6 Whooping cough 11 17 ... ... ... ... ... ... ... ... ... ... ... 1 7 6 2 2 2 4 4 13 15 28 7 Diphtheria, membranous croup 2 10 2 ... ... ... ... ... ... ... ... ... ... ... 1 2 3 4 1 3 ... 8 6 14 8 Enteric fever ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 67 45 ... ... 1 ... ... 2 1 ... ... ... ... 1 26 32 16 20 6 7 8 69 47 116 11 Epidemic or zymotic enteritis 27 16 ... ... ... ... ... ... ... ... ... ... ... ... 13 3 7 5 5 4 6 21 22 43 12 Other allied diseases ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 4 1 ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... ... 1 1 1 1 4 2 6 19 Gonorrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedœna, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas 5 ... ... ... ... 2 ... ... ... 1 1 ... ... ... 1 4 1 1 ... ... 2 4 5 9 22 Puerperal fever ... ... ... ... ... ... 3 1 ... ... ... ... ... ... 1 ... ... 2 ... 1 ... ... 4 4 23 Pyaemia, septicaemia 1 2 1 1 1 ... ... ... 4 3 3 ... ... ... 3 2 2 4 3 1 1 7 9 16 24 Infective endocarditis ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 2 25 Other allied diseases ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 26 Malarial fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Rheumatic fever ... ... 2 1 1 ... 2 1 ... ... ... ... ... 2 1 1 1 ... ... 1 1 3 4 7 28 Rheumatism of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis: 29 Brain or meninges, acute hydrocephalus 10 14 7 2 ... 1 ... ... ... ... ... ... ... ... 6 7 5 6 3 5 2 19 15 34 30 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Lungs 2 7 5 3 5 9 35 41 36 34 6 2 ... 6 37 30 25 40 21 19 17 121 64 185 32 Intestines, tabes mesenterica 6 3 1 ... ... ... 1 ... ... ... ... ... ... ... 2 1 3 2 ... ... 3 5 6 11 33 General, position undefined 4 2 1 ... 1 ... ... 1 ... ... ... ... ... 1 5 ... 3 ... ... ... ... 6 3 9 34 Other forms, scrofula 2 2 2 ... ... ... 1 1 1 ... ... ... ... ... 3 2 2 ... 1 ... 1 4 5 9 35 Other Infective diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 Hydatid diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Other diseases due to altered food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 41 Acute alcoholism, delirium tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (174) e CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 42 Chronic alcoholism ... ... ... ... ... ... 2 2 5 ... 1 ... ... 1 4 ... 2 3 ... ... ... 4 6 10 43 Chronic industrial poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 46 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 Cancer ... ... ... ... ... 1 l 8 19 18 15 ... 1 1 9 12 13 9 4 5 10 32 31 63 48 Diabetes mellitus ... ... ... ... ... ... 1 1 1 2 2 1 ... ... 2 3 2 ... 1 ... ... 4 4 8 49 Purpura hemorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anaemia, leucocythasmia ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 1 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 53 Premature birth 65 ... ... ... ... ... ... ... ... ... ... ... ... 7 10 14 11 ... 2 3 9 42 23 65 54 Injury at birth 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... 2 1 3 55 Debility at birth 22 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 1 6 5 3 ... 14 8 22 56 Atelectasis 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 57 Congenital defects 9 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 4 2 ... ... ... ... 4 5 9 58 Want of breast milk 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 59 Atrophy, debility, marasmus 55 3 ... ... ... ... ... ... ... ... ... ... ... ... 13 9 5 12 5 11 3 32 26 58 60 Dentition 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 1 4 1 5 61 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 62 Old Age, senile decay ... ... ... ... ... ... ... ... ... 3 23 55 23 4 13 17 14 25 13 10 8 38 66 104 63 Convulsions 16 1 ... ... ... ... ... ... ... ... ... ... ... 1 5 2 1 3 3 1 1 11 6 17 64 Meningitis 5 7 ... 1 ... 1 ... 2 ... ... ... ... ... ... 2 5 3 ... 4 1 2 13 4 17 65 Encephalitis ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 66 Apoplexy ... ... ... ... ... ... ... 8 11 21 27 13 3 4 12 15 6 20 10 8 8 35 48 83 67 Softening of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... 2 3 1 1 ... ... 1 3 1 1 ... ... 1 3 4 7 69 General Paralysis of insane ... ... ... ... ... 1 1 3 5 2 1 ... ... ... 3 2 1 4 ... 2 1 10 3 13 70 Other forms of insanity ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... 1 1 2 71 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 3 ... ... ... ... ... ... 1 2 3 73 Epilepsy ... 2 1 ... ... ... l 3 ... 1 2 ... ... ... ... 3 2 ... ... 1 1 4 6 10 74 Laryngismus Stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 75 Locomotor Ataxy ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 ... ... ... ... ... ... 2 ... 2 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... l ... 2 ... 2 ... ... ... 3 ... 1 ... 1 ... ... 3 2 5 77 Other diseases of brain or nervous system ... 2 ... ... ... ... ... ... 3 2 ... 1 ... ... 1 3 ... ... ... 1 ... 6 2 8 78 Otitis, otorrhœa 3 1 1 3 2 ... l 1 ... ... ... ... ... ... 1 3 ... ... 1 ... ... 6 6 12 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... 1 1 1 ... 1 ... 1 1 ... ... ... ... 1 2 2 ... ... 1 ... ... 3 3 6 82 Endocarditis, valvular diseases of the heart ... ... ... 3 5 2 4 7 11 9 12 3 ... 6 10 8 6 ... 8 3 6 25 31 56 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 85 Aneurism ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 1 1 ... ... ... ... ... 3 ... 3 86 Senile gangrene ... ... ... ... ... ... ... ... l 1 2 ... 1 ... 1 1 1 ... ... 1 ... 4 1 5 87 Embolism, thrombosis ... ... ... ... ... ... ... ... l ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and, circulatory system, including heart disease not stated to be valvular 1 ... ... 2 4 ... 5 5 7 16 16 11 ... 2 18 16 6 10 8 4 3 32 35 67 67 E 2 (174) CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 91 Laryngitis 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Acute bronchitis 35 10 2 ... ... ... 1 6 5 4 4 2 1 4 18 12 7 12 8 3 6 31 39 70 95 Chronic bronchitis ... ... ... ... ... ... 1 4 18 31 52 25 8 4 21 26 19 29 10 17 13 67 72 139 96 Lobar, croupous-pneumonia ... 2 1 ... 2 ... ... 2 3 3 2 1 ... 1 2 3 4 3 2 1 ... 13 3 16 97 Lobular, broncho-pneumonia 60 37 2 ... ... 1 ... 2 4 3 5 2 ... 2 25 25 19 16 9 7 13 61 55 116 98 Pneumonia, form not stated 11 16 2 2 3 3 7 9 9 9 11 4 1 1 13 23 7 17 9 9 8 52 35 87 99 Emphysema, asthma ... ... ... ... ... ... 1 ... ... 1 1 ... 1 ... 1 1 ... 1 ... 1 ... 1 3 4 100 Pleurisy 1 ... ... ... ... ... ... 1 2 ... 1 ... ... ... 1 1 ... 2 ... 1 ... 5 ... 5 101 Other and ill-defined diseases of respiratory system ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... 2 1 1 ... 2 2 4 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 2 2 105 Ulcer of stomach and duodenum ... ... ... ... ... ... 3 1 4 2 ... ... ... 1 2 1 3 1 ... 2 ... 2 8 10 106 Other diseases of stomach 2 ... ... ... ... ... ... ... ... 1 ... 2 ... ... 1 1 1 1 ... 1 ... 3 2 5 107 Enteritis 39 13 2 ... ... ... ... ... ... ... 2 2 ... ... 15 10 7 14 5 2 5 31 27 58 108 Appendicitis ... ... 1 2 1 ... ... 1 l ... ... ... ... ... 2 ... ... 3 ... ... 1 4 2 6 109 Obstruction of intestine 1 1 1 ... ... ... ... 1 3 2 1 1 ... ... ... ... 2 3 1 2 3 7 4 11 110 Other diseases of intestine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 111 Cirrhosis of liver ... ... ... ... ... ... ... 3 13 2 1 ... ... 1 1 1 4 3 4 2 4 9 11 20 112 Other diseases of liver ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 2 113 Peritonitis 1 1 ... ... ... ... 2 ... ... 2 1 ... ... ... ... 1 1 4 1 ... ... 4 3 7 114 Other and ill-defined diseases of digestive system 2 ... ... ... ... ... ... ... ... 1 1 1 ... 1 2 ... ... ... ... 1 1 1 4 5 115 Diseases of Lymphatic System and ductless glands ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 116 Acute nephritis. ... ... ... ... ... ... 1 2 2 ... 1 ... ... ... 3 2 ... 1 ... ... ... 3 3 6 117 Bright's disease. ... ... ... 1 1 2 4 10 13 13 18 4 ... 3 18 6 3 16 9 4 7 34 32 66 118 Calculus. ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 119 Diseases of bladder and prostate ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... 2 ... 1 ... ... 1 2 2 4 120 Other and ill-defined diseases of urinary system ... ... ... ... ... 1 ... 2 ... 2 ... 1 ... 1 1 2 1 ... ... 1 ... 3 3 6 121 Diseases of testis and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 124 Diseases of vagina and external genital organs . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions. ... ... ... ... ... 1 2 ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 3 3 129 Placenta prævia, flooding ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 2 130 Puerperal thrombosis . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and, ill-defined accidents and diseases of pregnancy and, childbirth ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 3 3 132 Arthritis, ostitis, periostitis . ... l ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... 