SH 0232 REPORT on the health and Sanitarp Condition of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1927, LEWIS T. ERASER BRYETT, M.D. (LOND.) Medical Officer of Health; (Died 14/12/1927) 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, 6rc. This report prepared by: MAITLAND RADFORD, M.D., B.S., D.P.H., Medical Officer of Health ; formerly Assistant Medical Officer of Health. [Printed by Order of the Health Committee.] LONDON: JAS. TRUSCOTT & SON, LTD., SUFFOLK LANE, LONDON, E.C. 4. METROPOLITAN BOROUGH OF SHORED ITCH. Public Health Committee. Ex officio—T. J. SILLITOE, Chairman—Councillor Dr. S. W. jeger. Vice-Chairman—Councillor Ellwood, Mrs. L. Alderman Land, C. Councillor Brown, T. W. ,, Fairchild, Mrs. E. M. „ Harvey, Mrs. J. ,, Kenny, T. J. „ Mitchell, A. „ O'Connor, Mrs. M. „ Reed, E. „ Ricketts, W. „ Saltzberg, l. „ Thurtle, Mrs. D. ,, Weatherley, R. W. Maternity and Child Welfare Committee. Esq., J.P., L.C.C. (Mayor). Chairman—Councillor Fairchild, Mrs. E. M. Vice-Chairman—Councillor Harvey, Mrs. J. Alderman Girling, Mrs. H., J.P. M.A.B. Councillor Baker, J. S. „ Ellwood, Mrs. L. ,, Lay, E. „ Ricketts, W. „ Varnals, G. J. „ Yarrow, W. E., J.P. (Co-opted) Colville, Lady Cynthia. „ Ferry, Mrs. A. „ Hills, Mrs. H. S. ,, J eger, Mrs. „ Seigert, Miss G. 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. Miss I. M. Heward. Miss G. H. Williams. Health Visitors. 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, Chief Clerk. 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. Miss A. C. Andrews, Sister. (Resigned 4/7/1927). Miss D. A. Kennedy, Sister. (Appointed 16/9/1927). Misses N. M. F'eltham and J. Boon (Staff Nurses). Misses F. Lloyd, M. Dunn, I. Enger and E. C. Wheeler (Probationers). Miss E. Riggs (Cook). Mrs. J. Durling, Mrs. G. Marshall, Mrs. J. McDonnell and Mrs. A. Hesketh J. P. Bear and J. E. Perry (Porters). (Cleaners and Waitrsese. Artificial Sun-light Clinic. Mrs. M. Pollard, Sister-in-charge. Staff of Dininer Centre. 31. Herbert Street. Miss M. Zemaitis (Cook). Mortuary Keeper. W. T. Bailey. Miss W. Miller (General Assistant). 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. Hon. Mrs. Olivier Richards, M.D., B.S., M.K.C.P. Mrs. E. M. Goffe, M.B., B.S., D.P.H. 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. Dfarnley, M.D., B.S. Fardley 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. Dental Hospital: Dentist. John Peter, M.C., M.R.C.S., L.R.C.P., L.D.S. Anaesthetist Maurice Marcus, M.B.B.S., M.R.C.S., L.R.C.P. Dental Mechanic. T. Lamb. Clerk and Nurse. Mrs. L. Frier. Caretakers. Mr. and Mrs. A. Whittard. Bacteriologist. F. H. Teale, M.D., F.R.C.P. Tuberculosis Officer. A. Leitch, M.B., Ch.B. Public Analyst. H. G. Harrison, M.A., F.I.C. Assistant Medical Officer of Health. Maitland Radford, M.D. (State Med.), D.P.H. Medical Officer of Health. Lewis T. Fraser Bryett, M.D., D.P.H. (Died 14th December, 1927.) iii CONTENTS. Page Acute Anterior Poliomyelitis 16 Anthrax 17 Appendicitis, mortality from 5 Bacteriological examinations 18 Bakehouses 31 Births in sub-districts 2 Birth rates 2 Cancer 5 Cerebro spinal fever16 Condensed milk regulations 30 Cookshops and Eating-houses 30 Cow-houses 29 Dairies, Cowsheds and Milk-shops Orders, 1885 and 1886 29 Deaths in sub-districts 3 Death rate 3 Deaths, ages at 3 Deaths, causes of 4 Deaths in public institutions 5 Deaths in outlying institutions 6 Diarrhoea 13 Diphtheria 10 Disinfection 19 Dysentery 17 Encephalitis Lethargica 17 Enteric Fever 12 Erysipelas 12 Factory andt Workshop Act, 1901 25 Food and Drugs Acts 31 Fried fish shops 30 Fur skin dressers 23 Glanders 17 Housing 25 Hydrophobia 17 Ice-cream shops 31 Infantile mortality 4 Infectious cases, number certified 8 Infectious cases, number removed to hospitals 8 Infectious diseases, age periods 11 Infectious diseases, deaths from 7 Infectious diseases, death rate 8 Infectious diseases, isolation 9 Infectious diseases, number of cases notified from schools 18 Infectious diseases, return cases 9 Influenza 14 Legal proceedings 65 Malaria17 Marriages 2 Maternity and Child Welfare 27 Measles 13 Milk (Special Designations) Order, 1922 30 Milk and Cream Regulations, 1912 29 Milk and Dairies Order, 1926 30 Mortuary 19 A2 b ®1. 125. t.s. 7/28. iv pack Municipal Dental Hospital 20 Ophthalmia neonatorum 16 Pneumonia 17 Population 1 Public Health (Preservatives, &c., in Food) Regulations 30 Puerperal fever 13 Puerperal Pyrexia 13 Rag and Bone Dealers 23 Rag Flock Act, 1911 34 Rats and Mice Destruction Act, 1919 24 Sanitary work 21 Scarlet fever 10 Schools, exclusions of children for infectious disease 9 Shelter 19 Slaughter-houses 29 Small-pox 9 Smoke nuisances 22 Stafi 34 Street markets and food 28 Tuberculosis 14 Typhus fever 14 Venereal Diseases 17 Verminous houses 23 Water supply 19 Whooping cough 14 APPENDIX. Statistical Tables :— For whole district during 1927 and previous years (Table I.) 39 Cases of Infectious disease notified during 1927 (Table II.) 40 Causes of, and ages at, death during year 1927 (Tables III. and V.) 41, 44 to 51 Infantile mortality during 1927 (Table IV.) 42 Notes to Tables III. and IV. 43 Comparison of London and Shoreditch birth and death rates in 1927 (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 1927 (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. 1, January, 1928. To the MAYOR, ALDERMEN and COUNCILLORS of the Metropolitan Borough of Shoreditch. Sir, Ladies and Gentlemen, Owing to the most sad death on 14th December, 1927, of the Medical Officer of Health, Dr. L. T. Fraser Bryett, the duty devolves upon me of submitting the following report on the health and sanitary conditions of the Borough for the year ending 31st December, 1927. POPULATION. The Registrar-General's estimate of the population of the Borough as at 30th June, 1927 is 105,700. Included are the inmates of the Holborn Institution, numbering approximately 1,000, who are not regarded as belonging to Shoreditch. Excluding these, 104,700 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 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 1,870 of which 951 were of males and 919 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 2,188 of which 1,123 were of males and 1,065 females. The distribution of the corrected births in the eight Wards of the Borough is given below :— Ward. Males. Females. Total. Moorfields 47 55 102 Church 230 178 408 Hoxton 181 180 361 Wenlock 165 175 340 Whitmore 174 188 362 Kingsland 114 93 207 Haggerston 116 107 223 Acton 96 89 185 Totals 1,123 1,065 2,188 Outside the Borough 331 births were registered, the parents being residents of Shoreditch. Of these 179 were of males and 152 females. Thirteen births, six of males, occurred within the Borough, the parents being non-residents. In the Shoreditch Institution there were 276 births, 145 of males and 131 females. In seven of these the parents were not residents of Shoreditch. The illegitimate births numbered 66, of which 33 were of males and 33 females. Of these 26 of which 17 were of males, occurred in the Shoreditch Institution. The birth-rate for the Borough was 20.9 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 16.7 per 1,000 population, and for London 16.1. MARRIAGES. The number for the year ended 31st December, 1927, was 956, as compared with 947 in 1926, 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 18.2 per 1,000 population, this rate being the same as that for the Metropolis. 3 DEATHS. The deaths during 1927 numbered 1,328, slightly above the number for the preceding year. They were distributed in the Borough as shown in the table below :— Ward. Males. Females. Total. Moorfields 30 22 52 Church 146 123 269 Hoxton 113 110 223 Wenlock 106 90 196 Whitmore 124 97 221 Kingsland 63 54 117 Haggerston 70 45 115 Acton 77 58 135 Totals 729 599 1,328 The deaths of males were 130 in excess of those of females, and the death-rate amongst males was approximately 19 per cent, higher than amongst females. The general death-rate was 12.7 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 1927, are contained in Tables I, III, IV, V and VI (Appendix). The death-rate was above the mean rate for the year during the first two-and-ahalf months, and again during the last three months of the year. The rate was lowest during the month of June, the average being 7.9 per 1,000. The highest point touched was during the second week of February, when the rate was 32.5 per 1,000 population, diseases of the respiratory organs being largely contributory to this elevation. The deaths amongst infants under one year numbered 163, of which 95 were of males. They amounted to 12.3 per cent, of the deaths from all causes, as compared with 12.8 for 1926. The mortality amongst infants under one year was at the rate 74 per 1,000 births registered during the year. The infantile mortalities for recent years were 66 in 1926, 88 in 1925, 87 in 1924, 82 in 1923, 102 in 1922, 114 in 1921 and 91 in 1920. The infantile mortality rate amongst males was 85 as compared with 64 amongst females. The chief causes of death amongst infants under a year were : Pneumonia, prematurity, atrophy, debility and marasmus, diarrhoea and enteritis and whooping cough. 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 W ard. j Hoxton Ward. Wenlock Ward. Whitmore Ward. Kingsland Ward. Haggerston Ward. Acton Ward. Totals Smallpox ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... ... ... ... 1 ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough ... 1 2 3 1 ... 3 1 ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... 1 ... ... ... ... 1 Tuberculous Meningitis ... ... ... 1 1 ... ... ... 2 Abdominal Tuberculosis ... ... ... ... 1 ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... 1 ... 1 2 4 Convulsions ... 3 1 ... 1 ... 1 ... 6 Laryngitis ... ... ... ... ... ... ... ... ... Bronchitis ... 4 ... 1 2 2 ... 1 10 Pneumonia (all forms) ... 14 3 7 5 2 3 5 39 Diarrhoea ... 1 ... ... ... ... ... 1 2 Enteritis ... 7 2 2 3 1 ... ... 15 Gastritis ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... 1 1 Rickets ... ... ... ... 1 ... ... ... 1 Suffocation, over-lying ... 1 ... 5 1 ... ... ... 2 Injury at Birth ... l ... ... ... ... ... ... 1 Atelectasis ... l ... ... 1 ... ... 1 3 Congenital Malformations ... ... 1 ... ... 1 ... 1 3 Premature Birth 1 5 2 1 7 1 1 5 26 Atrophy Debility and Marasmus ... 3 7 3 5 1 2 ... 21 Other causes ... 4 1 3 ... 1 2 2 13 Totals 1 45 19 25 31 9 13 20 163 The infantile mortality rates of the eight wards of the Borough are given in Table VI. (Appendix). The rate was highest in Church and lowest in Moorfields, being 110 and 10 per 1,000 births respectively. The infantile mortality for England and Wales was at the rate of 69, and for London 59 per 1,000 births. The deaths of children between the ages of one and two years numbered 53, the chief causes being measles and diseases of the respiratory organs. Between the ages of two and five years 43 deaths occurred, measles, scarlet fever, diphtheria, whooping cough, diseases of the respiratory organs and violence by accident or negligence being the main causes. Altogether 259 or 19.5 per cent, of the total number of deaths at all ages were of children under the age of five years. Taking the deaths at all ages, the chief causes were : diseases of the circulatory organs, including heart disease, which accounted for 164, tuberculosis 144, including 5 86 from phthisis, diseases of the brain and nervous system 87, bronchitis 128, pneumonia 167, old age 90, cancer 124, violence 67, whooping cough 24, Bright's disease 97, and prematurity which was given as causing 26 deaths. Of the deaths from cancer, 68 were of males and 56 females ; 7 were of persons aged 25 to 45 years, 67 of parsons aged between 45 and 65 years, 39 were aged between 65 and 75, and amongst persons aged 75 and upwards there were 11 deaths. In addition, 8 deaths were attributed to malignant disease or sarcoma. The deathrate due to cancer was 1.18 as compared with 1.1 for 1926, 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, 6 of them males, resulted from appendicitis, and 3 males died from peritonitis. Chronic alcoholism was the cause of death in one instance, and 5 males and 1 female were stated to have died from cirrhosis of the liver, a disease that may be caused through chronic poisoning by alcohol. Of the deaths due to violence, 42 were amongst males and 25 amongst females. Through accidents or negligence, 29 males and 20 females lost their lives ; 21 of these were in connection with vehicular traffic, 12 were due to falls, chiefly amongst people getting on in years, and 3 were attributed to suffocation. Two of these were amongst infants, and was due to suffocation in bed. There were 18 cases of suicide, 13 of which were amongst males. Attention has been directed in recent reports to the decrease in the number of infants suffocated in bed. During the five years ending 1897 the number averaged approximately 30 per annum ; during the five years ending 1927 this average has been only 2.2. 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 ... 154 154 St. Leonard's Hospital 494 27 521 Royal Chest Hospital 9 20 29 Home of Good Shepherd 8 ... 8 Convent Hospital ... 1 1 Infant Welfare Centre 2 ... 2 Totals 513 202 715 Elsewhere than in public institutions seven persons not belonging to Shoreditch died within the Borough. 6 In the subjoined table are set forth the various institutions outside Shoreditch with the number of persons belonging to the Borough dying therein :— • No. of Deaths. Asylums :— Cane Hill 3 Claybury 14 Colney Hatch 7 Dartford Heath 3 Fountain 1 Hundred Acres, Epsom 4 Leavesden 2 Tooting Bec 5 Hospitals for Infectious Diseases :— Brook 2 Eastern 25 Grove 2 Grove Park 2 London Fever 1 Northern 3 North-Eastern 5 North-Western 4 South-Eastern 4 General Hospitals :— Children's, Holborn 5 Cottage Hospital, Hayward's Heath 1 German 11 Guy's 2 London 13 Maudlesley 2 Metropolitan 44 Middlesex 2 Mildmay 6 North Middlesex 2 Queen's (Children) 36 Royal Free 4 Royal Northern 1 South London 1 No. of Deaths. General Hospitals (contd.) :— St. Bartholomew's 51 Three Counties, Stotfold 2 University College 2 Westminster 1 West Kent General 1 Special Hospitals :— Bethnal Green Chest 6 Brompton 1 Central London Throat, Nose and Ear 1 City of London Maternity 3 Colindale 4 Downs 2 Infants, Vincent Square 2 King George Sanatorium 1 National, Holborn 1 Royal Waterloo 1 St. Luke's 4 St. Margaret's 1 St. Peter's, Hampstead 1 St. Peter's, Westminster 3 Women's, Westminster 1 Other Institutions :— 214a, Cambridge Road 1 Cromwell House, Highgate 1 230, High Street, Homerton 2 Friern Barnet Infirmary 1 77a, Highgate Hill 1 Home for Jews, Tottenham 1 H.M. Prison, Wandsworth 1 New End, Hampstead 2 29, North Side, Clapham 1 Rochford House, Rochford 1 St. Joseph's Hospice 3 18, Southwold Road, Clapton 1 30, Twickenham Road 1 37, West Hill, Dartford 1 1, West Park Road, Epsom 1 Of 325 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 187 died in general hospitals, 39 in asylums, 48 in fever hospitals, 32 in hospitals for special diseases and 19 in other institutions. Elsewhere than in public institutions, 18 persons belonging to Shoreditch died beyond the limits of the Borough. 