SHOR 25 REPORT ON THE Health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1914, BY LEWIS T. ERASER BRYETT, M.D. (Lorn), 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 29 Artizans' dwellings 41 Appendicitis, mortality from 9 Bacteriological examinations 31 Bakehouses 19 Births in sub-districts 2 Birth rates 3 Cancer 8 Cerebro-spinal fever 29 Cholera 29 Coffeehouses 50 Cookshops 50 Co-operation between the Civil and Military Sanitary Authorities 44 Cow-houses 45 Customs and Inland Revenue Acts 44 Dairies 46 Deaths in sub-districts 3 Death rate 4 Deaths, ages at 7 Deaths, causes of 6 Deaths in public institutions 9 Deaths in outlying Institutions 10 Demolition of houses 41 Diarrhoea 24 Diphtheria 18 Disinfection 31 Enteric Fever 21 Erysipelas 22 Factories and Workshops Act, 1901 46 Factories, workshops and workplaces—sanitary work 47 Food condemned and destroyed 51 Food and Drugs Act 51 Fried fish shops 50 Glanders 29 Housing and Town Planning Act, 1909 41 Houses closed 38 Houses let in lodgings 44 House to house inspection 37 Hydrophobia 29 Ice cream shops 49 Infantile mortality 6 Infectious cases, number certified 13 Infectious cases, number removed to hospitals 14 Infectious diseases, age periods 12 Infectious diseases, deaths from 11 Infectious diseases, death rate 12 Infectious diseases, isolation 14 Infectious diseases, number of cases notified from schools 29 Influenza 26 Legal proceedings 34 Margarine Act, proceedings under 54 Marriages 3 Measles 24 Milk-shops 45 Milk and Cream Regulations, 1912 56 513—100—D & S.—Sch. 201. " Page. Milk premises, cowsheds, etc., on register 46 Mortuary 31 Notification of Births Act 3 Offensive business 46 Ophthalmia neonatorum 27 Outworkers 48 Polio-myelitis 29 Population 1 Puerperal fever 23 Rag Flock Act, 1911 46 Return cases 15 Sanitary work 32 Scarlet fever 17 Scarlet fever, return cases of 15 Schools, exclusions of children for infectious disease 31 Shelter 31 Sickness amongst the poor 11 Slaughter-houses 45 Small-pox 16 Smoke nuisance 35 Staff 56 Street markets and food 51 Tuberculosis 26 Typhus fever 26 Vaccination 16 Verminous houses 35 Violence, mortality from 9 Water supply 32 Whooping cough 25 Workshops on register 46 Zymotic diseases, deaths from 12 Zymotic death rate 12 APPENDIX. Statistical Tables :— For whole district during 1913 and previous years (Table I.) 59 Oases of Infectious disease notified during 1913 (Table II.) 60 Causes of, and ages at, death during year 1913 (Tables III. and V.) 61, 64 to 71 Infantile mortality during 1913 (Table IV.) 62 Notes to Table III. 63 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 Summary of Tuberculosis Certificates received (Table IX.) 75 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 76 to 79 Milk and Cream Regulations -Report 80 Housing, Town Planning, &c:, Act, 1909, Regulations 81 to 83 Report on tuberculosis dispensary 84 to 88 Report of Health Visitors 89 to 97 Metropolitan Borough of Shoreditch. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. January, 1915. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. Sir and Gentlemen, I have the honour to submit the following Report on the Health and Sanitary Condition of the Borough of Shoreditch during the Year ending December 31st, 1914. POPULATION. The estimated population for 1914 is 109,690, distributed in the Wards of the Borough as set out below : Ward. Population. Ward. Population. Moorfields 4,532 Whitmore 18,816 Church 18,618 Kingsland 10,670 Hoxton 16,214 Haggerston 11.137 Wenlock 17,343 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, 39,364; Shoreditch North-West, comprising Wenlock and Whitmore Wards, 36.159, and Shoreditch North-East, which comprises Kingsland, Haggerston and Acton Wards, 34,167. 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 108,362, whilst the estimated population of the Ward is reduced to 16,015, and that of the Registration Sub-District, Shoreditch North-West, to 34,831. (513) a 2 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 64 Whitmore 76 260 Church 106 175 Kingsland 72 148 Hoxton 78 208 Haggerston 66 169 Wenlock 90 178 Acton 83 149 In estimating the above figures, the area of the Holborn Union Workhouse premises and the population resident thereon and also the area of the Borough covered by water have not been taken into account. BIRTHS. The births registered in the Borough numbered 3,335, of which 1,710 were of males and 1,625 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 3,470, of which 1,764 were of males and 1,706 of females. The distribution of the corrected births in the eight Wards of the Borough is given below:— Ward. Males. Females. Total. Moorfields 44 47 91 Church 311 272 583 Hoxton 282 285 567 Wenlock 254 260 514 Whitmore 330 290 620 Kingsland 196 180 376 Haggerston 163 175 338 Acton • 184 197 381 Totals 1,764 1,706 3,470 Outside the Borough 201 births were registered—89 of males and 112 of females —the parents being residents of Shoreditch. In the Shoreditch Infirmary 100 births were registered, of which 52 were of males and 48 of females. In three of these (females) the parents did not belong to Shoreditch. In the Holborn Union Workhouse there were 70 births, 39 of males and 31 of females. In 63 of these (35 male and 28 female) the parents were not resident in Shoreditch. Of the births registered as occurring in the Shoreditch Infirmary 44 (21 of males and 23 of females) were illegitimate. In the Holborn Workhouse 50 (30 male and 20 female) were illegitimate, and elsewhere in the Borough 25, of which 15 were male and 10 female. 3 The birth-rate was 32.0 per 1,000 inhabitants, as compared with 31.1 in 1913, 32.1 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 1914 was 23.6; for 97 Great Towns, including London, it was 24.9, and for 145 smaller towns it was 23.6 per 1,000 living. The London birth-rate was 24.6 per 1,000 population. NOTIFICATION OF BIRTHS ACT, 1907. The births notified under the above Act daring 1914 numbered 3,183, as compared with 3,018 in 1913, 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 91 as compared with 90 in 1913, 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 190 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 97 per cent, of the number of births registered during the year. MARRIAGES. The marriages in Shoreditch during 1914 numbered 966 as compared with 1,028 in 1913, 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 17.8 per 1,000 population, as compared with 18.8 in 1913, 19.6 in 1912, 18.4 in 1911, 18.0 in 1910, and 16.9 in 1909. The marriage-rate for the Metropolis during 1914 was 19.1 per 1,000 population. DEATHS. The deaths during 1911 numbered 2,101, as compared with 2,008 in 1913, 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. 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 47 30 77 Church 208 148 356 Hoxton 196 159 355 Wenlock 139 151 290 Whitmore 230 203 433 Kingsland 9.8 94 192 Haggerston 99 90 189 Acton 123 86 209 Totals 1,140 961 2,101 (513) A 2 4 The deaths of males were 179 in excess of those of females. The death-rate for the year was 19.4* per 1,000 inhabitants, as compared with 18.4 in 1913, 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, and 20.6 in 1904. The death-rate for 1914 was slightly above the average for the previous ten years. The London death-rate during 1914 was 14.4 per 1,000 population, for England and Wales it was 13.6, for 97 great towns including London 14.9, and for 145 smaller towns it was 12.9 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 Moorflelds, Haggerston, and Acton Wards, and highest in Whitmore. The death-rate for the Borough averaged above the mean rate for the year during January and the first three weeks of February. It was below the mean from the end of February until the end of July. During August it rose and was markedly above the mean in September, falling again below in October. Throughout November and the greater part of December it averaged somewhat below the mean. There was a sharp rise, however, during the last week of the year. The highest weekly rates recorded during the year were those for the first week of January, the third week of September and the last of December, being 29.6, 30.5 and 30.5 per 1,000 population respectively. The lowest rate was 10.0 for the second week of December. The marked rise during September was due to increase in the number of deaths from diarrhoea. The rise during the last week of the year resulted mainly from increase in the number of deaths from diseases of the respiratory organs. The deaths of infants under the age of one year numbered 496, 282 being of males and 214 of females, the deaths amounting to 23.6 per cent. of the total number of deaths at all ages as compared with 26.3 in 1913, 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 1914 was at the rate of 143 per 1,000 births belonging to Shoreditch registered during the year. Amongst males the infantile mortality was 160 whilst amongst females it was 125 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. In Table 1V. (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 * Corrected for age and sex distribution the death-rate was 20'0 per 1,000 population. 5 being given. This table also gives the nett deaths and births daring the year amongst legitimate and illegitimate infants. Comparison with the table for 1913 shows that the decrease in the infantile mortality for 1914 is mainly the result of decreases in the numbers of deaths from atrophy, debility and marasmus, pneumonia, diarrhoea and enteritis. There were increases in the numbers of deaths from measles and whooping cough. In the subjoined table the causes of death amongst infants under one year for each of the eight Wards of the Borough are given:— Cause of Death. Moorfields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals. Small-pox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles . . . 11 4 ... 4 2 1 1 23 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough. 1 4 5 3 4 2 2 1 22 Diphtheria and Croup ... ... 1 ... 1 ... ... ... 2 Erysipelas ... 1 ... ... 1 ... ... ... 2 Tuberculous Meningitis ... 1 2 1 ... ... ... ... 4 Abdominal Tuberculosis ... 2 ... 1 1 1 ... 5 Other Tuberculous Diseases ... 1 1 1 1 1 1 ... 6 Meningitis (not Tuberculous) ... ... ... ... 1 1 1 ... 3 Convulsions 2 ... 1 2 3 1 4 2 15 Laryngitis ... ... ... ... ... ... ... ... 31 Bronchitis ... 5 5 4 13 1 1 2 Pneumonia (all forms) 1 20 12 6 7 4 4 6 60 Diarrhoea 2 16 12 10 23 7 6 6 82 Enteritis 1 3 6 8 7 1 1 4 31 Gastritis ... ... ... ... ... ... ... ... ... Syphilis ... 4 1 1 3 ... 2 ... 11 Rickets ... 1 • * • ... ... ... 1 ... 2 Suffocation, overlying 1 6 7 3 6 ... 4 ... 27 Injury at Birth ... ... ... ... 1 ... ... 1 2 Atelactasis ... 1 ... ... 1 1 1 4 Congenital Malformations ... 2 ... ... ... 3 4 3 12 Premature Birth 1 14 13 ]i 8 10 5 7 69 Atrophy, Debility and Marasmus ... 11 13 5 4 4 3 6 46 Other causes ... 6 3 6 12 5 4 1 37 Totals 9 109 86 62 101 43 46 40 496 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 187, and lowest in Moorfields, where it was only 99 per 1,000 births. The infantile mortality for England and Wales during 1914 was 105 and for London 103. It was somewhat lower than in 1913. Although fluctuating from year to year the infantile mortality has been steadily falling for the past 20 years. Taking the five years ending 1899 it averaged 196, the next five years it was 187, the next 153, whilst during the last five years it has averaged 119. These figures show a decrease over the period mentioned of nearly 24 per cent. The decrease in the infantile mortality for the Metropolis during the same period amounts to about 35 per cent. Attention is to be directed to the work of the Health Visitors which is detailed in their reports (Appendix), and it is hardly necessary to emphasize its importance in connection with the efforts for the reduction of the infantile mortality of the Borough. The weighing centres which began working last year have been well attended during the year under consideration. It may be mentioned that the accommodation at the Town Hall being required for other purposes it was necessary for the meetings of the centre presided over by Miss Charlesworth to be transferred to the Pitfield Street Baths, where a room was kindly provided by the Baths Committee. In August a communication was received from the Local Government Board, stating that an estimate had been laid before Parliament for a grant to be distributed by the Board in aid of the expenditure of local authorities and voluntary agencies making arrangements for maternity and child welfare in the direction of clinics, dispensaries and other measures primarily concerned with the provision of medicine and surgical advice and treatment. It was pointed out that up to the present, Local Authorities in their infant welfare work had concerned themselves more especially with the child in its first year of life. The matter, however, was one to be dealt with on a more comprehensive basis, and extension of the existing work was needed on the one hand for securing improved conditions before and at the time of birth, and on the other for continuing the work in relation to children beyond the first year of life. A memorandum was also forwarded by the Board with a view to assisting the formulation of schemes or extending the work already undertaken, from which it appears that the objects of a maternity and child welfare centre are briefly as follows:— (1) To advise expectant mothers on matters affecting their condition at the centre or at their homes when uecessary, and to arrange for complicated cases of pregnancy receiving proper hospital treatment. 7 (2) To secure the necessary assistance so as to ensure the mother having skilled and prompt attendance during confinement at home, or in complicated cases at a hospital. (3) To arrange for the treatment in hospital of complications arising after parturition, whether in mother or infant; to give systematic advice and treatment for infants at a baby clinic or infant dispensary and to watch over the child's health up to the age it attends school; to ensure the systematic home visitation of infants and of children not on the school register. The subject of the Board's communication was at the end of the year receiving the careful attention of the Health Committee. The deaths of children aged from 1 to 5 years numbered 332, of which 83 were attributed to measles, 29 to whooping cough, 12 to diphtheria, 44 to diarrhoea and enteritis, 35 to various forms of tuberculosis, 15 to bronchitis, .71 to pneumonia, and 12 to various forms of violence. Altogether 822 or 39.1 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 38.6 for 1913. Of children aged from 5 to 15 years there were 100 deaths. The chief causes were tuberculosis which accounted for 21, other infectious diseases which resulted in 22, and violence which accounted for 19, G of which were due to street accidents. Of persons aged between 15 and 25 years there died 66, of whom 24 perished from consumption. Of persons aged from 25 to 35 years there died 103, the chief causes being consumption, which accounted for 44, diseases of the circulatory organs for 10, and pneumonia, which resulted in 11 deaths. Two deaths were due to Bright's disease, and 6 to violence, 1 of which were suicidal and 1 homicidal. Of persons aged between 35 and 45 years there were 152 deaths, of which 60 resulted from consumption, 11 from cancer, 11 from diseases of the nervous system, 3 of which were due to general paralysis of the insane, 11 from diseases of the heart and circulatory organs, 13 from pneumonia, 7 from diseases of the digestive organs, 5 from Bright's disease, and 9 from violence, including 3 the result of suicidal acts. The deaths of persons aged from 45 to 55 years numbered 226, of which 43 were due to consumption, 29 to cancer, 33 to [diseases of the nervous system, 8 including 18 attributed to apoplexy, and 7 to general paralysis of the insane, 27 to diseases of the heart and circulatory organs, 19 to bronchitis, 21 to pneumonia, 7 to cirrhosis of the liver, 9 to Bright's disease, and' 8 to violence, including 2 the result of suicide. Of 245 deaths amongst persons aged from 55 to 65 years, 33 were attributed to consumption, 27 to cancer, 3 to old age, 24 to apoplexy, 2 to general paralysis of the insane, 36 to diseases of the heart and circulatory organs, 28 to bronchitis, 18 to pneumonia, 10 to cirrhosis of the liver, 16 to Bright's disease, and 13 to violence, of which 3 were the results of suicide. Of 218 deaths amongst persons aged from 65 to 75 years, 12 were the results of consumption, 19 of cancer, 9 of old age, 23 of apoplexy, 44 of diseases of the heart and circulatory organs, 33 of bronchitis, 21 pneumonia, 15 Bright's disease, and 8 of violence, including 1 of suicide. Of 129 persons who died aged from 75 to 85 years, in 3 instances death was attributed to cancer, in 44 to old age, in 12 to apoplexy, in 13 to diseases of the heart and circulatory organs, 24 to bronchitis, in 5 to Bright's disease, and 6 to violence, including 1 case of suicide. Of the persons who died aged 85 years and upwards, 1 died from cancer, 20 from old age, 1 from apoplexy, 1 from paralysis, 1 from disease of the circulatory organs, 5 from bronchitis, 3 from pneumonia, and 2 from the results of falls. The chief causes of death during the year were : tuberculosis which caused 304 including 229 attributed to phthisis or consumption, pneumonia which caused 235, bronchitis 158, diarrhoea and enteritis 172, diseases of the heart and circulatory system 170, measles 107, cancer 91, apoplexy 85, old age 76, prematurity 69, Bright's disease and acute nephritis 56, whooping cough 55, atrophy debility and marasmus 48, alcoholism and cirrhosis of the liver 38, and various forms of violence which caused 119 deaths. Of the 91 deaths attributed to cancer, 47 were of males and 44 of females. 12 were of persons under 45 years and 4 of persons over 75 years. In addition there were 14 deaths certified as due to malignant disease or sarcoma. Some of those attributed to malignant disease were doubtless the result of cancer. The death-rate from cancer was 0.84 per 1,000 population as compared with 0.59 in 1913, 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, 0.64 in 1894 and 0.54 in 1893. The rate for 1914 is therefore the highest so far recorded for the borough. 9 Of the deaths from alcoholism and cirrhosis of the liver 14 were of males and 24 of females. The deaths attributed to appendicitis numbered 2 as compared with 6 in 1913, 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 1914, 1 was of a male and 1 of a female. The deaths from peritonitis numbered 2, both of males. Taking the deaths from appendicitis and peritonitis together they were markedly below the average for the past 10 years. Of the deaths from violence 78 were of males and 41 of females. Through accident or negligence 106 persons lost their lives. In l5 instances street accidents in connection with vehicular traffic were the cause of death ; in 13 of these the persons killed were males. In 7 instances death resulted from burns and scalds; 4 of these were of females. In 7 instances drowning was the cause of death. The number of infants who lost their lives through being suffocated in bed was 27, as compared with 25 in 1913, 26 in 1912, and 22 in 1911. There were 2 cases of homicide, and 11 men committed suicide. DEATHS IN PUBLIC INSTITUTIONS. The number and distribution of the deaths of persons belonging and not belonging to the Borough in the public institutions situate in Shoreditch are as set out in the subjoined table:— Institution. Persons belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Union Workhouse 7 241 248 Shoreditch Workhouse 629 40 669 Royal Chest Hospital 12 44 56 Convent Hospital 3 — 3 Home of Good Shepherd 4 — 4 Babies' Home, Brunswick Place 4 1 5 Totals 659 326 985 The wards at the home of the Good Shepherd were closed during the year for the reception of infants, and the Babies' Home, Brunswick Place, ceased to exist. Elsewhere than in public institutions, 11 persons not belonging to Shoreditch died within the Borough. 10 In the subjoined table are set forth the various institutions outside Shoreditch with the numbers of persons belonging to the Borough dying therein:— Asylums. No. of Deaths. General Hospitals— continued. No. of Deaths. Banstead 7 St. Andrew's Hospital, Northampton 1 Cane Hill 1 Caterham 1 St. Bartholomew's 70 City of London 1 St. George's 1 Claybury 22 The Chelmsford Hospital 1 Colney Hatch 10 University College 2 Darenth 1 Vincent Square (Infants) 2 Dartford Heath 5 West Ham Hospital 1 Horton 4 St. Catherine Hospital, Hanwell 3 Ramsgate 1 Leavesden 9 Long Grove 5 Special Hospitals. 1 Manor 1 Borough Mental, Leicester 1 North Riding 1 Chest Hospital, Bethnal Tooting Bee 5 Green 5 City of London Lying-in 8 Hospitals for Infectious Diseases New Hospital for Women 1 Queen Mary's Hospital 2 Eastern 6 Orthopedic Hospital 1 Joyce Green 2 Salvation Army Mothers' Hospital 1 North Eastern 11 North Western 4 Infirmaries and Northern 2 houses. Park 1 Belmont Workhouse 10 South Eastern 4 Bethnal Green Infirmary Bromley Union Infirmary 8 1 General Hospitals. Hackney Infirmary 10 Cambridge Hospital, Al- Holborn Infirmary 5 dershot 1 Islington do. 1 Charing Cross 2 Lambeth do. 2 Cottage Hospital, Sutton 1 Marylebone do. 1 Evelina (Children) 1 Freidenheim 3 Other Institutions. German 9 Bethnal House 1 Gt. Ormond Street (Children) 12 Brixton Prison 1 Carnarvon Prison 1 Guy's 2 Hostel of God 1 London 16 St. Joseph's Hospice 3 Metropolitan 69 St. Luke's House 1 Middlesex 3 St. Peter's House 2 Mildmay 6 Eastcliff House, Margate 1 Military Hospital, Falmouth 1 Downs Sanatorium 2 Kelling do. 1 Prince of Wales 2 Millfield House, Rustington 1 Queen's (Children) 65 Catherine Gladstone Convalescent Home, Mitcham 1 Royal Portsmouth Hospital, Landport 1 Of 452 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 273 died in general hospitals, 76 in asylums, 30 in fever 11 hospitals, 38 in workhouses and infirmaries, 19 in hospitals for special diseases, and 16 in other institutions. Elsewhere than in public institutions 31 persons belonging to Shoreditch died beyond the limits of the Borough. Twelve of these were being conveyed to hospitals. Altogether 1,111 or 52.8 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 iu Hoxton Street during 1914 numbered 5,190 as compared with 4,836 in 1913, 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 998 as compared with 679 in 1913, 991 in 1912, 921 in 1911, 923 in 1910,945 in 1909,707 in 1908, and 763 in 1907. As compared with the figures for 1913 there were marked increases in the numbers of cases of consumption, measles and whooping cough. The cases of diarrhoea are unaltered in number. Diseases of the respiratory organs, which are also in the main to be regarded as infectious, numbered 1,462 cases as compared with 1,539 in 1913, 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 1914, bronchitis caused 1,303 and 93 were due to pneumonia. Rheumatism was given as the diagnosis in 378 cases as compared with 345 in 1913, 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 only 21 as compared with 28 in 1913, 28 in 1912, 53 in 1911, 53 in 1910, 47 in 1909 and 32 in 1908. Cases diagnosed as gout numbered 91 as compared with 49 iu 1913, 57 in 1912, 95 in 1911, 100 in 1910 and 104 in 1909. Dyspepsia and other disorders of the digestive system accounted for 510 as compared with 464 in 1913, 463 in 1912, 546 in 1911 and 688 in 1910. The cases diagnosed as cancer numbered 21 as compared with 34 in 1913, 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 153 cases, chiefly of ulcerated legs, as compared with 185 in 1913, 247 in 1912, 240 in 1911 and 263 in 1910, and diseases of the skin for 177 as compared with 167 in 1913, 148 in 1912, 163 in 1911 and 236 in 1910. INFECTIOUS DISEASES. The infectious diseases included under the headings numbered 1 to 35 and 171 in Table Y. (Appendix), resulted in 701 deaths as compared with 562 in 1913, 589 in 1912, 673 in 1911, 511 in 1910, 676 in 1909, 622 in 1908, 747 in 1907, 776 in 1906, 12 717 in 1905, 791 in 1904, 762 in 1903, 767 in 1902 and 762 in 1901. The number was above the average for the previous 10 years. The deaths from these diseases amounted to 33.3 per cent. of the total number of deaths from all causes as compared with 27.9 in 1913, 29.0 in 1912, 30.2 in 1911, 26*7 in 1910, 30.8 in 1909, and 30.7 in 1908. As compared with the figures for 1913, the mortality from consumption, measles, and whooping cough shews a marked increase. The deaths from consumption and the other forms of tuberculosis amounted to 44.3 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 deathrate from these infectious diseases was 6.4 per 1,000 inhabitants as compared with 5.1 in 1913, 5.3 in 1912, 6.1 in 1911, 4.5 in 1910, 5.9 in 1909, 5.4 in 1908, 6.5 in 1907, 6.7 in 1906, 6.2 in 1905, 6.8 in 1904, and 6.5 in 1903. It was somewhat above the average for previous years. In the subjoined table the deaths from the infectious diseases referred tc 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 169 204 28 15 20 16 56 70 51 46 21 5 ... 