2 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 68 69 ages. DEATHS IN EACH WARD. sex. Total. causes of death. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hexton. Wen lock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 134 Ulcer, bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Eczema 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 136 Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 137 Other and ill-defined diseases of integumentary system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... By Accident or Negligence. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 138 In mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In vehicular traffic ... ... 9 1 1 1 ... ... 1 2 1 ... ... ... 2 1 2 1 1 1 1 5 4 9 140 On railways ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 On vessels and docks, excluding drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 142 In building operations ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 1 143 By machinery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 144 By weapons and implements ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 145 Burns and scalds 1 6 2 ... ... ... ... 1 ... 1 1 ... ... 1 5 2 1 2 ... 1 ... 4 8 12 146 Poisons, poisonous vapours ... ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 147 Surgical narcosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 Drowning ... ... 1 ... ... ... ... 1 1 ... 2 ... ... ... 2 1 ... 1 ... ... ... 1 1 5 151 Suffocation, overlaid in bed 24 1 ... ... ... ... ... ... ... ... ... ... ... 1 7 2 ... 6 1 3 2 10 15 25 152 Suffocation otherwise 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 153 Falls, not specified 1 ... 1 ... ... ... 1 1 5 2 2 ... ... ... 8 3 3 2 ... ... ... 11 8 19 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 155 Otherwise, and not stated ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... 1 1 2 156 Homicide 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 3 3 Suicides, all forms. 157 By poison ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... 1 1 1 ... ... ... 2 1 3 158 By asphyxia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 159 By hanging and strangulation ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 2 ... ... 1 ... ... ... 3 ... 3 160 By drowning ... ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 161 By shooting ... ... ... ... ... ... l 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 2 51 By cut or stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 163 By precipitation from elevated places ... ... ... ... ... ... l 1 ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... 2 1 3 164 By crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 By other and unspecified methods ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 168 Other ill-defined and not specified causes 4 ... ... ... ... ... ... 2 1 ... 1 ... ... ... 1 1 1 2 ... 2 1 4 4 8 169 Malignant disease ... l 1 2 ... 2 l ... 3 3 1 ... ... ... 3 2 4 2 3 ... ... 8 6 14 170 Cerebro Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 530 257 47 27 30 37 92 l49 214 213 235 135 42 63 399 371 258 376 183 182 176 1065 943 2008 70 71 72 TABLE VI.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1913. DISTRICTS. Estimated population 1913. ANNUAL RATE FER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS DEATHS DURING THE TEARS : DEATHS DURING 1913 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Lough. * Fever. †Diarrhoea. Tuberculous Disease. Violence. 1910. 1911. 1912. 1913. London 4,518,191 24.5 12.7 15.8 13.6 14.2 1.3 ... 0.34 0.04 0.09 0.17 0.02 0.68 1.6 0.5 105 10.3 43.6 0.07 Shoreditch §109,082 31.1 16.8 20.2 18.3 18.4 2.2 ... 0.36 0.02 0.12 0.25 0.00 1.89 2.2 0.8 156 16.0 52.4 ... Wards. Moorfields 4,672 21.4 10.5 14.6 13.5 13.3 0.6 ... 0.21 ... ... 0.21 ... 0.21 1.5 0.4 130 20.6 30.1 ... Church 18,835 32.5 15.9 21.7 20.1 21.1 3.0 ... 0.57 ... 0.05 0.35 ... 2.70 2.2 1.3 196 18.0 66.3 ... Hoxton 16,430 35.0 16.5 19.1 18.5 22.5 3.2 ... 0.54 0.06 0.12 0.36 ... 2.58 2.4 0.9 184 14.2 51.2 ... Wenlock §16,014 28.1 14.6 16.2 19.1 16.1 2.0 ... 0.31 ... 0.18 0.12 ... 1.81 2.3 0.5 127 15.5 52.3 ... Whitmore ‡18,815 31.6 25.0 27.5 22.0 19.9 2.1 ... 0.42 0.05 0.21 0.10 ... 1.96 2.5 0.9 153 14.3 59.8 ... Kingsland 10,736 32.1 18.7 20.1 16.3 17.0 1.4 ... 0.09 ... 0.09 0.18 0.09 1.38 2.3 0.5 153 14.2 49.1 ... Haggerston 11,220 31.2 13.2 18.3 14.5 16.2 1.8 ... 0.17 0.08 0.26 0.35 ... 1.15 2.1 1.0 131 20.8 49.4 ... Acton 12,360 29.4 14.4 19.5 16.1 14.2 1.7 ... 0.24 ... ... 0.32 ... 1.05 1.8 0.5 118 14.7 45.4 ... * Fever includes typhus, typhoid and continued fevers. † Diarrhoea includes Enteritis in children under two years. ‡ The Shoreditch Workhouse is situate in this Ward. In the cases of some of the deaths in outlying institutions, the workhouse is the last known place of residence in the Borough. It is probable therefore that this Ward is credited with some deaths rightly belonging to other Wards in the Borough. § The inhabitants of the Holborn Union Workhouse, which is situate in Wenlock Ward, and the deaths occurring in that institution are excluded. NOTE.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, 0.00 is inserted ; where no deaths have occurred, dots are placed in the space under the heading. 73 TABLE VII. ANALYSIS of the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31st, 1913. Diseases. Diseases. All Causes 4,836 37 Atelectasis ... 38 Congenital malformations ... 39 Old age 160 1 Small-pox ... 40 Apoplexy 8 2 Measles 78 41 Epilepsy 73 3 Scarlet Fever 3 42 Convulsions 5 4 Typhus ... 43 Other diseases of brain and 5 Relapsing fever ... nervous system 279 6 Influenza 81 44 Diseases of organs of special sense 32 7 Whooping Cough 35 8 Diphtheria 4 9 Simple, continued and illdefined fever 16 45 Diseases of circulatory system 180 46 Laryngitis 22 10 Enteric fever ... 11 Simple cholera ... 47 Bronchitis 1,375 12 Diarrhoea, dysentery 101 48 Pneumonia 100 13 Remittent fever ... 49 Pleurisy 19 14 Hydrophobia ... 50 Other respiratory diseases 23 15 Glanders ... 51 Dentition 3 16 Cow pox and Effects of vaccination ... 52 Quinsy, sore throat 28 53 Enteritis 117 17 Venereal affections 54 54 Peritonitis ... 18 Erysipelas 19 55 Diseases of liver 11 19 Pyaemia and septicæmia 4 56 Other diseases of digestive system 305 20 Puerperal fever 1 21 Tabes mesenterica ... 22 Tuberculous meningitis 2 57 Diseases of lymphatic system and ductless glands 23 23 Phthisis 222 24 Scrofula, tuberculosis 23 58 Diseases of urinary system 39 25 Other zymotic diseases 36 26 Thrush ... 59 Diseases of the generative system 26 27 Worms and other parasitic diseases ... 60 Accidents of childbirth 17 61 Diseases of locomotive system 185 28 Starvation, want of breastmilk 1 62 Diseases of integumentary system 167 29 Alcoholism 10 63 Fracture and contusion 38 30 Rheumatic fever and rheumatism of heart 28 64 Gun shot wounds ... 65 Cut, stab 2 31 Rheumatism 345 66 Burns or scalds 4 32 Gout 49 67 Poison 2 33 Rickets ... 68 Drowning ... 34 Cancer 34 1 69 Suffocation ... 35 Other constitutional diseases 31 70 Otherwise 41 36 Premature birth ... 71 Other causes 375 74 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1913. Table VIII. PREMISES: NUMBER, OF PLACES— Number of inspections, 1913. Number of notices, 1913. Number of prosecutions 1913. On register at end of 1912. Added in 1913. Removed in 1913. On registei at end of 1913. Milk premises 291 17 18 290 2997 15 ... Cowsheds 7 ... ... 7 53 2 ... Slaughter-houses 5 ... ... 5 10 ... ... Other offensive trade premises 1 ... ... 1 1 ... ... Ice Cream premises 93 7 ... 98 155 19 ... Registered houses let in lodgings 272 8 ... 280 449 261 ... Number of intimation notices served for all purposes 4366 Overcrowding :— Number of dwelling rooms overcrowded " 298 Number remedied 298 Number of prosecutions Nil. Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 440 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 Nil. Customs and Inland Revenue Acts :— Number of dwellings for which applications were received during year 91 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 362 Total number of infectious bodies removed 1 75 BOROUOH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK DURING THE YEAR 1913. 1.—Inspection Inspection made by Sanitary Inspectors. Premises. N umber of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 858 17 – (Including Factory Laundries.) Workshops 1167 338 – (Including Workshop Laundries and Bakehouses.) Workplaces 684 105 (Excluding Outworkers' premises dealt with in Table 3.) Total 5709 460 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:* Want of cleanliness 229 229 – – Want of ventilation 3 3 – – Overcrowding 6 6 – – Want of drainage of floors – – – Other nuisances 516 516 – – Sanitary accommodation insufficient ... 