SHOR 29 REPORT ON THE health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1924, BY LEWIS T. ERASER BRYETT, M.D. (LOND.) Medical Officer of Health ; Diplomate in t'ublic Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health; and of the Royal Institute of Public Health, &c. [(Printed by Order of the Health Committee.] london: jas. truscott & son, ltd., suffolk lane, london, e.c. 4- METROPOLITAN BOROUGH OF SHOREDITCH. Public Health Committee. Maternity and Child Welfare Committee. Ex officio—A. T. PARRY, Esq., j.P. (Mayor.) Chairman—Councillor H. P. Griffiths. Vice-Chairman-—Councillor A. E. Short. Alderman Adams, J. C. „ Brown, T. W. Councillor Ball, A.J. „ Belcher, S. ,, Bicknell, C. „ Boreham, E. G. „ Dennison, J. J. Doubleday, H. ,, Land, C. ,, PoULTNEY, J. „ Reynolds, G. ,, Wakeling, A. Webb, Mrs. E. Chairman—Councillor J. K. Houseman. Vice-Chairman—Lady Cynthia Colville. (Co-opted.) Councillor Belcher, S. Bellamy, J. (Co-opted) Bicknell, Mrs. ,, Boge, Miss. Councillor Boreham, E. G. ,, Doubleday, H. (Co-opted) Ellis, Miss. Councillor Evans, H. D. „ Girling, Mrs. H., J.P. Morton, L. (Co-opted) Neate, Mrs. Councillor Short, A. E. Webb, Mrs. E. Sanitary Inspectors. J. H. Pearson, Senior Inspector. C. J. Wright. F. C. Shaw. A. Stratton. H. G. Chapman. J. B. Molloy. D. Grant. W. Sickelmore. R. A. Bishop. G. Walker. J. H. Thomas. T. W. Girling. Health Visitors. Miss B. C. Hunt. Miss M. Morrell. Miss I. M. Heward. MiSs G. H. Williams. Miss A. E. Barnes. Turberculosis Nurse. Mrs. Grange. H. P. Abbott. E. J. Hayes. W. Harris. G. H. Pratt. Clerical Staff. J. C. Goodwin. G. C. E. Gibbs. Mrs. I. M. Rutherford. F. E. Sharpe. Rat Officer. E. T. D. Jordan. Miss E. Lehane. E. R. Banks. A. W. Scott. E. Crawley (Part time Enquiry Officer). Staff of Model Maternity Centre, Kingsland Road. Miss M. D. Borrow, Matron. Miss A. C. Andrews, Sister. Misses M. McCosh and M. Paterson (Staff Nurses). Misses E. Bergin, M. Martin, A. Havinden and S. Sneyd (Probationers). Misses D. Woodruff, W. Pearman -and L. Moore (Maids). Mrs. L. Morgan (Cook). Mrs. H. Lewis, Mrs. M. Calnan, Mrs. G. Marshall, Mrs. C. Jennings, and Mrs. J. McDonnell (Cleaners and Waitresses). J. P. Bear and J. E. Perry (Porters). Staff of Dining Centre, 31, Herbert Street. Miss E. E. Thorogood (Cook). Mrs. M. Powney and Mrs. J. Harris (Cleaners and Waitresses). 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. Dentist. Mr. L. G. Ridout. Bacteriologist. Public Analyst. J. Andrew, M.R.C.S., L.R.C.P. H. G. Harrison, M.A., F.I.C. Tuberculosis Officer. Assistant Medical Officer of Health. A. J. McFarland, M.D., D.P.H. Maitland Radford, M.D. (State Med.), D.P.H. Medical Officer of Health. Lewis T. Fraser Bryett, M.D., D.P.H. Ill CONTEXTS. PAGB Acute Antsrior Poliomyelitis 17 Anthrax 23 Appendicitis, mortality from 5 Bacteriological examinations 24 Bakehouses 38 Births in sub-districts 2 Birth rates - Cancer 5 Cerebro spinal fever 17 Condensed milk regulations 35 Cookshops 35 Cow-houses 34 Dairies 34 Deaths in sub-districts 3 Death rate 3 Deaths, ages at 5 Deaths, causes of 4 Deaths in public institutions 5 Deaths in outlying institutions 11 Diarrhoea 14 Diphtheria 11 Disinfection 24 Dysentery 23 Encephalitis Lethargica 18 Enteric Fever 12 Erysipelas 13 Factories and Workshops Act, 1901 29 Factories, workshops and workplaces—sanitary work 29 Food condemned and destroyed 34 Food and Drugs Act 35 Fried fish shops 35 Fur skin dressers 26 Glanders 23 Housing Acts 28 Houses let in lodgings 28 Hydrophobia 23 Ice cream shops 35 Infantile mortality 4 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 23 Influenza 15 Legal proceedings 67 Malaria 23 Margarine Act, proceedings under 37 Marriages 2 Maternity and Child Welfare 30 Measles 14 Milk-shops 34 iv Page Milk and Cream Regulations, 1912 34 M;lk and Dairies (Amendment) Act, 1922 35 Milk premises, cowsheds, etc., on register 34 Mortuary 24 Notification of Births Act 30 Ophthalmia neonatorum 16 Outworkers 30 Pneumonia 23 Population 1 Puerperal fever 14 Rag and Bone Dealers 26 Rag Flock Act, 1911 39 Rats and Mice Destruction Act, 1919 28 Sanitary work 25 Scarlet fever 10 Schools, exclusions of children for infectious disease 23 Shelter 24 Slaughter-houses 34 Small-pox 10 Smoke nuisances 26 Staff 39 Street markets and food 34 Tuberculosis 15 Tuberculosis Case Committee 16 Tvphus fever 15 Verminous houses 27 Violence, mortality from 5 Water supply 25 Whooping cough 15 Workshops on register 29 Zymotic diseases, deaths from 7 Zymotic death rate 7 APPENDIX. Statistical Tables For whole district during 1924 and previous years (Table I.) 43 Cases of Infectious disease notified during 1924 (Table II.) 44 Causes of, and ages at, death during year 1924 (Tables III. and V.) 45, 48 to 55 Infantile mortality during 1924 (Table IV.) 46 Notes to Table III. and IV 47 Comparison of London and Shoreditch birth and death rates in 1924 (Table VI.) 56 Summary of proceedings under Public Health (London) Act, 1891 (Table VII.) 57 Summary of Tuberculosis Certificates received (Table VIII.) 65 Summary compiled from the abstracts of their work prepared by the Sanitary Inspectors for 1924 (Table IX.) 66 Housing Conditions 68 and 69 Summary of legal proceedings under the Public Health (London) Act, 1891 67 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 58 to 61 Return of work carried out at Tuberculosis Dispensary 62 to 64 Maternity and Child Welfare 70 and 71 Statistical Summary, Model Welfare Centre 72 Metropolitan Borough of Shoreditch. ANNUAL REPORT A OF THE MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. 2, January, 1925. To the MAYOR, ALDERMEN and COUNCILLORS of the Metropolitan Borough of Shoreditch. Sir, Ladies and Gentlemen, I have the honour to submit the following report for the year ending 31st December, 1924, upon the health and sanitary condition of the Borough of Shoreditch. As far as practicable this report has been compiled on lines similar to those of previous reports, due allowance being made for the instructions of the Minister of Health as laid down in the circular issued at the end of the year under consideration. POPULATION. The estimated population in the middle of 1924 was 106,500. This figure, which was furnished by the General Register Office, Somerset House, includes the population in the Holborn Institution, numbering about 1,000 persons, who are not regarded as Shoreditch people. Excluding these, 105,500 is the number of inhabitants taken into account for the statistical purposes of this report. Further information upon the subject of the population is contained in Tables I. and VI., and in those relating to the administration of the Factory and Workshop Act, 1901 (see Appendix). The latter also refer to the principal industries of the Borough. BIRTHS. The births registered in the Borough numbered 2,336, of which 1,200 were of males and 1,136 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 2,528, of which 1,309 were of males and 1,219 of females. The distribution of the- corrected births in the eight Wards of the Borough is given below:— Ward. Males. Females. Total. Moorfields 49 55 104 Church 224 224 448 Hoxton 204 207 411 Wenlock 207 173 380 Whitmore 229 201 430 Kingsland 135 119 254 Haggerston 126 119 245 Acton ... 135 121 256 Totals 1,309 1,219 2,528 Outside the Borough 205 births were registered, 112 of males and 93 of females, the parents being residents of Shoreditch. In the Shoreditch Institution 247 births occurred, of which 126 were of males and 121 of females. In 13 of these (3 of males and 10 of females) the parents did not belong to Shoreditch. There were no births in the Holborn Institution during the year. The maternity wards of this institution were closed during 1921, other arrangements for dealing elsewhere with maternity cases having been made. Of the births in the Shoreditch Institution, 30, of which 18 were male, were illegitimate. Elsewhere belonging to Shoreditch there were 27 births, 11 of males, which were illegitimate. The birth-rate was 23.9 per 1,000 inhabitants. The birth-rates for the eight wards of the Borough are given in Table VI. (Appendix). Compared with the rate for 1923 a very marked drop is observable, the decrease amounting to approximately 11 per cent. The births in England and Wales were at the rate of 18.8 per 1,000 total population ; for London the birth-rate was 18.7 per 1,000 population. MARRIAGES. The number of marriages in Shoreditch for the year ended 31st December, 1924, was 979, as compared with 873 in 1923, 959 in 1922, 976 in 1921, and 1,194 in 1920. The persons married were at the rate of 18.5 per 1,000 population, as compared with 17.3 for the Metropolis, 3 DEATHS. The deaths for the year 1924 numbered 1,444. They were distributed in the Borough as shown in the subjoined tabic :— Ward. Males. Females. Total. Moorfields 26 26 52 Church 155 115 270 Hoxton 134 113 247 Wenlock 111 97 208 Whitmore 154 94 248 Kingsland 68 72 140 Haggerston 78 64 142 Acton 74 63 137 Totals 800 644 1,444 The deaths of males were 156 in excess of those of females, and the death-rate amongst males was approximately 24 per cent. higher than amongst females. The general death-rate for the Borough was 13.7 per 1,000 population, somewhat higher than that of 1923, but nevertheless markedly below the average of the previous 10 years. The death-rate amongst males was 15.6 as compared with 1T8 per 1,000 for females. 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 was above the mean-rate for the year from January to the end of April, when it fell, and was below the mean until the middle of November; it then rose and was above the mean until the middle of December, when it again sank and was below the mean until the close of the year. The elevation during the first four months was mainly due to measles, influenza and diseases of the respiratory organs. The highest point touched was recorded during the second week of January, when the rate mounted to 28.9 per 1,000 ; the lowest points reached were 5.5 per 1,000 during the fourth week of June, and again in the first week of September. The deaths amongst infants under one year numbered 221, of which 129 were of males. This amounted to 15 3 per cent, of the deaths at all ages. The mortality amongst infants under one year was at the rate of 87 per 1,000 births registered during the year, as compared with 82 in 1923, 102 in 1922, 114 in 1921, and 91 in 1920. Amongst males the infantile mortality was during the year 99, as compared with 75 amongst females. The chief causes of death amongst infants under one year were prematurity, atrophy, debility and marasmus, pneumonia, bronchitis, diarrhoea and enteritis, whooping cough and measles. In Table IV. (Appendix) the causes of death amongst infants under one year are shown, the ages in weeks and months being given. The table also shows the nett deaths and births amongst legitimate and illegitimate infants. 4 In the subjoined table the causes of death amongst infants under one year are |iven 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 ... ... 4 1 7 1 ... ... 13 Scarlet Fever _ ... ... ... ... ... ... ... ... ... ... Whooping Cough ... 2 4 5 1 1 1 1 ... 15 Diphtheria and Croup ... ... 1 ... ... l ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 l ... ... 2 Abdominal Tuberculosis ... ... ... ...... ... 1 ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... 1 ... 1 ... 1 ... ... 3 Convulsions ... 1 ... 1 1 l 1 ... 5 Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis ... ... 3 3 4 4 2 1 1 18 Pneumonia (all forms) 4 11 6 5 9 6 8 5 54 Diarrhoea ... 1 2 2 1 ... ... 1 1 8 Enteritis ... 5 1 2 3 1 ... 1 13 Gastritis ... ... ... ... ... 1 ... ... 1 Syphilis 1 ... ... 1 1 ... ... 2 5 Rickets ... ... ... ... ... ... ... ... ... Suffocation, over-lying ... ... ... ... ... ... ... l 1 Injury at Birth ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... 1 1 1 ... ... ... 3 Congenital Malformations ... 1 4 2 ... 1 ... 1 9 Premature Birth ... 2 3 6 4 11 2 5 2 35 Atrophy, Debility and Marasmus 1 4 4 1 2 I 3 3 19 Other causes 1 2 2 2 3 2 1 1 14 Totals 12 37 ! 39 27 45 22 21 18 221 The infantile mortalities of the eight wards of the Borough are given in Table VI. (Appendix). The rate was highest in Moorfields and lowest in Acton, 115 and per 1,000 births respectively. The infantile mortality for England and Wales was at the rate of 75, and for London 69 per 1,000 births. The deaths of children between the ages of one and two years numbered 117, the chief causes being measles and diseases of the respiratory organs. Between the ages of two and five years 72 deaths occurred, measles, diphtheria, whooping cough, diseases of the respiratory organs and violence by accident or negligence being the main causes. Altogether 410 or 28.4 per cent. of the total number of deaths at all ages were of children under the age of five years. 5 The chief causes of death at all ages were : bronchitis, which accounted for 197 ; pneumonia, which caused 179 ; tuberculosis, 145, including 124 from consumption ; diseases of the heart and circulatory organs, 154; cancer, 119; old age, 83; measles, 58 ; violence, 66 ; Bright's disease, 46 ; apoplexy, 39 ; prematurity, 36 ; diarrhcea and enteritis, 29 ; influenza, 28 ; whooping cough, 28 ; and atrophy, debility and marasmus, to which were attributed 18 deaths. Of the deaths from cancer 68 were of males and 51 females ; 11 were of persons aged between 25 and 45 years, 62 of persons aged from 45 to 65 years, 29 and 16, respectively, were the numbers for the next two decades, and there was one death in a person over 85 years. There were, in addition, 7 deaths attributed to malignant disease and sarcoma. Doubtless some deaths from cancer arc included amongst those attributed to malignant disease. The death-rate due to cancer was 1.1 per 1,000 population, as compared with 1.0 in 1923, 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. Nine persons, 5 of them males, died from appendicitis. There were no deaths attributed to peritonitis. There were no deaths directly attributed to alcoholism, but there were 7 deaths, all of males, from cirrhosis of the liver. Of the deaths from violence, 42 were of males and 24 females. Through accident or negligence 30 males and 19 females lost their lives. Fifteen of these resulted through street accidents, nine from burns or scalds, and 12, mostly amongst old people, through falls. Seventeen persons, of whom 12 were males, committed suicide. .Three infants were suffocated in bed. The decrease in the mortality from this cause has been the subject of comment in previous reports. DEATHS IN PUBLIC INSTITUTIONS. The number and distribution of the deaths of persons belonging and not belonging to the Borough in the public institutions situate in Shoreditch are as set out in the subjoined table:— Institution. Persons belonging to Shoreditch. Persons not belonging to Shoreditch. Total. Holborn Institution 3 167 170 St. Leonard's Hospital . 556 13 569 Royal Chest Hospital 13 43 56 Home of Good Shepherd 3 3 6 Convent Hospital 1 2 3 Welfare Centre 1 1 Totals 577 228 805 Elsewhere than in public institutions four 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 1 New End, Hampstead 1 Bexley 1 Queen's (Children) 42 Bodmin 1 Queen's, Chislehurst 1 Cane Hill -1 Royal Free 1 Caterham 1 St. Bartholomew's 47 Claybury 14 St. Thomas's 1 Colney Hatch 3 University College 1 Darenth 1 Special Hospitals :— Dartford Heath 3 Epsom 1 Bethnal Green Chest 2 Leavesden 3 Hospital for Jewish Incurables, Tottenham 1 Long Grove 2 Merstham 1 City of London Maternity 14 Peckham House 1 Colindale 9 Tooting Bee 3 Downs 1 Hospitals for Infectious Diseases :— Homoeopathic 1 Ministry of Pensions, Bromley 1 Eastern 35 Ministry of Pensions Richmond 1 Grove 2 London Fever 1 Mothers' Hospital, Clapton 1 North-Eastern 13 Queen Mary's 4 North-Western 6 St. Anthony's 2 Park 4 St. Columba's 1 South-Eastern 6 St. Luke's 1 General Hospitals :— St. Margaret's 1 Special Surgical, Hammersmith 1 East London 1 Evelina (Children) 1 Other Institutions :— German 9 Gt. Ormond Street (Children) 4 214a, Cambridge Road 3 Guy's 3 72a, East Dulwich Grove 1 London 16 230, High Street, Homerton 3 London Jewish 1 5, Highbury Quadrant 1 Metropolitan 34 29, North Side, Clapton 1 Manor House, Golders Green 1 St. George's Home 5 Middlesex 2 St. Joseph's Hospice 5 Middlesex (North) 1 St. Peter's Home 2 Mildmay 6 1, Nottingham Place, Mildmay Memorial 1 St. Marylebone 1 Of 341 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 174 died in general hospitals, 37 in asylums, 67 in fever hospitals, 41 in hospitals for special diseases, and 22 in other institutions. Elsewhere than in Public institutions, 10 persons belonging to Shoreditch died beyond the limits of the Borough. 7 Altogether 917 or 63.5 per cent. of the deaths belonging to Shoreditch, occurred in public institutions. INFECTIOUS DISEASES. The infectious diseases included under the headings 1 to 35 and 171 in Table V. (Appendix) were the cause of 323 deaths, a number which is an increase on that for 1923, but is none the less below the average for previous years. The chief reason for this is an increase in the mortality from measles, whooping cough and influenza. The deaths from the diseases under the headings specified amounted to 22.3 per cent. of the total mortality from all causes as compared with 20.0 in 1923, 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 46.1 per cent, of these deaths. The death.rate due to these diseases was 3.0 per 1,000 population as compared with 2.6 in 1923, 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 tiave 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 48 88 11 6 13 18 26 37 35 27 8 4 2 Of the total mortality from all causes of children under five years, 33-1 per cent, resulted from these infectious diseases. In infants under one year diarrhoea, measles and whooping cough accounted for most of the deaths. Amongst children aged from one to five years, measles, diphtheria, tuberculosis and whooping cough 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, influenza and septic diseases. 