SHOR REPORT on the Health and Sanitary Condition of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1922, by LEWIS T. ERASER BRYETT, M.D. (LOND.), Medical Officer of Health; Diplomate in Fublic Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health, &c. [Printed by Order of the Health Committee.] LONDON: JAS. TRUSCOTT & SON, LTD., SUFFOLK LANE, LONDON, E.C. 4. METROPOLITAN BOROUGH OF SHOREDITCH. Public Health Committee. Ex-officio—W. H. GIRLING, Maternity and Child Welfare Committee. Esq., J.P., M.W.B. (Mayor). Chairman—Alderman T. W. Brown. Vice-Chairman—Alderman J. C. Adams. Councillor Bundy, T. J. Copsey, G., J.P. ,, Land, C. „ Linard, A. „ Lobb, J. „ Merson, W. „ Middleton, A. F. „ Naylor, A. ,, Neate, F. G. ,, Randall, W. H. Alderman C. E. Taylor. Chairman—Councillor W. E. Yarrow. Vice-Chairman—Lady Cynthia Colville (Co-opted). Councillor Bellamy, J. (Co-opted) Boge, Miss. Alderman Boreham, E. G. Councillor Cordery, W. „ Fames, Mrs. E. ,, Girling, Mrs. H., J.P. (Co-opted) Hunt, Mrs. L. Councillor Linard, A. (Co-opted) Randall, Mrs. A. Councillor Randall, W. H. Alderman Varnals, G. J., M.W.B. (Co-opted) Wilson, Mrs. H. Sanitary Inspectors. J. H. Pearson, Senior Inspector. C. J. Wright. F. C. Shaw. A. Stratton. H. G. Chapman. J. B. Molloy. D. Grant. W. Sickelmore. R. A. Bishop. G. Walker. J. H. Thomas. T. W. Girling. Health Visitors. Miss I. M. Heward. Miss A. E. Barnes. Miss G. H. Williams. Miss B. C. Hunt. Miss M. Morrell. Turberculosis Nurse. Rat Officer. Mrs. Grange. E. T. D. Jordan. Clerical Staff. H. P. Abbott. J. C. Goodwin. F. E. Sharpe. E. J. Hayes. G. C. E. Gibbs. Miss E. Lehane (temporary). W. Harris. Mrs. I. M. Rutherford. E. R. Banks (temporary). G. H. Pratt. A. R. Hurst (Enquiry Officer). Staff of Dining Centre, 152, King-stand Road. Mrs. L. Morgan. Mrs. H. Lewis. Mrs. C. Jennings. Mrs. M. Calnan. Mrs. G. Marshall. Miss A. Smith. Staff of Dining Centre, 31, Herbert Street. Miss E. E. Thorogood. Mrs. M. Powney. Mrs. J. Harris. Mortuary Keeper. W. J. Bailey. Disinfecting Officers. F. J. Ford. J. Wilson. T. L. Aust. Physicians to Maternity and Child Welfare Centres. Lady Briscoe, M.B., B.S. Mrs. Sylvia Smith, M.B., B.S. Bacteriologist. Public Analyst. J. Andrew, M.R.C.S., L.R.C.P. H. G. Harrison, M.A., F.I.C. Tuberculosis Officer. Assistant Medical Officer of Health. A. J. McFarland, M.D., D.P.H. Maitland Radford, M.D. (State Med.), D.P.H. Medical Officer of Health. Lewis T. Fraser Bryett, M.D., D.P.H. 11 CONTENTS. Page. Acute Anterior Poliomyelitis 16 Anthrax 16 Appendicitis, mortality from 5 Bacteriological examinations 18 Bakehouses 36 Births in sub-districts 2 Birth rates 2 Cancer 5 Cerebro-spinal fever 16 Cookshops 29 Cow-houses 28 Dairies 28 Deaths in sub-districts 3 Death rate 3 Deaths, ages at 5 Deaths, causes of 5 Deaths in public institutions 5 Deaths in outlying institutions 6 Diarrhoea 13 Diphtheria 10 Diphtheria, return cases of 9 Disinfection 18 Dysentery 17 Encephalitis Lethargica 16 Enteric Fever 12 Erysipelas 12 Factories and Workshops Act, 1901. 22 Factories, workshops and workplaces—sanitary work 22 Food condemned and destroyed 29 Food and Drugs Act 32 Food poisoning 30 Fried fish shops 29 Fur skin dressers 20 Glanders 16 Housing Acts 22 Houses let in lodgings 22 Hydrophobia 16 Ice cream shops 29 Infantile mortality 3 Infectious cases, number certified 8 Infectious cases, number removed to hospitals 8 Infectious diseases, age periods 7 Infectious diseases, deaths from 7 Infectious diseases, death rate 7 Infectious diseases, isolation 8 Infectious diseases, number of cases notified from schools 17 Influenza 14 Legal proceedings 68 Malaria 17 Margarine Act, proceedings under 34 Marriages 2 Maternity and Child Welfare 24 Measles 13 Milk-shops 29 iv Page. Milk and Cream Regulations, 1912 29 Milk premises, cowsheds, etc., on register 28 Mortuary 18 Notification of Births Act 24 Ophthalmia neonatorum 15 Outworkers 23 Pneumonia 17 Population 1 Puerperal fever 13 Rag Flock Act, 1911 36 Rats and Mice Destruction Act, 1919 21 Sanitary work 19 Scarlet fever 9 Scarlet fever, return cases of 9 Schools, exclusions of children for infectious disease 17 Shelter 18 Slaughter-houses 28 Small-pox 9 Smoke nuisances 19 Staff 36 Street markets and food 29 Tuberculosis 14 Typhus fever 14 Verminous houses 20 Violence, mortality from 5 Water supply 18 Whooping cough 14 Workshops on register 22 Zymotic diseases, deaths from 7 Zymotic death rate 7 APPENDIX. Statistical Tables :— For whole district during 1921 and previous years (Table I.) 41 Cases of Infectious disease notified during 1922 (Table II.) 42 Causes of, and ages at, death during year 1922 (Tables III. and V.) 43, 46 to 53 Infantile mortality during 1922 (Table IV.) 44 Notes to Table III. and IV. 45 Comparison of London and Shoreditch birth and death rates in 1922 (Table VI.) 54 Summary of proceedings under Public Health (London) Act, 1891 (Table VII.) 55 Summary of Tuberculosis Certificates received (Table VIII.) 66 Summary compiled from the abstracts of their work prepared by the Sanitary Inspectors for 1920 (Table IX.) 67 Housing Conditions 69 & 70 Summary of legal proceedings under the Public Health (London) Act, 1891 68 Factory and Workshop Act-—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 56 to 59 Report on tuberculosis dispensary 60 to 62 Return of work carried out at Tuberculosis Dispensary 64 & 65 Report of the Interim Tuberculosis Care Committee 63 Maternity and Child Welfare 71 & 72 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. 2. January, 1923. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Shoreditch. Sir, Ladies and Gentlemen, I have the honour to submit my report on the health and sanitary condition of the Borough for the year ending 31st December, 1922. POPULATION. The Registrar-General's estimate as at 30th June, 1922, is 105,800, which includes the population in the Holborn Institution, numbering about 1,000 persons, who are not regarded as belonging to the Borough. Excluding this population, 104,800 is the number taken into account for the statistical purposes of this report. Tables I. and VI., and those relating to the administration of the Factory and Workshop Act, 1901 (Appendix, pp. 41, 54, and 56 to 59), contain further information as regards the population and principal industries of the Borough. 2 BIRTHS. The births registered in the Borough numbered 2,645, of which 1,336 were of males and 1,093 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 2,926, of which 1,478 were of males and 1,448 of females. The distribution of the corrected births in the eight Wards of the Borough is given below:— Ward. Males. Females. Total. Moorfields 59 49 108 Church 256 250 506 Hoxton 261 233 494 Wenlock 223 227 450 Whitmore 247 239 486 Kingsland 162 136 298 Haggerston 130 157 287 Acton 140 157 297 Totals 1,478 1,448 2,926 Outside the Borough 292 births were registered, 14-7 of males and 145 of females, the parents being residents of Shoreditch. In the Shoreditch Institution 255 births occurred, of which 127 were of males and 128 of females. In 10 of these (5 of males and 5 of females) the parents did not belong to Shoreditch. In the Holborn Institution there was one female born whose parents were not resident in the Borough. Of the births in the Shoreditch Institution, 47 (19 males and 28 females) were illegitimate. Elsewhere belonging to the Borough there were 54 births, of which 26 were of males, which were illegitimate. The birth-rate for the Borough was 27.9 per 1,000 population. The birthrates for the eight wards of the Borough are given in Table VI. (Appendix). The birth-rate for England and Wales was 20.6 and for London 21.0 per 1,000 population. MARRIAGES. During 1922 there were 959 marriages as compared with 976 in 1921 and 1,194 in 1920. The persons married were at the rate of 18.3 per 1,000 population as compared with 18.4 for the metropolis. 3 DEATHS. During 1921 there were 1,712 deaths, which were distributed in the Borough as shown in the subjoined table :— Ward. Males. Females. Total. Moorfields 46 27 73 Church 188 156 344 Hoxton 151 133 284 Wenlock 115 107 222 Whitmore 168 132 300 Kingsland 76 63 139 Haggerston 85 70 155 Acton 98 97 195 Totals 927 785 1,712 The deaths of males were 142 in excess of those of females. The death rate for the year was 163, and was slightly below the average for the previous ten years. The causes of death, and the death rates for the Borough and its eight Wards, with other particulars as to the mortality amongst the inhabitants of Shoreditch during the year, are given in Tables I., III., IV., V. and VI. (Appendix). The death rate was markedly above the mean for the year during the month of January, the rates for the first four weeks being 31.8, 52, 37 and 30 5 per 1,000 inhabitants respectively. These high rates were due to the prevalence of influenza. During February, March, April and May the rate averaged a little over 19 per 1,000. For the remainder of the year the rate averaged well below 15 per 1,000 population. The highest point in the death rate during the year was touched in the second week of January, when 103 deaths were registered with one or two exceptions, the largest number in any one week for over 30 years. The lowest of the weekly death rates was 6 per 1,000, which was recorded for the first week of September. There were 301 deaths amongst infants under one year. Of these, 166 were of males and 135 females. They amounted to 17.5 per cent. of the total number of deaths from all causes. The mortality amongst infants under one year was at the rate of 102 per 1,000 births registered during the year, as compared with 114 in 1921 and 91 in 1920. Amongst males, the infantile mortality was 112 as compared with 93 amongst females. The chief causes of death amongst infants under one year during 1922 were pneumonia, prematurity, atrophy, debility and marasmus, diarrhoea and enteritis, bronchitis and measles, in the order given. a 2 4 In Table IV (Appendix) is a statement showing the various causes of death amongst infants under 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. In the subjoined table the causes of death amongst infants under one year are given for each of the eight Wards of the Borough :— Cause of Death. Moorfields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals Smallpox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... 6 2 4 5 1 ... 1 19 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough ... 2 ... 3 1 2 ... ... 8 Diphtheria and Croup ... 2 ... ... ... ... 1 ... 3 Erysipelas ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... 2 ... ... ... l ... ... 3 Abdominal Tuberculosis ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases ... 1 ... ... 1 1 ... 2 5 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 1 3 Convulsions ... 1 ... ... 2 ... ... 3 6 Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis 2 8 5 4 1 2 ... 1 23 Pneumonia (all forms) 2 15 8 11 12 13 7 4 72 Diarrhœa 1 1 2 ... 2 ... 2 1 9 Enteritis ... 5 4 1 4 ... ... 1 15 Gastritis ... ... 1 ... ... ... ... ... 1 Syphilis ... 2 ... ... ... ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... Suffocation, over-lying ... ... ... ... ... ... 1 ... 1 Injury at Birth ... ... ... 1 ... ... ... ... 1 Atelectasis ... 2 ... ... ... 1 1 2 6 Congenital Malformations ... ... 2 ... 2 1 3 2 10 Premature Birth 3 14 8 11 10 3 4 3 56 Atrophy, Debility and Marasmus 1 10 4 3 8 3 2 5 36 Other causes ... 2 2 5 5 4 2 1 21 Totals 9 73 38 43 53 33 25 27 301 The infantile mortalities of the eight Wards of the Borough are contained in Table VI (Appendix). The rate was highest in Church and lowest in Hoxton, being 144 and 77 per 1,000 births respectively. The infantile mortality for England and Wales during 1922 was 77 and for London 74 per 1,000 births. The deaths of children aged from one to two years numbered 168, and of children aged from two to five years 99, the chief causes of death being diphtheria, measles, whooping cough and pneumonia. Altogether 568, or 33.1 per cent. of the total number of deaths at all ages, were of children under five years of age. 5 The chief causes of death at all ages were : tuberculosis, which accounted for 182, including 148 from consumption; pneumonia, which caused 260 deaths; bronchitis, 202 ; diseases of the heart and circulatory organs, 169 ; old age, 90 ; cancer, 86 ; measles, 84 ; influenza, 69 ; prematurity, 56 ; diphtheria, 27 ; whooping cough, 27 ; apoplexy, 51 ; atrophy, debility and marasmus in infants including debility at birth, 36 ; nephritis, 51 ; and violence which resulted in 58 deaths. Of the deaths attributed to cancer, 47 were of males and 39 females, 7 were of persons under 45 years of age, 55 were of persons aged from 45 to 65 years, and the remaining 24 were amongst persons over 65 years of age. In addition, some 22 deaths were attributed to malignant disease and sarcoma. Some of those attributed to malignant disease were, in all probability, the result of cancer. The death rate due to cancer was 0'82 per 1,000 population as compared with 0'87 in 1921, 0.91 in 1920, 0.93 in 1919, 0.95 in 1918 and 1.1 in 1917. The figures indicate a steady decrease during recent years. The deaths from appendicitis numbered 11, ten being of males, and there were two deaths from peritonitis, both of males. No deaths were attributed to alcoholism. Three resulted from cirrhosis of the liver, two of which were of females. Of the deaths from violence, which were again below the average, 39 were of males and 19 females. Through accident or negligence 45 persons lost their lives. These included 12 from street accidents, 10 burns or scalds, and 12 through falls. Thirteen persons, ten of whom were males, committed suicide. There was one homicidal death. There was only one infant suffocated in bed. The great decrease in the number of deaths from this cause, which has characterised the years since 1915, is well worthy of note, and is highly satisfactory to record. The reasons for it have been commented on in previous reports. 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 Institution 6 134 140 St. Leonard's Hospital 613 11 624 Royal Chest Hospital 23 44 67 Home of Good Shepherd 6 1 7 Convent Hospital 1 1 2 Totals 649 191 840 6 Elsewhere than in public institutions 11 persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various institutions outside Shoreditch with the number of persons belonging to the Borough dying therein :— Asylums:— No. of Deaths. General Hospitals— continued. No. of Deaths. Banstead 3 Royal Northern 1 Brentwood 1 Royal Sussex County 1 Cane Hill 2 St. Bartholomew's 65 Caterham 1 St. Luke's, Lowestoft 1 Claybury 19 University College 1 Colney Hatch 14 Westminster 4 Darenth 1 Dartford Heath 1 Special Hospitals :— Fountain 1 Bethnal Green Chest 8 Hanwell 2 Brompton 1 Horton 1 City of London Maternity 9 Leavesden 11 Colindale 5 Long Grove 2 Cancer 2 Tooting Bec 2 Central London Throat & Ear 1 Hospitals for Infectious Homoeopathic 2 Infants' 1 Diseases Mount Vernon 1 Brook 2 Queen Mary's 1 Dartford 1 St. John's 1 Eastern 16 North-Eastern 12 Other Institutions :— North-Western 3 Borough Sanatorium, Brighton 1 Park 2 Camberwell House 1 South-Eastern 4 214a, Cambridge Road Western 1 Cornwall House, Wanstead 1 73a, Devon's Road, Bromley 1 General Hospitals:— Dollis Hill House 1 East London 5 230, High Street, Homerton 4 Edmonton Epileptic Colony 2 77a, Highgate Hill 1 French 1 4, King's Road, St. Pancras 1 German 3 29, North Side, Clapham 1 Gt. Ormond Street (Children) 6 14, Pembridge Square, Kensington 1 Guy's 1 Hampstead 1 Private Nursing Home, Hackney 1 Italian 1 London 16 St. Elizabeth's Home 1 Metropolitan 52 St. George's Home 2 Mildmay 9 St. Joseph's Hospice 1 Queen's (Children) 53 St. Peter's Home 1 Royal Free 1 74, Vallance Road 1 Of 383 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 224 died in general hospitals, 61 in asylums, 41 in fever hospitals, 32 in hospitals for special diseases, and 25 in other institutions. Elsewhere than in public institutions ; 25 persons belonging to Shoreditch died beyond the limits of the Borough. 7 Altogether 1,032 or 60.2 per cent. of the deaths of persons belonging to Shoreditch occurred in public institutions. INFECTIOUS DISEASES. The infectious diseases included under the headings 1 to 35 and 171 in Table V (Appendix) resulted in 441 deaths, a number again markedly below the average for previous years. This is mainly attributable to the comparatively low mortality from whooping cough, diarrhoea and tuberculosis. The deaths from the diseases under the headings specified amounted to 25.7 per cent. of the total number from all causes as compared with 26.6 in 1921, 25.0 in 1920, 28.5 in 1919, 37.7 in 1918 and 30.2 in 1917. Tuberculosis accounted for 41.2 per cent. of these deaths, and most of the remainder were attributable to measles and influenza. The death rate due to these diseases was 4.2 per 1,000 population, as compared with 3.8 in 1921, 3.9 in 1920, 4.5 in 1919, 9.1 in 1918, 6.8 in 1917 and 5.6 in 1916. 