SHOR 31 REPORT on the health and Sanitary Condition of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1926, BY LEWIS T. FRASER BRYETT, M.D. (LOND.) Medical Officer of Health ; Diplomate in Public Health, Royal Colleges of Physicians and Surgeons; Fellow of the Incorporated Society of Medical Officers of Health ; and of the Royal Institute of Public Health, &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—C. E. TAYLOR, Esq., J.P. (Mayor). Chairman—Councillor T. W. brown. Vice-Chairman—Councillor Dr. S. W. Jeger. Alderman Land, C. Councillor Baker, J. S. „ Belcher, S. P. L. „ Conyers, G. W. „ Ellwood, Mrs. L. „ Gates, P. E. ,, Green, A. „ Harvey, Mrs. J. „ Kempson, A. E. „ Mitchell, A. „ O'Connor, Mrs., M. „ Saltzberg. L. „ Thurtle, Mrs. D. Chairman—Councillor W. E. Yarrow. Vice-Chairman—Councillor E. Lay. Alderman Girling, Mrs. H., J.P. M.A.B. Councillor Belcher, S. P. L. ,, Bicknell, C. „ Ellwood, Mrs. L. „ Harvey, Mrs. J. „ O'Connor, Mrs. M. „ Ricketts, W. „ Varnals, G. j. (Co-opted) Boge, Miss F. M. „ Colville, Lady Cynthia. „ Fairchild, Mrs. E. M. „ Jeger, Mrs. „ Land, Mrs. Sanitary Inspectors. C. J. Wright. H. G. Chapman. W. Sickelmore. J. H. Pearson, Senior J. H. Thomas F. C. Shaw. J. B. Molloy. Inspector. R. A. Bishop. T. W. Girling. A. Stratton. D. Grant. G. Walker. Health Visitors. Miss I. M. Heward. Miss G. H. Williams. Miss A. E. Barnes. Miss B. C. Hunt. Miss M. Morrell. Miss A. M. Brotherton. Tuberculosis Nurse. Mrs. Grange. Rat Officer. E. T. D. Jordan. Clerical Staff. H. P. Abbott. E. J. Hayes. W. Harris. G. H. Pratt. G. C. E. Gibbs. W. L. Job. Mrs. I. M. Rutherford. E. R. Banks. Miss E. Lehane. H. Fitzgerald. A. W. Scott. E. Crawley (Part time Enquiry Officer). Staff of Model Maternity Centre, Kingsland Road. Miss M. D. Borrow, Matron. Misses M. D. Wenham and T. Boon (Staff Nurses). Miss A. C. Andrews, Sister. Misses M. Williams, Z. E. Halliday, M. E. Miss E. Riggs (Cook). Lamb and E. Axtens (Probationers). Mrs. M. Calnan, Mrs. G. Marshall and Mrs. J. McDonnell (Cleaners and Waitresses). J. P. Bear and J. E. Perry (Porters). Staff of Dining Centre, 31, Herbert Street. Miss M. Zemaitis (Cook). Mrs. Walduck (General Assistant). Mortuary Keeper. W. J. Bailey. Temporary Shelter. Mrs. Watson. Disinfecting Officers. A. Fawns. G. Kennedy. A. Flack. Physicians to Maternity and Child Welfare Centres. Mrs. Sylvia Smith, M.B., B.S. Miss Amy Hodgson, M.D., M.R.C.P. Hon. Mrs. Olivier Richards, M.D., B.S., M.R.C.P. Mrs. Elizabeth Dove Karn, M.R.C.S., L.R.C.P., D.P.H. Panel of Medical Specialists appointed under The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia Regulations). 1926. Miss G. Dearnley, M.D., B.S. Eardley Holland. M.D., F.R.C.P., F.R C.S. W. H. M. McCullagh, D.S.O., M.C., M.B., B.Ch., F.R.C.S. Dentist. W. E. Dodd, L.D.S. Artificial Sun-light Clinic. Mrs. M. Pollard, Sister-in-charge. Bacteriologist. J. Andrew, M.R.C.S., L.R.C.P. Public Analyst. H. G. Harrison, M.A., F.I.C. Tuberculosis Officer. A. Leitch, M.B., Ch.B. Assistant Medical Officer of Health. Maitland Radford, M.D. (State Med.), D.P.H. Medical Officer of Health. Lewis T. Fraser Bryett, M.D., D.P.H. CONTENTS. Page Acute Anterior Poliomyelitis 17 Anthrax 19 Appendicitis, mortality from 5 Bacteriological examinations 20 Bakehouses 31 Births in sub-districts 2 Birth rates 2 Cancer 5 Cerebro spinal fever 17 Condensed milk regulations 31 Cookshops and Eating-houses 31 Cow-houses 30 Dairies, Cowsheds and Milk-shops Orders, 1885 and 1886 31 Deaths in sub-districts 3 Death rate 3 Deaths, ages at 4 Deaths, causes of 5 Deaths in public institutions 5 Deaths in outlying institutions 6 Diarrhoea 13 Diphtheria 10 Disinfection 20 Dysentery 19 Encephalitis Lethargica 17 Enteric Fever 12 Erysipelas 12 Factory and Workshop Act, 1901 25 Food and Drugs Acts 32 Fried fish shops 31 Fur skin dressers 22 Glanders 19 Housing 24 Hydrophobia 19 Ice-cream shops 31 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 19 Infectious diseases, return cases 9 Influenza 14 Legal proceedings 65 Malaria 19 Marriages 2 Maternity and Child Welfare 27 Measles 13 Milk (Special Designations) Order, 1922 31 Milk and Cream Regulations, 1912 31 Milk and Dairies (Consolidation) Act, 1915 31 Mortuary 21 IV Page Municipal Dental Hospital 21 Ophthalmia neonatorum 16 Pneumonia 19 Population 1 Public Health (Meat) Regulations, 1924 65 Puerperal fever 13 Puerperal Pyrexia 13 Rag and Bone Dealers 23 Rats and Mice Destruction Act, 1919 24 Sanitary work 21 Scarlet fever 9 Schools, exclusions of children for infectious disease 19 Shelter 20 Slaughter-houses 30 Smallpox 9 Smoke nuisances 22 Staff 35 Street markets and food 30 Tuberculosis 14 Typhus fever 14 Veneral Diseases 19 Verminous houses 23 Water supply 21 Whooping cough 14 APPENDIX. Statistical Tables:— For whole district during 1926 and previous years (Table I.) 39 Cases of Infectious disease notified during 1926 (Table II.) 40 Causes of, and ages at, death during year 1926 (Tables III. and V.) 41, 44 to 51 Infantile mortality during 1926 (Table IV.) 42 Notes to Tables III. and IV 43 Comparison of London and Shoreditch birth and death rates in 1926 (Table VI.) 52 Summary of proceedings under Public Health (London) Act, 1891 (Table VII.) 53 Summary of Tuberculosis Certificates received (Table VIII.) 62 Summary compiled from the abstracts of their work prepared by the Sanitary Inspectors for 1926 (Table IX.) 63 Housing Conditions 64 and 65 Summary of legal proceedings under the Public Health (London) Act, 1891 65 Factory and Workshop Act—Summary of work (Tables 1, 2, 3, 4, 5 and 6) 54 to 57 Return of work carried out at Tuberculosis Dispensary 58 to 61 Maternity and Child Welfare 66 to 71 Nursing List 72 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. 2, January, 1927. To the MAYOR, ALDERMEN and COUNCILLORS of the Metropolitan Borough of Sho.reditch. Sir, Ladies and Gentlemen, I have the honour to submit the following report on the health and sanitary condition of the Borough for the year ending December 31st, 1926 : — POPULATION. The Registrar-General's estimate of the population of the Borough as at June 30th, 1926, is 107,400, an increase of 100 on the figure for 1925. Included are the inmates of the Holborn Institution, numbering approximately 1,000, who are not regarded as belonging to Shoreditch. Excluding these, 106,400 is the estimated figure taken into account for the statistical purposes of this report. Further information upon the subject of the population, area, number of inhabited houses, number of families, rateable value and the chief occupations of the inhabitants are contained in Tables I and VI and in those relating to the administration of the Factory and Workshop Act, 1901 (Appendix). 2 BIRTHS. The births registered in the Borough numbered 2,235 of which 1,095 were of males and 1,140 females. The number corrected by the inclusion of the births outside Shoreditch, the parents being residents in the Borough and the exclusion of those occurring within the Borough, the parents not being residents of Shoreditch, was 2,516 of which 1,235 were of males and 1,281 females. The distribution of the corrected births in the eight Wards of the Borough is given below : — Ward. Males. Females. Total. Moorfields 38 38 76 Church 235 227 462 Hoxton 220 218 438 Wenlock 186 213 399 Whitmore 203 197 400 Kingsland 115 118 233 Haggerston 117 145 262 Acton 121 125 246 Totals 1,235 1,281 2,516 Outside the Borough 290 births were registered, the parents being residents of Shoreditch. Of these 144 were of males and 146 females. Nine births, four of males, occurred within the Borough, the parents being non-residents. In the Shoreditch Institution there were 296 births, 151 of males and 145 females. In eight of these the parents were not residents of Shoreditch. The illegitimate births numbered 70, of which 34 were of males and 36 females. Of these 31, of which 17 were of males, occurred in the Shoreditch Institution. The birthrate for the Borough was 23.5 per 1,000 population. The birth-rates for the Wards of the Borough are given in Table VI (Appendix). The birth-rate for England and Wales was 17.8 per 1,000 population, and for London 17.1, the lowest so far recorded for any year except the last year of the war. MARRIAGES. The number for the year ended 31st December, 1926, was 947, as compared with 936 in 1925, 979 in 1924, 873 in 1923, 959 in 1922, 976 in 1921 and 1,194 in 1920. The persons married were at the rate of 17.8 per 1,000 population as compared with 17.2 for the Metropolis, 3 DEATHS. The deaths during 1926 numbered 1,298, markedly below the number for the preceding year. They were distributed in the Borough as shewn in the table below : — Ward. Males. Females. Total. Moorfields 37 19 56 Church 122 108 230 Hoxton 104 110 214 Wenlock 94 69 163 Whitmore 125 99 224 Kingsland 70 73 143 Haggerston 63 72 135 Acton 65 68 133 Totals 680 618 1,298 The deaths of males were 62 in excess of those of females, and the death-rate amongst males was approximately 17.8 per cent. higher than amongst females. The general death-rate is the lowest so far recorded for the Borough. It was 12.2 per 1,000 population. The causes of death and the death-rates for the Borough and its eight Wards, together with other particulars relating to the mortality amongst the inhabitants during 1926, are contained in Tables I, III, IV, V and VI (Appendix). The death-rate averaged above the mean rate for the year during the first four months, and it was again above the mean during the last two months of the year. The rate was lowest during the month of June, the average being 7.8 per 1,000. The highest point touched was during the first week of December, when the rate was 22.4 per 1,000 population. Diseases of the respiratory organs were largely contributory to the elevation of the rate during the latter part of the year. The deaths amongst infants under one year numbered 167, of which 87 were of males. They amounted to 12.8 per cent. of the deaths from all causes, as compared with 16.3 for 1925. The mortality amongst infants under one year was at the rate of 66 per 1,000 births registered during the year. This is the lowest infantile mortality rate so far recorded for Shoreditch. The infantile mortalities for recent years were 88 in 1925, 87 in 1924, 82 in 1923, 102 in 1922, 114 in 1921 and 91 in 1920. When compared with the rates prevalent twenty to thirty years ago, the decline in the infantile mortality of the Borough during recent years is very striking. The infantile mortality amongst males was 70 as compared with 62 amongst females. The chief causes of death amongst infants under a year were : prematurity, atrophy debility and marasmus, pneumonia and diarrhoea and enteritis. In Table IV (Appendix), the causes of death amongst infants under one year are given, together with the ages in weeks and months and 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 given for each of the eight Wards of the Borough : — Cause of Death. Moorfields Ward. Church Ward. Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals Smallpox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... ... ... 1 1 1 ... ... 3 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... 1 ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... 2 1 ... ... 1 ... 1 5 Convulsions ... 2 ... ... ... 1 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis ... ... 2 3 1 1 1 ... 8 Pneumonia (all forms) 3 6 7 8 3 4 7 4 42 Diarrhoea 1 ... 1 ... ... 1 ... 2 5 Enteritis ... 2 2 3 1 1 5 3 17 Gastritis ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... Suffocation, over-lying ... ... ... 1 ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... Atelectasis ... ... 1 ... 1 1 ... ... 3 Congenital Malformations ... ... ... 1 2 ... ... ... 3 Premature Birth ... 8 8 4 4 6 3 5 38 Atrophy Debility and Marasmus ... 7 ... 3 4 3 1 1 19 Other causes 1 2 3 2 3 3 3 1 18 Totals 5 29 25 27 20 23 21 17 167 The infantile mortalities for the Wards of the Borough are given in Table VI (Appendix). The rate was highest in Kingsland and lowest in Whitmore, being 98 and 50 per 1,000 births respectively. The infantile mortality for England and Wales was at the rate of 70, and for London it was 64 per 1,000 births registered. The deaths of children aged from one to two years numbered 55, the chief causes being measles and diseases of the respiratory organs. Of children aged from two to five years 43 died, the chief causes being measles, diphtheria, and diseases of the respiratory organs. Altogether 265 or 20.4 per cent. of the total number of deaths were of children under five years of age. Taking the deaths at all ages the chief causes were : diseases of the circulatory organs, including heart disease, which accounted for 155, tuberculosis 151, including 5 133 from phthisis, bronchitis 140, pneumonia 130, old age 123, cancer 116, violence 54, apoplexy 52, Brights disease 49, and prematurity which was given as causing 38 deaths. Of the deaths from cancer, 57 were of males and 59 females. Ten were of persons aged from 25 to 45 years, 62 of persons aged between 45 and 65 years, 32 were aged between 65 and 75 and amongst persons aged from 75 to 85 years, there were twelve deaths. In addition, nine deaths were attributed to malignant disease or sarcoma. The death-rate due to cancer was 1.1 as compared with 0.98 for 1925, 1.1 for 1924, 1.0 for 1923, 0.82 for 1922, 0.87 for 1921, 0.91 for 1920, 0.93 for 1919, 0.95 for 1918 and 1.1 for 1917. Eight deaths, six of them of males, resulted from appendicitis, and one male and one female died from peritonitis. No deaths were directly attributed to alcoholism, but four males and four females were stated to have died from cirrhosis of the liver, a disease caused through chronic poisoning by alcohol. Of the deaths due to violence, 38 were amongst males and 16 females. Through accidents or negligence, 25 males and 14 females lost their lives. Sixteen of these resulted through street accidents mostly in connection with vehicular traffic, seven were due to falls, chiefly amongst people getting on in years, and five were attributed to suffocation. Four of these were amongst infants, one being due to suffocation in bed. There were 15 cases of suicide, 13 of which were amongst males. It is worth mentioning again, that in years gone by, deaths due to suffocation of infants in bed were a somewhat conspicuous item in the mortality returns of the Borough. Since 1914, however, deaths from this cause have undergone a marked decrease. Taking the five years ending 1897, the number averaged approximately 30 per annum ; during the five years ending 1926 the average has been only two annually. 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 1 136 137 St. Leonard's Hospital 491 21 512 Royal Chest Hospital 13 52 65 Home of Good Shepherd 4 ... 4 Convent Hospital ... ... ... Infant Welfare Centre 1 ... 1 Totals 510 209 719 6 Elsewhere than in public institutions 8 persons not belonging to Shoreditch died within the Borough. In the subjoined table are set forth the various institutions outside Shoreditch with the number of persons belonging to the Borough dying therein : — No. of Deaths. General Hospitals— continued No. of Deiths. Asylums:- St. Bartholomew's 62 Abergavenny 1 University College 1 Barnwood 1 Claybury 10 Special Hospitals: — Colney Hatch 2 Dartford Heath 1 Bethnal Green Chest 3 Hanwell 2 Brompton 1 Horton ... 1 City of London Maternity 6 Leavesden 4 Colindale 8 Long Grove 1 Epilepsy Hospital, Maida Vale 2 Tooting Bec 2 Hospital for Jews, Tottenham 1 Watford 1 Infants ... 1 Ministry of Pensions, Orpington 1 Hospital for Infectious Diseases:— National, Isle of Wight 1 National, Holborn 1 Eastern 15 National, Finchley 1 Grove 1 St. Columba's 1 Joyce Green 1 St. Luke's 3 London Fever 2 St. Marks 1 North-Eastern 3 St. Peter's, Stepney 2 North-Western 2 St. Peter's, Westminster 1 Park 3 West End, Hampstead 1 South-Eastern 7 Other Institutions : — General Hospitals 2a, Bow Road 4 Charing Cross 1 214a, Cambridge Road 2 Children's, Holborn 2 Central Homes, Leytonstone 1 German 7 396, Commercial Road 1 Guys 2 230, High Street, Homerton 2 Hampstead General 1 72a, East Dulwich Grove 1 London 11 77a, Highgate Hill 1 London Temperance 3 Keycol Sanatorium, Bobbing 1 Metropolitan 49 29, North Side, Clapham 3 Middlesex 2 Rustington Convalescent Home 1 Mildmay 11 St. George's Home 3 Queen's (Children) 31 St. Joseph's Hospice 12 Ramsgate General 1 St. Pancras Infirmary 1 Royal Free 3 18, Thavies Inn 1 Royal Northern 1 Westminster Infirmary 1 Of 318 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 188 died in general hospitals, 26 in asylums, 34 in fever hospitals, 35 in hospitals for special diseases and 35 in other institutions. Elsewhere than in public institutions, 17 persons belonging to Shoreditch died beyond the limits of the Borough. 7 Altogether 828 or 63.7 per cent. of the people belonging to Shoreditch, who died during the year, died in public institutions. During recent years this percentage has markedly increased. INFECTIOUS DISEASES. The infectious diseases included under the headings 1 to 35 inclusive and 171 and 172 in Table V. (Appendix) were the cause of 265 deaths. This number is markedly below the average, being 20.4 per cent. of the total mortality from all causes, as compared with 21.5 per cent. in 1925, 22.3 in 1924, 20.3 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. The heavy mortality during 1918 was exceptional and was the result of influenza. During 1926 tuberculosis accounted for nearly 57 per cent.of the deaths from these infectious diseases. The death-rate due to these diseases was 2.5 per 1,000 population as compared with 2.8 in 1925, 3.0 in 1924, 2.6 in 1923, 4.2 in 1922, 3.8 in 1921, 3.9 in 1920, 4.5 in 1919, 9.1 in 1918 and 6.8 in 1917. In the subjoined table the deaths from the infectious diseases referred to above have been grouped according to age : — Age period. Under 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65-75 75-85 85 and upwards. No. of deaths 16 49 9 7 20 40 34 24 30 22 11 3 Of the total mortality from all causes of children under five years, 24.5 per cent. resulted from these diseases. In infants under one year diarrhoea and measles accounted for most of the deaths. Amongst children aged from one to five years, measles, diphtheria and tuberculosis were the chief causes of death. Most of the mortality from infectious diseases amongst persons aged from 15 years upwards was the result of consumption, influenza and sceptic diseases. The deaths from the principal zymotic diseases, smallpox, measles, scarlet fever diphtheria, whooping cough, enteric fever and diarrhoea (excluding enteritis) numbered 54, which yield a zymotic death-rate of 0.5 per 1,000 population. Including deaths from enteritis under two years this rate is increased to 0.6 per 1,000. 