SHOR 33 REPORT on the Health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1928, BY MAITLAND RADFORD, M.D., B.S., D.P.H. 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. Maternity and Child Welfare Committee. Ex officio—GEORGE REYNOLDS, Esq., J.P. (Mayor). Chairman—Alderman Dr. S. W. Jeger. Chairman—Alderman Lay, E. Vice-Chairman—Councillor Brown, T. W. Vice-Chairman—Councillor Harvey, Mrs. J. Alderman Girling, Mrs. H., J.P., M.A.B. Councillor Baker, J. S. ,, Land, C. „ Davies, H. W. Councillor Boast, W. B. „ Ellwood, Mrs. L. Crowe, W. J. ,, Fairchild, Mrs. E. M. Ellwood, Mrs. L. ,, Hurley, J. J. ,, Kellett, Miss E. „ Kellett, Miss E. „ Kempson, A. E. ,, Lee, E. „ Kenny, T. J. „ Smith, Mrs. M. ,, Lee, E. (Co-opted) Ingham, Mrs. R. M. „ O'Connor, Mrs. M. ,, Land, Mrs. A. Smith, Mrs. M. ,, Lay, Mrs. H. „ Manning, Mrs. E. „ Rogers, Mrs. M. Sanitary Inspectors. J. H. Pearson, Senior Inspector. C. J. Wright. J. H. Thomas. R. A. Bishop. D. Grant. H. G. Chapman. F. C. Shaw. T. W. Girling G. Walker. W. Sickelmore. J. B. Molloy. A. Stratton. Health Visitors. Miss I. M. Heward. Miss A. E. Barnes. Miss M. Morrell. Miss G. H. Williams. Miss B. C. Hunt. Miss A. M. Brotherton. Tuberculosis Nurse. Rat Officer. Mrs. Grange. E. T. D. Jordan. Clerical Staff. H. P. Abbott, Chief Clerk. G. C. E. Gibbs. Miss E. Lehane. E. J. Hayes. W. L. Job. H. Fitzgerald. W. Harris. Mrs. I. M. Rutherford. A. W. Scott. G. H. Pratt. E. R. Banks. W. E. Dale (Part time Enquiry Officer). Staff of Model Maternity Centre, Kingsland Road. Miss M. D. Borrow, Matron. Miss D. A. Kennedy, Sister. Misses H. M. Beale and D. McDowell (Staff Nurses). Misses K. Ball, J. Blakely, J. Palin, V. Taylor (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 Waitresses). Artificial Sun-light Clinic. Mrs. M. Pollard, Sister-in-charge. Staff of Dining- Centre, 31, Herbert Street. Miss M. Zemaitis (Cook). Miss W. Miller (General Assistant). Mortuary Keeper. Temporary Shelter. W. J. Bailey. 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.R.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 Fewer and Puerperal Pyrexia Regulations), 1926. Miss G. Dearnley, M.D., B.S. Eardley Holland, M.D., F.R.C.P., F.R.C.S. W. H. M. McCullagh, D.S.O., M.C., M.B., B.Ch., F.R.C.S. Dental Hospital: Dentist. John Peter, M.C., M.R.C.S., L.R.C.P., L.D.S. Anæsthetist. Maurice Marcus, M.B.B.S., M.R.C.S., L.R.C.P. Dental Mechanic. Clerk and Nurse. T. Lamb. Mrs. L. Frier. Caretakers. Mr. and Mrs A. Whittard. Bacteriologist. Public Analyst. F. H. Teale, M.D., F.R.C.P. H. G. Harrison, M.A., F.I.C. Tuberculosis Officer. Assistant Medical Officer of Health. A. Leitch, M.B., Ch.B. James Fanning, M.D., B.S., D.P.H. Medical Officer of Health. Administrative Maternity and Child Welfare Officer. Administrative Tuberculosis Officer. Maitland Radford, M.D., B.S., D.P.H. iii CONTENTS. Page Bacteriological examinations 30 Bakehouses 79 Births in sub-districts. 6 Birth rates 6 Cancer 13 Cerebro-spinal fever 24 Condensed milk regulations 78 Cookshops and Eating-houses 78 Cow-houses 77 Dairies, Cowsheds and Milk-shops Orders, 1885 and 1886 77 Deaths in sub-districts 7 Death rate . 7 Deaths, ages at 8 Deaths, causes of 8 Deaths in public institutions 15 Deaths in outlying institutions 14 Diarrhoea 28 Diphtheria 19 Disinfection 31 Encephalitis Lethargica 24 Enteric Fever 21 Erysipelas 21 Factory and Workshop Act, 1901 54 Food and Drugs Acts 79 Food Poisoning 29 Fried fish shops 78 Fur skin dressers 47 General description 3 Health Week 83 Housing 49 Ice-cream shops 78 Infantile mortality 10 Infectious cases, number certified 16 Infectious cases, number removed to hospitals 16 Infectious diseases, age periods 16 Infectious diseases, deaths from 16 Infectious diseases, number of cases notified from schools 28 Influenza 27 Legal proceedings 47 Lists of Acts and Regulations becoming operative during 1928 81 Malaria 25 Marriages 7 Maternal Mortality 10 Maternity and Child Welfare 59 Measles 25 Milk (Special Designations) Order, 1922 78 Milk and Cream Regulations, 1912 78 Milk and Dairies Order, 1926 78 Mortuary 31 Municipal Dental Hospital 42 Ophthalmia neonatorum 23 Pneumonia 25 Population 6 Puerperal fever 22 Puerperal Pyrexia 23 Rag and Bone Dealers 48 A2 iv Page Rag Flock Act, 1911 81 Rats and Mice Destruction Act, 1919 49 Sanitary work 45 Scarlet fever 18 Schools, exclusions of children for infectious disease 28 Shelter 31 Shoreditch Tuberculosis Care Committee 40 Slaughter-houses 77 Small-pox 17 Smoke nuisances 47 Staff 2 Street markets and food 77 Tuberculosis 31 Venereal Diseases 29 Verminous houses 48 Water supply 31 Whooping cough 27 LIST OF STATISTICAL TABLES CONTAINED IN THE REPORT. Statistical Summary 2 For whole district during 1928 and previous years 4 Cases of Infectious disease notified during 1928 10 Causes of, and ages at, death during year 1928 8&9 Infantile mortality during 1928 10 Comparison of London and Shoreditch birth and death rates in 1928 5 Summary of proceedings under Public Health (London) Act, 1891 44 Summary of Tuberculosis Certificates received 32 Summary compiled from the abstracts of their work prepared by the Sanitary Inspectors for 1928 46 Housing Conditions 50 & 51 Factory and Workshop Act—Summary of work 54 to 58 Return of work carried out at Tuberculosis Dispensary 36 to 40 Maternity and Child Welfare 59 to 70 Nursing List 30 Maternal Mortality 11 Cancer 13 Summary of deaths from Tuberculosis 34 & 35 Municipal Dental Hospital 42 to 44 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF the MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. 1. September, 1929. To the MAYOR, ALDERMEN and COUNCILLORS of the Metropolitan Borough of Shoreditch. Sir, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1928. In this, which deals with the first year during which I have had the honour to hold the post of Medical Officer of Health of the Borough, it will be found that the arrangement is slightly different from that of previous reports. The statistical information that has formerly been contained in an appendix will here be found in the appropriate sections of the main body of the report. The general health of the Borough has been satisfactorily maintained during the year. Owing to the new appointments and to the extension of the work of the department, much thought and time have been devoted to the consideration of the question of reorganisation. I have to thank the members of the Council and, in particular, the Chairman and members of the Health and Maternity and Child Welfare Committees for their assistance in this and in all other matters relating to the work for which I am respopsible. I have also to acknowledge the help rendered by my colleagues on the staff of this department. Health work is team work, and I am happy to be able to report that the team spirit has been everywhere in evidence. 2 Miss G. H. Williams, who has held the post of Health Visitor since May, 1917 left the Council's service on 3rd December owing to her marriage. Her loss has been keenly felt both by her friends on the staff and by the mothers amongst whom she worked for so many years. Our best wishes go with her. Dr. James Fanning, M.D., B.S. (London), D.P.H., commenced his duties as Assistant Medical Officer of Health on 10th April. I wish to place on record my appreciation of the great assistance he has given both in general public health work and in advancing our Maternity and Child Welfare services. I am, Sir, Ladies and Gentlemen, Your obedient Servant, MAITLAND RADFORD, Medical Officer of Health. Statistical Summary, 1928. Area of Borough 662-5 acres. Population (Registrar General's estimate) 101,200. Density of population per acre 151. Population, Census, 1921 104,248. Structurally separate dwellings occupied (Census, 1921) 13,727. Length of Public Streets .. .. .. .. .. (approx.) 43 miles. Rateable Value £959,866. Id. Rate produces £3,999. Marriages 1,033. Marriage rate 20-6. Births— Males. Females. Total. Legitimate . 1,031 985 2,016 Birth rate, 20-9. Illegitimate 40 35 75 Totals .. 1,071 1,020 2,091, Deaths.. .... 1,381. Death Rate 13-8. Deaths of Infants under 1 year of age 164. Infantile Mortality per 1,000 births 78. Legitimate 81. Illegitimate 40. Number of Women dying in, or in consequence of, childbirth— From Sepsis 3. Other causes 4. Zymotic Death Rate 1-05. 3 Deaths from— Measles (all ages) 59. Whooping Cough (all ages) 5. Diarrhoea and Enteritis (under 2 years of age) 25. Pulmonary Tuberculosis 120. Death Rate from Pulmonary Tuberculosis 2.0. Deaths from all forms of Tuberculosis 136. Tuberculosis Death Rate 2.6. GENERAL DESCRIPTION. Shoreditch is a district of irregular shape from the Southern part of which a narrow arm runs down to the City. It is elsewhere bounded by the following Boroughs:— On the West—Finsbury; on the North West—Islington; on the North and North East —Hackney; on the East—Bethnal Green and on the South East —Stepney. The area of the Borough is approximately one square mile. The longest diagonals, each in the neighbourhood of one and a-half miles, are those from the Southern extremity to the North boundary and from the West boundary to the East. The congestion of the houses and the narrowness of many of the streets over a large part of the district is indicated by the fact that there are in this small area forty-three miles of public streets. The average level of the Borough is 60 feet above ordnance mean sea level datum. I have to thank Mr. T. L. Hustler, the Borough Surveyor, for the following interesting geological note:— "The subsoil of the Borough is London Clay, with many pockets of gravel, some areas being covered to a depth of approximately three feet with a good quality sandy gravel. "On this subsoil over practically the whole of the Borough filling has been in the past deposited, so that the top surface can be taken as being approximately five feet thick of deposited material. By experience gained from excavations made during many years this deposit would appear to have been of a refuse description—in all probability from the City and other adjacent areas, deposited possibly over 100 years or more ago." Shoreditch is a densely-populated area the character of which is, however, changing. Owing to the proximity of the City, the growth of London and various economic factors,, there is a steady tendency for dwelling-houses in the Borough to be replaced by business premises and workshops. As will be seen from the distribution of the population given on page 6 this process has been most active in the Southern 4 portion but a considerably greater number of houses would already have been replaced in this manner had it not been for the security given to tenants by the Rent Restriction Acts. The effect of the foregoing has been to reduce the population but it is probable that the present inhabitants arc in respect of rooms available for living accommodation worse off than was the case when the population was considerably greater. Vital Statistics of the Borough of Shoreditch during 1928 and previous years. Year. 1 Population estimated to middle of each year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. 3 Nctt. Number. 6 Rate. 7 of Nonresidents registered in the District. 8 of residents not registered in the District. 9 Under 1 year of Age. At all Ages. Number. 4 Rate. 5 Number. 10 Rate per 1,000 nett Births. 11 N umber. 12 Rate. 13 1919 98134 2136 2286 22.3 1362 13.8 224 399 251 110 1537 15.7 1920 102044 3546 3731 36.9 1450 14.2 245 378 340 91 1583 15.6 1921 105200 2798 2975 28.5 1393 13.3 264 369 341 114 1498 14.4 1922 105800 2645 2926 27.9 1508 14.2 204 408 301 102 1712 16.3 1923 106200 2552 2832 26.9 1191 11.2 191 370 232 82 1370 13.0 1924 106500 2336 2528 23.9 1309 12.3 232 367 221 87 1444 13.7 1925 107300 2361 2627 24.6 1298 12.1 258 381 233 88 1421 13.3 1926 107300 2235 2516 23.5 1180 10.9 217 335 167 66 1298 12.2 1927 105700 1870 2188 20.9 1194 11.29 209 343 163 74 1328 12.7 1928 101200 1754 2091 20.9 1232 12.3 197 346 164 78 1381 13.8 Note.—The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn Institution, estimated at 1,000, has been deducted in calculating the rates. In column 6 are included the whole of the deaths except those of soldiers and sailors in public institutions, which were registered during the year as having actually occurred within the Borough. In column 12 is entered the number in column 6 corrected by subtraction of the number in column 8 and by the addition of the number in column 9. Deaths in column 10 have been similarly corrected by subtraction of the deaths under one year included in the number given in column 8 and by addition of the deaths under one year included in the number given in column 9. "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they reside. 5 ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31ST DECEMBER, 1928. DISTRICTS. Estimated Population 1928. 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 1928 EROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. 1 (cols 2-8) 2 3 4 5 6 7 8 9 10 Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa Enteritis (under 2 year: Tuberculous Disease, Violence. 1925. 1926 1927. 1928 Principal Zymotic Diseases. London 4,469,000 15.9 11.7 11.6 11.9 11.6 0.67 o.oo 0.30 0.02 0.09 0.09 0.01 0.16 0.9 0.55 67 7.6 ... 0.0 Shoreditch ‡100,200 20.9 13.3 12.2 12.7 13.8 1.05 ... 0.59 0.03 0.12 0.05 ... 0.25 1.3 0.49 78 9.0 67.0 ... Wards. Moorfields 3,990 18.9 15.1 12.3 11.6 10.3 0.50 ... 0.25 ... 0.17 ... ... 0.25 2.00 0.50 81 3.8 66.0 ... Church 17,570 22.1 12.5 12.3 14.7 13.4 1.88 ... 0.84 0.05 0.17 0.17 ... 0.63 1.25 0.57 118 8.5 73.2 ... Hoxton 15,300 23.1 13.3 13.1 14.0 16.2 1.18 ... 0.65 0.13 0.06 ... ... 0.33 1.63 0.85 66 11.3 64.9 ... Wenlock ‡ 13,750 23.2 12.7 11.6 14.3 14.7 0.87 ... 0.65 ... ... ... ... 0.22 1.53 0.87 53 11.8 56.6 ... \Vhitmore§ 17,520 19.1 13.6 11.8 11.9 13.4 0.86 ... 0.62 ... 0.11 ... ... 0.11 1.31 0.46 66 10.6 68.1 ... Kingsland 10,020 20.5 13.2 13.4 11.1 11.5 0.79 ... 0.19 ... 0.19 0.19 ... 0.19 0.59 0.19 68 5.2 75.7 ... Haggerston 10,570 20.7 13.8 11.1 10.5 11.8 0.75 ... 0.47 ... 0.19 ... ... 0.09 1.04 0.09 77 8.0 64.8 ... Acton 11,480 15.2 13.8 10.8 11.3 14.5 0.78 ... 0.52 ... 0.26 ... ... ... 1.74 0.17 114 5.9 64.1 ... * Fever includes typhus, typhoid and continued fevers. f 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 are placed in the space under the heading. The London population is adjusted to the middle of 1027. 6 POPULATION. The Registrar-General's estimate of the population of the Borough on 30th June 1928, is 101,200. This figure is 4,500 less than the corresponding figure for 1927 and includes the inmates of the Holborn Institution in Wenlock Ward, numbering approximately 1,000, who are not regarded for statistical purposes as belonging to Shoreditch. For the purposes of this report 100,200 is the estimated population for the year under consideration. The population in the various Wards of the Borough is estimated as follows :— Ward. Population. Area in acres* Density per acre. Moorfields 3,990 71 56 Church 17,570 105 167 Hoxton 15,300 79 194 Wenlock 13,750 96 180 Whitmore 17,520 81 216 Kingsland 10,020 72 139 Haggerston 10,570 68 155 Acton 11,480 86 134 The density of the population in the Borough as a whole is 151 per acre. * Exclusive of water. Further information upon the subject of the population, area, number of inhabited houses, and rateable value are contained in the Tables on pages 2 and 51. BIRTHS. Males. Females. Total. Number registered in the Borough 891 863 1,754 Number registered outside Borough, parents bring residents of Shoreditch 188 165 353 Number of those registered in Borough, parents not being residents of Shoreditch 7 10 17 Corrected number of births 1,071 1,020 2,091 The distribution of the corrected births and the birth rates in the eight Wards of Borough are given below:— Ward. Males. Females. Total. Births per 1,000 Population. Moorfields 33 41 74 18.6 Church 199 190 389 22.1 Hoxton 184 179 363 23.7 Wenlock 160 159 319 23.2 Whitmore 177 169 346 19.8 Kingsland 109 97 206 20.2 Haggerston 119 100 219 20.7 Acton 90 85 175 15.2 Totals 1,071 1,020 2,091 20.9 7 The birth rate for the Borough as a whole was 20.9. For England and Wales the birth rate was 16.7 and for London 15.9. The illegitimate births numbered 75, of which 40 were males and 35 females. Of these 29, of which 12 were males occurred in St. Leonard's Hospital. The illegitimate births amounted to 3.6 per cent. for all births credited to the Borough during the year. The number of births occurring in St. Leonard's Hospital was 275; 145 males and 130 females. In fourteen of these the parents were not Shoreditch residents. MARRIAGES. The number of marriages during the year was 1,033 and the persons married were at the rate of 20.6 per 1,000 population. The marriage rate for the Metropolis was 18.9 During recent years the corresponding figures have been as f ollows : — Year. No. of marriages. Marriage rate. Shoreditch. London. 1920 1,194 23.6 21.9 1921 976 18.9 19.6 1922 959 18.3 18.4 1923 873 16.6 17.3 1924 979 18.5 17.3 1925 936 17.5 17.2 1926 947 17.8 17.2 1927 956 18.2 18.2 1928 1,033 20.6 18.9 DEATHS. During 1928 the total number of deaths registered in the Borough was 1,232. The transferable deaths were as follows : — Deaths of non-residents registered in Shoreditch 197 Deaths of Shoreditch residents registered elsewhere 346 The number of deaths properly belonging to Shoreditch is accordingly 1,381, which figure gives a general death rate per 1,000 population of 13.8. The death rate in England and Wales for 1928 was 11.7 and in London 11.6. In the Table on page 4 are included corresponding figures for Shoreditch during recent years. The distribution of the deaths and the death rates in the different Wards are given below:— Ward. Males. Females Total. Deaths per 1,000 population. Deaths of infants under 1 year per 1,000 births registered. Moorfields 30 23 53 13.3 81.1 Church 129 106 235 13.4 118.2 Hoxton 127 121 248 16.2 66.1 Wenlock ... 117 86 203 14.8 53.3 Whitmore 130 105 235 13.4 66.5 Kingsland 65 50 115 11.5 68.0 Haggerston 71 54 125 11.8 77.6 Acton 94 73 167 14.6 114.3 Totals 763 618 1,381 13.8 78. 8 9 The causes of deaths at all ages together with Ward distribution and particulars relating to 1 the deaths in Public Institutions in the Borough is contained in the following table : — Causes of Death. AGES. DEATHS IN EACH WARD. SEX. Total. Belonging to Shoreditch. Not belonging to Shoreditch. Belonging to Shorditch. Not belonging to Shoreditch. Belonging to Shoreditch. Not belonging to Shoreditch. Belonging to Shoreditch. Not belonging to Shoreditch. belonging to Shoreditch. Not belonging to Shoreditch. Belonging to Shoreditch. Not belonging to Shoreditch. Under 1. 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55 55 to 65. 65 to 75 75 to 85. 85 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kiagsland. Haggerston. Acton. Male. Female, Holborn Institute. St. Leonard's Hospital. Royal Chest Hospital. Home of Good Shepherd. Convent Hospital. Infant Welfare Centre. 1 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Measles 9 28 19 3 ... ... ... ... ... ... ... ... ... ... 1 15 10 9 11 2 5 6 31 28 59 ... 1 6 ... ... ... 1 ... ... ... ... ... 4 Scarlet Fever ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough 2 2 1 ... ... .... ... ... ... ... ... ... ... ... ... 3 ... ... ... 2 ... ... 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... 6 Diphtheria 1 1 7 4 ... ... ... ... ... ... ... ... ... ... ... 3 1 ... 2 2 2 3 6 7 13 ... ... 1 ... ... ... ... ... ... ... ... ... 7 Influenza 2 3 ... ... 1 ... ... 1 ... 2 3 4 ... ... ... 1 4 4 3 2 1 1 8 8 16 ... ... ... ... ... ... ... ... ... ... ... ... 8 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Meningococcal, Meningitis ... 1 ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... 10 Tuberculosis of respiratory system ... 2 ... ... 1 14 20 19 23 24 14 5 1 ... 7 18 23 20 22 4 9 17 66 54 120 ... ... 40 1 3 7 ... ... ... ... ... ... 11 Other Tuberculous disease 3 3 ... 1 1 2 2 ... ... 1 3 ... ... ... 1 4 2 1 1 2 2 3 7 9 16 ... 1 5 ... ... 1 1 ... ... ... ... ... 12 Cancer, Malignant disease ... ... ... 1 ... ... 1 2 12 30 43 38 13 3 7 24 29 17 24 7 14 21 78 65 143 ... 2 56 ... 4 6 ... ... ... ... ... ... 13 Rheumatic Fever ... ... ... 2 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 1 1 ... 1 3 4 ... ... 1 ... ... 1 ... ... ... ... ... ... 14 Diabetes ... ... ... ... ... ... ... 1 1 ... 2 ... 1 ... ... ... 1 ... ... 1 1 2 4 1 5 ... ... 1 ... ... ... ... ... ... ... ... ... 15 Cerebral Hemorrhage, &c ... ... ... ... ... ... ... ... 1 6 14 14 8 6 2 7 9 10 3 6 6 6 22 27 49 ... 13 21 ... ... ... ... ... ... ... ... ... 16 Heart Disease ... ... l 1 2 3 4 6 12 26 45 46 43 4 5 30 25 31 37 23 15 27 90 103 193 ... 16 64 3 4 8 ... ... ... ... ... ... 17 Arterio Sclerosis ... ... ... ... ... ... ... ... 1 7 12 44. 28 5 3 14 19 18 15 13 5 10 58 39 97 5 53 62 1 ... ... ... ... ... ... ... ... 18 Bronchitis 2 3 ... 1 ... ... 1 2 2 6 1 4 19 13 1 ... 5 9 16 12 5 8 9 48 16 64 3 33 26 1 1 1 ... ... ... ... ... ... 19 Pneumonia (all forms 41 21 12 2 2 2 1 3 10 11 11 10 4 ... 6 25 24 19 21 12 12 11 73 57 130 ... 3 41 2 3 5 1 ... ... ... ... ... 20 Other respiratory diseases 1 ... ... ... 1 1 ... 2 1 2 2 2 6 ... ... 4 5 3 2 3 1 ... 8 10 18 ... ... 4 ... ... 1 ... ... ... ... ... ... 21 Ulcer of Stomach or duodenum ... ... ... ... ... ... ... 1 5 5 2 2 1 ... ... 2 2 1 2 2 4 3 12 4 16 ... ... 2 ... ... ... ... ... ... ... ... ... 22 Diarrhoea, etc. 23 2 1 ... ... ... ... 1 1 ... ... ... ... 1 1 11 6 3 3 2 2 1 17 12 29 ... ... 12 ... ... ... ... ... ... ... ... ... 23 Appendicitis and typhlitis ... ... ... 1 ... 1 2 ... ... 2 2 2 ... ... 1 3 2 1 2 ... 1 ... 9 1 10 ... ... 2 ... ... ... ... ... ... ... ... ... 24 Cirrhosis of Liver 1 ... ... ... ... ... ... 1 ... ... 5 2 1 ... ... 2 1 2 2 1 1 1 10 ... 10 ... ... 6 ... ... ... ... ... ... ... ... ... 25 Acute and Chronic Nephritis ... ... ... 1 1 1 2 ... 5 7 17 17 4 1 1 8 17 6 16 1 4 3 33 23 56 ... 5 34 1 1 2 ... ... ... ... ... ... 26 Puerperal Sepsis ... ... ... ... ... ... ... 2 1 ... ... ... ... ... 1 1 1 ... ... ... ... ... ... 3 3 ... ... 1 ... ... ... ... ... ... ... ... ... 27 Other accidents and diseases of pregnancy & parturition ... ... ... ... ... ... ... 1 3 ... ... ... ... ... ... ... 1 1 1 ... ... 1 ... 4 4 ... ... 1 ... ... ... ... ... ... ... ... ... 