7 Altogether 838 or 63.1 per cent, of the people belonging to Shoreditch who died during the year died in public institutions. During recent years this percentage has been as follows : 1920, 55 per cent.; 1921, 56.9 per cent. ; 1922, 60.2 per cent. ; 1923, 63.6 per cent. ; 1924, 63.5 per cent. ; 1925, 63.3 per cent. ; 1926, 63.7 per cent. INFECTIOUS DISEASES. The infectious diseases included under headings 1 to 35, inclusive, and 171 anc? 172 in Table V. (Appendix) were the cause of 243 deaths. Comparative figures regarding deaths from these diseases during recent years are contained in the following table:— Death rate from infectious diseases per 1,000 population. Percentage of total deaths due to infectious diseases. Percentage of deaths from infectious disease due to tuberculosis. 1918* 9.1 37.7 32 1 1919 4.5 28.5 47.6 1920 3.9 25.0 41.8 1921 3.8 26.6 43.1 1922 4.2 25.7 41.2 1923 2.6 20.3 58.5 1924 3.0 22.3 46.1 1925 2.8 21.5 50.0 1926 2.5 20.4 57.0 1927 2.3 18.2 46.9 * Influenza was the cause of an exceptionally large number of deaths in 1918. In the subjoined table the deaths from the infectious diseases during 1927 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 65-7575-85 85 and upwards. No. of deaths 35 35 17 11 14 14 21 19 43 21 10 2 1 Of the total mortality from all causes of children under five years, 27.1 per cent resulted from these diseases. Of the deaths of infants under one year, 14 were due to whooping cough and 7 enteritis. Amongst children aged from one to five years measles, diphtheria and tuberculosis were the chief causes of death. Most of mortality from infectious diseases amongst persons aged from 15 years upwards was the result of consumption, influenza and septic diseases. The deaths from the principal zymotic diseases—smallpox, measles, scarlet fever, diphtheria, whooping cough, enteric fever and diarrhoea (excluding enteritis) number 8 50, which yield a zymotic death-rate of 0.48 per 1,000 population. Including deaths from enteritis under two years this rate is increased to 0.54 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 Wenlock and lowest in Moorfields. The cases of scarlet fever, diphtheria, erysipelas, enteric fever and puerperal fever and pyrexia, numbered 961, as compared with 28,990 for the Metropolis ; the attack-rates were 9-2 for Shoreditch and 6.4 per 1,000 population for London. Excluding tuberculosis the following table shows the numbers of cases of infectious disease certified in the Borough, the numbers of the cases removed to hospita and the numbers of deaths attributed to the diseases specified, the numbers of cases for the four quarters of the year being given also :— Disease. First Quarter Second Quarter Third Quarter Fourth Quarter Total. Cases admittec to Hospita] Deaths. Smallpox Scarlet Fever or Scarlatina 70 98 101 114 383 376 3 Diphtheria and Membranous Croup 129 92 108 138 467 466 12 Enteric Fever 1 ... 1 2 4 4 1 Puerperal Fever 3 2 6 11 9 2 Puerperal Pyrexia 14 7 8 5 34 23 2 Acute Primary Pneumonia 125 42 30 76 273 217 46 Acute Influenzal Pneumonia 11 3 1 6 21 13 2 Erysipelas 16 14 12 20 62 27 6 Typhus Fever ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... Cerebro-Spinal Fever 1 ... ... ... 1 1 ... Glanders ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... Anterior Polio-myelitis 1 ... ... 1 2 2 ... Encephalitis Lethargica I 1 ... 2 4 2 1 Ophthalmia ... ... ... ... ... ... ... torum 23 11 10 5 49 3 ... Malaria ... ... ... 3 3 ... ... Dysentery ... ... ... ... ... ... ... Totals 395 270 271 378 1,314 1,143 75 Numbers and Percentages of cases 340 229 234 340 1,143 removed to hospi- tals. 86.1% 84.8% 86.3% 92.6% 87.0% 9 As compared with the figures for 1926 there were more cases of diphtheria and erysipelas, whilst cases of scarlet fever and ophthalmia neonatorum show a decrease. 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 and pyrexia, malaria and dysentery, and in some instances cases of measles and whooping cough. During July an intimation was received from the Board to the effect that owing to the decrease in the severity of scarlet fever and the increase in that of measles, it had been decided in regard to applications for admission in the Board's Hospitals to depart from the established practice of always giving priority to cases of the former disease. Under the new arrangement the Medical Officer of Health is asked when notice of a shortage of beds has been given by the Board, to obtain full particulars from the medical practitioner in attendance, and to recommend for admission those cases whether scarlet fever or measles which would in his opinion derive most benefit. The cases of diphtheria, scarlet fever, enteric fever, puerperal fever, puerperal pyrexia, cerebro-spinal fever, polio-myelitis and encephalitis lethargica, certified numbered 906 and the number removed to hospital was 883 or 97-5 per cent. Almost all the cases removed went into the hospitals of the Board. RETURN CASE. The following was noted during the year. A boy, aged 6 years, was removed to hospital with scarlet fever on 23rd March, and was discharged on 11th June. Five days later his sister, aged 3, developed scarlet fever and was removed to hospital. SMALLPOX. On 26th May a child, aged 14 months, was removed for observation after consultation with Dr. Wanklyn, and on the following day information was received that the diagnosis of smallpox had been confirmed. Four days later, however, this diagnosis was revised and a final decision was reached that the case was not one of smallpox. A large number of persons were kept under observation as contacts until final decision was received 10 SCARLET FEVER. The cases certified numbered 383 of which 33 or 8.6 per cent. were subsequently not regarded as scarlet fever. The corresponding percentage during recent years has been 1.7 in 1920, 2.5 in 1921, 1.4 in 1922, 1.2 in 1923, 13.4 in 1924, 11.7 in 1925, 14.6 per cent. in 1926. 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 7 9 16 ... ... ... Church 25 35 60 ... 1 1 Hoxton 37 27 64 ... ... ... Wenlock 19 24 43 ... ... ... Whitmore 31 30 61 2 ... 2 Kingsland 25 27 52 ... ... ... Haggerston 17 26 43 ... ... ... Acton 17 27 44 ... ... ... Totals for Borough 178 205 383 2 1 3 The cases are grouped according to ages in Table II. (Appendix). With exception of five cases all those certified during the year were removed to hospital. The attack rate was 3.7 per 1,000 inhabitants. It was lowest in Wenlock and highest in Kingsland, being 3.1 per 1,000 in the former as compared with 5.0 in the latter. The deaths were at the rate of 0.03 per 1,000 population. There were no deaths in Moorfields, Hoxton, Wenlock, Kingsland, Haggerston and Acton Wards. The case mortality was a shade under 0.7 per cent. Amongst children under five years there were 131 cases with a case mortality, allowing for errors in diagnosis, of 1.8 per cent. The case mortality amongst persons over five years was only 0.4 per cent., errors in diagnosis being allowed for. The casts certified as scarlet fever in London numbered 13,265, and were at the rate of 2.9 per 1,000 population. The deaths numbered 63, being at the rate of 0.01 per 1,000 population, as estimated for the middle of 1926. Taking the cases certified the case mortality for the Metropolis was barely 0.5 per cent. DIPHTHERIA (INCLUDING MEMBRANOUS CROUP). The cases certified numbered 467, of which 87 or 18.6 percent., were subsequently not regarded as being diphtheria. This percentage is lower than that for 1926. 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 6 8 14 1 ... 1 Church 41 42 83 1 1 2 Hoxton 31 36 67 ... ... ... Wenlock 27 25 52 ... ... ... Whitmore 50 61 111 ... 3 3 Kingsland 20 25 45 1 1 2 Haggerston 35 32 67 ... 3 3 Acton 7 21 28 ... 1 1 Totals for Borough 217 250 467 3 9 12 The cases are grouped according to ages in Table II (Appendix). They were, with one exception, all removed to hospital for treatment. The attack-rate was 4.5 per 1,000 inhabitants. The rate was highest in Haggerston and lowest in Acton Ward, being 6.1 and 2.3 per 1,000, respectively. The deaths numbered 12, the rate being 0.11 per 1,000 population. It was highest in Haggerston Ward, where it amounted to 0.27 per 1,000. There were no deaths in Hoxton and Wenlock Wards. Of the cases certified, 2.6 percent. terminated fatally. Six of the deaths were of children under five years. Allowing for 32 cases of children under 5 and 55 cases of those over 5 that were not regarded as diphtheria at the hospitals of the Metropolitan Asylums Board the case mortality was 2.9 per cent. in both the age groups 0.5 years and 5 upwards. During the year anti-toxin obtained from the Health Department was administered in one case before removal to hospital, 9,000 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 8 1 9 From 1 to 2 years 22 20 42 ,, 2 to 3 years 24 20 44 ,, 3 to 4 years 19 29 48 ,, 4 to 5 years 27 22 49 ,, 5 to 10 years 67 86 153 ,, 10 to 13 years 17 24 41 Over 13 years 20 47 67 Totals 204 249 453 12 In 255 of the cases "the patients were attending school and in 192 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 293 cases there were children in the house invaded who were attending school. In 51 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 38 instances there was evidence pointing to infection from previous cases in the Borough. In 330 instances the houses were occupied by members of more than one family, in 101 by single families and in 23 the cases occurred in artisan's dwellings of the block type. In 242 the sanitary condition of the dwellings was satisfactory, in 80 fairly so, and in 105 it was unsatisfactory. The cases certified as diphtheria in the Metropolis numbered 12,285, being at the rate of 2.7 per 1,000 population. The deaths numbered 387, the death-rate being 0.09 per 1,000 and the case mortality 3.1 per cent. ENTERIC FEVER. Four cases were certified, three of which were paratyphoid. One of these, a case of paratyphoid in a male of 27 years, proved fatal. In no case was information obtained as to the source of infection. The cases certified in London numbered 329, being at the rate of 0.07 per 1,000 population. The deaths numbered 27, the death rate being 0.006 per 1,000 and the case mortality 8 per cent. ERYSIPELAS. The cases certified as erysipelas numbered 62, 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 3 3 ... ... ... Church 5 7 12 ... ... ... Hoxton 8 1 9 1 ... 1 Wenlock 5 4 9 2 ... 2 Whitmore 6 6 12 1 ... 1 Kingsland 5 3 8 1 ... 1 Haggerston ... 4 4 ... ... ... Acton 2 3 5 ... 1 1 Totals for Borough 31 31 62 5 1 6 The deaths from erysipelas were at the rate of 0.06 per 1,000 inhabitants and 97 per cent. of the cases certified terminated fatally. 13 PUERPERAL FEVER. Eleven cases were certified, two of which terminated fatally; nine were removed to hospital. The cases certified were at the rate of 5.0 per 1,000 births as Compared with 3.9 in 1926, 4.9 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 265, and were at the rate of 3.5 per 1,000 births. The deaths in Shoreditch were at the rate of 0.91 per 1,000 births as compared with 1.3 for London. PUERPERAL PYREXIA. Puerperal pyrexia as defined in the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, 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. Thirty-four cases were certified, of which twenty-three were removed to hospital. Consultations with obstetric specialists, for which provision is made in the regulations above referred to, were held in 7 cases. DIARRHŒA. Three deaths were attributed to diarrhœa and 7 to enteritis. All these deaths were of infants under one year, and were at the rate of a little under 0.1 per 1,000 population or 4.6 per 1,000 births. The deaths from diarrhœa and enteritis in children under two years, in the Metropolis numbered 552 the death-rate being 0.12 per 1,000 inhabitants. MEASLES. The deaths numbered 7, this being greatly below the average for recent years. The deaths from this disease numbered 25 in 1926, 34 in 1925, 58 in 1924, 23 in 1923, in 1922, 18 in 1921, 50 in 1920, 12 in 1919, 72 in 1918, 139 in 1917, 33 in 1916, and 67 in 1915. Four of the deaths were amongst males and three females. All were amongst children under five years. The death rate was 0.09 per 1,000 as compared with 0.23 in 1926, 0.32 in 1925, 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 1927 were mostly during the first three months of the year. Four of these deaths occurred in Whitmore Ward and one each in Church, Kingsland and Acton Wards. Some 20 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 141 visits in connection with the cases. The number of cases removed to the hospitals of the Metropolitan Asylums Board was 106. B 14 The deaths from measles in the Metropolis numbered 179 as compared with 914 in 1926, 357 in 1925, 1,335 in 1924, 367 in 1923 and 1,559 in 1922. The death rate was 0.04 per 1,000 inhabitants. WHOOPING COUGH. There were 24 deaths from whooping cough in Shoreditch during the year and the death rate 0.22 per 1,000 inhabitants. The deaths for recent years were 0 in 1926, 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 546, the rate being 0.12 per 1,000. INFLUENZA. Twenty-five deaths, nine amongst males, were attributed to influenza. The death rate was 0.24 per 1,000 inhabitants. The deaths during recent years were 22 in 1926, 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 1,790, being at the rate of 0.39 per 1,000 inhabitants. The corresponding figures for last year were 786 and 0.17. TYPHUS FEVER. No cases were certified in Shoreditch. TUBERCULOSIS. Tuberculosis (Appendix Table V, Nos. 29 to 34 inclusive) resulted in 114 deaths as compared with 151 in 1926, 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 8.6 per cent. of the total mortality for the year. The deaths during 1927 include those of 21 persons who were not certified under the Tuberculosis Regulations in Shoreditch. The mortality was at the rate of 1.07 per 1,000 inhabitants, varying from 1.47 in Church to 0.80 in Wenlock. The deaths from tuberculosis of the lungs or consumption numbered 86, of which 57 were of males, a decrease of 47 on the figure for 1926. The death rate was 0.82 per 1,000 being highest in Church and lowest in Kingsland, the rates being 1.14 and 0.57 per 1,000 respectively. The deaths from tuberculosis in the Metropolis numbered 4,780, the death rate being 1.05 per 1,000 population. The deaths attributed to tuberculosis of the respiratory system numbered 4,140, which gives a rate of 0.91 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). 15 Subjoined are particulars of new cases and of deaths during 1927 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 10 3 1 3 4 5 2 ... 7 4 ... 1 1 1 10 2 7 5 4 ... 3 2 2 15 7 9 4 2 6 3 ... 1 20 8 21 1 2 6 7 1 ... 25 17 10 3 4 5 7 1 ... 35 32 14 ... ... 11 ... ... ... 45 26 13 ... 1 21 8 1 ... 55 10 2 1 ... 8 3 ... ... 65 and upwards 2 2 ... 1 3 ... ... 