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 119, the death-rate being IT 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 Hoxton Ward and lowest in Kingsland and Acton. The cases of scarlet fever, diphtheria, erysipelas, enteric fever and puerperal fever notified numbered 815 as compared with 25,433 for the whole of the Metropolis, the attack rates being 7-7 and 5-6 per 1,000 population respectively. Subjoined is a list of the infectious diseases which were notifiable during the year, excluding pulmonary tuberculosis, showing the numbers of cases certified in 8 the Borough for each of the four quarters of the year, and the numbers and percentages of the cases removed to hospital:— Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Deaths. Smallpox ... ... • • • ... ... ... Scarlet Fever or Scarlatina 79 84 98 105 366 2 Diphtheria and Membranous Croup 65 109 90 117 381 15 Typhus Fever ... ... ... ... ... ... Cholera ... ... ... ... ..... ..... Enteric Fever (Typhoid) 3 ..... ..... 1 4 1 Continued Fever ..... ..... ..... ............. ..... ..... Relapsing Fever ..... ..... ..... ... ..... ..... Puerperal Fever 4 2 3 1 10 1 Erysipelas 13 11 9 21 54 ..... Plague ..... ..... ..... ..... ..... ..... Cerebro-Spinal Fever ..... 1 1 ..... 2 2 Glanders ..... ..... ..... ..... ..... ..... Anthrax ..... ..... ..... ..... ..... ..... Hydrophobia ..... ..... ..... ..... ... ..... Anterior Polio-myelitis 2 2 2 6 1 Encephalitis Lethargica 2 12 6 1 21 ... Ophthalmia Neonatorum 16 11 23 26 76 1 Acute Primary Pneumonia 126 38 30 123 317 43 Acute Influenzal Pneumonia 18 6 3 14 41 5 Malaria ..... 2 ..... 1 3 1 Dysentery ..... ... ........ ..... ..... ... Trench Fever ..... ..... ..... ..... ..... ..... Totals 326 278 265 412 1,281 72 Numbers and percentages of cases removed to hospitals. ) 265 81-3% 241 86-7% 240 90-5% 314 76-2% 1,060 82-7% ..... ..... As compared with the figures for 1923 there is a decrease in the number of cases of scarlet fever and an increase in the number of diphtheria cases. Cases of anterior polio-myelitis (infantile paralysis) and encephalitis lethargica (sleepy sickness) both show marked increases and the cases of pneumonia also are increased. ISOLATION OF INFECTIOUS CASES. In the hospitals of the Metropolitan Asylums Board are received cases of scarlet ^ver, smallpox, diphtheria, membranous croup, enteric, typhus and continued fevers, relapsing fever, also cases of encephalitis lethargica and cerebro-spinal fever, 9 together with certain cases of measles, whooping cough, puerperal fever, trench fever, malaria and dysentery. The cases certified as scarlet fever, diphtheria, enteric fever, puerperal fever and cerebro-spinal fever, numbered 763, and the number of those removed to hospital, mainly to the hospitals of the Metropolitan Asylums Board was 756 or 99 per cent. RETURN CASES. The following came under observation during the year:— Florry W , age three years, of 35, L——- Street, was removed to hospital with diphtheria on December 20th, 1923; subsequently she was certified to have scarlet fever on February 25th, 1924, and she returned home on March 31st following. Louisa B , aged four, of the same address, fell ill on April 3rd and was removed to hospital on April 5th as a case of diphtheria, and Doris W , aged six, fell ill on the 9th and was removed on the 10th, also as a case of diphtheria. Albert M , aged five years, of 86, H Street, was removed to hospital on February 2nd suffering from scarlet fever, returning home on April 26th. On May 5th Charles M , aged three, of the same address, fell ill and was removed to hospital with scarlet fever the following day. Albert seemed quite well on his return ; he had no discharges from either his nose or his ears and nothing was noticed as regards his skin. James C , aged two years, of 119, W Street, was certified to have diphtheria and removed to hospital on February 2nd, returning home on May 28th. Fred C , aged 11, of same address, fell ill on June 1st and was removed to hospital certified as a case of scarlet fever. Henry F , aged nine, a playmate of Fred C 's, of the same address, was certified and removed to hospital as suffering from diphtheria. Subsequently, on June 12th, this case was certified to be one of scarlet fever. On June 13th, Ivy F , aged 10, was removed from the same address, certified as a case of diphtheria. Her case was afterwards regarded as possibly one of scarlet fever. The mother stated that James C on his return had a few pimples with mattery heads on his face and a slight nasal discharge. He was examined on June 25th but there was no signs of anything then. Amelia S , aged 10, of 11, W Road, was certified and removed to hospital on July 14th with scarlet fever, returning home on September 10th. It was noticed that there was a little soreness about her nostrils but otherwise she seemed quite well on her return. WiJliam S , aged two, fell ill on September 11th and was removed to hospital with scarlet fever on September 21st, and subsequently Eva L , aged 10, Henry S , aged five, and Lillian S , aged four, sickened respectively on 24th, 26th September, and 1st October. The indications pointed to Amelia being the source of infection, and she was returned to hospital for treatment of her nose. 10 SMALLPOX. Attention was directed to a few cases, which were suspectcd, but there is no reason for believing that there were any genuine cases of the disease in Shoreditch during the year. There were only four cases certified in the whole of London. In certain localities in the Midlands and in the Northern Counties of England cases were fairly numerous but the type of the disease was very mild and the mortality low. SCARLET FEVER. The cases certified numbered 366, of which 49 or 13.4 per cent. were subsequently not regarded as scarlet fever, a figure which is greatly in excess of the average. 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 1 2 3 ... ... ... Church 22 37 59 ... ... ... Hoxton 26 35 61 ... 1 1 Wenlock 25 26 51 1 ... 1 Whitmore 31 41 72 ... ... ... Kingsland 18 18 36 ... ... ... Haggerston 33 31 64 ... ... ... Acton 12 8 20 ... ... ... Totals for Borough 168 198 366 1 1 2 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified 361 or 98.6 per cent. were removed to hospital. The cases certified were at the rate of 3.4 per 1,000 inhabitants, being somewhat below the average for the previous 10 years. The attack-rate per 1,000 population in the Borough was lowest in Moorfields and highest in Haggerston Ward, being 0.6 in the former, as compared with 5.7 in the latter. The deaths were at the rate of 0.02 per 1,000 population. The case.mortality was at the rate of 0.6 per cent. of the cases certified, which is below the average for the previous 10 years. Amongst children under five years there were 157 of the cases. and the two fatal cases belong to this age group, the case mortality being 1.2, or allowing for errors in diagnosis 1.6 per cent. of the cases certified. 11 The cases of scarlet fever certified in London numbered 11,538, being at the rate of 2.5 per 1,000 population. The deaths numbered 129, which gave a rate of 0.02 per 1,000 population, as estimated for the middle of the year 1923. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 381, of which 92, or 24.1 per cent, were subsequently not regarded as being diphtheria, a number which is very greatly in excess of the average for the past 10 years. The number of cases and the deaths amongst males and females in the Borough and its eight wards arc given in the subjoined table :— Ward. DIPHTHERIA (including Membranous Croup). Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 2 8 10 ... ... ... Church 32 36 68 ... 1 1 Hoxton 25 30 55 1 2 3 Wenlock 24 38 62 ... 2 2 Whitmore 21 30 51 2 2 4 Kingsland 20 18 38 ... 1 1 Haggerston 30 25 55 ... ... ... Acton 18 24 42 1 3 4 Totals for Borough 172 209 381 4 11 15 The cases are grouped according to ages in Table II. (Appendix). Of the cases certified 379, or 99.5 per cent., were removed to hospital. The cases were certified at the rate of 3.6 per 1,000 inhabitants, the rate being the highest in Kingsland Ward.and lowest in Moorfields, 4.9 and 2.2 per 1,000 respectively. The deaths numbered 15, the rate being 0.14 per 1,000 population. The rate was highest in Acton Ward, where it amounted to 0.33 per 1,000. There were no deaths in Moorfields and Haggerston Wards. Of the cases certified 3.9 per cent. terminated fatally. Eleven of the deaths were of children under five years of age, the mortality being at the rate of 6.3 percent. of the cases certified amongst children at that age period. Allowing for errors in diagnosis, this mortality was increased to 8.1 per cent. Amongst persons over five years of age the mortality was 1.4, or, allowing for errors in diagnosis, 2.6 per cent. of the cases certified. During the year some 86,000 units of antitoxin supplied by the Sanitary Authority were used in fourteen diphtheria cases before removal to hospital. 12 The usual enquiries were made as to the circumstances attending the occurrence of diphtheria in the Borough. With respect to 364 of the cases certified during the year, they were distributed amongst males and females at certain age periods as set out in the subjoined table :— Age Period. Male. Female. Total. Under 1 year 6 5 11 From 1 to 2 years 23 13 36 ,, 2 to 3 years 20 17 37 „ 3 to 4 years 22 16 38 ,, 4 to 5 years 24 17 41 „ 5 to 10 years 41 54 95 „ 10 to 13 years 10 16 26 Over 13 years 24 56 80 Totals 170 194 364 In 158 of the cases the patients were children attending school and in 138 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 161 other cases, although the patients themselves were not school. going children, there were other children in the houses who were. In 27 instances the histories showed that there had been cases of "sore throat" amongst the inmates of the houses in which the patients resided. In 30 instances there was evidence pointing to infection from previous cases in the Borough. In 271 instances the houses were occupied by members of more than one family, in 69 by single families, and in 24 instances the cases occurred in artisans' dwellings of the block type. With regard to the sanitary condition of the dwellings, in 205 this was satisfactory, in 77 fairly so, and in 82 it was unsatisfactory, but these figures must not be taken as an indication that a satisfactory sanitary condition is favourable to the occurrence of diphtheria in houses ; their significance has been referred to in previous reports. The cases certified as diphtheria in the Metropolis numbered 10,765, the attack rate being 2.3 per 1,000. The deaths numbered 571 and the death.rate was 0.12 per 1,000 population, the case.mortality being 5 3 per cent. ENTERIC FEVER. Four cases were notified which give an attack rate of only 003 per 1,000 population. One of them terminated fatally. The particulars with regard to the cases are briefly as follows:—Towards the middle of October, 1923, Doris H-, aged 10, was taken ill with a " cold " at 13 No. 11, S-Dwellings. After three weeks at home she was admitted to the Shoreditch Institution, where she remained for another three weeks, when she was sent to a convalescent home at Heme Bay. The possibility of her illness having been enteric fever was not overlooked, but blood tests were negative. On 13th November, Mrs. H-, the mother, fell ill and her case was certified as one of enteric fever on 10th January. W. H., a female, aged 14, of the same address, was taken ill about 19th December and was certified as suffering from enteric fever on 3rd January. On 26th December J. H., a female, aged 7, began to show signs of illness; her case was certified on 11th January and terminated fatally. These three cases gave positive widal reactions. How infection was introduced into the household is not clear, but the probability is that the mother passed the infection on to the two children. The fourth case in the Borough was in a boy, aged nine years, who fell ill about 9th September, and was certified on 26th September. In this case nothing was ascertained throwing light upon the source of infection. The cases certified in London numbered 452, being at the rate of 0.09 per 1,000 population. The case-mortality was 11.5 per cent. of the cases certified, the deaths numbering 52, and the death-rate being 0.01 per 1,000 population. ERYSIPELAS. The cases certified as erysipelas numbered 54, with no deaths. The cases 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 ... 4 4 ... ... ... Church 4 4 8 ... ... ... Hoxton 5 5 10 ... ... ... Wenlock 4 4 8 ... ... ... Whitmore 4 3 7 ... ... ... Kingsland 4 5 9 ... ... ... Haggerston 3 1 4 ... ... ... Acton 2 2 4 ... ... ... Totals for Borough 26 28 54 ... ... ... Pyaemia and septicaemia (blood poisoning) caused the deaths of five males and six females, and infective endocarditis the deaths of five males and four females. 14 PUERPERAL FEVER. Ten cases were certified, of which one terminated fatally. The cases certified were at the rate of 3.9 per 1,000 births, as compared with 2.5 in 1923, 3.1 in 1922, 2.0 in 1921, 2.9 in 1920 and 1.3 in 1919. The cases certified in the Metropolis during 1924 numbered 298, and were at the rate of 3.5 per 1,000 births. DIARRHŒA. There were 15 deaths attributed to diarrhoea and 14 to enteritis. Six of the deaths from diarrhoea occurred in August and the early days of September. Of the deaths from diarrhoea nine were of infants under one year and the remainder of children aged from one to two years. Of the deaths from enteritis 10 were of infants under one year, and one of a child aged between one and two years, one aged from two to five and the other two were of persons over 65 years of age. Excluding deaths from enteritis, the death-rate was 0.14 per 1,000 population ; including deaths from enteritis in children under two years the mortality was at the rate of 0.24 per 1,000 inhabitants. The deaths from diarrhoea amongst infants under one year were at the rate of 3.5 per 1,000 births ; including deaths from enteritis under one year the rate was increased to 7.5 per 1,000 births. The usual enquiries were made with a view to the prevention of the spread of infection. The cases coming under observation were, however, comparatively few, the prevalance of the disease being again much below the average. The deaths from diarrhoea and enteritis in children under two years in the Metropolis numbered 735, the death.rate being 0.16 per 1,000 population. The mortality from diarrhoea and enteritis amongst infants under one year was at the rate of 7.8 per 1,000 births. MEASLES. The deaths numbered 58 as compared with 23 in 1923, 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 a little above the average for recent years. Thirty were of males and 28 females, and they were all, with the exception of three, amongst children under five years. The death-rate was 0.55 per 1,000 was compared with 0.21 in 1923, 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 first three months of the year and there were none after the beginning of June. Some 38 cases were nursed under arrangement with the District Nursing Association in connection with which 419 visits were made by the nurses. The deaths from measles in London numbered 1,335, as compared with 367 in 1923, 1,559 in 1922, 241 in 1921, 1,026 in 1920, and 1,359 in 1919. The death.rate for the year was 0.29 per 1,000 population. 