SHOR 26 REPORT ON THE Health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, in the county of london. FOR THE YEAR 1915, BY LEWIS T. FEASER BRYETT. (Lond.), Medical Officer of Health; Diplomate in Public Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health ; and of the Royal Institute of Public Health, dec. [Printed by Order of the Health Committee.] printed by darling and son, ltd., bacon street, london, e. REPORT Health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, in the county of london, FOR THE YEAR 1915, by LEWIS T. FRASER BRYETT, M.D. (Lond.), Medical Officer of Health ; Diplomate in Public Health, Royal Colleges of Physicians and Surgeon! : 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 bon, ltd., bacon street, london, e. CONTENTS. Page. Anthrax 23 Artizans' dwellings 33 Appendicitis, mortality from 7 Bacteriological examinations 24 Bakehouses 39 Births in sub-districts 2 Birth rates 3 Cancer 7 Cerebro-sp:nal fever 22 Cholera 23 Coffeehouses 39 Cookshops 39 Co operation between the Civil and Military Sanitary Authorities 35 Cow-houses 35 Customs and Inland Revenue Acts 35 Dairies 35 Deaths in sub-districts 4 Death rate 4 Deaths, ages at 7 Deaths, causes of 5 Deaths in public institutions 7 Deaths in outlying Institutions 8 Demolition of houses 32 Diarrhoea 18 Diphtheria 14 Dis nfection 24 Enteric Fever 15 Erysipelas 18 Factories and Workshops Act, 1901 36 Factories, workshops and workplaces—sanitary work 37 Food condemned and destroyed 40 Food and Drugs Act 40 Fried fish shops 40 Glanders 23 Housing and Town Planning Act, 1909 32 Houses closed 30 Houses let in lodgings 85 House to house inspection 30 Hydrophobia 23 Ice cream shops 39 Infantile mortality 5 Infectious cases, number certified 11 Infectious cases, number removed to hospitals 11 Infectious diseases, age periods 10 Infectious diseases, deaths from 9 Infectious diseases, death rate 10 Infectious diseases, isolation 12 Infectious diseases, number of cases notified from schools 24 Influenza 20 Legal proceedings 27 Margarine Act, proceedings under 42 Marriages 3 Measles 19 Milk shops 35 Milk and Cream Regulations, 1912 43 1067—100—D & S.—Sch. 201. a Page. Milk premises, cowsheds, etc., on register 35 Mortuary 25 Notification.of Births Act 3 Offensive business 36 Ophthalmia neonatorum 22 Outworkers 38 Polio-myelitis 23 Population 1 Puerperal fever 18 Rag Flock Act, 1911 36 Return cases 12 Sanitary work 25 Scarlet fever 13 Scarlet fever, return cases of 12 Schools, exclusions of children for infectious disease 24 Shelter 25 Sickness amongst the poor 9 Slaughter-houses 35 Small-pox 13 Smoke nuisance 28 Staff 43 Street markets and food 40 Tuberculosis 20 Typhus fever 20 Vaccination 13 Verminous houses 28 Violence, mortality from 7 Water supply 25 Whooping cough 20 Workshops on register 30 Zymotic diseases, deaths from 11 Zymotic death rate 11 APPENDIX. Statistical Tables For whole district during 1915 and previous years (Table I.) 47 Cases of Infectious disease notified during 1915 (Table II.) 48 Causes of, and ages at, death during year 1915 (Tables III. and V.) 49, 52 to 59 Infantile mortality during 1915 (Table IV.) 50 Notes to Table III. 51 Comparison of London and Shoreditch birch and death rates in 1915 (Table VI.) 60 Cases treated by District Medical Officer in 1915 (Table VII.) 61 Summary of proceedings under Public Health (London) Aot, 1891 (Table VIII.) 62 Summary of Tuberculosis Certificates received (Table IX.) 63 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 64 to 67 Report on tuberculosis dispensary 68 to 71 Report of Health Visitors 72 to 79 Metropolitan Borough of Shoreditch ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. January, 1916. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. Sir and Gentlemen, I have the honour to submit my Report on the Health and Sanitary Condition of the Borough of Shoreditch during the Year ending December 31st, 1915. All figures and references to the work of previous years have, as far as practicable, been omitted, in accordance with a suggestion of the Local Government Board. POPULATION. A very appreciable proportion of the male population of the Borough being absent on war service during 1915 a material decrease has to be noted. The estimate of the Registrar-General for the year is 103,627. This figure relates to the civil population only and is adopted for the purposes of this report, except where otherwise indicated. The estimated populations in the Wards of the Borough are as set out below : Ward. Population. Ward. Population. Moorfields 4,265 Whitmore 17.870 Church 17,550 Kingsland 10,050 Hoxton 15,310 Haggerston 10,520 Wenlock 16,347 Acton 11,715 The estimated populations of the Registration Sub-Districts of the Borough are as follows;—Shoreditch South, comprising Moorfields, Church and Hoxton Wards, 37,125; Shoreditch North-West, comprising Wenlock and Whitmore Wards, 34.217; and Shoreditch North-East, which comprises Kingsland, Haggerston and Acton Wards, 32,285, (1067) a 2 Included in the population of the Wenlock Ward is that of the Holborn Union Workhouse, which is situate in this Ward. The number in this institution on the night of the Census 1911 was 1,328. For certain statistical purposes this Workhouse population is not regarded as belonging to Shoreditch, and is excluded from the estimated population of the Borough, which becomes for these purposes, therefore, 102,299, whilst the estimated population of the Ward is reduced to 15,019, and that of the Registration Sub-District, Shoreditch North-West, to 32,889. 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 60 Whitmore 76 235 Church 106 165 Kingsland 72 140 Hoxton 78 196 Haggerston 66 160 Wenlock 90 166 Acton 83 141 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 2,955, of which 1,478 were of males and 1,477 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 3,091, of which 1,539 were of males and 1,552 of females. The distribution of the corrected births in the eight Wards of the Borough is given below ;— Ward. Males. Females. Total. Moorfields 37 46 83 Church 280 274 554 Hoxton 250 230 480 Wenlock 225 232 457 Whitmore 252 284 536 Kingsland 177 174 351 Haggerston 158 162 320 Acton 160 150 310 Totals 1,539 1,552 3,091 3 Outside the Borough 188 births were registered—85 of males and 103 of females —the parents being residents of Shoreditch. In the Shoreditch Infirmary 72 births were registered, of which 32 were of males and 40 of females. In five of these (2 males and 3 females) the parents did not belong to Shoreditch. In the Holborn Union Workhouse there were 48 births, 25 of males and 23 of females. In 47 of these (25 males and 22 females) the parents were not resident in the Borough. Of the births registered as occurring in the Shoreditch Infirmary 34 (15 male and 19 female) were entered as being illegitimate. In the Holborn Workhouse, 39 (19 male and 20 female) were so returned. Elsewhere in the Borough there were 39 births (17 of males and 22 of females) which were illegitimate. The birth-rate was 28-5 per 1,000 inhabitants. This rate is based upon the estimated population for 1914. The birth-rates for the eight wards of the Borough are contained in Table VI. (Appendix). The birth-rate for England and Wales was 21'9, for 96 Great Towns, including London, 22-8, for 148 smaller towns 21'6 and for London 22-6 per 1,000 population as estimated for the year 1914. NOTIFICATION OF BIRTHS ACT, 1907. The births notified under the above Act numbered 2,748, being approximately 89 per cent, of the births belonging to Shoreditch registered during the year. The notifications were in the majority of instances received from registered midwives. In addition there were 204 births occurring in public institutions outside the Borough, which were notified by the London County Council, lists of the same being sent in weekly. Including these, the births notified were approximately 95 per cent, of the number of births registered during the year. MARRIAGES. During 1915 there were 1,528 marriages in Shoreditch, a number greatly in excess of any yet recorded. The persons married were at the rate of 29'8 per 1,000 population, as compared with 25-7 for the Metropolis. DEATHS. The deaths during 1915 numbered 2,071, excluding those of all members of the armed forces of this or other countries. (1067) A 9 4 The distribution of the deaths amongst males and females in the eight Wards of the Borough is as shown in the following table :— Ward. Males. Females. Total. Moorfields 41 23 64 Church 194 163 357 Hoxton 166 165 331 Wenlock 163 141 304 Whitmore 224 189 413 Kingsland 103 114 217 Haggerston 109 96 205 Acton 81 99 180 Totals 1,081 990 2,071 The deaths of males were 91 in excess of those of females. The death-rate for the year was 20-2, being somewhat above the average for the previous ten years. In Tables I., III., IV., V. and VI. (Appendix) are given the causes of death, and the death-rates for the whole Borough and for its eight Wards, together with other particulars as to the mortality amongst the inhabitants of Shoreditch during the year. Tables I., III. and IV. are forms required by the Local Government Board. The death-rate was lowest in Moorfields and Acton Wards, and highest in Whitmore. The death-rate of the Borough averaged above the mean rate for the year during January, February, March and April, below from the beginning of May to the end of October, and above again during the last two months of the year. The highest rate recorded for any one week of the year was that of the first week of December when it was 29-3 per 1,000 population. The lowest rate was that of the second week of August when 10'1 per 1,000 was noted. The deaths of infants under the age of one year numbered 447, of which 242 were of males and 205 of females. These deaths were 21*5 per cent, of the total number of deaths at all ages. The number of infants under one year dying during 1915 was at the rate of 144 per 1,000 births belonging to Shoreditch registered during the year. Amongst males the infantile mortality was 157 per 1,000 births, as compared with 132 for females. The chief causes of death amongst infants under one year were, atrophy, debility and marasmus, prematurity, pneumonia, bronchitis, diarrhoea, enteritis, measles and whooping cough. In Table IV. (Appendix) is contained a statement showing the various causes of death amongst infants under the age of one year, the ages in weeks and months being given. The table also gives the nett deaths and births during the year amongst legitimate and illegitimate infants. 5 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 ... ... ... ... 1 ... ... ... 1 Measles ... 5 3 ... 3 6 ... 1 18 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough. . ... 2 2 "3 2 2 4 3 18 Diphtheria and Croup ... ... 1 1 1 ... ... ... 3 Erysipelas ... ... ... ... 1 1 ... ... 2 Tuberculous Meningitis ... ... 1 ... ... ... ... 1 2 Abdominal Tuberculosis ... 2 1 ... ... 2 1 ... 6 Other Tuberculous Diseases ... 2 2 1 1 1 ... 1 8 Meningitis (not Tuberculous) ... 1 1 5 5 3 ... 15 Convulsions ... 3 1 5 1 1 1 ... 12 Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis ... 3 4 10 7 3 2 1 30 Pneumonia (all forms) 1 10 13 13 9 6 14 7 73 Diarrhoea 1 5 13 3 9 5 5 41 Enteritis 1 19 8 4 14 5 2 "6 59 Gastritis ... ... ... ... 1 1 1 1 4 Syphilis 1 1 1 ... ... 1 2 ... 6 Rickets ... ... ... ... ... ... ... ... ... Suffocation, overlying ... 3 2 1 5 2 ... ... 13 Injury at Birth ... ... ... ... ... ... ... 1 1 Atelactasis ... ... 4 ... 4 ... ... ... 8 Congenital Malformations 1 1 1 .2 1 1 2 3 12 Premature Birth I 6 7 13 8 8 10 8 61 Atrophy, Debility and Marasmus 2 8 3 2 6 2 4 3 30 Other causes 1 5 2 3 6 4 2 1 24 Totals 9 76 70 69 83 50 54 36 447 The infantile mortalities of the eight Wards of the Borough are contained in Table VI. (Appendix). The rate was highest in Haggerston and lowest in Moorfields, being 169 and 108 per 1,000 births respective]}". The infantile mortality for England and Wales during 1915 was 110 and for London 103. The work of the Health Visitors is detailed in their reports which are appended (pp. 72 to 79). It was mentioned in my report for last year that a 6 communication from the Local Government Board upon the subject of arrangements for maternity and child welfare in the direction of clinics, dispensaries and other measures primarily concerned with the provision of medical and surgical advice and treatment was at the end of the year under the consideration of the Health Committee. Acting upon a report from,the Committee, the Council entered into an agreement with the owners of No. 152, Kingsland Road, and these premises were taken for the purposes of a maternity and child welfare Centre for the Borough. The accommodation thus provided consists of four rooms, with a basement for the purposes of the work of the Centre, and two rooms for the caretaker resident on the premises. In conjunction with the Women's League of Service arrangements were made for the provision of dinners at the Centre for nursing and expectant mothers. The expenses in connection with these dinners are being most generously defrayed by the League. The necessary equipment having been provided, the Centre was opened for work early in May by the Mayor. Two afternoons have been assigned for the weighing of babies and talks to mothers, and one for demonstrations in the making of serviceable garments for mothers and children by the Health Visitors and voluntary assistants. The dining hour is between 1.30 and 2.30 p.m. Usually about 30 nursing and expectant mothers attend daily for as long as the dinners appear necessary. Where it can be afforded a small charge of a penny or twopence is made. Cases for the dinners are recommended by the Health Visitors. Their selections are largely influenced by the home circumstances of the women. Children brought to the Centre are excluded from the dining room. They are taken care of by voluntary helpers in the creche furnished for the purpose, the mothers being thus enabled to have a good substantial meal in peace and comfort daily, a matter of no small importance as regards the welfare both of mother and child. In this connection the valuable assistance of the voluntary helpers mentioned must be gratefully acknowledged. Up to the end of the year the number of infants brought to the Centre for Weighing was 108 and the number of weighings was 596, giving an average of about 5 per infant. The number of nursing mothers was 111 and there were 28 ante-natal cases. Some 3,205 dinners were served, and 1,662 attendances were recorded for the creche of which 1,262 were of children in arms. The arrangement of the Centre and the work carried on thereat is, subject to instructions from the Health Committee, in the hands of a Committee appointed Under powers conferred on local authorities by the Notification of Births (Extension) Act, 1915. As at present constituted the Committee consists of representatives of the Borough Council and of the Women's League of Service, and is designated the Maternity Centre Committee. The deaths of children aged one to five years numbered 298, so that altogether 740 or 35'7 per cent, of the total number of deaths at all ages were of children under five years of age. 7 Of the deaths at all ages, the chief causes were : tuberculosis which accounted for 328 including 248 attributed to phthisis or consumption, pneumonia which caused 237, bronchitis 189, diseases of the heart and circulatory system 179, diarrhoea and enteritis 138, cancer 89, old age 91, measles 67, whooping' cough 36, Bright's disease and acute nephritis 79, prematurity 61, non - tuberculous meningitis 34, atrophy debility and marasmus 31, alcoholism and cirrhosis of the liver 24, and various forms of violence which resulted in 103 deaths. Of the deaths attributed to cancer, 45 were of males and 44 of females ; 5 were of persons under 45 years of age, 50 of persons aged from 45 to 65 years, 26 were of persons between 65 and 75 years, and 8 were of persons aged between 75 and 85 years. There were also some 10 deaths certified as due to malignant disease or sarcoma. Some of those attributed to malignant disease may have been the result of cancer. The cancer death-rate for the year was 0"87, the highest so far recorded. Of the deaths from alcoholism and cirrhosis of the liver 8 were of males and 24 of females. There were 4 deaths attributed to appendicitis, 3 of males, and 6 deaths to peritonitis of which 3 were of males. Of the deaths from violence 62 were of males and 41 females. Through accident or negligence 92 persons lost their lives including 10 infants through suffocation in bed, a number markedly below the average. There were 4 cases of homicide and 7 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 13 224 237 Shoreditch Workhouse 585 35 620 Royal Chest Hospital 6 25 31 Convent Hospital — 1 1 Totals 604 285 889 8 Elsewhere than in public institutions, 15 persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various institutions outside Shoreditch with the numbers of persons belonging to the Borough dying therein :— Asylums. No. of Deaths. General Hospitals— continued. No. of Deaths. Banstead 4 Poplar Hospital 1 Brentwood 1 Queen's (Children) 87 Cane Hill 2 Royal Free 2 Caterham 2 St. Bartholomew's 67 Claybury 19 St. Columba's 2 Colney Hatch 13 St. Thomas's 1 Dartford Heath 7 Vincent Square (Infants) 4 Epiletic Colony, Epsom 1 Westminster 1 Exeter 1 Special Hospitals. Fountain Temporary 1 Horton 4 Borough Mental, Leicester 1 Han well 1 Chest Hospital, Bethnal Green 9 Leavesden 7 Long Grove 2 City of London Lying-in 12 Manor 1 New Hospital for Women 1 Middlesex County 1 Queen Mary's Hospital .. 3 Tooting Bee 13 Seaman's Hospital 1 Hospitals for Infectious Disease. Infirmaries and Workhouses. Eastern 18 Joyce Green 1 Belmont Workhouse 6 North Eastern 22 Bethnal Green Infirmary 10 North Western 3 Cleveland Street do. 1 Northern ... 3 Hackney Infirmary 6 General Hospitals. Holborn do. 2 Islington do. 2 Cottage Hospital, Bushey Heath 1 Kensington do. Shoreditch Additional 1 East London Hospital 1 Workhouse 3 Evelina (Children) 2 West Ham Infirmary 1 German 6 Other Institutions. Great Northern 1 Homoepathic 1 Brook House 1 Gt. Ormond Street (Children) 4 Children's Convalescent Home, Beconfield 1 Italian 1 St. George's House 2 London 22 St. Michael's House Metropolitan 48 Broadstairs 1 Middlesex 4 St. Peter's House... 