1 Totals 107 79 31 21 62 32 10 10 † In addition. The cases certified numbered 238, being at the rate of 2.3 per 1,000 persons in the Borough, as compared with 2.7 in 1926, 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 rtified were most numerous in proportion to the population in Hoxton Ward and least in Moorfields, being at the rate of 2.9 per 1,000 in the former as compared with 1.6 in the latter. The cases certified as pulmonary tuberculosis numbered 186, and were at the rate of 1.8 per 1,000, as compared with 2.1 in 1926, 2.2 in 1925, 2.0 in 1924, 2.1 in 1923, 2.1 in 1922, 2.1 in 1921, 2.8 in 1920 and 4.0 in 1919. The notifications of pulmonary Tuberculosis were proportionately most numerous in Hoxton and least in Moorfields, being 2.5 and 0.7 per 1,000 respectively. At the close of the year there were on the Tuberculosis Register at the Town Hall names of 1,761 persons, of whom 968 were males. Approximately the names of 1.7 per cent. of the population were on the Register. This number is too large owing to the failure of those who have recovered to report themselves for the purpose of having their names removed. It is expected, however, that with improved arrangements for tuberculosis visiting the register will be brought up to date. The report of Dr. Leitch which summarises the work carried out at the Tuberculosis Dispensary during the year under consideration is appended (pp. 58-61) The removals to hospitals, sanatoria and other institutions are given in Table II. (Appendix). Of the deaths from consumption belonging to Shoreditch, approximately 39 per cent. occurred in public institutions within or without the Borough and of these 67 per cent. took place in St. Leonard's Hospital. B 2 16 OPHTHALMIA NEONATORUM. Under the Public Health (Ophthalmia Neonatorum) Regulations, 1926, the duty of notifying cases of ophthalmia neonatorum is placed solely upon the medical practitioner in charge of the cases. The certificates received numbered 62 relating to 49 cases, 27 being amongst males and 22 females. There were besides some 83 other cases of inflamed eyes in infants which were brought to our notice, by the Medical Officer of Health of the 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. 49 40 9 48 1 ... ... The usual supervision was exercised through the Health Visitors for securing proper treatment. Of the cases certified, seven were of a severe type. In one instance vision was impaired. A number of the cases received treatment at the Moorfields Eye Hospital. Nine cases were treated in hospital, one of them being admitted to St. Margaret's Hospital, a special institution of the Metropolitan Asylums Board for the treatment of this disease. When necessary mothers are admitted with their infants. Fourteen of the cases were attended to by nurses from the Local District Nursing Association who made an average of 22 visits per case. The certified cases were at the rate of 22.4 per 1,000 births as compared with 10.7 for London as a whole, more than twice as great. EPIDEMIC CEREBRO-SPINAL MENINGITIS. One case was certified. It occurred in an infant and terminated fatally in the Queen's Hospital. POLIO-MYELITIS. Two cases of the above disease. which is generally known as infantile paralysis, were certified. One of these was removed to the Western Hospital, where it was found not to be a case of poliomyelitis. The second case occurred in an infant aged eight months. The child was admitted to the Queen's Hospital and discharged in April. The arm, which was the part affected in this case, has improved since the child's discharge from hospital. 17 ENCEPHALITIS LETHARGICA. The following are brief particulars respecting the four cases certified during the year under consideration:— (1) A boy aged 2½ years was removed on January 5th to the Eastern Hospital, where the diagnosis was changed to pneumonia. He was discharged on 11th February. (2) A woman aged 28 years was certified on 5th April. At the time of certification the disease had reached an advanced stage, the patient being unable to look after herself by reason of tremors of the limbs. She was admitted to St. Leonard's Hospital, where she died towards the end of the year. (3) A young man aged 18 years was certified in October, and is being treated at home. The patient has only slight tremors, and is able to get about and to look after himself. He is not able to work. At the time of going to press no mental change was noticeable. (4) A young man aged 21 years was also notified in October. In this patient paralysis with accompanying tremors is very marked and salivation is excessive. He is unable to dress or feed himself, but there is no mental deterioration. He is being treated at home. GLANDERS, ANTHRAX AND HYDROPHOBIA. No cases were certified in Shoreditch during the year. PNEUMONIA, MALARIA AND DYSENTERY. In accordance with the Regulations of 1919 some 273 cases of acute primary pneumonia and 21 of influenzal pneumonia were certified during the year. Of the cases of pneumonia investigated 218 were treated in St. Leonard's Hospital, 4 in St. Bartholomew's Hospital and 5 in other institutions. Some 46 were nursed at home by relatives, 7 of There with the help of the District Nursing Association. Some 26 other cases of pneumonia (not notified) also received the nursing assistance of the Association. Altogether 451 visits were made by the nurses of the District Association in connection with pneumonia cases. In 108 instances the dwellings occupied were satisfactory as regards air space, light and ventilation; in 62 they were fairly so, and in 103 they were unsatisfactory. Three cases of malaria were certified. In each case the patient was an ex-service man and contracted the disease abroad. VENEREAL DISEASES. The London County Council is the authority responsible for the provision of facilities for the diagnosis and treatment of these diseases and special clinics are held in various voluntary hospitals and in other institutions. None of these are actually within the boundaries of the Borough but those at the Metropolitan, the London. the Royal Free and University College Hospitals are readily accessible to the people of Shoreditch. 18 In addition to the foregoing, The London County Council makes provision for doctors of laboratory facilities for aid in diagnosis, supply of salvarsan and its substitutes, provision of instruction for practitioners and students and co-ordinates the work of Hospitals, Public Health Services and practitioners. The Council also undertakes publicity and propaganda work with regard to matters relating to venereal diseases. A Shoreditch Propaganda Committee associated with the Shoreditch Public Welfare Association and working in close co-operation with the British Social Hygiene Council made arrangements in connection with the following film lectures, at the Town Hall:—Dr. Otto May—The Dangers of Ignorance. Film, Whatsoever a Man Soweth ; Dr. I. Feldman—The Shadow. At the Welfare Centre, Kingsland Road, Dr. Rose Turner delivered a series of four lectures (for women only), dalling mainly, though not exclusively, with the subject of venereal disease. No film was shown at the first lecture. The following films were shown at the other lectures:—The Gift of Life, Public Health, Twins at Work, Clean Milk and Care of the Teeth, The Shadow. 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 740, scarlet fever 639, measles 519, chicken pox 638, whooping cough 440, mumps 461 and 343 of other infectious diseases. The exclusions altogether numbered 3,780 and related to 38 schools. The scheme for the more effective control of measles in public Elementary Schools, referred to in previous reports, was reintroduced in a modified form in December. Under the new arrangements leaflets prepared in the Health Department are handed to the head teachers for distribution in the schools affected. A number of 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. In only a few instances was it found necessary to exclude any of the children. Information was also received from the School Medical Officer relative to the exclusions from school of 36 children on account of the presence of diphtheria bacilli in their noses or throats. The families, residents in some twenty-eight houses, to which the children belonged, were kept under observation; in one instance a case of diphtheria was subsequently notified amongst the residents in the house. BACTERIOLOGICAL EXAMINATIONS. During the year some 1,133 examinations were made. Dr. J. Andrew made 717 of these at his laboratory in Kingsland Road and Dr. F. H. Teale 416 at the University College Hospital Medical School. Of these 792 were for suspected diphtheria, 11 for 19 enteric fever, 251 for tuberculosis and 36 for gonorrhoea. Thirty Wassermann tests were made, two samples of faeces and two of urine were examined, five specimens of cerebrospinal fluid, three specimens for organisms and one for blood culture were also examined. Positive results were obtained in 137 of the examinations for diphtheria organisms, 36 of those for tubercle bacilli, six of the examinations for gonococci and in nine of the Wassermann tests. In addition to the above some 706 bacteriological examinations were made at the Royal Chest Hospital in connection with the work at the Tuberculosis Dispensary. DISINFECTION. The premises disinfected numbered 1,074; the articles removed to the Borough Disinfecting Station to be there disinfected totalled 11,713 and included 969 beds, 837 mattresses, 2,069 pillows, 530 bolsters and some 7,308 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. It was necessary to destroy one pair 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, was in use on three occasions during the year under consideration:— One family in which occurred a case thought at first, as described already, to be a case of small-pox was admitted to the Shelter while the house was disinfected. A family consisting of man, wife and five children were allowed to occupy the Shelter while the drains at their house were reconstructed in accordance with requirements of the Health Committee. A man was admitted to the Shelter in order that his clothes might be disinfected. PUBLIC MORTUARY. The bodies of 128 persons were deposited in the mortuary and inquests were held in 117 instances. In connection with these inquests 65 post-mortem examinations were made at the mortuary. No infectious bodies were removed to the mortuary by 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 of approximately 29.8 inches, which is above the average. 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 six premises: in five instances on account of non-payment of rates, and in one because water was not required. 20 Water was laid on to some 183 new premises and in 10 instances additional taps were provided in tenement houses. Four complaints were received as to the quality of the water, but there was no reason for suspecting the occurrence of any illness due to the water supplied. MUNICIPAL DENTAL HOSPITAL. In the preceding Annual Report reference was made to the decision of the Council towards the end of 1926 to establish an Institution for the care of the teeth of those who live or work in the Borough. At the beginning of the year now under consideration the lease of suitable premises at 164, Kingsland Road was obtained and the following staff was engaged:— Dental Surgeon (part time) J. Peter, M.C., M.R.C.S., L.R.C.P., L.D.S. Anaesthetist (part time) M. Marcus, M.B.B.S. Mechanic (full time) T. Lamb. Nurse (part time) Nurse Frier (Certificate of General Training). Caretakers (residents) Mr. & Mrs. Whittard. At first five Sessions were held at the following times:— Monday 6.30—8.30. Tuesday 2.30—4.30. Thursday 10 a.m.—12 noon. Friday 2.30—4.30. Friday 6.30—8.30. Owing to the large number of patients requiring extractions it was soon found necessary to hold an additional anaesthetic session. It was accordingly arranged for an extra session to be held every fortnight, the time of this being varied to suit the convenience of the patients. The summary of the work done during the year is as follows:— TABLE I.—INSPECTION AND TREATMENT OF CHILDREN. Number examined. Number needing treatment. Number refusing treatment. Number treated. Number of extractions. Number of Administrations of Anaesthetics. Number of fillings. Number of other operations. Number of children treated for orthodontics. Number of visits. Local. General. 2 years & under 25 16 ... 13 49 ... 12 ... ... 26 3 years & under 52 47 ... 32 93 ... 30 2 ... ... 57 4 years & under 143 140 ... 97 275 ... 82 21 ... ... 168 5 years & under 58 53 ... 44 128 ... 43 2 ... ... 63 Over 5 years 151 148 ... 110 266 11 80 22 5 5 180 Total 429 404 ... 296 811 11 247 47 5 5 499 21 TABLE II.— INSPECTION AND TREATMENT OF ADULTS. Number of patients examined. Number of patients treated Number of extractions. Number of Administrations of Aræsthetic. Number of fillings, including root fillings. Number of scalings. Number of other operations. Number of dentures fitted. Number of repairs to dentures. Number of crowns. Number of visits. Local. General. Maternity cases— Women 496 356 1240 21 166 58 29 124 37 5 ... 627 Unmarried girls (16-20) 290 185 647 28 84 32 9 43 13 6 ... 340 Men 53 43 54 11 13 22 4 1 ... ... ... 66 Tuberculosis cases- 343 235 646 46 90 54 22 53 11 5 397 Total including children, Table I 1611 1115 3398 117 600 213 64 221 61 16 ... 1929 TABLE III. Total attendances. No. of M. & C. W. cases. Anaesthetic Sessions attendances. Monday evening 444 96 76 Tuesday afternoon 397 170 49 Thursday morning 563 357 387 Friday afternoon 293 154 17 Friday evening 317 80 57 Total 2014 857 586 These figures are evidence of the extensive and useful work that is being done at the Hospital, and in view of the fact that most disease and chronic ill-health is caused in the first instance by neglect of the care of the teeth, this work should in time contribute appreciably towards improving the health of the Borough. So important is the Hospital that it is greatly to be hoped that it will before long be open as a full-time department. SANITARY WORK. Intimations as to insanitary conditions were served in respect to 5,720 premises. In 505 they were dealt with by Inspector Wright, in 528 by Inspector Chapman, 22 545 Inspector Sickelmore, 356 Inspector Thomas, 413 Inspector Shaw, 329 Inspector Molloy, 937 Inspector Bishop, 522 Inspector Girling, 444 Inspector Stratton, 590 Inspector Grant and 706 by Inspector Walker. In connection with the inspectors' work some 1,659 letters were written to owners and others concerned. The Inspectors made 45,958 visits ; 9,377 of these visits were in connection with dwellings, 2,623 workshops, besides factories, laundries, bakehouses, cowsheds and milk vendors' premises, ice-cream shops, slaughterhouses, and other places where food is prepared and sold were also visited. Some 644 visits of inspection 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 2,756 of the dwellings was the result of house-to-house inspection carried out in accordance with the intention of the Health Committee. Unfortunately, there was considerable illness amongst the Sanitary Inspectors during the year. As a result of this the house-to-house inspection was in arrears towards the end of the year. To catch up these arrears, and to bring the house-to-house inspection into line with the scheme approved in 1926, Mr. Gibbs, a member of the clerical staff of the Department, who has obtained his Sanitary Inspector's Certificate, was appointed as temporary Sanitary Inspector for six months, for the special duty of making house-to-house inspection. 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 1,235 instances. For non-compliance with the requirements of the Sanitary Authority proceedings were taken before the magistrate in 31 instances. SMOKE NUISANCES. There were two 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 seven observations were made by the Sanitary Inspectors and in four 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. 