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 60 130 16 9 22 17 38 42 44 37 15 8 3 Of the total number of deaths from all causes of children under the age of five years, 334 per cent. resulted from these diseases. In infants under one year, measles, diarrhoea, tuberculosis and influenza accounted for most of the deaths. Amongst children aged from one to five years, measles, diphtheria, and whooping cough were the chief causes of death. The deaths of 18 children under the age of five years were attributed to influenza. The chief causes of the mortality from infectious diseases amongst persons aged 15 years and upwards were consumption and influenza. The deaths from the principal zymotic diseases, viz., smallpox, measles, scarlet fever, diphtheria, whooping cough, enteric fever and diarrhoea, not including enteritis under two years, numbered 159, the death rate being 1.5 per 1,000 population. A comparison of the zymotic death rates of London and Shoreditch and the eight wards of the Borough is given in Table VI (Appendix). The rate was highest in Church and lowest in Acton and Moorfields Wards. The cases of smallpox, scarlet fever, erysipelas, enteric fever and puerperal fever notified numbered 854; for the whole of London the number was 35,186, the attack rates being 8.0 and 7.7 per 1,000 population respectively. Subjoined is a list of the infectious diseases which were notifiable during the year, excluding pulmonary tuberculosis, showing the numbers of cases certified in 8 the Borough for each of the four quarters of the year, and the numbers and percentages of the cases removed to hospital:— Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Smallpox ... ... ... 2 2 ... Scarlet Fever or Scarlatina 107 104 58 76 345 6 Diphtheria and Membranous Croup 102 100 121 116 439 27 Typhus Fever ... ... ... ... ... ... Cholera ... ... ... ... ... ... Enteric Fever (Typhoid) 1 4 ... ... 5 ... Continued Fever ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever 3 1 3 2 9 3 Erysipelas 11 10 17 16 54 3 Plague ... ... ... ... ... ... Cerebro-Spinal Fever ... ... 1 ... 1 1 Glanders ... ... ... ... ... ... Anthrax ... ... 1 ... 1 ... Hydrophobia ... ... ... ... ... ... Anterior Polio-myelitis ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... Ophthalmia Neonatorum 14 18 13 20 65 ... Acute Primary Pneumonia 154 52 43 83 332 61 Acute Influenzal Pneumonia 31 4 3 9 47 8 Malaria ... ... 2 ... 2 1 Dysentery ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... Totals 423 293 262 324 1,302 110 Numbers and percentages of cases removed to hospitals. 359 244 216 264 1,083 ... 84.8% 83.7% 82.4% 81.4% 83.2% ... As compared with the figures for 1921, scarlet fever cases show a great reduction in number, and the cases of diphtheria are markedly decreased. On the other hand, there was a marked increase in the cases of pneumonia, both acute primary and influenzal. ISOLATION OF INFECTIOUS CASES. The notifiable infectious diseases, cases of which are receivable into the hospitals of the Metropolitan Asylums Board, are:—Scarlet fever, smallpox, diphtheria, enteric typhus and continued fevers, relapsing fever, and certain cases of measles, whooping cough, puerperal fever, trench fever, malaria and dysentery. 9 The cases of smallpox, scarlet fever, diphtheria, enteric fever, puerperal fever, and cerebro-spinal fever certified (Table II, Appendix) numbered 801, and the number removed to hospitals (mainly to those of the Metropolitan Asylums Board) was 791 or 98.7 per cent. RETURN CASES. The following were noted during the year :— 1. Simmie M—, aged 8½ years, was certified as suffering from diphtheria and removed to hospital on March 7th, returning home on June 1st. Subsequently Samuel M—, aged 1 year, and Morris M—, aged 3 years, fell ill on June 8th and 9th respectively, and were removed to hospital certified to have diphtheria. It was stated that Simmie M—— developed a nasal discharge with soreness about his nostrils two days after his return home, which lasted about a week. The evidence of this, however, had disappeared by June 14th. 2. Thomas G—, aged 4 years, was certified on May 7th and removed to hospital with diphtheria, returning home on August 17th. Arthur F—, aged 1 year 10 months, not belonging to the family of the patient but resident in the same house, fell ill on August 31st, and was removed as suffering from diphtheria on September 3rd. Thomas G—, after his return home, was poorly, and on September 6th he was suffering from nasal catarrh and bronchitis, for which he was under treatment at the Queen's Hospital for Children. The result of an examination for diphtheria bacilli was negative. 3. Edmund H—, aged 4 years, was certified and removed to hospital with scarlet fever on March 3rd, returning home on August 30th. Whilst he was in hospital he is said to have had both whooping cough and diphtheria. Subsequently his sister Ellen, aged 10 years, fell ill on September 8th, and was certified to have diphtheria the following day and removed to hospital. Edmund is stated to have showed no signs of ill health on his return from hospital and on September 10th seemed perfectly well. SMALLPOX. During the latter half of the year a few cases suspected to be smallpox came under observation, and there were two cases certified and removed as being smallpox, but none of them were actually cases of the disease, nor is there any reason for believing that any cases occurred in Shoreditch. Some 69 cases were notified in the Metropolis and of these 20 terminated fatally. Most of the cases were notified during the last quarter of the year. SCARLET FEVER. The cases certified numbered 345, of which 5 or 1.4 per cent. were subsequently not regarded as scarlet fever. 10 The distribution of the cases certified, and the deaths amongst males and females in the Borough and its eight Wards during the year were as shown in the subjoined table Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 6 7 13 ... ... ... Church 26 22 48 1 ... 1 Hoxton 21 17 38 ... 1 1 Wenlock 18 25 43 ... ... ... Whitmore 26 31 57 2 ... 2 Kingsland 23 24 47 ... 2 2 Haggerston 18 21 39 ... ... ... Acton 22 38 60 ... ... ... Totals for Borough 160 185 345 3 3 6 The cases are grouped according to ages in Table II (Appendix). Of the cases certified 337 or 97.6 per cent. were removed to hospital. The cases certified were at the rate of 3.2 per 1,000 inhabitants, being a little below the average for the previous 10 years. The attack-rate per 1,000 population in the Borough was lowest in Hoxton, and highest in Acton Ward, being 24 in the former, as compared with 4.9 in the latter. The deaths numbered 6, being at the rate of 0.07 per 1,000 population. There were no deaths in Moorfields, Wenlock, Haggerston and Acton Wards. The death-rate was highest in Kingsland Ward where it was 0.19 per 1,000 population. The case-mortality was at the rate of 1.7 per cent. of the cases certified, being somewhat above the average for the previous 10 years. Amongst children under five years there were 125 cases, 3 of which were fatal, the case-mortality being 2.4 or 2.5 per cent. allowing for errors in diagnosis. Amongst persons over five years there were 220 cases with three deaths, and a case-mortality of T3 per cent, allowing for errors in diagnosis. The scarlet fever cases certified in the Metropolis numbered 17,233, being at the rate of 3.8 per 1,000 population. The deaths numbered 299, which give a rate of 0 07 per 1,000 population as estimated to the middle of the year 1921. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 439, of which 2 or 0.4 per cent. were subsequently not regarded as being diphtheria. 11 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 11 17 1 3 4 Church 35 45 80 6 3 9 Hoxton 23 31 54 1 ... 1 Wenlock 21 37 58 1 3 4 Whitmore 37 44 81 1 2 3 Kingsland 29 23 52 ... 1 1 Haggerston 29 35 64 1 3 4 Acton 13 20 33 ... 1 1 Totals for Borough ... 193 246 439 11 16 27 The cases are grouped according to ages in Table II (Appendix). Of the cases certified 438, or 99.7 per cent., were removed to hospital. The cases were certified at the rate of 4.1 per 1,000 inhabitants, the rate being the highest in Haggerston Ward and lowest in Acton, 5.8 and 2.7 per 1,000 respectively. The deaths numbered 27, the rate being 0.26 per 1,000 population. The rate was highest in Moorfields Ward, where it amounted to 0.9 per 1,000. It was lowest in Acton, where it was 0.08 per 1,000. Of the cases certified 6.1 per cent. terminated fatally. Of the deaths 24 were of children under five years of age, the mortality being at the rate of 12.1 per cent. of the cases certified amongst children at that age period. Allowing for errors in diagnosis, the mortality was a shade higher. Amongst persons over five years of age the mortality was 1.2, allowing for errors in diagnosis. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 431 of the cases certified during the year, they were distributed amongst males and females at certain age periods as set out in the subjoined table :— Age Period. Male. Female. Total. Under 1 year 8 8 16 From 1 to 2 years 29 27 56 „ 2 to 3 years 30 26 56 ,, 3 to 4 years 21 19 40 ,, 4 to 5 years 12 12 24 ,, 5 to 10 years 51 62 113 ,, 10 to 13 years 13 28 41 Over 13 years 28 57 85 Totals 192 239 431 12 In 200 of the cases the patients were children attending school, and in 154 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 192 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 54 instances the histories showed that there had been cases of " sore throat" amongst the inmates of the houses in which the patients resided. In 55 instances there was evidence pointing to infection from previous cases in the Borough. In 297 instances the houses were occupied by members of more than one family, in 99 by single families, and in 35 instances the cases occurred in artisans' dwellings of the block type. With regard to the sanitary condition of the dwellings, in 274 this was satisfactory, in 75 fairly so, and in 82 it was unsatisfactory, but these figures must not be taken as an indication that a satisfactory 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 15,346, the attack rate being 3.4 per 1,000. The deaths numbered 1,137 and the death-rate was 0.25 per 1,000 population, the case-mortality being 7.4 per cent. ENTERIC FEVER. The cases certified numbered five, being at the rate of 0.4 per 1,000 population. Of these, three subsequently proved not to be cases of enteric fever. Three of the cases were in Hoxton, one in Wenlock, and one in Whitmore Wards. The four cases in the first two of the Wards mentioned were in females. Of the two persons who actually had enteric fever, one was a boy under four years old and the other a schoolgirl aged 12 years. Nothing was ascertained throwing light upon the source of infection in either case. All the cases certified recovered. ERYSIPELAS. The cases certified as erysipelas numbered 54, with three 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 4 3 7 1 ... 1 Hoxton 4 4 8 ... ... ... Wenlock 2 6 8 ... ... ... Whitmore 8 9 17 ... ... ... Kingsland 3 3 6 ... ... ... Haggerston 3 3 l ... 1 Acton 2 2 4 l ... l Totals for Borough 27 27 54 3 ... 3 13 The deaths from erysipelas were at the rate of 0.02 per 1,000 inhabitants, and 5.5 per cent. of the cases certified terminated fatally. Pyaemia and septicæmia (blood poisoning) caused the deaths of 4 males and 4 females, and infective endocarditis caused the deaths of 3 males and 4 females. PUERPERAL FEVER. Nine cases were certified, of which 3 terminated fatally. The cases certified were at the rate of 3.1 per 1,000 births, as compared with 2.0 in 1921, 2.9 in 1920, 1.3 in 1919, 1.7 in 1918, 1.8 in 1917 and 1.0 in 1916. The cases certified in the Metropolis during 1922 were at the rate of 33 per 1,000 births. DIARRHOEA. Fifteen deaths were attributed to diarrhoea and 23 to enteritis. They were fairly evenly distributed throughout the year, and had no appreciable effect upon the death-rate during the summer and autumn months. Of the deaths from diarrhcea, 9 were of infants under one year, 2 of children aged from one to five years, 3 were of persons between 5.5 and 65 years, and 1 was over 65 years. Of the deaths from enteritis, 15 were in infants under one year, 5 of children aged from one to two years, 1 of a child between two and five years, 1 of a person between 35 and 45 years, and the remaining 1 was a person over 65 years of age. Excluding deaths from enteritis, the death-rate was 0.14 per 1,000 population; including deaths from enteritis in children under two years, the mortality was at the rate of 0.33 per 1,000 population. The deaths from diarrhoea amongst infants under one year were at the rate of 5.1 per 1,000 births ; including deaths from enteritis under one year, the rate was increased to 10.2 per 1,000 births. The meteorological conditions during the summer and autumn months were not favourable to the prevalence of diarrhoea. The usual enquiries were made with a view to the prevention of infection. The deaths from diarrhoea and enteritis in children under two years in the metropolis numbered 669, the death-rate being 0.15 per 1,000 population. MEASLES. The deaths numbered 84, of which 38 were of males, as compared with 18 in 1921, 50 in 1920, 12 in 1919, 72 in 1918,139 in 1917, 33 in 1916 and 67 in 1915. They were above the average for recent years. With the exception of two, they were all amongst children under five years of age. The death-rate was 0.81 as compared with 0.17 in 1921, 0.49 in 1920, 0.12 in 1919, 0.82 in 1918, 1.57 in 1917 and 0.33 in 1916. Most of the deaths during the year occurred during the months of March, April, May and June. Some 71 cases were nursed under arrangement with the District Nursing Association in connection with which 677 visits were made by the nurses. Of these cases, three terminated fatally. The deaths from measles in London numbered 1,559 as compared with 241 in 1921, 1,026 in 1920, and 1,359 in 1919. The death-rate for the year was 0'35 per 1,000 population. 14 WHOOPING COUGH. There were 27 deaths from this disease, as compared with 19 in 1921, 12 in 1920, 2 in 1919, 93 in 1918, 20 in 1917 and 35 in 1916. With one exception, all the deaths during 1922 were of children under five years. The death-rate was 0.26 per 1,000 population. The deaths in the metropolis numbered 1,123, the rate being 0.25 per 1,000 population. INFLUENZA. The deaths attributed to influenza numbered 69, of which 33 were amongst males. Of these, 58 occurred during the first six weeks of the year. The mortality was heaviest during the second week of January, when 26 persons were registered as having died from the disease. The following are the numbers of deaths from influenza recorded in Shoreditch during recent years : 27 in 1921, 51 in 1920, 121 in 1919, 295 in 1918, 12 in 1917, 22 in 1916, 26 in 1915, and 25 in 1914. TYPHUS FEVER. There is no reason for believing that any case of the above disease occurred in Shoreditch, and none seem to have been notified in London. TUBERCULOSIS. Tuberculosis (Appendix Table V, Nos. 29 to 34 inclusive) was given as causing 182 deaths as compared with 172 in 1921, 166 in 1920, 209 in 1919, 255 in 1918, 302 in 1917, 302 in 1916, and 328 in 1915. The deaths during 1922, although somewhat more numerous than in the two preceding years, are none the less markedly below the average in point of number. They amounted to 10'2 per cent. of the deaths from all causes. They were at the rate of 1.7 per 1,000 population for the Borough, the rate being highest in Hoxton and lowest in Haggerston Ward, 2.27 and 1.2 respectively. The deaths from tuberculosis of the lungs numbered 148, eight in excess of the number for 1921. Over a hundred of the deaths were of persons aged from 25 to 65 years. The deaths of males numbered 85 as compared with 63 for females. The deaths from pulmonary tuberculosis were at the rate of 1.4 per 1,000 population. The death rate from pulmonary tuberculosis during the year was highest in Moorfields, where it was over 2.2 per 1,000 population ; the rate was lowest in Whitmore Ward, 1.0 per 1,000 population. The deaths from tuberculosis in the Metropolis numbered 5,607, which give a rate of 1.2 per 1,000, and of these 4,723 were attributed to tuberculosis of the lungs, which give a death rate of 1.0 per 1,000 population. A summary of the notifications received under the tuberculosis regulations is contained in Table VIII, and the distribution of the cases according to age periods and localities is shown in Table II (Appendix). The certificates received numbered 287 for all forms being at the rate of 2.7 per 1,000 population as compared with 2.5 for 1921, and 3 per 1,000 for 1920. The cases 15 certified were most numerous in proportion to the population in Hoxton Ward and least in Kingsland, being 3.7 per 1,000 in the former as compared with 1.9 in the latter. The cases notified as pulmonary tuberculosis numbered 234, and were at the rate of 21 per 1,000 population as compared with 21 in 1921 and 2.8 in 1920. The notifications were most numerous in Hoxton and least in Kingsland, being 3.0 per 1,000 in the former as compared with 1.4 in the latter. Dr. McFarland's report on the work of the Tuberculosis Dispensary for the year 1922 is appended (pp. 60 to 62). The figures contained therein indicate much valuable work. A copy of the return as to work carried out in connection with the Dispensary rendered for the year 1922 to the Ministry of Health is also appended (p. 64 and 65). The Interim Tuberculosis Care Committee met twice a month during the year to deal with cases referred by the London County Council, Children's Care Committees or otherwise coming under its notice. During the latter part of the year the constitution of a permanent Tuberculosis Care Committee upon the lines laid down by the Local Government Board in a circular letter dated April 29th, 1915, was under the consideration of the Borough Council. It was submitted to and finally approved by the Ministry of Health