15 WHOOPING COUGH. There were 28 deaths from this disease as compared with 10 in 1923, 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 1924 were of children under five years. As in measles, bronchitis and pneumonia are the common complications which have to be guarded against in this disease. The death-rate was 026 per 1,000 population. The deaths in the Metropolis numbered 529, the rate being 0.11 per 1,000 population. INFLUENZA. The deaths attributed to influenza numbered 28, equally divided between the sexes, the death-rate being 0.26 per 1,000. They mostly occurred during the months of February and March. The deaths during recent years are as follows : 14 in 1923, 69 in 1922, 27 in 1921 51 in 1920, 121 in 1919, 295 in 1918, 12 in 1917, 22 in 1916, and 25 in 1914. There were 1,663 deaths from the disease in the Metropolis, the death.rate being 0 36 per 1,000 population. TYPHUS FEVER. There is no reason for believing that any cases occurred in Shoreditch. One case was notified elsewhere in the Metropolis. TUBERCULOSIS. Tuberculosis (Appendix, Table V., Nos. 29 to 34 inclusive) was given as causing 145 deaths during the year, as compared with 161 in 1923, 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 were below the smallest number so far recorded for the Borough in any one year. They accounted for approximately 10 per cent. of the total mortality for the year. The decrease in the number of deaths during the past five years as compared with the previous five years is very striking, even when allowance is made for the fluctuation in the population. The average for the former quinquennium is over 40 per cent. lower than that of the latter, a fact which is worthy of note. The mortality from tuberculosis has been steadily declining for the past 70 years. This comparatively sudden drop, however, is very remarkable. The deaths during 1924 include those of 24 persons who were not certified under the Tuberculosis Regulations in Shoreditch. The mortality was at the rate of 1.3 per 1,000 inhabitants, being highest in Hoxton and lowest in Kingsland Ward, 1.73 and 1.04 respectively. The deaths from tuberculosis of the lungs numbered 124, a decrease of 15 as compared with the number for 1923. The great majority of the deaths were of persons aged between 20 and 65 years. The deaths amongst males numbered 73, compared with 51 amongst females. The deaths from pulmonary tuberculosis were 16 at the rate of 11 per 1,000 population. The rate was highest in Church and lowest in White more and Kingsland Wards, being 1.6 for the former as compared with 085 for the latter. The deaths from tuberculosis in the Metropolis numbered 5167, the death.rate being 1.1 per 1,000 population. Of these 4,362 were attributed to tuberculosis of the respiratory organs, giving a death-rate of 0.9 per 1,000 persons. A summary of the notifications received under the regulations is contained in Table VIII. and the distribution of the cases according to age periods and localities is shown in Table II. (Appendix). The cases of tuberculosis certified numbered 266, being at the rate of 2.4 per 1,000 population as compared with 2.4 in 1923, 2.7 in 1922, 2.5 in 1921, 3 0 in 1920, and 5T in 1919. In proportion to population the cases certified were most numerous in Church and least in Whit more Ward, being at the rate of 3 7 per 1,000 persons in the former as compared with 1.4 in the latter. The cases certified as pulmonary tuberculosis numbered 215 and were at the rate of 2.0 per 1,000 population, the figures for previous years being 2.1 for 1923, 2.1 for 1922, 2.1 for 1921, 2.8 for 1920, and 4 0 for 1919. The notifications for pulmonary tuberculosis were most numerous in Church and least in Whit more Ward, 30 and 1.2 per 1,000 respectively. A report for 1924 by Dr. Leitch, who was acting Tuberculosis Officer during the latter six months of the year owing to the absence of the Tuberculosis Officer through illness, is appended (pp. 62.64). It summarises the work carried out at the Tuberculosis Dispensary during the year under consideration. Miss Wragge, the Hon. Secretary, reports that during the year 1924, the Tuberculosis Care Committee met on 16 occasions and dealt with 248 cases. Of these 142 were admitted to institutions during the year, while others were receiving institutional treatment who had been admitted previously. Assistance was given by various agencies to obtain extra nourishment, clothing, bedding, fares, insurance benefit and the like, and in some instances homes were found for children while the mother was away for treatment. Some 42 of the cases under the observation of the Committee terminated fatally during the year. The removals to hospitals, sanatoria and other institutions are given in Table II. (Appendix). Of the deaths from consumption belonging to Shoreditch, approximately 62 per cent. occurred in public institutions within or without the borough, 34 per cent. taking place in St. Leonard's Hospital. OPHTHALMIA NEONATORUM. The certificates received numbered 97, and they related to 76 cases. This is a decrease of two on the number for 1923. There were also some 53 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 17 under observation by the Health Visitors to ensure proper treatment. Of the cases certified, 11 were of a severe type, but in all there was recovery without impairment of vision. Many of the cases were treated at Moorfields Eye Hospital, the Queen's, the Metropolitan, and other institutions, and one case was 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. Fifteen of the cases were dealt with under nurses from the local district Nursing Association, some 348 visits being made in connection with them. The cases certified in Shoreditch were at the rate of 30.0 per 1,000 births as compared with 9.0 for London as a whole, more than three times as great. EPIDEMIC CEREBRO.SPINAL MENINGITIS. Two cases were certified, one in a boy aged three years, who fell ill about May 7th and was certified on May 28th from the Queen's Hospital, where he was admitted on May 24th ; this case recovered. The other case was in a schoolboy, aged 14 years, who was taken ill on September 15th and admitted to St. Bartholomew's Hospital on the 17th, where he was certified on the following day. The case terminated fatally, the cause of death being however pneumococcal meningitis. ACUTE ANTERIOR POLIOMYELITIS. The following cases were investigated during the year:— 1. A little boy, aged one year and eight months, of 27, S-Street, was taken ill on June 13th with sore throat, drowsiness and twitchings. He was taken to St. Bartholomew's Hospital on 21st and was certified two days later. Both legs were paralysed. At the end of the year the patient was in St. Mary's Hospital, Carshalton. 2. A little girl, aged a year and ten months, of 33, W- Place, was said to have had a fall on June 20th, which was followed by weakness of the legs. She was taken to Great Ormond Street Hospital on June 23rd and was certified three days later. This case terminated fatally on June 30th. 3. A little boy, aged one year and ten months, of 4, C-Place, was taken with vomiting which was attributed to a fall, and was seen at the Metropolitan Hospital on August 1st. Nothing definite was then noticeable about the child. On August 3rd, as the child still seemed unwell, he was taken to a doctor in the neighbourhood. Later on it was noticed that the child was weak on its legs and it was taken on August 15th to the Queen's Hospital. There being no vacant bed there the case was admitted to St. Leonard's Hospital The case was certified on August 18th. At the end of the year the child was still in the hospital with paralysis of both lower extremities. 4. Alittle boy, aged one year, was taken ill about August 1st with sleepiness, convulsions and loss of power in shoulders. He was taken to Great Ormond Street b 18 Hospital on September 9th and was subsequently under the care of a medical practitioner in the Borough, who certified the case on September 17th. There was no material alteration as regards this patient at the end of the year. 5. A little boy, aged 211/2 years, of 81, W— Place, who fell ill on September 30th with sleepiness, twitchings and spasmodic movements. He was taken to St. Bartholomew's Hospital the same day and was certified three days later. It is stated that there is no evidence of paralysis, but the patient is mentally defective and unable to speak. 6. A little girl aged one year and four months, of 48, G-Street, was taken ill on August 1st and was admitted to the Metropolitan Hospital on August 8th, whence she was transferred to St. Leonard's Hospital on December 6th with a view to admission to Queen Mary's Hospital, Carshalton. Both legs were paralysed. The case was certified on December 9th and a few days later was transferred to the hospital at Carshalton, where it was at the end of the year. ENCEPHALITIS LETHARGICA. The above disease, also known as epidemic encephalitis, may be classed as a general infectious disease. It is characterised by manifestations pointing to lesions in the central nervous system, especially localised paralyses, which are oftentimes associated with lethargy and stupor. A name for the disease, sometimes popularly used, is " Sleepy Sickness." The disease, however, is quite distinct from the malady known as sleeping sickness which is met with in certain parts of Africa. An interesting account of the disorder and the precautions to be taken when cases occur is contained in a revised memorandum which was issued by the Minister of Health at the beginning of June. The following are brief particulars as regards the cases certified in Shoreditch during the year under consideration :— 1. A young woman, aged 18 years, employed as a cardboard boxmaker, and resident at 51, H-Street was taken with a mild influenzal cold about 8th March ; she continued to work until 19th March. She was certified on 22nd March, and was removed to the Eastern Hospital on 24th March. This patient was discharged from hospital on 23rd April. There seems to have been some element of doubt about this case, but most probably it was a case of encephalitis lethargica. From enquiries made towards the end of the year the patient was back at work and said to be well, save with a liability to headaches. (2) A man aged 49, residing at 17, D- Street, employed as a carman, was taken ill during the first week of March with pain in his right shoulder. Headache was complained of on 20th March. Sleepiness was a noticeable feature on 23rd March ; he fell asleep whilst talking. He was seen by a medical man on 24th March, 19 and two days later was admitted to the London Hospital. His case was certified on 28th March. Enquiry towards the end of the year elicited the fact that the patient was then mentally affected and in an asylum. (3) A man aged 49 years, a resident in W-Street, costermonger by trade, was last at work on 15th March. He was taken with pain in the left side about 20th March. Three days later he was removed to the London Hospital and the case was certified on 25th March. He was subsequently transferred to St. Leonard's Hospital, in which institution he remained until the middle of June. It was stated in October that he was then well except for muscular tenderness and aching feet and legs when he sat down. He was, it was stated, sleeping well, but better by day than at night. 4. A school girl, aged nine years, of 114 C- Street, was taken ill about 24th March. She was admitted to St. Bartholomew's Hospital, where the case was certified on 7th April. Drowsiness, and a tendency to drooping of the upper eyelids, were observed. There was no complaint of pain anywhere. She was discharged from hospital about 23rd April and was then admitted to the North Western Hospital. Upon enquiry in October she was at home, and her condition remained much the same as when she was admitted to hospital. She was still lethargic, slightly deficient mentally, slow of understanding and taking little interest in her surroundings. She was said to be wakeful at night and to sleep heavily in the morning, when it was difficult to arouse her. 5. A boy aged five attending school and residing at 7, D- Street, first showed symptoms on 15th March, when he was restless and talkative all that night. Subsequently slight drooping of the upper eyelids was noticed. He was admitted to the Metropolitan Hospital on 20th March and his case was certified on 7th April. He was discharged from the hospital and admitted to St. Leonard's Hospital on 21st July. On enquiry in October it was stated that he was sleepless at night and mentally affected, being then an inmate of the Maudsley Hospital. 6. A boy aged seven attending school, residing at 68, N-Street, was taken ill about 18th March, when he was noticed to be restless and excited at night and to be preoccupied with a vacant look during the day. Slight facial paralysis was present on the left side. He was admitted to the Metropolitan Hospital on 1st April, where his case was certified six days later. In October the boy was at Highwood Hospital where he was stated to be progressing, but the mental condition remained unchanged. 7. A married woman, aged 33, residing at 87, S- Road, was taken ill on 28th March, waking up at night in a fright. Vomiting supervened and the case was thought to be one of influenza. She was delirious at times and very talkative. Then it was noticed that there was drooping of the upper eyelids. She was admitted to the London Hospital on 8th April and her case was certified six days later. She remained in the hospital for six weeks, and after being at home for two weeks, spent b 2 20 another two in the wards, being finally discharged from hospital on 20th June. On enquiry in October it was found that she was still attending the hospital as an outpatient, on account of pains in the head, giddiness at times and forgetfulness. 8. A boot repairer, aged 35 years, male, of 65, B-Street, was last at work sometime in January. He. went into St. Leonard's Hospital on 24th February, and was admitted on 15th April to St. Bartholomew's Hospital, where his case was certified on the following day. Symptoms : lethargy, squint, loss of memory, tremors of hands and legs and his voice hoarse; he was also stated to have had fits at night. The patient left St. Bartholomew's about the middle of May, and has since been in and out of St. Leonard's Hospital, said to be suffering from neuritis and neurasthenia. 9. A schoolboy aged nine, of 21, P- Street, was taken ill on 15th April, when sleeplessness, delirium and double vision were noted. He attended school up to 18th April. "He was subsequently taken to the Queen's Hospital out-patients' department, where his case was certified on 30th April. In October the information was that the boy was away in a convalescent home, and that he was apparently quite well. 10. A schoolboy, aged 11½ years, of 15, W-Street, was last at school on 22nd February, on which date he was taken ill. He went to St. Bartholomew's Hospital on 22nd March, where his case was certified on 12th April. Lethargy and drooping of the upper eyelids were noticeable features in the case. In October the patient seemed well, but his speech was halting. This had never been noticed prior to his illness. 11. A milliner, aged 19, of 38, P— Street, was last at work on April 24th, on which date she was taken with pains at the back of her neck. Three days later she was feverish, her vision is said to have become blurred and indistinct, and muscular tremors, twitchings and delirium were noted. She was admitted to St. Bartholomew's Hospital on April 29th, and her case was certified the following day. Upon enquiry in October it was learnt that the patient resumed her work towards the end of July and had since been quite well. 12. A dressmaker, aged 25 years, of 55, T-Street, was certified on June 16th from St. Leonard's Hospital, where she was admitted two days earlier. A brief history of this patient indicates that she probably had an attack of encephalitis lethargica in 1921 ; in May, 1923, she was again taken ill suddenly whilst at work ; the main features of the case subsequently noted were : Nystagmus, weakness of hand grips, especially the left, slow speech, but mental condition apparently normal; she shuffles along in walking with her head bent forward, and her appearance is suggestive of paralysis agitans, and she was very unsteady on her feet when her eyes were closed. Upon enquiry in October her condition had not materially altered and she was then in the Queen's Square Hospital. 21 13. A little boy, aged four years, of 118, B-Place, attending school up to June 13th, was taken ill on 16th with vomiting on waking up in the morning when he also complained of pain in his head. He was much inclined to sleep but the tendency to sleepiness had been noticed from about the end of May. He was admitted to the Metropolitan Hospital on June 19th and the case was certified on June 24th. There was drooping of the upper eyelids, but not marked. His right arm was paralysed from June 17th. Delirium was present on the night of the 18th. Speech was slow and difficult. This patient was in hospital for about three weeks. On enquiry in October, his mother stated that he was well exccpt for pain on attempting to bend his head back. 14. A labourer, aged 44, of 4, W-Place, was at work on June 21st when he was taken ill with indefinite pains, feverishness, sleeplessness and sore throat. Although sleepless he had a tendency to drowsiness. He was admitted to St. Leonard's Hospital on June 23rd, and his case was certified two days later. In the institution he was feverish and lethargic and there was loss of power in his legs. On the left the knee jerk was absent. Some delirium was manifest at times, but generally his mental condition was said to have been fair. There were marked tremors and his speech was slow. Upon enquiry in October it was stated that the patient was well except for some chronic rheumatism. 15. A schoolboy, aged eight years, of 10, H Place, was taken ill on June 4th with vomiting, loss of appetite, pains in his head and left groin. The next day he was feverish and became sleepy, delirium was present and his speech was slow. On June 6th he was admitted to the Queen's Hospital. The case was certified on June 27th. Upon enquiry in October it was stated that the patient was in the Little Folk Home, Bexhill, where he had been since August, and so far as could be ascertained he was doing well. 16. A married woman, aged 21, of 57, P-Street, was taken ill on July 6th, certified on July 11th, and on the following day removed to the North Western Hospital. Diarrhoea and drowsiness, with a generally nervous condition attributed to shock due to the death of a sister elsewhere from encephalitis lethargica, were the chief features of her illness. The patient was discharged from the hospital on July 18th, the diagnosis not being confirmed by the hospital authorities. 