23 FUR SKIN DRESSERS. At the end of the year there were two on the Register, one having been removed therefrom daring the course of the year. They were regularly inspected and some 13 visits were made in connection with them. Two Statutory Notices were served on account of lime-washing which were duly complied with. 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 67 visits of inspection were made in connection with them, and in 13 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 203, and in connection with them some 319 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 323 children, 105 boys and 218 girls, notified verminous by the School Medical Officer, were reported with a view to the homes, bidding, 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 21 boys and 29 girls had been given the opportunity of being cleansed at the cleansing stations, that in the case of 53 boys and 162 girls Statutory Notices had been served upon the parents to cleanse the children within 24 hours under Section 122 of the children's Act, 1908, and that in the cases of 2 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 8 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 240 the rooms occupied were satisfactory, varying from fairly clean to very clean, in 16 they were dirty, and in 1 also buggy. In 266 the bedding was clean or fairly so, in 4 it was dirty, in 1 dirty and buggy, and in 3 bugs and in 2 fleas were noted. In 6 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 nine Sanitary Notices were served upon owners and one upon the occupier of verminous dwellings. These were mostly for general repairs and cleansing. 24 The children reported by the School Authorities as suffering from scabies numbered 47, of whom 24 were females. As a result of the enquiries made by the Sanitary Inspectors six 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 statistical summary relating to the work carried out by the Rat Officer with a view to giving effect to the provisions of the above-mentioned Act during 1927 :— Number of complaints in hand 1st January, 1927 220 „ complaints (rats) during the year ending December 31st, 1927 326 „ complaints (mice) during the year ending December 31st, 1927 99 645 „ visits and re-visits 5,467 ,, rats caught in traps or killed by dogs 1,670 ,, rats found dead through poisoning 600 ,, premises cleared of rats 391 ,, premises cleared of mice 55 ,, pavements taken up, fronting houses 40 „ drains tested by Sanitary Inspectors 47 „ reconstructed or repaired 32 „ floors of kitchens, sculleries, passages and coal cellars concreted 82 „ letters to owners and agents 45 Amount of Rat-quit used 1,709 packets. „ Rodine used 2,051 tins. Most of the defective drains were in private houses. As the presence of rats is usually regarded as prima facie evidence of drain defects, the work of the Rat Officer is carried out in close co-operation with that of the District Sanitary Inspectors. The following are the total complaints for the past five years Year Rats. Mice. 1923 250 26 1924 295 46 1925 268 32 1926 354 73 1927 326 99 25 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 80 tenements were completed and the erection of 32 others was commenced. Mention should also be made that the erection of 104 flats by the Corporation of the City of London was completed 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 built upon a site adjoining Shepherdess Walk and Wenlock Road. Four other dwellings were commenced during the year, one 4-roomed house at 40, Shap Street, and a block of three flats at 44, Pearson Street. Reference was made in the preceding report to the inadequacy of the lighting of the staircases of many of the tenement buildings in the Borough, and it is satisfactory to be able to report that under Section 61 of the L.C.C. (General Powers) Act, 1927, the Council now have powers which should ensure a great improvement in this matter in the near future. The houses let in lodgings or occupied by members of more than one family on the register at the end of the year numbered 303, and some 1,231 visits of inspection were made in connection with them. In 213 instances intimations relating to various matters requiring attention were served upon the persons responsible for dealing with the same, and in 134 instances Statutory Notices followed. In 4 instances proceedings before the magistrate became necessary. 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. Both were granted. FACTORY AND WORKSHOP ACT, 1901. The number of workshops, exclusive of bakehouses, on the register at the end of the year was 1,631. Of these 369 had been added, 184 having been removed. A classification of the workshops registered is contained in the summary of proceedings under the Act which is appended. Some 2,623 visits of inspection were made in connection with workshops and 614 with factories. Five communications were received from the factory inspectors relative to the establishment of 151 new workshops in the Borough. As the result of inspection 127 were found in a satisfactory condition, and 11 were not in use. With regard to the remainder sanitary notices were necessary ; in 8 instances for cleansing, 1 on account of defective w.c., 2 for defective roofs, 1 for dirty urinal and 1 on account of w.c. being improperly screened. 26 Forty-seven written intimations were received from the factory inspector relating to insanitary conditions and infringements of the law as to public health in connection with 14 factories and 33 workshops. The chief insanitary conditions to which the factory inspector directed attention were : dirty conditions of walls and ceilings in 18, defective and insufficient w.c. accommodation in 27, defective roofs in 5, foul urinal in 1, obstructed drain in 1 and in one instance there was a defective ceiling. Including those brought under the notice of the department by the factory inspector 282 workshops were dealt with, 294 sanitary notices being served upon the parties responsible for their proper sanitary upkeep. In eight instances sanitary notices were not required. The following is an abstract of the sanitary work carried out to comply with these notices :— Premises cleansed throughout 122 Soil and vent pipes dealt with 3 „ „ partially 58 Water-closets newly constructed 4 Number of rooms cleansed 213 ,, repaired, etc. 227 Walls, floors, sashes, etc., repaired 72 ,, obstructions removed 50 Light and ventilation improved 3 Sinks, etc., cleansed and repaired 14 Roofs, guttering, etc., repaired 119 Overcrowding abated — Sink traps provided 6 Water reinstated or improved 3 Sculleries, yards, etc., paving repaired 7 Drains newly constructed 2 ,, reconstructed 6 Sculleries, yards, etc., cleansed or limewashed 94 repaired, etc. 25 ,, obstructions removed 15 Dust receptacles provided 21 Urinals cleansed, etc. 17 Foul accumulations removed 27 The number of factories under observation for insanitary conditions during the year was 93, and in connection with them some 93 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 27 instances, the removal of obstructions from drains and waterclosets in 24 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, 40 in the first and 40 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 959 out-workers, of whom 691 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 authorrities relating to some 1,568 out-workers, and of these 2 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 1927. 27 The number of out-workers reported was 2,527, and of these some 1,834 were residents in Shoreditch. These figures are below the average for the past five years, but they show an increase as compared with those for 1926. As pointed out in previous reports, in numerous instances names and addresses of the workers are duplicated owing to lists being sent in twice a year, and in some cases the same out-workers are employed by more than one firm, so that the numbers given above must not be taken as representing the actual numbers of individual out-workers. Tables are appended showing the distribution of out-workers as regards trades in the Borough. Most of them are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags and boxes, umbrellas, toys and crackers. Some 774 visits of inspection were made to places where home-work was being carried on, and in connection with these 88 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 17 and included 5 of scarlet fever, 8 diphtheria and 4 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 1,802 and there were in addition some 73 still births. Of the notifications 1,259 were received from registered midwives practising in the Borough. In addition, 201 births occurring in institutions outside Shoreditch were notified weekly, on forms sent in by the London County Council. Including there the live births notified during the year were approximately 95 per cent, of the births registered during the year as compared with 96 per cent, in 1926, 94 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 doctors and health visitors is appended (pp. 66-71). It follows generally on the lines of previous years. The work has been carried on as in previous years with the addition of a morning Toddlers' Clinic by Dr. Sylvia Smith. This was opened on Tuesday morning 1st February and was transferred to Wednesday morning in August and the opening in November of a new Infant Welfare Consultation at Hoxton Market Mission on Wednesday afternoon. In this clinic, which is taken by Dr. Edna Goffe, mothers resident in Health Visitors districts Nos. 5 and 6 are invited to take their babies. The total number of attendances at the various centres during the year was nearly 39,000, as compared with 35,500 during 1926. The number of attendances has shown a marked increase each year since 1918, and attendance at a welfare centre is now taken for granted by a large proportion of the mothers of the Borough. If more centres were available a still larger proportion of the mothers would attend. 28 The Monday afternoon clinic previously held in the basement of the Town Hall where the accommodation was not suitable for the purpose was transferred in July to the Hoxton Market Mission. Here the room is large, light and airy and the chanpp has been a great improvement. The numbers at the ante-natal clinics have been well maintained. The light clinic has been continued throughout the year and the numbers referred for treatment show an increase on the preceding year. Allowances of milk and dinners under Circular 185 were made as usual, the number showing little change as compared with the preceding year. Particulars as to the admissions to the wards of the Model Welfare Centre are given on page 71. According to information supplied by the Hospital Authorities 360 cases from Shoreditch were dealt with at the Ante-Natal and Consultative Maternity Centre of the City of London Maternity Hospital during 1927. Of these 213 were examined by the Obstetric Surgeon attached to the Centre, some 425 examinations being made. In 147 the Sister attached to the department saw and advised expectant mothers upon various aspects of their pregnancies, 459 examinations being made. The number of cases delivered in the District during the period under review was 154, and in the Hospital 212. In all cases the urine was tested. Some 8 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 7 instances, contracted pelvis in 9, albuminuria in 4, breech presentations in 6, transverse 1, heart disease 4, tuberculosis 2, bad histories 12, varicose veins 2, removal of placenta 1, hydrocephalus 1, faetal ascites 1, syphilis 1, prolapsed cord 1, breast abscess 1, epileptics 2, hydramnios 2, placenta praevia 5, Caesarian Scction 2, induction of labour 2, in 1 case decapitation was required, and in 3 cases version. There were 4 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 272 children under five years. The total number of visits to children under five was 2,745. Measles, ophthalmia neonatorum, otorrhoea, threadworms, tonsils and adenoids, pneumonia and bronchitis, 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. 29 The following were surrendered or seized and destroyed as unfit for the food of man:— 4 boxes (48 lbs.) of tomatoes, 500 tins of oxtail soup, 100 tins of mulligatawny soup. 56 tins of vegetable soup, 1 box (2 qrs.) of mixed fish, 168 lbs. of tomatoes, 21 boxes (441 lbs.) of apricots, 14 lbs. of sweets, 6 stone of skate wings, 7 cwts. of grapes, 1 cwt. of conger eels, 75 lbs. of apples, 9 lbs. of prawns, 2 tins of condensed milk, 78 packets of dates and 1 cwt. of dabs. SLAUGHTERHOUSES. The two slaughterhouses in the Borough were subject to the usual inspection and 26 visits were made in connection with them. Their general sanitary condition may be reported as satisfactory. Little use is made of them and the L.C.C. refused, for this reason, to renew the licence in respect of premises at 7, The Broadway, London Fields, which was accordingly removed from our register on 20th October. Some 54 butchers' shops were under inspection during the year and some 162 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 54 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 288 10 having been added and 2 removed therefrom. In 23 instances there were changes in the names of the persons registered. The premises were under regular inspection throughout the year and some 1,315 visits were made in connection with them. In 14 instances sanitary notices were served, mainly for cleansing. Three cases of diphtheria were 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. c 30 CONDENSED MILK REGULATIONS. Four samples were submitted for analysis under the above Regulations, all 0f which were returned as genuine. MILK AND DAIRIES ORDER, 1926. Under this Order a milk vendor was fined for delivering milk in a bottle which was not filled and closed on registered premises. PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS. These Regulations came into operation on January 1st, 1927, and so far as they relate to bacon, ham and egg yolk on 1st July, 1927. In these regulations the use of all preservatives in food, with the exception of specified inocuous substances which are allowed in minute quantities in certain foods as stated in the schedules to the regulations, is prohibited. Upon analysis of five samples of cordial taken towards the end of the year under consideration, it was found that these contained salicylic acid ranging from 1.8 to 2.9 grains per pint contrary to the provisions of these regulations. Proceedings were instituted but the cases did not come before the Magistrate until the new year. The Council was granted one guinea costs in respect of each summons. A sample of candied peel also taken towards the end of the year contained sulphite preservative expressed as sulphur dioxide 50 parts per million in excess of 100 parts allowed and was the subject of proceedings under these regulations. After the third sample had been examined at Somerset House, 3 guineas costs were awarded to the Borough Council. 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. COOKSHOPS AND EATING-HOUSES. Including the kitchens of public houses where food is prepared for customers, 190 were under inspection during the year, and some 689 visits were made in connection with them. Some 43 sanitary notices were served, mainly for cleansing. FRIED FISH SHOPS. Some 64 were under inspection and 304 visits were made to them. Thirty-five sanitary notices were served, mainly for cleansing. 