SHOR 28 REPORT on the health and Sanitary Condition of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1923, by LEWIS T. FRASER BRYETT, M.D. (LOND.), Medical Officer of Health; Diplomate in Public Health, Royal Colleges of Physicians and Surgeons; Felloiv of the Incorporated Society of Medical Officers of Health; and of the Royal Institute oj Public Health, &-r. [Printed by Order of the Health Committee.] london: jas. truscott & son, ltd., suffolk lane, london, e.c. 4. 74053 METROPOLITAN BOROUGH OF SHOREDITCH. Public Health Committee. Maternity and Child Welfare Committee. Ex officio—w. T. SMITHER, Esq., J.P. (Mayor). Chairman—Councillor H. P. Griffiths. Vice-Chairman—Councillor A. Short. Alderman, Adams J. C. „ Brown, T. W. „ Kelleher, P., J.P. Councillor Boreham, E. G. ,, Dennison, J. J. „ Doubleday, H. ,, Evans, H. D. „ Digby, Rev. E. „ Morton, L. „ Poultney, J. „ Reynolds, G. „ Wakeling, A. „ Webb, Mrs. E. Chairman—Councillor Mrs. E. Webb. Vice-Chairman—Councillor J. E. Houseman. Alderman Varnals, G. J., M.W.B. Councillor Bellamy, J. (Co-opted) Boge, Miss. Councillor Boreham, E. G. (Co-opted) Colville, Lady Cynthia. Councillor Doubleday, H. „ Girling, Mrs. H., J.P. (Co-opted) Neate, Mrs. „ Randall, Mrs. A. Councillor Short, A. „ Tucker, T. (Co-opted) Wilson, Mrs. Councillor Yarrow, W. E. Sanitary Inspectors. J. H. Pearson, Senior Inspector. C. J. Wright. H. G. Chapman. W. Sickelmore. J. H. Thomas. F. C. Shaw. J. B. Molloy. R. A. Bishop. T. W. Girling. A. Stratton. D. Grant. G. Walker. Health Visitors. Miss I. M.; Heward. Miss G. H. Williams. Miss A. E. Barnes. Miss B. C. Hunt. Miss M. Morrell. Turberculosis Nurse. Mrs. Grange. Rat Officer. E. T. D. Jordan. Clerical Staff. H. P. Abbott. E. J. Hayes. W. Harris. G. H. Pratt. J. C. Goodwin. G. C. E. Gibbs. Mrs. I. M. Rutherford. E. Crawley (Part time Enquiry Officer). F. E. Sharpe. Miss E. Lehane (temporary). E. R. Banks (temporary). Staff of Model Maternity Centre, Kingsland Road. Miss M. D. Borrow. Matron. Mrs. L. Morgan. Mrs. M. Calnan. Mrs. H. Lewis. Mrs. G. Marshall. Mrs. C. Jennings. J. P. Bear. 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. Mrs. Sylvia Smith, M.B., B.S. Hon. Mrs. Olivier Richards, M.D., B.S., M.R.C.P. Bacteriologist. J. Andrew, M.R.C.S., L.R.C.P. Tuberculosis Officer. A. J. MCFarland, M.D., D.P.H. Public Analyst. H. G. Harrison, M.A., F.I.C. Assistant Medical Officer of Health. Maitland Radford, M.D. (State Med.), D.P.H. Medical Officer of Health. Lewis T. Fraser Bryett, M.D., D.P.H. iii CONTENTS. Page Acute Antsrior Poliomyelitis 15 Anthrax 15 Appendicitis, mortality from 5 Bacteriological examinations 16 Bakehouses 31 Births in sub-districts 2 Birth rates 2 Cancer 5 Cerebro-spinal fever 15 Condensed milk regulations 27 Cookshops 30 Cow-houses 26 Dairies 26 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 Diarrhœa 12 Diphtheria 10 Disinfection 17 Dysentery 16 Enteric Fever 11 Erysipelas 12 Factories and Workshops Act, 1901 21 Factories, workshops and workplaces—sanitary work 21 Food condemned and destroyed 31 Food and Drugs Act 27 Fried fish shops 31 Fur skin dressers 18 Glanders 15 Housing Acts 20 Houses let in lodgings 21 Hydrophobia 15 Ice cream shops 31 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 16 Influenza 13 Legal proceedings 59 Malaria 16 Margarine Act, proceedings under 29 Marriages 2 Maternity and Child Welfare 23 Measles 13 Milk-shops 26 iv Page Milk and Cream Regulations, 1912 26 Milk and Dairies (Amendment) Act, 1922 27 Milk premises, cowsheds, etc., on register 26 Mortuary 17 Notification of Births Act 23 Ophthalmia neonatorum 15 Outworkers 22 Pneumonia 16 Population 1 Puerperal fever 12 Rag and Bone Dealers 19 Rag Flock Act, 1911 31 Rats and Mice Destruction Act, 1919 20 Sanitary work 17 Scarlet fever 9 Schools, exclusions of children for infectious disease 16 Shelter 17 Slaughter-houses 26 Small-pox 9 Smoke nuisances 18 Staff 32 Street markets and food 31 Tuberculosis 14 Tuberculosis Case Committee 14 Typhus fever 13 Verminous houses 19 Violence, mortality from 5 Water supply 17 Whooping cough 13 Workshops on register 21 Zymotic diseases, deaths from 7 Zymotic death rate 7 APPENDIX. Statistical Tables:— For whole district during 1921 and previous years (Table I.) 35 Cases of Infectious disease notified during 1922 (Table II.) 36 Causes of, and ages at, death during year 1922 (Tables III. and V.) 37, 40 to 47 Infantile mortality during 1922 (Table IV.) 38 Notes to Table III. and IV. 39 Comparison of London and Shoreditch birth and death rates in 1922 (Table VI.) 48 Summary of proceedings under Public Health (London) Act, 1891 (Table VII.) 49 Summary of Tuberculosis Certificates received (Table VIII.) 57 Summary compiled from the abstracts of their work prepared by the Sanitary Inspectors for 1920 (Table IX.) 58 Housing Conditions 66 & 67 Summary of legal proceedings under the Public Health (London) Act, 1891 59 Factory and Workshop Act—Summary of work (Tables r, 2, 3, 4, 5 and 6) 50 to 53 Return of work carried out at Tuberculosis Dispensary 54 to 56 Sanitary Inspectors 60 to 65 Maternity and Child Welfare 68 & 69 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. 2, January, 1924. To the MAYOR, ALDERMEN and COUNCILLORS of the Metropolitan Borough of Shoreditch. Sir, Ladies and Gentlemen, I have the honour to report on the health and sanitary condition of the Borough of Shoreditch for the year ending 31st December, 1923. POPULATION. The Registrar-General's estimate as at 30th June, 1923, is 106,200. This includes the population in the Holborn Institution, numbering about a thousand persons, who are not regarded as belonging to the Borough. Excluding this population, 105,200 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, contained in the appendix to this Report, give further information upon the subject of the population, and also refer to the principal industries of the Borough. BIRTHS. The births registered in the Borough numbered 2,552, of which 1,278 were of males and 1,274 of females. The number, corrected by the inclusion of the births 2 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 2,832, of which 1,418 were of males and 1,414 of females. The distribution of the corrected births in the eight Wards of the Borough is given below:— Ward. Males. Females. Total. Moorfields 45 42 87 Church 229 227 456 Hoxton 248 233 481 Wenlock 229 236 465 Whitmore 238 246 484 Kingsland 134 145 279 Haggerston 155 148 303 Acton 140 137 277 Totals 1,418 1,414 2,832 Outside the Borough 292 births were registered, 146 of males and 146 of females, the parents being residents of Shoreditch. In the Shoreditch Institution 275 births occurred, of which 135 were of males and 140 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, and elsewhere in the Borough one male infant was born whose parents did not belong to Shoreditch. Of the births in the Shoreditch Institution, 29 (12 males and 17 females) were illegitimate. Elsewhere belonging to the Borough there were 74 births, of which 34 were of males, which were illegitimate. The birth in the Holborn Institution also was illegitimate. The birth-rate for the Borough was 26.9 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 19.7 and for London 20.2 per 1,000 population. MARRIAGES. During 1923 there were 873 marriages as compared with 959 in 1922, 976 in 1921, and 1,194 in 1920. The persons married were at the rate of 16.6 per 1,000 population as compared with 17.3 for the Metropolis. 3 DEATHS. The deaths for the year 1923 numbered 1,370, which is the smallest number for any year so far recorded. They were distributed in the Borough as shown in the subjoined table:— Ward. Males. Females. Total. Moorfields 25 28 53 Church 134 108 242 Hoxton 119 105 224 Wenlock 100 83 183 Whitmore 126 119 245 Kingsland 73 62 135 Haggerston 76 69 145 Acton 78 65 143 Totals 731 639 1,370 The deaths of males were 92 in excess of those of females, and the death-rate amongst males was approximately 23 per cent. higher than amongst females. The general death-rate for the Borough was 13.0 per 1,000 population, the lowest yet recorded. The causes of death and the death-rates for the Borough and its eight wards, together with other particulars respecting the mortality amongst the inhabitants during the year, are given in Tables I, III, IV, V, and VI (Appendix). The death-rate on an average was above the mean from the beginning of the year until the end of May, when it came down and ranged below the mean until the end of November. There was a sharp rise during the early part of December, mainly the result of measles and diseases of the respiratory organs. The rate fell towards the end of the month, but remained above the mean for the year. The highest point touched was in the third week of December, when there were 49 deaths with a rate of 24.5 per 1,000 ; the lowest was 7 per 1,000 during the first week of August. The deaths amongst infants under one year numbered 232, of which 136 were of males and 96 females. They amounted to 16.9 per cent. of the deaths at all ages. The mortality amongst infants under one year was at the rate of 82 per 1,000 births registered during the year as compared with 102 in 1922, 114 in 1921, and 91 in 1920, and is the lowest so far recorded. The infantile mortality amongst males was 96 as compared with 67 amongst females. The chief causes of death amongst infants under one year were prematurity, atrophy, debility, and marasmus, pneumonia, diarrhoea and enteritis, congenital malformations and bronchitis. 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 4 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 1 1 ... 1 ... ... ... 1 4 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough ... ... 1 ... 3 ... 1 ... 5 Diphtheria and Croup ... ... ... 1 ... ... ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... 1 ... ... ... ... 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... 1 ... 1 ... ... 1 3 Meningitis (not Tuberculous) ... 1 ... ... ... 3 ... ... 4 Convulsions 1 ... 2 ... ... 1 ... 1 5 Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis ... 2 5 3 2 ... 2 1 15 Pneumonia (all forms) ... 7 10 3 9 8 5 1 43 Diarrhœa ... 3 1 1 1 1 2 1 10 Enteritis 1 3 4 ... 3 2 ... 4 17 Gastritis ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... 1 1 ... ... 2 Rickets ... ... ... ... ... ... ... 1 1 Suffocation, over-lying ... ... 1 ... ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... Atelectasis ... 3 1 ... ... ... ... 1 5 Congenital Malformations ... 2 2 4 ... 3 1 4 16 Premature Birth 1 5 9 4 9 6 11 3 48 Atrophy, Debility and Marasmus 1 5 6 1 9 3 2 1 28 Other causes 2 3 5 3 4 2 ... 2 21 Totals 7 37 48 22 42 30 24 22 232 The infantile mortalities of the eight wards of the Borough are contained in Table VI (Appendix). The highest rate was in Kingsland, and the lowest in Wenlock, 109 and 47 per 1,000 births respectively. The infantile mortality for England and Wales was 69 and for London 60 per 1,000 births. The chief causes of death at all ages were: tuberculosis, which accounted for 161, including 139 from consumption ; pneumonia, which caused 175 deaths; bronchitis, 152; diseases of the heart and circulatory organs, 155; old age, 54; cancer, 108; prematurity, 48; apoplexy, 52; Bright's disease, 58; atrophy, debility, and maramus, 29; violence, 55; and diarrhoea and enteritis, 33 deaths. 5 Of the deaths attributed to cancer 45 were of males and 63 females; 11 were of persons under 45 years, 57 were aged from 45 to 65 years, and the remaining 40 were of persons aged 65 years and upwards, 14 being over 75 years but under 85 years. In addition some 16 deaths were given as the result of malignant diseases and sarcoma. Doubtless some deaths due to cancer are included amongst those attributed to malignant disease. The death-rate due to cancer was 1.0 as compared with 0.82 in 1922, 0.87 in 1921, 0.91 in 1920, 0.93 in 1919, 0.95 in 1918, and 1.1 in 1917. Eleven persons, 8 of them males, died from appendicitis, and 1 person, a male, died from peritonitis. No deaths were attributed to alcoholism, but there were 3 deaths, all of males, from cirrhosis of the liver. Of the deaths from violence, 37 were of males and 18 females. They were again below the average. Through accident or negligence 29 males and 15 females lost their lives. These included 9 from street accidents, 5 from burns and scalds and 15 through falls, mostly amongst old people. There was 1 case of homicide, and 11 persons, 8 of them males, committed suicide. Two infants were suffocated in bed. The decrease in the mortality from this cause has been commented upon in previous reports. It has been a characteristic of the years since 1915; and when the average mortality from this cause during the past five years, which is less than 3, is contrasted with the average for the five years 1893 to 1897, which is a little over 30, the result so far as this particular cause of death is concerned cannot be regarded as other than highly satisfactory. 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 6 132 138 St. Leonard's Hospital 475 4 479 Royal Chest Hospital 17 45 62 Home of Good Shepherd 7 ... 7 Convent Hospital 1 2 3 Totals 506 183 689 Elsewhere than in public institutions 8 persons not belonging to Shoreditch died within the Borough. 6 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 2 Royal Free 4 Brentwood 1 St. Bartholomew's 62 Cane Hill 1 St. Mary's 1 Caterham 1 S.E. Hospital, Sydenham 1 Claybury 14 Westminster 1 Colney Hatch 6 Special Hospitals:— Dartford Heath 5 Fountain 2 Bethnal Green Chest 4 Hanwell 3 Brompton 1 Leavesden 3 Chelsea Hospital for Women 1 Long Grove 1 City of London Maternity 6 Tooting Bec 2 Colindale 6 Downs 3 Hospitals for Infectious Diseases:— Homoeopathic 1 Infants 1 Eastern 12 Ministry of Pensions, Orpington 1 Grove 3 North-Eastern 10 Mothers' Hospital, Clapton 1 North-Western 4 Queen Mary's 1 Park 1 St. Columba's 1 Southern 1 St. Margaret's 1 South-Eastern 3 Upper Heath, Hampstead 1 South-Western 1 Other Institutions:— Archway House 2 Western 1 General Hospitals:— 214a, Cambridge Road 4 Charing Cross 2 Dollis Hill House 1 Children's, Paddington 1 Greenwich Union Infirmary 1 East London 5 230, High Street, Homerton 6 German 6 77a, Highgate Hill; 1 Gt. Ormond Street (Children 6 Newington Institution 1 Guy's 4 29, North Side, Clapham 1 London 18 Paddington Infirmary 1 Metropolitan 54 14, Pembridge Square, Kensington 2 Middlesex 3 Mildmay 2 St. George's Home 2 National 9 St. Joseph's Hospice 8 N. Middlesex, Edmonton 1 St. Pancras House 1 Queen's (Children) 46 St. Peter's Home 3 Of 366 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 226 died in general hospitals, 41 in asylums, 36 in fever hospitals, 29 in hospitals for special diseases, and 34 in other institutions. Elsewhere than in public institutions, 4 persons belonging to Shoreditch died beyond the limits of the Borough. 7 Altogether 872, or 63.6 per cent., of the deaths of persons belonging to Shoreditch took place in public institutions. INFECTIOUS DISEASES. The infectious diseases included under the headings 1 to 35 and 171 in Table V (Appendix) were the cause of 275 deaths, a number which is very greatly below the average for previous years. The chief reason for this is the comparatively low mortality from measles, whooping cough, influenza, diarrhoea, and tuberculosis. The deaths from the diseases under the headings specified amounted to only 20.0 per cent. of the total mortality from all causes as compared with 25.7 in 1922, 26.6 in 1921, 25.0 in 1920, 28.5 in 1919, 37.7 in 1918, and 30.2 in 1917. Tuberculosis accounted for 58.5 per cent. of these deaths. The death-rate due to these diseases was 2.6 per 1,000 population as compared with 4.2 in 1922, 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. The high rate of 1918 was due to the heavy mortality from influenza. 