17. A school girl, aged 10 years, of 12, K-Street, was taken ill on July 4th with headache, vomiting and drowsiness. She was taken to the Queen's Hospital, where the case was certified on July 12th. She was an out-patient at the hospital until the end of August, when she returned to school. She has since enjoyed good health. 18. A chairmaker, male, aged 38 years, of 12, T- Street, was last at work on July 21st. Towards the end of June he had a large number of his teeth extracted and was stated that he had not been well since. The onset of his illness was characterised 22 by feverishness, nausea and bad vision; then lethargy, drooping of the eyelids, squint in respect of the left eye, with pains in the lower part of his body, and delirium were noted. His case was certified by a medical practitioner in the borough and removed to the Eastern Hospital. He was in that institution for about a week and then went down to Brighton for a holiday. On his return he resumed his occupation and has since remained at work. 19. A school girl, aged six years, of 36, A—Buildings, was ailing from the end of February, sleepiness being an outstanding feature. On July 26th, whilst at a Sunday School treat, she collapsed and lost the use of her legs. She was taken to the Queen's Hospital on July 28th and then to the National Hospital Queen's Square, where she was admitted on August 1st. The patient was semiconscious on admission and remained so until September 1st. She was delirious at night and her speech was slow and hesitating. Her legs were said to have been paralysed. This patient returned home in November. She was reported at the end of the year to be nervous and excitable, to sleep badly, to be noisy at times, and spiteful to other children. Her speech was slow, she eats slowly, screams without apparent reason and wants to lie in bed. She complains sometimes of blurred vision. Physically she seems strong and healthy. 20. A little boy, aged 2½ years, of 71, A— Street, was taken ill with catarrhal symptoms and cough on October 20th and three days later became unconscious. His case was certified on November 4th and the patient was removed to the Eastern Hospital. He died there a few days later, the cause of death being certified to have been tuberculous meningitis. 21. A man, aged 26, of 43, W—Terrace, was certified on December 29th and removed to hospital as suffering from diphtheria and encephalitis lethargica. This patient was, however, discharged after a few days, as, in the opinion of the hospital authorities, he was not suffering as certified. In connection with the cases certified it may be noted that no two cases occurred in the same house. So far as could be ascertained there were no secondary cases. The number of persons belonging to the families in which the eases were certified was 119 and there were besides some 76 other persons resident in the houses invaded. In eight instances there were histories of influenza and catarrhal affections amongst the inmates of the houses. In one instance three cases were certified in the same street but there was nothing to indicate any connection between them. One of these cases proved not to be a case of encephalitis lethargica. With regard to the sanitary condition of the houses, six were unsatisfactory, mainly on the grounds of being dirty and overcrowded, the remainder were satisfactory or fairly so. The invaded houses were pretty generally distributed and with two exceptions were north of Old Street; there was nothing pointing to any grouping beyond the instance referred to above. 1 23 GLANDERS, ANTHRAX AND HYDROPHOBIA. No cases of the above diseases were notified in Shoreditch during the year. Some seven cases of anthrax were notified in London. PNEUMONIA, MALARIA AND DYSENTERY. Some 317 cases of acute primary and 41 cases of influenzal pneumonia were certified during the year, also three cases of malaria. Of the cases of pneumonia investigated, 235 were treated in St. Leonard's Hospital, 30 in other hospitals, principally the Metropolitan, Queen's, St. Bartholomew's and the Mildmay Mission; 55 were nursed at home by relatives and 21 were nursed with the help of the District Nursing Association. Some 42 other cases of pneumonia also received nursing assistance. Altogether 692 visits were made by the District Nurses in connection with pneumonia cases. Evidence of infection was obtained in 14 of the cases enquired into. In 145 the dwellings occupied were satisfactory with respect to air space, light and ventilation, in 70 they were fair, and in the remaining 126 they were unsatisfactory. Two of the malaria cases were in men who had been abroad and the third was in a woman. The latter had not been out of the country so far as could be ascertained, but her husband, who had been a soldier in India, had had an attack of malaria about six weeks before the case of his wife was certified, which was on November 5th. 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:—One for enteric fever, two for encephalitis lethargica, one erysipelas, 543 for diphtheria, 521 for scarlet fever, 907 measles, 692 chicken-pox, 502 whooping cough, 262 mumps, and 332 for other infectious ailments. The exclusions altogether numbered 3,763 and related to 42 schools. Early in the year, a scheme drawn up by the School Medical Officer with a view to the more effective control of measles in public elementary schools was put into operation in consequence of the increase in the number of cases amongst the children attending certain of the schools in the Borough. The scheme involves close cooperation between the school nurse, head teacher, school attendance staff and the public health staff of the Borough, special attention being paid to the children under five years of age particularly with a view to the provision of nursing assistance where necessary at the earliest possible moment. The schools referred to included the infant departments at Canal Road, Napier Street, Redvers Street, Scawfell Street, Shap Street and Trinity Place. 1 24 Several intimations were received as to investigations by the school medical authorities as regards the occurrence of cases of scarlet fever and diphtheria at certain of the schools in the Borough. Information was also received from the School Medical Officer respecting four children excluded from school on account of presence of diphtheria bacilli in their noses or throats. The families to which these children belonged were kept under observation but no cases of diphtheria were subsequently notified amongst the members thereof. BACTERIOLOGICAL EXAMINATIONS. During the year some 772 examinations were made by Dr. J. Andrew, Pathologist, Metropolitan Hospital. Of these 447 were for suspected diphtheria 10 for enteric fever, 254 for tuberculosis, 1 for anthrax, and 29 for gonorrhoea, Twenty-two Wassermann tests were made, and 1 sample of urine, 2 blood counts, 4 organisms, 1 P.M. specimens and 1 sample of pus were also examined. Positive results were obtained in 71 of the examinations for diphtheria, 54 of those for tubercle blacilli, 3 for enteric fever, 8 for gonorrhoea and in 4 of the Wassermann tests. In addition it may be mentioned that some 693 bacteriological examinations were made in connection with the work at the Tuberculosis Dispensary. DISINFECTION. The premises disinfected numbered 987; the articles removed and disinfected at the Borough Disinfecting Station totalled 21,184, and included 902 beds, 1124 mattresses, 1,995 pillows, 610 bolsters, and 16,553 others, such as sheets, blankets, quilts, curtains, carpets, clothing and the like. It was necessary to destroy 2 pairs of mattresses and 2 beds which were so dilapidated and contaminated as to render it inadvisable to return them. These were replaced with new. In addition 30,802 blankets, and 214,941 articles of wearing apparel were disinfected for trade purposes. THE SHELTER. The Shelter in Reeves Place, provided under the Public Health (London) Act, 1891, Section 60 (4), for the temporary accommodation of families in cases of dangerous infectious disease to facilitate measures for disinfection, was not in use during the year except on one occasion on account of vermin. PUBLIC MORTUARY. The bodies of 171 persons were received in the Mortuary during 1924. The inquests held numbered 161 and the post mortems made 161, of which 84 were made in the post mortem room attached to the Mortuary. No infectious bodies were removed to the Mortuary by the Sanitary Authority during the year, 1 25 WATER SUPPLY. The Meteorological Table for London, deduced from observations at Greenwich under the Astronomer Royal, issued by the Registrar-General for 1924, shows that the rainfall for the year amounted to 30.769 inches, which is 7.204 inches above the average extending over the 35 years 1881 to 1915. July was the wettest and March 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 61 premises, all of them in the Northern District. The grounds for withdrawing the supplies were:—On account of defective water pipes in 7 instances, waste on occupied premises 2, waste on empty premises 10, by request of the consumer in 9 instances, on account of non-payment of rates in 2, and premises demolished in 31 instances. 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 6,224 premises. In 621 instances they were dealt with by Inspector Wright, in 673 by Inspector Chapman, 515 Inspector Sickelmore, 586 Inspector Thomas, 422 Inspector Shaw, 637 Inspector Molloy, 706 Inspector Bishop, 420 Inspector Girling, 529 Inspector Stratton, 531 Inspector Grant and 584 under the supervision of Inspector Walker. In connection with the work of the Sanitary Inspectors 1,614 letters were written to owners and others concerned. Some 52,022 visits of inspection were made by the Inspectors in connection with some 11,683 premises, which included 9,442 dwellings, 1,447 workshops, besides factories, laundries, bakehouses, cowsheds and milk vendors' premises, ice cream shops, slaughterhouses, places where food is prepared and sold, and other premises. Some 1,008 visits of inspection made in connection with the street markets, food exposed for sale, stables and stable yards, are included in the total given above. The inspection of 3,279 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. A special note may be made as to the reconstruction of the drainage system at St. Leonard's Hospital and Institution. This was carried out in accordance with plans submitted by the Architect, Mr. Danby Smith, F.R.I.B.A. the work being supervised on behalf of the Sanitary Authority by Inspector Bishop. Approximately 1,500 yards of drains, mostly iron 4 to 12 inch diameter, were laid, and in connection 1 26 with the system 153 gullies were fixed and some 90 manholes with numerous ventilation and soil pipes were constructed or reconstructed. The work was commenced at the end of 1923 and was in progress throughout 1924, being completed in December and was a very extensive undertaking. 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 Inspecfors. The Summary includes the work carried out to comply with the provisions of the Factory and Workshops Act, 1901, and also that done in connection with the drains and sanitary arrangements of new buildings. Most of the work done was carried out to comply with the requirements stated on the intimation notices served. Statutory Notices under the Public Health (London) Act, 1891, were served by order of the Sanitary Authority upon parties responsible for the abatement of nuisances and for otherwise not complying with the requirements of the Act in 1,107 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 91 instances. A Summary is given on page 67 (Appendix) showing the results of these proceedings. SMOKE NUISANCES. Ten communications were received from the London County Council referring to the emission of black smoke from shafts on 3 premises. These were all duly brought to the notice of the parties responsible. In three cases intimations were served after observation by the Sanitary Inspectors, which were effective, and it was not necessary to report any of them to the Sanitary Authority for further action. FUR SKIN DRESSERS. At the end of the year there were four premises upon the register. They were subject to regular inspection and some 18 visits were made in connection with them. During the year it was necessary to serve six Statutory Notices for cleansing. Five of these were duly complied with. In one instance a summons had to be taken out in order to get what was required done. One guinea costs were allowed by the Court. RAG AND BONE DEALERS. Some eighteen premises to which the byelaws under Section 9 of the London County Council (General Powers) Act, 1908, are applicable were on the register at the end of the year. In the great majority the businesses carried on thereat are only in a small way. They were all subject to inspection and some 48 visits were made by the inspectors in connection with them. In four instances it was necessary 1 27 to direct the attention of the proprietors to the necessity of cleanliness. In one instance contraventions of byelaws Nos. 6, 7, 8 and 9 had to be reported to the Health Committee. The notice under the byelaws served by order of the Committee was duly complied with. VERMINOUS HOUSES. The houses in which it was necessary to take measures on account of the presence of vermin numbered 355, and some 666 rooms were dealt with during the year. Sanitary notices were served where necessary and the usual steps were taken. In an appreciable proportion the cases came under our notice through intimations from the School Authorities. During the year the homes of some 109 children, 31 boys and 78 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 22 boys and 22 girls had been given the opportunity of being cleansed at the cleansing stations, that in the cases of 9 boys and 30 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 26 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 101 the rooms occupied were satisfactory, varying from fairly clean to very clean, in eight they were dirty. In 101 the bedding was clean, or fairly so, in four it was dirty, in three bugs were noticed, and in one it was both dirty and buggy. In one of the houses evidence of poverty was marked. No evidence of lice was found in connection with any 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 5 sanitary notices were served upon owners and two upon occupiers of verminous dwellings, mostly for general cleansing and repairs. The children reported by the School Authorities as suffering from scabies numbered 60, of whom 40 were males and 20 females. In 4 cases the addresses were erroneous. As a result of the enquiries made by the Sanitary Officers one other case came under observation. As far as practicable steps were taken to prevent the spread of infection. 1 28 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) 268 ,, ,, (mice) 32 „ visits and revisits 4,520 „ rats caught in traps or killed by dogs 880 ,, rats found dead through poisoning 224 „ premises cleared of rats 279 „ premises cleared of mice 21 ,, pavements taken up, fronting houses 36 ,, drains reconstructed and repaired 17 ,, drains tested by Sanitary Inspectors 29 ,, floors of kitchens, sculleries, passages and coal cellars concreted 54 The poisons used included 2,000 packets of Ratquit, which provided some 40,120 baits, 23 lbs. of Londovus, 447 tins of Rodine, and 504 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 in the Borough is referred to on p. 25 and also in the Appendix (pp. 68-69). About the middle of the year a start was made on the area included in the Ware Street housing scheme by the clearance of a site occupied by a number of houses at the Kingsland Road end of Wilmer Gardens and Phillip Street, some 12 four-roomed houses in the former and 17 five-roomed in the latter being demolished. By the end of the year the erection of one of the blocks of dwellings (39 separate lettings) contemplated in the scheme was well in progress, and so far as can be foreseen there appears no reason now why the work which is being carried out by the London County Council should not be steadily proceeded with until completion. Three four-roomed cottages were demolished in Pritchard's Road. These were on part of a site to be occupied by a block of 28 dwellings to be erected for the Borough Council. These dwellings were in process of construction 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 305,12 having been added to and three struck off. Some 1,917 visits of inspection were made in connection with these houses. In 338 instances intimations relating to various matters requiring attention were sent to the persons responsible for dealing with the same, and in 95 statutory notices were served by order of the Sanitary Authority. 