9 9 – – unsuitable or defective 222 222 – – not separate for sexes 5 5 – Offences under the Factory and Workshop Act: Illegal occupation of underground bakehouse (S. 101) – – – – Breach of special sanitary requirements for bakehouses (Ss. 97 to 100) – – – – Other offences – – – – (Excluding offences relating to outwork which are included in Part 3 of this Report.) Total 990 990 — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 76 3. Home Work. NATURE OF WORK. OUTWORKERS LISTS, SECTION 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises. Sections 109 and 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made. (S. 109.) Prosecutions. (S.109, 110.) Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Con- Worktractors. men. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel: (1) Making, &c. 70 67 1,076 3 ... 37 ... ... ... 53 55 ... 17 ... ... (2) Cleaning & washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 2 ... 6 1 ... 3 ... ... ... 4 4 ... ... ... ... Artificial flowers ... ... ... 2 ... 47 ... ... ... 6 6 ... 3 ... ... Fur pulling 2 ... 8 ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... 5 5 ... 2 ... ... Paper bags and boxes 30 ... 425 ... ... ... ... ... ... 20 20 ... 5 ... ... Brush making ... ... ... ... ... ... ... ... ... 6 6 ... 1 ... ... Total 104 67 1,515 6 ... 87 ... ... ... 94 96 ... 28 ... ... (a) There were no names and addresses of outworkers received in respect to the following classes of work : Sacks, basket making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors and grapnels, cart gear, locks, latches and keys, pea picking, household linen, lace, lace curtains and nets, curtains and furniture hangings, brass and brass articles, tents, feather sorting, and carding, &c., of buttons. (b) The figures in columns 2, 3, and 4 are the total number of lists received from employers who sent them both for February and August, and of the entries of names of outworkers in those lists. They are therefore double the number of employers and approximately double the number of individual outworkers whose names are given, since in the February and August lists of the same employers, the same outworker's name will often be repeated. (c) There were no prosecutions, but lettex-s were sent to employers in 24 instances of failure to send lists of outworkers employed in making wearing apparel, &c., in 20 instances for similar failures in respect to paper bag and box making, in 1 instance in respect to artificial flowers, and 1 in respect to cabinet making. 77 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. 764 (a) Cabinet making 468 (b) French Polishing 81 (c) Upholstery 57 (d) Other workers 158 198 (2) Dress (a) Tailoring 88 (e) Shirt making 11 (b) Mantles 8 (f) Boot & Shoe trades 33 (c) Dress 22 (g) Artificial flowers 6 (d) Millinery 17 (h) Other workers 20 (3) Skin, leather, hair and feather trades 64 (a) Furriers 7 (b) Saddlery & Harness 25 (c) Feathers 3 (d) Other workers 29 (4) Paper, printing, book, stationery and fancy goods trades 61 (a) Box & bag makers 40 (b) Other workers 21 (5) Laundry and Washing 28 (6) Food 1 (7) Metals, machines, implements and conveyances 46 (8) Precious metals, jewels, &c. 2 (9) Other trades than those mentioned above 68 Total number of workshops on Register 1,232 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 67, including 5 factory bakehouses. 5.—Other Matters. Class. Number. (1) (2) Matters notified to II.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s.133) Nil. Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector referring to 24 ( 79 workshops ) & 7 factories. Reports (of action taken) sent to H.M. Inspector. referring to 18 ( 79 workshops ) & 7 factories. Other Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 38 78 6.—Shewing the Numbers of Outworkers Received from other Districts during 1913. DISTRICT. Making Wearing Apparel. Cleaning and Washing. Lace Curtains. Artificial Flowers. Furniture and Upholstery For Pulling. Feather Sorting. Umbrellas, &c. Paper bags and Boxes. Brush Making. Tents. Dolls and Toys. Total. Feb. Aug. Feb. | Aug. | Feb. Aug. | Feb. Aug. | Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Battersea ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Bethnal Green 61 39 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 16 22 29 20 ... ... ... 188 Camberwell 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...7... City of London 422 445 ... ... ... ... ... ... ... 1 11 16 ... 1 41 38 2 2 ... ... ... ... ... 1053 Chelsea 6 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Deptf ord ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Edmonton ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Enfield 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...2 Finsbury 118 81 ... ... ... ... ... 7 7 5 1 9 8 16 3 2 78 84 5 10 ... ... ... ... 439 Hackney 136 139 ... ... ... ... ... ... 15 4 9 3 ... 1 4 4 22 24 29 40 1 ... ... ... 441 Hampstead 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Holborn 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 9 Hornsey 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ilford 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Islington 28 17 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 8 ... ... ... ... ... ... ... 55 Kensington 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Lambeth 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ...... ... 1 1 ... ... ... ... ... ... 4 Lewisham 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Poplar 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 ... ... ... ... ... ... 9 Southwark 2 3 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 St. Marylebone 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 St. Pancras ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 Stepney 25 23 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 50 Stoke Newington 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Walthamstow ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Wandsworth 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Westminster 13 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 West Ham 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Woking 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Total 837 786 1 2 1 ... 55 51 14 17 14 28 8 18 48 44 130 140 64 71 1 ... ... ... 2330 1623 3 1 106 31 42 26 92 270 135 1 79 METROPOLITAN BOROUGH OF SHOREDITCH. INFANTILE MORTALITY. Report of the Medical Officer of Health. To the Chairman and Members of the Health Committee. Gentlemen, In accordance with your instructions I submit for your consideration the subjoined report on the subject of the infantile mortality of the Borough to which in his letters, dated June 4th and 11th, 1913, Dr. Addison, M.P., directs attention and for the amelioration of which he makes suggestions. Infantile mortality means, as Dr. Addison points out, the number of infants dying during a year out of every thousand whose births are registered during that year. For the purposes of this report it will be useful in the first place to present a comparison between the rates at which infants have so died in Shoreditch and London respectively. The Metropolis has been selected for this purpose as affording a fair average for all the London Boroughs. In the following table, therefore, are shown the infantile mortalities for Shoreditch and London from 1870 to 1909 inclusive, averaged for eight quinquennial periods, and also the general death-rates similarly averaged ; the rates for the years 1910-1912 inclusive are also stated:— Period. Shoreditch. London. Infantile General Infantile General Mortality. Death-rate. Mortality. Death-rate. 1870-74 162 24.5 161 22.9 1875-79 154 23.9 155 22.5 1880-84 160 23.8 152 21.2 1885-89 172 23.3 150 19.4 1890-94 175 23.7 154 20.1 1895-99 196 22.6 164 18.7 1900-04 187 20.9 144 17.0 1905-09 153 19.4 119 15.2 1910 147 16.8 103 13.7 1911 170 20.2 129 15.0 1912 128 18.3 91 13.6 During the first two of the periods given there was practically no difference between the infantile mortalities of Shoreditch and London. In connection with this it is worthy of mention that the proportion of well-to-do people in Shoreditch was considerably greater then than at the present time. From the second 80 quinquennial period, however, the mortality for Shoreditch increased, attaining a maximum in the five years ending 1899, and has since been decreasing ; on the other hand, the London infantile mortality decreased until the fourth quinquennial period and then increased, reaching a maximum during the same period as Shoreditch and has since decreased. Notwithstanding the rise and fall in the infantile mortalities, the general death-rates both of Shoreditch and London have steadily declined throughout. The rise observable in both the general death-rates during the five years, 1890-91, was without doubt due to