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, 45 per cent, resulted from the infectious diseases referred to as compared with 39 in 1913, 40 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, measles, whooping cough, diarrhoea, diphtheria, and tuberculosis caused most of the deaths. The chief cause of the mortality from infectious diseases amongst persons aged 20 years and upwards was consumption. The deaths from the principal zymotic diseases—namely, small pox, measles, scarlet fever, diphtheria, including membranous croup, whooping cough, enteric fever and diarrhoea*—numbered 315 as compared with 245 in 1913, 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 2.9 per 1,000 population as compared with 2.2 in 1913, 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, 3.1 in 1900, 3.6 in 1899, 4.1 in 1898, 4.2 in 1897, 4.3 in 1896, 3.8 in .1895, 2.8 in 1894 and 4.7 in 1893. The zymotic death-rate, although considerably higher than for last year, was none the less below the average for the years given above. A * Not including enteritis in children under 2 years. 13 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 Church Ward and lowest in Acton, being 4.0 and 0.9 per 1,000 population respectively. Excluding the 3 cases of cerebro-spinal fever, 1 of acute anterior poliomyelitis, 25 of ophthalmia neonatorum, 1 case of anthrax, and the cases of tuberculosis, 874 cases of infectious disease were notified, an increase of 178 on the figure for 1913. 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 1914 874 7.9 The cases of notifiable infectious disease certified in the Metropolis during 1914 numbered some 40,500, excluding cases certified as anthrax, glanders, pulmonary tuberculosis, ophthalmia neonatorum, measles, cerebro-spinal fever, and acute poliomyelitis. The attack-rate was 8.9 per 1,000 inhabitants as compared with 6.7 in 1913, 5.2 in 1912, 5.3 in 1911 and 4.4 in 1910. The attack-rate for Shoreditch therefore was markedly lower than that of the Metropolis during 1914. 14 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 76 77 94 182 429 5 Diphtheria and Membranous Croup 46 43 55 73 217 20 Typhus Fever ... ... ... ... ... ... Cholera ... ... ... ... ... ... Enteric Fever (Typhoid) 3 ... 7 9 19 2 Continued Fever ... ... ... 1 1 ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever 3 3 2 3 11 2 Erysipelas 52 47 38 60 197 8 Plague ... ... ... ... ... ... Cerebro-Spinal Fever ... 1 1 1 3 2 Glanders ... ... ... ... ... ... Anthrax 1 ... ... ... 1 ... Hydrophobia ... ... ... ... ... ... Acute Anterior Poliomyelitis ... ... ... 1 1 ... Ophthalmia Neonatorum 1 10 5 9 25 ... Totals 182 181 202 339 904 39 Numbers and percent ages of cases removed to hospitals. 143 133 176 271 723 ... 78.6% 73.4% 87.1% 79.9% 79.9% ... As compared with the figures for 1913, scarlet fever, diphtheria, and erysipelas shew marked increases. Although the cases of notifiable infectious disease were more numerous than for last year, none the less they were below the average for the past twenty-five years. The deaths from the principal zymotic diseases which are notifiable, namely, small pox, scarlet fever, diphtheria and enteric fever were at the rate of 0.24 per 1,000 population, whereas the rate for the principal zymotic diseases which are not notifiable, namely measles, whooping cough and diarrhoea was 2.6 or more than ten times as great. ISOLATION OF INFECTIOUS CASES. Cases of smallpox, scarlet fever, and diphtheria removed to hospital, are with very few exceptions, taken to the hospitals of the Metropolitan Asylums Board. Cases of enteric fever, puerperal fever, and erysipelas not infrequently go into the 15 Shoreditch Infirmary or into general hospitals in the neighbourhood. Cases of measles, whooping cough and puerperal fever, the patients not being paupers, as well as Poor Law cases, may be admitted into the hospitals of the Metropolitan Asylums Board under the Orders made by the Local Government Hoard in 1911 and 1912. The notifiable infectious diseases, cases of which are now receivable into the hospitals of the Board, are smallpox, 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 680, and the number removed to hospital (not necessarily to hospitals of the Metropolitan Asylums Board) was 661, which gives a percentage of 97.2 as compared with 95.5 in 1913, 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. During October and November prompt removal of cases of scarlet fever and diphtheria to the hospitals of the Metropolitan Asylums Board could not in many cases be obtained. This appears to have been due to the accommodation at the disposal of the Board becoming restricted, owing to the increasing numbers of cases which had to be coped with. It became necessary, therefore, to send to the Board daily lists of the cases requiring removal. Those most urgent were attended to first, and all were eventually removed. Some, however, had to wait several days, and the departure from the customary practice was severely felt in the Borough. Moreover, it was not unattended by considerable risk of extension of the diseases in a densely populated poor locality like Shoreditch, and possibly was not without some effect in this respect. RETURN CASES. Two instances came under observation in which scarlet fever followed on the return from hospital of patients who had been suffering from that disease:— Alice M-. aged 12, was in hospital from July 10th to August 20th, on which date she returned home. James M-, aged 5, of the same address, was taken ill on August 29th, and certified on 31st. The mother stated that she noticed that Alice's feet were peeling on her return from hospital. Lily G-, aged 10, after being in hospital for 44 days, returned home on October 9th. It is stated that there was some peeling of the feet, but otherwise there was nothing to comment on. Charlotte G-, aged 20, cf the same address, was taken ill on October 13th and certified on 16th. Isabella C-, aged 11, a playmate of Lily G-, resident in the same street, was in her company on October 12th ; she fell ill on October 15th, and was certified on 19th. Arthur S-, aged 7½, also a playmate, resident in an adjoining street, was taken ill on October 16th, and was certified on the 19th. 16 One instance of a return case of diphtheria was noted:—John T-, aged 4, returned from hospital after 62 days therein, on February 17th ; William T-, aged 2½, of the same address, was taken ill on March 1st, and certified on March 3rd. SMALLPOX. There were no cases of smallpox in Shoreditch during the year, and only about 3 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 1913-14, and relate to the year 1912. Of the births registered during that year, in 34.0 per cent. vaccination was successfully performed and 35.0 per cent. were not finally accounted for, the latter figure including postponed cases. Altogether 55.8 per cent. of the children whose births were registered in 1912 were unvaccinated at the end of the year. The last figure includes those exempted by conscientious objection certificates, which numbered 710 or 20'6 per cent. of the births registered as compared with 13.1 in 1911, 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 1912 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 1912 35.0 20.9 9.2 17 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 for 1912 show a further and a marked decrease in the amount of vaccination in the Borough, as compared with those for the previous year. SCARLET FEVER. The cases certified during 1914 numbered 429 as compared with 340 in 1913, 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 15, or 3.5 per cent. of cases certified, intimations were received from the Metropolitan Asylums Board that the patients had not been suffering from the disease. Corrected for errors in diagnosis, the cases during the year numbered 414 as compared with 332 in 1913, 150 in 1912, 212 in 1911, 181 in 1910, 321 in 1909, 573 in 1908, 822 in 1907, 5y9 in 1906, 776 in 1905, 326 in 1904, and 237 in 1903. The distribution of the cases certified, and the deaths amongst males and females 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 27 37 64 ... ... ... Hoxton 28 41 69 ... ... ... Wenloek 37 40 77 1 ... 1 Whitmore 39 30 69 ... ... ... Kingsland 21 25 46 ... ... ... Haggerston 20 26 46 1 2 3 Acton 21 25 46 1 ... 1 Totals for Borough 199 230 429 3 2 5 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified 422 or 98 per cent. were removed to hospital as compared with 97.6 in 1913, 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 3.8 per 1,000 inhabitants as compared with 3.0 in 1913, 1.3 in 1912, 2.1 in 1911, 1.8 in 1910, 2.9 in 1909, 5.1 in 1908, (513) B 18 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 Wenlock Ward and lowest in Moorfields, being 4.4 in the former as compared with 2.6 per 1,000 population in the latter. The deaths numbered 5 as compared with 3 in 1913, 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 0'04 per 1,000 population as compared with 0.02 in 1913, 0.03 in 1912, 0.06 in 1911, 0.03 in 1910, 0.06 in 1909, 0.24 in 190S, 0.24 in 1907, 0.17 in 1906, 0.23 in 1905 and 0.ll in 1904. There were no deaths from scarlet fever during the year in Moorfields, Church, Hoxton, Whitmore and Kingsland Wards. The case mortality was at the rate of 11 per cent. of the cases certified as compared with 0.8 in 1913, 2.6 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 1903,33 in 1902, 3.5 in 1901 and 5.4 in 1900. The case mortality and the death-rate were therefore below the average. Amongst children under 5 years there were 113 cases with 3 deaths, the case mortality (allowing for errors in diagnosis) being 2.7 per cent. as compared with 1.1 in 1913, 5 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 1901, 2.7 in 1903, 5.3 in 1902, 6.8 in 1901, and 12 in 1900. Amongst persons over 5 years there were 316 cases with 2 deaths. The case mortality was therefore 0.6 per cent. (allowing for errors in diagnosis) as compared with 0.8 in 1913, 1.1 in 1912, 1.6 in 1910, 1.9 in 1909, 2.2 in 1908,1.2 in 1907,1.3 in 1906, l.0 in 1905, l.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 25,093, the attack-rate being 5.5 per 1,000 inhabitants as compared with 3.8 in 1913, 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 316, the death-rate being 0.07 per 1,000 as compared with 0.04 in 1913, 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 217 as compared with 181 in 1913, 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 9 of these cases were other than diphtheria. 19 The numbers of cases and the deaths amongst males and females in the Borough and its eight wards are given in the subjoined table:— Ward. DIPHTHERIA (Including Membranous Croup). Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 1 4 5 ... 1 1 Church 23 20 43 2 2 4 Hoxton 16 18 34 4 3 7 Wenlock 11 10 21 ... 2 2 Whitmore 10 20 30 ... 1 1 Kingsland 21 9 30 1 1 2 Haggerston 20 13 33 ... 3 3 Acton 10 11 21 ... ... ... Totals for Borough 112 105 217 7 13 20 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified, approximately 95 per cent. were removed to hospital as compared with 95 per cent. in 1913, 95 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 1.9 per 1,000 inhabitants as compared with 1.6 in 1913, 1.2 in 1912, 1.5 in 1911. 1.1 in 1910, 15 in 1909 and 1.7 in 1908. The attack-rate was highest in Haggerston Ward and lowest in Moorfields, being 2.9 per 1,000 in the former and 1.1 in the latter ward. The deaths numbered 20, the death-rate being 0.18 per 1,000 as compared with 0.12 in 1913, 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 Hoxton Ward where it was 0.43 per 1,000 population. There were no deaths from diphtheria during the year in Acton Ward. The case mortality was 9.2 per cent. of the cases certified as compared with 7.7 in 1913, 13.1 in 1912, 12.7 in 1911, 11.0 in 1910, 115 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 1914, 14 were of children under 5 years of age, the mortality being at the rate of 13'3 per cent. of the cases certified amongst children at that age period (13.8 allowing for errors in diagnosis) as compared with 15.4 in 1913, 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, (513) b 2 20 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 5 deaths of children aged from 5 to 10 years and one death in a child over 10 years but under 15. The mortality amongst children over 5 years of age was at the rate of 5.3 per cent. of the cases certified, or, allowing for errors in diagnosis, 5.6 per cent. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 207 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 7 14 From 1 to 2 years 12 4 16 „ 2„ 3 „ 15 14 29 „ 3 „ 4 „ 16 9 25 „ 4 „ 5 „ 11 6 17 „ 5 „ 10 „ 32 28 60 „ 10„13 „ 6 13 19 Over 13 years 7 20 27 Totals 106 101 207 In 93 of the cases the patients were children attending school and in 72 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 92 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 36 instances the histories showed that there had been cases of "sore throat" amongst the inmates of the houses in which the patients resided. In 45 instances there was evidence pointing to infection from previous cases in the Borough. In 149 instances the houses were occupied by members of more than one family, in 35 by single families, and in 23 instances the cases occurred in artisan's dwellings of the block type. With regard to the sanitary condition of the dwellings, in 138 this was satisfactory, in 31 fairly so, and in 38 it was unsatisfactory, but these figures must not be taken as an indication that a satisfactory sanitary condition is favourable to the occurrence of diphtheria in houses. The cases certified as diphtheria in London numbered 9,172 as compared with 7,654 in 1913, 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 2.0, 1.7, 1.5, 1.6, 1.1, 1.4, 1.6 and 1.8 per 1,000 population for the 8 years respectively. The deaths from the disease in the Metropolis numbered 706 as compared with 431 in 1913,452 in 1912, 612 in 1911, 434 in 1910, 605 in 1909 and 724 in 1908, the death-rate for the seven years respectively being 0.16, 0.09, 0.10, 0.11, 0.09, 0.12 and 0.15 per 1,000 population. 21 ENTERIC OR TYPHOID FEVER. The cases certified numbered 19 of which one was subsequently not regarded as enteric fever at the hospital to which it was removed, and in the case of another there were good grounds also for not regarding it as one of enteric fever. A verdict of death from typhoid fever was returned at an inquest on September 8th in the case of a man aged 31 who was taken ill on September 2nd and died about three days later. This case was not certified. One case was certified as continued fever ; this proved not to be a case of enteric fever. The numbers of cases certified yearly since 1889 are set out in the following table:— Year. Number of Cases. Year. Number of Cases. 1890 202 1903 101 1891 111 1904 48 1892 91 1905 36 1893 111 1906 39 1894 85 1907 34 1895 99 1908 101 1896 114 1909 49 1897 107 1910 49 1898 91 1911 22 1899 171 1912 14 1900 122 1913 15 1901 96 1914 19 1902 149 Attention may be again directed to the small number of cases during the year. Although more numerous than in 1913 they were none the less over 50 per cent. below the average for the previous ten years. The cases were certified at the rate of somewhat less than 0.2 per 1,000 population as compared with 0.1 in 1913, 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 were two deaths during the year, including the one the cause of which was determined by the inquest mentioned above, the rate being 0.01 per 1,000 inhabitants as compared with 0.00 in 1913, 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 10.5 per cent. of the cases certified (11.7 per cent. deducting the cases not regarded as having been enteric fever) as compared with 6.6 in 1913, 28.5 in 1912, 4.5 in 1911 and 16 in 1910. The case mortality for the 20 years ending 1913 averaged 13.2 per cent. of the cases certified. 22 The distribution of the cases certified and deaths amongst males and females in the Borough and its eight Wards during 1914 are shown in the subjoined table:— Wards. ENTERIC FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields ... ... ... ... ... ... Church 1 2 3 ... 1 1 Hoxton 4 4 ... ... ... Wenlock 2 1 3 ... ... ... Whitmore 2 1 3 ... ... ... Kingsland 2 2 1 ... 1 Haggerston 3 3 ... ... ... Acton ... 1 1 ... ... ... Totals for Borough 14 5 19 1 1 2 The cases are grouped according to ages in Table II. (Appendix). With one exception they were removed to hospital for treatment. None of the cases appeared to be connected and nothing definite was ascertained as to the source of infection in any of them. In three or four instances it is probable that the patients were infected without the Borough. Oysters had been consumed in two instances and fried fish in several. In one case the patient was a carpenter who had been engaged on putting up wooden huts for troops on Salisbury Plain, and there is little doubt that he contracted the disease whilst working there. In another the patient had been hopping near Maidstone and seems to have obtained water for drinking purposes from streams in the neighbourhood where he was employed. The cases certified in the Metropolis numbered 793 as compared with 758 in 1913, 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. The attack-rate per 1,000 population was the same as that for Shoreditch. The deaths numbered 117 as compared with 111 in 1913, 117 in 1912, 141 in 191J, 196 in 1910, 146 in 1909 and 225 in 1908. The death-rate for 1914 was 0'03 per 1,000 inhabitants. ERYSIPELAS. The cases certified to be erysipelas numbered 197 as compared with 151 in 1913, 149 in 1912, 159 in 1911, 127 in 1910, 143 in 1909, 124 in 1908, 133 in 190/ and 144 in 1906. 23 The deaths numbered 8 as compared with 9 in 1913, 6 in 1912, 4 in 1911, 1 in 1910, 16 in 1909, 5 in 1908, 6 in 1907 and 2 in 1906. The figures for previous years are contained in the reports for 1913 and 1908. The attack-rate per 1,000 inhabitants was markedly above the average for recent 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 3 ... 3 1 ... 1 Church 17 25 42 ... 1 1 Hoxton 5 14 19 1 1 2 Wenlock 12 15 27 1 1 2 Whitmore 21 27 48 ... 1 1 Kingsland 7 11 18 ... ... ... Haggerston 8 13 21 ... 1 1 Acton 9 10 19 ... ... ... Totals for Borough 82 115 197 3 5 8 The death-rate was 0-07 per 1,000 inhabitants, as compared with 0'08 in 1913, 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 4-0 per cent, of the cases certified, as compared with 5.9 in 1913, 4 in 1912, 2.5 in 1911, 0.00 in 1910, 11.2 in 1909, 4 in 1908, 4.5 in 1907, 1.3 in 1906, 2.1 in 1905, 2.6 in 1904, 4.7 in 1903, 4.6 in 1902, 4.2 in 1901 and 5.8 in 1900. It may be mentioned that an undertaker was fined 20s., with 12s. 6d. costs, for retaining in a workshop for more than 48 hours the body of a person dead of erysipelas. Pyaemia and septicaemia (blood-poisoning) were given as the cause of 18 deaths, 12 of males and 6 of females. Infective endocarditis caused the deaths of 2 males. PUERPERAL FEVER. Eleven cases were certiGed with 2 deaths. The cases were at the rate of 3.1 per 1,000 births, as compared with 2.6 in 1913, 2.2 in 1912, 1.4 in 1911, 2.2 in 1910, 3.5 in 1909, 1.3 in 1908, 0.8 in 1907, 1.5 in 1906, 2.2 in 1905, 1.3 in 1904, 1.7 in 1903, 2.2 in 1902, 1.7 in 1901 and 2.5 in 1900. They were therefore above the average for recent years. 