31 ICE-CREAM SHOPS. The number under observation during the year was 126, and 256 visits of inspection were made. In 16 instances sanitary notices were served. Most of these were for general cleansing. BAKEHOUSES. The bakehouses in the Borough, to the number of 61, were inspected. Thirty were found in a satisfactory sanitary condition. The necessary sanitary notices were served and duly complied with, and advice was given regarding cleanliness both of the premises and of the hands of the employees. Thirty-six of the bakehouses on the register at the close of the year were underground. In 29 power is used in connection with the work of bread baking. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison M.A., show that 1,062 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 1927. 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 243 2 0.8% – – – – – 151 17 6 2nd 289 4 1.4% 1 – 1 1 1 1 0 180 12 6 3rd 164 4 2.4% 3 – 3 3 7 1 0 102 10 0 4th 366 10 2.7% 7 – 7 6 8 8 0 228 15 0 Totals for year. 1,062 20 1.9% 11 — 11 10 16 16 0 663 15 0 The samples taken included 489 of milk (2 informal), 66 butter, 63 vinegar, 46 margarine, 37 cocoa, 30 pepper, 18 non-alcoholic wine, 16 tea, 15 whisky, 14 Gripping, 14 sultanas, 13 raisins, 12 malt vinegar, 11 ground ginger, 10 coffee, 8 custard powder, 8 jam, 8 machine-skimmed condensed milk, 8 sausage, 8 candied Peel 7 ground almonds, 7 tapioca, 7 currants, 6 self-raising flour, 6 olive oil, 6 gin, c 2 32 5 tartaric acid, 5 mustard, 5 glycerine, 5 ammoniated tincture of quinine,'5 breakfast sausage, 4 camphorated oil, 4 ground rice, 4 sago, 4 boracic acid, 4 full-cream condensed milk, 4 full-cream dried milk (2 informal), 4 meat pie, 4 fruit cordial, 4 mixed spice, 4 Lisbon wine, 3 bun mixture, 3 lard, 3 rice, 3 salmon and shrimp paste, 3 coffee and chicory, 3 sauce, 3 rum, 2 baking powder, 2 compound liquorice powder, 2 arrowroot, 2 dried milk food, 2 corned beef, 2 sugar, 1 each of " Brinite " (informal) modified full-cream dried milk, lime juice cordial, turpentine, brawn, ground cinnamon, apples, apricots, mixed fruit, fruit salad, gelatine, lemon squash, mincemeat, ground nutmegs, oatmeal, shredded cocoanut, flour, sodium bicarbonate, bloater paste, bread and butter, oil of eucalyptus and pickles. Of the samples of milk 8 or 1*6 per cent, were found to be below the standard fixed by the Board of Agriculture. The proportion of milk samples returned as adulterated during 1927 was again greatly below the average. 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 138 2 1.4 2nd 130 1 0.8 3rd 87 4 4.6 4th 142 1 0.7 In three of the samples water was certified to have been added; in two cases it was less than 5 per cent., and in the third case it was 8 per cent.; in five the samples showed deficiencies in milk fat; in one of these it was less than 5 per cent., and in the other four the deficiency ranged from 13 to 42 per cent. taking the standard of the Board of Agriculture. Legal proceedings were instituted in five or 62.5 per cent. of the cases in which samples of milk were below standard. In one instance a warranty was proven and the case was dismissed. In two instances the summonses were dismissed upon payment of costs, and in the other two cases costs only were allowed the Council. No legal proceedings were considered advisable as regards the remainder of tinsamples of milk below standard. The percentage of the adulterated samples of milk in which it was not thought advisable to institute legal proceedings was 37.5. Sixty-six samples of butter were taken, all of which were returned as genuine, 28 were reported as containing boric acid, not exceeding 0.5 per cent. in each. 33 Forty-six samples of margarine were taken, all of which were returned as genuine. Of the 63 samples of vinegar taken, four contained 1, 3, 4 and 6 percent, excessive water respectively. No proceedings were taken. One sample of mustard was found to contain 5 per cent, of wheat and had traces of turmeric. No action was taken. One sample of whisky contained 1 per cent. excessive water. A warning letter was sent to the vendor. The informal sample of " Brinite " was a preparation of common salt with some sodium sulphate and sodium sulphite. The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1903-1927 inclusive :— Year. Number of Samples. Number of persons in the Borough to each Sample. Number of Samples adulterated. Percentage of Samples adulterated. Number of prosecutions instituted. Summonses withdrawn on account of warranties. Prosecutions proceeded with. | Number of successful prosecutions. Fines and Costs. Amount paid to Public Analyst. £. s. d. £. s. d. 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 1927 1062 101 20 1.9 11 ... 11 10 16 16 0 663 15 0 The percentage of samples found to be adulterated is the lowest so far recorded. 34 RAG FLOCK ACT, 1911. Under the above Act 19 samples (3 informal) were taken for analysis. Of the formal samples four contained 2,166, 835, 690 and 150 parts respectively of soluble chlorine per 100,000 in excess of the amount allowed. Proceedings were instituted and the defendant was ordered to pay £5 5s. Od. costs in each case. The 3 informal samples contained 135; 285, 2,270 parts per 100,000 in excess of the 30 parts per 100,000 allowed. STAFF. In the last month of the year under consideration Dr. Bryett, who had been Medical Officer of Health for thirty-four years, died after a long illness, during the greater part of which, with characterisitic courage and devotion to duty, he continued at his post. The Council has placed on record an appreciation of the line work done by Dr. Bryett as Medical Officer of Health of the Borough, and of deep regret at his sad death. The members of the staff of the Public Health Department wish to express their grief at the loss of the chief under whose leadership they have served for so many years. The late Medical Officer of Health was absent from duty on account of illness for some months during the year under consideration. During this period the Assistant Medical Officer of Health was relieved of his clinical duties in connection with the work of the Maternity and Child Welfare Committee, the following temporary appointments being made : Dr. Olivier Richards took charge of the wards at the Model Welfare Centre ; Dr. Edna Goffe and Dr. Elizabeth Karn, of Infant Welfare Consultations, and Dr. Mackenzie Shattock of the Light Clinic. The Maternity and Child Welfare Committee accepted with great regret the resignation owing to ill-health of Dr. Amy Hodgson of her appointment as Medical Officer to the Infant Welfare Consultations held on Tuesday afternoons at the Model Centre, and on Friday afternoons at Harbour Lights. Dr. Karn was subsequently appointed to the former, and Dr. Goffe to the latter consultations. Reference has already been made, under the heading of Sanitary Work, to the absence through illness of members of the staff. Mr. Wright was absent from this cause from 19th January until 8th May, Mr. Thomas from 19th January until 21st March, and Mr. Pearson from 6th October until after the end of the year. The particulars of appointments to the staff consequent upon the opening of the Shoreditch Municipal Dental Hospital have been given under the general description of that institution. 35 Sister Andrews resigned her appointment at the Model Welfare Centre on securing in July the appointment of Matron to the Poplar Maternity and Child Welfare Centre. Sister Kennedy was appointed by the Maternity and Child Welfare Committee at their meeting of 15th July to the post thus vacated. As in previous years, Mrs. Levi, a former health visitor, was temporarily employed during the period of the health visitors' holidays. The following is a brief summary of the communications prepared by the Clerical Staff:— Under the Health Committee some 30,771 communications written and printed were despatched from the Office during the year. These included 7,284 notices and summonses, 7,503 letters, cards and other communications under the Public Health and Sale of Food and Drugs Acts, 170 in connection with the work under the Factory and Workshops Acts, 10,614 on various matters relating to infectious disease, verminous cases and disinfection, and 5,200 agendas and reports respecting the work carried out. In connection with the work under the Maternity and Child Welfare Committee some 29,120 communications were despatched, including 11,148 forms, books and cards in connection with the distribution of milk, 12,532 letters and other communications, and 5,440 agendas and reports. I have to acknowledge the help rendered by all members of the staff during a year made difficult by much illness. I have also to express my thanks to the Mayor, the Chairman and members respectively of the Health and Maternity and Child Welfare Committees, and to the numbers 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, Maitland Radford, Medical Officer of Health. 37 Metropolitan Borough of Shoreditch. APPENDIX TO THE REPORT of the M edical Officer of Health, containing Statistical Tables and Summaries of Proceedings under the Public Health and Factory and Workshops Act during the Year 1927, 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 1927. 39 Vital Statistics of the Borough of Shoreditch during 1927 and previous years. Year population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Nonresidents registered in the District. of residents not registered in the District. Under 1 year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 nett N umber. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1920 107300 2235 2516 23.5 1180 10.9 217 335 167 66 1298 12.2 1 >.!•). ]05700 1870 2188 20.9 1194 11.29 209 343 163 74 1328 12.7 Note.— The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn Ii^titution, estimated at 1,000, lias 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 Total population at all ages 104,308 (exclusive of area 642.5 Number of families 25,373 covered by water). Number of inhabited houses 11,889 Rateable value £954,350 Average number of persons per Yield of penny rate £3,857 house 8.8 At cencsus of 1921. © TABLE II. Cases of infectious disease notified during the Year 1927 in the Borough of Shoreditch. Notifiable Disease. At all Ages. Number of Cases Notified. Total Cases Notified in each Ward of the Borough. Total Cases Removed to Hospital. 1 2 3 4 6 6 7 8 At Ages—Years. Moor fields. Church. Hoxton. Wenlock. Whitmore. Kings- land. Haggerston. Acton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C), Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 467 11 195 208 33 19 1 ... 14 83 67 52 111 45 67 28 466 Erysipelas 62 4 3 3 9 11 23 9 3 12 9 9 12 8 4 5 27 Scarlet fever 383 5 126 212 33 7 ... ... 16 60 64 43 61 52 43 44 376 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 4 ... ... 1 2 1 ... ... 1 ... 1 ... ... ... 2 ... 4 Relapsing fever (R), Continued fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 11 ... ... ... 3 8 ... ... ... 2 5 4 ... ... ... 9 Puerperal Pyrexia 34 ... ... ... 15 19 ... ... 1 5 3 5 7 2 7 4 23 Cerebro-spinal meningitis 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... Poliomyelitis 2 1 ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... 2 Encephalitis lethargica 4 ... 1 ... 2 1 ... ... ... ... 1 ... ... 1 2 ... 2 Pulmonary tuberculosis 186 ... 2 ii 45 73 51 4 4 28 40 27* 231 21 19 24 200‡ Other forms of tuberculosis 52 ... 13 20 9 7 2 1 3 9 7 6 9 6 9 3 51 ‡ Ophthalmia neonatorum 49 49 ... ... ... ... ... ... 1 11 6 5 14 7 3 2 3 Acute primary pneumonia 273 27 106 43 22 30 32 13 2 63 26 45 61 21 30 19 217‡ Acute influenzal pneumonia 21 1 1 ... 5 7 4 3 ... 2 3 12 ... ... 4 ... 331‡ Malaria 3 ... ... ... ... 2 1 ... ... 1 1 ... ... ... 1 ... ... Totals 1,552 99. 447 498 178 186 114 30 45 274 230 210 302 164 197 130 1,394 * This Number includes the cases of consumption notified from the Holborn Institution, Highgate, * This includes the cases of consumption in the St. Leonard's Hospital. * Removed to St. Leonard's and other Hospitals or Sanatoria. It is to be noted that the cases of tuberculosis removed during the year included cases certified in previous years as well as cases certified in 1926. 41 TABLE III. Causes of, and ages at, death during the Year 1927 in the Borough of Shoreditch. CAUSES OF DEATH. Nett Deaths at the subjoined Ages of " Residents" whether occurring within or without the District (a). Totai. Deaths whether or " Residents " or " NonResidents" in Institutions in the District (b) All Ages. Under 1. 1 and under 2. 2 and under 3. 5 and under 15. 15 and under 23. 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) 1328 163 53 43 51 59 118 382 459 715 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric fever 1 ... ... ... ... ... 1 ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... 3 Measles 7 2 4 1 ... ... ... ... ... ... 4 Scarlet fever 3 ... ... 2 1 ... ... ... ... ... 5 Whooping cough 24 14 8 2 ... ... ... ... ... 2 6 Diphtheria and Croup 12 ... 4 2 6 ... ... ... ... 7 Influenza 25 1 1 1 ... ... 5 14 3 3 8 Erysipelas 6 1 ... ... ... ... 1 3 1 4 9 Phthisis (pulmonary tuberculosis) 86 ... ... ... 3 18 21 41 3 32 10 Tuberculous meningitis 12 2 2 3 3 1 1 ... ... 3 11 Other tuberculous diseases 16 1 3 1 3 3 5 ... ... 7 12 Cancer, malignant disease 132 ... ... ... ... ... 7 71 54 61 13 Rheumatic fever 10 ... ... ... 3 3 2 1 1 3 14 Meningitis (see note (d) ) 7 4 ... 1 2 ... ... ... ... ... 15 Organic heart disease 168 ... 1 ... 1 12 13 68 73 ... 16 Bronchitis 128 7 1 2 ... ... 8 33 77 96 17 Pneumonia (all forms) 167 37 24 15 10 5 8 39 29 69 18 Other diseases of respiratory organs 4 2 ... 2 ... ... ... ... ... 4 19 Diarrhoea and Enteritis (see note (e) ) 19 19 ... ... ... ... ... ... ... 12 20 Appendicitis and Typhlitis 8 ... ... 2 ... 1 3 2 ... 1 21 Cirrhosis of liver 6 ... ... ... ... ... ... 4 2 4 21a Alcoholism 1 ... ... ... ... ... ... 1 ... 22 Nephritis and Bright's disease 97 ... ... ... 1 3 4 36 53 74 23 Puerperal fever 2 ... ... ... ... 1 1 ... ... 1 24 Other accidents and diseases of pregnancy and parturition 1 ... ... ... ... ... 1 ... 1 25 Congenital Debility and malformation, including premature birth 55 55 ... ... ... ... ... ... ... 24 26 Violent deaths, excluding suicide 49 4 ... 8 4 4 5 9 15 34 27 Suicides 18 ... ... ... ... ... 6 10 2 3 28 Other defined diseases 257 13 3 3 12 8 25 48 145 244 29 Diseases ill-defined or unknown 7 3 ... ... ... ... 1 2 1 33 1328 163 53 43 51 59 118 382 459 715 42 TABLE IV. INFANTILE MORTALITY IN THE BOROUGH OF SHOREDITCH DURING THE YEAR 1927. 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 tinder 1 Month 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under 1 Year. All causes Certified 33 2 9 7 51 24 30 29 29 163 Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... 1 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... 1 ... 5 5 11 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 1 ... 1 Tuberculous meningitis ... ... ... ... ... 1 ... ... ... 2 Abdominal tuberculosis (b) ... ... ... ... ... ... ... 1 ... 1 Other tuberculous diseases ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... 1 ... 3 4 Convulsions ... ... ... ... ... 2 1 ... ... 6 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 4 ... 4 2 10 Pneumonia (all forms) ... ... 2 1 3 3 11 10 12 39 Diarrhoea ... ... ... ... ... l 1 ... 2 Enteritis ... ... ... ... ... 