influenza outbreaks. The decline in the general death-rate for Shoreditch—and the same may be said for London in a lesser degree—has been greater since it synchronised with the decline in the infantile mortality. Generally, the figures go to show that the rates for Shoreditch have been subjected to influences common to the whole of the Metropolis, and they indicate a definite improvement in the public health during the past forty years especially during the last twenty years. The improvement, however, is more manifest in the case of the Metropolis, especially when the infantile mortalities for recent years are compared, that for Shoreditch for a number of years past ranging at a considerably higher level than that of London. As helping to throw light upon the reason why such a difference exists between the infantile mortalities of Shoreditch and the Metropolis, a few words about the causes of death amongst infants under the age of one year are necessary. The chief of these causes are: prematurity, debility and wasting, diarrhoea, enteritis and gastritis, pneumonia, bronchitis, whooping cough, measles, tuberculosis and suffocation. Briefly, the premature births of infants depend upon adverse conditions affecting the health of the mothers during pregnancy, such as insufficient nourishment, excesses of any kind, overwork, injury, certain constitutional maladies, and other debilitating influences; debility and wasting mainly result from improper or insufficient feeding or a combination of both, mostly due to want of knowledge or lack of means on the part of those in charge of the infants; suffocation in the great majority of instances results from want of forethought or negligence; the remainder are the results of infections and are predisposed to by any conditions as regards the infants and their surroundings which are prejudicial to health, and of these there are none more important than the want of space which is so frequently met with in the dwellings 'occupied by the poorer working classes. It is to be pointed out that this does not necessarily mean overcrowding such as can be legally dealt with by the Sanitary Authority, but it does imply such close personal contact as to facilitate transference of infection in the event of the introduction of infection within the dwelling. On this, the Committee may be reminded, that the standards as to cubic space which are fixed by the by-laws as to houses occupied by members of more than one family in force in the Borough are 300 cubic feet for each person where a room is used for sleeping only, and 400 in cases where the room is used both for living and sleeping, with half those amounts for children under the ages of ten years. It can hardly be stated that these amounts are generous even for healthy persons; when 81 sickness occurs they become totally inadequate. Fortunately there are hospitals and other institutions for the reception of the sick and these to a considerable extent save the situation. Generally it may be stated that the influences at work affecting the infantile mortality are many, and they are in the main dependent upon circumstances intimately associated not only with the sanitary environment, but also with the social condition and the habits of the people. As having a very important bearing upon, and in fact being a most potent influence in the production of the excessive infantile mortality in Shoreditch comparing it with that of London, it is to be mentioned that Shoreditch has a far larger proportion of the poorest sections of the community amongst its population than London as a whole, which is distinctly greater than it was forty years ago, and there is no reason for believing that this proportion is decreasing, rather the contrary appears to be the case. Moreover, there are in the Borough, as compared with London generally nearly three times as many persons dwelling on each acre. With the exceptions of Bethnal Green and Southwark, which have approximately the same density per acre as Shoreditch, the Borough is the most densily populated district in London. Although during the past thirty years in Shoreditch the density of the population per acre has markedly decreased, there being now over 15,000 fewer persons and 3,621 fewer inhabited houses, none the less there ha3 been a gradual increase in the number of persons in the inhabited houses. According to the figures of the last census this would appear to be at least 15 per cent. greater than in 1881. It may also be noted that the birth-rate for the Borough, although it shows a considerable decline, still remains much above the average for London. This fact may be taken as indicating that in the densely populated area of Shoreditch there is a larger number of infants to be cared for proportionately than is the case with London generally, and without doubt there are less means to do it with. Poverty and its hardships, especially those associated with the congestion of a population on an area, promote the existence of conditions prejudicial to the health of the people generally, and under such conditions infants are as a rule proportionately affected. In these respects Shoreditch is unquestionably heavily handicapped as compared with London as a whole. Whilst what has been stated affords an explanation of the marked difference between the infantile mortalities of Shoreditch and London, it may also be taken as pointing to the necessity of greater activity in Shoreditch and an amount of work above the average for the Metropolis being required for the Borough if its infantile mortality is to be reduced to something approaching that for London. Such a reduction is within the bounds of possibility provided the necessary efforts are made. With reference to this it will be noticed, on turning to the table of mortality rates, that the infantile mortality markedly decreased between 1899 and 1909, the decrease, in fact, for Shoreditch amounting to 22 per cent., for London to 27 per cent., and the averages for the three years 1910-12 show further decreases. Now, during these (174) f 82 periods there have been in Shoreditch marked decreases in the numbers of infants dying from prematurity, debility at birth, wasting and the effects of injudicious feeding, also from bronchitis and from suffocation in bed in a lesser degree. These causes of death are amongst those likely to be first affected as the results of increase of knowledge as to the care of infants. These decreases have taken place during a period when there has been an increasing amount of attention given to the subject of infantile mortality, and is not unreasonable to assume that to some extent they are directly or indirectly attributable to it. In this connection, without including that of a general practitioner, mention may be made of the large amount of work done for the infants of Shoreditch by the Queen's Hospital for Children, and other similar institutions in the Metropolis, by the Mission in Harman Street and the Babies' Home in Brunswick Place, also during the past three years by the Council's Health Visitors. This must have been the means of spreading both directly and indirectly knowledge as to the care and management of infants, and it is suggested that it has materially assisted in the reduction of the infantile mortality of the Borough to which attention has been directed. The decrease of the number of infants suffocated in bed also may be specially noted as an indication of more thought and less neglect ; and on the whole the outlook is encouraging, and it may reasonably be expected that with increased activity and proper co-ordination of the work there is every likelihood of a still more marked reduction in the infantile mortality of the Borough. Upon this, Dr. Addision may be quoted; his suggestion is "a methodical campaign covering the whole of the "Borough in which the aid of voluntary workers and associations is enlisted "and brought into orderly relationship, in which the arrangements are facilitated "for the supplies of suitable milk and for the necessary assistance and advice "being available for nursing mothers and for infants who stand in need of it." He believes that "such a campaign can only be carried on with efficiency and full "success with the co-operation, direction, and supervision of the Medical Officer "of Health and the Sanitary Authorities." He further suggests "a determined "campaign to improve the housing conditions of the people, to provide increased " sanitary conveniences, and to abate the evils arising from overcrowding." In commenting upon the above suggestions, I may remind your Committee that the question of the adequacy of the sanitary staff for the needs of the Borough came under your consideration in May, 1912, and was carefully gone into at that time, and upon your recommendation the Council increased the staff by two sanitary inspectors, a health