28 Congenital debility and malformation, premature birth 53 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 12 5 3 12 4 7 8 30 23 53 ... ... 19 ... ... ... 1 2 ... ... ... ... 29 Suicide ... ... ... ... ... 1 2 3 2 3 2 3 2 ... ... 2 3 2 2 ... 6 3 11 7 18 ... ... 4 ... ... ... ... ... ... ... ... ... 30 Other deaths from violence 2 1 2 4 ... 3 2 2 1 6 8 13 3 3 2 10 13 12 8 2 1 2 31 19 50 1 2 19 3 ... ... ... ... ... ... ... ... 31 Other defined diseases 24 2 6 5 1 5 3 8 14 26 15 34 42 9 12 20 3 23 33 18 16 29 106 88 194 ... 9 81 2 2 1 ... ... ... ... ... ... 32 Causes, ill defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 The deaths amongst infants under one year numbered 164 of which 87 were males and 77 females. These deaths amounted to 11.9 per cent. of the total nett Shoreditch deaths from all causes compared with 12.3 per cent. in 1927. The mortality amongst infants under one year was at the rate of 78 per 1 000 births registered during the year. Amongst male infants this rate was 81 and amongst females 76. The infant mortality rates in the different Wards of the Borough are included in the foregoing table. The number of deaths of illegitimate infants was 3 which figure gives a mortality rate of 40 per 1,000 illegitimate births. The chief causes of deaths amongst infants were pneumonia, prematurity, diarrhoea and enteritis, congenital debility and measles. During the last ten years the infant mortality rates for England and Wales, London and Shoreditch have been as follows:— Deaths of Infants under one year per 1,000 births registered: — Year. England and Wales. London. Shoreditch. 1919 93.2 85 110 1920 84.5 76 91 1921 81.2 80 114 1922 74.7 75 102 1923 69.2 61 82 1924 74.2 69 87 1925 74.5 68 88 1926 70.2 64 66 1927 69.7 59 74 1928 69 67 78 The causes of deaths of infants under one year together with ages and ward distribution are given in the following table : — MATERNAL MORTALITY. The number of Shoreditch women who lost their lives in connection with childbirth during the year was 7. This gives a Maternal Mortality rate per 1,000 births of 3.3. There were in addition three deaths associated with childbirth but not classified thereto. ' To face page 10 INFANTILE MORTALITY IN THE BOROUGH DURING YEAR 1928. CAUSES OF DEATH. AGES. DEATHS IN EACH WARD. SEX. Under 1 day. 1 day-1 week 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total under 1 year. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 1 Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Measles ... ... ... ... ... ... ... ... 3 6 9 1 2 1 3 1 ... ... 1 3 6 4 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping cough ... ... ... ... ... ... ... ... 1 1 2 ... 1 ... ... ... 1 ... ... 2 ... 6 Diphtheria ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 7 Erysipelas ... ... ... 1 ... 1 ... 1 ... ... 2 ... 1 1 ... ... ... ... ... 1 1 8 Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 German measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 (a) with Pulmonary complications ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 14 (b) with Non-Pulmonary complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 (c) without stated complications ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 16 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 Other Tuberculous diseases ... ... ... ... ... ... ... 1 1 1 3 ... 1 ... ... ... ... 1 1 2 1 20 Bronchitis ... ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... 1 ... 1 ... 2 ... 21 Pneumonia (all forms) ... ... 1 ... 2 3 9 14 5 10 41 1 12 5 4 6 3 6 4 18 23 22 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Empyema ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 24 Other Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 Laringitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Convulsions ... 2 1 ... ... 3 ... ... ... ... 3 ... ... ... ... ... 1 ... 2 1 2 28 Diarrhoea and Enteritis ... ... ... ... 1 1 3 11 5 3 23 1 10 4 3 2 2 1 ... 13 10 29 Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other diseases of the stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Syphilis ... 1 ... ... ... 1 1 ... ... ... 2 ... ... ... ... ... 1 1 ... 1 1 32 Congenital malformation 2 2 ... ... ... 4 2 ... ... ... 6 ... ... ... 1 ... 1 2 2 3 3 33 Congenital debility 1 ... ... ... 3 4 2 4 ... ... 10 ... 3 1 ... 3 1 1 1 4 6 34 Premature birth 14 9 ... 4 ... 28 7 ... ... ... 35 2 8 4 2 8 2 4 5 21 14 35 Injury at birth 1 ... ... 1 ... 2 ... ... ... ... 2 ... 1 ... ... 1 ... ... ... 2 ... 36 Suffocation in bed or not stated. Accidental mechanical suffocation ... 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 37 Atelectasis 1 2 1 ... ... 4 ... ... ... ... 4 ... 1 2 ... ... ... ... 1 2 2 38 Other defined diseases ... ... ... ... 1 1 2 6 3 2 14 1 2 3 3 1 1 ... 3 10 4 39 Causes ill-defined or unknown ... ... ... 1 ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 Totals 19 17 4 8 7 55 29 37 20 23 164 7 44 23 16 23 14 17 20 87 77 *Deaths of persons belonging to Shoreditch occurring beyond limits of Borough are included. 11 The particulars of these deaths are entered in the following table:— MATERNAL MORTALITY. AGES. Married. Single. Widowed. WARDS. 15 to 20 yrs. 20 to 25 yrs. 25 to 30 yrs. 30 to 35 yrs. 35 to 40 yrs. 40 to 45 yrs. 45 yrs. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. H aggers ton. Acton. Accidents of Pregnancy:— ... ... 2 1 1 3 ... 6 1 ... 1 1 2 1 1 ... ... 1 Abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta praevia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal hæmorrhage ... ... ... 1 ... 1 ... 2 ... ... ... ... ... ... 1 ... ... ... Other accidents of childbirth ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... Puerperal sepsis ... ... 2 ... ... 1 ... 2 1 ... 1 1 1 ... ... ... ... ... Puerperal phlegmasia alba dolens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not returned as septic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal embolism and sudden death ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... Puerperal albuminuria and convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Childbirth not assignable to other headings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal diseases of the breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *Pulmonary Tuberculosis ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... *Lobar Pneumonia (Pneumonia and Pleurisy) ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... *Chronic Nephritis ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... ... ... *These deaths were stated to have been associated with childbirth, etc., but have not been classified to childbirth. 12 The fact that the maternal mortality rate throughout the country as a whole has, in spite of the development of Maternity and Child Welfare work and social services not fallen during recent years, has excited widespread interest. A special Committee has been set up by the Ministry of Health to investigate the matter. It has been thought advisable to investigate thoroughly the arrangements for patients' care obtaining in Shoreditch, and a report on the matter by the Assistant Medical Officcr of Health will be found in the Maternity and Child Welfare Section of this report. The recommendations contained in this portion of Dr. Fanning's report have my full support. It will be noted from the Table on page 8 that the chief causes of death of children between the ages of one and two years were Measles and Pneumonia— these two causes in fact accounted for 49 out of a total of 69 deaths between these ages. The same two diseases were responsible for 31 out of the 51 deaths of children aged two to live years. Altogether 284 or 20.6 per cent. of the total number of deaths of all ages were of children under the age of 5 years. Considering the deaths at all ages the chief causes arc seen to be as follows:— Heart disease, 193 (14 per cent.); Cancer, 143 (10 per cent.); Tuberculosis, all forms, 136 (10 per cent.) ; Pneumonia, all forms, 130 (9 per cent.). The number of deaths due to accidents in connection with vehicular traffic was 15. In the years 1919 to 1927, inclusive, the corresponding figures were respectively 8, 16, 10, 12, 9, 15, 14, 16 and 21. The particulars regarding the deaths from cancer are contained in the following table. 13 DEATHS FROM CANCER IN THE BOROUGH DURING YEAR 1928. AGES. SEX. Total. WARDS. 0 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. Male. Female. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. All situations 1 ... 1 2 12 30 43 38 13 3 78 65 143 7 24 29 17 24 7 14 21 Tongue ... ... ... ... ... ... 2 3 ... ... 5 ... 5 ... 2 1 ... ... 1 1 ... Other Buccal Cavity ... ... ... ... ... 3 1 ... ... ... 3 1 4 ... 1 ... 1 1 1 ... ... Pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Oesophagus ... ... ... ... 1 2 4 ... ... ... 4 3 7 1 4 ... 1 ... ... 1 ... Stomach ... ... ... ... 2 5 10 6 4 ... 19 10 29 3 5 6 6 4 1 1 3 Liver ... ... ... ... ... 2 2 1 1 ... 4 2 6 ... ... 2 2 1 ... ... 1 Gall Bladder ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 Intestine ... ... ... ... 2 3 3 8 1 ... 10 8 18 ... 2 3 1 5 1 4 2 Rectum ... ... ... ... 1 2 1 2 1 ... 5 2 7 1 2 1 1 1 ... ... 1 Others ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ovary and Fallopian tube ... ... ... ... 1 3 2 ... ... ... ... 6 6 ... 3 1 ... ... ... ... 2 Vagina, vulva ... ... ... ... 2 1 2 ... 2 ... ... 7 7 ... 2 1 1 2 ... ... 1 Breast ... ... ... ... 1 4 7 2 2 ... ... 16 16 ... 1 4 3 4 2 ... 2 Skin ... ... ... ... ... 1 ... 1 ... ... 3 ... 3 ... ... ... ... 1 ... 1 1 Larynx ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Lunga Pleura ... ... ... ... 1 ... 1 1 ... ... 2 1 3 ... ... 1 ... ... ... 1 1 Pancreas ... ... ... ... 1 2 2 4 ... ... 5 4 9 ... 1 2 ... 3 ... 2 1 Bladder ... ... ... ... ... 2 3 2 2 ... 7 2 9 1 ... 4 ... ... ... ... 4 Prostate ... ... ... ... ... ... 2 4 ... 1 7 ... 7 1 1 1 1 1 ... 2 ... Others l ... ... 1 ... ... ... 3 ... ... 3 2 5 ... ... 2 ... 1 1 1 ... B 14 It is most important to remember with regard to deaths from Cancer that this disease, so hopeless in its advanced stages, can in the early stages be treated with steadily improving prospccts of success. For this reason anyone having any anxiety on the matter should at once seek medical advice. The particulars regarding deaths from Tuberculosis are given in the section of this report devoted to that disease. In the subjoined table are set forth the various institutions outside Shoreditch with the number of persons belonging to the Borough dying therein:— Asylums:— No. of Deaths. No. of Deaths. Cane Hill 1 Special Hospitals:— Claybury 16 Bethnal Green Chest 1 Derby Borough Mental 1 Brompton 1 Fountain 1 City of London Maternity 3 Grove, Epsom 2 Colindale 10 Horton 2 Downs 1 Hanwell 1 East London Children's 3 Hundred Acres, Epsom 2 Evelina, Southwark 1 Leavesden 1 Highwood, Brentwood I London County Mental Hospital 8 Infants, Vincent Square 2 Mothers' Hospital 2 Napsbury 1 Metropolitan Ear, Nose and Throat 1 Tooting Bee 5 National, Holborn 1 Hospitals for Infectious Diseases:— St. George's, Chelsea 1 St. Luke's, Paddington 1 Brook 5 St. Margaret's 1 Eastern 25 St. Mark's, City Road 1 Joyce Green 1 St. Peter's, Westminster 2 North-Eastern 20 24, Underwood Street, North-Western 2 Stepney 1 South-Eastern 6 South-Western 2 Other Institutions :— Western 1 19a, Bishop's Road 2 214a, Cambridge Road 8 General Hospitals:— 199, Dartmouth Park Hill 1 Charing Cross 2 12, Exmoor Street, Kensington 1 Children's, Holborn 9 230, High Street, Homerton 6 German 4 72a, East Dulwich Grove 1 Guy's 1 2, Horsham Road, Dorking 1 Homoepathic 1 Friern Barnet Infirmary 4 Ilford Emergency 1 Hackney Branch, Brentwood 1 London 18 H.M. Prison, Islington 1 London Jewish 2 Middle House, Epsom 1 Manor House, Hendon 1 28, Marloes Road 2 Metropolitan 38 1, Old Church Road, Romford 1 Middlesex 2 29, North Side, Clapham 1 Mildmay 7 The Forest, Hook Road, Epsom 1 Mildmay Memorial 1 129, St. John's Road, Islington 2 Northampton General 1 Poplar 1 St. Joseph's Hospice 8 Queen's (Children) 40 St. Peter's, Stepney 9 St. Bartholomew's 58 St. David's, Ealing 1 St. Bartholomew's, Rochester 1 1, West Park Road, Epsom 4 St. Thomas's 1 Rosa Morrison Home, East Barnet 1 St. Mary's 2 Westminster 2 St. George's, Stepney 1 Woolwich Memorial 2 2a, South Grove, Stepney 1 15 Of 384 persons belonging to Shorcditch (lying in public institutions beyond the limits of the Borough, 195 died in general hospitals, 41 in asylums, 62 in fever hospitals, 34 in hospitals for special diseases, and 52 in other institutions. Elsewhere than in public institutions, 19 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 925 or 67.0 per cent. of the people belonging to Shoreditch who died during the year died in public institutions. The corresponding figures for recent years have been as follows:- 1920 55 per cent. 1921 56.9 „ 1922 60.2 „ 1923 63.6 „ 1924 63.5 „ 1925 63.3 „ 1926 63.7 „ 1927 631 „ INFECTIOUS DISEASES. Excluding tuberculosis, the deaths during the year from notifiable infectious disease numbered 151 (11 per cent. of total deaths). The corresponding number for 1927 was 75, the increase during the year under consideration being due to the fact that in 1928 there were 130 deaths from acute primary and acute influenzal pneumonia, whilst the number of deaths from these diseases in 1927 was 48. B2 16 The following table shows the numbers of cases of infectious disease (tuberculosis excluded) notified in the Borough, together with distribution as to quarter, age and Ward:— ] NUMBER OF CASES NOTIFIED. NOTIFIABLE DISEASE. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total AGES. WARDS. Cases removed to Hospital. Diagnosis revised subsequently. Deaths. I II III IV V VI VII VIII Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 Moorfields. Church. Hoxton. Wen- lock. Whitmore. Kings land. Haggerston. Acton. Enteric fever 2 ... 4 4 10 ... 1 I 3 ... 4 1 1 3 1 l ... ... 2 2 10 ... ... Smallpox 2 ... 1 ... 3 ... ... ... 1 ... 1 1 ... 1 ... 2 ... ... ... ... 3 ... ... Scarlet fever 83 134 147 171 535 11 194 288 30 12 ... ... 22 100 52 62 65 99 86 49 531 78 3 Diphtheria 140 99 102 111 452 16 177 198 34 24 3 ... 15 91 80 53 45 47 84 37 449 98 13 Acute primary pneumonia. 110 47 27 64 248 55 91 36 20 20 18 8 4 52 42 40 45 22 31 12 162 ... 130 Acute influenzal pneumonia 11 3 1 7 22 3 9 ... 2 4 4 ... 1 4 3 12 ... ... 1 1 5 ... Erysipelas 14 11 6 18 49 3 4 3 5 9 18 7 1 11 7 8 10 7 2 3 27 ... 2 Puerperal fever 2 1 3 1 7 ... ... ... 1 6 ... ... 1 4 1 ... 1 ... ... ... 7 ... 3 Puerperal pyrexia 6 9 2 7 24 ... ... ... 9 15 ... ... 1 4 3 4 6 3 1 2 20 ... ... Cerebro-spinal fever 1 ... 1 ... 2 ... 1 1 ... ... ... ... ... ... ... 1 ... ... 1 ... 2 ... ... Encephalitis Lethargica 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... Ophthalmia neonatorum 5 4 12 10 31 31 ... ... ... ... ... ... 1 10 1 3 5 3 7 1 4 ... ... Malaria ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... Totals 377 309 306 393 1,385 119 477 577 106 91 48 17 47 280 191 186 178 181 215 107 1,221 176 151 Numbers and percentages of cases moved to hospitals. 327 278 282 333 1,221 86.7% 89.0% 92.1% 84.7% 88.1% 17 SMALLPOX. Three cases of smallpox were notified during the year. In the first case, which occurred in February, the patient was an old man, an inmate of the Holborn Institution. In the second, which occurred in July, the patient was a young woman, an in-patient of St. Leonard's Hospital. Vaccination of all contacts amongst patients and Staff was carried out in both these institutions, and there were fortunately no secondary cases. In both instances the disease was of the mild type and both patients made a good recovery. As will be seen from the following table, there has been an increase in the number of cases of smallpox in England and Wales during the last ten years. Until 1928, London remained immune during this outbreak, but the infection has now established itself in the metropolis. Figures already to hand show that during 1929 the number of cases occurring in London will be much greater than in the year covered by this Report. SMALLPOX—CASES NOTIFIED. England & Wales. London. Shoreditch 1919 129 28 Nil. 1920 206 22 „ 1921 187 2 „ 1922 669 69 „ 1923 2,462 16 „ 1924 3,792 4 „ 1925 5,355 15 „ 1926 10,205 5 „ 1927 14,769 5 „ 1928 12,433 296 3 1929 l0,991 1,230 266 The administrative measures adopted are prompt removal of patient, disinfection of home and of clothes and personal effects of those with whom patient had been in contact. In order to facilitate this disinfection use is made of the Council's shelter in Reeves Place. A list is made of all contacts and these are offered vaccination and kept under observation during the quarantine period of eighteen days. The type of disease is very mild as may be seen from the fact that there was during 1928 only one fatal case of smallpox amongst all those notified in London. This mildness made the administrative control extremely difficult for the reason that in many cases the patients feel very little illness, and either do not seek medical aid at all, or only do so after they have been spreading the infection for many days. 18 SCARLET FEVER. The cases certified numbered 535 of which 78 or 14.0 were subsequently not regarded as Scarlet Fever. The actual number of cases wis accordingly 457 which gives an attack rate of 4.6 per 1,000 inhabitants. The age seasonal and Ward distribution of the cases are included in the table on page 16. There were 3 fatal cases, two of which fell in the age group 2-5 and one being between 10-15. All three were females. The number of cases, deaths amongs. males and females and the attack, death and case mortality rates in the Borough and Wards are given in the subjoined table:— SCARLET FEVER. Wards. No. of cases. Fatal cases. Rates per 1,000 population. Case mortality. Deaths per 100 cases. Male. Female. Total. Male. Female. Total. Attack Death Moorfields 14 8 22 ... ... ... 5.5 ... ... Church 45 55 100 ... 1 1 5.7 0.05 1.2 Hoxton 23 29 52 ... 2 2 3.4 0.13 4.0 Wenlock 28 34 62 ... ... ... 4.5 ... ... Whitmore 32 33 65 ... ... ... 3.7 ... ... Ivingsland 52 47 99 ... ... ... 9.9 ... ... Haggerston 43 43 86 ... ... ... 8.1 ... ... Acton 28 21 49 ... ... ... 4.3 ... ... Total 265 270 535 ... 3 3 4.6 0.03 0.66 London ... ... 15,355 ... ... 78 3.4 0.02 0.51 Scarlet fever has now assumed a very mild form with the happy result that the deaths therefrom are fewer and the illness less severe than was formerly the case. From the administrative point of view this mildness of type makes the control of the disease more difficult for the reason that diagnosis is less sure and that patients frequently do not feel sufficiently ill to seek medical advice. The measures taken to control the disease are as follows :— Isolation of patient. With the exception of 4 cases all those certified were removed to Hospital. Disinfection of home and of articles likely to spread infection. Advice to those exposed as to early symptoms and importance of seeking medical aid. Enquiry is made as to the source of infection. A mild missed case may be found, the removal of which to Hospital may prevent several more inmates of the house from contracting the disease. 10 DIPHTHERIA. The cases certified numbered 452 of which 98 or 21.7 per cent. were subsequently not regarded as being diphtheria. The number of cases during the year was thus 354 which gives an attack rate of 3.5 per 1,000 inhabitants. The age seasonal and Ward distribution of the cases are included in the table on page 16. There were 13 fatal cases—6 males and 7 females. These occurred in the following age groups: — Under one year 1 Aged 1-2 years 1 Aged 2-5 years 7 Aged 5-10 years 4 The number of cases, the deaths amongst males and females and the attack, death and mortality rates in the Borough, its Wards and in London are given in the subjoined table:— Ward. Notifications. Fatal cases. Rates per 1,000 population. Case mortality. Deaths per 100 cases. M. F. Total M. F. Total Attack Death Moorfields 8 7 15 ... ... ... 3.7 ... ... Church 33 58 91 2 1 3 5.2 0.17 4.3 Hoxton 41 39 80 ... 1 1 5.2 0.06 1.6 Wenlock 26 27 53 ... — — 3.8 ... ... Whitmore 25 20 45 ... 2 2 2.6 0.11 5.7 Kingsland 20 27 47 1 1 2 4.7 0.19 5.4 Haggerston 28 56 84 1 1 2 7.9 0.19 3.1 Acton 19 18 37 2 1 3 3.2 0.26 10.3 Total 200 252 452 6 7 13 3.5 0.13 3.67 London ... ... 12,241 ... ... 388 2.7 0.09 3.1 Diphtheria is one of the serious diseases of childhood. As will be seen by a comparison of the foregoing tables it is, though somewhat less prevalent than scarlet fever, responsible for a larger number of deaths. In addition to the lives lost through this disease it must be remembered that the after effects in those who recover are frequently most harmful and far-reaching. As compared with London as a whole it will be seen that Diphtheria in Shoreditch is more prevalent and somewhat more severe in type. The greater prevalence is probably clue to overcrowding in the homes which favours the spread of infection from child to child. The fact that a slightly larger proportion of cases terminate fatally may reasonably be attributed to the some cause and to the relatively unfavourable conditions of child life in the Borough as regards the promotion of general stamina and power to resist disease. 