towards the close of the year. The Interim Committee was a Committee called together by the London County Council during the war to act until circumstances would permit of the formation of a permanent Committee. The permanent Committee commenced work with the beginning of the current year. The report of the Hon. Secretary, Miss Wragge, indicates a good deal of useful work carried out during the year (Appendix, p. 63), and a marked increase on that of the previous year. The usual steps were taken by the Sanitary Authority as regards disinfection in cases of tuberculosis during the year. The cases of consumption removed to hospitals, sanitoria and other institutions amounted to approximately 90 per cent. of the number of cases notified in the Borough during the year. Of the deaths from consumption belonging to Shoreditch approximately 50 per cent. occurred in public institutions within or without the Borough, 21 per cent. taking place in St. Leonard's Hospital. OPHTHALMIA NEONATORUM. Some 97 certificates were received relating to 65 cases, an increase of 4 on the number for 1921. There were also some 47 other cases of inflamed eyes in infants which were reported but not formally notified. They were all kept under observation by the Health Visitors with a view to ensuring proper treatment. Some 17 of the cases were severe. All recovered without impairment of vision. Many of the cases were treated at Moorfields Eye Hospital, the Queen's, and the Metropolitan Hospitals. Four cases were removed to St. Margaret's Hospital, an institution of the Metropolitan Asylums Board especially provided for the treatment of ophthalmia neonatorum, mothers as well as the infants being admitted if necessary. Fourteen of the cases 16 were under nurses from the Local District Nursing Association who made some 358 visits in connection with them. The cases certified in Shoreditch were at the rate of 22.2 per 1,000 births as compared with 9.2 for the Metropolis as a whole. EPIDEMIC CEREBROSPINAL MENINGITIS. One case only was certified : a boy, aged 4 months, died in the Queen's Hospital from post basic meningitis on August 19th ; the meningococcus of cerebro-spinal fever was found. Five deaths were certified to be due to meningitis other than tuberculous, three in infants under twelve months, but so far as could be ascertained there was no reason for regarding any of them as having been caused by the meningococcus of cerebrospinal fever. During the year some 88 cases were certified in London. ACUTE ANTERIOR POLIOMYELITIS. No cases were certified in Shoreditch. Some 41 cases were notified in the Metropolis, mostly during the latter part of the year. ENCEPHALITIS LETHARGICA. There were no cases certified in Shoreditch. Some 71 cases, most of which occurred during the first six months of the year, were certified in London. GLANDERS, ANTHRAX AND HYDROPHOBIA. One case of anthrax was certified in Shoreditch. The particulars are briefly as follows :— A young man, aged 25 years, employed in the brush trade, and working with bristles, was certified as suffering from Anthrax on September 7th. He first noticed a pimple over his right eye on September 1st, on 5th and 6th he was seen by his doctor and again on 7th, when he was sent to St. Bartholomew's Hospital, where the case was diagnosed as one of anthrax and certified accordingly. Attention was directed to a consignment of black bristles from China, two cases having been received on August 14th. These had been recently handled by the patient. There were also on the premises a number of bundles of white bristles from Russia received back in February ; these, however, were stated not to have been handled by the patient. It is also to be mentioned that there were horse bristles supplied by a British firm on the premises at the time. Samples from all three of the classes of bristles were submitted to the bacteriologist, who reported the presence of anthrax bacilli and spores in both the Chinese and Russian, but not in the British. Further examinations indicated that the bulk of the Chinese were not infected, but the Russian bristles were highly charged with bacilli and spores and there was reason for assuming that the Chinese had been infected from the Russian. This was subsequently borne out by 17 the patient upon his return from hospital, who recollected occasions on which he had handled both the Russian and Chinese, which rendered the transmission of the bacilli from the one class of bristles to the other perfectly easy. The case was reported to the Authorities of the Ministry of Health and Home Office, and the necessary steps were taken as regards disinfection. The patient, notwithstanding the time elapsing, some six days, before the recognised treatment was commenced, made a good recovery. Altogether there were nine cases of anthrax notified in London during the year. PNEUMONIA, MALARIA AND DYSENTERY. The cases certified under the Regulations of 1919 were 332 of acute primary pneumonia, 47 of acute influenzal pneumonia, and 2 of malaria. No cases of dysentery were certified. Of the cases of pneumonia investigated, 256 were treated in St. Leonards' Hospital, 10 in other hospitals, 70 were nursed at home by relatives without and 40 with the assistance of the District Nursing Association. It may also be mentioned that some 34 other cases of pneumonia which were not notified were nursed through the District Nursing Association. In 27 of the cases enquired into, 7 of influenzal pneumonia, there was evidence of infection from previous cases. In 219 the dwellings occupied were satisfactory with respect to air space, light and ventilation, in 67 they were fair, and in 90 they were unsatisfactory. 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 :—4 for small pox, 597 for diphtheria, 543 for scarlet fever, 1,539 measles, 274 chicken-pox, 371 whooping cough, 77 mumps, and 922 for other infectious ailments. The exclusions altogether numbered 4,327 and related to 37 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 at Catherine Street, Curtain Road, Haggerston Road, Laburnum Street, Maidstone Street, Scawfell Street, and Wenlock Road schools. Altogether, 169 children were excluded, namely, 31 in February, 119 in March, and 19 in April. Information was also received from the School Medical Officer respecting 13 children excluded from school by reason of the presence of diphtheria bacilli in their noses or throats. No cases of diphtheria were subsequently notified in the families to which they belonged. B 18 BACTERIOLOGICAL EXAMINATIONS. During the year some 459 examinations were made by Dr. J. Andrew, Pathologist, Metropolitan Hospital. Of these, 274 were for suspected diphtheria, 5 for enteric fever, 162 for tuberculosis, 10 for anthrax, 1 for gonorrhoea and 1 for dysentery. Four specimens of urine, one of a tumour and one of pus were included. The results were positive in 52 of the examinations for diphtheria, in 38 of those for tubercle bacilli, and in 4 of the anthrax examinations. In addition, some 432 specimens were examined for tubercle bacilli in connection with the work of the tuberculosis dispensary at the Royal Chest Hospital, City Road. DISINFECTION. The premises disinfected numbered 1,045 ; the articles removed and disinfected at the Borough Disinfecting Station totalled 21,576, and included 905 beds, 1,154 mattresses, 1,851 pillows, 547 bolsters and 17,119 others, such as sheets, blankets, quilts, curtains, carpets, clothing and the like. It was necessary to destroy 2 beds, 41 pairs of mattresses, 2 pillows and 1 bolster which were so dilapidated and contaminated as to render it inadvisable to return them. These were replaced with new. THE SHELTER. The shelter in Reeves Place, provided under the Public Health (London) Act 1891, Section 60 (4), for the temporary accommodation of families in cases of dangerous infectious disease to facilitate measures for disinfection was in use on one occasion for the reception of a family of seven persons in connection with a case certified as smallpox. PUBLIC MORTUARY. During the year the bodies of 185 persons were deposited in the mortuary. The inquests held numbered 155 in connection with which 155 post mortem examinations were made, 83 of these taking place at the post mortem room attached to the mortuary. The body of one person dying of infectious disease was removed to the mortuary. WATER SUPPLY. The Meteorological Table for London, deduced from observations at Greenwich under the Astronomer Royal, issued by the Registrar-General for 1922, shows that the rainfall for the year amounted to 23T77 inches, which is slightly below the average. July was the wettest and May the driest months of the year. The fall during July was considerably above the average for that month. 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 54 premises, all of them in the Northern District. The grounds for withdrawing the supplies were :—On account of defective water pipes in 19 instances, waste on empty premises 5, by request of the consumer in 6 instances, non-payment of rates in 7, and premises demolished in 17 instances. 19 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. SANITARY WORK. Intimations as to insanitary conditions were served in respect to 5,381 premises. In 633 instances they were dealt with by Inspector Wright, in 521 by Inspector Chapman, 447 Inspector Sickelmore, 418 Inspector Thomas, 331 Inspector Shaw, 485 Inspector Molloy, 728 Inspector Bishop, 371 Inspector Girling, 431 Inspector Stratton, 543 Inspector Grant, and in 473 under the supervision of Inspector Walker. In connection with the work of the Sanitary Inspectors 1,576 letters were written to owners and others concerned. Some 48,317 visits of inspection were made by the Inspectors in connection with some 8,876 premises, which included 6,513 dwellings, 1,460 workshops, besides factories, laundries, bakehouses, cowsheds and milk vendors' premises, ice cream shops, slaughterhouses, places where food is prepared and sold, and other premises. Several hundred visits of inspection made in connection with the street markets, food exposed for sale, stables and stable yards, and common courts and yards, are included in the total given above. The inspection of 1,495 of the dwellings was the result of a house-to-house visitation which was in progress during the year by order of the Sanitary Authority. In Table IX. (Appendix) is contained a Summary giving particulars as to the work done for the abatement of nuisances and for improving the dwellings of the people in the Borough, which has been compiled by the Senior Inspector from particulars supplied by the Sanitary Inspectors. The Summary includes the work carried out to comply with the provisions of 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 to comply with the requirements stated on the intimation notices served. 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 not complying with the requirements of the Act in 1,085 instances. For non-compliance with Statutory Notices and other infringements of the Acts relating to public health, and of bylaws made thereunder and other offences, proceedings were taken before the Magistrate in 122 instances. A Summary is given on page 68 (Appendix) showing the results of these proceedings. SMOKE NUISANCES. Twenty communications were received from the London County Council referring to the emission of black smoke from the shafts on 11 premises. These were all duly brought to the notice of the parties responsible. In four cases intimations were served after observation by the sanitary inspectors, but it was not necessary to report any of them to the Sanitary Authority for further action. b 2 20 FUR SKIN DRESSERS. During the year special attention was given to the condition of the premises ascertained to exist in Shoreditch coming under the bylaws made by the London County Council under the provisions of the Public Health (London) Act, 1891, for regulating the conduct of the business of a dresser of fur skins, which means any business in which skins or pelts from the carcases of animals are cleaned, soaked, scraped or otherwise treated to retain and preserve the wool or hair. Briefly, the bylaws contain provisions relating to the removal of offensive skins, the disposal of refuse, the prevention of effluvium from offensive liquids, the repair and cleansing of floors and walls, the cleansing of receptacles and utensils, the limewashing of walls and ceilings, the construction of the walls, paving, and alterations and repairs. There are also provisions for securing the access to the premises of duly authorised officers, for the punishment of offenders, and for regulating the mode of application to the London County Council for sanction to establish anew the business of a dresser of fur skins. The bylaws were allowed by the Minister of Health on March 22nd, 1922. The businesses in Shoreditch coming under the bylaws are situate at 34, Anning Street, 12, Northport Street, 110, New North Road, 32, Retford Street, and 2, Short Street. The premises were visited by the senior Inspector and placed on the register. They were all found to more or less contravene the bylaws, and the necessary notices were served by order of the Health Committee, indicating the works required to bring the premises into compliance with the bylaws. The notices were complied with, floors being properly paved and drained, walls rendered impervious and cleansed and limewashed, and suitable receptacles for filth were provided. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 328, and some 728 rooms were dealt with during the year. Sanitary notices were served where necessary and the usual steps were taken. In a large proportion the cases came under our notice through intimations from the School Authorities. During the year the homes of some 213 children, 72 boys and 141 girls, notified as 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 on the children being cleansed and their clothing disinfected at the cleansing stations of the London County Council in the neighbourhood. Intimations were received that 37 boys and 55 girls had been given the opportunity of being cleansed at the cleansing stations, that in the cases of 36 boys and 63 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 2 boys and 25 girls legal proceedings were pending for non-compliance with the requirements of Statutory Notices under the Act mentioned. In a number of instances the same children figured more than once upon the notices and their homes had to be visited and dealt with accordingly. 21 * In practically all the cases reported the homes were visited by the Sanitary Inspectors, and the following summarises the results obtained:—In 189 the rooms occupied were satisfactory, varying from fairly clean to very clean, in 14 they were dirty, in 8 buggy, and in 2 both dirty and buggy. In 186 the bedding was clean, or fairly so, in 13 it was dirty, in 5 bugs were noticed, and in 9 it was both dirty and buggy. In 6 instances more or less evidence of lice was observed in the bedding. Where lice were present the bedding was also dirty and otherwise verminous. In four of the houses evidence of poverty was marked. There were in addition to the foregoing 5 cases in which the addresses were erroneous, and in some instances the forms received related to non-residents in the Borough ; these were duly forwarded to their proper destination. Evidence of lice was found in the bedding in 2.8 per cent. of the cases investigated. Arising out of the visits of the Sanitary Inspectors in connection with the cases reported by the School Medical Officer some 14 sanitary notices were served upon owners and 3 upon occupiers of verminous dwellings, mostly for general cleansing and repairs. The children reported by the School Authorities as suffering from Scabies numbered 103, of whom 58 were males and 45 females. As a result of the enquiries made by the Sanitary Officers 10 other cases came under observation. As far as practicable steps were taken to prevent the spread of infection. There is a slight decrease in the number of Scabies cases noted as compared with the figure for 1921. RATS AND MICE DESTRUCTION ACT, 1919. The following is a summary of the work resulting from visits by the Rat Officer with a view to giving effect to the provisions of the above-mentioned Act:— Number of complaints (rats) 298 „ (mice) 37 „ visits 6,262 „ rats caught in traps or killed by dogs 1,060 „ rats found dead through poisoning 180 „ premises cleared of rats 273 ,, premises cleared of mice 25 ,, of pavements taken up, fronting houses 58 ,, drains reconstructed 47 „ drains tested by Sanitary Inspectors 70 „ floors of kitchens, sculleries, passages and coal cellars concreted 90 Amount of Londovus used 67 lbs. Rat-Quit used 4,019 packets. Rodine used 396 tins. Number of baits provided 94,955 Most of the rats caught in traps were males. As regards the localities in the Borough which were infested, these do not differ materially from those of the previous year. 22 HOUSING. The special house-to-house inspection of the dwelling houses in the Borough which was in progress during the year is referred to elsewhere (pp. 19, 69 and 70). The scheme for the improvement of the Ware Street area referred to in former reports was approved by the Ministry of Health, the order made by the Minister confirming same under Part I of the Housing of the Working Classes Act, 1890, being dated 29th June, 1922. It is understood that the London County Council now have the matter in hand. The condition of a good deal of the property on the area is very bad. Active steps to give effect to the scheme with as little delay as possible therefore arc an urgent necessity. Early in the year some 25 flats in Teale Street were completed and came into occupation. Eight houses, numbered 1, 2,15,16,17,18, 19 and 20, Seabright Gardens, and 1 and 2, Teale Court were demolished during the year to make way for some 30 more flats which were in course of erection at the end of the year. No. 24, Ware Street was closed by the owner upon receipt of a Statutory Notice under the Public Health (London) Act, 1891, the premises being in a very dirty and dilapidated condition. It was dealt with and subsequently relet for occupation. No. 7 Ware Street was closed by order of the Magistrate. No. 56, Britannia Street, an eightroomed house, was closed and subsequently demolished as a dangerous structure. The houses let in lodgings or occupied by members of more than one family on the register at the end of the year numbered 295, some 36 being struck off on revision. Sonic 1,623 visits of inspection were made in connection with them which were associated with the service of 339 intimation and 88 statutory notices. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of the year was 1,460. Of these 180 had been added, 144 having been removed. A classification of the workshops registered is contained in the summary of proceedings under the Act which is appended. Some 2,811 visits of inspection were made in connection with workshops and 890 to factories. Six communications were received from the factory inspectors relative to the establishment of 62 new workshops in the Borough. As the result of inspection 45 were found in a satisfactory condition, and 4 were not in use. With regard to the remainder sanitary notices were necessary ; in 4 instances for cleansing, one on account of insufficient ventilation to w.c., 1 for an additional w.c., 8 on account of defective w.c.'s, and 1 for a defective roof. Fifty-one written intimations were received from the factory inspector relating to insanitary conditions and infringements of the law as to public health in connection with 25 factories and 26 workshops. The chief insanitary conditions to which the factory inspector directed attention were: dirty conditions of walls and ceilings in 38, defective and insufficient w.c. accommodation in 11, absence of proper ventila- 23 tion in 2, defective wall in 1, accumulation of rubbish in 1, no w.c. accommodation in 2, and in one instance attention was directed to the unfitness of premises upon which food was being stored. Including those brought under the notice of the department by the factory inspector 530 workshops were dealt with, 527 sanitary notices being served upon the parties responsible for their proper sanitary upkeep. The following is an abstract of the sanitary work carried out to comply with these notices Premises cleansed throughout 98 Soil and vent pipes dealt with 9 „ partially 123 Water-closets newly constructed 57 Number of rooms cleansed 357 „ repaired, etc. 255 Walls, floors, sashes, etc., repaired 114 ,, Obstructions removed 22 Light and ventilation improved 5 Sinks, etc., cleansed and repaired 21 Roofs, guttering, etc., repaired 215 Overcrowding abated — Sink traps provided 3 Water reinstated or improved 5 Sculleries, yards, etc., paving repaired 35 Drains newly constructed 11 „ reconstructed 7 Sculleries, yards, etc., cleansed or limewashed 114 „ repaired, etc. 36 „ Obstructions removed 23 Dust receptacles provided 45 Urinals cleansed, etc. 11 Foul accumulations removed 53 The number of factories under observation for insanitary conditions during the year was 37, and in connection with them some 37 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 26 instances, the provision of new drains in 1, the construction of a new water-closet in 3, the removal of obstructions from drains and waterclosets in 3 instances, besides several other matters. Limewashing of factories can only legally be dealt with by the factory inspector, but defects in connection with the sanitary arrangements in factories are matters within the province of the sanitary authority. During the year 77 lists of out-workers were received from employers in the Borough, 38 in the first and 39 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 1,167 out-workers, of whom 896 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 1,679 out-workers, and of these 47 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 1922. The number of out-workers reported was 2,846 and of these some 1,903 were residents in Shoreditch. These figures, although below the average for the past five years, show an increase as compared with those for 1921. 24 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. Some 1,280 visits of inspection were made to places where home-work was being carried on, and in connection with these 233 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 44 and included 13 of scarlet fever, 24 diphtheria and 7 pneumonia. The usual steps were taken in connection with them by the officers of the sanitary authority. MATERNITY AND CHILD WELFARE. The births notified under the Notification of Births Act, 1907, numbered 2,318, and there were in addition 50 still births. Of the notifications 1,674 were received from registered midwives practising in the Borough. In addition, some 250 occurring in institutions outside Shoreditch were notified on the forms sent in weekly by the London County Council. Including these the births notified during the year were approximately 88 per cent. of the births registered as compared with 98 per cent. in 1921, 85 in 1920, and 95 in 1919. Towards the end of the year this decrease in the number of notifications came under the notice of the Maternity and Child Welfare Committee, and the medical practitioners and registered midwives were again circularised upon the subject of their duties as regards notification. A Summary of the work of the doctors and health visitors is appended (pp. 71 and 70). The work has followed on the same general lines as in previous years, but extension has been necessary to meet the needs of the Borough. The additional dining centre at 31, Herbert Street, to which reference was made in the Annual Report for 1921, was opened towards the end of April. Towards the end of the year an additional infant welfare consultation was established under Dr. Radford at 152, Kingsland Road on Thursday afternoons in place of the weighing centre, previously held there on that day. The full staff employed by the Borough Council in connection with maternity and child welfare work at the end of the year was as follows : an assistant medical officer of health, 5 health visitors, 3 male clerks (one temporary), 2 female clerks (one temporary), and an enquiry officer. At the Centre, 152, Kingsland Road, a cook-caretaker and assistant cook, a vegetable hand and general assistant, a cleaning assistant, a part-time waitress and a part-time babies' nurse. At the Centre, 31, Herbert Street, a cook-caretaker, a nurse and cleaner, and a helper and waitress. 25 At the end of the year the doctors' consultations were being held as follows:- Monday Afternoons.—Infant Welfare, by Lady Briscoe, M.B., at 152, Kingsland Road. Tuesday Afternoons.—Infant Welfare, by Dr. Maitland Radford, at Hoxton Hall. Thursday Afternoons.—Infant Welfare, by Dr. Maitland Radford, at 152, Kingsland Road. Friday Mornings.—Ante-Natal, by Dr. Sylvia Smith, at 152, Kingsland Road. Friday Afternoons.—Infant Welfare, by Dr. Sylvia Smith, at 152, Kingsland Road, and by Dr. Maitland Radford at Harbour Lights, Goldsmith's Row. Under the Shoreditch School for Mothers which undertakes the maternity and child welfare work, in that part of the Borough comprising the major portion lying to the west of East and New North Roads, the following doctors' consultations were held at its Centre which is situate at 28, Herbert Street :— Tuesday Afternoons.—Infant Welfare, by Dr. Pratt. Thursday Mornings.—Ante-Natal, by Dr. Tribe. Thursday Afternoons.—Infant Welfare, by Dr. Pratt. The following indicates the arrangements in operation as regards the work of the municipal health visiting staff: The health visitors attend at their office at the Town Hall from 9 to 10.30 a.m., the rest of the morning being spent in visiting on their respective districts. On Friday mornings two health visitors in rotation attend the ante-natal consultation at 152, Kingsland Road. Saturday mornings are usually given to clerical work. The afternoons are allocated as follows:— Monday.—Miss Morrell, and, on alternate weeks, Miss Barnes and Miss Hunt at the Infant Welfare Consultation, 152, Kingsland Road. Tuesday.—Misses Williams, Heward and Hunt at the Infant Welfare Consultation, Hoxton Hall, and Misses Barnes and Morrell at the Weighing Centre, 152, Kingsland Road. Wednesday.—Misses Heward, Williams, Morrell and Hunt at the Sewing Class held at 152, Kingsland Road. Thursday.—Miss Barnes at the Infant Weighing Centre, Haggerston Baths, and Misses Hunt and Morrell at the Infant Welfare Consultation, 152, Kingsland Road. Friday.—Misses Williams and Heward at the Infant Welfare Consultation, 152, Kingsland Road, and Misses Barnes, Hunt and Morrell at the Infant Welfare Consultation, at Harbour Lights, Goldsmith's Row. The health visiting staff of the Shoreditch School for Mothers, Misses Dance and Fitzmaurice, attend in the mornings at the Centre, No. 28, Herbert Street, and they carry out their duties in the district allotted for their work in accordance with 26 the directions of the committee controlling the Centre. Reports as to the work done by them are rendered fortnightly to the Maternity and Child Welfare Committee of the Borough on lines similar to those laid down for the municipal health visitors. An average of 73 dinners daily were served during the year at the centre, 152, Ivingsland Road. At 31, Herbert Street, since its opening, the average number has been 22 daily. For confinement cases special invalid dinners are provided. The amounts of milk allowed to nursing and expectant mothers and children during the year under consideration and the two preceding years, together with the numbers of families supplied, and the cost of the milk, are as. shown in the subjoined table:— 1920. 1921. 1922. Number of families to whom milk allowed 1,359 2,607 2,559 Number of gallons of milk allowed 31,798 76,726 62,164 Total cost of milk allowed during year £5,014 3s. 4d. £11,952 9s. 2fd. £7,459 13s. 9d. The total amounts of dried milk disposed of during the year were 5,419 lbs, of Glaxo and 185 lbs. of Lacta sold, and 3,440i lbs. of Glaxo and 99½ lbs. of Lacta allowed free. Virol to the extent of 282½ lbs. was sold and 191f lbs. were allowed free. It may be mentioned that shortly after the commencement of the financial year 1922-23 the expenditure of the Borough Council upon the provision of milk and dinners in connection with their maternity and child welfare work became the subject of correspondence with the Minister of Health. At the end of the period covered by this report the matter was still under consideration. In the course of the negotiations with the Ministry upon this subject, the method of giving effect to the Ministry's Circular No. 185 in the Borough was closely investigated on behalf of the Ministry. Certain alterations in procedure were subsequently suggested by the Minister. The most important of these were as follows : The consideration of all milk applications by a Sub-Committee consisting of the Chairman of the Maternity and Child Welfare Committee, the Borough Accountant and the Medical Officer of Health; the discontinuance of allowing both milk and dinners to the same person; arranging for a reduction in the price of the milk purchased by the Borough Council, and increasing the stringency as regards the scale of income entitling applicants to be recipients of milk from the Borough Council. These suggestions were given effect to and resulted in a considerable saving. A word is necessary with respect to the Model Maternity and Child Welfare Centre with the construction of which the Committee decided to proceed, as mentioned 27 in the Annual Report for 1921. After the necessary steps were taken, tenders were invited for the erection of the Centre on the site purchased at the corner of Kingsland Road and Laburnum Street. That of J. Jarvis & Sons, Ltd., for £21,760, was accepted by the Council on 30th May and the work was commenced in August. At the end of the year it was well in hand and considerable progress had been made. At the Ante-Natal and Consultative Maternity Centre of the City of London Maternity Hospital some 514 cases were dealt with. Of these 12.5 were examined by the obstetric surgeons in charge of the centre. Some were examined more than once so that altogether 206 examinations were made. The remaining cases were seen by the sister attached to the centre and advised upon the various aspects of their pregnancies. The special features noted were: contracted pelves in 7 cases, prolapse of cord in 2, breach to vertex in 3, albuminuria in 11, pyelitis in 1, mitral disease 1, fibroids 1, slight ante partem haemorrhage in 2, varicose veins 1, and rupture of membranes in 1 case. There were 14 examinations because of previous histories, and 8 on account of the duration of the pregnancies. TJrine was tested in all cases. The great majority of the cases under observation proved to be normal. During the year 289 cases were admitted to the hospital for confinement and some 275 were attended at their own homes by the staff of the hospital. The very valuable work carried out during the year by the local District Nursing Association, a work of the greatest possible service in the homes of the poor, may here be referred to as the major part of it lies amongst children under five years. Of some 4,001 visits at all ages, 2,654 were made to 202 sick children under the age mentioned. The cases nursed included measles, pneumonia, bronchitis, ear disease, ophthalmia neonatorum, and a number of other complaints. Subjoined is a Summary of all the cases nursed by the Association at the instance of the Borough Council during the year:— Cases. Visits. Pneumonia 74 970 Ophthalmia Neonatorum 14 358 Inflammation of eyes 3 44 Post-Part. Pyrexia 18 241 Miscarriage 11 99 Measles 71 677 Threadworms 24 188 Constipation 3 19 Influenza 29 347 Conjunctivitis 3 98 Septic Throat 3 29 Scalds 4 90 Bronchitis 6 84 Carried forward 263 3,244 28  Cases. Visits. Brought forward 263 3,244 mpetigo 1 10 Meningitis 1 4 Tuberculosis 1 8 Ulcer 1 36 Abscess 9 103 Otorrhœa 14 362 Club Feet 1 16 Keratitis 1 43 Whooping-cough 6 87 Abortion 1 6 Gastritis 1 5 Hydrocephalus 1 43 Blepharitis 1 13 Intestinal Obstruction 1 10 Pyrexia 1 5 Purulent Blisters 1 6 305 4,001 Of the cases nursed sixteen terminated fatally—six of pneumonia, three of influenza, three of measles, and one each of bronchitis, scalds, whooping-cough and hydrocephalus. Three of the deaths from pneumonia and the death from influenza were of persons five years of age and upwards, the rest were of children under five years. SLAUCxHTERHOUSES. The three licensed in Shoreditch were under regular inspection throughout the year, some 47 visits being made in connection with them. Their general sanitary condition may be reported on as being satisfactory. In this connection it may be mentioned that 60 butchers' shops and other premises upon which meat is sold were under supervision during the year, some 396 visits of inspection being made to them. COWHOUSES. The two registered in the Borough were under inspection during the year and the report as to their sanitary condition is satisfactory. In October the cows kept were found to number 28, of which 22 were at 38, Nile Street and 6 at 76, St. John's Road. The number of dairymen and milk purveyors on the register at the end of the year was 219. During the year the sale of milk was discontinued in 18 and commenced in 34, whilst in 35 instances there were changes in the names of the persons 29 registered. The premises were under observation throughout the year, some 1,792 visits having been made to them. In 18 instances sanitary notices were served: in 5 for general cleansing, 3 for defective roofs, 3 defective guttering and rain water pipes, 3 obstructed drains, and in 4 for defective dust receptacles. Two cases of diphtheria and one each of scarlet fever and pneumonia occurred on milk purveyors' premises. In these the usual steps as regards the sale of milk and disinfection were taken by the Sanitary Authority. It may be noted that the Milk and Dairies (Amendment) Act, 1922, except Section 31, came into operation on September 1st, 1922. Section 2 empowers a Local Authority, by whom a register of purveyors of milk is kept, to refuse to register or to remove from the register retailers of milk if they are satisfied that their acts or defaults are likely to endanger the public health. MILK AND CREAM REGULATIONS, 1912. None of the samples of milk submitted to the Public Analyst were reported as containing any preservative. One sample of preserved cream was sold contrary to the regulations and proceedings were taken (p. 35). There is very little sale for cream in Shoreditch. COOKSHOPS AND EATING-HOUSES. Including the kitchens of publichouses where food is prepared for customers 147 were under inspection during the year and some 546 visits were made in connection with them. The sanitary notices served numbered 54, of which 27 were for general cleansing, 8 for defective roofs, 2 defective drains, 4 defective w.c.s, 8 dust receptacles and 5 insanitary accumulations. FRIED-FISH SHOPS. There were 60 under inspection in connection with which 29 Sanitary Notices were served : 6 for defective roofs and rain water pipes, 3 w.c.s, 2 dust receptacles, and 18 for general cleansing. Some 455 visits of inspection were made. ICECREAM SHOPS. Some 215 visits of inspection were made to 77 icecream shops. Eighteen Sanitary Notices were served, mostly for general cleansing. STREET MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers as regards food exposed for sale and the following were seized or surrendered and destroyed as unfit for the food of man 1 bovine liver, 26 hams, 2 tins liquid eggs, l¼ cwts. plaice, ¾ cwt. roes, 10 cwts. 3 qrs. skate, 5½ stone whiting, 3 cwts. winkles, 1¾ cwts. soles, ½ cwt. and 1 barrel of apples, ½ cwt. bananas, 1 cwt. chestnuts, 3 barrels of grapes, 7½ cwts. and 2 barrels of pears, 140 lbs. rhubarb, 16 cases tomatoes, 1 cwt. broccoli, 600 cauliflowers, 1 cwt. onions, and 14 cwts. potatoes. 