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 and lowest in Moorfields. It may be noted that the Shoreditch rate this year does not exceed that of London, which is a very exceptional circumstance. The zymotic death-rate for Shoreditch has invariably exceeded that of London in the past. The cases of scarlet fever, diphtheria, erysipelas, enteric fever and puerperal fever notified, numbered 872, as compared with 28,476 for the whole of the metropolis ; the attack-rates being 8.2 for Shoreditch and 6.2 per 1,000 population for London, 8 Excluding tuberculosis the following table shows the numbers of cases of infectious disease certified in the Borough, the numbers of the cases removed to hospital and the numbers of deaths attributed to the diseases specified, the numbers of cases for the four quarters of the year being also given : — Disease. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Cases admitted to Hospital. Deaths. Smallpox ... ... ... ... ... ... ... Scarlet Fever or Scarlatina 88 114 136 94 432 432 4 Diphtheria and Membranous Croup 109 70 70 123 372 372 12 Enteric Fever ... 3 3 ... 6 6 ... Puerperal Fever 3 1 4 2 10 10 3 Puerperal Pyrexia ... ... ... 5 5 3 Acute Primary Pneumonia 45 51 38 118 252 211 33 Acute Influenzal Pneumonia 14 5 3 11 33 6 4 Erysipelas 14 9 12 17 52 26 5 Typhus Fever ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... Cerebro-Spinal Fever 1 2 ... 1 4 4 4 Glanders ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... Anterior Polio-myelitis ... 1 ... 2 3 2 ... Encephalitis Lethargica 2 2 2 2 8 7 1 Ophthalmia Neonatorum 17 13 19 17 66 6 ... Malaria ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... Totals 293 271 287 392 1,243 1,085 66 Numbers and Percentages of cases removed to hospitals. 254 247 256 328 1,085 ... ... 86.7% 91.1% 89.2% 83.7% 87.3% ... ... As compared with the figures for 1925 there were fewer cases of diphtheria, scarlet fever and erysipelas, whilst cases of ophthalmia neonatorum show an increase. ISOLATION OF INFECTIOUS CASES. The hospitals of the Metropolitan Asylums Board receive cases of smallpox, scarlet fever, diphtheria and membranous croup, enteric, typhus and continued fevers, relapsing fever, anterior polio-myelitis, encephalitis lethargica, cerebro-spinal fever, puerperal fever, trench fever, malaria and dysentery, and in some instances cases of measles and whooping cough. 9 The Board have recently intimated that arrangements have been made for isolation of cases of measles in their hospitals in the event of the disease becoming epidemic. Towards the latter part of the year feverish conditions in lying-in women were made notifiable as puerperal pyrexia. Cases of puerperal pyrexia are also receivable into the hospitals of the Board. The cases of diphtheria, scarlet fever, enteric fever, puerperal fever, puerperal pyrexia, cerebro-spinal fever, polio-myelitis and encephalitis lethargica certified numbered 840, and the number removed to hospital was 836, or 99.5 per cent. Almost all the cases removed went into the hospitals of the Board. RETURN CASES. The following were noted during the year : — (1) Olive H — —, aged 14, resident at a house in H— —Street, was removed with scarlet fever on November 6th, 1925, returning home on December 17th following. Seven days later Dorothy H— —, aged nine, a sister, fell ill and was removed on December 30th. Ronald H— —, aged three, was taken ill on January 18th, 1926, and was removed to hospital the following day and subsequently Phyllis H— —, aged 15, was taken ill and removed to hospital on January 25th. Olive, when examined on January 26th had slightly enlarged tonsils and glands could be felt, but otherwise she seemed quite well. It was ascertained in connection with these cases that a maid, aged 17, a daily worker at the house in H— —Street, developed a sore throat towards the end of October, 1925, but there was no history of any eruption or desquamation. There is the possibility of a missed case in connection with this series. (2) John S— — , aged three, a resident at a house in S— —Road, was removed to hospital with scarlet fever on July 15th, returning home on November 18th. At the time of his return he had a nasal discharge. Dorothy S— —, sister, aged six, of same address, was taken ill on December 3rd and removed to hospital two days later. She was attending school at the time she fell ill. The nasal discharge in the case of John was still present on December 9th and the usual instructions were given. No further cases occurred. SMALLPOX. No cases were certified in Shoreditch. Two or three were certified elsewhere in the metropolis, one of which proved fatal. A few residents in the Borough who may have been more or less exposed to infection in connection with the cases mentioned had to be kept under observation but none of them showed any signs of the disease. SCARLET FEVER. The cases certified numbered 432, of which 63, or 14.6 per cent., were subsequently not regarded as scarlet fever. This percentage is higher than that for 1925, and is greatly above the average. 1 10 The distribution of the cases certified, and the deaths amongst males and females in the Borough and its eight Wards during the year were as shown in the subjoined table: — Wards. SCARLET FEVER. Notifications. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 2 4 6 . . . Church 41 22 63 1 . 1 Hoxton 32 51 83 . 1 1 Wenlock 24 48 72 . 1 1 Whitmore 27 40 67 1 . 1 Kingsland 28 22 50 . . . Haggerston 17 19 36 . . . Acton 26 29 55 . . . Totals for Borough 197 235 432 2 2 4 The cases are grouped according to ages in Table II. (Appendix). All the cases certified during the year were removed to hospital. The attack rate was 4.0 per 1,000 inhabitants. It was lowest in Moorfields and highest in Wenlock Ward, being 1.3 per 1,000 in the former as compared with 5.1 in the latter. The deaths were at the rate of 0.04 per 1,000 population. There were no deaths in Moorfields, Kingsland, Haggerston and Acton Wards. The case mortality was a shade under 1 per cent. Amongst children under five years there were 149 cases with a case mortality, allowing for errors in diagnosis, of 2.6 per cent. The case mortality amongst persons over five years were only 0.4 per cent., errors in diagnosis being allowed for. The cases certified as scarlet fever in London numbered 12,369 and were at the rate of 2.7 per 1,000 population. The deaths numbered 82, being at the rate of 0.02 per 1,000 population, as estimated for the middle of 1925. Taking the cases certified, the case mortality for the Metropolis was barely 0.7 per cent. When this is compared with the mortality of 60 or 70 years ago scarlet fever can hardly be regarded now-adays otherwise than a benign disease, so far as fatality is concerned. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 372, of which 87, or 23.4 per cent., were subsequently not regarded as being diphtheria. This percentage is slightly higher than that for 1925, and is greatly above the average for previous years. 1 11 The number of cases and the deaths amongst males and females in the Borough and its eight Wards are given in the subjoined table:- Ward. DIPHTHERIA (including Membranous Croup). Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 4 5 9 . . . Church 31 38 69 . 1 1 Hoxton 31 27 58 3 1 4 Wenlock 28 33 61 1 . 1 Whitmore 34 31 65 1 2 3 Kingsland 24 12 36 . . . Haggerston 21 24 45 . 1 1 Acton 14 15 29 2 . 2 Totals for Borough 187 185 372 7 5 12 The cases are grouped according to ages in Table II (Appendix). They were all removed to hospital for treatment. The attack-rate was 3.5 per 1,000 inhabitants. The rate was highest in Wenlock and lowest in Moorfields Ward, 4.3 and 1.9 per 1,000, respectively. The deaths numbered 12, the rate being 0.12 per 1,000 population. It was highest in Hoxton Ward, where it amounted to 0.24 per 1,000. There were no deaths in Moorfields and Kingsland Wards. Of the cases certified, 3.2 per cent, terminated fatally. Nine of the deaths were of children under five years. Allowing for 31 cases not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board, the case mortality was 7.0 percent. Amongst persons over five years, the mortality was 1.9 per cent, allowing for some 56 cases not regarded as being diphtheria. During the year anti-toxin obtained from the Health Department was administered in two cases before removal to hospital, some 20,000 units being used. The usual enquiries were made. With regard to the cases investigated, they were distributed amongst males and females according to age periods as set out below:— Age Period. Male. Female. Total. Under 1 year 6 5 11 From 1 to 2 years 16 15 31 „ 2 to 3 years 29 17 46 „ 3 to 4 years 15 13 28 „ 4 to 5 years 14 24 38 „ 5 to 10 years 59 43 102 „ 10 to 13 years 18 18 36 Over 13 years 26 50 76 Totals 183 185 368 1 12 In 184 of the cases the patients were attending school and in 154 they were at school within a week of being certified as having the disease. In some instances the children were attending whilst suffering from diphtheria, the nature of the illness not being recognised. In 163 other cases, in which the patients were not schoolgoing children, there were children in the house invaded who were. In 15 instances the histories showed the presence of cases of "sore throat" amongst the inmates of the houses in which the patients were resident, and in 16 instances there was evidence pointing to infection from previous cases in the Borough. In 263 instances the houses were occupied by members of more than one family, in 71 by single families and in 34 the cases occurred in artisan's dwellings of the block type. In 227 the sanitary condition of the dwellings was satisfactory, in 43 fairly so, and in 98 it was unsatisfactory. The cases certified as diphtheria in the Metropolis numbered 13,630, being at the rate of 2.9 per 1,000 population. The deaths numbered 538, the death-rate being 0.12 per 1,000 and the case mortality 3.9 per cent. ENTERIC FEVER. Six cases were certified, one of which proved not to be as certified, and one was a case of paratyphoid B. about which nothing was ascertained throwing light upon the source of infection. With regard to the others, one was in all probability connected with certain cases which occurred in the Queen's Hospital in the early part of the year; so far as the rest were concerned, nothing was ascertained throwing light upon the source of infection. One case proved fatal; Widal's reaction was positive and typhoid ulceration was found post mortem. The cases certified in London numbered 312, being at the rate of 0.06 per 1,000 population. The deaths numbered 28, the death rate being 0.01 per 1,000 and the case mortality 9 per cent. ERYSIPELAS. The cases certified as erysipelas numbered 52, with three deaths. The cases and deaths amongst males and females in the Borough and its eight Wards were distributed as set out below:— Ward. ERYSIPELAS. Cases Certified. Fatal Cases. Male. Female. Total. Male. Female. Total. Moorfields 1 2 3 . . . Church 2 7 9 . . . Hoxton 8 4 12 1 . 1 Wenlock 1 3 4 . . . Whitmore 6 4 10 . . . Kingsland 2 5 7 . 2 2 Haggerston 1 2 3 . . . Acton 2 2 4 . . . Totals for Borough 23 29 52 1 2 3 1 13 The deaths from erysipelas were at the rate of 0.02 per 1,000 inhabitants and approximately 6 per cent, of the cases certified terminated fatally. Pyaemia and septicaemia, popularly known as blood poisoning, resulted in the deaths of four males and two females, and infective endocarditis caused the deaths of eight persons, seven of whom were females. PUERPERAL FEVER. Ten cases were certified, three of which terminated fatally; they were all removed to hospital. The cases certified were at the rate of 3.9 per 1,000 births as compared with 1.9 in 1925, 3.9 in 1924, 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 numbered 341, and were at the rate of 4.3 per 1,000 births. The deaths in Shoreditch were at the rate of 1.2 per 1.000 births as compared with 1.5 for London. PUERPERAL PYREXIA. Under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, which came into operation on the 1st day of October, 1926, the above condition became notifiable. Puerperal pyrexia means any febrile condition, other than puerperal fever, occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4° Fahrenheit or more has been sustained during a period of 24 hours, or has recurred during that period. Five cases were certified, three of which were removed to hospital. In connection with cases notified facilities have been provided for consultations with obstretric specialists and for skilled nursing. Institutional treatment is also readily obtainable for such cases as require it. DIARRHCEA. Twelve deaths were attributed to diarrhoea and 20 to enteritis. Eight of the deaths from diarrhoea and 14 of those from enteritis were of infants under one year. Excluding deaths from enteritis the death-rate was 0.11 per 1,000 population. Including deaths from enteritis in children under two years, the rate was 0.26 per 1,000 population. The deaths from diarrhoea amongst infants under one year were at the rate of 3.1 per 1,000 births; including deaths from enteritis, under one year, the rate was 8.7 per 1,000 births. The prevalence of the disease was again below the average. The usual enquiries were made, but the cases were comparatively few. The deaths from diarrhoea and enteritis in children under two years, in the Metropolis numbered 934, the death-rate being 0.20 per 1,000 inhabitants. The mortality from diarrhoea and enteritis amongst infants under one year was at the rate of 10.6 Per 1,000 births. MEASLES. The deaths numbered 25, as compared with 34 in 1925, 58 in 1924, 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 B 1 14 67 in 1915, being again below the average for recent years. Nine of the deaths were amongst males and 16 females. All were amongst children under five years. The death-rate was 0.23 per 1,000 as compared with 0.32 in 1925, 0.55 in 1924, 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. The deaths during 1926 were mostly during the first three months of the year. They were relatively most numerous in Church Ward. There were none in Moorfields Ward. Some 27 cases were nursed by nurses from the Local District Nursing Association in accordance with arrangements made by the Borough Council with the Association. The nurses paid 394 visits in connection with the cases. The deaths from measles in the Metropolis numbered 914 as compared with 357 in 1925, 1,335 in 1924, 367 in 1923 and 1,559 in 1922. The death-rate was 0.20 per 1,000 inhabitants. WHOOPING COUGH. There was not a single death from whooping cough registered as belonging to Shoreditch during the year. The records would have to be searched a long way back to find a year without a death from this disease. The deaths for recent years were 29 in 1925, 28 in 1924, 10 in 1923, 27 in 1922, 19 in 1921, 12 in 1920, 2 in 1919, and 93 in 1918. The deaths in the Metropolis numbered 232, the rate being 0.05 per 1,000 inhabitants. INFLUENZA. Twenty-two deaths, nine amongst males, were attributed to influenza. The death-rate was 0.20 per 1,000 inhabitants. Most of the deaths occurred during the first four months of the year. The deaths during recent years were 19 in 1925, 28 in 1924, 14 in 1923, 69 in 1922, 27 in 1921, 51 in 1920, 121 in 1919, 295 in 1918, and 12 in 1917. The deaths in the Metropolis numbered 786, being at the rate of 0.17 per 1,000 inhabitants. TYPHUS FEVER. No cases were certified in Shoreditch, and there are no grounds for believing any occurred elsewhere in London. TUBERCULOSIS. Tuberculosis (Appendix Table V., Nos. 29 to 34 inclusive) resulted in 151 deaths as compared with 154 in 1925, 145 in 1924, 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. It accounted for 11.6 per cent, of the total mortality for the year. The deaths during 1926 include those of 24 persons who were not certified under the Tuberculosis Regulations in Shoreditch. The mortality was at the rate of 1.4 per 1,000 inhabitants, varying from 1.76 in Moorfields to 1.22 in Wenlock Ward. 1 15 The deaths from tuberculosis of the lungs or consumption numbered 133, an increase of nine on the figure for 1925. They were mostly amongst persons aged from 15 to 65 years. Eighty-two of them were of males. The death-rate was 1.2 per 1,000 being highest in Moorfields and lowest in Wenlock Ward, 1.76 and 0.9 per 1,000 respectively. The deaths from tuberculosis in the Metropolis numbered 4,553, the death-rate being 0.9 per 1,000 population. The deaths attributed to tuberculosis of the respiratory system numbered 3,895, which gives a rate of 0.8 per 1,000 persons. A summary of the notifications under the regulations received during the year is contained in Table VIII. and the distribution of the cases according to age periods and localities is given in Table II. (Appendix). Subjoined are particulars of new cases and of deaths during 1926 in the form required by the Minister of Health:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 0 1 . . 1 . . 1 . 1 1 1 12 6 . . 3 5 5 3 3 13 4 . . . 2 10 . 6 4 2 1 1 . 2 15 11 13 7 4 5 9 . . 