SHOR 35 REPORT on the Health and Sanitary Condition OF THE Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1930, BY MAITLAND RADFORD, M.D., B.S., D.P.H., Medical Officer of Health. london: jas. truscott & son, ltd. suffolk lane, e.c. 4. EXISTING MATERNITY CENTER KING SLAND R° iii. METROPOLITAN BOROUGH OF SHOREDITCH. PUBLIC HEALTH COMMITTEE. MATERNITY AND CHILD WELFARE (Nov., 1929—Oct., 1930.) COMMITTEE. (Nov., 1929—Oct., 1930.) Ex-officio: Dr. S. W. Jeger, j.p. (Mayor). Chairman: Councillor Brown, T. W. Chairman: Alderman Lay, E. W. Vice-Chairman: Councillor Crowe, W. J. Vice-Chairman: Alderman Girling, Mrs. H., Alderman Land, C. J.P., M.A.B. Councillor Coombs, T. C. Alderman Reynolds, G. ,, Crofts, R. O. Councillor Baker, J. S. ,, Ellwood, Mrs. L. ,, Davies, H. w. ,, Harvey, Mrs. J. ,, Fairchild, Mrs. E. M. ,, Isaacs, L. ,, Harvey, Mrs. J. „ Kellett, Miss E. ,, Hurley, J. J. „ Kempson, A. E. ,, Kellett, Miss E. ,, Kenny, T. J. ,, Lee. E., ,, O'Connor, Mrs. M. (Co-opted) Colville, Lady Cynthia ,, Reed, E. ,, Higgins, Mrs. C. ,, Smith, Mrs. M. ,, Ingham, Mrs. R. M. ,, Tucker, T. ,, Lay, Mrs. H. „ Rogers, Mrs. M. PUBLIC HEALTH COMMITTEE. MATERNITY AND CHILD WELFARE COMMITTEE. (Nov. and Dec., 1930.) (Nov. and Dec., 1930.) Ex-officio: Mrs. H. Girling, J.P., l.c.c. (Mayor). Chairman: Alderman Dr. S. W. Jeger, Chairman: Councillor Kellett, Miss E. L.C.C. Vice-Chairman: Councillor Ellett, W. T. Vice-Chairman: Councillor Crowe, W. J. Alderman Lay, E. W. Councillor Brown, T. W. Councillor Baker, J. S. ,, Coombs, T. C. „ Ellwood, Mrs. L. ,, Ellwood, Mrs. L. „ Hurley, J. J. ,, Fairchild, Mrs. E. M. „ Fairchild, Mrs. E. M. „ Harvey, Mrs. J. Lee, E. „ Kellett, Miss E. ,, O'Connor, Mrs. M. „ Kempson, A. E. (Co-opted) Colville, Lady Cynthia, j.p. ,, Kenny, T. J. „ Higgins, Mrs. C. ,, O'Connor, Mrs. M. ,, Ingham, Mrs. R. M. ,, Reed, E. ,, Lay Mrs H ,, Smith, Mrs. M. ,, Murphy, Mrs. ,, Thurtle, Mrs. D. ,, Tucker, T. A2 iv. CONTENTS. section. page I.—Statistics and General Information 2 to 7 II.—Population, Births, Marriages and Deaths 8 to 18 III.—Infectious Disease 19 to 38 IV.—Sanitary Work 39 to 62 V.—Tuberculosis 63 to 75 VI.—Municipal Dental Hospital 76 to 82 VII.—Shoreditch Women's Hospital 83 & 84 VIII.—Housing 85 to 98 IX.—Maternity and Child Welfare 99 to 119 X.—Health Week 120 & 121 XI.—Staff 122 & 123 LIST OF STATISTICAL TABLES CONTAINED IN THE REPORT. Statistical Summary 2 For whole district during 1930 and previous years 3 Cases of Infectious disease notified during 1930 19 Causes of, and ages at, death during year 1930 12 & 13 Infantile mortality during 1930 14 Comparison of London and Shoreditch birth and death rates in 1930 4 Summary of proceedings under Public Health (London) Act, 1891 58 to 61 Summary of Tuberculosis Certificates received 63 Summary compiled from the abstracts of their work prepared by the Sanitary Inspectors for 1930 40 & 41 Housing Conditions 85 to 98 Factory and Workshop Act—Summary of work 53 to 57 Return of work carried out at Tuberculosis Dispensary 68 to 73 Maternity and Child Welfare 114 to 119 Nursing List 36 Maternal Mortality 15 & 16 Cancer 17 & 18 Summary of deaths from Tuberculosis 66 & 67 Municipal Dental Hospital 76 to 80 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. Town Hall, Old Street, E.C. 1. June, 1931. To the MAYOR, ALDERMEN and COUNCILLORS of the Metropolitan Borough of Shoreditch. Madam, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1930. It is gratifying to be able to report that so low an infantile mortality rate as 65 has never before been recorded in Shoreditch. It is hoped that the epidemic of small-pox (Variola minor), particulars of which are given in the report, reached its peak during the year. This disease, though happily not severe, was the cause of over 700 persons being removed to hospital, of the infliction of anxiety, inconvenience, and in many cases, serious economic loss upon a large number of families, and of a very great strain being thrown upon the administrative resources of the Health Department. More pleasant is it to remember important developments of the Health Services of the Borough. These include a Tuberculosis Dispensary, new Dental Hospital, Maternity and Child Welfare extension, Women's Hospital, Laundry, Municipal Midwife, Municipal Day Nursery, arrangements in connection with all of which were well advanced at the end of the year. I wish to place on record my appreciation of the manner in which the Staff of the Department carried out their duties and to thank them for their ready help throughout a very busy year. In this connection I will name Dr. James Fanning, Assistant Medical Officer of Health, who retired; his successor, Dr. Evelyn McGregor; Mr. Davies, Dental Surgeon; Mr. Wilsher, Chief Clerk; and Mr. Pearson, Chief Sanitary Inspector. Finally, I wish to thank all the members of the Council, and in particular the Chairmen and Members of the Health and Maternity and Child Welfare Committees for their assistance in all matters relating to the work for which I am responsible. I am, Madam, Ladies and Gentlemen, Your obedient Servant, MAITLAND RADFORD, Medical Officer of Health. 2 I.—STATISTICS AND GENERAL INFORMATION. STATISTICS AND SOCIAL CONDITIONS. Area: 662 acres. Population—Census 1921, 104,248; Registrar-General's estimate 1929—99,710. Number of inhabitated houses, T921—13,727. Number of houses (end of 1930) according to Rate Books, 14,183. Number of families and separate occupiers, 1921—25,373. Rateable value, £762,879. Sum represented by penny rate £3,083. Some account of the social and economic conditions prevailing in the Borough will be found in Section VI of this report. Briefly, Shoreditch is a densely populated (average 150 to the acre) area containing approximately 14,000 structurally separate dwellings and 3,000 business premises. The length of public streets in the Borough is 43 miles. A great variety of industries are carried on in these business premises. Furniture making is one of the most common of these, and one which is by tradition firmly established in the Borough. The number of home workers cannot be stated with accuracy, as there is necessarily some overlapping in lists received from employers— 700 may be given as a round number. Particulars regarding home work will be found in Section IV of this report, page 58. Unemployment was, unhappily, prevalent throughout the year, and must be considered one of the most harmful of the conditions that have had a prejudicial effect upon health. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1930. Total. M. F. Birth Rate Live births Legitimate 1,914 951 963 20.1 Illegitimate 74 37 37 1,988 988 1,000 Still births Rate per 1,000 total births 18.7 Percentage of total deaths occurring in Public Institutions 67.5 Number of women dying in, or in consequence of, childbirth— From Sepsis 4 „ other causes 3 Death rate of infants under one year of age per 1,000 live births:— Legitimate 63. Illegitimate 108. Total 65. Deaths from Measles (all ages) 49 „ Whooping Cough (all ages) 3 „ Diarrhoea (under 2 years of age) 20 „ Pulmonary Tuberculosis 87 „ all forms of Tuberculosis 100 Death rate from Pulmonary Tuberculosis 0.9 % 1 uberculosis Death Rate 1.0% 3 For purposes of comparison the vital statistics of the Borough during recent years are given in the following table:— Year. 1 Population estimated to middle of each year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to tm District. Uncorrected Number. 3 Nett. Number. 6 Rate. 7 of Nonresidents registered in the District. 8 of residents not registered in the District. 9 Under 1 year of Age. At all Agei. N umber. 4 Rate. 5 Number. 10 Rate per 1,000 nett Births. 11 Number. 12 Rate. 13 1920 102044 3546 3731 36.9 1450 14.2 245 378 340 91 1583 15.6 1921 105200 (Census) 2798 2975 28.5 1393 13.3 264 369 341 114 1498 14.4 1922 105800 2645 2926 279 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 121 258 381 233 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 1929 99710 1685 2005 20.3 1438 14.9 254 409 168 83 1593 16.1 1930 99710 1664 1998 20.1 1097 12.2 214 325 129 65 1208 12.2 Note.—The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn Institution, estimated at 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. 4 ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 3RD JANUARY, 1930. districts. Estimated Population 1930. 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 1930 from Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. 1 (cols 2.8) 2 3 4. 5 6 7 8 9 10 Principal Zymotic Diseases. Smallpox. Measles. Scvlet Fever. Diphtheria Whooping Congh. *Fever. Diarrhoea Enteritis (under 2 year. Tuberculous Disease. Violence. 1817. 1928. 1929. 1930. London 4,417,900 15.7 11.9 11.6 13.8 11.4 0.56 o.oo 0.23 0.02 0.10 0.03 0.01 0.16 0.96 0.55 59 7.4 ... ... Shoreditch ‡98,710 20.1 12.7 13.8 16.1 12.2 0.96 0.02 0.50 0.01 0.20 0.04 0.00 0.20 10 0.86 65 8'4 67.5 ... Wards. Moorfields 3,940 20.6 11.6 10.3 18.5 15.5 0.51 ... 0.25 ... ... ... ... 0.25 1.02 0.76 49 8.3 75.0 ... Church 17,360 20.4 14.7 13.4 17.1 12.3 1.15 0.05 0.74 0.06 0.11 0.05 ... 0.12 1.09 0.98 85 9.3 71.5 ... Hoxton 15,080 21.5 14.0 16.2 16.1 12.7 0.93 ... 0.46 • • • 0.33 ... ... 0.13 0.73 0.79 49 9.0 61.8 ... Wenlock‡ 13,570 24.5 14.3 14.7 15.9 13.0 0.81 ... 0.51 ... 0.15 ... ... 0.15 1.19 1.03 51 8.5 67.1 ... Whitmore§ 17,020 19.4 11.9 13.4 17.1 13.1 0.82 ... 0.58 ... 0.12 ... ... 0.12 0.99 0.82 63 7.6 70.4 ... Kingsland 9,910 21.1 11.1 11 5 14.5 10.1 1.01 ... 0.30 ... 0.50 010 ... 0.10 1.20 0.81 53 7.0 69.0 ... Haggerston 10,460 19.1 10.5 11.8 13.6 11.1 1.43 0.09 0.48 ... 0.28 ... ... 0.57 1.05 0.86 70 8.1 63.7 ... Acton 11,370 13.8 11.3 14.5 16.3 10.5 0.77 ... 0.26 ... 0.08 0.87 ... 0.35 0.88 0.70 102 8.4 62.1 ... *Fever includes typhus, typhoid and continued fevers. †Diarrhoea in this table includes enteritis in children under two years. ‡The inhabitants of the Holborn Institution, which is situate in Wenlock Ward, estimated at 1,000, and the deaths occurring in that institution are excluded. § The Shoreditch Institution is situate in this Ward. In the cases of some of the deaths in outlying institutions, the Shoreditch Institution is the last known place of residence. This Ward is therefore probably credited with some deaths belonging to other Wards. Note.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, 0 00 is inserted; where no deaths have occurred, dots are placed in the space under the heading. The London population is adjusted to the middle of 1929. 5 GENERAL. Shoreditch is a district of irregular shape of which the two longest diagonals are approximately one and a half miles. Its boundaries are as follow Hackney, N. & N.E.; Bethnal Green, E.; Stepney, S.E.; City, S.; Finsbury, W.; Islington, N. & N.W. The average height of the Borough above sea level is 60 feet. The subsoil of the Borough is London clay with many pockets of gravel. Some areas are covered to a depth of three feet with a good quality sandy gravel on this subsoil. Refuse material, probably from the City and other adjacent areas, which has been deposited on this subsoil during the last 100 years or more, now has a depth of approximately five feet. The Meteorological Table for London, deduced from observations at Greenwich under the superintendence of the Astronomer Royal, issued by the Registrar-General for 1930, shows a rainfall for the year of 697 millimetres. This figure is 101 millimetres above the average for the thirty-five years, 1881-1915. HOSPITALS. Within the Borough— St. Leonard's Hospital, Hoxton Street, N. 1, General, London County Council, formerly Shoreditch Guardians 556 beds. Royal Chest Hospital, City Road, E.C. 1 85 beds. Shoreditch Model Welfare Centre, 210, Kingsland Road, E. 2 10 cots for babies. Medical Mission of the Good Shepherd, 41-49, Harman Street, N. 1. 10 cots for babies and young children. Shoreditch Tuberculosis Dispensary, 145, Great Cambridge Street, E. 2 No beds. Shoreditch Municipal Dental Hospital, 164, Kingsland Road, E.2 No beds. Welfare Centres, see page 100, M. & C.W. Section of this report. City of London & East London Dispensary, Wilson Street, E.C. 2 No beds. London County Council School Treatment Centre, Hoxton House, Hoxton Street, N. 1 No beds. Near the Boundary of the Borough— General Hospitals— Metropolitan Hospital, Kingsland Road, E. 8 150 beds. Royal Northern Hospital, Holloway Road, N. 7 220 beds. German Hospital, Ritson Road, Dalston, E. 8 160 beds. London Hospital, Mile End, E. 1 839 beds. University College Hospital, Gower Street, W.C. 1 540 beds. St. Bartholomew's Hospital, West Smithfield, E.C. 1 692 beds. Royal Free Hospital, Gray's Inn Road, W.C. 1 268 beds. 6 Special Hospitals— Queen's Hospital for Children, Hackney Road, E. 2 170 beds. City of London Maternity Hospital, City Road, E.C. 1 71 beds. Royal London Ophthalmic Hospital (late Moorfields), E.C. 1 138 beds. St. Mark's Hospital for Cancer, Fistula and other Diseases of Rectum, City Road, E.C. 1 72 beds. City of London Hospital for Diseases of the Heart and Lungs, Victoria Park, E. 2 186 beds. Elizabeth Garrett Anderson Hospital for Women, Euston Road, N.W. 1 107 beds. Hospitals under Public Health Department of London County Council used by Inhabitants of Shoreditch— 9 Fever Hospitals (acute) containing 4,665 beds. 2 Fever Hospitals (Convalescent) containing 1,881 beds. 3 River Hospitals (Fever or Small Pox) containing 1,898 beds. Hospital for Ophthalmia Neonatorum— St. Margaret's, Leighton Road, Kentish Town, N.W. 5. 60 beds. Hospitals for Venereal Disease— Sheffield Street Hospital, Kingsway, W.C. 2 (Women) 52 beds. Thavies Inn Infirmary, Robin Hood Court, Holborn, E.C. 1 (Women) 20 beds. Hospital for Post Encephalitis Lethargica— Northern, Winchmore Hill, N. 21 (part of) 125 beds. 10 Sanatoria and Hospitals for Tuberculous Patients containing beds as follows: 725 (Children). 210 (Women), 581 (Men), 627 (Men and Women). 4 Hospitals for Mental Defectives containing 7,127 beds. Training Colony for Improvable Imbeciles and the Feeble Minded, Darenth, Dartford, Kent 2,260 beds. Children's Hospitals and Homes— Queen Mary's Hospital for Children, Carshalton, Surrey 900 beds. The Down's Hospital for Children, Sutton, Surrey 360 beds. St. Anne's Home, Heme Bay, Kent (Convalescent Children) 150 beds. Contagious Diseases of the Skin and Scalp— Goldie Leigh Homes, Abbey Wood, S.E. 2 218 beds. Ophthalmia— White Oak, Swanley Junction, Kent 364 beds. Venereal Disease Clinics accessible from Shoreditch— The London County Council (Whitechapel) Clinic, Turner Street (adjoining the London Hospital), Mile End, E. 1. Metropolitan Hospital, Kingsland Road, E. 8. Royal Free Hospital, Gray's Inn Road, W.C. 1. 7 AMBULANCE FACILITIES. Ambulances are provided by the London County Council in accordance with arrangements, detailed particulars of which will be found in the London County Council reports, and can be obtained upon application to the London County Council (City 7200) or to the Public Health Department, Shoreditch Town Hall. Briefly, the London County Council provides ambulances free of cost for the conveyance of persons meeting with accidents, parturient women if the case is one of urgency, persons suffering from illness upon medical certificate, and persons suffering from infectious disease to the Council's fever hospitals. In other cases ambulances are supplied at a charge of 10s. if going wholly within Administrative County of London. Additional charges are made if there is more than one patient, and there is a special scale of charges for journeys extending outside London. HOUSE REFUSE. The removal of this is under the administrative control of the Borough Surveyor. It is collected at never longer than weekly intervals; in many instances it is collected daily, and from a considerable proportion of the premises in the Borough two or three times a week. Refuse is removed in horse-drawn vehicles and is either burned at the destructor at the Electricity Station or is taken away by barge from the wharf in Kingsland Road. At the time of writing arrangements are well advanced for the introduction of two motor vehicles to be used in conjunction with the existing carts. ACTS, REGULATIONS AND ORDERS which became operative during 1930. Acts. Local Government Act, 1929. See page 108. Housing Act, 1930. Regulations and Orders. The Vaccination Order, 1930. See page 23. The Parrots (Prohibition of Import) Regulations, 1930. Agricultural Produce (Grading & Marking) (Eggs) Regulations, 1930. ,, „ (Glasshouse grown Tomatoes & Cucumbers) Regulations, 1930. ,, „ (Dressed Poultry) Regulations, 1930. ,, „ (Strawberries) Regulations, 1930. ,, „ (Canned Fruit, Peas & Beans) Regulations, 1930. ,, „ (Cherries) Regulations, 1930. The Merchandise Marks (Imported Goods) No. 4 Order, 1929 (which deals with the sale of imported Malt products). The Merchandise Marks (Imported Goods) No. 5 Order, 1930 (which deals with the sale of imported Tomatoes). 8 II.—POPULATION, BIRTHS, MARRIAGES AND DEATHS. POPULATION. The Registrar-General's estimate of the mid-1930 population will not be available until after the 1931 census has been taken, and in these circumstances it has been decided to act upon the suggestion contained in the Ministry of Health Circular 1119, and to use the Registrar-General's mid-year 1929 estimate for statistical purposes in this report. The Registrar-General's estimate of the population of the Borough on 30th June, 1929, was 99,710. This figure is 2,490 less than the corresponding figure for 1928, 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 purpose of this report 98,710 will accordingly be regarded as the population for the year 1930. The population in the various Wards of the Borough is estimated as follows:— Ward. Population. Area in acres* Density per acre. Moorfields 3,940 71 55 Church 17,360 105 165 Hoxton 15,080 79 190 Wenlock 13,570 96 141 Whitmore 17,020 81 210 Kingsland 9,910 72 137 Haggerston 10,460 68 154 Acton 11,370 86 132 *Exclusive of water. The density of the population in the Borough as a whole is 150 per acre. Further information upon the subject of the population, area, number of inhabited houses and rateable value are contained in the Tables on pages 3. BIRTHS. Males. Females. Total. Number registered in the Borough 826 838 1,664 Number registered outside the Borough, parents being residents of Shoreditch 173 171 344 Number registered in the Borough, parents not being residents of Shoreditch 11 9 20 Corrected number of births 988 1,000 1,988 The distribution of the corrected births and the birth rates in the eight Wards of the Borough are given below:— Ward. Males. Females. Total. Births per 1,000 Population. Moorfields 44 37 81 20.6 Church 155 199 354 20.4 Hoxton 163 161 324 21.5 Wenlock 179 154 333 24.5 Whitmore 159 172 331 19.4 Kingsland 116 93 209 21.1 Haggerston 97 102 199 19.1 Acton 75 82 157 13.8 Totals 988 1,000 1,988 20.1 9 The birth rate for the Borough as a whole was 20.1. For England and Wales the birth rate was 16 3 and for London 15.7. The illegitimate births numbered 74, of which 37 were males and 37 females. Of these 30, of which 16 were males, occurred in St. Leonard's Hospital. The illegitimate births amounted to 3 7 per cent. for all births credited to the Borough during the year. The number of births occurring in St. Leonard's Hospital was 337: 160 males and 168 females. In 20 of these the parents were not Shoreditch residents. MARRIAGES. The number of marriages during the year was 960 and the persons married were at the rate of 19 63 per 1,000 population. The marriage rate for the Metropolis was 19.1 During recent years the corresponding figures have been as follows :— Year. No. of marriages. Marriage rate. Shoreditch. London. 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 1929 956 19.3 19.1 1930 969 19.6 19.4 DEATHS. During 1930 the total number of deaths registered in the Borough was 1,097. The transferable deaths were as follows :— Deaths of non-residents registered in Shoreditch 214 Deaths of Shoreditch residents registered elsewhere 325 The number of deaths properly belonging to Shoreditch is accordingly 1,208, which figure gives a general death rate per 1,000 population of 12.2. The death rate in England and Wales for 1930 was 11.4 and in London 11.4. In connection with these deaths 101 inquests were held. In the Table on page 3 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 39 21 60 15.5 49.4 Church 116 98 214 12.3 84.8 Hoxton 94 97 191 12.7 49.4 Wenlock 94 83 177 13.0 51.1 Whitmore 125 98 223 13.1 63.4 Kingsland 53 47 100 10.1 52.6 Haggerston 68 56 124 11.1 70.4 Acton 56 63 119 10.5 101.9 Totals 645 563 1,208 12 .2 64.9 10 Considering the deaths at all ages the chief causes are seen to be as follows:— Heart disease, 227 (19 per cent.); Cancer, 133 (11 per cent.); Tuberculosis, all forms, 100 (8 per cent.); Pneumonia, all forms, 107 (9 per cent.). The number of deaths due to accidents in connection with vehicular traffic was 21. In the years 1920 to 1929, inclusive, the corresponding figures were respectively 16, 10, 12, 9, 15, 14, 16, 21,15 and 18. The particulars regarding the deaths from cancer are contained in the table on page 18. It will be noted from the Table on page 12 that the chief causes of death of children between the ages of one and two years were Measles and Pneumonia —these two causes accounted for 37 out of a total of 52 deaths between these ages- Altogether 210 or 17 4 per cent. of the total number of deaths of all ages were of children under the age of 5 years. 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. Claybury 12 Hospitals for Infectious Diseases—contd.— Dartford 5 East Riding 1 South-Western 1 Fountain 1 Western 1 Horton 1 General Hospitals :— Hundred Acres, Epsom 1 Charing Cross 1 Leavesden 1 Children's, Holborn 6 Manor, Epsom 2 German 12 Tooting Bec 1 Guy's 5 1, West Park Road, Epsom 2 Jubilee, Woodford 1 London 9 Hospitals for Infectious Diseases:— London Jewish 2 Metropolitan 23 Brook 6 Middlesex 3 Eastern 21 Mildmay 7 Grove 1 Plumstead 1 Grove Park 2 Queen's (Children) 13 Joyce Green 2 Queen Mary's, West Ham 2 London Fever 2 Royal Free 5 Northern 1 Royal Waterloo 1 North-Eastern 11 St. Bartholomew's 40 North- Western 3 St. George's 1 Park 6 St. Thomas's 1 Southern 1 University College 1 South-Eastern 3 Westminster 2 11  No. of Deaths. No. of Deaths. Special Hospitals Other Institutions :— Addenbrooke Hospital 1 Archway Hospital 3 Bethnal Green Chest 3 2a, Bow Road 1 Cancer 1 214a, Cambridge Road 6 City of London Maternity 3 199, Dartmouth Park Hill 1 Colindale 5 73a, Devons Road 1 East Ham Memorial 1 East London Children's 1 72a, East Dulwich Grove 1 Epileptic Colony, Edmonton 1 230, High Street, Homerton 4 Infants, Vincent Square 1 Friern Barnet Infirmary 2 Mothers' Hospital 1 4, King's Road, St. Pancras 1 Mount Vernon 1 29, North Side, Clapham 3 National 1 Queen Mary's, Carshalton 1 St. George's Home, Chelsea 1 Queen Mary's, Wandsworth 1 St. Joseph's Hospice 7 Royal Northern 1 Star & Garter Home, Sandgate 1 St. Columba's 1 St. Luke's, Paddington 3 76, St. Mark's Road, Maidenhead 1 St. Margaret's 1 St. Mark's 1 1, Uxbridge Road 1 Of 287 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 136 died in general hospitals, 27 in asylums, 61 in fever hospitals, 29 in hospitals for special diseases, and 34 in other institutions. Elsewhere than in public institutions 38 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 815 or 67 5 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. 1925 63.3 per cent. 1921 56.9 „ 1926 63.7 „ 1922 60.2 „ 1927 63.1 „ 1923 63.6 „ 1928 67 0 „ 1924 63.5 „ 1929 63.9 „ PUBLIC MORTUARY, 1930. Number of bodies deposited from— St. Leonard's Hospital 67 L.C.C. Infectious Hospitals 10 Undertakers 6 Other sources 97 Total number of bodies deposited 180 Number of post-mortem examinations performed 97 12, 13 The causes of deaths at all ages together with Ward distribution and particulars relating to the deaths in Public Institutions in the Borough is contained in the following table CAUSES OF DEATH. AGES. DEATHS NEACH WARD SEX. Holborn Institute. St. Leonard's Hospital. Royal Chest Hospital. Hume of Good Shepherd. Convent Hospital. Infant Welfare Centre. 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. Hokton Wenlock Whitmore Kingsland Haggerston Acton. Male. Female. 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. Belonging to Shoreditch. Not belortging to Shoreditch Belonging to Shoreditch. Not belonging to Shoreditch. All Causes 129 52 29 30 8 21 27 60 69 139 222 210 170 42 ... ... 645 563 M F M F M F M F M F M F M F M F 1 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Smallpox 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 Measles 13 25 8 3 ... ... ... ... ... ... ... ... ... ... ... 1 5 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Scarlet Fever ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 4 4 3 6 4 1 2 2 3 2 1 23 26 ... ... 10 ... ... ... ... ... ... ... ... ... 5 Whooping Cough 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Diphtheria 2 5 5 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 2 ... ... 2 ... ... ... ... ... ... ... ... ... 7 Influenza ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 3 1 1 i 1 1 4 2 1 1 9 11 ... ... ... •.. ... ... ... ... ... ... ... ... 8 Encephalitis Lethargica ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 9 Meningococcal Meningitis .. 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Tuberculosis of respiratory system ... ... ... ... ... 8 12 16 10 21 14 4 2 ... 1 1 11 6 8 3 8 4 10 6 5 5 6 3 8 2 57 30 ... 3 28 3 1 7 ... ... ... ... ... ... 11 Other Tuberculous diseases 2 1 2 2 ... 1 1 1 1 1 1 ... ... ... 1 1 2 ...... 8 ... 2 2 1 1 1 1 1 ... ... 8 5 ... ... 6 ... ... ... ... 1 ... ... ... ... 12 Cancer, Malignant disease ... ... ... ... ... ... ... 3 7 27 46 36 13 1 7 3 11 10 16 13 8 11 21 4 4 3 5 5 5 7 77 56 ... 2 60 1 7 ... ... ... ... ... ... 13 Rheumatic Fever ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Diabetes ... ... ... ... ... ... ... 1 ... ... 5 2 ... ... ... 1 ... ... ... 1 3 3 | i ... ... ... 8 ... ... 4 ... ... ... ... ... ... ... ... ... 15.Cerebral Haemorrhage, &c. ... ... ... ... ... ... ... ... 1 6 17 23 6 1 3 1 3 7 3 6 5 4 3 7 3 2 ... 1 5 1 25 29 ... 34 35 1 ... ... ... ... ... ... ... ... 16 Heart Disease ... ... ... 1 1 7 4 9 11 22 40 61 56 15 8 6 23 15 13 16 19 18 24 20 9 9 10 9 9 20 114 113 ... 16 99 6 4 7 ... ... ... ... ... ... 17 Arterio Sclerosis ... ... ... ... ... ... ... ... 2 4 8 16 22 1 2 2 6 7 3 4 3 2 2 9 2 ... 4 2 1 4 23 30 1 42 32, 1 ... 1 ... ... ... ... ... ... 18 Bronchitis 2 ... ... ... ... ... ... 3 ... 6 14 14 10 5 2 1 3 4 5 5 7 6 3 3 3 2 4 3 2 1 29 25 ... 23 11 ... ... 8 1 ... ... ... ... ... 19 Pneumonia (all forms) 28 12 4 2 ... 1 3 8 3 9 18 14 4 1 5 2 8 8 10 10 6, 7 17 4 5 2 5 6 5 7 61 46 ... 1 45 1 2, 6 ... ... ... ... 1 ... 20 Other respiratory diseases ... ... ... ... ... ... ... ... ... 3 ... ... 1 ... ... ... ... ... 1 ... ... 2 ... 1 ... ... ... ... ... 4 ... ... ... 2 ... ... 2 ... ... ... ... ... ... 21 Ulcer of Stomach or duodenum ... ... ... ... ... ... ... 2 2 2 1 ... ... ... ... ... ... ... 2 ... 1 ... 1 ... ... 1 2 ... ... ... 6 1 ... ... ... ... ... ... ... ... ... ... ... ... 22 Diarrhoea, etc. 18 2 ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 1 1 1 1 1 3 2 4 2 2 2 15 7 ... 9 ... ... ... 1 ... ... ... ... ... 23 Appendicitis and typhlitis ... ... ... 1 1 ... ... 1 1 ... 2 2 ... ... ... ... 1 ... 1 2 1 1 1 ... ... ... 1 ... 5 3 ... ... 4 ... ... ... ... ... ... ... ... ... 24 Cirrhosis of Liver ... ... ... ... ... ... ... 1 ... 1 3 ... ... ... ... ... 4 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 5 ... ... ... 3 ... 1 ... ... ... ... ... ... ... 25 Acute and Chronic Nephritis ... ... ... 1 ... ... ... 2 2 6 13 5 3 2 1 ... 4 4 ... 3 1 2 2 5 1 2 4 1 1 3 14 20 ... 2 14 ... 1 ... ... ... ... ... ... ... 26 Puerperal Sepsis ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... 1 ... ... ... 4 ... ... 2 ... ... ... ... ... ... ... ... ... 27 Other accidents and diseases of pregnancy & parturition ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 3 ... ... 1 ... ... ... ... ... ... ... ... ... 28 Congenital debility and malformation, premature birth 45 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 6 6 4 3 1 3 4 6 2 1 2 2 2 5 21 26 ... ... 17 ... ... ... ... ... ... 1 ... ... 29 Suicide ... ... ... ... ... ... ... 2 4 7 9 2 ... ... 1 ... 3 1 2 ... 3 3 1 ... 3 ... 1 2 3 1 17 7 ... 2 6 ... ... ... ... ... ... ... ... ... 30 Other deaths from violence 3 3 2 3 3 ... 2 5 7 4 8 7 10 4 1 1 8 5 4 6 6 2 4 9 2 3 3 3 3 1 31 30 1 3 32 12 ... ... ... ... ... ... ... ... 31 Other defined diseases 13 3 6 7 1 2 4 3 12 20 22 24 43 12 6 1 15 12 14 16 18 9 19 11 6 9 11 11 7 7 96 76* ... 12 87† ... ... 5 2 ... ... 3 ... ... 32 Causes, ill defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... * Includes 4 deaths from Erysipelas. † Two deaths from Erysipelas are included in " Other defined diseases" belonging to Shoreditch and dying in St. Leonard's Hospital. B. 14 Infantile Mortality. The deaths amongst infants under one year numbered 129, of which 65 were males and 61 females. These deaths amounted to 10.7 per cent, of the total nett Shoreditch deaths from all causes as compared with 10.6 per cent. in 1929. The mortality amongst infants under one year was at the rate of 65 per 1,000 births registered during the year. This is the lowest infantile mortality rate ever recorded in Shoreditch. Amongst male infants this rate was 66 and amongst females 64. The infant mortality rates in the different Wards of the Borough are included in the table on the opposite page. The number of deaths of illegitimate infants was 8, which figure gives a mortality rate of 108 per 1,000 illegitimate births. The chief causes of deaths amongst infants were pneumonia, prematurity, diarrhoea and enteritis 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. 1921 81.2 80 114 1922 747 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 1929 74 70 83 1930 60 59 65 The causes of deaths of infants under one year together with ages and ward distribution are given in the table on the opposite page. To face page 14 Infantile Mortality in the Borough during Year 1930. CAUSE 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 ... ... ... ... ... ... ... ... ... ...... ...i... ... ... ... ... ... ... ... ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 3 Measles ... ... ... ... ... ... ... ... 5 8 13 ... 3 1 4 1 1 1 2 5 8 4 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 5 Whooping cough ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 1 ... 6 Diphtheria ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... 1 1 ... ... 2 7 Erysipelas ... ... ... ... ... ... 1 1 ... ... 2 ... ... ... ... 1 l ... ... ... 2 8 Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 German measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 (a) with Pulmonary complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 (b) with Non - Pulmonary complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 (c) without stated complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Meningococcal Meningitis ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... . . . ... ... 1 ... 18 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 Other Tuberculous diseases ... ... ... ... ... ... ... 