visitor, and a clerk, and in December, 1912, the additional staff commenced work. The sanitary staff of the Borough was thereby increased in strength by approximately 43 per cent. It need hardly be pointed out that it is much too early to say anything as to the effect of this addition beyond stating that the amount both of sanitary inspection and health visiting has been greatly increased. The increase in the number of health visitors has enabled the Committee to take certain steps which may be regarded as being in the right direction towards the proper co-ordination of the work : the Borough has been divided into two districts for the purpose of health visiting, namely, 83 Hoxton and Haggerston, and two weighing centres for infants have within the past three months been established, one at the Town Hall for Hoxton and the other at the Haggerston Baths for Haggerston. The meetings at present held weekly at each centre are being well attended. Mothers bring their babies to be weighed when the Health Visitors give such instructions as may appear necessary as regards feeding, clothing and the general care of infants, and there is every reason for believing that the gatherings will, as time goes on, result in most useful work in the campaign for the reduction of the infantile mortality of the Borough. It may be added that the assistance of properly qualified voluntary workers at these centres would undoubtedly be most useful and would be welcomed. With reference to the services of Voluntary Workers and Associations, this is a question, which it may be remembered, received a good deal of attention at the hands of the Health Committee back in 1911, in connection with a communication from the Shoreditch Public Welfare Association advocating the adoption of a system of voluntary health visiting with a view to assisting the Council's Health Visitor in her work. After reviewing the manner in which such systems were working in other Boroughs and considering a report from the Town Clerk expressing the opinion that the Council would be liable for the acts and defaults of voluntary workers appointed by the Council, the Health Committee had an interview with a representative of the Public Welfare Association at which it was pointed out that while they were in accord with the principle of voluntary health work, the Committee were not inclined to take any steps likely to place them in the position of incurring the liability to which the Town Clerk had directed attention. It was, however, agreed that if the Public Welfare Association would send in the names of two persons willing to take up the work and possessed of the requisite qualifications, it would be considered what arrangements might be come to in the matter. Subsequently towards the end of the year the Health Visitor had the assistance of a lady who gave three full days to the work each week for a period of three months, and at the end of 1912 another lady also gave her services for three days for a period of six months. Both were fully qualified in accordance with the requirements of the Health Visitors (London) Order, 1909, and gave their services voluntarily and it may be added they both did some most excellent work. It is a point to be emphasized that if the Sanitary Authority or its officers identify themselves with any system of Voluntary Health Visiting, due regard must be paid to the qualifications of those who offer their services for the work. Not only should Voluntary Workers be duly qualified under the Order mentioned, but they should be otherwise fitted for the work. Besides technical knowledge, to do good work in health visiting, patience, judgment, tact, and kindliness are requisite qualifications, and without them it is quite easy to do much harm in health visiting. Subject to the wishes of the Borough Council, as Medical Office of Health I shall be glad to render every assistance in my power in bringing into orderly relationship the aid of suitably qualified voluntary workers and associations in the campaign against the excessive infantile mortality of the Borough. (174) F 2 84 As pointed out by Dr. Addison, there exists a need for some arrangement to facilitate a wholesome supply of milk for the food of infants who have to be brought up by hand. In a very large number of cases the want of means of the parents stands in the way. Doubtless in many instances they would be able to afford part of the cost, but not the whole. There is, at present no statutory power enabling the Borough Council to help out of the rates. It might, however, be managed if a fund were raised for the purpose, the suggestion being an arrangement with some of the milk vendors in the Borough having premises conveniently situated for the purpose to supply applicants with milk at a reduced price on the production of vouchers duly authenticated for the purpose, the difference to make up the market price of the milk being defrayed out of the fund mentioned. With reference to the suggestion as to improving the housing conditions of the people, the increase in the staff of Sanitary Inspectors has since December last been the means of enabling a far larger amount of work than before being carried out with this object, and this will become manifest in due course when the same is recorded at the end of the current year. There has been a marked increase in the amount of house to house inspection, each inspector now being able to give special attention to such streets and courts as appear to require it. It may also be added that the increase in the sanitary staff is enabling much more work being done for abating the evils arising from overcrowding, and it may reasonably be assumed that as time goes on this increase will not be without its effect in helping to reduce the infantile mortality of the Borough. As regards the sanitary conveniences in the Borough to which Dr. Addison directs attention, there are, according to information received from the Engineer in charge of them, some thirty-five, of which five are specially constructed below the surface of the ground. The latter are fitted with lavatory accommodation and provide conveniences for both men and women. Your Committee may be reminded that for six months free accommodation was provided for both sexes at the underground conveniences, and at the meeting of the Council on July 1st it was decided to continue to do so, the results so far being reported on satisfactorily. It is also to be mentioned that there are in addition five urinals attached to public houses accessible from the street which have been enlarged and are now lighted and maintained by the Council, being to all intents and purposes public urinals. While it may be possible that increased accommodation would be beneficial in the neighbourhood of some of the public houses, still, taken as a whole, the Borough may be sta.ed to be fairly well supplied with public sanitary conveniences, I am, Gentlemen, Your obedient Servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. 85 METROPOLITAN BOROUGH OF SHOREDITCH. MILK AND CREAM REGULATIONS, 1912. Report for the year ended 31st December, 1913. 1. Milk, and Cream not sold as Preserved Cream. — (A) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 498 Nil. Cream 2 . Nil. 2. Cream sold as Preserved Gream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i) Correct statements made 3 (ii) Statements incorrect — 3 (b) Determinations made of milk fat in cream sold as preserved cream. (i) Above 35 per cent. 3 (ii) Below 35 per cent. — 3 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (1) and the proviso in Article V. (2) of the Regulations have not been observed. Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. Nil. 3. Thickening substances. No evidence of their addition to cream or to preserved cream was found. 4. Other observations. It is to be noted that cream, whether preserved or not, is difficult to procure in Shoreditch. But few shops stock it, there being very little demand for it. It has to be ordered at most of the dairies. The two samples of cream taken were obtained, one at the Aerated Bread Company's, and the other at an Express Dairy Company's depot, to be used for fruit ordered at the same time. LEWIS T. FRASER BRYETT, Medical Officer of Health. 86 TUBERCULOSIS DISPENSARY. Report for 1913 by Lytton Maitland, M.D. Lond., D.P.H. Camb. Royal Hospital for Diseases of the Chest, City Road, E. January 1914. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, Since October 1912, there has been instituted at the Royal Hospital for the Diseases of the Chest, City Road, situated within the Borough of Shoreditch, a department for the prevention of consumption. This department has been developed so as to fulfil as far as possible the objects comprised within the sphere of work of a Tuberculosis Dispensary. Of the patients attending the department a large majority was resident in Shoreditch, and as the result of negotiations it was decided that this department should form the basis of the Shoreditch Tuberculosis Dispensary. It has, therefore, been arranged that the medical officer in charge of the department and the visiting sister shall act in close co-operation with the Medical Officer of Health in regard to cases under the care of the dispensary and that they shall be officers of the Local Authority, acting under the instructions of the Medical Officer of Health, in accordance with the provisions of Articles XI. and XII. of the Public Health (Tuberculosis) Regulations 1912 of the Local Government Board. This section requires such enquiries to be made and such steps to be taken "as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable to infection." As regards the clinical side of the work of the dispensary, the Medical Officer, working as he does, in the hospital buildings has the advantage of ready access, not only to members of the staff for consultation in difficult cases, but also to the X-ray department for very helpful assistance in diagnosis, and to the dental department for a highly important side of the treatment of tuberculosis. These advantages are only some of those which the intimate association with a hospital gives to a Tuberculosis Dispensary held in such an institution. The objects of an anti-tuberculosis dispensary, as it should preferably be called, are by this time fairly recognised. Foremost should be placed the recognition of the disease in its earliest stages, when it has far and away the best prospect of being cured or rendered inactive either permanently or for a long period. To this end potential patients must be encouraged to seek advice and submit to examination at the dispensary; and all those living in close association with tuberculous persons should be overhauled and classed as " contacts." 87 A dispensary should further work by bringing skilled influence to bear on the home conditions in the direction of hygienic and dietetic improvement; both for the direct benefit of the actual sufferer, and for the better protection of the contacts. Here the importance of having a properly trained visiting nurse is obvious. She must have knowledge of the social difficulties of the district and tactful resource in advancing the claims of hygiene. An acquaintance with the various charitable agencies working in the district is a necessary part of her equipment and she should be able to fill an important place on the committee of an After-care association. Under present conditions a certain amount of the medical treatment is rather an important function of the dispensary, at any rate in the eyes of the patients, but it is hoped that in the course of time more strictly hygienic methods may be adopted on a larger scale. It is to be deplored that the structural limitations of so many of the homes renders anything approaching "sanatorium" conditions exceedingly difficult to arrange short of sending the patients away. Beds at the disposal of the Borough at sanatoria or hospitals are badly needed, and the provision of open-air schools under the auspices of the London County Council will be a measure of the greatest assistance to tuberculosis dispensaries. It is desirable that an After-Care Committee should be formed in Shoreditch to assist patients after their discharge from a sanatorium and to co-operate with the several charitable organisations in dealing with the more promising cases. The Dispensary at the Royal Hospital for Diseases of the Chest, City Road, is at present open for the attendance of patients on four afternoons a week, and also on Monday and Thursday evenings, at 8 p.m., for the convenience of those who are at work during the day and who can ill afford to lose the time which an afternoon visit entails. These two nights are usually busy ones, so that the evening attendance seems to meet a definite need. During the past year "contacts" have been examined at the hospital and not at the homes of the patients. This plan has certain definite advantages, though it may not always be conducive to the accumulation of large figures. It should be noted that contacts are not examined of those cases sent by medical practitioners for an opinion only and not for treatment. Contacts are kept under observation and examined again and again at intervals and their records carefully filed ; in this way the earliest manifestations of the disease will be detected. The official arrangements with the Borough Council regarding the work of the Dispensary in relation to Shoreditch cases is to take effect from April 1st, 1913, but in submitting a statistical report it will be found convenient to give the figures relating to the whole of the year 1913. New cases 413 Total attendances 2,948 Visits paid to homes 1,205 88 The cases reached the Dispensary through the following channels:— Sent through the Town Hall (Health Visitors, &c.) 62 Transferred from Royal Hospital for Diseases of the Chest 64 Sent by medical practitioners 52 Sent through school doctors, &c. 60 Brought up as " contacts " 155 By the London Insurance Committee 1 Sent through other agencies 19 Total 413 Work done in Special Departments. Examinations by the X-rays 57 Treatments in Dental Department 40 Specimens examined in Bacteriological Department 247 The new cases, classified according to the diagnosis, give the following figures:— 107 pulmonary tuberculosis = about 25 per cent. 170 suspected to be tuberculous = „ 42 „ 67 per cent. 136 not tuberculous or suffering — from other diseases ,, 33 „ 113 The deaths numbered 14. The attendances each month were as follows Month. New Cases. Attendances. January 46 226 February 39 219 March 28 234 April 31 256 May 30 242 June 36 269 July 53 280 August 22 237 September 31 247 October 26 256 November 32 241 December 39 241 413 2,948 89 Completer analyses of the records will be available in the future, as the material has been carefully filed, and the full history, progress, condition of home, with a record of every attendance of each patient is preserved in a card index system. Several of the Dispensary patients were admitted for a few weeks to the wards of the Hospital. It will be a great advantage now that the Dispensary can claim the reservation of a few beds in the Hospital for the use of Dispensary patients. Many cases urgently require complete rest in bed for a limited period owing to a febrile condition, and it is sometimes possible to draft patients to one of the Sanatoria in connection with which the Hospital works, if such persons could be passed through this channel. I am, Yours faithfully, LYTTON MAITLAND, M.D, (Lond.), D.P.H. (Gamb.). Metropolitan Borough of Shoreditch. REPORTS on the WORK OF HEALTH VISITING During the Year ending 31st December, 1913, IN THE BOROUGH OF SHOREDITCH, BY Ethel J. Charlesworth, Health Visitor, Hoxton, Certificates of the San. Insp. Exam. Board, London; Central Midwivcs Board; National Health Society, &c. AND Maude E. Jacocks, Health Visitor, Haggerston, Certificates of Derbyshire Royal Infirmary; Queen Charlotte's Hospital; Central Midwives Board ; Queen Victoria's Jubilee Institute and Royal Sanitary Institute. 92 REPORT OF THE HEALTH VISITOR, HOXTON. Town Hall, Shoreditch, June, 1914. To the Medical Officer of Health. Sir, I have much pleasure in submitting the following report on the work of Health Visiting in the Hoxton Division of the Borough during the year 1913. Part of my time has been spent in visiting various people resident in Shoreditch, and the rest in the clerical work which the visiting involves. The total number of (1) visits paid; (2) attendances of parents at the Town Hall; (3) interviews in connection with the above amounts to 2,781. This total is composed of the numbers given in the following division of the work done :— I. Work in connection with the notification of Births Act. (a.) Visits and revisits to homes 1,400 Visits 706 Revisits 696 (b.) Attendances of parents at the Town Hall, consequent on these visits 322 II. Work in connection with the prevalence of Epidemic Diarrhcea during the summer. (a.) Special visits to infants 6 (b.) Enquiries into deaths of infants 24 III. Work in connection with notifications of Puerperal Septicœmia. Visits and revisits to patients 4 One being a revisit. 93 IV. Work in connection with notifications of Ophthalmia neonatorum. Visits and revisits to patients 14 being revisited. 