24 The deaths were at the rate of 0.6 per 1,000 births, as compared with 1.2 in 1913, 1.1 in 1012, 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 1963, 0.7 in 1902 and 0.2 in 1901. The mortality was at the rate of 18 per cent. of the cases notified during the year. DIARRHOEA. The deaths numbered 126, and there were besides 46 attributed to enteritis. The numbers of deaths from diarrhoea in previous years were 159 in 1913, 40 in 1912, 162 in 1911, 66 in 1910, 79 in 1909, 112 in 1908, and 74 in 1907. The deaths were therefore again 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, 82 were of infants under one year, 35 of children aged from one to five years, 2 of children aged from five to ten years, and the others were of persons aged thirty-five and upwards. Of the deaths from enteritis 31 were of infants under one year, 0 of children aged from one to five years, 1 of a child aged between five and ten years and the rest were of persons over fifty-five years. The diarrhoea death-rate was, excluding deaths from enteritis, 1.16 per 1,000 population as compared with 1.4 in 1913, 0.37 in 1912, 1.47 in 1911, 0.58 in 1910 0.69 in 1909, 0.82 in 1908, 0.64 in 1907 and 1.68 in 1906. Taking the deaths from diarrhoea and including those from enteritis amongst children under two years together numbering 163 the mortality was at the rate of 1.50 per 1,000 population as compared with 1.89 for 1913, 0.85 for 1912 and 2.1 for 1911. The deaths from diarrhoea amongst infants under one year were at the rate of 23.6 per 1,000 births registered during the year as compared with 39.2 in 1913, 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. The deaths from diarrhoea including enteritis in children under two years of age in the Metropolis numbered 3,031 as compared with 3,098 for 1013, giving a death-rate of 0.67 as compared with 0.68 for 1913. MEASLES. The deaths from measles numbered 107 as compared with 40 in 1913, 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 more numerous than in 1013, and the number of cases reported through the school authorities was also markedly increased, so there is no doubt that the disease was much more prevalent than in 1013. The deaths registered were distributed during the year as follows: 1 in March, 7 in May, 15 in June, 23 in July, 27 in August, 12 in September, 7 in October, 9 in November and 5 in December. All the deaths were of children under 10 years of age; 23 died aged under one year, 83 aged between one 25 and five years, and one over five years. The measles death-rate was 0.98 per 1,000 population as compared with 0.36 in 1913, 1.14 in 1912, 1.13 in 1911, 0.70 in 1910, 1.10 in 1909, 0.44 in 1908, 0.99 in 1907, 0.64 in 1906, 0.52 in 1905, 0.69 in 1901, and 0-85 in 1903. The rate was highest in Church Ward and lowest in Acton, being 1.88 per 1,000 inhabitants in the former as compared with 0.24 in the latter ward. The number of instances in which houses were brought to the notice of the Health Department as having measles therein was 745, as compared With 251 in 1913, 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. lrrom the inquiries made, in 100 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 721. Eleven cases were notified from other sources. Intimations were received from the Metropolitan Asylums Board as to the removal of 14 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; 443 rooms were sprayed, and the usual steps were taken as to bedding and textile articles. Altogether some 313 beds, 178 mattresses, 461 pillows, 134 bolsters, and 1,896 other articles were removed for disinfection at the disinfecting station. In 16 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 Shoreditch to deal with it as far as practicable on the same lines as with other dangerous infectious diseases. The deaths from measles in London numbered 1,385, as compared with 1,570 in 1913, 1,799 in 1912, 2,570 in 1911, 1,980 in 1910 and 2,321 in 1909, the deathrate being 0.31, as compared with 0.34 in 1913, 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 55, 26 of males and 29 of females. Of these 22 were of infants aged under 1 year, 29 of children aged between 1 and 5 years, and 4 of children aged from 5 to 10 years. Deaths were most numerous during April, May, June, July, August and September. The whooping cough death-rate was 0.50 per 1,000 population, as compared with 0.25 in 1913, 0.38 in 1912, 0.29 in 1911, 0.39 in 1910 and 0.64 in 1909. The rate was highest in Moorfields and lowest in Acton being 0.88 in the former and 0.16 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 26 not paupers who are reasonably believed to be suffering from whooping cougb, 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 191-4. Some 49 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 918, the death-rate being 020 per 1,000 population. INFLUENZA. The deaths attributed to influenza numbered 25, as compared with 22 in 1913, 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 624 as compared with 863 in 1913,537 in 1912, 496 in 1911, 723 in 1910, 1,231 in 1909, 1,334 in 1.908, 967 in 1907, 895 in 1906, 664 in 1905, 707 in 1904, 664 in 1903, 1,036 in 1902, 664 in 1901 and 1,950 in 1900. The deaths were most numerous during the months of January, February, and December. No deaths were registered in Shoreditch during the months of August and September. TYPHUS FEVER. No cases were certified during the year. TUBERCULOSIS. Tuberculosis (Appendix,Table V., Nos. 29 to 34 inclusive) was given as the cause of 304 deaths as compared with 248 in 1913, 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, though greater than usual for recent years, was slightly below the average for the previous 14 years. The deaths from tuberculosis amounted to 14.4 per cent. of the total number of deaths from all causes, as compared with 11.8 in 1913, 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 2.8 per 1,000 population, as compared with 2.2 in 1913, 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 Hoxton, where it was 3.5, and lowest in Wenlock Ward, where it amounted to 1.9 per 1,000 inhabitants. The deaths from tuberculosis of the lungs or consumption numbered 229 as compared with 185 in 1913, 217 in 1912, 183 in 1911, 169 in 1910, 194 in 1909, 224 in 1908, 232 in 1907 and 233 in 1906. The great majority of the deaths were amongst persons aged from 25 to 65 years. There were 150 deaths amongst males as compared with 79 amongst females. The consumption death-rate was 2.1 per 1,000 population as compared with 1.7 for 1913, 1.9 for 1912, 1.7 for 1911, 1.4 for 27 1910 and 1.7 for 1909. It was therefore higher than usual. The rate was highest in Hoxton and lowest in Wenlock Ward, being 2.9 per 1,000 for the former and 1.3 for the latter. The deaths from tuberculosis in London numbered 7,740, giving a death-rate of 1.7 per 1,000 population. The deaths attributed to consumption numbered 6,281, the death-rate being 1.39 per 1,000 as compared with 1.30 in 1913 and 1.34 in 1912. A summary of the notification received under the Public Health (Tuberculosis) Regulations, 1912, is given in Table IX. (Appendix). The distribution of the cases according to age periods and localities is shown in Table II. (Appendix). The cases certified were most numerous in proportion to the population in Whitmore Ward, where they amounted to 7.9 per 1,000 for tuberculosis of the lungs, and 2.3 for other forms of tuberculosis. They were least in Haggerston and Acton Wards, where the cases of tuberculosis of the lungs were at the rate of 2.7 and other forms of tuberculosis 0'8 per 1,000 population. Where the patients are not inmates of public institutions in the Borough, and also where they are not attending the tuberculosis dispensary, the addresses stated on the certificates are visited by the Sanitary Inspectors in the case of male adults, and by the Health Visitors in the case of women and children. In all cases steps are taken with a view to getting proper treatment for the patient, preventing the spread of infection, and securing such measures for the disinfection of dwellings and the removal of insanitary conditions as may appear needful. Where necessary, cases are referred to the Tuberculosis Dispensary. During the year inquiries were made respecting some 364 of the cases of pulmonary tuberculosis certified. In 197 of these the patients were males and 167 females. Generally their occupations did not differ materially from those given in previous reports. The cases of non-pulmonary tuberculosis visited numbered 84 of which 42 were in males and 42 females. The school children affected with tuberculosis—pulmonary and non-pulmonary—numbered 59, of which 32 were boys and 27 girls. In inspecting the dwellings of tuberculous patients, attention is especially directed to the amount of cubic space available for the patient, particularly for sleeping, the means provided for securing efficient ventilation, the amount of light, the presence of dampness, and general conditions as regards cleanliness. As the result of the inspections in cases of pulmonary tuberculosis, in 179 instances the dwellings may be described as satisfactory or fairly so; and in 185 they were unsatisfactory; in the cases of non-pulmonary tuberculosis, 26 of the dwellings were satisfactory and 58 unsatisfactory. In 63 instances of pulmonary tuberculosis there were family histories of the disease, and in 61 there was more or less evidence pointing to infection from previous cases either in the patients home or place where they worked. With respect to non-pulmonary tuberculosis there were family histories in 22, and more or less evidence of infection in 8. 28 Disinfection was carried out by the Sanitary Authority in connection with 218 rooms at 160 premises and the usual steps were taken as regards textile articles exposed to infection therein, some 1,723 articles including 147 beds, 124 mattresses, 212 pillows and 76 bolsters being disinfected by the sanitary authority. According to the reports received from the Insurance Committee for the County of London, some 79 insured persons from Shoreditch, 58 males and 21 females, were sent to sanatoria or hospitals and discharged therefrom during the year. The periods spent by the patients in the institutions varied from a few.days to over seven months, the usual length of time being from two to three months. With regard to the males 34 seem to have more or less improved, and 15 do not appear to have derived any benefit. In 9 instances no information was obtained. As regards the females 14 were improved, and 6 seemed much the same when they returned as they were before admission. In one instance no information was obtained, and 1 case does not seem to have been phthisis. The males sent to Sanatoria mostly went to Downs, the females to Winchmore Hill. The accommodation for consumptives at the Shoreditch Infirmary was largely used during the year, mainly by advanced cases. About 44 per cent, of the deaths from phthisis in the Borough occurred at this institution. Upwards of 60 per cent, of the persons belonging to Shoreditch who perished from consumption died in public institutions within or without the Borough. Particulars as to the work of the tuberculosis dispensary at the Royal Hospital for Diseases of the Chest in the City Road are contained in the Report of the tuberculosis officer, which is appended (page 84). Owing to illness, Dr. Lytton Maitland was absent during the latter part of the year. His place was ably filled by Dr. A. J. McFarland, who rendered valuable services during his absence. Much useful work was accomplished, and marked progress was made during the year. Some 588 new cases attended the dispensary as compared with 417 in 1913, whilst the attendances numbered 3,806 as compared with 2,948 for last year. The home visits numbered 2,720 or more than double that of 1913. These visits are made by the tuberculosis officer and the dispensary nurse with a view to ascertaining the hygienic conditions of the homes and their surroundings, for the discovery of contact cases, and for advice and instruction as to the precautionary measures to be taken for the prevention of the disease. Insanitary conditions in the homes of the patients are reported to the Health Department to be dealt with. OPHTHALMIA NEONATORUM. Some 38 certificates were received relating to 25 cases. Under the Public Health (Ophthalmia Neonatorum) Regulations, 1914, which came into operation on April 1st, it is now the duty of certified midwives to notify cases of ophthalmia neonatorum. Nine of the certificates were signed by midwives. The cases notified in previous years were 32 in 1913, 17 in 1912, and 32 in 1911. With the exception of 4 in the Shoreditch Infirmary, the cases were inquired into by the 29 Health Visitors and are referred to in their reports (Appendix, pp. 92, 96). Some 57 visits were made in connection with them. Sixteen of the cases visited were mild or of moderate severity, the other 5 were severe, and were removed to hospital for treatment. Three seem to have each lost the sight of one eye, the other two recovered completely. The cases certified were at the rate of 7*2 per 1,000 births as compared with 9-4 in 1913, 4'8 in 1912, and 9'1 in 1911. The cases certified in the Metropolis during the year numbered 8^0, being at the rate of 8*1 per 1,000 births. EPIDEMIC CEREBRO-SPINAL MENINGITIS. Three cases were certified with two deaths. All were removed to hospital. In two of the cases the meningococcus of cerebro-spinal fever seems to have been present in the cerebro-spinal fluid. There were also 20 deaths attributed to meningitis, of which 7 were of children under five years. The casos certified in the metropolis numbered 74 with 24 deaths, and there were some 393 deaths attributed to simple meningitis. ACUTE POLIOMYELITIS. One case was certified in a little girl aged two years, who was taken into the infirmary. The usual inquiries were made, and precautions taken as to disinfection. Nothing was discovered to throw light upon the source of infection. In the metropolis during the year some 93 cases were certified. GLANDERS, ANTHRAX AND HYDROPHOBIA. A case of anthrax was certified iri a man aged 36 years, a pensioned soldier who was employed at the East India Dock. At the end of December, 1913, he was employed unloading hides from a steamer. He is said to have scratched a pimple on his right cheek which quickly became swollen on December 31st. He saw a doctor and was afterwards on January 6th admitted to St. Bartholomew's Hospital where the nature of the disease was recognised. Two intimations were received from the Veterinary Inspector of the London County Council as to the presence of glanders amongst horses at two stables in the Borough. The usual inquiries were made by the Sanitary officers in view of the possibility of the existence of infection amongst those employed at the stables. CHOLERA. No intimations were received during the year under the cholera regulations as regards the arrival in the Borough of persons 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:— 30 School. Enteric Fever. Small Pox. Diphtheria. Scarlet Fever. Measles. Chicken Pox. Whooping Cough. Mumps. Other Causes. Total. Bath Street ... ... ... ... 1 ... ... ... 4 5 Brunswick Street (special) ... ... ... 5 2 ... ... 1 12 20 Brecknock (Blind) ... ... ... ... ... 1 ... ... ... 1 Canal Road ... ... 1 2 41 10 35 2 40 131 Catherine Street ... ... 7 5 22 22 7 2 17 82 Chatham Gardens ... ... 5 6 40 21 22 8 20 122 Chequer Street ... ... ... 1 ... ... ... ... ... 1 Colebrook Row ... ... ... ... ... ... 1 ... ... 1 Coleman Street Ward ... ... 1 ... ... 3 ... ... ... 4 Curtain Road ... ... 14 8 45 4 23 5 35 134 Dalston Central ... ... ... ... ... ... 1 ... ... 1 Daniel Street ... ... ... 1 1 ... ... ... ... 2 Globe Road ... ... ... ... ... ... ... ... 1 1 Gopsall Street ... ... 16 49 111 15 38 22 67 318 Haggerston Road ... ... 5 12 64 34 11 19 45 190 Harnond Square ... ... 6 39 107 57 63 30 159 461 Hanover Street ... ... ... 1 ... ... ... 2 ... 3 Hoxton Central ... ... 1 12 ... ... 1 1 2 17 Hoxton House ... ... 25 28 93 34 26 21 111 339 Laburnum Street ... ... 10 19 19 28 2 3 14 95 London Fields ... ... ... ... ... ... ... 1 ... 1 Maidstone Street ... ... 34 37 145 22 35 36 86 395 Mowlem Street ... ... ... 1 1 ... ... ... ... 2 Napier Street ... ... 22 109 87 6 45 9 106 386 Popham Road ... ... ... ... 1 ... ... ... ... 1 Pritchards Road ... ... 1 4 13 13 1 ... ... 32 Queen's Road Queen's Head Street ... ... ... 12 ... ... ... ... ... 12 ... ... ... 1 ... ... ... ... ... 1 Red vers Street ... ... 4 20 49 2 6 2 24 107 Roclielle Street ... ... 1 1 4 2 ... ... ... 8 Rother field Street ... ... ... 1 ... ... ... 1 ... 2 St. Colomba's ... ... 1 1 ... ... ... ... ... 2 St. John's Church ... ... 6 15 21 12 14 1 13 82 St. John's Road ... ... 18 69 59 37 38 35 38 294 St. Joseph's (R.C.) ... ... 1 ... 2 ... ... ... ... 3 St. Mark's ... ... ... 9 10 12 14 1 1 47 St. Monica's ... ... ... 3 23 ... 2 ... ... 28 St. Paul's, Broke Road ... ... 7 17 6 4 5 3 16 58 St. Peter's ... ... ... ... 2 ... ... 0 3 5 St. Phillip's ... ... ... ... ... 4 ... ... ... 4 Seawfell Street ... ... 26 54 41 39 30 3 78 271 Scrutton Street ... ... 3 11 24 4 1 6 37 87 Shap Street ... ... 15 28 22 11 10 24 58 168 Shepperton Road ... ... ... 3 ... ... 5 3 5 16 Shoreditch Technical ... ... ... 1 ... ... ... ... ... 1 Somerford Street ... ... ... ... 1 ... ... ... ... 1 Trinity Place ... ... 4 19 43 35 4 11 30 146 Virginia Road ... ... 6 6 ... ... ... ... 1 13 Wenlock Road ... ... ... 6 82 65 29 18 26 226 Totals 4 ... 240 616 1,182 497 469 270 1,050 4,328 31 As compared with the figures for last year there were marked increases in the number of exclusions for scarlet fever and measles. On account of the occurrence of cases of measles amongst those attending, children under five years who had not had measles were by order of the school medical officer excluded from class rooms of the infants' departments of the following schools: Haggerston Road, Hamond Square, Hoxton Street, Napier Street, Shap Street, St. John's Road and Wenlock Road. Some 16 class rooms were affected. The numbers excluded were : 10 in February, 4 in April and 116 in May. Altogether 130 children were excluded. BACTERIOLOGICAL EXAMINATIONS. Dr. Bulloch at the London Hospital Medical School made 225 examinations in cases of suspected infectious diseases in the Borough. In 29 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 7 instances Widal's tests were made in suspected cases of enteric fever; 5 were negative. In 189 instances the sputum of persons suspected to have consumption was examined, with positive results as to the presence of the tubercle bacillus in 54. In addition 297 specimens were examined for tubercle bacilli at the Tuberculosis Dispensary. DISINFECTION. During 1914 disinfection was carried out by the Sanitary Authority at 1,521, premises, as compared with 1,139 in 1913, 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 26,931, as compared with 22,937 in 1913, 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 1,531 beds, 1,590 mattresses, 2,684 pillows, 1,006 bolsters, and 19,120 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. Included are 193 beds, 301 mattresses, 314 pillows, 128 bolsters and 1,043 other articles disinfected on account of vermin. It was necessary to destroy 5 beds and 12 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. PUBLIC MORTUARY. The bodies of 501 persons dying during the year were received into the Public Mortuary as compared with 362 in 1913, 373 in 1912, 379 in 1911, 382 in 32 1910, 392 in 1909 and 1567 in 1908. In two instancss the bodies of persons dead of infections disease were placed in the mortuary. A specially constructed shell is provided for the reception of such bodies. The inquests held on bodies deposited at the mortuary numbered 375 as compared with 304 in 1913, 294 in 1912, 303 in 1911, 322 in 1910, 317 in 1909 and 302 in 1908. The post mortem examinations carried out for the purposes of the above inquests numbered 255 as compared with 214 in 1913, 218 in 1912, 226 in 1911,214 in 1910,211 in 1909 and 208 in 1908. The figures for previous years are contained in the reports for 1911 and 1903. WATER SUPPLY. The rainfall for the year measured at Oxford amounted to 29-804 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 11-674 inches. The rainiest month was December, when 5'818 inches fell. Least rain fell in January, the fall amounting to 0-547 inch. The general rainfall for the Thames Valley above Teddington amounted to 32-07 inches, and for the Lee Valley 27*62 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 63 premises as compared with 42 in 1913, 40 in 1912, 80 in 1911, 82 in 1910, 83 in 1909, 65 in 1908, and 113 in 1907. These were all in the New River District. The grounds for cutting the water off were as follows : on account of defective water pipes in 3 instances, premises being demolished in 17, waste on empty premises 38, by request of the consumer 4, and in 1 instance for arrears in the rate. There were no complaints received as to the quality of the water supplied in the Borough, nor was there any reason for suspecting the occurrence of any illness due to the water. In accordance with the requirements of Section 78 of the London County Council (General Powers) Act, 1907, additional water taps were provided at 26 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. Intimations under the Public Health (London) Act, 1891, as to insanitary-conditions were served in respect to 4,606 premises. In 511 instances the premises were dealt with under the supervision of Inspector Firth, in 835 under Inspector Jordan, 407 Inspector Langstone, 582 Inspector Pearson, 610 Inspector 33 Stokes, 500 Inspector Wright, 575 Inspector Pratt and 586 under the supervision of Inspector Chapman. In connection with the work arising out of the sanitary notices served, some 1,026 letters were sent to owners of property, builders, and others concerned. Some 41,430 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, aud places where food is prepared and sold. The house to house inspection carried out during the year is referred to later in the report (page 37). In the subjoined table is contained a summary giving an idea as to the nature of the work done for the abatement of nuisances and for improving the dwellings of the people in the Borough, which has been compiled from the abstracts of their work prepared by the sanitary inspectors:— — Insp. Firth. Insp. Jordan Insp. Langstone. Insp. Pearson. Insp. Stokes. Insp. Wright. Insp. Pratt. Insp. Chapman. Total. New drain? constructed 4 1 1 12 13 ... 4 10 48 Drains re-constructed or repaired 41 13 15 39 53 26 59 22 268 Sinks trapped and disconnected . 50 39 61 30 5 17 2 201 Stack pipes reinstated 86 13 51 79 93 45 103 68 538 Eaves gutters reinstated 65 11 22 68 93 45 103 71 478 Stack pipes disconnected 28 15 1 5 13 ... 62 Accumulations of sewage removed 2 31 17 36 53 15 13 167 Soil pipes ventilated 1 1 2 2 4 ... 4 14 New water closets constructed 4 43 33 13 ... 1 94 W.c.'s re constructed or repaired 38 55 22 80 80 20 68 11 374 W.c.'s cleansed and white-washed 19 269 62 190 315 109 65 205 1,234 W.c.'s flushing apparatus repaired 40 115 39 76 70 27 65 95 533 Obstructions in w.c.'s removed 30 19 16 42 48 15 54 56 280 Overcrowding in houses abated 41 4 22 37 49 48 29 26 256 Damp courses in houses provided 29 ... 6 8 ... 1 44 1 89 Walls pointed 39 3 11 24 21 13 62 1 174 Roofs repaired 46 31 75 56 88 38 180 111 625 Stairs repaired 42 2 16 17 11 36 6 32 156 Floors repaired 54 11 18 35 17 23 53 83 299 Ventilation under floors provided 19 1 3 1 2 ... ... 8 34 Doors repaired 22 16 21 10 21 25 21 28 164 Door sills provided 58 4 ... 9 ... ... 29 1 101 Sashes repaired 13 26 16 36 14 19 15 56 195 Houses cleansed throughout 2 117 25 70 72 38 41 61 426 Houses cleansed in part 268 11 223 54 63 197 249 313 1,378 Total number of rooms cleansed 694 873 734 679 818 708 747 1,259 6.512 Yards or areas lime-washed 68 82 70 125 356 167 97 239 1,204 Yards paved 117 12 26 54 47 37 94 56 443 Areas and forecourts paved 27 ... 3 4 12 2 9 4 61 New areas constructed ... ... ... ... ... ... ... ... ... Sculleries paved 7 3 5 4 15 4 11 ... 49 Dust receptacles provided 90 20 78 37 56 47 83 84 495 Dung receptacles provided 12 1 ... 1 1 ... 