20 The administrative measures taken in regard to the disease are as follows:— The isolation of the patient. With three exceptions all cases were removed to Hospital for treatment. It is most important that diphtheria antitoxin should be administered at the earliest possible moment, and this is done on arrival at the Fever Hospital, which is usually within an hour of the doctor telephoning particulars of the case. If for any reason the case is to be treated at home or is not to be immediately removed to hospital anti-toxin can be obtained from the Public Health Department by the Doctor in charge of the case. Disinfection of the house is carried out as in the case of scarlet fever, particular attention being paid to all articles put into the mouth, e.g., spoons, forks, etc. It is advised that these should be boiled after use if there has been a case in the home. Those who may have contracted the disease are advised regarding early symptoms and of the importance of obtaining medical aid. The fact that the germ causing diphtheria can be detected in the throats of those suffering from, and in certain cases of those who have recovered from the disease, is of value in its administrative control for the following reasons The diagnosis of doubtful cases is rendered less difficult, diagnosis may in some instances be made more rapidly; individuals may be discovered who, though they are not themselves ill, are harbouring the germs in their throats and are thus a source of infection to others. During the year the number of bacteriological examinations made in connection with these cases numbered 819. Home enquiries were made regarding 437 of the notifications received. Amongst these the age distribution was found to be as follows:— Age period. Male. Female. Total. Under 1 year 12 5 17 1-2 years 18 13 31 2-3 years 14 20 34 3-4 years 25 27 52 4-5 years 28 27 55 5-10 years 62 79 141 10-13 years 13 16 29 Over 13 years 24 54 78 Total 196 241 437 In 241 of the cases the patients were attending school and in 185 they were at school within a week of being certified as having the disease. In 42 instances there was evidence pointing to infection from a previous case. In 205 cases the sanitary conditions of the home were satisfactory, in 67 fairly so, and in 146 unsatisfactory. The provision of facilities for the immunization of children against diphtheria is a question that must engage the consideration of Public Health authorities. It is now possible by means of easily administered skin injections, firstly to test the 21 resistance of a child to this disease, and secondly if the resistance is poor and the child accordingly a likely victim, to raise the resistance by a further injection so as to make the child immune. Great care is necessary in regard to the preparation and use of the materials, but when all safeguards are taken excellent results are claimed for the procedure. Diphtheria immunization is extensively practised in America and clinics have been set up by various Public Health Authorities in this Country. At the time of writing fourteen Metropolitan Boroughs have established these clinics, viz.:—City of Westminster, Battersea, Bermondsey, Camberwell, Deptford, Hackney, Holborn, Stoke Newington, Wandsworth, St. Marylebone, Lambeth, Finsbury, Poplar and Southwark. As diphtheria is both most common and most severe in the early years of child life, it is held that the authority responsible for the provision of facilities for immunization should be the same as that responsible for Maternity and Child Welfare. For this reason this matter has in London been undertaken by the Borough Councils. The progress of diphtheria immunization in this Country will be kept under observation and further reports will in due course be made upon the matter. ENTERIC FEVERS. Ten cases of this disease were notified in the Borough during the year. Of these four proved upon further investigation to be cases of paratyphoid fever. In four instances the diagnosis was not confirmed. Investigations were made in all cases. It was not possible to trace the source of infection, but the cases of paratyphoid, two of which occurred in August, and two in October, were part of a widespread outbreak which was attributed to cream and upon which a report was made by the County Medical Officer of Health. There were no fatal cases in this Borough. ERYSIPELAS. The cases certified numbered 49 and there were 2 deaths. The deaths occurred at the ages of two weeks and six months respectively. The age, seasonal and ward distribution of the cases are included in the table on page 16. A comparison between London and Shoreditch is contained in the following table:— Per 1,000 inhabitants. Deaths per 100 cases. Attack rate. Death rate. London 0.48 0.02 5.08 Shoreditch 0.49 0.02 4.08 These cases are not as a routine measure admitted to Hospital. 27 however were moved, mostly to St. Leonard's Hospital, during the course of the year. 22 Administrative measures have for their object the securing of adequate treatment, the discovery of the source and the prevention of the spread of infection A case of erysipelas in the house is a source of danger during the puerperium and enquiries are accordingly made and steps are taken to safeguard against this dan-. r PUERPERAL FEVER. Seven cases were certified, all of which were removed to Hospital. There were three deaths. A comparison between London and Shoreditch during the last 10 years is contained in the following table:— London. Shoreditch. Year. Cases. Cases per 1,000 births. Deaths. Deaths per 1,000 births. Cases. Cases per 1,000 births. Deaths Deaths per 1,000 births. 1919 313 3.7 155 1.8 3 1.3 3 1.3 1920 451 3.7 215 1.7 11 2.9 5 1.3 1921 353 3.5 142 1.4 12 4.0 4 2.0 1922 311 3.3 129 1.3 9 3.1 3 1.0 1923 352 3.9 126 1.3 7 2.5 ... ... 1924 298 3.5 106 1.2 10 3.9 1 0.4 1925 324 3.9 117 1.4 13 49 2 0.8 1926 341 4.3 127 1.6 10 3.9 3 1.2 1927 265 3.5 96 1.3 11 5.0 2 0.91 1928 295 3.5 115 1.5 7 3.4 3 1.4 Puerperal fever is a disease caused by the infection of the generative tract after labour. It may be stated as a general rule that the actual source of the infecting agent lies in the patient herself or in the hands, instruments and appliances of the Doctor or Midwife. On receipt of a notification steps are taken to secure the best treatment for the patient, to ascertain the source of infection and to carry out such disinfection as may be necessary. The majority of cases are removed to Hospital and the earlier this is done the better. Search for the source of infection is undertaken primarily with a view to making sure that its activity is not allowed to continue with the risk of further infections. All cases occurring in the practice of midwives are further investigated by the London County Council, who are the authority responsible for the supervision of midwives practising in the Metropolis. Midwives in whose practice a case of puerperal fever has occurred are required to carry out a complete disinfection of their persons, clothes and instruments before taking fresh cases. It sometimes happens that improper examinations and manipulations arc made by unqualified women who are engaged ostensibly to give general assistance to the patient. These women, known as " handy women," who are most useful so 23 long as they confine themselves to their proper sphere, become a grave danger if they attempt to usurp the functions of the midwife. Enquiries are made with the object of discovering and preventing the abuse to which reference has just been made. Under the Maternity and Child Welfare Section of this report particulars will be given of the Council's scheme for ante-natal care and supervision. Of this scheme, which includes the provision of sterilized maternity dressings upon the application of the Doctor or Midwife, it may be said here that everything that is done by way of caring for the health of the patient and assisting her to make the best possible arrangements for her confinement lessens the risk of infection during the lying-in period. 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. Provision is made in these Regulations for consultations between the Doctor notifying and obstetric specialists, and arrangements have been made with three specialists whose names are included in the list of the staff at the beginning of this report, to meet practitioners in consultation on these cases upon request. During the year 24 cases were notified, of which 20 were removed to hospital. Consultations with the specialists above referred to were held in two cases. OPHTHALMIA NEONATORUM. This disease, the duty of notifying which was, under the Public Health (Ophthalmia Neonatorum) Regulations, 1926, placed solely upon the medical practitioner in charge of the case, consists of a purulent discharge from the eye of an infant occurring within 21 days of birth. The disease, which, if not properly treated, may cause blindness or serious impairment of vision, is due to a gonorrheal infection of the child's eyes during birth. Infection is nearly always from the genital tract and the mother should accordingly also undergo treatment. Cases. Vision unimpaired Vision impaired. Total blindness. Deaths. Notified. Treated at home. In Hospital. 31 26 5 29 1 ... 1* 24 *At a time when the eyes were improving, this infant was admitted to hospital where it died from "Streptococcal Meningitis and Marasmus." The cases per 1,000 births numbered 14.8 in Shoreditch as compared with 9.8 for London as a whole. In addition to the cases notified, 71 cases of inflammation of the eyes in the newlyborn were brought to our notice by the Medical Officer of Health of the London County Council. In all cases brought to her notice the Health Visitor does all that lies in her power to secure that the child receives prompt and thorough treatment, and she keeps the case under close observation until the eyes are cured. At St. Margaret's Hospital—a special institution of the Metropolitan Asylums Board for the treatment of this disease—mothers can be admitted with their infants, thus securing continuity of breast-feeding. Six of the cases notified during the year were nursed by the nurses of the Shoreditch and Bethnal Green Nursing Association, the nurses acting under the instructions of the Doctor in charge of the case. CEREBRO-SPINAL MENINGITIS. One case was certified during the year. A child aged 1 year and 7 months was admitted to a fever hospital under a notification of diphtheria. After admission, however, she was found to be suffering from cerebro-spinal meningitis. The case terminated fatally. In addition to the foregoing, a certificate of death from cerebro-spinal meningitis was given respecting a girl aged 13 who died at St. Bartholomew's Hospital. A post-mortem examination was made. This case was not certified before death. ENCEPHALITIS LETHARGICA. One case was notified during the year, of which the particulars are as follows A youth, aged 16 years, a cabinet maker, was diagnosed as suffering from this disease about two months after the initial symptoms, which were described as follows: "Appeared to become lazy. Last Wednesday eyes had unusual appearance—seen to flicker." The patient was admitted to the Eastern Hospital, Homerton. This disease, which is often most insidious in its initial stages, has the most serious sequelae. These patients, of whom there are several in the Borough, become partially paralysed and are able to do little or nothing for themselves. Their mental stale becomes changed, and, while they are not certifiable as insane, they are often so depressed and emotional as to be a grave anxiety to those having care of them. It has in the past been extremely difficult to obtain suitable treatment for these cases, and it is most satisfactory to be able to report that since the end of the year covered by this report arrangements have been made by the Metropolitan Asylums Board for the admission of these cases to a special institution. 25 ACUTE PRIMARY PNEUMONIA. ACUTE INFLUENZAL PNEUMONIA. The number of cases notified during the year was as follows Acute primary pneumonia 248 Influenzal pneumonia 22 Of the 270 eases thus brought to the notice of the Department it was found that 171 were receiving treatment in various institutions, as follows:—148 in St. Leonard's Hospital, 7 in St. Bartholomew's Hospital and 16 in other institutions. Of the cases treated at home, 19 were visited by the Nurses of the Shoreditch and Bethnal Green District Nursing Association, acting under the direction of the doctor in charge of the case. The sanitary condition of the homes visited as a result of these notifications was found as regards air space, light and ventilation, to be as follows:—Satisfactory 105, fairly satisfactory 60, unsatisfactory 75. In addition to the cases of pneumonia notified, as above, 39 cases of pneumonia not of notifiable type were visited by the District Nursing Association. Altogether the Association paid 810 visits in connection with 58 cases of pneumonia. MALARIA. Only one case was certified during the year, the patient being an ex-service man who contracted the disease abroad. MEASLES. This is not a notifiable disease. It is, however, one of the most serious diseases of childhood. The deaths numbered 59 and occurred in the following age groups:— Under 1 year 9 One to 2 years 28 Two to 5 years 19 Five to 10 years 3 59 During the year under consideration measles was unusually prevalent and was responsible for more deaths than have been caused by this disease in any year since 1922. Measles was responsible for 19 per cent. of all deaths of children under 10 years age and for 20 per cent. of all deaths of children under 5 years. 26 As will be seen from the following table, measles is a disease which tends to become widespread every few years, the probable explanation being that after a bad measles year a large number of children are protected by reason of the fart that they have had the disease. Deaths Death rate per 1,000 population Year Shoreditch London Shoreditch London 1919 12 359 0.12 0.08 1920 50 1,026 0.49 0.22 1921 18 241 0.17 0.05 1922 84 1,559 0.81 0.35 1923 23 367 0.21 0.08 1924 58 1,335 0.55 0.29 1925 34 357 0.32 0.13 1926 25 914 0.23 0.20 1927 7 179 0.09 0.04 1928 59 1,355 0.59 0.30 The distribution of the deaths in the different wards was as shown on the table on pages 8 and 9. Although not a notifiable disease, information regarding cases of measles reaches the Public Health Department in various ways: From the School Authorities, from the Health Visitors, and from Medical Practitioners in the Borough. The number of cases thus brought to our knowledge was 1,754. As explained in the last Annual Report, the Metropolitan Asylums Board will take severe cases, or cases in which home nursing is specially difficult, upon the recommendation of the Medical Officer of Health. During the year the number of cases removed to the hospitals of the Board was 374. In accordance with arrangements made by the Borough Council, the District Nursing Association paid 1,209 visits in connection with 109 cases of measles. In addition to giving such advice and assistance as was practicable in individual cases, an attempt was made to educate the public by means of warning notices, distributed through the medium of the schools, of the dangers of and the precautions that should be taken regarding the disease. The notice referred to was as follows:— "MEASLES WARNING." "Measles has appeared in your neighbourhood, and there is a possibility "that the disease may become prevalent. "Measles is a highly infectious disease, especially in the early stages of "illness before the rash appears. The early symptoms are those of a cold, "which may be at first, slight; there is generally running at the eyes and nose, "sneezing and possibly a dry cough, followed by a rash about the fourth day " after the first, appearance of illness. "Measles should always be treated as a serious disease, especially in young "children. As soon as it is suspected the child should be put to bed in a well"ventilated room (as far as possible away from other children) and be kept "warm. A doctor should be called in at once, for many children lose their lives, 27 "or suffer from ill-health for years as a result of the after-effects of the disease, mainly because the disease is neglected in the early stages. The child should "on no account be exposed to chill or draughts, or allowed to run about until "the doctor or nurse gives consent. "Immediately measles occurs in your family you should inform the Head Teacher of the school attended by your children, or the Health Visitor at the "Infant Welfare Centre, or send word to the Medical Officer of Health at the "Town Hall. "A child showing signs of sickening or suffering from measles must not "attend Sunday School, Cinemas, Public Baths, or any place of entertainment, "nor mix with other children. "Arrangements for the removal of a measles patient to hospital or for "nursing assistance in the home may be made in special cases when the need "for this is known to the Medical Officer of Health. The sooner you send word "of the existence of measles in the home the sooner will the Medical Officer "of Health know, and the sooner will help be forthcoming. Do not wait until "bronchitis or pneumonia develop—it may then be too late." WHOOPING COUGH. There were 5 deaths from whooping cough during the year. Two of the deaths occurred at under one year of age, two between one and two, and one between two and five. The death rate from this disease was 0.05 per 1,000 inhabitants. The deaths in London as a whole numbered 396, the death rate being 0.09. The number of deaths in Shoreditch in recent years have been as follows:— Year. Deaths. Year. Deaths 1918 93 1923 10 1919 2 1924 28 1920 12 1925 29 1921 19 1926 0 1922 27 1927 24 INFLUENZA. The number of deaths attributed to influenza was 16, this being considerably below the average for recent years. As will be seen from the table on page 8 the deaths occurred for the most part at the extremes of life. The number of deaths in Shoreditch during recent years has been as follows:— Year. Deaths. Year. Deaths. 1917 12 1923 14 1918 295 1924 28 1919 121 1925 19 1920 51 1926 22 1921 27 1927 25 1922 69 28 During the last three years the deaths and death rate from influenza in London as a whole have been as follows:— Number of deaths. Deaths per 1,000 population. 1926 786 0.17 1927 1,790 0.39 1928 502 0.11 DIARRHŒA. During the year 25 deaths in children under two years of age were attributed to diarrhoea, this being at the rate of 0.25 deaths per 1,000 population. Of these deaths 23 occurred in infants under one year of age and were at the rate of 11.0 deaths per 1,000 births. Diarrhcea was responsible for 14 per cent. of all deaths occurring in infants under one year of age. In London as a whole the deaths from diarrhœa and enteritis in children under two years of age reached 738, the death rate being 0.16 per 1,000 inhabitants. Cases of diarrhœa and enteritis occurring in infants and young children should be quickly brought to the notice of the Health Visitors by the parents. It is most important that treatment should be begun promptly and before the strength is undermined. As soon as she knows that a child is suffering from this condition the Health Visitor advises the parents as to the best method of obtaining the medical care appropriate to the case. INFECTIOUS DISEASES AND SCHOOLS. In accordance with the requirements of the School Management code of the London County Council, information is received concerning children excluded from school by reason of the fact that they are suffering from infectious disease or reside in houses in which infectious disease exists. The particulars of these exclusions from school are as follows:— Disease from which suffering or to which exposed. Number of exclusions from School. Diphtheria 691 Scarlet Fever 904 Measles 2,267 Chicken Pox 736 Whooping Cough 278 Mumps 223 Other Infectious Disease 478 5,577 29 The scheme for the more effective control of measles in public elementary schools, which, as stated in the last report, was reintroduced in a modified form in December, 1927, was continued during the measles epidemic. As explained, leaflets prepared in the Health Department were handed to the Head Teachers for distribution in the schools affected. In addition to the exclusions from school referred to above information was received from the School Medical Officer that 27 children had been excluded from school on account of the presence of diphtheria bacilli in their noses or throats. The families resident in some nineteen houses to which these children belonged were kept under observation. No cases of diphtheria, however, were subsequently notified amongst the residents of these houses. 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 of the Metropolitan, the London, the Royal Free and University College Hospitals, are readily accessible to the people of Shoreditch. Lists of these centres are displayed in the Public Conveniences in the Borough and can also be seen in the Health Department. The London County Council also provides for doctors, laboratory facilities to aid diagnosis, the supply of salvarsan and its substitutes, and courses of instruction in modern methods of diagnosis and treatment. The County Council further co-ordinates the work of hospitals, public health services and practitioners, and undertakes publicity and propaganda work with regard to matters relating to venereal disease. FOOD POISONING. An inquest was held on the 14th February upon a young girl aged 5 years who died from food poisoning. Death took place in St. Leonard's Hospital after five days' illness. A post mortem examination was made by Dr. Bronte and bacteriological and serological examinations were made at the Ministry of Health laboratories. The father became ill at the same time as the child which fact pointed to a common source of infection. After careful enquiry concerning the family dietary, it appeared likely that the child had finished a partly eaten fried duck's egg that the father had left upon his plate. The bacteriological report pointed to the conclusion that the same organism was responsible for both the child's death and the father's illness, the organism in question being one that might contaminate an egg shell from the filth of a farm yard. The Coroner expressed the view that in the process of breaking the shell and frying the duck's egg these organisms had escaped destruction with the result above stated. He further added that boiling was in his opinion a safer method of cooking as it ensured the killing of all organisms on the shell. c 30 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 1928. Disease. Under 5. Visits. Disease. Over 5. Visits. Boils 1 3 Pneumonia 17 248 Measles 92 1009 Miscarriage. 5 32 Scalds 1 19 Abscess 11 277 Tonsilitis. 1 6 Influenza 2 26 Prematurity 2 9 Measles 17 200 Otorrhœa 33 582 Ante-natal 7 150 Threadworms 48 330 German Measles. 1 6 Tonsils & Adenoids 66 319 Mastitis 2 29 Pneumonia 30 383 Post-Partum Pyrexia 4 69 Cervical glands 1 11 Bronchitis. 