28 V. Work in connection with notifications of Tuberculosis. (a.) Visits and revisits to patients 504 Visits 240 Revisits 264 (b.) Enquiries into deaths from tuberculosis 9 VI. Miscellaneous work arising out of the above. (a.) Miscellaneous visits 74 (b.) Interviews with various people concerned in the work 71 VII. Futile visits, i.e., to those who were absent, removed, or for some other cause could not be found 339 Total number 2,781 I. Notifications of Births. As in previous years this branch of the work has occupied the principal part of my time ; the most noteworthy event in this connection has been the establishment of a weekly instruction class held at the Town Hall. It has been apparent from the first that although home visiting is of paramount importance and cannot be replaced, it can be very usefully supplemented by giving those visited an opportunity of assembling to learn some things, which can then be taught more conveniently and effectively than in the home. Since April of this year, I have, when visiting for the first time, invited each mother to come and see me at the Town Hall on Wednesday afternoon each week, and bring the baby to be weighed, that she may have some idea of the progress made. Mothers are encouraged to bring even healthy breast-fed babies regularly, though not necessarily frequently, in order that any sign of deterioration may be discovered, and medical advice obtained, before any further harm results. Wednesday was chosen as the day since it was then possible for me to have the use of a room at the Town Hall, but it is not the most convenient day for those who come. Some are unable to come on account of the day, others have very young children besides the baby, who can neither be left alone nor brought ; the majority gladly accept the invitation, and a certain number of these have attended. 94 The following table gives particulars as to the attendances : — No. attending. Total No. of attendances. No. of days open. Average attendance A tendance on one day. Attendance of individuals. On day. Of individual. Maximum. Minimum. Maximum. Minimum. 93 322 34 9.14 3.44 17 2(1) 17(2) 1(3) (1) The minimum attendance was on the opening day, when only two had been asked to come. (2) Two others attended 15 times each ; these and many others, who came once only in 1913, still continue to come (1914). (3) Twenty-seven came once only, and for various reasons have not attended since ; some from clean homes apparently disliked to sit uncomfortably close to others not so scrupulous as to personal cleanliness, and close quarters were at that time unavoidable. The infants brought ranged from healthy breast-fed babies, who made excellent progress, to the bottle-fed baby of poor physique, whose condition improved very slowly and uncertainly. Those whose babies did. not increase in weight, or were found to have other unsatisfactory symptoms were advised to consult a doctor. These were also visited in their own homes to ascertain whether some defect in the mixing or storage of food, &c. was the cause of the trouble. When brought to the Town Hall, the baby is undressed, weighed and examined and its condition commented on. Whilst being dressed, the mother is shown how to handle the baby properly, how to dress it with the least expenditure of her own time, and the least inconvenience to the baby ; a lesson much needed by all but a few, but quickly learnt by the unprejudiced. One of the advantages of having the weekly class has been the opportunity afforded of teaching better methods of clothing of infants. Many babies are at one and the same time, both overdressed and insufficently clad; they wear several layers of garments, but the materials afford no real warmth, and the shape gives no protection to those parts of the body which most require to be clothed. This is to a great extent the direct result of poverty, bat it is also its indirect result. Very few mothers in this Borough have the means to obtain leisure to keep pace with the times, and to learn for themselves that garments once thought suitable are now discarded in favour of more rational and not more expensive fashions. To point out defects in clothing when visiting a home is often undesirable, and more often useless; to show suitable clothing to those who come to seek advice is a superior method and much more effectual. Patterns of suitable clothes are placed at the disposal of those attending, and many have used them ; one woman who having only one child, had less calls on her purse, and more leisure than some others, gradually made an entirely new set of clothes for the baby, which was then most satisfactorily dressed, 95 This same woman made the maximum number of attendances for any one person; the baby was delicate and despite devoted care, made no progress for some weeks. Owing to the kindness of Miss Tucker, Secretary of the East London Friendly Workers' Association, the mother and baby had a fortnight's holiday by the sea and were greatly benefited thereby; the child has since made good progress. This is but one instance of the practical sympathy shown by the Association to mothers and babies requiring change of air or nourishment at home; and I am greatly indebted to them for their assistance. Shoreditch Public Welfare Association.— School for Mothers. On and after November 20th, 1913, I have, in accordance with your instructions, handed information concerning the notifications of births occurring in a specified area of Hoxton to Miss Childe, the Superintendent of the Shoreditch School for Mothers, which has recently been established by the Shoreditch Public Welfare Association. From November 20th to December 31st, a list of 138 names and addresses was given; Miss Childe has visited and given a report in each case. Those visited by Miss Childe are asked to attend at the S. John's Church Room in Vestry Street, on Wednesday afternoon each week for further advice, and to have the baby weighed. The number of attendances from November 20th to December 31st was 45. When a notification from this area relates to a family already well known to me, no information is given regarding this birth, the notification being added to those with which I deal myself. II. Epidemic Diarrhcea. Owing to my absence on leave during three weeks in August, a great deal of the work in connection with epidemic diarrhoea in infants resident in Hoxton was kindly undertaken by my colleague, Miss Jacocks. Before and after that date I paid six visits in connection with cases kindly notified me by the Almoner of the Metropolitan Hospital, and also enquired into the circumstances attending the death of 24 infants from epidemic diarrhæa. At three houses no first hand information was obtainable, the parents being always out at work all day. The reported information received is not considered sufficiently reliable for inclusion in the following table relating to the enquiries made. Total. Condition of Home. Method of Feeding. Evidence of Infection. Clean and Fairly Clean. Dirty and Very Dirty. Proper Food Store. Natural. Natural and Artificial. Artificial. Cases in same and Neighbouring House. No Traceable Infection. 21 11 10 None None 9 12 10 11 96 It was particularly regrettable that one of these infants should have died, as it was an only child, living in a good home and very well cared for. Weaning occurred at a time when epidemic diarrhoea was prevalent, and this child became infected; after two days' comparatively slight illness, she grew rapidly worse and died after an illness of four to five days' duration. The mother had attributed the first symptoms of the disease to "teething," and had not taken the child to a doctor until the complaint had made considerable advance. It appeared that if prompter treatment had been given the child's life might have been saved, and at least, would have had a greater chance of recovery. Such a case points out need for further educational work amongst the inexperienced ; also to the need for the provision of proper storage for food in every home. This home, although kept very clean and well ventilated, consisted of one room; there was no accommodation for food, two unventilated cupboards, one on each side of the fireplace, being the only store places that existed. Five of these infants died in Institutions, two of these were admitted suffering from epidemic diarrhoea, three had been admitted some time previously for illness due to other causes. III. Puerperal Septicaemia. Three cases have been certified during the year. One occurred in the practice of a doctor; the patient was removed to the Infirmary and died there a few days later. Two occurred in the practice of the same midwife, but with an interval of 5 months between the two; both, eventually recovered. IV. Ophthalmia Neonatorum. Sixteen cases have been notified. Five of these occurred in the practice of doctors including one in an institution. Eleven of those occurred in the practice of midwives. Two cases were severe, but received regular and constant attention, both being taken to Moorfields Hospital, and one was admitted for a few days. All apparently made satisfactory recoveries, though in some instances where the severity of the disease was not clearly marked at first, recovery was prolonged and slow; possibly because the parents treated it with less regularity than when alarmed by more obviously serious symptoms. One of these children died at eight weeks of erysipelas. V. Tuberculosis. A considerable portion of my time has been spent in visiting women and children notified as suffering from some form of tuberculosis, especially in the early part of the year, when several notifications were received each week, owing to the terms of a new Order, which required all forms of tuberculosis to be notified. 