1 1 ... 2 ... 1 ... 1 ... ... ... ... 2 ... 20 Bronchitis ... ... ... ... ... ... 1 ... ... 1 2 ... 1 ... ... 1 ... ... ... 2 ... 21 Pneumonia (all forms) ... ... ... 1 1 2 7 11 5 3 28 2 5 5 3 4 4 2 3 14 14 22 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Empyema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Other Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Rickets ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... 27 Convulsions ... 1 ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... 1 ... 28 Diarrhœa and Enteritis ... ... ... 1 ... 1 3 8 4 2 18 1 1 2 2 2 1 5 4 11 7 29 Ulcer of stomach and duodenum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other diseases of the stomach ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 31 Syphili. ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 32 Congenital malformation 2 2 2 1 ... 7 1 ... ... 1 9 ... 3 ... ... 4 ... 1 1 3 6 33 Congenial debility and icterus ... 1 3 ... ... 4 1 1 1 ... 7 ... 3 ... ... 1 ... 1 2 4 3 34 Premature birth 9 11 3 1 ... 24 2 ... ... ... 26 ... 3 7 3 4 3 2 4 12 14 35 Injury at birth 1 1 ... 1 ... 3 ... ... ... ... 3 ... 1 ... 1 1 ... ... ... 1 2 36 Suffocation in bed or not stated. Accidental mechanical suffocation ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 37 Atelectasis 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... 38 Other defined diseases l ... 1 1 ... 3 1 2 1 1 8 1 5 ... 1 ... ... 1 ... 5 3 39 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 14 16 9 6 1 46 18 26 21 18 129 4 30 16 17 21 11 14 16 65 64 Deaths of persons belonging to Shoreditch occurring beyond limits of Borough are included. 15 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 5. The particulars of these deaths, classified according to age and cause, are given in the table on page 16. For purposes of comparison the maternal mortality rates per 1,000 live births in England and Wales, London and Shoreditch, during the year 193U and ten preceding vears are given as follows:— Year. England and Wales. London. Shoreditch. Deaths from Sepsis. Deaths from other diseases and accidents of Pregnancy. Total. Deaths from Sepsis. Deaths from other diseases and accidents of Pregnancy. Total. Deaths from Sepsis. Deaths from other diseases and accidents of Pregnancy. Total. 1930 1.92 2.48 4.40 1.71 1.45 3.16 2.0 1.5 3.5 1929 1.80 2.53 4.33 1.88 1.73 3.61 1.0 1.0 2.0 1928 1.79 2.63 4.42 1.59 2.00 3.59 1.43 1.91 3.34 1927 1.57 2.54 4.11 1.31 1.60 2.90 0.91 0.47 1.38 1926 1.60 2.52 4.12 1.61 1.74 3.35 1.19 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 Abortion was an associated cause of death in four of the seven maternal deaths that occurred during 1930. In connection with these deaths, it is pertinent to remember that those who advocate the dissemination of knowledge upon the subject of birth control argue that such knowledge should prevent women from being exposed to the temptation to resort to the desperate measure of abortion. B2 16 The particulars of these deaths are entered in the following table : — MATERNAL MORTALITY. AGES. 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. Married. Single. Widowed. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Accidents of Pregnancy :— ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other accidents of pregnancy ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... ... ... ... Puerperal haemorrhage ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... Other accidents of childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal sepsis ... ... 1 1 1 1 ... 4 ... ... ... ... 1 ... 2 ... 1 ... Puerperal phlegmasia alba dolens not returned as septic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal embolism and sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal albuminuria and convulsions ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... Childbirth not assignable to other headings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal diseases of the breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mitral Stenosis and pregnancy ... ... ... l ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... *This death was associated with pregnancy or childbirth, but was assigned to Heart Disease. 17 Cancer. The deaths from Cancer in the Borough during the year numbered 133 as compared with 146 in 1929. Particulars concerning these deaths as regards age, situation of disease and Ward are given in the table on page 18. The deaths from Cancer during the last five years per million persons living are riven in the following comparative table England and Wales. London. Shoreditch. 1926 1,362 1,400 1,201 1927 1,376 1,400 1,261 1928 1,425 1,520 1,428 1929 1,437 1,300 1,479 1930 1,454 1,553 1,346 Inasmuch as the cause of cancer is not known, it is impossible to take preventive measures against this disease as is done in the case of diseases the cause of which is clearly understood. Although cancer cannot be prevented, it can in many instances be cured if diagnosed early and suitably treated. Many lives are lost as a result of delay in obtaining medical advice. It is important that the main facts concerning cancer should be known to the general public. In a book recently issued by the British Cancer Campaign, entitled "The Truth about Cancer," these facts are summarised as follows :— 1. CACER IS RELENTLESS IF IGNORED. 2. In its early stages very often cancer is quite painless. 3. In early stages cancer is a purely local disease. 4. In its early stages very often cancer can be treated with complete success. 5. It is in its earliest stages that competent medical advice must be sought. 6. The. only Reliable measures of treatment for cancer known at present are surgical operation and radiation. 7. For complete success treatment of cancer by operation or radiation must be extensive and adequate. When the Shoreditch Women's Hospital is opened it is anticipated that in many cases it will be the means of securing earlier diagnosis and treatment of women suffering from this disease. Propaganda of the facts concerning cancer will be much assisted so far as women are concerned, when we are able to invite those who have any anxiety in the matter to attend the Municipal Hospital for examination. As explained on page 83, the Hospital will be linked with various Institutions in such a manner as to secure that patients receive appropriate treatment without delay. The question of providing facilities of a similar kind for men is one which is being kept in mind and in which the experience regarding cancer gained at the Women's Hospital will be of great value. 18 Deaths from Cancer in the Borough during Year 1930. AGES. SEX. WARDS. 0 to 15. 15 to 20. 20 to 28. 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. M F M F M F M F M F M F M F M F All situations ... ... ... 3 7 27 46 36 13 1 77 56 7 3 11 10 16 13 8 11 21 4 4 3 5 5 5 7 Tongue ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Buccal Cavity ... ... ... ... ... ... 1 1 ... ... 2 ... ... ... 1 1 ... ... ... ... Pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Oesophagus ... ... ... 1 ... ... 2 3 1 ... 6 1 ... ... 3 ... 2 1 1 ... Stomach ... ... ... 1 1 7 11 11 5 ... 23 13 1 3 1 5 4 2 3 8 1 1 3 1 3 Liver ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... 1 1 ... ... ... Gall Bladder ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... Intestines ... ... ... ... ... 4 3 1 ... 1 4 6 1 1 1 1 2 2 ... 1 ... 1 Rectum ... ... ... ... ... 1 5 3 ... ... 8 1 1 1 2 1 2 1 ... ... 1 Others ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterus ... ... ... ... ... 4 2 3 ... ... ... 10 1 2 2 1 ... ... 2 2 Ovary and Fallopian tube ... ... ... ... ... 2 1 2 ... ... ... 5 ... 2 2 ... ... ... ... 1 Vagina, vulva ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Breast ... ... ... ... 1 3 3 1 1 ... ... 9 1 2 ... 3 2 ... 1 ... Skin ... ... ... ... ... ... 1 3 ... ... 2 2 ... 1 1 ... ... ... 1 1 Larynx ... ... ... ... 2 ... 3 2 ... ... 7 ... 4 ... ... ... 2 1 ... ... Lung and Pleura ... ... ... 1 1 3 4 2 ... ... 9 2 1 3 2 1 1 2 1 ... ... ... Pancreas ... ... ... ... ... ... 3 ... ... ... 1 2 ... ... ... ... 1 ... 1 1 Bladder ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... Prostate ... ... ... ... ... ... 1 1 3 ... 5 ... ... 1 ... ... 1 2 ... 1 Others ... ... ... ... ... 1 5 3 1 ... 7 3 ... 2 2 1 2 1 1 ... 1 ... 19 III. INFECTIOUS DISEASE Notifiable Disease Excluding tuberculosis, the deaths during the year from notifiable infectious diseases numbered 140 (11.6 per cent. of total deaths). The corresponding number for 1929 was 177 (11.1 per cent. of total deaths.) The following table shows the numbers of eases of infectious disease (tuberculosis excluded) notified in the Borough, together with distribution as to quarter, age and Ward:— NOTIFIABLE DISEASE. NUMBER OF CASES NOTIFIED. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total AGES. WARDS. Cases removed to Hospital. Diagnosis revised subsequently. Deaths. Under 1 year. 1 to 5. 5 to 15 15 to 25. 25 to 45. 45 to 65. 65 I II III IV V VI VII VIII Moor- fields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton Chicken pox 122 202 53 ... 377 22 124 224 5 2 ... ... 11 77 65 94 65 21 29 15 2 l ... Enteric fever ... ... ... 4 4 ... 1 1 ... 1 1 ... ... ... ... ... 1 3 ... ... 4 l ... Small-pox 378 274 76 60 788 16 75 312 195 130 58 2 12 158 161 40 122 91 152 52 788 29 2 Scarlet fever 103 84 120 127 434 8 167 218 30 9 2 ... 17 82 67 49 73 41 70 35 429 50 1 Diphtheria 113 71 84 78 346 9 174 121 17 21 4 ... 22 65 68 44 47 37 34 29 244 20 20 Acute primary pneumonia 37 19 11 25 92 7 25 18 10 14 13 5 2 21 6 9 23 11 8 12 50 Acute influenzal pneumonia 3 ... 2 ... 5 ... 1 ... ... 1 2 1 ... 1 1 ... 1 2 ... ... ... ... 107 Erysipelas 13 19 13 22 67 6 3 11 6 13 23 5 1 14 7 14 11 8 6 6 35 ... 4 Puerperal fever Puerperal 3 1 1 1 6 ... ... ... 3 3 ... ... ... 3 1 2 ... ... ... ... 5 2 4 pyrexia Cerebro-spinal 8 2 6 7 23 ... ... ... 6 17 ... ... ... 8 2 2 3 3 2 3 15 3 ... fever Acute ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lethargica Ophthalmia 2 ... ... 3 5 ... ... ... 2 1 2 ... ... 3 ... ... ... ... 2 ... 2 2 2 neonatorum 10 6 8 5 29 29 ... ... ... ... ... ... ... 7 4 3 1 4 7 3 2 ... ... Dysentery 2 ... ... 3 5 ... 1 ... 1 3 ... ... ... 2 ... ... ... 3 ... ... 5 1 ... Totals 794 678 374 335 2,181 97 571 905 275 215 105 13 65 441 382 257 347 224 310 1155 1,681 109 140 Numbers and 635 446 299 301 1,681 percentages of cases moved to hospitals. 79.9% 65.8% 79.9% 89.8% 77.1% Note.—The following diseases are notifiable:— Small-pox, cholera, diphtheria, erysipelas, scarlet fever, typhus fever, typhoid fevers, relapsing fever, continued fever, puerperal fever, puerperal pyrexia, plague, cerebro spinal meningitis, acute polio encephalitis and poliomyelitis, encephalitis lethargica, glanders, anthrax, hydrophobia, malaria, dysentery, acute primary pneumonia, acute influenzal pneumonia, ophthalmia neonatorum. Tuberculosis, all forms (for which see special section of this report). 20 Smallpox. (Variola minor.) No. of cases notified 788 No. of cases in which diagnosis not confirmed 29 No. of actual cases 759 No. of cases sent for observation 45 No. of observation cases subsequently notified 36 included above. The age, Seasonal and Ward distribution are included in the table on page 19. Further information is contained in the following table:— Ward. No. of cases. Fatal Cases. Rates per 1,000 Population. Case Mortality Deaths per 100 cases. M. F. Total. M. F. Total. Attack Death. Moorfields 6 6 12 ... ... ... 3.0 ... ... Church 64 88 152 ... 1 1 8.8 0.06 0.66 Hoxton 86 69 155 ... ... ... 10.3 ... ... Wenlock 13 25 38 ... ... ... 2.8 ... ... Whitmore 59 60 119 ... ... ... 7.0 ... ... Kingsland 36 54 90 ... ... ... 9.1 ... ... Haggerston 61 81 142 1 ... 1 13.6 0.1 0.70 Acton 26 25 51 ... ... ... 4.5 ... ... Total 351 408 759 ... ... ... 7.7 0.02 0.26 London ... ... 5167 ... ... 12 1.2 0.00 0.23 The following table shows the prevalence of smallpox in the country, London and Shoreditch during recent years :— Cases Notified. England & Wales. London. Shoreditch. 1920 206 22 Nil. 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 10,975 1,905 246 1930 11,855 5,167 788 21 The particulars of the two fatal cases are as follows :— 1. Male, 10 years, certified cause of death : 1 (a) Encephalo Myelitis. (b) Smallpox (Not vaccinated). P.M. 2. Female, 8 months, certified cause of death : 1 (a) Broncho-Pneumonia. (b) Smallpox. (Vaccinated after infection). P.M. The condition as to vaccination of the 759 cases was as follows:— Unvaccinated 653 Vaccinated after infection 11 Vaccinated more than 10 years previously 94 Vaccinated less than 10 years previously 1 (Pt. 8 years of age, vaccinated in infancy—one small scar.) It was explained in the previous report that the work of contact surveillance had begun to assume such proportions by the end of 1929 as to be difficult to deal with by the regular sanitary and clerical staff. During the year now under consideration the number of contacts under surveillance was approximately 9,260. The work falling upon the Sanitary Inspectors became so heavy that their routine duties could not be carried out satisfactorily, and a temporary stall was accordingly appointed as follows :— Mr. Barlow Commenced duty 2nd April, 1930. „ Parkinson ,, ,, 10th April, 1930. Miss Littlejohn (Nurse) „ „ 14th January, 1930. ,, O'Keefe (Nurse) „ „ 20th January, 1930. „ Sumpner (Nura) ,, „ 10th March, 1930. Mrs Campbell (Nurse) ,, „ 27th January, 1930. In addition to the above named, temporary clerical assistance was required to With correspondence relating to smallpox cases. With the aid of this staff administrative measures were taken as laid down in Ministry of Health Memorandum No. 71a/Med. It was not possible, however, to persuade more than a small proportion of those who had been exposed to infection to be Vaccinated. It was Found that many persons who had been exposed to infection were thrown temporarily or permanently out of work as an indirect result of these administrative measures, and for this reason, among others, the Council at their meeting on 21st October requested the Minister of Health to approve the following administrative procedure so long as smallpox retained its mild character:- "Diagnosis.- The Medical Officer of Health or his Assistants to see any suspected case when requested by a medical practitioner to do so, and to endeavour to see as many as possible of all notified cases. (It is not always practicable for the Medical 22 Officer of Health to see all cases during an epidemic, and confirmation by the Medical Officer of Health should not be insisted upon as a condition to the removal to hospital of cases that have been notified.) Disinfection.—The contents of the room occupied by the patient, together with the clothing of the patient, to be disinfected after removal of the patient to hospital. Disinfection to be carried out during regular office hours unless in special circumstances the Medical Officer of Health instructs otherwise. The cases notified after 6 p.m. on week days to be disinfected the following morning, and cases notified after 1 p.m. on Saturday to be disinfected on Monday morning. Surveillance of Contacts.—Close contacts to be kept under observation by Officers of the Public Health Department for unexpired portion of incubation period (18 days) by visits at their homes and enquiries from responsible persons as to their health. Pamphlets on precautions to be taken to be left at the home and contacts instructed to call in a doctor on any sign of illness. Unless the circumstances are exceptional, visits to the homes of contacts to be confined to usual office hours. The surveillance of contacts at work to be discontinued. Information that an individual resident in Shoreditch and working elsewhere is a contact not in future to be sent to the Medical Officer of Health of the district in which he works. As before, information that an individual has developed smallpox to be given either to his employer, or, if working outside the Borough, to the Medical Officer of Health of the district in which he works. It will be seen that the general effect of these recommendations, if adopted, would be that mild smallpox would be treated in much the same manner as Scarlet Fever; that the loss of employment amongst smallpox contacts would be reduced to a minimum, and that the staff would, except in exceptional cases, be able to confine their duties to usual office hours. In support of this application it would be opportune to remind the Minister that in Circular 1025, issued in August, 1929, the mild character of the smallpox now prevalent was referred to, and was given as one of the reasons for modifying advice to be given regarding the vaccination of children of school age and adolescents." In December the Minister intimated his approval of the suggested procedure with the reservation that the diagnosis should be verified by the Medical Officer of Health before the case was removed, and that immediately after removal steps should be taken to secure the disinfection of personal clothing, bedding or beds which might have become infected. In order to prevent the possibility of smallpox infection spreading in the Borough as a result of the prevalent mild cases of the disease being mistaken for chickenpox, the latter disease was made notifiable for a period of six months, commencing 8th February. During the six months that notification was in force 393 cases were notified, all of which were seen by the Medical Officer of Health or Assistant Medical Officer of Health. Only 15 cases notified as chickenpox proved to be smallpox, and it was decided not to prolong notification for a further period as the error intended to 23 be guarded against did not appear to be sufficiently common to justify this administrative measure. It may be mentioned in passing that the disease with which mild smallpox (Variola minor) is especially likely to be confused is influenza. Variola minor commences with rise of temperature, headache and a general feeling of ill heath, and it is at this stage that medical advice is commonly sought. The patient frequently pays no attention to the rash that appears two or three days later, as he then feels much better and considers that he has recovered. A proposal to make influenza notifiable, with the object of following up cases a few days after the initial symptoms, was abandoned as impracticable after careful consideration. Vaccination Order. Under this Order, as from the 1st April, 1930, the functions relating to vaccination carried out by the Boards of Guardians were transferred to the Borough Council, to be discharged as functions relating to Public Health. The officers transferred were as follows:— Vaccination Officers: (1) Mr. Dyson (Mansfield Street Baths), Shoreditch North-East Sub- District (Acton, Haggerston, Kingsland and Whitmore Wards). (2) Mr. H. W. Williams (94, New North Road), Shoreditch South-West Sub-District (Church, Hoxton, Moorfields and Wenlock Wards). Public Vaccinators : (1) Dr. S. W. Jeger, 79, New North Road, N. 1 (Shoreditch South-West District). (2) Dr. L. M. Ladell, 116, St. John's Road, N. 1 (Shoreditch North-East District). Owing to the fact that he was the Mayor of the Borough, Dr. S. W. Jeger resigned his appointment and Dr. N. H. Clubwala was appointed as from the 1st April, 1930, for the Shorcditch South-West District. The following report upon vaccination is in the form required by the RegistrarGeneral:— Vaccination. Return showing the number of Persons successfully vaccinated and re-vaccinated at the cost of the Rates by the Medical Officers of the Poor Law Institutions and the Public Vaccinators during the vear ended 30th September, 1930 :— Shoreditch Borough Council. Name of Poor Law Institution of Vaccination district. Name of Medical Officer or Public Vaccinator. Numbers of successful primary vaccinations of persons. Number of successful re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Observations. Under one year of age. One year and upwards. Total. Leonard's Hospital. Dr. T. Kelleher 3 23 26 41 — Cottage Homes, Shoreditch Dr. Levy — 5 6 — — Dr. S. R. Wright - 1 Shoreditch Dr. S. W. Jeger 263 806 1,069 357 — South-West District. Dr. N. H. Clubwala Shoreditch North-East District. Dr. L. M. Ladell 199 524 723 248 - 465 1,359 1,824 646 24 Scarlet Fever. The cases certified numbered 434, of which 50 or 11.5 per cent. were subsequently not regarded as Scarlet Fever. The actual number of cases was accordingly 384, which gives an attack rate of 3.9 per 1,000 inhabitants. The age seasonal and Ward distribution of the cases are included in the table on page 19. There was one fatal case, a female between 5 and 10 years of age. The number of cases, deaths and the attack, death and case mortality rates in the Borough and Wards are given in the subjoined table :— 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 9 7 16 ... ... ... 4.1 ... ... Church 33 44 77 ... 1 1 4.4 0.06 1.30 Hoxton 17 44 61 ... ... ... 4.0 ... ... Wenlock 18 28 46 ... ... ... 3.4 ... ... Whitmore 30 26 56 ... ... ... 3.3 ... ... Kingsland 13 20 33 ... ... ... 3.3 ... ... Haggerston 31 33 64 ... ... ... 6.1 ... ... Acton 13 18 31 ... ... ... 2.7 ... ... Total 164 220 384 ... 1 1 3.9 0.01 0.26 London ... ... 16,750 ... ... 112 3.8 0.02 0.67 The number of cases in Shoreditch was more than in 1929, in which year there were 314 cases with an attack rate of 3 2. The measures taken to control the disease are as follows :— Isolation of patient. With the exception of 5 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. Search for source of infection. A missed case is sometimes found still in the infectious stage, and is removed to Hospital. As is the case with Diphtheria, susceptibility to Scarlet Fever can now be ascertained by a simple test and persons who are liable to contract the disease can be immunized. There is no clinic for this purpose in Shoreditch, and no case of artificial Scarlet Fever immunization came to the knowledge of the Public Health Department. 25 Diphtheria. The cases certified numbered 346 of which 20 or 5.8 per cent. were subsequently not regarded as being diphtheria. The number of cases during the year was thus 326 which gives an attack rate of 3.3 per 1,000 inhabitants. The age seasonal and Ward distribution of the cases are included in the table on page 19. There were 20 fatal cases—9 males and 11 females. These occurred in the following age groups :— Under 1 year 2 Aged 1-2 years 5 Aged 2-5 years 5 Aged 5-10 years 8 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. No. of cases. Fatal cases. Rates per 1,000 population. Case mortality. Deaths per 100 cases. M. F. Total M. F. Total Attack. Death. Moorfields 11 11 22 ... ... ... 5.6 ... ... Church 23 36 59 1 1 2 3.4 0.11 3.4 Hoxton 27 36 63 2 3 5 4.2 0.33 7.9 Wenlock 17 23 40 1 1 2 2.9 0.l5 5.0 Whitmore 30 16 46 1 1 2 2.7 0.12 4.3 Kingsland 16 19 35 1 4 5 3.5 0.50 14.3 Haggerston 16 17 33 2 1 3 3.1 0.28 9.0 Acton 16 12 28 1 ... 1 2.5 0.09 36 Total 156 170 326 9 11 20 3.3 0.20 6.13 London ... .... 13,527 ... ... 460 3.1 0.10 3.4 Diphtheria is to be regarded as a serious disease of childhood, both by reason of the lives which it takes and the prolonged ill-health by which it is often followed. The cases in Shoreditch were more numerous than in 1929, when they numbered 281. The type of disease was more severe as is shown by the fact that it caused twice as many deaths as in 1929. 26 The conditions prevailing in the Borough are on the whole favourable to this disease, and diphtheria is relatively more prevalent in Shoreditch than in the rest of London:— Cases Notified per 1,000 Population. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. England and Wales 1.76 1.37 1.05 1.07 1.23 1.31 1.33 1.55 1.59 ... London 3.62 3.37 2.27 2.31 2.73 2.96 2.71 2.75 2.68 3,1 Shoreditch 5.8 4.1 3.4 3.6 4.1 4.0 3.7 3.5 2.8 3.3 The administrative measures taken in regard to the disease are as follows:— The isolation of the patient. With one exception 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 have been exposed to infection 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 for the purpose of detecting the diphtheria bacillus numbered 845. Home enquiries were made regarding the notifications received. The age distribution was as follows:— Age period. Male. Female. Total. Under 1 year 6 3 9 1-2 years 21 18 39 2-3 years 16 22 38 3-4 years 22 14 36 4-5 years 28 21 49 5-10 years 37 53 90 10-13 years 7 15 22 Over 13 years 16 27 43 Total 153 173 326 In 22 instances there was evidence pointing to infection from a previous case. 27 The problem of the child who harbours diphtheria germs in its throat, and who, though not ill, is a source of danger to others is a most difficult one. The London County Council have made arrangements under which these children, called "carriers," can receive treatment at special clinics at Guy's, London, and St. Mary's hospitals. Like smallpox, diphtheria is now a preventable disease. Unlike the mild type of smallpox now prevalent, diphtheria is unhappily a very serious disease. During the last five years the number of Shoreditch persons who have died from diphtheria is 67. Of these 43 were under five years of age, 23 between the ages of five and ten, and one over ten. It must be remembered that in addition to the children who died there were a large number whose health was seriously impaired. The fact that illness and death from this cause is preventable is one that calls for the full and careful consideration of a Public Authority responsible for the prevention of infectious disease. Twelve of the Metropolitan Borough Councils have clinics at which children are tested as to their susceptibility to diphtheria, and, if not immune, are protected by means of an easily administered skin injection. There are a number of similar clinics in districts surrounding London and in many counties and towns throughout the country. So far as is known, no Shoreditch children were protected against diphtheria by this means during the year. Enteric Fevers. Three cases of typhoid fever were notified during the year. In one instance the diagnosis was not confirmed. The two cases were both men, one aged 40 and the other 46. It was not possible to trace the source of infection in either case. There was one case of paratyphoid—a young girl aged 13—who had been ill for many weeks before a doctor was consulted, and she was admitted to hospital. She had been at the seaside at about the time when infection probably occurred, and information was sought from the Medical Officer of Health of the district in question, but it was not possible to trace the source of infection. All these cases made a good recovery. Dysentery. Five cases of dysentery were notified. In one the diagnosis was not confirmed. There cases occurred in one family. A man aged 29 years was notified as suffering, and in the course of investigation it was found that his wife and small daughter, aged 3, had previously both had dysentery and had not completely recovered. Both were accordingly removed to hospital. It was not possible to trace the source of infection in the case of the mother daughter, but it appeared possible that they had become infected while on a the country. The remaining case was that of a young woman aged 24. The way in which she became infected was not ascertained. These patients all recovered satisfactorily. 28 Erysipelas. The cases certified numbered 67, and there were 4 deaths, all females. The deaths occurred at the ages of 47 years, 46 years, 3 months and 2 months respectively. The age, seasonal and ward distribution of the cases are included in the table on page 19. 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 0.54 0.03 6.75 Shoreditch 0.68 0.04 5.97 These cases are not as a routine measure admitted to Hospital; 35 however were moved, mostly to St. Leonard's Hospital, during the course of the year. 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 a confinement or the puerperium, and enquiries are accordingly made and steps taken to safeguard against this danger. Puerperal Fever. Six cases were certified, five of whom were removed to Hospital. There were four deaths. The particulars of the four fatal cases are as follows:— Age 27 years—Cause of death " Septicaemia following abortion." Age 30 years—Cause of death " Coma-Septicaemia—Septic abortion induced by deceased." Age 30 years—Cause of death " Puerperal Septicaemia." Age 40 years—Cause of death " Septicaemia following incomplete abortion, insufficient evidence if natural or due to interference." It is several years since there have been as many as four deaths from Puerperal Fever in Shoreditch. It will be noticed, however, that in three of these four cases infection was associated with abortion. 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. 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 4.9 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 1929 315 4.5 131 1.9 5 1.9 2 1.0 1930 296 4.2 119 1.7 6 3.0 4 2.0 29 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 preventing 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 are 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 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 this abuse. 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 puerperal fever. 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 five specialists whose names are included in the list of the staff at the end of this report, to meet practitioners in consultation on these cases upon request. During the year 23 cases were notified, of which 16 were removed to hospital. Consultations with the specialists above referred to were held in three 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. If not properly treated, Ophthalmia Neonatorum may cause blindness or serious impairment of vision. It is due to a gonorrheal infection of the child's eyes during C 30 birth. Infection is nearly always from the genital tract and the mother should accordingly also undergo treatment. Unfortunately, however, it is only possible to arrange this in very few casts. Cases. Vision unimpaired Vision impaired. Total blindness. Deaths. Notified. Treated at home. In Hospital. 30 25 5 30 ... ... ... The cases per 1,000 births numbered 15.0 in Shoreditch as compared with 8 9 for London as a whole. In addition to the cases notified, 110 cases of inflammation of the eyes in the newly born were reported by the Medical Officer of Health of the London County Council. The Health Visitor does all that lies in her power to secure that the child receives prompt and thorough treatment, and she keeps cases under close observation until the eyes are cured. At St. Margaret's Hospital—a special institution of the London County Council for the treatment of this disease—mothers can be admitted with their infants, thus securing continuity of breast-feeding. Four of the cases notified during the year were nursed by the nurses of the Shoreditch and Bethnal Green District Nursing Association, the nurses acting under the instructions of the doctor in charge of the case. Cerebro-Spinal Meningitis. No case was certified during the year. Encephalitis Lethargica. Number of cases notified during the year 5 Number of cases Post Encephalitis Lethargica known to live in Borough at end of year 31 Number of cases Post Encephalitis Lethargica admitted to special Institutions during the year Nil Number of applications for admission made by Medical Officer of Health 3 Of the five cases notified during the year two were females, aged 49 and 56 years, and three were males, aged 19, 21 and 26 years. The after effects of this disease are most serious. Years after the initial illness these patients are frequently in a condition of partial paralysis most distressing to themselves and to the members of their family who are called upon to give them the very great deal of assistance that they require. Arrangements have recently been made and are now under the control of the London County Council whereby cases of post encephalitis lethargica (persons suffering from the after effects of the disease) are admitted to special institutions. 