20 18 20 . 2 20 8 . 1 25 21 25 2 2 12 12 . 2 35 19 20 1 1 12 8 2 . 45 26 18 . . 16 8 . . 55 15 3 . . 13 3 . . 65 and upwards 1 . 1 . 4 1 . . Totals 116 109 40 22 83 50 6 12 In addition it may be mentioned that a male aged from 35 to 45 years and a male in the 1 to 5 years age period were transfers from other Boroughs. The former was suffering from pulmonary and the latter from the non-pulmonary form of the disease. The cases certified numbered 287, being at the rate of 2.7 per 1,000 persons in the Borough, as compared with 2.9 in 1925, 2.4 in 1924, 2.4 in 1923, 2.7 in 1922, 2.5 in 1921, 3.0 in 1920 and 5.1 in 1919. The cases were most numerous in proportion to the population in Wenlock Ward and least in Kingsland, being at the rate of 3.1 per 1,000 in the former as compared with 1.5 in the latter. The cases certified as pulmonary tuberculosis numbered 225 and were at the rate of 2.1 per 1,000, as compared with 2.2 in 1925, 2.0 in 1924, 2.1 in 1923, 2.1 in 1922, 2.1 in 1921, 2.8 in 1920, B2 1 16 and 4.0 in 1919. The notifications of pulmonary tuberculosis were proportionately most numerous in Moorfields and least in Kingsland Ward, 2.6 and 1.2 per 1,000 respectively. At the close of the year there were on the Tuberculosis Register at the Town Hall the names of 1,695 persons, of whom 941 were males. Approximately the names of 1.6 per cent, of the population were on the Register. The report of Dr. Leitch which summarises the work carried out at the Tuberculosis Dispensary during the year under consideration is appended( pp. 58-62). The Tuberculosis Care Committee met on 19 occasions and dealt with some 311 cases. Of these 133 were admitted to institutions. Of the cases under observation 57 terminated fatally. The useful character of the work carried out by this committee has been referred to in previous reports. The removals to hospitals, sanatoria and other institutions are given in Table II. (Appendix). Of the deaths from consumption belonging to Shoreditch, approximately 65 per cent, occurred in public institutions within or without the Borough, and of these 30 per cent, took place in St. Leonard's Hospital. OPHTHALMIA NEONATORUM. The procedure in respect to the notification of the above disease was amended by the Public Health (Ophthalmia Neonatorum) Regulations of July 31st, 1926. Under these regulations, which came into operation on October 1st, 1926, midwives are no longer required to notify. The duty of notifying cases of ophthalmia neonatorum is placed solely upon the medical practitioner in charge of the cases. The certificates received numbered 91 relating to 66 cases, 38 being amongst males and 28 females. The number was a marked increase on the figure for 1925. There were besides some 54 other cases of inflamed eyes in infants which were brought to our notice through the Medical Officer of Health, London County Council. These were not formally notified. Subjoined are the particulars relating to the cases certified during the year as required by the Minister of Health:— Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 66 58 8 66 . . . The usual supervision was exercised through the Health Visitors for securing proper treatment. Of the cases certified four were of a severe type. All recovered without impairment of vision. A number of the cases received treatment at the Moorfields Eye Hospital. Of the cases dealt with in hospital three went into St. Margaret's Hospital, a special institution of the Metropolitan Asylums Board for 1 17 the treatment of this disease. When necessary mothers are admitted with their infants. Sixteen of the cases were attended to by nurses from the Local District Nursing Association who made an average of 34 visits per case. The certified cases were at the rate of 26.2 per 1,000 births as compared with i) for London as a whole, almost three times as great. EPIDEMIC CEREBRO-SPINAL MENINGITIS. Four cases were certified. One was in a female infant four months old, who fell ill about January 22nd with fits and drowsiness. It was admitted to the Queen's Hospital on January 31st and was notified six days later. The meningococcus was found. The child recovered and left the hospital on February 25th. The second case was that of a little girl aged four years who was taken ill on April 5th and admitted to the Queen's Hospital the following day. The case was certified on April 7th and terminated fatally on May 1st. The meningococcus was present. The third case was in a little boy, 18 months old, who fell ill on April 19th and was admitted to St. Bartholomew's Hospital the same day. The case was certified on April 23rd and the child died on May 11th from meningococcul meningitis. The fourth case was in a male infant eight months old, who was taken ill on October 10th, admitted to the Mildmay Mission Hospital on October 23rd, certified on October 24th, and died two days later. POLIOMYELITIS. Three cases of the above disease, which is generally known as infantile paralysis, were certified. One of these was removed to the North Eastern Hospital, where it was subsequently not regarded as a case of poliomyelitis. The second case was certified from St. Bartholomew's Hospital and was treated at home. The left leg was affected. The child seems to have completely recovered. On enquiry in Februaryof the current year no signs of weakness in the left leg were observed. The third case was treated in the Queen's Hospital. The patient was affected in the legs, arms, and hands, and at the end of the year was still under treatment. ENCEPHALITIS LETHARGICA. The following are brief particulars respecting the cases certified during the year under consideration:— (1) A young woman, aged 28, of 18, H— Street, a machinist, last at work in October, 1925, was taken ill about the middle of November. Drowsiness, loss of power left side, arm and leg, with irregular muscular movements left side of face were observed and the case was certified on January 5th, 1926. It was subsequently admitted to St. Bartholomew's Hospital, where it terminated fatally on January 29th, the cause of death being a cyst of the left basal ganglia with inflammation of the base of the brain. (2) A married woman, aged 31, of 79, H— Street, was taken ill about January 1st but continued at work making babies' shoes until January 16th. She 1 18 was removed to the Mildmay Mission Hospital on February 1st and her case was certified on February 3rd. Giddiness but no sickness, double vision, severe headache in front and at the back of her head together with pains in the nape of her neck were amongst the symptoms noted. The patient could not sleep at night. There was slight drooping of both upper eyelids and her face was mask-like. The case appears to have done well. At the end of the year the patient was at home and sleeping well at night, being bright and normal mentally and enjoying good health. (3) A little girl, aged two years, of 46, R—Street, was taken ill about March 13th and was certified on April 4 th from the Queen's Hospital, where she was admitted on March 14th. There was weakness of the facial muscles and a double internal squint. The child seems not to have been acutely ill and at the time of notification was improving. At the end of the year the child seems to have completely recovered and was quite normal and intelligent. (4) A young woman, aged 22, of 40, W—Place, employed as a kitchen hand, was taken ill on April 14th with pains in head and body, trembling and a series of fits. The case was certified on April 17th and the same day admitted to the Eastern Hospital. The diagnosis at the hospital was hysteria and the patient left the institution on May 4th. (5) A young married woman, aged 21, of 30, F—Street, a French polisher, was taken ill about May 14th with a sore throat followed by a sleepy feeling accompanied by loss of power. The patient was certified on July 1st and removed to the South Eastern Hospital. The case was not regarded as one of encephalitis lethargica and was discharged from hospital on July 9th. (6) A lad, aged 15, of 17, V—Street, was taken ill with twitchings and spasmodic movements associated with drowsiness about August, 1924. He attended St. Bartholomew's Hospital and other institutions and finally on July 29th, 1926, was admitted to St. Leonard's Hospital. The case was certified on August 7th. When seen by the Assistant Medical Officer of Health four days later, the patient was lying helplessly in bed, he was unable to feed himself, there were gross tremors on attempting to move his hands, he was incontinent and unable to talk or to follow any but the most simple remarks. The face was mask-like and the mouth open and dribbling saliva. At the end of the year his condition showed no signs of any improvement. (7) A little girl, aged six years, of 68, N—Street, attending school, was taken ill about October 31st with drowsiness. She was difficult to rouse but when up was able to walk. The case was certified on November 3rd. On November 5th nothing abnormal was noticed about the child and subsequent enquiry showed that the child was physically fit and attending school. (8) A boy, aged 11, residing in G—Row, was last at school on November 10th. The date of onset in indefinite. The initial symptoms were twitchings and sleepiness. Excitability at night was noticed and there was double vision. The case was certified op November 17th and on the following day was admitted to the Eastern Hospital, 1 19 where the diagnosis was confirmed. Subsequently it was ascertained that the patient had completely recovered and the mother stated that the lad was in better health than before he was taken ill. GLANDERS, ANTHRAX AND HYDROPHOBIA. No cases were certified in Shoreditch and there were but five cases of anthrax notified in the Metropolis during the year. PNEUMONIA, MALARIA AND DYSENTERY. In accordance with the Regulations of 1919 some 257 cases of acute primary pneumonia and 32 of influenzal pneumonia were certified during the year. Of the cases of pneumonia investigated 204 were treated in St. Leonard's Hospital, 3 in St. Bartholomew's Hospital, and 7 in other institutions. Some 42 were nursed at home by relatives, 14 of them with the help of the District Nursing Association. Some 29 other cases of pneumonia (not notified) also received the nursing assistance of the Association. Altogether 669 visits were made by the nurses of the District Association in connection with pneumonia cases. Evidence of infection was obtained in 35 of the cases investigated. In 108 instances the dwellings occupied were satisfactory as regards air space, light and ventilation; in 54 they were fairly so, and in 94 they were unsatisfactory. There were no cases of malaria, dysentery or trench fever certified. VENEREAL DISEASES. During the year three lectures were delivered at the Shoreditch Town Hall, by Mr. E. B. Turner, F.R.C.S., under the auspices of the Health Committee, in cooperation with the propaganda Committee of the Shoreditch Public Welfare Association, which is affiliated with the British Social Hygiene Council. The films exhibited at the lectures were "Damaged Goods" on January 6th, "The End of the Road" on April 14th and "Whatsoever a Man Soweth" on October 8th. The average attendance was about 1,200 and the lectures were highly appreciated. INFECTIOUS DISEASES AND SCHOOLS. The numbers of children suffering from infectious diseases or resident in houses in which infectious diseases existed, concerning whom intimations of exclusion from school were received, in accordance with the requirements of the School Management Code of the London County Council, were as follows: diphtheria 567, scarlet fever 564, measles 813, chicken pox 663, whooping cough 119, mumps 202 and 235 of other infectious diseases. The exclusions altogether numbered 3,163 and related to 34 schools. The scheme for the more effective control of measles in public Elementary Schools, referred to in previous reports, was discontinued early in the year owing to the decrease 1 20 in the prevalence of the disease. It was, however, operative as regards the infants departments of the following schools: Laburnum Street in January, Redvers Street and Haggerston Road in February and Trinity Place in March. Some eight intimations were received as to investigations by the School Medical Authorities in consequence of the occurrence of cases of scarlet fever and diphtheria amongst children attending some of the schools in the Borough, but only in a few instances were exclusions necessary. Information was also received from the School Medical Officer, as to the exclusions from school of some 32 children, on account of the presence of the micro-organisms of diphtheria in their throats or noses as ascertained by bacteriological examination. The families to which the children belonged were resident in fifteen houses. They were kept under observation, but no cases of diphtheria were subsequently notified amongst the members there of, nor is there any evidence that such cases occurred. BACTERIOLOGICAL EXAMINATIONS. During 1926 some 1,046 examinations were made by Dr. J. Andrew at his laboratory in the Kingsland Road. Of these 621 were for suspected diphtheria, five for enteric fever, 330 for tuberculosis, one for influenza and 12 for gonorrhoea. Fourteen Wassermann tests were made and nine samples of urine, one specimen of cerebro-spinal fluid, one of a tumour from the breast, five for organisms and two specimens of ice cream were also examined. Some 45 shaving brushes were examined for anthrax. The presence of anthrax bacilli was not confirmed by animal experiments. The results obtained were positive in 84 of the examinations for diphtheria organisms, 50 of those for tubercle bacilli, three of the examinations for gonococci, and in four of the Wassermann tests. In addition, some 620 bacteriological examinations were made at the Royal Chest Hospital in connection with the work of the Tuberculosis Dispensary. DISINFECTION. The premises disinfected numbered 1,052; the articles removed to the Borough Disinfecting Station to be there disinfected totalled 14,204, and included 1,244 beds, 1,114 mattresses, 2,566 pillows, 781 bolsters, and some 8,499 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. It was necessary to destroy two pairs of mattresses which were so dilapidated and contaminated as to render it inadvisable to return them. These were replaced with new. THE SHELTER. The accommodation provided under Section 60 (4) of the Public Health (London) Act, 1891, at the shelter in Reeves Place was not in use on account of infectious disease. A family had the use of rooms there for some 15 days on account of a badly defective drain, accommodation elsewhere being impossible, 1 21 PUBLIC MORTUARY. The bodies of 132 persons were deposited in the mortuary and inquests were held in 114 instances. In all cases where there were inquests post-mortem examinations were made, 63 of these at the mortuary. No infectious bodies were removed to the mortuary by the sanitary authority. WATER SUPPLY. The Meteorological Table for London deduced from observations at Greenwich, under the Astronomer Royal, issued by the Registrar General for 1926, shows a rainfall for the year amounting to 28T35 inches, which is above the average. Most rain fell in November and least in March. 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 seven premises: in three instances on account of nonpayments of rates, in two on account of demolition, in one for waste on empty premises, and in one because water was not required. Water was laid on to some 48 new premises and in 18 instances additional taps were provided in tenement houses. No complaints were received as to the quality of the water and there was no reason for suspecting the occurrence of any illness due to the water supplied. MUNICIPAL DENTAL HOSPITAL. The Health Committee recognising that the care of the teeth is a matter of prime importance as regards the health of the individual and consequently of the health of the community of which the individual is a unit, decided to recommend the Borough Council to establish an institution for the care of the teeth of those who live or work in Shoreditch. Towards the close of the year the recommendation was adopted by the Borough Council and steps were taken by the Health Committee to give effect to the same. An account of the procedure adopted does not fall within the scope of this year's report, but it may be mentioned that the scheme included acquiring premises in a commanding situation for a surgery, waiting and recovery rooms, workshop and quarters for a resident caretaker. The staff to be appointed included a part-time dental surgeon, an anaesthetist, a mechanic and a trained hospital nurse. A scale of fees is to be arranged and there is to be no restriction as to anyone availing himself of the use of the institution so long as he is connected with the Borough. Such is a brief outline of the project which was duly given effect to, and within four months of the close of the year under consideration the Borough of Shoreditch Municipal Dental Hospital opened its doors to the public. SANITARY WORK. Intimations as to insanitary conditions were served in respect to 6,213 premises, In 602 they were dealt with by Inspector Wright, in 640 by Inspector Chapman. 