14 123 Other Post-Partum conditions 13 206 Injury to leg 1 15 Injury to arm 1 10 Whooping Cough 1 11 Burns 1 23 Abortion 5 48 Crushed Finger 1 17 Osteo-Myelitis 1 10 Constipation 1 9 Tuberculosis 1 5 Laryngitis 1 15 Influenzal Pnuemonia 1 14 Circumcision 1 6 Blepharitis 4 79 Stomatitis 4 26 Impetigo 10 84 Rectal Prolapse 1 20 Abscess 7 81 Colitis 1 5 Influenza 1 7 Discharge from eyes 7 87 Intestinal 5 64 Eczema 1 12 Broncho-Pneumonia 9 161 Influenzal Pneumonia 1 4 Corneal ulcers 1 6 Septic umbilicus 1 12 Conjunctivitis 5 75 Pemphigus 4 74 Whooping Cough 1 8 Ophthalmia Neonatorum 6 133 Totals 365 cases 3,827 visits Totals 88 cases 1,331 visits The total number of cases at all ages was 453, in connection with which visits were made by the Nurses of the Association. Amongst persons over five years there were three deaths from pneumonia, and one from influenza and bronchopneumonia, and amongst the children under five, two died from pneumonia and one from tonsils and adenoids. BACTERIOLOGICAL EXAMINATIONS. With the exception of those carried out at the Chest Hospital in connection with the work of the Tuberculosis Dispensary, all the examinations made on behalf of the Borough Council are by Dr. F. H. Teale at the University College Hospital Medical School. 31 In order to enable practitioners to receive reports upon specimens without delay a box has been placed on the front steps of the Town Hall into which specimens may be put between 12 noon and 7 p.m. At 7 p.m. the specimens are then taken by messenger to the laboratory. Under this arrangement the report upon a throat swab taken by a doctor at his evening surgery is telephoned to him the following morning. During the year some 1,143 examinations were made, which included the following:—For suspected diphtheria 819, for suspected tuberculosis 209, in connection with the diagnosis of venereal disease 78. DISINFECTION. The premises disinfected numbered 1,246. The articles removed to the Borough Council's Disinfecting Station, totalled 14,063, and included 1,135 beds, 911 mattresses, 2,326 pillows, 622 bolsters and some 9,069 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. It was necessary to destroy two pairs of mattresses, one spring mattress and one bed, which were so dilapidated and contaminated as to render it inadvisable to return them. These were replaced with new. The larger of the steam disinfectors which had been in use for over 40 years was found to be no longer efficient and was reported to be beyond repair. A new steam disinfector by Messrs. Manlove, Alliott & Co. was accordingly installed, and at the same time the connections with the two boilers were altered so that each can now be used with either of the two disinfectors, Thanks are due to Mr. Smith, the Baths Superintendent, for his advice and assistance in connection with this work. 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. In the first instance a family was allowed to occupy the shelter while the rooms at their house were cleansed in accordance with the requirements of the Health Committee, and on two occasions the shelter was used to accommodate smallpox contacts whilst disinfection of their clothing was being carried out. PUBLIC MORTUARY. The bodies of 150 persons were deposited in the mortuary and inquests were held in 125 instances. In connection with these inquests 75 post mortem examinations were held at the mortuary. WATER SUPPLY. The Meteorological Table for London deduced from observations at Greenwich under the superintendence of the Astronomer Royal issued by the Registrar-General for 1928 shows a rainfall for the year of 643 millimeters. This figure is 47 millimeters above the average for the thirty-five years, 1881-1915. TUBERCULOSIS. All forms of tuberculosis are notifiable. Notifications arc made on one of four forms, A, B, C and D. A—Notification by Doctor who makes diagnosis. B—Notification by School Medical Inspector. C—Notification of the admission of a case of tuberculosis to an institution. D— Notification of the discharge of a case of tuberculosis from an institution. By primary notifications are meant notifications of patients who have not previously been notified either in this or previous years in Shoreditch either on Form A or B. c 2 32 Particulars of the notifications received during the year are given in the following Table:— PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the Period from the 1st January, 1928, to the 29tii December, 1928, in the Metropolitan Borough of Shoreditch. Age-periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Notifications on Form d. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. 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. •15 to 55. 55 to 65. 65 and upwards. Total Primary Notifications. Under 5. 5 to 10. 10 to 15. Total Primary Notifications. Pulmonary, Males ... 1 l 4 11 23 15 19 18 14 4 110 200 ... ... ... ... ... 51 131 20 58 ,, Females ... ... 2 3 18 16 17 14 12 10 1 93 150 ... ... ... ... ... 30 73 8 33 Non-pulmonary, Males ... 8 10 5 3 1 1 1 2 ... ... 31 42 ... ... ... ... ... 9 39 4 15 ,, Females ... 6 3 4 2 2 3 ... 2 ... ... 22 28 ... 1 ... 1 1 ... 18 ... 9 Cols. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Patients notified as suffering from both pulmonary and non-pulmonary disease are included in the "pulmonary" returns. 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 eases 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, cither on Form A or on Form B, are included in this column. Cols. 21-23. Only notifications on Form C, made by the medical officers of sanatoria, as defined in the Tuberculosis Regulations are included in this column. From the foregoing table it will be seen that the total number of cases notified for the first time during the year under consideration was 257 (Columns 13 and 18). 33 The number of persons notified per 1,000 inhabitants during the year under consideration, and the preceding nine years is shown in the following table:— Year. Pulmonary. Non-Pulmonary. All forms. 1919 4.0 1.1 5.1 1920 2.8 0.2 3.0 1921 2.1 0.4 2.5 1922 2.1 0.6 2.7 1923 2.1 0.3 2.4 1924 2.0 0.4 2.4 1925 2.2 0.7 2.9 1926 2.1 0.6 2.7 1927 1.8 0.5 2.3 1928 2.0 0.6 2.6 The number of cases notified in each of the eight wards during 1928 was as follows:— Ward. Pulmonary. NonPulmonary. Total. No. per 1,000 inhabitants. Moorfields 1 3 4 1.0 Church 42 8 50 2.8 Hoxton 32 13 45 2.9 Wenlock 40 11 51 3.7 VVhitmore 37 3 40 2.3 Kingsland 17 3 20 2.0 Haggerston 19 6 25 2.4 Acton 15 7 22 1.9 Total 203 54 257 The number of cases removed to Hospital (Columns 20 and 21, Table on page 32) was 351. Of these 261 went to Sanatoria and 90 to Poor Law Institutions. The number of cases discharged from Hospital (Columns 22 and 23—Table on page 32 was 147). Of these 115 were from Sanatoria and 32 from Poor Law Institutions. A register of all notified cases of Tuberculosis is kept at the Town Hall. The additions to and removals from during 1928 and state of the register at the end of the year is shown in the following table:— PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. Number of cases on the Tuberculosis Register, 31st December, 1927 687 563 281 230 1,761 Number of cases notified under the Public Health (Tuberculosis) Regulations, 1912, during the year 1928 110 93 31 23 257 Other cases added to the Tuberculosis Register during 1928 9 7 1 1 18 *Number of cases removed from Tuberculosis Register during 1928 80 63 21 21 185 Cases remaining on Tuberculosis Register, 31st December, 1928 726 600 292 233 1,851 *The particulars of cases removed from Tuberculosis Register during 1928 are as follows:— Deaths 129 Patients removed from Borough 46 Cases removed from register as "cured" 10 Total 185 34 35 DEATHS FROM TUBERCULOSIS IX THE BOROUGH DURING YEAR 1928. The deaths from Tuberculosis during 1928 are classified as to situation of disease, age and ward in the following table:— AGES. DEATHS IN EACH WARD. SEX. TOTAL. DEATHS. Under 1 year. 1 to 2 years. 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 In 85 „ Moorfields. Church. Hoxton. Wenlock Whit more. Kingsland. Haggcrston Acton. Male. Fermle. Not in Institutions. St. Leonards. Otner Institutions. Belonging to Shoreditch. Not belonging to Shoreditch. Belonging to Shoreditch. Not belonging to Sho.'editch. Belong ng to Shoreditch. Not belonging to Shoreditch. All forms 3 5 ... 1 2 16 22 19 23 22 17 5 1 8 22 25 21 23 6 11 20 73 63 136 56 ... 45 1 4 ... Respiratory system ... 2 ... ... 1 14 20 19 23 21 14 5 1 7 18 23 20 22 4 9 17 66 54 120 55 ... 40 1 3 ... Central nervous system 1 2 ... ... 1 1 ... ... ... ... ... ... ... ... 2 1 ... ... ... ... 2 ... 3 0 ... ... 2 ... 1 ... Intestines and periteum 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 1 3 ... ... ... ... ... ... Vertebral column ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin and subcutaneous tissue ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bones (Vertebral column excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lymphatic system (abdominal glands excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Genito-urinary system ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Other sites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disseminated Tuberculosis— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Active 1 ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... 1 1 1 1 3 4 ... ... 2 ... ... ... Chronic or unstated ... 1 ... ... ... ... ... ... ... ... 2 ... ... 1 I ... ... 1 ... ... ... ... l 6 1 ... l ... ... ... The death rates from Pulmonary and Non-Pulmonary Tuberculosis for 1928 in London and Shoreditch are compared in the following table:— Deaths per 1,000 population. Percentage of total mortality caused by Tuberculosis. Pulmonary NonPulmonary All forms Pulmonary NonPulmonary All forms Shoreditch 1.20 0.16 1.36 8.69 1.16 9.85 London 0.84 0.13 0.98 7.29 1.10 8.15 The death rates from all forms of Tuberculosis in Shoreditch and London during the last 10 years are compared in the following table:— Year. Shoreditch. London. 1919 2.1 1.4 1920 1.6 1.2 1921 1.6 1.2 1922 1.7 1.2 1923 1.5 1.1 1924 1.3 1.1 1925 1.4 1.0 1926 1.4 0.9 1927 1.07 1.05 1928 1.36 0.98 1 1 36 The deaths per 1,000 population from all forms of Tuberculosis in the eight wards of the Borough during 1928, are given in the table on page 5. It will be seen from the table of deaths on page 35 that 56 out of a total of 136 deaths occurring during the year took place in the patients' own houses. The desire of patients to remain at home is one with which it is easy to sympathise but it cannot be stated too clearly that, unless there are in the home space for isolation and facilities for nursing, rare in this Borough, the dying patient constitutes a grave menace to other members of the family. The Shoreditch Tuberculosis Dispensary is at the Royal Chest Hospital, and is under the joint administration of the Finsbury, Islington and Shoreditch Borough Councils. The Dispensary Staff includes three Tuberculosis Visitors, one of whom is responsible for visiting patients resident in Shoreditch. In his report for 1927 the Tuberculosis Officer stated that it was difficult for one sister to carry out the home visiting of the large number of cases on the Shoreditch Register as thoroughly as was desirable. During the year under consideration the Health Committee gave this matter their attention, and in December a second Tuberculosis Nurse was appointed for the Borough. This officer, who did not take up her duties until after the expiration of the year under consideration, has office accommodation at the Town Hall. The work of the Tuberculosis Dispensary and of the Shoreditch Tuberculosis Care Committee during 1928 is dealt with in the following reports by Dr. A. Lcitch, the Medical Officer to the Dispensary, and by Miss Smith, Hon. Secretary to the Care Committee:—- BOROUGH OF SHOREDITCH TUBERCULOSIS DISPENSARY. Report for Year 1928. To the Medical Officer of Health, Town Hall, Shoreditch. Sir, In presenting my Report on the work done in the Tuberculosis Dispensary during 1928, I beg to inform you that, as arranged at the Conference with the representatives of the Ministry of Pensions, held towards the end of 1927,1 attended the Metropolitan Boarding Clinic, Westminster, twice weekly for a number of weeks in the early part of the year. You will, no doubt, remember that the Conference referred to concerned those tuberculous War Pensioners who had been in receipt of Treatment Allowances for, in many cases, several years. The Ministry of Pensions considered the time had arrived when the physical condition of these pensioners should be reviewed with the object of granting satisfactory pension awards rather than continuing Treatment Allowances indefinitely. The arrangement was that all pensioners who had been receiving Treatment Allowances for more than one year should be so boarded. Many of these were put forward by the Board for final awards, and in the majority of cases, I am glad to report the Ministry agreed. Such cases were, of course, recommended for 100 per cent, awards. On the other hand, there are still cases which have not yet been given permanent pensions, and to these I am giving close attention, since, 1 37 in my opinion, it is doubtful if any tuberculous War Pensioner should be given a final award less than the maximum. In apparently arrested cases the disease may again become active, and when this occurs, the outlook is serious, when not grave. Of the cases not arrested, in spite of several years treatment, it can only be presumed that such cannot take place now. It is with regret that I have to state that in not a few cases inadequate awards have and are being made by the Ministry of Pensions. Such is my opinion. The difficulty these patients have in obtaining employment, even when fit for a suitable occupation, hardly seems to be appreciated; and I am convinced that more sympathetic consideration is only just. The number of attendances in 1928 when compared with that for 1927 shows a slight decrease; the fall is due partly to the smaller number of examinations and reports called for by the Ministry of Pensions, viz., 139, as compared with 429 in 1927. The number of visits paid to the Dispensary by patients for treatment, examination and supervision is really greater than in 1927. The number of New Cases seen in 1928 was 27 more, i.e., 705 and 678, than in 1927. The number of cases referred to the Dispensary by Doctors for opinion and treatment exceeded the corresponding figure for ] 927 by 46, the figures being 200 and 154. The number of New Cases found to be Tuberculous was 114, as compared with 136 in a slightly smaller total number of patients examined in 1927. The Special Session for School Children held on Tuesdays from 4.30 to 6 p.m. more than retains its popularity, the total attendances showing a substantial increase on the figures for 1927. Details are given in the table relating to this part of the work. With regard to the arrangements made as to the investigation of non-pulmonary cases on the Notification Register of five years standing or longer, it has been found that many of these may be considered as no longer suffering from Tuberculosis. Some 270 names have been submitted and 94 persons have attended for examination. Of these, 79 were found to be healthy and certainly not suffering from Tuberculosis. Of the remaining 15, a few were still receiving treatment, or, for other reasons, it was considered inadvisable that their names should be removed. Of the 176 cases not investigated, owing to non-attendance, a very small number are undergoing treatment; the greater number, however, probably consists of cases in which the diagnosis has either not been confirmed or the disease has been cured naturally. I hope to see many of these cases in the future. During this investigation several interesting features have been noticed, e.g., a comparatively small number appear to have had Institutional Treatment; in other cases the disease has been so mild and the illness of such short duration that the patient has been quite unaware that there was or had been any suggestion that the patient suffered from Tuberculosis. I am sure that exactly the same would be found on examining long standing cases of Pulmonary Tuberculosis. It has been both a pleasure and instructive to have had the opportunity of examining cases of many years duration and I trust that from your point of view the results are satisfactory. 1 38 The total number of patients on the Dispensary Register on 31st December 1928, was -568, a decrease of 19 when compared with the corresponding number for 1927. The figure 19 includes 6 cases discharged as cured. I have again to acknowledge the hearty co-operation and thoroughness of the work of all the members of the Dispensary Staff. I beg to remain, Sir, Yours obediently, A. LEITCH, Tuberculosis Officcr. STATISTICAL REPORT FOR 1928. 1927. 1928. Total attendances 5,809 5,728 Total new persons examined 678 705 Renewed cases 422 440 Sisters' visits to homes 2,744 2,339 Medical Officers' visits 377 380 All New Persons Examined according to monthly Returns:— Tuberculous. Suspects. NonTuberculous. Total. "Contacts" 19 7 263 2.-9 Other New Persons 119 17 280 416 Totals 138 24 543 705 The numbers of Insured and Non-Insured New Persons examined are:— Insured 290 Non-Insured 415 Total 705 The numbers of Insured and Non-Insured Attendances are:— Insured 3,304 Non-Insured 2,424 Total 5,728 1 39 Final Analysis of all New Persons attending:— Under 15 years. Over 15 years. Total M. F. M. F. Total New Persons 137 152 181 235 705 Pulmonary Tuberculosis 5 4 48 45 102 Non-Pulmonary Tuberculosis 3 ... 3 6 12 Suspects 2 3 3 3 11 Non-Tuberculous 127 145 127 1S1 580 SPECIAL SESSION FOR SCHOOL CHILDREN. The number of Attendances and Examinations made each month are shown in the following table:— Attendances. Examinations. Attendances. Examinations. January 39 20 July 28 12 February 34 8 August 10 4 March 33 17 September 22 8 April 21 7 October 28 6 Mav 36 14 November 27 14 June 30 14 December 16 1 Total Attendances 324 Total Examinations 125 Ditto 1927 227 Ditto 1927 124 Analysis of all persons attending the Dispensary during 1928:— Under 15 years. Over 15 years. Totals. Tuberculous. Males 53 268 321 Females 35 198 233 Totals 88 466 554 Non-T ubekculous. Males 202 191 393 Females 208 279 487 Totals 410 470 880 1 40 The New Persons examined and the Examinations and Attendances each munti were as follows:— New Persons Examined. 1 Examinations. Attendances. Ins. NonIns. Total. Ins. NonIns. Total. Ins. NonIns. Total. January 19 47 66 103 103 206 276 243 519 February 24 38 62 78 82 160 244 219 463 March 26 31 57 82 102 184 249 231 480 April 26 19 45 92 56 148 259 185 444 May 19 47 66 75 102 177 266 231 497 June 25 32 57 80 83 163 280 190 470 July 30 36 66 92 75 167 292 167 459 August 22 25 47 84 64 148 283 139 42° September 26 21 47 80 52 132 269 150 419 October 37 42 79 97 103 200 337 243 580 November 19 42 61 73 103 176 299 228 527 December 17 35 52 67 80 147 250 198 448 Totals 290 415 705 1,003 1,005 2,008 3,304 2,424 5,728 In addition to the foregoing, the following further information may be given:— Total Number of Bacteriological Examinations 735 ,, ,, X-Ray Examinations 39 ,, ,, Patients recommended to the London County Council 154 Progress Reports furnished, etc. 162 Examinations made for, and Reports sent to the Ministry of Pensions 130 ,, ,, Patients sent by Doctors 200 Total Number of Patients on the Dispensary Register on 31st December, 1928:- Insured 336 Non-Insured 232 Total 568 REPORT OF SHOREDITCH TUBERCULOSIS CARE COMMITTEE, 1928. The Tuberculosis Care Committee has for its Chairman, Dr. Maitland Radford, Medical Officer of Health, and for its Vice-Chairman, Dr. Leitch, Tuberculosis Officer, and the following members:—The Rev. F. E. Birch, Chaplain, St. Leonard's Hospital , Miss Broomfield, Secretary, I.C.A.A.; Dr. Fanning, Assistant M.O.H.; Sister Grange, Tuberculosis Visitor; Miss Kaslor, Secretary, British Red Cross Society; 1 41 [jr. Lewis, L.C.C. Divisional Medical Officer; Miss Marriott, L.C.C. District Organiser; Miss Miller, Secretary C.O.S.; Miss Tucker, Secretary, East London Workers for the Poor; Miss Wragge, Warden, Maurice Hostel, Women's Settlement; Miss Capper; Miss Smith (Hon. Secretary). It will be seen from the above that the Committee represents most of the Social Organisations in the Borough, so that it has been able to carry out its duties adequately. These may shortly be described as the general care of all the families who on account of tuberculosis have fallen on hard times, or are in need of advice. The following brief report gives an outline of the kind of assistance given. The Committee has met on 20 occasions, and dealt with 296 cases in connection with their admission to institutions, improvement of home conditions, or relief of distress. Two hundred and forty-three cases have been admitted to institutions, and of these 50 paid contributions towards their treatment varying from 2s. to 15s. weekly. Four hundred and sixty-four visits have been paid in addition to those paid by C.O.S., and I.C.A.A., and the number of interviews given in the office has exceeded these. Fifty-eight patients have died. It has been possible to assist 37 families who were needing help of various kinds. Seven were provided with clothing, 5 with beds and bedding, 1 with a shelter to relieve overcrowding, 8 with nourishment and other necessaries, 2 with dentures, 5 had maintenance grants. The children of 1 family and 2 patients were admitted to Homes, 2 patients were assisted with repairs to surgical appliances. The arrears were paid for 1 patient —so that he has been able to draw his sickness benefit. The children of 1 family were boarded out while the mother was ill, 1 girl was accepted for training for the staff of a sanatorium, and another assisted with holiday expenses. This has been possible through the kind co-operation of the Borough Council, the Charity Organisation Society, the Guardians, Invalid Children's Aid Association, Maurice Hostel Women's Settlement, Red Cross Society, and the United Services Fund. Efforts are still being made to start a Handicraft Class and it is hoped that this will very soon be possible. 1 42 MUNICIPAL DENTAL HOSPITAL. A summary of the work done during the year is contained in the following tables : — TABLE I.—INSPECTION AND TREATMENT OF CHILDREN. Number examined. Number needing treatment. Number refusing treatment. Number treated. Number of extractions. Number of Administrations of Anesthetics. Number of fillings. Number of other operations. Number of children treated for orthodontics. Number of visits. Local. General. 2 vears & under 27 20 ... 11 33 ... 11 ... ... ... 