31 This has proved a great boon both to the patients and their families, and it is hoped that this accommodation will be extended so that all these cases will have an opportunity of receiving institutional treatment. Acute Poliomyelitis. No case was notified during the year. This disease, which most commonly attacks children, is characterised by acute feverish onset, with pain in one or more limbs, and is followed by more or less extensive paralysis. The disease is frequently not diagnosed during the initial stages, and the number of actual cases is no doubt considerably in excess of the notifications. The after treatment of the paralysis, which should extend over several years, is most important. If neglected, children easily become badly crippled, who under skilled orthopaedic treatment might enjoy normally active lives. The number of children under five years of age known to the health visitors to be suffering from paralysis following this disease is five. Every effort is made to secure that these children attend hospital and that the parents carry out the advice given. I have to thank Dr. Lewis, the Divisional School Medical Officer, for the information that 24 Shoreditch children who are similarly afflicted attend the Hoxton House Physically Defective School. These children are all medically inspected at the school and are referred to hospital when necessary. The Invalid Children's Aid Association render valuable assistance in the case of children to whom apparatus for the correction of deformity has been supplied at hospital. A note of the particulars of each case is sent by the hospital to the Association, whose visitors advise and assist the parents in all matters relating to the use, repair and inspection of the apparatus supplied. Acute Primary Pneumonia. Acute Influenzal Pneumonia. The number of cases notified during the year was as follows :— Acute primary pneumonia 92 Influenzal pneumonia 5 Of the 97 cases thus brought to the notice of the Department it was found that 69 were receiving treatment in various institutions, as follows:—52 in St. Leonard's Hospital, 2 in the Metropolitan Hospital, 3 in St. Bartholomew's Hospital, and 12 in other institutions. Of the cases treated at home, 4 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 45, fairly satisfactory 15, unsatisfactory 22. In addition to the cases of pneumonia notified, as above, 52 cases of pneumonia not of notifiable type were visited by the District Nursing Association. Altogether the Association paid 543 visits in connection with 56 cases of pneumonia. C2 32 Infectious Diseases not notifiable in Shoreditch. Measles. This disease, which is one of the most serious of childhood, was more prevalent than during 1929. The deaths numbered 49 and occurred in the following age groups :— Under 1 year 13 One to 2 years 25 Two to 5 years 8 Five to 10 years 3 49 Measles was responsible for 21.9 per cent. of all deaths of children under 5 years of age. As will be seen from the following table, measles is a disease which tends to become widespread every few years, for the reason that after a bad measles year a large number of children are protected by the fact that they have had the disease. Year Deaths Death rate per 1,000 population Shoreditch London Shoreditch London 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 1929 17 194 0.17 0.04 1930 49 1,035 0.50 0.23 The distribution of the deaths in the different wards was as shown on the table on pages 12 and 13. 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 1,165. The London County Council 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 Council was 248. In accordance with arrangements made by the Borough Council, the District Nursing Association paid 363 visits in connection with 40 cases of measles. 33 For the reasons explained in the report for the year 1929, the appointment of special nurses to visit schools, obtain lists of absentees likely to be suffering from measles, and to visit the homes of these children, was not a great success and was not repeated. The existing arrangements regarding measles cannot, however, be regarded as satisfactory. During the last five years 157 Shoreditch children have died from measles, of whom 151 have been under five years of age and G between the ages of five and ten years. During the same period the deaths from whooping cough numbered 72, from diphtheria 67 and from scarlet fever 18. Measles is thus seen to be one of the chief killing diseases of early childhood. It is highly infectious and prompt diagnosis and good nursing are all important in preventing pneumonia which is the most common fatal complication. Unfortunately, the seriousness of measles is not appreciated as it should be by parents, and medical assistance is often not sought until the child is obviously very ill. Unfortunately, also the housing conditions in the Borough are such that proper nursing and isolation are impossible in many homes. There does not appear to be any logical reason for the present administrative difference made between scarlet fever and measles. If the latter were made notifiable and all cases were removed as is the case with the former, the following very definite benefits might be expected to result:— The seriousness of the disease would be impressed upon the public and parents would be under an obligation to obtain medical advice. The development of complications would be prevented to a considerable extent by prompt removal to hospital. It is reasonable to expect that isolation would tend to prevent the spread of infection. A measles serum prepared from blood given voluntarily by patients recovering from measles is now available, and in one or two of the Metropolitan Boroughs this is used in the Public Health Departments to protect susceptible children in homes in which cases of measles have occurred. If it proves practicable to confer artificial immunity in this way a valuable new weapon with which to fight the disease will be in the hands of the Public Health Service. Whooping Cough. There were 3 deaths from whooping cough during the year. One of the deaths occurred under one year of age, one between one and two, and one between two and five. The death rate from this disease was 0.04 per 1,000 inhabitants. The deaths in London as a whole numbered 131, the death rate being 0.03. The number of death in Shoreditch in recent years have been as follows:- Year. Deaths. Year. Deaths. 1921 19 1926 0 1922 27 1927 24 1923 10 1928 5 1924 28 1929 40 1925 29 34 The number of cases removed to the hospitals of the London County Council during the year was 12. What has been written in favour of the notification of measles applies with almost equal force to the notification of whooping cough. Whooping cough also is a serious disease commonly neglected at first, frequently leading to complications and for which isolation and good nursing are required. Glandular Fever. Two cases of this disease were brought to the notice of the Health Department under interesting circumstances. On 27th March a practitioner asked for a second opinion upon a case which he believed to be one of Typhus Fever. The patient was a girl aged 16 who became suddenly ill and developed a well marked blotchy rash a few days later. There were bites upon the skin, probably due to lice. After consultation with a member of the medical staff of the Ministry of Health it was decided to regard the case as one of Typhus and it was accordingly notified and removed to the Western Fever Hospital. The mother of the girl was taken ill with somewhat similar symptoms a few day later and was also removed to the Western Hospital as a case of Typhus. The true nature of the illness from which these patients were suffering was not suspected until the fourth week of the disease when the enlargement of the glands and the examination of the blood (showing mononuclear leucocytosis) pointed to glandular fever as the correct diagnosis. The notifications referred to were withdrawn. Influenza. There was only one death attributed to influenza. The number of deaths in Shoreditch during recent years has been as follows:— Year. Deaths. Year. Deaths. 1921 27 1926 22 1922 69 1927 25 1923 14 1928 16 1924 28 1929 68 1925 19 During the last four years the deaths and death rate from influenza in London as a whole have been as follows:— Number of Deaths per 1,000 deaths. population. 1927 1,790 0.39 1928 502 0.11 1929 3,088 0.69 1930 370 008 Diarrhœa. There was somewhat less diarrhcea in Shoreditch than during 1929, though the disease was rather more prevalent in London as a whole. 35 Particulars as to the deaths are contained in the following table:— Deaths under two years. Deaths under one year. Total Number. Rate per 1,000 population. Total Number. Rate per 1,000 births. Percentage of deaths under 1 year. London 696 0.16 638 9.9 15.1 Shoreditch 20 0.20 18 9.0 13.9 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 Number of exclusions exposed. from School. Smallpox 719 Diphtheria 480 Scarlet Fever 630 Measles 1,180 Chicken Pox 593 Whooping Cough 92 Mumps 158 Typhoid Fever 3 Other Infectious Disease 163 4,018 In addition to the exclusions from school referred to above, information was received from the School Medical Officer that three children had been excluded from 36 school on account of the presence of diphtheria bacilli in their noses or throats. The families resident in the three houses to which these children belonged were kept under observation. No cases of diphtheria, however, were subsequently notified amongst the residents of these houses. Nursing in the Home. The Shoreditch and Bethnal Green District Nursing Association undertakes home nursing in the Borough and have an agreement with the Borough Council under which the following types of cases are nursed under medical direction in this Borough in consideration of a payment of Is. 4d. per visit:—(i) cases referred by M.O.H., (ii) children under 5 years of age (the cost of these cases being chargeable to the M. & C. W. Committee), (iii) cases of notifiable diseases. Subjoined is a list of cases nursed under this agreement during the year 1930. Disease. Under 5. Visits. Disease. Over 5. Visits. Measles 32 237 Osteo-Myelitis 2 79 Broncho-Pneumonia 15 144 Tuberculosis 17 402 Pneumonia 14 121 Measles 8 126 Marasmus 1 2 Pneumonia 27 278 Bronchitis 11 65 Influenza 6 59 Threadworms 50 364 Erysipelas 3 21 Tonsils and Adenoids 75 247 Diabetes 2 95 Intestinal 9 53 Hemiplegia 1 5 Burns 3 45 Senility 1 4 Pyrexia 3 35 Pleurisy 1 25 Cardiac 1 10 Post-Partum Pyrexia 7 67 Abscess 1 3 Parturition 6 61 Stomatitis 2 7 Puerperal Pyrexia 1 13 Phymosis 1 15 Miscarriage 3 25 Septic Throat 1 3 Abortion 12 144 Mastoid 66 Lying-in 1 13 Impetigo 1 20 Mammary Abscess 3 24 Ulcer of Buttock 1 46 Mastitis 2 42 Dermatitis 1 35 Intestinal 1 5 Eczema 1 11 Ante-natal 8 67 Constipation 1 11 Post Partum Rheumatism 1 7 Phlebitis 2 30 Glands of Neck 1 18 Scald of Arm 1 17 Tuberculosis 11 15 Prematurity 1 52 Otorrhœa 41 654 Discharging Eyes 7 81 Ophthalmia Neonatorum 4 52 Pemphigus 2 16 Conjunctivitis 1 6 Circumcision 1 9 Septic umbilicus 3 24 Totals 300 cases 2,491 Totals 114 cases 1,585 visits 37 The total number of cases at all ages was 414, in connection with which 4,076 visits were made by the Nurses of the Association. Amongst persons over five years there were four deaths from pneumonia, five from tuberculosis, two from measles and one from abortion, and amongst the children under five, three died from pneumonia and one from measles. 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. 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 sent in this way is telephoned to the doctor the following morning. During the year some 1,309 examinations were made, which included the following:—For suspected diphtheria 845, for suspected tuberculosis 237, in connection with the diagnosis of venereal disease 79. Disinfection. The premises disinfected numbered 2,030. The articles removed to the Borough Council's Disinfecting Station totalled 40,802, and included 1,749 beds, 803 mattresses, 3,529 pillows, 1,016 bolsters and some 33,705 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. It was necessary to destroy one pair of mattresses, which was too dilapidated to be returned. It was replaced. The Shelter. The accommodation provided under Section 60 (4) of the Public Health (London) Act, 1891, was in use on 41 occasions, in order to facilitate disinfection after removal of smallpox cases. 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 °f 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 38 in modern methods of diagnosis and treatment. The County Council further coordinates the work of hospitals, public health services and practitioners, and undertakes publicity and propaganda work with regard to matters relating to venereal disease. Though the means for treatment are available, much educational work remains to be done. Cases not infrequently come to the notice of the Department in which patients recommended to one of these clinics discontinue treatment before they are cured, thus running the gravest risk of disaster to themselves, of infecting their wife or husband and of transmitting disease to their children. The number of bacteriological examinations carried out on behalf of the Borough Council in connection with the diagnosis of venereal disease during the past five years is as follows:— 1926 26 1929 69 1927 66 1930 79 1928 78 39 IV.—SANITARY WORK. The re-arrangement explained in the last Annual Report under which the Borough was divided into ten sanitary districts, and duties under the Sale of Food and Drugs Acts and other similar duties were allocated to two Inspectors was continued during the year, which is thus the first complete year during which this new arrangement has been in operation. DISTRICT INSPECTORS. The total number of Intimations served as to insanitary conditions was 5,126. The number served by each Sanitary Inspector was as follows:— Inspector Wright 525 Inspector Girling 611 „ Chapman 331 „ Stratton 407 „ Sickelmore 511 „ Walker 544 „ Thomas 385 „ Gibbs 524 „ Molloy 431 Tempy. Inspector Barlow 96 „ Bishop 669 „ „ Parkinson 92 In connection with the Inspectors' sanitary work, some 1,483 letters were written to owners and others. 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 1,016 instances. For non-compliance with the requirements of the Sanitary Authority, proceedings were taken before the Magistrates in 37 instances. A list of Legal Proceedings will be found on pages 58, 59, 60 and 61. The following tables (pages 40-41), prepared by the Senior Sanitary Inspector, summarise the visits and work of the Sanitary Inspectors during 1930, 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:- 40 Inspections, 1930. Wright. Chapman. Sickelmore. Thomas. Molloy. Bishop. Girling. Stratton. Walker. Gibbs. Barlow. (Temporary.) Parkinson. (Temporary.) Shaw. Grant. Totals. House to house 258 233 116 96 194 37 279 108 129 324 126 97 ... ... 1,997 Other premises 432 432 740 492 577 941 761 663 502 474 ... 9 ... ... 6,023 Re-inspections, &c 2,698 1,416 1,892 2,496 1,734 2,412 2,321 2,050 2,627 1,999 352 464 ... ... 22,461 Visits in connection with— Smallpox 1,063 1,303 756 1,016 942 1,376 649 953 1,043 1,261 2,358 1,700 ... ... 14,420 Other infectious diseases 36 41 107 99 65 146 244 40 102 124 ... ... ... ... 1,004 Houses let in lodgings 22 22 17 ... 10 5 582 ... 134 7 ... ... ... ... 799 Workshops 79 245 38 90 113 112 322 101 73 199 ... ... ... ... 1,372 Factories 2 70 38 20 21 103 23 36 15 34 ... ... ... ... 362 Outworkers 70 25 49 150 139 87 42 16 39 99 ... ... ... ... 716 Bakehouses 4 ... 8 10 10 13 29 9 5 14 ... ... ... ... 102 Milkshops, Cowsheds 174 52 73 93 59 152 72 75 121 92 ... ... ... ... 963 Cookshops 15 160 17 7 21 21 60 12 42 61 ... ... ... ... 416 Fried Fish Shops 38 16 23 12 6 28 33 12 19 24 ... ... ... ... 211 Ice Cream Shops 22 16 15 11 12 42 42 10 31 25 ... ... ... ... 226 Slaughter Houses ... ... ... ... ... 5 ... ... ... ... ... ... ... ... 5 Meat and Food ... 2 9 4 15 13 27 1 19 2 ... ... ... ... 92 Stables ... ... ... 1 ... ... 3 ... 4 ... ... ... ... ... 8 Rag and Bone 5 ... 13 2 ... 10 4 ... 7 7 ... ... ... ... 48 Markets 14 28 21 39 22 32 35 27 22 32 16 15 39 36 378 Total 51,603 41 Work done,1930. Wright. Chapman. Sickelmore. Thomas. Molloy. Bishop. Girling. stratton. Walker. Gibbs. Barlow. (Temporary.) 1 Parkinson. (Temporary.) Totals. Premises throughout 5 19 7 8 3 2 30 10 10 12 ... ... 106 „ partially 203 166 190 153 177 220 207 223 271 255 69 61 2,195 „ total rooms 549 399 535 420 418 440 637 682 695 678 197 122 5,772 Verminous rooms 7 6 11 17 1 25 10 22 54 10 ... 11 174 „ premises 6 2 10 12 ... 19 7 19 46 2 ... 11 134 Premises, generally rePaired 323 110 319 200 188 320 408 331 327 383 69 79 3,057 Light and ventilation 1 1 6 ... 1 3 2 ... 3 ... 1 ... 18 Roofs, gutters, rain-water Pipes 209 67 303 210 149 212 235 147 224 228 35 50 2,069 Overcrowding 1 1 2 10 14 75 7 5 18 3 ... ... 136 Water re-instated 7 3 15 ... 9 4 28 4 6 6 1 ... 83 Drains new 2 3 4 1 2 5 4 2 2 3 ... ... 28 „ re-constructed 6 5 4 1 1 3 15 6 17 15 ... ... 73 „ improved or repaired 13 18 42 39 26 25 8 4 33 20 2 3 233 „ obstructions removed 22 13 34 30 7 20 16 18 25 23 ... 2 210 Soil, vent pipes repaired 1 6 19 1 2 6 ... 1 14 4 1 6 61 W.C.S New 57 26 28 8 13 55 36 20 11 100 ... ... 354 Improved or repaired 73 61 194 104 86 94 102 76 83 92 2 12 979 Obstructions removed 12 9 26 18 10 15 33 21 35 20 3 1 203 Sinks improved 12 31 20 20 19 2 46 10 13 14 1 ... 188 „ traps provided 2 1 2 3 4 2 ... ... 1 12 ... 1 28 Outdoor Premises. Floors, Paving repaired 34 5 41 41 24 32 39 24 28 49 1 14 332 Cleansed or limewashed 63 72 72 80 2 103 3 57 123 ... ... ... 575 Improved or repaired ... ... • • • ... ... ... ... ... ... ... ... ... ... Ashpits provided 35 22 66 30 59 78 64 48 54 45 17 3 521 " improved or repaired ... 1 7 ... 2 1 2 ... ... ... ... ... 13 „ abolished ... ... 7 ... 2 5 3 ... ... 1 3 ... 21 Accumulations removed 17 7 15 ... 14 25 8 4 19 27 1 ... 137 Urinals Cleansed or repaired 1 ... ... ... 1 1 ... ... 1 ... ... ... 4 removed 1 ... ... ... ... 1 1 ... 1 ... ... ... 4 42 The following summary follows in the main return made to the Medical Officer of Health of the London County Council for inclusion in his Annual Report for the year 1930:— Sanitary Area. premises. NUMBER OF PLACES- Number of inspections, 1930. Number of notices, 1930. Number of prosecutions, 1930. On register at end of 1929. Added in 1930. Removed in 1930. On register at end of 1930. Milk premises 288 5 20 273 863 11 ... Cowsheds 2 ... ... 2 31 1 ... Slaughterhouses 1 ... ... 1 5 ... ... Offensive trade premises 1 ... ... 1 8 2 ... Ice Cream premises 91 5 ... 96 226 12 ... Houses let in lodgings 389 19 6 402 799 191 ... Restaurants and eating houses 194 ... 5 189 456 23 ... Smoke Nuisances. (1) Number of observations 748 (4) Number of Statutory notices (2) Number of intimations served 11 served 1 (3) Number of complaints received 3 (5) Number of legal proceedings Nil (6) Number of convictions Nil Cleansing and Disinfection. Number of adults cleansed 6 Number of premises cleansed— Number of children cleansed Nil (a) After infectious diseases 1,999 (b) For vermin 31 Water Supply to Tenement Houses. Number of premises supplied 35 Number of prosecutions Nil Sanitary Officers. Number of Sanitary Inspectors (whole-time): Male—13. Female—Nil. „ „ „ (part-time): Male—Nil. Female—Nil. Number of Health Visitors (wholetime): Municipal—6. Voluntary—2. „ „ (part-time) : Nil. Total number of houses in the Borough 14,026 Number of houses occupied by the Working Classes 13,126 Number of houses inspected— (a) On account of complaints or illness (Public Health Act) 6,023 (b) House-to-house (Housing Consolidated Regulations, 1925) (Public Health Act) 1,997 43 Number of Notices served— (a) Under Public Health Act— (i.) Intimation 5,126 (ii.) Statutory 1,016 (b) Under Housing Act — Number of houses repaired or nuisances remedied under Public Health Act, 1891 5,126 Number of houses repaired under Section 3 of Housing Act, 1925— (a) By owners — (b) By Local Authority in default of owners — Note.—This Section was, in August, rendered inoperative by the Housing Act, 1930. Number of houses closed on notice by owner that they could not be made fit — Number of houses for the Working Classes— (a) Erected during the year 54 (b) In course of erection 55 Number of representations by Medical Officer or other person — Number of houses included in such representations — Number of Closing Orders made — Number of Closing Orders determined (i.e., houses made fit) — Number of Demolition Orders — Number of houses demolished— (a) In pursuance of Orders — (b) Voluntary 59 Underground Rooms. Number illegally occupied 2 Number closed or illegal occupation discontinued 2 Overcrowding. Number of cases of overcrowding found 136 Number remedied 92 Number of prosecutions — Fur Skin Dressers. At the end of the year there was one on the Register. Eight visits of inspection were made, and two Intimation Notices were served in respect of lime washing. These were duly complied with. Rag and Bone Dealers. Some 22 premises to which bye-laws under Section 9 of the London County Council (General Powers) Act, 1908, apply, were on the Register at the end of the year. The visits paid to these during the year numbered 48. Intimations as to the need for cleanliness were written and duly attended to in 7 instances. 44 Verminous Houses. The houses where it was necessary to take measures on account of the presence of vermin numbered 133, and in connection with them some 174 rooms were dealt with during the year. Sanitary notices were served where required and the usual steps taken. A fair number of the premises came under notice through intimations from the School Authorities as to children reported as being in a verminous condition. During the year the homes of some 70 children, 37 boys and 33 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. Intimations were received that 18 boys and 10 girls had been given the opportunity of being cleansed at these stations, that in the case of 15 boys and 22 girls Statutory Notices had been served upon the parents to cleanse the children within 24 hours under Section 122 of the Children's Act, 1908, and that in the cases of 2 boys and 1 girl legal proceedings were pending for non-compliance with the requirements of Statutory Notices under this Act. In 2 cases the addresses given were erroneous. In all the cases reported the homes were visited by the Sanitary Inspectors, and the following summarises the results obtained:—In 63 the rooms occupied were satisfactory, varying from fairly clean to very clean, in 3 they were dirty, and in 2 also buggy. In 62 the bedding was clean or fairly so, in 6 it was verminous, overcrowding was noticed in one instance. In four 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 three Sanitary Notices were served upon the owners and two upon the occupiers for cleansing. The children reported by the School Authorities as suffering from scabies numbered 41, of whom 29 were females. As a result of the enquiries made 4 other cases came under observation. As far as practicable steps were taken to prevent infection spreading. In 1 case the address given was erroneous. London County Council (General Powers) Act, 1928, Section 28. Application was made to the Magistrate for the removal to St. Leonard's Hospital of two individuals under this Section. Water Supply. The number of certificates issued as required under the Public Health (London) Act, 1891, Section 48 (2), was 35. The water supply is almost entirely from the Metropolitan Water Board. There are, however, a certain number of wells in the Borough from one or two of which drinking water is obtained. Nine wells were under the observation of the Sanitary Inspectors during the year. 45 Rats and Mice Destruction Act, 1919. Summary. Inspectors. Wright. Chapman. Sickelmore. Thomas. Molloy. Bishop. Girling Stratton Walker. Gibbs. 1 Total. Complaints dealt with 10 68 25 5 9 15 25 6 31 17 211 Drains tested 4 1 22 4 1 4 11 1 14 5 67 Found defective 2 1 4 2 — 2 1 — 8 — 20 Found satisfactory 2 — 18 2 1 2 10 1 6 5 47 Premises where egress of rats was ascertained 10 14 13 4 - 14 21 1 21 - 98 Premises reported freed from rats 9 1 23 5 9 15 25 6 26 15 134 FOOD. Street Markets and Food. The number of inspections of premises at which food is prepared or sold, made by each Inspector during the year, is shown in the Table on page 40. The following were surrendered or seized and destroyed as unfit for the food of man : 1 tin of peeled tomatoes, 1 bundle (4 boxes) of tomatoes, 1 tray of chocolate, 56 lbs. of plaice, 5 cwts. of pigs' heads, 20 lbs. of currants and 3 qrs. of haddocks. Slaughterhouses. There is only one licensed slaughterhouse in the Borough. No animals however were slaughtered during the year. Meat. The number of butchers' shops under inspection during the year was 54 and the number of visits of inspection was 92. General observation was kept of all meat stalls where butchers' meat was exposed for sale. Ten warning letters were sent in respect of minor infringements of the Public Health (Meat) Regulations, 1924. Legal proceedings were instituted in one case, and the defendant was ordered to pay £1 10s. costs. Cowhouses. Particulars regarding the inspection of the two cowhouses in the Borough are contained in the Table on page 42. At the end of the year 26 cows were being kept in these two cowhouses. 1 Structural improvements were carried out during the year at the premises in St. John's Road whereby the lighting and ventilation were made much better. d 46 The sanitary condition of both cowhouses can be regarded as satisfactory. Speaking generally, however, the arrangement under which cows are kept in the middle of a densely-populated urban area like Shoreditch cannot be regarded as altogether suitable. The Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations prohibit a person suffering from Tuberculosis, who is in an infectious condition, 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. It was not necessary for these reasons to prohibit any person from following his occupation in a dairy during the year under consideration. cookshops and eating-houses. Including the kitchens of public houses where food is prepared for customers, 189 were under inspection during the year, and some 456 visits were made in connection with them. Some 23 sanitary notices were served, mainly for cleansing. Fried Fish Shops. Some 59 were under inspection and 211 visits were made to them. Twenty-three sanitary notices were served, mainly for cleansing. Ice-Cream Shops. The number under observation during the year was 96, and 226 visits of inspection were made. In 12 instances sanitary notices were served. Most of these were for general cleansing. The L.C.C. (General Powers) Act, 1928, provides for the registration of ice-cream premises. At the end of the year the number on the register was 96. Bakehouses. The number of bakehouses on the register throughout the year was 52. The number underground was 35 and the number of factory bakehouses was 29. In connection with bakehouses the Sanitary Inspectors paid 102 visits of inspection. Intimation notices were served in 19 instances. Registration of Hairdressers. At the end of the year the number of hairdressers in the Borough on the voluntary register of hairdressers agreeing to comply with the hygienic requirements of the Council was 14. Sale of Food Order, 1921. The provisions of this Order respecting the marking of Meat, etc., are complied with in the Borough. No contraventions were noticed during the year. 47 Regulations as to the Sale of Eggs. All eggs exposed for sale in the Borough during the year appeared properly marked. No complaints or evidence as to contravention were received during the year. INSPECTORS WITH SPECIAL DUTIES. The arrangement under which Mr. Grant and Mr. Shaw continued throughout the year to devote the whole of their time to the matters referred to in this sub-section of the Report worked well, and it is hoped that this arrangement will become permanent. Food and Drugs Acts. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 1,056 samples were submitted to him during the year. This number is at the rate of 10.5 per 1,000 inhabitants. The results of the year's work are summarised in the following table:— Quarter of 19^0. Number of Samples taken. Number of Samples Adulterated. Percentage Adulterated. Number of Prosecutions Instituted. Prosecutions withdrawn because of Warranties, &c. Prosecutions Proceeded with Number of Successful Prosecutions. Fines and Costs. Amount paid to Analyst for Samples Analysed. £ s. d. £ s. d. 1st 280 4 1.9% 0 - 0 0 175 0 0 2nd 271 10 3.3% 9 - 9 9 23 3 0 169 7 6 3rd 217 8 3.6% 5 - 5 5 11 16 0 135 12 6 4th 283 4 1.4% 2 - 2 2 7 5 0 180 0 0 Totals for Year 1,056 26 2.46% 16 - 16 16 42 4 0 660 0 0 The samples taken included: 559 milks, 34 butter, 24 dried fruits (3 informal), 21 bread and butter (17 informal), 21 tea (1 informal), 30 cheese, tinfoil wrapped (21 informal), 20 margarine, 17 whisky, 17 sterilised milk, 16 condensed milk (sweetened), 16 sausage (5 informal), 14 jam (8 informal), 11 meat pies (10 informal), 11 tinned fish (informal), 11 rum, 10 cake ingredients, 9 cordials (6 informal), 8 tinned fruits (informal), 8 beet, 7 gins, 7 non-alcoholic wines, 7 sugar, 6 sweets, 6 dripping, 6 tapioca (2 informal), 5 marmalade (4 informal), 5 malt vinegar, 5 boiled ham (4 informal), 5 wine (1 informal), 4 milk chocolate, 4 cocoa, 4 coffee, 4 self-raising flour, 4 pepper, 4 pearl barley, 4 lard, 4 bread, 4 cake, 4 castor oil (informal), 4 compound syrup of figs (informal), 3 flour, 3 lemonade powder, 3 cream (2 informal), 3 cod liver oil emulsion (informal), 3 boracic ointment (informal), 3 zinc ointment (informal), 3 mustard (2 informal), 2 brawns (1 informal), 2 Kruschen salts (informal), 2 cheese, 2 ground arrowroot (1 informal), 2 lemon squash, 2 saveloys, 2 weak tincture of iodine (informal), 2 comp. liquorice powder (informal), 2 ground rice (informal), D 2 48 and 1 each of Glauber salts (informal), glycerine (informal), pressed beef (informal), vinegar essence (informal), baking powder, beef paste, chicory and coffee, egg substitute powder, sago, sardines, tea dust, ground ginger, jelly, nut oil, olive oil, rice, chicken and ham paste, corned beef, bread and margarine, lime juice cordial and chopped meat. Of the samples of milk 14 or 2.4 per cent. were found to be below the standard fixed by the Board of Agriculture. In the subjoined table are shown the number of samples of milk taken during the four quarters of the year, with the numbers and percentage of those not found to be genuine:— Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st 128 2 1.5 2nd 180 9 5.0 3rd 125 3 2.4 4th 143 0 0 In two of the samples, water was certified to have been added; in both cases it was less than 5 per cent.; in 11 cases the samples showed deficiency in fat ranging from 1 to 35 per cent., taking the standard as laid down by the Sale of Milk Regulations. In one sample it was certified that 3 per cent. water was added and 3 per cent. fat abstracted. Legal proceedings were instituted in nine, or 64.28 per cent., of the cases in which samples of milk were below standard. No legal proceedings were considered advisable regarding 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 35.72. Of the forty samples of vinegar taken, one contained 9 per cent. excessive water. Proceedings were taken and the defendant was found guilty and ordered to pay £2 2s. costs. Of the 18 samples of sausages taken, three were certified to contain sulphur dioxide to the extent of 250, 240 and 100 parts per million respectively. Legal proceedings were instituted in all three cases, and fines and costs amounting to £5 1s. were imposed. Of the 35 samples of spirits taken, two samples of whisky contained 3.2 per cent. and 2 per cent. excessive water. One sample of gin was certified to contain 5.8 per cent. of excessive water. Proceedings were instituted regarding the cases with 49 excessive water to 5.8 per cent. and 3.2 per cent., and £3 3s. costs were allowed the Council in each case. Twenty informal samples of bread and butter were taken. Three were found to have margarine substituted for butter. Three formal samples were taken from the same sources, and in one case margarine was again found substituted for butter. Proceedings were instituted and the defendant was fined £2 with £3 3s. costs. The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1906-1930 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. 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 1929 1060 95 26 2.5 15 15 15 48 8 6 662 10 0 1930 1056 44 26 2.46 16 16 16 42 4 0 660 0 0 Milk (Special Designations) Order, 1923. The following samples were taken and submitted to the Bacteriologist for examination: 1 sample of Grade "A" T.T.; 1 sample of "Certified" milk and 5 samples of "Pasteurized" milk. The results show that the milks conformed to the standard laid down by the Order. 50 Two samples of ordinary undesignated milk with the following results:— Sample No. 24. B. coli present in 0.001 c.c.m. Colonies growing at 37° C.—434,000 per c.c.m. „ „ 22° C.—245,000 per c.c.m. B. Sporogenes and whelchii present in 10 c.c.m. Sample No. 25. B. coli present in 0 001 c.c.m. Colonies growing at 37° C.—136,400 per c.c.m. „ ,, 22° C.—75,600 per c.c.m. B. Sporogenes and whelchii present in 10 c.c.m. Four samples of "Pasteurized" Milk and 1 Grade "A" T.T. Milk. The results show that these milks did not conform to the standard laid down by the Order. The following are the results of the examinations made by the Bacteriologist:— Sample No. 16—Grade "A" T.T. Milk. No. of bacteria per 1 c.c.—710,000 (a) 1/10 c.c. 63,500 (b) 1/100 c.c. 7,120 (c) 1/1000 c.c. 784 Not more than 200,000 allowed. Presence of B. coli in 1/100 c.c. in three tubes:— 48 hrs. 72 hrs. 1. + + 2. + + 3. + + No B. coli in 1/100 c.c. allowed. Sample No. 15—Pasteurized Milk. No. of bacteria per 1 c.c.—627,000 (a) 1/10 c.c. 58,400 (b) 1/100 c.c. 6,250 (c) 1/1000 c.c. 672 Not more than 100,00 allowed. Presence of B. coli in 1/10 c.c. in three tubes:— 48 hrs. 72 hrs. 1. + + 2. + + 3. + + Sample No. 17—Pasteurized Milk. No. of bacteria per 1 c.c.—125,000 (a) 1/10 c.c. 10,600 ) (b)1/100 c.c. 1,240 (c) 1/1000 c.c. 146 ) Not more than 100,000 allowed. Presence of B. coli in 1/10 c.c. in three tubes:— 48 hrs. 72 hrs. 1. — — 2. — — 3. — — 51 Sample No. 18—Pasteurized Milk. No. of bacteria per 1 c.c.—222,500 (a) 1/10 c.c. 19,760 ) (b) 1/100 c.c. 2,140 (c) 1/1000 c.c. 256 Not more than 100,00 allowed. Presence of B. coli in 1/10 c.c. in three tubes:— 48 hrs. 72 hrs. 1. — — 2. — — 3. — — Sample No. 19—Pasteurized. Milk. No. of bacteria per 1 c.c.—128,000 (a) 1/10 c.c. 11,800 (b) 1/100 c.c. 1,220 (c) 1/1000 c.c. 146) NOt more than 100,00 allowed. Presence of B. coli in 1/10 c.c. in three tubes:— 48 hrs. 72 hrs. 1. + + 2. + + 3. + + Notes on these samples. Sample No. 16—Grade "A" T.T. Milk. Warning letter was sent by M.O.H. 8/4/30. Endeavours were made to obtain further samples of Grade "A" Milk, but were unsuccessful. Sample No. 17— "Pasteurized Milk." Sample No. 18— „ „ Sample No. 19— „ „ Warning letters were sent in each case and further samples were taken which conformed to the standard. The explanation given was that due care had not been taken by the man in charge of the Pasteurizing plant. Sample No. 15— "Pasteurized" Milk. Warning letter sent by the M.O.H. 8/4/30. The explanation given was that the milk was wrongly labelled and should not have been sold as designated milk. Sale of "Pasteurized" milk has been discontinued in the Borough by this vendor. Treatment of Milk by Heat. An enquiry was carried out during the year with the object of ascertaining the extent to which milk sold in the Borough is subjected to heat before reaching the purchaser. It was found that, with the exception of the relatively very small quantity of milk supplied from the two cow sheds in the Borough, milk sold in Shoreditch is obtained wholesale from some seventeen firms. A letter was written 52 to each of these, and from replies received it is clear that, with the exception referred to, all milk is subjected to heat by the various wholesale dealers. This fact has an important bearing upon the safety of milk as a food for the young. During the last ten years the Maternity & Child Welfare Committee have supplied a large amount of milk from the milk shops in the Borough to nursing and expectant mothers, infants and young children. During 1930 the amount supplied was approximately 30,500 gallons. It is known from the London County Council Reports that an appreciable percentage of this milk contains tubercle bacilli, and that it does not otherwise conform to a satisfactory bacteriological standard, but tuberculosis and infantile diarrhoea, the two diseases to be feared as a result of giving milk thus contaminated to infants and young children, have shown a definite tendency to decrease during this period. There are doubtless other factors to be considered, but it is reasonable to suppose that the fact that it has been possible to give away 1,200 pints and more of undesignated milk daily for ten years without any ill effects having become apparent is largely attributable to the heating of milk by the wholesale dealers. Milk and Cream Regulations, 1912. None of the samples of milk submitted for analysis were reported to contain any preservative. Three samples of cream were submitted for analysis none of which were reported to contain any preservative. Condensed Milk Regulations. Sixteen samples of condensed milk were submitted for analysis under the above Regulations, all of which were certified to comply with the standard laid down by the Regulations. Milk and Dairies Order, 1926. General observation was kept on all purveyors of milk by the Food and Drug Inspectors. In one case a purveyor of milk was observed " filling bottles in the street." Legal proceedings were instituted and the defendant was fined 10s. Merchandise Marks Act, 1926, Orders. General observation was kept of all stalls and shops in the Borough where foodstuffs scheduled under these Orders were exposed for sale. Thirty-four warning letters were sent in respect of minor infringements. These proved effective and no further action was necessary. Meat Regulations, 1924. General observation was kept of all meat stalls where butcher's meat was exposed for sale. Ten warning letters were sent in respect of minor infringements. Smoke Nuisances. There were 3 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 748 observations were made by the Sanitary Inspectors and in 53 11 instances intimation notices and in 1 statutory notice were served on the Offenders. These were effective, and there was no necessity for further action on the part of the Sanitary Authorities. Rag Flock Acts, 1911 and 1928. Under the above Act, 36 samples were taken for analysis. Two contained 65 and 190 parts respectively of soluble chlorine per 100,000 in excess of the amount allowed. In both cases proceedings were instituted and fines and costs to the extent of £19 9s. 0d. were imposed. FACTORY AND WORKSHOP ACT, 1901. Factories are dealt with by H.M. Inspectors of Factories and Workshops by 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 1,612. The number added to the register was 161, the number removed 144. A classilication of the workshops on the register at the end of the year is contained in the following table:— Registered Workshops—1930. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades. 1,078 (a) Cabinet making 600 (c) Upholstery 95 (b) French polishing 173 (d) Other workers 210 (2) Dress 194 (a) Tailoring 83 le) Shirt making 1 (b) Mantles 15 (f) Boot and shoe trades 29 (c) Dress 18 (g) Artificial flowers 3 (d) Millinery 9 (h) Other workers 36 (3) Skin, leather, hair and feather trades 64 (a) Furriers 15 (c) Feathers 1 (b) Saddlery and Harness 8 (d) Other workers 40 (4) Paper, printing, book, stationery and fancy goods trades 58 (a) Box and bag makers 38 (b) Other workers 20 (5) Laundry and washing 6 (6) Food 16 (7) Metals, machines, implements and conveyances 87 (8) Precious metals, jewels, &c. 1 (9) Other trades than those mentioned above 108 Total number of workshops on Register 1,612 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 52, including 29 factory bakehouses. 54 The particulars of inspections made by the Sanitary Inspectors are as follows:— Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 362 49 1 Workshops (Including Workshop Laundries) 1,372 179 1 Workplaces (Excluding Outworkers' premises dealt with in Table III.) 893 72 Totals 2,627 300 2 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 112 112 Want of ventilation Overcrowding Want of drainage of floors Other nuisances 237 237 Sanitary accommodation insufficient 10 10 unsuitable or defective 122 122 not separate for sexes 2 2 Offences under the Factory and Workshop Act: Illegal occupation of underground bakehouse (Section 101) Breach of special sanitary requirements for bakehouses (Sections 97 to 100) Other offences (Excluding offences relating to outwork which are included in table on page 56.) Totals 483 483 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Act. 55 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133). 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5). Notified by H.M. Inspector 23 (referring to 16 factories and 7 workshops.) Reports (of action taken) sent to H.M. Inspector. 3 (referring to 16 factories and 7 workshops.) Other 3 Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 35 During the year 179 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 167 Premises cleansed partially 55 Number of rooms cleansed 197 Walls, floors, sashes, etc., repaired 47 Light and ventilation improved — Roofs, guttering, etc., repaired 77 Overcrowding abated — Water reinstated or improved 1 Drains newly constructed 2 Drains reconstructed 6 Drains, repaired, etc. 14 Drains obstructions removed 19 Urinals cleansed, etc. 3 Soil and vent pipes dealt with 11 Water-closets newly constructed 30 W'ater-closets repaired, etc. 109 Water-closets obstructions removed 13 Sinks, etc., cleansed and repaired 5 Sink traps provided 15 Sculleries, yards, etc., paving repaired 3 Sculleries, yards, etc., cleansed or limewashed 39 Dust receptacles provided 8 Foul accumulations removed 3 The number of factories under observation for insanitary conditions during the year was 49, and in connection with them some 49 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 42 instances, the removal of obstructions from drains and water-closets in 12 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 80 lists of out-workers were received from employers in the borough, 40 in the first and 40 in the second half-year. Those for the first half-year are due in February, for the second in August. These lists contained the names 891 out-workers, of whom 652 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the sanitary authorities of the districts to which they belonged. 56 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. Instances. Notices served. Prosecutions. Instances. Orders made. (S. 109.) Prosecutions. (S. 109, 110.^ Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) '6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing apparel:— (1) Making, &c 42 63 488 6 4 55 ... ... ... 35 35 ... 7 ... ... (2) Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 2 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers 4 ... 28 ... ... ... ... ... ... 2 2 ... 1 ... ... Fur pulling 2 19 ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... Paper bags and boxes 16 ... 134 5 ... 65 ... ... ... 20 20 ... 3 ... ... Brush making ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... Xmas Crackers ... ... ... ... ... ... ... ... ... 4 4 ... ... ... ... Leather Goods 2 ... 26 1 ... 4 ... ... ... 3 3 ... ... ... ... Carding of Buttons ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Totals 68 82 681 12 4 124 ... ... ... 69 69 ... 11 ... ... (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, and feather sorting. (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. 57 Communications were received from various sanitary authorities relating to some 1,291 outworkers for firms outside Shoreditch and as 21 o£ 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 1930. Showing the Numbers of Outworkers Received from other Districts during 1930. districts. Making Wearing Apparel. Toys and Crackers. Artificial Flowers. Furniture and Upholstery. Fur Pulling. Lace Curtains. Umbrellas, &c. Paper Hags and Boxes. Brush Making. Fancy Leather Goods. Card Mounting. Sponges. 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 l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Bermondsey l 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Bethnal Green 39 40 14 20 1 ... 2 ... ... ... ... ... ... ... 26 19 ... ... ... ... ... ... ... ... 177 Camberwell 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 City of London 178 191 3 ... 3 ... ... ... ... 7 ... ... 27 19 1 ... ... ... 2 3 ... ... ... ... 440 Croydon ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Deptford 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Edmonton ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Finsbury 62 68 9 10 7 ... l 1 ... 2 ... ... 6 2 34 40 ... ... 6 5 5 4 ... ... 264 Hackney 85 79 4 7 3 ... 2 2 ... 2 ... ... 1 1 16 26 ... ... ... ... ... ... ... ... 239 Hammersmith 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Hampstead 1 1 ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Holborn ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Hornsey 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Poplar 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Islington 19 13 4 4 2 1 ... ... ... ... ... ... ... ... 2 7 ... ... ... ... ... ... ... ... 52 Kingston 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Leyton 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 4 Southwark 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 St. Marylebone 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Stepney 7 14 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 24 St. Pancras 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Stoke Newington 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 9 ... ... ... ... ... ... ... ... ... 12 Tottenham ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Westminster 18 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 Totals 430 448 34 42 16 3 5 3 6 1 2 ... ... 34 22 88 95 14 14 8 8 5 4 ... ... 1,291 878 76 19 8 18 ... 56 183 28 16 9 ... 58 The total number of outworkers reported was 2,182, and of these some 1,509 were residents in Shoreditch. These figures are below the average for the past five years. As pointed out in previous reports, in numerous instances names and addresses of outworkers are duplicated owing to lists being sent in twice a year, and in some cases the same outworkers are employed by more than one firm, so that the numbers given above must not be taken as representing the actual numbers of individual outworkers and the tables on pages 56 and 57 show the distribution of outworkers 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 706 visits of inspection were made to places where home-work was being carried on, and in connection with these 69 sanitary notices were served. The cases of notifiable infectious disease occurring at outworkers' premises numbered 11 and included 5 smallpox, 5 scarlet fever and 1 diphtheria. The usual steps were taken in connection with them by the officers of the sanitary authority. LEGAL PROCEEDINGS. The following is a full list of legal proceedings instituted during the year under report:— Public Health (London) Act, 1891, and Bye-Laws. Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. Jan. 3 Non - compliance with Statutory Notice, 61, Grange Street. - 2 2 0 Notice complied with prior to hearing. Jan. 10 Non - compliance with Statutory Notice, 71, Grange Street. - 1 1 0 Notice complied with prior to hearing. Jan. 10 Non - compliance with Statutory Notice, 71, Grange Street. - 1 1 0 Notice complied with prior to hearing. Jan. 31 Fixing a soil pipe in connection with W.C. at 56, Shaftesbury Street without notice. - 2 2 0 - Feb. 7 Non - compliance with Statutory Notice, 18, Laburnum Street. - 2 2 0 Magistrate's Order for Notice to be complied with within 14 days. Feb. 21 Non - compliance with Statutory Notice, 6, Witham Street. - - Magistrate's Order for Notice to be complied with within 14 days. 59 Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. Feb. 21 Non - compliance with Statutory Notice, 130, Bridport Place. 2 0 0 2 2 0 - Feb. 27 Non - compliance with Statutory Notice, 5, Norris Street. - 1 1 0 Notice complied with prior to hearing. Feb. 27 Non - compliance with Statutory Noticc, 21, Norris Street. - 1 1 0 Notice complied with prior to hearing. Mar. 7 Non - compliance with Statutory Notice, 46, Wilson Street. - 2 2 0 Notice complied with prior to hearing. Mar. 7 Non - compliance with Statutory Notice, 66, Gopsall Street. 5 0 0 2 2 0 - Mar. 14 Fixing a W.C. pan and trap at 60, Grange Street without notice. 1 0 0 2 2 0 - Mar. 21 Fixing a W.C. pan and trap at 22, Victoria Chambers, Paul Street, without notice. - - - Mar. 21 Non - compliance with Statutory Notice, 3, Felton Street. 1 0 0 2 2 0 - Apr. 11 Non - compliance with Statutory Notice, 42, Charles Square. - 2 2 0 Magistrate's Order for Notice to be complied with within 14 days. Apr. 25 Non - compliance with terms of Magistrate's Order, 6, Witham Street. 5 0 0 - Nuisance Order to continue. Apr. 25 Non - compliance with Statutory Notice, 10, Wareham Street. - 1 1 0 Notice complied with prior to hearing. May 2 Non - compliance with Statutory Notice, 165, New North Road. - 2 2 0 Magistrate's Order for Notice to be complied with within 7 days. May 16 Non - compliance with terms of Magistrate's Order, 42, Charles Square. 2 0 0 2 2 0 - May 16 Non - compliance with Statutory Notice, 42, Charles Square. - 2 2 0 Notice complied with prior to hearing. May 16 Removal of offensive matter by road during prohibited hours. - - Dismissed under Probation of Offenders Act. June 6 Non - compliance with Statutory Notice, 64, Gopsall Street. - 1 1 0 Magistrate's Order for Notice to be complied with within 7 days. 60 Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. July 4 Non - compliance with Statutory Notice, 151, Hackney Road. - l 3 0 Magistrate's Order for Notice to be complied with within 28 days. July 11 Non - compliance with Statutory Notice, 93, Brunswick Street. - 2 2 0 Magistrate's Order for Notice to be complied with within 21 days. July 25 Non - compliance with Statutory Notice, 34a, Scrutton Street. - - Magistrate's Order for Notice to be complied with within 7 days. Aug. 29 Non - compliance with Statutory Notice, 62, Grange Street. - 2 2 0 Notice complied with prior to hearing. Sept. 5 Non - compliance with Statutory Notice, 33, Anning Street. - 2 2 0 Adjourned sine die. Sept. 5 Non - compliance with terms of Magistrate's Order, 151, Hackney Road. 5 0 0 2 2 0 - Sept. 5 Non - compliance with terms of Magistrate's Order, 93, Brunswick Street. 5 0 0 2 2 0 - Sept. 12 Non - compliance with Statutory Notice, 42, Grange Street. - 1 3 0 Notice complied with prior to hearing. Oct. 10 Non - compliance with Statutory Notice, 66, Gopsall Street. - 2 2 0 Notice complied with prior to hearing. Oct. 10 Fixing a W.C. pan at 1 to 3, Penn Street without notice. 1 1 0 2 2 0 - Oct. 31 Non - compliance with Statutory Notice, 20, Whiston Street. - 2 2 0 Magistrate's Order for Notice to be complied with within 28 days. Oct. 31 Non - compliance with Statutory Notice, 22, Whiston Street. - 2 2 0 Magistrate's Order for Notice to be complied with within 28 days. Oct. 31 Non - compliance with Statutory Notice, 49, Grange Street. - 2 2 0 Notice complied with prior to hearing. Oct. 31 Non - compliance with Statutory Notice, 32, Grange Street. - 1 0 0 Notice complied with prior to hearing. Nov. 14 Non - compliance with Statutory Notice, 56, Grange Street. - 1 1 0 Notice complied with prior to hearing. Nov. 14 Non - compliance with Statutory Notice, 133, St. John's Road. - 2 2 0 Notice complied with prior to hearing. 61 Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. Nov. 25 Having 20 lbs. of currants at 39, Pitfield Street deposited for the purpose of sale, which were unsound and unfit for the food of man. 10 0 0 5 5 0 - Dec. 10 Non - compliance with Statutory Notice, 1, Ilva Place. - 1 1 0 Magistrate's Order for Notice to be complied with within 14 days. Dec. 10 Non - compliance with Statutory Notice, 1, Ilva Place. - 1 1 0 Magistrate's Order for Notice to be complied with within 14 days. Dec. 12 Non - compliance with terms of Magistrate's Order, 20, Whiston Street. 2 0 0 0 10 0 - Dec. 12 Non - compliance with terms of Magistrate's Order, 22, Whiston Street. 2 0 0 0 10 0 - Food and Drugs (Adulteration) Act, 1928. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. Milk and Dairies Order, 1926. Public Health (Meat) Regulations, 1924. Jan. 17 Failure to cover stall 1 10 0 — — Jan. 22 in proper manner. Filling milk bottles in street. 0 10 0 — — May 9 Selling milk not of the nature, substance and quality demanded by the purchaser. - 3 3 0 Dismissed under Probation of Offenders Act. May 23 do. do. — 2 10 0 — June 6 Selling beef sausages not labelled in accordance with the Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. - 1 1 0 June 13 Selling milk not of the nature, substance and quality demanded by the purchaser. 1 0 0 3 3 0 - June 20 do. do. — 1 0 0 — June 20 do. do. — 5 0 0 — July 4 do. do. — 2 2 0 e 62 Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. July 4 Selling milk not of the nature, substance and quality demanded by the purchaser. - 2 2 0 - July 18 do. do. - 2 2 0 - Aug. 1 do. do. 0 2 0 1 8 0 — Oct. 17 Selling whiskey not of the nature, substance and quality demanded by the purchaser. - 3 3 0 Dismissed under Probation of Offenders Act. Oct. 17 Filling milk bottles in street. 0 10 0 - - Oct. 20 Selling gin not of the nature, substance and quality demanded by the purchaser. - 3 3 0 Dismissed under Probation of Offenders Act. Oct. 24 Selling pork sausages not labelled in accordance with the Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. 0 10 0 1 10 0 - Oct. 24 Selling beef sausages not labelled in accordance with the Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. 0 10 0 1 10 0 - Nov. 14 Selling bread and butter which was not of the nature, substance and quality demanded by the purchaser. 2 0 0 3 3 0 - Nov. 28 Filling milk bottles in street. 0 15 0 - - Dec. 29 Selling vinegar not of the nature, substance and quality demanded by the purchaser. - 2 2 0 Rag Flock Acts, 1911 and 1928. Feb. 14 Being in possession of rag flock which did not conform to standard. - 4 4 0 - Apr. 4 Being in possession of rag flock to be used for the purpose of making articles of upholstery which did not conform to standard. 10 0 0 5 5 0 - PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS. 1912 Summary of Notifications during the Period from the 29th December, 1929, to the 27th December, 1930, in the Metropolitan Borough of Shoreditch. Notifications on Form A. (By Doctor who takes diagnosis.) Notifications on Form B. (By School Medical Inspector.) Number of Primary Notifications *of new cases of Tuberculosis †. Number of Notifications on Form C. (of admission of case to Institution). Number of Notifications on Form D. (of discharge of case from Institution). Number of Primary Notifications *of new cases of Tuberculosis†. Total Notifications on Form A. Age-periods. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and upwards. Total (all ages). Under 5. 5 to 10. 10 to 15. Total 0-15 Total Notifications on Form B. Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. Pulmonary, Males ... 3 2 5 9 13 13 23 23 10 ... 101 175 ... ... ... ... ... 45 84 32 57 „ Females ... ... 6 7 10 11 18 16 4 4 ... 76 119 ... ... ... ••• ... 24 57 16 58 Non-pulmonary, Males ... 3 7 1 1 1 3 1 ... ... ... 17 21 ... ... ... ... ... 2 27 ... 18 Females ... 3 6 6 1 3 1 2 ... 1 ... 23 30 ... ... ... ... ... ... 14 1 15 Cols. (1) (2) (3) W (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) v.—TUBERCULOSIS. The particulars of the notifications received during the year are given in the following summary:— 63 Patients notified as suffering from both pulmonary and non-pulmonary disease arc included among the "pulmonary" returns only. *Primary notifications relate to patients who have never previously been notified, either on Form A or on Form B, in the Sanitary District in which the case was notified in 1930. Any additional notification of a case which has been previously notified in the same Sanitary District is regarded as duplicate. †Cols. 2-13 and 15-18. Only those cases which have been notified for the first time during the year on Form A or on Form B in Shoreditch, and which have not been brought to the notice of the M.O.H. in a previous year otherwise than through formal notifica ion, are included in Cols. 2-13, or 15-18, respectively. Notifications of tuberculosis which are made by Naval, Military, or Air Force medical authorities in pursuance of §5 (b) of the Local Government (Emergency Provisions) Act, 1916, are included in the Table above as if they were notifications made on Form A: Col. 14. All notifications on Form A, whether duplicate or not, are included in this column. Col. 19. All notifications which have been made during the year on Form B in Shoreditch, whether the cases have previously been notitied in the area or not, cither on Form A or on Form B, arc included in this column. 64 Particulars of new cases coming to the knowledge of the Medical Officer of Health are given in Supplementary Returns made to the Ministry of Health, viz.:— Aged Periods. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 and upwards. Total Cases. Pulmonary— Males — — — — — 1 2 1 1 — 4 9 Females - - 1 — 1 1 — — — — — 3 Non-Pulmonary— Males 1 1 — — — 1 — — — — — 3 Females - 1 — 1 1 - - - 1 1 - 5 Source of Information. No. of Cases. Pulmonary. NonPulmonary. from Local Registrars Death Returns transferable Deaths from Registrar( General 8 4 1 3 Posthumous notifications - — "Transfers" from other Areas (other than transferable deaths) 3 1 Forms C and D (in respect of cases not previously known to M.O.H.) - - Other sources (if any) — - The number of cases removed from the Tuberculosis Register during the year was 265. The particulars of these cases are as follows :— Deaths 107 Patients removed from Borough 73 Cases removed from Register as cured 85 The following comparative figures for recent years show that tuberculosis is becoming less prevalent in Shoreditch :— Year. Total Number Primary Notifications. Notifications per 1,000 Inhabitants. Pulmonary. Non-Pulmonary. All forms. 1919 503 4.0 1.1 5.1 1920 303 2.8 0.2 3.0 1921 265 2.1 0.4 2.5 1922 287 2.1 0.6 2.7 1923 259 2.1 0.3 2.4 1924 266 2.0 0.4 2.4 1925 303 2.2 0.7 2.9 1926 287 2.1 0.6 2.7 1927 238 1.8 0.5 2.3 1928 257 2.0 0.6 2.6 1929 251 2.2 0.4 2.6 1930 217 1.8 0.4 2.2 31st August, 1931. Sir, As requested in Memorandum ( ref.ro. 111a 736/4002) and 31st.July, I have to inform you that the new cases of erculosis and deaths from this disease during 1930 were as follows: Age Periods New Cases Deaths Pulmonery Non-Pulmonery Pulmonery Non-Pulmone ry M F M F M F M F .......... - - 1 - - - 1 - .......... 3 - 1 4 - - 1 2 .......... 2 7 7 6 - - 1 - .......... 5 7 1 7 - - - - .......... 9 11 1 2 2 6 — 1 .......... 14 12 2 3 5 8 1 - .......... 15 18 3 1 9 5 2 _ .......... 24 16 1 2 8 3 1 — .......... 24 4 - 1 16 5 - 1 and upwards 10 4 - 2 10 4 - 1 4 — — — 6 — — — 110 79 20 28 56 31 7 5 The ratio of non-notified tuberculosis deaths to total cenculosis for the year 1930 was 1 in 6. There is no evidence of excessive incidence of, or mortality tuberculosis in any particular occupation in shoreditch. Yours faithfully, Medical officer of Health. tary, stry of Health, itehall, S.W. 65 The distribution of the cases notified among the different Wards was as follows:— Ward. Pulmonary. NonPulmonary. Total. No. per 1,000 inhabitants. Moorfields 4 .. 4 1.0 Church 46 10 56 3.2 Hoxton 36 1 37 2.5 Wenlock 22 12 34 2.5 Whitmore 23 6 29 1.7 Kingsland 11 4 15 1.5 Haggerston ... 19 3 22 2.1 Acton 16 4 20 1.8 Total 177 40 217 - The additions to, and removals from, the Tuberculosis Register during the year were as follows:— PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. Number of cases on the Tuberculosis Register, 31st December, 1929 732 662 1,394 284 217 501 1,895 Number of cases notified under the Public Health (Tuberculosis) Regulations, 1912, during the year 1930 101 76 177 17 23 40 217 Other cases added to the Tuberculosis Register during 1930 9 3 12 3 5 8 20 Total 842 741 1,583 304 245 549 2,132 Cases removed from Tuberculosis Register during 1930 102 66 168 48 49 97 265 Cases remaining on Tuberculosis Register 31st December, 1930 740 675 1,415 256 196 452 1,867 66 The deaths from Tuberculosis, which numbered 100 are classified DEATHS FROM TUBERCULOSIS IN AGES. Undei 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 and upwards. 1 All forms 2 1 2 2 ... 9 13 17 11 22 15 4 2 Respiratory system ... ... ... ... ... 8 12 16 10 21 14 4 2 Central nervous system ... 1 2 2 ... 1 1 ... ... ... ... ... ... Intestines and periteum ... ... ... ... ... ... ... 