1 1 17 (513) 0 34 In connection with the foregoing 4 old brick drains were abolished, and in 43 instances nuisances and annoyance due to rats on premises were dealt with. In 82 instances water supplies were restored to premises, and in 135 leaky water pipes were repaired. In 7 instances urinals were constructed or reconstructed, and in 30 instances they were cleansed and repaired. Foul accumulations causing or likely to cause nuisances were dealt with on 153 premises. Nuisances through the improper stabling of animals were remedied in 39 instances, and in two 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 514 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. Alma Street, No. 15 Fined 20s., costs 23s. Branch Place, No. 17 Order to do work in 48 hours; 10s. 6d. costs. „ No. 17 „ „ „ „ „ „ No. 17 Summons withdrawn. Bridport Place, No. 124 Order to do work in 14 days. East Road, No. 75 Fined £1 ; costs 12s. 6d. Falkirk Street, No. 52 Summons withdrawn ; 10s. 6d. costs. Gorsuch Street, No. 7 „ „ „ Great Chart Street, No. 70 Costs 5s. Mansfield Street, No. 108 Fined £1; costs 2s. New North Road, No. 56 Summons withdrawn; 2s. costs. With respect to the house in Alma Street, the owner was in default through not complying with a statutory notice under the Public Health (London) Act, 1891, as amended by the London County Council (General Powers) Act, 1907, requiring the provision of an additional water tap for the occupiers, the premises being an occupied tenement dwelling-house. The three summonses in the case of the house in Branch Place were taken against the owner for not complying with the requirements of three statutory notices requiring the removal of an accumulation of rubbish in the yard, the 35 amending of a defective drain and the provision of a proper dust receptacle. In the latter case the summons was withdrawn as the dust receptacle needed had been provided when it came before the Court. The summons in respect to the house in Bridport Place was for non-compliance with a statutory notice under Public Health (London) Act, 1891, requiring the abatement of a nuisance due to the roof being defective and the premises being dirty. The summons in respect to the house in East Road was taken against a builder for connecting a sink waste into a soil pipe contrary to the London County Council by-laws dealing with such matters. In the case of the house in Falkirk Street the owner was summoned for not complying with a statutory notice requiring the provision of a dust receptacle. The receptacle had been provided when the case came on for hearing before the magistrate. At the house in Gorsuch Street there was a defective drain. It, however, had been dealt with to the satisfaction of the Sanitary Authority when the case came before the magistrate, so the summons was withdrawn. In the case of the house in Great Chart Street a builder had committed a breach of the London County Council by-laws through failing to give proper notice to the Clerk to the Sanitary Authority of his intention to fix a new w.c. pan. In the case of the house in Mansfield Street a builder had constructed a watercloset without giving the notice required under London County Council by-laws. At the house in New North Road the yard paving was defective, this had been remedied when the case came into Court, so the summons was withdrawn on payment of the sum mentioned. SMOKE NUISANCES. During the year some 17 complaints were received from the London County Council relating to the emission of black smoke from shafts belonging to 19 factories and work-places. In all cases the necessary steps were taken for obtaining the abatement of the nuisances. Eleven intimation notices were served, but it was not necessary to report any of the cases to the Sanitary Authority for further action. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 395 as compared with 440 in 1913, 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 570 as compared with 610 in 1913, 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 (513) c 2 36 where necessary, sprayed with lysol or fumigated with sulphur fumes as required. Bedding and textile articles, excluding personal clothing, were removed and disinfected by the officers of the Borough Council. Th6 number of articles disinfected are stated on page 31. In the great majority of the cases the steps taken were the result of information received from the school authorities. During the year the homes of some 1,738 children, 788 boys and 950 girls, notified as being verminous by the School Medical Officer, were reported with a view to steps being taken by the Sanitary Authority under the London County Council (General Powers) Act, 1904, Part IV., to deal with the homes, bedding and clothing where necessary, the children themselves having been cleansed at the County Council's Cleansing Stations in the neighbourhood of the Borough. In numerous instances the same children were notified as being in a verminous condition on more than one occasion during the year. Altogether there were received intimations that 461 boys and 316 girls had been given the opportunity of being cleansed at the Council's cleansing stations, that in the cases of 311 boys and 601 girls statutory notices had been served upon the parents to cleanse the children within 24 hours under Section 122 of the Children Act, 1908, and that in the cases of 16 boys and 33 girls legal proceedings were to be instituted for non-compliance with the requirements of the aforesaid statutory notices. In a number of instances the same homes were dealt with two or three times during the year. In practically the whole of the cases reported the houses were visited by the Sanitary Inspectors, and the following summarises the results obtained :—In 1,040 the rooms occupied were satisfactory, i.e., they varied from fairly clean to very clean, in 156 they were dirty, in 114 they were buggy, and in 115 they were both dirty and infested with bugs. In 1,061 the bedding was clean or fairly so, in 221 it was dirty, in 56 bugs were observed, and in 45 it was both dirty and buggy. In 121 instances the bedding showed more or less evidence of lice, the insects themselves or their eggs being observed. It is to be noted that where lice were present the bedding was usually dirty and otherwise verminous. In some cases, however, it appeared to be quite clean. In 46 instances mothers attributed the presence of lice to the use of second hand clothing purchased for the children. In 516 instances the homes were markedly infested with fleas, in 49 overcrowding was found, and in 82 there were marked evidences of poverty. In 225 instances there were indications of recent efforts at cleansing, doubtless in most cases in expectation of the visit of the Sanitary Officer. In 57 instances there was difficulty in obtaining entrance to the dwelling for the purpose of inspection. In some cases as many as five or six visits had to be made before the necessary inspection could be carried out, and in 13 cases notice of intention to apply to a Magistrate for an order to enter the dwelling had to be given. Altogether in these cases some 208 visits had to be made when 57 should have been sufficient. It is also to be mentioned that in the cases of 260 of the children notified the addresses were erroneous and the children could not be traced; in 122 they were not known at 37 the addresses stated on the forms, in 90 they had left the addresses, in 20 the addresses given did not exist so far as Shoreditch is concerned, in 26 the houses were found to be empty and in two instances they had been demolished. In a number of instances forms were received containing addresses situate in adjoining Boroughs; these were duly forwarded to the respective Medical Officers of Health. Evidence of lice were found in the bedding in a little over 8 per cent, of the cases investigated. Compared with last year there seems to be a slight improvement. As a result of the Inspectors' visits a large amount of cleansing and disinfection was carried out in connection with the homes and a number of sanitary defects came under observation and were remedied. Altogether some 235 sanitary notices were served on owners and 47 on occupiers of verminous dwellings in connection with the work arising out of the visits made by the sanitary officers. It may also be mentioned that 15 children, two of whom could not be traced, suffering from scabies commonly known as "itch" were reported by the School Medical Officer and 16 by the Superintendent of the Outpatient Department of the London Hospital, the latter with the consent of the patients or their friends. In all cases where possible steps were taken for preventing the spread of infection, bedding, clothing and textile articles likely to harbour the mites causing the disease being disinfected as often as appeared necessary. It need hardly be pointed out that a very appreciable part of the time of the Sanitary Staff has been occupied by this very unpleasant but at the same time most important and necessary public health duty. HOUSE-TO-HOUSE INSPECTION. Including blocks of artizans' dwellings as streets, house-to-house inspection was carried out in 73 streets, in the Borough. Altogether some 2,093 dwellings were inspected and of these 869 were reported as being in a satisfactory sanitary condition. In connection with the remainder 1,073 sanitary notices were served. In 119 the dwellings were found unoccupied; most of these were tenements in artizans' dwellings. In the majority of cases the defects found were of minor importance. Special attention was directed to the houses in Essex Street in consequence of allegations as to the large amount of overcrowding therein, altogether 55 houses containing 453 rooms and occupied by 269 families, mostly of the poorer working class, were inspected in this street. In six instances marked evidence of overcrowding of the house as a whole was found. In 39 other cases rooms were distinctly overcrowded and in 33 others there was some slight deficiency of cubic space according to the standard laid down in the byelaws as to houses let in lodgings or occupied by members of more than one family. In all cases the necessary steps were taken for secuiing the abatement of the overcrowding and some 49 sanitary notices were served. 38 HOUSES CLOSED. The following houses were closed voluntarily by the owners upon the service of sanitary notices under the Public Health Act, 1891, either on account of being unfit for habitation or in order to allow the works necessary to put them in a satisfactory sanitary condition being carried out in a proper and efficient manner, which would have been difficult or impossible whilst the houses were in occupation :— Aske Street, Nos. 16 and 17. Avebury Street, No. 1. Bevenden Street, No. 19. Britannia Street, No. 29. Boston Street, Nos. 40, 71 and 79. Catherine Street, No. 68. Cavendish Street, Nos. 31 and 37. Cottage Place, No. 1. Cremer Street, No. 25. Crondall Street, Nos. 42, 44 and 46. Custance Street, No. 68. Dereham Place, No. 19. Dunloe Street, No. 39. Essex Place, Nos. 3, 11, 13 and 19. East Road, No. 12. Felton Street, No. 8. Hoxton Street, No. 10. New Inn Yard, Nos. 44 and 46. Ormsby Street, No. 6. Retford Street, Nos. 2, 5, 12, 14 and 15. Rushton Street, No. 3. St. Johns Road, No. 158. Scawfell Street, No. 13. Vincent Street, No. 9. Weymouth Terrace, No. 124. Wimbourne Street, No. la. York Street, Nos. 43, 45 and 47. The houses in Aske Street each contained six rooms and scullery. The drains were defective and the premises infested with rats. The owner closed them upon receipt of a sanitary notice from Inspector Pearson. They were subsequently dealt with, but remained unoccupied at the end of the year. The house in Avebury Street, containing five rooms, was closed by the owner on receipt of a sanitary notice from Inspector Langstone. It was generally dirty, dilapidated and verminous. It was dealt with and afterwards re-occupied. The house in Bevenden Street, containing five rooms, was dirty and dilapidated, and was closed by the owner to comply with the requirements of a statutory notice under the Public Health (London) Act, 1891. It was dealt with under the supervision of Inspector Stokes and subsequently re-let. The houses in Boston Street, each containing three rooms, except in the case of No. 40 where there are four, were dirty and dilapidated, and were closed by the owner upon receipt of a sanitary notice from Inspector Firth. They were effectively dealt with and subsequently re-occupied. The house in Britannia Street, consisting of eight rooms and scullery, was generally dirty, dilapidated and verminous. It was closed by the owner on receipt of a sanitary notice from Inspector Wright, thoroughly dealt with and afterwards re-occupied. 39 The house in Catherine Street contains four rooms. It wan dirty, dilapidated and overcrowded, and was closed by the owner on receipt of a statutory notice under the Public Health (London) Act, 1891, and remained unoccupied at the end of the year. No. 31, Cavendish Street, consisting of six rooms, was closed by the owner following the receipt of a statutory notice under the Public Health (London) Act, 1891. It was very dirty and dilapidated, the roof was defective, and the sanitary arrangements generally required attention. It was dealt with under the supervision of Inspector Stokes and subsequently re-occupied. No. 37, Cavendish Street, also a six-roomed house, was in a dirty and dilapidated condition. On receipt of a sanitary notice from Inspector Stokes the house was closed, dealt with, and then re-let as a workshop. The house in Cottage Place, consisting of three rooms, was closed by the owner on receipt of a statutory notice. It was overcrowded. The house in Cremer Street, containing four rooms and scullery, was generally dirty, dilapidated and verminous. It was closed by the owner on receipt of a sanitary notice from Inspector Pearson, dealt with, and subsequently re-let. The houses in Crondall Street, each consisting of six rooms, were closed by the owner on receipt of statutory notices under the Public Health (London) Act, 1891. They were very dirty and dilapidated, and some of the brickwork was so defective and dangerous as to necessitate the attention of the District Surveyor. These houses remained closed at the end of the year. The house in Custance Street, containing four rooms, was dirty, dilapidated, and verminous, and was closed by the owner on receipt of a sanitary notice from Inspector Stokes. It was re-occupied after being dealt with. The house in Dereham Place, consisting of six rooms, was dirty and dilapidated, and was closed by the owner on receipt of a sanitary notice from Inspector Jordan. It was dealt with and subsequently re-let. The house in Dunloe Street, containing four rooms and scullery, was closed, by the owner on receipt of a sanitary notice from Inspector Pratt. It was generally dilapidated, and the sanitary arrangements were defective. It remained closed at the end of the year. The house in East Road, containing six rooms, was generally dirty and dilapidated, and the roof was defective. It was closed by the owner on receipt of a sanitary notice from Inspector Stokes, dealt with, and afterwards re occupied. The houses in Essex Place, each consisting of three rooms, were closed by the owner on receipt of sanitary notices from Inspector Firth. They were generally dirty and dilapidated. They were dealt with and re-let. 40 The house in Felton Street, consisting of six rooms, was generally dirty, dilapidated and verminous. It was closed by the owner on receipt of a sanitary notice from Inspector Langstone, dealt with throughout, and subsequently re-occupied. The house in Hoxton Street was in connection with a cookshop. It contained six rooms, including the shop and kitchen. It was generally dirty and dilapidated, and was closed by the owner on receipt of a sanitary notice from Inspector Pearson. It remained closed at the end of the year. The houses in New Inn Yard, each consisting of nine rooms, were generally dirty and dilapidated, and were closed by the owner on receipt of sanitary notices from Inspector Jordan. They remained closed at the end of the year. The house in Ormsby Street, containing four rooms, was dirty, and the roof was defective. It was closed by the owner on receipt of a sanitary notice from Inspector Pratt. The premises were dealt with and subsequently re-let. The houses in Retford Street, each consisting of four rooms and scullery, were generally dirty and dilapidated, and also verminous. They were closed by the owner on receipt of sanitary notices from Inspector Pearson. With the exception of No. 2, which remained closed at the end of the year, they were dealt with and re-occupied. The house in Rushton Street, consisting of six rooms, was generally dirty and dilapidated, and there was some overcrowding. It was closed by the owner on receipt of a sanitary notice from Inspector Langstone, dealt with, and subsequently re-occupied. The house in St. John's Road, consisting of five rooms, was very dirty and dilapidated ; the roof was defective, as also were the sanitary arrangements. It was closed by the owner on receipt of a sanitary notice from Inspector Langstone, and remained closed at the end of the year. The house in Scawfell Street, containing six rooms and scullery, was generally dirty and dilapidated, and the sanitary arrangements were defective. It was closed by the owner on receipt of a sanitary notice from Inspector Pratt, dealt with, and subsequently re-occupied. The house in Weymouth Terrace, consisting of five rooms and scullery, was generally dirty and dilapidated. It was closed by the owner on receipt of a sanitary notice from Inspector Pratt, dealt with, and afterwards re-let. The house in Wimbourne Street, containing six rooms and scullery, was in a dirty and verminous condition, and was closed by the owner on receipt of a sanitary notice from Inspector Wright. It was dealt with and then re-let. The house in Yincent Street, consisting of four rooms, was overcrowded. It was closed by the owner on receipt of a statutory notice under the Public Health (London) Act, 1891. After being cleansed throughout the house again came into occupation. 41 The houses in York Street, each containing four rooms and scullery, were closed by the owner on receipt of sanitary notices from Inspector Firth. They were generally dirty. After being dealt with they were re-occupied. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. The following houses came under my notice as having during the year been closed for demolition:— Clifton Street, No. 23—a six-roomed house, was demolished. New Inn Street, Nos. 8, 9, 10, 11, 12 and 13—five-roomed houses, were demolished. New Inn Square, Nos. 1, 2, 3, 4 and 9—three-roomed houses, were demolished HOUSING AND TOWN PLANNING ACT, 1909. No houses were inspected under the above Act during the year under consideration. With reference to Halcombe Place, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 mentioned in the report for 1913, the work required in connection therewith being outstanding at the end of that year, these houses were thoroughly dealt with by the owner, being cleansed and repaired. Also where necessary proper steps were taken to abolish the dampness of some of the walls, which was the chief insanitary condition requiring attention. No further action therefore was necessary under the Act. Since the Act came into operation 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 official representations under the Act, and of these 2 have been demolished, one has ceased to be used as a dwelling house, 2 have been dealt with satisfactorily and re-occupied as dwelling houses and the other 10 were still closed at the end of the year. The rest of the houses were dealt with to the satisfaction of the Sanitary Authority and no further action was therefore necessary. ARTISANS' DWELLINGS. The artisans' dwellings in the Borough were under observation during the year, and their sanitary condition may be reported 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. 42 The numbers of tenements, rooms and persons in the artisans' dwellings in the Borough, estimated for 1914, are contained in the subjoined table:— Number of blocks. Number of tenements. Number of rooms. Number of persons. Class A 44 1,935 4,775 6,650 Class B 15 379 919 1,800 Total for the whole 59 2,314 5,694 8,450 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 1.4, as compared with 2.0 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. 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. 248 29.3 167 25.1 81 45.0 The proportion of deaths attributed to prematurity was at the rate of 0.1 per 1,000 births as compared with 36.7 in 1913, 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 there were no deaths from prematurity, whilst in Class B there was only one, the rate being 0.5 per 1,000 births. For the whole Borough the deaths from prematurity amounted to 10.9 per 1,000 births. The infantile mortality for the whole of the dwellings was 173 per 1,000 births as compared with 143 in 1913, 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 150 as compared with 152 in 1913, 76 in 1912, 125 in 1911, 65 in 19J0, 101 in ]909, 75 in 1908, 99 in 1907, 84 in 1906 and 134 in 1905. For Class B the mortality was 222, as compared with 115 in 1913, 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. 43 The infantile mortality is the highest so far recorded for the dwellings as a whole and also for the Class B dwellings. 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. Xumber of deaths. Rate per 1,000 inhabitants. Rate per 1,000 inhabitants. All causes 162 19.1 105 15.8 57 31.7 19.4 Principal Zymotic diseases. 