AC 4363 SHOR 38 REPORT on the Health and Sanitary Condition of the Metropolitan Borough of Shoreditch IN THE COUNTY OF LONDON, FOR THE YEAR 1933, BY MAITLAND RADFORD, M.D., B.S., D.P.H., Medical Officer of Health. London: S. Tinsley & Co. Ltd. 60 worship street. e.c.2 650/78 REPORT on the Health and Sanitary Condition of the Metropolitan Borough of Shoreditch IN THE COUNTY OF LONDON, FOR THE YEAR 1933, BY MAITLAND RADFORD, M.D., B.S., D.P.H., Medical Officer of Health. london: s. tinsley & co. l td. 60 worship street. e.c. iii METROPOLITAN BOROUGH OF SHOREDITCH. PUBLIC HEALTH COMMITTEE. MATERNITY AND CHILD WELFARE (Nov., 1932—Oct., 1933.) COMMITTEE. (Nov., 1932—Oct., 1933.) Ex-Officio: J. E. Houseman, Esq., j.p. (Mayor). Chairman: Councillor Matthews, Dr. A. D. ,, „ Parr, W. Vice-Chairman: Councillor Sherwin, A. H. ,, ,, ,, Palmer, R. E. Alderman Davie, Dr. R. E., m.a., m.c. „ Jeger, Dr. S. W., l.c.c. „ Lusher-Pentney, Mrs. C. R. Councillor Brookes, R. W. ,, Brown, W. J. ,, Crofts, R. O. ,, Jarvis, Mrs. M. J, ,, Parker, W. J. „ Ricketts, W. „ Rider, D. „ Thurtle, Mrs. D. ,, Tucker, T. Chairman: Councillor Yarrow, W. E., j.p. Vice-Chairman: Councillor Lee, E. Alderman Lusher-Pentney, Mrs. C. R. ,, Varnals, G. J. Councillor Baker, J. S. „ Ellett, W. T. ,, Girling, Mrs. H., j.p., l.c.c ,, Jarvis, Mrs. M. J. „ Jones, E. A. ,, Mitchell, M. „ Palmer, R. E, (Co-opted) Baker, Miss D. W, ,, Colville, Lady Cynthia, j.p. ,, Crouch, Mrs. A. N. ,, Furse, Mrs. J. ,, Yeoman, Mrs PUBLIC HEALTH COMMITTEE. MATERNITY AND CHILD WELFARE (Nov., 1933—Dec., 1933.) COMMITTEE. (Nov., 1933—Dec., 1933.) Ex-Officio: J. S. Baker, Esq., j.p. (Mayor). Chairman: Councillor Parr, W. Vice-Chairman: Councillor Palmer, R. E. Alderman Jeger, Dr. S. W., l.c.c. ,, Lusher-Pentney, Mrs. C. R. Councillor Brookes, R. W. „ Brown, W. J. ,, Girling, Mrs. H., j.p., l.c.c. „ Houseman, J. E., j.p. ,, Jarvis, Mrs. M. J. ,, Orgel, S. ,, Parker, W. J. ,, Ricketts, W. „ Rider, D. „ Sherwin, A. H. ,, Thurtle, Mrs. D. Chairman : Councillor Yarrow, W. E., j.p. Vice-Chairman : Councillor Lee, E. Alderman Lusher-Pentney, Mrs. C. R. ,, Parry, A. T., j.p. ,, Varnals, G. J. Councillor Abraham, G. „ Ellett, W. T. „ Girling, Mrs. H., j.p., l.c.c. ,, Jarvis, Mrs. M. J. ,, Palmer, R. E. (Co-opted) Baker, Miss D. W. ,, Colville, Lady Cynthia, j.p. ,, Crouch, Mrs. A. N. „ Furse, Mrs. J. „ Yeoman, Mrs. AA iv. CONTENTS. page Section. I.—Statistics and General Information 2 to 11 II.—Population, Births, Marriages and Deaths 12 to 21 III.—Infectious Disease 25 to 4-j IV.—Sanitary Work 44 to 73 V.—Tuberculosis 74 to 91 VI.—Municipal Dental Hospital 92 to 100 VII.—Housing 101 to 111 VIII.—Maternity and Child Welfare 112 to 139 IX.—Health Week 140 and 141 X.—Staff 142 and 143 LIST OF STATISTICAL TABLES CONTAINED IN THE REPORT. Statistical Summary 2 For whole district during 1933 and previous years 3 Comparison of London and Shoreditch birth and death rates in 1933 4 Birth-rate, death-rate and analysis of mortality during 1933 5 Unemployment 7 Population, births, marriages and deaths 12 to 16 Causes of, and ages at, death during year 1933 18 & 19 Infantile mortality during 1933 20a Maternal mortality 21 & 22 Cancer 24 Cases of Infectious disease notified during 1933 25 Vaccination Officers' return 28 Nursing List 42 Summary compiled from the abstracts of their work prepared by the Sanitary Inspectors for 1933 46 & 47 Return of samples taken under Sale of Food and Drugs Acts 61 Factory and Workshop Act—Summary of work 65 to 69 Summary of legal proceedings 70 to 73 Summary of Tuberculosis Certificates received 74 Return of work carried out at Tuberculosis Dispensary 74 to 91 Summary of deaths from Tuberculosis 80 & 81 Municipal Dental Hospital 92 to 100 Housing Conditions 101 to 111 Routine Medical Inspection of Elementary School Entrants 122 & 123 Statistical Report upon the Work of the Health Visitors 134 Report of Attendances at Welfare Centres 135 Metropolitan Borough of Shoreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. Public Health Offices, 8/14, Laburnum Street, E.2. May, 1934. TO the MAYOR, ALDERMEN and COUNCILLORS of the Metropolitan Borough of Shoreditch. Sir, Ladies and Gentlemen, I beg to present my Annual Report for the year 1933. Scarlet Fever and Diphtheria were both more prevalent than during the last few years. In this respect Shoreditch shares the increased incidence of these diseases recorded for the Metropolis as a whole. In the case of Diphtheria there is evidence of increased severity, and consideration of this makes it a matter for great satisfaction that Shoreditch now