515 Inspector Sickelmore, 485 Inspector Thomas, 344 Inspector Shaw, 717 Inspector 1 22 Molloy, 753 Inspector Bishop, 617 Inspector Girling, 539 Inspector Stratton, 499 Inspector Grant, and 509 by Inspector Walker. In connection with the inspectors' work some 1,822 letters were written to owners and others concerned. The Inspectors made 51,171 visits in connection with 12,056 premises, which were under inspection. The premises included 9,775 dwellings, 1,446 workshops, besides factories, laundries, bakehouses, cowsheds and milk vendors' premises, icecream shops, slaughterhouses, and other places where food is prepared and sold. Some 978 visits of inspection were made in connection with the street markets, stables and stable yards, and for the detection of unsound food are included in the total given above. The inspection of 3,202 of the dwellings was the result of a houseto-house visitation carried out in accordance with a scheme settled by the Health Committee with a view to securing as far as practicable uniformity and regularity in connection therewith (p. 35). In Table IX. (Appendix) a summary is given showing particulars of the work carried out for the abatement of nuisances and for improving the sanitary condition of the dwellings of the people which has been compiled by the Senior Inspector from information supplied by the Sanitary Staff. The work done in compliance with the provisions of the Factory and Workshops Act, 1901, and in connection with the drains and sanitary arrangements of new buildings is included in the Summary. Most of it was carried out to meet the requirements indicated on the written intimations given by the Sanitary Inspectors. 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 infringing the Act in 1,511 instances. For non-compliance with the requirements of the Sanitary Authority proceedings were taken before the magistrate in 91 instances. SMOKE NUISANCES. There were three communications from the London County Council referring to the emission of black smoke. The same were duly brought to the notice of the parties responsible. Some 25 observations were made by the Sanitary Inspectors and in three instances intimations were given to the offenders. These were effective and there was no necessity for further action on the part of the Sanitary Authority. FUR SKIN DRESSERS. At the end of the year there were three on the register, one having been removed therefrom during the course of the year. They were regularly inspected and some 14 visits were made in connection with them. Six Statutory Notices were served. Four of them were on account of lime-washing which were duly complied with. One was for an offensive accumulation, and one for a defective condition of the flooring. Legal proceedings were taken and the defendant was fined 20s. for the former and 40s. for the latter offence, 23 RAG AND BONE DEALERS. Some 22 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. Some 81 visits of inspection were made in connection with them and in four instances written intimations on account of the need for cleanliness were required. These were duly attended to. VERMINOUS HOUSES. The houses where it was necessary to take measures on account of the presence of vermin numbered 279, and in connection with them some 444 rooms were dealt with during the year. Sanitary notices were served where required and the usual steps were taken. An appreciable number of the premises came under notice through intimations from the School Authorities respecting children reported as being in a verminous condition. During the year the homes of some 692 children, 164 boys and 528 girls, notified as verminous by the School Medical Officer, were reported with a view to the homes, bedding, etc., where necessary, being dealt with by the Sanitary Authority, whilst the children were cleaned and their clothing disinfected at the cleansing stations of the London County Council in the neighbourhood. Intimations were received that 28 boys and 23 girls had been given the opportunity of being cleansed at the cleansing stations, that in the case of 136 boys and 497 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 8 girls legal proceedings were pending for non-compliance with the requirements of Statutory Notices under the Act mentioned. In some instances the same children were more than once reported and their homes had to be visited and dealt with accordingly. In 17 cases the addresses given were erroneous. In practically all the cases reported the homes were visited by the Sanitary Inspectors and the following summarises the results obtained:—In 649 the rooms occupied were satisfactory, varying from fairly clean to very clean, in 24 they were dirty, and in 2 buggy. In 642 the bedding was clean or fairly so, in 13 it was dirty, in 1 dirty and buggy, and in 7 bugs and in 12 fleas were noted. In 5 of the homes evidence of poverty was marked. No evidence of lice was found in connection with any of the homes. Arising out of the visits of the Sanitary Inspectors some 15 Sanitary Notices were served upon owners and one upon the occupier of verminous dwellings. These were mostly for general repairs and cleansing. The children reported by the School Authorities as suffering from scabies numbered 52 of whom 32 were females. As a result of the enquiries made by the 24 Sanitary Inspectors eight other cases came under observation. As far as practicable steps were taken to prevent infection spreading. 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) 354 „ „ (mice) 73 ,, visits and revisits 5,349 rats caught in traps or killed by dogs 1,600 ,, rats found dead through poisoning 420 ,, premises cleared of rats 305 „ premises cleared of mice 56 „ pavements taken up, fronting houses 45 drains reconstructed and repaired 25 „ drains tested by Sanitary Inspectors 45 ,, floors of kitchens, sculleries, passages and coal cellars concreted 47 The poisons used included 1,576 packets of Ratquit, which provided some 31,500 baits, 35 lbs. of Londovus, and 1,726 tins of Rodine. 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 dwelling houses in the Borough is referred to on page 22. Further particulars as regards housing are contained in the Appendix (pp. 64/65). The work on the area included in the London County Council Ware Street Housing Scheme continued in progress throughout the year. Some 48 tenements were completed and the erection of 48 others was commenced. Mention should also be made that the erection of 104 flats by the Corporation of the City of London was in progress during the year. These dwellings which contain 342 rooms are for the accommodation of persons displaced in the city in connection with schemes for improving the housing conditions of the people. The dwellings are being built upon a site adjoining Shepherdess Walk and Wenlock Road. Towards the end of the year a further inspection was made under the instructions of the Health Committee with regard to the adequacy of the artificial lighting of the common stairs of the artisans dwellings in the Borough. In a very appreciable number 25 of cases this was found to be very defective. A communication was sent to the London County Council with a view to early legislation in connection therewith. The houses let in lodgings or occupied by members of more than one family on the register at the end of the year numbered 307, and some 978 visits of inspection were made in conncction with them. In 249 instances intimations relating to various matters requiring attention were served upon the persons responsible for dealing with the same, and in 146 instances Statutory Notices followed. In 20 instances proceedings before the magistrate became necessary. It may be mentioned that the old byelaws as to houses let in lodgings made by the Borough Council have ceased to be operative since the beginning of March of the year under consideration, when new byelaws made by the London County Council for the whole of London came into force. There were two applications for certificates under the Rent and Mortgage Interest (Restrictions) Acts, 1920-23, that dwellings were not in all respects reasonably fit for human habitation. One was not granted. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of the year was 1,446. Of these 113 had been added, 165 having been removed. A classification of the workshops registered is contained in the summary of proceedings under the Act which is appended. Some 2,443 visits of inspection were made in connection with workshops and 426 to factories. Five communications were received from the factory inspectors relative to the establishment of 179 new workshops in the Borough. As the result of inspection 153 were found in a satisfactory condition, and 11 were not in use. With regard to the remainder sanitary notices were necessary ; in eight instances for cleansing, two for the provision of proper and separate W.C. accommodation, three on account of defective w.c., one for defective roof, one for defective sink waste and two on account of accumulations of rubbish. Sixty-two written intimations were received from the factory inspector relating to insanitary conditions and infringements of the law as to public health in connection with 18 factories and 44 workshops. The chief insanitary conditions to which the factory inspector directed attention were : dirty conditions of walls and ceilings in 52, defective and insufficient w.c. accommodation in 39, w.c.'s not properly screened in 14, overcrowding in two, defective roofs in three, defective service pipe in one, dampness in one, bad smells in five, and in one instance there was an accumulation of refuse. Including those brought under the notice of the department by the factory inspector 326 workshops were dealt with, 318 sanitary notices being served upon the parties responsible for their proper sanitary upkeep. In eight instances sanitary 26 notices were not required. The following is an abstract of the sanitary work carried out to comnlv with these notices:— Premises cleansed throughout 97 partially 82 Number of rooms cleansed 290 Walls, floors, sashes, etc., repaired 88 Light and ventilation improved 3 Roofs, guttering, etc., repaired 107 Overcrowding abated — Water reinstated or improved 4 Drains newly constructed 1 „ reconstructed 6 ,, repaired, etc. 18 ,, obstructions removed 19 Urinals cleansed, etc. 8 Soil and vent pipes dealt with 11 Water-closets newly constructed 2 ,, repaired, etc. 213 ,, obstructions removed 30 Sinks, etc., cleansed and repaired 11 Sink traps provided 2 Sculleries, yards, etc., paving repaired 8 Sculleries, yards, etc., cleansed or limewashed 113 Dust receptacles provided 25 Foul accumulations removed 31 The number of factories under observation for insanitary conditions during the year was 52, and in connection with them some 52 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 34 instances, the removal of obstructions from drains and waterclosets in 30 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 80 lists of out-workers were received from employers in the Borough, 41 in the first and 39 in the second half-year. Those for the first halfyear are due in February, for the second in August. These lists contained the names of 940 out-workers, of whom 681 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 1,511 out-workers, and of these 11 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 1926. The number of out-workers reported was 2,451 and of these some 1,780 were residents in Shoreditch. These figures are above the average for the past five years, but they show a decrease as compared with those for 1925. 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 27 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 824 visits of inspection were made to places where home-work was being carried on, and in connection with these 120 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 25 and included 3 of scarlet fever, 18 diphtheria, one erysipelas and three pneumonia. The usual steps were taken in connection with them by the officers of the sanitary authority. MATERNITY AND CHILD WELFARE. The births notified numbered 2,096 and there were in addition some 59 still births. Of the notifications 1,483 were received from registered midwives practising in the Borough. In addition, 332 births occurring in institutions outside Shoreditch were notified weekly, on forms sent in by the London County Council. Including these the live births notified during the year were approximately 96 per cent. of the births registered during the year as compared with 94 per cent. in 1925, 98 in 1924, 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.66-71). It follows generally on the lines of previous years. An important item to be reported in connection with the work during 1926, is the institution of an artificial sunlight clinic, which was opened on May 31st, at the Model Welfare Centre. Treatment is given on Monday, Wednesday and Friday afternoons. The general arrangements in connection with this treatment are under the supervision of the Assistant Medical Officer of Health, Dr. Maitland Radford. Dr. Radford attends the Clinic on Wednesday afternoons, when he sees every patient undergoing treatment. Prior to taking charge of this Clinic, Dr. Radford attended the Artificial Sunlight Department at University College Hospital. The actual dosage is administered by Sister Pollard, who is also responsible for keeping the records. Sister Pollard received a general training at the London Hospital and has since undergone a course of training in Actino-Therapy, under Professor Leonard Hill. At the time of her appointment here last May, Sister Pollard had been for 10 months in charge of the Stratford Day Nursery Light Clinic and this post she still holds. Assistance has been obtained in the general management of the Clinic from several ladies who have kindly given their services. Many of them have been members of The Incorporated Society of Trained Masseurs and they have been desirous of gaining an insight into this branch of treatment. It has been made clear to these ladies that we do not undertake to give a definite course of instruction nor to issue any certificate of proficiency. The voluntary assistance thus rendered has been most valuable in carrying on the work at the Clinic and has obviated the necessity of enlarging the salaried staff. 28 The lamp used at the Shoreditch Centre is a a Quartz Mercury pheric lamp of Kelvin, Bottomly and Baird. It runs at an amperage of 4½—2½, the latter figure being reached and maintained a few moments after the lamp is started. The current is direct and the voltage 250. The cases treated have been (a) infants and children under five years, referred from the various Welfare Centres in the Borough, and (b) infants and children from the Wards in the same building. Patients suffering from tuberculosis are not treated at this Clinic. The cases dealt with include rickets, debility, marasmus, anemia and general ill health and failure to gain weight. Cases are not treated in groups according to disease. The in-patients are treated in the mornings and do not mix with the afternoon patients. Exposure is at three feet from the lamp. The routine dosage in minutes has been as follows: 1—2—3—4—5—5—5—6—6—6—7—7—7—8—8—8—8 each exposure being equally divided between front and back. In cases showing idiosyncrasy the routine is modified. The children not resident in the institution are held in front of the lamp by their mothers, and both mothers and children and all persons working in the department wear goggles or shades, to protect their eyes. There has been no case of inflammation of the eyes attributable to exposure to the lamp. The actual average duration" of treatment is affected by cases who are unable or unwilling to continue their attendances. The average aimed at has been from four to six months. The temperature of each patient was taken before and after treatment for nearly the whole of the period during which the work at the Clinic has been carried on. In December, however, it was decided to discontinue taking the temperature after exposure as this was found to involve considerable delay and there was no reason for believing the temperature rose as a result of treatment, with the doses as given above. The pulse is not taken as a routine. The weights of all patients are taken, and together with dosage and temperature are recorded on the chart in use for each patient. During the period under consideration, X-ray records have not been made, but it is expected that arrangements will be made during the current year for cases being referred from the Light Clinic for X-ray examination at St. Leonard's Hospital. During the seven months the Clinic has been open, 138 children have received treatment. The general opinion of parents and of the assistants at the Clinic is that children are brighter and happier and that they eat and sleep more satisfactorily. In this opinion the Assistant Medical Officer of Health concurs. He points out, however, that these children also attend the Welfare Centres where their parents are given general advice as to their management and where many also receive cod liver oil. When facilities for X-ray records are available accurate information as to the benefit derived in cases of rickets will be obtainable. A comparison of the weight curve of a number of children receiving light treatment and a similar number not 29 receiving this treatment will be prepared in due course. Erythema has only been noticed in a few cases. There have been no recorded cases of desquamation. pigmentation has not occurred. Local lesions have not been treated. During the period under consideration the lamp has been run for 221 hours 40 minutes, and the cost of the current used has been 11s. 5d. The average cost of the current per hour would thus amount to -6 of a penny. The average cost of each patient's treatment, excluding initial expenditure, has been approximately 8s. It would not be wise without more prolonged experience to make a definite statement as to the extent of the benefit derivable from the treatment but there are good grounds for believing that the artificial sunlight clinic is a very valuable adjunct to our maternity and child welfare work. The medical staff for the centres during the year was unchanged and the same remark is applicable to the health visitors. The following probationers received certificates during the year : Misses D. M. Punter, D. Harrop, and B. Duncan. It is a matter of regret to have to report that Mrs. Thompson was obliged to discontinue giving massage to the infants