1 29 FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of the year was 1,447. Of these 233 had been added, 261 having been removed. A classification of the workshops registered is contained in the summary of proceedings under the Act which is appended. Some 3,506 visits of inspection were made in connection with workshops and 564 to factories. Four communications were received from the Factory Inspector relative to the establishment of 206 new workshops in the Borough. As the result of inspection 169 were found in a satisfactory condition, and 10 were not in use. With regard to the remainder sanitary notices were necessary; in 9 instances for cleansing, one on account of obstructed urinal, 6 for additional w.c.'s, 1 on account of defective w.c., 1 for a defective roof, and 2 for defective dust receptacles. Seventy-six written intimations were received from the Factory Inspector relating to insanitary conditions and infringements of the law as to public health in connection with 20 factories and 56 workshops. The chief insanitary conditions to which the Factory Inspector directed attention were: dirty conditions of walls and ceilings in 21, defective and insufficient w.c. accommodation in 46, absence of proper ventilation in one, defective sink waste in one, defective roofs in nine, overcrowding in two, foul urinal in one, smoke nuisance in one, accumulation of rubbish in two, an absence of watercloset accommodation in one, and in one instance there was a defective dust receptacle. Including those brought under the notice of the department by the Factory Inspector 464 workshops were dealt with, 476 sanitary notices being served upon the parties responsible for their proper sanitary upkeep. The following is an abstract of the sanitary work carried out to comply with these notices:— Premises cleansed throughout 76 Soil and vent pipes dealt with 5 ,, ,, partially 151 Water-closets newly constructed 19 Number of rooms cleansed 313 ,, repaired, etc. 234 Walls, floors, sashes, etc., repaired 79 „ obstructions removed 22 Light and ventilation improved 2 Sinks, etc., cleansed and repaired 14 Roofs, guttering, etc., repaired 170 Overcrowding abated 3 Sink traps provided 2 Water reinstated or improved 1 Sculleries, yards, etc., paving repaired 10 Drains newly constructed 8 „ reconstructed 5 Sculleries, yards, etc., cleansed or limewashed 126 „ repaired, etc. 25 ,, obstructions removed 16 Dust receptacles provided 41 Urinals cleansed, etc. 7 Foul accumulations removed 67 The number of factories under observation for insanitary conditions during the year was 62, and in connection with them some 62 sanitary notices were served. 1 30 The work carried out to comply with these notices included the cleansing and repairing of water-closets in 37 instances, the construction of new water-closets in 4, the removal of obstructions from drains and water-closets in 8 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 63 lists of out-workers were received from employers in the Borough, 29 in the first and 31 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 741 out-workers, of whom 543 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 1,665 out-workers, and of these 36 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 1924. The number of out-workers reported was 2,406 and of these some 1,827 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 1923. As pointed out in previous reports, in numerous instances names and addresses of out-workers are duplicated owing to lists being sent in twice a year, and in some cases the same out-workers are employed by more than one firm, so that the numbers given above must not be taken as representing the actual numbers of individual out-workers. Tables are appended showing the distribution of out-workers as regards trades in the Borough. Most of them are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags and boxes, and brushes. Some 1,144 visits of inspection were made to places where home-work was being carried on, and in connection with these 129 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 33 and included 7 of scarlet fever, 14 diphtheria and 12 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 2,189, and there were in addition some 51 still births. Of the notifications, 1,428 were received from registered midwives practising in the Borough. In addition, 282 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 98 per cent, of the number registered during the year as compared with 88 in 1923, 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. 70 and 71). It follows on the general lines of previous years. 1 31 Subjoined are brief particulars as to the staff employed and the work carried on at the Model centre, 210, Kingsland Road, during the year under consideration. The staff comprises a matron (Miss Borrow), a sister, two staff nurses, four probationers and a cook, who are resident in the institution. Non-resident are the assistant medical officer of health (Dr. Radford), who is in charge of the observation wards, an emergency medical officer (Dr. Hamilton), who also acts as occasional anaesthetist for dental purposes, an anaesthetist (Dr. Davie) for the dental clinic, and for consultations the staff is as under:— Infant Welfare Du Richards Monday afternoons. ,, „ Dr. Richards Wednesday afternoons. ,, ,, Dr. Radford Thursday afternoons. „ ,, Dr. Smith Friday afternoons. Ante Natal Dr. Smith Friday mornings. Five health visitors, in accordance with a scheme laid down, together with a female clerk, are in attendance at the consultations. A weighing centre and a sewing class are conducted by the health visitors on Tuesday and Wednesday afternoons respectively, and the dentist (Mr. Ridout) attends on Wednesday mornings. The regular staff employed in cleaning, waiting, &c., are: two porters (male), a cook-help and cleaner, a part-time cleaner, a cleaner and waitress, a cleaner and laundress, and a baby minder. These are not resident. At the weekly ante-natal clinic on Fridays, the average attendance has been nine mothers or expectant mothers per session. Although mothers may come to the centre from all parts of the Borough they are mostly from the locality lying near. On the west side of the Borough the mothers go to the Shoreditch School for Mothers. The observation wards arc for the use of the whole of the Borough, including the district allotted to the Shoreditch School for Mothers. During the last six months of the year the children attending the consultations averaged 233 per week. From Monday to Friday, inclusive, a mid-day dinner was supplied to nursing and expectant mothers, who averaged 34 per diem for the last six months of the year. There is another dining centre for the western part of the Borough which is in use mainly for the area of the Shoreditch School for Mothers. All arrangements as regards the supply of milk are made at the Town Hall, which is the centre of administration in accordance with a scheme settled by the Maternity and Child Welfare Committee. Dried milk only is distributed at the centre as is done in the cases of the other consultation centres. In cases where cow's milk is required for infants in the wards, certified milk is used. Since the centre was opened for the reception of infants early in the year, the cots in the observation wards have been in constant use. Owing to the necessity of keeping the children in the institution for lengthy periods the total number of cases passed through these wards has been restricted. From 7th February to the end of the year 39 infants were admitted. One of the cases terminated fatally, but all those discharged were greatly benefited by their treatment in the institution. 1 32 With regard to the use of the wards specially for mothers and children for the establishment of breast feeding, difficulty has been experienced in persuading mothers to enter the institution, mainly owing to the fact that they have those at home who require to be looked after. A case or two, however, have been admitted with benefit both to mother and child, and in some instances the mother has attended at stated intervals during the day to nurse her infant whilst it was in the institution. The cases admitted to the observation wards (see Statistical Summary, p. 72 Appendix) were those suffering from disorders of digestion, marasmus, debility, prematurity and the like. For the most part treatment in the wards means careful attention to general management and to diet. At the Infant Welfare consultations advice is given as regards the care of infants and children. Beyond such simple remedies as aperients, treatment is not undertaken. Cases requiring to be under medical supervision are referred to medical practitioners or hospitals in the neighbourhood. At the ante-natal consultations mothers are advised as regards their general health. Any requiring special treatment are referred to the City of London Maternity Hospital, City Road, there being special facilities for this under an agreement between the Borough Council and the Hospital Authorities. Mothers, however, are not bound by this and it is open to them to select any other hospital they may desire. The Dental Clinic was commenced in March. One session is being held weekly on Wednesday mornings. The average attendance is about eight per session. From what has been stated it may be gathered that this Centre is a most important adjunct in connection with the Maternity and Child Welfare work carried on in the Borough. This may be briefly outlined as follows:— 1. The Central Offices at the Town Hall for administration with the requisite staff, medical, health visiting, and clerical. 2. Various Centres are held as below:— Town Hall Infant Welfare Consultation—Mondays. Model Centre „ „ „ Hoxton Hall „ „ Tuesdays. Model Centre Infant Weighings ,, Model Centre Infant Welfare Consultation—Wednesdays. Model Centre Dental Clinic—Wednesdays. Model Centre Infant Welfare Consultation—Thursdays. Model Centre ,, „ Fridays. Model Centre Ante-Natal Consultation—Fridays. Harbour Lights Infant Welfare Consultation—Fridays. also School for Mothers Infant Welfare Consultation—Tuesdays. School for Mothers „ „ Thursdays. School for Mothers Ante Natal Consultation—Thursdays. 1 33 During the year there were five municipal health visitors attending the consultations referred to above and they were assisted by two lady clerks. Two whole-time health visitors are employed by the Shoreditch School for Mothers, a voluntary institution situate at 28, Herbert Street, and operating in a district in the western part of the Borough (vide No. 6 Summary on pp. 70 and 71). At the end of the year seven health visitors were at work in Shoreditch. With regard to health visiting during the year 1924 the summary appended (pp. 70 and 71) shows that, taking the number of children under five years of age living in Shoreditch as being approximately 14,000, and the number of births 2,528 registered during the year, each child under one year was on the average visited three times. The number of children aged from one to five years is estimated at 11,500, more than half therefore of the children belonging to this age period were visited. The summary figures also indicate that approximately 28 per cent, of the expectant mothers in the Borough were visited. The number of infants and children attending the various centres was 1,779, some 1,281 being under one year, whilst the total attendances numbered 25,763, some 17,261 of which were of children under one year. The average of the attendance was 50 per session. During 1924, according to the information supplied by the Hospital authorities, some 389 cases from Shoreditch were dealt with at the Ante-Natal and Consultative Maternity Centre of the City of London Maternity Hospital. Of these 128 were examined by the Obstetric Surgeon attached to the Centre, some 213 examinations being made. In all cases the urine was tested. In 261 cases the Sister attached to the department saw and advised cases upon various aspects of their pregnancy. Seventeen cases were referred to this Centre by the Council's Medical Officers, six for diagnoses and eleven for their confinements in the institution. Special features noted during the year were: version in 2, contracted pelvis 13, past history 4, breech 5, breech version 5, albuminuria 7, post maturity 1, and varicose veins 3. The great majority of the cases were normal before admission and practically all who were treated ante-natally had normal confinements. The number of cases admitted to the hospital was 169, and 101 were attended during their confinements in their own homes. The cases nursed under the District Nursing Association numbered some 354, of which 294 were amongst children under the age of five years. Of some 3,730 visits to patients of all ages 3,039 were made to children under the age mentioned. The various ailments dealt with were fairly numerous, but pneumonia, measles, influenza, threadworms, tonsils and adenoids, otorrhoea, ophthalmia neonatorum, post partem troubles and miscarriage furnished the majority of the cases nursed. Ten of the cases terminated fatally—seven from pneumonia, two influenza and a case of marasmus. Two of the deaths from pneumonia and the two from influenza were amongst persons over five years of age. c 1 34 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: 2½ lbs. faggots, 31 hams, 2 tons 2 cwts. offal, 2 cwts. pigs' feet, 10 rabbits, 2 fowls, 2 boxes bream, 1 cwt. conger-eel, 60 crabs, 84 lbs. dabs, 2 qrs. and four boxes haddocks, 3 cwts. mackerel, 2 qrs. plaice, one box, 1 cwt. 78 lbs. skate, 3 qrs. skate and dog fish, two sacks winkles, 3 barrels apples, 84 lbs. bananas, two-thirds of a railway truck of brussels sprouts, one barrel, 2½ cwts. grapes, half ton potatoes, 1 cwt. 2 qrs. 14 lbs. and five tubs strawberries, 20 bundles tomatoes, and 3 cwts. william pears. Legal proceedings were taken against the persons upon whose premises the faggots and the two fowls and the rabbit mentioned above were deposited for the purpose of sale for human food. In the case of the faggots the defendant was ordered to pay a guinea costs. With respect to the fowls and rabbit the defendant was fined £8 and ordered to pay £2 2s. costs. SLAUGHTERHOUSES. The two slaughterhouses in use in the Borough were subject to the usual inspection and some 38 visits of inspection were made in connection with them. Their general sanitary condition may be reported as satisfactory. Some 56 butchers' shops besides other premises upon which meat is sold were also under supervision during the year. COWHOUSES. The usual inspection of the cowhouses in the Borough was carried out, some 19 visits of inspection being made. Their sanitary condition may be reported as satisfactory. On October 1st the number of cows kept was 28, one more than last year. The number of dairymen and milk purveyors on the register at the end of the year was 256. During the year the sale of milk was discontinued inl6 and commenced in 17, and in 32 instances there were changes in the names of the persons registered. The premises were under observation throughout the year, some 1,665 visits being made in connection with them. In 15 instances sanitary notices were served, the chief items requiring attention being general cleansing, defective roofs, defective drains, and defective dust receptacles. No cases of notifiable infectious disease were certified on any of the milk vendors' premises during the year. MILK AND CREAM REGULATIONS, 1912. None of the samples of milk submitted to the Public Analyst were reported as containing any preservative, No samples of cream were submitted. 35 CONDENSED MILK REGULATIONS. Four samples of condensed, two of which were full cream sweetened, one full cream unsweetened and one skimmed sweetened were submitted for analyses. They were all reported by the Public Analyst to be genuine. MILK AND DAIRIES (AMENDMENT) ACT, 1922. At the end of 1923 one person was on the register as licensed to sell certified milk. During 1924 three others were added, two for certified milk and one for Grade A tuberculin tested milk. COOK-SHOPS AND EATING-HOUSES. Including the kitchens of public-houses where food is prepared for customers 175 were under inspection during the year and some 511 visits were made in connection with them. The sanitary notices served numbered 73 including 61 which were mainly for cleansing. Other matters requiring attention were defective drains and waterclosets, defective roofs and defective dust receptacles. FRIED-FISH SHOPS. Some 57 were under inspection in connection with which 23 sanitary notices were served, 10 being mainly for general cleansing. Some 302 visits of inspection were made. ICE CREAM SHOPS. There were 127 under observation during the year and 293 visits of inspection were made in connection with them. Twenty-nine sanitary notices were served mostly for general cleansing. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 1,051 samples were submitted to him during the year. This number is at the rate of 9.9 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 1924. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions Proceeded with. Number of successful Prosecutions. Fines and Costs. Amount paid to Analyst for Samples Analysed. £ s. d. £ s. d. 1st 202 7 3.4% 6 ... 6 2 1 13 0 126 5 0 2nd 290 17 5.9% 7 ... 7 6 39 4 0 181 5 0 3rd 214 7 3.2% 4 ... 4 3 8 12 0 133 15 0 4th 345 6 1.7% 0 ... 0 0 ... 215 12 6 Totals for Year. 1,051 37 3.5% 17 ... 