1 Mildmay 9 Downs Sanatorium 4 Of 461 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 265 died in general hospitals, 80 in asylums, 47 in fever hospitals, 32 in workhouses and infirmaries, 27 in hospitals for special diseases, 9 and 10 in other institutions. Elsewhere than in public institutions 33 persons belonging to Shoreditch died beyond the limits of the Borough ; in three instances during conveyance to hospitals. Altogether 1,065 or 51.4 per cent. of the deaths of persons belonging to Shoreditch took place in public institutions. SICKNESS AMONGST THE POOH. The cases coming under the treatment of the district medical officers in connection with the Poor Law Dispensary in Hoxton Street during 1915 numbered 3,625, a number smaller than in any year since 1903. An analysis of the cases is recorded in Table VII. (Appendix). The diseases classed as infectious accounted for 481, a smaller number than for many years past. Measles, influenza, whooping cough, diarrhoea and tuberculosis all shew marked decreases in the number of cases. Diseases of the respiratory organs, which are also in the main to be regarded as infectious, numbered 1,104; of these bronchitis accounted for 1,003 and 64 were due to pneumonia. Rheumatism was given as the diagnosis in 215, a number considerably below the average. Oases of rheumatic fever numbered 21 and were again below the average in point of number. Cases diagnosed as gout numbered 31, a smaller number than for some years past. Dyspepsia and other disorders of the digestive system accounted for 316, a number also markedly below the average. Cases of cancer numbered 18, a number somewhat below the average for recent years. Diseases of the locomotive system, chiefly of ulcerated legs, accounted for 113, and 174 were attributed to diseases of the skin. The marked decreases in the numbers of cases noted for this year are in all probability largely to be ascribed to the more affluent circumstances of the poor for the time being arising out of the war, which has doubtless enabled many to secure the services of private practitioners. INFECTIOUS DISEASES. The infectious diseases included under the headings numbered 1 to 35 and .171 in Table V. (Appendix) resulted in 650 deaths. The number was slightly below the average for the previous 10 years. The deaths from these diseases amounted to 31.3 per cent. of the total number of deaths from all causes. As compared with the figures for 1914, the mortality from consumption, cerebro-spinal fever and scarlet fever shew increases, whilst those from measles and whooping cough are decreased. The deaths from consumption and the other forms of tuberculosis 10 amounted to 50.5 per cent. of the total number of deaths from infections diseases, and of the remainder measles, whooping cough, and diarrhoea accounted for the greater number. The death-rate from these infectious diseases was 6.3 per 1,000 inhabitants. In the subjoined table the deaths from the infectious diseases referred to above have been grouped according to age :— Age period. Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 85 and upwards. No. of deaths 138 155 33 15 28 28 57 66 71 34 23 7 1 Of the total number of deaths of children under 5 years of age .39.5 per cent. resulted from the infectious diseases referred to. 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. Consumption was the chief cause of the mortality from infectious diseases amongst persons aged 20 years and upwards. The deaths from the principal zymotic diseases—namely, small pox, measles, scarlet fever, diphtheria, including membranous croup, whooping cough, enteric fever and diarrhoea*—numbered 222 and the death-rate, which is termed the zymotic death-rate, was 2.1 per 1,000 population. The zymotic death-rate was markedly below the average for previous years. A comparison of the zymotic death-rates of London and Shoreditch and the 8 wards of the Borough is given in Table VI. (Appendix). The rate was highest in Whitmore Ward and lowest in Moorfields, being 3.8 and 0.9 per 1,000 population respectively. Excluding the cases of cerebro-spinal fever, acute anterior poliomyelitis, ophthalmia neonatorum, chicken pox which was notifiable during the second quarter of the year, and the cases of tuberculosis, 1,020 cases of notifiable infectious disease were certified, an increase of 146 on the figure for 1914, the attack-rate being 9'9 per 1,000 population. The cases of notifiable infectious disease certified in the Metropolis during 1915 excluding those of anthrax, glanders, pulmonary tuberculosis, ophthalmia neonatorum, measles, cerebro-spinal fever, acute anterior poliomyelitis and chicken pox, numbered 31,155 giving an attack-rate of 6'9 per 1,000 population. * Not including enteritis in children under 2 years. 11 Subjoined is a list of the infectious diseases which are notifiable, excluding julmonary tuberculosis, showing the numbers of cases certified in the Borough 'or each of the four quarters of the year, and the numbers and percentage of the sases removed to hospital :— Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Small Pox ... ... ... ... ... ... Scarlet Fever or Scarlatina 76 100 201 169 546 13 Diphtheria and Membranous Croup 53 44 82 90 269 21 Typhus Fever ... ... ... ... ... ... Cholera ... ... ... ... ... ... Enteric Fever (Typhoid) 3 ... 4 13 20 3 Continued Fever ... 1 .. . 1 2 ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever 5 2 2 9 4 Erysipelas 46 39 40 49 171: 13 Plague ... ... ... ... ... ... ... Cerebro-Spinal Fever 7 16 10 7 40 23 Glanders ... ... ... ... ... ... Anthrax ... ... ... ... ... . v . Hydrophobia ... ... ... ... ... ... Acute Anterior Poliomyelitis ... 1 ... ... 1 ... Ophthalmia Neonatorum 9 4 10 7 30 ... Chicken Pox ... 159 ... ... 159 ... Totals 199 366 347 338 1,250 77 Numbers and percentages of cases removed to hospitals. 168 84-4% 192 52-4% 301 86-7% 297 87-8% 958 75-8% ... As compared with the figures for 1914, scarlet fever and diphtheria are markedly increased as regards the numbers of cases. The great increase in the number of cases certified as cerebro-spinal fever is also to be noted. Erysipelas shews a decrease. The deaths from the principal zymotic diseases which are notifiable, namely, small pox, scarlet fever, diphtheria and enteric fever were at the rate of 036 per 1,000 population; the rate from measles,* whooping cough and diarrhoea which are not notifiable, was 2'2 per 1,000 inhabitants. * Measles was made a notifiable infectious disease by order of the Local Government Board from January 1st, 1916. 12 ISOLATION OF INFECTIOUS CASES. The notifiable infectious diseases, cases of which are admissible to the hospitals of the Metropolitan Asylums Board, are small-pox, scarlet fever, diphtheria, enteric fever, continued fever, typhus fever, puerperal fever, cerebrospinal fever and acute anterior poliomyelitis. The number of cases of these diseases certified (Table II., Appendix) was 897, the number removed to hospital (mainly to the hospitals of the Metropolitan Asylums Board) was 876, which gives a percentage of 98.7, the highest so far recorded. In October an intimation was received from the Metropolitan Asylums Board to the effect that the accommodation provided by the Board, being considerably curtailed during the year by certain of the hospitals being handed over to the military authorities, was becoming exhausted and that there might be some delay as regards the removal of cases. As it turned out there was in some cases a little delay, but it was only experienced for a few weeks. RETURN CASES. The following instances were noted during the year :—(1) Arthur H. S , aged 7, was certified to have scarlet fever on October 18th and removed to hospital on October 20th, 1914, returning home on December 9th ; on December 28th Edmund S , aged 2 8/12 years was certified to have scarlet fever and removed to hospital the following day. Nothing was noticeable as regards the convalescent Arthur. The mother attributed the recurrence of the disease to an album, which had been put away and overlooked at the disinfection and produced again when he returned. (2) Emily L , aged 2, was certified to have scarlet fever and removed to hospital on June 28th. She returned home on August 26th. Elizabeth L , aged 6, fell ill on August 28th, sore throat was noticed on 29th and the rash the following day when she was certified to have scarlet fever and removed to hospital. The mother asserted that Emily's skin was rough and that there was some spots about her on her return. (3) Thomas L , aged 4, was removed to hospital on June 20th, certified to have scarlet fever and returned home on August 13th. He appeared in good health and nothing about the child attracted the mother's attention. Daniel L , aged 6, was taken ill on September 6th the rash being observed the same day. He was certified to have scarlet fever and removed to hospital on September 7th. It is to be noted that Daniel was away at Mitcham from August 27th to September 3rd. (4) Florence G , aged 8, was certified on June 26th to have scarlet fever and removed to hospital the following day. She returned home on September 17th, Herbert G , aged 14, was taken ill on September 30th and the rash was 13 observed on October 1st when the patient was certified and removed to hospital. Florence had nasal catarrh which the mother stated came to her notice on October 1st when she believed it commenced. SMALL POX. There were no cases of smallpox in Shoreditch during the year, and only about 13 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, relating to the year 1912. The figures for 1913 are not available, the tabulation of the returns having been postponed till after the war has ended. SCARLET FEVER. The cases certified numbered 546, of which 9 or 1*6 per icent. were subsequently not regarded as scarlet fever. 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 3 9 12 ... ... ... Church 38 53 91 ... 1 1 Hoxton 47 61 108 2 2 4 Wenlock 22 39 61 2 2 Whitmore 48 50 98 2 1 3 Kingsland 34 37 71 1 1 2 Haggerston 41 34 75 ... ... ... Acton 13 17 30 ... 1 1 Totals for Borough... 246 300 546 5 8 13 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified 543 or 98 per cent. were removed to hospital. This is the highest percentage so far recorded. The cases certified were at the rate of 5.3 per 1,000 inhabitants, being above the average for the previous ten years. The attack rate per 1,000 population in the Borough was highest in Haggerston, and lowest in Acton Ward, being 7.l in the former, as compared with 2.6 in the latter. 14 The deaths numbered 13, the rate being 012 per 1,000 population. There were no deaths from scarlet fever in Haggerston Ward. The case mortality was at the rate of 2'4 per cent, of the cases certified, being somewhat below the average for the previous ten years. Amongst children under 5 years there were 182 cases with 7 deaths, the case mortality (allowing for errors in diagnosis) being 4 per cent. Amongst persons over 5 years there were 364 cases with 6 deaths, the case mortality (allowing for errors in diagnosis) being 1*6 per cent. The scarlet fever cases in the Metropolis numbered 17,104, the attack-rate being 3-7 per 1,000 population, and the deaths numbered 331, giving a rate of 0-07 per 1,000 population as estimated for 1914. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 269, of which 10 were subsequently not regarded as being diphtheria. The numbers of cases and the deaths amongst males and females in the Borough and its eight wards are given in the subjoined table :— Ward. DIPHTHERIA (including Membranous Croup). Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 6 5 11 ... ... ... Church 32 33 65 1 2 3 Hoxton 18 13 31 1 2 3 Wenlock 4 10 14 1 3 4 Whitmore 18 22 40 2 2 4 Kingsland 24 26 50 1 1 2 Haggerston 21 25 46 3 2 5 Acton 4 8 12 ... ... ... Totals for Borough 127 142 269 9 12 21 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified, approximately 99 per cent. were removed to hospital, the highest percentage so far recorded. The cases were certified at the rate of 2.5 per 1,000 inhabitants, the rate being highest in Kingsland Ward and lowest in Wenlock, 4.9 and 0.9 per 1,000 respectively. The deaths numbered 21, the rate being 0.20 per 1,000 population. It was highest in Haggerston Ward, where it amounted to 0.47 per 1,000. There were no deaths from the disease in Moorfields and Acton Wards. Of the cases certified 7.8 per cent. terminated fatally. Fifteen of the deaths were of children under five years of age, the mortality being at the rate of 13.3 per cent. of the cases certified 15 amongst children at that age period. Allowing for errors in diagnosis the mortality was 13.8 per cent. Amongst persons over five years of age the mortality was 3.8, or allowing for errors of diagnosis 3.9, per cent. of the cases certified. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 261 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 4 2 6 From 1 to 2 years 12 11 23 „ 2 „ 3 „ 15 14 29 „ 3 „ 4„ 17 15 32 „ 4 „ 5 „ 8 13 21 „ 5 „ 10 „ 39 42 81 „ 10„13 „ 8 20 28 Over 13 years 12 29 41 Totals 115 146 261 In 124 of the cases the patients were children attending school and in 97 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 102 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 32 instances the histories showed that there had been cases of " sore throat" amongst the inmates of the houses in which the patients resided. In 35 instances there was evidence pointing to infection from previous cases in the Borough. In 178 instances the houses were occupied by members of more than one family, in 55 by single families, and in 28 instances the cases occurred in artisans' dwellings of the block type. With regard to the sanitary condition of the dwellings, in 149 this was satisfactory, in 61 fairly so, and in 51 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 ; their significance has been referred to in previous reports. The cases certified as diphtheria in the Metropolis numbered 9,180, the attack rate being 2.0 per 1,000. The deaths numbered 700 and the death-rate was 0.15 per 1,000 population as estimated for 1914. ENTERIC OR TYPHOID FEYER. The cases notified numbered 22, including two certified as continued fever. Of these, six were subsequently not regarded as being cases of typhoid fever. The cases were certified at the rate of 0.2 per 1,000 population. 16 The distribution of the cases certified and deaths amongst males and females in the Borough and its eight Wards during 1915 are shown in the subjoined table :— Wards. ENTERIC FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields ... ... ... ... ... ... Church 2 ... 2 ... ... ... Hoxton 1 1 2 ... ... ... Wenlock ... 2 2 ... ... ... Whitmore ... 1 1 ... 1 ...1 Kingsland 3 6 9 1 ... 1 Haggerston 4 1 5 1 ... 1 Acton ... 1 1 ... ... ... Totals for Borough 10 12 22 2 1 3 The cases are grouped according to ages in Table II. (Appendix). The death-rate was 0.03 per 1,000 population and the case mortality 13.6 per cent. of the cases certified. Deducting cases not enteric fever the case-mortality was 18.7 per cent. Most of the cases were certified during the last quarter of the year. With regard to those certified during the first six months, in one case the patient was a soldier who probably contracted the disease in France ; in two others there was nothing throwing light upon the source of infection. Most of the cases during the latter part of the year occurred in two houses. The particulars are briefly as follows :— (1) A. L., female, aged 11 years, of 15, B Street, was ailing from the end of August until September 22nd, when she was certified to have enteric fever. (2) W. L., male, aged 4 years, brother to above patient, was ailing from about September 8th and was certified on September 22nd. These cases were followed by two others— (3) T. L., male, aged 7, certified on October 2nd, and (4) E. L , female, aged 5, certified on October 4th. These latter seem to have become unwell during the last fortnight of September. The family are foreigners, and the conditions which prevailed in the home were such as would favour the transference of infection. The first case was unrecognized for three weeks and possibly longer. The other three cases were probably secondary to it. Nothing was obtained to throw light upon the origin of the first case. 17 The second series of cases occurred at No. 51, S Street, a six-roomed house occupied by two families, the C family, 9 in number, upstairs, and the N family, 8 in number, downstairs. Each family occupied three rooms. The general sanitary condition of the house may be described as fair. (1) About October 15th, Gerald C , aged 16, became poorly. He was in bed for about three weeks and began to get about again towards the end of the second week of November. When seen on November 27th he had the appearance of having passed through a serious illness. From the history given there is little doubt that he had had enteric fever. On November 3rd, Edward N , aged 13, a companion of Gerald 0 , was certified and removed to hospital as having scarlet fever, but the illness proved to be enteric fever. The history of the onset leaves it open to doubt as to whether he was infected at the same time as the other lad or whether his was a secondary case. The two lads were together a good deal and had a number of soldier friends, of whom some had recently been discharged from hospital. No history was obtained pointing to any special article of food being implicated. Secondary cases in the house occurred as follows :— (2) Connie C , aged 5, was taken poorly about November 5th; she was ailing all through November and well on into December. This case was not certified, but there is little doubt that it was one of enteric fever. Gerald C , aged 47, the father, became ill about November 5th ; he returned to work on November 23rd. This case was not certified. Emily C , aged 17, became ill about November 5th, was certified to have enteric fever and removed to Shoreditch Infirmary on November 26th. (3) Edith C , aged 40, the mother, was taken ill about November 22nd, certified as suffering from continued fever on December 2nd, and removed to the Shoreditch Infirmary, where she was subsequently certified to be suffering from enteric fever. (4) Nellie N , aged 9, was taken ill about December 4th, and certified to have enteric fever on December 30th. (5) Harold C , aged 9, was taken ill about December 14th, and certified on December 28th. (6) Robert C , aged 10 months, was noticed poorly on December 21st, and certified on December 31st. None of these cases proved fatal. It is to be noted that the disease existed amongst the members of the two families from about the middle of October until nearly the end of November before its nature was recognised. There was no proper medical attendance during this period, the illness being attributed to influenza. No precautions were taken and the other members of the families who took the disease became infected in consequence. (1067) B 18 The cases certified in the Metropolis, including cases of continued fever, numbered 676, giving an attack rate of 01 per 1,000 population. The deaths in the Metropolis numbered 120, the rate being 0'02 per 1,000 inhabitants as estimated for 1914. ERYSIPELAS. The cases certified as erysipelas numbered 174, with 13 deaths. The cases and deaths amongst males and females in the Borough and its eight Wards were distributed as set out below :— Ward. ERYSIPELAS. Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields ... 1 1 ... ... ... Church ... 9 17 26 1 ... ] Hoxton 9 9 18 ... 1 1 Wenlock 17 12 29 1 1 2 Whitmore 15 34 49 1 3 4 Kingsland 8 7 15 ... 2 2 Haggerston 5 17 22 ... ... ... Acton ... 5 9 14 i 2 3 Totals for Borough... 68 106 174 4 9 13 The death-rate was 0.12 per 1,000 inhabitants and the case-mortality 7.5 per cent. Pyaemia and septicaemia, commonly termed blood-poisoning, were given as causing the deaths of 6 males and 3 females. Infective endocarditis, another form of blood-poisoning, caused the deaths of 1 male and 6 females. PUERPERAL FEVER. Nine cases were certified with 4 deaths. The cases were at the rate of 2.9 per 1,000 births, which is somewhat above the average for recent years in the Borough. Eight of the cases were removed to the infirmary or to hospital for treatment. The deaths were at the rate of l.3 per 1,000 births, which is higher than usual, and the case mortality was 44.4 per cent. of the cases certified. DIARRHCEA. The deaths numbered 82, not including 56 attributed to enteritis. They were below the average for recent years. Most of the deaths occurred during the period from the middle of August to the middle of October. Of the deaths from diarrhoea, 19 61 were of infants under one year, 16 of children aged from one to five years, 3 were of persons aged from ten to thirty-five years, and the remaining 2 were of persons over 45 years of age. Of the deaths from enteritis 39 were of infants under one year, 12 of children aged from one to five years, and the remainder of persons over twenty-five years. The diarrhoea death-rate was, excluding deaths from enteritis, O'SO per 1,000 population. Including deaths from enteritis under two years the mortality was at the rate of 1.24 per 1,000 population. The deaths from diarrhoea amongst infants under one year were at the rate of 19.6 per 1,000 births. The usual enquiries were made by the Health Visitors as regards infantile diarrhoea cases and deaths, and as far as circumstances permitted steps were taken with a view to preventing the spread of infection. The deaths from diarrhoea including enteritis in children under two years of age in the Metropolis numbered 2,542, and the death-rate was 0.56 per 1,000 population as estimated for 1914. MEASLES. The deaths numbered 67, being 40 less than for 1914. The disease was less prevalent as indicated by a decrease in the number of cases coming under the care of the district medical officers and a decrease in the number of cases reported by the School Authorities. The deaths registered were distributed during the year as follows : 4 in January, 1 in February, 6 in March, 9 in April, 19 in May, 18 in June, 7 in July, 2 in August, and 1 in September. All the deaths were of children under 10 years of age, and with the exception of three they were all amongst children under five years old. Of the deaths 40 were of males. The death-rate was 0.65 per 1,000 ; it was highest in Whitmore and lowest in Moorfields, being 1.51 and 0.23 per 1,000 population respectively. The number of instances in which houses came under the notice of the Health Department as having measles therein was 533, being 182 less than in the previous year. In all cases the information came from the School Authorities. Some of the houses were reported more than once. From the inquiries made, in 42 instances the illness did not appear to have been measles. Altogether some 537 children were reported as suffering. Intimations were received as to the removal of two cases to hospitals of the Metropolitan Asylums Board. Disinfection in many instances was carried out by the officers of the Borough Council; 167 rooms were dealt with and the usual steps taken as to bedding and textile articles. Altogether 142 beds, 129 mattresses, 249 pillows, 110 bolsters, and 2,267 other articles were removed for disinfection. In 26 instances disinfection was carried out by the occupiers of the dwellings infected, to the satisfaction of medical practitioners in attendance on the cases. (1067) B ? 20 The deaths from measles in the Metropolis numbered 2,270, and the death-rate was 0'50 per 1,000 population as estimated for 1914. WHOOPING COUGH. The deaths from whooping cough numbered 36, of which 18 were of infants under one year, 14 of children aged from 1 to 5 years, and 4 aged from 5 to 10 years. Deaths occurred in each month of the year, except January and July. They were most numerous during April. The death-rate was 0.35 per 1,000 population ; it was highest in Acton Ward where it was 0.76; no deaths from the disease occurred in Moorfields Ward. The deaths from whooping cough in London numbered 1146, and the deathrate was 0'25 per 1,000 population as estimated for 1914. INFLUENZA. There were 26 deaths attributed to influenza; they were most numerous during the months of March and April. Some 1,057 deaths were registered as due to the disease in the Metropolis. TYPHUS. No cases were certified during the year in Shoreditch; 5 cases were notified in the Metropolis. TUBERCULOSIS. Tuberculosis (Appendix, Table V., Nos. 29 to 34 inclusive) was given as the cause of 328 deaths, a number somewhat above the average for the previous 15 years. They amounted to 15.8 per cent, of the total deaths from all causes. The death-rate was 3.2 per 1,000 inhabitants ; it was highest in Church and lowest in Acton Ward, being 4.1 and 2.3 respectively. The deaths from tuberculosis of the lungs, commonly known as consumption, numbered 248, of which, most were of persons aged from 25 to 65 years. The deaths of males numbered 142 as compared with 106 for females. The consumption death-rate was 2.4 per 1,000, which is above the average for recent years. It was highest in Church and lowest in Moorfields Ward, being 3.3 and 1.6 per 1,000 respectively. The deaths from tuberculosis in London numbered 8,407, giving a death-rate of 1.8 per 1,000 ; the deaths attributed to consumption numbered 6,786, the deathrate being 1.5 per 1,000 inhabitants as estimated for 1914. A summary of the notifications received under the Public Health (Tuberculosis) Regulations, 1912, is given in Table IX. (Appendix), and the distribution of the cases according to age periods and localities is shown in Table II. (Appendix). 21 The cases certified were most numerous in proportion to the population in Whitmore Ward, where they amounted to 6.7 per 1,000 for tuberculosis of the lungs, and 2.0 for other forms of tuberculosis. They were least numerous in Church Ward, where the cases of tuberculosis of the lungs were 3.3 and of other forms of tuberculosis 0.8 per 1,000 inhabitants. In all cases of tuberculosis steps are now taken with the object of securing proper treatment for the patients certified, for preventing the spread of infection, and for the removal of insanitary conditions prejudicial to the patients. A large proportion of the work already falls upon the Tuberculosis Dispensary and its officers; there remains, however, a considerable amount which has to be dealt with by the officers of the Health Department in connection with cases not attending the Dispensary. It is hoped that in course of time these cases will be reduced to a minimum. The sanitary work arising in connection with the dwellings occupied by the patients is and will remain strictly a matter for the officers of the Health Department. During the year inquiries were made by the Sanitary officers respecting some 311 of the cases of consumption certified; in 182 the patients were males and 129 they were females. The cases of non-pulmonary tuberculosis visited numbered 78 of which 44 were in males and 34 females. Of the foregoing 29 were school children, 12 boys and 17 girls, and 15 of them, 5 boys and 10 girls, were cases of pulmonary tuberculosis. In the inspection of the dwellings of tuberculous patients, attention is especially directed to the amount of cubic space available for sleeping, the means provided for securing efficient ventilation, the amount of light, the presence of dampness, and cleanliness. As the results of the inspections during the year, in cases of pulmonary tuberculosis, in 150 the dwellings were satisfactory or fairly so and in 161 they were unsatisfactory; in the cases of non-pulmonary tuberculosis, 30 were satisfactory or in fair condition, and 48 were unsatisfactory. In 101 of the cases of pulmonary tuberculosis family histories of the disease were more or less clear, and in 94 there was evidence of infection from previous cases, mostly in the patients' families. In the non-pulmonary tuberculosis cases there were family histories in 25, and evidence of infection in 17 instances. Disinfection was carried out by the Sanitary Authority in connection with 164 rooms at 144 premises, and the usual steps were taken as regards textile articles exposed to infection therein, some 3,131 articles including 134 beds. 179 mattresses, 294 pillows and 119 bolsters being disinfected. According to the reports received from the Insurance Committee for the County of London, some 81 insured persons, 68 males and 13 females, who were inmates of sanatoria or hospitals, were discharged therefrom during the year. The periods spent by the patients at the institutions to which they had been sent varied from a few days to seven months, the usual length of time being from two to three 22 months. Of the males 56 seem to have more or less improved in health and 9 of the females were benefited. In 5 instances there appears to have been doubt as to whether the patients were actually suffering from phthisis. The Downs for males and Winchmore Hili for females were the Sanatoria to which most of patients went. Four of the patients above referred to died during the year. The deaths of insured patients during the year altogether totalled 58 of which 42 were of males and 16 females. In accordance with arrangements made by the London County Council for the provision of residential accommodation for uninsured persons suffering from tuberculosis, some 18 persons belonging to Shoreditch, men, women and children, received the benefit of sanatorium or hospitial in-patient treatment. Table II (appendix) shows that over 62 per cent, of the cases of consumption were removed to hospitals, sanatoria or the infirmary. Something closely approaching 59 per cent, of the deaths from consumption belonging to Shoreditch occurred in public institutions within or without the Borough 12 per cent, taking place in the Shoreditch Infirmary. A report on the work of the Tuberculosis Dispensary at the Royal Hospital for Diseases of the Chest in the City Road is appended (page 68). The figures given by Dr. A. J. McFarland, the tuberculosis officer, indicate a very marked increase in the work at the Dispensary, and it will be noted that the London Insurance Committee are making greater use of the Dispensary than formerly, for the benefit of insured persons. OPHTHALMIA NEONATORUM. Some 45 certificates were received relating to 30 cases. Twenty of the certificates were signed by midwives. With the exception of 6 which occurred in the Shoreditch Infirmary, the cases were inquired into by the Health Visitors and are referred to in their reports (Appendix, pp.. 74, 78). Some 68 visits were paid in connection with them. Of the cases visited by the Health Visitors, 25 were mild or of moderate severity, 2 left the Borough and were lost sight of, and 3 were severe cases of which 1 died in hospital, 1 recovered with the loss of sight in one eye and in 1 vision was impaired. This last infant also died. The cases certified were at the rate of 9.7 per 1,000 births. The cases certified in the Metropolis numbered 788, being at the rate of 7.5 per 1,000 births. CEREBRO-SPINAL MENINGITIS. The cases certified numbered 40, the majority occurring during the second and third quarters of the year. In 32 of the cases the meningococcus or the micro-organism of the disease was reported to have been found. Of these cases 24 terminated fatally and 23 of the deaths were registered during the year. The mortality was therefore 66.6 per cent. With respect to the 8 cases in which the 23 toicro-organism was not found, 4 died from tuberculous meningitis, 1 from pneumo-coccal meningitis, 1 from whooping cough, and 2 recovered. The majority of the cases certified were in children under the age of 15 years. With regard to the sanitary condition of the houses in which the cases occurred, in 26 instances this was satisfactory or fairly so, in 6 it was unsatisfactory; in 5 instances the presence of bugs was noted in the dwellings and in 1 instance fleas were very numerous; in 15 cases cats or dogs were kept. No cases were certified in Moorfields Ward, otherwise there was nothing apparent calling for remark as to the distribution of the cases beyond the fact that they were more numerous where the population is densest, that is, in the central parts of the Borough; in Shap Street three houses were invaded, in Watsons Place, Bookham Street and Falkirk Street, two each, in the rest of the streets where the cases occurred only one house in each was invaded. In no instances did more than 1 case occur in the same house; no secondary cases could be traced, although in the families in which the cases occurred the contacts numbered 125 whilst there were 179 other persons resident under the same roofs, a total of 304 men, women and children. In 13 instances relatives of the patients were soldiers, but in no case could any history be obtained as to cerebro-spinal fever in connection with them. With reference to the health of the inmates of the invaded houses, in one case a child had had pneumonia and another a sore throat, in a second there had been influenza in the family, in a third there had been measles in the house but not in the patient's family, in two others there had been "colds" in the house, in another a child had had a discharge from the ears, and in another instance a girl had had headache and giddiness for which she had been treated at a hospital. In connection with the other 25 cases the health of the inmates of the houses seems to have been good. Eleven deaths were registered as due to meningitis (non-tuberculous) ; so far as could be ascertained there were no reasons for believing any of these to have been due to cerebro-spinal fever. ACUTE POLIOMYELITIS. One case was certified—the patient, a little boy aged 6 years, returned from hospital after an attack of scarlet fever on May 26th, he went to school on June 7th for a few days ; subsequently on June 14th it was discovered in the morning that he had lost the use of his legs. The case was admitted to Gt. Ormond Street Hospital. Nothing was ascertained throwing light upon the source of infection. GLANDERS, ANTHRAX AND HYDROPHOBIA. No cases occurred and there is nothing to report. CHOLERA. No intimations were received under the cholera regulations as regards the arrival in the Borough of persons from localities abroad where cholera existed. 24 INFECTIOUS DISEASES AND SCHOOLS. The numbers of children belonging to Shoreditch who were suffering from infectious diseases, or were resident in houses in which infectious diseases existed, concerning whom intimations of exclusion from school were received from head teachers in accordance with the requirements of the school management code of the London County Council, were as follows:—6 for enteric fever, 352 for diphtheria, 689 for scarlet fever, 882 measles, 503 chicken-pox, 370 whooping cough, 322 mumps and 1,218 for other infectious ailments. The exclusions altogether numbered 4,342 and related to 43 schools. 