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 35 53 10 8 13 15 38 43 31 19 7 3 ... Of the total mortality from all causes of children under five years, 25.8 per cent. resulted from these infectious diseases. In infants under one year diarrhœa, tuberculosis, and whooping cough accounted for most of the deaths. Amongst children aged from one to five years, measles, diphtheria, tuberculosis, whooping cough, and scarlet fever may be mentioned as the chief causes of death. Most of the mortality from infectious diseases amongst persons aged 15 years and upwards was the result of consumption and influenza. The deaths from the principal zymotic diseases—viz., smallpox, measles, scarlet fever, diphtheria, whooping cough, enteric fever, and diarrhoea, excluding enteritis under two years—numbered 67, the death-rate being 0.6 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 Hoxton Wards and lowest in Moorfields. The cases of smallpox, diphtheria, scarlet fever, erysipelas, enteric fever, and puerperal fever numbered 825 as compared with 23,054 for the Metropolis, the attack-rates being 7.7 and 5.0 per 1,000 population respectively. Subjoined is a list of the infectious diseases which were notifiable during the year, excluding pulmonary tuberculosis, showing the number of cases certified in the Borough 8 for each of the four quarters of the year and the numbers and percentages of the case; removed to hospital:— Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Smallpox 1 ... ... ... 1 ... Scarlet Fever or Scarlatina 53 66 121 151 391 6 Diphtheria and Membranous Croup 83 73 84 125 365 13 Typhus Fever ... ... ... ... ... ... Cholera ... ... ... ... ... ... Enteric Fever (Typhoid) 1 ... 3 ... 4 1 Continued Fever ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... Puerperal Fever 3 1 2 1 7 ... Erysipelas 14 10 16 20 60 3 Plague ... ... ... ... ... ... Cerebro-Spinal Fever ... 2 ... ... 2 1 Glanders ... ... ... ... ... ... Anthrax ... 1 ... ... 1 1 Hydrophobia ... ... ... ... ... ... Anterior Polio-myelitis 1 ... ... ... 1 ... Encephalitis Lethargica 1 ... ... ... 1 ... Ophthalmia Neonatorum 24 25 17 12 78 ... Acute Primary Pneumonia 50 57 48 64 219 37 Acute Influenzal Pneumonia 6 5 6 11 28 2 Malaria ... ... ... 2 2 ... Dysentery ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... Totals 237 240 297 386 1,160 64 Numbers and percentages of cases removed to hospitals. 204 192 266 319 981 ... 86.1% 80.0% 89.6% 82.6% 84.6% ... As compared with the figures for 1922, there is a decrease in the number of cases of diphtheria, an increase in the number of cases of scarlet fever, and a marked decrease in the amount of pneumonia. ISOLATION OF INFECTIOUS CASES. The hospitals of the Metropolitan Asylums Board receive cases of scarlet fever, smallpox, diphtheria, including membranous croup, enteric, typhus, and continued fevers, relapsing fever, together with certain cases of measles, whooping cough, puerperal fever, trench fever, malaria and dysentery. The cases of smallpox, diphtheria, scarlet fever, enteric fever, puerperal fever and cerebro-spinal fever certified numbered 770 (Table II, Appendix), and the number 9 removed to hospital, mainly to the hospitals of the Metropolitan Asylums Board, was 755, or 98 per cent. SMALLPOX. A case was certified and removed to hospital as being one of smallpox, but it proved not to be one of this disease. Attention was directed to a few cases which aroused suspicion, but they all turned out to be other than smallpox, nor is there any reason for believing that any cases occurred in Shoreditch during the year. In September two families resident in the Borough were under observation as contacts in connection with a case in an adjoining Borough. The usual precautions were taken, and none of the members of the families who had been exposed to infection manifested any sign of the disease. The cases certified in the Metropolis numbered 16, of which 9 were notified during September. Only one terminated fatally. SCARLET FEVER. The cases certified numbered 391, of which 4, or 1.2 per cent., were subsequently not regarded as scarlet fever. The distribution of the cases certified, and the deaths amongst males and females in the Borough and its eight Wards during the year were as shown in the subjoined table:— Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 9 9 18 1 ... 1 Church 42 56 98 ... ... ... Hoxton 30 31 61 ... 3 3 Wenlock 34 43 77 ... ... ... Whitmore 30 35 65 ... 1 1 Kingsland 12 11 23 ... 1 1 Haggerston 18 13 31 ... ... ... Acton 10 8 18 ... ... ... Totals for Borough 185 206 391 1 5 6 The cases are grouped according to ages in Table II (Appendix). Of the cases certified 383, or 97.9 per cent., were removed to hospital. The cases certified were at the rate of 3.7 per 1,000 inhabitants, being slightly below the average for the previous 10 years. The attack-rate per 1,000 population in the Borough was lowest in Acton, and highest in Church Ward, being 1.4 in the former, as compared with 5.3 in the latter. 10 The deaths numbered 6, being at the rate of 0.06 per 1,000 population. There were no deaths in Church, Wenlock, Haggerston, and Acton Wards. The death-rate was highest in Moorfields Ward, where it was 0.22 per 1,000 population. The case-mortality was at the rate of 1.5 per cent. of the cases certified, being a shade above the average for the previous 10 years. Amongst children under five years there were 165 cases, 4 of which were fatal, the case-mortality being 2.4 allowing for errors in diagnosis. Amongst persons over five years there were 226 cases with 2 deaths, and a case-mortality of 0.9 per cent. allowing for errors in diagnosis. The scarlet fever cases certified in the Metropolis numbered 10,121, being at the rate of 2.2 per 1,000 population. The deaths numbered 112, which give a rate of 0.02 per 1,000 population as estimated to the middle of the year 1922. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 365, of which 16, or 4.4 per cent., were subsequently not regarded as being diphtheria. The numbers of cases and the deaths amongst males and females in the Borough and its eight Wards are given in the subjoined table:— Ward. DIPHTHERIA (including Membranous Croup). Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 5 8 13 1 ... 1 Church 25 34 59 2 1 3 Hoxton 25 32 57 1 1 2 Wenlock 22 22 44 ... 2 2 Whitmore 30 45 75 1 1 2 Kingsland 4 23 27 ... 1 ] Haggerston 26 25 51 ... 1 1 Acton 21 18 39 ... 1 1 Totals for Borough 158 207 365 5 8 13 The cases are grouped according to ages in Table II (Appendix). Of the cases certified 362, or 99 0 per cent., were removed to hospital. The cases were certified at the rate of 3.4 per 1,000 inhabitants, the rate being the highest in Haggerston Ward and lowest in Kingsland, 4.6 and 2.5 per 1,000 respectively. The deaths numbered 13, the rate being 0.12 per 1,000 population. The rate was highest in Moorfields Ward, where it amounted to 0.22 per 1,000. It was lowest in Acton, where it was 0.08 per 1,000. Of the cases certified 3.5 per cent. terminated fatally. Of the deaths 12 were of children under five years of age, the mortality being at the rate of 6.7 per cent. of the cases certified amongst children at that 11 age period. Allowing for errors in diagnosis, the mortality was 7.0 per cent. Amongst persons over five years of age the mortality was 0.5, allowing for errors in diagnosis. The case mortality for the year is the lowest so far recorded for the Borough. The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to the cases certified during the year, they were distributed amongst males and females at certain age periods as set out in the subjoined table:— Age Period. Male. Female. Total. Under 1 year 4 15 19 From 1 to 2 years 25 13 38 „ 2 to 3 years 20 23 43 „ 3 to 4 years 19 30 49 „ 4 to 5 years 13 12 25 „ 5 to 10 years 33 41 74 „ 10 to 13 years 19 26 45 Over 13 years 25 47 72 Totals 158 207 365 In 157 of the cases the patients were children attending school, and in 131 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 169 other cases, although the patients themselves were not school-going children, there were other children in the houses who were. In 36 instances the histories showed that there had been cases of "sore throat" amongst the inmates of the houses in which the patients resided. In 38 instances there was evidence pointing to infection from previous cases in the Borough. In 273 instances the houses were occupied by members of more than one family, in 63 by single families, and in 29 instances the cases occurred in artisans' dwellings of the block type. With regard to the sanitary condition of the dwellings, in 233 this was satisfactory, in 46 fairly so, and in 86 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 10,389, the attack rate being 2.3 per 1,000. The deaths numbered 602 and the death-rate was 0.13 per 1,000 population, the case-mortality being 5.8 per cent. ENTERIC FEVER. The cases certified numbered four, being at the rate of 0.03 per 1,000 population. The cases were in Moorfields, Hoxton, Wenlock and Whitmore Wards. The case 12 in Hoxton Ward, that of a boy aged fourteen, terminated fatally. The other cases were amongst females. One of these was a nurse aged 29 employed in St. Leonard's Hospital. The case in Wenlock Ward was regarded by the Hospital Authorities as being one of Paratyphoid, B. The boy who died is said to have eaten cockles about ten days before he began to feel unwell. With regard to the other cases nothing was ascertained throwing light upon the source of the disease. ERYSIPELAS. The cases certified as erysipelas numbered 60, 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 2 3 5 ... ... ... Church 4 8 12 ... 1 1 Hoxton 6 2 8 1 ... 1 Wenlock 6 4 10 ... ... ... Whitmore 9 1 10 ... ... ... Kingsland 2 4 6 ... ... ... Haggerston ... 3 3 ... ... ... Acton 1 5 6 ... 1 1 Totals for Borough 30 30 60 1 2 3 The deaths from erysipelas were at the rate of 0.02 per 1,000 inhabitants, and 5 per cent. of the cases certified terminated fatally. Pyaemia and septicaemia (blood poisoning) caused the deaths of 5 males and 3 females, and infective endocarditis caused the deaths of 3 males and 3 females. PUERPERAL FEVER. Seven cases were certified, none of which terminated fatally. The cases certified were at the rate of 2 5 per 1,000 births, as compared with 31 in 1922, 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 1923 were at the rate of 3.9 per 1,000 births. DIARRHCEA. Fourteen deaths were attributed to diarrhœa and 19 to enteritis. Most of them occurred during August, September and October. They did not appreciably affect the death rate during the summer and autumn months. Of the deaths from diarrhoea 10 were of infants under one year, 3 of children aged from one to two years, and one was of a person aged from 45 to 55 years. Of the deaths from enteritis, 13 17 were of infants under one year, one of a child aged from one to two years, and one of a person aged between 25 and 35 years. Excluding deaths from enteritis the death-rate was 0.13 per 1,000 population ; including such deaths in children under two years the mortality was at the rate of 0.30 per 1,000 population. The deaths from diarrhoea amongst infants under one year were at the rate of 4.9 per 1,000 births ; including deaths from enteritis under one year this rate was increased to 10.9 per 1,000 births. Enquiries were made with a view to the prevention of the spread of infection, but hardly any cases came under observation. The disease was much less prevalent than usual. The deaths from diarrhoea and enteritis in children under two years in the Metropolis numbered 936 the death-rate being 0.20 per 1,000 population, or 10.2 per 1,000 births. MEASLES. The deaths numbered 23 as compared with 84 in 1922, 18 in 1921, 50 in 1920, 12 in 1919, 72 in 1918, 139 in 1917, 33 in 1916 and 67 in 1915, being below the average for recent years. Nine were of males, and fourteen females, and they were all amongst children under five years. The death-rate was 0.21 per 1,000 as compared with 0.81 in 1922, 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 took place during the last month of the year. Some 38 cases were nursed under arrangement with the District Nursing Association in connection with which 418 visits were made by the nurses. Of the cases so nursed two terminated fatally. The deaths from measles in London numbered 367, as compared with 1,559 in 1922, 241 in 1921, 1,026 in 1920 and 1,359 in 1919. The death.rate for the year was 0.08 per 1,000 population. WHOOPING COUGH. There were 10 deaths from this disease as compared with 27 in 1922, 19 in 1921, 12 in 1920, 2 in 1919, 93 in 1918, 20 in 1917 and 35 in 1916. All the deaths during 1923 were of children under five years. The death-rate was 0.09 per 1,000 population. The deaths in the Metropolis numbered 425 the rate being 0.09 per 1,000 population. INFLUENZA. The deaths attributed to influenza numbered 14, five of which were amongst males. They mostly occurred during the period extending from the middle of February to the middle of April. The mortality was heaviest in the second week of March. The deaths during recent years are given in the report for last year. TYPHUS FEVER. There is no reason for believing that any cases occurred in Shoreditch, nor were any notified elsewhere in the Metropolis. 14 TUBERCULOSIS. Tuberculosis (Appendix, Table V, Nos. 29 to 34 inclusive) was given as the cause of 161 deaths, as compared with 182 in 1922, 172 in 1921, 166 in 1920, 209 in 1919, 255 in 1918, 302 in 1917, 302 in 1916 and 328 in 1915. The deaths are the smallest number so far recorded for the Borough, but they accounted for nearly 12 per cent. of the total mortality during the year. They include 32 of persons who were not certified under the tuberculosis regulations in Shoreditch. They were at the rate of 1.5 per 1,000 inhabitants, the rate being highest in Haggeston, and lowest in Kingsland, 2.08 and 0.95 respectively. The deaths from tuberculosis of the lungs numbered 139, nine less than in 1922. The majority of the deaths were of persons aged from 25 to 65 years. The deaths of males numbered 75 as compared with 64 for females. The deaths from pulmonary tuberculosis were at the rate of 1.3 per 1,000 population. The rate was highest in Haggerston, and lowest in Kingsland, being 1.72 and 0.66 respectively. The deaths from tuberculosis in the Metropolis numbered 5,034, the death-rate being 1.1 per 1,000, and of these 4,237 were attributed to tuberculosis of the respiratory system, giving a death-rate of 0.9 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). There were 259 cases of tuberculosis certified, being at the rate of 2.4 per 1,000 population as compared with 2.7 in 1922, 2.5 in 1921, and 3.0 per 1,000 in 1920. In proportion to the population the cases certified were most numerous in Hoxton, and least in Kingsland, being 3.6 per 1,000 in the former as compared with 1.0 in the latter Ward. The cases certified as pulmonary tuberculosis numbered 228, and were at the rate of 2.1 per 1,000 population as compared with 2.1 in 1922, 2.1 in 1921, and 2.8 in 1920. The notifications of pulmonary tuberculosis were most numerous in Hoxton and least in Kingsland Ward, being 3. per 1,000 in the former as compared with 0. in the latter. Dr. McFarland's report on the work of the Tuberculosis Dispensary for 1923 is appended (pp. 54-56). The figures indicate much valuable work. The report of the Hon. Secretary, Miss Wragge, upon the useful work of the Tuberculosis Care Committee shows that the Committee met on 18 occasions and dealt with 222 cases. Of these, 184 were sent by the London County Council for institutional treatment and others were helped by various agencies to obtain extra nourishment and clothing, admission to voluntary homes, insurance benefit, work, and in other ways. During the year some 48 of the cases under the observation of the Committee terminated fatally. The removals to hospitals, sanatoria, and other institutions were more numerous than the cases notified during the year (Table II, p. 36). They included cases certified in previous years. Of the deaths from consumption belonging to Shoreditch, approximately 55 per cent.occurred in public institutions, 32 per cent, taking place in St. Leonard's Hospital. 