27 3 years & under 92 85 ... 53 137 ... 48 6 ... ... 96 4 years & under 182 161 ... 111 330 ... 96 17 ... ... 204 5 years & under 78 7 6 ... 46 151 1 37 1 ... 6 79 Over 5 years 293 288 ... 196 366 34 152 47 6 3 388 Total 672 630 ... 417 1017 35 344 71 6 9 791 TABLE II.—INSPECTION AND TREATMENT OF ADULTS. Number of patients examined. Number of patients treated. Number of extractions. Number of Administrations of Anaesthetics. Number of lillings, 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— 885 627 2308 39 239 81 66 277 74 5 ... 1021 Women 782 534 1238 34 143 89 22 280 68 23 ... 882 Unmarried girls (16-20) 147 94 214 7 45 34 1 20 8 1 ... 178 Men 849 589 1101 92 153 126 30 274 72 24 ... 95 Total including children, Table I 3335 2261 5878 207 924 401 119 857 222 53 ... 3826 1 43 TABLE III. Total ttendances. No. of M. & C. W. cases. AnæSthetic Sessions attendances. Monday afternoon 278 131 12 Monday evening 760 125 259 Tuesday afternoon 763 312 165 Thursday morning 851 445 297 Friday afternoon 638 254 94 Friday evening 664 83 71 Total 3,954 1,350 898 All who live or work in the Borough of Shoreditch are eligible to attend the Dental Hospital. The charges are as follows:— Extractions, with or without local Anaesthetic Is. per tooth. Gas Extractions 5s. per visit. Fillings (Root treatment not included) 5s. per tooth. Root treatment 5s. per tooth. Scaling 5s. Dentures—Full upper and lower £6 0 0 plus charge for extraction (maximum charge 10s.). Do. do. do. (Maternity Cases) £4 0 0. Partial Dentures—extractions not included £1 for first two teeth. 5s. each subsequent tooth. School Children resident in Shoreditch Is. per visit. Repairs to be charged according to work involved. Half rates only are charged to patients under 21 years of age. Residents of the Borough who state that they are unable to afford to pay in accordance with the above scale are asked to complete a form stating the number in family and the income. After verification by the Enquiry Officer this statement , is used to fix the proportion of the full charge to be paid, The remissions being 25, 50, 75 and 100 per cent, in accordance with the following income limits approved by the Council:— No., in family: No. charge to be made. To pay 25% of maximum. To pay 50% of maximum. To pay 75% of maximum. s. d. s. d. s. d. s. d. 1 13 0 15 0 17 0 20 0 2 10 6 12 6 14 0 18 0 3 Income 8 6 10 0 12 0 16 0 4 per 7 6 8 6 10 6 14 0 5 head 7 0 8 0 9 6 12 0 6 after 6 6 7 6 8 6 10 0 7 deducting 6 6 7 6 8 6 10 0 8 rent, 6 6 7 6 8 6 10 0 9 not 6 6 7 6 8 6 10 0 10 more 6 6 7 6 8 6 10 0 11 than 6 6 7 6 8 6 10 0 12 6 6 7 6 8 6 10 0 1 44 There was a gratifying increase in the attendances during the year that is evidence both of the need for and the good repute of this institution. Neglected teeth are a most frequent cause of chronic ill-health which is brought about partly by the continued absorption into the system of poisons from decayed teeth and inflamed root sockets and partly by the derangement of the digestive functions that result from a septic mouth. The duty of taking care of the teeth is not discharged simply by going to the dental surgeon when pain becomes unbearable, for by that time much harm to the general health has been done and the opportunity of saving the teeth has often been lost. Children should be taken regularly to the dental surgeon from their earliest years. At these visits he is able to correct tendencies, likely, if uncorrected, to cause serious later trouble. Adults also should form the habit of having their teeth regularly inspected, or, if this appears to be a counsel of perfection, they should at least always give prompt attention to the slightest warning of dental trouble. The Hospital was maintained during 1928 on a half:time basis, five sessioi.s being held weekly and to these sessions an alternate Monday afternoon was added during the year. Since the end of the year under consideration, however, arrangements have been made for making the hospital full time. Particulars of these arrangements will be dealt with in the next annual report in which it is expected to be able to record a still further extension of the usefulness of the institution. PUBLIC HEALTH (LONDON) ACT, 1891. SUMMARY OF PROCEEDINGS DURING 1928. TABLE VII. PREMISES. NUMBER OF PLACES— Number of inspections, 1928. Number of notices, 1928. Number of prosecutions 1928. On register at end of 1927. Added in 1928. Removed in 1928. On register at end of 1928. Milk premises 280 10 2 288 1,246 16 ... Cowsheds 2 ... ... 2 26 ... ... Slaughterhouses 1 ... 1 1 17 ... ... Offensive trade premises 24 ... ... 24 91 7 ... Ice Cream premises 126 26 14 138 337 10 ... Houses let in lodgings 303 296 ... 296 1,034 188 4 Restaurants and eating houses ... ... ... 190 510 4 ... Number of intimation notices served for all purposes 6,357 Underground Rooms— Number illegally occupied A large muni A large number Number closed or illegal occupation discontinue 2 1 45 Overcrowding:— Number of cases of overcrowding found 227 Number remedied 146 Number of prosecutions Smoke Nuisances:— Number of observations 27 Number of intimations served 3 Number of Statutory notices served Number of complaints received 5 Number of legal proceedings Number of convictions Amount of penalty and costs imposed in each case Cleansing and Disinfection:— Number of adults cleansed 4 Number of children cleansed 6 Number of premises cleansed:— (a) After infectious diseases 1,191 (b) for vermin 185 Water Supply to Tenement Houses:— Number of premises supplied 7 Number of prosecutions London County Council (General Powers Act), 1904:— Number of premises dealt with under Section 20 185 The intimations as to insanitary conditions which as stated were served in respect of 6,357 premises were dealt with by the Sanitary Inspectors as follows:— By Inspector Wright 678, Inspector Chapman 496, Inspector Sickelmore 600, Inspector Thomas 410, Inspector Shaw 514, Inspector Molloy 430, Inspector Bishop 652, Inspector Girling 534, Inspector Stratton 491, Inspector Grant 510, Inspector Walker 632, and by Inspector Gibbs 410. In connection with the Inspectors' Sanitary work some 1,910 letters were written to owners and others concerned. The Sanitary Inspectors made 50,337 visits. Of these visits 10,265 were in connection with dwellings and 2,123 with workshops. Visits made in connection with factories, laundries, bakehouses, cowsheds and milk vendors' premises, ice-cream shops, slaughterhouses and other places where food is prepared and sold, together with some 587 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 totals given above. Statutory notices under the Public Health (London) Act, 1891, were served by order of the Sanitary Authority upon the parties responsible for the abatement of nuisances in 1,333 instances. For non-compliance with the requirements of the Sanitary Authority proceedings were taken before the Magistrate in 64 instances, D 1 46 Summary compiled from the Abstracts of the work of the Sanitary Inspectors by the Senior Inspector, for the Year 1928. Insp. Wright. Insp. Chapman. I nsp. Sickelmore. Insp. Thomas. I nsp. Shaw. Insp. Molloy. Insp. Bishop. I nsp. Girling. Insp. Stratton. Insp. Grant. Insp. Walker. I nsp. Gibbs. Totals. Premises cleansed throughout 24 49 19 23 2 2 10 36 5 73 8 3 255 ,, ,, partially 243 258 210 208 250 191 298 183 242 228 343 296 2,950 ,, ,, total rooms 608 764 645 549 526 461 759 451 630 843 1198 494 7,928 ,, ,, verminous tooms 9 10 15 8 54 2 19 27 14 62 56 34 310 ,, ,, verminous premises 9 5 15 6 20 2 19 11 7 38 41 12 185 Premises generally repaired—Walls, floors, sashes, &c. 392 167 368 302 484 220 367 301 338 332 491 231 3,993 Light and ventilation improved ... ... 16 ... 1 ... 1 ... 2 ... 6 ... 26 Roofs, guttering, rain water pipes improved or repaired 269 129 343 251 280 177 284 189 238 155 349 173 2,837 Overcrowding dealt with 8 7 10 16 19 11 75 8 21 20 32 ... 227 Water reinstated or improved 4 8 36 2 3 5 1 ... 5 5 8 ... 77 Drains newly constructed 1 7 9 ... ... 1 2 8 1 10 4 ... 43 ,, re-constructed 4 6 3 4 12 9 3 4 7 7 3 ... 62 ,, improved or repaired 21 7 64 55 49 40 10 5 15 10 18 6 300 ,, obstructions removed 25 20 35 32 35 14 11 22 21 22 41 3 281 Soil and vent pipes—Improved or repaired 3 2 8 4 2 2 11 1 1 4 ... 1 39 Water closets—Newly constructed 6 40 69 1 2 ... 14 22 6 9 70 ... 239 ,, improved or repaired 110 71 267 97 77 92 72 115 82 87 20 44 1,134 ,, obstructions removed 16 8 41 39 18 14 23 30 29 14 42 8 282 Sinks, etc., improved, cleansed or repaired 14 31 7 9 12 7 12 28 10 12 22 6 170 Sinks, etc., traps provided 2 3 5 ... 1 ... 1 1 ... 4 ... ... 17 Outdoor premises— Floors or paving repaired 45 6 73 49 26 17 58 10 39 27 16 31 437 Cleansed or limewashed 48 55 102 77 36 2 215 1 62 224 222 140 1,184 Improved or repaired ... ... ... ... ... ... ... ... ... ... ... ... ... Ash-pits—Dust-bins provided 66 38 65 24 67 57 74 21 57 28 64 58 619 improved or repaired ... 1 3 ... 1 1 ... ... ... 1 1 1 9 abolished ... 1 ... ... 3 ... 6 ... ... 4 2 ... 16 1 Accumulations removed 11 16 14 5 7 5 13 1 2 16 12 2 114 Urinals cleansed or repaired ... ... ... ... 2 ... 1 ... ... ... ... ... 3 Animals removed 4 ... 2 ... 1 ... 2 ... ... 4 1 ... 11 The following table prepared by the Senior Inspector summarises the work of the Sanitary Inspectors during 1928, 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:— 1 47 The following is a summary of legal proceedings taken during 1928:— SUMMARY OF LEGAL PROCEEDINGS DURING 1928. PUBLIC HEALTH (LONDON) ACT, 1891. In 1 instance a summons was withdrawn on the work being done. Costs, amounting to 10s. 6d. were allowed to the Borough Council. Nuisance orders were made in 21 instances, costs amounting to £22 lis. 6d. being ordered to be paid to the Council. In 30 instances the Statutory Notices were complied with before the cases came on for hearing £20 Is. Od. being ordered to be paid to the Council. In one instance, for non-compliance with Statutory Notice, the defendant was fined £2, and ordered to pay £5 5s. Od. costs, in another the defendant was fined £2 and ordered to pay £1 Is. Od. costs, in two instances Prohibition Orders were made, and in one instance the summons was dismissed. In two instances, for non-compliance with the Magistrate's Order the defendants were ordered to pay £3 3s. Od. and £1 Is. Od. costs, respectively. BREACHES OF LONDON COUNTY COUNCIL BYE-LAWS. There were four prosecutions. In three instances the defendants were ordered to pay costs amounting to £1 Is. Od., 10s. 6d., and 2s. Od., respectively ; and in one instance defendant was fined £1 0s. Od., and ordered to pay £1 Is. Od. costs. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1927. In one instance defendant was fined 2s. and ordered to pay £2 2s. Od. costs. SMOKE NUISANCES. There were five communications from the London County Council referring to the emission of black smoke. These were duly brought to the notice of the parties responsible. Some 27 observations were made by the Sanitary Inspectors and in three instances intimations were given to the Offenders. These were effective, and there was no necessity for further action on the part of the Sanitary Authorities. FUR SKIN DRESSERS. At the end of the year there were two on the Register. They were regularly inspected and some 9 visits were made in connection with them. Two Intimation Notices were served on account of lime-washing which were duly complied with. D 2 48 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 82 visits of inspection were made in connection with them, and in 5 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 185, and in connection with them some 227 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 111 children, 41 boys and 70 girls, notified as verminous by the School Medical Officer, were reported with a view to the homes, bedding, etc., where necessary, being dealt with by the Sanitary Authority, whilst the children were cleaned and their clothing disinfected at the cleansing stations of the London County Council in the neighbourhood. Intimations were received that 16 boys and 22 girls had been given the opportunity of being cleansed at the cleansing stations, that in the case of 22 boys and 39 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 3 boys and 9 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 7 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 94 the rooms occupied were satisfactory, varying from fairly clean to very clean, in 7 they were dirty, and in 3 also buggy. In 100 the bedding was clean or fairly so, in 4 it was dirty, overcrowding was noticed in two instances. In 4 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 one Sanitary Notice was served upon the owner for cleansing. The children reported by the School Authorities as suffering from scabies numbered 57, of whom 28 were females. As a result of the enquiries made by the Sanitary Inspectors seven other cases came under observation. As far as practicable steps were taken to prevent infection spreading. 49 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 1928:— Number of complaints in hand 1st January, 1928 240 ,, complaints (rats) during the year ending December 31st, 1928 321 ,, complaints (mice) during the year ending December 31st, 1928 119 680 ,, visit and re-visits 5,123 ,, rats caught in traps or killed by dogs 1,450 ,, rats found dead through poisoning 640 „ premises cleared of rats 350 ,, premises cleared of mice 70 ,, pavements taken up, fronting houses 58 ,, drains tested by Sanitary Inspectors 60 ,, reconstructed or repaired 30 ,, floors of kitchens, sculleries, passages and coal cellars concreted 78 ,, letters to owners and agents 30 Amount of Rat-quit used 1,661 packets. ,, Rodine used 2,137 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. 1924 295 46 1925 268 32 1926 354 73 1927 326 99 1928 321 119 HOUSING. Reference has been made in previous reports to the house-to-house inspection carried out by the Sanitary Inspectors in accordance with the instructions of the Health Committee. This has been continued throughout the year according to plan. 50 Statistics for the Year 1928, are as follows:- Number of new houses erected during the year:- (a) Total (including numbers given separately under (b)) 72 (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) 10,265 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation - 2.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers - 3.—Action under Statutory Powers. A. Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit— (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 notices served requiring defects to be remedied (intimation 6,357 (statutory 1,216 (2) Number of houses repaired or nuisances remedied under P. H. Acts, 1891— (a) by owners 6,357 (b) by Local Authority in default of owners - 51 C. Proceedings under Sections 11, 14, 15 and 18 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (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 pur- j suance of Demolition Orders Number of houses repaired under Section 3 of Housing Act, 1925— (a) By Owners Nil. (b) By Local Authority in default of owners Nil. Number of houses closed on notice by owner that they could not be made fit Nil. Number of houses for the working classes— (a) Erected during year 70 (b) In course of erection 32 Number of houses demolished— (a) In pursuance of Orders - (b) Voluntarily - Total number of houses in the borough 14,031 Number of houses occupied by the working classes 13,131 The number of intimation notices served during the year requiring nuisances to be remedied was 6,357, and in 1,216 it became necessary to follow them up with statutory notices. It will be noted from the foregoing that in the majority of cases the necessary work was done upon receipt of an intimation notice. Of the 72 new houses erected during the year 66 were completed tenements on the area included in the London County Council Ware Street Housing Scheme. The erection of 32 further tenements was commenced during the year. No representations, closing orders or demolition orders were made during the year. No dwelling houses were voluntarily demolished. The estimated total number of houses in the Borough at the end of the year under consideration was 14,031, 13,131 being occupied by the working classes. 52 The work of improving the lighting of the staircases of the tenement buildings in the Borough in accordance with Section 61 of the London County Council (General Powers) Act, 1927, was continued during the year, and in 15 instances alterations have been carried out to meet the requirements of the Health Committee. At the end of the year the lighting of these staircases was still unsatisfactory in one instance. The houses let in lodgings on the register at the end of the year numbered 296. Of the 188 intimation notices relating to these houses 100 were complied with, and in 88 cases a statutory notice became necessary. Four applications were made under the Rent and Mortgage Interest (Restriction) Acts, 1920-23, for certificates to the effect that dwellings were not in all respects reasonably fit for habitation. All were granted. From the point of view of health the housing conditions of the people of Shoreditch constitute the most unsatisfactory feature in the life of the Borough. As already stated the density of the population as a whole is 151 to the acre. This, however, includes the relatively sparsely populated southern portion of the Borough. In the Whitmore Ward, for example, the density of the population is 210 to the acre. The density of dwelling houses over the whole Borough is in the neighbourhood of 20 to the acre, but this figure also is considerably higher in the residential areas. Of the evils of overcrowding of which these figures are the statistical summary, everything is known and little remains to be said. Neither the health of the body nor the health of the mind can prosper under conditions of serious overcrowding. In reporting cases of overcrowding to the Health Committee it has been the practice to state the amount of cubic space available per head. This method, which has the advantage of endeavouring to secure an adequate supply of fresh air, nevertheless leaves out of account a most important aspect of the problem, and one which may have quite as far reaching ill effects as those produced by living and sleeping in badly ventilated rooms. Consideration of reports upon cases of overcrowding has frequently made it apparent that the number of rooms at the disposal of families including young girls and youths does not make it possible for the sexes to have separate sleeping accommodation. To turn from the evil to its remedy ; it has been reported on page 45 that out of 227 cases of overcrowding brought to the notice of the Department 146 have been remedied. The London County Council give preferential consideration for accommodation on their housing estates to applicants who are recommended on health grounds, and in cases of special hardship, and many cases of overcrowding have been dealt with in this way. 53 This remedy, however, is only open to those who can afford both the new rent and the additional cost of travel from their new homes to their place of employment, and is of limited application. In regard to a large proportion of the overcrowding that obtains in this Borough there does not appear, in the absence of fresh legislation, to be any solution. Owing to the fact referred to at the beginning of this report that dwelling houses are steadily being replaced by business premises, the situation is getting worse rather than better, and it is impossible for overcrowded families to find alternative accommodation within the Borough. The Council have had this aspect of the problem under consideration, and in December of the year under consideration passed a resolution recommending that representations should be made to His Majesty's Government with a view to legislation being introduced to prevent the conversion of dwelling houses into workshops. Powers similar to those asked for were contained in the Housing (Additional Powers) Act, 1919, Section 6, but were not included in the 1925 Consolidated Act. If building schemes within the Borough are considered, the two difficulties that at once arise are of building at a rent that can be afforded by those who are now overcrowded and to devise a scheme in such a congested area that will rehouse even as many persons as those dehoused in clearing the site. In considering the difficulty, referred to above, of those who are prevented from moving to the outer ring by the fact that they cannot afford the additional cost of travel to and from work, reference should be made to an interesting resolution passed by the Council during the year. In this resolution the Minister of Health was asked to consider the practicability of a scheme for providing facilities for free or assisted travel between house and place of enployment to those recommended or such assistance by the Sanitary Authority in whose area they reside. That the vital statistics of the Borough are so satisfactory as they are in spite of the congestion of the population is a tribute to the sanitary habits and life of the people and to the efficacy of the work done, by means of constant inspection, in keeping their houses in habitable repair. One further matter may be referred to while considering this question of overcrowding. Cases not infrequently come to notice in which parents living already under badly overcrowded conditions continue to have children, often unwanted children, for whom there is little or no prospect of a healthy environment, and who, in fact, will make worse, conditions already bad. It is hoped that the time is not far distant when public opinion will favour the inclusion of wise advice upon birth control, and the spacing of children in public health propaganda. This could, if 54 the approval of the Ministry of Health were obtained, suitably be done through the medium of Maternity and Child Welfare work, The advice might also be profitably given in certain cases to those attending tuberculosis and venerea! disease clinics. FACTORY AND WORKSHOP ACT, 1901. Factories are dealt with by H.M. Inspectors of Factories and Workshops bv the Officers of the Borough Council. Certain sanitary defects, however occurring in factories are only remediable under the Public Health Act, and are referred by H.M. Inspectors to the Health Department. The number of workshops, exclusive of bakehouses, on the register at the end of the year was 1,622. The number added to the register was 163, the number removed 172. A classification of the workshops on the register at the end of the year is contained in the following table :— Registered Workshops—1928. Workshops on the Register (s. 131) at the end of the year. Number. (1) 1 (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades. 1,110 (a) Cabinet making 644 (b) French polishing 162 (c) Upholstery 114 (d) Other workers 190 (2) Dress 1S7 (a) Tailoring 80 (e) Shirt making 1 (b) Mantles 10 (f) Boot and shoe trades 31 (c) Dress 13 (g) Artificial flowers 1 (d) Millinery 16 (h) Other workers 35 (3) Skin, leather, hair and feather trades 50 (a) Furriers 16 (b) Saddlery and Harness 13 (c) Feathers — (d) Other workers 21 (4) Paper, printing, book, stationery and fancy goods trades 65 (a) Box and bag makers 42 (b) Other workers 23 (5) Laundry and washing 7 (6) Food 9 (7) Metals, machines, implements and conveyances 44 (8) Precious metals, jewels, &c. 1 (9) Other trades than those mentioned above 149 Total number of workshops on Register 1,622 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 59, including 35 factory bakehouses. 