1 ... ... ... ... ... Vertebral column ... ... ... ... ... ... ... ... ... ... ... ... ... Joints ... ... ... ... ... ... ... ... ... ... ... ... ... Skin and subcutaneous tissue ... ... ... ... ... ... ... ... ... ... ... ... ... Bones (Vertebral column excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... Lymphatic system (abdominal glands excepted) ... ... ... ... ... ... ... ... ... ... 1 ... ... Genito-urinary system ... ... ... ... ... ... ... ... 1 ... ... ... ... Other sites ... ... ... ... ... ... ... ... ... ... ... ... ... Disseminated Tuberculosis— Acute 2 ... ... ... ... ... ... ... ... ... ... ... ... Chronic or unstated ... ... ... ... ... ... ... ... ... 1 ... ... ... The death rates from Pulmonary and Non-Pulmonary Tuberculosis for 1930 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 0.88 0.13 1.0 7.20 1.08 8.28 London 0.85 0.12 0.96 7.31 1.01 8.32 67 as to situation of disease and ward in the following table:— THE BOROUGH DURING 1930. DEATHS IN EACH WARD. SEX. TOTAL DEATHS. Moorfields. Church. Hoxton. Wenlock Whitmore. Kingsland Haggerston. Acton. Male. Female. Not in Institutions. St. Leonards. Other Institutions Belonging to Shoreditch. Not belonging to Shoreditch. Belonging to Shoreditch. Not belonging to Shoreditch. 4 19 11 16 17 12 11 10 65 35 100 38 34 3 1 11 2 17 11 12 16 10 9 10 57 30 87 38 28 3 1 10 1 • • • ... 1 1 2 2 ... 4 3 7 ... 3 ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... The death rates per 1,000 from all forms of Tuberculosis in Shoreditch and London during the last 10 years are compared in the following table:— Year. Shoreditch. London. 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 1929 1.15 1.03 1930 1.0 0.96 68 TUBERCULOSIS DISPENSARY. During the year a series of conferences were held between representatives of the Health Committees of Finsbury, Islington and Shoreditch at which the question of terminating the agreement under which a joint dispensary has been provided for these three Boroughs at the Royal Chest Hospital, City Road, since October, 1913, was fully discussed. As a result of these deliberations, the Council decided at their meeting on 11th March not to renew the present agreement after 31st March, 1931, and to consider arrangements to be made for the establishment of a separate dispensary for Shoreditch after that date. The association with the Hospital authorities during the years that the present agreement has been operative have been most happy, and has been the means of doing a very great deal of excellent work. I wish to thank Dr. Leitch and the Medical and Nursing Staff who have assisted him for their co-operation and help during the past years, and to place on record an appreciation of the fine service they have rendered in combating tuberculosis in the Borough. At their meeting on the 16th December, the Committee appointed Dr. Carl Knight Cullen, M.R.C.S., L.R.C.P., D.P.H. (Assistant Tuberculosis Officer and Assistant Medical Officer of Health, Metropolitan Borough of Poplar), to the post of Tuberculosis Officer. It was arranged that Dr. Cullen should take up his duties at the beginning of March, 1931. Premises suitable for adaptation for the purpose of a Shoreditch Dispensary were purchased at 145, Great Cambridge Street, and by the end of the year the approval of the Ministry of Health and the London County Council having been given to the plans, the work of reconstruction was in hand. The work of the Dispensary during the year is shown in the following tables in the form required by the Ministry of Health:— 69 Tuberculosis Scheme of the Shoreditch Metropolitan Borough Council. Return showing the work of the Dispensary (or Dispensaries) during the year 1930. Diagnosis. Pulmonary. Non-pulmonary. Total. (1) Adults. (2) Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. New Cases(1) examined during the year (excluding contacts):- (a) Definitely tuberculous 43 28 8 8 3 2 11 10 46 30 19 18 (b) Doubtfully tuberculous(2) — — — — — — — — 2 — — — (c) Non-tuberculous — — — — — — — — 72 47 35 34 -Contacts examined during the year:— (a) Definitely tuberculous 19 12 4 4 — 2 1 1 19 14 5 5 (b) Doubtfully tuberculous(8) — — — — — — — — — 1 — (c) Non-tuberculous - - - - - - - - 44 62 70 61 -Cases written off the Dispensary Register(9) as (a) Cured(10) 2 2 — — 1 — 2 — 3 2 2 — (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 120 110 107 97 -Number of Persons on Dispensary Register(9) on December 31st:— (a) Diagnosis completed 261 208 28 29 33 25 53 29 294 233 81 58 (b) Diagnosis not completed — — — — — — — — 2 — 1 — 1. Number of persons on Dispensary Register(9) on January 1st 646 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 15 2. Number of patients transferred from other areas and of "lost sight of" (11) cases returned 40 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants 4 3. Number of patients transferred to other areas and cases "lost sight of" 95 (b) Otherwise 147 11. Number of other visits by Tuberculosis Officers to Homes 295 4. Died during the year 65 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes Approx. 3,540 5. Number of observation cases (8) under A (b) and B (b) above in which period of observation exceeded 2 months 3 13. Number of (a) Specimens of sputum, etc., examined 718 6. Number of attendances at the Dispensary (including Contacts) 5,795 (b) X-ray examinations made in connection with Dispensary work 99 14. Number of Insured Persons on Dispensary Register(9) on the 31st December 352 7. Number of attendances of non-pulmonary cases at Orthopaedic Outstations for treatment or super- vision 15. Number of Insured Persons under Domiciliary Treatment (4) on the 31st December 154 8. Number of attendances, at General Hospitals or other Institutions P proved for the purpose, of Patients for 16. Number of reports received during the year in respect of Insured Persons:— (a) "Light " treatment (a) Form G.P. 17 2 (b) Other special forms of treatment (b) Form G.P. 36 - 70 Notes. (N.B.—Notes 1 to 5 below repeat definitions (d) to (h) on p. 7 of Memorandum 37/T.) (1) Public Medical Treatment.—Treatment at a dispensary or residential institution or "general supervision," under a scheme approved by the Minister of Health for the treatment of tuberculosis, of a person who has been diagnosed to be suffering from tuberculosis. (Note.—A patient under domiciliary treatment should be regarded as also under "general supervision" by the Tuberculosis Officer.) (2) Patient.—A person who has been diagnosed to be suffering from tuberculosis and is under public medical treatment for tuberculosis. (The term does not include a person who is kept under observation pending the establishment of the diagnosis, and who is referred to in the Memorandum as an "observation case," but includes all persons on the Dispensary Register who are under "general supervision," even if not in receipt of any treatment.) (3) Dispensary Treatment.—Treatment by a Tuberculosis Officer in cases where the patient is seen not less frequently than once in every month, and is examined not less often than once in three months. (4) Domiciliary Treatment.—Treatment of an insured patient by his Insurance practitioner on the recommendation of the Tuberculosis Officer. (5) Year.—The calendar year ending on the 31st day of December. (6) Adults.—For the purposes of Tuberculosis Records all patients of 15 years and upwards should be classed as adults. (7) New cases.— (a) All persons examined for the first time at, or in connection with, the Dispensary, except definite cases of tuberculosis transferred from the areas of other local authorities. Persons seen in consultation, who will subsequently be dealt with by their own private practitioners, should be included. (b) Persons who have been dealt with previously by the Dispensary and charged as "cured," or provisionally diagnosed as not, at that time, suffering from tuberculosis, who return to the Dispensary as suspected cases of tuberculosis. (8) Observation Cases.—Persons attending at, or in connection with, the Dispensary, in whose cases the Tuberculosis Officer cannot, within a period of one month from his first examination of the case, come to a definite diagnosis after physical examination and the application of the necessary tests. In completing sections A and B, such cases should be entered under sub-head (b) in each section. (9) Dispensary Register.—List containing names of all persons attending at, or seen in connection with, the Dispensary for diagnosis or for treatment for tuberculosis, including patients under "general supervision" (whether or not accompanied by domiciliary treatment), and patients or observation cases in residential institutions, and "contacts." (This must be distinguished from the Notification Register kept by the Medical Officer of Health.) Table E TUBERCULOSIS SCHEME of the Shoreditch Metropolitan Borough Council. (a) Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary (or Dispensaries) at the end of 1930, arranged according to the years in which the patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates Previous to 1926 1926 1927 1928 1929 1930 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Alive Discharged as cured Adults M. 4 1 — — 1 F. 5 — — — — Children M. 1 — — — — F. 1 — — — — Disease arrested Adults M. 17 1 — — 1 1 1 - — 1 — — — — — F. 24 3 — — 3 3 — — — — — — — — — Children M. 2 — — — — — — — — — 1 — — — — F. 1 — — — — — — — — — — — — — — Disease not arrested Adults M. 43 5 23 9 37 2 — 6 3 9 3 4 4 5 13 2 2 11 6 19 10 5 10 7 22 17 9 21 4 34 F. 24 2 8 7 17 5 2 5 1 8 2 — 6 3 9 7 1 9 5 15 15 3 15 6 24 12 6 14 3 23 Children M. — — — — — 2 — — — — 1 — — — — 3 — — — — 5 — — — — 11 — — 1 1 F. 1 — — — — — — — — — 4 — 1 — 1 — — — — — 5 — 2 — 2 9 1 1 — 2 Condition not ascertained during the Year 21 3 2 2 7 5 1 1 — 2 2 1 2 — 3 4 — 1 — 1 5 — 3 — 3 — — — — — Lost Sight of or otherwise removed from Dispensary Register 91 15 28 9 52 33 6 10 9 25 10 11 3 1 15 11 2 9 2 13 6 5 5 1 11 1 — 1 — 1 Dead Adults M. 3 — 7 42 49 2 1 4 37 42 2 — 8 23 31 2 1 2 20 23 6 1 7 11 19 3 1 2 6 9 F. 6 2 5 17 24 1 — 6 24 30 2 — 1 10 11 4 — 3 12 15 3 — 4 4 8 — — — 5 5 Children M. — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — F. 1 — — 1 1 1 — 1 1 2 — — — 1 1 — — — — — — — — — — — — — — — Totals 245 32 73 88 193 55 11 33 75 119 27 16 25 43 84 33 6 35 45 86 55 14 46 29 89 53 17 39 19 75 To face page 71. [p.t.o. Table F (b) Non-Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary (or Dispensaries) at the end of 1930, arranged according to the years in which the Patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates Previous to 1926 1926 1927 1928 1929 1930 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Alive Discharged as cured Adults M. 3 — — — 3 F. — — 1 1 2 Children M. 1 — — 1 2 F. 1 — — 1 2 Disease arrested Adults M. 4 — — 1 5 — — — — — — — 1 — 1 — — — — — — — — — F. 4 — — — 4 1 — — — 1 — — — — — — — 1 1 2 — — 1 — 1 Chil- | dren M. 3 1 1 3 8 3 1 — 1 5 3 — — 1 4 — 1 — — 1 1 — — 1 F. 1 — — — 1 1 — 1 — 2 — — — — — — — — — — — — — — — Disease not arrested Adults M. 3 — 1 3 7 1 — 1 1 3 — — — — — 1 — — — 1 1 — 1 — 2 1 2 — — 3 F. 3 — — — 3 1 — — — 1 2 — — 1 3 1 — — 1 2 2 — — — 2 3 — — — 3 Children M. 3 — — 2 5 1 — — — 1 2 — — — 2 5 1 1 1 8 2 1 — 2 5 6 2 — 4 12 F. 1 1 — 1 3 — — — — — 3 — — 2 5 — — — — — 2 1 1 1 5 6 2 — 3 11 Transferred to Pulmonary 1 — 1 — 2 2 — — — 2 — — — — — — — — 1 1 1 — — — 1 — — — — — Condition not ascertained during the year 7 1 — 2 10 1 — — 1 2 1 — — — 1 — 1 — 1 1 — 1 1 3 — — — — — Lost Sight of or otherwise removed from Dispensary Register 7 3 — 13 23 — 1 — 6 7 5 — 1 4 10 3 2 2 3 10 1 1 — 2 4 — — 1 — 1 Dead Adults M. 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — F. 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — Children M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — 1 — — 1 — — — — — — — — — — — — — — — — — — — — Totals 44 6 4 28 82 11 3 2 9 25 16 — 2 8 i 26 10 5 4 7 26 11 3 4 6 24 16 6 1 7 30 71 (10) Cured.—Patients with tuberculosis should not be deleted from the Dispensary Register as "cured" until in the case of non-pulmonary tuberculosis, 3 years, and in the case of pulmonary tuberculosis, 5 years, have elapsed without any symptoms of active disease (i.e., arrest has been maintained for 3 years). (11) Cases "lost sight of."—Patients who have failed to submit themselves for examination during two consecutive calendar years notwithstanding all efforts to trace them. These should be written off the Dispensary Register at the end of the year. (Patients who are known to have left the district permanently but who cannot be transferred to another local authority because their destination is not known, and patients seen only in consultation for the purpose of diagnosis, and others who desire no further assistance under the tuberculosis scheme for public medical treatment may be marked off at once.) Table E—(See inset). Note.—Group I.: Cases with slight constitutional disturbance (if any). Group III.: Cases with profound systemic disturbance or constitutional deterioration, and with little or no prospect of recovery. Group II.: All cases which cannot be placed in Groups I. and III. Table F—(See inset). The work of the Tuberculosis Dispensary is further dealt with by Dr. Leitch, the Tuberculosis Officer, and Miss M. Sutton-Sharpe, in the two following reports:— Royal Chest Hospital. Shoreditch Tuberculosis Dispensary. Statistical Report for year 1930. To The Medical Officer of Health. The total attendances paid to the Dispensary and the total number of new cases examined are somewhat less than in 1929 owing to a smaller number of old cases on the Tuberculosis Register being seen than in the previous year. Except for this, the figures would ha ve been more or less identical. The following table shows at a glance the work done during the year in question. 1929. 1930. Total attendances 6,017 5,795 Total examinations 2,137 1,755 Total new persons examined 797 565 Renewed cases 482 529 Sisters' visits to homes 2,155 2,108 Medical Officers' visits 347 299 72 The comparative numbers of insured and non-insured attendances were:— Insured 3,170 Non-insured 2,625 Total 5,795 Of the new persons, including "Contacts," examined, there were:— Insured 226 Non-insured 339 Total 565 As analysed, according to the monthly returns, there were:— Tuberculous. Suspects. NonTuberculous. Total. "Contacts" 37 13 218 268 Other New Persons 113 2 182. 297 Totals 150 15 400 565 The final analysis of all the new persons shown in the above table is as follows:— Under 15 years. Over 15 years. Total M. F. M. F. Total New Persons 126 115 176 148 565 Pulmonary Tuberculosis 11 11 56 36 114 Non-Pulmonary Tuberculosis 9 9 2 3 23 Suspects 1 ... 2 ... 3 Non-Tuberculous 105 95 116 109 425 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 38 14 July 34 12 February 41 13 August 7 1 March 30 5 September 41 15 April 23 5 October 45 21 May 27 13 November 37 19 June 29 10 December 32 11 Total Attendances 384 Total Examinations 139 Ditto, 1929 293 Ditto, 1929 120 73 The following table is an analysis of all persons attending the Dispensary:— Under 15 years. Over 15 years. Totals. Non-Tuberculous. Males 178 185 363 Females 180 222 402 Totals 358 407 765 Tuberculous. Males 81 294 375 Females 58 233 291 Totals 139 527 666 Further information relating to the work of the Dispensary is as follows:— The Laboratory Examinations made during the year total 717, and consisted of the following:— 683 specimens of Sputum. 20 specimens of Urine. 13 Nose and Throat Swabs for suspected diphtheria, and 1 Blood Examination. Total number of X-ray examinations 99 „ „ Patients recommended to the London County Council for Institutional Treatment 170 „ „ Progress Reports furnished, etc. 231 „ „ Examinations made for, and Reports sent to, the Ministry of Pensions 24 „ „ Patients sent by Doctors 139 The number of patients on the Dispensary Register on 31st December, 1930:— Insured 352 Non-insured 317 Total 669 A. LEITCH, Tuberculosis Officer. TUBERCULOSIS CARE COMMITTEE FOR SHOREDITCH. 32, Herbert Street, Hoxton, N. 1. Telephone: Clerkenwell 7313. Particulars of the excellent work performed by this Committee during the year are contained in the following report by the Hon. Secretary, Miss Sutton Sharpe:— The Tuberculosis Care Committee has for its Chairman, Dr. Maitland Radford (M.O.H.), Vice-Chairman, Dr. Leitch (T.O.), and the following members: Miss Broomfield (I.C.A.A.), Rev. F. E. Birch, Dr. Fanning (Asst. M.O.H.), Sister Grange (Dispensary Nurse), Miss Hiscoke (T.B. Nurse), Mrs. Jeger, Dr. Kelleher (St. Leonard's Hospital), Miss Kastor (Red Cross), Councillor Kenny, Dr. Lewis (Hoxton House), Miss Murch (District Organiser of Children's Care Committees), 74 Miss Miller (C.O.S.), P. Rockliff, Esq. (Tabernacle House), Miss Tucker (East End Workers amongst the Poor), Miss Wragge (Maurice Hostel), and the Hon. Secretary, Miss Sutton Sharpe. In the name "Tuberculosis Care Committee" the work of this Committee is shown. It is the "care" of all Tuberculous persons and the "care" of their families. There are many troubles that come to those stricken with tuberculosis and to the families where one member has this disease. Clothes present a problem to patients going away to Sanatoria, and many pairs of pyjamas are handed over to despairing mothers who do not know how to get such expensive things for the son going away "to get better." Sometimes the Committee has to consider the whole outfit for some man or woman whose money has all gone in the long dragging months of ill health, then the Committee puts the patient in touch with the Society or Institution able to help. Work must be changed, patients must be got to airier surroundings for their employment. This is not easy but with the kind assistance of other workers, suitable jobs have been found by this Committee and living made more possible for some. In various families we find some debt dragging down the mother. A debt she has incurred sometimes without her husband's knowledge. In one instance it took much questioning and many friendly talks to find out about the millstone. But when all was clear the mother was persuaded to tell her husband, then the moneylender was paid off and the mother now looking much happier, cheerfully came up week after week to pay back to the Committee half of the debt by degrees; the other half was a gift. A boy of 17 was working in an underground cellar for less than 15s. a week. Undersized, lame and sick and ill, living in lodgings because his father had turned him out—" such a nuisance because he was lame!" The Committee got him away to one of the L.C.C. Training Colonies, the Maurice Hostel gave him a complete new outfit and now the C.O.S. has been battling for many months to get his insurance on a sound footing; and the boy writes regularly. The Committee has had very loyal workers this year, two members of Toc H League of Women Helpers have come with utmost regularity every week and done clerical work. This regular filing away of papers and orderly working is of the utmost value to the Secretary. Also there have been helpers in visiting. Co-operation with the Borough Council and the C.O.S., I.C.A.A., Red Cross, and the close touch between this Committee and many other activities has made for quickness and ease in dealing with cases. Handicraft Centre. This Committee at Easter opened a class for the Tuberculous patients who were sufficiently well to require occupation though not fit for regular work. The L.C.C. provides an excellent teacher, the Royal Chest Hospital has lent a room and sufficient funds have been collected for materials and tools; and now the class is going well and proving of service to those wearied with the idle life enforced by their illness 75 It is a class where men and women learn leather work, raffia work and various things, but also it is becoming somewhat of a social event and Friday morning in the Lecture Room of the Royal Chest Hospital is a very pleasant friendly time for students and teacher and those that visit it. And for two hours these tuberculous men and women are bright and interested, and the fact that they are ill is forgotten. Each student is supplied with one pint of milk at each class. At their meeting on 21st October, the Council adopted a resolution of the Health Committee recommending that the constitution of the Care Committee should be revised as follows:— (1) That, subject to the approval of the London County Council, the Shoreditch Tuberculosis Care Committee be constituted of 15 members, including two representatives of the Public Health Committee, and one representative of the Local Public Assistance Committee. (2) That the appointment of such Committee be made by the Council on the recommendation of the Public Health Committee, who shall consider recommendations from the Tuberculosis Care Committee. (3) That the Tuberculosis Care Committee be appointed annually. (4) That casual vacancies caused by resignation or disqualification be filled by the Committee on the recommendation of the Public Health Committee ; and (5) That the Public Health Committee shall have the power to declare vacant the appointment of any member of the Tuberculosis Care Committee for non-attendance at the meetings of the Committee for a period of three months. 76 VI.—MUNICIPAL DENTAL HOSPITAL, 164, Kingsland Road. REPORT FOR THE YEAR 1930. Eleven sessions per week have been held at this Hospital throughout the year, the time table being as follows:— Monday 2.30 to 4.30 and 6.30 to 8.30 p.m. Tuesday 10 a.m. to 12 noon and 2.30 to 4.30 p.m. Wednesday 10 a.m. to 12 noon, 2.30 to 4.30 p.m. and 6.30 to 8.30 p.m. Thursday 10 a.m. to 12 noon, and 2.30 to 4.30 p.m. (Maternity and Child Welfare Cases). Friday 2.30 to 4.30, and 6.30 to 8.30 p.m. As will be explained later, it became necessary to engage the services of a temporary Assistant Dental Surgeon for some weeks at the end of the year, but there are no changes to report in the permanent staff which is as follows:— Dental Surgeon, Sister and Clerk, Nurse, three Dental Mechanics, Caretaker and Cleaner. Anaesthetics are administered by a medical practitioner who is not a whole time officer of the Council. The names of these Officers will be found in the section of this Report dealing with Staff. A summary of the work done during the year is contained in the following tables:— Table I.—Inspection and Treatment of Children. Number of examinations. Number of attendances for treatment. Number of extractions. Number of Administrations of Anaesthetics. Number of fillings. Number of other operations. Number of children receiving orthodontic treatment. Number of children's visits for orthodontic treatment. Number of visits. Local. General. Under 2 years 30 16 48 ... 15 1 2 ... ... 35 „ 3 years 125 86 247 ... 72 10 7 ... ... 149 „ 4 years 276 198 553 ... 167 42 3 ... ... | 331 „ 5 years 115 88 199 61 22 2 1 4 138 Over 5 years 807 656 983 17 283 232 61 15 167 924 Total 1353 1044 2030 17 598 307 75 16 171 1577 Table II.—Inspection and Treatment of Adults. Number of examinations. Number of attendances for treatment. Number of extractions. Number of Administrations of Anaesthetics. Number of fillings, including root fillings. Number of scalings. Number of other operations. Number of dentures fitted. Number of repairs to dentures. j Number of visits. Local. General. Maternity cases 1083 838 1954 29 297 105 35 390 119 8 1290 Women 2187 1690 2169 61 332 319 82 768 257 59 2376 Unmarried girls (16-20) 455 365 394 14 109 208 12 77 12 3 528 Men 2229 1738 2468 121 388 326 96 753 265 59 2412 Tuberculous 49 37 34 — 6 10 3 18 7 2 52 Total including children (Table I) 7356 5712 9049 242 1730 1275 233 2081 669 l31 8235 77 Table III. Sessions. Total attendances. Total. No. of visits M. & C. W. cases. Anaesthetic Sessions attendances. Morning. Afternoon. Evening. Monday 4 758 916 1,678 270 481 (6 special visits) Tuesday 697 713 — 1,410 366 298(27 „ „) Wednesday 653 655 853 2,161 294 83 (19 „ „) Thursday 758 671 — 1,429 456 334(19 „ „) Friday - 678 879 1,557 207 534(14 „ „) Total 2,112 3,475 2,648 8,235 1,593 1,730 Shortly after the end of the year covered by this Report the Council decided that as from 1st April, 1931, the scale of charges should be the same as that of the Approved Societies under the National Health Insurance Act. At the same time it was decided to vary the income scale qualifying for remission of charges. At the time of writing, the Council's complete scale of charges is as follows:— Scaling, per individual 7s. 6d. but not chargeable in respect of a jaw in which a denture of eight or more teeth is supplied. Fillings, per filling 7s. 6d. with a maximum charge of 12s. 6d. for any one tooth. Root Treatment, per tooth 7s. 6d. with a maximum charge of 17s. 6d. for fillings and root treatment in any one tooth Extractions, per tooth, with local anaesthetic 2s. 6d. Maximum for Upper or Lower 12s. 6d. Maximum for Upper and Lower £1 2s. 6d. Extractions, with general anaesthetics.—Extraction fee, 2s. 6d. each tooth; maxima as for Local. Simple administration fee, Upper or Lower, 7s. 6d.; Upper and Lower, 10s. Prolonged Anaesthesia (12 or more teeth): Extractions, £1 2s. 6d.; Anaesthetist's fee, £1 1s. 0d. Dentures, full Upper or Lower £2 15s. 0d. Dentures, full Upper and Lower £5 10s. 0d. Partial Dentures, extractions not included £1 1s. 0d. for first two teeth. 5s. 0d. for each subsequent tooth. F 78 Repairs.—7s. 6d. for the first, 5s. for each subsequent item on a denture as stated below, with a maximum of 12s. 6d. for each denture in respect of items 1, 2 and 4, and of £1 in respect of all items:— (1) Cracks, fissures, or fractures of dentures. (2) The replacing of a loosened tooth, or loosened band or wire. (3) The adding of one new tooth or one band or one wire. (4) An extension of the plate, even when that extension embraces part of a natural tooth. Remakes.—14s. for the first two teeth, and 3s. 4d. for each additional tooth, up to a maximum of £1 16s. 8d. for nine teeth or more. Maximum (including any necessary additions at 5s. per tooth) per denture, £1. Remakes within 12 months Half original fee. Crowns £1 12s. 6d. including any necessary root treatment. Examination and report fee where patient does not return for treatment 2s. 6d. The age limit for young persons receiving treatment at half price was lowered from 21 years to 19 years of age. School children 1s. 0d. for first treatment, and 1s. 0d. for all subsequent visits, making the maximum charge 2s. 0d. for a course of treatment. Residents of the Borough who state 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 Income per head after deducting rent. National Health and Unemployment Insurance contributions not more than: 14 0 16 0 18 6 21 0 2 12 0 14 0 16 6 19 0 3 10 0 12 0 14 6 17 0 4 9 0 10 0 11 0 14 6 5 8 0 9 0 10 0 12 6 6 7 0 8 0 9 0 10 6 7 7 0 8 0 9 0 10 6 8 7 0 8 0 9 0 10 6 9 7 0 8 0 9 0 10 6 10 7 0 8 0 9 0 10 6 11 7 0 8 0 9 0 10 6 12 7 0 8 0 9 0 10 6 The charge to be made in special X-Ray cases is considered and determined by the Committee. The charge made in Orthodontic cases is the cost of the appliance, plus 50 per cent. of such cost, in addition to the ordinary charge of 2s. made to school children, subject to the reduced scale of charges for necessitous cases being applied. 79 As explained in the last Annual Report the number of sessions was increased to eleven per week at the beginning of June, 1929. The year 1930 is accordingly the first complete year for which we have records of the work done under this new arrangement. A comparison of the work done each year since this Hospital was opened is contained in the following table:— 1927. From 31st March, Five Sessions. 1928. Five Sessions. 1929. Jan.-May, Five Sessions. June-Dec., Eleven Sessions. 1930. Eleven Sessions. No. of children's visits 499 794 1,081 1,577 No. of adults' visits 1,430 3,032 3,505 6,658 No. of maternity cases visits 627 1,021 1,209 1,290 No. of dentures fitted 61 222 329 699 The steady increase shown in the foregoing table of the work done is most satisfactory. In this Borough neglect of the teeth is one of the most common and one of the most far-reaching causes of ill-health, and the statistical records here given of treatment carried out mean in fact that an increasingly large number of the people of Shoreditch are either regaining their health, or, better still, preserving their health by availing themselves of facilities for dental treatment now within the reach of all. Particularly gratifying in the record of the last year's work is the fact that 16 children made 171 attendances for orthodontic treatment. As has been explained, this treatment consists in correcting deformities and mal positions of the teeth and jaws of growing children, and is the means of removing conditions that would otherwise seriously prejudice their future health. Reference has been made to the fact that it became necessary to engage a temporary Assistant Dental Surgeon. Shortly after the summer recess the Health Committee had under consideration the steps necessary to be taken to deal with the arrears of work that had accumulated as a result of the increasing number of patients. These arrears fell into two categories—patients who were waiting for dentures and patients who were waiting for the completion of other forms of treatment. In order to overtake the arrears of dentures, the Committee decided in September to modify, as a temporary measure, the rules as to eligibility for treatment, and accordingly instructed the Dental Surgeon that extractions likely to necessitate the provision of dentures should not be performed unless the case was urgent, or the patient in pain. In practice this decision has not been very effective as a large F 2 80 proportion of patients postpone their visits until their teeth are so far decayed as to causc pain or to make extraction an urgent matter on grounds of health. To deal with arrears of work, other than dentures, the services of a temporary Dental Surgeon were engaged for five sessions each week. Mr. Metcalf, L.D.S., R.C.S. (Eng.), was the gentleman appointed. He commenced duty on 3rd November, and was still attending the hospital at the end of the year. The Committee also gave instructions that children of school age should only receive orthodontic treatment at the Dental Hospital, as these children were able to attend the London County Council school dental clinics. As will be seen from the following figures, the arrears both of dentures and of other work had been considerably reduced by the end of the year:— Arrears of Denture work. Arrears of other work. 27th September 196 496 26th December 30 111 It will be necessary early in the New Year to consider the steps necessary to be taken in view of the fact that it does not appear to be possible for the regular staff to deal with the number of patients who are eligible under the Council's original resolution and who wish to receive treatment. Discussion upon the arrangements referred to in the last Annual Report for the rehousing of the Hospital continued throughout the year. The scheme finally decided upon was the erection of a building on the vacant site at the rear of the Model Welfare Centre. The semi-basement to accommodate breast-feeding and light clinics, the ground floor a Women's Hospital, and the top floor the new Dental Hospital. Each floor is to be self-contained, and there is to be a separate entrance from the street to each. A plan of the proposed new building appears as a frontispiece to this Report. SHOREDITCH MUNICIPAL DENTAL HOSPITAL, 1930. Report by Mr. H. L. Davies, L.D.S., R.C.S. (England). The number of patients of all kinds and the number of attendances made by them has steadily increased throughout the year. A temporary part-time Assistant Dental Surgeon was engaged in November to deal with arrears of work which were by this means much reduced by the end of the year. The policy of the Hospital has been "Hospital treatment with private practice civility," and all members of the staff have worked in this spirit. The present premises served their purpose for a part-time Hospital, but they are no longer adequate. With the prospect of a new and up-to-date building in sight, there is every reason to believe that the Hospital will be better attended and more popular than ever. It is hoped that the equipment of the new Hospital will include an X-Ray apparatus, as more accurate and quicker results would be obtained than is possible under the present arrangement of referring patients to St. Leonard's Hospital. 