97 Unless the patients were regularly seeking advice from a medical man, or had for some time regularly attended one hospital, it has been my custom during this year to advise them to attend the Dispensary for Tuberculosis, attached to the Royal Hospital for Diseases of the Chest, City Road. A large number have very gladly availed themselves of this opportunity, and I have, therefore, in accordance with your instructions ceased to visit them, the officers of the Dispensary undertaking all the home-visiting that is required. Two hundred and forty notifications sent related to those previously not known to me. Of these:— a. One hundred and eight referred to adult women ; b. One hundred and thirty-two referred to children up to fourteen years and girls from fourteen to sixteen years. a. Fifty-six adult women were insured persons. Twenty-two of these have, to my knowledge, been to State sanatoria for treatment; the majority remaining there for three months. It is difficult to say until a longer time has elapsed whether or not this treatment will permanently benefit these patients. Of the insured who applied for sanatorium benefit, three were refused. One has since been admitted to a private institution belonging to a religious order; the others remain at home, apparently in much the same condition as before. Three patients have made arrangements for admission to sanatoria independently of State Insurance; two of these were not insured. b. Of those under sixteen years— Twenty have to my knowledge, been admitted to sanatoria or convalescent homes ; eleven of these entered the Infirmary, and were sent on from there, nine were dealt with by the Invalid Children's Aid Association and other societies interested in social welfare. Fifty four were suffering from some form of tuberculosis other than phthisis, and several of these patients were found, on enquiry, to have been afflicted for a long while, sometimes for years, and to have already had longer or shorter periods of treatment as in-patients of hospitals or convalescent homes; often the parents and even the patients had come to accept the maimed or crippled condition as an unalterable state of affairs. In such cases, where the patient was already occupying a separate bed, there was little that could be done beyond informing the parents of the infectious nature of the disease, and the possibility of its appearance in the same or any form in other members of the same family. In that event it is to be hoped that the warning given will induce parents to seek prompt and early treatment. (174) G 98 VI. Miscellaneous Visits and Interviews. These include visits to homes for various purposes, other than those given in the foregoing classifications; also interviews with people indirectly connected with the work, such as almoners of Hospital, and secretaries of various agencies for social service. I have to express my thanks to all those who have thus assisted me during the year. I am Yours faithfully, ETHEL J. CHARLESWORTH, Health Visitor. 99 REPORT OF THE HEALTH VISITOR, HAGGERSTON. Town Hall, Shoreditch, E.C. To the Medical Officer of Health. January, 1914. Sir, I beg to submit the following Report on the work of Health Visiting in the Haggerston Division during the year 1913. The total number of visits paid, attendances of parents at Haggerston Baths and interviews was 3,952, distributed as follows :— 1. Visits in connection with the Notification of Births Act :— First visits 1,435 Re-visits 722 2,157 2. Meetings at Weighing Centre 34 3. Parents' Attendances at Weighing Centre 520 4. Visits in connection with Notifications of Ophthalmia Neonatorum:— First visits 16 Re-visits 29 45 5. Visits in connection with cases of Summer Diarrhæa 35 Enquiries into deaths from Summer Diarrhcea 31 66 6. Enquiries into cases of Puerperal Septicaemia:— First visits 5 Re-visits 3 8 7. Visits in connection with Notifications of Tuberculosis:— First visits 218 Re-visits 249 467 8. Enquiries into deaths from Phthisis 15 9. Miscellaneous visits 80 10. Futile visits 466 11. Interviews held with various people in connection with the work 94 12. Letters written 78 Notification of Births Act. This work has been more satisfactorily followed up since the opening, on April 10th, of the Weekly Weighing Centre and Class for Mothers at the Haggerston Baths, 100 Less difficulty has been experienced in keeping in touch with the delicate and wasting babies which have attended on the weighing days. 170 babies were brought, and there were 520 attendances. The average number attending each week was 15. Advice is given to the mothers at the Class on feeding and clothing of infants, also instructions for knitting garments, and paper patterns are distributed as required. Efforts to improve the clothing have been made in many cases, and more would be done were it not for want of means to buy new material. At the end of the year I held a Clothing Competition at which the babies were to be dressed entirely in wool or flannel made of old or new material. There were 13 entries, and all were so good that a prize was given to each. These were provided by friends. There is great need of a source from which mothers may obtain milk, when it is evident that from lack of means their babies are not maintaining a satisfactory standard of weight. Observation goes to prove that not so much the ignorance of the mother as lack of funds to provide necessary food before and after the child's birth is the chief contributory cause of Infantile Mortality. Ophthalmia Neonatorum. All the 16 certified cases recovered satisfactorily, and none had to be removed. Puerperal Septicemia. Five cases were certified Four of these were attended by doctors, removed to hospitals, and two died. The fifth was a slight case attended by a midwife. It made a quick recovery. Summer Diarrhcea. Some of these cases were sent in by the almoners of various hospitals, and others were found when visiting. From May onwards the leaflets provided by the Health Department on the "Prevention of Summer Diarrhoea" were distributed and explained. Also at the Weighing Centre I gave short talks to the mothers on the best means for prevention. Details gained as the result of enquiries into deaths from this disease are as follows:— Condition of Home. Method of Feeding. Evidence of Infection. Total. Clean and fairly clean. Dirty and very dirty. Proper food store. Natural. Natural and Artificial. Artificial. Cases in same house. Cases in neighbour's house. No evidence. 31 21 10 2 8 3 20 12 1 18 101 Defective dustbins and swarms of flies were found in seven of the cases. Lack of well ventilated cupboards for storing food is only too general, and this deficiency contributes largely to the spread of this disease. Milk and other food is generally found in drawers or cupboards close to fireplaces, if not actually exposed to the questionable atmosphere of the general living room. Tuberculosis. Of the 218 cases visited for the first time 116 were under 16 years of age, 34 of the latter being tuberculosis of the lungs, the remaining 82 being tubercular glands, joints, skin, and bowels. Twelve were away in hospital or Convalescent Homes. Many of the notified cases have since attended the Tuberculosis Dispensary at City Road Chest Hospital and are revisited from there. Thirteen cases were sent to Sanatoria by the Insurance Commissioners and six were admitted to various homes. The remainder were treated at home or admitted to the Infirmary. In the majority of the cases it is found impossible for the patients to observe all the requirements necessary to prevent the spread of infection. Separate rooms are seldom possible, and scarcity of bedclothes render the provision even of separate beds very difficult. Most people now recognise the necessity of fresh air, and a closed window is an exception, but when bedding is scarce, one can hardly wonder at windows being closed at night during the winter, a procedure which too often results in the contraction of the disease by other members of the family. Grateful thanks are due to Miss Tucker of the East London Workers' Society for the ready and immediate response to all appeals on behalf of urgent cases, whether in need of food, clothing, change of air or financial help, and also to other social workers who have contributed information and help in various ways. I am, Yours faithfully, MAUDE E. JACOCKS, Health Visitor. (174) h