5 6 2 2 15 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... ... ... ... ... ... ... ... 1 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlying ... ... ... 1 1 ... 1 ... ... 2 Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 2 ... 1 ... 3 ... ... ... ... 3 Congenital malformations (c) 2 ... ... ... 2 1 ... ... ... 3 Premature birth 20 ... 2 3 25 ... 1 ... ... 26 Atrophy, Debility and Marasmus 2 1 2 1 6 6 6 2 1 21 Other causes 4 1 1 6 1 2 2 2 13 33 2 9 7 51 24 30 29 29 163 Nett Births in the year.—Legitimate, 2,122 ; illegitimate, 66. Nett Deaths in the year of legitimate infants, 1 51 ; illegitimate infants, 12. 43 NOTES TO TABLE III. The classification and numbering of Causes of Death are those of the " Short [jst on page xxv. of the Manual of the International List of Causes of Death." (a) All " Transferable Deaths " of residents, i.e., of persons resident in the district who have died outside it, have been included with the other deaths in columns 2-10. Transferable deaths of non-residents, i.e., of persons resident, elsewhere in England or Wales who have died in the district, have been in like manner excluded from these columns. For the precise meaning of the term " Transferable Deaths," see footnote to Table I. (b) All deaths occurring in institutions for the sick and infirm situated within the district, whether of residents or of non-residents, have been entered in the last column of Table III. (c) All deaths certified by registered medical practitioners and all inquest cases have been classified as " Certified " ; all other deaths being regarded as " Uncertified." (d) Exclusive of "Tuberculous Meningitis" (10), but inclusive of cerebrospinal meningitis. (e) Title 19 has been used for deaths from diarrhoea and enteritis at all ages. (In the "Short List" deaths from diarrhoea and enteritis under 2 years are included under 19 ; those at 2 years and over being placed under title 28.) NOTES TO TABLE IV. (a) The total in the last column of Table IV equals the total of column 10 of Table I and in column 3 of Table III. (b) Under abdominal tuberculosis have been included deaths from culous peritonitis and enteritis, and from tabes mesenteiica. (c) The total deaths from congenital malformation, prematuie 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. Id) For references to the meaning of any other headings, see Notes to Table III. 44 TABLE V. DEATHS FROM ALL CAUSES IN THE BOROUGH OF SHOREDITCH, AND IN EACH WARD DURING THE YEAR ENDING 31st DECEMBER, 1927. Note.—The deaths of persons not belonging to Shoreditch occurring in hospitals and other institutions in the Borough are excluded ; deaths of persons belonging to Shoreditch occurring in public institutions in London beyond the limits of the Borough are included. CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. i Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. I 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 05. 65 to 75. 75 to 8"). 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total. 1 Smallpox 'Vaccinated 1 i Unvaccinated .No statement ... 1 2 Measles ... ... ... 2 4 1 i 4 i i 4 3 7 3 Scarlet fever ... ... ... 2 1 ... I 2 2 1 3 4 Typhus fever ... ... ... ... 5 Epidemic influenza ... ... 1 1 1 3 2 9 5 2 i i 2 6 3 7 i 2 3 i-6 9 25 6 Whooping cough ... ... 14 8 2 4 4 '9 1 3 3 13 11 24 7 Diphtheria, rhembranous croup 4 2 6 I 2 3 2 O 1 3 9 12 8 Enteric fever ... 1 ... 1 1 1 9 Asiatic cholera... ... 10 Diarrhoea, dysentery ... 3 ... ... 1 1 1 1 2 3 11 Epidemic or zymotic enteritis 7 ... ... ... 5 "i l 5 2 7 12 Other allied, diseases ... ... ... 13 Hydrophobia ... ... 14 Glanders, farcy ... ... 15 Tetanus... 1 1 i ... ::: 1 1 1 16 Anthrax, splenic fever ... i ii 1 ... 1 17 Cow-pox, accidents of vaccination ... ... 18 Syphilis i 1 ! 2 3 i 1 2 i 1 i 5 8 19 Gonorrhoea i 20 Phagedoena, hospital gangrene ... ... . i!... 21 Erysipelas I 1 3 1 1 2 1 l "i i 5 1 6 22 Puerperal fever 1 i 1 i 2 2 23 Pyaemia, septicaemia ... i 5 4 I i i 1 3 3 3 2 l "7 6 13 24 Infective endocarditis... I "i 2 1 1 1 1 2 2 4 25 Other allied diseases | 26 Malarial fever ... 27 Rheumatic fever 1 i 1 i i i 1 1 I i 1 1 i i "i 6 1 7 28 Rheumatism of the heart 1 2 1 1 1 3 3 Tuberculosis :— 29 Brain or meninges, acute hydrocephalus 2 2 3 1 2 1 I 3 2 2 2 2 l 1 5 7 12 30 Larynx ... 1 I i I 1 ... i 3 3 31 Lungs ... "i 2 8 io 11 10 32 ! 9 3 4 21 12 9 14 1 *6 i*2 8 i 57 29 86 32 Intestines, tabes mesenterica... l 1 ... j 1 1 33 General, position undefined ... 2 1 2 "i i 3 1 2 1 1 •i 1 3 7 34 Other forms, scrofula ... 1 2 2 2 i I 2 3 2 1 5 35 Other infective diseases ... 36 Thrush ... 37 Actinomycosis ... 38 Hydatid diseases 39 Scurvy ... ... 40 Other diseases due to altered food ... 41 Acute alcoholism, delirium tremens ... ... ... 1 - ... 46 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under ]. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total. 42 Chronic alcoholism ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 43 Chronic industrial poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 Other chronic poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Osteo-arthritis, rheumatoid arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 46 Gout ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 17 Cancer ... ... ... ... ... ... ... 4 3 29 38 39 10 1 5 20 20 25 24 5 9 16 68 56 124 48 Diabetes mellitus ... ... ... ... ... ... ... 2 2 1 2 ... ... ... ... 4 ... 1 ... ... 1 1 4 3 7 19 Purpura hsemorrhagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 Anaemia, leucocythaemia ... ... 2 1 ... ... 1 ... 1 ... ... 1 ... ... ... 1 1 3 ... ... 1 ... 2 4 6 52 Lymphadenoma, Hodgkin's disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 53 Premature birth 26 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 2 5 6 2 ... 5 14 12 26 >4 Injury at birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 35 Debility at birth 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 1 2 >6 Atelectasis 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... 1 3 1 4 >7 Congenital defects 3 i ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 4 ... 4 58 Want of breast milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... >9 Atrophy, debility, marasmus 18 i ... ... ... ... ... ... ... ... ... ... ... ... ... 3 7 3 4 1 1 ... 11 8 19 50 Dentition 1 ...... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 (51 Rickets 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 62 Old age, senile decay ... 1 ... ... ... ... ... ... ... ... ... 20 54 16 6 18 19 6 211 9 4 7 38 52 90 / 63 Convulsions 4 ... ... ...1 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... 1 ... 2 2 4 I 64 Meningitis , 2 ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 1 1 5 ... 5 65 Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 66 Apoplexy ... ... ... ... ... ... ... ... ... 1 4 4 1 ... 2 4 1 1 2 3 5 10 15 67 Softening of brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 68 Hemiplegia, brain paralysis ... ... ... ... ... ... ... ... ... 1 ... ..."1 ... ... ... 1 ... ... ... ... ... ... 1 ... 1 69 General paralysis of insane ... ... ... ... ... ... ... ... 1 2 2 ... ... ... ... 1 ... 2 1 ... ... 3 2 5 70 Other forms of insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 72 Cerebral tumour ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... 1 3 3 73 Epilepsy ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 74 Laryngismus stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 75 Locomotor ataxy ... ... ... ... ... ... ... ... ... 2 ... ... ... ...::: ... ... ... 2 ... ... ... ... 2 ... 2 76 Paraplegia, diseases of spinal cord ... ... ... ... ... ... 1 ... ... ... 1 2 2 ... ... 2 ... 1 ... 1 ... 2 5 1 6 77 Other diseases of brain or nervous system 2 ... ... ... ... 2 ... 1 3 2 7 21 6 2 4 5 8 4 6 6 6 7 23 23 46 78 Otitis, otorrhcea 1 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... 2 2 2 4 79 Diseases of nose, epistaxis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 80 Diseases of eye, ophthalmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 Pericarditis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 82 Endocarditis, valvular diseases of the heart ... ... ... ... 1 2 1 1 2 3 6 6 4 ... 1 5 6 2 3 4 2 3 15 11 26 8 3 Hypertrophy of heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 84 Angina pectoris ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 1 ... ... ... ... ... ... 2 ... 2 85 Aneurism ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... 1 ... ... 2 ... 2 86 Senile gangrene ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 Embolism, thrombosis ... ... ... ... ... ... ... ... ... 1 6 2 1 ... 1 1 1 ... ... 2 3 2 5 88 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 Varicose veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 90 Other and ill-defined diseases of heart and circulatory system, including heart disease not stated to be valvular ... 1 ... ... ... 3 4 3 6 22 29 35 25 ...... 4 19 25 19 16 13 11 21 58 70 128 48 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX.[] Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. |25 to 35. j 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 8o and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton Male. Female. Total 91 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 92 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 93 Other diseases of larynx and trachea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Acute bronchitis 7 1 2 ... ... ... ... 1 3 2 ... 5 4 ... 1 9 4 5 7 4 ... 1 16 15 31 95 Chronic bronchitis ... ... ... ... ... ... ... ... 4 10 15 42 25 1 4 18 15 15 21 8 10 6 49 48 97 96 Lobar croupous pneumonia ... 2 2 ... 1 2 ... ... 5 11 9 5 4 l 1 7 11 10 5 1 3 6 31 13 44 97 Lobular broncho-pneumonia 38 18 12 6 1 1 ... ... ... 3 5 6 3 ... 2 31 12 12 9 9 ... 4 43 47 90 98 Pneumonia, form not stated 2 4 1 1 1 ... ... ... 3 8 3 6 4 ... 2 8 9 3 4 3 3 1 21 12 33 99 Emphysema, asthma ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... ... ... ... ... ... 1 1 2 100 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 101 Other and ill-defined diseases of respiratory system ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 2 ... 2 102 Diseases of mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 103 Diseases of pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 104 Diseases of oesophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 105 Ulcer of stomach and duodenum 1 ... ... ... ... ... ... 3 2 3 3 1 ... ... ... 2 4 1 2 2 2 ... 10 3 13 106 Other-diseases of stomach. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 107 Enteritis 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 ... 3 1 ... ... 5 4 9 108 Appendicitis ... ... ... ... ... ... ... ... 1 2 1 1 ... ... 1 1 1 1 ... 1 1 2 6 2 8 109 Obstruction of intestine ... ... ... ... ... ... ... ... l ... 1 1 ... ... ... ... 1 ... 2 ... ... ... 2 1 3 110 Other diseases of intestine 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... 2 2 111 Cirrhosis of liver ... ... 1 ... ... ... ... ... ... 1 3 2 ... ... ... 2 1 ... 2 ... ... 1 5 1 6 112 Other diseases of liver ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 113 Peritonitis 1 ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... 2 ... ... ... ... ... 6 114 Other and ill-defined diseases of digestive system ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 115 Diseases of lymphatic system and ductless glands ... ... ... ... ... ... ... ... ... l 3 ... ... ... ... ... ... 3 ... ... ... 1 ... 4 4 116 Acute nephritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Bright's disease ... ... ... ... 1 ... ... ... ... 8 28 3i 20 ! 1 7 21 14 16 10 ... ... 10 56 41 97 118 Calculus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 119 Diseases of bladder and prostate ... ... ... ... ... ... ... ... ... ... 1 2 1 ... ... ... ... ... 2 ... ... ... 3 1 4 120 Other and ill-defined diseases of urinary system ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 121 Diseases of testes and penis ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 9 122 Diseases of ovaries ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 123 Diseases of uterus and appendages ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 l 124 Diseases of vagina and external genital organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 125 Diseases of breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Abortion, miscarriage ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 l 127 Puerperal mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Placenta prasvia, flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 130 Puerperal thrombosis ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Other and ill-defined accidents and diseases of pregnancy and childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 132 Arthritis, ostitis, periostitis ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... 3 3 133 Other and ill-defined diseases of osseous system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. 1 1 Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. Total. 134 Ulcer, bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 Pemphigus ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 1 137 Other and ill-defined diseases of integumentary system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... By Accident or Negligence : 138 In mines and quarries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In vehicular traffic ... ... 2 2 1 ... 2 1 2 2 4 ... 3 1 1 2 4 3 5 2 4 ... 14 7 21 140 On railways ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... l ... ... ... ... ... ... ... 1 1 141 On vessels and docks, excluding drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 142 In building operations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143 By machinery ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 144 By weapons and implements ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 145 Burns and scalds 1 ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 1 ... ... ... ... 2 2 4 146 Poisons, poisonous vapours ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 147 Surgical narcosis ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 148 Effects of electric shock ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Corrosion by chemicals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 150 Drowning ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... 2 151 Suffocation, overlaid in bed 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 1 2 152 Suffocation otherwise ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... 1 I 153 Falls, not specified 1 ... ... ... ... ... ... ... 1 ... 1 5 2 ... ... 3 2 ... 3 2 2 ... 5 7 12 I 154 Weather agencies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ,... ... ... 155 Otherwise, and not stated ... ... 2 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 2 1 3 156 Homicide Suicidcs, all fotitis !— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 157 By poison ... ... ... ... ... ... ... 1 1 1 2 ... 1 ... 1 1 1 2 ... ... ... 1 5 1 6 158 By asphyxia ... ... ... ... ... ... ...!... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 159 By hanging and strangulation ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 160 By drowning ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... 1 1 1 2 161 By shooting ... ... 1 . 162 By cut or stab ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 ... ... ... ... ... 