81 As a new Hospital is being erected, I will refrain from further comment on the present premises. I have endeavoured to set out below the chief points of interest:— 1.—SCHOOL CHILDREN. The rapid increase of attendances made by the school children appears to be due to the fact that the Hospital is becoming more popular with this type of patient. The reason for this is probably that parents of the patients are finding that the Hospital is prepared to give close attention to the various diseases of the teeth and to the saving of existing teeth where possible, in preference to extracting them. It must not be forgotten that the period of 5-14 years is very important for dental treatment, because at these ages baby teeth are being shed and permanent ones coming into position. Owing to the present-day diet it is at this period that permanent teeth are misplaced and irregularly formed. The correction of dental diseases at this age will have a beneficial and far-reaching effect on the health of the Borough in years to come. Many children are sent to the Hospital because their bad teeth have caused digestive troubles. These are, in my opinion, caused by (1) absorption of septic matter from the mouth, (2) inefficient masticating area through loss of teeth. If the child of to-day, who will be the citizen of to-morrow, receives early and regular dental treatment, much digestive and other illness will be prevented. A most gratifying result obtained in this branch of the work has been the education of parents to accept the advice of the Dental Surgeon as to the treatment and preservation of baby teeth. Parents are too apt to come to the Hospital with a demand for wholesale extractions. 2.—ORTHODONTIC TREATMENT (or regulation of misplaced teeth). Orthodontic treatment covers much more ground than is generally understood. A few of the cases which have passed through my hands at the Hospital during the past year will give one an idea of how varied the work really is, and what treatment the word "orthodontic" covers. (a) A boy, aged 9, with upper lip shortened, and in consequence a bad mouth breather. After treatment with a lip exerciser and an oral screen, the lip developed to such an extent that he is now a good nose breather, with a more intelligent look. (b) A child with the upper lip firmly attached to the upper gum, thus preventing the child from speaking correctly. After treatment, which necessitated cutting away the fibrous attachment, the child's lips are now quite normal. 82 (c) A child with a receding lower jaw with the lower lip closing behind the upper teeth. By inserting plates in this case the jaw was brought forward to normal position. Other cases consist of protruding teeth, instanding teeth, rotated teeth, teeth badly spaced and teeth badly crowded. These cases have all been successfully treated at the Hospital. About 95 per cent. of the children who present themselves for orthodontic treatment are mouth breathers, the reason being that mouth breathing prevents the normal development of the jaws as no muscular movement takes place as in nose breathing. Furthermore, mouth breathers are:— (a) Flat chested. (b) Easily get out of breath when running. (c) Backward at school. (d) Suffer from adenoids and tonsilitis. (e) Always bear a dull vacant facial expression, and, to sum it up in a word, are of a C3 class. It is to make these C3 children into A1 class that orthodontics are practised. There are, of course, exceptions even in this class of patient. There is every reason to hope that an increasing number of parents will bring their children for this treatment as the Hospital gets better known. 3.—EVENING WORK. At present there are only three evening sessions for day workers per week, or approximately 25 per cent. of the available time. This is proving inadequate. It would appear that extra evening sessions are required. Saturday is the best day of all for treatment of these patients, but, unfortunately, we should be compelled to forego other sessions if this were instituted. 4.—POPULARITY OF GENERAL ANAESTHETICS. From the foregoing statistics, it will be seen that injections for extractions are becoming very much less frequent, being only 12-6 per cent, of the total. Gas is so popular that patients often prefer it even in cases in which a local anaesthetic is advised. 5.—STAFF. I wish to take this opportunity to express my appreciation of the assistance I have received from all members of the staff. In thanking the staff one and all, I will refer to Sister Frier's gift for making the patients welcome and for assisting them in all matters relating to their treatment. 83 VII.—SHOREDITCH WOMEN'S HOSPITAL. An important new development of the Health Services of the Borough was approved by the Council at their meeting in March when it was decided to establish a Women's Hospital, under Section 75 of the Public Health (London) Act, in accordance with the following general scheme:— Scope of Hospital. Women to receive advice and out-patient treatment on matters relating to their health, special attention being paid to slight degrees of ill-health. The staff engaged to be in sympathy with the Council's resolution upon Birth Control. Provision for venereal disease treatment in the Hospital to be arranged. If a whole-time nurse is appointed, minor ailments to be treated at times when the doctors are not in attendance. Medical Staff. The Medical Staff required, who would be women, would be as follows:— A General Physician. A Gynaecologist experienced in the use of contraceptives. (These doctors to attend at the same time for two sessions each week.) A Specialist in the treatment of Venereal Disease to attend, say, one session every two weeks, to begin with, on a day on which a usual session is being held. Women consultants on the staff of a general Hospital, to attend and see cases at the request of the regular Doctors. Hospital Treatment. An arrangement to be made, if possible, with the same Hospital, under which— (a) Cases requiring in-patient treatment shall be admitted. (b) Cases requiring special treatment or examination by special methods shall receive the same by appointment. Bacteriological Examinations. Bacteriological Examinations to be undertaken by Dr. Teale, University College Hospital, the Bacteriologist for the Borough. Convalescence. Arrangements to be made under which cases recommended from the Hospital shall be admitted, with youngest baby, if possible, to convalescent homes. Eligibility for Treatment. All women who live or work in the Borough of Shoreditch to be eligible to attend the Hospital, but In-patient treatment at a Hospital under the aforesaid arrangement, and convalescence to be limited to those residing in the Borough. Charges. A scale of charges to be prepared, such charges to be remitted or reduced to residents in the Borough who cannot afford them. Also a scale of income to be prepared to be applied as is done at the Dental Hospital. Arrangements to be made for payments to cover attendance for a course of treatment extending over a. prescribed period. 84 General Practitioners. General Practitioners in the Borough to be written to, and invited to send cases up for consultation or for special forms of treatment. Reports upon such cases to be sent from the Hospital to the Practitioners. Times for Sessions. To begin with, two sessions each week to be held—one afternoon session and one evening session. Staff. The Clerical and Nursing Staff required would be as follows :— (i.) Part of time of lady clerk in the Public Health Department to be allocated to the clerical work. (ii.) One nurse to begin with—either part-time or whole-time. If the nurse is engaged for whole-time, she could carry out the clerical duties. Records. All records to be kept under numbers. The names and addresses of patients not to appear on case sheets. At their meeting on the 20th May, 1930, the Council designated Dr. Helena Wright for the post of Gynaecologist. It was later decided to accommodate this Hospital on the ground floor of a building to be erected on the vacant space at the rear of the Model Welfare Centre, and plans, which are reproduced as a frontispiece to this Report, were prepared by Mr. Hustler, the Borough Surveyor. It will be noted that the building will house three different departments in such a manner that each will have its own separate entrance. A Report should for the most part confine itself to recording work done, but inasmuch as this Hospital is likely to be the first of its kind in the country, brief reference will be made to the hopes that are entertained of the useful function that it will perform. Experience in the now extensive Maternity and Child Welfare Services in the Borough has taught that there are a large number of ailments, some slight but debilitating, some serious and likely permanently to cripple health or to shorten life, from which women suffer, for the diagnosis and treatment of which existing facilities are inadequate. Experience of the conditions in this Borough has further convinced the Council that the demand existing among working class married women for information as to methods of family limitation is one which should be met by the provision of facilities through the Public Health Services. The latter, no less than the former, is essentially a medical question, and reference to the approved scheme for this Hospital will show that it is intended to place first rate medical advice upon all these matters at the service of the women of the Borough. The preparation of plans and negotiations regarding the various sanctions to be obtained took considerable time, and work was not actually commenced upon the new building during the year under consideration. 85 VIII.—HOUSING. The following particulars are given in the form required by the Ministry of Health:— Statistics. Number of new houses erected during the year:— (a) Total including numbers given separately under (b)— (i.) By the Shoreditch Borough Council 0 (ii.) By other Local Authorities 55 (iii.) By other bodies and persons 0 (b) With State assistance under the Housing Acts— (i.) By the Shoreditch Borough Council 0 (a) For the purpose of Part II. of the Act of 1925 — (b) For the purpose of Part III. of the Act of 1925 — (c) For other purposes — (ii.) By other bodies or persons 0 I. Inspection of dwelling houses during the year:— 1. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 8,020 The number of inspections made 30,481 2. Number of dwelling houses (included under sub-head (i.) above) inspected and recorded under the Housing Consolidated Regulations, 1925 0 The number of inspections made 0 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 4. Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 0 II. Remedy of defects during the year without service of formal notices:— Number of defective dwelling houses rendered fit in consequence of informal action of Shoreditch Borough Council or its Officers 4,000 86 III. Action under Statutory Powers during the year:— A. Proceedings under Section 3 of the Housing Act, 1925 : (1) Number of dwelling houses in respect of which Notices were served requiring repairs 0 (2) Number of dwelling houses which were rendered fit after service of formal Notices— (a) By owners 0 (b) By Borough Council in default of owners 0 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 B. Proceedings under Public Health Acts: (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 1,126 (2) Number of dwelling houses in which defects were remedied after service of formal Notices— (a) By owners 1,126 (b) By Borough Council in default of owners 0 C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 : (1) Number of representations made with a view to the making of Closing Orders 0 (2) Number of dwelling houses in respect of which Closing Orders were made 0 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit 0 (4) Number of dwelling houses in respect of which demolition orders were made 0 (5) Number of dwelling houses demolished in pursuance of demolition orders 0 IV. Total number of housesowned by the Shoreditch Borough Council is as follows ; none of these were built within the last two years (1) Part III. of the Housing Act, 1925 Nil (2) Part II. of the Housing Act, 1925 Nil (3) Other powers:— Housing of the Working Classes Act, 1890—built or aquired 106 flats 11 shops l44 houses Housing, Town Planning, &c., Act, 1919 115 flats 14 cottage 15 houses renovated 87 Housing Conditions. General observations.—Speaking generally, it may be said that the housing conditions are bad and constitute the worst factor in the environment of the inhabitants of Shoreditch. The total number of houses in the Borough is estimated to be 14,026, of which the number occupied by the working classes is approximately 13,700. The average number of houses to the acre is 21, but as Moorfields Ward, which adjoins the City, is largely and increasingly occupied with business premises, this average is considerably exceeded in the densely populated residential districts. The approximate number of the various types of houses is as follows :— Two-room cottages 601 Four-room cottages 3,051 Six-room houses 3,968 Tenement houses 2,994 Blocks of tenement dwellings 249 containing 3,088 separate dwellings. In his Annual Report for the year 1919 my predecessor wrote: "Much of the residential house property in Shoreditch is old, the wear and tear is great, and it will always require much looking after." The eleven years that have since elapsed have served to aggravate the general position thus described. 88 Sufficiency of supply of houses.—Information under this heading can best be given by quoting the following figures from the Census of 1921:— 1 Wards. 2 Population. 3 Area in Acres. 4 Persons per Acre. 5 Private Families. 6 Population in Private Families. 7 Structurally Separate Dwellings Occupicd. 8 Rooms Occupied. 9 Rooms per Person. 10 Structurally Separate Dwellings per Acre. Moorfields 4,349 71 61 1,106 4,313 910 3,257 0.76 12.8 Church 17,153 105 163 4,207 16,928 2,506 10,338 0.61 23.9 Hoxton 16,686 79 211 4,307 16,507 2,297 10,310 0.62 29.0 Wenlock 16,287 96 170 3,793 15,097 1,619 9,536 0.63 16.5 Whitmore 16,761 81 207 3,939 15,793 1,955 9,693 0.61 24.1 Kingsland 10,484 72 146 2,550 10,448 1,377 7,103 0.68 19.1 Haggerston 10,381 68 153 2,329 10,300 1,436 6,599 0.64 21.1 Acton 12,147 86 141 3,142 12,108 1,627 8,980 0.74 18.9 Shoreditch 104,248 658 158 25,373 101,494 13,727 65,816 0.65 20.9 London 4,484,523 74,850 60 1,120,897 4,243,838 701,035 4,057,271 0.96 9.4 Notes on foregoing table. Column 2.—According to the Registrar General's estimate there has been a fall in the Shoreditch population since the Census amounting to approximately 4 per cent. Column 4.—The density of the population per acre in Shoreditch is now estimated to be 150. Columns 5 & 6.—Present-day estimate for Shoreditch is 4 per cent. less than Census figure. Column 7.—The estimated number of the dwellings is now 13,700. Column 10.—It is important to remember when considering figures in this column and in others in which reference is made to dwellings, that there are a large number of factories, workshops and business premises in Shoreditch, and that these are not included in figures here given. The proportion of these business premises is highest in Moorfields Ward. 89 From the foregoing it will be seen that Shoreditch is seriously overcrowded both as regards the number of buildings it contains and the number of persons housed therein. A large proportion of the dwellings are old and dilapidated, and though originally designed as the houses of single families are now inhabited by two families or more without having been adapted for this purpose. Of the families living under these conditions, it may safely be said that a great number would not continue to do so if both the extra rent for better accommodation, and the cost of travelling between the areas in which this is available and their workplace, could be afforded. In a word, the housing difficulty in this Borough is due not to a lack of houses, of which there are already too many, but to the fact that owing to a complex variety of circumstances, too many people are compelled to live in this small area. For many years the population of Shoreditch has been decreasing; this tendency being due to the replacement of dwelling houses by business premises in the neighbourhood of the City, and to the improved facilities for travel which make it possible for those who can so afford to live in less crowded areas. But for the war and subsequent legislation, the effect of industrial and economic causes would undoubtedly have been to accelerate the demolition of dwelling houses, and the industrialisation of the area. The Rent Restriction Acts, however, have checked this tendency. In considering changes in the population to be anticipated in the future, it would appear certain that industrialisation, and consequent fall in population, will continue, but how quickly or slowly this inevitable change will occur must depend to a great extent upon future legislation as affecting the security of the tenant. I have to thank Mr. Bean, the Council's Valuation Officer, for the following note showing the relative numbers of dwelling houses and business premises in the Borough at the present time:— "Of the 17,195 separately rated hereditaments appearing in the rate book, 14,183 are occupied as dwelling houses, or are rateable as such, and 3,012 are occupied solely for business premises." The number of separately rated hereditaments per acre in the Borough is 26. Overcrowding.—There are a great many houses in which there are two or more persons per room, and in which persons of the opposite sex over twelve years of age are obliged to occupy the same sleeping apartment, although not living together as husband and wife. Owing to the generally overcrowded state of the Borough and the very great difficulty experienced by poor persons in finding alternative accommodation, it has not been practicable to apply a uniform standard of overcrowding to all cases. The attention of the Health Committee has, however, been directed to houses in which 90 the cubic space per head has been less than that laid down in the Byelaws respecting houses let in lodgings allowed by the Local Government Board in October, 1912, viz.:— Sleeping rooms ... Not less than 300 cubic feet free air space per head per person over 10 years of age. Not less than 150 cubic feet free air space per head per person under 10 years of age. Rooms used for Not less than 400 cubic feet free air space per head per both living and person over 10 years of age. sleeping. Not less than 200 cubic feet free air space per head per person under 10 years of age. There is no vacant land available in Shoreditch on which new houses or dwellings can be built, and vacant houses or rooms are extremely rare and quickly become re-tenanted. The question of the cause of the overcrowding accordingly resolves itself into the question of why a population of close upon 100,000 is compelled to seek housing accommodation in this small area. The reasons for this are historical, economic and vocational. Last century the population of Shoreditch was greater than it is to-day, and consisted of a densely crowded working class population in the South of the Borough, which clustered round the business premises and workshops in and adjoining the City, and a more prosperous residential population in the Northern part. Gradually the business premises have replaced the slums adjoining the City, and the more prosperous residents have moved further afield. The result has been that Shoreditch is now chiefly inhabited by members of the working classes. The number of houses originally designed for one family and now occupied by two or more families, without having been adapted for this purpose, must be in the neighbourhood of 6,000. The rents of a large proportion of the lettings in the Borough are fixed under the Rent Restriction Acts, and are thus lower than rents for corresponding unrestricted accommodation elsewhere. This fact and the additional expense in the form of fares to which a home away from the area would render them liable, combine to exert economic pressure upon those living under crowded or otherwise unsatisfactory housing conditions to remain where they are. Reference has been made to the steady growth of business premises in the South of the Borough. This now extends along the South-west border, and but for the Rent Restriction Acts, would have been much more rapid. The inhabitants of working age living in Shoreditch are largely employed in these business premises, or in adjoining areas, and when out of employment they hope to obtain work in or near their homes. Thus, whether in work or out of work, the presence of an industrial area in close proximity is a further and strong inducement to those of working age to remain in the locality. 91 A great economy is effected if young men and women who are living at home are able to return home from work for their mid-day meal. The number of cases of overcrowding coming to the notice of the Officers of the Health Department during the year was 136. It must be understood that these were bad cases which were so obvious as to attract attention, or cases which were the subject of complaint. It has not been the practice of the Sanitary Inspectors to take measurements of cubic space available per head as part of their routine inspections. To have done so would have occupied a great deal of time, and would undoubtedly have brought to light many cases in which the requisite space was not available, but in which it was not practicable for the Sanitary Authority to take effective action. Of the 136 cases of overcrowding referred to above, 92 were remedied as follows:— Moved to L.C.C. estates outside the Borough 44 Moved elsewhere 48 In all, 47 cases of overcrowding were reported to the Health Committee during the year. Owing to the general circumstances already explained, the Committee decided in all but one instance that nothing more could be done than to give instructions that the persons living under these conditions should be urged to endeavour to obtain better accommodation. The full particulars of many of these cases were sent to the Ministry of Health. The following five examples will serve to illustrate the types of case to which reference has been made:— No. 1.—No. of rooms, 3. Adults: male, 4; female, 4. Children: male, 2; female, 2. Cubic space available, 3,400 cub. ft. Cubic space required, 4,000 cub. ft. This family require a 6-roomed house. The L.C.C. have not a house large enough on the Morden Estate, therefore unable to offer accommodation. Total income, £6 Is. per week. No. 2.—No. of rooms, 2. Adults: male, 1; female, 5. Children: male, 2; female, 1. Cubic space available, 1,650 cub. ft. Cubic space required, 2,600 cub. ft. Income, £2 1s. 6d. per week. Not sufficient to recommend to L.C.C. No. 3.—No. of rooms, 1. Adults: male, 2; female, 1. Children: male, 2; female, 3. Cubic space available, 900 cub. ft. Cubic space required, 2,200 cub. ft. Unwilling to go out of the Borough owing to employment. Tuberculosis in family. Income, £4 16s. per week. No. 4.—No. of rooms, 2. Adults: male, 1; female, 1. Children: male, 5; female, 2. Cubic space available, 1,060 cub. ft. Cubic space required, 2,800 cub. ft. 92 L.C.C. refused to offer accommodation as applicant was not a suitable tenant. Income, £5 5s. per week. No. 5.—No. of rooms, 1. Adults: male, 1; female, 1. Children: male, 2; Cubic space available, 500 cub. ft. Cubic space required, 1,200 cub. ft. L.C.C. regret being unable to offer accommodation as rent of 17s. per week, together with travelling expenses, would be too great a strain on their resources. Income, £3 per week. The circumstances in the isolated instance referred to above were as follows:— A family consisting of father, aged 60, bedridden wife, daughter aged 16, and son aged 13, occupied a small back room on first floor, having a capacity of 500 cubic feet. Owing to the fact that this room contained a considerable quantity of furniture, the air space was appreciably less than this figure. There was no fire place or stove, and only one small broken window, measuring 5 square feet. The ceiling, which was sloping, varied in height from 5 to 8 feet. The walls and ceiling were dirty and dilapidated, and the floor was broken. As it appeared to the Committee that the father had not made any serious attempt to find alternative accommodation or otherwise to comply with the notice urging him to abate the overcrowding, a summons was issued. An order was made for compliance within 14 days. Later it became necessary to issue a summons for non-compliance with this order, and the defendant was fined £5. An application by the defendant for an extension of time in which to pay this fine'was granted, and at the expiration of the 14 days allowed, the defendant was committed to prison. A period of nearly eight months elapsed between the facts of the case being reported to the Committee and the imprisonment of the defendant. The overcrowding was finally abated by the family moving to another part of London. Fitness of Houses. In the Ministry of Health Manual on Unfit Houses and Unhealthy Areas, 1919, the following standard of fitness is laid down. A fit house should be:— 1. Free from serious dampness; 2. Satisfactorily lighted and ventilated ; 3. Properly drained and provided with adequate sanitary conveniences and with a sink and suitable arrangements for disposing of slop water; 4. In good general repair; and should have 5. A satisfactory water supply; 6. Adequate washing accommodation ; 7. Adequate facilities for preparing and cooking food; and 8. A well ventilated store for food. 93 With regard to these desiderata, it may be said generally that houses are kept in a satisfactory condition so far as items 1, 3 and 5 are concerned, but with regard to the other items a very large number of houses do not conform to a satisfactory standard. Under the heading of lighting, mention must be made of the free wiring scheme of the Borough Council. I am informed by Mr. Weekes, the Borough Electrical Engineer, that up to 31st March, 1931, the number of electric light installations provided under this scheme was 11,172. Nearly half the families in the Borough are thus enjoying the benefits of electric light in their homes. Good artificial lighting in the home has such far reaching reactions upon health that this scheme must be regarded as an important ally of the Health Services. Reference should also be made to the fact that steps have been taken to improve the lighting of the staircases of the tenement buildings in the Borough in accordance with Sec. 61 of the London County Council (General Powers) Act, 1927. It has been explained that many houses are overcrowded, old and more or less dilapidated, that there is no vacant space for building, and no vacant dwelling house accommodation. The result of this combination of circumstances has been that the predominating activity of the Sanitary Authority has been to keep existing houses, so far as possible, in reasonable habitable repair by means of action under the Public Health (London) Act. The number of houses dealt with during each of the last five years is as follows:— 1926 6,213 1927 5,736 1928 6,357 1929 5,347 1930 5,126. It will be seen that the work carried out under the Public Health (London) Act is considerable. The procedure works well, and the requirements of the Inspectors are, on the whole, complied with in a reasonable manner. No difficulty is experienced in taking action under the Public Health Act. In spite of the work done, however, in compliance with sanitary notices, these houses gradually become so defective structurally that they require to be largely rebuilt or reconditioned to prevent them from becoming dangerous and liable to be demolished in part or wholly under the direction of the District Surveyor of the L.C.C. During 1930 dangerous structure notices were served respecting 148 premises. This Authority has not availed itself of its power under section 3 of the Housing Act, 1925, for the following reasons:— In practice little difficulty is experienced in requiring owners to keep houses in repair under the Public Health (London) Act. The fact that in many houses repairs could not be carried out while the house is occupied, and that there is nowhere for tenants to go, has deterred the Committee from taking action under the Housing Act. g 94 The difficulty just referred to does not, of course, apply to empty houses, but these are now very few. The following are the particulars of the results of the action that was taken under the corresponding section (28) of the Housing, Town Planning, &c., Act, 1919:— Houses scheduled as derelict and suitable for action under this Schedule 264 Houses purchased by Borough Council, repaired and let 13 Houses dealt with by owners without service of notice 57 Number of notices served 83 Houses repaired by owners in compliance with notice 32 Houses repaired by Council in default of owners 4 Houses in respect of which owners appealed to Ministry of Health on grounds that property could not be repaired without reconstruction 29 In every case decision of Ministry was given in favour of owners. The experience summarised above has had the effect of discouraging similar action under the 1925 Act for two reasons. In the first place difficulty was experienced by the Borough Council in recovering money spent upon repairs when the owners were in default. In the second, the result of appeals to the Ministry of Health created the impression that in so far as a large proportion of the houses deemed suitable for action under this Section were concerned, the Act was not likely to prove workable. For the last eleven years a routine house-to-house inspection has been carried out, and has been the means of bringing to light and of having rectified a very large number of defects. The number of houses inspected under this scheme has been as follows:— 1920 4,495 1921 1,987 1922 1,495 1923 1,619 1924 3,279 1925 3,270 1926 3,202 1927 2,756 1928 3,973 1929 2,050 1930 1,997 Water Supply.