17 11 49 9 0 656 17 6 36 The samples taken included 480 of milk, 3 of dried full cream milk (informal), 2 of full cream sweetened condensed milk, 2 of skimmed milk, ] full cream unsweetened condensed milk, 1 sweetened condcnscd skimmed milk, ]00 vinegar, 94 butter, 56 margarine, 49 pepper, 39 cocoa, 26 tea, ]8 mustard, 14 coffee, 11 baking powder, 11 olive oil, 10 self-raising flour, 9 lard, 8 sausage, 8 malt vinegar, 7 tapioca, 6 honey, 6 rice, 6 custard powder, 5 ammoniated tincture of quinine, 5 ground ginger, 5 sugar (1 informal), 5 dripping, 4 non-alcoholic wines, 4 boric acid ointment, 4 borax, 4 sago, 4 zinc ointment, 4 camphorated oil, 4 jam, 3 arrowroot, 3 castor oil, 3 glycerine, 3 shredded suet, 3 sulphur ointment, 3 ground almonds, 3 jelly, 2 extract of malt with codliver oil (informal), 2 ground cinnamon, 2 mixed spice, 1 each of boracic acid, cheese, cinnamon, ground rice, phenol ointment, seed tapioca, cloves, lemonade powder and ground nutmeg. Of the samples of milk 17 or 35 per cent. were found to be below the standard fixed by the Board of Agriculture. The proportion of milk samples returned as adulterated during 1924 was again greatly below the average, being the lowest so far recorded in Shoreditch. 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 100 5 5.0 2nd 146 8 5.5 3rd 95 3 3.2 4th 139 1 0.7 In five of the samples water was certified to have been added ; in four of these it was less, and in the other it was more than 5 per cent. In nine the samples showed deficiencies in milk-fat; in one of these it was less and in the other eight it was more than 5 per cent. taking the standard of the Board of Agriculture. In three samples traces of colouring matter were present. Legal proceedings were instituted in 13 or 76 5 per cent. of the cases in which samples of milk were below standard. In two instances the summonses were dismissed warranties being proved. In four instances the defendants were fined, and in three of these costs were also allowed the Council. In three instances costs only were allowed the Council. In one instance the case was dismissed, the defendant proving to the satisfaction of the Magistrate that the milk was sold as received from the cow. 37 In three instances the cases were dismissed. In these proceedings were taken unde Section 4 of the Milk and Dairies Amendment Act 1922 for selling milk containing added colouring matter. In two the actual amounts of colouring matter were not stated on the analyst's certificates, and in the other the magistrate was not satisfied that colouring matter had been added. No legal proceedings were considered advisable as regards the remainder of the samples of milk below standard. The percentage of the adulterated samples of milk in which it was not thought advisable to institute legal proceedings was 23-5 which is markedly below the average. In the four cases in which convictions were obtained the aggregate of fines and costs amounted to £44 2s. and the average amount paid by the defendants was £11 0s. 6d. The fines amounted to 15 per cent. of the maximum which might have been inflicted. Ninety-four samples of butter were taken, 93 of which were returned as genuine, 62 were reported as containing boric acid not exceeding 0.5 per cent. in each. In one instance water was present in excess of the amount allowed by law, and a warning letter was sent to the vendor. Fifty-six samples of margarine were taken, all of which were returned as genuine. Fifty-three contained boric acid but not exceeding0-5 percent. in a.ny case. In two instances legal proceedings were instituted for selling margarine in unstamped wrappers. Convictions were obtained in both, one penalty being £1 and the other 10s. - Of the 100 samples of vinegar taken six contained excessive water, ranging from 1 to 8 per cent. No proceedings were taken. Three samples of mustard contained wheat flour 15 per cent. and turmeric traces in each. One vendor was summoned, the Council being allowed 10s. 6d. costs. Three samples of shredded suet were each found to contain moisture. In one wheat and rice flour and in the other two rice flour was also present. No proceedings were instituted owing to the fact that each sample had a label attached disclosing the presence of the foreign ingredients. Three samples of non-alcoholic wine contained salicylic acid, ranging from 0.2 to 1.1 grains per pint. One sample of borax contained arsenic 75 parts per million in excess of the B.P. limit for purified borax. No action was taken. One sample of sago was, on analysis, found to be tapioca. No action was taken. 38 One sample of seed tapioca contained 1.9 per cent. rice. No action was thought necessary. One sample of sausage contained 2.1 grains boric acid. No action was taken. The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts 'for the years 1902-1924 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 71 253 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 931 109 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 1924 1051 101 37 3.5 17 17 11 49 9 0 656 17 6 The percentage of samples found adulterated was markedly below the average for recent years. With reference to the convictions in 1924, in 2 instances the defendants had been previously convicted once. The remaining 4 were first convictions under the Sale of Food and Drugs Acts. BAKEHOUSES. The usual inspection of the bakehouses in the Borough was carried out. The number on the register at the end of the year was 61. Of these 36 are below ground 39 level. In 25 electric power is used in connection with the process of bread making. In 12 cleansing and lime-washing were required, and in six there were infringements of Section 8 of the London County Council (General Powers) Act, 1908. Sanitary notices were served in all cases and were duly complied with. There was no necessity for specially bringing any of the bakehouses under the notice of the Sanitary Authority. RAG FLOCK ACT, 1911. Four samples were taken and submitted for analysis. These all complied with the requirements of the law, none exceeding the 30 parts per 100,000 soluble fhlorine allowed. STAFF. Early in the year Miss A. C. Andrews was appointed sister at the Maternity and Child Welfare Centre, Kingsland Road, and commenced her duties at the beginning of February. Misses M. M. McCosh and M. Paterson, appointed staff nurses, commenced on 8th and 21st January respectively. The former nurse left the service of the Council at the end of the year, the vacancy being filled by Miss A. M. Smith. Misses E. Bergin and M. Martin were appointed probationers for 12 months commencing in January. The latter left in December. Misses A. Havenden and S. Sneyd were appointed additional probationers and commenced work in June. During the year there were three maids employed at the centre. One left at the end of February and the other two, one of whom filled the place of the first, left in October, the Committee having decided to employ non-resident cleaners. Mrs. Morgan, who was employed as non-resident cook, left the service of the Council in September. An additional porter was appointed in the person of Mr. J. E. Perry, who commenced duty in June. With regard to the office staff at the Town Hall, concerned with Maternity and Child Welfare Work, Miss E. Lehane and Mr. E. R. Banks, temporarily employed, were appointed permanently as members of the -clerical staff in May, and Mr. A. W. Scott was appointed junior clerk, and commenced work in July. From 18th February to 24th May Miss M. Roodhouse was temporarily employed as health visitor during the absence of Miss Williams through illness. The first session of the Dental Clinic at the Centre was held on 12th March under Mr. L. G. Ridout and Dr. Davie was appointed to give anaesthetics once a month. Towards the end of the year Dr. J. L. Hamilton was appointed emergency anaesthetist to act when required at the Dental Clinic. The last infant welfare session at the Haggerston Baths for weighings, &c., was held on 17th January, the session being then transferred to the Kingsland Road Centre, where an additional infant welfare consultation was established under ' Dr. Olivier Richards. There was nothing during the year calling for special comment as regards the staff under the Health Committee. In connection with the work under the Health Committee some 20,992 communications, written and printed, were despatched from the office during the year. These included 7,143 notices 40 and summonses, 4,422 letters, cards and other communications on matters under the Public Health and Sale of Food and Drugs Acts, 151 in connection with the work under the Factory and Workshops Acts, 7,716 on various matters connected with infectious disease, verminous cases and disinfection, and some 1,560 agendas and reports relative to the work of the department. In addition there were some 11,535 forms, milk books and cards, 7,490 letters and other communications, and 4,032 agendas, reports and other documents relating to the work under the Maternity and Child Welfare Committee, which were despatched during the course of the year. Altogether the number was just over 44,000, somewhat less than for last year, the decrease being mainly dtie to a falling off in the number of applications for milk. I have again to express my satisfaction with the way in which the various members of the staff have discharged their duties and my recognition of the assistance they have given, and also to acknowledge the valuable help rendered by the Assistant Medical Officer of Health and the Senior Inspector in the work of safeguarding the health of the people of Shoreditch during the year. I desire also to thank the Mayor, the Chairman and members respectively of the Health and Maternity and Child Welfare Committees, and the members of the Borough Council generally for their kind consideration and help in connection with the work of the year. I have the honour to be, Sir, Ladies and Gentlemen, Your obedient Servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. 41 Metropolitan Borough of Shoreditch. APPENDIX TO THE REPORT OF THE M EDICAL o FFICER OF H EALTH, CONTAINING Statistical Tables and Summaries of Proceedings under the Public Health and Factory and Workshops Act during the Year 1924, copy of the Report of the Tuberculosis Officer, 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, together with a Summary of the Work of the Medical Officers and Health Visitors in connection with Maternity and Child Welfare, and a Summary relating to the Infants admitted to the Wards at 210, Kingsland Road, during the Year prepared by the Assistant Medical Officer of Health. 43 TABLE I. Vital Statistics of the Borough of Shoreditch during 1924 and previous years' Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaihs belonging to the district. Uncorrected Number. Nett. Number. Rate. of Nonresidents registered in the District. of residents not regis tered in the District. Under 1 year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 142 204 408 301 102 1712 16.3 1923 106200 2552 2832 269 1191 11.2 191 370 232 82 1370 13.0 1924 106500 2336 2528 23.9 1309 12.3 232 367 221 87 1444 13.7 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 Number of inhabited houses Average number of persons per house 104,308 11,889 8.8 , At Census of 1921. * The birth rates 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. Cases of infectious disease notified during the Year 1924 in the Borough of Shoreditch. Notifiable Disease. 1 At all Ages. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Total Cases Removed to Hospital. Under 1. 1 to 5. At Ages —Years. 45 to 65. 65 and upwards. 1 2 3 4 5 6 7 8 Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. 5 to 15. 15 to 25. 25 to 45. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C), Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 381 12 161 143 43 21 1 ... 10 68 55 62 51 38 55 42 379 Erysipelas 54 4 3 5 6 16 12 18 4 8 10 8 7 9 4 4 26 Scarlet fever 366 2 151 190 17 6 ... ... 3 59 61 51 72 36 64 20 361 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 4 ... ... 3 ... 1 ... ... ... ... 3 ... ... 1 ... ... 4 Relapsing fever (R), Continued fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 10 ... ... ... 4 6 ... ... ... 3 ... ... 2 1 1 3 10 Cerebro-spinal meningitis 2 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 2 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 6 ... 6 ... ... ... ... ... ... 2 3 ... ... 1 ... ... 5 Encephalitis lethargica 21 ... 2 10 2 5 2 ... 2 1 1 3 4 4 4 2 19 Pulmonary'tuberculosis 215 ... 3 11 51 85 59 6 8 57 30 38 * 24† 18 19 21 212‡ Other forms of tuberculosis 51 1 8 18 16 5 1 2 ... 13 6 6 4 7 9 6 53‡ Ophthalmia neonatorum 76 76 ... ... ... ... ... ... ... 22 12 4 11 13 13 1 1 Acute primary pneumonia 317 57 173 26 24 18 12 7 4 63 50 59 57 30 27 27 242‡ Acute influenzal pneumonia 41 4 13 3 6 8 6 1 ... ... 6 26 2 2 3 2 10‡ Malaria 3 ... ... ... 2 1 ... ... ... 1 ... ... 1 ... 1 1 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1,547 156 521 410 171 172 93 24 31 297 237 258 235 161 200 128 1,325 44 * This Number includes the cases of consumption notified from the Holborn Institution, Highgate, † This includes the cases of consumption in the Shoreditch Institution. ‡ Removed to the Shoreditch Institution, Hospitals or Sanatoria. 45 TABLE III. Causes of, and ages at death during the Year 1924 in the Borough of Shoreditch. causes of death. Neti- Deaths at the subjoined Ages of Residents" whether occurring within or without the district (a). Totai. Deaths whether ok " 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) 1444 221 117 72 34 69 158 374 399 804 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric fever 1 ... ... ... 1 ... ... ... ... 1 2 Smallpox ... ... ... ... ... ... ... ... ... ... ...3 Measles 58 13 31 11 3 ... ... ... ... 2 4 Scarlet fever 2 ... ... 2 ... ... ... ... ... ... 5 Whooping cough 28 15 7 6 ... ... ... ... ... 19 6 Diphtheria and Croup 15 2 3 6 4 ... ... ... ... ... 7 Influenza 28 1 ... 2 ... 2 2 12 9 8 8 Erysipelas ... ... ... ... ... ... ... ... ... ... 9 Phthisis (pulmonary tuberculosis) 124 ... 1 2 2 21 51 44 3 68 10 Tuberculous meningitis 6 2 2 2 ... ... ... ... ... 4 11 Other tuberculous diseases 15 1 3 1 3 3 2 2 4 12 Cancer, malignant disease 126 ... ... ... ... ... 13 67 46 63 13 Rheumatic fever 1 ... ... ... 1 ... ... ... ... ... 14 Meningitis (see note (d) ) 8 2 1 3 1 ... 1 ... ... ... 15 Organic heart disease 43 ... ... ... 1 6 15 12 9 23 16 Bronchitis ... 197 21 5 5 ... ... 10 65 91 142 17 Pneumonia (all forms) 179 51 48 16 2 6 9 28 19 62 18 Other diseases of respiratory organs 2 1 1 5 19 Diarrhoea and Enter0itis (see note (e) 29 19 7 1 ... ... ... ... 2 13 20 Appendicitis and Typhlitis 9 ... ... ... 2 1 3 2 1 ... 21 Cirrhosis of liver 7 ... ... ... ... ... ... 3 4 5 2 la Alcoholism ... ... ... ... ... ... ... ... ... ... 22 Nephritis and Bright's disease 46 2 ... ... 1 3 4 18 18 39 23 Puerpural fever 1 ... ... ... ... 1 ... ... ... 1 24 Other accidents and diseases of pregnancy and parturition 8 ... ... ... ... 3 5 ... ... 4 25 Congenital Debility and malformation, including premature birth 67 67 ... ... ... ... ... ... ... 25 26 Violent deaths, excluding suicide 49 6 1 11 3 4 5 6 13 25 27 Suicides 17 ... ... ... ... 1 3 11 2 2 28 Other defined diseases 375 19 6 4 10 18 35 103 180 288 29 Diseases ill-defined or known 3 ... 2 ... ... ... ... ... 1 ... 1444 221 117 72 34 69 158 374 399 804 46 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH DURING THE YEAR 1924. 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 46 11 7 6 70 32 35 44 40 221 Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 2 2 9 13 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... 1 ... 1 ... 2 3 8 15 Diphtheria and Croup ... ... ... ... ... ... ... 2 ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... .... ... ... ... 1 ... 1 2 Abdominal tuberculosis (b) ... ... ... ... ... ... 1 ... ... 1 Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... 2 1 ... 3 Convulsions ... 2 ... ... 3 ... ... ... 2 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 4 2 8 3 18 Pneumonia (all forms) ... 1 2 ... 8 12 9 16 9 54 Diarrhoea ... • • • ... ... ... ... 2 2 4 8 Enteritis ... • • • ... ... ... 3 3 4 3 13 Gastritis ... • • • ... ... ... 1 ... ... ... 1 Syphilis ... 1 ... ... 1 1 3 ... ... 5 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... 1 ... 1 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 3 • • • ... ... 3 ... ... ... ... 3 Congenital malformations (c) 6 1 1 ... 8 1 1 ... ... 10 Premature birth 26 3 2 2 33 2 ... ... ... 35 Atrophy, Debility and ... ... ... ... ... ... ... ... ... ... V Marasmus 5 2 ... 2 9 5 5 3 ... 22 Other causes 2 1 ... ... 3 2 2 2 1 10 46 11 7 6 70 32 35 44 40 221 Nett Births in the year.—Legitimate, 2,471 ; illegitimate, 57. Nett Deaths in the year of legitimate infants, 212 ; illegitimate infants, 9. 47 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 1. (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 spinal meningitis. (e) Title 19 has been used for deaths from diarrhoea and enteritis at all ages. (In the " Short List " deaths from diarrhcea and enteritis under 2 years are included under 19 ; those at 2 years and over being placed under title 28.) NOTES TO TABLE IV. (a) The total in the last column of Table IV equals the total of column 10 of Table I and in column 3 of Table III. (b) Under abdominal tuberculosis have been included deaths from tuberculous peritonitis and enteritis, and from tabes mesenterica. (c) The total deaths from congenital malformation, premature birth, atrophy, debility and marasmus equal the total in Table III under the heading congenital debility and malformation, including premature birth. Want of breast milk has been included under atrophy and debility. (d) For references to the meaning of any other headings, see Notes to Table III. 48 49 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31ST DECEMBER, 1924. 