30 FOOD POISONING. The following particulars relating to a death in the Borough which there are grounds for believing was due to food poisoning are of interest and are recorded accordingly:— A woman, named Sarah F—,aged 34, belonging to a Jewish household resident in Shoreditch, was admitted to St. Leonard's Hospital in a state of collapse about midday on September 1st, 1922. She died about 1.30 a.m. on September 2nd, and during the course of the same morning the death was reported over the telephone by Dr. Feldman as one of suspected food poisoning. Upon the circumstances being enquired into the following information was obtained The deceased was taken ill about midnight on August 27th or early in the morning of the 28th with faintness, abdominal pain, vomiting and diarrhoea. She was under treatment at home by her medical attendant until her removal to St. Leonard's Hospital on September 1st. A man named Solly P—, a resident in the same house was also taken ill about 1.30 a.m. ori August 28th with abdominal pains and discomfort, faintness, vomiting and diarrhoea. He was not in Shoreditch at the time of the onset of symptoms, but at a house in Stepney, where his father and mother, and other members of his family resided. He was too ill to return to his home in this Borough until late in the clay, when he recovered somewhat, but he remained very unwell for five or six days. The family resident in Shoreditch consisted of the deceased, Solly P—, and five children, aged respectively 11, 7, 5, 3 years, and 3 months. The oldest of the children was observed to be slightly unwell during the 28th August, but he quickly recovered. The rest of the children were so far as could be ascertained unaffected. The family in Stepney comprised, besides the parents of Solly P—, his two brothers and three sisters. There was also a male lodger in the house. The history obtained indicates that the mother, all the daughters, and the two sons fell ill about midnight on the 25th August or early in the morning of the 26th, and that the illness was similar to that in the Shoreditch household. They were attended by a doctor until August 30th, when they all seem to have recovered. The articles of food taken by the family in Shoreditch were:—On August 26th, corned beef purchased in Brick Lane, Stepney, during the morning, and salt beef, purchased in Church Street, Bethnal Green, in the evening, the same being eaten with beetroot, cucumber and brown vinegar. On August 27th the whole of the family, except the infant, had chicken broth in the afternoon, which was brought from the Stepney household about the middle of the same day. It was in a jelly, and is said to have tasted quite all right and nothing was noticed in connection with it to excite suspicion. The food taken by the family in Stepney on August 25th included sardines (Marie Elisabeth brand) in the afternoon, of which all partook except the father, and chicken broth in the evening. All had chicken broth, including the lodger. The chicken broth had been made earlier in the day. It was what was left of this broth that was brought to the house in Shoreditch and consumed by the family there on 27th August, somewhere about 48 hours after it had been made. So 31 far as could be ascertained no cases were reported in which corned beef, salt beef or sardines were believed to have given rise to illness in the neighbourhoods of the houses in Shoreditch and Stepney other than the cases mentioned. It will be noted that whilst the corned beef and salt beef are stated to have been consumed by the family in Shoreditch, none seems to have been eaten by that in Stepney. On the other hand, whilst sardines were eaten by the Stepney family, they had none in the Shoreditch household. The article of food which was consumed in common by the two families was the chicken broth. Altogether 8 in Stepney and 6 in Shoreditch had this broth, and of these, 6 amongst the former and 3 of the latter fell ill, i.e., nine of the fourteen persons who had the broth were affected. Unfortunately none of the broth was left and no examination was made, nor was any examination possible of the corned beef and the salt beef. The empty sardine tin was subjected to examination, but the result was negative. The death of Sarah F—was reported to the Coroner, who ordered a post mortem examination of her body. This was made by Dr. Feldman at St. Teonard's Hospital on September 2nd. The stomach and its contents, and pieces of liver, spleen, kidney and small intestine were with due precaution transmitted to Dr. Bruce White, Pathology Laboratory, University of Bristol. It was noted at the post mortem that the liver and kidneys were fatty. The liver weighed about 90 ounces and the heart 13½. There was a good deal of fat about the body. The Ministry of Health were notified of the case over the telephone on September 2nd. The specimens for examination were sent to Bristol at the suggestion of the Ministry pursuant to arrangements made with the Medical Research Council under which bacteriological investigations in the elucidation of food poisoning outbreaks are to be carried out at Bristol by Dr. Bruce White, the object being to co-ordinate the bacteriological work connected with these outbreaks under one bacteriologist. Specimens of the blood and faces of some of the persons attacked with the illness, both in Stepney and Shoreditch, were also sent to the bacteriologist. The reports of the bacteriologist show that cultures of an organism isolated from the small intestine, spleen and stomach contents on examination were found to belong to the most frequent food poisoning group, viz., Bacillus Aertrycke (type mutton), and samples of blood from members of the Stepney family who had been ill powerfully agglutinated the above-mentioned organism isolated from the organs of Sarah F—. The bacillus named was found in connection with an outbreak of food poisoning in 1898 at Aertrycke in Belgium—hence the name. It is allied to the Gaertner bacillus. Bacilli of this type have since been isolated in a number of food poisoning outbreaks. Bacillus Aertrycke is apparently identical with Bacillus Suipestifer, the microbe associated with swine fever. There are several types of Bacillus Aertrycke, but the one most frequently met with in food poisoning outbreaks is the mutton type mentioned above, which was isolated in a food poisoning outbreak due to mutton at Newcastle in 1911. To briefly summarise the results of the investigations made:—Fourteen persons, of whom four were children under 12 years of age, belonging to the two households partook of chicken broth made on August 25th, one family on the same day the broth 32 was made, and the other on August 27th, two days later. On August 26th six of the first household and on August 28th three of the second household of these persons became ill. Three of the four children were not noticed to be unwell, and the older, a boy of between eleven and twelve years, was only slightly ill. The symptoms of the disorder were similar in the two households. One of the cases terminated fatally. The results of the examinations made by the bacteriologist indicate that the illness in both households was due to the same cause, namely, the Bacillus Aertrycke. None of the chicken broth was available for examination, but the only food consumed in common by the two households so far as could be ascertained was the chicken broth, and it may be presumed therefore that it was infected with the bacillus named and was the vehicle of infection, but how it became infected is an open question. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, show that 1,068 samples were submitted to him during the year. This number is at the rate of 10.2 per 1,000 inhabitants, and is above the average for recent years. The results of the year's work are summarised in the following table :— Quarter of 1922. 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 266 21 7.9% 4 ... 4 3 9 9 0 199 10 0 2nd 257 16 6.2% 6 ... 6 3 9 9 0 160 12 6 3rd 178 6 3.4% 2 ... 2 2 2 4 0 111 5 0 4th 367 15 4.1% 8 ... 8 6 10 3 0 229 7 6 Totals for Year. 1,068 58 5.4% 20 ... 20 14 31 5 0 700 15 0 The samples taken included 582 of milk, 3 of separated milk, 3 of dried milk, 3 of milk powder, 2 of skimmed milk, 1 evaporated milk, 52 butter, 39 margarine, 94 vinegar, 63 pepper, 55 cocoa, 28 mustard, 20 coffee, 11 tapioca, 9 baking powder, 8 medicine, 6 lard, 6 sweetmeats, 5 non-alcoholic ginger wine, 5 ground ginger, 4 ground almonds, 4 sago, 4 dripping, 4 self-raising flour, 3 custard powder, 3 bread and butter, 3 arrowroot, 3 malt vinegar, 3 sausage, 3 sweet spirits of nitre, 3 breakfast sausage, 3 ground rice, 2 brawn, 2 glycerine, 2 ammoniated tincture of quinine, 2 sugar, 2 tincture of iodine, 2 ginger wine, 2 rice, 2 tea, 2 boric acid ointment, 2 nonalcoholic orange wine, 1 each of ground cinnamon, ipecacuanha wine, syrup of squills, tea dust, syrup of tolu, spirit of camphor, preserved cream, compound mustard, corned beef, friar's balsam, camphorated oil, oatmeal and flaked rice. 33 Of the samples of milk 42 or 7.2 per cent. were found to be below the standard fixed by the Board of Agriculture. The proportion of milk samples returned as adulterated during 1922 was again below the average. It is, however, to be mentioned that 6 of the samples were only below standard to a very slight extent and the Public Analyst noted them as being possibly genuine. If these be deducted the percentage of adulteration is reduced to 6.2. 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 159 21 13.2 2nd 146 15 10.3 3rd 110 5 4.5 4th 167 1 0.6 In 13 of the samples water was certified to have been added, in all of which it was less than 5 per cent., taking the standard of the Board of Agriculture. In one of these added colouring matter was certified to have been present. In 20 the samples showed deficiencies of milk-fat; in 1 it was 5 per cent., in 8 the deficiency was more and in 11 it was less than 5 per cent. Colouring matter was noted as being present in one of the last. Three samples of separated milk and two of skimmed milk were taken. One of the samples of separated milk was certified to contain 2 per cent. added water and added colouring matter, the others were all returned as genuine. Three samples of milk powder were analysed, one of which was found to be deficient in milk-fat to the extent of 5 per cent. Three samples of dried milk and one of evaporated milk were also analysed and returned genuine. Legal proceedings were instituted in 9 or 21.4 per cent. of the cases in which samples of milk were below standard. In 3 instances the summonses were dismissed, warranties being proved. In 5 instances the defendants were not fined, but the Borough Council were allowed costs. In 1 instance the summons was dismissed on the ground that the milk in the shop from which the sample had been taken was not intended for sale. No legal proceedings were considered advisable as regards the remainder of the samples below standard. The percentage of the adulterated samples of milk in which it was not thought advisable to institute legal proceedings was 78.6, which is above the average. In the 5 cases in which costs were allowed the aggregate amounted to £'17 17s., the average amount paid by the defendants as costs was £3 11s. 5d. C 34 Fifty-three samples of butter were taken, and all were returned as genuine, 34 of the samples taken contained a small amount of boric acid, not exceeding 0.5 per cent. in each. Thirty-nine samples of margarine were taken. In four instances proceedings were instituted for excessive water. In two of these the defendants were fined £2 and 10s. respectively, in the third £1 1s. as costs were allowed the Council. In the fourth case the defendant successfully pleaded a warranty, and the case was dismissed. The wholesalers were then proceeded against for giving a false warranty, but this case also was dismissed as the defendants were able to convince the magistrate that they had sold the margarine as they had received it from abroad. Four samples of margarine were taken, which were served in wrappers not bearing the word "Margarine" legibly stamped thereon as required by the Margarine Act. In two instances proceedings were taken, in one of which the offender was convicted and fined 10s., and in the other 2s. as costs were allowed the Council. Warning letters were sent to the other two. Thirty-two of the samples of margarine contained small amounts of boric acid not exceeding in any instance 0'5 per cent. Of the 94 samples of vinegar taken, 6 contained excessive water. Proceedings were taken in two instances. In one case, where the excess was 35 per cent., the defendant was fined £5, and the other case, where the excess of water was 14 per cent., 23s. as costs were allowed the Council. One sample purchased as bread and butter was found, on analysis, to be bread and margarine. No action was taken as a notice was exhibited in the place where the purchase was made to the effect that only margarine was used at the establishment. One sample of boric acid ointment was found to be deficient in boric acid to the extent of 15 6 per cent. compared with the B.P. standard. The defendant was fined 20s., including costs. One sample of sweet spirits of nitre was found to be deficient in ethyl nitrite to the extent of 42 per cent. No action was taken owing to the fact that the bottles used in the sampling were so large that they may have permitted some of the ethyl nitrite to have been lost by evaporation. It may be noted that all the eight samples of medicine taken were returned as being in accordance with the prescriptions. Three samples of non-alcoholic ginger wine contained salicylic acid 31, 2 2 and 2.2 respectively. No action was taken. One sample of sago was found to contain 0.4 per cent. split lentils. No action was taken. Of the samples of mustard one was found to contain starchy farina 12 per cent. with traces of turmeric, and another 10 per cent. starchy farina with traces of turmeric. No action was taken. One of the samples of coffee contained 45 per cent. chicory. A warning letter was sent to the vendor. 35 One sample of preserved cream was served in an unlabelled receptacle. Proceedings were instituted and the defendant was ordered to pay £2 2s. costs to the Council. The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1902-22 inclusive:— Year. Number of Samples. Number of persons in the Borough to each Sample. Number of Samples adulterated. Percentage of Samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties. Prosecutions proceeded with. Number of successful prosecutions. Fines and Costs. Amount paid to Public Analyst. £ s. d. £ s. d. 1902 281 420 71 25.3 54 2 52 48 117 9 0 140 10 0 1903 707 166 112 15.8 60 5 55 51 173 11 6 353 10 0 1904 612 189 110 17.9 56 6 50 46 128 5 0 306 0 0 1905 536 215 98 18.2 57 2 51 47 233 18 0 267 0 0 1906 520 224 122 23.4 44 2 42 34 106 12 6 260 0 0 1907 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 1908 580 200 92 15.8 45 ... 45 39 117 10 0 290 0 0 1909 570 200 92 16.1 76 2 74 69 255 18 6 276 5 0 1910 578 200 133 23.0 65 ... 60 49 93 17 6 279 5 0 1911 577 200 149 25.8 64 ... 62 58 180 0 6 278 17 6 1912 584 190 100 17.1 48 ... 48 45 172 11 0 281 10 0 1913 768 144 132 17.1 47 ... 47 42 94 2 6 350 10 0 1914 768 143 132 17.1 36 ... 36 21 74 6 0 350 10 0 1915 768 135 130 17.8 43 ... 43 30 63 16 0 350 10 0 1916 768 130 144 18.7 50 ... 49 36 134 18 0 350 10 0 1917 770 129 154 20.0 65 ... 65 41 99 12 0 351 5 0 1918 724 134 137 17.5 54 1 53 37 284 13 0 340 12 6 1919 632 155 72 11.3 32 1 31 17 137 3 0 316 0 0 1920 934 109 69 7.4 25 1 24 14 38 3 6 700 10 0 1921 1077 98 58 5.4 25 25 20 94 14 0 807 15 0 1922 1068 97 58 5.4 20 ... 