—Every dwelling house in the Borough has a water supply from the mains of the Metropolitan Water Board. In the great majority of cases the supply is inside the house, but there are some houses in which the tap is in the yard. It has been explained that houses originally designed for one are now occupied in many instances by two or more families. In these houses the water supply has, in the majority of cases, been carried to one of the upper storeys. Water Closets.—With very few exceptions all houses have water-closet accommodation within their own curtilage. In the case of tenement houses the original accommodation is frequently found to be inadequate, and a considerable 95 number of water-closets to serve these houses are built yearly as a result of action taken by the Sanitary Authority. In the few cases in which the water-closet is not within the curtilage, the house abuts upon a yard not used as a general thoroughfare. V.—Unhealthy Areas. During the year 1919 the following areas were represented as insanitary under Part I of the Housing of the Working Classes Act, 1890:— 1. Ware Street area, 14.2 acres in extent, comprising Phillip Street, Louisa Square, part of Whitmore Road, part of Hoxton Street, Smart's Buildings, Barrett's Buildings, Byng's Buildings, Wilmer Gardens, Louisa Street, Watson's Place, Ware Street, Nancy Street, Adelaide Place, Canal Road (south side), Mill Row, Halcombe Place, Halcombe Street, Reeves Place and Nuttall Street. The number of houses in the area is 574, but about 80 were empty and more or less in ruins. The average population for the five years ending 1918 was estimated at 5,000. A scheme for the improvement of part of this area was made by the London County Council in May, 1920. The area included in this scheme was 9.2 acres on which a population of 2,621 occupied 349 houses. A local Enquiry was held at the Town Hall in November, 1920. The scheme was approved by the Ministry of Health in June, 1922. Work upon the scheme was commenced in the Summer of 1924. By the end of 1930 the number of blocks of dwellings completed was 11, containing 319 tenements. Two further blocks were in course of erection at the end of 1930, one in Kingsland Road, and one in Phillip Street. Eight sites included in the scheme still remain to be dealt with. 2. Britannia Gardens area, 1.68 acres in extent, comprising Britannia Gardens, Canton Terrace, Kingsnorth Place, Pimlico Walk, and Pounds Buildings. Included in this area are 114 houses with a population of about 560 persons. 3. Drysdale Place area, 2.19 acres in extent, including Crooked Billet Yard, Dodsley's Folly, Drysdale Place, Eliza Place, Windsor Place, and part of Drysdale Street, comprising 104 houses with an estimated population of 520 persons. A number of the houses in Windsor Place are derelict. 4. Lynedoch Street area, 1.8 acres in extent, comprising Lynedoch Street and Ely Place, including 152 houses with about 900 persons. 5. Wilks Place area, 0.56 acres in extent, including Barton Court, Wilks Place and Wilks Court; the houses number 47 with an estimated population of 230 persons. In January, 1921, the London County Council intimated to the Borough Council that this area would not be the subject of an improvement scheme for, say, seven years. G2 96 6. Foundry Place area, 0-7 acres in extent, including Foundry Place, Foundry Row, Foundry Walk, Royal Oak Place and Royal Oak Walk, the number of houses being 68 with an estimated population of 330 persons. No improvement scheme has as yet been made by the London County Council respecting areas Nos. 2, 3, 4, 5 and 6, referred to above. In 1929 the following area, population 506, was represented under Part II of the Housing Act, 1925:— Drysdale Street, even numbers 4 to 24 inclusive. Drysdale Place, Nos. 1 to 32 inclusive. Sarah Street, Nos. 1 to 26 inclusive, including Nos. 14a and 26a. Eliza Place, Nos. 1 to 12 inclusive. Crooked Billet Yard, Nos. 1 to 8 inclusive. Windsor Place, Nos. 4 and 8 to 25, inclusive. Basing House Yard, Nos. 1 to 5 inclusive. At their meeting in November, 1929, the Council directed a reconstruction scheme to be prepared for the improvement of this area under Sec. 37 of the Housing Act, 1925. It will be noted that this area is in the main the same as that represented in 1919 (No. 3 above). At their meeting in October, 1930, it was resolved by the Council that the representation made by the Medical Officer of Health under Part II of the Housing Act, 1925, with respect to the Drysdale Street area, be referred to the L.C.C. with a view to such area being dealt with as an improvement area under the Housing Act, 1930. VI.—Houses Let in Lodgings. The houses on the register numbered 402, and the number of inspections made was 799. The general remarks regarding old and ill-adapted houses in the Borough apply with special force to the houses on this register. The Byelaws are adequate, and are reasonably complied with, the difficulties met with being due to the general housing situation. VII.—General. Consideration of the housing conditions in Shoreditch, of which the foregoing report gives a brief summary, forces a few conclusions upon the mind. Firstly.—The great need of this district, which is a cockpit in which conflicting interests fight continually for building sites, is some form of authoritative zoning arrangement which will allocate certain areas for industrial development, and others for housing schemes. 97 Secondly.—In spite of the efforts that have been made, the number of new dwellings that have been built since the war is far too few having regard to the deplorable housing conditions that are known to exist. It will be noted that in 1919 six areas, containing a population of 7,540, were represented, and that of these a scheme has only been approved in respect of part of one (containing a population of 2,621), and that this scheme is not yet completed. It is especially important that new schemes should be carried out quickly in an area in which, as has been explained, a large proportion of the houses arc old, and many are literally falling into ruins. Further, when considered in terms of the lives of children, a few years is a long time. In ten years a very large number of children reach and leave behind them those impressionable years during which, of all the years in their lives, the greatest ill effects to mind and body are likely to result from living under the conditions implied by saying that their homes are situated in unhealthy areas. Thirdly.—Reference should be made to the proposal of the Shoreditch Borough Council that free or assisted travel facilities be granted between home and workplace. If this were done, many workers with young children would be able to enjoy a home life in the less densely populated outlying districts. Lastly.—There is the problem of rebuilding within the Borough. The greatest difficulty in the path of housing schemes is to find alternative accommodation for those who occupy the houses to be demolished. The worse the overcrowding, the greater this difficulty, and hence a deadlock is reached during which the evils attendant upon long delays bear fruit. The urgency of the situation is such that housing authorities should have power to provide temporary housing accommodation, as was done for soldiers during the war, either within or outside London, and if necessary to pay the travelling expenses of workers until the new homes are ready for occupation. New dwellings in Shoreditch tend of necessity to take the form of blocks of tenement dwellings. During the last few years it has been most gratifying to see the improvement in happiness, health and standard of living enjoyed by many families who have moved into the flats in the Ware Street area. The following is a list of tenement dwellings built in the Borough since the war:— By the Borough Council— St. Leonard's Dwellings, New North Road 40 flats. Teale Street Dwellings 75 „ By the London County Council— Ware Street Area Flats 319 „ Whiston Street Dwellings 12 „ By the Corporation of the City of London— A block of 104 flats upon site adjoining Wenlock Road. These flats were built to accommodate persons displaced in connection with housing schemes in the City. 98 In all 550 flats have been built in the Borough since the war. Whatever the changes in the population, it is certain that there will be a large residential population in Shoreditch for very many years to come of which an increasing proportion will be housed in flats. A few general observations upon flats may accordingly not be out of place. As stated, the flats recently built are a very great improvement upon the houses which they replaced. Ideas, however, regarding housing accommodation are moving rapidly. It is now realised that a house should not only meet the essential requirements of health, but that the surroundings should be spacious and pleasant. The place called "home" should be so designed as to make possible the contented enjoyment of leisure upon which the health of the mind depends as much as does the health of the body upon fresh air and good food. Reports of flats recently built in Germany and elsewhere indicate that it has been possible upon the Continent to pay more attention to this aspect of the housing question than we are doing in London. One hears of gardens round the flats, nurseries in which children can be left while their parents are at work or enjoying themselves at the theatre, bathing pools and so forth. The dwellers in a densely crowded urban area are at a disadvantage as regards health and happiness compared with those living where there is more elbow room, and for this reason houses should be designed so as to compensate, as far as possible, for this disadvantage. 99 IX.—MATERNITY AND CHILD WELFARE. Home Visiting. As has been explained in previous reports, the Borough is divided into seven districts, six being allocated to the six Health Visitors employed by the Borough Council, and one to the two Health Visitors of the Shoreditch School for Mothers. The School for Mothers is a voluntary organisation that has done excellent work in the Borough in close co-operation with the Town Hall for many years. Home visiting is the mainstay of maternity and child welfare work, upon which welfare centres and ancillary activities depend for support. The increase in the number of Centres, however, necessitated by the steady growth of their popularity, makes it increasingly difficult to arrange the work of the Health Visitor so that the time available for home visiting is not unduly curtailed. As in former years, we have been able to overcome this difficulty to some extent owing to the generous help given at the Centres by voluntary workers, to whom cordial thanks are tendered for their services. On five days each week four students attend from the National Health Society. They are instructed in the various branches of maternity and child welfare work and are later, incidentally, most useful in the general work of the department. At the end of the year a scheme was under consideration for engaging Probationer Health Visitors. The number of visits paid by the Health Visitors during the year, particulars of which are given in the accompanying table, corresponds to approximately ten visits each per half day after the necessary clerical work has been done. This is a good average if detailed and helpful advice is given in the home. When viewed, however, in relation to the child population to be visited, the amount of visiting cannot be regarded as adequate. Thus it is estimated that the children under one year received an average of three visits each. There are probably some 7,000 children in the Borough aged one to five, and approximately 9,500 visits were paid to these. Infant Welfare Centres. We have become used to crowded Centres in Shoreditch, and the year under consideration was no exception to the rule. Approximately 60 per cent of all infants under one year were brought to the Centres, making an average of eleven visits each. Crowded Centres, however, although gratifying as evidence of the appreciation of the mothers, do not afford the Health Visitors an opportunity for doing their best work, as it is impossible for them to give the full care and attention they wish to each individual if too large a number have to be passed through the Centre during each session. At the end of the year the Committee were considering opening fresh Centres, which they hope to be able to do without encroaching unduly upon the time available for home visiting. Particulars as to the attendances at the various Centres will be found in the table at the end of this section. 100 The weekly programme of Infant Welfare consultations (afternoons, 2 to 4) is as follows:— Monday Model Welfare Centre, 210, Kingsland Road. Hoxton Market Institute. Tuesday 28, Model Welfare Centre, 210, Kingsland Road. Herbert Street. Hoxton Hall. Wednesday Model Welfare Centre, 210, Kingsland Road. Hoxton Market Institute. Thursday Model Welfare Centre, 210, Kingsland Road. Dental Chnic, 164, Kingsland Road. 28, Herbert Street. Friday Model Welfare Centre, 210, Kingsland Road. Harbour Lights, Goldsmith Row. Mothers and children are referred if necessary to the following ancillary Centres:— Babies' Wards.—Model Welfare Centre. There is accommodation at this Centre for 10 babies, or 8 babies and 2 mothers, and the cases treated are babies suffering from disorders of nutrition; mothers can be admitted with their babies for the establishment of breast feeding. The nursing staff comprises a matron (Miss Borrow), sister, two staff nurses and four probationers. Statistical summary relating to children admitted:— Number of cases in the wards on 1st January, 1930 10 Number of cases admitted 54 babies and 3 mothers. Average duration of stay 9 weeks. Reasons for admission:— Wasting and malnutrition and debility 26 Prematurity 5 Disorders of digestion 5 Observation 8 Weaning 2 Establishment of breast feeding 8 All those discharged were either normal or very much improved. There was one case of infectious disease during the year. Four cases were transferred to hospitals. Two deaths occurred, one from Pneumonia and one from Wasting, in which the Thymus was found at the post-mortem examination to be enlarged. Artificial Sunlight Clinic. This Clinic is held on Monday, Tuesday, Wednesday and Friday afternoons, and is under the medical direction of the Assistant Medical Officer of Health. A mercury vapour lamp (K.L.B.) is used. Sister Pollard gives the treatment and is responsible for the records and the general management of the Clinic. Artificial Sunlight Clinic. To face page I O0 101 During the year 244 children were referred to this Clinic, making 4,095 attendances. The average number of visits per child was 17, and the average number of attendances per session was 20. The accommodation lhas been inadequate for some time, and arrangement have been made for the Clinic to be transferred to the basement of the new building to be erected on the vacant site at the rear of the Model Welfare Centre. Very many thanks are due to the members of the Sutton Branch of the Voluntary Aid Detachmcnt for the regular and willing help they have given. As in previous years, this help has contributed largely to the success of the Clinic. Otorrhœa Clinic. The Otorrhcea Clinic is held at the Model Welfare Centre every morning, Saturday included, from 10 to 11. The useful work of this Clinic has been continued throughout the year. The Assistant Medical Officer of Health is responsible for the general supervision of the work and sees all patients once a week. Treatment is carried out by a Nurse supplied by the Shoreditch and Bethnal Green Nursing Association. A Health Visitor attends also on the day of the doctor's visit, and she assists in the general arrangement of the Clinics at other times. Particulars of the Cases treated during the year are given table:— in the following Diagnosis Discharged well Discont'd Treatment Referred to Hospital Still Attending Totals Improved Not Improved Otitis Media Suppurative 38 28 13 8 6 93 Otitis Media Catarrhal 5 7 2 — — 14 Meatitis 4 — — 1 — 5 Internal Ear Disease — — — — — — Eustachian Obstruction — — — — — — Rhinitis 4 3 1 — — 8 Diphtheria Wax in Ears 6 — — — 6 Turbinate Disease 1 — 1 — — 2 No Ear Disease found 7 — — 8 — 15 Totals 65 38 17 17 6 143 Dental Treatment. Dental treatment was first undertaken by the Borough Council to supply the needs of mothers and children attending the Welfare Centre, and it is satisfactory to be able to report that the number of cases referred from the Centres to the Dental Hospital for treatment continues to increase. It is not necessary to repeat here what has already been written in the report upon the Dental Hospital as to the importance of dental treatment generally, but reference may be made to the fact that large numbers of children are found to have defective teeth when they are examined as school entrants. Early detection of 102 irregularity or decay in the teeth of children attending the Welfare Centres and the securing of proper treatment at the Dental Hospital should do much to improve the dental records of school entrants. The number of cases reported from the Welfare Centres for dental treatment since this has been available are as follows:— Year. First Attendances. Total Attendances. 1924 118 244 1925 138 479 1926 168 476 1927 279 682 1928 357 1,101 1929 266 1,413 1930 410 1,666 Agreement with Queen's Hospital for Examination and Treatment of Children referred from Welfare Centres. This Agreement which came into operation on 22nd January, 1930, contains provision for the following:— (1) Examination and report by member of Honorary Staff. (2) Treatment at Minor Ailment Centre. (3) Admission to Hospital of suitable cases for examination or treatment. The following are the particulars of the cases referred under this Agreement during the year:— Consultation Cases 107 Minor Ailment Cases 121 Admission to the Wards 2 Sewing Classes. Two classes are held each week—one at the Model Welfare Centre on Thursday afternoon and one at the School for Mothers on Monday afternoon. These classes fulfil a most useful purpose, as many young girls in Shoreditch work in factories when they leave school and are ignorant of needlecraft when they marry. The attendances at the Sewing Classes during the last five years have been as follows:— 28, Herbert Street. Model Welfare Centre. 1926 296 611 1927 484 592 1928 463 549 1929 319 526 1930 416 595 Dining Centres. Two dining centres are maintained by the Maternity & Child Welfare Committee. Necessitous, nursing and expectant mothers are referred to these and derive great benefit. Expectant mothers are not entitled to receive dinners until the seventh month of pregnancy. Good midday meals at this time are of great value in building up the health of the mother, and in giving the child a good start in life. 103 This good start is continued by allowing the nursing mother to attend for dinners which are the means of making it possible for many to breast feed their babies who would otherwise wean them at once or after a few weeks. The attendances at these two Centres during the year were as follows :— Model Welfare Centre. 31, Herbert St. Number of individual mothers attending ... 114 122 Total attendances 6,625 8,749 Milk Allowances. An allowance of milk is made to necessitous nursing and expectant mothers and to children under 5 years of age whose parents are necessitous. These allowances, which are made upon the recommendation of the Health Visitor, and the certificate of the Assistant Medical Officer of Health, after report by the Enquiry Officer, are as follows:— Nursing and expectant mothers 1 pint daily. Child under 3 years of age 1 pint daily. Child 3-5 years (upon special medical certificate) 1 pint daily. Child 3-18 months (upon special medical certificate) 1½ pints daily. 1 lb. of dried milk per week is allowed at the discretion of the doctor instead of 1 pint of wet milk daily. The number of individuals in receipt of milk allowance which was 800 at the beginning of the year, reached a maximum of 1,200 in June and fell to 1,000 at the end of the year. Necessitousness referred to above in connection with allowance of dinners or milk is determined by the application of the following scale to the family income. This scale was revised in February, as follows :– No. in family. Net family income per head. Free Dinners and Milk. Half-price Dinners and Milk. s. d. s. d. 1 14 0 16 0 2 12 0 14 0 3 10 0 12 0 4 9 0 10 0 5 8 0 9 0 6 (and over) 7 0 8 0 In calculating the net family income for the purposes of this scale, there should be deducted from the gross income payments made in respect of rent and contributions for State insurances, for health, unemployment and pensions and voluntary contributions for hospital treatment. 104 Nursing. The District Nursing Association undertake the nursing of children under five years referred to them by medical practitioners and by the Maternity and Child Welfare Department. The number of visits paid was 2,491. The particulars of these cases will be found on page 36 of this report. Convalescence. Children recommended for convalescent treatment by the doctors at the Welfare Centres are referred to the Invalid Children's Aid Association. The Maternity and Child Welfare Committee make a contribution towards the cost in suitable cases after considering a report by the Secretary of the Care Committee upon the financial aspect of the case. The total number of children towards the cost of whose convalescence the Committee contributed during the year was 30. The average period of convalescence was 9 weeks (not including one case away for 19 months). The overcrowding, bad housing conditions and dearth of open spaces, combine to make convalescent treatment most necessary for children who are found either to be recovering from illness or in a generally debilitated condition. At the end of the year the Maternity and Child Welfare Committee had under consideration the extension of the facilities at present available and also the provision of convalescent treatment for women coming under their care. School Entrants. The figures relating to the physical condition of children on attaining school age are of interest:— Boys. Girls. Total. Number of entrants 972 930 1,902 Number with defects (other than dental) requiring treatment 111 107 218 Number with dental defects requiring treatment 307 283 590 Number with defects (other than dental) not requiring treatment 83 47 130 Number with dental defects (not requiring treatment) 13 6 19 An interesting comparison may be made between the number of defective school entrants in Shoreditch and in London as a whole :— London. Shoreditch. 1929 1930 1929 1930 Number of school entrants inspected 76,024 64,632 2,103 1,902 Number found requiring treatment (other than dental) 13,072 10,856 264 218 Percentage requiring treatment 17.2 16.8 12.5 11.5 105 Maternal Care. Careful consideration has been given to the question of improving the facilities for safeguarding the health of the women of the Borough during pregnancy, confinement and the puerperium. At the end of the year the arrangements made for this purpose were as follows :— Ante-Natal Clinics. Model Welfare Centre, Wednesday morning (transferred from Hoxton Market Institute in April) ; Friday morning. Shoreditch School for Mothers—Thursday morning. The home visits to expectant mothers and total attendances at the Ante-Natal Clinics during recent years are shown in this table :— Year. Home Visits. Attendances at Ante-Natal Centres. First Visits. Re-visits. First Attendance. Total Attendances. 1925 564 463 380 673 1926 641 559 504 863 1927 619 490 399 750 1928 592 453 412 763 1929 641 515 494 961 1930 626 579 525 984 It will be seen that both the number of visits and the number of attendances show a tendency to increase, and this is encouraging as evidence that the importance of examination and advice at this critical time is being more fully realised. It has been previously reported that a panel of consultants was appointed and advice in regard to cases notified under the Puerperal Fever and Puerperal Pyrexia Regulations. The services of these Consultants have now been extended so as to include advice upon all conditions arising during pregnancy, parturition or the puerperium. To meet the anticipated increased demand for their services, two additional Consultants have been placed upon the panel. The complete list will be found in the section of this report dealing with the Staff. The number of Midwives practising in Shoreditch is 40. Maternity Outfits. There was an increased demand for the packages of sterile dressings for confinement cases which were first supplied by the Borough Council during 1929. These are supplied on the recommendation of the doctor or midwife by whom the confinement is to be conducted. The cost of the packets to the Council is 5s. 10d., and the patient is asked to contribute what can be afforded. During the year 838 packets of dressings were distributed. The following is a list of the contents of these packets :— Sterilized Maternity Dressings— 2 Draw Sheets, Bolton sheeting, washable. 1 Binder, soft calico. 106 6 Sanitary Towels, very large. 6 Sanitary Towels, smaller. 6 Safety Pins. 1 pkt. Wool Flakes, for wipes. 1 Small Accouchement Sheet. 2 Sheets of prepared paper for mackintosh. Home Helps. The Scheme for the provision of Home Helps, the inception of which was referred to in the last Annual Report, came into operation during the year under consideration. Towards the end of the year it was decided to work with a panel of Home Helps. This has proved much better than selecting women at random as it affords opportunity for tuition in their duties. Application for a Home Help is made by the husband, who is required to state his earnings and to give the name of his employer. The Home Help is provided in those cases in which the family income per head is within the following scale :— Number in Family. Income per head after deduction of rent. Free. Half price, i.e., 6d. per day hour s. d. s. d. 1 21 0 40 0 2 18 0 35 0 3 15 0 25 0 4 13 6 19 0 5 12 6 16 0 6 11 6 14 0 7 10 0 12 6 8 9 0 11 0 9 8 0 10 0 10 7 6 9 0 11 7 0 8 6 12 7 0 8 0 The working arrangements and the duties of the Home Helps under this scheme are explained in the following leaflet, copies of which are given both to the Home Help and the family to which she is supplied :— "Home Helps. "Arrangements have been made by the Maternity and Child Welfare Committee for the supply of Home Helps to homes in cases of childbirth occurring in the Borough. "Care has been taken in the selection of women to act as Home Helps both in regard to character and competency, but the Maternity and Child Welfare Committee cannot accept responsibility for the conduct of these Home Helps. 