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:—Maidstone Street, Laburnum Street, Gopsall Street, Canal Road, Hamond Square, St. Monica's, St. John's Road, Napier Street, St. John's Church, Haggerston Road and Wenlock Road. Some 21 class rooms were affected. The exclusions numbered 202 of which 8 occurred in February, 8 March, 15 April, 151 May, 12 June and 8 in November. Intimations were also received from the school medical officer as to the exclusion of twelve children found as the result of bacteriological examination to be harbouring diphtheria bacilli in throat or nose. These cases were kept under observation until they were free from the micro-organisms. BACTERIOLOGICAL EXAMINATIONS. The bacteriological examinations made by Dr. Bulloch, F.R.S., at the London Hospital Medical School numbered 219, of which 56 were for suspected diphtheria, 3 for enteric fever, 153 for consumption and 7 for cerebro-spinal fever. The positive results were 11 for diphtheria, 1 for enteric fever, 56 for consumption and 2 for cerebro-spinal fever. In addition some 320 specimens were examined for tubercle bacilli in connection with the work at the Tuberculosis Dispensary. DISINFECTION. The premises disinfected numbered 1,406; the articles removed and disinfected at the Borough disinfecting station totalled 39,147 and included 1,560 beds, 1,895 mattresses, 2,951 pillows, 1,316 bolsters and 31,425 others, such as sheets, blankeis, quilts, curtains, carpets, clothing and the like. Included amongst the foregoing are 159 beds, 220 mattresses, 365 pillows, 106 bolsters and 2,086 other articles dealt with on account of vermin. It was necessary to destroy one bed and four palliasses which were so dilapidated and contaminated as to render it inadvisable to return them. These were replaced with new. In two instances there was a little damage to articles removed for which compensation was made. 25 THE SHELTER. The Shelter in Reeves Place provided under the Public Health (London) Act, 1891, section 60 (4) for the temporary accommodation of members of any family in which any dangerous infectious disease has appeared was not in use during the year. PUBLIC MORTUARY. Some 416 bodies of persons dying during the year were received into the Mortuary, 334 inquests were held, 196 post mortem examinations were made in connection therewith and the bodies of five persons dead of infectious disease were deposited in the Mortuary. For infectious bodies a specially constructed shell is used. WATER SUPPLY. The rainfall for the year measured at Oxford was 32.302 inches. Taking the mean fall for 35 years, it was above the average. Most rain fell during the last quarter of the year, the rainfall for that period amounting to 9.630 inches. The rainiest month was December, when 5.003 inches fell. Least rain fell in April, the amount being 0'827 inch. The general rainfall for the Thames Valley above Teddington amounted to 35'53 inches, and for the Lee Valley 30.10 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 32 premises, all of them in the New River District. The grounds for withdrawing the supplies were : on account of defective water pipes in 12 instances, waste on empty premises 7, by request of the consumer 6, and in 7 instances for arrears in the water rate. No complaints were received as to the quality of the water, nor was there any reason for suspecting the occurrence of any illness due to consumption of the water. In accordance with Section 78 of the London County Council (General Powers) Act, 1907, additional taps were provided for the supply of upper floors in six houses occupied by members of more than one family. SANITARY WORK. Intimations under the Public Health (London) Act, 1891, as to insanitary conditions were served in respect to 3,973 premises. In 549 instances the premises were dealt with under the supervision of Inspector Firth, in 671 under Inspector Jordan, 400 Inspector Langstone, 493 Inspector Pearson, 754 Inspector Stokes, 597 Inspector Pratt and 509 under the supervision of Inspector Chapman. In connection with the work carried out some 772 letters were sent to owners of property, builders, and others concerned. 26 Some 37,350 visits of inspection were made by the sanitary inspectors, the premises under inspection including dwelling houses, artisans' dwellings, houses let in lodgings, outworkers' premises, factories, workshops, laundries, bakehouses, cowsheds, milk vendors' premises, ice cream shops, slaughterhouses, and places where food is prepared and sold. The special house to house inspections carried out during the year are referred to later (page 30). 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, the same having been compiled from the abstracts of their work prepared by the sanitary inspectors :— Insp. Firth. Insp. Jordan. Insp. Langstone. Insp. Pearson. Insp. Stokes. Insp. Pratt Insp. Chapman. Total. New drains constructed 1 9 14 4 8 ... 11 47 Drains re-constructed or repaired 14 12 6 31 89 73 9 234 Sinks trapped and disconnected 36 17 ... 10 28 28 5 124 Stack pipes reinstated 62 8 44 100 94 61 39 408 Eaves gutters reinstated 67 5 19 90 89 62 50 382 Stack pipes disconnected 19 25 ... 8 21 2 ... 75 Accumnlations of sewage removed ... 21 25 48 95 26 23 238 Soil pipes ventilated 4 1 2 1 16 1 ... 25 New water closets constructed 3 85 1 5 4 1 ... 99 W.c.'s re constructed or repaired 32 38 24 64 86 70 13 327 W.c.'s cleansed and white-washed 37 205 54 177 315 83 140 1,011 W.c.'s flushing apparatus repaired 60 45 29 64 167 89 80 534 Obstructions in w.c.'s removed 68 26 43 33 87 48 36 341 Overcrowding in houses abated 38 7 22 17 22 16 9 131 Damp courses in houses provided 5 ... 2 ... 2 1 5 15 Walls pointed 37 ... 8 16 34 53 1 149 Roofs repaired 108 38 136 134 191 222 155 984 Stairs repaired 43 2 7 6 11 34 35 138 Floors repaired 37 8 16 32 35 35 69 232 Ventilation under floors provided 21 ... 3 1 2 ... ... 27 Doors repaired 22 15 14 13 22 36 49 171 Door sills provided 64 ... 4 3 4 5 1 81 Sashes repaired 26 35 19 22 27 30 84 243 Houses cleansed throughout 17 109 48 74 101 26 26 401 Houses cleansed in part 264 10 182 133 132 250 253 1,224 Total number of rooms cleansed 618 727 609 679 831 623 938 5,028 Yaras or areas lime-washed 117 65 30 140 785 95 156 1,397 Yards paved 91 19 30 31 43 57 35 309 Areas and forecourts paved 13 ... 5 2 5 21 4 50 New areas constructed ... ... ... 1 ... ... ... 1 Sculleries paved 4 ... 2 4 9 9 ... 28 Dust receptacles provided 211 28 53 39 38 69 79 517 DuDg receptacles provided ... 1 4 2 ... 4 ... 11 In connection with the foregoing it may be mentioned that 7 old brick drains were abolished, and in 45 instances nuisance due to rats were dealt with. In 102 cases water supplies were restored, and in 120 leaky water pipes were repaired. In 4 cases new urinals were provided and in 11 they were cleansed and repaired. Foul accumulations were dealt with on 201 premises. In 24 instances the stabling of animals was improved, and in 5 the stables were paved under the supervision of the sanitary officers with a view to the abatement or prevention of nuisance. 27 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. Most of the work done was carried out 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 476 instances. For non-compliance with statutory notices and for breaches of by-laws Droceedings were taken before the Magistrate with the results stated below :— Premises. Result of Proceedings. Britannia Street No. 22 Summons withdrawn ; cosis, £1 lis. 6d. Bristow Street, No. 2 Closing Order made. Broadway,London Fields, No. 27. Summons dismissed ; 2 guineas costs against Council. Cavendish Street, No. 47 Summons withdrawn. „ „ No. 49 Order to do work in 14 days. City Road, No. 157 Summons withdrawn ; costs, 1 guinea. Edith Street, No. 17 Summons withdrawn. Falkirk Street, No. 52 Fine of 40s. Laburnum Street, No. 20 Order to do work in 10 days ; costs, 1 guinea. Reeves Place, No. 17 Fine of 40s. Wenlock Street, No. 35 Order to do work in 7 days. Westmoreland Place, No. 61. Order to do work in 21 days. Wilmer Gardens, No. 93 Summons withdrawn ; costs, 10s. 6d. „ „ No. 95 „ „ „ „ No. 97 Fine of 25s. with 1 guinea costs. With reference to the premises in Britannia Street, which are used for providing meals for some 200 workgirls daily, the roof was very leaky, the walls dirty and there was a serious defect in connection with the drain. The case was twice adjourned to give the owner time to comply with the statutory notice. After the second adjournment the requirements of the notice having been carried out, the summons was withdrawn. The premises in Bristow Street were in occupation as a bakery. The drains were in a very defective condition. No steps were taken to deal with them nor did there seem to be any likelihood of such being taken. The premises were accordingly closed under a magistrate's order made in accordance with the provisions of the Public Health (London) Act, 1891. The summons in respect to the premises in Broadway, London Fields, were taken against the owner for not complying with the requirements of a statutory notice to provide proper separate sanitary accommodation for males and females 28 employed thereat. The premises comprised a lock-up shop where four persons were employed in selling articles over a counter and the work incidental thereto. It was considered by the council that the premises constituted a workplace within the meaning of Section 38 of the Public Health (London) Act, 1891. The magistrate, however, was of a different opinion, and dismissed the summons. With reference to No. 47, Cavendish Street, a dust "receptacle was required which was provided before the case came into court; No. 49 was in a dirty and dilapidated condition, and a nuisance order was made as stated. At the premises in the City Road the roof and eaves guttering were defective, the yard and a urinal dirty, and the cellar paving defective. The necessary work was in progress when the case came before the magistrate, and the summons was withdrawn on payment of costs. At No. 17, Edith Street the drain was obstructed ; the obstruction had been removed when the case came into court. The summons in respect to 52, Falkirk Street was taken against the owner on account of the drain being defective. The premises in Laburnum Street were dirty and dilapidated, the w.c., eaves guttering, yard paving and roof of a workshop in rear were defective At No. 17, Reeves Place a longhopper w.c. pan had been fixed in contravention of the London County Council by-laws. At the house in Wenlock Street some of the rooms were dirty and the eaves guttering was defective. At No. 93, Wilmer Gardens the w.c. was obstructed, and at No. 95 a dust receptacle was required. When the case3 came into court the requirements of the statutory notices served had been complied with, and the summons were withdrawn in consequence. With respect to No. 97, where the-w.c. was also obstructed, the magistrate convicted. SMOKE NUISANCES. One complaint was received from the London County Council respecting the emission of black smoke from a shaft belonging to a factory. Notice was served, and the necessary steps were taken. Altogether 12 intimation notices were served in connection with cases coming under the observation of the inspectors. 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 276, and some 446 rooms were dealt with during the year. Sanitary notices were served where necessary, and the usual steps were 29 taken. In the great majority of instances the cases came under our notice through intimations from the school authorities. Daring the year the homes of some 1,317 children, 613 boys and 704 girls, notified as being verminous by the School Medical Officer, were reported with a view to the homes and bedding where necessary being dealt with by the Sanitary Authority, the children themselves having been cleansed and their clothing disinfected at the cleansing stations of the London County Council in the neighbourhood. Intimations were received that 373 boys and 252 girls had been given the opportunity of being cleansed at the cleansing stations; that in the cases of 228 boys and 423 girls statutory notices had been served upon the parents to cleanse the children within 24 hours under Section 122 of the Children's Act, 1908, and that in the cases of 12 boys and 29 girls legal proceedings were pending for non-compliance with the requirements of statutory notices. In numerous instances the same children were reported more than once, and their homes had to be visited and dealt with accordingly. In practically all the cases reported the homes were visited by the sanitary inspectors, and the following summarises the results obtained :—In 790 the rooms occupied were satisfactory, varying from fairly clean to very clean, in 149 they were dirty, in 87 buggy, and in 87 both dirty and buggy. In 771 the bedding was clean or fairly so, in 250 it was dirty, in 54 bugs were noticed, and in 30 it was both dirty and buggy. In 75 instances more or less evidence of lice was observed in the bedding. Where lice were present the bedding was usually dirty and otherwise verminous : they were, however, noticed in some cases where the bedding appeared otherwise quite clean. In 16 instances the presence of lice was attributed to second-hand clothing purchased for the children. In 244 cases the homes were markedly infested with fleas, in 24 overcrowding was found, and in 18 there was marked evidence of poverty. The poverty-stricken cases were, however, far less numerous than in former years. In 165 instances there were indications of recent steps for cleansing, doubtless in most cases in expectation of the visit from the sanitary officer. In 71 instances there was difficulty in obtaining entrance to the dwelling for 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 21 instances notice of intention to apply for a magistrate's order to enter the dwelling had to be given. In connection with these cases some 209 visits had to be made where 71 should have been sufficient. It is to be uoted that in the cases of 234 children the addresses were erroneous. In most of these the children could not be traced ; in 103 they were not known at the addresses stated on the forms, in 84 they had left the addresses, in 21 the addresses were non-existent in the Borough, in 24 the houses were empcy, and in two they had been demolished. In a number of instances forms were received relating to nonresidents in the Borough ; these were duly forwarded to their proper destination. Evidence of lice was found in the bedding in 5.7 per cent, of the cases investigated, which is considerably lower than that for previous years. 30 As a result of the visits of the inspectors, a large amount of cleansing and disinfection was carried out in the homes and numerous sanitary defects remedied. Altogether some 214 sanitary notices were served upon owners and 40 upon the occupiers of verminous dwellings. It it also to be mentioned that 21 children, one of whom could not be traced, were reported by the School Medical Officer as suffering from scabies or "itch" and 10 persons by the Superintendent of the Out-patients 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. HOUSE-TO-HOUSE INSPECTION. During the year house-to-house inspection was carried out in connection with some 1,425 dwellings of which 616 were found in a satisfactory sanitary condition and 88 were unoccupied. The remainder more or less required attention and 721 sanitary notices were served. The sanitary defects noted were mostly of minor importance. HOUSES CLOSED. The following houses were closed voluntarily by the owners upon the service of sanitary notices under the Public Health (London) Act, 1891, either on account of unfitness for habitation or in order to allow the works necessary to put them in a satisfactory sanitary condition being carried out effectively which would have been difficult or impracticable whilst the houses were in occupation :— Britannia Gardens, No. 18. Kenning Terrace, No. 11. Cavendish Street, No. 49. Kingsnorth Place, No. 3. Oremer Street, No. 9. Queen's Road, No. 11. Ely Place, No. 4. Reeves Place, No. 19. Enfield Buildings, No. 18. Rushton Street, No. 40. Hows Street, No. 23. Westmoreland Place, No. 57, Halcomb Street, No. 9. Weymouth Terrace, No. 60. Hilcot Street, Nos. 19 and 36. Witchampton Street, No. 1. The house in Britannia Gardens, containing three rooms, was generally dirty, dilapidated and verminous, and was closed by the owner on receipt of a sanitary notice from Inspector Pearson. The house in Cavendish Street, containing six rooms and scullery, was generally dirty and dilapidated; a statutory notice was served and a nuisance order made by the Magistrate. Thereupon to comply with the requirements of the order the owner decided to close the house. The house in Cremer Street, containing five rooms, was dirty, dilapidated and damp. It was closed by the owner to comply with the requirements of a statutory notice. 31 The house in Ely Place, containing two rooms, was closed by the owner to comply with the requirements of a statutory notice, the premises being dirty and dilapidated. The dwelling in Enfield Buildings, consisting of three rooms, was dirty and verminous, and was closed by the owner on receipt of a sanitary notice from Inspector Pearson. No. 23, Hows Street, containing six rooms and scullery, was closed by the owner to comply with the requirements of a statutory notice, the premises being generally dirty and dilapidated. The house in Halcomb Street, containing five rooms, was dirty and dilapidated, and was closed by the owner on receipt of a sanitary notice from Inspector Chapman. No. 36, Hilcot Street, containing two rooms, was closed by the owner on receipt of a statutory notice. The roof was very defective. No. 19, Hilcot Street, containing five rooms, was closed by the owner on receipt of a sanitary notice from Inspector Chapman. The house was dirty and dilapidated. The houses in Kenning Terrace and Kingsnorth Place, each comprising four rooms and scullery, were generally dirty and dilapidated, and were closed by the owners on receipt of statutory notices. No. 11, Queen's Road, a six-roomed house, and No. 17, Reeves Place, a fourroomed house, were dirty and dilapidated. They were closed by the owners on receipt of sanitary notices from Inspector Chapman. No. 40, Rushton Street, containing six rooms and scullery, was dirty and dilapidated, and was closed by the owner on receipt of a statutory notice. The house in Westmoreland Place, containing eight rooms, was generally dilapidated and verminous, and the drains were in a defective condition. It was closed by the owner on receipt of a statutory notice. The house in Weymouth Terrace, containing seven rooms and scullery, was closed by the owner on receipt of a sanitary notice from Inspector Pratt; the premises were generally dirty and dilapidated, the roof was defective and there were defects in the sanitary arrangements. The house in Witchampton Street, containing seven rooms and scullery, was generally dirty and dilapidated, the roof was also defective and some of the brickwork dangerous. It was closed by the owner on receipt of a statutory notice. 