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 G5. 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 13 31 11 3 ... ... ... ... ... ... ... ... ... ... 3 8 11 8 21 2 4 1 30 28 58 3 Scarlet fever ... ••• 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 2 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza 1 ... 2 ... ... 1 1 ... 2 4 8 4 3 2 2 l 5 9 5 2 3 1 14 14 28 6 Whooping cough 15 7 6 ... ... ... ... ... ... ... ... ... ... ... 2 9 6 2 2 2 5 ... 19 9 28 7 Diphtheria, membranous croup 2 3 6 4 ... ... ... ... ... ... ... ... ... ... ... 1 3 2 4 1 ... 4 4 11 15 8 Enteric fever ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhœa, dysentery 4 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... 1 1 3 3 6 11 Epidemic or zymotic enteritis 5 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 1 1 ... ... ... 7 2 9 12 Other allied diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Anthrax, splenic fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis 4 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 1 ... 2 1 ... ... 1 4 2 6 19 Gonorrhœea ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 20 Phagedœna, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Puerperal fever ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 23 Pyæmia, septicæmia 1 ... 2 1 1 ... ... 2 1 1 2 ... ... ... 1 ... ... ... 4 3 1 2 5 6 11 24 Infective endocarditis ... ... ... ... 1 3 ... 1 3 ... ... 1 ... ... ... ... 2 1 5 1 ... ... 5 4 9 25 Other allied diseases ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 26 Malarial fever ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 27 Rheumatic fever ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 28 Rheumatism of the heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis:— 29 Brain or meninges, acute hydrocephalus 2 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 2 ... 1 4 2 6 30 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Lungs ... 1 2 ... 2 7 14 22 29 28 16 3 ... ... 4 30 16 17 16 9 17 15 73 51 124 32 Intestines, tabes mesenterica 1 l ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 ... 3 1 4 33 General, position undefined ... 1 ... 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... 2 1 ... 1 ... 1 3 4 34 Other forms, scrofula ... l 1 ... 1 ... ... ... 2 1 1 ... ... ... ... ••• 2 1 3 ... ... 1 5 2 7 35 Other infective diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 Thrush ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 Hydatid diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Other diseases due to altered food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . .. ... ... ... ... 41 Acute alcoholism, delirium tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 ol 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 47 Cancer ... ... ... ... ... ... ... 2 9 23 39 29 16 1 6 23 18 23 18 10 9 12 68 51 119 48 Diabetes mellitus ... ... ... ... ... 1 ... ... ... ... 2 ... ... ... ... 1 1 ... ... 1 ... ... 1 2 3 49 Purpura hæmorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Hæmophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anæmia, leucocythæmia ... ... ... ... ... 1 ... 1 1 ... 1 1 ... ... ... ... ... 1 2 ... 1 1 2 3 5 52 Lymphadenoma, Hodgkin's disease ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 53 Premature birth 36 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 4 6 4 11 2 5 2 17 19 36 54 Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 Debility at birth 3 ... ... ... ... ... ... ... ... ••• ... ... ... ... ... 2 ... ... ... ... 1 ... 3 ... 3 56 Atelectasis 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 3 ... 3 57 Congenital defects 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 2 ... 1 ... I 6 4 10 58 Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Atrophy, debility, marasmus 18 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 5 1 2 1 1 4 12 6 18 60 Dentition 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... 2 1 3 61 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... 62 Old age, senile decay ... ... ... ... ... ... ... ... ... ... 4 27 40 12 2 6 21 8 19 8 11 8 40 43 83 63 Convulsions 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 1 1 ... 4 2 6 64 Meningitis 2 ... 2 ... 1 ... ... ... 1 ... ... ... ... ... ... 3 ... 2 ... 1 ... ... 3 3 6 65 Encephalitisj ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 66 Apoplexy ... ... ... ... ... 1 ... ... 2 3 12 15 5 1 1 6 7 6 7 3 6 3 16 23 39 67 Softening of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... 3 1 ... ... ... 1 2 2 4 69 General paralysis of insane ... ... ... ... ... ... ... 1 5 3 ... ... ... ... ... 2 ... 1 1 3 1 1 8 1 9 70 Other forms of insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 2 ... 1 ... ... ... 2 2 4 73 Epilepsy ... ... ... ... 1 ... 1 ... ... 2 2 2 ... ... ... 2 3 1 2 ... ... ... 4 4 8 74 Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... 75 Locomotor ataxy ... ... ... ... ... ... ... ... ... 1 2 1 1 ... 1 1 ... 2 ... 1 ... ... 5 ... 5 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... ... 1 ... 1 ... ... 2 ... 1 ... ... 1 ... ... 1 1 ... 4 4 77 Other diseases of brain or nervous system ... .... 1 ... ... ... ... 1 1 ... ... ... ... ... ... 1 2 ... ... ... ... ... 1 2 3 78 Otitis, otorrhœa ... 1 ... ... 1 1 ... 1 ... 1 ... ... ... ... 1 ... 2 ... 2 ... ... ... 4 1 5 79 Diseases of nose, epistaxis ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 82 Endocarditis, valvular diseases of the heart ... ... ... ... 1 3 3 8 7 8 4 7 2 ... 1 11 2 11 4 8 3 3 19 24 43 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... 1 1 ... 1 ... ... 3 ... 3 85 Aneurism ... ... ... ... ... ... ... ... 1 1 5 ... ... ... ... 3 1 1 1 1 ... ... 5 2 7 86 Senile gangrene ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... 1 1 ... 1 2 3 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and, ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular ... 1 ... ... ... 3 2 1 4 12 25 33 14 2 ... 21 15 13 21 9 9 9 54 43 97 5X 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 21 5 5 ... ... ... ... ... ... 3 4 2 2 1 1 10 9 5 7 5 2 4 23 20 43 95 Chronic bronchitis ... ... ... ... ... ... ... 2 8 20 38 53 27 6 3 29 27 22 24 16 15 18 88 66 154 96 Lobar croupous pneumonia 1 3 ... ... 2 ... 2 1 4 11 4 6 ... ... 1 5 3 11 6 4 1 3 22 12 34 97 Lobular broncho-pneumonia 47 41 13 ... ... ... ... ... 1 2 3 4 3 ... 5 24 21 14 12 13 13 12 52 62 114 98 Pneumonia, form not stated 3 4 3 ... ... 3 1 1 2 4 4 6 ... ... ... 6 10 4 3 4 2 2 14 17 31 9,9 Emphysema, asthma ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 1 100 Pleurisy ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... 1 1 101 Other and ill-defined diseases of respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of œsophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... 4 3 1 ... ... ... ... 1 1 2 1 ... 2 1 7 1 8 106 Other diseases of stomach 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 2 107 Enteritis 10 1 1 ... ... ... ... ... ... ... ... 2 ... ... ... 5 1 2 4 1 ... 1 8 6 14 108 Appendicitis ... ... ... 2 ... 1 ... 2 1 2 ... 1 ... ... ... 1 1 ... 3 1 1 2 5 4 9 109 Obstruction of intestine 2 ... ... ... 1 ... ... ... ... 2 2 2 ... ... ... 2 2 1 ... 1 1 2 5 4 9 110 Other diseases of intestine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1ll Cirrhosis of liver ... ... ... ... ... ... ... ... ... 2 1 4 ... ... ... 2 1 1 1 1 ... 1 7 ... 7 112 Other diseases of liver ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 1 ... ... ... ... ... 2 2 113 Peritonitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114 Other and ill-defined diseases of digestive system ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 2 115 Diseases of lymphatic system and ductless glands 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... l ... ... ... 2 2 116 Acute nephritis 2 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... 1 1 ... 1 ... 2 2 4 117 Bright's disease ... ... ... 1 ... 1 1 ... 4 10 7 11 4 3 2 8 4 3 9 5 6 5 26 16 42 118 Calculus ... ... ... ... ... l ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 119 Diseases of bladder and prostate ... ... ... ... ... ... ... ... ... ... 4 5 3 ... ... 6 ... 1 1 1 2 1 10 21 12 120 Other and ill-defined diseases of urinary system ... ... ... l ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 2 121 Diseases of testes and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 2 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 129 Placenta prævia, flooding ... ... ... ... ... ... ... 1 2 ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... 3 3 130 Puerperal thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 2 132 Arthritis, ostitis, periostitis ... ... 1 2 ... l ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 3 1 4 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... 2 ... 2 04 55 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. 85 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 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 136 Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 137 Other and ill-defined diseases of integumentary system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... ... By Accident or Negligence: 138 In mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In vehicular traffic ... ... 6 ... ... 2 ... ... 1 1 2 2 1 ... 1 4 3 1 2 2 1 1 10 5 15 140 On railways ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 ... ... ... ... ... ... 2 ... 2 145 Burns and scalds 1 1 3 1 ... ... ... ... ... ... ... 2 ... 1 1 ... 2 1 1 2 2 ... 5 4 9 146 Poisons, poisonous vapours ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 147 Surgical narcosis ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 151 Suffocation, overlaid in bed... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... l ... ... ... ... ... ... 2 2 1 3 152 Suffocation otherwise 2 ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 1 2 153 Falls, not specified ... ... 1 1 1 ... ... 1 2 1 3 2 ... 3 3 2 1 ... 2 1 6 6 12 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 155 Otherwise, and not stated ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... 1 ... ... ... 1 2 3 156 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suicides, all forms :— 157 By poison ... ... ... ... ... ... ... 1 1 ... 4 ... ... ... ... 2 ... ... 2 1 ... 1 3 3 6 158 By asphyxia ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 1 1 ... ... 1 3 ... 3 159 By hanging and strangulation ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 160 By drowning ... ... ... ... ... 1 ... ... ... 3 ... ... ... ... ... ... 1 ... 1 ... ... 1 3 1 4 161 By shooting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 162 By cut or stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 163 By precipitation from elevated places ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 164 By crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 By other and unspecified methods ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 168 Other ill-defined and not specified causes ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 1 ... ... ... ... ... 1 2 3 169 Malignant disease ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 3 ... 1 1 ... 1 ... 5 2 7 170 Abscess ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 1 1 2 171 Cerebro-spinal fever ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... 2 Totals 221 117 72 20 14 36 33 53 105 162 212 234 133 32 52 270 247 208 248 140 142 137 800 644 1444 56 TABLE VI.— ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1924. DISTRICTS. Estimated Population 1924. 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 1924 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. *Fever. †Diarrhcea Tuberculous Disease. Violence. 1921. 1922. 1923. 1924. London 4,564,109 18.7 12.4 13.4 11.2 12.1 0.6 0.00 0.29 0.03 0.12 0.11 0.01 0.16 1.1 0.44 69 8.6 ... 0.1 Shoreditch ‡105,500 23.9 14.4 16.3 13.0 13.7 1.2 ... 0.55 0.02 0.14 0.26 0.00 0.24 1.3 0.62 87 11.3 64.2 ... Wards. Moorfields 4,520 23.0 14.5 16.2 11.7 11.5 1.3 ... 0.66 ... ... 0.44 ... 0.22 1.10 0.88 115 13.4 71.1 ... Church 18,500 24.2 15.9 18.7 13.1 14.6 1.4 ... 0.43 ... 0.05 0.46 ... 0.46 1.73 0.59 83 8.8 66.2 ... Hoxton 16,100 25.5 14.1 17.9 14.1 15.3 1.7 ... 0.68 0.06 0.18 0.37 0.06 0.37 1.18 0.80 95 14.1 62.7 ... Wenlock ‡13,760 27.6 15.9 16.2 13.3 15.1 1.1... 0.58 0.07 0.14 0.14 ... 0.14 1.45 0.50 71 10.5 60.4 ... Whitmore §18,780 22.9 14.0 16.0 13.0 13.2 1.6 ... 1.12 ... 0.21 0.10 ... 0.21 147 0.59 104 10.4 70.9 ... Kingsland 10,570 24.0 14.2 13.2 12.8 13.2 0.5 ... 0.19 ... 0.09 0.19 ... 0.09 1.04 0.66 86 11.4 55.7 ... Haggerston 11,120 22.0 13.3 14.1 13.1 12.7 0.9 ... 0.36 ... ... 0.45 ... 0.09 1.70 0.54 85 11.9 65.5 ... Acton 12,150 21.0 12.5 16.1 11.8 11.2 0.5 ... 0.08 ... 0.33 ... ... 0.16 1.39 0.57 70 11.6 59.1 ... * Fever includes typhus, typhoid and continued fevers. † Diarrhœa 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, O'OO 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 1923. 57 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1924. TABLE VII. PREMISES. NUMBER OF PLACES- Number of inspections, 1924. Number of notices, 1924. Number of prosecutions, 1924. On register at end of 1923. Added in 1924. Removed in 1924. On register at end of 1924. Milk premises 255 17 16 256 1,665 15 ... Cowsheds 2 ... ... 2 19 ... ... Slaughterhouses 2 ... ... 2 38 ... ... Other offensive trade premises 4 18 ... 22 66 11 ... Ice Cream premises 117 10 ... 127 293 29 ... Registered houses let in lodgings 296 12 3 305 1,917 338 ... Number of intimation notices served for all purposes 6,224 Overcrowding Number of dwelling rooms overcrowded 44 Number remedied 19 Number of prosecutions 1 Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 355 Underground rooms:— Number dealt with during year 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 Customs and Inland Revenue Acts:— Number of dwellings for which applications were received during the year Number of prosecutions under Bye-laws under Public Health (London) Act, 1891:— With respect to water closets, earth closets, &c. 3 Mortuary:— Total number of bodies removed 171 Total number of infectious bodies removed 58 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK DURING THE YEAR 1924. 1.—Inspection. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 564 62 ... Workshops (Including Workshop Laundries and Bakehouses) 3,743 476 2 Workplaces (Excluding Outworkers' premises dealt with in Table III.) 1,106 130 ... Totals 5,413 668 2 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:* Want of cleanliness 439 439 ... ... Want of ventilation 1 1 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 798 798 ... 2 Sanitary accommodation insufficient 19 19 ... ... unsuitable or tive 256 256 ... ... 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 1,513 1,513 ... 2 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 59 3.—Home Work—1924. nature of work. outworkers' lists, section 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 and 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made. (S.109.) Prosecutions. (S.109, 110.) Twice in the Year. Once in the Year. Failing to keep or permit inspection of Failing to send Lists. Outworkers. Lists. Outworkers. Lists. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing apparel:— (1) Making, &c. 38 25 453 6 1 65 ... ... ... 57 57 ... 14 ... ... (2) Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Artificial flowers ... ... ... 1 ... 10 ... ... ... 3 3 ... 3 ... ... Fur pulling ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... 5 5 ... 2 ... ... Paper bags and boxes 16 ... 149 2 ... 38 ... ... ... 51 51 ... 13 ... ... Brush making ... ... ... ... ... ... ... ... ... 6 6 ... 1 ... ... Xmas Crackers ... ... ... ... ... ... ... ... ... 4 4 ... ... ... ... Totals 54 25 602 9 l 113 ... ... ... 129 129 ... 33 ... ... (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. 60 4.—Registered Workshops—1924. Workshops on the Register (s.131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades 1,023 (a) Cabinet making 600 (b) French polishing 108 (c) Upholstery 61 (d) Other workers 254 (2) Dress 143 (a) Tailoring 59 (e) Shirt making 1 (b) Mantles 8 (f) Boot and shoe trades 18 (c) Dress 5 (g) Artificial flowers 3 (d) Millinery 5 (h) Other workers 44 (3) Skin, leather, hair and feather trades 63 (a) Furriers 16 (b) Saddlery and Harness 9 (c) Feathers — (d) Other workers 38 (4) Paper, printing, book, stationery and fancy goods trades 54 (a) Box and bag makers 32 (b) Other workers 22 (5) Laundry and washing 4 (6) Food 14 (7) Metals, machines, implements and conveyances 35 (8) Precious metals, jewels, &c. 3 (9) Other trades than those mentioned above 108 Total number of workshops on Register 1,447 Note.— A separate register is kept for bakehouses, the number of which in use at the end of the year was 61, including 25 factory bakehouses. 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s.133). 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s.5.) Notified by H.M. Inspector 76( referring to 20 factories and workshops.) Reports (of action taken) sent to H.M. Inspector. 3(referring to 20 factories and 56 workshops.) Other 21 Underground Bakehouses (s.101):— Certificates granted during the year Nil. In use at the end of the year 36 61 6.