28 3.3 15 2.2 13 7.2 3.2 All forms of Tuberculosis 21 2.4 19 2.8 2 1.1 2.8 Phthisis 18 2.1 17 2.5 1 0.5 2.1 Bronchitis 7 0.9 5 0.7 2 1.1 1.5 Pneumonia 11 1.3 5 0.7 6 3.3 2.1 The deaths of residents of the dwellings in public institutions numbered 74, being 43 for the Class A and 31 for the Class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 45'8, being 409 for Class A and 5P4 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 67, of which 41 were in the Class A dwellings and 26 in the Class B. The attack-rates per 1,000 population were 7-9 for the whole of the dwellings, 6'1 for Class A, and 14'4 for Class B, as compared with 7'9 'for the whole Borough. The cases included 1 of puerperal fever, 27 of scarlet fever, 24 of diphtheria, 11 of erysipelas, 2 of enteric fever and 2 of cerebro-spinal fever. The number of cases and the attack-rates per 1,000 inhabitants are set out below:— — Scarlet Fever. Diphtheria. Puerperal Fever. Erysipelas. Enteric Fever. Cerebrospinal Fever. Cases. Rate. Cases. Rate. Cases. Rate. Cases. Rate. Cases. Rate. Cases. Rate. Class A 15 2.2 13 1.9 1 0.1 9 1.3 2 0.3 1 0.1 Class B 13 7.2 11 6.1 — — 2 1.1 — — 1 0.5 The whole of the dwellings 28 3.3 24 2.8 1 0.1 11 1.3 2 0.2 2 0.2 44 For the Borough as a whole the attack-rates for the above diseases were as follows:—scarlet fever, 3.8; diphtheria, 1.9; enteric fever, 0.2; erysipelas, 1.8; cerebro-spinal fever and puerperal fever, 01 per 1,000 inhabitants. HOUSES LET IN LODGINGS. No houses let in lodgings or occupied by members of more than one family were placed on the register during the year. The number registered remains the same as for last year, namely, 280. There were 380 visits of inspection made, and 184 intimations, with some 63 statutory notices, were served in connection with these houses during the course of the year. CUSTOMS AND INLAND REVENUE ACTS. No applications were received except one with regard to a common lodginghouse. The Housing and Town Planning Act, Section 35 (1), provides for exemption from inhabited house duty where the charge to lodgers does not exceed sixpence per night. The certificate was granted after the premises had been inspected. CO-OPE RATION BETWEEN THE CIVIL AND MILITARY SANITARY AUTHORITIES. Owing to the huge increases in the populations of various localities in different parts of the country due to the very large numbers of troops quartered (herein in consequence of the war, it early became apparent that special arrangements were necessary involving the closest co-operation between the civil and military sanitary authorities for co-ordinating the measures required for the protection of the health both of civilians and soldiers. To this end special instructions agreed upon by the War Office and the Local Government Board were issued for the guidance of sanitary authorities and their officers, as regards places where troops are quartered. The organization of the arrangements for supervising the sanitation of billets, quarters, and other places occupied by troops in London was the work of the Deputy Director of Medical Services for the London District. From September 12th onward the following places in the occupation of troops in Shoreditch were regularly under the inspection of the Council's sanitary officers :— No. 112, Shaftesbury Street, the Headquarters of the 4th Battalion, City of London Regiment, Royal Fusiliers T.F. Nos. 22 and 24, Sun Street, the Headquarters of the 7th City of London Battalion, the London Regiment T.F. Each of these headquarters comprise drill hall, canteen and recreation rooms for the men, with the necessary sanitary accommodation, officers' quarters, orderly room and accommodation for the resident staff. The former is under the sanitary supervision of Inspector Stokes and the latter of Inspector Jordan. Reports are rendered weekly to the Deputy Director of Medical Services, London District, at the Horse Guards, dealing with such particulars as the numbers of men using the headquarters and the numbers sleeping there, the 45 sufficiency and the sanitary condition of the accommodation provided for sleeping, also for messing; of the sanitary accommodation in the way of water-closets, urinals and ablution places, the arrangements for the disposal of refuse, and such other matters likely to give rise to nuisance or affect the health of the troops as may from time to time come under observation. The quality of the various articles of food prepared and sold on the premises is a matter for special attention, and up to the present has been excellent. Comparatively few of the men have meals at the headquarters; very few sleep there, most of the men residing at home. Ample space for sleeping those who remain has always been available. The scale laid down is 400 cubic feet, with 40 superficial feet per man. Generally it may be stated that the premises were found during the year in a satisfactory sanitary condition. Matters requiring attention were brought to the notice of the officers commanding the respective head quarters, and were also mentioned in the weekly reports. Suggestions made for remedying sanitary defects were given effect to. The Headquarters of the King's Royal Rifles Cadets at 42, Sun Street, were also inspected. They were not being used otherwise than in time of peace, and were found to be satisfactory from a sanitary point of view. SLAUGHTER HOUSES. The licensed slaughter houses in the Borough at the end of the year numbered 5 as compared with 5 in 1913, 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. They were inspected from time to time during the year, and their general conditions may be reported as satisfactory. Slaughtering in Shoreditch is almost entirely restricted to sheep. COWHOUSES. The cowhouses on the register at the end of the year numbered 6, one less than for last year. At an inspection made just before the annual licensing 5 were found in a satisfactory sanitary condition, but cows were kept in only 2 of them. The cowshed at No. 274, Hoxton Street, was found to be in use as a cabinet-making and french-polishiag workshop, and that at No. 22, Bracklyn Street, was in a dirty state, the roof being defective and there being no cows. The licences in these two cases were opposed by the Borough Council. The opposition was not persisted in as regards No. 22, Bracklyn Street, as the necessary steps had been taken to comply with the sanitary requirements of the Borough Council before the case was dealt with by the Licensing Committee. In the other case, that of 274, Hoxton Street, the license was not renewed. The number of cows found to be kept in the cowhouses in the Borough on October 13th of the year under consideration was 30, as compared with 32 in 1913, 37 in 1912, 41 in 1911, 39 in 1910, 44 in 1909, 52 in 1908, 57 in 1907, 74 in 1906, 86 in 1905, 95 in 1904, and 101 in 1903. The number of dairymen and milk purveyors on the register at the end of the year was 293, as compared with 290 in 1913, 291 in 1912, 292 in 1911, 292 in 1910, 46 302 in 1000, 202 in 1008, 284 in 1007, 288 in 1006, 280 in 1005, 204 in 1004, 300 in 1003, and 304 in 1002. During the year the sale of milk was discontinued at 20 and commenced at 23 premises, and in 40 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 2,741 visits were made in connection with them. In 20 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. Three cases of scarlet fever and one of measles occurred on premises where milk was sold and the usual steps were taken by the Sanitary Authority, and in 3 instances milk vendors were cautioned as to measures. 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 51 samples were taken and submitted to the Public Analyst, and in 0 instances proceedings were taken. The particulars respecting the prosecutions are briefly as follows:— 1. A person in whose possession rag flock containing 12.2 parts in excess of the 30 parts of chloride of sodium per 100,000 allowed was summoned. The summons was dismissed, a warranty being produced. The guarantors were then proceeded against and fined £2, with £1 costs. 2. In a similar case, the rag flock containing 24.7 parts of chloride of sodium in excess, the guarantors were fined £1 and £1 costs. 3. In three instances the samples were found to contain 15.3, 43.7 and 18.9 parts of sodium chloride in excess respectively; in each case the guarantors were substituted and ordered to pay 10s. 6d. costs. 4. The sample contained 173 parts in excess of chloride of sodium, and the person in whose possession the flock was, was fined £5 and 23s. costs. The defendant in this case had been twice previously convicted. 5. In two the samples were found to contain respectively 8.0 and 3.1 parts in excess of chloride of sodium; in each case the guarantor was ordered to pay 10s. 6d. costs. 6. The sample contained 45.0 parts of chloride of sodium in excess; the summons was dismissed against the person in whose possession the flock was, and the guarantors were substituted and fined £2, with 31s. 6d. costs. FACTORY AND WORKSHOP ACT, 1001. The number of workshops, exclusive of bakehouses, on the register at the end of 1014 was 1,281, 237 having been placed on and 188 taken off during the year. The numbers for previous years were 1,232 in 1013, 1,143 in 1012, 1,136 in 1,011, 1,173 in 1010, 1,226 in 1009, 1,183 in 1008, 1,251 in 1007, 1,278 in 1006, 1,218 in 1005, 1,133 in 47 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 3,174 visits of inspection were made in connection with workshops, and 500 to factories. Five communications were received from the Factory Inspector relative to the establishment of 63 new workshops in the Borough. On inspection 43 were found to be in a satisfactory sanitary condition, and 5 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 15 notices were served. From the Factory Inspector 23 written intimations were received relating to insanitary conditions and infringements of the law as to public health in connection with 39 workshops and 3 factories. The chief insanitary conditions to which the Factory Inspector directed attention were: dirty conditions of walls and ceilings in 15 instances, defective and insufficient water-closet accommodation in 3, want of proper separate accommodation for the sexes in 13, overcrowding in 1, want of proper light and ventilation in 1, other defects in connection with sanitary accommodation 2, want of proper ventilation 1, no lobby to w.c.'s 2, and w.c's and urinals dirty 4 instances. Including those brought under our notice by the Factory Inspector, 384 workshops were dealt with and 353 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 1914 :— New drains constructed 6 Urinals repaired and Drains relaid or repaired 10 cleansed 8 Stack pipes disconnected 4 New water-closets con- Stack pipes reinstated 18 structed 11 Eaves gutters reinstated 20 Water-closets' flushing appa- Sink waste pipes discon- ratus repaired 67 nected 12 Water supply laid on or Yards paved 9 restored 10 Areas paved 1 Leaky water pipes repaired 14 Forecourts paved 6 Rooms cleansed and white- Door sills provided 2 washed 387 Water-closets reconstructed 41 Doors repaired 3 Water-closets cleansed and Sashes repaired 4 lime-washed 170 Dust receptacles provided 2 Yards cleansed and white- Dung receptacles provided 2 washed 79 Foul accumulations re- Areas cleansed and white- moved 13 washed 2 Ventilation improved 2 Roofs repaired 35 Damp courses provided 2 Floors repaired 17 Walls pointed 6 Stairs repaired 2 Obstructions removed from water-closets 36 48 It may also be added that in 13 instances nuisances owing to flooding with sewage had to be dealt with, in 3 cases overcrowding, and in 1 case owing to rats infesting the premises. In 38 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 25, and in connection with them some 25 sanitary notices were served. The works carried out to comply with these notices included the construction, reconstruction or repair of drains in 5 instances, the disconnection of stack pipes in 6, of sink waste pipes in 23, the repair of water closets in 18, the construction of new water-closets in 6, and new urinals in 3 instances, besides a number of other items connected with cleansing and repairing. Limewashing of factories in accordance with the requirements of the Factory and Workshop Act is a matter with which the Factory Inspectors deal. Defects in connection with the sanitary arrangements in factories come within the province of the Sanitary Authority. During the year 107 lists of out-workers were received from employers in the Borough, 54 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 1,604 out-workers, of whom 1,127 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 2,378 out-workers, and of these 85 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 1914. The number of out-workers brought to our notice during 1914 was 3,982, as compared with 3,932 in 1913, 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 1914, some 2,581 were residents in Shoreditch, as compared with 2,703 in 1913, 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 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 cut-workers as regards trades in the Borough. Most of them are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags and boxes, and brushes. During the year some 2,141 visits of inspection were made to places where homework was being carried on, and sanitary notices were served in 156 instances. 49 The work carried out to comply with these notices included the disconnection of sink waste pipes in 9 instances, the reinstatement of stack pipes in 20, of eaves gutters in 19 ; various works in connection with the water-closet accommodation in 32, with the water supply in 17 ; the cleansing of 265 rooms, 41 yards, 8 areas, and 35 water-closets ; the repair of roofs in 29, floors in 14, stairs in 14, sashes in 4, and doors in 5 instances, the provision of 24 dust receptacles besides other work. In 3 instances overcrowding was found, in 11 cases the rooms required to be dealt with on account of vermin, in 1 instance drains were relaid and in 8 repaired, and in 2 instances accumulations of sewage were dealt with. 14 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 7 instances on account of delay in sending in the lists relating to out-workers employed in making wearing apparel, in 8 relating to paper bag and box making out-workers, and in 3 relating to artificial flower 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 75, of which 43 are under and 32 above ground. Of these 10 were not in use, namely, those situate at 17, Cropley Street (a factory bakery), 88, Bridport Place, 41, Dunloe Street, 55, Hackney Road, 189, High Street, 200, Kingsland Road, 249, Old Street, 30, Pitfield Street, 44, Whiston Street and 42, Whitmore Road. The outbreak of war doubtless added to the number of those unoccupied. In 4 of the bakehouses mechanical power is used and they are therefore factories within the meaning of the Factory and Workshops Acts. As the result of the inspections made all those in use as bakehouses may be reported on as being in a satisfactory sanitary condition at the end of the year. In some 29 instances sanitary notices were necessary for limewashing and cleansing, in 2 on account of the presence of dampness in the walls and in 1 for defective yard paving. The notices served were all complied with and it was not necessary to bring any of the premises specially under the notice of the Sanitary Authority. ICE CREAM SHOPS. The following summarises the work for 1914:—Inspector Firth had 7 under observation, 2 of which required cleansing. Inspector Jordan had 9 in connection with which 2 sanitary notices were required for defective roofs. Inspector Langstone had 18 under observation 2 of which required cleansing. Inspector Pearson visited 24 at 8 of which it was found that the sale of ice cream had been discontinued; 9 sanitary notices were required, 6 were for cleansing and 3 for other matters. Inspector Stokes had 12 under inspection; 1 sanitary notice was (513) D 50 required for cleansing and repairs. On Inspector Wright's district 10 were under observation all of which were found to be in a satisfactory condition. Inspector Pratt had 9 under inspection in connection with which 3 sanitary notices were necessary, mainly for general cleansing and repairs. Inspector Chapman had 6 premises under observation ; 2 of which required cleansing throughout. Altogether some 81 premises whereon ice cream was being manufactured or sold were under observation during the year. Of these 59 were found in a satisfactory sanitary condition. The remainder all more or less required attention and 22 notices were served. There was a marked decrease in the number of ice cream shops in the Borough as compared with the number for 1913. COOKSHOPS, COFFEE HOUSES AND EATING HOUSES. Inspector Firth had 9 under observation, 2 of which required cleansing. Inspector Jordan had 89 under inspection including the kitchens of 15 public houses where dinners are prepared for the public ; in 32 instances sanitary notices were required ; 22 kitchens and 9 other rooms and in 1 case the house throughout were cleansed, in 1 instance the roof was repaired, in 4 sinks were unstopped, in 1 the drain was unstopped, in 1 the drains were reconstructed, in 5 water closets were cleansed and in several instances other matters were attended to. Inspector Langstone had 11 under inspection, all of which were reported as being in a satisfactory sanitary condition. Inspector Pearson had 30 under inspection, 4 of which required cleansing, 4 showed defects in connection with the sanitary arrangements and in 5 other sanitary defects required attention. Inspector Stokes had 15 under observation, 4 of which required attention for cleansing and repairs, 1 for defective drainage and 1 on account of absence of proper means for the disposal of refuse. On Inspector Wright's district 17 were under observation, and 13 sanitary notices were required, mainly for cleansing and limewashing. Inspector Pratt visited 14, of which 7 required attention chiefly for cleansing and repairs ; in ] instance the roof was defective and in 2 there were defects in connection with the sanitary arrangements. Inspector Chapman had 10 under inspection in connection with which 4 sanitary notices were required principally for cleansing. Altogether 194 premises where food is prepared including the kitchens of public-houses, were under observation during the year as compared with 193 in 1913, 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 81 instances sanitary notices were necessary. FRIED FISH SHOPS. On Inspector Firth's district. 3 were under observation, and in 2 instances sanitary notices were required for cleansing. On Inspector Jordan's district, 5 were inspected, and sanitary notices were required for a defective roof and a defective water closet respectively. On Inspector Langstone's district, 5 were visited and found in a satisfactory sanitary condition. On Inspector Pearson's 51 10 were visited and all found satisfactory. Inspector Stokes had 5 under observation, in connection with 3 of which sanitary notices were necessary for cleansing and repairs. On Inspector Wright's district, 7 were visited and all found in a satisfactory sanitary condition. Inspector Pratt had 10 under observation in connection with which 4 sanitary notices were necessary mainly for cleansing and repairs. Inspector Chapman visited 10, of which 2 required cleansing. Altogether 55 fried fish shops were under inspection during the year and 13 sanitary notices were served in connection with them mainly for cleansing and repairs. STREET MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers in accordance with the instructions of the Borough Council as regards food exposed for sale. The following were seized or surrendered and destroyed as unfit for the food of man during the year :— Salted herrings 1 box, herrings 150, plaice 91 lbs., tripe 2½ cwts., pigs' kidneys 2i Cwts., liver 3 lbs., rabbits 40, chickens 25, pork 19 lbs., mutton 1½ cwts., mutton loins and breasts 3 cwts., mutton 3 necks, scraggs of mutton 1 stone 12 lbs., aitch bone 10 lbs., beef | cwt., beef in brine 80 lbs, pressed pork 7¼ lbs.; tomatoes 64 lbs., oranges 236, bananas 1 case. In one case proceedings were taken against a vendor for exposing for sale 61 lbs. of rotten tomatoes; he was fined £5 with 23s. costs. They were seized by Inspector Stokes. Another vendor was fined £5 with 2s. costs for having in his possession 19 lbs. of stinking pork intended for use in making German sausage. The pork was seized by Inspector Stokes. A third was fined £5 with 23s. C03ts for having deposited on his premises some 80 lbs. of beef intended for human food the same being unsound. The beef was found in a brine tub in a shed behind the shop and was taken possession of by Inspector Stokes. In a fourth case where 36 rabbits and 4 other rabbits in pieces, the same being exposed for sale and uufit for food, were seized by Inspector Pratt, the defendant was fined £5 with 12s. 6d. costs. In one case proceedings were taken against the owner of a barrow for not removing the same, in accordance with the requirements of the Council's regulations dealing with the removal of stalls and barrows from the market streets. The summons was withdrawn. SALE OP 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 7 per 1,000 inhabitants. (513) D 2 52 The results of the year's work are summarised in the following table :— Quarter of the year 1314. Number of Samples taken. Number of SamplesAdulterated. Percentage Adulterated. Number of Prosecutions instituted. Prosecut ions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of successful Prosecutions. Pines and Costs. t paid to Analyst for Samples analysed. £ s. d. £ s. d. 1st 156 29 19-1% 10 10 6 22 11 0 78 0 0 2nd 175 81 17-7% 6 6 3 18 16 6 87 10 0 3rd 176 39 17-6% 16 16 10 19 0 6 .87 2 6 4th 261 33 12-6% 5 5 2 15 1 0 97 17 6 Total for Year. | 768 132 17-1% 37 37 21 75 9 0 350 10 0 The samples taken included 556 of milk, 119 of butter, 6 margarine, 3 arrowroot, 2 brawn, 1 bread and butter, 5 cheese, 12 coffee, 1 citric acid, 1 cocoa, 5 cream, 1 crushed linseed, 7 dripping, 3 golden syrup, 2 lard, 3 linseed meal, 2 malt vinegar, 6 non-alcoholic orange wine, 6 non-alcoholic raisin wine, 2 nonalcoholic ginger wine, 2 olive oil, 1 preserved cream, 2 pickled walnuts, 3 raspberry jam, 8 sausage, 1 separated milk, 1 table jelly, 1 Tarragona port wine, 4 vinegar and 1 of white sugar. One informal sample of black currant jam was also taken. Of the samples of milk 108 or 19.4 per cent. were found to be below the standard fixed by the Board of Agriculture as compared with 25'3 in 1913, 22.2 in 1912, 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, and 23.5 in 1904. The proportion of milk samples returned as adulterated during 1914 was below the average. It is, however, to be mentioned that 22 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 15.4 as compared with 19.6 for 1913. 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 1st 127 28 22 2nd 124 28 22.5 3rd 131 32 24.4 4th 174 20 11.5 53 In 47 of the samples water was certified to have been added; in 4 the amount was more and in 43 it was less than 5 per cent., taking the standard of the Board of Agriculture. In 33 the samples showed deficiencies in milk fat; in 16 the deficiency was more, and in 17 it was less than 5 per cent. In 6 instances both fat had been abstracted and water added. One of the samples contained traces of artificial colouring matter. None showed the presence of preservatives. One sample had .02 per cent. of foreign matter present, mainly breadcrumbs. Legal proceedings were instituted in 26 or 24.0 per cent. of the cases in which the samples of milk were below standard, and in 13 of these convictions were obtained. In eight instances the summonses were dismissed, warranties being proved, in three cases the defendants were ordered to pay 23s. costs and in one case two guineas. The summons was dismissed in another instance but the defendant paid 23s. costs. 