32 In the case of No. 49, Cavendish Street., the necessary work was carried out, but the house remained closed at the end of the year. Nothing was done as regards the two houses in Hilcofc Street and they remained closed. No. 1, Witchampton Street, remained closed, but the necessary works were in progress to make it fit for habitation at the end of the year. As regards the rest of the houses, they were all dealt with in a satisfactory manner and re-occupied before the close of the year. DEMOLITION OF HOUSES OCCUPIED BY PERSONS OF THE WORKING CLASS. The following houses came under my notice as having been closed for demolition :— City Road, Nos. 189 and 191—eight-roomed houses—demolished in connection with a street improvement:. Christopher Street, Nos. 25, 27 and 29—eight-roomed houses—demolished for the erection of warehouses. Crondall Street, No. 63—an eight-roomed house—demolished for the extension of a workshop. Westmoreland Place, Nos. 2,4, 6, 8 and 10—five-roomed houses with sculleries —demolished in connection with a street improvement. HOUSING AND TOWN PLANNING ACT, 1909. The following is a brief account of the work done under the above Act :— Nos. 37 and 38, Ware Street, each containing six rooms, were very dirty and dilapidated, doors, windows, floors, stairs, eaves guttering, flues, area railings and front doorsteps all being defective, as well as the roof at No. 37, which was very leaky. They were inspected by order of the Health Committee on September 28th. The usual written intimation was given to the owner but nothing was attempted to deal with the premises. Official representations under the Act were accordingly made by the Medical Officer of Health, and the houses were closed by order of the Sanitary Authority. At the end of the year nothing had been done to render them fit for habitation and they remained closed. No. 87, Wilmer Gardens, containing 12 rooms, was generally dirty and dilapidated, the flooring, eaves guttering and sanitary arrangements generally being defective, and the window frames, firegrates and doors having disappeared . The premises were inspected by order of the Health Committee on February 25th. Intimation to the owner having been disregarded, an official representation wras made and the house was closed by order of the Sanitary Authority. 33 ARTISANS' DWELLINGS. The artisans' dwellings in the Borough were under observation during the year. As a whole their sanitary condition may be reported as 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. The numbers of tenements, rooms and persons in the artisans' dwellings in the Borough, estimated for 1915, 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 6,600 Class B 15 379 919 1,900 Total for the whole 59 2,314 5,694 8,500 Taking the figures in the above table, the number of rooms per tenement averages 2'4 for both classes of dwellings, but the number of persons per room for the Class A is approximately 1.3, as compared with 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. 216 25.4 172 26.0 44 23.1 The proportion of deaths attributed to prematurity was at the rate of 4.0 per 1,000 births. For Class A it was 5.8 and nil in the Class B dwellings. For the Borough the deaths were 19.7 per 1,000 births. The infantile mortality was for the whole of the dwellings 148 per 1,000 births. For the Class A it was 116 as compared with 272 for Class B, which is the highest so far recorded for this Class. (1067) c 34 In the subjoined table are given the deaths and death-rates from certain causes for the dwellings and the corresponding rates for the whole Borough :— Cause of Death. The whole of the Dwellings. Class A. Class B. The Borough. Number of deaths. Rate per 1,000 inhabitants. Number of deaths. Rate per 1,000 inhabitants. Number Rate per of 1,000 deaths, inhabitants. Rate per 1,000 inhabitants. All causes 113 13.3 87 13.2 26 13.7 20.2 Principal Zymotic diseases. 14 1.6 10 1.5 4 2.1 2.1 All forms of Tuberculosis 12 1.4 8 1.2 4 2.1 3.2 Phthisis 10 1.1 8 1.2 2 1.0 2.4 Bronchitis 15 1.7 14 2.1 1 0.5 1.8 Pneumonia 9 1.0 5 0.7 4 2.1 2.3 The deaths of residents of the dwellings in public institutions numbered 48, being 32 for the Class A and 16 for the Class B dwellings. The percentage of the total deaths of residents of the dwellings dying in public institutions was 42.4, being 37.9 for Class A and 61.5 for Class B. The percentages for the Borough and for the wards are contained in Table VI. (Appendix). The cases of notifiable infectious disease numbered 89, of which 65 were in the Class A dwellings and 24 in the Class B. The attack.rates per 1,000 population were 10.4 for the whole of the dwellings, 9.8 for Class A, and 12.6 for Class B, as compared with 10.2 for the whole Borough. The cases included 1 of puerperal fever, 46 of scarlet fever, 28 of diphtheria, 12 of erysipelas, 1 of enteric fever and 1 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 37 5.6 17 2.5 — — 9 1.3 1 0.1 1 0.1 Class B 9 4.7 11 6.1 1 0.5 3 1.5 — — — — The whole of the dwellings 46 54 28 3.2 1 0.1 12 1.4 1 0.1 1 0.1 For the Borough as a whole the attack.rates for the above diseases were as follows :—scarlet fever, 5.3 ; diphtheria, 2.5; enteric fever, 0.02; erysipelas, 1.7; cerebro-spinal fever 0.3 and puerperal fever, 0.08 per 1,000 inhabitants. 35 HOUSES LET IN LODGINGS. The number on the register remains as for 1914, namely, 280, none having been added during the year. The visits of inspection numbered 287, and some 146 intimations with 49 statutory notices, were served in connection with them during the course of the year. CUSTOMS AND INLAND REVENUE ACTS. No applications were received during the year as regards the inspection of houses for the purposes of the above Acts. CO-OPERATION BETWEEN THE CIVIL AND MILITARY SANITARY AUTHORITIES. Billets and quarters occupied by troops in the Borough were subject to regular inspection by the sanitary officers of the Borough throughout the year. Considerable improvement was noted as regards the quarters occupied. Generally the condition both of billets and quarters may be reported as very satisfactory from a sanitary point of view. Weekly reports in accordance with instructions were rendered to the Deputy Director of Medical Services for the London District. It is also to be mentioned that there was a considerable interchange of information between the sanitary authority and the military in respect to infectious disease. SLAUGHTER HOUSES. The licensed slaughter houses in the Borough at the end of the year numbered three, the use of two having been discontinued. They were subject to the usual inspection and their general condition may be reported as satisfactory. COWHOUSES. The cowhouses on the register numbered 5, the use of one situate at No. 7, Mintern Street having been discontinued early in the year. Four were found in a satisfactory sanitary condition. The fifth was in a dirty and dilapidated condition and the renewal of the licence was objected to by the Borough Council. The licence was, however, renewed on the understanding that the necessary steps would be taken to remedy the defects which were the grounds of the Council's objection. Cows are only kept at two of the licensed premises; on October 18th some 31 cows were numbered in the Borough. The number of dairymen and milk purveyors on the register at the end of the year was 291. During the year the sale of milk was discontinued at 17 and commenced at 15 premises, and in 35 instances there were changes in the names of the persons registered. The premises where milk is sold were under observation throughout the year, and some 2,614 visits were made in connection with them. (I076) C 2 36 In 18 instances sanitary notices were served; in 10 for general cleansing, in 2 for defective roofs, in one for dirty utensils, and in 5 for the provision of proper dust receptacles. Four cases of scarlet fever occurred on milk purveyors' premises and the usual steps were taken by the Sanitary Authority. OFFENSIVE BUSINESS. The ti>ipe 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 14 samples-were taken and submitted to the Public Analyst, and in 3 instances proceedings were taken. The particulars respecting the prosecutions are briefly as follows :— 1. A person in whose possession rag flock containing 75.5 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 £5, with £2 2s. Od. costs. 2. In a similar case, the rag flock containing 128.0 parts of chloride of sodium in excess, the defendant was fined £5 and £1 1s. Od. costs. 3. In another instance the sample was found to contain 207.0 parts of sodium chloride in excess; the defendant was fined £5 and £1 Is. 0d. costs. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of the year was 1,334, the largest number so far recorded, 165 having been placed on and 112 taken off. A classification of the workshops registered is contained in the summary of proceedings under the Act, which is appended. Some 2,888 visits of inspection were made in connection with workshops, and 543 to factories. Nineteen communications were received from the Factory Inspector relative to the establishment of 83 new workshops in the Borough. On inspection 70 were found to be in a satisfactory sanitary condition, and one was not in occupation at the time it was visited. The remainder were more or less unsatisfactory from a sanitary point of view, and some 10 sanitary notices were served. From the Factory Inspector 25 written intimations were received relating to insanitary conditions and infringements of the law as to public health in connection with some 38 workshops. The chief insanitary conditions to which the Factory Inspector directed attention were : dirty walls and ceilings in 9 instances, 37 defective and insufficient water-closet accommodation in 12, want of proper separate accommodation for the sexes in 14, overcrowding in one, accumulation of refuse in one, and defect in a drain through a manhole cover being broken in one instance. Four of these workshops were not in occupation at the time of visit. Including those brought under our notice by the Factory Inspector, 261 workshops were dealt with and 2151 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 1915 :— New drains constructed 3 Drains relaid or repaired 11 Stack pipes disconnected 8 Stack pipes reinstated 12 Eaves gutters reinstated 11 Sink waste pipes disconnected 6 Yardspaved 7 Water-closets reconstructed 25 Water-closets cleansed and lime-waslied 101 Yards cleansed and whitewashed 75 Areas cleansed and whitewashed 7 Roofs repaired58 Floors repaired11 Stairs repaired 2 Obstructions removed from water-closets21 Urinals repaired and cleansed 3 New water-closets constructed 10 Water-closets' flushing apparatus repaired 26 Water supply laid on or restored 1 Rooms cleansed and whitewashed 226 Doors repaired 10 Sashes repaired 4 Dust receptacles provided 11 Foul accumulations removed 9 Walls pointed 3 It may be added that in 18 instances nuisances owing to flooding with sewage had to be dealt with, in 5 cases overcrowding and in 1 owing to rats infesting the premises. In 22 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 14, and in connection with them some 26 sanitary notices were served. The works carried out to comply with these notices included the construction, reconstruction or repair of drains in 1 instances, the disconnection of stack pipes in 3, of sink waste pipes in 2, the repair of water-closets in 10, the construction of new water-closets in 12, anil new urinals in 1 instance, besides a number of other items connected with 38 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 114 lists of out-workers were received from employers in the Borough, 58 in the first and 56 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 1,657 out-workers, of whom 1,292 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 2,435 out-workers, and of these 53 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 1915. The number of out-workers reported was 4,(192, of whom 2,800 were residents in Shoreditch. 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 out-workers as regards trades in the Borough. Most of them are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags and boxes, and brushes. During the year some 1,989 visits of inspection were made to places where homework was being carried on, and sanitary notices were served in 148 instances. The work carried out to comply with these notices included the disconnection of sink waste pipes in 5 instances, the reinstatement of stack pipes in 18, of eaves gutters in 18; various works in connection with the water-closet accommodation in 33, with the water supply in 11 ; the cleansing of 183 rooms, 26 yards, 5 areas, and 29 water-closets; the repair of roofs in 51, floors in 17, stairs in 2, sashes in 12, and doors in 10 instances, and the provision of 32 dust receptacles besides other work. In 3 instances overcrowding was found, in 10 cases the rooms required to be dealt with on account of vermin, in 18 instances drains were repaired, and in 11 instances accumulations of sewage were dealt with. Some 16 cases of notifiable infectious disease occurred at out-workers' premises. The necessary steps were taken. In connection with the out-workers' lists it was necessary to write to employers in 5 instances by reason of delay in sending in 39 the lists relating to out-workers making wearing apparel ami in 5 relating to out-workers making paper bags and boxes. There was no necessity for further action. It may be mentioned that enquiries were made during the year as regards the nutrition of children under school age and unemployment and distress amongst home workers, especially in the cabinet making and clothing trades. From the evidence obtained it may be stated that there has probably been no period, at all events in the recent history of Shoreditch, during which there has been generally in the Borough less unemployment and distress. BAKEHOUSES. The bakehouses on the register at the end of the year numbered 75, of which 43 are under ground and 32 above ground. Included are the following which have not been in use as bakehouses for some years past: Nos. 88, Bridport Place, 41, Dunioe Street, 55, Hackney Road, 189, High Street, 249, Old Street, and 30, Pitfield Street. No. 17, Cropley Street for many years a large factory bakery ceased as such during the year. The following were also out of use at the end of the year : Nos. J3, Mansfield Street, 76, Pitfield Street and 44, Whiston Street. It is also to be mentioned that, in addition to the above, some 32, sixteen above and sixteen below ground in the occupation of persons of German nationality, were closed in consequence of popular feeling. Of these 24 were subsequently re opened during the year. It will be noted therefore that altogether some 42 of the bakehouses in the Borough were out of use for more or less lengthened periods during the year. As the result of inspection the general sanitary condition of the bakehouses may be reported as satisfactory. In four of them mechanical power is used and they are therefore factories within the meaning of the Factory Acts. In 29 instances sanitary notices were served mostly for limewashing and cleansing. The notices were complied with and there was no necessity for action on the part of the Sanitary Authority. ICE CREAM SHOPS. These premises to the number of 92 were under inspection during the year and 73 were found in a satisfactory sanitary condition. The remainder more or less needed attention, chietly for minor sanitary defects and cleansing, and some 19 sanitary notices were served. COOKSHOPS, COFFEE HOUSES AND EATING HOUSES. Of these Inspector Firth had 7, Inspector Jordan 70, including the kitchens of 19 licensed houses, Inspector Langstone 24, Inspector Pearson 32, Inspector Stokes 40 15, Inspector Pratt 13, and Inspector Chapman 11, under observation. Altogether they numbered 172, and in 48 instances sanitary notices were required, chiefly for cleansing. In a few instances there were some serious defects in connection with the sanitary arrangements, but otherwise they were of minor importance. FRIED FISH SHOPS. Of these there were 48 under observation; 35 were found in a satisfactory sanitary condition; the remainder more or less needed attention, and some 13 sanitary notices were served, mainly for cleansing. STREET MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers as regards food exposed for sale. The following were seized or surrendered and destroyed as unfit for the food of man:—Skate 2 cwts., conger eel 2 boxes, 1 ton 4 cwt. 14£ lbs. of pork, veal and beef joints, sausages and faggots and 2 barrels of sausage meat and faggots, 2 cwt. quarters of bacon, 2 boxes of meat offal, 29 lbs. of beef and mutton, 18 lbs. and 6 pieces of beef, 2 bushels of bread, 4 cwt. tomatoes, and 144 oranges. No legal proceedings were taken. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 768 samples were submitted to him for analysis during the year. This number is at the rate of 7'5 per 1,000 inhabitants. The results of the year's work are summarised in the following table :— Quarter of the year 1915. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions proceeded with. Number of successful Prosecutions. Fines and Costs. Amount paid to Analyst for Samples analysed. £ s. d. £ s. d. 1st 162 35 21.6% 8 — 8 5 12 13 6 81 0 0 2nd 169 40 23.6% 11 — 11 7 16 6 0 84 10 0 3rd 151 28 18.5% 7 — 7 6 11 13 0 75 10 0 4th 286 27 9.4% 17 — 17 12 22 13 6 109 10 0 Total for Year. 768 130 17.8% 43 — 43 30 63 16 0 350 10 0 41 The samples taken included 521 of milk, 109 of butter, 21 margarine, 3 arrowroot, 1 brawn,. 3 bread and butter, 9 cheese, 11 coffee, 8 mustard, 9 cocoa, 4 dripping, 16 lard, 2 malt vinegar, 1 non-alcoholic ginger wine, 3 pickles, 2 olive oil, 9 sausage, 1 skimmed milk, 2 table jelly, 7 pepper, 6 ground rice, 5 ground ginger, 4 camphorated oil, 3 sago, 3 tapioca, 1 lime juice cordial, 1 pork pie, 1 borax, 1 honey and 1 of boric acid. Of the samples of milk 113 or 21.6 per cent, were found to be below the standard fixed by the Board of Agriculture. The proportion of milk samples returned as adulterated during 1915 was again below the average. It is, however, to be mentioned that 21 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 17.6. In the subjoined table are shown the numbers of samples of milk taken during the four quarters of the year with the numbers and percentages of those found not to be genuine. Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st 102 32 31.3 2nd 129 40 31 3rd 112 22 19.6 4th 178 19 10.6 In 47 of the samples water was certified to have been added; in 12 the amount was more and in 35 it was less than 5 per cent., taking the standard of the Board of Agriculture. In 30 the samples showed deficiencies in milk fat; in 11 the deficiency was more, and in 19 it was less than 5 per cent. In 10 instances both fat had been abstracted and water added. Four of the samples contained traces of artificial colouring matter. None showed the presence of preservatives. Legal proceedings were instituted in 28 or 24'7 per cent, of the cases in which the samples of milk were below standard, and in 15 of these convictions were obtained. In ten instances the summonses were dismissed, warx-anties being proved, one summons was adjourned sine die, and in two cases the summonses were dismissed, the defendants being cautioned. There were two summonses for refusal to serve, in one of which a fine of £2 was inflicted, and in the other a fine 5s. with 12s. 6d. costs. No legal proceedings were considered advisable as regards the rest of the samples below standard. 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 75, which is again above the average. 42 In the cases in which convictions were obtained the penalties for milkadulteration amounted to £32 9s. 6d., which is equivalent to 4.5 per cent, of the full amount of the penalties to which the defendants were liable. Taking fines and costs, which in the aggregate amounted to £42 10s. 6d., the average amount paid by the defendants on conviction was £2 16s. 8d. Of the samples of butter taken 4 or 3.6 per cent, were not genuine. Nearly all the samples taken contained a small amount of boric acid not exceeding 0.5 percent. 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 23 1 41 2nd 18 ... ... 3rd 20 1 5 4th 48 2 41 Of the samples sold as butter found not genuine two were samples of margarine, one contained foreign fats in a large amount and was probably a mixture of butter and margarine, and one contained water in excess of the 16 per cent, standard. In the first two cases proceedings were taken, the defendants being fined £1 10s. 0d. and 9s. 6d., with 10s. 6d. costs, respectively. In the case of the mixture proceedings were also taken, the defendant being fined £3. The penalties inflicted amounted to £4 19s. 6d., or approximately 2.2 per cent, of the maximum penalties to which the defendants were liable. Including costs, which amounted to 10s. 6d., the amounts paid by defendants averaged £1 16s. 8d., which is lower than any so far recorded. Twenty-one 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 in 9 instances and convictions obtained in all. Nearly every one of the Margarine samples contained boric acid, but not exceeding 0.5 per cent. The fines amounted to £4 2s. 6d., and £4 14s. 6d. costs were allowed the Council. The fines under the Margarine Act amounted to a little under 2.3 per cent, of the maximum penalties to which the defendants were liable. Including costs, the amounts paid by the defendants averaged 19s. 6d. The sample of brawn contained boric acid to the extent of 5 grains per pound. One of the samples of coffee contained 30 per cent, of chicory; the vendor was 43 fined £3 with £1 Is. Od. costs, being the third conviction under the Act. Six of the samples of sausage and one of pork pie were found to contain boric acid in amounts varying from 3 to 15 grains per pound. No proceedings were thought advisable, but letters of caution were sent to the vendors. A sample of camphorated oil was deficient in camphor to the extent of 65 per cent., but it was not thought advisable to prosecute. Two samples of sago turned out to be tapioca, and in one instance cinnamon was supplied when ground ginger was asked for. The remainder of the samples were returned as genuine. The percentage of samples found adulterated was again somewhat below the average. With reference to the convictions during 1915, in 4 instances the defendants had been once, in 6 twice, in 2 three times, in 1 as many as 8 times, previously convicted for offences under the Act. MILK AND CREAM REGULATIONS, 1912. None of the 521 samples of milk submitted to the Public Analyst contained any preservative. No samples of cream or preserved cream were taken. Both these articles are difficult to get in the Borough, there being but very little demand for them. SANITARY STAFF. The following were serving during the year in H.M.'s Navy and Army :— Sanitary Inspector J. Wright, Staff-Sergeant, R.A.M.C., T.F. Clerk E. J. Hayes, Seaman, R.N.A.S. „ W. Harris, Private, R.A.M.C. Messenger H. Ansell, 3rd Writer, R.N. Disinfector F. J. Ford, Private, A.S.C. „ J. F. Wilson, 2nd Corporal, R.E. The work on Inspector Wright's district was attended to during the year by Inspectors Langstone and Stokes. Messrs. J. S. Filmer and R. Mackenzie were temporarily appointed on the Clerical Staff, and two assistants were engaged during the absence of Disinfectors Ford and Wilson. The arrangements made enabled the work of the Department being coped with efficiently, but they entailed some additional work for the regular members of the Sanitary Staff. In connection with the work of the Department some 18,300 communications, written and printed, were dispatched from the office during the year. They included 4,215 notices and summonses, and 2,714 letters, cards and other communications on matters under the Public Health and Sale of Food and Drugs 44 Acts, 468 in connection with the work under the Factory and Workshops Acts, 9,953 on various matters connected with infectious disease, verminous cases and disinfection, and 950 agendas and reports concerning the work of the Department. I have again to place on record my satisfaction as to the work done by the officers of the Department, and also my cordial appreciation of the valuable assistance in connection with my work rendered by Mr. Firth and the other members of the sanitary Staff, especially during my absence through illness. I have also to thank the Chairman and Members of the Health Committee and the 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. FRASER BRYETT, Medical Officer of Health. APPENDIX TO THE REPORT of the MEDICAL OFFICER OF HEALTH, containing Statistical Tables and a Summary of Sanitary Proceedings under the Public Health and Factory and Workshop Acts, during the Year 1915, the Report of the Tuberculosis Officer, and the Reports of the Health Visitors for the Year. Tables I., II., III. and IV. are forms required by the Local Government Board. 47 TABLE I. Vital Statistics of the Borough of Shoreditch during 1915 and previous Years. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the district. Transferable Deaths Nett Deaths belonging to the District. Uncorrected N umber. 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 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 1915 103627 2955 3091 30.2 1877 18.1 300 494 447 144 2071 20.2 Note.—The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn Union Workhouse has been deducted in calculating the rates. In column 6 are included the whole of the deaths except those of soldiers and sailors in public institutions, which were 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 year included in the number given in column 8 and by addition of the deaths under 1 year 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 or inhabited houses, 11,535 Average number of persons per house 9.6 At Census of 1911. 48 TABLE II. Cases of infectious disease notified during the Year 1915 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) 269 8 105 131 17 8 ... ... 11 65 31 14 40 50 46 12 266 Erysipelas 174 6 8 11 25 37 63 24 1 26 18 29 49 15 22 14 53 Scarlet Fever 546 17 165 321 29 13 1 ... 12 91 108 61 98 71 75 30 543 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 20 ... 3 5 5 4 3 ... ... 2 2 2 1 8 4 1 20 Relapsing fever (R), Continued fever (C) 2(C) ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... 2 Puerperal fever 9 ... ... ... 4 5 ... ... ... 3 ... 1 2 ... 3 ... 8 Cerebro-spinal Meningitis 40 13 11 1l 3 1 1 ... ... 7 6 5 8 7 5 2 36 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polio-myelitis 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Pulmonary Tuberculosis 429 1 16 38 61 169 108 36 17 57 60 53* 120† 39 38 45 266‡ Other forms of Tuberculosis 130 24 36 36 17 8 4 5 8 14 12 26 37 9 12 12 22‡ Ophthalmia Neonatorum 30 30 ... ... ... ... ... ... ... 4 8 3 1 7 6 1 ... Chicken pox 159 18 65 71 4 1 ... ... 16 31 28 18 34 6 13 13 19 Totals 1,809 117 409 625 166 247 180 65 65 301 273 212 390 213 225 130 1,236 *This Number includes the cases of consumption notified from the Holborn Union Infirmary, Highgatc. †This includes the cases of consumption in the Shoreditch Workhouse. ‡Removed to the Shoreditch Infirmary, Hospitals and Sanatoria. 49 TABLE III. Causes of, and ages at death during the Year 1915 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). A11 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) 2071 447 149 144 92 83 263 457 436 889 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric Fever 3 ... ... 1 ... 1 1 ... ... ... 2 Small-pox ... ... ... ... ... ... ... ... ... ... 3 Measles 67 18 27 19 3 ... ... ... ... 15 4 Scarlet Fever 13 ... 2 5 6 ... ... ... ... ... 5 Whooping-cough 36 18 5 9 4 ... ... ... ... 11 6 Diphtheria and Croup 21 3 ... 12 4 1 1 ... ... 1 7 Influenza 26 1 3 1 2 2 3 7 7 2 8 Erysipelas 13 2 ... 1 ... ... 1 5 4 15 9 Phthisis (Pulmonary Tuberculosis) 248 2 2 4 35 98 84 17 128 10 Tuberculous Meningitis 35 2 9 8 12 3 1 ... ... 4 11 Other Tuberculous diseases 45 12 6 11 3 6 ... 6 1 21 12 Cancer, malignant disease 99 ... ... ... 1 1 8 52 37 43 13 Rheumatic Fever 3 ... ... ... 1 1 ... 1 ... 1 14 Meningitis (see note (d)) 34 15 7 ... 5 1 ... 2 ... 7 15 Organic Heart Disease 70 1 1 1 4 5 16 25 17 36 16 Bronchitis 189 30 7 8 ... 1 13 51 79 109 17 Pneumonia (all forms) 237 73 42 30 8 3 21 35 25 58 18 Other diseases of Respiratory organs 15 1 1 1 ... ... 2 7 3 10 19 Diarrhoea and Enteritis {see note (e)) 138 100 22 6 1 1 3 2 3 53 20 Appendicitis and Typhlitis 4 ... ... 1 2 1 ... ... ... 1 21 Cirrhosis of Liver 18 ... ... ... ... 1 3 8 6 13 21a Alcoholism 6 ... ... ... ... ... 3 2 1 6 22 Nephritis and Bright's Disease 79 ... 1 2 2 1 10 37 26 39 23 Puerperal Fever 4 ... ... ... ... ... 4 ... ... 2 24 Other accidents and diseases of Pregnancy and Parturition 8 ... ... ... ... 1 6 1 ... 4 25 Congenital Debility and malformation, including premature birth 104 103 1 ... ... ... ... ... ... 18 26 Violent deaths, excluding suicide 96 17 3 6 16 4 11 22 17 18 27 Suicides 7 ... ... ... ... ... 3 2 2 1 28 Other defined diseases 447 48 10 12 12 14 54 106 191 273 29 Diseases ill-defined or unknown 6 1 ... 2 ... ... 1 2 ... ... 2071 447 149 144 92 83 263 457 436 889 (1067) D 50 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH during the year 1915. 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 under 1 Year. All causes Certified 71 15 16 8 110 83 83 87 84 447 Uncertified ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... 1 1 Measles ... ... ... ... ... 1 1 2 14 18 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 4 '3 4 7 l8 Diphtheria and Croup ... ... ... ... ... ... ... ... 3 3 Erysipelas ... ... ... ... ... 1 ... 1 ... 2 Tuberculous Meningitis ... ... ... ... ... ... ... 2 ... 2 Abdominal Tuberculosis (b) ... ... ... ... ... 1 3 2 ... 6 Other Tuberculous Diseases ... ... ... 1 1 1 1 2 3 8 Meningitis (not Tuberculous) ... ... ... ... ... ... 4 6 5 15 Convulsions 4 1 1 ... 6 3 ... 2 1 12 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 1 l ... ... 2 8 7 7 6 30 Pneumonia (all forms) 1 l 3 ... 5 9 20 20 19 73 Diarrhœa ... ... ... ... ... 10 9 12 10 41 Enteritis ... ... 1 ... 1 19 12 18 9 59 Gastritis ... 1 ... 1 2 ... ... 2 ... 4 Syphilis ... ... 1 ... 1 2 2 1 ... 6 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 4 1 1 ... 5 4 3 ... 1 13 Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 7 1 ... ... 8 1 ... ... ... 8 Congenital Malformations (c) 7 2 1 2 12 ... ... ... ... 12 Premature birth 38 5 5 4 52 7 2 ... ... 61 Atrophy, Debility and Marasmus 6 2 l ... 9 8 10 3 1 30 Other causes 2 1 2 ... 5 5 6 3 5 24 71 15 16 8 110 83 83 87 84 447 Nett Births in the year—Legitimate 3,018, illegitimate 73. Nett Deaths in the year of legitimate infants 437, illegitimate infants 10. 51 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 Diarrhœa and Enteritis at all ages. (In the "Short List" deaths from Diarrhœa and Enteritis under 2 years are included under 19; those at 2 years and over being placed under Title 28.) 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 and 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. (1067) D 2 52 53 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1915. Note.—The deaths of persons not belonging to Shoreditch occurring in hospitals and other institutions in the Borough are excluded; deaths of persons belonging to Shoreditch occurring in public institutions in London beyond the limits of the Borough are included. CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 1 Small Pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 18 46 3 ... ... ... ... ... ... ... ... ... ... 1 10 8 10 27 4 3 4 40 27 67 3 Scarlet fever ... 7 6 ... ... ... ... ... ... ... ... ... ... ... 1 4 2 3 2 ... 1 5 8 13 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza 1 4 1 1 2 ... 1 2 3 4 5 1 1 ... 2 4 8 9 1 1 1 11 15 26 6 Whooping cough 18 14 4 ... ... ... ... ... ... ... ... ... ... ... 6 3 4 2 6 6 9 13 23 36 7 Diphtheria, membranous croup 3 12 3 1 1 ... 1 ... ... ... ... ... ... ... 4 2 4 4 2 5 ... 9 12 21 8 Enteric fever ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... 2 1 3 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 37 10 ... 1 ... 1 1 ... 1 ... 1 ... ... 2 9 13 5 13 5 5 ... 28 24 52 11 Epidemic or zymotic enteritis 24 6 ... ... ... ... ... ... ... 1 ... 1 ... ... 9 5 1 8 4 ... 3 14 16 30 12 Other allied diseases 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 2 2 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 6 1 ... ... ... ... 1 1 ... ... ... ... ... 1 1 3 1 ... 1 2 ... 5 4 9 19 Gonorrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedœna, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas 2 1 ... ... ... ... ... 1 4 1 2 2 ... ... 1 1 2 4 2 ... 3 4 9 13 22 Puerperal fever ... ... ... ... ... ... 1 3 ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... 4 4 23 Pysemia, septicæmia 1 3 ... ... 1 2 ... 1 ... ... 1 ... ... ... 1 1 1 2 9 2 ... 6 3 9 24 Infective endocarditis ... 1 ... 1 ... 2 3 ... ... ... ... ... ... ... 2 1 3 ... ... ... 1 1 6 7 25 Other allied diseases ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 1 2 26 Malarial fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Rheumatic fever ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 1 ... 1 2 3 28 Rheumatism of the heart ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 1 2 Tuberculosis: 29 Brain or meninges, acute hydrocephalus 2 17 10 2 3 ... 1 ... ... ... ... ... ... 2 5 10 3 7 3 2 3 13 22 35 30 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Lungs 2 6 2 4 14 21 42 56 56 28 13 4 ... 7 57 45 29 41 24 24 21 142 106 248 32 Intestines, tabes mesenterica 6 4 ... ... ... ... ... ... 1 ... ... ... ... ... 2 2 2 1 3 1 ... 8 3 11 33 General, position undefined 4 13 2 1 ... ... ... ... 2 ... ... ... ... 2 4 4 2 5 2 ... 3 14 8 22 34 Other forms, scrofula 2 ... ... ... 4 2 ... ... 2 1 1 ... ... ... 4 1 2 2 2 1 ... 8 4 12 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 54 55 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 2 ... 2 1 ... ... ... 2 2 ... 1 ... ... 1 2 4 6 43 Chronic industrial poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 Cancer ... ... ... ... ... ... 3 2 22 28 26 8 ... 4 15 9 15 17 9 9 11 45 44 89 48 Diabetes mellitus ... ... ... ... ... ... ... ... 1 ... 4 ... ... ... 1 ... 1 ... 1 ... 2 2 3 5 49 Purpura hæmorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Hæmophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anæmia, leucocythæmia ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... 1 ... 2 2 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 53 Premature birth 61 ... ... ... ... ... ... ... ... ... ... ... ... 1 6 7 14 9 7 11 6 35 26 61 54 Injury at birth 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 55 Debility at birth 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... 1 1 4 2 6 56 Atelectasis 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 4 ... ... ... 5 3 8 57 Congenital defects 12 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 1 1 2 4 9 3 12 58 Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Atrophy, debility, marasmus 24 1 ... ... ... ... ... ... ... ... ... ... ... 2 8 3 1 4 2 3 2 13 12 25 60 Dentition 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 1 ... ... 4 4 8 61 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 62 Old Age, senile decay ... ... ... ... ... ... ... ... ... 1 21 56 14 2 10 19 11 18 10 10 12 38 54 92 63 Convulsions 12 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 4 2 2 1 ... 11 2 13 64 Meningitis 5 4 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 1 2 3 2 1 1 5 6 11 65 Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 66 Apoplexy ... ... ... ... ... ... ... ... 10 24 11 15 2 3 8 7 4 16 8 9 7 26 36 62 67 Softening of brain ... ... ... ... ... ... ... ... 1 1 1 2 ... ... ... ... ... 2 2 ... 1 3 2 5 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... ... 1 2 1 ... ... 1 1 ... ... ... ... 2 1 3 4 69 General Paralysis of insane ... ... ... ... ... ... ... 6 4 ... ... ... ... ... 2 ... 1 2 2 1 2 8 2 10 70 Other forms of insanity ... ... ... ... . . . ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 1 71 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... 1 ... ... ... 1 1 1 1 ... ... ... ... ... 1 1 ... 3 ... ... 1 4 5 73 Epilepsy ... ... ... ... 1 ... 5 5 1 2 ... 1 ... ... 1 3 1 6 2 ... 2 10 5 15 74 Laryngismus Stridulus ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 75 Locomotor Ataxy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... ... ... 2 1 1 ... ... ... 1 ... 1 ... ... ... 2 2 2 4 77 Other diseases of brain or nervous system 1 2 ... ... 1 ... ... ... 1 2 2 1 ... 1 ... 4 1 2 1 1 ... 4 6 10 78 Otitis, otorrhæa 1 1 l 1 ... 2 ... 1 ... ... ... ... ... ... ... 3 2 2 ... ... ... 