in the wards on account of ill-health. Considerable benefit was derived from this treatment, which it is hoped before long will again be available. The numbers at the weekly Ante-Natal Clinics have been well maintained, and the numbers attending the Child Welfare Centres show a marked increase during the year. The numbers of centres and Ante-Natal and Infant Welfare consultations remain unchanged. Dinners were served as usual during the year at the Model Centre in Kingsland Road and at the Dining Centre, 28, Herbert Street. The temporary appointment of Miss Zemaitis at the latter Centre referred to in last year's report was made permanent during the year. According to information supplied by the Hospital Authorities 409 cases from Shoreditch were dealt with at the Ante-Natal and Consultative Maternity Centre of the City of London Maternity Hospital during 1926. Of these 206 were examined by the Obstetric Surgeon attached to the Centre, some 379 examinations being made. In all cases the urine was tested. In 203 the Sister attached to the department saw and advised expectant mothers upon various aspects of their pregnancies. Some 18 cases were referred to this Centre by the Council's Medical Officers under the existing agreement with the Hospital for diagnoses and for their confinements in the institution. Special features noted during the year were : haemorrhage in 8 instances, contracted pelvis in 22, albuminuria in 16, breech presentations in 6, transverse 2, Pneumonia 2, pyelitis 6, phlebitis 2, heart disease 2, tuberculosis 2, bad histories 24, varicose veins 2, septic boils 1, hydrocephalus 2, gonorrhoea 1, hip disease 1, c 30 hydramnios 1, and placenta praevia in 1 instance ; in one instance Caesarian Section was necessary and in 10 induction of labour ; in 1 case decapitation was required, and in 2 there were discharging breasts after delivery. There were 9 sets of twins. The number of cases admitted to the wards for their confinements were 199, and 187 were attended in their own homes. The cases nursed under the arrangement with the District Nursing Association numbered 390 altogether and included 321 amongst children under five years. The total number of visits to patients was 4,741 and of these 3,550 were to children under five. Measles, ophthalmia neonatorum, otorrhoea, threadworms, tonsils and adenoids, pneumonia, bronchitis, skin eruptions and discharging eyes furnished the majority of the cases under five years. Further particulars are given in the Nursing List (Appendix p. 72). STREET MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers as regards food exposed for sale in the market streets and generally throughout the Borough. The following were surrendered or seized and destroyed as unfit for the food of man : 8 cwts. pigs heads, 146 lbs. of eels, 1 box (3 qrs.) plaice, 5 boxes and 1 cwt. 2 qrs. skate, 2 bushels of winkles, 1½ cwt. of bottled fish, 1 stalk and 1 crate of bananas, 17 ½ skips black currants, 50 lbs. grapes, 23 boats of greengages, 6 cwt. 80 lbs. of pears, 6 cwt. of strawberries, 4 cwt. 14 lbs. of cob nuts, 60 bags of cabbages, 12 bags of cauliflowers, 10 bags of greens, 69 boxes of lettuce, 3 bags of potatoes, 1 ton 3 qrs., 1 box and 17 bags of radishes, 2 ton 6 cwt. of savoys, and 25| tins of condensed milk. SLAUGHTERHOUSES. The two slaughterhouses in the Borough were subject to the usual inspection and 10 visits were made in connection with them. Their general sanitary condition may be reported as satisfactory, but little use is made of them. Some 54 butchers' shops were under inspection during the year and some 295 visits of inspection were made. Due attention was given to the shops and stalls coming within the scope of the Public Health (Meat) Regulations, 1924. COWHOUSES. Some 17 visits of inspection were made to the two cowhouses in the Borough. Their sanitary condition may be reported as satisfactory. There were 26 cows kept in the sheds towards the close of the year. The number of dairymen and milk purveyors on the register at the end of the year was 270, 14 having been added and eight removed therefrom. In 24 instances there were changes in the names of the persons registered. The premises were under regular inspection throughout the year and some 1,454 visits were made in connection with them. In nine instances sanitary notices were served, mainly for cleansing. One case of scarlet fever, two of diphtheria and one of tuberculosis were 31 certified on milk vendors premises during the year. The usual steps were taken for safeguarding the milk. The Public Health (Prevention of Tuberculosis) Regulations, 1925, prohibit a person suffering from tuberculosis of the respiratory tract from following any employment or occupation in connection with a dairy, which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk, if he is in an infectious condition. There was no necessity for any action under these regulations during the year, with a view to enforcing same. MILK AND CREAM REGULATIONS, 1912. None of the samples of milk submitted for analysis were reported to contain any preservative. No samples of cream were submitted for analysis. CONDENSED MILK REGULATIONS. No samples were submitted for analysis. MILK AND DAIRIES ORDER, 1926. The above Order, made under the Milk and Dairies (Consolidation) Act, 1915, came into operation on October 1st, 1926. It codifies and amends the Dairies Cowsheds and Milk Shops Orders of 1885 and 1886, which are rescinded. MILK (SPECIAL DESIGNATIONS) ORDER, 1922. The following are the premises at which " certified " milk may be sold in accordance with the requirements of the above Order : 73, Kingsland Road, 193, Kingsland Road, 60, Shepherdess Walk, 13/15, Sun Street and 147, Goldsmith Row. The latter was an addition during the year. COOKSHOPS AND EATING-HOUSES. Including the kitchens of public houses where food is prepared for customers, 178 were under inspection during the year, and some 429 visits were made in connection with them. Some 56 sanitary notices were served, mainly for cleansing. FRIED FISH SHOPS. Some 58 were under inspection and 290 visits were made to them. Eighteen sanitary notices were served, mainly for cleansing. ICE-CREAM SHOPS. The number under observation during the year was 132 and 276 visits of inspection were made. In 11 instances sanitary notices were served. Most of these were for general cleansing. BAKEHOUSES. The bakehouses in the Borough, to the number of 57, were inspected and reported 0n to the Health Committee. Thirty-four were found in a satisfactory sanitary c°ndition. In 20 lime-washing and cleansing were necessary. In one an additional C3 32 w.c. was required, in one eaves guttering was defective, and in one there was a blocked drain. The necessary sanitary notices were served and duly complied with. The bakehouses at 32, Clifton Street, 271, Hoxton Street, 164 Kingsland Road, and 76, Pitfield Street, were not in use as bakehouses when visited. Altogether, therefore, at the close of the year there were 61 bakehouses on the register, of which 36 are underground. In 28 power is used in connection with the work of bread making. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 1,058 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 1926. 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 249 4 1.6% 2 – 2 1 3 0 0 155 12 6 2nd 217 10 4.6% 1 – 1 — 2 2 0 135 12 6 3rd 223 6 2.7% – – – – 139 7 6 4 th 369 7 1.9% – – – – 230 12 6 Totals for Year. 1,058 27 2.5% 3 – 3 1 5 2 0 661 5 0 The samples taken included 513 of milk, 69 butter, 59 vinegar, 53 cocoa, 46 margarine, 39 pepper, 25 tea, 16 baking powder, 16 dripping, 16 non-alcoholic wine, 13 coffee, 13 lard, 12 jam, 10 rice, 9 ground almonds, 9 custard powder, 9 tapioca, 9 malt vinegar, 8 cheese, 8 mustard, 8 sago, 6 arrowroot, 6 sausage, 5 self-raising flour, 5 ginger, 5 ice cream, 5 ground rice, 4 camphorated oil, 4 olive oil, 4 beef sausage, 3 black pudding, 3 ground ginger, 3 beef suet, 3 mixed spice, 2 barley, 2 pearl barley, 2 pressed beef, 2 brawn, 2 chocolate sweetmeats, 2 coffee and chicory, 2 faggots, 2 glycerin, 2 compound liquorice powder, 2 mustard compound, 2 ammoniated tincture of quinine, 2 breakfast sausage, 2 saveloy, 2 semolina, 2 sugar, 1 each of apples (informal), friar's balsam, corned beef, chocolate (informal), desiccated cocoanut, ground cinnamon, lemon squash, meat pie, mince meat, salmon paste, tartaric acid and spirits of camphor. Of the samples of milk seven, or 1.3 per cent., were found to be below the standard fixed by the Board of Agriculture. The proportion of milk samples returned as adulterated during 1926 was again greatly below the average. 33 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 not found to be genuine:— Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st 153 3 1.9 2nd 96 4 4.2 3rd 115 — 0.0 4th 149 — 0.0 In two of the samples water was certified to have been added; in each of these it was less than 5 per cent. ; in four, the samples showed deficiencies in milk fat; in two of these it was less and in the other two it was more than five per cent., taking the standard of the Board of Agriculture. Legal proceedings were instituted in three or 42.9 per cent. of the cases in which samples of milk were below standard. In one instance the summons was dismissed in view of the variation in result of analysis of different portions of the sample. In one instance the defendant was fined, and in the other case costs only were allowed the Council. 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 57.1. In the case in which a conviction was obtained, the fine amounted to £3, which was 15 per cent. of the maximum which might have been inflicted. 69 samples of butter were taken, all of which were returned as genuine, 32 were reported as containing boric acid, not exceeding 0.5 per cent. in each. 46 samples of margarine were taken, all of which were returned as genuine. Boric acid was present in 30, but not exceeding 0'5 per cent. in any case. Of the 59 samples of vinegar taken, one contained four per cent. excessive water. No proceedings were taken. The sample of salmon paste contained boric acid 5.1 grains per pound. No action was taken. The sample of meat pie contained boric acid 3.6 grains per pound. No action was taken. Two samples of mustard were found to contain 7 and 15 per cent. of wheat flour respectively and each had traces of turmeric. No proceedings were taken. One sample of sausage contained boric acid, 6 2 grains per pound. No action was taken. 34 One sample of beef sausage contained boric acid, 4.9 grains per pound and one 3.2 grains per pound. No proceedings were taken in cither case. One sample of cheese contained tin 0.035 grains per pound, one 0.063, one 0.098, one 0.175 and another 0.245. No action was taken. One sample of beef suet was found to contain moisture 1.1 per cent. with rice flour 10.4 per cent., one moisture 1.2 per cent. and rice flour 16.6 percent., and another moisture 1.5 per cent. with rice flour 12.2 per cent. No action was taken. One sample of ground ginger contained excessive mineral matter (ash) to the extent of 2.5 per cent. No action was taken. Three samples of non-alcoholic wine contained salicylic acid, ranging from 1.4 to 1.7 grains per pint. No proceedings were taken. The informal sample of apples contained arsenic 0.0031 grains per pound, i.e., less than one-third of the Royal Commission limit. The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1902-1926 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. 1902 281 420 71 25.3 54 2 52 48 £ s. d. £ s. d. 117 9 0 140 10 0 1903 707 166 112 15.8 60 5 55 51 173 11 6 353 10 0 1904 612 189 110 17.9 56 6 50 46 128 5 0 306 0 0 1905 536 215 98 18 2 57 2 51 47 233 18 0 267 0 0 1906 520 224 122 23.4 44 2 42 34 106 12 6 260 0 0 1907 519 223 99 19.0 36 4 32 27 67 14 0 259 10 0 1908 580 200 92 15.8 45 ... 45 39 117 10 0 290 0 0 1909 570 200 92 16.1 76 2 74 69 255 18 6 276 5 0 1910 578 200 133 23.0 65 ... 60 49 93 17 6 279 5 0 1911 577 200 149 25.8 64 ... 62 58 180 0 6 278 17 6 1912 584 190 100 17.1 48 1 48 45 172 11 0 281 10 0 1913 768 144 132 17.1 47 ... 47 42 94 2 6 350 10 0 1914 768 143 132 17.1 36 ... 36 21 74 6 0 350 10 0 1915 768 135 130 17.8 43 ... 43 30 63 16 0 350 10 0 1916 768 130 144 18.7 50 ... 49 36 134 18 0 350 10 0 1917 770 129 154 20.0 65 ... 65 41 99 12 0 351 5 0 1918 724 134 137 17.5 54 1 53 37 284 13 0 340 12 6 1919 632 155 72 11.3 32 1 31 17 137 3 0 316 0 0 1920 934 109 69 7.4 25 1 24 14 38 3 6 700 10 0 1921 1077 98 58 5.4 25 ... 25 20 94 14 0 807 15 0 1922 1068 97 58 5.4 20 ... 20 14 31 5 0 700 15 0 1923 1049 101 51 4.9 19 ... 19 10 24 18 6 655 12 6 1924 1051 101 37 3.5 17 ... 17 11 49 9 0 656 17 6 1925 1073 100 55 5.1 16 2 14 5 32 14 6 670 12 6 1926 1058 101 27 2.5 3 ... 3 1 5 2 0 661 5 0 35 The percentage of samples found adulterated was again markedly below the average for past years, in fact lower than it has ever been. With reference to the conviction in 1926, the defendant had not been previously convicted. STAFF. Mr. Shaw, Sanitary Inspector, was absent on account of illness from the end of April until the end of July. Mr. Thomas, Sanitary Inspector, was away from May 14th to 29th, and Mr. Grant from May 18th to 29th, on account of illness. The Rat Officer, Mr. Jordan, was also away ill from the middle of March to the middle of April. Early in the year the Health Committee adopted a scheme for a systematic house-to-house inspection, which briefly is as follows: Each of the district inspectors is provided with a map and a street list of the houses of his district; the period within which the house-to-house inspection is to be carried out has been determined by the Committee, and the number of streets and houses assigned to each inspector for annual inspection ; the progress of the inspection is indicated on a map of the Borough, which is submitted to the Committee at stated intervals. A statement showing the number of houses inspected is also rendered monthly. Towards the end of the year the Health Committee, being of opinion that it would be a benefit to the inspectors and an advantage, generally, so far as the sanitary inspection of the Borough is concerned, to change their districts, reported to the Borough Council accordingly, submitting a scheme showing the changes contemplated. This was adopted, and from 1st January, 1927, the districts allotted to the inspectors will be as follows : No. 1 Mr. Chapman, No. 2 Mr. Sickelmore, No. 3 Mr. Bishop, No. 4 Mr. Shaw, No. 6 Mr. Grant, No. 7 Mr. Walker, No. 8 Mr. Girling, No. 9 Mr. Stratton, No. 10 Mr. Wright, No. 11 Mr. Molloy, No. 12 Mr. Thomas. The three disinfectors, Messrs. Fawns, Kennedy and Flack, who were temporarily employed, were taken on the permanent staff in February. With regard to the staff employed under the Maternity and Child Welfare Committee the following probationers were appointed: Miss Margaret Williams and Miss Zettie E. Halliday, who commenced their duties early in January, Miss Margery E. Lamb, who commenced on April 19th, and Miss Elsie Axtens, who commenced duty on May 8th. Mr. H. Fitzgerald from the Libraries Department was appointed in place of Mr. F. Sharpe, who obtained an appointment under the Bethnal Green Borough Council and commenced duty on February 1st. Mr A. W. Scott was appointed to the permanent staff on September 14th. The appointment of Mrs. M. Pollard, sister in charge of the Light Clinic, has already been referred to. Dr. Elizabeth D. Karn was appointed to take over Dr. Maitland Radford's Infant Welfare Consultation at Harbour Lights and commenced this duty on May 28th. The following obstetric specialists were appointed as Consultants under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 :— Miss G. Dearnley, M.D., B.S., Gynaecological Surgeon, Royal Free Hospital. 36 Eardley Holland, Esq., M.D., F.R.C.P., F.R.C.S., Gynaecological Surgeon, City of London Maternity Hospital and London Hospital. W. H. M. McCullagh, Esq., D.S.O., M.C., M.B., B.Ch., F.R.C.S., Gynaecological Surgeon, City of London Maternity Hospital and Metropolitan Hospital. Mrs. A. Levi, a former Health visitor, was temporarily employed with the approval of the Ministry of Health from May to October whilst Health visitors were taking their holidays. The appointment of Miss Zemaitis has already been mentioned. She took Miss Thorogood's place on her resignation. The appointment was temporary and she commenced duty on July 12th. Mrs. Walduck was appointed to assist Miss Zemaitis and commenced work the same date. Miss N. Boon was engaged as temporary nurse at the Model Welfare Centre from the beginning of January to the beginning of March. During the absence of Mr. Bear, porter at the Kingsland Road Model Centre, through illness, Mr. H. Peters was engaged to do his work and commenced duty on December 15th. The work of the Clerical Staff must not be overlooked. Under the Health Committee some 23,625 communications written and printed were despatched from the Office during the year. These included 8,564 notices and summonses, 4,358 letters, cards and other communications under the Public Health and Sale of Food and Drugs Acts, 234 in connection with the work under the Factory and Workshops Acts, 7,680 on various matters relating to infectious disease, verminous cases and disinfection, and 2,860 agendas and reports respecting the work carried out. In connection with the work under the Maternity and Child Welfare Committee some 26,861 communications were despatched, including 11,524 forms, books and cards in connection with the distribution of milk, 9,961 letters and other communications, and 5,376 agendas and reports. I have again to acknowledge the valuable help rendered by Dr. Maitland Radford, the Assistant Medical Officer of Health, and Mr. Pearson, the Senior Inspector, in connection with the work carried out during the year. My thanks are due to them for their assistance and also to the other members of the staff employed in safeguarding the health of the people of the Borough. I have also to express my thanks to the Mayor, the Chairmen and members respectively of the Health and Maternity and Child Welfare Committees, and to the members of the Borough Council generally for their kind consideration and help in connection with the work carried out during the year. I have the honour to be, Sir, Ladies and Gentlemen, Your obedient Servant, LEWIS T. FRASER BRYETT, Medical Officer of Health. 