20 14 31 5 0 700 15 0 The percentage of samples found adulterated was again below the average for recent years. With reference to the convictions in 1922, in two instances the defendants had been previously convicted once under the Sale of Food and Drugs Acts. Towards the latter part of the year a circular letter from the Ministry of Health, dated 17th July, 1922, came under the consideration of the Health Committee. In this letter attention was directed to the prosecution of a milk vendor for selling milk deficient in fat, in which the Local Authority withdrew from the proceedings because it was shown that the vendor's milk subjected to constant tests over a number of years had given uniformly satisfactory results. Whilst the Minister fully appreciated that Local Authorities would often have to institute proceedings for selling milk deficient in fat, he felt that they would desire to avoid irritating vendors who were doing their best to secure milk sold by them being of good quality. Conditions of a c 2 36 temporary character may result occasionally in milk from cows normally giving milk of the proper fat content being below standard in this respect, and the results of an isolated test cannot be regarded as conclusive. The Minister therefore was of opinion that it is extremely undesirable that a prosecution should be based upon the results of an isolated test when other tests of the particular milk supply have proved satisfactory, and it was suggested for the consideration of the Local Authority that in such cases prosecutions should be instituted only where a scries of tests have shown repeated default. In conjunction with the above communication a letter from the Society of Medical Officers of Health, dated 17th August, 1922, expressing regret that such a circular should have been issued, and trusting that the Minister on reconsideration would withdraw it, was also under the consideration of the Health Committee. The Committee, after very fully considering the matter, were of opinion that the suggestion in the circular, if given effect to, would be very destructive to the administration of the Sale of Food and Drugs Acts in relation to Milk, and they recommended the Borough Council to approach the Ministry of Health with a view to the withdrawal of the circular, which the Borough Council did accordingly.* BAKEHOUSES. The bakehouses on the register number 63, three having been struck off and one, a factory bakery in Britannia Street, having been added during the past 12 months. Of the 63 on the Register 37 are below ground level. In 21 electric power is used in the process connected with the bread making. They were all inspected and may be reported as generally satisfactory from a sanitary point of view. In thirteen sanitary notices were required for various matters of major or minor importance requiring attention. These were duly served and complied with. RAG FLOCK ACT, 1911. Under the above Act 30 samples were taken and submitted for analysis. Four shewed excesses of soluble chlorine ranging from 1816 to 228T parts per 100,000. Proceedings were instituted and in each instance the person from whom the sample was purchased pleaded a warranty and was dismissed from the case. The warrantors were then proceeded against and fines amounting in the aggregate to £15 with 10 guineas costs were imposed. STAFF. There is no change to be recorded as regards the staff of Sanitary Inspectors during the year. Mr. A. W. Cockman, who was appointed on the Clerical Staff in May, 1920, died in March, 1922. He was an efficient officer and his loss is much regretted in the department. The vacancy thus created was not filled. * Circular withdrawn in May, 1923, 37 The Staff employed by the Borough Council in the Maternity and Child Welfare work differs in the following particulars from that employed in 1921:— Miss Morrell who was appointed health visitor in December, 1921, commenced her duties on January 30th. Miss Robinson, the temporary health visitor, left the service of the Council on the return to duty of Miss Barnes after her illness towards the end of February. At the beginning of May. Miss Frith relinquished her post of clerk, and Mrs. Rutherford, who was at the time holding a temporary post on the clerical Staff, was appointed to the position thus vacated. Miss Lehane was then appointed temporarily to assist at the centres and with the clerical work of the department and commenced duty on 22nd May. Miss Smith was appointed assistant cook at the Maternity Centre, 152, Kingsland Road, in place of Mrs. Campbell, who was obliged to resign on account of ill health. Miss Thorogood was appointed cook caretaker, Mrs. Powney nurse and cleaner, and Mrs. Harris helper and waitress at the Council's dining centre, 31, Herbert Street, and commenced their duties early in the year. Mr. J. Watson, mortuary keeper, after twenty-four years' service, during which he discharged the duties appertaining to his office in an efficient and satisfactory manner, was obliged to leave the service of the Borough on account of ill health. He retired on a pension in December. Mr. W. Bailey, who had been acting temporarily as mortuary keeper for several months, was appointed permanently to the position at the end of the year. In connection with the work of the Department, some 21,916 communications, written and printed, were despatched from the office during the year. These included 7,530 notices and summonses, 3,812 letters, cards and other communications on matters under the Public Health and Sale of Food and Drugs Acts, 241 in connection with the work under the Factory and Workshops Acts, 8,933 on various matters connected with infectious disease, verminous cases and disinfection, and some 1,400 agendas and reports concerning the work of the Department. In addition to the foregoing, some 11,592 forms, milk books and cards, 9,386 letters and other communications, and 4,680 agendas, reports and other documents relating to the work under the Maternity and Child Welfare Committee were despatched, so that altogether the total number exceeded 47,000, which is again greatly above the average for previous years. The increase of over 2,000 as compared with 1921 is due to the large amount of clerical work under the Maternity and Child Welfare Committee which was approximately 25 per cent. greater than in 1921. I have again to express my satisfaction as to the manner in which the various officers belonging to the department have discharged their duties, and to place on record my recognition of the valuable assistance rendered by the Assistant Medical Officer of Health, the Senior Inspector, and the other Officers concerned in the work of protecting the health of the Borough during the year. 38 My thanks are also due to the Mayor, the Chairmen and Members of the Health and Maternity and Child Welfare Committees, and the Members of the Borough Council generally for their kind consideration and help in connection with the work during the year. I have the honour to be, Sir, Ladies and Gentlemen, Your obedient Servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. Metropolitan Borough of Shoreditch. APPENDIX TO THE REPORT of the Medical Officer of Health, containing Statistical Tables and Summaries of Proceedings under the Public Health and Factory and Workshops Act during the Year 1922, a Summary compiled from the abstracts of the Work of the Sanitary Inspectors by the Senior Inspector, Statistical Information relating to Housing, a Summary showing the Results of Police Court Proceedings taken during the Year, copies of the Reports of the Tuberculosis Officer and Tuberculosis Care Committee, together with a Summary of the Work of the Medical Officers and Health Visitors in connection with Maternity and Child Welfare during the Year prepared by the Assistant Medical Officer of Health. 41 TABLE I. Vital Statistics of the Borough of Shoreditch during 1922 and previous years. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. N umber. Rate. of Nonresidents registered in the District. of residents not regis tered in the District. Under 1 year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 nett Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1916 99932 2833 2983 30.3* 1687 16.2 290 444 369 124 1841 18.7 1917 89675 2056 2225 22.2 1789 19.9 260 461 352 158 1990 22.5 1918 87645 1514 1719 17.5 1990 22.7 317 435 286 166 2108 24.2 1919 98134 2136 2286 22.3 1362 13.8 224 399 251 110 1537 15.7 1920 102044 3546 3731 36.9 1450 14.2 245 378 340 91 1583 15.6 1921 105200 2798 2975 28.5 1393 13.3 264 369 341 114 1498 14.4 1922 105800 2645 2926 27.9 1508 14.2 204 408 301 102 1712 163 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 Institution, estimated at 1000, 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 one year included in the number given in column 8 and by addition of the deaths under one 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 104,308 Number of inhabited houses 11,889 Average number of persons per house 8.8 At Census of 1921. * The birth rate for 1915 and 1916, based upon the estimated population for 1914 and the Registrar-General's estimate for 1916, were 28.5 and 27.4 per 1,000 respectively. 42 TABLE II. Cases of infectious disease notified during the Year 1922 in the Borough of Shoreditch. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Total Cases Removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 8 Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Smallpox 2 ... ... 2 ... ... ... ... ... ... ... ... 1 1 ... ... 2 Cholera (C), Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 439 17 181 191 35 15 ... ... 17 80 54 58 81 52 64 33 438 Erysipelas 54 3 1 5 10 13 16 6 1 7 8 8 17 6 3 4 20 Scarlet fever 345 7 118 183 27 10 ... ... 13 48 38 43 57 47 39 60 337 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 5 ... 1 1 1 2 ... 3 1 1 5 Relapsing fever (R), Continued fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 9 ... ... ... 3 6 ... ... 1 2 ... ... 2 2 ... 2 8 Cerebro-spinal meningitis 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Anthrax 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary tuberculosis 234 2 3 17 56 101 51 4 7 33 48 36* 39† 15 30 26 212‡ Other forms of tuberculosis 53 2 15 19 4 10 2 1 3 5 11 7 11 6 4 6 41 ‡ Ophthalmia neonatorum 65 65 ... ... ... ... ... ... 1 11 13 7 15 10 6 2 4 Acute primary pneumonia 332 59 166 41 16 30 17 3 3 51 56 94 72 19 23 14 253‡ Acute influenzal pneumonia 47 6 14 8 7 6 3 3 1 5 7 24 3 3 4 14‡ Malaria 2 ... ... ... 2 ... ... ... ... ... ... ...... 2 ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1,589 162 499 467 161 194 89 17 48 242 238 278 301 158 173 151 1,336 * This Number includes the cases of consumption notified from the Holborn Institution, Highgate, † This includes the cases of consumption in the St. Leonard's Hospital. ‡ Removed to the St. Leonard's Hospital, Hospitals or Sanatoria. It is to be noted that the cases removed during the year included cases certified in previous years as well as cases certified in 1922. 43 TABLE III. Causes of, and ages at death during the Year 1922 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 or "Residents" or "NonResidents" in Institutions in the District (6), All Apes. Under 1. 1 and under 2. 2 and under 6. 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) 1712 301 168 99 53 70 178 435 408 840 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric fever ... ... ... ... ... ... ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... 3 Measles 84 19 44 19 2 ... ... ... ... 50 4 Scarlet fever 6 . . 4 1 2 3 ... ... ... ... ... 5 Whooping cough 27 7 13 6 1 ... ... ... ... 18 6 Diphtheria and croup 27 3 10 11 3 ... ... ... ... ... 7 Influenza 69 9 5 4 2 4 8 19 18 2 8 Erysipelas 3 ... ... ... ... ... ... 3 ... 3 9 Phthisis (pulmonary tuberculosis) 148 2 1 1 5 25 60 48 6 72 10 Tuberculous meningitis 13 4 3 3 2 1 4 11 Other tuberculous diseases 21 3 1 2 3 4 3 5 8 12 Cancer, malignant disease 108 ... ... 1 2 1 7 66 31 42 13 Rheumatic fever 3 ... ... ... 1 ... 2 ... ... 2 14 Meningitis (see note (d) ) 5 3 ... ... ... ... 2 ... ... 2 15 Organic heart disease 65 ... ... 1 1 4 14 27 18 13 16 Bronchitis 202 23 7 2 2 ... 8 65 95 124 17 Pneumonia (all forms) 260 72 70 30 6 3 18 36 25 84 18 Other diseases of respiratory organs 8 ... ... ... 1 ... 1 4 2 6 19 Diarrhoea and enteritis (see note (e) ) 38 24 6 2 ... ... 1 3 2 13 20 Appendicitis and typhlitis 11 ... ... ... 3 3 1 4 4 21 Cirrhosis of liver 3 ... ... ... ... ... ... 2 1 4 2la Alcoholism ... ... ... ... ... ... ... ... ... ... 22 Nephritis and Bright's disease 51 ... ... 2 2 1 4 24 18 42 23 Puerpural fever 3 ... ... ... ... 1 2 ... 2 24 Other accidents and diseases of pregnancy and parturition 3 ... ... ... ... ... 3 ... ... 2 25 Congenital Debility and malformation, including premature birth 104 102 1 1 ... ... ... ... ... 35 26 Violent deaths, excluding suicide 45 4 3 6 3 4 5 10 10 16 27 Suicides 13 ... ... ... ... 1 3 6 3 3 28 Other defined diseases 387 23 3 6 11 17 36 112 179 289 29 Diseases ill-defined or unknown 5 3 ... ... ... 1 ... 1 ... ... 1712 301 168 99 53 70 178 435 408 840 44 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH DURING THE YEAR 1922. 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. I 1-3 Months. 3-6 Months. 6 9 Months. 9-12 Months. Total Deaths under 1 Year. All causes Certified 65 17 9 10 101 53 39 59 49 301 Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... Chickcn-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 9 8 19 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... 1 4 3 8 Diphtheria and croup ... ... ... ... ... ... 1 1 1 3 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... 3 ... 3 Abdominal tuberculosis (b) ... ... ... ... ... 1 ... ... ... 1 Other tuberculous diseases ... ... ... ... ... 1 1 1 2 5 Meningitis (not tuberculous) ... ... ... ... ... ... 1 2 ... 3 Convulsions 1 3 ... ... 4 2 ... ... ... 6 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 1 1 1 l 4 8 3 6 2 23 Pneumonia (all forms) 2 2 l l 6 16 13 22 15 72 Diarrhœa ... ... ... ... ... 1 3 2 3 9 Enteritis ... ... ... ... ... 1 5 3 6 15 Gastritis ... ... 1 ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... 1 ... 1 ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... 1 ... 1 Injury at birth ... ... ... 1 1 ... ... ... ... 1 Atelectasis 5 1 ... ... 6 ... ... ... ... 6 Congenital malformations (c) 2 2 1 l 6 3 ... 1 ... 10 Premature birth 38 4 4 4 50 5 1 ... ... 56 Atrophy, Debility and marasmus 12 3 ... ... 15 9 9 2 1 36 Other causes 4 1 1 2 8 3 1 1 8 21 65 17 9 10 101 53 39 59 49 301 Nett Births in the year.—Legitimate, 2,825; illegitimate, 101. Nett Deaths in the year of legitimate infants, 290 ; illegitimate infants, 11. 45 NOTES TO TABLE III. The classification and numbering of Causes of Death arc 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 classified as "Certified"; all other deaths being regarded as "Uncertified." (d) Exclusive of "Tuberculous Meningitis" (10), but inclusive of cerebrospinal meningitis. (e) Title 19 has been used for deaths from diarrhoea and enteritis at all ages. (In the "Short List" deaths from diarrhoea and enteritis under 2 years are included under 19; those at 2 years and over being placed under title 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. 46 47 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31st DECEMBER, 1922. 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 2. 2 to 5, 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 36 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggcrston. Acton. Male. Female. 1 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 19 44 19 2 ... ... ... ... ... ... ... ... ... ... ... 24 12 10 21 6 3 8 38 46 84 3 Scarlet fever ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 2 ... ... 3 3 6 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza 9 5 4 1 1 2 2 5 3 ... 15 9 6 3 3 10 12 10 16 5 12 1 33 36 69 6 Whooping cough 7 13 6 1 ... ... ... ... ... ... ... ... ... ... ... 5 3 4 6 7 2 ... 13 14 27 7 Diphtheria, membranous croup 3 10 11 3 ... ... ... ... ... ... ... ... ... ... 4 9 1 4 3 1 4 1 11 16 27 8 Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 7 ... ... ... ... ... ... ... ... ... 3 1 ... ... 1 1 2 1 3 ... 1 2 6 5 11 11 Epidemic or zymotic enteritis 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... 1 ... 2 2 4 12 Other allied diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 1 2 19 Gonorrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedoena, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 ... ... ... ... 1 1 3 ... 3 22 Puerperal fever ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... 3 ... ... ... ... ... ... ... 3 3 23 Pyaemia, septicaemia 1 ... 2 ... 1 1 ... 1 ... ... ... ... 1 ... ... ... 4 1 ... 1 1 1 4 4 8 24 Infective endocarditis ... ... ... ... ... 1 2 1 2 ... 1 ... ... ... ... ... 2 2 ... ... 1 2 3 4 7 25 Other allied diseases ... ... ... ... 1 ... ... ... ... ... 2 ... ... ... 1 ... ... ... 1 ... ... 1 2 1 3 26 Malarial fever ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 27 Rheumatic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 Rheumatism of the heart ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... 3 3 Tuberculosis:— 29 Brain or meninges, acute hydrocephalus 4 3 3 2 ... 1 ... ... ... ... ... ... ... ... ... 6 ... 2 2 2 ... 1 8 5 13 30 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• 31 Lungs 2 1 1 ... 5 13 12 29 31 36 12 ... 1 ... 10 32 29 15 20 12 12 18 85 63 148 32 Intestines, tabes mesenterica ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 33 General, position undefined 2 1 2 2 ... 1 ... ... ... ... ... ... ... ... ... 1 2 ... 2 ... 2 l 5 3 8 34 Other forms, scrofula 1 ... ... ... 1 2 1 ... 3 2 2 ... ... ... ... 1 5 1 2 2 ... 1 7 5 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... oc 49 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total. 42 Chronic alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 43 Chronic industrial poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 Gout ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 1 ... ... ... ... 2 ... 