2 5 7 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis 1 2 l ... ... ... ... ... ... ... 1 ... ... ... ... 2 1 2 ... ... ... 2 3 5 82 Endocarditis, valvular diseases of the heart ... ... l 2 3 2 10 5 15 10 10 6 ... 3 11 12 11 9 5 7 7 30 35 65 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 l ... ... ... 2 2 85 Aneurism ... ... ... ... ... ... ... 2 1 4 2 ... ... ... ... 3 1 4 ... ... 1 6 3 9 86 Senile gangrene ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 1 ... ... ... ... ... 2 2 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Phlebitis ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular ... ... 1 3 2 1 9 5 15 ! 18 28 10 3 5 16 13 12 19 11 12 7 36 59 95 56" 57 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. Haggerscon. Acton. Male. Female. 91 Laryngitis ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Acute bronchitis 30 15 ... ... ... ... 2 2 ... 8 7 2 2 3 7 10 21 16 5 3 3 40 28 68 95 Chronic bronchitis ... ... ... ... ... 1 ... 9 16 27 39 26 3 1 23 21 17 21 14 15 9 65 56 121 96 Lobar, croupous-pneumonia 2 6 2 ... ... ... 1 9 3 2 2 1 ... ... 2 3 4 3 ... 7 2 14 7 21 97 Lobular, broncho-pneumonia 59 50 1 ... 1 ... 1 3 2 5 10 4 ... 2 19 23 24 24 12 21 11 79 57 136 98 Pneumonia, form not stated 12 16 3 2 1 1 5 9 12 11 6 2 ... 5 13 15 17 9 9 6 6 40 40 80 99 Emphysema, asthma ... ... ... ... ... ... ... 1 ... 2 ... 2 ... ... 1 2 ... 1 1 ... ... 4 1 5 100 Pleurisy ... 2 ... ... ... ... ... ... 1 1 1 ... ... ... ... ... 3 ... ... 1 1 3 2 5 101 Other and ill-defined diseases of respirator system 1 ... ... ... ... ... ... 1 3 ... ... ... ... ... 2 2 ... 1 ... ... ... 4 1 5 102 Diseases of mouth and annexa ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 103 Diseases of pharynx ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... ... 1 2 2 1 ... ... ... ... 2 1 1 1 ... 1 ... 3 3 6 106 Other diseases of stomach 4 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 1 1 1 4 2 6 107 Enteritis 39 12 ... ... ... ... 1 1 1 ... 1 ... 1 1 19 7 7 11 4 3 4 26 30 56 108 Appendicitis ... 1 1 1 1 ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... 3 1 4 109 Obstruction of intestine 3 3 1 ... ... 1 ... ... ... 1 2 ... ... ... 1 1 2 3 2 1 1 5 6 11 110 Other diseases of intestine ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 111 Cirrhosis of liver ... ... ... ... ... 1 ... 3 4 4 6 ... ... 3 2 2 6 3 1 ... 1 6 12 18 112 Other diseases of liver ... ... ... ... ... ... ... ... 2 1 ... 1 ... ... ... 1 1 1 1 ... ... 1 3 4 113 Peritonitis 1 ... ... ... ... ... ... 4 ... ... 1 ... ... 2 ... ... 1 1 1 1 ... 3 3 6 114 Other and ill-defined diseases of digestive system 1 ... 1 ... ... ... ... 1 1 ... ... ... ... ... 1 1 ... 2 ... ... ... 1 3 4 115 Diseases of Lymphatic System and ductless glands 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 116 Acute nephritis ... 3 ... ... ... ... ... 1 2 1 2 ... ... ... 2 2 1 2 2 ... ... 6 3 9 117 Bright's disease ... ... 1 1 ... 1 1 8 16 18 18 6 ... 2 16 11 8 11 11 6 5 39 31 70 118 Calculus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 119 Diseases of bladder and prostate ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 2 ... ... ... ... ... ... 3 ... 3 120 Other and ill-defined diseases of urinary system ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... 2 ... ... ... ... 1 ... 1 2 3 121 Diseases of testis and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Placenta prcevia, flooding ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... 1 2 ... ... 1 ... 4 4 130 Puerperal thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... ... 1 2 ... 1 ... ... ... ... ... 1 1 ... ... ... 1 1 ... 4 4 132 Arthritis, ostitis, periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58 59 causes of death ages. DEATHS IN EACH WARD. sex. Total. Under 1. i 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. Whitraore. Kingsland. Haggerston. Acton. Male. Female. 184 Ulcer, bedsore ... 135 Eczema ... i 1 i i 136 Pemphigus ... ... 137 Other and ill-defined, diseases of integumentary system ... ... 1 1 1 1 By Accident or Negligence. 138 In mines and quarries... 139 In vehicular traffic 2 4 2 3 I 3 2 1 5 5 3 2 2 1 14 7 2.1 140 On railways ... ... 141 On vessels and docks, excluding drowning. 142 In building operations... 143 By machinery ... ... ... "i 1 1 1 144 By weapons and implements ... "i 1 1 1 145 Burns and scalds 6 3 ... ... "2 3 i i 9 "3 1 3 8 11 146 Poisons, poisonous vapours ... 1 1 2 1 1 2 147 Surgical narcosis ... i "i 1 1 148 Effects of electric shock ... 149 Corrosion by chemicals ... 150 Drowning 2 "2 "2 1 "l 3 1 "4 151 Suffocation, overlaid in bed ... 10 2 2 "5 1 4 6 10 152 Suffocation otherwise ... 3 .. fi i 1 2 1 1 1 2 3 5 153 Falls, not specified 1 3 1 i "3 "3 "5 5 5 5 3 10 3 1 19 11 30 154 Weather agencies 155 Otherwise, and not stated ... 2 ... i i i 1 ] "4 "i 5 i "6 156 Homicide ... 1 1 l ... 1 ... 1 ... ••• 2 ... 1 ... 2 2 ! 4 Suicides, all forms. 157 By poison ... ... ... 1 1 ... 1 1 158 By asphyxia ... ... ... ... 159 By hanging and strangulation 1 i ... 2 "2 160 By drowning ... 1 "i 1 1 161 By shooting ... i "i ... 1 1 162 By cut or stab ... i "1 1 1. ... 2 2 163 By precipitation from elevated places ... 164 Bv crushing ... ... 165 By other and unspecified methods ... ... 166 Execution ... ... ... ... 167 Sudden death ... 168 Other ill-defined and not specified causes 1 2 1 1 1 1 1 1 1 2 2 4 6 169 Malignant disease l 1 l 2 1 1 3 1 1 3 2 3 7 3 10 170 Abscess ... i ... 1 1 1 ... 2 1 1 ... ... 2 2 4 171 Cerebro Spinal Fever ... 10 7 4 1 1 1 "7 "3 3 2 4 3 19 4 23 Total 447 293 62 30 41 42 106 157 228 229 246 162 28 64 357 331 304 413 217 205 180 1081 990 2071 60 TA.BLE VI.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER. 1915. DISTRICTS. Estimated population 1915. ANNUAL RATE PER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS: Principal Zymotic Diseases. Small Pox. Measles. DEATHS DURING 1915 FROM Tuberculous Disease. Violence. Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Scarlet Fever. Diphtheria. Whooping Cough. Fever. †Diarrhœa. 1912. 1913. 1914. 1915. London 4,518,021 24.3 13.6 14.2 14.4 14.4 1.5 0.00 0.50 0.07 0.15 0.25 0.02 0.56 1.8 0.73 111 10.0 43.6 0.1 Shoreditch ‡102,299 28.5 18.3 18.4 19.4 20.2 2.6 ... 0.65 0.12 0.20 0.35 0.03 1.24 3.2 1.0 144 16.7 52.1 ... Wards. Moorfields 4,265 18.1 13.5 13.3 16.9 15.0 0.9 ... 0.23 ... ... ... ... 0.70 2.5 0.4 108 7.8 40.6 ... Church 17,550 29.9 20.1 21.1 19.1 20.3 3.2 ... 0.57 0.05 0.22 0.34 ... 1.99 4.1 1.3 137 18.2 59.6 ... Hoxton 15,310 29.5 18.5 22.5 21.7 21.6 2.6 ... 0.51 0.26 0.13 0.19 ... 1.56 4.0 0.9 146 17.8 54.9 ... Wenlock ‡15,019 28.5 19.1 16.1 18.1 20.2 2.0 ... 0.66 0.13 0.26 0.26 ... 0.72 2.5 0.6 152 15.1 43.0 ... Whitmore §17,870 28.4 22.0 19.9 23.0 23.1 3.8 ... 1.51 0.16 0.22 0.11 0.05 1.73 3.1 1.6 155 20.8 54.4 ... Kingsland 10,050 32.9 16.3 17.0 17.9 21.5 2.7 ... 0.39 0.19 0.19 0.59 0.1 1.29 3.3 0.9 142 17.9 48.3 ... Haggerston 10,520 28.7 14.5 16.2 16.9 19.4 2.1 ... 0.28 ... 0.47 0.57 0.09 0.76 2.6 0.7 169 14.1 52.6 ... Acton 11,715 25.0 16.1 14.2 16.9 15.2 1.7 ... 0.34 0.08 ... 0.76 ... 0.51 2.3 0.5 116 10.0 49.4 ... *Fever includes typhus, typhoid and continued fevers. †Diarrhœa 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. 61 TABLE VII. ANALYSIS of the Cases Treated by the District Medical Officers of the Borough during the Year ending December 31st, 1915. Diseases. Diseases. All Causes 3,625 37 Atelectasis ... 38 Congenital malformations 1 39 Old age 296 1 Small-pox ... 40 Apoplexy 10 2 Measles 97 41 Epilepsy 62 3 Scarlet Fever 9 42 Convulsions 3 4 Typhus ... 43 Other diseases of brain and nervous system 216 5 Relapsing fever ... 6 Influenza 40 44 Diseases of organs of special sense 35 7 Whooping Cough 39 8 Diphtheria 2 45 Diseases of circulatory system 128 9 Simple, continued and illdefined fever 11 46 Laryngitis 4 10 Enteric fever ... 47 Bronchitis 1,003 11 Simple cholera ... 48 Pneumonia 64 12 Diarrhoea, dysentery 31 49 Pleurisy 11 13 Remittent fever ... 50 Other respiratory diseases 22 14 Hydrophobia ... 51 Dentition 17 15 Glanders ... 16 Cow pox and Effects of vaccination ... 52 Quinsy, sore throat 15 53 Enteritis 36 17 Venereal affections 26 54 Peritonitis ... 18 Erysipelas 16 55 Diseases of liver 15 19 PyaBmia and septicaemia 9 56 Other diseases of digestive system 233 20 Puerperal fever ... 21 Tabes mesenterica 1 57 Diseases of lymphatic system and ductless glands 6 22 Tuberculous meningitis ... 23 Phthisis 140 24 Scrofula, tuberculosis 35 58 Diseases of urinary system 45 25 Other zymotic diseases 25 59 Diseases of the generative system 28 26 Thrush ... 27 Worms and other parasitic diseases 2 60 Accidents of childbirth 10 61 Diseases of locomotive system 113 28 Starvation, want of breastmilk ... 62 Diseases of integumentary system 124 29 Alcoholism 15 63 Fracture and contusion 31 30 Rheumatic fever and rheumatism of heart 21 64 Gun shot wounds ... 65 Cut, stab ... 31 Rheumatism 215 66 Burns or scalds 4 32 Gout 37 67 Poison ... 33 Rickets 2 68 Drowning ... 34 Cancer 18 69 Suffocation ... 35 Other constitutional diseases 32 70 Otherwise 46 36 Premature birth 1 71 Other causes 222 62 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1915. Table VIII. PREMISES. NUMBER OF PLACES— Number of inspections, 1915. Number of notices, 1915. Number of prosecutions 1915. On register at end of 1914. Added in 1915. Removed in 1915. On register at end of 1915. Milk premises 293 15 17 291 2614 18 ... Cowsheds 6 ... 1 5 23 1 ... Slaughter-houses 5 ... 2 3 28 ... ... Other offensive trade premises 1 ... ... 1 1 ... ... Ice Cream premises 81 16 5 92 193 19 ... Registered houses let in lodgings 280 ... ... 280 287 146 ... Number of intimation notices served for all purposes 3973 Overcrowding:— Number of dwelling rooms overcrowded 131 Number remedied 131 Number of prosecutions Nil. Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 276 Underground rooms:— Number dealt with during year 1 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 17 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year Nil. Customs and Inland Revenue Acts:— Number of dwellings for which applications were received during year Nil. Number of prosecutions under By-laws under Public Health (London) Act, 1891:— With respect to water closets, earth closets, etc. 1 Mortuary:— Total number of bodies removed 416 Total number of infectious bodies removed 5 63 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Table IX.—Summary of Notifications during the Period from the 3rd January, 1915, to the 1st January, 1916, 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 1 10 6 7 11 13 48 51 56 20 20 243 338 ... 1 l 2 3 105 85 „ Females ... 7 9 12 18 19 31 35 17 17 15 180 242 ... 2 ... 2 4 41 35 Non-Pulmonary, Males 15 20 7 7 9 3 2 3 2 ... 3 71 79 1 2 l 4 7 1 11 ,, Females 10 14 7 7 4 1 2 1 1 1 1 49 53 1 1 3 5 6 4 7 Cols. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (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, 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. 64 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK DURING THE YEAR 1915. 1.—Inspection. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (3) (3) (4) Factories (Including Factory Laundries.) 543 26 — Workshops (Including Workshop Laundries and Bakehouses.) 3168 234 — Workplaces (Excluding Outworkers' premises dealt with in Table 3.) 766 72 — Total 4477 332 — 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 226 226 — — Want of ventilation — — — — Overcrowding 5 5 — — Want of drainage of floors — — — — Other nuisances 299 299 — — Sanitary accommodation insufficient 12 12 — — unsuitable or defective 84 84 — — not separate for sexes 14 14 — — 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 629 629 — — *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 65 (1067) 3. Home Work—1915. 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 Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel: ... (1) Making, &c. 66 73 1,133 12 5 102 ... ... ... 99 99 ... 8 ... ... (2) Cleaning & washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 2 ... 7 ... ... ... ... ... ... 1 1 ... ... ... ... Artificial flowers 4 ... 50 ... ... ... ... ... ... 5 5 ... 2 ... ... Fur pulling 2 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Paper bags and boxes 24 ... 232 4 ... 50 ... ... ... 38 38 ... 6 ... ... Brush making ... ... ... ... ... ... ... ... ... 4 4 ... ... ... ... Total 98 73 1,427 16 5 152 ... ... ... 148 148 ... 16 ... ... E (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 5 instances of failure to send lists of outworkers employed in making wearing apparel, &c., and in 5 instances for similar failures in respect to paper bag and box making. 66 4.—Registered Workshops—1915. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades. 824 (a) Cabinet making 515 (b) French Polishing 85 (c) Upholstery 68 (d) Other workers 156 (2) Dress 237 (a) Tailoring 113 (e) Shirt making 6 (b) Mantles 11 (f) Boot & Shoe trades 34 (c) Dress. 29 (g) Artificial flowers 5 (d) Millinery 12 (h) Other workers 27 (3) Skin, leather, hair and feather trades 83 (a) Furriers 11 (b) Saddlery & Harness 28 (c) Feathers 3 (d) Other workers 41 (4) Paper, printing, book, stationery and fancy goods trades 71 (a) Box & bag makers 54 (b) Other workers 17 (5) Laundry and Washing 24 (6) Food 3 (7) Metals, machines, implements and conveyances 46 (8) Precious metals, jewels, &c. 2 (9) Other trades than those mentioned above 44 Total number of workshops on Register 1,334 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 57, including 4 factory bakehouses. 5.—Other Matters. Class. (1) Number. (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 25 referring to 38 workshops.) Reports (of action taken) sent to H.M. Inspector. 11 (referring to 38 workshops.) Other Nil. Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 27 67 6.—Shewing the Numbers op Outworkers Received from other Districts during 1915. DISTRICT. Making Wearing Apparel. Cleaning and Wa-hing. Lace Curtains. Artificial Flowers. Furniture and Upholstery. Far Pulling. Feather Sorting. Umbrellas, &c. paper Bags and Boxes. Brush Making. Tents. Dolls and Toys. 1 Total. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Battersea ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Bethnal Green 38 50 ... ... ... ... ... ... 10 ... ... ... ... ... ... 1 31 47 30 27 ... ... ... ... 234 Bromley ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Camberwell 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 City of London 369 352 ... ... ... ... 32 47 ... ... 7 8 10 5 38 41 6 8 ... ... ... ... ... ... 923 Chelsea 6 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Colchester 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Deptford 3 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Enfield ] 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Finsbury ... 175 ... ... ... ... ... 13 ... 2 ... 8 ... 9 ... 1 ... 126 ... 9 ... ... ... ... 343 Hackney 164 166 ... ... 4 ... 34 31 11 5 6 4 10 12 1 16 26 23 34 29 22 4 1 1 604 Hampstead ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Holborn 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Ilford 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Islington 34 53 ... ... ... ... 9 5 ... ... ... 2 ... ... ... ... 2 18 ... 4 ... ... ... ... 127 Kensington 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Lambeth ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Leeds 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Leyton ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Paddington 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Poplar 6 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 ... ... ... ... ... ... ... 20 Salford 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Southwark 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 St. Marylebone ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 St. Pancras ... ... ... ... ... ... ... ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Stepney 34 49 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Stoke Newington 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Tottenham 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Wandsworth 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Westminster l5 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 West Ham 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Woolwich 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Total 695 889 2 ... 4 ... 75 96 24 10 14 22 20 26 39 59 76 223 64 69 22 4 1 1 2,435 1584 2 4 171 34 36 46 98 299 133 26 2 (1067) E 2 68 TUBERCULOSIS DISPENSARY. Report for 1915. A. J. McFarland, M.D. {Dublin), D.P.H. (Oxford), Tuberculosis Officer. Royal Hospital for Diseases of the Chest, City Road, London, E.C. 14th February, 1916. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, I beg to submit the following Report of the work done in the Tuberculosis Dispensary:— During the year 1915 the attendance has been excellent, and the number of new patients has increased. New patients numbering 953 were examined at the Dispensary; of these, 623 were "Contacts," the remaining 330 being patients sent to the Dispensary from various sources for examination and in a great many cases for treatment also. The new cases comprised 413 males and 540 females, and are divided into three classes:-TUBERCULOUS, "SUSPECTS," and NON-TUBERCULOUS. The Tuberculous cases numbered 190, and the age incidence was as follows:— Children under 14 years, 28 cases; between 14 and 40 years, 120 cases; over 40 years, 42 cases. There were only 5 cases of Surgical Tuberculosis. The "Suspects" numbered 143, and the age incidence was as follows:— Children under 14 years, 90 cases; between 14 and 40 years, 43 cases; over 40 years, 10 cases. The new cases showing no evidence of Tuberculosis numbered 620, and of these 494 were "Contacts," many of whom only attended once for examination. The remaining 126 were sent to the Dispensary as they were suffering from certain symptoms which made it advisable for them to be kept under observation until a definite diagnosis had been made. As regards "Suspects" among children under 14 years of age, they almost all, in addition to cough and malnutrition, showed some enlargement of the lymphatic glands in the neck; whilst some of them in addition gave a history of measles, whooping cough or pneumonia in early childhood and on examination 69 showed some signs of Fibrosis at one or other base of the lung. These children, though generally delicate and requiring care, in tbe absence of definite evidence should not be classed definitely as Tuberculous. Any scheme for the prevention and treatment of Tuberculosis should make provision for both these classes, to which some Authorities have applied the term "Pretuberculous." For some considerable time I have watched many cases of Suspected Tuberculosis in children, and have seen nothing but good results from judicious treatment, if continued for a length of time. The main problems with regard to the prevention of Tuberculosis in children are:— 1. To determine whether the child approaches the physiological normal, or is below par. 2. If the child is below par, to determine the cause. 