37 Metropolitan Borough of Shoreditch. APPENDIX TO THE REPOR T of the M edical o fficer of Health, containing Statistical Tables and Summaries of Proceedings under the Public Health and Factory and Workshops Act during the Year 1926, copy of the Report of the Tuberculosis Officer, and a Summary of Notifications under the Public Health (Tuberculosis) Regulations, 1912, 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, 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, and Particulars as to Cases Nursed by the District Nursing Association on behalf of the Shoreditch Borough Council during the Year 1926. 30 TABLE I. Vital Statistics of the Borough of Shorcditch during 1926 and previous years. Births. Total Deaths Registered in the District. T ransferable Deaths Nett Deaths belonging to the District. Year. Population estimated to middle of each year. Uncorrected Number. Nett. Number. Rate. of Nonresidents registered in the District. of residents not registered in the District. Under 1 year of Age. At all Ages. Number. Rate. N umber. Rate per 1,000 nett Births. N umber. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1917 89675 2056 2225 22.2 1789 19.9 260 461 352 158 1990 22.5 1918 87645 1514 1719 17.5 1990 22.7 317 435 286 166 2108 24.2 1919 98134 2136 2286 22.3 1362 13.8 224 399 251 110 1537 15.7 1920 102044 3546 3731 36.9 1450 14.2 245 378 340 91 1583 15.6 1921 105200 2798 2975 28.5 1393 13.3 264 369 341 114 1498 14.4 1922 105800 2645 2926 27'9 1508 14.2 204 408 301 102 1712 16.3 1923 106200 2552 2832 26.9 1191 11.2 191 370 232 82 1370 13.0 1924 106500 2336 2528 23.9 1309 12.3 232 367 221 87 1444 13.7 1925 107300 2361 2627 24.6 1298 12.1 258 381 233 88 1421 13.3 1926 l(i7300 2235 2516 23.5 1180 10.9 217 335 167 66 1298 12.2 Note.—The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn 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 642.5 covered by water). Rateable value £950,991 Yield of penny rate £3,842 Total population at all ages 104,308 Number of families 25,373 Number of inhabitated houses11,889 Average number of persons per house 8.8 At Census of 1921. 40 TABLE II. Cases of infectious disease notified during the Year 1926 in the Borough of Shoreditch. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Notifiable Disease. At all Ages. At Ages —Years. 1 2 3 4 5 6 7 8 Total Cases Removed to Hospital. Under 1. 1 to 5 to 15. 15 to 25. 25 to 45. 15 to 6. 65 and upwards. Moorfields. Church. Moxton. Wenlock Whit- more Kingslane ilagger- stone. Acton. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C), Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 372 14 144 153 37 19 5 ... 9 69 58 61 65 36 45 29 372 Erysipelas 52 4 5 6 4 13 14 6 3 9 12 4 10 7 3 4 26 Scarlet fever 432 5 144 259 20 4 ... ... 6 63 83 72 67 50 36 55 432 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 6 ... 1 2 1 1 1 ... ... ... ... ... ... 2 2 2 6 Relapsing fever (R), Continued fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 10 ... ... ... 7 3 ... ... ... 5 ... 2 2 ... 1 ... 10 Puerperal Pyrexia 5 ... ... ... 3 1 1 ... ... ... 1 4 ... ... ... ... 3 Cerebro-spinal meningitis 4 2 2 ... ... ... ... ... ... 1 1 ... ... 1 1 ... 4 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 3 ... 2 1 ... ... ... ... ... 2 ... ... ... ... ... 1 2 Encephalitis lethargica 8 ... 1 2 3 2 ... ... ... 2 2 1 ... 2 1 ... 7 Pulmonary tuberculosis 225 1 2 12 62 85 62 1 12 44 34 34* 38 † 13 22 28 216‡ Other forms of tuberculosis 62 1 18 23 13 6 ... 1 1 11 16 10 10 3 5 6 52‡ Ophthalmia neonatorum 66 66 ... ... ... ... ... ... ... 17 7 6 15 8 13 ... 6 Acute primary pneumonia 252 45 113 27 16 20 23 8 6 50 41 44 48 19 26 18 211 ‡ Acute influenzal pneumonia 33 4 5 4 4 7 8 1 ... 2 6 23 1 1 ... ... 6‡ Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Trench fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1,530 142 437 489 170 161 114 17 37 275 261 261 25G 142 155 143 1,353 * This Number includes the cases of consumption notified from the Holborn Institution, Highgate, f This includes the cases of consumption in the St. Leonard's Hospital. J Removed to St. Leonard's and oth-r Hospitals or Sanatoria. It is to be noted that the cases of tuberculosis removed during the year included cases certified in previous years as well as cases certified in 1925. 41 TABLE III. Causes of, and ages at, death during the Year 192o in the Borough of Shoreditch. CAUSES OF DEATH Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the dlstrict (a). Total Deaths whether of Residents " or " NonResidents" in Institutions in the District (b) 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) 1298 167 55 43 38 81 156 344 414 719 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric fever 1 ... ... ... ... 1 ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... 3 Measles 25 3 18 4 ... ... ... ... ... 8 4 Scarlet fever 4 ... 1 2 1 ... ... ... ... ... 5 Whooping cough ... ... ... ... ... ... ... ... ... ... 6 Diphtheria and Croup 12 ... 4 5 2 ... ... 1 ... ... 7 Influenza 22 2 ... 1 1 2 3 6 7 ... 8 Erysipelas 3 ... ... ... ... ... ... 1 2 2 9 Phthisis (pulmonary tuberculosis) 133 ... ... ... 2 43 43 40 5 62 10 Tuberculous meningitis 9 1 1 5 1 ... 1 ... ... 5 11 Other tuberculous diseases 9 ... ... 2 3 1 3 ... ... 6 12 Cancer, malignant disease 125 ... ... 1 ... ... 11 67 46 55 13 Rheumatic fever 7 ... ... ... 3 3 1 ... ... 3 14 Meningitis (see note (d) 13 4 3 2 1 3 ... ... ... 1 15 Organic heart disease 33 ... ... 1 2 1 3 14 12 15 16 Bronchitis 14 8 2 ... ... ... 8 55 67 101 17 Pneumonia (all forms) 130 43 14 12 4 3 14 23 17 46 18 Other diseases of respiratory organs 9 ... 1 3 ... 1 2 2 ... 4 19 Diarrhoea and Enteritis (see note (e) ) 32 22 4 ... 1 ... 1 3 1 10 20 Appendicitis and Typhlitis 8 1 ... ... 4 1 ... 2 ... 1 21 Cirrhosis of liver 8 ... ... ... ... ... ... 6 2 8 21aAlcoholism ... ... ... ... ... ... ... ... ... ... 22 Nephritis and Bright's disease 49 ... ... ... ... 1 9 21 18 42 23 Puerpural fever 3 ... ... ... ... 2 1 ... ... 1 24 Other accidents and diseases of pregnancy and parturition 3 ... ... ... ... ... 3 ... ... 1 25 Congenital Debility and malformation, including premature birth 60 60 ... ... ... ... ... ... ... 31 26 Violent deaths, excluding suicide 39 4 2 4 5 4 5 7 8 18 27 Suicides 15 ... ... ... ... ... 7 5 3 4 28 Other defined diseases 403 16 5 1 8 15 41 191 226 295 29 Diseases ill-defined or unknown 3 3 ... ... ... ... ... ... ... ... 1298 167 55 43 38 81 156 344 414 719 42 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH DURING THE YEAR 1926. 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 44 13 10 5 72 24 18 28 25 167 Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 3 3 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup- ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... ... 1 Abdominal tuberculosis (b) ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... 1 1 2 ... 1 2 ... 5 Convulsions 3 1 ... ... 4 ... ... ... ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 1 3 2 1 8 Pneumonia (all forms) ... ... 1 2 3 6 3 17 13 42 Diarrhæa ... ... l ... 1 ... 2 1 1 5 Enteritis ... ... ... ... ... 5 7 3 2 17 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... 1 ... 1 ... ... ... ... 1 Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 1 ... ... 3 ... ... ... ... 3 Congenital malformations (c) 2 ... 1 ... 3 ... ... ... ... 3 Premature birth 27 6 1 ... 34 4 ... ... ... 38 Atrophy, Debility and Marasmus 6 2 2 ... 10 7 1 ... 1 19 Other causes 3 3 2 2 10 1 1 2 4 18 44 13 10 5 72 24 18 28 25 167 Nett Births in the year.—Legitimate, 2,446; illegitimate, 70. Nett Deaths in the year of legitimate infants, 163; illegitimate infants, 4. X43 NOTES TO TABLE III. The classification and numbering of Causes of Death arc those of the "Short List of page xxv. of the Manual of the International List of Causes of Death." (a) All "Transferable Deaths" of residents, i.e., of persons resident in the district who have died outside it, have been included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England or Wales who have died in the district, have been in like manner excluded from these columns. For the precise meaning of the term "Transferable Deaths," see footnote to Table I. (ih) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, have been entered in the last column of Table III. (c) All deaths certified by registered medical practitioners and all inquest cases have been classified as "Certified"; all other deaths being regarded as " Uncertified." (d) Exclusive of "Tuberculous Meningitis" (10), but inclusive of cerebrospinal meningitis. (e) Title 19 has been used for deaths from diarrhoea and enteritis at all ages. (In the "Short List" deaths from diarrhoea and enteritis under 2 years are included under 19; those at 2 years and over being placed under title 28.) NOTES TO TABLE IV. (a) The total in the last column of Table IV equals the total of column 10 of Table I and in column 3 of Table III. (b) Under abdominal tuberculosis have been included deaths from tuberculous peritonitis and enteritis, and from tabes mesenterica. (c) The total deaths from congenital malformation, premature birth, atrophy, debility and marasmus equal the total in Table III under the headings congenital debility and malformation, atelectasis and 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. 44 4s TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31st DECEMBER, 1926. Note.—The deaths of persons not belonging to Shorcditch 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. AGES. DEATHS IN EACH WARD SEX. Total. CAUSES OF DEATH. 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. Ilaggerston. Acton. Male. Female. 1 Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 3 18 4 ... ... ... ... ... ... ... ... ... ... ... ... 7 4 5 4 2 1 2 9 16 25 3 Scarlet fever ... l 2 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... 2 2 4 4 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Epidemic influenza 2 ... 1 1 ... 1 1 2 1 3 3 4 3 ... ... 3 5 3 8 1 2 ... 9 13 22 6 Whooping cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Diphtheria, membranous croup ... 4 5 2 ... ... ... ... ... 1 ... ... ... ... ... 1 4 1 3 ... 1 2 7 5 12 8 Enteric fever ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 9 Asiatic cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Diarrhoea, dysentery 5 2 ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... 2 ... ... 3 1 2 8 1 9 11 Epidemic or zymotic enteritis 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 1 2 3 12 Other allied diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... • • • ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Glanders, farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Anthrax, splenic fever ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Cow-pox, accidents of vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 Gonorrhoea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 Phagedoena, hospital gangrene ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Erysipelas ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... 1 ... ... 2 ... ... 1 2 ... 22 Puerperal fever ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... 3 3 23 Pyaemia, septicaemia ... 1 ... ... ... ... 2 1 ... 2 ... ... ... ... ... ... 5 1 ... ... ... ... 4 2 6 24 Infective endocarditis ... ... 1 ... ... 2 2 3 ... ... ... ... ... ... ... 1 2 2 2 ... 1 ... 1 ... 8 25 Other allied diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Malarial fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Rheumatic fever ... ... ... ... 3 2 1 ... 1 ... ... ... ... ... 1 ... 2 1 1 1 1 ... 4 3 7 28 Rheumatism of the heart ... ... ... 2 ... 1 1 l ... ... 1 ... ... ... 1 1 ... 2 ... 1 1 ... 3 3 6 Tuberculosis :— 29 Brain or meninges, acute hydrocephalus 1 1 5 ... 1 ... ... 1 ... ... ... ... ... ... ... 2 1 3 1 ... 1 1 5 4 9 30 Larynx ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 31 Lungs ... ... ... ... 2 14 29 24 19 23 17 5 ... ... 8 26 20 12 21 17 15 14 82 51 133 32 Intestines, tabes mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 General, position undefined ... ... 2 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 1 1 1 1 4 5 34 Other forms, scrofula ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... 2 ... ... 1 ... ... ... 1 2 3 35 Other infective diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 Thrash ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Actinomycosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 Hydatid diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Other diseases due to altered food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 41 Acute alcoholism, delirium tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 47 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Iloxton. Wen lock. Whit more K ingslard. Haggerston. ' Acton. Male. Female. 42 Chronic alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 43 Chronic industrial poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Ostco-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 Cancer ... ... ... ... ... ... ... 2 8 24 38 32 12 ... 7 15 15 11 26 14 16 12 57 59 116 48 Diabetes mellitus ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... 2 1 ... ... ... ... 1 1 3 4 49 Purpura haemorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Hemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anaemia, leucocythæmia ... ... ... ... ... 1 ... ... 2 ... 1 1 ... ... ... 3 ... 1 ... ... ... 1 4 1 5 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 53 Premature birth 38 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 8 4 4 6 3 5 18 20 38 54 Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 Debility at birth 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 56 Atelectasis 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... 1 2 3 57 Congenital defects 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... 3 ... 3 58 Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Atrophy, debility, marasmus 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... 3 4 3 1 1 7 11 18 60 Dentition ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 62 Old age, senile decay ... ... ... ... ... ... ... ... ... ... 1 35 59 28 9 21 14 11 26 14 15 13 59 64 123 63 Convulsions 4 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... 1 1 ... 3 3 6 64 Meningitis 2 2 1 1 ... 2 1 ... ... ... ... ... ... ... ... 2 5 1 ... 1 ... ... 4 5 9 65 Encephalitis ... . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 66 Apoplexy ... ... ... ... ... ... ... 1 3 2 16 20 10 ... 3 11 5 2 13 11 5 2 25 27 52 67 Softening of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 2 69 General paralysis of insane ... ... ... ... ... ... ... ... 2 3 1 1 ... ... ... 1 1 1 2 ... 1 1 5 2 7 70 Other forms of insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... ... 1 ... 1 ... 2 3 1 ... ... ... ... ... 2 1 1 1 3 ... ... 6 2 8 73 Epilepsy ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 1 2 74 Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 75 Locomotor ataxy ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 77 Other diseases of brain or nervous system ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... 1 1 ... ... 1 2 3 78 Otitis, otorrhæa 1 ... ... 1 ... 1 ... 3 1 ... ... ... ... ... ... 1 2 l 2 1 ... ... 2 5 7 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 82 Endocarditis, valvular diseases of the heart ... ... 1 ... 2 1 ... 1 2 9 5 10 1 1 3 4 6 3 5 3 3 6 17 16 33 83 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 1 ... 1 ... ... ... 1 ... 3 ... 3 85 Aneurism ... ... ... ... ... ... ... ... 1 1 2 3 ... ... 1 1 1 1 2 ... 1 ... 4 3 7 86 Senile gangrene ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 38 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular 1 ... ... ... 1 ... 3 2 6 14 21 44 13 4 4 18 13 16 18 12 14 14 47 62 109 48 49 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Total. Under 1. 1 to 2. 2 to 5. 5 to lo. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 15. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Moxton. Wen lock. Whit more Kingsland. Taggers ton Acton Male. Female. 91 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Acute bronchitis 8 2 ... ... ... ... ... ... 1 4 4 6 5 ... 1 5 7 5 2 4 4 2 14 16 30 95 Chronic bronchitis ... ... ... ... ... ... ... 1 6 13 34 34 20 2 1 12 29 16 15 12 7 18 58 52 110 96 Lobar croupous pneumonia 5 1 ... ... ... 1 ... 2 2 5 1 6 1 ... 2 4 3 8 5 2 5 1 15 15 30 97 Lobular broncho-pneumonia 36 12 11 2 ... ... ... ... 1 2 4 2 1 ... 2 19 8 9 10 8 8 7 46 25 71 98 Pneumonia, form not stated 2 1 1 2 ... ... 2 2 7 1 4 7 ... ... 1 6 5 4 7 1 4 1 14 15 29 99 Emphysema, asthma ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 Pleurisy ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 101 Other and ill-defined diseases of respiratory system ... 1 2 ... ... ... 1 2 ... 1 1 ... ... ... ... 2 2 1 2 1 ... ... 6 2 8 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum ... ... ... ... ... ... ... 1 3 2 1 ... ... ... ... ... ... 2 2 1 1 1 6 1 7 106 Other diseases of stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Enteritis 14 2 ... 1 ... ... ... ... ... ... 2 ... 1 ... ... 3 4 4 2 ... 3 4 12 8 20 108 Appendicitis 1 ... ... 3 1 ... 1 ... ... ... 2 ... ... ... 1 2 1 1 ... ... 2 1 6 9 8 109 Obstruction of intestine 2 ... ... ... 1 ... ... ... ... ... 3 ... ... 1 ... 1 3 ... 2 1 ... ... 4 3 7 110 Other diseases of intestine ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 111 Cirrhosis of liver ... ... ... ... ... ... ... ... ... 