2 47 Cancer ... ... ... ... ... ... 1 2 4 19 36 18 ... ... 4 11 14 11 17 5 7 17 47 39 86 48 Diabetes mellitus ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... 1 2 ... ... ... ... 1 2 3 49 Purpura hæmorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anaemia, leucocythmæia ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... 1 1 ... 1 ... ... ... ... 1 2 3 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 53 Premature birth 56 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 14 8 11 10 3 4 3 32 24 56 54 Injury at birth 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 55 Debility at birth 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... 1 ... ... 2 1 6 7 56 Atelectasis 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 1 2 4 2 6 57 Congenital defects 10 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 1 3 2 6 5 11 58 Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Atrophy, debility, marasmus 29 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 8 1 3 8 3 2 3 19 11 30 60 Dentition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 Rickets ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 1 2 62 Old age, senile decay ... ... ... ... ... ... ... ... ... ... 2 15 54 19 4 18 19 13 10 6 7 13 40 50 90 63 Convulsions 6 ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 2 ... ... 3 5 3 8 64 Meningitis 3 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... 2 1 2 3 5 65 Encephalitis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 1 66 Apoplexy ... ... ... ... ... ... ... ... 2 9 21 15 4 ... 5 10 7 11 7 3 1 7 26 25 51 67 Softening of brain ... ... ... ... ... ... l ... ... ... 1 ... 1 ... ... ... ... 1 1 ... ... 1 1 2 3 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... 1 2 1 4 ... ... 1 2 1 ... 1 1 1 1 4 4 8 69 General paralysis of insane ... ... ... ... ... ... ... 1 3 1 2 ... ... ... 2 ... 1 2 2 ... ... ... 6 1 7 70 Other forms of insanity 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... 2 ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 2 2 4 73 Epilepsy ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 2 1 3 74 Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 75 Locomotor ataxy ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... ... ... 1 2 1 2 ... ... 2 ... ... ... ... 1 1 2 5 1 6 77 Other diseases of brain or nervous system ... 1 ... ... ... ... ... ... ... 3 ... ... ... ... ... 2 ... 1 ... 1 ... ... 3 1 4 78 Otitis, otorrhœa 2 ... ... 3 l 3 2 1 ... ... ... ... ... ... 1 2 3 ... 2 2 2 ... 6 6 12 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 2 82 Endocarditis, valvular diseases of the heart ... ... ... 1 ... 1 2 6 8 15 12 11 7 ... 2 15 7 8 16 2 7 6 27 36 63 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... 1 2 ... 2 85 Aneurism ... ... ... ... ... ... ... ... 1 2 1 ... 2 ... ... 1 2 1 ... ... 1 1 4 2 6 86 Senile gangrene ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... 1 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular ... ... ... 1 ... ... 1 2 8 9 25 32 16 1 2 15 14 17 18 10 5 14 55 40 95 50 51 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore Kingsland. Haggerston. Acton. Male. Female. Total. 91 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Acute bronchitis 23 7 2 1 1 ... ... ... 1 4 4 12 4 ... 2 12 14 11 10 5 1 4 32 27 59 95 Chronic bronchitis ... ... ... ... ... ... ... 3 4 17 40 45 26 8 3 26 22 20 27 14 16 15 87 56 143 96 Lobar croupous pneumonia 8 4 1 1 3 ... ... 3 1 3 7 5 1 ... ... 7 8 9 4 3 3 3 21 16 37 97 Lobular broncho-pneumonia 61 60 25 2 ... ... 1 2 5 2 8 8 3 ... 7 30 32 17 23 25 21 22 91 86 177 98 Pneumonia, form not stated 3 6 4 ... ... 1 1 3 4 10 6 7 1 5 11 10 1 6 4 4 5 31 15 46 99 Emphysema, asthma ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 1 1 1 2 100 Pleurisy ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 1 101 Other and ill-defined diseases of respiratory system ... ... ... ... 1 ... ... 1 ... 3 ... ... ... ... ... 3 1 ... ... ... ... 1 3 2 5 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... l ... ... 2 5 3 ... ... ... ... 2 2 1 ... ... 3 3 10 1 11 106 Other diseases of stomach ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 107 Enteritis 15 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... 5 6 2 5 ... 2 3 10 13 23 108 Appendicitis ... ... ... 2 1 3 ... ... l 4 ... ... ... ... 1 2 1 ... 3 1 2 1 10 1 11 109 Obstruction of intestine 1 ... ... ... ... ... ... ... 2 1 1 2 ... ... ... 2 2 ... 2 ... ... 1 4 3 7 110 Other diseases of intestine ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 111 Cirrhosis of liver ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 2 ... 1 ... ... ... ... 1 2 3 112 Other diseases of liver ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 113 Peritonitis ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 2 ... 2 114 Other and ill-defined diseases of digestive system 1 ... ... ... ... ... ... ... 1 ... 2 ... ... ... 1 ... 1 ... 2 ... ... ... 3 1 4 115 Diseases of lymphatic system and ductless glands ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 1 116 Acute nephritis ... ... 2 ... 9 ... ... ... 1 1 ... ... ... ... 1 ... ... 2 ... 1 1 1 2 4 6 117 Bright's disease ... ... ... ... ... ... 1 1 2 10 13 11 6 1 ... 11 17 7 11 ... 6 3 15 30 45 118 Calculus ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 119 Diseases of bladder and prostate ... ... ... ... ... ... ... ... ... ... 2 2 1 ... ... 2 ... 1 ... 2 ... ... 5 ... 5 120 Other and ill-defined diseases of urinary system ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... 2 ... 1 ... 2 1 3 121 Diseases of testes and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Placenta prævia, flooding ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 130 Puerperal thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 132 Arthritis, ostitis, periostitis ... ... 1 ... l ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 1 ... 1 2 3 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 52 53 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total. 134 Ulcer, bedsore ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 1 ... ... ... 1 1 2 135 Eczema ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 1 136 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 1 ... 2 ... 1 ... 2 1 1 2 ... 1 2 2 2 3 1 ... 1 8 4 12 140 On railways ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 141 On vessels and docks, excluding drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 142 In building operations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143 By machinery ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 144 By weapons and implements ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 145 Burns and scalds ... 2 3 1 ... ... ... ... 1 ... ... 2 ... 1 1 3 2 1 ... 1 1 1 7 3 10 146 Poisons, poisonous vapours ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 147 Surgical narcosis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 Drowning ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 151 Suffocation, overlaid in bed 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 152 Suffocation otherwise l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 153 Falls, not specified l 1 ... 1 ... ... ... ... 1 2 2 1 3 ... ... 1 3 4 ... 1 3 5 7 12 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 155 Otherwise, and not stated 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... 2 1 3 156 Homicide ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 Suicides, all forms :— 157 By poison ... ... ... ... ... 1 ... ... l 2 1 ... ... ... ... 3 1 1 ... ... ... ... 3 2 5 158 By asphyxia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 159 By hanging and strangulation ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 ... ... 1 3 ... 3 160 By drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 161 By shooting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 162 By cut or stab ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 1 ... ... ... ... 2 ... 2 163 By precipitation from elevated places ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... 1 1 2 164 By crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 By other and unspecified methods ... ... ... ... ... ... ... ... l ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 166 Execution ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 168 Other ill-defined and not specified causes 4 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 1 1 1 1 1 4 2 6 169 Malignant disease ... ... l ... 2 ... ... ... 1 4 7 7 ... ... 1 5 2 2 4 1 1 6 12 10 22 170 Abscess ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 171 Cerebro-spinal fever 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Totals 301 168 99 31 22 39 31 69 109 187 248 230 145 33 73 344 284 222 300 139 155 195 927 785 1712 54 TABLE VI.— ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1922. DISTRICTS. Estimated Population 1922. ANNUAL RATE PER 1,000 PERSONS LIVING. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS: DEATHS DURING 1922 FROM Deaths under 1 year to 1,000 Births. Inquest Cases. Deaths in Public 1 institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. *Fever. †Diarrhœa Tuberculous Disease. Violence. 1919. 1920. 1921. 1922. London 4,514,405 21.0 13.4 12.4 12.4 13.4 1.0 0.00 0.35 0.07 0.25 0.25 0.01 0.15 1.2 0.45 74 7.8 48.7 0.1 Shoreditch ‡104,800 27.9 15.7 15.6 14.4 16.3 1.7 ... 0.81 0.06 0.26 0.26 ... 0.33 1.7 0.55 102 10.7 60.2 ... Wards. Moorfields 4,500 24.0 15.3 15.4 14.5 16.2 1.1 ... ... ... 0.09 ... ... 0.22 2.22 0.44 83 5.5 53.4 ... Church 18,419 27.4 16.1 14.6 15.9 18.7 2.5 ... 1.30 0.05 0.49 0.27 ... 0.38 2.17 0.76 144 12.8 65.1 ... Hoxton 15,860 31.1 16.8 17.2 14.1 17.9 1.5 ... 0.76 0.06 0.06 0.19 ... 0.44 2.27 0.69 77 12.6 55.2 ... Wenlock ‡13,712 32.8 15.6 19.0 15.9 16.2 1.5 ... 0.73 ... 0.29 0.29 ... 0.22 1.38 0.44 95 9.0 66.2 ... Whilmore §18,700 26.0 15.7 15.6 14.0 16.0 2.1 ... 1.12 0.11 0.16 0.32 ... 0.43 1.39 0.64 109 9.6 65.6 ... Kingsland 10,526 28.3 15.0 14.6 14.2 13.2 1.5 ... 0.57 0.19 0.09 0.66 ... ... 1.52 0.29 110 12.2 57.0 ... Haggerston 10,983 26.1 14.3 13.5 13.3 14.1 1.2 ... 0.28 ... 0.37 0.19 ... 0.37 1.28 0.29 87 8.3 59.3 ... Acton 12,100 24.5 15.8 14.5 12.5 16.1 1.1 ... 0.66 ... 0.08 ... ... 0.41 1.74 0.58 99 8.7 49.7 ... * Fever includes typhus, typhoid and continued fevers. † Diarrhoea in this table includes enteritis in children under two years. ‡ The inhabitants of the Holborn Institution, which is situate in Wenlock Ward, estimated at 1,000, and the deaths occurring in that institution are excluded. § The Shoreditch Institution is situate in this Ward. In the cases of some of the deaths in outlying institutions, the Shoreditch Institution 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. The estimated population for London is to the middle of 1921, that of Shoreditch to the middle of 1922. 55 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1922. TABLE VII. PREMISES. NUMBER OF PLACES- Number of inspections, 1922. Number of notices, 1922. Number of prosecutions, 1922. On register at end of 1921. Added in 1922. Removed in 1922. On register at end of 1922. Milk premises 203 34 18 219 1,792 18 ... Cowsheds 2 ... ... 2 24 ... ... Slaughterhouses 3 ... ... 3 47 ... ... Other offensive trade premises ... ... ... ... ... ... ... Ice Cream premises 72 14 9 77 215 18 ... Registered houses let in lodgings 331 ... 36 295 1,623 339 ... Number of intimation notices served for all purposes 5,381 Overcrowding :— Number of dwelling rooms overcrowded 50 Number remedied 18 Number of prosecutions Nil. Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 328 Underground rooms :— Number dealt with during year Nil. Insanitary houses:— Number closed under the Public Health (London) Act, 1891 1 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891 :— Number of persons accommodated during the year 7 Customs and Inland Revenue Acts :— Number of dwellings for which applications were received during the year Nil. Number of prosecutions under Bye-laws under Public Health (London) Act, 1891:— With respect to water closets, earth closets, &c 1 Mortuary:— Total number of bodies removed 185 Total number of infectious bodies removed 1 56 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK DURING THE YEAR 1922. 1.—Inspection. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 890 37 1 Workshops (Including Workshop Laundries and Bakehouses) 3,073 540 5 Workplaces (Excluding Outworkers' premises dealt with in Table III.) 1,216 101 ... Totals 5,179 678 6 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 221 221 ... 2 Want of ventilation 5 5 ... ... Overcrowding ... ... ... ... Want of drainage of floors 1 1 ... 1 Other nuisances 1,058 1,058 ... ... Sanitary accommodation insufficient 57 57 unsuitable or defective 277 277 ... 3 not separate for sexes ... ... ... ... Offences under the Factory and Workshop Act: ... ... ... ... Illegal occupation of underground ... ... ... ... bakehouse (Section 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (Sections 97 to 100) ... ... ... ... Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) ... ... ... ... Totals 1,619 1,619 ... 6 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 57 3.—Home Work—1922. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 and 110 Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made. (S. 109.) Prosecutions. (S. 109, 110.) Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. 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. 54 76 791 4 ... 31 ... ... ... 164 164 ... 20 ... ... (2) Cleaning and washing ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... 3 3 ... ... ... ... Artificial flowers 2 ... 16 ... ... ... ... ... ... 8 8 ... 2 ... ... Fur pulling 2 ... 8 ... ... ... ... ... ... 2 2 ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... 2 2 ... 1 ... ... Paper bags and boxes 14 ... 194 1 ... 51 ... ... ... 50 50 ... 19 ... ... Brush making ... ... ... ... ... ... ... ... ... 4 4 ... 2 ... ... Total 72 76 1,009 5 ... 82 ... ... ... 233 233 ... 44 ... ... (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 workers whose names are given, since in the February and August lists of the same employers, the same outworker's name will often be repeated. 58 4.— Registered Workshops—1922. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades 993 (a) Cabinet making 589 (b) French polishing 92 (c) Upholstery 67 (d) Other workers 245 (2) Dress 162 (a) Tailoring 60 (e) Shirt making 2 (b) Mantles 5 (f) Boot and shoe trades 28 (c) Dress 9 (g) Artificial flowers 3 (d) Millinery 3 (h) Other workers 52 (3) Skin, leather, hair and feather trades 65 (a) Furriers 19 (b) Saddlery and Harness 12 (c) Feathers 2 (d) Other workers 32 (4) Paper, printing, book, stationery and fancy goods trades 57 (a) Box and bag makers 40 (b) Other workers 17 (5) Laundry and washing 2 (6) Food 14 (7) Metals, machines, implements and conveyances 49 (8) Precious metals, jewels, &c 1 (9) Other trades than those mentioned above 117 Total number of workshops on Register 1,460 Note.— A separate register is kept for bakehouses, the number of which in use at the end of the year was 63, including 21 factory bakehouses. 5.— Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshops Act (s. 133) 9 Action taken in matters referred by H.M. Inspector as remediable under the Notified by H.M. Inspector 51 referring to 25 factories and 26 workshops. Public Health Acts, but not under the Factory and Workshops Act (s. 5.) Reports (of action taken) sent to H.M. Inspector. 3 referring to 25 factories and 26 workshops. Other 12 Underground Bakehouses (s. 101) :— Certificates granted during the year Nil. In use at the end of the year 37 59 G.— Showing the Numbers of Outworkers Received from other Districts during 1922. DISTRICTS. Making Wearing Apparel. Confectionery Packing. Artificial Flowers. Furniture and Uoholstery. Fur Pulling. Feather Sorting. Umbrellas, &c. Paper Bags and Boxes. Brush Making. Card Mounting. Dolls and Toys. Total. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Bermondsey 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Bethnal Green 49 49 ... ... ... ... ... ... l 1 ... ... ... ... 31 43 30 20 ... ... ... ... 224 Bromley 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Camberwell 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 City of London 237 244 ... ... 28 40 ... ... 5 7 1 1 1 25 2 2 ... ... ... ... ... ... 616 Chelsea 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Enfield ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Finsbury 35 53 ... ... 14 20 ... 1 3 2 l ... ... 4 37 44 ... ... ... ... 3 7 230 Hackney 113 104 ... ... 12 13 ... 2 3 2 2 ... ... ... 20 19 23 12 ... ... 7 ... 345 Hammersmith 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Hampstead 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Holborn 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Hornsey 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Ilford ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Islington 32 33 ... ... 13 18 ... ... ... ... ... ... ... ... 9 9 3 4 ... ... ... 2 126 Lewisham ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Leyton 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Paddington 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Poplar 3 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 11 Southwark 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 St. Marylebone 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Stepney 6 12 ... ... ... ... ... ... ... ... ... ... ... ... ... 