15 OPHTHALMIA NEONATORUM. The certificates received numbered 108, and they related to 78 cases. This is an increase of 13 on the number for 1922. There were also some 63 other cases of inflamed eyes in infants which were brought to our notice by the Medical Officer of Health, London County Council, but not formally notified. They were all kept under observation by the Health Visitors to ensure proper treatment. Of the cases certified, 28 were of a severe type, but in all there was recovery without impairment of vision. One child, whilst suffering from ophthalmia neonatorum, died from other causes. Many of the cases were treated at Moorfields Eye Hospital, the Queen's, the Metropolitan, St. Bartholomew's, and St. Leonard's Hospitals. Five cases were removed to St. Margaret's Hospital, an institution of the Metropolitan Asylums Board especially provided for the treatment of this disease, mothers as well as the infants being admitted when necessary. Twenty-one of the cases were dealt with under nurses from the local district Nursing Association, some 538 visits being made in connection with them. The cases certified in Shoreditch were at the rate of 27.5 per 1,000 births as compared with 8.3 for London as a whole, more than three times as great. EPIDEMIC CEREBRO-SPINAL MENINGITIS. Two cases were certified, one a boy aged 4 months died in the Queen's Hospital on April 14th. He was taken ill on January 12th. The meningococcus of cerebrospinal fever was found in the cerebro-spinal fluid. The other case, a girl aged 10 months, was admitted to St. Bartholomew's Hospital, and was certified on May 5th. This case recovered. A girl, aged between two and five years, died from this disease also, but the case was not recognised during life. Six deaths were certified to have been due to meningitis other than tuberculous, four in infants under 12 months. So far as could be ascertained, there was no reason for regarding any of them as having been caused by the meningococcus of cerebro-spinal fever. During the year some 71 cases were certified in London, and 57 deaths were attributed to meningococcal meningitis. ACUTE ANTERIOR POLIOMYELITIS. One case was certified on February 23rd, the patient being a male infant ten months old. He was noticed to be ailing for about a week at the beginning of February. He subsequently came under observation at one of the Council's Welfare Centres, and the mother was directed to take him to the Mildmay Mission Hospital, where he was admitted on February 22nd. In the Metropolis there were notified 117 cases, the majority during the latter part of the year, and there were thirteen deaths. GLANDERS, ANTHRAX AND HYDROPHOBIA. On the morning of April 25th information was received from the Metropolitan Hospital that a young man aged 32, residing in Shoreditch, had died from anthrax. Inquiry showed that he had been handling bales of horsehair from Russia, the last 16 time on April 20th, at premises in Scrutton Street, where the hair had been deposited for a short time for examination, pending dispatch to a firm in an adjoining district. The deceased fell ill about midday on the 20th whilst at work. The same night a spot was noticed behind his right ear. He was attended at home until the 23rd, when he was taken to the Metropolitan Hospital, where he died on April 25th. This case was associated with the occurrence of two others elsewhere, in all probability due to the same source of infection. The Home Office Authorities and the Medical Officer of Health of the district concerned were communicated with and the necessary steps were taken as regards disinfection. Altogether, five cases of anthrax were notified in London during the year. PNEUMONIA, MALARIA AND DYSENTERY. The cases certified under the 1919 Regulations were 219 of acute primary and 28 of influenzal pneumonia, and 2 cases of malaria. The cases of pneumonia investigated numbered 234, which included some not certified. Of these, 161 were treated in St. Leonard's Hospital, 24 in other hospitals, 32 were nursed at home without, and 17 with, the help of the District Nursing Association. In 156 of the dwellings occupied 52 were reported as being satisfactory with respect to air space, light and ventilation, in 29 the conditions were fair, and in 75 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 :—2 for smallpox, 4 for enteric fever, 469 diphtheria, 575 scarlet fever, 1,229 measles, 724 chicken-pox, 288 whooping cough, 330 mumps and 894 for other infectious ailments. Altogether the exclusions numbered 4,515, and related to 40 schools. Information was also received from the School Medical Officer respecting three children excluded from school on account of the presence of diphtheria bacilli in their noses or throats. No cases were subsequently notified in the families to which they belonged. BACTERIOLOGICAL EXAMINATIONS. During the year some 549 examinations were made by Dr. J. Andrew, Pathologist, Metropolitan Hospital. Of these 293 were for suspected diphtheria, 9 for enteric fever, 218 for tuberculosis and 6 for gonorrhoea. Nineteen Wassermann tests were made, and 3 samples of urine were also examined. A sample of fur was also subjected to examination. Positive results were obtained in 62 of the examinations for diphtheria, 42 of those for tubercle bacilli, 1 for enteric fever and in 12 of the Wassermann tests. 17 In addition some 716 specimens were examined in connection with the work of the tuberculosis dispensary at the Royal Chest Hospital, City Road. DISINFECTION. The premises disinfected numbered 943 ; the articles removed and disinfected at the Borough Disinfecting station totalled 22,382, and included 890 beds, 1,051 mattresses, 1,923 pillows, 586 bolsters and 17,932 others, such as sheets, blankets, quilts, curtains, carpets, clothing and the like. It was necessary to destroy 1 bed and 2 pairs of mattresses, which were so dilapidated and contaminated as to make it inadvisable to return them. These were replaced with new. During the latter part of the year some 68,100 blankets and 42,000 pieces of wearing apparel were disinfected for trade purposes. THE SHELTER. The accommodation provided under the Public Health (London) Act, 1891, Section 60 (4), was in use during the year on one occasion for suspected smallpox by two families whilst their homes and clothing were being disinfected. PUBLIC MORTUARY. The bodies of 174 persons were deposited in the Mortuary, and the inquests held numbered 156, in connection with which 156 post-mortem examinations were made, 79 in the post-mortem room attached to the Mortuary. No infectious bodies were removed to the Mortuary by the Sanitary Authority during the year. WATER SUPPLY. The Meteorological Table for London, deduced from observations at Greenwich under the Astronomer Royal, issued by the Registrar-General for 1923, shows that the rainfall for the year amounted to 24.003 inches, which is slightly above the average. October was the wettest and June the driest month of the year. 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 65 premises, all of them in the Northern District. The grounds for withdrawing the supplies were On account of defective water pipes in 40 instances, waste on empty premises 3, by request of the consumer in 2 instances, non-payment of rates in 3, and premises demolished in 17 instances. Water was also laid on to 31 new premises in the Borough. 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 5,394 premises. In 578 instances they were dealt with by Inspector Wright, in 560 by Inspector Chapman, 403 Inspector Sickelmore, 425 Inspector Thomas, 326 Inspector Shaw, b 18 468 Inspector Molloy, 654 Inspector Bishop, 619 Inspector Girling, 471 Inspector Stratton, 419 Inspector Grant, and in 471 under the supervision of Inspector Walker. In connection with the work of the Sanitary Inspectors 1,523 letters were written to owners and others concerned. Some 47,348 visits of inspection were made by the Inspectors in connection with some 9,347 premises, which included 7,137 dwellings, 1,475 workshops, besides factories, laundries, bakehouses, cowsheds and milk vendors' premises, ice cream shops, slaughterhouses, places where food is prepared and sold, and other premises. Nearly 1,200 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 1,619 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 900 instances. For non-compliance with Statutory Notices and other infringements of the Acts relating to public health, and of byelaws made thereunder and other offences, proceedings were taken before the Magistrate in 67 instances. A Summary is given on page 59 (Appendix) showing the results of these proceedings. SMOKE NUISANCES. Twenty-two communications were received from the London County Council referring to the emission of black smoke from shafts on 9 premises. These were all duly brought to the notice of the parties responsible. In eleven cases intimations were served after observation by the Sanitary Inspectors, which were effective except in one instance. This was reported to the Sanitary Authority and a statutory notice was served under the Public Health (London) Act, 1891, which resulted in the abatement of the nuisance. FUR SKIN DRESSERS. The number of premises on the Register at the end of the year was four, the business at 34, Anning Street having been discontinued. Some 13 visits of inspection were made in connection with these premises and three intimations as to insanitary conditions were given. In one instance a statutory notice was required for cleansing which was duly complied with. 19 RAG AND BONE DEALERS. Byelaws made by the London County Council under Section 9 of the London County Council (General Powers) Act, 1908, for regulating the conduct of the business of a rag and bone dealer and with respect to premises used for such business, and the apparatus, utensils and appliances in connection therewith were allowed and confirmed in September. Seventeen premises to which the byelaws are applicable have been placed upon the register, which is being kept for the purpose and are now under observation. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 286, and some 584 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 163 children, 37 boys and 126 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 21 boys and 51 girls had been given the opportunity of being cleansed at the cleansing stations, that in the cases of 17 boys and 61 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 1 boy and 20 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. In practically all the cases reported the homes were visited by the Sanitary Inspectors, and the following summarises the results obtained :—In 149 the rooms occupied were satisfactory, varying from fairly clean to very clean, in 9 they were dirty, in 3 buggy, and in 2 both dirty and buggy. In 144 the bedding was clean, or fairly so, in 10 it was dirty, in 6 bugs were noticed, and in 2 it was both dirty and buggy. In 1 instance evidence of lice was observed in the bedding. In this case the bedding was also dirty and otherwise verminous. In two of the houses evidence of poverty was marked. There were in addition to the foregoing 8 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 0.6 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 9 sanitary notices were served upon b 2 20 owners and 4 upon occupiers of verminous dwellings, mostly for general cleansing and repairs. The children reported by the School Authorities as suffering from scabies numbered 56, of whom 30 were males and 26 females. In 4 cases the addresses were erroneous. As a result of the enquiries made by the Sanitary Officers 5 other cases came under observation. As far as practicable steps were taken to prevent the spread of infection. There is a marked decrease in the number of scabies cases noted as compared with the figure for 1922 RATS AND MICE DESTRUCTION ACT, 1919. The following is a summary indicating the work done by the Rat Officer with a view to giving effect to the provisions of the above-mentioned Act:— Number of complaints (rats) 260 „ „ (mice) 26 ,, visits 6,175 „ rats caught in traps or killed by dogs 1,186 „ rats found dead through poisoning 211 „ premises cleared of rats 276 „ premises cleared of mice 20 „ of pavements taken up, fronting houses 36 ,, drains reconstructed 42 „ drains tested by Sanitary Inspectors 66 „ floors of kitchens, sculleries, passages and coal cellars concreted 54 The poisons used included 3,369 packets of Ratquit, which provided some 66,950 baits, 33 lbs. of Londovus, 347 tins of Rodine, and 391 of Rondovus. Experience shows that variation in the poisoned baits used is very frequently necessary. The rat-infested localities in the Borough did not differ materially from those of the previous year. HOUSING. The special house-to-house inspection of the dwelling-houses is referred to on p. 18. See also pp. 66 and 67 (Appendix). The London County Council have the matter of the Ware Street Area in hand, but progress is not so far apparent. The great difficulty to be overcome is the provision of alternate housing accommodation for the people displaced. It is understood that as soon as it is possible for such accommodation to be provided the execution of the work to give effect to the scheme approved will be commenced. It is hoped that this will take place now at an early date and that during the current year substantial progress will be made. 21 Early in the year 12 flats (3, 4 and 5-roomed) erected by the London County Council on the corner of Whiston Street and Goldsmith Row came into occupation, and later on in the year 30 flats (2, 3 and 4-roomed) built for the Shoreditch Borough Council also became occupied. In connection with the latter, Nos. 55, 57, 59 and 61, Pritchards Row—4-roomed cottages—were demolished, their sites being required for the erection of some of the flats. Nos. 11 and 12, Hutley Place, which were in a very dilapidated condition, becoming empty, remained so at the end of the year. The houses let in lodgings or occupied by members of more than one family on the register at the end of the year numbered 296, two having been added to and one struck off the Register. Some 1,447 visits of inspection were made in connection with these houses, 215 intimations were served, and 113 statutory notices. As the result of a special inquiry during the year it was found that the number of basements in the Borough used for dwelling purposes was 4,229 ; in 423 of these the ceilings were at or below ground level, in 825 the width of the area did not exceed 3 feet, and in 996 the width did not exceed 4 feet. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of the year was 1,475. Of these 143 had been added, 128 having been removed. A classification of the workshops registered is contained in the summary of proceedings under the Act which is appended. Some 2,137 visits of inspection were made in connection with workshops and 372 to factories. Two communications were received from the factory inspectors relative to the establishment of 48 new workshops in the Borough. As the result of inspection 37 were found in a satisfactory condition, and 1 was not in use. With regard to the remainder sanitary notices were necessary ; in 9 instances for cleansing, and 1 for proper and separate w.c. accommodation. Thirty-nine written intimations were received from the factory inspector relating to insanitary conditions and infringements of the law as to public health in connection with 21 factories and 18 workshops. The chief insanitary conditions to which the factory inspector directed attention were : dirty conditions of walls and ceilings in 24, defective and insufficient w.c. accommodation in 10, w.c.'s not properly screened in 6, smoke nuisance in 1, accumulation of rubbish in 1, and in one instance attention was directed to the unfitness of premises for use as a workshop. Including those brought under the notice of the department by the factory inspector 439 workshops were dealt with, 430 sanitary notices being served upon 22 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 104 Soil and vent pipes dealt with 4 ,, partially 114 Water-closets newly constructed 36 Number of rooms cleansed 326 ,, repaired, etc. 238 Walls, floors, sashes, etc., repaired 141 „ obstructions removed 17 Light and ventilation improved 2 Sinks, etc., cleansed and repaired 10 Roofs, guttering, etc., repaired 162 Overcrowding abated 1 Sink traps provided 3 Water reinstated or improved 1 Sculleries, yards, etc., paving repaired 15 Drains newly constructed 9 ,, reconstructed 3 Sculleries, yards, etc., cleansed or limewashed 89 ,, repaired, etc. 31 ,, obstructions removed 16 Dust receptacles provided 23 Urinals cleansed, etc. 5 Foul accumulations removed . 