—Showing the Numbers of Outworkers Received from other Districts during 1924. districts. Making Wearing Apparel. Confectionery Packing. Artificial Flowers. Furniture and Upholstery. Fur Pulling. Feather Sorting. Umbrellas, &c. Paper Bags and Boxes. Brush Making. Fancy Leather Goods. Crackers and Toys. Totals. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Battersea 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Bermondsey ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Bethnal Green 46 47 ... ... ... ... ... ... ... ... ... 1 ... ... 51 50 11 9 ... ... 1 1 217 Bromley ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Camberwell 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 City of London 244 260 ... ... 11 12 ... ... 11 10 ... 5 22 26 4 1 ... ... 2 6 3 2 619 Chelsea 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Enfield 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Finsbury 49 63 ... ... 16 12 l ... 2 4 3 16 ... ... 41 35 ... ... 3 ... 9 22 276 Hackney 125 120 ... ... 1 5 4 5 1 1 ... ... ... ... 18 10 9 9 ... ... 5 5 318 Hertford ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... 4 Holborn 6 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hornsey 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Islington 13 30 ... ... 3 ... ... ... ... ... 2 ... ... ... 15 13 4 4 ... ... 2 1 92 Kensington ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Lambeth ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Poplar 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 Southwark 1 2 ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 6 St. Marylebone 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Stepney 8 15 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 5 8 ... ... ... ... 37 St. Pancras 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Stoke Newington 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Tottenham 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 4 Westminster 17 20 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 38 Willesden ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Totals 528 584 31 35 5 5 14 17 5 22 23 26 133 110 29 34 5 6 21 32 1,665 1,112 66 10 31 27 49 243 63 11 53 62 SHOREDITCH TUBERCULOSIS DISPENSARY. REPORT FOR 1924. by Alfred Leitch, M.B., Ch.B., Acting Tuberculosis Officer. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, I have much pleasure in Submitting the following report for the year 1924 The total number of attendances during the year was 6,088, and the number of persons attending the Dispensary was 1,203; of these 509 were suffering from some form of tuberculosis. New persons examined for the first time number 657, 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, 532 examinations were made, and the same number of reports sent to various War Pensions Authorities. During the year 169 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 the Department have been of the greatest assistance to me, and have carried out their duties to my satisfaction. Statistical Report, 1924. 1924. 1923. Total attendances ... ... ... 6,088 6,390 ' Total new patients examined for the first^p time ... ... ... ••• 657 716 Renewed cases ... ... ... ... 546 630 Sisters' visits ... ... ... ... 2,816 2,682 Medical Officers' visits " 258 361 All New Persons Examined. Tuberculous. Suspects. NonTuberculous. Totals. Contacts 47 17 279 343 Other new cases 99 20 195 314 Totals 146 37 474 657 63 Detailed Analysis of all New Persons attending for the first time. Insured. Non-Insured. Totals Under 15 years. Over 15 years. M. F. M. F. M. F. Total new persons 158 99 129 126 56 89 657 Pulmonary Tuberculosis 59 30 2 3 30 22 146 Non-Pulmonary Tuberculosis 2 1 5 6 1 2 17 Suspects 11 9 5 3 7 2 37 Non-Tuberculous 86 59 117 114 18 63 457 Analysis of all Persons attending this Dispensary during 1924. Under 15 years. Over 15 years. Totals. Ins. Non-Ins. Males 110 356 121 587 Females 214 188 214 616 Totals 324 544 335 1,203 Tuberculous. Males 32 220 67 319 Females 26 77 87 190 Totals 58 297 154 509 64 The New Persons examined, and the attendances each month were as follows New Persons Examined. Attendances. Insured. NonInsured. Totals. Insured. NonInsured. Totals. January .. 31 44 75 361 266 627 February .. 20 71 91 299 308 607 March 28 34 62 296 271 567 April 28 28 56 290 219 509 May 21 40 61 334 217 551 June 25 22 47 280 189 469 July 18 44 62 296 211 507 August 14 7 21 259 139 398 September 19 30 49 279 173 452 October .. 22 25 47 315 169 484 November.. 18 33 51 268 194 462 December .. 12 23 35 281 174 455 Totals 256 401 657 3,558 2,530 6,088 Total number of persons attending during the year 1924. Insured .. .. .. .. .. 544 Non-insured .. .. .. .. 659 Total .. 1,203 In addition to the foregoing, the following information may also be given:—■ Bacteriological examinations ... ... ... ... ... 693 Number of examinations made and reports sent to the Local - War Pensions Authority ... 532 Number of persons recommended for Institutional treatment 169 Number of Progress Reports sent to the London County Council ... ... ... ... ... ... ... 175 Number of patients sent by Doctors ... 172 SCHOOL CHILDREN'S SESSIONS. The change in day and time of the special session for school children has resulted in a great increase in the number of children attending. At 28 sessions held on Saturday mornings, the total attendances were 27 and the number of patients examined 16. At 23 sessions held on Tuesday afternoons, the total attendances were 130, and the number examined 73. For the last 13 sessions in the year, when the scheme was in full working order, the tQtal attendances were 111, and the number examined 56. Alfred Leitch. 65 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Table VIII.—Summary of Notifications during the Period from the 30th December, 1923, to the 3rd January, 1925, 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 ... 2 l 6 12 14 20 26 23 18 5 127 227 ... ... ... ... ... 59 85 „ Females ... 1 l 3 9 16 22 17 14 4 1 88 144 ... ... ... ... ... 29 39 Non-pulmonary, Males ... 5 7 4 4 4 4 ... 1 ... 1 30 40 ... ... ... ... ... 8 22 ,, Females l 3 2 4 6 2 1 ... ... ... 1 20 31 ... l ... 1 2 7 16 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, E are included in this column. 66 TABLE IX. Summary compiled from the Abstracts of the work of the Sanitary Inspectors by the Senior Inspector, for the Year 1924. 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 75 25 9 55 17 53 75 10 22 86 29 456 partially 148 348 196 316 215 291 325 164 215 213 391 2,822 ,, ,, total rooms 445 1382 615 948 630 1130 1408 422 946 853 1101 9,880 ,, ,, verminous rooms 39 43 20 53 7 16 240 32 68 55 93 666 Premises generally repaired—Walls, floors, sashes, &c. 205 315 300 274 283 201 463 110 351 319 300 3,121 Light and ventilation improved • • • 14 6 ... 1 3 2 • • • • • • 1 • • • 27 Roofs, guttering, rain water pipes improved or repaired 103 352 405 348 186 181 414 109 402 195 343 3,038 Overcrowding dealt with • • • • • • 10 5 1 4 3 4 4 7 6 44 Water reinstated or improved • • • 22 6 1 3 • • • 3 • • • 7 4 16 62 Drains newly constructed 2 2 5 • • • • • • 8 • • • 3 3 3 • • • 26 ,, re-constructed 10 8 2 8 17 • • • 16 2 3 4 7 77 „ improved or repaired 9 22 43 25 44 27 34 8 19 19 40 290 ,, obstructions removed 9 24 37 34 54 26 30 17 25 22 24 302 Soil and vent pipes—Improved or repaired 9 1 4 5 1 • • • 9 1 3 • • • 7 40 Water closets—newly constructed 28 7 • • • 8 2 11 2 13 6 10 • • • 87 ,, improved or repaired 86 76 79 163 46 216 117 188 105 85 147 1,308 ,, obstructions removed 9 20 21 54 16 31 36 16 12 11 51 277 Sinks, etc., improved, cleansed or repaired 32 21 22 19 14 22 24 27 12 20 16 229 Sinks, etc., traps provided 5 1 1 5 2 3 2 1 • • • • • • • • • 20 Outdoor premises— Floors or paving repaired 6 39 29 42 34 45 77 3 59 55 49 438 Cleansed or limewashed 80 300 151 87 78 43 270 63 83 228 192 1,575 Improved or repaired • • • • • • 1 • • • • • • • • • • • • • • • • • • • • • • • • 1 Ash-pits—Dust-bins provided 18 89 76 32 57 78 88 64 53 88 99 742 „ Improved or repaired 3 • • • 1 16 • • • • • • • • • 1 • • • 1 5 27 ,, Abolished • • • • • • 2 2 • • • 1 4 • • • 7 2 1 19 Accumulations removed 29 7 19 1 4 74 25 3 • • • 14 27 213 Urinals cleansed or repaired 3 • • • 3 • • • • • • 7 • • • • • • • • • 2 1 16 Animals removed • • • 1 1 • • • 3 2 4 3 • • • 1 1 16 67 SUMMARY OF LEGAL PROCEEDINGS DURING 1924. PUBLIC HEALTH (LONDON) ACT, 1891. In seven instances summonses, were withdrawn on the work being done. Costs amounting to £3 13s. 6d. were allowed to the Borough Council. Nuisance orders were made in 30 instances, costs amounting to £19 8s. 6d. being ordered to be paid to the Council. In 34 instances the Statutory Notices were complied with before the cases came on for hearing, £20 11s. being ordered to be paid to the Council. In one instance, for non-compliance with a Statutory Notice, the defendant was fined £3 and ordered to pay £2 2s. costs, and in one instance the defendant was fined £1 without costs. In one instance, for non-compliance with the Magistrate's order, the defendant was fined £3 and ordered to pay £1 1s. costs, and in another instance the defendant was fined £1 without costs. In one instance for exposing unsound food for sale, the vendor was ordered to pay £1 1s. costs, and in, one instance the vendor was fined £8 and ordered to pay £2 2s. costs. BREACHES OF LONDON COUNTY COUNCIL BYE-LAWS. In three instances the defendants were ordered to pay £1 1s. each costs to the Borough Council, in one instance £2 2s. and in one instance 2s. METROPOLITAN PAVING ACT, 1817, SECTION 65. Eight defendants were fined altogether £2 5s. for refusal to remove their stalls from the public highway, one case was dismissed and one defendant was bound over in sum of 40s. for six months. 68 METROPOLITAN BOROUGH OF SHOREDITCH. HOUSING CONDITIONS. Statistics. Year ended 31st December, 1924. 1.—General. (1) Estimated population 106,500 (2) General death-rate 13.7 (3) Death-rate from tuberculosis 1.3 (4) Infantile mortality 87 (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) 9,442 (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. (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit- Nil. (a) by owners (b) by Local Authority in default of owners (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 69 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6,224 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 6,224 (b) by Local Authority in default of owners — C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders (2) Number of dwelling-houses in respect of which Closing Orders were made (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in suance of Demolition Orders Nil. 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I, or (b), Part II, of the Act of 1890:— (1) Name of area (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced Nil. 4.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 Nil. 5.—Staff engaged on housing work, with, briefly, the duties of each officer So much of the time of the Medical Officer of Health, Senior Inspector, eleven Sanitary Inspectors and five Clerks as may be necessary. The duties are as required under the various Acts relating to the Health and Housing. In addition, it may be mentioned that the services of the Borough Surveyor and his staff, together with those of one Superintendent, a Caretaker, an Assistant Caretaker, and eight 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. 70 METROPOLITAN BOROUGH OF SHOREDITCH. MATERNITY AND CHILD WELFARE. Summary of Work for the Year 1924. BY Dr. Maitland Radford. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. Totals. No. of 1st visits to infants 389 392 440 397 476 525 2,619 No. of re-visits to infants 497 1,007 652 606 778 1,767 5,307 No. of visits to children (1-5 years) 963 1,175 1,049 1,329 823 2,231 7,570 No. of 1st visits to expectant mothers 76 79 101 79 139 215 719 No. of re-visits to expectant mothers 25 132 52 95 84 191 579 No. of 1st visits to infants with diarrhœa • • • • • • 9 • • • • • • • • • 9 No. of 1st visits to cases of ophthalmia neonatorum 12 10 20 19 12 • • • 73 No. of re-visits to cases of ophthalmia neonatorum 10 24 19 20 26 • • • 99 No. of 1st visits to cases of puerperal fever 1 2 3 • • • • • • • • • 6 No. of futile visits 210 228 55 195 159 386 1,233 Special visits, dairies, etc 72 • • • 35 • • • 81 • • • 188 Health Visitors' attendances— (a) Haggerston Baths Centre • • • • • • 3 • • • • • • • • • 3 (b) Town Hall Centre 43 • • • 4 40 20 • • • 107 (c) Hoxton Hall Centre 33 • • • 23 48 • • • • • • 104 (d) Maternity Centre 94 195 127 125 133 • • • 674 (e) Harbour Lights Centre • • • 47 46 • • • 49 • • • 142 (f) School for Mothers Centre • • • • • • • • • • • • 1 294 295 1st attendances of infants and children at Weighing Centres— (a) Haggerston Baths Centre • • • • • • 11 • • • • • • • • • 11 (b) Town Hall Centre 92 • • • • • • • • • • • • • • • 92 (c) Hoxton Hall Centre • • • • • • • • • 97 • • • • • • 97 (d) Maternity Centre 58 265 199 69 196 • • • 787 (e) Harbour Lights Centre • • • • • • 266 • • • 26 • • • 292 (f) School for Mothers Centre • • • • • • • • • • • • • • • 500 500 Total attendances at Centres— (a) Haggerston Baths Centre • • • • • • 188 • • • • • • • • • 188 (b) Town Hall Centre 1,854 • • • • • • • • • • • • • • • 1,854 (c) Hoxton Hall Centre • • • • • • • • • 3,235 • • • • • • 3 235 (d) Maternity Centre 911 3,949 2,224 1,393 3,008 11,585 (e) Harbour Lights Centre • • • • • • 3,732 • • • 129 • • • 3 861 (f) School for Mothers Centre • • • • • • • • • • • • • • • 5,040 5,040 Dr. Richards (Maternity Centre). No. of infants seen for 1st time • • • 143 189 • • • • • • • • • 332 No. of children (1-5 yrs.) seen for 1st time • • • 71 107 • • • • • • • • • 178 Total attendances of infants and children • • • 918 593 • • • • • • • • • 1,511 Dr. Smith (Maternity Centre). No. of infants seen for 1st time 66 • • • • • • 55 • • • • • • 121 No. of children (1-5 yrs.) seen for 1st time 17 • • • • • • 4 • • • • • • 21 Total attendances of infants and children 688 • • • • • • 1,034 • • • • • • 1,722 No. of expectant mothers seen for 1st time 26 75 61 19 79 • • • 260 attendances of expectant mothers 75 129 103 39 90 • • • 436 71 MATERNITY AND CHILD WELFARE—continued. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. Totals. Dr. Radford (Maternity Centre). No. of infants seen for 1st time • • • • • • • • • • • • 189 • • • 189 No. of children (1-5 yrs.) seen for 1st time • • • • • • • • • • • • 98 • • • 98 Total attendances of infants and children • • • • • • • • • • • • 875 • • • 875 Dr. Radford (Town Hall Centre). No. of infants seen for 1st time 73 • • • • • • • • • • • • • • • 73 No. of children (1-5 yrs.) seen for 1st time 16 • • • • • • • • • • • • • • • 16 Total attendances of infants and children 595 • • • • • • • • • • • • • • • 595 Dr. Radford (Hoxton Hall Centre). No. of infants seen for 1st time • • • • • • • • • 77 • • • • • • 77 No. of children (1-5 yrs.) seen for 1st time • • • • • • • • • 16 • • • • • • 16 Total attendances of infants and children • • • • • • • • • 777 • • • • • • 777 Dr. Radford (Harbour Lights Centre.) No. of infants seen for 1st time • • • • • • 183 • • • 26 • • • 209 No. of children (1-5 yrs.) seen for 1st time • • • • • • 121 • • • 32 • • • 153 Total attendances of infants and children • • • • • • 789 • • • 129 • • • 918 Dental Clinic (Maternity Centre). No. of 1st attendances 2 21 12 26 23 34 118 Total No. of attendances • • • 59 • • • 80 • • • 105 244 Dr. Tribe (School for Mothers). No. of expectant mothers seen for 1st time • • • • • • • • • • • • • • • 88 88 Total attendances of expectant mothers • • • • • • • • • • • • • • • 139 139 Dr. Pratt (School for Mothers). No. of infants seen for 1st time • • • • • • • • • • • • • • • 370 370 No. of children( 1-5 yrs.) seen for 1st time • • • • • • • • • • • • • • • 130 130 Total attendances of infants and children • • • • • • • • • • • • • • • 3,726 3,726 No. of attendances at Sewing Classes 61 54 12 116 162 302 707 Interviews connected with work 199 209 677 287 185 722 2,279 Report on Infants attending Doctors' consultations. No. suffering from disorders of digestion and nutrition 602 667 149 769 224 • • • 2,411 No. suffering from other minor ailments 289 115 169 527 247 • • • 1,347 No. referred to Hospital or to Medical Practitioner 120 89 88 133 175 • • • 605 72 METROPOLITAN BOROUGH OF SHOREDITCH. Statistical Summary relating to Infants Admitted to the Municipal Model Welfare Centre, 210, Kingsland Road, for the year 1924:— (1) Number of cases admitted—39. (2) Average duration of stay—7 weeks. (3) Reasons for admission and the number of cases under certain specified heads:— Marasmus 15 Rickets 3 Debility 9 Dyspepsia 2 Enteritis 5 To establish breast feeding 2 Cleft palate and marasmus 1 Re-admission after neglect at home 1 Prematurity (2 lbs. 10 ozs.) 1 (4) Number of cases discharged during the year:— (a) In good health 12 (b) Improved 15 (c) No improvement 2 against medical advice. 1 admitted in error and discharged after three days, and 1 discharged after three days at request of mother. (5) There were no cases of measles, whooping cough, epidemic diarrhœa or other infectious illness. (6) Number of deaths—One, a male infant, age four weeks and five days. (а) Date of death—March 26th, 1924. (b) Cause of death—Enteritis. (c) Period of residence—20 days. (7) There were no discharges on account of illness, infectious or otherwise.