16 ... ... ... ... ... ... 34 St. Pancras 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Stoke Newington ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Tottenham ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Westminster 18 21 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Willesden 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 522 545 3 4 67 91 6 3 13 12 4 7 29 100 134 56 36 ... ... 13 9 1,678 Totals 1,067 7 158 9 25 11 53 234 92 ... 22 60 SHOREDITCH TUBERCULOSIS DISPENSARY. Report for 1922 BY A. J. McFarland, M.D., D.P.H., Tuberculosis Officer. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, I beg to submit a report of the work done in the Shoreditch Tuberculosis Dispensary during the year 1922. The total number of persons attending during the year was 1281. Of these 676 attended for the first time, the remaining 605 had been examined in previous years, and had attended during the year for treatment or for re-examination. Of the new persons examined 168 were found to be suffering from some form of Tuberculosis. Of the persons examined in previous years 451 were Tuberculous. All persons suffering from Tuberculosis who are likely to benefit from Residential Treatment are advised to accept such treatment, and if they agree to accept Residential Treatment the necessary forms are sent to the Medical Officer, London County Council. During the year 166 persons were sent to Residential Institutions—69 of these were sent to Sanatoria. The Local War Pensions Committee have sent a large number of pensioners for examination and report—693 reports were sent during the year. Statistical Report for Shoreditch, 1922. 1922. 1921. Total attendances 7,121 8,362 Total persons examined for the first time 676 744 Renewed cases 605 792 Sisters' visits to homes 2,715 1,871 Medical Officers' visits 343 265 61 Detailed Analysis of all New Persons attending for the first time. Insured. Non-Insured. Under 15 years. Over 15 years. M. F. M. F. M. F. Total Total new persons 160 91 143 140 59 83 676 Pulmonary Tuberculosis 64 36 5 3 19 28 155 Non-Pulmonary Tuberculosis 1 .. 6 4 1 1 13 "Suspects" 9 4 .. 1 3 3 20 Non-Tuberculous 86 51 132 132 36 51 488 Analysis of all Persons attending the Dispensary during 1922. Males Under 15 years of age. Over 15 years of age. Ins. Non Ins. Total. 183 423 118 724 Females 176 165 216 557 Totals 359 588 334 1,281 Tuberculous. Males 37 288 68 393 Females 41 94 91 226 Totals 78 382 159 619 62 All New Persons Examined. Contacts 30 12 246 288 Other new cases 138 8 242 388 Totals 168 20 488 676 Total number of Patients: Insured 588 b— Non-Insured 693 Total 1,281 Attendances in the Special Departments :— Bacteriological Examinations— 432. X-Ray Examinations—102. The New Persons examined, and attendances each month were as follows:— New Persons Examined. Attendances. Insured. NonInsured. Total. Insured. NonInsured. Total. January 27 46 73 506 245 751 February 37 46 83 449 242 691 March 25 46 71 477 271 748 April 22 32 54 357 196 553 May 20 46 66 396 232 628 Tune 13 33 46 396 191 587 July 18 19 37 349 170 519 August 14 26 40 359 131 490 September 16 25 41 381 136 517 October 22 44 66 381 218 599 November.. 17 37 54 385 198 563 December 20 25 45 326 149 475 Totals 251 425 676 4,742 2,379 7,121 A. J. McFarland. 63 REPORT OF THE INTERIM TUBERCULOSIS CARE COMMITTEE FOR SHOREDITCH From January 1st to December 31st, 1922. The Committee has met 17 times and has dealt with 197 cases during the year. The C mmittee consists of 16 members, including the Medical Officer of Health, the Assistant Medical Officer of Health, the Tuberculosis Officer, School Medical Officer, Representatives of Board of Guardians, the Borough Council, War Pensions Committee and Red Cross Society, the Secretaries of the Friendly Workers amongst the Poor, the Local Charity Organisation Society and Invalid Children's Aid Association, the District Organiser of Children's Care Committees, and two Representatives of Maurice Hostel Women's Settlement. Cases have been referred to the Interim Tuberculosis Care Committee as follows:— By London County Council for visiting and assessing 111 j„ Dispensary 40 ,, Brompton Hospital 5 ,, St. Bartholomew's Hospital .. 1 ,, Invalid Children's Aid Association .. 4 „ Soldiers and Sailors Families' Association .. 1 „ Charity Organisation Society 1 ,, District Organiser of Children's Ca e Committee .. 2 Privately 2 Of these 89 are still current, 39 are completed, in 7 cases no action was possible, 48 have died, and 14 have been referred to other Societies. Cases have been referred to other Societies as follows :— Invalid Children's Aid Association 8 To other Boroughs 2 To District Organiser of Children's Care Committees 4 who is also notified of all families where there are children. M. Wragge. 64 TUBERCULOSIS DISPENSARIES IN LONDON. Metropolitan Borough of Shoreditch. Return as to work carried out in connection with the Shoreditch Tuberculosis Dispensary at the Royal Chest Hospital, City Road, E.C. 1, for the year 1922. (The return relates only to persons residing in Shoreditch.) number of Under observation at the Dispensary on January 1st pending diagnosis. Examined for the first time during the year. total Found to be Under observation at the Dispensary on 31st December pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis Not suffering from Tuberculosis. Pulmonary. NonPulmonary. (a) All persons (including "Contacts")— Adults M. 32 219 251 103 4 122 16 6 „ F. 31 174 205 73 2 118 7 5 Children under 15 M. 10 143 153 5 6 132 8 2 „ „ F. 18 140 158 6 6 134 9 3 Total 91 676 767 187 18 506 40 16 (b) "Contacts " (included in (a))— Adults M. 8 38 46 12 1 26 4 3 „ „ F. 13 73 86 17 — 65 3 1 Children under 15 M. 5 82 87 6 4 70 5 2 „ „ F. 9 95 104 4 5 89 4 2 (c) Insured persons (included in (a)) M. 18 160 178 76 2 95 3 2 F. 12 91 103 45 2 51 2 3 OS 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 280 2. Total number of attendances of patients at the Dispensary during the year Insured 4,742 Uninsured 2,379 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis — 4. Number of cases in which the period of observation at the Dispensary exceeded two months 40 5. Number of insured patients under domiciliary treatment on December 31stf 240 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 10 7. Number of persons referred to affiliated hospital for consultation 16 8. Number of consultations with Medical Practitioners at the homes of patients Insured — Uninsured — 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 343 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2,715 11. Number of specimens of sputum examined in connection with the work of the Dispensary 432 * Insured persons under domiciliary treatment by Insurance practitioners have been excluded, even though they may have attended the dispensary at intervals for examination or consultation. Such cases have been included under Head 5. † So far as can be ascertained all insured persons in the dispensary area actually receiving domiciliary treatment from Insurance Practitioners have been included, irrespective of the date upon which they were placed under domiciliary treatment and of any attendance at the dispensary. 17th February, 1923. (Signed) A. J. McFARLAND, Medical Officer of the Dispensary. 66 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Table VI11.—Summary of Notifications during the Period from the 1st January, 1922, to the 31st December, 1922, in the Metropolitan Borough of Shoreditch. Age-periods. Notifications on Form A. Notifications on Form B. Number ot Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institu tions. 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 l ... 3 4 11 15 28 27 27 10 3 129 209 ... l l 2 3 52 76 „ Females l 3 4 4 13 17 23 23 11 3 1 103 153 ... ... ... ... ... 38 46 Non-pulmonary, Males ... 12 6 5 3 ... 3 ... 1 ... 1 31 39 ... l l 2 2 3 21 „ Females 2 3 2 2 ... 1 3 4 1 ... ... 18 20 ... l l 2 2 2 15 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. 67 TABLE IX. Summary compiled from the Abstracts of the work of the Sanitary Inspectors by the Senior Inspector, for the Year 1922. Insp. Wright. Insp. Chapman. Insp. Sickelmore. Insp. Thomas. Insp. Shaw. Insp. Molloy. Insp. Bishop. Insp. Girling. Insp. Stratton. Insp. Grant. Insp. Walker. s. Premises cleansed throughout 104 28 33 51 8 44 53 26 27 64 13 451 ,, ,, partially 235 281 198 152 155 213 315 133 194 276 247 2,399 ,, ,, total rooms 724 999 681 796 443 802 766 374 866 827 811 8,089 ,, ,, verminous rooms 38 22 29 112 55 22 129 83 49 59 130 728 Premises generally repaired—Walls, floors, sashes, &c. 171 123 271 279 149 136 337 168 176 183 289 2,282 Light and ventilation improved 8 3 2 2 ... ... 16 48 2 ... 5 86 Roofs, guttering, rain water pipes improved or repaired 182 362 432 246 150 168 312 178 307 281 278 2,896 Overcrowding dealt with 4 1 ... 11 1 5 ... 8 1 2 8 41 Water reinstated or improved 2 28 3 ... 17 6 54 ... 8 6 23 147 Drains newly constructed 8 3 2 2 1 1 11 3 1 1 2 35 ,, re-constructed 4 7 21 6 21 8 8 9 8 5 8 105 ,, improved or repaired 40 17 77 41 41 25 57 33 17 21 43 412 ,, obstructions removed 10 32 45 23 33 22 45 10 26 46 33 325 Soil and vent pipes—Improved or repaired 4 1 9 14 1 ... 7 3 4 2 8 53 Water closets—newly constructed 50 8 12 13 2 2 2 34 7 3 ... 133 improved or repaired 186 123 90 164 70 75 191 60 105 192 147 1,403 ,, obstructions removed 10 29 17 26 14 23 52 5 17 8 31 232 Sinks, etc., improved, cleansed or repaired 53 28 32 24 10 17 35 10 14 79 25 327 Sinks, etc., traps-provided 22 6 ... 10 1 1 6 4 ... 2 4 56 Outdoor premises— Floors or paving repaired 26 74 34 63 42 61 77 19 44 70 83 593 Cleansed or limewashed 149 217 123 147 3 10 143 34 96 109 250 1,281 Improved or repaired ... ... 1 ... 1 ... ... 2 ... 1 3 8 Ash-pits—Dust-bins provided 58 75 75 79 54 55 118 110 95 104 120 943 ,, Improved or repaired 7 1 2 10 ... 1 1 ... ... 4 ... 26 ,, Abolished ... ... 6 4 ... ... 14 4 5 3 2 38 Accumulations removed 49 3 6 16 5 37 45 10 5 17 23 216 Urinals cleansed or repaired 8 1 2 2 3 1 3 ... 3 1 3 27 Animals removed 1 4 1 5 1 5 6 5 ... ... 5 33 68 SUMMARY OF LEGAL PROCEEDINGS DURING 1922. PUBLIC HEALTH (LONDON) ACT, 1891. In 7 instances summonses were withdrawn on the work being done. Costs amounting to £2 12s. 6d. were allowed to the Borough Council. Nuisance orders were made in 55 instances, costs amounting to £34 19s. being ordered to be paid to the Council. In 36 instances the Statutory Notices were complied with before the cases came on for hearing, £21 being ordered to be paid to the Council. In 4 instances for non-compliance with Statutory Notices the defendants were fined £6 19s. 6d. and ordered to pay £2 12s. 6d. costs. In 9 instances for non-compliance with Magistrates' Orders the defendants were fined altogether £15 and ordered to pay £9 17s. costs, and in 3 instances for similar offences the defendants were ordered to pay costs amounting to six guineas. One Closing Order was made. For non-compliance with Closing Orders 3 summonses were adjourned sine die, and in one the defendant was fined £3. BREACHES OF LONDON COUNTY COUNCIL BYE-LAWS UNDER THE PUBLIC HEALTH AND METROPOLIS LOCAL MANAGEMENT ACTS. In 1 instance the defendant was fined £10 and ordered to pay £2 2s. costs to the Borough Council, and in 1 instance the defendant was ordered to pay £1 3s. costs. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1908. In one instance a fine of 10s was inflicted for a contravention of the provisions of Section 3 of the Act. DAIRIES, COWSHEDS AND MILKSHOPS ORDERS, 1885 and 1886. A milk purveyor was fined £3 with a guinea costs for selling milk without being registered with the Borough Council. 69 METROPOLITAN BOROUGH OF SHOREDITCH. HOUSING CONDITIONS. Statistics. Year ended 31st December, 1922. 1.— General. (1) Estimated population 105,800 (2) General death-rate 16.3 (3) Death-rate from tuberculosis 1.7 (4) Infantile mortality 102 (5) Number of dwelling-houses of all classes 14,000 (Estimated) (6) Number of working-class dwelling-houses 13,000 (Estimated) (7) Number of new working-class houses erected 25 2.— Unfit Dwelling-houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,513 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 - (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation - II.— Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers - III.— Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit— Nil. (a) by owners (b) by Local Authority in default of owners (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 70 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,703 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 4,703 (b) by Local Authority in default of owners — C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders (2) Number of dwelling-houses in respect of which Closing Orders were made (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders ... 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I, or (b). Part II, of the Act of 1890 (1) Name of area (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced Nil. 4.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 Nil. 5.—Staff engaged on housing work, with, briefly, the duties of each officer:— So much of the time of the Medical Officer of Health, Senior Inspector, eleven Sanitary Inspectors and five Clerks as may be necessary. The duties are as required under the various Acts relating to the Health and Housing. In addition, it may be mentioned that the services of the Borough Surveyor and his staff, together with those of 2 Superintendents, an Assistant Caretaker, a Rent Collector and three Workmen, with the necessary clerical assistance, are required in connection with some 374 dwellings for the working class, which are now the property of the Borough Council. 71 METROPOLITAN BOROUGH OF SHOREDITCH. MATERNITY AND CHILD WELFARE. Summary of Work for the Year 1922. BY Dr. Maitland Radford. Districts. 1. 2. 3. 4. 5. 6. Totals. 1st visits to infants 398 432 564 465 638 409 2,906 Re-visits to infants 849 1,057 625 702 931 1,859 6,023 No. visits to children (1-5 years) 955 998 717 1,130 414 2,801 7,014 No. 1st visits to expectant mothers 96 80 134 90 114 163 677 No. re-visits to expectant mothers 30 98 127 105 101 186 647 No. 1st visits to infants with diarrhœa 2 ... 28 ... ... ... 30 No. 1st visits to cases of ophthalmia neonatorum, or eye discharge 9 29 18 ... 30 ... 86 No. of re-visits to cases of ophthalmia neonatorum 23 38 34 ... 60 ... 155 No. 1st visits to cases of puerperal fever 3 ... 2 ... 3 ... 8 No. of futile visits 207 237 86 341 214 507 1,590 Special visits, dairies, etc. 156 5 129 ... 6 ... 296 Health Visitors' attendances— (a) Haggerston Baths ... 6 51 ... 35 ... 92 (b) Hoxton Hall 49 2 4 43 44 ... 142 (c) Maternity Centre 140 167 109 133 125 674 (d) Harbour Lights ... 41 42 ... 44 ... 127 (e) School for Mothers 2 2 4 1st attendances of infants and children at Weighing Centre— (a) Haggerston Baths ... ... 123 ... 120 ... 243 (b) Hoxton Hall 81 ... ... 90 200 ... 371 (c) Maternity Centre 682 184 77 103 117 ... 1,163 (d) Harbour Lights ... ... 235 ... 190 ... 425 (e) School for Mothers ... ... ... ... ... 411 411 Total attendances at Centres— (a) Haggerston Baths ... ... 1,031 ... 646 ... 1,677 (b) Hoxton Hall 707 ... ... 1,418 826 ... 2,951 (c) Maternity Centre 840 1,374 892 1,065 270 ... 4,351 (d) Harbour Lights ... 11 3,412 ... 826 ... 4,249 (e) School for Mothers ... ... ... ... ... 4,063 4,063 72 Maternity and Child Welfare— Summary of Work— continued. Districts. 1. 2. 3. 4. 5. 6. Totals Lady Briscoe, M.B. (152, Kingsland Road). No. infants seen for 1st time ... 184 79 ... 75 ... 338 No. children (1-5 yrs.) seen for 1st time ... 35 25 ... 150 ... 210 Total No. consultations ... 219 598 ... 346 ... 1,163 Dr. Smith (152, Kingsland Road). No. infants seen for 1st time 103 ... ... 75 ... ... 178 No. children (1-5 yrs.) seen for 1st time 36 ... ... 25 ... ... 61 Total No. infants and children seen 781 ... ... 772 ... ... 1,553 No. expectant mothers seen for 1st time 22 33 97 41 100 ... 293 Total No. ante natal consultations 59 57 179 72 110 ... 477 Dr. Radford (152, Kingsland Road). No. of infants seen for 1st time ... ... ... 150 ... ... 150 No. children (1-5 yrs.) seen for 1st time ... ... ... 30 ... ... 30 Total No. consultations ... ... ... 200 ... ... 200 Dr. Radford (Harbour Lights). No. infants seen for 1st time ... ... 235 ... 240 ... 475 No. children (1-5 yrs.) seen for 1st time ... ... 135 ... 58 ... 193 Total No. consultations ... ... 568 ... 348 ... 916 Dr. Radford (Hoxton Hall). No. infants seen for 1st time 30 ... ... 76 160 ... 266 No. children (1-5 yrs.) seen for 1st time 10 ... ... 31 48 ... 89 Total No. consultations 76 ... ... 387 300 ... 763 Dr. Tribe (School for Mothers). No. expectant mothers seen for 1st time ... ... ... ... ... 88 88 Total No. consultations ... ... ... ... ... 158 158 Dr. Pratt (School for Mothers). No. infants seen for 1st time ... ... ... ... ... 320 320 No. children (1-5 yrs.) seen for 1st time ... ... ... ... ... 91 91 Total No. consultations ... ... ... ... ... 4.060 4,060 No. attendances at Sewing Class 34 134 31 93 293 235 820 Interviews connected with work 321 193 476 308 126 1,182 2,606 Report on Infants attending Doctors' Consultations. No. suffering from disorders of tion and nutrition 380 270 235 346 300 ... 1,531 No. suffering from other minor ailments 197 130 206 241 100 ... 874 No. referred to Hospital or to Medical Practitioner 25 24 71 26 126 ... 272