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 three 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 78 as compared with 77 in 1913, 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 £28, which is equivalent to 3.3 per cent. of the full amount of the penalties to which the defendants were liable as compared with 4.6 per cent, in 1913, 6.9 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 £47 19s. 0d., the average amount paid by the defendants on conviction was £3 13s. 9d., as compared with £2 14s. Id. in 1913, £3 15s. 5d. in 1912, £2 8s. 3d. in 1911, £1 11s. 6d. in 1910, £12 6s. 4d. in 1909, £3 Is. 4d. in 1908, £1 13s. 7d. in 1907, £2 9s. 6d. in 1906, £2 19s. 3d. in 1905, £2 6s. lOd. in 1904, £1 18s. 6d. in 1903, and £2 18s. Id. 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 7 or 5.8 per cent. were not genuine, as compared with 22 per cent. in 1913, 6.7 in 1912, 7.9 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. 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 16 1 6.2 2nd 21 ... ... 3rd 26 4 15.3 4th 56 2 3.5 54 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 five contained water in excess of the 16 per cent. standard. With regard to the first two proceedings were taken ; in one case the defendant was fined £1 Is. Od., with 23s. costs, and in the other £2 Os. Od. with 23s. costs. Proceedings were also taken in respect to two of the samples found to contain excess of water ; in one instance the summons was dismissed, a warranty being proved, and in the second the defendant was fined 7s. with 23s costs. The penalties inflicted amounted to £6 17s. Od., or approximately 3.7 per cent. of the maximum penalties to which the defendants were liable, as compared with 8.5 in 1913, 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 9s. 0d., the amounts defendants were ordered to pay averaged £2 5s. 8d., as compared with £5 Is. 8d. in 1913, £4 18s. Id. in 1912, £8 Is. 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 Is. in 1905, £3 Is. in 1904, £4 10s. in 1903 and £4 10s. in 1902. Three 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 2 of the cases. The other case was withdrawn. The fines amounted to 17s. and £1 5s. Od. costs were allowed the Council. The fines under the Margarine Act amounted to a little over 2.l per cent. of the maximum penalties to which the defendants were liable. Including costs, the amounts paid by defendants averaged £1 Is. Od. as compared with £1 6s. lOd. in 1913, £1 13s. 5d. for 1912, £1 16s. Id. in 1911, 15s. in 1910, £1 12s. 6d. in 1909 and £1 4s. 6d. in 1908. Both of the samples of brawn were found to contain boric acid, in one to the extent of 11.2 grains per lb. and in the other 7 grains per lb. In each case a letter of caution was sent to the vendor. One of the samples of cream was found to contain the equivalent of 22.4 grains of boric acid per lb. No proceedings were taken, but the vendor was cautioned. One of the samples of dripping was found to contain 2'9 per cent, of water; no action was deemed necessary. One of the samples of golden syrup was found to contain glucose syrup to the extent of 35 per cent. Proceedings were taken but the magistrate dismissed the case as he was not satisfied that golden syrup had been asked for when the sample was purchased. 55 Three of the samples of non-alcoholic orange wine were not genuine, two of them containing salicylic acid to the extent of 3.5 and 4.6 grains per pint respectively, and the other 10T5 per cent. by volume of alcohol. In the latter case proceedings were taken and the vendor was fined £2 with £1 3s. 0d. costs. Four of the samples of non-alcoholic raisin wine were not genuine, one containing benzoic acid to the extent of 8.8 grains per pint, another salicylic acid 4.37 grains per pint, a third 11.95 per cent. of alcohol by volume and the fourth salicylic acid to the extent of 105 grains per pint. In the last two cases proceedings were taken and the vendors were fined £2 with 23s. costs and £7 with £5 5s. 0d. costs respectively. Both the samples of ginger wine were found to contain salicylic acid, in one to the extent of 4.53 grains per pint and in the other 3.67 grains. Proceedings were not thought advisable in these cases. Two of the samples of sausage were found to contain boric acid, one (pork) to the extent of 3.5 grains per lb. and the other (beef) to the extent of 4.6 grains. No proceedings were taken. A sample of vinegar was found to contain numerous "vinegar eels," otherwise the rest of the samples were returned as genuine. The subjoined table shows a comparison of the results of the work under the Sale of Food and Drags Acts during the years 1902-14 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 1914 768 143 132 17.1 36 ... 36 21 74 6 0 350 10 0 The percentage of samples found adulterated was again somewhat below the average. With reference to the convictions under the Act during 1914, in 4 instances the defendants had been once, in 3 twice, in 1 three times, in 1 instance four times, and in 1 seven times previously convicted. 56 MILK AND CREAM REGULATIONS, 1912. During the year 556 samples of milk, 5 of cream, and 1 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 the personnel of the staff of the Health Department since my last report. Some 16,895 communications, written and printed, were dispatched from the Office of the Department as compared with 17,602 in 1913, 15,719 in 1912, 16,520 in 1911 and 13,639 in 1910. They included some 4,406 notices and summonses, 2,892 letters, cards and other communications on matters under the Public Health and Sale of Food and Drugs Acts, 632 in connection with work under the Factory and Workshops Acts, 7,995 on various matters relating to infectious disease, verminous cases and disinfection, and 970 agendas and reports concerning the work of the Department. It is to be noted that Inspector Wright was away on active service in France during the latter part of the year, having enlisted in the 1st London Sanitary Company, Territorial Force. The work on his district was undertaken by Inspectors Langstone and Stokes. During February, March, April and May I was unfortunately absent owing to illness, and for the greater part of that period was quite unable to perform any duty. I have again to record my satisfaction as to the work of the Department and my thanks to the Staff for their assistance in connection with my work during the year. I must also take the opportunity of expressing my cordial appreciation of the admirable manner in which Mr. Firth and the other officers of the staff of the department carried on the work during my enforced absence. My thanks are also due to the Chairman and Members of the Health Committee and to the Borough Council for their kind consideration and help in connection with the work of the Department during the year. I have the honour to be, Gentlemen, Your obedient Servant, LEWIS T. ERASER 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 1914; a copy of the Regulations made under Section 17 (7) of the Housing and Town Planning Act, 1909; a copy of a Report on the Proceedings under the Milk and Cream Regulations 1912; the Report of the Tuberculosis Officer; and the Reports of the Health Visitors for the Year. Tables II., III. and IV. are forms required by the Local Government Board. " v ........ ; » - ; ! ~ . \ " ■ 59 TABLE I. Vital Statistics of the Borough of Shoreditch during 1914 and previous Years. year. Population estimated to middle of each Year. Births. Total Deaths Beqistered 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. 1 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 1914 109690 3335 3470 32.0 1952 17.8 337 486 496 143 2101 19.4 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' Number of inhabited houses, 11,535 Average number of persons per house 9.6 At Census of 1911. 60 TABLE II. Cases of infectious disease notified during the Year 1914 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. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Moorfields, Church. Hoxton. Wenlock Whitmore, Kingsland, Haggerston, Acton. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C), Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous group) 217 15 90 89 12 10 1 ... 5 43 34 21 30 30 33 21 206 Erysipelas 197 11 6 15 18 69 56 22 3 42 19 27 48 18 21 19 60 Scarlet Fever 429 6 107 280 27 9 ... ... 12 64 69 77 69 46 46 46 425 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 19 ... 1 5 5 6 2 ... ... 3 4 3 3 9 3 1 18 Relapsing fever (R), Continued fever (C) 1(C) ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Puerperal fever 11 ... ... ... 2 9 ... ... ... 2 ... 3 3 ... 1 2 8 Cerebro-spinal Meningitis 3 ... ... 3 ... ... ... ... ... 1 ... 1 ... ... 1 ... 3 Anthrax 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 Polio-myelitis 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Pulmonary Tuberculosis 478 1 17 46 55 195 135 29 13 78 74 63* 149† 36 31 34 296‡ Other forms of Tuberculosis 126 31 23 46 14 5 6 1 4 16 13 16 44 11 10 12 11‡ Ophthalmia Neonatorum 25 25 ... ... ... ... ... ... ... 5 4 2 8 2 3 1 ... Totals 1,508 89 245 484 134 304 200 52 37 255 217 213 355 145 150 136 1,030 * This Number includes the cases of consumption notified from the Holborn Union Infirmary. Hijjhgate. † This includes the cases of consumption in the Shoreditch Workhouse. ‡ Removed to the Shoreditch Infirmary, Hospitals and Sanatoria. 61 TABLE III. Causes of, and ages at death during the Year 1914 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 1. 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) 2101 496 203 129 100 66 255 471 381 985 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric Fever 2 ... ... 1 ... ... 1 ... ... 2 2 Small-pox ... ... ... ... ... ... ... ... ... ... 3 Measles 107 23 55 28 1 ... ... ... ... 53 4 Scarlet Fever 5 ... 2 1 1 1 ... ... ... ... 5 Whooping-cough 55 22 15 14 4 ... ... ... ... 19 6 Diphtheria and Croup 20 2 6 6 6 ... ... ... ... ... 7 Influenza 25 8 ... ... 2 2 1 7 5 2 8 Erysipelas 8 2 ... ... ... ... 3 ... 3 4 9 Phthisis (Pulmonary Tuberculosis) 229 2 1 2 8 24 104 76 12 136 10 Tuberculous Meningitis 26 4 4 11 5 2 ... ... ... 5 11 Other Tuberculous diseases 49 9 8 9 8 3 6 4 2 14 12 Cancer, malignant disease 105 ... ... ... 1 1 15 59 29 54 13 Rheumatic Fever 8 ... ... ... 2 ... 5 1 ... 5 14 Meningitis (see note (d)) 22 3 4 1 3 2 4 3 2 8 15 Organic Heart Disease 65 ... ... ... 4 5 11 26 19 19 16 Bronchitis 158 31 11 4 ... ... 3 47 62 110 17 Pneumonia (all forms) 235 60 42 29 7 6 24 39 28 66 18 Other diseases of Respiratory organs 17 ... 2 ... 1 ... 2 7 5 5 19 Diarrhoea and Enteritis (see note (e)) 172 113 36 8 3 ... 1 6 5 64 20 Appendicitis and Typhlitis 2 ... ... ... 1 1 ... ... ... 1 21 Cirrhosis of Liver 22 ... ... ... ... ... 3 17 2 17 21a Alcoholism 16 ... ... ... ... ... 5 8 3 24 22 Nephritis and Bright's Disease 56 ... ... 1 2 1 7 25 20 21 23 Puerperal Fever 2 ... ... ... ... ... 2 ... ... 1 24 Other accidents and diseases of Pregnancy and Parturition 8 ... ... ... ... 1 7 ... ... 3 25 Congenital Debility and malformation, including premature birth 131 127 4 ... ... ... ... ... ... 33 26 Violent deaths, excluding suicide 108 32 7 5 19 4 11 16 14 20 27 Suicides 11 ... ... ... ... ... 4 5 2 2 28 Other defined diseases 433 56 5 "9 22 13 36 124 168 297 29 Diseases ill-defined or unknown 4 2 1 ... ... ... ... 1 ... ... 2101 496 203 129 100 66 255 471 381 985 62 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH during the year 1914. 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 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths nnder 1 Year. All causes Certified 76 21 16 14 127 95 124 83 67 496 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 ... 6 16 23 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... 1 1 4 7 5 5 22 Diphtheria and Croup ... ... ... ... ... 2 ... ... ... 2 Erysipelas ... ... ... 1 1 ... 1 ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... 1 1 2 4 Abdominal Tuberculosis (b) ... ... ... ... ... ... 2 2 1 5 Other Tuberculous Diseases ... ... ... ... ... ... 4 ... 2 6 Meningitis (not Tuberculous) ... ... ... ... ... 1 1 1 ... 3 Convulsions ... 4 1 ... 10 2 1 2 ... 15 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 2 1 4 9 10 ... ... 31 Pneumonia (all forms) ... ... 1 ... 1 14 13 19 13 60 Diarrhœa ... ... 1 1 3 13 35 15 16 82 Enteritis ... 1 ... 2 3 7 12 5 4 31 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... 1 1 3 3 3 1 11 Rickets ... ... ... ... ... ... ... 2 ... 2 Suffocation, overlying 3 1 3 ... 7 12 7 1 ... 27 Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 3 ... ... ... 3 1 ... ... ... 4 Congenital Malformations (c) 3 3 ... 1 7 2 3 ... ... 12 Premature birth 50 3 5 3 61 5 3 ... ... 69 Atrophy, Debility and Marasmus 4 3 2 1 10 12 15 8 1 46 Other causes 5 5 1 2 13 7 6 5 6 37 76 21 16 14 127 95 124 83 67 496 63 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.) 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. 64 65 TABLE Y. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1914. 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. Moor fields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 1 Small Pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 23 83 1 ... ... ... ... ... ... ... ... ... ... 2 35 20 12 16 11 8 3 56 51 107 3 Scarlet fever ... 3 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 1 3 2 5 4 Typhus fever ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza 8 1 1 1 1 ... 1 2 5 3 2 ... ... ... 2 4 17 1 ... 1 15 10 25 6 Whooping cough 22 29 4 ... ... ... ... ... ... ... ... ... ... 4 8 9 5 14 9 4 2 26 29 55 7 Diphtheria,membranous croup 2 12 5 1 ... ... ... ... ... ... ... ... ... 1 4 7 2 1 2 3 7 13 20 8 Enteric fever ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 1 2 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 37 15 1 ... ... ... ... 1 1 2 ... 1 ... 2 11 13 6 18 1 5 2 32 26 58 11 Epidemic or zymotic enteritis 45 20 1 ... ... ... ... ... ... 1 ... 1 ... 1 16 7 8 14 9 9 4 31 37 68 12 Other allied diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 11 ... ... ... ... ... ... ... ... ... 1 ... ... ... 4 2 1 3 .. . ... ... 9 3 12 19 Gonorrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedœna, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas 2 ... ... ... ... ... 2 1 ... ... 3 ... ... 1 1 2 2 1 ... ... ... 3 5 8 22 Puerperal fever ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 23 Pyæmia, septicaemia 3 1 2 1 2 1 1 2 1 3 1 ... ... ... 1 3 ... 5 3 4 2 12 6 18 24 Infective endocarditis ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 25 Other allied diseases ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 1 3 ... 3 26 Malarial fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Rheumatic fever ... ... ... 2 ... ... 3 2 ... 1 ... ... ... ... 1 1 1 ... 1 1 4 4 8 28 Rheumatism of the heart 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 2 Tuberculosis: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 29 Brain or meninges, acute hydrocephalus 4 15 4 1 1 1 ... ... ... ... ... ... ... ... 5 7 2 4 3 1 4 16 10 26 30 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Lungs 2 3 4 4 12 12 44 60 43 33 12 ... ... 12 26 48 22 49 26 25 21 150 79 223 32 Intestines, tabes mesenterica 5 10 1 1 1 2 1 1 ... ... ... 5 ... 4 4 2 4 3 9 13 22 33 General, position undefined 3 7 1 2 1 2 ... ... ... ... ... ... 1 3 0 3 3 2 ... 2 7 9 16 34 Other forms, scrofula 1 ... 2 2 ... 1 1 2 1 ... ... 1 ... 2 2 1 1 2 1 ... 2 4 7 11 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 ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... 2 ... 1 ... ... ... 2 1 3 66 67 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 ... ... ... ... ... ... 1 4 6 ... 2 ... ... ... 3 2 2 2 1 2 1 5 8 13 43 Chronic industrial poisonings ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 Gout ... ... . . . ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 1 47 Cancer ... ... ... ... ... ... 1 11 29 27 19 3 ... 4 7 24 11 15 9 5 16 47 44 91 48 Diabetes mellitus ... ... ... ... ... ... 1 1 1 1 1 1 ... ... 1 1 1 2 ... 1 ... 2 4 6 49 Purpura hæmorrhagica 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 50 Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anæmia, leucocythæmia ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 53 Premature birth 69 ... ... ... ... ... ... ... ... ... ... ... ... 1 14 12 11 8 10 5 8 45 24 69 54 Injury at birth 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 2 55 Debility at birth 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 56 Atelectasis 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 ... 3 1 4 57 Congenital defects 12 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 4 4 3 4 9 13 58 Want of breast milk 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 59 Atrophy, debility, marasmus 45 3 ... ... ... ... ... ... ... ... ... ... ... ... 15 12 4 4 3 2 8 29 19 48 60 Dentition 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 2 2 4 61 Rickets 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 ... 2 62 Old Age, senile decay ... ... ... ... ... ... ... ... ... 3 9 44 20 5 5 10 9 19 4 10 14 27 49 76 63 Convulsions 15 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 3 4 1 3 2 12 4 16 64 Meningitis 3 4 1 2 1 2 2 2 1 2 ... ... ... 4 1 3 4 2 5 1 8 12 20 65 Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 66 Apoplexy ... ... ... ... ... ... 2 5 18 24 23 12 1 2 10 16 16 19 6 7 9 42 43 85 67 Softening of brain ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... 1 ... ... ... 2 2 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... 1 ... 2 ... 1 1 ... 1 1 ... 1 ... ... 3 1 4 69 General Paralysis of insane ... ... ... ... 1 ... ... 3 7 2 ... 1 ... ... 6 3 2 1 1 1 ... 13 1 14 70 Other forms of insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Chorea ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 72 Cerebral tumour ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 2 73 Epilepsy 1 ... ... 1 ... 1 ... ... ... 1 1 1 ... 1 1 ... 1 2 ... ... 1 3 3 6 74 Laryngismus Stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 75 Locomotor Ataxy ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... 1 ... ... 1 ... 1 3 ... 3 76 Paraplegia, diseases of spinal cord ... ... ... ... ... 1 1 ... 2 1 2 ... ... 1 2 1 ... 2 ... ... 1 2 5 7 77 Other diseases of brain or nervous system ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... 2 2 78 Otitis, otorrhœa 4 1 1 2 ... ... ... ... ... 1 ... ... ... ... 3 2 ... ... 1 2 1 5 4 9 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... 1 1 ... ... 1 ... ... ... 1 ... 1 ... ... 1 1 1 ... 1 ... 1 3 2 5 82 Endocarditis, valvular diseases of the heart ... ... 2 2 3 2 5 6 14 12 16 3 ... ... 11 11 7 13 11 7 2 31 34 65 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 1 85 Aneurism ... ... ... ... ... ... ... ... 4 3 2 ... ... ... ... 2 2 2 1 ... 1 8 1 9 86 Senile gangrene ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and, circulatory system, including heart disease not stated to be valvular ... 1 3 6 1 1 5 5 13 20 25 8 1 4 11 16 14 17 9 6 12 42 47 89 68 69 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 5. 5 to 10. 10 to J 5. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 94 Acute bronchitis 31 15 ... ... ... ... ... ... 1 3 2 4 1 8 9 8 22 2 1 7 25 32 57 95 Chronic bronchitis ... ... ... ... ... ... ... 3 18 25 31 20 4 2 15 11 19 26 8 9 11 59 42 101 96 Lobar, croupous-pneumonia ... 4 ... 1 1 ... 3 6 6 5 2 2 ... ... 6 5 10 3 3 2 1 16 14 30 97 Lobular, broncho-pneumonia 51 53 2 2 ... 2 1 7 4 8 1 2 2 36 22 18 20 9 15 11 73 60 133 98 Pneumonia, form not stated 9 14 2 2 2 1 6 6 8 9 11 1 1 4 16 12 11 13 4 3 9 38 34 72 99 Emphysema, asthma ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 100 Pleurisy ... ... 1 ... ... ... ... 1 1 2 1 2 ... ... 1 1 2 2 ... ... 2 4 4 8 101 Other and ill-defined diseases of respiratory system ... 2 ... ... ... ... ... 1 1 2 2 ... 1 1 1 2 1 ... ... 2 2 6 8 102 Diseases of mouth and annexa 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 2 103 Diseases of pharynx ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... ... 1 2 3 3 ... ... ... ... 2 1 1 3 1 1 7 2 9 106 Other diseases of stomach 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 107 Enteritis 31 9 1 ... ... ... ... ... ... 2 1 ... ... 2 3 8 9 13 1 4 6 30 16 46 108 Appendicitis ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 1 2 109 Obstruction of intestine 2 2 l 1 ... ... ... ... ... 2 ... ... ... ... 1 3 ... 2 1 ... 1 5 3 8 110 Other diseases of intestine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 111 Cirrhosis of liver ... ... ... ... ... ... ... 3 7 10 2 ... ... 1 3 1 3 9 1 ... 4 7 15 22 112 Other diseases of liver ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 2 113 Peritonitis 1 ... ... ... ... •.. 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 2 ... 2 114 Other and ill-defined diseases of digestive system ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 115 Diseases of Lymphatic System and ductless glands ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 116 Acute nephritis.. ... 1 l ... ... ... ... ... ... ... 2 ... ... ... ... 1 1 1 ... ... 1 3 1 4 117 Bright's disease ... ... l ... ... 1 2 5 9 16 13 5 ... 3 11 6 7 9 6 4 6 25 27 52 118 Calculus ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... 2 1 ... ... ... ... 3 ... 3 119 Diseases of bladder and prostate ... ... ... 1 2 2 1 1 1 1 1 ... ... 4 1 5 120 Other and ill-defined diseases of urinary system ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 2 121 Diseases of testis and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 1 123 Diseases of uterus and appendages ... ... ... ... ... l ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 2 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 2 129 Placenta prævia, flooding ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 2 130 Puerperal thrombosis . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... l ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 2 132 Arthritis, ostitis, periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 70 71 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. Ac on. Male. Female. 134 Ulcer, bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 Pemphigus 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... 1 ... 1 ... 1 137 Other and ill-defined diseases of integumentary system ... l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 By Accident or Negligence. 138 In mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In vehicular traffic 1 6 2 1 2 1 1 1 3 1 1 2 2 2 3 13 2 15 140 On railways ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 141 On vessels and docks, excluding drowning. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 142 In building operations ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 143 By machinery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 144 By weapons and implements ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 145 Burns and scalds ... 2 ... ... ... ... ... 1 ... ... 2 ... ... ... ... 2 2 ... ... ... 1 3 4 7 146 Poisons, poisonous vapours ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... 1 1 1 ... ... ... 1 2 3 147 Surgical narcosis ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 2 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 150 Drowning ... 1 3 ... ... ... ... 1 ... ... ... ... ... ... 1 1 2 1 ... 