55 The particulars of inspections made by the Sanitary Inspectors are as follows:- Premises. Inspections. Number of Written Notices. Prosecutions. (1) (2) (3) (4) Factories 541 97 ... Workshops (Including Factory Laundries) 2,123 254 ... (Including Workshop Laundries Workplaces 1,126 65 (Excluding Outworkers' premises dealt with in Table III.) Totals 3,790 416 ... The defects found and dealt with were as follows:- Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts :* Want of cleanliness 117 117 ... ... Want of ventilation 1 1 ... ... Overcrowding 1 1 ... ... Want of drainage of floors ... ... ... ... Other nuisances 339 339 ... ... Sanitary accommodation insufficient ... ... ... ... unsuitable or defective 183 183 ... ... not separate for sexes ... ... ... ... Offences under the Factory and Workshop Act: Illegal occupation of underground bakehouse (Section 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (Sections 97 to 100) ... ... ... ... Other offences ... ... ... ... (Excluding offences relating to outwork which are included in Part 3 of this Report.) Totals 641 641 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts 56 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act Nil. (s. 133). Action taken in matters re- Notified by H.M. Inspector ... 541 ] 2 factories and | ferred by H.M. Inspector j \42 workshops./ as remediable under the f Public Health Acts, but i ✓ referring to \ not under the Factory ] Reports (of action taken) sent to 5 I 12 factories and 1 and Workshops Act (s. 5.) H.M. Inspector. V42 workshops./ Other 5 Underground Bakehouses (s. 101):- Certificates granted during the year Nil. In use at the end of the year 35 During the year 354 Sanitary Notices were served upon as many workshops. The following is an abstract of the sanitary work carried out in compliance with these notices:- Premises cleansed throughout 60 Soil and vent pipes dealt with 6 Premises cleansed partially 57 Water-closets newly constructed 13 Number of rooms cleansed 209 Water-closets repaired, etc. 166 Walls, floors, sashes, etc., re- Water-closets obstructions repaired 65 moved 17 Light and ventilation improved 1 Sinks, etc., cleansed and reRoofs, guttering, etc., repaired 116 paired 7 Overcrowding abated 1 Sink traps provided 3 Water reinstated or improved 1 Sculleries, yards, etc., paving reDrains newly constructed 6 paired 9 Drains reconstructed 1 Sculleries, yards, etc., cleansed Drains repaired, etc 11 or limewashed 58 Drains obstructions removed ... 13 Dust receptacles provided ... 13 Urinals cleansed, etc. ... ... 4 Foul accumulations removed ... 13 The number of factories under observation for insanitary conditions during the year was 97, and in connection with them some 97 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 60 instances, the removal of obstructions from drains and waterclosets in 63 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. HOME WORK. During the year 79 lists of out-workers were received from employers in the Borough, 40 in the first and 39 in the second half-year. Those for the first half-year are due in February, for the second in August. These lists contained the names 57 918 out-workers, of whom 085 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the sanitary authorities of the districts to which thej- belonged. The following is a summary of the lists received from employers in the Borough : 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. Orders made. (S. 109.) Prosecutions. (S. 109, 110.1 Twice in the Year. Once in the Year. Failing to keep or permit inspection of Failing to send Lists. Instances. Notices served. Prosecutions. Instances. 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. 50 46 605 4 ... 15 ... ... ... 28 28 ... 3 ... ... (2) Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 2 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers 4 ... 57 ... ... ... ... ... ... 4 4 ... 1 ... ... Fur pulling 2 ... 8 ... ... ... ... ... ... 3 3 ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... 6 6 ... 1 ... ... Paper bags and boxes 16 ... 180 1 ... 3 ... ... ... 32 32 ... 6 ... ... Brush making ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... Xmas Crackers ... ... ... ... ... ... ... ... ... 3 3 ... ... ... ... Totals 74 46 854 5 ... 18 ... ... ... 77 77 ... 12 ... ... (a) There were no names and addresses of outworkers received in respect to the following classes of work :—Sacks, basket making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors and grapnels, cart gear, locks, latches and keys, pea picking, household linen, lace, lace curtains and nets, curtains and furniture hangings, brass and brass articles, tents, feather sorting, and carding, &c., of buttons. (b) The figures in columns 2, 3 and 4 are the total number of lists received from employers who sent them both for February and August, and of the entries of names of outworkers in those lists. They are therefore double the number of employers and approximately double the number of individual workers whose names are given, since in the February and August lists of the same employers, the same outworker's name will often be repeated. 58 Communications were received from various sanitary authorities relating to some 1,489 outworkers for firms outside Shoreditch and as 21 of these were residents in other Boroughs, their addresses were forwarded to the authorities concerned. The following table shows the numbers of addresses of outworkers received from the sanitary authorities referred to during 1928. Showing the Numbers of Outworkers Received from other Districts during 1928. DISTRICTS. Making Wearing Apparel. Confectionery Packing. Artificial Flowers. Furniture and Upholsterv. Fur Pulling. Feather Sorting. Umbrellas, &c. Paper bags and Boxes. Brush Making. Fancy Leather Goods. Card Mounting. 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. Feb. Aug. Battersea ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Bethnal Green 49 48 ... ... ... ... ... ... l ... ... ... 1 ... 34 26 10 10 ... ... ... ... l 1 181 Camberwell 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 City of London 210 199 ... ... 10 9 2 ... 5 2 ... ... 31 29 1 ... ... ... 3 ... ... ... l ... 505 Chelsea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 5 7 Enfield 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Finsbury 66 68 ... ... 3 16 ... 1 7 8 ... ... 8 2 65 31 ... ... ... 1 ... ... 17 15 318 Hackney 123 79 ... 2 3 3 ... ... 1 1 ... ... ... ... 17 30 3 7 1 ... ... ... 9 3 282 Hammersmith 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Holborn 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Hornsey 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Poplar ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Islington 13 17 ... ... ... 6 ... 1 ... 1 ... ... ... ... ... 11 2 ... ... ... ... ... 4 4 73 Kingston 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Kensington ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Leyton 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 5 Lambeth ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Southwark ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 St. Marvlebone 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Stepney 7 10 ... ... ... ... ... ... ... ... ... ... ... ... 6 4 ... ... ... ... ... ... ... ... 27 St. Pancras ... 4 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Stoke Newington 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 11 Tottenham ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Wandsworth ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Westminster 17 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 34 503 472 ... 2 18 34 4 3 14 16 ... 2 40 31 135 103 15 18 4 3 ... 6 36 30 Totals 97 5 2 52 7 30 2 71 238 33 7 6 66 1,489 50 The total number of out-workers reported was 2,407, and of these some 1,701 were residents in Shoreditch. These figures are below the average for the past I've years, and show a decrease as compared with those for 1927. As pointed out in previous reports, in numerous instances names and addresses of out-workers are duplicated owing to lists being sent in twice a year, and in some cases the same out-workers are employed by more than one firm, so that the numbers given above must not be taken as representing the actual numbers of individual out-workers. Tables are appended showing the distribution of out-workers as regards trades in the Borough. Most of them are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags and boxes, umbrellas, toys and crackers. Some 821 visits of inspection were made to places where home-work was being carried on, and in connection with these 77 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 12 and included 1 smallpox, 5 of scarlet fever, 3 diphtheria, 1 erysipelas and 2 pneumonia. The usual steps were taken in connection with them by the officers of the sanitary authority. MATERNITY AND CHILD WELFARE, 1928. REPORT BY DR. JAMES FANNING, ASSISTANT MEDICAL OFFICER OF HEALTH. The notified live births numbered 1,956, and there were in addition 54 still births. Of the notifications 1,149 were received from registered midwives practising in the Borough. The live births notified during the year were approximately 93.5 per cent. of the number registered during the year. For the purpose of Maternity and Child Welfare, the Borough is divided into seven Health Visitors' areas, the administrative centre being at the Town Hall. Six of these areas are allocated to the six Health Visitors employed by the Borough Council, and the remaining one to two Health Visitors employed by The School for Mothers, a voluntary organisation working in conjunction with the Town Hall. It may be said that the foundation of a scheme for Maternity and Child Welfare consists of two main activities, home visiting and the clinic, and to each of these the Health Visitors give approximately half their time. Furthermore, the number of attendances at the clinics are to a great extent dependent on the amount of home visiting done. The chief centre of clinic activity is the Carnegie Model Welfare Centre, 210, Kingsland Road, but clinics are also held in other parts of the Borough. The clinical medical staff consists of the full-time Assistant Medical Officer of Health and four part-time medical officers. In addition, two part-time medical officers are employed by the School for Mothers. The following is a list of the various consultation centres in being during the past year:- Model Welfare Centre Infant Welfare Consulta- Monday-Friday daily, tion 2 p.m. Model Welfare Centre Toddlers' Clinic Wednesday, 10.30 a.m. 60 Model Welfare Centre Ante-natal Consultation Friday, 10.30 a.m. Hoxton Hall Infant Welfare Consulta- Tuesday, 2 p.m. tion. Hoxton Market Mission Infant Welfare Consulta- Monday, 2 p.m. tion. Wednesday, 2 p.m. Harbour Lights (Goldsmith Infant Welfare Consulta- Friday, 2 p.m. Row). tion (two doctors). School for Mothers Infant Welfare Consulta- Tuesday, 10 a.m. tion. School for Mothers Infant Welfare Consulta- Thursday, 10 a.m. tion. School for Mothers Ante-natal Consultation Thursday, 10 a.m. In addition ultra-violet light clinics arc held on Mondays, Tuesdays, Wednesdays and Fridays.* A doctor and at least one Health Visitor are in attendance at each infant welfare consultation, and invaluable help is rendered by voluntary workers, to whom we are extremely grateful for their assistance during the year. The total number of attendances of voluntary workers during the year was 1,101. The total attendances at the various clinics numbered 47,154 as compared with 45,421 during the previous year. Although the figures show an increase, the rate of increase has not been so great as in previous years, the inference being that the more resistant section of the population now remains to be tapped. The total number of children under 5 resident in the Borough is estimated to be approximately 11,000. The attendance of children over 1 year still remains comparatively poor, and it is proposed to launch an intensive effort to persuade mothers to bring this very important group under medical supervision. As the result of an investigation held during the year, details of which are given at the end of this section, it was found that approximately 75 per cent. of Shoreditch mothers are confined in their own homes, and in this connection it is worthy of note that in every year of the past decennium the mortality rate for puerperal sepsis in Shoreditch has been below that of London as a whole, and in some years considerably so. Why this should be so under such conditions of overcrowding and poverty it is difficult to say with certainty, but it is significant to note in this connection that a comparatively large proportion (about 77 per cent.) of Shoreditch mothers have had ante-natal examination, and that the majority of cases of puerperal sepsis can be directly attributed to trauma or other causes which are to a large extent preventable. The number of mothers and children on free milk has remained approximately the same as in the previous year, and inestimable advantages have been derived from it. Dinners have been supplied to nursing and expectant mothers at the See Report on Light Clinic, page 74. 61 Model Welfare Centre and 31, Herbert Street daily, except Saturdays and Sundays, on which days milk is substituted. The numbers attending daily have averaged 21.8 at the former Centre, and at the latter 32.4. The dinners are extremely valuable for the purpose for which they arc intended, but there is still considerable scope for their extension, many preferring to have the pint of milk at home. MODEL WELFARE CENTRE—OBSERVATION WARDS. The Babies' Wards at the Model Welfare Centre have been in constant use, the demand for cots always exceeding the number at our disposal. The nursing staff comprises a Matron (Miss Borrow), a Sister, two staff nurses and four probationers. The usual period for which a probationer holds her appointment is one year, at the end of which she undergoes an examination, and, if proficient, a certificate is given her by the Maternity and Child Welfare Committee. Staff nurses Bcale and McDowell were appointed in April and October respectively to fill vacancies caused by resignations. Probationers Palin, Taylor, Blakely and Ball were appointed during the year. Statistical summary relating to children admitted :— Number of cases in the wards on January 1st, 1928 9 babies. Number of cases admitted 39 babies, 3 mothers. Average duration of stay 12½ weeks. Reasons for admission— Wasting 12 Malnutrition 6 Vomiting ... 2 Rickets 1 Prematurity 1 Weaning 2 For establishment of breast feeding ... 15 All those discharged were either normal or very much improved. There was no case of infectious disease during the year. In one case a mother and baby were transferred to a fever hospital for suspected scarlet fever, but the diagnosis was not confirmed, and they were re-admitted later. There was 1 death on May 31st after 9 weeks' residence from marasmus and peritonitis. One baby was diagnosed as suffering from tuberculous peritonitis and was transferred to the Queen's Hospital for children, where it died a week later following operation, the diagnosis being confirmed. This case was particularly interesting as the child was only 6 months old and had been breast fed from birth. Unfortunately, it has not been possible to persuade the mother to undergo examination. The attendance at the Wednesday morning Toddlers' Clinic, which was commenced as an experiment in February, 1927, has averaged 11 per session, and shows no sign of increasing, so that it is proposed to discontinue it in the near future. E 62 The mothers have so little time to spare that they prefer to bring their toddlers to the ordinary afternoon clinics with the younger babies. The Sewing Class conducted by the Health Visitors on Wednesday afternoons had an average attendance of 20. A special clinic is held for mothers and children at the Municipal Dental Hospital on Thursdays at 10.30 a.m., and the attendances totalled 1,101 as compared with 682 in the previous year. During the year assistance was given by the Borough Council toward the cost of maintenance of 30 children at Convalescent Homes. This is more than twice as many as in previous years. In 28 cases convalescence was arranged through the Shoreditch Branch of the Invalid Children's Aid Association, in 1, through the Metropolitan Hospital, and in 1, through the Association of Infant Welfare Centres. In addition 9 cases were brought to the notice of the Guardians as being suitable for convalescence. This opportunity is taken of drawing special attention to the great power for good that these Convalescent Homes exert for a Borough such as this. The results are in many cases nothing short of marvellous. Children for whom everything else has been tried return after 2 months improved out of all knowledge. Unfortunately, most of the approved homes will not accept unvaccinated children, so that many of the children who would benefit from a stay in the country or at the seaside are denied this privilege. Frequently, also, difficulty is met with in the case of parents who refuse to part with their children even for a short period. The question of health education in connection with Maternity and Child Welfare has been considered during the year. The value of talks or lectures cannot, of course, be compared with that of the advice given individually by the doctor or health visitor, but they are probably a useful adjunct to the activities of a centre. A few talks to mothers were arranged during the year, but it was found extraordinarily difficult to persuade mothers to wait for these set lectures at the clinics or to come for them in the evenings. Even when a lecturer of repute came to speak, the response was usually very poor. The explanation probably lies in the fact that the great majority of women of this Borough have practically no leisure, and their lives are spent hurrying from one essential duty to another. Meetings for fathers, consisting of a health talk and discussion, at which cinema films were shown, were held frequently during the year. These were a little better attended, but here again interest was difficult to rouse. As in previous years difficulty was experienced in getting mothers to come in for the establishment of breast feeding, owing to other calls on their time. It is hoped in the near future to develop a clinic at which in certain cases mothers will be able to leave their babies during the day and attend for instruction in breast feeding. The following are typical examples of the cases admitted during the year :— Case 1.—D.V. 3. Age 3 months. An under-sized, marasmic baby weighing 7 lb. 12 oz. Fed on dried milk mixture before admission. Stools were loose and offensive. Was put on lactic acid whole milk and made good 63 progress. Feeds were changed to a humanized dried milk mixture before discharge, and he was discharged after 3 months weighing 10 lb. 12 oz. Case 2.—A. 3. Age 4½ months. Weight 8 lb. 13 oz. Had gained practically no weight since birth. Had been fed partly on breast and partly on dried milk. On admission mother had no breast milk and was unable to come in with the child on account of family cares. Failed to gain on modified dried milk. Put on modified cow's milk (peptonized 1 hour) with no added fat. Increased to full strength peptonized cow's milk. Put on lactic acid skimmed cow's milk owing to attack of diarrhoea. Then whole lactic acid milk and finally modified dried milk. Discharged after 3 months having gained 3 lb. 3 oz. Case 3.—C.J.C. Aged 3 weeks. Weight 4½ lbs. A premature baby. Mother attended for feeding. At first took only 2½ oz. breast milk daily. Discharged nine weeks later, fully breast fed, weighing 6 lb. 4 oz. Case 4.—B.S. Age 1 year 4 months. Weight 15 lb. Extremely emaciated on admission, with slight bronchitis. During the month previous to admission he had been in hospital with bronchitis, and had lost 6 lb. With careful dieting he made good progress and was discharged after two months weighing 21 lb. 7 oz. Incidentally, progress was well maintained after discharge. Case 5.—C.A.K. Age 6 weeks. A small baby which was still below its birth weight on admission. Admitted with mother, who had only 4 oz. breast milk daily. Discharged after two months fully breast fed. The cases nursed under the arrangement with the District Nursing Association numbered 102 children under five years. The total number of visits to children under five was 1,218. Measles, pneumonia, pemphigus, impetigo and ophthalmia neonatorum furnished the majority of the cases under five years. Further particulars are given in the Nursing list (page 30). The following figures, obtained through the courtesy of the L.C.C. School Medical Staff are of great interest. They relate to the physical condition of Shoreditch children entering the schools in 1928 :— SCHOOL ENTRANTS, 1928. Boys. Girls. Total. Number of Entrants 1,112 890 2,002 Number with defects (other than dental) requiring treatment 165 155 320 Number with dental defects requiring treatment ... 