3. To use every means to improve their conditions and surroundings. Two facts stand out prominently:— 1. That the incidence of Tuberculous disease and the death rate therefrom are always higher amongst those living in crowded and unhealthy surroundings. 2. The quick improvement in these children when they are given sufficient nourishment, and placed in healthy surroundings. It is a matter for regret that there is no Sanatorium for these "Pretuberculous" cases. The London County Council propose establishing an Interim Committee to deal with the Tuberculous children in this district, and I hope that some provision will be made for those cases which, while not Tuberculous, are very likely to become so if allowed to drift. The London Insurance Committee have made use of this Dispensary since April, 1915, to a much great extent than formerly, and this has naturally entailed an increase of work and correspondence. Since the 1st April, 1915, 72 patients residing in the Borough of Shoreditch have been sent to this Dispensary to be examined and reported on as to their suitability for Sanatorium, Hospital, or Domiciliary treatment. Of these cases 33 (27 males and 6 females) were recommended for Sanatorium treatment; 21 (15 males and 6 females) for admission to Hospital, and 11 (7 males and 4 females) for Domiciliary treatment. 7 (4 males and 3 females) were found not to be Tuberculous. 70 Some of these patients on leaving the Sanatorium return to this Dispensary, and. it would be of great interest if a report stating the condition of the patient, and the signs present in the lungs, could be sent to the Dispensary on the patient's discharge from the Sanatorium. In May, 1915, I received a communication from you, instructing me to obtain reports for the London Insurance Committee as to the condition of 46 insured patients, a list of the names and the names of the Doctors who attended them being appended. I wrote to the medical men, and received satisfactory information in nearly all cases. The services of two members of the Honorary Staff of the Hospital—Dr. R. Murray Leslie and Dr. Phear—have been available for consultation on the afternoons when the Dispensary is open. Their assistance has been most valuable to me, and their services are greatly appreciated. The X-ray and other special departments of the Hospital continue to be at my disposal, with resulting great benefit to the patients attending this Dispensary. STATISTICAL REPORT. Comparative statistics during 1914 and 1915:— 1914. 1915. New cases 588 953 Total attendances 3,806 6,140 Visits to homes 2,720 3,101 1915. Table showing the various channels through which patients came to attend this Dispensary:— Town Hall (Health Visitors, &c.) 65 Royal Hospital for Diseases of the Chest 109 Medical Practitioners 50 Schools and Care Committee 30 "Contacts" 622 London Insurance Committee 54 Other agencies 23 Total 953 40 deaths occurred amongst the patients who attended this Dispensary during the year. 71 The new cases, classified according to the diagnosis, give the following figures:— Tubercular. Suspects. Not Tubercular. Total. "Contacts" 32 98 492 622 Other new cases 158 45 128 331 Totals 190 143 620 953 The attendances each month were as follows:— Month. New Cases. Attendances. January 93 517 February 82 555 March 83 549 April 92 498 May 85 517 June 70 476 July 107 559 August 51 391 September 69 428 October 95 561 November 79 616 December 47 473 953 6,140 Attendance in Special Departments. X-ray examination 120 Dental Treatment 74 Bacteriological examination 320 I am, Yours faithfully, A. J. McFARLAND, M.D. (Dublin), D.P.H. (Oxford), Tuberculosis Officer. 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. 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 1915. The total number of (1) visits paid; (2) personal attendances, and attendances of parents at (a) the Weighing Centre, and (b) the Maternity Centre; (3) interviews in connection with the above amounts to 2,764. This total is composed of work in collection with:— I. Notifications of Births 1,159 (a) Visits 925 Revisits 234 (b.) Attendances at the Weighing Centres :— 1. Hoxton Baths, January-June 25 80 2. Maternity Centre, July-December 51 3. Haggerston Baths 0 (c.) Attendances of parents at Weighing Centre:— 1. Hoxton Baths, January-June 531 830 2. Maternity Centre, July-December, instead of baths 160 3. „ „ those attending dining rooms 139 73 II. Visits to expectant mothers 30 III. Epidemic Diarrhœa 35 Infant death enquiries 25 Visits to notified cases 10 IV. Notifications of Puerperal Septicœmia 4 Visits 3 Revisits 1 V. Notifications of Ophthalmia Neonatorum 16 Visits 14 Revisits 2 VI. Notifications of Tuberculosis 134 (a.) Visits 97 Revisits 37 (b.) Enquiries into deaths from tuberculosis 25 VII. Miscellaneous work in connection with above 142 ( (a.) Visits to homes 78 (b.) Interviews with various people collnected with the work 64 VIII. Futile visits 309 Total number 2,764 Notifications of Births. The addresses of 489 births notified in Hoxton, lying to the west of East Road and New North Road, were handed to Miss Childe, Superintendent of the Shoreditch School for Mothers, and these were visited by Miss Childe, and reports handed into me. These addresses related to approximately one third of the births occurring in Hoxton during the year up to and including November. Since that time, the arrangement for furnishing information to the School has terminated, and I have, as previous to the formation of the School, visited in the whole of Hoxton. Since April 1st, I have according to your instructions not visited those attended by the midwives from Harman Street. The remainder of the births have, with very few exceptions, been visited by me at least once, and many have been several times revisited. The exceptions are made for some definite reason which makes visiting less necessary than usual. 74 The attendances at the weighing centre at the Pitfield Street Baths during the first half of the year were good, and showed a marked tendency to increase. Satisfactory progress was being made, when, in June, it was suddenly decided that the room should be put at the disposal of the National Relief Fund Committee, and consequently it became necessary to transfer the Centre to the Maternity Centre at 152, Kingsland Road. This change being made without due notice had a disastrous effect on the attendances, which fell to less than one-third of those for the first half of the year and a great deal of the time and energy spent on building up the connection between myself and those attending was entirely wasted. The establishment of a branch of the Women's League of Service Dining Rooms for Mothers, at the Council's Maternity Centre, has been of the greatest, possible help in connection with work for the prevention of deterioration in infant health. The babies whose mothers attend the Dining Rooms are weighed weekly; it is interesting to compare the records kept of the progress of baby whose mother has attended the Dining Rooms before and after its birth, with the records of an older baby in the same family, when the mother was habitually underfed, before and after its birth. A visual comparison also of the babies shows that the advantage is all on the side of the younger one, whose mother was more satisfactorily nourished. Notifications of Puerperal Septicaemia. Three cases have been certified during the year. One was a slight case, the patient was admitted for a short time to a hospital and quickly recovered. One occurring in a midwife's practice was removed to hospital and recovered; one occurring in a doctor's practice, died in hospital after a few days illness. Ophthalmia Neonatorum. Sixteen cases were notified for Hoxton, two of these were investigated by my colleague during my absence. Two of these occurred in the practice of doctors, and fourteen in that of mnidwives. One child was severely affected, and vision seriously impaired; the general health was most unsatisfactory, and the child died in an institution when about four months old. Another child, in a similar condition, was the second in the same family, the first having been notified in 1913; the family removed to another Borough when the baby was about five weeks old. Five were slight cases which made rapid recovery; the remainder received adequate attention. Parents are urged to attend the Royal Ophthalmic Hospital in City Road whenever circumstances make this possible. Tuberculosis. Owing to the increasing activities of the Tuberculosis Dispensary, the amount of my work in connection with tuberculosis continues to diminish. 75 Of the 101 notifications received, (a) 61 referred to adult women, (b) 40 referred to children up to 14 years, and girls from 11-16 years. Frequently I do not see the patient more than once, as whenever possible she is advised to attend the Tuberculosis Dispensary, and if she does so there is no need to keep in touch with her. I desire to express my thanks to all those whose kind co-operation has assisted me in my work. I am again much indebted to Miss Tucker, of the East London Friendly Workers' Association, whose kind and practical assistance has been readily given whenever circumstances have permitted. Special thanks are also due to those helpers of the Women's League of Service who have extended their interest to women attending the Dining Rooms, and have assisted them in various ways. I have the honour to be, Your obedient Servant, ETHEL J. CHARLESWORTH. 76 REPORT ON HEALTH VISITING, HAGGERSTON. BY Maude E. Jacocks, Health Visitor, Certificates of Derbyshire Royal Infirmary; Queen Charlotte's Hospital; Central Midwivcs Board; Queen Victoria's Jubilee Institute and Royal Sanitary Institute. Town Hall, Shoreditch, E.C. To the Medical Officer of Health. January, 1916. Sir, I have pleasure in submitting the Report on the wort of Health Visiting in the Haggerston Division during the year 1915. The total number of visits paid, included interviews, attendances at the Haggerston Baths Centre, and the Maternity Centre, 152, Kingsland Road, also attendances of mothers at the same, amounted to 4,603. This number was distributed as follows:— 1. Visits under the Notification of Births Act:— First visit 1,309 Revisit 554 1,863 2. Ante-natal cases 62 3. (a) Attendances at Haggerston Baths Centre 51 (&) Parents attendances at Haggerston Baths Centre 1,264 4. (a) Attendances at Maternity Centre 61 (&) Parents attendances at Maternity Centre 303 5. Visits in connection with Ophthalmia Neonatorum:— First visits 15 Revisits 37 52 6. Visits in connection with Diarrhoea in infants 11 7. Enquiries into infantile deaths from Diarrhoea 17 8. Enquiries into cases of Puerperal Septicaemia:— First visits 4 Revisits 4 8 77 9. Visits in connection with Tuberculosis cases in women and children:— First visits 151 Revisits 1975 347 10. Enquiries into Deaths from Phthisis 23 11. Enquiries into Deaths of Infants 62 12. Miscellaneous visits 71 13. Interviews in connection with the work 144 14. Futile visits 264 101 Letters were written. Notification of Births. In addition to the home visits, the work under this heading has been greatly augmented by the opening of the Maternity Centre in Kingsland Road on May 11th. Here we are able to send the mothers when need arises for daily dinners provided by the Women's League of Service. The cases chosen to attend are those mothers whose babies do not make good progress, or where the mother is known to be delicate, and also necessitous cases. * Ante-natal cases are fed if necessary for six months before the birth of the child, and post-natal for nine months if the child is still breast fed. Results have been highly satisfactory and encouraging. On Tuesday afternoons the babies whose mothers attend this centre are weighed, and advice is given to all mothers who stay for the consultation. 21 ante-natal cases and 45 post-natal cases have attended from Haggerston, and have generally shewn great appreciation. It has made all the difference to an overworked or delicate mother to come to a daintily laid and well cooked dinner, and to be able to sit down comfortably in cheerful company to enjoy it. The dinner hour is fixed at 2 p.m., so that father will have returned to work, the older children to school, and the baby and children under school age can be brought to be cared for in the creche during the dinner hour. The only difficulty has been to keep the numbers down to the level of accommodation, and it has required no little ingenuity on the part of the helpers to fit in the numbers at the dining tables, and also the babies and toddlers in the creche. At the Haggerston Baths the Thursday attendances have shown no falling off in numbers, although many have been transferred to the Maternity Centre. 78 Mothers have been more regular in attending, and the results have been correspondingly satisfactory. There were 49 mothers on the register at the beginning of the year, and 142 new ones have attended during the year. 10 mothers came from 20 to 40 afternoons, 17 over 10, and 142 from 2 to 10 afternoons. The work would have been greatly impeded by the large number of attendances had I not been assisted as before by a friend who has been most regular in helping on Thursday afternoons. Ante-natal Work. The work in connection with these cases has been greatly assisted by the opening of the Maternity Centre, and many mothers have attributed their fine babies and improved health to the good regular dinners which have been provided there. 21 cases attended the centre, and the majority continued as post-natal cases. These also, when necessary, wait on Tuesday afternoons for advice. Ophthalmia Neonatorum. Of the 15 notified cases, 12 made a complete recovery at home, 1 only was serious enough to be admitted to hospital and this case died at four months of marasmus. One removed from the borough two days after notification, and 1 became permanently blind in one eye owing to the parents' obstinacy in not carrying out the advice given by the doctor and myself. Puerperal Septicemia. 4 cases were notified, 3 of these were attended at the confinement by doctors and 1 by a midwife. Three were admitted to hospitals and one of these died. The others made satisfactory recoveries. Infantile Diarrhoea. Eleven cases were brought to my notice, and visited under this heading, but many others were seen and advised during the ordinary home visiting. Preventive advice both written and verbal was given in the homes and at the Centres, before and during the months this disease is prevalent with the result that mothers are increasingly careful as to precautionary measures, and are not so apt to regard it as a child's inevitable complaint. Of the 17 deaths enquired into 12 occurred in Haggerston, and 5 were visited in Hoxton during the absence of my colleague, Miss Charlesworth, on annual leave. 79 Oil enquiry I found that 4 had been breast fed, but had also been used to a "dummy"—5 had been fed on fresh and 8 on condensed milk. 8 deaths occurred in children who were delicate from birth, and who quickly succumbed to the infection. In the majority of these cases the misuse of the dustbin, even if in good order was very evident, refuse being either piled up and exposed, or thrown in the yards. A more generous use of water in the yards and fronts of houses would greatly diminish the spreading of this disease. Tuberculosis in Women and Children. Of the 151 cases notified, 95 were said to have tuberculosis of lungs, and 56 tuberculosis of abdomen, glands, skin, joints and meninges. 29 were over 50 years of age, 18 under 12 months, 41 between 12 months and 16 years. The remainder were between 16 and 50 years. 23 were insured persons, and seven of these were sent by the Insurance Commissioner's to Sanatoria. 37 were admitted to the Infirmary, 15 to other hospitals and two schoolchildren were sent by the London County Council to Sanatoria. A large number of the cases were eventually examined and treated at the Tuberculosis Dispensary, and if retained as patients, were subsequently visited from there. I have much pleasure in thanking Mrs. Casson the "lady in charge," and all the helpers from the "Women's League of Service" for their co-operation in the work at the Maternity Centre—and Mrs. Ford who has so regularly assisted me at the Haggerston Baths Centre. Miss Tucker of the East London Workers' Society has also given valuable help, as in previous years, to all cases which I have sent to her, and grateful thanks are due to her for all such help. Gifts of Maternity Outfits from Queen Mary's Workrooms, and children's clothing from "The Royal New Zealand Society for the Health of Women and Children" Nelson, New Zealand, kindly sent through the National Union of Women's Suffrage Societies, have been most useful and have effectually helped to demonstrate the reform needed in the clothing of infants and young children. I am, Sir, Your obedient Servant, MAUDE E. JACOCKS, Health Visitor. 1 1 REPORT ON THE Health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, in the county of london, FOR THE YEAR 19 15, by LEWIS T. ERASER BRYETT, M.D. (Lond.), Medical Officer of Health; Diplomate in Public Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health, tf&c. [.Printed by Order of the Health Committee.] PRINTED BY DARLING AND SON, LTD., BACON STREET, LONDON. E.