22 The number of factories under observation for insanitary conditions during the year was 61, and in connection with them some 61 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 61 instances, the provision of new drains in 2, the construction of new water-closets in 15, the removal of obstructions from drains and waterclosets in 5 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 65 lists of out-workers were received from employers in the Borough, 37 in the first and 28 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 787 out-workers, of whom 608 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 1,701 out-workers, and of these 22 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 1923. The number of out-workers reported was 2,488 and of these some 1,866 were residents in Shoreditch. These figures are below the average for the past five years, and they show a decrease as compared with those for 1922. 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 23 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 1,041 visits of inspection were made to places where home-work was being carried on, and in connection with these 169 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 36 and included 14 of scarlet fever, 15 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 notified births numbered 2,276, and there were in addition some 74 still births. Of the notifications, 1,546 were received from registered midwives practising in the Borough. In addition, 219 births occurring in institutions outside Shoreditch were notified on forms sent in weekly by the London County Council. Including these, the live births notified during the year were approximately 88 per cent. of the number registered during the year as compared with 88 in 1922, 98 in 1921, 85 in 1920, and 95 in 1919. A summary of the work of the doctors and health visitors is appended (pp. 68 and 69). It follows the general lines of previous years. To meet the needs of the southern part of the Borough an additional infant welfare consultation was established at the Town Hall early in the year under Dr. Radford, for Monday afternoons. The outstanding event of the year with respect to maternity and child welfare in the Borough was the completion of the erection and the opening of the Model Centre in the Kingsland Road. In recording this a brief review of this important branch of public health work from its inception down to the present will not be out of place in this report. The Notification of Births Act of 1907 was adopted in Shoreditch in 1909, and came into operation in August of that year. The first municipal health visitor was appointed, and entered on her duties in the following November. In 1912 a second health visitor was appointed, and in the following year two Weighing Centres for infants were established under the Borough Council. At this time also the Shoreditch School for Mothers, a voluntary institution, was conducting a Centre in the Borough, so that during 1913 there were three Centres, each attended by a health visitor, one of whom was appointed by the voluntary body mentioned. These Centres quickly demonstrated their value and were well attended. In August, 1914, an intimation was received from the Local Government Board upon the subject of a grant in aid of expenditure being available for maternity and child welfare work, and at the same time defining the objects thereof as follows :— 1. To advise expectant mothers on matters affecting their condition at the Centres or at their homes when necessary and to arrange for complicated cases of pregnancy receiving proper hospital treatment. 24 2. To secure the necessary assistance so as to ensure the mothers having skilled and prompt attendance during confinement at home or in complicated cases in a hospital. 3. To arrange for the treatment in hospital of complications arising after parturition, whether in mother or infant ; to give systematic advice and treatment for infants at a baby clinic or infant dispensary, and to watch over the child's health up to the age it attends school; to ensure the systematic home visitation of infants and children not on the School Register. In 1915 a Maternity and Child Welfare Centre was opened at 152, Kingsland Road by the Borough Council, and at this Centre arrangements were made in conjunction with the Women's League of Service for the provision of dinners for nursing and expectant mothers. Early in 1916 a lady physician was appointed to attend once a week for consultations at the Centre, which quickly proved a most valuable adjunct to the Maternity and Child Welfare work in the Borough. It soon became evident, however, that the premises were inadequate for the purpose. During the year the Maternity and Child Welfare work was carefully reviewed by the Health Committee, with the result that the staff of health visitors appointed by the Borough Council was increased to four. The year 1917 was marked by a great increase in the work. Besides the municipal health visitors there were two others, one employed by the Shoreditch School for Mothers, and one at that time engaged by the Harman Street Mission, who were participating in the work, and continued to do so for about a year. It was at this juncture, just when the need for such provision was becoming urgent, that the Carnegie United Kingdom Trust made their generous offer to erect and equip after the war a suitable building for the purposes of maternity and child welfare work in Shoreditch. The Borough Council gratefully accepted this generous offer, and undertook to provide site, plans, obtain the necessary estimates for the work, and they also agreed to bear the cost of efficiently maintaining the Centre when erected. During 1918 a scheme for the provision of a Model Centre was under consideration, but progress in connection therewith was much hampered owing to the Great War. The year 1919 was marked by an agreement, which was entered into with the City of London Lying-in Hospital, whereby consultative and local Maternity Centres were provided for the Borough. Progress was made as regards the provision of the Model Centre, the handsome sum of £25,000 being promised by the Trust for the erection and equipment of the same. A site in the Kingsland Road was obtained at a cost of about £6,000, and towards the end of the year the Council's proposals as regards the arrangements and the accommodation required at the Centre were under the consideration of the Minister of Health. Plans were prepared by the architect appointed by the Council, Mr. F. Danby Smith, submitted to and 25 approved by the Minister, and such was the position at the end of 1920. It is to be mentioned that the Maternity and Child Welfare Committee appointed in December, 1919, assumed control of the work from the beginning of 1920. During 1921 the proposed Model Centre was the subject of correspondence with the Trust and with the Ministry of Health, and at the end of the year the Maternity and Child Welfare Committee decided to proceed with the approved scheme without further delay, and steps were taken accordingly. The building contract was signed with Messrs. Jarvis and Sons at the end of June, 1922, and the erection of the Centre was commenced about the middle of August following, and was well in progress at the end of the year. By the end of 1923 the work was completed, the building erected and equipped. The accommodation provides for a ward for six infants, and there are also two small wards, each for a mother and infant, and an isolation ward. In the suite of rooms on the north side of the ground floor there is the necessary accommodation for ante-natal and infant welfare consultations and for a dental clinic. The main hall of the building has been provided for dinners to nursing and expectant mothers, for use as a waiting room, for lectures and other purposes incidental to Maternity and Child Welfare Work. The opening ceremony took place on the afternoon of Saturday, December 15th, His Worship the Mayor of Shoreditch (Mr. Alderman Parry) presiding. The Earl of Elgin and Kincardine, on behalf of the Carnegie United Kingdom Trust, formally handed over the institution to the Mayor, requesting him to accept it on behalf of the Shoreditch Borough Council. In the course of his remarks the Earl intimated that the Trustees had selected Shoreditch because they felt that it was a district in which such an institution was especially needed, having regard to the conditions under which the people are living, and the enthusiasm for maternity and child welfare work manifest in the Borough. After accepting the Institution on behalf of the Borough, the Mayor asked Her Royal Highness, Princess Mary, Viscountess Lascelles, to declare the building open. Her Royal Highness thereupon declared the building open in the presence of about 200 citizens of Shoreditch and others invited to the ceremony, and afterwards made a tour of inspection of the Institution, taking a keen interest in the building and its equipment and the work intended to be carried on therein. At the Ante-Natal and Consultative Maternity Centre of the City of London Maternity Hospital the reports show that 417 cases were dealt with. Of these, 120 were examined by the obstetric surgeon attached to the Centre, the number of examinations totalling 213, and the remainder were seen by the sister attached to the Centre and advised upon the various aspects of their pregnancies. Special features met with were : version in 7, albuminuria in 6, contracted pelvis in 16, scabies 1, prolapse of vaginal wall 1, past history 5. In all cases the urine was tested. 26 The number of cases admitted to the wards from Shoreditch as in-patients was 219, and 167 were attended in their own homes. The great majority of the cases were normal before admission, and practically all who were treated ante-natally had normal confinements. The cases nursed under the District Nursing Association during the year numbered 257, of which 207 were amongst children under five years. Of some 3,691 visits to patients at all ages 2,063 were made to children under the age mentioned. Pneumonia, measles, threadworms, ophthalmia neonatorum, post-partem pyrexia and miscarriage furnished the majority of the cases nursed. Ten of the cases terminated fatally—6 of pneumonia, 2 of measles, 1 of post-partem pyrexia, and 1 of the cases of ophthalmia neonatorum. The last was due to congenital heart disease and bronchitis. Three of the deaths from pneumonia and the death from measles were of persons over five years of age. SLAUGHTERHOUSES. During the year the slaughterhouse at 179, New North Road, ceased to be used as such, so that at the end of the year there were only two in use in the Borough. Some 56 visits of inspection were made in connection with them, and their general sanitary condition may be reported as satisfactory. Some 47 butchers' shops, besides other premises upon which meat is sold, were also under supervision during the year. COWHOUSES. The two cowhouses on the register were under inspection during the year, and their sanitary condition may be reported as satisfactory. In October 27 cows were found to be kept, 22 at 38, Nile Street, and 5 at 76, St. John's Road. The number of dairymen and milk purveyors on the register at the end of the year was 255. During the year the sale of milk was discontinued in 8 and commenced in 44, and in 29 instances there were changes in the names of the persons registered. The premises were under observation throughout the year, some 1,822 visits being made in connection with them. In nine instances sanitary notices were served, the chief items requiring attention being general cleansing, defective roofs, defective flushing apparatus to water-closets, defective drain, defective dust receptacle and an accumulation of rubbish. Three cases of scarlet fever and two of diphtheria occurred on milk purveyors' premises, and the usual steps as regards the sale of milk and disinfection were taken by the sanitary authority. MILK AND CREAM REGULATIONS, 1912. None of the samples of milk submitted to the Public Analyst were reported to contain any preservative. Two samples of cream were also analysed and found free from preservative. 27 CONDENSED MILK REGULATIONS. Ten samples of condensed milk were taken, four of which were full cream and six machine skimmed. Three samples of the full cream and four of the machine skimmed milk were returned by the Analyst as genuine. One sample of full cream and two samples of machine skimmed milk were submitted for analysis in unopened tins. These were of the consistency required by the Regulations, the Public Analyst's remarks being that the three samples would yield a satisfactory fluid in the specified dilution. MILK AND DAIRIES (AMENDMENT) ACT, 1922. Under Section 3 of the above Act, which came into operation on January 1st, 1923, one licence was granted to sell certified milk. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H G. Harrison, M.A., show that 1,049 samples were submitted to him during the year. This number is at the rate of 10 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 1923. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. N umber of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions Proceeded with. Number of successful Prosecutions. Finrs and Costs. Amount paid to Analyst for Samples Analysed. £ s. d. £ s. d. 1st 294 16 5.4% 6 ... 6 5 9 3 0 183 15 0 2nd 224 17 7.6% 9 ... 9 4 13 15 6 140 0 0 3rd 174 10 5.7% 3 ... 3 1 2 0 0 108 15 0 4 th 357 8 2.2% 1 ... 1 ... ... 223 2 6 Totals for Year. 1,049 51 4.9% 19 ... 19 10 24 18 6 655 12 6 The samples taken included 539 of milk, 2 of separated milk, 6 of dried milk, 1 of skimmed milk, 4 of condensed full cream milk, 6 of condensed machine skimmed milk, 68 butter, 64 vinegar, 56 cocoa, 51 margarine, 40 pepper, 27 tea, 19 mustard, 17 coffee, 14 olive oil, 8 cod liver oil, 8 lard, 8 self.raising flour, 7 baking powder, 6 dripping, 5 custard powder, 5 borax, 5 ground almonds, 4 medicine, 4 non.alcoholic wine, 4 tapioca, 4 boric acid ointment, 3 malt vinegar, 3 rice, 3 ground rice, 3 sugar, 3 coffee and chicory, 3 zinc ointment, 3 sago, 3 compound mustard, 3 pineapple, 28 2 Glauber's salts, 2 breakfast sausage, 2 egg substitute powder, 2 cream, 2 herrings in tomato, 2 mincemeat, 2 ointment, 1 each of cheese, ground ginger, meat pie, ground nutmeg, flaked rice, beef suet, flaked tapioca, peaches, corned beef, brawn, green peas, ammoniated tincture of quinine, flour, jam, pickle, salmon, sauce, German sausage, tomato ketchup, cake or bun powder, sardines, veal, ribs of beef, tomato, arrowroot, and non.alcoholic ginger wine. Of the samples of milk 26, or 4.8 per cent., were found to be below the standard fixed by the Board of Agriculture. The proportion of milk samples returned as adulterated during 1923 was again below the average, and was, in fact, the lowest so far recorded in Shoreditch. Moreover, it is to be mentioned that 4 of the samples were only below the 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 4.0. 