241 185 426 Number with defects (other than dental) not requiring treatment ... 91 59 150 Number with dental defects not requiring treatment 7 4 11 e2 64 It will thus be seen that in spite of all that has been done to safeguard the health of the young child a great deal of work still remains, and the efficiency of that work as it affects the pre-school child will be reflected in an improvement in years to come on figures such as those given above. REPORT ON MATERNAL CARE IN SHOREDITCH. In view of the continued high rate of maternal mortality which is general all over the country, it has been considered advisable to review the position as it exists in Shoreditch with particular reference to the facilities existing for maternal cartbefore, during, and after confinement. For this purpose, a series of 1,000 consecutive confinements occurring in the Borough during 1928 has been investigated, and the information gathered is set out in this memorandum. The following table shows the maternal mortality rates of Shoreditch during recent years compared with those of England and Wales, and London. Those due to puerperal fever are shown separately from those due to other diseases and accidents associated with child birth, but it should be remembered that many cases of puerperal fever have their origin in the " accidents " of childbirth :—- Year. England and Wales. London. Shoreditch. Deaths from Sepsis, per 1,000 live births. Deaths from other diseases and accidents of Pregnancy. Total. Deaths from Sepsis, per 1,000 live births. Deaths from other diseases and accidents of Pregnancy. Total. Deaths from Sepsis, per 1,000 live births. Deaths from other diseases and accidents of Pregnancy. Total. 1927 1.56 2.54 4.10 1.31 1.59 2.90 0.91 0.47 1.38 1926 1.60 2.52 4.12 1.61 1.74 3.35 149 1.2 2.4 1925 1.56 2.52 4.08 1.42 1.77 3.19 0.76 2.24 3.04 1924 1.39 2.51 3.90 1.24 1.84 3.08 0.39 3.2 3.59 1923 1.30 2.51 3.81 1.37 1.52 2.89 0.0 1.41 1.41 1922 1.38 2.43 3.81 1.36 1.48 2.84 1.02 1.0 2.0 1921 1.38 2.53 3.91 1.42 1.56 2.98 1.34 1.0 2.0 1920 1.81 2.52 4.33 1.78 1.60 3.38 1.34 0.53 1.83 1919 1.67 2.70 4.37 1.88 1.85 3.73 1.75 2.18 3.93 It will thus be seen that the total maternal mortality rate of Shoreditch is considerably lower than that of England and Wales, and compares very favourably with that of London. Care during Confinement.—The importance of proper education of the doctor and midwife cannot be exaggerated, and has been recognised by the proper authorities. It may be pointed out, however, that childbirth cannot be separated into a watertight compartment and considered as a local condition, but must be considered as interacting with other bodily conditions. The midwife, therefore, with her limited training, cannot be given entire charge of the whole process—the responsibility that the mother shall come through the confinement with her general health unimpaired is too great. It is becoming recognised that the ordinary function of the midwife is 65 the conduct of normal labour followed by nursing care during the puerperium. The following figures show the nature of the attention received by Shoreditch mothers who are confined in their own homes. Of 1,000 cases investigated, 751 or 75.1 per cent. were confined in their own homes :— Cases Confined at Home. Cases. Percentage. Attended by midwife and doctor 19 2.5 Attended by midwife only 495 65.8 Attended by doctor and untrained woman 126 16.8 Attended by student and untrained woman 101 14.9 Of the cases attended by midwives, 226 or 43.9 per cent. were attended by a midwife in private practice. The majority of mothers then, prefer to be confined in their own homes, although in many cases the home conditions are not all that could be desired. This preference does not appear to be due to any lack of institutional facilities, but simply to a dislike to leaving home and family. During the actual labour the children are usually cared for by neighbours, but are quite frequently turned out on the stairs. That these home confinements do not cause a high sepsis rate is shown by the statistics given above, but there is no doubt that in many cases the conditions are unsatisfactory from other points of view. It will be noted that the majority of cases are attended during confinement by a midwife, who usually leaves on the tenth day. The few cases attended by a doctor, in addition to the midwife, represent complicated cases for which help has been sent. A large proportion (31.7 per cent.) of the number confined at home were attended by a doctor or student with an untrained nurse. The attendance of a trained midwife to perform nursing duties is desirable at every confinement, and the British Medical Association has embodied in a national scheme recently submitted to the Ministry of Health a proposal that a doctor should be in attendance during the ante-natal period, the complicated labour, and the post-natal period, and that normal labour should be supervised by the midwife. It is also realised that a high degree of skill and special knowledge must be possessed by doctors undertaking this work. Quite a considerable number of cases (14.9 per cent.) were attended by hospital students. These were all from St. Bartholomew's Hospital, even though Shoreditch lies outside the official boundary of the St. Bartholomew's district. The numbers attended by students appear to be increasing, possibly owing to the fact that claims for payment are often not pressed by the hospitals. Although the attention given appears to be good on the whole, yet the objection mentioned previously remains, and in the case of the hospital student, in particular, it is to be feared that the handywoman is more prominent than she should be. The demand for increased facilities for teaching midwifery is of course reflected in this extension of student work, and while experience for students is very necessary, it would seem desirable that they should be accompanied to their cases by a trained midwife. If the hospitals were to insist on this, it should not be difficult for suitable arrangements to be made. 66 Of the cases attended by midwives (43.9 per cent.) were attended by those in private practice. The ordinary fee appears to be a level one of 21s., with an increase to 30s. or 35s. for a first baby. Special facilities provided by the Borough Council for the care of mothers include :— 1. Agreement with the City of London Hospital for hospital consultation and admission when necessary. 2. Arrangements under the Puerperal Pyrexia and Fever Regulations for the visiting of cases by Consultants. 3. Ante-natal clinics (2) to which post-natal cases may also be sent. 4. Provision of milk or dinners for expectant and nursing mothers. 5. Provision of sterilized maternity dressings free where required. A scheme for the provision of home helps is at present under consideration. Ante-natal Care.—The necessity for ante-natal care of every pregnant woman is becoming now generally recognised. Of the 1,000 cases here under consideration, the following table shows the number receiving ante-natal examination (as distinct from "booking " or interview) :— Cases. Percentage. Number receiving examination from Doctor 452 45.2 Number receiving examination from Midwife only 338 33.8 Number receiving no examination 210 21.0 It will thus be seen that the number receiving no ante-natal attention is considerable, although it is probably lower than the average throughout the country. A great deal of educative work still remains to be done in order to impress women, and in some cases even their doctors, as to the importance of this care. In spite of the fact that many more mothers are now being examined ante-natally. there are really few of these in which the examination is sufficiently complete. Many do not report till the later months, and where the case is in sole charge of a midwife, they are often not encouraged to come till advanced abdominal signs are present. It is of the greatest importance that every pregnant woman should have a general physical examination by a doctor as early as possible. In this way unsuspected disorders such as tuberculosis, heart disease, and many others can be detected, and suitable precautions taken before the strain of pregnancy makes symptoms manifest. This is a work which cannot be undertaken by a midwife, however skilled, and it should be continued with periodic observation and local examination in the later months. There would probably be a certain amount of objection on the part of some midwives to a scheme by which they referred all their cases to an Ante-natal Centre, but there is no doubt that many would welcome it, and it should be possible to arrange times when they could be present with their patients. The following gives an impression of the amount of ante-natal work done by the various bodies working in Shoreditch. 67 Of the 1,000 confinements under consideration the numbers examined ante-natally at the following Centres were :— St. Bartholomew's Hospital 150 Model Welfare Centre, Shoreditch 116 City of London Hospital 124 Salvation Army, Nichols Square 131 Harman Street Mission 64 School for Mothers, Herbert Street 21 Jewish Home, Underwood Street 6 Royal Free Hospital 9 London Hospital 5 Several cases were examined at more than one Centre. A few particulars of their methods of working are given herewith :— St. Bartholomew's Hospital.—Patients are seen as early as possible in pregnancy. When first seen, there is a general and pelvic examination by the doctor. Every case is seen by a consultant at 36 weeks. Primigravidae are seen frequently, but normal multiparae are seen only twice. No routine Wassermann reaction is taken. City of London Hospital.—Patients are advised to come as early as possible, and the history is taken and the urine examined by an experienced midwife. "If necessary" they are seen by a doctor. As a routine, they are told to come at the 7th month, when all are seen by a doctor. They are seen every fortnight after the 7th month. Wassermann reactions are not taken as a routine, and internal measurements are only taken in special cases. Model Welfare Centre.—All cases have a full physical examination by the doctor on their first visit, and are afterwards seen regularly. No routine Wassermann reaction is taken, and internal measurements are only taken in special cases. Salvation Army, Nichols Square.—Cases are examined ante-natally, and are attended in their confinements by midwives with pupils. Abnormal cases are sent to the Salvation Army Hospital at Clapton. Patients are examined monthly, and fortnightly for the last two months. There is no routine internal examination. A charge is made of 1 guinea for a multipara, and 25s. for primigravida. Necessitous cases are quite free. Harman Street Mission.—'Cases are seen by midwives only. They are advised to come as early as possible, and are examined by the nurse. After this, they are seen every fortnight. Special cases are referred to a doctor or a hospital. Every case is visited at home. The ordinary charge is 1 guinea for multiparae, or 25s. for primigravidae, but some cases are free. POST-NATAL CARE. It is now the custom of many authorities to arrange for a consultation and enquiry into the mother's health at least once, a few weeks after the birth of the baby. It does not appear to be done as a routine at any of the hospitals working for Shoreditch mothers. The City of London Hospital has a Post-natal Clinic to which patients come as symptoms arise,. and similarly, at the Model Welfare Centre, and at the School for Mothers, Herbert Street, cases are seen in conjunction with the Ante-natal Clinics. Much ill-health does arise often as a result of confinement, 68 and it is difficult to find time to deal with these complaints at other clinics, so from that point of view the establishment of a separate Post-natal Clinic would be extremely useful. It is proposed to follow up those cases at which there is any suspicion that the confinement has not been absolutely normal, and it is hoped that this will lead to an early detection of abnormalities. Of the total number of cases investigated, only 16 per cent. actually had a post-natal examination. RELATIONSHIP OF THE BOROUGH COUNCIL TO INSTITUTIONS. An agreement exists between the Borough Council and the City of London Maternity Hospital by which, in consideration of the annual payment of £200 paid by the Borough Council, the City of London Hospital undertakes to render various services, namely :— (i.) To provide a consultative Maternity Centre, and the local Maternitv Centre for the Borough, and to admit for diagnosis, advice, or treatment by members of the Honorary Staff in Out-patients or Wards, expectant or nursing mothers who may be referred by the Medical Officer of Health or the Medical Officer of any local Maternity Centre provided or recognised by the Borough Council. (ii.) To furnish such report as to diagnosis or treatment as may be necessary to the Medical Officer referring the case to the Centre. (iii.) To give statistical and other information annually. (iv.) The Hospital Authority will receive as in-patients lying-in cases in which the Medical Officer of Health considers their admission to hospital is desirable by reason of domestic conditions (to the extent only of the accommodation which may from time to time be reasonably available). It is probable that the greater part of the hospital's work in Shoreditch would be done in the absence of any agreement, but at the same time some definite provision for lying-in beds and consultative facilities by the Local Authority is essential, and the alternatives are, an agreement with the local Poor Law Hospital or a Municipal Maternity Home. Of the institutional confinement work, by far the most for any one institution is done by St. Leonard's Hospital (Shoreditch Board of Guardians), the distribution of 249 cases being : — St. Leonard's Hospital139 London Hospital 3 City of London Hospital 57 East End Mother's Home 2 St. Bartholomew's Hospital 24 Bethnal Green Hospital 1 Salvation Army, Clapton 10 St Peter's Hospital 1 Royal Free Hospital 7 Mildmay Home 1 Jewish Home, Underwood Street 4 Unfortunately, there is no ante-natal department in connection with St. Leonard's Hospital, and, of the patients admitted there, only 51 per cent. have had ante-natal care of any kind. The majority of those who have been examined have attended the Model Welfare Centre Ante-natal Clinic, but there is at present no effective co-operation between the clinic and the hospital. Under the new Local Government Act it is to be hoped that a scheme may be evolved which will allow this hospital to take a big share in the care of the mothers of the Borough, and which will enable it to act in close co-operation with the Borough Council. 69 Particulars of the Health Visitors' visits and of the attendances at the various Welfare Centres during the year are given in the following tables :— Annual Report for Year 1928. VISITS. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total. No. of 1st visits to infants 233 260 250 334 298 269 416 2,060 No. of re-visits to infants 410 476 534 396 636 550 1,302 951 4,304 1,906 No. of 1st visits to children aged 1 to 5 years (irrespective of whether visited previously as an infant) 103 204 189 158 108 193 No. of re-visits to children aged 1 to 5 years 1,065 1,095 855 1,391 1,100 1,230 1,320 8,056 No. of 1st visits to expectant mothers 53 59 70 86 96 95 133 592 No. of re-visits to expectant mothers 34 62 76 60 28 62 131 453 No. of futile visits 159 84 40 141 147 281 615 1,467 No. of interviews in connection with work 344 243 618 486 87 486 541 2,805 *No. of 1st visits to infants with diarrhoea ... 1 1 ... ... ... ... 2 *No. of 1st visits to cases of ophthalmia neonatorum 2 3 3 4 5 5 ... 22 *No. of re-visits to cases of ophthalmia neonatorum ... 5 10 7 7 11 11 ... 51 No. of 1st visits to cases of puerperal fever ... 4 1 ... ... 5 ... 10 No. of re-visits to cases of puerperal fever ... ... 1 1 ... 1 ... 3 No. of 1st visits to cases of puerperal pyrexia 2 3 1 4 ... 3 ... 13 No. of re-visits to cases of puerperal pyrexia ... 2 6 ... ... 3 ... 11 No. of Health Visitors' attendances at Clinics: (a) Hoxton Market Institute 28 38 1 ... 62 101 ... 230 (b) Hoxton Hall Centre ... ... 15 50 ... 14 ... 79 (c) Maternity Centre 135 190 113 158 94 62 ... 752 (d) Harbour Lights Centre 52 46 48 ... 14 9 ... 169 (e) School for Mothers Centre ... ... ... ... ... ... 323 323 * These visits are also included above. 70 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. •• •• •• •• •• 91 •• 91 over 1 yr. •• •• •• •• •• 37 •- 37 (Wed.) under 1 yr. •• •• •• •• 43 72 •• 115 over 1 yr. •• •• •• •• 25 39 •• 64 (b) Hoxton Hall: (Tues.) under 1 yr. •• •• •• 88 •• •• •• 88 over 1 yr. •• •• •• 16 •• •• •• 16 (c) Maternity Centre : (Mon.) under 1 vr. •• 145 •• •• •• •• •• 145 over 1 yr. •• 38 •• •• •• •• •• 38 (Tues.) under 1 yr. 64 55 •• •• •• •• •• 119 over 1 yr. 22 17 •• •• •• •• •• 39 (Wed.) under 1 yr. •• •• •• •• •• •• •• (a.m.) over 1 yr. 2 •• •• •• •• •• •• 2 (Wed.) under 1 yr. •• •• 81 •• •• •• •• 81 (p.m.) over 1 yr. •• •• 54 •• •• •• •• 54 (Thur.) under 1 yr. •• •• •• •• 132 •• •• 132 over 1 yr. •• •• •• •• 57 •• •• 57 (Fri.) under 1 yr. •• •• •• 80 •• •• •• 80 over 1 yr. •• •• •• 23 •• •• •• 23 (d) Harbour Lights : (Fri.) under 1 yr. 59 •• 82 •• •• •• •• 141 over 1 yr. 24 •• 66 •• •• •• •• 90 (e) School for Mothers : (Tues.) under 1 yr. •• •• •• •• •• •• 179 179 over 1 yr. •• •• •• •• •• •• 50 50 (Thur.) under 1 yr. •• .. •• .. •• •• 165 165 over 1 yr. •• •• •• •• •• •• 48 48 71 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 •• •• •• •• •• 1,252 •• 1,252 Children •• •• •• •• •• 1,195 •• 1,195 Mothers without children •• •• •• •• •• 721 •• 721 (Wed.) Infants •• •• •• •• 431 1,006 •• 1,437 Children •• •• •• •• 360 965 •• 1,325 Mothers without children •• •• •• •• 214 479 •• 693 (b) Hoxton Hall: (Tues.) Infants •• •• •• 1,522 •• •• •• 1,522 Children •• •• •• 1,397 •• •• •• 1,397 Mothers without children •• •• •• 433 •• •• •• 433 (c) Maternity Centre : (Mon.) Infants •• 1,627 •• •• •• •• •• 1,627 Children Mothers without •• 877 •• •• •• •• •• 877 children •• 605 •• •• •• •• •• 605 (Tues.) Infants 1,345 736 •• •• •• •• •• 2,081 Children 1,267 529 •• •• •• •• •• 1,796 Mothers without children 573 347 •• •• •• •• •• 920 (Wed.) Infants •• 2 •• •• 14 •• •• 16 (a.m.) Children 13 444 •• •• 81 •• •• 538 Mothers without children •• 59 •• •• 44 •• •• 103 (Wed.) Infants •• •• 1,322 •• •• •• •• 1,322 (p.m.) Children •• •• 1,364 •• •• •• •• 1,364 Mothers without children •• •• 493 •• •• •• •• 493 (Thur.) Infants •• •• •• •• 1,659 •• •• 1,659 Children Mothers without •• •• •• •• 915 •• •• 915 children •• •• •• •• 589 •• •• 589 (Fri.) Infants •• •• •• 1,314 •• •• •• 1,314 Children Mothers without •• •• •• 971 •• •• •• 971 children •• •• •• 410 •• •• •• 410 72 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 867 .. 1,493 .. .. .. .. 2,360 Children Mothers without 767 .. 1,011 .. .. .. .. 1,778 children 649 .. 721 .. .. .. .. 1,370 (e) School for Mothers : (Tues.) Infants .. .. .. .. .. .. 1,829 1,829 Children Mothers without .. .. .. .. .. .. 1,024 1,024 children .. .. .. .. .. .. 1 1 (Thur.) Infants .. .. .. .. .. .. 2,060 2,060 Children Mothers without .. .. .. .. .. .. 1,527 1,527 children .. .. .. .. .. .. 185 185 ANTE-NATAL CONSULTATIONS. Maternity Centre: Dr. Smith (Friday). No. of 1st attendances 57 85 42 30 52 44 .. 310 Total No. of attendances 103 163 97 83 59 90 595 School for Mothers : Dr. Tribe (Friday). No. of 1st attendances .. .. .. .. .. .. 102 102 Total No. of attendances .. .. .. .. .. .. 168 168 Dental Clinic: Mr. J. Peter. No. of 1st attendances 53 63 55 50 26 36 74 357 Total No. of attendances 152 182 161 175 94 107 230 1,101 Sewing Classes (2): Total No. of attendances 286 30 .. 165 45 23 463 1,012 73 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.) 2 145 715 36 342 Dr. Karn (Tues.) 1 74 647 20 343 2 57 278 7 116 Dr. Richards (Wed.) 3 72 62S 28 490 Dr. Smith (Wed.) (a.m.) 1 1 2 3 48 2 — — 39 443 4 — 6 - 10 5 6 18 3 60 Dr. Fanning (Thur.) 5 109 508 30 283 Dr. Smith (Fri.) 4 72 654 18 364 Hoxton Market. Dr. Fanning (Mon.) 6 90 533 38 368 Dr. Goffe (Wed.) 5 38 176 14 100 6 71 450 35 230 Hoxton Hall. Dr. Fanning (Tues.) 4 82 584 18 377 Harbour Lights. Dr. Karn (Fri.) 3 70 696 35 287 Dr. Goffe (Fri.) 1 49 489 26 235 School for Mothers. Dr. Pratt (Tues.) 7 179 912 50 598 Dr. Pratt (Thur.) 7 165 996 49 765 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 617 910 627 828 148 464 991 4,585 3,709 572 Number suffering from other minor ailments 410 111 527 761 206 551 1,143 128 Number referred to Hospital or to Medical Practitioner 57 81 59 63 112 72 The remainder are making satisfactory progress. 74 Under the terms of an agreement between the Borough Council and the Hospital a consultative Ante-Natal Clinic is held at the City of London Maternity Hospital. The following report upon the work done during the year has been received from the Secretary:— CITY OF LONDON MATERNITY HOSPITAL. The Medical Officer of Health, Shoreditch. 