107 In any case where a Home Help is found inefficient or unsatisfactory in any respect, information should be sent at once to the Medical Officer of Health at the Town Hall. " The Duties of a Home Help are as follows :— "On being summoned to the case, she must as soon as possible inform the Medical Officer of Health at the Town Hall. A stamped addressed envelope will be given for this purpose. "She must not attend the case until the confinement is over, and her services are only to be given between the hours of 7 a.m. and 7 p.m. (except in special circumstances). "She is only expected to attend up to a maximum of 48 hours per week for two weeks. Any time in excess of this is not paid for unless special authority is given. "The times of attendances must be entered on a time-sheet daily, which sheet should be signed by the patient or some responsible person on her behalf, and presented at the Town Hall for payment as each week is completed. "The duties consist of general home management, including cooking, not more than two weeks' washing, and the care of the children (she will not undertake arrears of washing). "A doctor and a nurse, or midwife, will be in attendance, and it must be fully understood that no nursing duties are to be undertaken by the Home Help. "If there are not suitable facilities for washing in the house, the Home Help will wash elsewhere (Baths, etc.) and out-of-pocket expenses, if any, will be paid. "Patients are not expected to provide meals for Home Helps. "Home Helps will be under the general supervision of the Health Department, and they are expected to attend at the Model Welfare Centre, 210, Kingsland Road, as requested from time to time for instruction in their duties." The foregoing rules for Home Helps were not so drawn in the first instance, but were modified to their present form in order to prevent the possibility of a Home Help being placed in the predicament of being present at a confinement at which the doctor or midwife failed to arrive. Consideration of the position arising in homes in which the confinement is conducted by a doctor or student, and where consequently no arrangement is made for the necessary nursing duties during the puerperium, led the Council to decide that they would supply a nurse to doctors' cases if a Home Help is being supplied. The question of arrangements for the nursing of cases delivered by students in which a Home Help is supplied was taken up with the Hospitals concerned, and was still under discussion at the end of the year. The number of cases in which a Home Help was supplied was 33, and in two of these a Nurse was supplied also. 108 Ante-Natal Consultative Centre. The agreement between the Borough Council and the City of London Maternity Hospital, under which cases have been referred to this Clinic, expired on the 31st March. The following is the report received from the Secretary for the first three months of the year, viz. :— "The total number of cases dealt with was 116, all of whom were examined by the Obstetric Surgeon in charge of the Department; the number of examinations by the Surgeon was 270 and by the Sister 139. "The number of patients delivered in the district during the period under review was 28, and in the Hospital, 66. Urine was tested in all cases." With a view to carrying on and extending the excellent principle of co-operation with Hospitals embodied in the agreement just terminated, the Council entered into fresh agreements—one with the City of London Maternity Hospital and the other with St. Bartholomew's Hospital, under which cases could be referred for examination and report by a member of the Honorary Staff for a fee of half-a-guinea, and for admission to the wards at a charge of two guineas per week. Ministry of Health Memorandum 156/M.C.W. This important Memorandum was issued by the Ministry of Health in December. At the end of the year the Committee were engaged in a careful consideration of the Ministry's suggestions in relation to the arrangements for maternal care already in being in this Borough. Although nothing was definitely settled during the year covered by this report, it may be noted that these deliberations led to the recommendation that an additional Ante-Natal Clinic should be opened and that a Municipal Midwife should be appointed. Local Government Act, 1929. This Act, which came into force on 1st April, introduced important changes in the administrative arrangements in connection with Maternity and Child Welfare. The 50 per cent. grant payable by the Ministry of Health upon approved expenditure which has proved of such assistance to a young and growing service has been discontinued. The equivalent of the grant previously made is now included in the Treasury block grant which is revised every few years. The change from percentage grant to block grant was viewed with apprehension by many of those who are keenly interested in the expansion of Maternity and Child Welfare, as assistance from the Treasury for new schemes or extensions rendered necessary now lags behind any fresh expenditure incurred by the local authority. It is to be hoped that these fears will prove groundless, and that the growth of the Maternity and Child Welfare services which are of great and far reaching importance to the health of the Nation will continue unchecked both in the Borough and in the country as a whole. The discontinuance of the Ministry of Health grant has placed local authorities in a different relationship to the voluntary organisation to whom this grant was 109 formerly paid. The discontinued grant is now, in certain cases, included in that to the borough council concerned, by whom it is passed on to the voluntary organisations, subject to the following conditions set forth in the Ministry of Health scheme prepared under Section 101 of the Act:— (i) That the Council are satisfied as to the efficiency of the Maternity and Child Welfare service provided by the association in respect of which the contribution is payable, and that such service is being used by a reasonable number of those persons for whom it is provided ; (ii) That no reduction or alteration of such service is made without the consent of the Council; (iii) That such service, and any premises in which it is carried on, are open to inspection at all reasonable times by any officer of the Council duly authorised by the Council, and by any officer of the Ministry of Health appointed for that purpose by the Minister ; (iv) That the association sends to the Council in each year a copy of the annual report of the association on maternity and child welfare work of the previous year, together with a statement of the accounts of the association for that year relating to such work, and a copy of the auditor's certificate thereon, and furnishes the Council from time to time with such other information relating to the maternity and child welfare services provided by the association and the expenditure thereon as the Council may reasonably require : Provided that the Council shall not, except with the consent of the Minister of Health, terminate or make any reduction in the annual contribution payable to an association in respect of any service on the ground that any of the foregoing conditions are not fulfilled in the case of that service. The following voluntary organisations receive the discontinued Ministry grant subject to the conditions set forth above. Shoreditch School for Mothers. Amount payable in respect of discontinued grant—£755 1s. 6d. This organisation which has done most valuable work in the Borough for many years administers the two following institutions :— School for Mothers, 28, Herbert Street. This is a centre for health visiting. Two Health Visitors are employed who are responsible for visiting in an area (District 7 in accompanying tables) containing some 1,600 children under five years of age, and in which about 460 births occur annually. Two Infant Welfare Centres, and Ante-Natal Centre and a Sewing Class are held weekly at this Centre. The Borough Council makes an annual grant of £200 in respect of the important duties under the Maternity and Child Welfare Act that have been delegated to this Centre. H 110 Brunswick Day Nursery, Brunswick Place. This Nursery accommodates 35 children. The attendances during the year were as follows : Whole days, 6,730 ; half days, 675. Dr. Dancy, who is the doctor in charge of the Nursery, visits weekly. In case of emergency a local practitioner is consulted. The staff consists of Matron, Nurse and six Probationers. The domestic staff consisting of daily cleaner, and laundry woman two days weekly, is non-resident. Sun Babies' Nursery, Norris Street, Hoxton. Amount payable in respect of discontinued grant, £1,013 4s. 10d. This Day Nursery has been approved to accommodate 100 children, but there is barely sufficient elbow room for this number during the winter, and the average attendance is somewhat less. The attendances during the year were as follows: Whole days, 20,489; half days, 1,296. Dr. Leslie Ladell is in medical charge of the Nursery. A weekly inspection is made and Dr. Ladell is available at other times in emergency. Suitable cases receive light treatment (carbon arc lamp) under the medical direction of Dr. Ladell and Dr. Howard Humphries. An interesting feature of the work of this Nursery is that Dr. Hamilton Pearson attends regularly for the purpose of detecting, and where possible, correcting, backwardness and early tendencies to abnormality in the children. The Maternity and Child Welfare Committee have an arrangement under which payment is made for admission of children of necessitous parents to this Nursery upon the recommendation of the Health Visitor that the home conditions make this desirable. The Council pay 6d. per day per child under this arrangement. The total number of children so admitted was 69, and the total number of attendances was 4,632. Exclusive of payments made under the arrangement just referred to, the Council make a grant to the Sun Babies' Nursery of £63 per annum. Medical Mission of the Good Shepherd, Harman Street, Hoxton. Amount payable in respect of discontinued Ministry grant, £176 4s. 8d. At this Institution there are ten cots for the treatment of babies and young children suffering from acute medical conditions. Cases are frequently accepted for admission on the recommendation of the Maternity and Child Welfare Department. These wards are under the care of Dr. W. E. A. Worley, who visits daily, and is available at any time in case of emergency. The Nursing Staff is as follows: Matron, Sister and four Probationers. 111 During the year 67 children were admitted. There were five deaths. The particulars of the condition from which they were suffering are as follows :— Pneumonia 12 Diarrhoea 2 Diarrhoea and Vomiting 13 Otorrhoea 2 Wasting and wrong feeding 13 Starolitis 1 Vomiting 1 Circumcision 1 Pyrexia 1 Bronchitis 12 Tubercular Meningitis 2 Colitis 1 Scald 1 Hare Lip and Cleft Palate 1 Septic Hand 1 Eczema 2 Abdominal Obstruction 1 At this Institution there are also two midwives who take the cases in the surrounding district, but this part of the work does not rank for grant, and accordingly does not come under the supervision of the Maternity and Child Welfare Committee. German Tour—23rd May to 10th June, 1930. Special leave of absence was granted to two of the Health Visitors to join this Tour. They were much interested in all they saw, and returned to their work with new ideas and fresh enthusiasm from which we have all benefited. The following report was submitted to the Maternity and Child Welfare Committee:— "20th June, 1930. "Ladies and Gentlemen, German Tour (23rd May to 10th June), 1930. "This tour was arranged by the Association of Women Public Health Officers, with the assistance of the Public Health Training School in Berlin. A very extensive programme was carried out, and institutions connected with Public Health were visited in ten towns in Northern Germany. "Hamburg was our first place of call, and at 9 a.m., 26th May, we were officially received in the Health Office by Professor Pheiffer and the Medical Officer of Health. The welcome we received here and also at every point throughout the tour, was very enthusiastic, and great stress was laid on the fact that both countries were out to learn as much as possible from each other, in order that every avenue leading to the health and welfare of the people was fully explored and used. "The Bambeck Hospital, situated on the outskirts of Hamburg, was visited, the normal number of patients is 2,400, and there are departments for every kind of patient except certified lunatics. In this, and in every hospital we visited, we found that all patients admitted were isolated in glass cubicles for periods varying from 3 to 21 days, before being drafted to their respective wards. The Venereal Disease Block was of great interest, and here there are usually 200 men and 300 women under treatment either indoor or as out-patients. In Hamburg, venereal disease is notifiable. Medical Practitioners must notify H 2 112 every case they find, but they may continue to treat the patient themselves if they wish to do so. Also, from every child born in the borough a Wasserman blood test is taken, and if a positive reaction is obtained the mother and child are notifiable cases. "Later, we visited Grienstrasse School, which is a model school built on a new Housing Estate. This School is run by a Parents' Council, and the aim of the Teaching Staff is to maintain good relations between home and school, and to provide an atmosphere in the school as much like home as possible. The class rooms are fitted with chairs and tables graded in size, instead of desks, and special workrooms for practical work are fitted up. To these rooms the children return voluntarily in the afternoons and evenings for practical instruction and recreation. A Kindergarten is attached for children under school age. "In Germany generally, Kindergarten Schools and Day Nurseries are largely made use of by mothers wishing to leave their children, whilst out as work, or when shopping, or during the time spent in the laundry. In the new Housing Estates a Kindergarten and a Central Laundry are arranged in every block of flats. "In Lichtenberg, where slum dwellers are being re-housed, every house it so arranged that it faces south or west, and the rent is stationary for families with more than four children—thus avoiding overcrowding. Open-air river baths are provided on an area of 30,000 square yards of river bank, and there are facilities for 12,000 people to undress. We visited these baths between 10 and 11 a.m. on Saturday (31st May) and hundreds of people were either bathing or taking sun baths on the banks. "Swimming is compulsory in elementary schools throughout Germany, and everywhere possible Open-air Pools are provided and large numbers of people take advantage of them. Men and women in employment usually pay about 2d., unemployed and children are free. "Convalescent Homes for men, women and children are provided by the State or Municipality in every part of Germany. Jena, a town of 15,500 inhabitants, has 39 small convalescent homes for children alone. Some of these houses have, in the first instance, been given by philanthropists, some are simple structures of wood taking 12 to 40 children. All are in charge of a Matron with a Kindergarten Staff, and a doctor visits and examines all children once weekly or at any other time deemed necessary by the Matron. "We were interested here to see the Marl Zeiss Public Library, which gives reading and studying facilities to the working classes for a very small subscription. No limit is placed on educational books borrowed, but a small amount has to be paid if more than one novel is taken out within a month. In Dresden we visited the International Health Exhibition and the Museum of Hygiene. This Exhibition dealt with every aspect of health and we wished we could transport many exhibits to Shoreditch. At Dresden, also, we visited a Convalescent Home 113 School for children who are recommended by the Medical Officers for a change of air. We saw the children having their afternoon rest lying on trestles in a wood. "A swimming pool is also provided, and there are facilities for gymnastic exercises in the open air, and we were impressed with the arrangements for washing hands and feet in hot and cold water. "The last two days of the tour were spent in the Westphalian Industrial Area. We visited Essen and the Welfare Department of Krupps; also the Housing Estate where each block has its own Kindergarten, swimming pool, and facilities for gymnastics for adults and children. "At Bottrop we were taken to the Sewage Works, which deals with all sewage from this area. This is a coal mining district, and we were interested to hear from the Medical Officer of Health that their unemployment problem was as acute there as in England. "We feel that this Tour has been of great educational value to all members of the party, and we should like to express our gratitude to the Committee for giving us this opportunity. " We are, Ladies and Gentlemen, " Your obedient Servants, (Signed) " I. M. Heward. " Mary Morrell." SCHEMES IN PROGRESS AT THE END OF THE YEAR. Day Nursery. The Committee have been greatly impressed by the advantage derived by children living under bad housing conditions from attendance at Day Nurseries, and accordingly gave instructions for search to be made for a suitable site for a Municipal Day Nursery. It is not easy to find accommodation of this kind in Shoreditch, but eventually the Committee were successful and obtained two semidetached houses, Nos. 77 and 79, in Queen's Road, the combined gardens of which constitute a pleasant open space. At the end of the year plans were under consideration for rebuilding these two houses and erecting shelters in the garden. Laundry. The amount of laundry work required by the Maternity and Child Welfare Committee has been steadily increasing during recent years. To deal with this it was decided to extend the small laundry in the basement of the Welfare Centre by means of excavation. At the end of the year this work had made considerable progress, and it is hoped that before many months have passed the whole of the washing of the Health Department will be undertaken in these extended premises. 114 Particulars of the Health Visitors' visits and of the attendances at the various Welfare Centres during the year are given in the following tables:— Visits. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total. No. of 1st visits to infants 244 238 189 325 292 254 462 2,002 No. of re-visits to infants 333 452 321 381 677 477 1,319 3,960 No. of 1st visits to children aged 1 to 5 years (irrespective of whether visited previously as an infant) 173 64 103 123 142 188 1,086 1,879 No. of re-visits to children aged 1 to 5 years 693 1,073 1,090 1,190 1,126 1,245 1,318 7,735 No. of 1st visits to expectant mothers 82 60 35 62 72 111 209 631 No. of re-visits to expectant mothers 125 81 26 60 59 61 172 584 No. of unsuccessful visits 188 97 238 159 211 283 472 1,648 No. of interviews in connection with work 246 236 104 447 72 442 1,068 2,615 *No. of 1st visits to infants with diarrhæa 8 ... ... ... ... ... ... 8 *No. of 1st visits to cases of ophthalmia neonatorum 13 1 10 29 11 19 ... 83 *No. of re-visits to cases of ophthalmia neonatorum 15 3 12 19 17 20 ... 86 No. of 1st visits to cases of puerperal fever ... ... ... 5 1 ... ... 6 No. of re-visits to cases of puerperal fever ... 1 ... 3 3 ... ... 7 No. of 1st visits to cases of puerperal pyrexia 1 4 1 4 1 4 ... 15 No. of re-visits to cases of puerperal pyrexia 1 8 1 3 2 6 ... 21 No. of Health Visitors' attendances at Centres: (a) Hoxton Market Institute 42 2 1 12 110 117 ... 284 (b) Hoxton Hall Centre ... 1 7 52 2 8 ... 70 (c) Maternity Centre 149 202 100 151 96 58 ... 756 (d) Harbour Lights Centre 50 27 52 ... 1 4 ... 134 (e) School for Mothers Centre ... ... ... ... ... ... 331 331 *These visits are also included above. 115 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. .. .. .. .. .. 78 .. 78 over 1 yr. .. •• .. .. .. 44 •• 44 (Wed.) under 1 yr. .. .. .. .. 30 78 .. 108 over 1 yr. .. •• .. •• 19 41 •• 60 (b) Hoxton Hall: (Tues.) under 1 yr. .. .. .. 74 .. .. .. 74 over 1 yr. .. •• .. 13 .. .. .. 13 (Mon.) under 1 yr. .. 108 .. .. .. .. .. 108 over 1 yr. .. 49 .. •• .. .. .. 49 (Tues.) under 1 yr. 94 113 .. .. .. .. .. 207 over 1 yr. 35 23 .. .. .. .. .. 58 (c) Maternity Centre : (Wed.) under 1 yr. .. .. 79 .. .. .. .. 79 over 1 yr. .. .. 26 •• •• .. •• 26 (Thur.) under 1 yr. .. .. .. .. 161 .. .. 161 over 1 yr. .. .. •• •• 57 .. •• 57 (Fri.) under 1 yr. .. .. .. 92 .. .. .. 92 over 1 yr. .. .. •• 19 •• .. •• 19 (d) Harbour Liehts : (Fri.) under 1 yr. 63 .. 74 .. .. .. .. 137 over 1 yr. 26 •• 18 •• •• .. •• 44 (e) School for Mothers : (Tues.) under 1 yr. .. .. .. .. .. .. 200 200 over 1 yr. •• •- •• •• .. .. 40 40 (Thur.) under 1 yr. .. .. .. .. .. .. 151 151 over 1 yr. •• .. .. .. .. .. 36 36 116 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 .. .. .. .. .. 1,283 .. 1,283 Children .. .. .. .. .. 1,093 .. 1,093 Mothers without children .. .. .. .. .. 431 .. 431 (Wed.) Infants .. .. .. .. 396 1,319 .. 1,715 Children .. .. .. .. 248 816 .. 1,064 Mothers without children .. .. .. .. 199 307 .. 506 (b) Hoxton Hall: (Tues.) Infants .. .. .. 1,444 .. .. .. 1,444 Children .. .. .. 1,176 .. .. .. 1,176 Mothers without children .. .. .. 360 .. .. .. 360 (c) Maternity Centre: (Mon.) Infants .. 1,275 .. .. .. .. .. 1,275 Children .. 1,186 .. .. .. .. .. 1,186 Mothers without children .. 411 .. .. .. .. .. 411 (Tues.) Infants 1,476 1038 .. .. .. .. .. 2,514 Children 1,211 902 .. .. .. .. .. 1,113 Mothers without children 300 365 .. .. .. .. .. 665 (Wed.) Infants .. .. 1,471 .. .. .. .. 1,471 Children .. .. 1,278 .. .. .. .. 1,278 Mothers without children .. .. 352 .. .. .. .. 352 (Thur.) Infants .. .. .. .. 1,820 .. .. 1,820 Children .. .. .. .. 1,061 .. .. 1,061 Mothers without children .. .. .. .. 516 .. .. 516 (Fri.) Infants .. .. .. 1,290 .. .. .. 1,290 Children .. .. .. 1,072 .. .. .. 1,072 Mothers without children .. .. .. 348 .. .. .. 348 117 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 972 .. 1,008 .. .. .. .. 1,980 Children 981 .. 1,101 .. .. .. .. 2,082 Mothers without children 360 .. 585 .. .. .. .. 945 (e) School for Mothers: (Tues.) Infants .. .. .. .. .. .. 2,052 2,052 Children .. .. .. .. .. .. 1,080 1,080 Mothers without children .. .. .. .. .. .. 21 21 (Thur.) Infants .. .. .. .. .. .. 2,070 2,070 Children .. .. .. .. .. .. 1,043 1,043 Mothers without children .. .. .. .. .. .. 140 140 Ante-natal Consultations. Hoxton Market: Dr. Smith (Wednesday). Transferred to M.C. April, 1930. No. of 1st attendances .. .. .. 3 5 5 .. 13 Total No. of attendances .. .. .. 19 11 19 •• 49 Maternity Centre: Dr. Smith (Friday). No. of 1st attendances 23 30 16 5 17 2 .. 93 Total No. of attendances 41 55 39 25 27 3 •• 190 School for Mothers: Dr. Tribe (Friday). No. of 1st attendances .. .. .. .. .. .. 145 145 Total No. of attendances .. .. .. .. .. •• 231 231 118 As from the 30th April, 1930, the Wednesday Ante-Natal Clinic which had been held at Hoxton Market Institute, was transferred to the Maternity Centre. The Wednesday and Friday attendances were thereafter recorded together. Health Visitors' Districts. 1. 2. 3. 4. 5. 6. 7. Total Maternity Centre: Dr. Smith (Wed. and Fri.) No. of 1st attendances 33 90 52 30 47 31 .. 283 Total No. of attendances 66 134 93 104 94 47 .. 538 Health Visitors' Districts. Total. 1. 2. 3. 4. 5. 6. 7. Dental Clinic (Mr. H. L. Davies) Number of first attendances 54 72 47 61 45 29 103 411 Total number of attendances 191 269 205 258 218 165 384 1,690 Health Visitors' Districts. Total. 1. 2. 3. 4. 5. 6. 7. Sewing Classes(2). Total number of attendances 292 3 — 246 64 — 416 1,021 119 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.) 2 108 680 50 430 Dr. Phillips (Tues.) 1 80 586 30 446 Dr. Karn 1 16 177 7 161 Dr. Goffe 2 115 713 25 461 Dr. Richards (Wed.) 3 80 600 25 485 Dr. Rose (Thur.) 5 63 224 16 131 Dr. Fanning 5 47 176 21 130 Dr. McGregor 5 37 253 16 126 Dr. Smith (Fri.) 4 92 705 18 464 Hoxton Market. Dr. Rose (Mon.) 6 27 148 21 138 Dr. McGregor 6 28 210 6 135 Dr. Fanning 6 22 173 12 117 Dr. Goffe (Wed.) 6 78 521 36 305 5 39 170 18 84 Hoxton Hall. Dr. Rose (Tues.) 4 19 190 6 136 Dr. Fanning 4 23 195 5 167 Dr. McGregor 4 28 153 4 177 Harbour Lights. Dr. Phillips (Fri.) 3 61 412 14 308 Dr. Karn 3 9 79 4 43 Dr. Goffe (Fri.) 1 63 576 22 469 School for Mothers. Dr. Dancy (Tues.) 7 48 390 15 205 Dr. Pratt 7 152 667 25 431 Dr. Pratt (Thur.) 7 133 798 22 437 Dr. Dancy 7 18 150 14 122 Report of Infants attending Doctors Consultations. Health Visitors' Districts. Total. 1. 2. 3. 4. 5. 6. 7. Number suffering from disorders of digestion and nutrition 820 901 1,024 997 136 455 1,030 5,363 Number suffering from other minor ailments 1,123 413 850 791 84 637 616 4,514 Number referred to Hospital or to Medical Practitioner 91 203 117 92 87 56 127 773 The remainder were making satisfactory progress. 120 X.—HEALTH WEEK. The fourth consecutive Annual Health Week Exhibition arranged by the Borough Council and the third in the Town Hall was held during the week commencing Monday, 6th October. Great interest was shown both in the exhibits and in the lectures, and the number of persons who attended was greater than during any of the previous Health Weeks. A list of the exhibits and the lectures together with the number of persons attending each day are given below:— Exhibits. 1. The Parazone Company, Limited. 2. A. Wander, Limited (Ovaltine). 3. Hovis, Limited. 4. Sun Babies Nursery. 5. Nasal Hygiene Exhibit. 6. Borough of Shoreditch Electricity Department. 7. Borough of Shoreditch Maternity and Child Welfare Department. 8. Tuberculosis Dispensary. 9. Handicraft Class. 10. Health and Cleanliness Council. 11. Borough of Shoreditch Sanitary Inspectors. 12. Borough of Shoreditch Maternity and Child Welfare Department. 13. 14. Borough of Shoreditch Dental Hospital. 15. 16. Borough of Shoreditch Maternity and Child Welfare Department. 17. Borough of Shoreditch Sanitary Inspectors. 18. Borough of Shoreditch Baths Department. 19. Borough of Shoreditch Libraries Department. 20. Metropolitan Water Board. 21. British Social Hygiene Council. 22. Marmite Food Extract Company, Limited. 23. Virol, Limited. 24. Borough of Shoreditch Highways and Works Department. 25. Borough of Shoreditch Maternity and Child Welfare Department, Good Room. 26. Bad Room. 27. The Workers' Birth Control Group. 28. United Dairies, Limited. 121 Lectures. Miss M. Borrow, Matron, Model Welfare Centre, entitled " The Scientific Management of Infants." Dr. M. B. Ray, entitled " Rheumatism." Dr. Maitland Radford, Medical Officer of Health, entitled " Germs and what they are." Lieut. I. T. Muller, entitled "Health Through Daily Exercise," with demonstration. Dr. Octavia Lewin, entitled " Nasal Hygiene." Mr. P. W. James, Superintendent Registrar, entitled " Births, Deaths and Marriages." Dr. E. C. McGregor, Assistant Medical Officer of Health, entitled " Infant Feeding in Bygone Days." Mr. Alderman E. W. Lay, entitled " Child Welfare Work." Dr. A. Leitch, entitled " Tuberculosis." Dr. H. W. S. Wright (to married men), entitled " Birth Control." Dr. F. Vincent Denne, Dental Board of the United Kingdom, entitled " Why we have toothache." " The Care of the Teeth." Dr. Alice Rose, entitled " The Mothers' Diet as it affects the well-being of the Child." Mr. F. Marsh, Elma Electric Service Bureau, entitled " Electric Light and Health." Mr. R. A. Bishop, Sanitary Inspector, entitled " From Infancy to Old Age, or Health and the Sanitary Inspector." Dr. Helena Wright (to married women), entitled " Birth Control." Attendances. Days. School Children. 2-9 p.m. Total. Mornings. Monday - 1,025 1,025 Tuesday 96 1,735 1,831 Wednesday 299 1,754 2,053 Thursday 71 1,994 2,065 Friday 188 1,204 1,392 Saturday — 1,260 1,260 654 8,972 9,626 122 XI.—STAFF. Medical Officer of Health. Administrative Maternity and Child Welfare Officer. Administrative Tuberculosis Officer. Maitland Radford, M.D., B.S., D.P.H. Assistant Medical Officer of Health. James Fanning, M.D., B.S., D.P.H. (resigned 23/4/30). E. C. McGregor, M.B., Ch.B., D.H.P. (appointed. 15/4/30). Clerical Staff. E. G. Wilsher, Chief Clerk and Administrative Assistant. E. J. Haves and G. H. Pratt, First Assistant Clerks. H. P. Abbott, General Assistant. VV. Harris. Mrs. I. M. Rutherford. W. Wilson. W. L. Job. Miss E. Lehane. W. E. Dale (Part-time E. R. Banks. H. Fitzgerald. Enquiry Officer). 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. Sickelmorh. J. B. Molloy. A. Stratton. G. C. E. Gibbs. Note.—In addition to their Sanitary Inspector's certificates, all the Inspectors possess the recognised certificates foe inspection of meat and other foods. Health Visitors. Miss I. M. Heward, S.R.N., C.M.B. Miss B. C. Hunt , S.N.R., C.M.B. Miss M. Morrell, C.M.B. (Certs, of Sanitary Inspectors' Joint (Inspector of Nuisances, R.S.I.) Examination Board.) Miss M. Redcliffe, C.M.B. Mrs. D. Bales, S.N.R., C.M.B. Miss A. M. Brotherton, S.R.N., C.M.B. Tuberculosis Nurse and Infectious Disease Visitor. Miss W. I. Hiscoke, S.R.N., C.M.B. Dental Hospital: Dental Surgeon. H. L. Davies, L.D.S., R.C.S. (Eng.). Dental Mechanics. Sister and Clerk. Caretaker. T. Lamb. Mrs. L. Frier, S.R.N., C.M.B. Mr. A. Whittard. T. A. Diss. Assistant Nurse and Clerk. D. A. F. Robinson. Miss A. Randles, S.R.N., C.M.B. Model Welfare Centre, Kingsland Road. Miss D. Borrow, S.R.N., C.M.B., Matron. Miss D. A. Kennedy, S.R.N., C.M.B. (Sister), Miss G. E. Woods, S.R.N., Miss M. Hitchcock, S.R.N. (Staff Nurses), and 4 Probationers. Miss E. Riggs (Cook), Mrs. J. McDonnell (Waitress), J. P. Bear and J. E. Perry (Porters). Staff of Dining Centre, 31, Herbert Street. Miss M. Zemaitis (Cook-Caretaker). Miss W. Miller (General Assistant). Vaccination Officers. *S. W. Dyson, Haggerston Public Baths, Mansfield Street, E. 2. (For Whitmore, Kingsland, Haggerston and Acton Wards.) *W. H. Williams, 94, New North Road, N. 1. (For Moorfields, Church, Hoxton and Wenlock Wards.) * These two Officers also act as Registrars of Births and Deaths, and in the case of Mr. Dyson also as Registrar of Marriages. Disinfecting Officers. A. Fawns. G. Kennedy. A. Flack. Mortuary Keeper. Temporary Shelter. W. J. Bailey. Mrs. Watson (resigned 15/7/30). Mrs. A. Whittard (appointed 15/7/30). 123 The following officers who are not members of the permanent staff perform various duties in connection with the work of the department: Clerical Staff. H. Sewell. F. S. Hughes. W. F. Leaver. Dental Hospital: Anaesthetist. Maurice Marcus, M.B.B.S, M.R.C.S., L.R.C.P. Modal Welfare Centre, Kingsland Road. Physicians to Maternity and Child Welfare Centres. Sylvia Smith, M.B., B.S. Hon. Mrs. Olivier Richards, M.D., B.S., M.R.C.P. E, M. Goffe, M.B., B.S., D.P.H. Elizabeth Dove, M.R.C.S., L.R.C.P., D.P.H. Gladys Hill, M.D., B.S. Panel of Obstetrical Consultants. Gertrude 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. E. W. Roques, M.D., B.Ch., F.R.C.S. Harold Chapple. M.B., M.Ch., F.R.C.S. Artificial Sunlight Clinic. Mrs. M. Pollard, ,S.R.N., Sister-in-charge. Breast-Feeding Clinic. Miss R. Christey, S.R.N., C.M.B., Nurse. Mrs. J. Dukling, Mrs. A. Hesketh, Mrs. E. Williament {Cleaners). Tuberculosis Officer. Bacteriologist. Public Analyst. A Lritch, M.B., Ch.B. F. H. Teale, M.D., F.R.C.P. H. G. Harrison, M.A., F.I.C. Public Vaccinators. Dr. N H. Clubwala, 247, Kingsland Road, E. 2. (For Moorfields, Church, Hoxton and Wenlock Wards.) Dr. L. M. Ladell, 110, St. John's Road, N. 1. (For Whitmore, Haggerston, Kingsland and Acton Wards.) Dr. James Fanning, who had held the post of Assistant Medical Officer of Health since April, 1928, resigned in April, 1930, upon his appointment to the post of Assistant Medical Officer of Health to the Surrey County Council. Dr. Evelyn McGregor, who was appointed as his successor, was required to give three months' notice before relinquishing her duties as Assistant Medical Officer of Health to the County of Nottinghamshire, and accordingly did not commence duty in Shoreditch until July. During this interval Dr. Alice Rose was appointed temporarily as Assistant Medical Officer of Health, and, as smallpox was prevalent the time, her services were further retained during the holiday month of August when Dr. McGregor was in charge of the Department. Two additions were made to the permanent staff of the Dental Hospital: Nurse Randies was appointed Assistant Nurse and Clerk in January, and Mr. D. A. F. Robinson was appointed third Dental Mechanic in the following month. As stated in portion of report relating to infectious disease, two temporary Sanitary Inspectors and four temporary nurses were engaged to assist in the surveillance of smallpox contacts. An additional temporary Clerk was also engaged. On abatement of smallpox he remained in the Department to assist in additional work caused through extension of various services. INDEX. page Area 2 Ambulance facilities 7 Acute Poliomyelitis 31 Acute Primary Pneumonia 31 Acute Influenzal Pneumonia 31 Ante-natal Clinics 105 Births in sub-districts 8 Birth-rates 8 Bacteriological examinations 37 Butchers' shops 45 Bakehouses 46 Brunswick Day Nursery 110 Cancer 16 Cerebro-Spinal Meningitis 30 Cowhouses 45 Cookshops and Eating-houses 46 Condensed Milk Regulations 52 Convalescence 104 Deaths in sub-districts 9 Death rate 9 Deaths—ages at 12 Deaths—causes of 12 Deaths in Public Institutions 11 Deaths in Outlying Institutions 10 Diphtheria 25 Dysentery 27 Diarrhæa 34 Disinfection 37 Dental Hospital 76 Dental Hospital, Scale of Charges 78 (treatment) Dental Hospital—Orthodontic 81 Dining Centres 102 Day Nursery 113 Enteric fevers 27 Erysipelas 28 Encephalitis Lethargica 30 Fur Skin Dressers 43 Fried Fish Shops 46 Food and Drugs Acts 47 Factory and Workshop Act 53 Glandular Fever 34 Hospitals 5 House refuse 7 Hairdressers 46 Houses let in lodgings 96 Home Visiting 99 Home Helps 106 Health Week 120 Housing conditions 85 Inhabited houses 2 Infantile Mortality 14 Infectious cases, number certified 19 Infectious cases, number removed to hospitals 19 Infectious diseases, age periods 19 Infectious diseases, deaths from 19 Infectious diseases and schools 35 Influenza 34 Ice Cream Shops 46 Infant Welfare Centres 99 page L.C.C. (General Powers) Act, 1928— Sec. 28 44 Legal Proceedings 58 Local Government Act, 1929 108 Laundry 113 Medical Mission of Good Shepherd 110 Maternity Outfits 105 Maternal Care 105 Milk Allowances 103 Maternity and Child Welfare 99 Merchandise Marks Act, 1926 52 Marriages 9 Marriage-rate 9 Mortuary 11 Maternal mortality 15 Measles 32 Milk (Special Designations) Order, 1923 49 Milk and Cream Regulations, 1912 52 Milk and Dairies Order, 1926 52 Meat Regulations, 1924 52 Nursing in the home 36 Ophthalmia Neonatorum 29 Overcrowding 43 Outworkers 55 Ottorrhcea Clinics 101 Population 8 Puerperal fever 28 Puerperal pyrexia 29 Public Health (Prevention of Tuberculosis) Regulations, 1925 46 Rateable value 2 Rag and Bone Dealers 43 Rats and Mice (Destruction) Act 45 Regulations as to the Sale of Eggs 47 Rag Flock Acts 53 Sun Babies' Nursery 110 Smallpox 20 Scarlet fever 24 Sanitary Work 39 Shelter 37 Smoke Nuisances 52 Sanitary Officers 42 Staff 122 Street Markets and Food 45 Slaughterhouses 45 Sale of Food Order 46 Sewing Classes 102 School for Mothers 109 Treatment of Milk by Heat 51 Tuberculosis 63 Tuberculosis, deaths from 66 Tuberculosis Dispensary 68 Tuberculosis Care Committee 73 Unemployment 2 Underground Rooms 43 Unhealthy Areas 95 Vital Statistics3 Venereal Diseases 37 Verminous Houses 44 Whooping Cough 33 Water Supply to Tenement Houses 42 Water Supply 44 Women's Hospital 83 '