3 3 2 ... ... 2 2 2 1 ... 1 ... ... 4 4 8 112 Other diseases of liver ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 ... ... ... ... ... ... 1 1 2 113 Peritonitis ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 2 114 Other and ill-defined diseases of digestive system 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 2 115 Diseases of lymphatic system and ductless glands ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 116 Acute nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Bright's disease ... ... ... ... ... ... l 1 8 11 10 10 6 2 2 12 8 7 11 1 3 5 25 24 49 118 Calculus ... ... ... 1 ... ... ... 1 ... ... ... ... .. ... ... ... ... ... ... 1 ... ... ... 1 ... 1 119 Diseases of bladder and prostate ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... 1 2 ... 1 ... ... ... 3 1 4 120 Other and ill-defined diseases of urinary system 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... 1 1 2 121 Diseases of testes and penis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... ... ... 122 Diseases of ovaries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Diseases of uterus and appendages ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 124 Diseases of vagina and external genital organs ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 1 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Placenta praevia, Hooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 130 Puerperal thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... 3 3 132 Arthritis, ostitis, periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 1 ... ... ... ... 2 2 50 51 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. sex. Under 1. 1 to 2. 1 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total. 134 Ulcer, bedsore ... .... .... .... ... ... .... ... ..... .... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... 135 Eczema ... ... .... .... .... ... ... ... ... ... ... ... ... ... ... ... ... .... .... .... ... .... ... ... ... 136 Pemphigus 3 ... ... ..... ... .... .... .... ... .... ... ... ... ... ... .... 2 ... ... .... 2 ... 2 2 4 137 Other and ill-defined diseases of integumentary system ... ... ... ... ... ... ... ... .... .... 1 ... ... .... ... ... 1 ... .... .... ... ... 1 ... 1 By Accident or Negligence: 138 In mines and quarries ... ... ... .... ... ... ... .... ... .... ... ... ... ... .... ... ... ... ... ... .... .... .... .... .... 139 In vehicular traffic ... .... 2 ... ... 2 ... 2 ... 1 .... .... 3 ... ... 1 3 3 3 1 ... ... 12 4 10 140 On railways ... .... ... ... .... ... .... ... ... ... ... ... ... ... ... ... .... .... .... .... ... ... ... ... ... 141 On vessels and docks, excluding drowning ... .... ... .... ... .... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 142 In building operations ... ... ... ... ... ... ... ... ... .... .... .... ... ... ... .... .... .... .... .... .... .... .... ... ... 143 By machinery ... ... ... ... ... .... .... ... .... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 144 By weapons and implements ... ... .... .... ... ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... 145 Burns and scalds ... 1 1 ... ... ... ... .... ... 1 ... .... ... ... .... 1 ... .... .... 1 ... ... .... 3 3 146 Poisons, poisonous vapours ... 1 ... .... .... .... .... .... 1 ... ... ... 1 ... ... ... 1 ... .... 1 ... .... .... 3 3 147 Surgical narcosis ... .... .... .... .... ... .... .... 1 ... .... ... ... .... ... 1 ... ... .... .... ... .... 1 ... 1 148 Effects of electric shock ... .... ... .... .... ... ... .... .... .... .... .... .... ... ... .... .... ... ... ... ... .... .... ... ... 149 Corrosion by chemicals ... ... .... .... .... .... ... .... .... .... .... .... ... ... ... ... .... .... .... .... .... ... .... ... ... 150 Drowning ... ... .... ... ... .... ... ... .... 1 ... ... ... ... ... .... ... ... ... 1 ... ... 1 ... 1 151 Suffocation, overlaid in bed 1 ... ... .... .... ... ... ... ... ... ... .... ... ... ... .... ... 1 ... ... .... ... 1 ... 1 152 Suffocation otherwise 3 ... ... ... ... ... .... ... ... ... 1 ... ... ... ... 1 ... .... 1 2 ... ... 3 1 4 153 Falls, not specified ... ... 1 ... ... ... ... 1 ... 2 ... ... 1 ... 1 1 3 ... 2 ... .... ... 4 3 7 154 Weather agencies ... ... .... .... .... .... ... .... ... ... ... ... .... .... ... ... ... .... .... ... ..... .... .... .... .... 155 Otherwise, and not stated ... ... 1 ... 1 .... ... ... ... ... ... ... ... ... ... .... 1 ... ... .... 1 ... 2 ... 2 156 Homicide Suicides, all forms:— 157 By poison .... ... ... ... ... ... ... 1 ... 2 1 ... ... ... 1 ... 1 ... .... ... 1 1 3 1 4 158 By asphyxia ... .... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 .... ... ... ... ... ... 1 ... 1 159 By hanging and strangulation ... .... .... ... .... ... ... ... 1 ... 1 1 ... ... ... 1 ... 1 1 ... ... ... 3 ... 3 160 By drowning ... .... .... ... ... ... ... 1 2 1 .... ... ... ... ... ... .... 1 1 ... .... ... 3 1 4 161 By shooting ... .... .... .... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... .... .... ... ... ... ... 162 By cut or stab .... ... ... ... ... ... ... ... 1 ... ... 1 1 .... .... ... ... ... 1 ... 1 ... ... 2 ... 2 163 By precipitation from elevated places ... .... .... .... .... .... .... ... .... .... ... .... 1 ... .... .... ... ... .... .... 1 1 .... 1 164 By crushing ... ... ... ... .... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... .... 165 By other and unspecified methods ... .... .... ... ... .... .... ... ... ... .... ... .... ... ... ... ... .... .... ... ... ... ... ... ... 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... .... ... ... ... ... .... ... ... .... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... 168 Other ill-defined and not specified causes 3 ... ... ... ... .... ... ... ... .... ... ... ... ... ... ... .... 1 1 ... ... 1 2 1 3 169 Malignant disease ... ... 1 ... .... ... ... ... 1 ... 5 2 ... ... ... 2 ... 2 ... ... 1 3 7 2 9 170 Abscess .... .... .... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 171 Cerebro-spinal fever 2 1 1 .... .... .... ... .... ... ... ... ... .... ... ... ... ... ... ... ... ... 2 2 2 4 172 Encephalitis Lethargica ... ... ... 1 ... ... ... .... ... .... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Totals 167 55 43 25 13 31 50 64 92 144 200 237 139 38 56 230 214 163 224 143 135 133 680 618 1298 c K TABLE VI.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1926. DISTRICTS. Estimated Population 1926. ANNUAL RATE PER 1,000 PERSONS LIVING. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS: Principal Zymotic Disease?. Smallpox. Measles. DEATHS DURING 1926 FROM †Diarrhcra Tuberculous Disease, Violence. Deaths under 1 year to 1,000 Births. Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Scarlet Fever. Diphtheria. Whooping Cough. *Fever. 1923. 1924. 1925. 1926. London 4,602,000 17.1 11.2 12.1 11.7 11.6 0.6 0.00 0.20 0.02 0.12 0.05 0.01 0.20 0.9 0.48 64 9.4 ... 0.0 Shoreditch ‡106.400 23.5 13.0 13.7 13.3 12.2 0.6 ... 0.23 0.04 0.12 ... 0. 00 0.26 1.4 0.50 66 9.2 63.8 ... Wards. Moorfields 4,548 16.7 11.7 11.5 15.1 12.3 0.2 ... ... ... ... ... ... 0.22 1.76 0.44 66 7.1 58.9 ... Church 18,640 24.2 13.1 14.6 12.5 12.3 0.6 ... 0.37 0.05 0.05 ... ... 0.15 1.61 0.43 63 9.1 63.9 ... Hoxton 16,240 26.9 14. 1 15.3 13.3 13.1 0.8 ... 0.24 0.06 0.24 ... ... 0.31 1.29 0.67 57 10.3 67.7 ... Wenlock ‡113,963 28.6 13.3 15.1 12.7 11.6 0.7 ... 0.36 0.07 0.07 ... ... 0.22 1.22 0.50 67 9.2 64.4 ... Whitmore §18,900 21.1 13.0 13.2 13.6 11.8 0.5 ... 0.21 0.05 0.15 ... ... 0.10 1.26 0.42 50 8.1 64.3 ... Kingsland 10,635 21.9 12.8 13.2 13.2 13.4 0.6 ... 0.18 ... ... ... 0.09 1 0.37 1.69 0.66 98 11.2 60.1 ... Haggerston 11,222 23.3 13.1 12.7 13.8 11.1 0.6 ... 0. 09 ... 0.09 ... ... 0.44 1.51 0.53 80 9.6 68.1 ... Actou 12,252 20.0 11.8 11.2 13.8 10.8 0.7 ... 0.16 ... 0.16 ... ... 0.41 1.30 0.40 69 8.3 57.1 ... * Fever includes typhus, typhoid and continued fevers. † Diarrhoea in this table includes enteritis in children under two years. ‡ The inhabitants of the Holborn Institution, which is situate in Wenlock Ward, estimated at 1,000, and the deaths occurring in that institution are excluded. § The Shoreditch Institution is situate in this Ward. In the cases of some of the deaths in outlying institutions, the Shoreditch Institution is the last known place of residence. This Ward is therefore probably credited with some deaths belonging to other Wards. Note.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, 0.00 is inserted: where no deaths have occurred, dots are placed in the space under the heading. The London population is adjusted to the middle of 11)25. 53 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1920. TABLE VII. PREMISES. NUMBER OF PLACES— Number of inspections, 1926. Number of notices, 1926. Number of prosecutions, 1926. On register at end of 1925. Added in 1926. Removed in 1926. On register at end of 1926. Milk premises 261 14 8 270 1,454 9 .... Cowsheds 2 .... .... 2 17 ... ... Slaughterhouses 2 ... .... 2 10 ... 1 Other offensive trade premises 26 ... 1 25 95 10 2 Ice Cream premises 135 5 8 132 276 11 .... Registered houses let in lodgings 307 ... ... 307 987 249 20 Number of intimation notices served for all purposes 6,213 Overcrowding Number of dwelling rooms overcrowded 191 Number remedied 74 Number of prosecutions 1 Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 279 Underground rooms Number dealt with during year 1 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 and other Acts:— With respect to water closets, earth closets, houses let in lodgings, &c 4 Mortuary Total number of bodies removed 132 Total number of infectious bodies removed 54 BOROUGH OF SHOREDITCH. Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK DURING THE YEAR 1926. 1.—Inspection. Inspections made by Sanitary Inspectors. Premises. Inspections. Number of Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 426 52 ... Workshops (Including Workshop Laundries and Bakehouses) 2,679 344 ... Workplaces (Excluding Outworkers' premises dealt with in Table III.) 995 85 ... Totals 4,100 481 ... 2.-Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (i) __ (2) (3) _ w (5)_ Nuisances under the Public Health Acts:* Want of cleanliness 311 311 ... ... Want of ventilation 3 3 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 313 313 ... ... Sanitary accommodation insufficient 2 2 ... ... unsuitable or defective 243 243 ... ... 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 872 872 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 55 3.—Home Work—1926. 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. (8) Prosecutions. Notices served. (12) Prosecutions. (13) Instances. (14) Orders made. (S. 109. (15) Prosecutions. (S. 109 110.1) (16) Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. (9) Failing to send Lists. CIO) Instances. tin Outworkers. Outworkers. (1) Lists. (2) Contractors. (3) Workmen. (4) Lists. (5) Contractors. (6) Workmen. (") Wearing apparel:— (1) Making, &c. 50 39 586 2 ... 9 .... ... ... 56 56 ... 12 ... ... (2) Cleaning and washing ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 2 ... 4 ... ... ... ... ... ... ... .... ... ... ... ... Artificial flowers ... ... ... ... ... .... ... ... ... 7 7 ... 2 ... ... Fur pulling ... ... ... ... ... .... ... .... ... ... ... ... ... ... ... Umbrellas ... ... ... ... ... .... ... ... ... 8 8 ... 2 ... ... Paper bags and boxes 24 ... 291 2 ... 11 ... ... .... 48 48 ... 9 ... ... Brush making ... .... ... ... .... ... ... ... ... 1 1 ... ... ... .. Totals 76 39 881 4 .... 20 ... ... .... 120 120 ... 25 ... ... (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, wire netting, 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. 56 4.—Registered Workshops—1926. 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. 975 (a) Cabinet making 572 (b) French polishing 131 156 (c) Upholstery 67 (d) Other workers 205 (2) Dress (a) Tailoring 66 (e) Shirt making 1 63 (b) Mantles 11 (f) Boot and shoe trades 29 (c) Dress 7 (g) Artificial flowers 4 (d) Millinery 5 (h) Other workers 33 (3) Skin, leather, hair and feather trades (a) Furriers 17 (b) Saddlery and Harness 11 52 (c) Feathers 1 (d) Other workers 39 (4) Paper, printing, book, stationery and fancy goods trades (a) Box and bag makers 38 (b) Other workers 14 9 (5) Laundry and washing (6) Food 7 (7) Metals, machines, implements and conveyances 42 (8) Precious metals, jewels, &c. 1 (9) Other trades than those mentioned above 136 Total number of workshops on Register 1,446 Note.—A separate register is kept for bakehouses, the number of which use at the end of the year was 61, including 28 factory bakehouses. in 5.—Other Matters. Class. N umber. (1) (2) Matters notified to H.M. Insnector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s.133) Nil. Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5.) Other Notified by H.M. Inspector 62 referring to 18 factories and 44 workshops. Reports (of action taken) sent to H.M. Inspector. referring to 5 18 factories and 44 workshops. 6 Underground(s.101):- Certificate granted during the year Nil In use at the end of the year 36 57 6.—Showing the Numbers of Outworkers Received from other Districts during 1926. DISTRICTS. Making Wearing Apparel. Confectionery Packing. Artificial Flowers. F urniture and Upholstery. Fur Pulling. Feather Sorting. Umbrellas, &c. Paper Bags and Boxes. Brush Making. Fancy Leather Goods. Crackers and Toys. 1 Totals. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Bethnal Green 44 38 ... .... ... ... l 1 ... ... ... .... ... ... 48 43 10 9 ... ... .... ... 194 Camberwell 9 2 ... ... .... ... ... ... .... ... .... ... ... .... ... ... ... ... ... ... ... ... 4 City of London 250 239 ... .... l 13 ... .... 9 10 ... ... 31 35 1 3 ... ... ... ... ... 1 593 Chelsea 3 .... ... .... ... .... .... ... ... ... .... ... .... .... ... ... .... ... ... ..... ... ... 3 Enfield 2 2 ... .... ... ... ... ... ... .... ... .. ... ... ... ... ... ... ... ... ... 14 18 Finsburv 59 72 .... ... 7 ... 2 ... 4 4 ... 1 ... 7 25 26 ... ... .... ... 16 .... 230 Hackney 114 100 ... .... 3 2 6 1 1 1 ... 1 ... .... 9 3 l 6 ... ... 7 8 263 Kingston-upon- Thames 1 1 ... ... .... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Holborn 7 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... 12 Hornsey 2 3 ... ... ... ... ... .... .... ... ... ... ... ... ... ... ... ... .... ... .... ... 5 Islington 21 18 ... ... 3 ... ... .... .... .... .... ... 3 3 16 10 ... ... ... ... .... ... 90 Lambeth 1 ... ... ... .... .... .... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... 1 Southwark 1 2 ... .... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 5 St. Marvlebone 1 2 ... ... .... .... ... .... .... .... .... .... ... .... .... ... ... ... ... ... ... ... 3 Stepney 9 11 ... ... ... ... .... .... ... .... ... ... ... .. 10 ... ... ... ... ... ... ... 35 St. Pancras 1 1 ... ... ... ... ... ... ... .... .... .... ... ... 3 ... ... ... ... ... ... ... 5 Stoke Newington 9 ... .... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... 9 Tottenham 2 1 ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Westminster 19 23 ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 42 West Ham ... 1 ... ... ... ... ... ... ... .... .... ... .... ... ... ... ... ... ... ... ... ... 1 541 521 ... .... 15 20 9 2 14 15 ... 2 41 45 113 90 13 18 ... ... 23 29 Totals 1,062 ... 35 11 29 2 86 203 31 ... .. 52 1,511 58 BOROUGH OF SHOREDITCH TUBERCULOSIS DISPENSARY. REPORT FOR THE YEAR 1926 by Alfred Leitch, M.B., Ch.B., Tuberculosis Officer. To the Medical Officer of Health, The Town Hall, Shoreditch. Sir, Herewith I beg to submit my report of the work done in the Tuberculosis Dispensary during the year 1926. The total number of attendances for the purposes of examination, supervision and treatment during the year was 6,086—an increase of 368 as compared with the number for the year 1925. The total number of persons who attended was 1,262, i.e., 100 more than in 1925. This increase, however, was not due to an increase in the number of new cases. It resulted mainly from a searching out of certain persons who had failed to attend the Dispensary for some time past. This is seen by the totals of tuberculous persons attending, viz., 501 in 1926, as compared with 433 in 1925. The total number of new persons examined was practically the same, viz., 616. In 1925, the number was 610. Of the new persons examined 152 were found to be tuberculous and 28 were regarded as suspicious. Most of the definite cases and a number of old cases were recommended to the London County Council for Institutional treatment and nearly all were accepted. Visits paid by medical officers to the homes of patients were increased by 109, viz., 367 as compared with 258. Owing to the change in the return of work done in tuberculosis dispensaries by the Ministry of Health, I found it was necessary that the Dispensary Register should be revised. This was a somewhat formidable matter, since it meant the inspection of several thousands of case records, dating back to 1912. I am glad to report, however, that it has been accomplished, and I have to acknowledge the help given to me in this connection by the Staff of the Dispensary, and at the same time I must express my satisfaction with the way in which the routine duties have been carried out. I am, Sir, Yours obediently, A. Leitch, Tuberculosis Officer. o9 STATISTICAL REPORT, 1926. 1925. 