1 1 2 163 By precipitation from elevated places ... ... ... ... ... ... ... 1 2 1 ... ... ... ... ... ... ... 2 ... 2 ... ... 2 2 1 164 By crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 165 By other and unspecified methods ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 166 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 167 Sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...i 168 Other ill-defined and not specified causes 3 ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... 2 ... 2 1 1 ... 1 3 4 169 Malignant disease ... ... ... ... ... ... ... ... ... 2 2 4 ... ... ... 1 ... 3 3 ... ... 1 5 3 8 170 Abscess ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 ... 3 171 Cerebro-spinal 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 2 172 Encephalitis Lethargica ... ... ... ... ... ... ... i ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Totals 16C 52 42 32 19 29 30 42 73 172 208 256 180 28 52 269 223 196 221 117 115 135 729 599 1328 52 TABLE VI.—ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31st DECEMBER, 1927. DISTRICTS. Estimated Population 1927. ANNUAL RATE PER 1,000 PERSONS LIVING. Infants under 1 year. Death rate per 1,000 Live Births. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS: DEATHS DURING 1927 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Principal Zymotic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. .Fever. Tuberculous Disease. Violence. Diarrhoea. Enteritis (under 2 years). 1924. 1923. 1926. 1927. London 4,541,000 16.1 12.1 11.7 11.6 11.9 0.27 0.00 0.04 0.01 0.09 0.12 0.01 1.0 '0.51 7.5 59 7.9 0.0 Shoreditch + 104,700 20.9 13.7 13.3 12.2 12.7 054 0.00 0.07 0.02 0.11 0.23 0 00 1.1 0.63 4.6 74 8.3 63.1 ... Wards. Moorfields 4,485 22.7 1 11.5 15.1 12.3 11.6 0.24 0.00 ... ... 0.22 ... ... 1.13 0.67 ... 98 9.6 57.7 ... Church 18,354 21.9 14.6 12.5 12.3 14.7 0.49 0.00 0.05 0.05 0.11 0.22 0.05 1.41 0.60 1.46 110 8.6 67.2 ... Hoxton 15,990 22.8 15.3 13.3 13.1 14.0 0.25 0.00 • • • ... .... 0.25 ... 1.00 0.69 ... 53 9.4 61.0 ... Wenlock †13,749 24.7 15.1 12.7 11.6 14.3 0.65 0.00 • • • • • • • • • 0.65 ... 0.80 0.87 2.9. 74 9.7 60.2 ... Whitmore §18,605 19.5 13.2 13.6 11.8 11.9 0.51 0.00 0.22 010 0.16 0.05 ... 1 .14 0.59 ... 86 6.8 64.7 ... Kingsland 10,469 19.8 13.2 13.2 13.4 1M 0.29 0.00 0.09 ... 0.19 0.00 ... 0.80 0.29 4.8 43 9.4 65.8 ... Haggerston 11,052 20.4 12.7 13.8 1M 10.5 0.64 0.00 • • • • • • 0.27 0.27 ... 1.28 0.82 4.5 58 9.6 54.0 ... Acton 11,996 15.4 11.2 13.8 10.8 11.3 0.50 0.00 0.08 ... 0.08 . 0.25 ... 0.90 0.25 5.4 108 3.7 53.3 ... * Fever includes typhus, typhoid and continued fevers. † Diarrhoea in this table includes enteritis in children under two years. J 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 arc placed in the space under the heading. The London population is adjusted to the middle of 1926. 53 PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1927. TABLE VII. PREMISES. NUMBER OF PLACES- Number of inspections, 1927. Number of notices, 1927. Number of prosecutions, 1927. On register at end of 1926. Added in 1927. Removed in 1927. On register at end of 1927. Milk premises 270 17 7 280 1,315 14 ... Cowsheds 2 ... ... 2 21 ... ... Slaughterhouses 2 ... 1 1 26 ... ... Other offensive trade premises 25 ... 1 24 80 12 ... Ice Cream premises 132 11 17 126 256 14 ... Registered houses let in lodgings 307 ... 4 303 1,218 213 4 Number of intimation notices served for all purposes 5,720 Overcrowding:— Number of dwelling rooms overcrowded 172 Number remedied 85 Number of prosecutions — Number of premises dealt with under Section 20 of the London County Council (General Powers) Act, 1904 203 Underground rooms:— Number dealt with during year 2 Insanitary houses:— Number closed under the Public Health (London) Act, 1891 — Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891:— Number of persons accommodated during the year 12 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. 10 Mortuary:— Total number of bodies removed 128 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 HOME WORK DURING THE YEAR 1927. 1.—Inspection. Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (D (2) (3) (4) Factories (Including Factory Laundries) 614 93 ... Workshops (Including Workshop Laundries and Bakehouses) 2,903 343 ... Workplaces (Excluding Outworkers' premises dealt with in Table III.) 1,249 94 ... Totals 4,766 530 ... 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :* Want of cleanliness 180 180 ... ... Want of ventilation 2 2 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 439 439 ... ... Sanitary accommodation insufficient 4 4 ... unsuitable or defective 277 277 ... ... not separate for sexes 2 2 ... ... 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 904 904 ... ... * Including those specified in Sections 2, ii, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 3.—Home Work—1927. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in unwholesome premises, Section 108. Outwork in infected premises, Sections 109 and 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made. (S. 109.) Prosecutions. (S. 109, 110.) Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing apparel:— (1) Making, &c. 52 45 595 3 17 11 ... ... ... 39 39 ... 8 ... ... (2) Cleaning and washing • • • ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 2 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers 4 ... 60 ... ... ... ... ... ... 8 8 ... 1 ... ... Fur pulling 2 ... 12 ... ... ... ... ... ... 3 3 ... ... ... ... Umbrellas ... ... ... ... ... ... 6 6 ... ... ... ... Paper bags and boxes 16 ... 178 3 ... 37 ... ... ... 29 29 ... 6 ... ... Brush making ... ... ... ... ... ... ... 2 2 ... 2 ... ... Xmas Crackers ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Totals 76 45 849 6 17 48 ... ... ... 88 88 ... 17 ... ... 55 (a) There were no names and addresses of outworkers received in respect to the following classes of work :—Sacks, basket making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors and grapnels, cart gear, locks, latches and keys, pea picking, household linen, lace, lace curtains and nets, curtains and furniture hangings, brass and brass articles, tents, feather sorting, and carding, &c., of buttons. (b) The figures in columns 2, 3 and 4 are the total number of lists received from employers who sent them both for February and August, and of the entries of names of outworkers in those lists. They are therefore double the number of employers and approximately double the number of individual workers whose names are given, since in the February and August lists of the same employers, the same outworker's name will often be repeated. 56 4.—Registered Workshops—1927. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades. 1,107 (a) Cabinet making 614 (b) French polishing 160 (c) Upholstery 82 (d) Other workers 251 (2) Dress 188 (a) Tailoring 83 (e) Shirt making 1 (b) Mantles 13 (f) Boot and shoe trades 36 (c) Dress 10 (g) Artificial flowers (d) Millinery 6 (h) Other workers 39 (3) Skin, leather, hair and feather trades 46 (a) Furriers 16 (b) Saddlery and Harness 10 (c) Feathers 1 (d) Other workers 19 (4) Paper, printing, book, stationery and fancy goods trades 64 (a) Box and bag makers 36 (b) Other workers 28 (5) Laundry and washing 8 (6) Food 8 (7) Metals, machines, implements and conveyances 26 (8) Precious metals, jewels, &c. 1 (9) Other trades than those mentioned above 183 Total number of workshops on Register 1,631 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 61, including 29 factory bakehouses. 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and 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.) Notified by H.M. Inspector 47 referring to 14 factories and 33 workshops. Reports (of action taken) sent to H.M. Inspector. 2 referring to 14 factories and 33 workshops. Other 7 Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 36 6.—Showing the Numbers of Outworkers Received from other Districts during 1927. DISTRICTS. Making Wearing Apparel. Confectionery Packing. Artificial Flowers. Furniture and Upholstery. Fur Pulling. Feather Sorting. Umbrellas, &c. Paper Bags and Boxes. Brush Making. Fancy Leather Goods. Crackers and Toys. Totals. Feb. Aug. Feb. Aug. Feb. Aug, Feb. Aug. Feb. Aug. Feb. Aug. Feb Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Battersea ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Bethnal Green 56 65 ... ... ... ... l ... ... ... ... ... ... ... 38 27 7 12 ... ... ... ... 206 Camberwell ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 City of London 230 225 ... ... 9 9 ... ... 8 6 ... 1 36 35 ... ... ... ... ... 1 1 1 562 Chelsea ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Deptford ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enfield 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Finsbury 83 66 ... ... 5 12 l 2 ... 7 ... ... 3 11 31 32 ... ... ... 7 27 12 299 Hackney 99 124 ... 2 3 4 l 1 2 1 ... ... ... ... 6 19 l 2 1 ... 9 3 278 Hammersmith ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Holborn 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Hornsey 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Hull 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Islington 16 37 ... ... ... ... ... ... ... ... ... ... ... 21 16 1 2 ... ... 7 3 114 Kingston 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Kensington ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Leyton 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Lambeth ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Southwark 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 5 St. Marylebone 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Stepney 9 18 ... ... ... ... ... ... ... ... ... ... ... ... 7 4 ... ... ... ... ... ... 38 St. Pancras 1 2 ... ... ... ... l 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 6 Stoke Newington 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 6 Tottenham 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 4 Westminster 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Totals 527 563 ... 2 21 31 4 4 10 14 ... 1 40 46 106 101 9 16 l 8 44 20 1,568 1,090 2 52 8 24 l 86 207 25 9 64 57 58 BOROUGH OF SHOREDITCH TUBERCULOSIS DISPENSARY. Report for Year 1927. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, Herewith I beg to submit my Report of the work done in the Tuberculosis Dispensary during the year 1927. The total number of attendances during the year, viz., 5,809, is less than that for the year 1926, but rather more than the corresponding number for 1925. The total number of new persons examined, viz., 678, shows an increase of 62 when compared with the total for 1926. In my Report for last year I stated that the Dispensary Register had been revised. In the course of this revision, I found it necessary to include a number of cases in which a definite diagnosis had not been made in past years. The actual number so included was 100, a number out of proportion to the definite cases. During the year 1927 special attention has been given to these cases, and I am glad to state the number of such cases now on the Register is 29 ; several of these have been known at the Dispensary for a period of less than one month. There are two matters in connection with the Council's Tuberculosis Scheme to which I think it advisable to call attention. At the moment, there is only one Sister on the Dispensary Staff, and half of her time is spent in the Dispensary. When it is remembered that there are some 1,761 notified cases of Tuberculosis in the Borough, it will be seen that Home Visiting by the Sister cannot be carried out as thoroughly and consistently as is desirable. During the past year 2,744 such visits have been paid to the homes of patients ; it should be noted, however, that a large number of cases require constant attention. I may perhaps be allowed to add that the Sister visits all notified cases of Tuberculosis, not merely those attending the Dispensary. The services of a second Sister would put Home Visiting on a sound footing. The second matter which calls for consideration is the home nursing of bedridden cases. The number of such cases is not large, but the attendance of a nurse for an hour or so daily adds enormously to the comfort of these patients. I would suggest that arrangements be made with some local Nursing Association for the provision of this service. I desire again to express my satisfaction with the way in which the members of the Staff of the Dispensary have carried out their duties, and I have to thank you for the assistance given by your Department. I am, Sir, Yours obediently, A. LEITCH, Tuberculosis Officer. 59 STATISTICAL REPORT, 1927. 1926. 1927. Total attendances 6,086 5,809 Total new persons examined 616 678 Renewed cases 543 422 Sisters' visits to homes 2,705 2,744 Medical Officers' visits 367 377 Analysis of all persons attending the Dispensary during 1927 : — Non-Tuberculous. Under 15 years. Over 15 years. Totals Ins. Non-Ins. Males 187 137 34 358 Females 177 110 117 404 Totals 364 247 151 762 Tuberculous. Males 50 231 49 330 Females 37 101 90 228 Totals 87 332 139 558 60 All New Persons Examined according to monthly Returns:— Tuberculous. Suspects. NonTuberculous. Total. " Contacts " 25 9 290 324 Other New Persons 108 16 230 354 Totals 133 25 520 678 Final Analysis of all New Persons attending:— Insured. Non-Insured. Total Under 15 years. Over 15 years. M. F. M. F. M. F. Total New Persons 167 104 148 124 49 86 678 Pulmonary Tuberculosis 57 24 2 6 27 12 128 Non-Pulmonary Tuberculosis 3 2 3 ... ... ... 8 Suspects 3 6 3 3 1 3 19 Non-Tuberculous 104 72 140 115 21 71 523 The numbers of Insured and Non-Insured Attendances are:— Insured 3,142 Non-Insured 2,667 Total 5,809 The numbers of Insured and Non-Insured New Persons examined are :— Insured 271 Non-Insured 407 Total 678 61 The New Persons examined and the Examinations and Attendances each month were as follows :— New Persons Examined. Examinations. Attendances. Ins. NonIns. Total. Ins. NonIns. Total. Ins. NonIns. Total. January 17 25 42 85 80 165 279 213 492 February 31 41 72 88 97 185 252 243 495 March 25 49 74 99 116 215 305 274 579 April 19 30 49 90 66 156 247 199 446 May 22 42 64 98 99 197 281 224 505 June 18 25 43 74 70 144 247 207 454 July 23 23 51 83 70 153 255 206 461 August 21 31 52 83 58 141 251 171 422 September 18 15 33 85 73 158 255 179 434 October 29 59 88 92 120 212 262 262 524 November 23 42 65 98 93 191 264 263 527 December 20 25 45 89 80 169 244 226 470 Totals 271 407 678 1,064 1,022 2,086 3,142 2,667 5,809 SPECIAL SESSION FOR SCHOOL CHILDREN. The number of attendances and examinations made each month are shown in thr following table Attendances. Examinations. Attendances. Examinations. January 12 8 July 20 7 February 24 11 August 12 6 March 18 11 September 12 6 April 25 15 October 23 14 May 28 16 November 22 12 June 14 11 December 17 7 Total Attendances 227 Total Examinations 124 Ditto 1926 289 Ditto 1926 138 In addition to the foregoing, the following further information may be given :— Total number of Bacteriological Examinations 706 ,, „ X-ray Examinations 34 ,, Patients recommended to the London County Council 190 ,, ,, Progress Reports furnished, etc 255 ,, Examinations made for and Reports sent to, the Ministry of Pensions 429 „ „ Patients sent by Doctors 154 Total Number of Patients on Dispensary Register on 31st December, 1927: — Insured 332 Non-Insured 255 Total 587 E PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Table VIII.