1 1 5 2 7 151 Suffocation, overlaid in bed 27 ... ... ... ... ... ... ... ... ... ... ... ... 1 5 6 3 7 ... 3 2 14 13 27 152 Suffocation otherwise 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 1 2 153 Falls, not specified 2 6 1 ... ... ... ... 3 3 7 2 ... ... 1 5 4 10 9 ... 1 1 20 13 33 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 155 Otherwise, and not stated ... 2 1 ... 1 ... ... ... ... 2 1 ... ... ... 2 1 1 ... 1 1 1 5 2 7 156 Homicide 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 1 2 Suicides, all forms. 157 By poison ... ... ... ... ... ... 1 1 ... 1 ... 1 ... 1 1 ... 1 ... ... 1 ... 4 ... 4 158 By asphyxia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 159 By hanging and strangulation ... ... ... ... ... ... ... 1 2 1 1 ... ... ... 2 1 1 ... 1 5 ... 5 160 By drowning ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 161 By shooting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 162 By cut or stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 163 By precipitation from elevated places ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 2 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 1 1 ... 3 1 4 169 Malignant disease ... ... ... 1 1 ... 1 2 1 2 3 3 ... 2 2 1 2 2 2 1 2 9 5 14 170 Abscess ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 171 Cerebro Spinal Fever ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 9 2 Total 496 332 59 41 40 26 103 152 226 245 218 129 34 77 356 355 290 433 192 189 209 1140 961 2101 72 TABLE VI.— ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1914. DISTRICTS. Estimated population 1914. ANNUAL RATE PEE 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS DEATHS DURING THE YEARS: DEATHS DURING 1914 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Lough. 'Fever. 'I t Diarrhoea. 1 Tuberculous Disease. Violence. 1911. 1912. 1913. 1914. London 1,518,021 24.3 15.8 13.6 14.2 14.4 ... ... 0.31 0.07 0.16 0.20 0.03 0.67 1.7 0.60 104 10.3 45.7 0.08 Shoreditch ‡ 108,362 32.0 20.2 18.3 18.4 19.4 3.2 ... 0.98 0.04 0.18 0.50 0.02 1.50 2.8 1.1 143 17.4 52.8 ... Wards. Moor fields 4,582 20.0 14.6 13.5 13.3 16.9 2.4 ... 0.44 ... 0.22 0.88 ... 0.66 3.2 0.9 99 15.5 42.8 ... Church 18,618 31.3 21.7 20.1 21.1 19.1 4.1 ... 1.88 ... 0.21 0.43 0.10 1.45 2.2 1.1 187 17.7 56.4 ... Hoxton 16,214 34.9 19.1 18.5 22.5 21.9 3.9 ... 1.23 ... 0.43 0.55 ... 1.23 3.5 1.1 152 16.3 51.8 ... Wenlock + 16,015 32.9 16.2 19T 16.1 I8T 2.6 ... 0.75 0.06 0.12 0.30 ... 0.87 1.9 1.5 121 21.0 45.8 ... Whitmore § 18,816 32.9 27.5 22.0 19.9 23.0 3.9 ... 0.>5 ... 0.05 0.74 ... 1.70 3.2 1.2 163 18.7 561 ... Kingsand 10,670 35.3 20.1 16'3 17.0 17.9 3.2 ... 1.03 ... 0.18 0.84 0.09 0.99 3.1 0.8 114 15.1 52.0 ... Haggerston 1.1,137 30.3 18.3 14.5 16.2 16.9 3.1 ... 0.71 0.27 0.27 036 ... 1.26 2.6 0.8 136 20.1 60.3 ... Acton 12,360 30.8 19.5 161 14.2 16.9 1.2 ... 0.24 0.08 ... 0T6 ... 0.48 2.5 0.8 105 12.4 46.4 ... * Fever includes typhus, typhoid and continued fevers, † Diarrhoea in this table includes enteritis in children under two years. ‡ The inhabitants of the Holborn Union Workhouse, which is situate in Wenlock Ward, and the deaths occurring in that institution are excluded. § 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. This Ward is therefore probably credited with some deaths belonging to other Wards. 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, 1914. Diseases. Diseases. All cause 5,190 37 Atelectasis ... 38 Congenital malformation. ... 39 Old age 199 1 Smallpox ... 40 Apoplexy 6 2 Measles 267 41 Epilepsy 85 3 Scarlet Fever 11 42 Convulsions 1 4 Typhus ... 43 Other diseases of brain and nervous system 238 5 Relapsing fever ... 6 Influenza 70 7 Whooping Cough 100 44 Diseases of organs of special sense 39 8 Diphtheria 3 9 Simple, continued and illdefined fever 15 45 Diseases of circulatory system 191 46 Laryngitis 13 10 Enteric fever ... 11 Simple cholera ... 47 Bronchitis 1,303 12 Diarrhoea, dysentery 101 48 Pneumonia 93 13 Remittent fever ... 49 Pleurisy 29 14 Hydrophobia ... 50 Other respiratory diseases. 24 15 Glanders ... 51 Dentition 14 16 Cow pox and Effects of vaccination ... 52 Quinsy, sore throat 39 53 Enteritis 111 17 Venereal affections 39 54 Peritonitis 3 18 Erysipelas 23 55 Diseases of liver 9 19 Pyaemia and septicaemia 7 56 Other diseases of digestive system 334 20 Puerperal fever 2 21 Tabes mesenterica 2 22 Tuberculous meningitis 1 57 Diseases of lymphatic system and ductless glands 18 23 Phthisis 264 24 Scrofula, tuberculosis 46 25 Other zymotic diseases 45 58 Diseases of urinary system 57 59 Diseases of the generative system 38 26 Thrush 1 27 Worms and other parasitic diseases 2 60 Accidents of childbirth 23 61 Diseases of locomotive system 153 28 Starvation, want of breastmilk ... 62 Diseases of integumentary system 177 29 Alcoholism 8 63 Fracture and contusion 41 30 Rheumatic fever and rheumatism of heart 21 64 Gun shot wounds • • • 65 Cut, stab 1 31 Rheumatism 378 66 Burns or scalds 20 32 Gout 91 67 Poison 2 33 Rickets 4 68 Drowning ... 34 Cancer 21 69 Suffocation ... 35 Other constitutional diseases 32 70 Otherwise 45 36 Premature birth 1 71 Other causes 327 74 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1914. Table VIII. premises. number of places— Number of inspections, 1914. Number of notices, 1911. Number of prosecutions, 1914. On register at end of 1913. Added in 1914. Removed in 1914. On register at end of 1914. Milk premises 290 23 20 293 2741 29 ... Cowsheds. 7 ... 1 6 57 1 ... Slaughter-houses. 5 ... ... 5 30 .... ... Other offensive trade premises 1 ... ... 1 1 ... ... Ice Cream premises 98 2 19 81 177 22 ... Registered houses let in lodgings 280 ... ... 280 380 184 ... Number of intimation notices served for all purposes 4606 Overcrowding:— Number of dwelling rooms overcrowded 256 Number remedied 256 Number of prosecutions Nil. Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 395 Underground rooms :— Number dealt with during year 12 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 42 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 1 Number of prosecutions under By-laws under Public Health (London) Act, 1891:— With respect to water closets, earth closets, etc3 Mortuary:— Total number of bodies removed 501 Total number of infectious bodies removed 2 75 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Table IX.— Summary of Notifications during the Period from the 4th January, 1914, to the 2nd January, 1915, in the Metropolitan Borough of Shoreditch. Age-periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. 0 to 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 and upwards. Total Primary Notifications. Total Notifications on Form A. Under 5. 5 to 10. 10 to 15. Total Primary Notifications. Pulmonary, Males I 4 9 12 12 8 47 68 57 27 10 255 354 ... 2 ... 2 2 146 61 „ Females ... 13 12 11 12 23 39 41 29 22 19 221 300 ... ... ... ... 1 64 25 Non-Pulmonary, Males. 21 10 .11 9 6 3 2 1 3 2 ... 68 76 ... 4 1 5 5 7 2 „ Females 10 13 11 10 3 2 2 ... ... 1 1 53 61 ... ... ... ... ... 2 ... Cols. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (I8) (19) (20) (21) Patients notified as suffering from both pulmonary and non-pulmonary disease are included in the " pulmonary " returns. Primary Notifications relate to patients who have not previously been notified in this or former years, either on Form A or on Form B, in Shoreditch. A School Medical Inspector is required to notify on Form B all cases of tuberculosis discovered in the course of inspection of children attending public elementary schools whether or not these have been previously notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A, and which have never previously been notified in Shoreditch, either on Form A or on Form B, are included in these returns. Col. 14. All notifications on Form A, whether duplicate or not, are included in this column. Cols. 15-18. Only those cases which have been notified for the first time during the year on Form B, and which have never previously been notified in Shoreditch, either on Form A or on Form B, are included in these columns. Col. 19. All notifications which have been made during the year on Form B in the area concerned, whether the cases have previously been notified in the area or not, either on Form A or on Form B, are included in this column. Col. 21. Only notifications on Form C, made by the medical officers of sanatoria, as defined in the Tuberculosis Regulations, are included in this column. 76 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK DURING THE YEAR 1914. 1.—Inspection Inspection made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries.) 500 25 — Workshops (Including Workshop Laundries and Bakehouses.) 3365 353 — Workplaces (Excluding Outworkers' premises dealt with in Table 3.) 823 117 — Total 4688 495 — 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 174 174 – – Want of ventilation 4 4 – – Overcrowding 2 2 – – Want of drainage of floors – – – – Other nuisances 498 498 – – Sanitary accommodation 'insufficient 3 3 – – unsuitable or defective 211 211 – – not separate for sexes 13 13 – – 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 905 905 – – * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 3. Home Work—1914. 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. Outworkers. Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) 04) (15) (16) Wearing Apparel : (1) Making, &c. 70 102 956 2 ... 88 ... ... ... 98 99 ... 6 ... ... (2) Cleaning & washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 2 ... 7 ... ... ... ... ... ... 2 2 ... ... ... ... Artificial flowers 2 ... 10 1 ... 6 ... ... ... 6 7 ... 2 ... ... Fur pulling 2 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... Paper bags and boxes 24 ... 414 4 ... 16 ... ... ... 40 41 ... 4 ... ... Brush making ... ... ... ... ... ... ... ... ... 5 5 ... 2 ... ... Total 100 102 1,392 7 ... 110 ... ... ... 153 156 ... 14 ... ... 77 (a) There were no names and addresses of outworkers received in respect to the following classes of work : Sacks, basket making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors and grapnels, cart gear, locks, latches and keys, pea picking, household linen, lace, lace curtains and nets, curtains and furniture hangings, brass and brass articles, tents, feather sorting, and carding, &c., of buttons. (b) The figures in columns 2, 3, and 4 are the total number of lists received from employers who sent them both for February and August, and of the entries of names of outworkers in those lists. They are therefore double the number of employers and approximately double the number of individual outworkers whose names are given, since in the February and August lists of the same employers, the same outworker's name will often be repeated. (c) There were no prosecutions, but letters were sent to employers in 7 instances of failure to send lists of outworkers employed in making wearing apparel, &c., in 8 instances for similar failures in respect to paper bag and box making, and in 3 instances in respect to artificial flowers. 78 4.—Registered Workshops—1914. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) (1) Furniture, woodwork, fitting and other branches of the 803 furniture trades. (a) Cabinet making 521 (b) French Polishing 80 (c) Upholstery 55 (d) Other workers 147 (2) Dress 230 (a) Tailoring 95 (e) Shirt making 15 (b) Mantles 9 (f) Boot & Shoe trades 31 (c) Dress 26 (g) Artificial flowers 9 (d) Millinery 18 (h) Other workers 27 (3) Skin, leather, hair and feather trades 63 (a) Furriers 7 (b) Saddlery & Harness 26 (c) Feathers 2 (d) Other workers 28 (4) Paper, printing, book, stationery and fancy goods trades 57 (a) Box & bag makers 44 (b) Other workers 13 (5) Laundry and Washing 31 (6) Food (7) Metals, machines, implements and conveyances 39 (8) Precious metals, jewels, &c. 1 (9) Other trades than those mentioned above 57 Total number of workshops on Register 1,281 Note.—a separate register is kept for bakehouses, the number of which in use at the end of the year was 65, including 4 factory bakehouses. 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshops Act (s. 133) Nil. Action taken in 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 23 39 workshops & 3 factories. Reports (of action taken) sent to H.M. Inspector. referring to 6 39 workshops & 3 factories. Other Nil. Underground Bakehouses (s. 101) :— Certificates granted during the year Nil. In use at the end of the year 38 6. Shewing the Numbers of Outworkers Received from other Districts during 1914. DISTRICT. Making Wearing Cleaning and. Lace Curtains. Artificial Flowers. Furniture and Upholsterv Fur Pulling. Feather Sorting. Umbrellas, &c. paper Bags and Boxes. Brush Making. Tents. Dolls and Toys. Total. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Bermondsey 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Battersea ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Bethnal Green 40 31 ... ... ... ... ... 1 2 5 ... 7 1 7 ... ... 24 29 17 19 ... ... ... ... 183 Camberwell 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 City of London 434 426 ... ... ... ... 20 28 ... ... 9 7 11 7 33 39 1 4 ... ... ... ... ... ... 1019 Chelsea 4 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Deptford 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Entield 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Finsbury 83 74 ... ... 1 ... 13 2 5 ... 1 5 6 6 1 2 85 64 6 6 ... ... ... ... 360 Hackney 159 157 ... ... 1 ... 7 25 ... 8 1 5 2 ... 2 3 32 31 25 34 ... ... ... 2 494 Hampstead 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Holborn 4 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Hornsey 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ilford ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Islington 30 74 ... ... 2 ... ... 4 ... 3 ... ... ... ... ... ... 18 20 2 ... ... ... ... ... 153 Kensington 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Lambeth 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Leyton ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 7 ... ... ... ... ... ... 1 Poplar 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Southwark 4 3 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 St. Marylebone 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 St. Pancras 1 1 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Stepney 22 21 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 45 Stoke Newington 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Tottenham 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Wandsworth 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Westminster 14 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 West Ham 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Total 823 829 2 2 4 ... 40 60 8 21 11 25 20 20 36 44 166 156 50 59 ... ... ... 2 2378 1652 4 4 100 29 36 40 80 322 109 ... 2 79 80 METROPOLITAN BOROUGH OF SHOREDITCH. MILK AND CREAM REGULATIONS, 1912. Report for the year ended 31st December, 1914. 1. Milk, and Cream not sold as Preserved Cream. — (a) (b) Number of samples amined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 556 Nil. Cream 5 1 2. Cream sold as Preserved Cream. (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 1 (ii) Statements incorrect — 1 (b) Determinations made of milk fat in cream sold as preserved cream. (i) Above 35 per cent. Nil. (ii) Below 35 per cent. Nil. (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. LEWIS T. FRASER BRYETT, Medical Officer of Health. 81 METROPOLITAN BOROUGH OF SHOREDITCH. HOUSING, TOWN PLANNING, Etc., ACT, 1009. Regulations. Prescribed by the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch, under section 17 (7) of the Housing, Town Planning, &c., Act, 1909. Every room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, shall comply with the following regulations, namely:— 1. The sub-soil of the site of the room shall be effectually drained by means of a sub-soil drain properly trapped and ventilated wherever the dampness of the siie renders such a precaution necessary. 2. Every drain passing under the room, other than a drain for the drainage of the sub-soil of the site of the room, shall be gastight and watertight. 3. The room shall be effectually protected against the rising of any effluvium or exhalation by means of a layer of asphalt or of good concrete at least six inches thick, or four inches thick if properly grouted laid upon the ground of the site of the entire room or in some equally effectual manner. 4. The space if any beneath the floor of the room shall be provided with adequafe means of ventilation. 5. (i) Every wall of the room shall be provided with a proper horizontal damp-proof course, which if the floor of the room be formed of woodwork, shall be beneath the level of the lowest timbers or woodwork of such floor, and in every other case shall be not less than one inch below the level of the upper surface of such floor, (ii) No part of any wall of the room shall where it is practicable to avoid it, be in contact with the ground or earth. Provided that where any wall of the room is in contact with the ground or earth, such wall or such part thereof as is so in contact shall unless constructed as a hollow wall have an efficient vertical damp-proof course extending from the base thereof to a height of at least six inches above the surface of such ground or earth. 6. Unless the room is provided with a fireplace and a flue properly constructed and properly connected with such fireplace it shall be provided with special and adequate means of ventilation by one or more suitably placed apertures or air shafts. 7. An area or open space properly paved with impervious material and effectually drained by means of a properly trapped gulley shall (513) F 82 adjoin the room and extend either throughout the entire length of one side thereof, or at least throughout the entire width of any window or windows required by these regulations, and (except where the area of such window or windows shall be of not less extent than one-seventh of the floor area of the room) for three feet on both sides of such window or windows. Such area or open space shall be not less than two feet wide in every part thereof and shall be open upwards from a level three inches below the level of the damp-proof course in the adjoining wall of the room. Provided (a) that where a bay window in the room having side lights overlooks such area the width thereof in front of such window may be one foot at the least, and (b) that any steps necessary for access to any part of the building comprising the room may be placed in or over such area if they are so placed as not to be over or across any window of the room required by the regulation in that behalf. 8. (i) The room shall be effectually lighted by means of one or more windows opening directly into the external air. (ii) Every such window shall be so constructed that one-half at the least may be opened and that the opening may extend to the top of the window. (iii) The total area of such window or windows, clear of the sash frames, shall be equal at the least to one-eighth of the floor area of the room and a portion of such total area equal in extent to at least one-tentli of such floor area shall be so situated that a line making an angle of thirty degrees with a horizontal plane can be drawn upwards from any point thereon in a vertical plane at right angles to the plane of the window so as not to intersect within a distance of ten feet measured horizontally from the window any wall of any area adjoining the room or any other wall or any kerb or other obstruction except an open fence. For the purposes of this paragraph a bay window having side lights shall be assumed to be equivalent to a flat window of the same area and of the same height in relation to the room and situated at a distance from the outside area wall equal to the mean width of the area. (iv.) In estimating the area of a window or windows for the purpose of this regulation no account shall be taken of any part of any such window which is above the mean level of the ceiling of the room. (v.) Any such window or windows shall overlook the area or open space provided in pursuance of the regulation in that behalf. 83 In pursuance of a resolution passed by the Local Authority at their meeting on the Seventh day of January, One Thousand Nine Hundred and Thirteen, the Common Seal of the Council of the Metropolitan Borough of Shoreditch, was hereunto affixed this Twenty-seventh day of January, One Thousand Nine Hundred and Thirteen, in the presence of Seal of the Borough V Council. S. G. PORTER, Chairman of the Finance Committee. J. A. D. MILNE, Town Cleric. The consent of the Local Government Board is hereby given to the foregoing regulations this Thirteenth day of March, 1913. H. C. MONRO, Secretary. Acting on behalf of the said Board under the authority of their General Order, dated the Twenty-sixth day of May, 1877. Seal of the Local Government Board. (513) F 2 84 TUBERCULOSIS DISPENSARY. Report for 1914. Lttton Maitland, M.D. Lond,, D.P.H. Camb., Tuberculosis Officer. Royal Hospital for Diseases of the Chest, City Road, London, E.C. February, 1915. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, In the absence of Dr. Maitland on sick leave, I beg to submit the following Report:— The Tuberculosis Dispensary in connection with the Royal Hospital for Diseases of the Chest has now been established for over two years and is in full working order. For the first 12 months after the establishment of the Dispensary at the Hospital, tuberculosis patients were treated indiscriminately from all the surrounding boroughs, and were also advised as to the precautions to be taken to prevent the spread of infection. As the result of negotiations between the Hospital and the Borough Council of Shoreditch it was decided that the Prevention of Consumption Department should act as the special Tuberculosis Dispensary for the Borough—an arrangement which immediately received the approval of the Local Government Board, and came into operation on April 1st, 1913. A joint Dispensary Committee was appointed consisting of an equal number of representatives from the Borough Council and the Hospital, and to which all matters connected with the management of the Dispensary are referred for decision. The Chairman of the Hospital— Mr. De La Rue—was appointed Chairman of the Committee, and the Medical Officer of Health—Dr. Bryett—Yice-Chairman. The members of the Committee have worked together most harmoniously, and the meetings have been animated by a common desire to enhance the usefulness and value of the Dispensary to the inhabitants of the Borough. Since this department has acted as the special Dispensary for Shoreditch the proportion of patients for the various boroughs has considerably altered. Thus, while in 1913, 68 per cent. of the cases (2,918 out of 4,290 total attendances) came from Shoreditch, in 1914, 88 per cent. (3,806 out of 4,497 total attendances) belonged to this Borough. The Tuberculosis Officer and Visiting Sister are for the purposes of Articles XI. and XII. of the Public Health (Tuberculosis) Regulations, 1912, officers of the Borough Council. They act in close co-operation with the Medical Officer of 85 Health. While a certain proportion of patients from other boroughs are attended to at the Dispensary, the Tuberculosis Officer and Visiting Nurse have confined their visits entirely to the Borough of Shoreditch. This accounts largely for the fall in attendance from other boroughs (791 in 1914 as against 1,242 in 1913), and for the increased attendances from Shoreditch (3,806 as against 2,948 in 1913). Tuberculous patients are apt to neglect coming to the Dispensary if they are not looked up now and again, and it is part of the Visiting Nurse's duty to visit periodically each patient whose name is in the books, and in this way the Dispensary officers keep in close touch with all the patients and acquire an intimate knowledge of their home conditions. The objects of a Tuberculosis Dispensary are two-fold—(a) the diagnosis and treatment of consumption, and (b) the prevention of the disease. With both objects in view we endeavour to persuade members of the patient's family—the "contacts"—to come to this Dispensary for examination, and in carrying out this work we receive great assistance from the Health Visitors connected with the Town Hall. During the year 1914, 320 " contacts," mostly children, were examined at the Dispensary. Of this number 33 were found to be suffering from tuberculosis, while 102 exhibited suspicious symptoms and are being kept under observation. The periodic examination of these " suspects " is a most important part of the work of the Tuberculosis Officer. The homes of patients suffering from tuberculosis are visited not only by the nurse but when possible by the Tuberculosis Officer also, and advice and instruction are given as to the management of the case, the importance of fresh air, disinfection, &c., &c. If any insanitary conditions are found the Medical Officer of Health is communicated with so that the defects may be remedied. The means employed for the prevention of consumption beyond the giving of advice and instruction to the patients at the dispensary and in their homes must necessarily remain in the hands of the Medical Officer of Health, as the prevention of disease is the work of the Health Department of the Borough. With a view to the early diagnosis and to some extent also to the prevention of disease, the Medical Officer of Health in response to a request from the Dispensary Committee at their November meeting agreed to send to the Tuberculosis Officer a weekly list of the names of all patients notified to him by local practitioners and medical officers of other institutions, as suffering from tuberculosis. The first list came on the 21st November, 1914, and since then a list has been sent from the Town Hall each week. On receipt of this list a letter is sent to those Medical Practitioners who have notified the cases, suggesting to them that the Visiting Nurse of this Department should visit the houses of these patients, 86 and endeavour to persuade the other inmates to come to this Dispensary for examination. Appreciative replies have been received from the doctors, who have unanimously shewn themselves anxious to help in the fight against consumption in the Borough. As a result a great many "contacts" have already been examined, and cases discovered which would otherwise have escaped observation. Two members of the Honorary Staff—Dr. Murray Leslie and Dr. Arthur Phear—are available for consultation on the afternoons when the department is open, and are always consulted by the Tuberculosis Officer in regard to diagnosis and treatment. The X-ray and other special departments of the hospital are open to the Tuberculosis Officer, and the advantages the patients derive from the fact that the Dispensary is situated in a hospital are inestimable. After-care. During the early part of the year an attempt was made to bring the work of the Department under the notice of the various charitable agencies at work in the district. Frequent meetings were held in the Tuberculosis Officer's Consulting Room, and Cases which were regarded as being in need of assistance were brought forward by the Medical Officer of this Department. In this way the Medical Officer and the Tuberculosis Nurse were able to avail themselves of the co-operation of the workers connected with the various charitable institutions. The series of meetings were interrupted during the summer vacation and, owing to the regrettable absence of Dr. Maitland, the Medical Officer of this Department, on sick leave, they have not yet been resumed. The fight against tuberculosis, as most people are aware, is necessarily a protracted and very arduous one, and some of the pressing difficulties may be mentioned. (1.) Patients in whom the disease is too advanced for admission to Hospital or Sanatorium. These patients often act as a source of infection to those persons with whom they come in contact, and at present, apart from the usual precautionary measures, we have no remedy except to persuade them to go into an infirmary. Suitable isolation homes for advanced cases not too far away from their families would be a great boon to the community. (2.) Patients returning from Hospital or Sanatorium with the disease improved or arrested. Most of these return to their usual work. A great many are, however> quite unfit for their former employment, but have to go back to it as they are unable to secure a new occupation at anything like a living wage. In consequence, a recrudescence of the disease in an aggravated and often incurable form is but too often the result. 87 After-care organizations are a crying need for this class of patient, and should be in every district. The task of such an organization is often an uphill and difficult one, and individual workers must not only have practical knowledge, but must be sustained by enthusiasm. The beneficial results however, will amply repay them for their noble efforts in the fight against poverty and disease. Some attempt must be made to co-ordinate all the agencies that can be brought to bear upon the patient and his environment in order that the maximum amount of good may be accomplished. It may be useful here to enumerate some of the principal headings included under the term of after-care :— 1. Remedying of sanitary or other defects in the house. 2. The provision of adequate treatment for the patient and extra nourishment when required. 3. Improvement of the patient's domestic environment. 4. The finding of suitable work for the patient under improved conditions, either at his old occupation or at a new one, with sufficient remuneration. STATISTICAL REPORT. 1913. New cases 413 Total attendances 2,948 Visits paid to homes 1,205 1914. New cases 588 Total attendances3,806 Visits paid to homes 2,720 Table showing the various channels through which the patients came to attend the Dispensary:— Town Hall (Health Visitors, &c.) 89 Royal Hospital for Diseases of the Chest 73 Medical Practitioners 44 School Doctors, &c. 33 " Contacts " 304 London Insurance Committee 5 Other agencies ... 40 Total 588 Attendance in the Special Departments. X-ray examination 108 Treatment in Dental Department 33 Bacteriological examination 297 88 The new cases, classified according to the diagnosis, give the following figures:— Tubercular. Suspects. Not Tubercular. Total. "Contacts" 32 99 174 305 Other new cases 100 144 39 283 Totals 132 243 213 588 Tuberculous cases and suspects 63.8 per cent. Non-tuberculous cases 36.2 „ Deaths during the year 1914 of patients who have attended the Tuberculosis Dispensary 48 The attendances each month were as follows:— Month. New Cases. Attendances. January 46 302 February 45 288 March 68 314 April 42 262 May 64 268 June 57 293 July 42 272 August 25 225 September 34 237 October 55 404 November 50 450 December 60 473 588 3,806 I am, Yours faithfully, ARMAR J. McFARLAND, M.D. (Dubl.), D.P.H. (Oxford) Acting Tuberculosis Officer. 89 REPORT ON HEALTH VISITING, HOXTON. BY Ethel J. Charlesworth, Health Visitor, Certificates of the San. Insp. Exam. Board, London; Central Midwives Board ; National Health Society, &c. Town Hall, Shoreditch February 1915. To the Medical Officer of health. Sir, I have the pleasure to submit the following report on the work of Health Visiting in the Hoxton Division of the Borough during the year 1914. Part of my time has been spent in visiting certain residents of Hoxton, and part in the clerical work which such visits involve. The total number of (1) visits paid ; (2) personal attendances and attendances of parents at the Weighing Centre ; (3) interviews in connection with the above amounts to 3,362. This total is composed of work in conection with :— I. Notification of Births. (a.) Visits and revisits to homes 1,733 Visits 984 Revisits 749 (b.) Attendances at the Weighing Centres 53 (c.) Attendances of parents at the Weighing Centres 791 II. Epidemic Diarrhoea. Infant death enquiries 16 90 III. Notifications of Puerperal Septicemia. Visits and revisits II Visits 4 Revisits 7 IV. Notifications of Ophthalmia Neonatorum. Visits and revisits 19 Visits 11 Revisits 8 V. Notifications of Tuberculosis. (a.) Visits and revisits to patients 253 Visits 133 Revisits 120 (b.) Enquiries into deaths from tuberculosis 7 VI. Miscellaneous work in connection with the above. (a.) Visits to homes 81 (b).) Interviews with various people concerned in the work113 VII. Futile visits, i.e., to those who had removed, or for some other cause could not be found ... ... ... 277 Total number 3,362 I. Notifications of Births. Some of the notifications received related to births occurring in homes above the standard for visiting; the others have all been dealt with, though in some instances the visits were futile, for reasons such as inaccuracy in the address, or continual absence from home. Those visited have been invited to come and see me on Wednesday afternoon each week, and bring the baby to be weighed and examined, so that any signs of deterioration may be detected early, and proper measures taken whenever possible to prevent loss of health. There is great difficulty in securing means for the prevention of deterioration when this is due to underfeeding, especially of the mother. The records of some naturally fed infants who have attended regularly to be weighed, show little or no progress until some arrangement has been made to supply nourishment (in the form of milk, dinners, or both) to the mother. During the time when this nourishment is given, the child's weight and general condition has shown marked improvement, which has not been maintained after the cessation of the supply of nourishment, which, as a rule, lasts for not more than a month. 91 I am much indebted to Miss Tucker, Secretary of the East London Friendly Workers' Association, for her very valuable help in supplying nourishment for those most in need, and often for a month at a time. The Hoxton branch of the Invalid Dinner Kitchen supplies meals for the mother in certain carefully selected instances during the first three weeks after childbirth, but assistance for prematernity and maternity cases, in order to be really adequate, requires to be given contiuously, and often for a period of many months duration. Such assistance cannot be given by any of the existing organisation* in this Borough, and the establishment of a restaurant to supply nourishing food to needy mothers, before and after the birth of a child, would be of great benefit in many instances. The following table gives particulars as to the attendances on the weekly weighing days:— No. attending. Total No. of attendances. No. of days open. Average attendance Attendance on one day. Attendance of individuals. On day. Of individual. Maximum. Minimum. Maximum. Minimum. 175 791 51 15.51 4.5 29 3 29 1 The figures relating to the attendances cannot be considered as unsatisfactory, in view of the disadvantages under which this branch of the work was carried on. At the beginning of the year the accommodation at the Town Hall was quite inadequate for the purpose, and, in consequence, numbers had to be discouraged rather than encouraged to attend. In June the room was considerably enlarged, and the numbers attending increased rapidly, the maximum attendance of 29 being attained at the end of August. Early in September, and during my absence on annual leave, arrangements over which I had no control were made to place this room at the disposal of the workers of the National Relief Fund, and for the Weighing Centre to be transferred to the Hoxton Baths, Pitfield Street. This sudden change of meeting-place led to some confusion, and the attendances dropped considerably for some weeks, and did not recover until the end of the year. The addresses of some 599 of the births notified in that part of Hoxton lying to the west of East Road and New North Road were handed to Miss Childe, the official Health Visitor of the Shoreditch School for Mothers which has its headquarters at No. 51, Brunswick Place. These were in due course visited by Miss Childe, who also reports that some 807 attendances were made during the year at the Infant Consultation Centre held at the address mentioned. 92 II. Epidemic Diarrhœa. Deaths of infants, under 8 months, from Epidemic Diarrhoea. With three exceptions these cases all occurred in crowded areas, and in houses of poor type, where the standard of cleanliness was not high, and where there was ample opportunity for infection from diarrhoea to spread between members of the same family and between families in the same house. One infant was also suffering from measles, and one (aged 2 months) was the child of a woman certified as phthisical some months previous to the child's birth. In the course of routine visiting and revisiting, and especially from May to October, particular instruction was given both as to the means of prevention of epidemic diarrhoea and of the steps to be taken if it should appear. Printe 1 directions were also given, and those attending the Weighing Centre were constantly reminded of the dangers of this disease ; no fatal cases occurred amongst those attending. III. Puerperal Septicœmia. Six cases have been certified during the year. Two of these were, during my absence, investigated by my colleague, Miss Jacocks. Three occurred in the practice of doctors, including one in an institution ; two were severe cases and the patients died. Three occurred in the practice of midwives. IV. Ophthalmia Neonatorum. Ten cases were notified, and I also investigated one occurring in Haggerston during the absence of my colleague. Two of these occurred in the practice of doctors, and eight in the practice of midwives. One child died at 6 weeks, of whooping cough. Two others were severely affected and admitted to hospitals ; the remainder were treated at home, and apparently made satisfactory progress. V. Tuberculosis. The amount of work done in connection with tuberculous women and children is less than in the previous years, and has gradually diminished during the year owing to the increasing number of tubercular patients who attend the Tuberculosis Dispensary. Of the 133 notifications received, (a) 74 referred to adult women, (b) 59 referred to children up to 14 years, and girls from 14-16 years. (a) 34 adult women were insured ; 14 of these have been admitted to State sanatoria, the majority remaining for three months ; two of these have since died at home. 93 One patient, not insured, was sent away to a sanatorium for three months, through the agency of the East London Friendly Workers' Association. (ft) 12 children were admitted to the Infirmary, 13 to hospitals. Children of school age requiring sanatorium treatment are now dealt with by the London County Council, and I have not therefore endeavoured, as in previous years, to obtain such treatment through private agencies. I have to express my thanks to all those whose kind co-operation has assisted me in my work. I am, Sir, Your obedient Servant, ETHEL J. CHARLESWORTH, Health Visitor. 94 REPORT on HEALTH VISITING, HAGGERSTON. by Maude E. Jacocks, Health Visitor, Certificates of Derbyshire Royal Infirmary; Queen Charlotte's Hospital; Central Midwives Board ; Queen Victoria's Jubilee Institute and Royal Sanitary Institute. Town Hall, Shoreditch, E.C. January, 1915. Tn the Medical Officer of Health. Sir, The Report on the work of Health Visiting in the Haggerston Division of the Borough during the year 1914 is as follows:— The total number of visits paid, attendances ( (re) personal, (L) of mothers) at the Haggerston Baths Maternity Centre, and interviews was 4,653. The total may be classified as follows:— 1. Visits under the Notification of Births Act:— First visits 1,549 Re-visits 551 2,100 2. Ante-natal cases 14 3. Personal Attendances at Maternity Centre 50 4. Attendances of Mothers at Maternity Centre 1,165 5. Visits in connection with Ophthalmia Neonatorum :— First visits 11 Re-visits 27 38 6. Visits in connection with Summer Diarrhoea 12 7. Enquiries into Deaths from Summer Diarrhoea 40 8. Enquiries into cases of Puerperal Septicaemia :— First visits 5 Re-visits 7 12 95 9. Visits in connection with Tuberculosis:— First visits 192 Re-visits 203 395 10. Enquiries into Deaths from Phthisis 22 11. Special Visits in connection with Prince of Wales' Relief Fund 40 12. Special Visits in connection with the Soldiers' and Sailors' Families Association . 38 13. Enquiries into Deaths of Infants under 12 months 75 14. Miscellaneous visits 93 15. Futile visits 349 16. Interviews 210 In connection with the work arising out of the above visits and enquiries some 80 letters were written. Notification of Births. During this year almost every birth in the Division has been visited, and, in consequence, the visits now are expected, and in most instances welcomed. The large number thus dealt with makes it impossible to re-visit, excepting in special and necessary cases. The work at the Haggerston Baths Maternity Centre in a great measure compensates for this, as an increasing number of mothers have availed themselves of the opportunity to bring their babies each week for advice and help. 252 mothers have attended—83 once only—some of these latter had been attending regularly during the previous year. Four attended over 20 times, 29 over 10 times, the remainder varying from 2 to 10 times. 19 were continuing their attendances at the end of the year. The numbers attending on most of the afternoons have been so large that difficulty in providing accommodation has hampered the work greatly. Some have been unable to wait until their turn came, and were it not that I have been assisted by friends in the immediate clerical work for the afternoon, many more would have had to go away without attention. This proves how anxious the mothers are for the welfare of their infants, and it is a pity such anxiety should be frustrated by the powerlessness of one's ability to do more. The sale of Virol at a cheap rate, although adding to the work, has been greatly appreciated by the mothers for the delicate babies, and the results have been most satisfactory. Miss Charlesworth, my colleague, attended four of the meetings at Haggerston during my absence, and on two occasions I attended those at Hoxton. When the war began, I was asked, in my official capacity, to serve on a Ward Committee of the National Relief Fund, and also on the Soldiers' and Sailors' Families Association Committee at Haggeraton. This has been a pleasure, as well as proving most useful in bringing me in contact with people who are interested in the infant welfare of the Borough. 96 Most of the cases I have visited from each Committee have been in connection with my infant work. Substantial help has also been given, particularly in clothing, for necessitous cases from Queen Mary's Needlework Guild and Queen Mary's Workrooms, through the National Relief Committees. Ante-natal Work. The 14 cases mentioned under this heading were visited for this only, but do not adequately represent all the ante-natal work done. Advice has been given to expectant mothers on hygiene and preparation for themselves and infants when visiting for other purposes, and also at the Maternity Centre, but with such large numbers to deal with, it is impossible to carry out a systematic course. Ophthalmia Neonatorum. Eleven cases were notified, and seven of these made a complete recovery. One died at 3 weeks of congenital syphilis. Three severe cases were removed to hospital, and each of these lost the sight of one eye. Puerperal Septicœmia. Of the 5 cases notified, 3 were attended at their confinements by doctors, and 2 by midwives. Four were removed to hospitals for treatment, and all recovered. Enquiries into Deaths of Infants. These enquiries have been made to verify the notifications of deaths in the Registrar's returns, and have often proved useful in following up cases of removal since birth which had been visited and were then lost sight of. Summer Diarrhoea. Twelve cases of this complaint were notified by the Almoners of the Queen's Hospital and the Metropolitan Hospital. Forty deaths were enquired into; one result of these enquiries was that 26 of the babies had been fed on condensed milk or patent foods. Thirteen were fed on cow's milk, and one only was breast fed. Although cow's milk during the hot weather is easily infected, the infection is more evident and more easily controlled, whereas a tin of condensed milk is a greater source of danger ; exposed as it may be to the infection of a dirty tinopener, then for days to the germs of a " living room," liable to be dipped into by baby's dummy, older children's fingers and parents' spoons. The same applies tc patent foods, which, although not so palatable, are frequently dipped into by the curious and left exposed to germs. 97 Tuberculosis. There were 192 cases notified, 95 of these were under 16 years, 41 over 50 years, and 28 under 12 months ; 21 only were insured persons. Of the cases, 124 were certified as suffering from tuberculosis of the lungs, and the remainder from tuberculosis of joints, glands, skin, bowels, &c. Six were sent to Sanatoria by the Insurance Commissioners, 3 to private sanatoria, 22 were admitted to homes or hospitals, and 43 to the Infirmary. Increasing care is taken by relatives to prevent the spread of infection from this disease, although want of space in the dwellings still renders it almost impossible. I have again pleasure in thanking Miss Tucker of the East London Workers' Society for valuable help given in all cases referred to her, especially those in which nourishment has been needed for expectant and nursing mothers. Thanks are also due to the Committee OI the National Relief Fund for the extra milk which was granted to applicants where there were infants under 12 months, and to other societies and agencies which have contributed help or information. I am, Sir, Your obedient Servant, MAUDE E. JACOCKS, Health Visitor, (513 i g