13th March, 1929. Dear Sir, I beg to submit the following Report upon the cases from your Borough attended at our Ante-natal Centre during the year ended 31st December, 1928. The total number of cases dealt with was 368. Of these 84 were seen and advised by the Sister attached to the Centre upon the various aspects of their pregnancy. The remaining 283 were examined by the Obstetric Surgeon in charge of the Department; the number of examinations by the Surgeon was 630 and by the Sister 504. The number of patients delivered on the District during the period under review was 119 and in the Hospital 200. Urine was tested in all cases. The list of special features met with is appended herewith. Yours faithfully, RALPH B. CANNINGS, K.G,, Secretary. SPECIAL FEATURES DURING THE YEAR 1928. Ante partum Haemorrhage, 4; Albuminuria, 15; Breech, 7; Bad Hearts, 4; Bad Histories, 13; Caesarean Section, 3; Contracted Pelvis, 20; Decapitation, 1; Eclampsia, 1; Inductions, 6; Impacted Shoulders, 1; Hernia, 1; Prolapsed Cord, 4; Post partum Haemorrhage, 4; Placenta Praevia, 2; Para typhoid, 1; Pyelitis, 2; Post-mature, 2; Premature Babies, 5; Pneumonia, 1; Spina Bifida, 2; Twins, 2 sets; Transverse, 1; Tuberculosis, 2; Varicose Veins, 8; Version-Breech to Vertex, 15 ; Vomiting, 1. REPORT ON LIGHT CLINIC AT MODEL WELFARE CENTRE. By Dr. James Fanning, Assistant Medical Officer of Health. The Ultra-Violet Light Clinic at the Model Welfare Centre was opened on 31st May, 1926, and the following is an account of cases treated there from that date to the end of 1928. The lamp in use is the K.B.B. Mercury Vapour type. The routine first exposure has been one minute at a distance of three feet, and this has been gradually increased to a maximum of from seven to fifteen minutes. The length of time individual cases have been under treatment has varied greatly. It has been very difficult to draw any definite conclusion as to the optimum period over which treatment should be 75 carried out without interruption, since the indefinite type of case treated has, in general, made it difficult to attribute results to their appropriate causes. The impression has been gained, however, that the best results are obtained by a course of twelve weeks (2 exposures per week) followed by an interruption for four weeks. Temperature and weight charts were kept regularly, and each patient was seen by the Medical Officer at fortnightly intervals. The Clinic is open on four afternoons a week. As has been pointed out, results are difficult to measure, and these conclusions are almost entirely arbitrary, but an attempt has been made to give an unbiassed impression of the actual usefulness of the treatment. Weight charts, particularly, have been studied in each case. Key to column headings. A 1 Result very good and attributed entirely to light. A 2 Result very good and attributed partly to light. A 3 Result very good but not attributed to light. B 1 Result good and attributed entirely to light. B 2 Result good and attributed partly to light. B 3 Result good but not attributed to light. C 1 Result fair and attributed entirely to light. C 2 Result fair and attributed partly to light. C 3 Result fair but not attributed to light. D Not improved In order to arrive at conclusions as to benefit derived from Light Treatment, the cases treated have been classified according to the following table. A1 A2 A3 B1 B2 B3 C1 C2 C3 D Total. 1 Debility and Underweight 17 4 3 36 7 1 8 9 20 53 158 2 Debility 2 ... ... 3 2 ... 2 1 2 6 18 3 Debility following Measles 1 ... ... 1 ... ... 1 ... ... 1 4 4 Underweight without Debility ... ... ... ... ... ... 1 ... 1 3 5 5 Rickets 4 3 ... 3 5 ... 2* 1* ... 3* 21 6 Anaemia 1 ... ... ... ... 1 ... ... ... 1 3 7 Wasting 1 11 ... ... 1 ... ... ... ... 3 16 8 Backwardness 1 ... ... 2 1 ... 1 ... 2 10 17 9 Eczema ... ... ... ... ... ... 1 ... ... ... 1 10 Pyelitis (Chronic) ... ... ... ... ... ... ... ... ... 1 1 11 Enlarged Cervical Glands (Septic) 1 ... ... ... ... ... ... ... ... 1 2 12 Genu Valgum ... ... ... ... ... ... 1 ... ... ... 1 13 Impetigo ... ... ... 1 ... ... ... ... ... ... 1 14 Asthma ... ... ... ... ... ... ... ... ... 1 1 Totals 28 18 3 46 16 2 17 11 25 83 249 * Course incomplete. 76 In addition to these, twelve healthy children were treated for prophylactic reasons, and all of these made good progress. Besides the cases treated in the above table, there were 333 children who came for fewer than 8 exposures, and who are not included. Reasons for this difficulty in getting regular and prolonged attendance arc varied, and number, among others, intercurrent illness, fright on the part of the children during the first few exposures, and lack of time on the part of the mothers. Also, during the winter, when colds were common, these attacks were often wrongly attributed to the treatment, with its resulting loss of favour. It will be noted that the largest number of cases dealt with falls under the rather comprehensive heading of "debility and underweight." The great majority of these cases were suffering from malnutrition, which could generally be ascribed to insufficiency in the quantity or the quality of their food, or to the unhygienic conditions under which they were compelled to live. This is emphasised by the rapid improvement which nearly always occurs when these children are sent away for convalescent treatment. From the table it will be seen that a distinct improvement, which can be whollv or partly attributed to ultra-violet light, is noted in about half the cases belonging to this group. Under this heading, nine cases were also markedly catarrhal, but the catarrhal condition was only definitely improved in two. In the few cases in which the treatment was administered to small healthv children, little difference in the rate of growth was noticed. The value of ultra-violet light in the treatment of rickets is again abundantly shown. No case which completed its course of treatment failed to improve greatly. The diagnosis of rickets was not made unless bone changes were present, and in most cases was confirmed by X-ray examination. Under the heading of "backwardness," were included such cases as delayed dentition, or delay in talking or walking, and as a rule there was no improvement which could be attributed to the actual light. No serious ill effects occurred as a result of treatment, and only in four cases was any intolerance at all noted. Of these, one was more restless, and two cried and became sleepless on the average commencing doses. In the fourth case attacks of vomiting and jaundice occurred after each of the first two exposures, and the treat ment was discontinued. In all these cases it is quite likely that tolerance could have been obtained by the administration of exceptionally small doses. There can be no doubt that the administration of ultra-violet light has proved itself to be a distinctly valuable adjunct to the other activities of the Child Welfare Centre. It is important, however, to realise that it is only an adjunct, and ordinary principles of hygiene and nutrition must take first place in treatment. Within these limits the existence of artificial light treatment is amply justified. 77 STREET MARKETS AND FOOD. The usual supervision was exercised by the Sanitary Officers as regards food exposed for sale in the market streets and generally throughout the Borough. The Merchandise Marks (imported goods), No. 3 Order, 1928, in respect of fresh apples came into operation on the 13th November, 1928. The supervision in connection with this order is among the duties of the Sanitary Inspectors. The following were surrendered or seized and destroyed as unfit for the food of man:— 3 qrs. of dabs, 1 trunk and 1 qr. of plaice, 28 lbs. of mackerel, 130 lbs. of cod, 1 box of haddock, 2 qrs. 15 lbs. of skate, 3 qrs. of whiting, 1 bag of mussels, 1 cwt. of potatoes, 12 boxes and 2 tons 2 qrs. of apples, 1 ton 18 cwts. 1 qr. 6 lbs. of strawberries^ 39 cases of loganberries, 35 lbs. of butter, 2 tons 16 cwts. of tinned food, 2 tons of butter beans and 1 tinned ham. SLAUGHTERHOUSES. There is only one slaughterhouse in the Borough and this is little used. The number of inspections made during the year was 17 and the sanitary condition is reported to be satisfactory. The following is a list of animals killed:— 20 Sheep. There were no carcases or offal condemned. MEAT. The number of butchers' shops under inspection during the year was 54 and the number of visits of inspection was 190. Due attention was given to the shops and stalls coming within the scope of the Public Health (Meat) Regulations, 1924. COWHOUSES. Some 26 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 two 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 1,246 visits were made in connection with them. In 16 instances sanitary notices were served, mainly for 78 cleansing. Two cases of diphtheria and two of scarlet fever 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, prohibited a person suffering from tuberculosis of the respiratory tract from following any employment or occupation in connection with a dairy, which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk, if he is in an infectious condition. There was no necessity for any action under these regulations during the year with a view to enforcing same. MILK AND CREAM REGULATIONS, 1912. None of the samples of milk submitted for analysis were reported to contain any preservative. No samples of cream were submitted for analysis. CONDENSED MILK REGULATIONS. Two samples were submitted for analysis under the above Regulations, both of which were returned as genuine. MILK AND DAIRIES ORDER, 1926. Under this Order five milk vendors were fined for delivering milk in bottles which were not filled and closed on registered premises. MILK (SPECIAL DESIGNATIONS) ORDER, 1922. The following are the premises at which "designated" milk may be sold in accordance with the requirements of the above Order: 73, Kingsland Road, 193, Kingsland Road, 378, Old Street, 60, Shepherdess Walk, and 147, Goldsmith Row. COOKSHOPS AND EATING-HOUSES. Including the kitchens of public houses where food is prepared for customers, 193 were under inspection during the year, and some 510 visits were made in connection with them. Some 27 sanitary notices were served, mainly for cleansing. FRIED FISH SHOPS. Some 62 were under inspection and 279 visits were made to them. Twenty-eight sanitary notices were served, mainly for cleansing. ICE-CREAM SHOPS. The number under observation during the year was 123, and 337 visits of inspection were made. In 10 instances sanitary noticcs were served. Most of these were for general cleansing. The L.C.C. (General Powers) Act, 1928, which came into operation during the year, provides for the registration of ice cream premises. The register is in progress of compilation. 79 BAKEHOUSES. The number of bakehouses on the register at the beginning of the year was 61. Two were removed, and the number on the register at the end of the year was 59. Of the bakehouses on the register at the end of the year the number underground was 35 and the number of factory bakehouses was 35. In connection with bakehouses the Sanitary Inspectors paid 200 visits of inspection. Intimation notices were served in 26 instances. SALE OF FOOD AND DRUGS ACTS. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 1,076 samples were submitted to him during the year. This number is at the rate ot 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 1928. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, etc. Prosecutions Proceeded with Number of Successful Prosecutions. Fines and Costs. Amount paid to Analyst for Samples Analysed. £ s. d. £. s. d. 1st 287 4 1.4% 2 — 2 — — 179 7 6 2nd 283 6 2.1% 1 — 1 1 1 1 0 176 17 6 3rd 133 1 0.7% 83 2 6 4 th 373 7 1.9% 6 — 6 6 15 15 0 233 2 6 Totals for Year 1,076 18 1.67% 9 — 9 7 16 16 0 672 10 0 The samples taken included 445 of milk, 72 butter, 51 sultanas, 43 margarine, 43 vinegar, 34 cocoa, 28 currants, 21 lard, 19 dripping, 19 tea, 19 raisins, 17 cake, 17 self.raising flour, 16 whisky (1 informal), 14 rice, 12 sausages, 11 sauce, 11 flour, 11 prunes, 10 sweetmeats, 10 gin, 8 candied peel, 8 pepper (1 informal), 6 rum, 6 brawn, 6 corned beef, 5 coffee, 5 jam, 5 ground rice, 5 ammoniated tincture of quinine, 4 brandy, 4 custard powder, 4 tapioca, 4 weak tincture of iodine, 3 tinned fish, 3 salmon and shrimp paste, 3 oil of eucalyptus, 3 lemonade powder, 3 ground almonds, 3 mixed fruits, 3 glycerine, 3 mincemeat, 3 non-alcoholic wine, 2 dried milk (informal), 2 camphorated oil, 2 compound liquorice powder, 2 condensed milk (sweetened), 2 pickles, 2 apricots, 2 tomatoes, 2 ground ginger, 2 pearl barley, 2 oil of almonds, 2 olive oil, 2 table jelly, 2 paregoric, 1 each of baking powder, chocolate, chutney, 80 muscatels, dried pears, damsons, loganberries, peaches, tinned pears, ketchup, orange marmalade, peas, tinned salmon, cheese, coffee and chicory essence, fish paste, friar's balsam, black pudding, sugar, wine, chicken and ham, cornflour, oil of cloves, oil of juniper, sago, boric acid, macaroni, mustard, compound mustard, and suet. Of the samples of milk 6 or 1.1 per cent. were found to be below the standard fixed by the Board of Agriculture. The proportion of milk samples returned as adulterated during 1928 was again greatly below the average. In the subjoined table are shown the number 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 147 2 1.3 2nd 115 4 3.9 3rd 71 — — 4th 112 — — In four of the samples water was certified to have been added; in the four cases it was less than 5 per cent.; in two the samples showed deficiencies in milk fat; in these the deficiency was 6 and 7 per cent. respectively, taking the standard of the Board of Agriculture. Legal proceedings were instituted in two or 33.3 per cent of the cases in which samples of milk were below standard. In one instance the case was dismissed, and in the other costs only were allowed the Council. No legal proceedings were considered advisable as regards the remainder of the samples of milk below standard. The percentage of the adulterated samples of milk in which it was not thought advisable to institute legal proceedings was 66.7. Seventy-two samples of butter were taken, and of these one was reported as containing boric acid, to the extent of 9.1 grains per pound. Fifty-one samples of sultanas were taken, one of which was found to contain 12.8 per cent. currants. Proceedings were instituted and costs allowed the Council. Of the forty-three samples of vinegar taken, two contained 2 and 4 per cent. excessive water, respectively. No proceedings were taken. 81 The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1904.1928 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. 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 1928 1076 93 18 1.7 9 ... 9 7 16 16 0 672 10 0 The percentage of samples found to be adulterated is the lowest so far recorded. RAG FLOCK ACT, 1911. Under the above Act 10 samples were taken for analysis. Two contained 207, and 32 parts respectively of soluble chlorine per 100,000 in excess of the amount allowed. Proceedings were instituted and the defendant was ordered to pay £3 3s. Od. costs in the first and £2 2s. Od. costs in the second. ACTS AND REGULATIONS WHICH BECAME OPERATIVE DURING 1928. ACTS. Agricultural Produce (Grading and Marking) Act, 1928. Food and Drugs (Adulteration) Act, 1928. Rag Flock Act (1911) Amendment Act, 1928. 82 REGULATIONS. Agricultural Produce Grading and Marking (General) Regulations, 1928. ,, ,, Grading and Marking (Apples and Pears) Regulations, 1928. ,, ,, Grading and Marking (Eggs) Regulations, 1928. Public Health (Condensed Milk) Amendment Regulations, 1927. ,, ,, (Dried Milk) Amendment Regulations, 1927. ,, ,, (Infectious Diseases) Regulations, 1927. ,, ,,(Notification of Puerperal Fever and Puerperal Pyrexia) Amendment Regulations, 1928. ,, ,, (Ophthalmia Neonatorum) Amendment Regulations, 1928. „ ,, (Preservatives, etc., in Food) Regulations (Part). The Merchandise Marks (Imported Goods) No. 3 Order, 1928 (Part). L.C.C. (GENERAL POWERS) ACT, 1928. Part IV, Section 24, applies the following sections of the Public Health (London) Act, 1891, to urinals to the same extent as they apply to water closets: Section 39 (Bye-laws as to water closets, etc.) ,, 40 (Power for Sanitary Authority to authorise examination of water closets, etc.) ,, 41 (Penalty on persons improperly making or altering water closets, etc.) ,, 42 (Improper construction or repair of water closet or drain.) ,, 25 provides that any person having charge or control of premises in which is lying the body of a person who has died from any infectious disease to which Section 55 (Notification of Infectious Disease) of the Public Health (London) Act, 1891, applies shall take such steps as may be reasonably practicable to prevent persons coming into contact with the body unnecessarily, and provides a penalty for non-compliance. ,, 26 contains provision for the compulsory cleansing of verminous persons refusing to go to a cleansing station, and gives power to the local Authority to provide such cleansing apparatus and attendants as may be necessary. ,, 27 authorises a Justice of the Peace, on the application of a Medical Officer, to issue a warrant to enter any common lodging house in the district in which he has reason to believe there is a person suffering, or who has recently suffered, from any infectious disease to which Section 55 of the Public Health (London) Act, 1891, applies, and for the examination of such person. ,, 28 is the Section which provides for the removal of aged or physically incapacitated persons residing in premises which are insanitary, or who is suffering from any grave chronic disease, and is unable to devote to himself or to receive from persons with whom he resides proper care and attention, and for the detention of such persons by the Guardians at the cost of the Local Autliority. 83 Section 29 provides for the registration of premises used for the manufacture, etc., of Ice Cream. ,, 30 applies certain sections of the Public Health (London) Act, dealing with powers of entry, penalty on obstructing execution of Act, and the protection of Sanitary Authority and their officers from personal liability, to this part of the General Powers Act. Part V.— Powers to Borough Councils. Section 32 amends the Metropolis Management Act as to combined drains. 33 gives Borough Councils powers to provide and maintain in, upon or under any street vested in or repairable by them orderly bins or other receptacles for the collection and temporary deposit of street refuse and waste paper, and the storage of sand, etc. 35 gives power to Borough Councils to provide in public streets seats and drinking fountains for the use of the public and troughs for watering horses or cattle. ,, 37 gives power to local Councils to serve notices on owners of premises on which surface water flows on and over the footpath, to provide and maintain such down pipes, channels or gutters as may be necessary to prevent so far as is reasonably practicable the water from such premises from flowing over the footpath, and provides penalties for non-compliance. 38 authorises the Borough Council to give notice to any owner or occupier of land abutting upon any street requiring them so to fence off, channel or embank such lands as to prevent soil or refuse from such' lands from falling upon or being washed or carried into the street or into any sewer or gulley therein in such quantities as to obstruct the highway or choke up such sewer or gulley, and provides penalties for non-compliance. HEALTH WEEK. Encouraged by the success of the Health Week Exhibition, held in October, 1927, at the Hoxton Market Mission, it was decided this year to engage the large Hall of the Town Hall for this purpose. A list of the various exhibits and lectures and the number of attendances on each day are appended. The attendances are proof of a most gratifying interest evinced by the people of this Borough for matters relating to Health. Particularly encouraging were the excellent attendances at the lectures and the good questions and keen discussions that often followed. 84 EXHIBITS. 1. Central Council for Infant and Child Welfare. 14. Fruit Trades Federation. 15. Cow and Gate Milk Food. 2 Borough of Shoreditch Electricity Department. l6.. Borough of Shoreditch Dental Hospital 17. Virol and Milk. 3. Central Council for Infant and Child Welfare. 18. National Women's Total Abstinence Union. 4. United Dairies (London), Ltd. 19. John Knight, Ltd. 5. Hovis, Ltd. 20. Metropolitan Water Board. 6. Central Council for Infant and Child 21. Dental Board of United Kingdom. Welfare. 22. Institute of Hygiene. 7. Borough of Shoreditch Libraries 23. National Milk Publicity Council. 8. partment. Sun Babies' Day Nursery. 24. Health and Cleanliness Council. 25. British Social Hygiene Council. 9. Borough of Shoreditch Maternity and Child Welfare Department. 20. Sunlight League. 27. Eugenics Society. 10. Borough of Shoreditch Health Department. 28. College of Pestology. 29. Model of Room prepared for Confinement. 11. Borough of Shoreditch Highways and Works Department. 30. A Good Room and a Bad Room. 31. Borough of Shoreditch Health Department. 12. Borough of Shoreditch Baths Department. 32. National Association for the Prevention of Tuberculosis. 13. Metropolitan Asylums Board. LECTURES. Miss Gilder, National Milk Publicity Council, entitled "Health Rules." Mr. Sanders, British Social Hygiene Council, entitled "Tragedy of Ignorance." Miss Keating, Central Council for Infant and Child Welfare; entitled "The Importance of Clothing with regard to Health." Dr. Denne, Dental Board of United Kingdom, entitled "Teeth, Health and Efficiency." Dr. Mabel Brodie, Health and Cleanliness Council, entitled "The First Law of Health." Dr. E. D. Karn, entitled "The Diet and General Management of the Toddler." Mr. Thornhill (Messrs. D. W. Gibbs, Ltd.), " Care of the Teeth." Mr. Partington, Fruit Trades Federation, entitled " Fruit and Health." Miss M. Green, Dental Board of United Kingdom, entitled "The Teeth in Relation to Health." Dr. Olivier Richards, entitled "Rickets." Dr. Hamill, entitled "Rheumatism in Childhood." Dr. Platt, Industrial Health Societv, entitled " Food, its Use and Abuse." George S. Francis, Esq., of the British Electrical Development Association, entitled "Electricity and Public Health." P. B. Tustin, Esq., United Dairies, Ltd., entitled "The Food Industry and the Health Department." Viscountess Erleigh, entitled "The Dav Nursery and The Nursery School." S. G. Peill, Esq., National Association for the Prevention of Tuberculosis, entitled "The Prevention of Consumption." Councillor Dr. S. W. Jeger, Chairman, Health Committee, entitled "The Public Health Department." Dr. Octavia Lewin, entitled "Nasal Hygiene." Dr. Dora Cadman, British Social Hygiene Council, entitled "Tragedy of Ignorance." Dr. Sylvia Smith, entitled "Ante-Natal Care." Dr. Naomi Dancy, Health and Cleanliness Council, entitled " A Healthy Lile." Councillor Mrs. E. M. Fairchild, Chairman, Maternity and Child Welfare Committee, entitled "The Early Habits of Young Children." Dr. J. Fanning, Assistant Medical Officer of Health, entitled, "What everyone should know about Infectious Disease." C. M. Docker, Esq. (Kelvinator, Ltd.) entitled "Refrigeration for the Small Trader and the Home." Mr. T. J. S. Smellie, National Milk Publicity Council, entitled "Foods for Health." Cooking Demonstrations by Miss B. James, National Milk Publicity Council. ATTENDANCES. Monday 974 Tuesday 1,339 Wednesday 1,828 Thursday 2,063 Friday l,849 Saturday 1,508 Total 9,561 R11/70