1926. Total attendances 5,718 6,086 Total new persons examined 610 616 Renewed cases 552 543 Sisters' visits to homes 2,984 2,705 Medical Officers' visits 258 367 Analysis of all persons attending the Dispensary during 1926: — Under 15 years. Over 15 years. Totals. Ins. Non-Ins. Males 205 330 139 674 Females 201 200 187 588 Totals 406 530 326 1,262 Tuberculous. Males 34 187 85 306 Females 21 97 77 195 Totals 55 284 162 501 60 All New Persons Examined. Tuberculous. Suspects. NonTuberculous. Total. Contacts 25 11 270 306 Other new patients 127 17 166 310 Totals 152 28 436 616 Detailed Analysis of all New Persons examined. Insured. Non-Insured. Total Under 15 years. Over 15 years. M. F. M. F. M. F. Total new persons 152 101 121 125 40 77 616 Pulmonary Tuberculosis 48 32 2 3 19 31 135 Non-Pulmonary Tuberculosis 4 8 4 1 17 Suspects 5 5 6 6 2 4 28 Non-Tuberculous 101 60 104 111 19 41 436 The New Persons examined, the examinations and the attendances each month were as follows:— New Persons Examined. Examinations. Attendances. Ins. NonIns. Totals. Ins. NonIns. Totals. Ins. NonIns. Totals. January 25 26 51 92 96 188 273 222 495 February 24 45 69 88 122 210 269 249 518 March 21 45 66 112 116 228 308 311 619 April 19 28 47 85 108 193 274 261 535 May 28 36 64 99 80 179 287 229 516 June 21 45 66 104 112 216 284 283 567 July 25 17 42 91 57 148 273 207 480 August 16 14 30 59 51 110 253 165 418 September 21 22 43 92 63 155 270 195 465 October 13 24 37 78 90 168 256 233 489 November 20 35 55 84 85 169 284 226 510 December. 20 26 46 99 84 183 276 198 474 Totals 253 363 616 1,083 1,064 2,147 3,307 2,779 6,086 61 SPECIAL SESSION FOR SCHOOL CHILDREN. The number of attendances and examinations made each month are shown in the following table:— Attendances. Examinations. Attendances. Examinations. January 13 7 July 33 10 February 18 14 August 6 March 42 18 September 17 10 April 17 9 October 26 12 May 27 9 November 35 15 J une 36 22 December 19 12 Total Attendances 289 Total Examinations 138 The comparative numbers of insured and Non-Insured Attendances are given in the following table: — Insured 3,307 Non-Insured 2,779 Total 6,086 Registered New Persons, including "Contacts" were apportioned as follows: — Insured 253 Non-Insured 363 Total 616 Total Number of Patients on Dispensary Register on 31st December, 1926: — Insured 294 Non-Insured 307 Total 601 In addition to the foregoing, the following further information may be given: — Total number of Bacteriological Examinations 620 ,, „ X-Ray Examinations 38 „ „ Patients recommended to the London County Council 219 ,, ,, Progress Reports furnished, etc. 197 „ ,, Examinations made and Reports sent to the Ministry of Pensions 471 „ „ Patients sent by Doctors 160 02 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Table VIII.—Summary of Notifications during the Period from the 3rd January, 1926, to the 1st January, 1927, in the Metropolitan Borough of Shoreditch. Age-periods. Notifications on Form A. Notifications on Form B. N umber ot Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. Total Notifications on Form B. P. .or 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 G5. 05 and upwards. Total Primary Notifications. Total Notifications on Ft rm A. Under 5 5 to 10. 10 to 15. Total Primary N oti fi cations. Pulmonary, Males l l o o ... 11 18 21 19 26 15 l 116 187 ... ... ... ... .... 32 88 ,, Females ... l 3 6 13 20 25 20 18 3 ... 109 179 ... ... ... ... .... 25 71 Non-pulmonary, Males ... 12 13 4 7 ... 2 1 ... ... 1 40 46 ... ... ... ... ... 12 22 ,, Females l 6 4 2 4 2 2 1 ... ... ... 22 32 ... ... ... ... ... 3 15 Cols. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) Patients notified as suffering from both pulmonary and non-pulmonary disease are included in the pulmonary returns. Primary Notifications relate to patients who have not previously been notified in this or former years, either on Form A or on Form 13, 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, arc included in this column. Cols 15-18. Only those cases which have been notified for the first time during the year on Form B, and which have never previously been notified in Shoreditch, either on Form A or on Form B, are included in these columns. Col. 19. All notifications which have been made during the year on Form B, whether the cases have previously been notified in the area or not, either on Form A or on Form B, are included in this column. Col. 21. Only notifications on Form C, made by the medical officers of sanatoria, as defined in the Tuberculosis Regulations, are included in this column. 6 3 TABLE IX. Summary compiled from the Abstracts of the work of the Sanitary Inspectors by the Senior Inspector, for the Year 1926. Insp. Wright. Insp. Chapman. Insp. Sickel- more. Insp. Thomas. Insp. Shaw. Insp. Molloy. Insp. Bishop. Insp. Girling, Insp. Stratton. Insp. Grant. Insp. Walker. Totals. Premises clcansed throughout 42 25 27 19 10 30 37 51 11 35 4 291 partially 154 325 233 222 170 405 380 205 240 272 295 2,901 ,, ,, total rooms 442 1214 702 533 487 1319 1033 552 879 1028 851 9,040 ,, ,, verminous rooms 24 19 5 109 3 27 96 10 33 39 79 444 ,, ,, verminous premises 21 12 4 59 3 24 32 10 25 21 68 279 Premises generally repaired—Walls, floors, sashes, &c. 185 209 341 224 309 300 467 390 243 434 426 3,528 Light and ventilation improved 1 3 12 ... 2 2 1 ... 1 ... 1 23 Roofs, guttering, rain water pipes improved or repaired 79 279 432 225 134 232 290 201 311 251 320 3,454 Overcrowding dealt with 3 17 11 14 7 32 24 24 29 7 23 191 Water reinstated or improved 1 17 9 1 ... 8 7 2 11 3 18 77 Dr lins newly constructed ... 6 10 1 ... 1 ... 1 3 4 3 29 ,, re-constructed ... 2 11 10 ... 3 18 3 2 2 4 55 ,, improved or repaired 6 11 80 28 5 21 15 17 19 14 23 239 ,, obstructions removed 15 31 32 36 27 31 30 27 39 35 19 322 Soil and vent pipes—Improved or repaired 5 1 4 2 ... 3 5 5 1 3 4 33 Water closets—Newly constructed 18 36 14 1 2 7 ... 29 5 3 3 118 ,, improved or repaired 95 80 81 128 61 218 121 108 91 79 105 1,167 ,, obstructions removed 10 15 13 56 19 29 44 21 22 12 21 262 Sinks, etc., improved, cleansed or repaired 61 21 19 27 7 30 37 15 23 10 14 264 Sinks, etc., traps provided 2 2 1 1 1 2 6 14 ... ... ... 29 Outdoor premises— Floors or paving repaired 5 29 147 20 19 85 32 15 43 34 21 450 Cleansed or limewashed 99 149 153 119 71 48 225 62 144 121 110 1,301 Improved or repaired ... ... 2 ... ... ... ... ... ... 2 Ash-pits—Dust-bins provided 26 58 95 33 55 74 155 63 100 69 86 814 ,, improved or repaired 8 ... 2 3 ... ... 2 ... ... 1 ... 10 ,, abolished ... ... 2 1 ... 5 16 ... ... 2 1 27 Accumulations removed 16 5 24 14 ... 39 14 13 5 11 28 174 Urinals cleansed or repaired 5 ... ... ... 2 1 1 3 1 ... 13 12 64 METROPOLITAN BOROUGH OF SHORED[TCH, HOUSING. Statistics for the Year 1926. Number of new houses erected during the year : — (a) Total (including numbers given separately under (b)) (b) With State assistance under the Housing Acts " (i) By the Local Authority. (ii) By other bodies or persons. 1.—Unfit dwelling houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 9.575 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 — (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 — 2 —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 3 —Action under Statutory Powers. A. Proceedings under Section 3 of the Housing Act, 1925. (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 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6,213 (2) Number of dwelling-houses in which defects were remedied— (а) by owners 6,212 (б) by Local Authority in default of owners 1 65 C. Proceedings under Sections 11, 11 and 15 of the Housing Act, 1925. (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 Nil. Closing Orders were determined, the dwellinghouses having been rendered fit (4) Number of dwelling-houses in respect or which Demolition Orders were made (5) Number of dwelling-houses demolished in suance of Demolition Orders ... ... .. SUMMARY OF LEGAL PROCEEDINGS DURING 1920. PUBLIC HEALTH (LONDON) ACT, 1891. In 13 instances summonses were withdrawn on the work being done. Costs amounting to £5 15s. 6d. were allowed to the Borough Council. Nuisance orders were made in 18 instances, costs amounting to £17 2s. Od. being ordered to be paid to the Council. In 42 instances the Statutory Notices were complied with before the cases came on for hearing, £21 10s. 6d. being ordered to be paid to the Council. In five instances, for non-compliance with Statutory Notices, the defendants were fined £5 and ordered to pay £5 5s. costs. In one instance, for non-compliance with the Magistrate's order, the defendant was fined £5. BREACHES OF LONDON COUNTY COUNCIL BYE-LAWS. In one instance the defendant was fined £2 or 21 days, in one instance the defendant was fined £1 or 10 days and in two instances the defendants were each fined £1 and ordered to pay £1 1s. costs to the Borough Council. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1902. In one instance the defendant was fined 7s. 6d. and ordered to pay 12s. 6d. costs to the Borough Council for not having his name and address inscribed on icecream barrow. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. For offences under the above Regulations seven defendants were fined £2 17s. 6d. METROPOLITAN PAVING ACT, 1817, SECTION 65. One defendant was dismissed under the Probation of Offenders Act for refusal to remove his stall from the public highway, and ordered to pay £1 costs to the Borough Council. 0 66 METROPOLITAN BOROUGH OF SHOREDITCH. MATERNITY AND CHILD WELFARE. Summary of Work for the Year 1920 by Dr. Maitland Radford. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total. No. of 1st visits to infants 269 339 295 377 374 180 532 2.466 No. of re-visits to infants 700 722 619 472 754 754 1,578 5,599 No. of 1st visits to children aged 1 to 5 years (irrespective of whether visited previously as an infant) 51 224 239 228 78 311 906 2,037 No. of re-visits to children aged 1 to 5 years 897 1301 924 1,391 1,342 1,143 1,589 8,587 No. of 1st visits to expectant mothers 50 55 70 70 104 76 216 611 No. of re-visits to expectant mothers 44 102 76 63 61 56 157 559 No. of futile visits 150 204 34 177 112 248 734 1,659 No. of interviews in connection with work 324 256 505 433 113 288 1,135 3,054 *No. of 1st visits to infants with diarrhoea ... ... 3 1 11 ... ... 15 *No. of 1st visits to cases of ophthalmia neonatorum 9 9 8 18 9 6 ... 59 No. of re-visits to cases of ophthalmia neonatorum 12 14 16 27 15 8 ... 92 No. of 1st visits to cases of puerperal fever ... 1 ... 2 ... 1 ... 4 No. of re-visits to cases of puerperal fever ... ... ... 2 ... ... ... 2 No. of 1st visits to cases of puerperal pyrexia ... ... ... 2 ... ... ... 2 No. of Health Visitors' attendances at Centres: (a) Town Hall Centre 29 ... ... ... 24 49 ... 102 (b) Hoxton Hall Centre ... 24 52 6 22 ... 104 (c) Maternity Centre 128 177 133 147 147 136 ... 868 (d) Harbour Lights Centre 52 4s 50 1 ... ... 151 (e) School for Mothers Centre ... ... ... ... ... ... 315 315 * These visits are also included above. 67 NUMBER OF FIRST ATTENDANCES OF INFANTS AND CHILDREN AT WELFARE CLINICS. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total. (a) Town Hall: (Mon.) under 1 yr. ... ... ... ... ... 90 ... 90 over 1 yr. ... ... ... ... ... 76 ... 76 (b) Hoxton Hall: (Tues.) under 1 yr. ... ... ... 89 ... ... ... 89 over 1 yr. ... ... ... 24 ... ... ... 24 (c) Maternity Centre: (Mon.) under 1 yr. ... 159 ... ... ... ... ... 159 over 1 yr. ... 41 ... ... ... ... ... 41 (Tues.) under 1 yr. 75 68 ... ... ... ... ... 143 over 1 yr. 25 34 ... ... ... ... ... 59 (Wed.) under 1 yr. ... ... 93 ... ... ... ... 93 over 1 yr. ... ... 76 ... ... ... ... 76 (Thur.) under 1 yr. ... ... ... ... 156 ... ... 156 over 1 yr. ... ... ... ... 77 ... ... 77 (Fri.) under 1 yr. ... ... ... 89 ... 70 ... 159 over 1 yr. ... ... ... 15 ... 29 ... 44 (d) Harbour Lights: (Fri.) under 1 yr. 81 ... 106 ... ... ... ... 187 over 1 yr. 24 ... 67 ... ... ... ... 91 (e) School for Mothers: (Tues.) under 1 yr. ... ... ... ... ... ... 195 195 over 1 yr. ... ... ... ... ... ... 52 52 (Thur.) under 1 yr. ... ... ... ... ... ... 239 239 over 1 yr. ... ... ... ... ... ... 57 57 68 TOTAL ATTENDANCES OF INFANTS AND CHILDREN AT WELFARE CLINICS. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total (a) Town Hall: (Mon.) Infants ... ... ... ... ... 1,056 ... 1,056 Children ... ... ... ... ... 858 ... 858 Mothers without children ... ... ... ... ... 699 ... 699 (b) Hoxton Hall: (Tues.) Infants ... ... ... 1,499 ... ... ... 1,499 Children ... ... ... 1,236 ... ... ... 1,236 Mothers without children ... ... ... 330 ... ... ... 330 (c) Maternity Centre: (Mon.) Infants ... 1,571 ... ... ... ... ... 1,571 Children ... 722 ... ... ... ... ... 722 Mothers without children ... 622 ... ... ... ... ... 622 (Tues.) Infants 1,317 1,041 ... ... ... ... ... 2,358 Children 800 532 ... ... ... ... ... 1,332 Mothers without children 523 436 ... ... ... ... ... 959 (Wed.) Infants ... ... 1,728 ... ... ... ... 1,728 Children ... ... 1,338 ... ... ... ... 1,336 Mothers without children ... ... 379 ... ... ... ... 379 (Thur.) Infants ... ... ... ... 1,695 ... ... 1,695 Children ... ... ... ... 929 ... ... 929 Mothers without children ... ... ... ... 742 ... ... 742 (Fri.) Infants ... ... ... 1,419 ... 791 ... 2,210 Children ... ... ... 847 ... 537 ... 1,384 Mothers without children ... ... ... 305 ... 260 ... 565 69 TOTAL ATTENDANCES OF INFANTS AND CHILDREN AT WELFARE CLINICS—C o ntinued. Health Visitor's Districts. 1. 2. 3. 4. 5. 6. 7. Total. (d) Harbour Lights: (Fri.) Infants -940 ... 1,502 ... ... ... ... 2,412 Children 692 ... 995 ... ... ... ... 1,687 Mothers without children 591 ... 518 ... ... ... ... 1,109 (e) School for Mothers : (Tues.) Infants ... ... ... ... ... ... 1,773 1,773 Children ... ... ... ... ... ... 911 911 Mothers without children ... ... ... ... ... ... 6 6 (Thur.) Infants ... ... ... ... ... ... 2,192 2,192 Children ... ... ... ... ... ... 1,045 1,045 Mothers without children ... ... ... ... ... ... 88 88 ANTE-NATAL CONSULTATIONS. Maternity Centre: Dr. Smith (Friday). No. of 1st attendances 32 90 47 41 84 32 ... 326 Total No. of attendances 54 167 112 76 94 66 ... 569 School for Mothers: Dr. Tribe (Friday) No. of 1st attendances ... ... ... ... ... ... 178 178 Total No. of attendances ... ... ... ... ... ... 294 294 Dental Clinic (Maternity Centre): Mr. W. Dodd (Thursday). No. of 1st attendances 11 47 38 29 22 21 ... 168 Total No. of attendances 30 89 134 90 50 83 ... 476 Sewing Classes (2). Total No. of attendances 296 ... ... 177 92 46 296 907 70 CHILD WELFARE CONSULTATIONS. Health Visitors' District No. Infants seen by Doctor. Children (1-5 yrs.) seen by Doctor. For 1st time. Total No. For 1st time. Total No. Maternity Centre. Dr. Richards (Mon.) 2 148 763 43 354 Dr. Hodgson (Tue.) 2 1 67 77 354 538 37 23 172 235 Dr. Richards (Wed.) 3 82 833 46 552 Dr. Radford (Thu.) 5 158 661 60 314 Dr. Smith (Fri.) 4 6 77 62 621 354 10 18 336 191 Town Hall. Dr. Radford (Mon.) 6 90 569 67 316 Hoxton Hall. Dr. Radford (Tue.) 4 75 542 21 400 Harbour Lights. Dr. Radford (Fri.) 3 103 655 56 344 Dr. Hodgson (Fri.) 1 79 617 28 244 School for Mothers. Dr. Pratt (Tue.) 7 192 1,036 52 603 Dr. Pratt (Thu.) 7 235 1,270 57 734 REPORT ON INFANTS ATTENDING DOCTORS' CONSULTATIONS. Health Visitors' Districts. 1 2 3 4 5 6 7 Total. Number suffering from disorders of digestion and nutrition 734 625 262 785 212 633 503 3,754 Number suffering from other minor ailments 450 134 253 599 194 478 423 2,536 Number referred to Hospital or to Medical Practitioner 59 73 130 106 130 59 77 634 The remainder are making satisfactory progress. 71 MODEL WELFARE CENTRE. The following is a statistical Summary relating to Infants admitted to the Municipal Model Welfare Centre, 210, Kingsland Road, for the year 1926: — (1) Number of cases in the wards on 1st January, 1920: 10 babies. (2) Number of cases admitted : 50 babies and 2 mothers. (3) Average duration of stay : 10 weeks. (1) Reasons for admission and the number of cases under certain specified heads Marasmus 19* Rickets 5 Vomiting 3 Dyspepsia 13 Enteritis 1 Illness or absence of mothers 3 Prematurity 6 (5) Number of cases discharged during the year : — (a) In good health 19 (b) Improved 27 (6) There was one case of whooping cough and one of scarlatina, which were transferred to hospitals of the Metropolitan Asylums Board. (7) Number of deaths: one died from enteritis on 13th August after six days residence. (8) The discharges on account of illness, infectious or otherwise, were as follows: — Two cases referred to under Section 6 above, which made satisfactory recoveries. One child which was transferred to the Queen's Hospital diagnosed as intussusception. The case however made a satisfactory recovery without operation. * Includes one re-admission. 72 NURSING LIST. Subjoined is a list of cases nursed for the Shoreditch Borough Council by the Shoreditch and Bethnal Green District Nursing Association during the year 1926. Disease Under 5. Visits. Disease. Over 5. Visits. Pemphigus 4 67 Pneumonia 24 391 Measles 24 351 Miscarriage 5 51 Ophthalmia Mammary Abscess 5 103 Neonatorum 16 557 Post-Partum 7 72 Influenzal Influenza 3 30 Pneumonia 1 16 Parturition 2 34 Otorrhoea 17 392 Measles 3 43 Threadworms 57 444 Ante-natal 7 245 Tonsils & Adenoids 106 391 Abortion 3 33 Pneumonia 19 278 Phlegmasia Dolen, 1 20 Pyrexia 1 4 Influenzal Bronchitis 16 187 Pneumonia 1 63 Tuberculous hip 1 60 Influenza and Abscess of ear 2 18 Pneumonia 2 21 Sickness 1 6 Pue- peral Pyrexia 3 53 Umbilical hernia 1 38 Mastitii 3 32 Constipation 2 7 Scalds 2 49 Septic throat 2 12 Enteritis 2 46 Stomatitis 1 10 Impetigo 17 268 Marasmus 1 5 Scabies 1 6 Mastoid Abscess 1 2 Tuberculosis 1 12 Discharge from eyes 10 149 Intestinal 2 9 Septic blisters 1 15 Sores on scalp 1 14 Broncho-Pneumonia 7 81 • Skin rash 1 10 Rheumatism 1 8 Nasal cartarrh 1 18 Conjunctivitis 1 17 Totals 321 3,550 Totals 69 1,191 cases visits cases visits The total number of cases at all ages was 390, in connection with which 4,741 visits were made by the Nurses of the Association. Amongst persons over five years there were one death from influenza, one from influenzal pneumonia, one from influenza and pneumonia, and two from pneumonia, and amongst the children under five, two died from pneumonia, one from broncho-pneumonia, one from pemphigus and one from sickness.