—Summary of Notifications during the Period from the 2nd January, 1927, to the 31st December, 1927, in the Metropolitan Borough of Shoreditch. Age-periods. Notifications on Form A. Notifications on Form B. Number ot Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. Total Notifications on Form B. Poor Law 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. 65 and upwards. Total Primary Notifications. Total Notifications on Form A. Under 5. 5 to 10. 10 to 15. Total Primary Notifications. ! Pulmonary, Males ... l 2 2 7 8 17 32 26 10 2 107 188 ... ... ... ... ... 28 102 ,, Females ... l ... 7 9 21 10 14 13 2 2 79 124 ... ... ... ... ... 8 62 Non-pulmonary, Males ... 10 7 5 4 1 3 ... ... 1 ... 31 48 ... ... ... ... ... 5 26 ,, Females ... 3 4 4 2 2 4 ... 1 ... 1 21 23 ... ... ... ... ... 3 17 Cols. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) 62 Patients notified as suffering from both pulmonary and non-pulmonary disease are included in the " pulmonary " returns. Primary Notifications relate to patients who have not previously been notified in this or former years, either on Form A or on Form B, in Shoreditch. A School Medical Inspector is required to notify on Form B all cases of tuberculosis discovered in the course of inspection of children attending public elementary schools whether or not these have been previously notified. Cols. 2-13. Only those cases which have been notified for the first time during the year on Form A, and which have never previously been notified in Shoreditch, either on Form A or on Form B, are included in these returns. Col. 14:. All notifications on Form A, whether duplicate or not, are included in this column. Cols. 15-18. Only those cases which have been notified for the first time during the year on Form B, and which have never previously been notified in Shoreditch, either on Form A or on Form B, are included in these columns. Col. 19. All notifications which have been made during the year on Form B, whether the cases have previously been notified in the area or not, either on Form A or on Form B, are included in this column. Col. 21. Only notifications on Form C, made by the medical officers of sanatoria, as defined in the Tuberculosis Regulations, are included in this column. t ai 1 1 ix. SC'MMAKY COMVll.h'.l) I ROM THE AllSTRACTS Ol- TIIK wouk ol 1111 SANITAKY InsPKCTOUS I1Y HIE Si-mou 1 ssl'l < 1<1h, foh the Year l'J27. Insp. Wright. Insp. Chapman. Insp. Sickelmore. Insp. Thomas. Insp. Shaw. Insp. Molloy. Insp. Bishop. Insp. Girling. Insp. Stratton. Insp. Grant. Insp. Walker. Total. Premises cleansed throughout 16 79 35 8 7 3 2 31 21 28 34 264 „ ,, partially 216 183 298 186 273 63 300 149 225 246 424 2,563 „ „ total rooms 490 847 955 410 639 392 653 332 662 746 1182 7,308 „ ,, verminous rooms 20 9 15 23 4 24 21 31 63 109 319 ,, ,, verminous premises 15 9 15 18 1 ... 20 9 16 24 76 203 Premises generally repaired—Walls, floors, sashes, &c. 298 117 336 247 328 174 335 285 350 393 399 3,262 Light and ventilation improved 3 4 7 ... ... ... 2 ... 2 1 1 20 Roofs, guttering, rain water pipes improved or repaired 262 112 371 229 245 141 306 172 194 199 374 2,805 Overcrowding dealt with 14 1 17 4 9 10 38 2 17 26 34 172 Water reinstated or improved 2 9 39 3 ... 4 2 6 4 3 10 82 Drains newly constructed 1 ... 6 ... ... 2 1 13 1 9 4 37 „ re-constructed 10 10 4 4 13 3 10 9 2 6 9 80 improved or repaired 29 10 65 20 20 5 45 7 12 24 23 260 ,, obstructions removed 35 20 29 28 26 11 7 34 14 28 26 258 Soil and vent pipes—Improved or repaired 2 5 66 ... 4 ... 16 3 2 20 6 124 Water closets—Newly constructed 2 20 128 ... 1 10 1 40 2 45 87 336 ,, improved or repaired 97 67 413 80 66 57 65 124 76 148 99 1,292 ,, obstructions removed 8 15 115 22 16 11 16 27 17 21 63 332 Sinks, etc., improved, cleansed or repaired 4 18 48 12 5 10 11 19 9 20 18 174 Sinks, etc., traps provided ... 2 8 2 ... ... 4 ... 3 ... 1 20 Outdoor premises— Floors or paving repaired 28 14 95 32 41 12 57 9 45 34 43 410 Cleansed or limewashed 27 96 110 84 49 2 197 1 75 294 248 1,193 Improved or repaired 2 1 ... ... ... ... ... ... ... ... ... 3 Ash-pits—Dust-bins provided 54 29 232 41 85 50 131 61 71 60 122 936 ,, improved or repaired ... ... ... 5 ... ... ... ... ... ... ... 5 „ abolished ... ... ... ... ... ... 20 ... ... 4 ... 24 Accumulations removed 9 11 6 4 8 5 18 26 4 12 10 113 Urinals cleansed or repaired 1 1 ... 1 2 5 5 ... 1 ... 2 18 Animals removed 1 2 ... ... ... ... 5 2 ... 4 2 16 63 64 METROPOLITAN BOROUGH OF SHOREDITCH, HOUSING. Statistics for the Year 1927. Number of new houses erected during the year:— (a) Total (including numbers given separately under (b)) 181 (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)... ' ... 9,377 (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. Nil. (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit— (a) by owners (b) by Local Authority in default of owners (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 5,736 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 5,736 (b) by Local Authority in default of owners — 65 C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. Nil. (1) Number of representations made with a view to the making of Closing Orders (2) Number of dwelling-houses in respect of which Closing Orders were made (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders SUMMARY OF LEGAL PROCEEDINGS DURING 1927. PUBLIC HEALTH (LONDON) ACT, 1891. In 2 instances summonses were -withdrawn on the work being done. Costs amounting to £1 Is. Od. were allowed to the Borough Council. Nuisance orders were made in 6 instances, costs amounting to £4 4s. Od. being ordered to be paid to the Council. In 19 instances the Statutory Notices were complied with before the cases came ••n for hearing, £11 lis. Od. being ordered to be paid to the Council. In one instance, for non-compliance with Statutory Notice, the defendant was lined £1. In one instance, for non-compliance with the Magistrate's order, the defendant was fined £2 and ordered to pay £2 2s. 0d. costs. BREACHES OF LONDON COUNTY COUNCIL BYE-LAWS. There were seven prosecutions. In three instances the defendants were ordered to pay costs amounting to £1 3s. Od., £1 Is. Od. and £1 Is. Od. respectively; in one instance defendant was fined Is. Od. and ordered to pay £1 Is. Od. costs ; and in one instance defendant was fined 10s. Od. Two cases were dismissed. 66 METROPOLITAN BOROUGH OF SHOREDITCH. MATERNITY AND CHILD WELFARE. Annual Report for Year 1927. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total. No. of 1st visits to infants 244 273 234 323 325 28 427 2,114 No. of re-visits to infants 517 585 561 413 688 650 1,358 4,772 No. of 1st visits to children aged 1 to 5 years (irrespective of whether visited previously as an infant) 65 129 202 185 97 214 1,240 2,132 No. of re-visits to children aged 1 to 5 years 905 1,299 808 1,319 1,207 1,328 1,554 8,420 No. of 1st visits to expectant mothers 46 67 53 46 98 94 215, 619 No. of re-visits to expectant mothers 34 80 83 61 43 49 140 490 No. of futile visits 104 196 59 169 150 297 714 1,689 No. of interviews in connection with work 360 226 550 485 123 487 1,136 3,367 *No. of 1st visits to cases of ophthalmia neonatorum 8 9 3 18 8 3 ... 49 *No. of re-visits to cases of ophthalmia neonatorum 8 14 2 12 12 3 ... 51 No. of 1st visits to cases of puerperal fever ... 3 4 3 3 ... 13 No. of re-visits to cases of puerperal fever ... 4 11 ... ... ... ... 15 No. of 1st visits to cases of puerperal pyrexia 2 ... 8 3 1 ... 14 No. of re-visits to cases of puerperal pyrexia 1 ... ... ... ... ... ... 1 No. of Health Visitors' attendances at Clinics: (a) Hoxton Market Institute 27 3 ... 3 27 55 ... 115 (b) Hoxton Hall Centre ... ... 16 49 11 ... 76 (c) Maternity Centre 136 168 125 145 157 111 ... 84- (d) Harbour Lights Centre 52 49 49 ... ... 1 ... 151 (e) School for Mothers Centre ... ... ... ... ... ... 318 3L * 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) Hoxton Market Institute: (Mon.) under 1 yr. .. .. .. .. .. 98 .. 98 over 1 yr. .. .. .. .. .. 55 .. 55 (Wed.) under 1 yr. .. .. .. .. 6 8 .. 14 over 1 yr. .. .. .. .. 8 4 .. 12 (b) Hoxton Hall: (Tues.) under 1 yr. .. .. .. 75 .. .. .. 75 over 1 yr. .. .. .. 24 .. .. .. 24 (c) Maternity Centre : (Mon.) under 1 yr. .. 116 .. .. .. .. .. 116 over 1 yr. .. 19 .. .. .. .. .. 19 (Tues.) under 1 yr. 59 65 .. .. .. .. .. 124 over 1 yr. 21 13 .. .. .. .. .. 34 (Wed.) under 1 yr. .. 4 .. .. 54 .. .. 58 (a.m.) over 1 yr. 4 1 .. 1 27 .. .. 33 (Wed.) under 1 yr. .. .. 80 .. .. .. .. 80 (p.m.) over 1 yr. .. .. 48 .. .. .. .. 48 (Thur.) under 1 yr. .. .. .. .. 131 .. .. 131 over 1 yr. .. .. .. .. 39 .. .. 39 (Fri.) under 1 yr. .. .. .. 73 .. 60 .. 133 over 1 yr. .. .. .. 11 .. 41 .. 52 (d) Harbour Lights : (Fri.) under 1 yr. 55 .. 100 .. .. .. .. 155 over 1 yr. 17 .. 54 .. •• .. .. 71 (e) School for Mothers : (Tues.) under 1 yr. .. .. .. .. .. .. 173 173 over 1 yr. .. .. .. .. .. .. 87 87 (Thur.) under 1 yr. .. .. .. .. .. .. 147 147 over 1 yr. .. .. .. .. .. .. 59 59 68 TOTAL ATTENDANCES OF INFANTS AND CHILDREN AT WELFARE CLINICS. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total (a) Hoxton Market Institute : (Mon.) Infants .. .. .. .. .. 1,056 .. 1,056 Children .. .. .. .. .. 1,150 .. 1,150 Mothers without children .. .. .. .. .. 958 .. 958 (Wed.) Infants .. .. .. .. 87 144 .. 231 Children .. .. .. .. 61 95 .. 156 Mothers without children .. .. .. .. 42 46 .. .. (b) Hoxton Hall: (Tues.) Infants .. .. .. 1,406 .. .. .. l,40fl Children .. .. .. 1,267 .. .. .. 1,207 Mothers without children .. .. .. 386 .. .. .. 386 (c) Maternity Centre : (Mon.) Infants .. 1,493 .. .. .. .. .. 1,493 Children .. 1,039 .. .. .. .. .. 1,039 Mothers without children .. 605 .. .. .. .. .. 605 (Tues.) Infants 1,172 862 .. .. .. .. .. 2,034 Children 1,185 573 .. .. .. .. .. 1, 758 Mothers without children 585 457 .. .. .. .. .. 1,042 (Wed.) Infants .. 2 .. .. 554 .. .. 550 (a.m.) Children 11 99 .. 4 261 .. .. 375 Mothers without children .. .. .. .. 250 .. .. 250 (Wed.) Infants .. .. 1,632 .. .. .. .. 1,632 (p.m.) Children .. .. 1,546 .. .. .. .. 1,546 Mothers without children .. .. 396 .. .. .. .. 396 (Thur.) Infants .. .. .. .. 1,414 .. .. 1,414 Children .. .. .. .. 813 .. .. 813 Mothers without children .. .. .. .. 495 .. .. 495 (Fri.) Infants .. .. .. 1,460 .. 792 .. 2,252 Children .. .. .. 975 .. 635 .. 1,610 Mothers without children .. .. .. 400 .. 282 .. 682 69 TOTAL ATTENDANCES OF INFANTS AND CHILDREN AT WELFARE CLINICS—Continued. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total. (d) Harbour Lights : (Fri.) Infants 853 .. 1,459 .. .. .. .. 2,312 Children 810 . . 998 .. .. .. .. 1,808 Mothers without children 689 .. 642 .. .. .. .. 1,331 (e) School for Mothers : (Tues.) Infants .. .. .. .. .. .. 1,838 1,838 Children .. .. .. .. .. .. 1,165 1,165 Mothers without children .. .. .. .. .. .. 32 32 (Thur.) Infants .. .. .. .. .. .. 2,036 2,036 Children .. .. .. .. .. .. 1,349 1,349 Mothers without children .. .. .. .. .. .. 154 154 ANTE-NATAL CONSULTATIONS. Maternity Centre: Dr. Smith (Friday). No. of 1st attendances 34 71 47 31 50 42 .. 275 Total No. of attendances 80 137 126 100 68 68 .. 579 School for Mothers : Dr. Tribe (Friday). No. of 1st attendances .. .. .. .. .. .. 124 124 Total No. of attendances .. •• •• .. .. •• 171 171 Dental Clinic: Mr. J. Peter. No. of 1st attendances 45 61 38 52 20 35 28 279 Total No. of attendances 107 152 102 136 42 88 55 682 Sewing Classes (2): Total No. of attendances 273 42 170 62 45 484 1,076 F 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. 127 637 23 420 Dr. Karn (Tues.) 1 61 460 14 262 2 68 250 9 184 Dr. Richards (Wed.) 3 75 622 24 494 Dr. Smith (Wed.) 1 0 0 4 21 (a.m.) 2 0 0 1 17 4 0 0 1 1 5 50 265 26 125 Dr. Goffe (Thur.) 5 115 613 40 243 Dr. Smith (Fri.) 4 84 570 13 247 6 59 313 28 195 Hoxton Market. Dr. Karn (Mon.) 6 94 475 49 358 Dr. Goffe (Wed.) 5 9 27 9 35 6 8 46 3 28 Hoxton Hall. Dr. Goffe (Tues.) 4 69 576 25 404 Harbour Lights Dr. Karn (Fri.) 3 82 662 35 293 Dr. Goffe (Fri.) 1 48 500 11 236 School for Mothers. Dr. Pratt (Tues.) 7 173 927 80 658 Dr. Pratt (Thur.) 7 221 1,029 66 711 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 482 1,000 221 547 242 669 746 3,907 Number suffering from other 2,676 minor ailments 355 139 186 609 211 513 663 Number referred to Hospital or to Medical Practitioner 56 101 85 44 124 70 92 572 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 1927 :— (1) Number of cases in the wards on 1st January, 1926 : 10 babies. (2) Number of cases admitted : 45 babies and 3 mothers. (3) Average duration of stay: 5 weeks. (4) Reasons for admission and the number of cases under certain specified heads :— Infants— Marasmus 17* Rickets 1 Vomiting 3 Dyspepsia 8 Enteritis 1 Illness or absence of mothers 6 Prematurity 5 Mothers— Breast abscess 1 Weaning 1 Debility prior to convalescence 1 Debility 5* (5) Number of cases discharged during the year (a) In good health 14 (b) Improved 23 (6) There was one case of whooping cough, one of diphtheria and one of scarlatina, which were transferred to hospitals of the Metropolitan Asylums Board. Of these the first two have been transferred to other Hospitals, where they still are, and the third has made a satisfactory recovery. (7) Number of deaths : one died from prematurity on 5th March after three days' residence, and one died from duodenal ulcer on 7th March after 19 days' residence. (8) The discharges on account of illness, infectious or otherwise, were as follows :— Three cases referred to under Section 6 above. One child was transferred to the Mildmay Hospital for operation for glands of neck. This child made a satisfactory recovery and was later sent to convalescent home. One child was transferred to the Woodford Convalescent Home. One child was transferred to the National Children's Home, hoping to be adopted. * 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 1927. Disease. Under 5. Visits. Disease. Over 5. Visits. Pemphigus 4 92 Pneumonia 18 258 Measles 15 93 Miscarriage 11 132 Ophthalmia Neonatorum 14 314 Mammary Abscess 6 214 Influenza 7 56 Prematurity 2 18 Measles 5 38 Vaginitis 1 55 Ante-natal 7 176 Otorrhoea 21 454 Influenza and Pneumonia 2 5 Threadworms 46 363 Tonsils & Adenoids 83 312 Puerperal Pyrexia 6 108 Pneumonia 15 193 Mastitis 1 6 Cervical adenitis 1 6 Post-Partum Bronchitis 10 98 Pyrexia 4 60 Tuberculous hip 1 28 Other Post-Partum Abscess of ear 1 6 conditions 4 66 Diarrhoea & Sickness 1 7 Influenza and Pertussis 4 47 Bronchitis 1 19 Constipation 1 3 Influenza and Influenza & Burns 1 14 Rheumatism 1 4 Circumcision 3 35 Phlebitis. Post- Enteritis 3 18 Partum 1 9 Stomatitis 1 7 Impetigo 12 214 Marasmus 1 4 Abscess 3 36 Gingivitis 1 18 Influenza 1 9 Tuberculosis 1 12 Discharge from eyes 7 84 Injury to eye 3 15 Intestinal 1 6 Eczema 2 29 Broncho-Pneumonia 5 68 Skin rash 1 3 Corneal ulcers 2 42 Septic umbil 1 9 Conjunctivitis 1 13 Phymosis 1 12 Stigmatism 1 8 Totals 272 2,745 Totals 74 1,151 cases visits cases visits The total number of cases at all ages was 346, in connection with which visits were made by the Nurses of the Association. Amongst persons over five years there were two deaths from pneumonia, and amongst the children under five, two died from pneumonia, one from measles and pneumonia, one from pertussis and pneumonia and one from enteritis.