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 155 7 4.5 2nd 125 10 8.0 3rd 107 7 6.5 4th 152 2 1.3 In 9 of the samples water was certified to have been added ; in 8 of these it was less than 5 per cent., and in the other it was 5 per cent. In 12 the samples showed deficiencies in milk fat ; in 6 of these it was less than 5 per cent., and in the other 6 it was more than 5 per cent. In 1 sample, in which the deficiency was less than 5 per cent., there was added water, but less than 5 per cent., taking the standard of the Board of Agriculture. Legal proceedings were instituted in 11, or 42.3 per cent., of the cases in which samples of milk were below standard. In 5 instances the summonses were dismissed, warranties being proved. In 5 instances the defendants were fined, and in 3 of these costs were also allowed the Council. In 1 instance the summons was dismissed, the magistrate not being satisfied that the person who served the inspector was a servant of the defendant. No legal proceedings were considered advisable as regards the remainder of the samples of milk below standard. The 29 percentage of the adulterated samples of milk in which it was not thought advisable to institute legal proceedings was 57.7, which is below the average. In the 5 cases in which convictions were obtained the aggregate of fines and costs amounted to £10 15s. 6d., and the average amount paid by the defendants was £2 3s. 1d. The fines amounted to 3T per cent. of the maximum which might have been inflicted. Sixty-eight samples of butter were taken, 64 of which were returned as genuine. Forty-nine were reported as containing boric acid not exceeding 0'5 per cent. in each. In one instance where margarine was substituted for butter legal proceedings were instituted, and the defendant was fined £5. Another summons against this defendant was withdrawn. In two instances water was present in excess of the legal maximum, and proceedings were instituted. In one case the defendant was fined £1 with £1 Is. costs. In the other the summons was dismissed, a warranty being proved. In a third instance in which water was present in excess of the legal maximum to a slight extent only, no action was taken. Fifty-one samples of margarine were taken, 1 of which contained water in excess of the legal maximum. Proceedings against the vendor were taken in this case, the summons being withdrawn upon payment of £2 2s. costs to the Council. Forty-nine of the samples contained boric acid not exceeding 0 .5 per cent. in each. Of the 64 samples of vinegar taken, 9 contained excessive water. Proceedings were taken in 2 instances. In 1 case, where the excess was 21 per cent., the defendant was fined £3. In the other, where the excess was 10 per cent., a warranty was proved, and the summons was dismissed. One sample of zinc ointment was found to be deficient in zinc oxide to the extent of 7.3 per cent. Legal proceedings were instituted and the defendant was fined £2. One sample of beef suet was found to contain 4.3 per cent. water and 19.7 per cent. ground rice, but no action was deemed advisable. Two samples of non-alcoholic wine were found to contain small amounts of salicylic acid. Proceedings were not thought advisable. Nine samples of tinned food which were taken contained variable amounts of tin ranging from 0.259 to 2.31 grains per pound. No action was taken. Two samples of borax were found to contain arsenic. In 1 arsenic was present to the extent of 75 parts per million, the other to the extent of 35 parts per million. No action was considered advisable. Four samples of medicine (prescriptions) were taken, and 2 samples of ointment (prescriptions). All were found to be correctly prepared according to prescription. 30 The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1902.1923 inclusive:— Year. Number of Samples. Number of persons in the Borough to each Sample. Number of Samples adulterated. Percentage of Samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties. Prosecutions proceeded with. Number of successful prosecutions. Fines and Costs. Amount paid to Public Analyst. £ s. d. £ s. d. 1902 281 420 71 25.3 54 2 52 48 117 9 0 140 10 0 1903 707 166 112 15.8 60 5 55 51 173 11 6 353 10 0 1904 612 189 110 17.9 56 6 50 46 128 5 0 306 0 0 1905 536 215 98 18.2 57 2 51 47 233 18 0 267 0 0 1906 520 224 122 23.4 44 2 42 34 106 12 6 260 0 0 1907 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 1908 580 200 92 15.8 45 ... 45 39 117 10 0 290 0 0 1909 570 200 92 16.1 76 2 74 69 255 18 6 276 5 0 1910 578 200 133 23.0 65 ... 60 49 93 17 6 279 5 0 1911 577 200 149 25.8 64 ... 62 58 180 0 6 278 17 6 1912 584 190 100 17.1 48 1 48 45 172 11 0 281 10 0 1913 768 144 132 17.1 47 ... 47 42 94 2 6 350 10 0 1914 768 143 132 17.1 36 ... 36 21 74 6 0 350 10 0 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 1923 1049 101 51 4.9 19 ... 19 10 24 18 6 655 12 6 The percentage of samples found adulterated was markedly below the average for recent years. With reference to the convictions in 1923, in 2 instances the defendants had been previously convicted twice, and in 1 instance once. The remaining 6 were first convictions under the Sale of Food and Drugs Acts. COOKSHOPS AND EATING.HOUSES. Including the kitchens of public.houses where food is prepared for customers, 152 were under inspection during the year and some 581 visits were made in connection with them. The sanitary notices served numbered 97, including 63 which were mainly for general cleansing, 12 for defective drains and w.c.s, 10 for defective roofs, and 6 for defective dust receptacles. 31 FRIED-FISH SHOPS. Some 57 were under inspection in connection with which 38 sanitary notices were served, 24 of which were mainly for general cleansing. Some 332 visits of inspection were made. ICE-CREAM SHOPS. There were 117 under observation during the year, and 295 visits of inspection were made in connection with them. Twenty-three sanitary notices were served, mostly for general cleansing. BAKEHOUSES. The bakehouses on the register at the end of the year numbered 61, and included 36 below ground level. In 22 electrical power was in use in connection with the process of bread making. The bakehouse situate at 16, Paul Street and the Britannia Trade Bakery in Britannia Street being closed were struck off the Register. The bakehouses have been subject to the usual inspection, and their general sanitary condition may be described as satisfactory. In 9 cleansing and limewashing were required, in 2 there were other minor sanitary defects requiring attention, and in one there was an infringement of Section 8 of the London County Council (General Powers) Act, 1908, owing to the position of a w.c. and inlet to a drain. Sanitary notices were served, and in all cases complied with. In one instance the bakehouse premises were renovated, the work being carried out in a satisfactory manner without the service of a sanitary notice. STREET MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers as regards food exposed for sale. The following were seized or surrendered and destroyed as unfit for the food of man : 8 sides of bacon, 9 ox tails, 4 cwt. pigs heads, 2 boxes of dabs, 5 drafts of eels, 2 qtrs. of fish roes, 2 qtrs. haddocks, 2½ cwt., 1 box and 1 trunk of kate, 2 barrels of sprats, 2 qtrs. of whiting, 12 baskets of carrots, 131 crates cauliflowers, 80½ bushels and 3 boats (baskets) cherries, 512 boxes, 313 cases and 60 bushels cucumbers, ½ bushel of gooseberries, 12 baskets greengages, 129 crates lettuces, 3 tons 4 cwt. onions, 1 ton 12 cwt. potatoes, 1½ bushels of red currants, 1 ton 1 cwt. 3 qtrs. and 14 lbs. strawberries, and 10 cwt. 2 qtrs., 15 baskets, 124 boxes, 12 bundles and § bushel of tomatoes. Legal proceedings were taken against the person upon whose premises the ox tails above mentioned were deposited for the purpose of preparation for sale for human food. The magistrate bound the defendant over. RAG FLOCK ACT, 1911. Twelve samples were taken and submitted for analysis. They all complied with the requirements of the law, all containing less than 30 parts per 100,000 of soluble chlorine. 32 STAFF. Early in the year Lady Briscoe, M.B., relinquished her appointment as physician at the Centre, 152, Kingsland Road, after seven years' valuable work in the Borough. Dr. Olivier Richards was appointed to fill this vacancy. Miss M. D. Borrow was appointed Matron of the Maternity and Child Welfare Centre, then in course of erection in the Kingsland Road in July, and entered on her duties later on in the year. In December Mr. J. P. Bear was appointed porter at the New Centre. The possibility of making a reduction in the number of Sanitary Inspectors was the subject of a special report (pp. 60-65, Appendix). After consideration by the appropriate Committee of the Council no action in the direction indicated was deemed advisable. In connection with the work of the Department, some 20,369 communications, written and printed, were despatched from the office during the year. These included 6,835 notices and summonses, 3,202 letters, cards and other communications on matters under the Public Health and Sale of Food and Drugs Acts, 183 in connection with the work under the Factory and Workshops Acts, 7,489 on various matters connected with infectious disease, verminous cases and disinfection, and some 2,660 agendas and reports concerning the work of the Department. In addition to the foregoing, some 14,932 forms, milk books and cards, 7,701 letters and other communications, and 4,480 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. I have again to recognise the satisfactory manner in which the various officers belonging to the department have discharged their duties, and to acknowledge the valuable assistance rendered by the Assistant Medical Officer of Health, the Senior Inspector and the rest of the staff concerned in the work of protecting the health of the people of Shoreditch during the year. My best thanks are also due to the Mayor, the Chairman and Members of the Health and Maternity and Child Welfare Committees especially, and the Members of the Borough Council generally for their kind consideration and help in connection with the work of 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 1923, 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, copy of the Report of the Tuberculosis Officer, 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 and a Special Report upon the Staff of Sanitary Inspectors employed under the Borough Council. 35 TABLE I. Vital Statistics of the Borough of Shoreditch during 1923 and previous years. Year. 1 Population estimated to middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. 3 Nett. Number. 6 Rate. 7 of Nonresidents registered in the District. 8 of residents not registered in the District. 9 Under 1 year of Age. At all Ages. Number. 4 Rate. 5 Number. 10 Rate per 1,000 nett Births. 11 Number. 12 Rate. 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 16.3 1923 106200 2552 2832 26.9 1191 11.2 191 370 232 82 1370 13.0 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. c 2 86 TABLE II. Cases of infectious disease notified during the Year 1923 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 6 6 7 8 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Moorfields, Church. Hoxton. Wenlock. Whitmore Kingsland. Haggerston. Acton. Smallpox 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Cholera (C), Plague P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Diphtheria (including Membranous croup) 365 21 157 130 36 21 ... ... 13 59 57 44 75 27 51 39 362 Erysipelas 60 3 6 6 10 13 18 ... 5 12 8 10 10 6 3 6 30 Scarlet fever 391 15 150 194 24 8 ... ... 18 98 61 77 65 23 31 18 383 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 4 ... ... 2 ... 1 1 ... 1 ... 1 1 1 ... ... ... 4 Relapsing fever (R), Continued fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 7 ... ... ... 1 6 ... ... ... 2 ... 2 1 2 ... ... 3 Cerebro-spinal meningitis 2 2 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Anthrax 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 Poliomyelitis 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Encephalitis lethargica 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 Pulmonary tuberculosis 228 ... 8 19 43 89 64 5 8 43 50 34* 37† 9 32 15 231‡ Other forms of tuberculosis 31 1 5 18 4 3 ... ... ... 5 8 5 4 2 4 3 35‡ Ophthalmia neonatorum 78 78 ... ... ... ... ... ... ... 18 22 7 11 9 6 5 5 Acute primary pneumonia 219 26 75 41 23 25 25 4 2 53 36 41 42 17 15 13 182‡ Acute influenzal pneumonia 28 1 4 3 5 7 7 1 ... ... 6 22 ... ... ... ... 6‡ Malaria 2 ... ... ... ... 2 ... ... ... ... ... 1 ... 1 ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1,419 148 405 414 147 176 115 14 47 292 250 244 248 96 142 100 1,247 * 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 St. Leonard's and other Hospitals or Sanatoria. It is to be noted that the cases of tuberculosis removed during the year included cases certified in previous years as well as cases certified in 1923. 37 TABLE III. Causes of, and ages at death during the Year 1923 in the Borough of Shoreditch. CAUSES OF DEATH. Nett Deaths at the subjoined Ages of "Residents" whether occurring within OR WITHOUT THE DISTRICT (a). Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District (6), All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (c) 1370 232 60 48 45 63 188 381 353 689 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric fever 1 ... ... ... 1 ... ... ...... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... 3 Measles 23 4 8 11 ... ... ... ... ... ... 4 Scarlet fever 6 ... ... 4 2 ... ... ... ... ... 5 Whooping cough 10 5 4 1 ... ... ... ... ... 6 6 Diphtheria and Croup 13 2 4 6 1 ... ... ... ... ... 7 Influenza 14 3 1 ... ... ... 2 5 3 ... 8 Erysipelas 3 ... ... ... 2 ... ... 1 ... 2 9 Phthisis (pulmonary tuberculosis) 139 ... ... ... 4 23 70 37 5 66 10 Tuberculous meningitis 8 2 ... 3 3 ... ... ... ... 2 11 Other tuberculous diseases 14 3 ... 4 1 ... 3 3 5 12 Cancer, malignant disease 124 ... ... ... ... 2 13 63 46 56 13 Rheumatic fever 6 ... ... 1 3 2 ... ... ... 6 14 Meningitis (see note (d)) 7 4 1 1 ... ... 1 ... ... 1 15 Organic heart disease 48 ... ... ... 5 4 6 20 13 21 16 Bronchitis 152 16 4 1 ... ... 10 43 78 104 17 Pneumonia (all forms) 175 42 21 9 7 10 18 42 26 66 18 Other diseases of respiratory organs 10 ... ... 1 ... ... 1 7 1 3 19 Diarrhœa and Enteritis (see note (e) ) 33 27 4 ... ... ... 1 1 7 20 Appendicitis and Typhlitis 11 ... ... 1 3 3 4 ... ... 1 21 Cirrhosis of liver 3 ... ... ... ... ... ... 3 ... ... 21a Alcoholism ... ... ... ... ... ... ... ... ... ... 22 Nephritis and Bright's disease 58 ... 1 1 ... 2 10 25 19 43 23 Puerpural fever ... ... ... ... ... ... ... ... ... ... 24 Other accidents and diseases of pregnancy and parturition 4 ... ... ... ... ... 4 ... ... ... 25 Congenital Debility and malformation, including premature birth 94 92 1 ... ... 1 ... ... ... 38 26 Violent deaths, excluding suicide 44 5 5 2 4 4 3 10 11 16 27 Suicides 11 ... ... ... ... 1 5 4 1 4 28 Other defined diseases 354 23 6 2 9 11 37 116 150 241 29 Diseases ill-defined or unknown 5 4 ... ... ... ... ... 1 ... 1 1370 232 60 48 45 63 188 381 353 689 38 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH DURING THE YEAR 1923. Nett deaths from stated causes at various ages under One Year of Age (see Note (a)). CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9—12 Months. Total Deaths under 1 Year. All causes Certified 57 17 6 9 89 46 35 30 32 232 Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 3 4 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... 2 1 2 5 Diphtheria and Croup ... ... ... ... ... ... 1 1 ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... 1 1 2 Abdominal tuberculosis (b) ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... 2 1 3 Meningitis (not tuberculous) ... ... ... ... ... 1 ... ... 3 4 Convulsions ... ... ... 2 2 1 1 1 ... 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 2 2 5 4 3 1 15 Pneumonia (all forms) ... 3 1 ... 4 14 9 8 8 43 Diarrhœa ... 1 ... ... 1 2 1 3 3 10 Enteritis ... 1 ... 1 2 2 6 4 3 17 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 ... 1 ... ... ... 1 2 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying 1 ... ... ... 1 ... ... ... ... 1 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 3 2 ... ... 5 ... ... ... ... 5 Congenital malformations (c) 5 2 ... 1 8 5 2 ... 1 16 Premature birth 36 4 3 ... 43 5 ... ... ... 48 Atrophy, Debility and Marasmus 7 3 ... 1 11 7 6 3 1 28 Other causes 5 1 1 2 9 4 3 2 3 21 57 17 6 9 89 46 35 30 32 232 Nett Births in the year.—Legitimate, 2,729; illegitimate, 103. Nett Deaths in the year of legitimate infants, 222; illegitimate infants, 10. 39 NOTES TO TABLE III. The classification and numbering of Causes of Death are those of the "Short List on page xxv. of the Manual of the International List of Causes of Death." (a) All "Transferable Deaths " of residents, i.e., of persons resident in the district who have died outside it, have been included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England or Wales who have died in the district, have been in like manner excluded from these columns. For the precise meaning of the term "Transferable Deaths," see footnote to Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, have been entered in the last column of Table III. (c) All deaths certified by registered medical practitioners and all inquest cases have been 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 culous 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. 40 41 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1923. 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. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 1 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 4 8 11 ... ... ... ... ... ... ... ... ... ... ... 1 5 2 5 2 1 3 4 9 14 23 3 Scarlet fever ... ... 4 1 1 ... ... ... ... ... ... ... ... ... 1 ... 3 ... 1 1 ... ... 1 5 6 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... 5 Epidemic influenza 3 1 ... ... ... ... ... 2 ... 2 3 2 1 ... ... 3 1 2 5 1 1 1 5 9 14 6 Whooping cough 5 4 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 4 ... 2 ... 4 6 10 7 Diphtheria, membranous croup 2 4 6 1 ... ... ... ... ... ... ... ... ... ... 1 3 2 2 2 1 1 1 5 8 13 8 Enteric fever ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 5 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 1 ... 3 ... ... 1 2 5 7 11 Epidemic or zymotic enteritis 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 3 ... 5 2 7 12 Other allied diseases ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 16 Anthrax, splenic fever ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 3 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 1 1 ... ... 4 ... 4 19 Gonorrhœa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedoena, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... 1 1 2 3 22 Puerperal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Pyaemia, septicaemia 2 1 ... ... ... ... 1 ... ... 2 ... 1 1 ... ... 2 1 1 ... 3 1 ... 5 3 8 24 Infective endocarditis ... ... ... ... ... 1 1 3 1 ... ... ... ... ... ... 1 1 2 2 ... ... ... 3 3 6 25 Other allied diseases ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 26 Malarial fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Rheumatic fever ... ... 1 ... 3 2 ... ... ... ... ... ... ... ... ... 1 2 ... 2 ... 1 ... 4 2 6 28 Rheumatism of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis:— 29 Brain or meninges, acute hydrocephalus 2 ... 3 2 1 ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 1 3 ... 3 5 8 30 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Lungs ... ... ... 3 1 10 13 31 39 24 13 4 1 ... 5 25 26 17 26 7 19 14 75 64 139 32 Intestines, tabes mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 General, position undefined 2 ... 4 1 ... ... ... ... ... 1 1 ... ... ... ... 2 1 1 3 ... 1 1 6 3 9 34 Other forms, scrofula 1 ... ... ... ... ... ... 1 2 1 ... ... ... ... ... 1 2 ... 2 ... ... ... 3 2 5 35 Other infective diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Actinomycosis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 38 Hydatid diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Other diseases due to altered food ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 41 Acute alcoholism, delirium tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 42 43 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. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 42 Chronic alcoholism ... ... ...... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 43 Chronic industrial poisonings ... ... ... . .... . ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ...... ... ... ...... ...... 44 Other chronic poisonings ... ... ... ...... ... ...... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 Gout ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... 47 Cancer ... ...... ... ... ... ... ... 5 6 23 34 26 14 ... 5 19 16 16 15 11 11 15 45 63 108 48 Diabetes mellitus ... ... ... ... ... ... ... ... ... 3 1 1 ... ... 1 ... 1 ... 2 .... ... 1 2 3 5 49 Purpura hæmorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ...... ... 50 Hæmophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ...... ... ... ... ... ... ... ... ... ... 51 Anaemia, leucocythæmia ... ... ... ... ... 1 ... ... 1 1 2 1 ... ... ... ...... 2 1 1 1 ... 1 4 2 6 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... 1 ... ...... ... ... ... ...... 1 ... ...... ... ... ... ... 1 ... 1 53 Premature birth 48 ... ... ... ... ... ... ... ... ...... ... ... ... ...... 1 5 9 4 9 6 11 3 25 23 48 54 Injury at birth 2 ... ... ... ... ... ... ... ...... ... ... ... ...... ... 1 ... ... 1 ... ... ... ... 2 ... 2 55 Debility at birth 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 1 2 3 56 Atelectasis 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ...... ... ... ... 1 l 4 5 57 Congenital defects 16 ... ... ...... ...... 1 ... ... ... ... ... ...... ... ... ... 2 2 4 1 3 1 4 12 5 17 58 Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ...... ... ...... ... ... ... ...... ... ...... ...... 59 Atrophy, debility, marasmus 25 l ... ... ... ... ... ...... ... ... ... ... ... ... 1 5 ... 1 7 3 2 1 16 10 26 60 Dentition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ...... ... ... ... ... .... ... ... 61 Rickets l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 62 Old age, senile decay ... ... ... ... ... ... ... ... ...... ... 1 20 22 11 4 5 8 11 10 5 6 5 27 27 54 63 Convulsions 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 1 ... 1 4 1 5 64 Meningitis 4 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 2 3 ... ... 2 4 6 65 Encephalitis ... ... ... ... ... ... 1 ... ... 1 ... ...... ... ... ... 1 ... ... ... ... ... 1 1 1 2 66 Apoplexy ... ... ... ... ... ... ... ... 3 9 15 17 8 ... 5 8 11 7 10 6 2 3 19 33 52 67 Softening of brain ... ... ... ... ... ... ... ... ... ... 1 ... ...... ... ...... ... ... ... 1 ... ... ... 1 ... 1 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... ... ...... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 1 69 General paralysis of insane ... ... ... ... ... 1 ... 1 2 3 2 ... 1 ... ... 1 ... 2 3 1 ... 1 10 ... 10 70 Other forms of insanity ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 71 Chorea ... ...... ... ... ... ...... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... ...... ... ... ... ... ...... ... 1 ...... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 73 Epilepsy ... ... ...... ... ... ... 1 2 ... 1 2 ... ... ... ... ... 1 3 ... ... ... 2 4 2 6 74 Laryngismus stridulus ...... ...... ... ... ... ... ... ...... ... ... ...... ... ... ...... ... ... ... ... ...... ... ... ... ... ... ... 75 Locomotor ataxy ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 1 1 ... 1 ... ... ... 3 ... 3 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... ... 1 ... 2 2 ... ... ... ... 1 ... ... 1 ... 1 2 ... 5 5 77 Other diseases of brain or nervous system ... 2 ... 2 2 ... ... ... 1 ... ... ... ... ... ... 2 2 1 1 ... ... 1 2 5 7 78 Otitis, otorrhœa ... ... ... 3 ... ... ... 1 3 1 ... ... ...... ... ... 1 3 1 1 1 ... 1 7 1 8 79 Diseases of nose, epistaxis ... .... ... ... ...... ... ... ... ... ... ... ... ... ... ...... ... ... ... ...... ... ... ... ... ...... ... 80 Diseases of eye, ophthalmia ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... ... ... ... ... ... 1 ... ... ... ... ...... ... ... ... ...... ... ... ... 1 ... ... ...... 1 1 82 Endocarditis, valvular diseases of the heart ... ... ... 3 2 2 1 3 3 10 10 11 2 ... 5 3 7 4 14 7 1 6 20 27 47 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 85 Aneurism ... ... ... ... ... ... ... ... ...... 5 3 ... ... ... ... ... 1 1 4 1 ... 1 7 1 8 86 Senile gangrene ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... 2 1 ... ... ... 2 1 3 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 88 Phlebitis ... ... ... ... ... ... ... ... ...... ... ... 1 ... ... 1 ... ... ... ... ... ...... ... ... 1 1 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular ... ... ... ... 1 2 1 1 7 10 22 26 23 2 5 18 9 12 18 8 16 9 41 54 95 44 45 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. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 91 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Acute bronchitis 16 4 1 ... ... ... ... 2 2 6 5 2 3 ... 2 11 9 7 5 1 3 3 22 19 41 95 Chronic bronchitis ... ... ... ... ... ... ... 2 4 11 21 41 30 2 1 26 6 17 18 16 12 15 60 51 11 96 Lobar croupous pneumonia 5 2 ... 3 ... 2 3 3 5 10 8 6 ... ... 1 7 7 6 11 3 6 6 30 17 47 97 Lobular broncho-pneumonia 36 17 5 3 1 1 3 1 2 4 4 7 4 ... 1 18 17 10 15 14 8 5 51 37 88 98 Pneumonia, form not stated 1 2 4 ... ... ... 1 3 4 7 9 6 2 ... 1 6 9 4 7 4 4 5 26 14 40 99 Emphysema, asthma ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 1 ... ... ... ... 1 1 2 1 3 100 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 101 Other and ill-defined diseases of respiratory system ... ... 1 ... ... ... ... 1 ... 3 2 ... ... ... ... 1 2 2 1 ... 1 ... 5 2 7 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... ... ... 1 1 4 4 ... ... ... ... 3 3 ... 2 1 ... 1 7 3 10 106 Other diseases of stomach ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 ... 1 ... 1 1 2 3 107 Enteritis 17 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 5 4 3 2 ... 4 14 5 19 108 Appendicitis ... ... 1 1 2 3 ... 2 2 ... ... ... ... ... ... 1 2 2 2 ... ... 3 8 3 11 109 Obstruction of intestine 1 ... ... ... ... ... 1 ... 1 ... 1 2 ... ... 1 1 2 1 1 ... ... ... 3 3 6 110 Other diseases of intestine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 111 Cirrhosis of liver ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 1 1 ... ... ... ... 3 ... 3 112 Other diseases of liver ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... 2 ... ... ... 1 ... ... ... 3 3 113 Peritonitis • •• ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 114 Other and ill-defined diseases of digestive system ... 1 ... ...! ... ... ... 1 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... 1 3 ... 3 115 Diseases of lymphatic system and ductless glands 1 1 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... 1 1 3 1 4 116 Acute nephritis ... 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... 1 ... 1 1 ... 3 1 4 117 Bright's disease ... ... ... ... ... ... 2 2 7 10 14 14 5 ... ... 13 7 7 9 3 7 6 29 25 54 118 Calculus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 119 Diseases of bladder and prostate ... ... ... ... ... ... ... 1 ... ... 4 6 ... ... ... 1 4 1 ... 2 3 ... 11 ... 11 120 Other and ill-defined diseases of urinary system ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 121 Diseases of testes and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Placenta prævia, flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 130 Puerperal thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 1 ... ... ... ... 1 1 3 3 132 Arthritis, ostitis, periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 47 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. 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. 134 Ulcer, bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 Pemphigus 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 137 Other and ill-defined diseases of integumentary system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... By Accident or Negligence: 138 In mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In vehicular traffic ... ... 1 ... ... ... 2 ... ... 2 ... ... ... 1 1 2 2 2 2 ... ... ... 7 2 9 140 On railways ... ... ... ... ... ... ... ... 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 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 145 Burns and scalds ... 4 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 ... 1 ... 1 3 2 5 146 Poisons, poisonous vapours ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 147 Surgical narcosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 Drowning ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 ... 2 151 Suffocation, overlaid in bed 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 2 152 Suffocation otherwise 3 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 2 4 153 Falls, not specified ... ... 1 ... ... ... ... ... ... ... 5 6 3 ... ... 4 4 2 3 1 1 ... 9 6 15 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 155 Otherwise, and not stated ... ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 3 ... 3 156 Homicide ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 Suicides, all forms:— 157 By poison ... ... ... ... ... ... ... 3 ... 1 ... ... ... ... . . . 1 ... ... 1 2 ... ... 2 2 4 158 By asphyxia ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 159 By hanging and strangulation ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 160 By drowning ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... 1 1 2 161 By shooting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 162 By cut or stab ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 163 By precipitation from elevated places ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... 1 ... ... 2 ... 2 164 By crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 By other and unspecified methods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... 168 Other ill-defined and not specified causes 4 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 1 1 ... ... ... 3 2 5 169 Malignant disease ... ... ... ... ... 2 ... l 1 1 5 4 2 ... ... 1 5 ... 3 1 4 2 7 9 16 170 Abscess 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... 1 ... ... ... 1 1 171 Cerebro-spinal fever 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 1 2 Totals 232 60 48 28 17 29 34 82 106 173 208 211 125 17 53 242 224 183 245 135 145 143 731 639 1370 48 TABLE VI.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31st DECEMBER, 1923. DISTRICTS. Estimated Population 1923. ANNUAL RATE PER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS: DEATHS DURING 1923 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. *Fever. †Diarrhœa Tuberculous Disease. Violence. 1920. 1921. 1922. 1923. London 4,531,230 20.2 12.4 12.4 13.4 11.2 0.6 000 0.08 0.02 0.13 0.09 0.01 0.20 1.1 0.45 60 9.1 ... 0.1 Shoreditch + 105,200 26.9 15.6 14.4 16.3 13.0 0.8 ... 0.21 0.06 0.12 0.09 0 00 0.30 1.5 0.52 82 11.8 63.6 ... Wards. Moorfields 4,516 19.2 15.4 14.5 16.2 11.7 0.1 ... 0.22 0.22 0.22 ... ... 0.22 1.10 0.22 80 13.2 56.6 Church 18,491 24.7 14.6 15.9 18.7 13.1 0.9 ... 0.27 ... 0.16 0.05 ... 0.38 1.57 0.60 81 9.9 72.3 Hoxton 15,924 30.2 17.2 14 .1 17.9 14.1 0.9 ... 0.12 0.19 0.12 0.12 0.06 0.31 1.76 0.63 99 12.0 66.0 Wenlock 13,760 33.8 19.0 15.9 16.2 13.3 0.7 ... 0.36 ... 0.14 0.07 ... 0.14 1.53 0.79 47 12.6 62.3 Whitmore §18,772 25.8 15.6 14.0 16.0 13.0 0.8 ... 0.10 0.05 0.10 0.21 ... 0.37 1.60 0.37 87 13.9 64.5 Kingsland 10,566 26.4 14.6 14.2 13.2 12.8 0.5 ... 0.09 0.09 0.09 ... ... 0.19 0.95 0.47 109 11.1 60.7 Haggerston 11,023 27.5 13.5 13.3 14.1 13.1 0.8 ... 027 ... 0.09 0.18 ... 0.27 2.08 0.45 79 11.0 64.8 Acton 12,148 22.8 14.5 12.5 16.1 11.8 0.8 ... 0.33 ... 0.08 ... ... 0.41 1.23 0.41 79 11.2 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 London population is adjusted to the middle of 1922. 49 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1923. TABLE VII. PREMISES. NUMBER OF PLACES— Number of inspections, 1923. N umber of notices, 1923. Number of prosecutions, 1923. On register at end of 1922. Added in 1923. Removed in 1923. On register at end of 1923. Milk premises 219 44 8 255 1,822 17 ... Cowsheds 2 ... ... 2 25 . . . ... Slaughterhouses 3 ... ... 2 56 ... ... Other offensive trade premises 5 ... ... 4 13 4 ... Ice Cream premises 77 45 5 117 295 23 ... Registered houses let in lodgings 295 2 1 296 1,447 215 ... Number of intimation notices served for all purposes 5,394 Overcrowding:— Number of dwelling rooms overcrowded 48 Number remedied 12 Number of prosecutions ... Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 286 Underground rooms:— Number dealt with during year 2 Insanitary houses :— Number closed under the Public Health (London) Act, 1891 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 10 Customs and Inland Revenue Acts:— Number of dwellings for which applications were received during the year ... Number of prosecutions under Byc-laws under Public Health (London) Act, 1891 :— With respect to water closets, earth closets, &c. 3 Mortuary:— Total number of bodies removed 174 Total number of infectious bodies removed ... D 50 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK DURING THE YEAR 1923. 2.—Defects Found. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:* Want of cleanliness 308 308 ... ... Want of ventilation 2 2 ... ... Overcrowding 1 1 ... ... Want of drainage of floors ... ... ... Other nuisances 770 770 ... 1 Sanitary accommodation insufficient 36 36 ... 1 unsuitable or defective 255 255 ... ... 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 1,372 1,372 ... 2 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 1.—Inspection. Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries) 372 61 ... Workshops (Including Workshop Laundries and Bakehouses) 2,427 442 ... Workplaces (Excluding Outworkers' premises dealt with in Table III.) 1,208 158 ... Totals 4,007 661 ... 51 3.—Home Work—1923. nature of work. (1) 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. (8) Prosecutions. Instances. (11) Notices served. (12) Prosecutions. (13) Instances. (14) Orders made. (S. 109.) (15) Prosecutions. (S. 109, 110.) (16) Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. (9) Failing to send Lists. (10) Lists. (2) Outworkers. Lists. (5) Outworkers. Contractors. (3) Workmen. (4) Contractors. (6) Workmen. (7) Wearing apparel:— (1) Making, &c. 40 24 563 7 ... 39 ... ... ... 92 92 ... 20 ... ... (2) Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... 4 4 ... ... ... ... Artificial flowers ... ... ... 1 ... 7 ... ... ... 19 19 ... 7 ... ... Fur pulling 2 ... 3 1 ... 1 ... ... ... 2 2 ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... 3 3 ... ... ... ... Paper bags and boxes 12 ... 134 2 ... 16 ... ... ... 36 36 ... 9 ... ... Brush making ... ... ... ... ... ... ... ... ... 6 6 ... ... ... ... Xmas Crackers ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... Total 54 24 700 11 63 164 164 36 ... ... (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. D 2 52 4.—Registered Workshops—1923. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades 996 (a) Cabinet making 589 (b) French polishing 197 (c) Upholstery 70 (d) Other workers 140 (2) Dress 158 (a) Tailoring 66 (e) Shirt making 2 (b) Mantles 11 (f) Boot and shoe trades 26 (c) Dress 15 (g) Artificial flowers 3 (d) Millinery 2 (h) Other workers 33 (3) Skin, leather, hair and feather trades 58 (a) Furriers 20 (b) Saddlery and Harness 13 (c) Feathers 2 (d) Other workers 23 (4) Paper, printing, book, stationery and fancy goods trades 69 (a) Box and bag makers 44 (b) Other workers 25 (5) Laundry and washing 6 (6) Food 13 (7) Metals, machines, implements and conveyances 42 (8) Precious metals, jewels, &c. 2 (9) Other trades than those mentioned above 131 Total number of workshops on Register 1,475 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 61, including 22 factory bakehouses. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshops Act (s. 133). Action taken in matters re-. Notified by H.M. Inspector 3 oq/ referring to \ 1 21 factoriesand 1 ferred by H.M. Inspector i \ 18 workshops./ as remediable under the f Public Health Acts, but ( / referring to \ not under the Factory j Reports (of action taken) sent to 3 I 21 factories and 1 and Workshops Act (s. 5.) ' H.M. Inspector. \ 18 workshops./ Other 13 Underground Bakehouses (s. 101) :— Nil. Certificates granted during the year In use at the end of the year ... ... ... ... ... 36 53 6.—Showing the Numbers of Outworkers Received from other Districts during 1923. districts. Making Wearing Apparel. Fancy Leather Goods, Artificial Flowers. Furniture and Upholstery. Fur Pulling. Feather Sorting. Umbrellas, &c. Paper Bags and Boxes. Brush Making. Card Mounting. Crackers 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. Bethnal Green 49 44 1 ... ... ... ... ... ... ... ... ... ... ... 48 41 19 15 ... ... ... ... 217 Camberwell ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 City of London 248 260 ... ... 38 16 ... ... 9 9 ... 1 25 23 1 ... ... ... ... ... 1 ... 631 Chelsea 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 East Ham 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Enfield 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Finsbury 53 41 6 1 21 22 1 2 6 3 ... 1 1 ... 49 51 ... ... ... ... 8 9 275 Hackney 108 114 ... ... 12 15 8 5 2 2 ... 1 ... ... 25 13 8 8 ... ... 1 6 328 Hertford ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... ... ... ... ... 6 Holborn 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Hornsey 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Ilford 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Islington 21 24 1 ... 14 4 ... ... ... ... ... ... ... ... 12 17 5 4 ... ... 1 2 105 Poplar 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 5 Southwark 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 St. Marylebone 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Stepney 8 9 ... ... ... ... ... ... ... 1 ... ... ... ... 10 12 ... ... ... ... ... 1 41 St. Pancras ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Stoke Newington ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 Tottenham 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Westminster 17 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 34 Willesden 12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Totals 536 538 8 1 85 57 9 7 17 15 ... 3 26 23 146 135 38 27 ... ... 11 19 1,701 1,074 9 142 16 32 3 49 281 65 ... 30 54 SHOREDITCH TUBERCULOSIS DISPENSARY. REPORT FOR 1923. By A. J. McFarland, M.D., D.P.H., Tuberculosis Officer. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, I have much pleasure in submitting my report for the year 1923. The total number of attendances during the year was 6,390, and the number of persons attending the Dispensary was 1,346 ; of these 570 were suffering from some form of Tuberculosis. New persons examined for the first time numbered 716, and 163 were found to be tuberculous ; many of these have been sent to Residential Institutions. The Local War Pensions Authority continue to send a large number of pensioners for examination and reports, 600 examinations were made, and the same number of reports sent to the various War Pensions Authorities. During the year, 180 persons were recommended to the London County Council for Residential treatment. The great majority of these were eventually sent either to Hospital or Sanatorium. The staff of my Department have been of the greatest assistance to me, and have carried out their duties to my satisfaction. Statistical Report for Shoreditch, 1923. 1923. 1922. Total attendances 6,390 7,121 Total new persons examined for the first time 716 676 Renewed cases 630 605 Sisters' visits 2,682 2,715 Medical Officers' visits 361 343 55 Detailed Analysis of all New Persons attending for the first time. Insured. Under 15 years of age. NonInsured, Over 15 years. Totals M. F. M. F. M. F. 144 116 154 155 40 107 716 Pulmonary Tuberculosis 52 40 3 4 17 22 138 Non-Pulmonary Tuberculosis 2 3 9 6 1 4 25 "Suspects" 5 4 2 1 .. 7 19 Non-Tuberculous 85 69 140 144 22 74 534 Analysis of all Persons attending the Dispensary during 1923. Under 15 years. Over 15 years. Totals. Ins. Non-Ins. Males 219 373 103 695 Females 240 188 223 651 Totals 459 561 326 1,346 Tuberculous. Males 40 223 75 338 Females 28 90 114 232 Totals 68 313 189 570 56 The New Persons examined, and the attendances each month were as follows:— New Persons Examined. Attendances. Insured. NonInsured. Totals. Insured. NonInsured. Totals. January 18 40 58 328 291 619 February 23 49 72 282 258 540 March 26 48 74 305 261 566 April 19 42 61 280 239 519 May 34 37 71 353 241 594 June 25 42 67 298 220 518 July 19 42 61 298 229 527 August 8 24 32 261 192 453 September 25 34 59 277 183 460 October 22 47 69 328 231 559 November 19 33 52 315 235 550 December 22 18 40 275 210 485 Totals 260 456 716 3,600 2,790 6,390 All New Persons Examined. Tuberculous. Suspects. NonTuberculous. Totals. Contacts 40 10 348 398 Other new cases 123 9 186 318 Totals 163 19 534 716 Total number of Patients: Insured 561 Non-insured 785 Total 1,346 Bacteriological examinations 716 Number of examinations made and reports sent to the Local War Pensions Authority 600 Number of persons recommended for Residential treatment 180 A. J. McFarland. 57 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Table VIII.—Summary of Notifications during the Period from the 1st January, 1923, to the 31st December, 1923, in the Metropolitan Borough of Shoreditch. Age-periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and upwards. Total Primary Notifications. Total Notifications on Form A. Under 5 5 to 10. 10 to 15. Total Primary Notifications. Pulmonary, Males ... 4 5 2 7 8 21 19 28 16 4 114 202 ... ... ... ... ... 54 94 „ Females ... 4 8 4 13 15 22 27 15 5 1 114 198 ... ... ... ... 1 38 45 Non-pulmonary, Males 1 4 6 6 ... ... ... ... ... ... ... 17 28 ... ... 1 1 1 1 17 „ Females ... 1 3 2 3 1 2 1 ... ... ... 13 21 ... ... ... ... 4 13 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. TABLE IX. Summary compiled from the Abstracts of the work of the Sanitary Inspectors by the Senior Inspector, for the Year 1923. - Insp. Wright. Insp. Chapman. Insp. Sickelmore. Insp. Thomas. Insp. Shaw. Insp. Molloy. Insp. Bishop. Insp. Girling. Insp. Stratton. Insp. Grant. Insp. Walker. Totals. Premises cleansed throughout 64 36 23 37 7 61 70 50 25 62 22 457 partially 263 305 133 254 149 192 299 306 206 214 251 2,572 „ „ total rooms 681 1178 588 649 427 757 862 732 920 813 807 8,414 „ „ verminous rooms 22 32 25 98 4 15 80 49 52 81 126 584 Premises generally repaired—Walls, floors, sashes, &c. 166 389 243 145 134 122 315 256 189 541 243 2,743 Light and ventilation improved ... 1 5 ... 1 1 1 2 2 ... 3 16 Roofs, guttering, rain water pipes improved or repaired 144 254 353 208 141 133 333 194 308 272 226 2,566 Overcrowding dealt with ... 2 1 ... 6 2 5 3 4 6 19 48 Water reinstated or improved ... 26 13 4 18 5 22 3 10 1 24 126 Drains newly constructed 9 2 4 1 ... 1 ... 3 2 4 2 28 „ re-constructed 7 5 10 3 11 1 14 10 6 3 3 73 „ improved or repaired 29 31 71 25 22 18 44 24 20 21 38 343 „ obstructions removed 11 25 56 21 41 33 37 14 39 26 26 329 Soil and vent pipes—Improved or repaired 12 1 9 8 1 ... 3 4 2 ... 6 46 Water closets—newly constructed 25 9 6 3 1 4 1 ... 2 40 8 99 „ improved or repaired 156 124 80 193 40 158 152 167 72 85 126 1,353 „ obstructions removed 16 34 30 38 8 20 41 9 25 18 20 259 Sinks, etc., improved, cleansed or repaired 45 19 23 23 9 12 23 25 15 18 15 227 Sinks, etc., traps provided 6 5 2 5 ... 1 2 5 • • • ... 1 27 Outdoor premises— Floors or paving repaired 25 39 39 65 32 43 56 23 52 56 71 501 Cleansed or limewashed 108 163 155 119 5 • • • 175 5 76 162 222 1,190 8 Improved or repaired ... ... 4 ... ... • • • ... 1 2 ... 1 Ash-pits—Dust-bins provided 22 73 73 52 50 52 91 82 71 106 51 723 „ Improved or repaired 4 2 7 6 ... 3 ... ... ... ... ... 22 „ Abolished 1 ... 7 ... ... 1 4 ... 3 1 2 19 Accumulations removed 17 3 13 9 6 19 45 2 11 24 23 172 Urinals cleansed or repaired 3 • • • 4 ... 1 1 8 ... 1 ... ... 18 Animals removed ... 1 2 1 ... 2 5 1 2 ... 5 19 58 59 SUMMARY OF LEGAL PROCEEDINGS DURING 1923. PUBLIC HEALTH (LONDON) ACT, 1891. In six instances summonses were withdrawn on the work being done. Costs amounting to £3 11s. were allowed to the Borough Council. Nuisance orders were made in 20 instances, costs amounting to £12 1s. 6d. being ordered to be paid to the Council. In 30 instances the Statutory Notices were complied with before the cases came on for hearing, £23 12s. 6d. being ordered to be paid to the Council. In one instance, for non-compliance with a Statutory Notice, the defendant was fined £2 and ordered to pay £2 2s. costs. In one instance, a prohibition order was made, and in another case the summons was adjourned sine die. In one instance, for non-compliance with Statutory Notice, the summons was dismissed, £2 2s. costs being allowed against the Council. In one instance, for non-compliance with Magistrate's order, the defendant was ordered to pay £2 2s. costs. BREACHES OF LONDON COUNTY COUNCIL BYE-LAWS. In two instances the defendants were ordered to pay 2s. each costs to the Borough Council, and in one instance a fine of £2 was inflicted, with £3 3s. costs. METROPOLITAN PAVING ACT, 1817, SECTION 65. Three defendants were fined altogether £1 for refusal to remove their stalls from the public highway. 60 Town Hall, Old Street, Shoreditch, E.C. 2. 16th July, 1923 To the Chairman and Members of the Health Committee. Ladies and Gentlemen, SANITARY INSPECTORS. The following resolution of the Special Standing Joint Committee, viz.:— "To request the Law and Establishment and Health Committees to consider the possibility of making a reduction in the number of Sanitary Inspectors and report generally as to the steps to be taken to effect such reduction," came before your Committee on June 20th last. The matter was referred to me to report on and in pursuance of your instructions I beg to present the following:— The Borough of Shoreditch has, including waterways, an area of 658 acres, and on the night of the Census contained 104,248 persons. This population, however, is probably about 2,000 under the actual number at the present time. Taking the Census figures, the density of the population per acre averages for the Borough 158, varying from 61 per acre in Moorfields to 207 and 211 in Whitmore and Hoxton Wards respectively. Compared with the average for the Metropolis as a whole, which is approximately 60, the great density of the population in Shoreditch becomes obvious. With one exception the Borough is the most densely populated in the whole of London. The figures show that on the night of the Census 82,037 persons were dwelling in 9,513 undivided private houses, 84 in some 8 structurally divided houses, and 9,921 in 467 blocks of flats. There were 303 shops not containing dwellings, and 1,664 which contained dwellings accommodating 8,734 persons. There were besides some 1,745 other premises, e.g., workshops, factories, warehouses and other like premises which contained no dwellings, and 237 containing dwellings affording housing accommodation for 3,472 persons. At the Census 274 dwellings containing 1,036 rooms were returned as vacant. Excluding these, together with those occupied by caretakers, the structurally separate dwellings occupied by private families numbered 13,727, and included 3,910 dwellings consisting of from 1 to 3 rooms, 4,403 of 4 to 5 rooms, 4,914 of 6 to 8 rooms and 500 of 9 rooms and over. Altogether these dwellings contained 66,145 occupied rooms. 61 The dwellings occupied by one private family numbered 6,714 and contained 23,504 rooms, those occupied by two private families numbered 3,869 and contained 21,019 rooms, and those occupied by three private families numbered 3,144 and contained 21,622 rooms. Of 25,373 families, 4,044 were living in the 1 to 3-roomed dwellings, 7,134 in the 4 to 5-roomed, 12,292 in the 6 to 8 and 1,903 were resident in the dwellings containing 9 rooms and over, the numbers of which are given above. The average number of persons to the family was approximately four. The number of persons in Shoreditch to each room averaged approximately 1.5, varying from 1.6 in Church and Whitmore to 1.3 in Moorfields and Acton Wards. The average number of persons per room in the Metropolis works out at slightly over one. Shoreditch is the worst off in all London with respect to the number of persons per room. Briefly the foregoing figures indicate that Shoreditch is an extremely densely populated working-class district, inhabited by people living under conditions prejudicial to health and likely to favour the prevalence of infectious disease. As showing the state of the past and present health of the people of the Borough the subjoined table, which gives the infantile mortalities and general death-rates for Shoreditch and for London during the fifty years 1870 to 1919 inclusive, averaged for ten quinquennial periods, is useful; the rates for the years 1920-1922 inclusive are also given:— Period. Shoreditch. London. Infantile Mortality. General Death-rate. Infantile Mortality. General Death-rate. 1870.74 162 24.5 161 22.9 1875.79 154 23.9 155 22.5 1880.84 160 23.8 152 21.2 1885.89 172 23.3 150 19.4 1890.94 175 23.7 154 20.1 1895.99 196 22.6 164 18.7 1900.04 187 20.9 144 17.0 1905.09 153 19.4 119 15.2 1910.14 149 18.6 106 14.2 1915.19 140 20.2 99 15.3 1920 91 15.6 75 12.4 1921 114 14.4 80 12.4 1922 102 16.3 74 13.4 62 During the first two of the periods there was practically no difference between the infantile mortalities of Shoreditch and London; the general death rate, however, was somewhat higher in Shoreditch but not greatly so. In connection with this, it may be mentioned that the proportion of well-to-do people resident in Shoreditch was markedly greater than at present, and the social and sanitary conditions in the Borough more nearly approximated to the general average obtaining in the Metropolis. From the second quinquennial period, however, the infantile mortality increased, attaining a maximum during the five years ending 1899. It has since been decreasing. On the other hand, the London infantile mortality decreased until the fourth quinquennium and then increased, reaching a maximum during the same period as Shoreditch, when it again began to decrease. It will be noticed that the general death rates, both of Shoreditch and London, have steadily declined save for the slight rise during the five years ending 1894, and the more marked rise during the last of the five-year periods, both of which were, without doubt, the results of Influenza epidemics. The rates for the last three years show still further decreases. The decline in the general death rate for Shoreditch, and the same holds also for London in a somewhat lesser degree, has been greater since it has synchronised with the decline in the infantile mortality. Generally, the figures go to show that the rates for Shoreditch have been subjected to influences common to the whole of the Metropolis. They indicate a definite improvement in the public health during the past fifty years, especially during the latter half of this period. The improvement, however, is distinctly more manifest in the case of the Metropolis than for Shoreditch. Whilst the general death rate of Shoreditch has decreased by about 18 per cent., that of London has fallen by 33 per cent., and if we take the infantile mortalities, the decrease for Shoreditch has been only 13'5 per cent, as compared with 38 per cent, for London. The decline in the infantile mortality for London, therefore, has been almost three times as great as for Shoreditch. Taking the three years ending 1922, the Shoreditch infantile mortality had averaged 102 per 1,000 births, and the general death rate 15.4 per 1,000 population as compared with 76 and 12.4 respectively for London as a whole, figures which show that the infantile mortality for Shoreditch has averaged approximately 34 per cent, higher than that of London, while the general death rate shows an excess of 21 per cent. Again, if we compare the death rates from the infectious diseases—scarlet fever, diphtheria, enteric fever, measles, whooping cough and diarrhoea—we find that during the ten years ending 1922 the rate for Shoreditch has averaged twice that of London as a whole, whilst the death rate from tuberculosis has been between 50 and 60 per cent, higher than that of the Metropolis. From time to time in the past the question of the adequacy of the Sanitary Staff has engaged the attention of the Shoreditch Sanitary Authority, and a brief reference to the action taken will be helpful for the purpose of this Report. 63 Prior to the year 1890 the number of Sanitary Inspectors employed in the Borough never exceeded two. In November of that year an additional Inspector was appointed. This appointment was the result of a public enquiry which was held by direction of the Secretary of State in consequence of serious allegations relative to the insanitary conditions existing in certain localities in the district. In January, 1892, when the Public Health (London) Act, 1891, came into operation, another Inspector was appointed, so that in 1893 the Staff of the Health Department included a Medical Officer of Health, a Public Analyst, a Chief Inspector and three District Inspectors, a Clerk and a Messenger for the office work, three Disinfecting Officers, a Caretaker for the Shelter used in connection with disinfection, and a part-time Mortuary Keeper. Early in 1896, in consequence of the small number of Inspectors employed in the Borough as compared with the average for the Metropolis, the adequacy of the Sanitary Staff again came under consideration, when two additional Inspectors were appointed, raising the number to six. At this figure it remained until 1912, when the subject was again under consideration, and the number of Sanitary Inspectors was raised to eight. During the period of the war, for reasons which need not be enlarged on, the sanitary work necessary in the Borough became markedly curtailed and great arrears accumulated. After the War these, in due course, came under the consideration of the Borough Council, and at their Meeting on January 20th, 1920, the following notice of motion was agreed to and adopted:— "That there shall be conducted and completed within six months an inspection of every dwelling-house in the Borough, and that the landlord shall be compelled forthwith to make the premises fit for human habitation in all respects as laid down in 1919 legislation, and further, that all derelict houses be taken over by the Council at once and put into habitable condition." That matter was referred to the Health Committee with a view to the necessary steps being taken to give effect to the Council's resolution. The Committee reported that it would be possible to comply with the requirements of the first portion of the motion provided the words "as soon as possible" were substituted for the words "within six months," and it was pointed out that the latter part of the requirements of the notice of motion referring to derelict houses was already being dealt with by the appropriate Committee. The Committee were of opinion that to carry out an inspection within six months would require such an enormous increase in the Sanitary Staff that they did not feel that it would be justifiable to attempt it. They were, however, satisfied in view of the arrears referred to and having regard to the ordinary sanitary requirements in the Borough, that a substantial increase in the Sanitary Staff was imperative. To give effect to their suggested modification therefore, the Health Committee recommended that five additional Inspectors should be appointed, thus increasing the number to thirteen, that one of the Inspectors should be appointed Senior Inspector with special duties as laid down by the Committee, and that the 64 remainder of the Inspectors be assigned districts. To cope with the increased clerical work likely to be entailed, it was recommended that two additional clerks should be appointed. The Committee's recommendations were adopted by the Council at their first Meeting in March, 1920, and the Sanitary Staff was increased accordingly. The staff has since been reduced by one Sanitary Inspector and one Clerk. The staff of the Sanitary Inspectors at the present time therefore, including the Senior Inspector, numbers twelve. Taking the figures for the Metropolis as given in the last Annual Report of the County Medical Officer of Health, the number of Sanitary Inspectors in proportion to the number of inhabitants in Shoreditch is approximately 43 per cent, above the average for London. It is for your Committee to consider whether this proportion is justifiable upon the ground that the same is necessary to adequately cope with the sanitary needs of the Borough. The adverse conditions under which a very large section of the inhabitants of Shoreditch live and move and have their being are, I believe, well within the knowledge of your Committee and need not be dwelt upon in detail. It will suffice to emphasise the fact that from the Census figures given above, it is clear that in Shoreditch we have a resident population, mainly working class, dwelling under conditions which undoubtedly require an amount of sanitary supervision above the average as compared with the requirements of the Metropolis generally. That this is so is borne out by the fact that the public health of the Borough, as gauged by the general death-rate, the death-rates from infectious disease including tuberculosis, and the infantile mortality, is markedly below the general level for the Metropolis. Taking these excessive rates as a guide, there is not the least doubt that the Borough, from the point of view of sanitation, requires a far larger staff of Inspectors than the general average for the Metropolis. With the present staff of twelve Inspectors, from an estimate based upon the number of premises inspected and dealt with during a period of twelve months approximately two years are required for a general inspection throughout the Borough. A considerable amount of house-to-house inspection is now being carried out, but the Inspectors' time is much broken up, and only a fraction is available for this owing to the routine work arising from complaints, from infectious disease, from factory and workshops inspections, from proceedings under the Sale of Food and Drugs Acts and other matters of an urgent character which necessarily claim a large proportion of the time of the Sanitary Inspectors. The amount of sanitary work now being done in Shoreditch by the existing staff is large, but considering the needs of the Borough, it is by no means excessive. The average number of visits of inspection, including primary and revisits, made by the 65 Sanitary Inspectors range from four to five thousand in the course of the year. This indicates a good average amount of work per Inspector, and in this respect Shoreditch will bear comparison with the Metropolis generally. A decrease in the number of Inspectors will inevitably be associated with a reduction in the amount of sanitary work in the Borough. The arrears of the war period have to a considerable extent been cleared up but a good deal yet remains to be done in this respect. Having regard, therefore, to the conditions under which so large a proportion of the people of Shoreditch are living, and the general needs of the Borough from the point of view of sanitation, I feel bound to state that I cannot accept the responsibility of advising your Committee that the time is opportune for further reducing the number of Sanitary Inspectors employed in the Borough. Whilst recognising the importance of economy in public expenditure, your Committee will, I feel sure, agree that to endeavour to save expense by measures likely to react to the prejudice of the health of the people is much to be deprecated, and moreover may result in serious responsibility being incurred by the Sanitary Authority. I am, Ladies and Gentlemen, Your obedient Servant, Lewis T. Fraser Bryett, Medical Officer of Health. E 66 METROPOLITAN BOROUGH OF SHOREDITCH. HOUSING CONDITIONS. Statistics. Year ended 31st December, 1923. 1.—General. (1) Estimated population 106,200 (2) General death-rate 13.0 (3) Death-rate from tuberculosis 1.5 (4) Infantile mortality 82 (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 30 2.—Unfit Dwelling-houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,137 (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 — (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. Nil. (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit— (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 67 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,726 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 4,726 (b) by Local Authority in default of owners — C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. Nil. (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 (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 Nil. (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced 4.—Number of houses not complying with the building bye-laws Nil. erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 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 one Superintendent, a Caretaker, an Assistant Caretaker, and four 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. 68 METROPOLITAN BOROUGH OF SHOREDITCH. MATERNITY AND CHILD WELFARE. Summary of Work for the Year 1923. by Dr. Maitland Radford. — Districts. 1. 2. 3. 4. 5. 6. Totals. 1st visits to infants 306 465 591 514 515 445 2,836 Re-visits to infants 780 852 518 718 663 2,448 5,979 No. of visits to children (1-5 years) 998 983 941 1,010 691 3,815 8,438 No. of 1st visits to expectant mothers 62 73 91 67 122 209 624 No. of re-visits to expectant mothers 87 109 61 73 40 235 605 No. of 1st visits to infants with diarrhœa ... ... ... ... ... ... ... No. of 1st visits to cases of ophthalmia neonatorum 5 22 19 22 17 ... 85 No. of re-visits to cases of ophthalmia neonatorum 5 34 30 17 27 ... 113 No. of 1st visits to cases of puerperal fever 2 1 ... 1 1 ... 5 No. of futile visits 166 193 63 204 155 570 1,351 Special visits, dairies, etc. 76 ... 159 1 132 ... 368 Health Visitors' attendances— (a) Haggerston Baths Centre 7 ... 47 7 ... ... 61 (b) Hoxton Hall Centre 46 ... 2 46 11 ... 105 (c) Maternity Centre 114 173 90 106 103 ... 586 (d) Harbour Lights Centre ... 44 48 ... 48 ... 140 (e) Town Hall Centre 36 ... 3 34 ... ... 73 (/) School for Mothers Centre ... ... ... ... ... 300 300 1st attendances of infants and children at Weighing Centres— (a) Haggerston Baths Centre ... ... 136 ... ... ... 136 (b) Hoxton Hall Centre ... ... ... 125 ... ... 125 (c) Maternity Centre 51 221 38 27 201 ... 538 (d) Harbour Lights Centre ... ... 269 ... 66 ... 335 (e) Town Hall Centre 115 ... ... ... ... ... 115 (/) School for Mothers Centre ... ... ... ... ... 176 176 Total attendances at Centres— (a) Haggerston Baths Centre ... ... 1,657 ... ... ... 1,657 (b) Hoxton Hall Centre ... ... ... 2,585 ... ... 2,585 (c) Maternity Centre 864 2,240 236 1,115 2,073 ... 6,528 (d) Harbour Lights Centre ... ... 3,567 ... 98 ... 3,665 (e) Town Hall Centre 1,686 ... ... ... ... ... 1,686 (f) School for Mothers Centre ... ... ... ... ... 4,816 4,816 Dr. Richards (152, Kingsland Rd.) No. of infants seen for 1st time ... 187 32 ... ... ... 219 No. of children (1-5 yrs.) seen for 1st time ... 10 12 ... ... ... 22 Total attendances of infants and children ... 834 211 ... ... ... 1,045 Dr. Smith (152, Kingsland Road). No. of infants seen for 1st time 44 ... ... 42 ... ... 80 No. of children (1-5 yrs.) seen for 1st time 55 ... ... 8 ... ... 63 Total attendances of infants and children 664 ... ... 869 ... ... 1,533 No. of expectant mothers seen for 1st time 29 27 51 22 100 ... 229 Total attendances of expectant mothers 101 70 112 42 130 ... 455 69 Maternity and Child Welfare—Summary of Work—continued. Districts. 1. 2. 3. 4. 5. 6. Totals Dr. Radford (152, Kingsland Road). No. of infants seen for 1st time ... ... ... ... 128 ... 128 No. of children (1-5 yrs.) seen for 1st time ... ... ... ... 67 ... 67 Total attendances of infants and children ... ... ... ... 786 ... 786 Dr Radford (Harbour Lights). No. of infants seen for1st time ... ... 179 ... 50 ... 229 No. of children (1-5 yrs.) seen for 1st time ... ... 93 ... 20 ... 113 Total attendances of infants and children ... ... 23 ... 110 ... 833 Dr. Radford (Town Hall Centre). No. of infants seen for 1st time 70 ... ... ... ... ... 70 No. of children (1-5 yrs.) seen for 1st time 17 ... ... ... ... ... 17 Total attendances of infants and children 532 ... ... ... ... ... 532 Dr. Radford (Hoxton Hall). No. of infants seen for 1st time ... ... ... 106 ... ... 106 No. of children (1-5 yrs.) seen for 1st time ... ... ... 24 ... ... 24 Total attendances of infants and children ... ... ... 631 ... ... 631 Dr. Tribe (School for Mothers). No. of expectant mothers seen for 1st time ... ... ... ... ... 67 67 Total attendances of expectant mothers ... ... ... ... ... 102 102 Dr. Pratt (School for Mothers). No. of infants seen for 1st time ... ... ... ... ... 315 315 No. of children (1-5 yrs.) seen for 1st time ... ... ... ... ... 87 87 Total attendances of infants and children ... ... ... ... ... 3,766 3,766 No. of attendances at Sewing Class 106 66 ... 91 177 161 601 Interviews connected with work 396 ... 718 438 105 867 2,524 Report on Infants attending Doctors' Consultations. No. suffering from disorders of digestion and nutrition 678 538 149 704 239 ... 2,308 No. suffering from other minor ailments 327 106 154 281 39 ... 907 No. referred to Hospital or to Medical Practitioner 51 38 93 76 224 ... 482