has a Diphtheria Immunization Clinic, and that parents are evincing a desire to have their children protected against this disease, and are attending the Clinic in increasing numbers. Indications of the social changes that are slowly but surely altering the character of the Borough are to be found in a birth rate of 16 per thousand, which though still the highest in London, is the lowest so far recorded for Shoreditch, and in the Registrar-General's estimated mid-1933 population of 93,550, also a low record that may be compared with the estimated figures for the year 192-3 of 106,200 and for the year 1913 of 110,410. This, which is the seventh 1 have prepared, is the last Annual Report that it will be my privilege to submit to you. , At the end of March the neighbouring Borough Council of St. Pancras did me the honour to appoint me to the post of Medical Officer of Health, and 1 take up my new duties on 1st July. In these circumstances the thanks that are due from me to the staff of the Health Department are tendered, not only in respect of the year just concluded, but of the keen and willing assistance that I have received from one and all throughout the period that I have held my present post. For the reason that the administrative duties of these officers place them in key positions so far as the efficient working of the department is concerned, I wish especially to thank Dr. Evelyn McGregor, the Assistant Medical Officer of Health, Dr. Cullen, the Tuberculosis Officer, Mr. Wilsher, the Chief Clerk, and Mr. Wright, the Senior Sanitary Inspector. In conclusion, I take this opportunity to thank past and present members of the Council for the unfailing assistance and encouragement accorded to me in my work during the thirteen years that I have served this Authority. These years have seen advances in the Health services of the Borough with which it is a great privilege to have been associated, and for the future development of which 1 beg you, Sir, Ladies and Gentlemen, to accept the best wishes of Your obedient Servant, MA1TLAND RADFORD, Medical Officer of Health. 2 I.—STATISTICS AND GENERAL INFORMATION. STATISTICS. Area: 662 acres. Population—Census .1931, 97,038; RegistrarGeneral's estimate mid-1933—93,550. Number of structurally separate dwellings 1931 Census-—14,115. Number of bouses (end of 1933) according to Rate Books, 14,238. Number of families and separate occupiers, 1931 Census—25,156. Rateable value, £838,510. Sum represented by penny rate, £3,230. The length of public streets in the Borough is 43 miles. Briefly, Shoreditch is a densely populated (average 141 to the acre) area containing approximately 14,000 structurally separate dwellings and 3,000 business premises. 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—500 may be given as a round number. Particulars regarding home work will be found in Section IV of this report, page 67. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1933. Total. M. F. Birth Rate Live births Legitimate 1,443 707 736 160 Illegitimate 51 32 19 1,494 739 755 Still births Rate per 1,000 total births 35.5 General death rate 13.0 Percentage of total deaths occurring in Public Institutions 68.5 Number of women dying in,or in consequence of, childbirth— From Sepsis 4 ,, other causes 2 Death rate of infants under one year of age per 1,000 live births:— Legitimate, 69. Illegitimate, 196. Total, 74. 3 Deaths from Measles (all ages) 7 ,, Whooping Cough (all ages) 14 ,, Diarrhoea (under 2 years of age) 22 ,, Pulmonary Tuberculosis 90 ,, all forms of Tuberculosis 98 Death rate from Pulmonary Tuberculosis 096 Tuberculosis Death Rate 105 For purposes of comparison the vital statistics of the Borough during recent years are given in the following table:— Year Population estimated to middle of each year Births Total Deaths Registered in the District Transferable Deaths Nett Deaths Belonging to the District Uncorrected Number Nett Number Rate of Nonresidents registered in the District of residents not registered in the District Under 1 year of age At all Ages Number Rate Number Rate per 1,000 nett Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1929 99710 1685 2005 20.3 1438 14.9 254 409 168 83 1593 16.1 1930 98960 1664 1988 20.3 1097 11.2 214 325 129 65 1208 12.3 1931 98260 1399 1684 17.1 1105 11.2 195 317 126 75 1227 12.5 1932 95800 1361 1674 17.5 1039 10.8 215 356 134 80 1180 12.3 1933 93550 1233 1494 16.0 1153 12.3 254 313 110 74 1212 13.0 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 races. 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 for the years 1929 and 1930. The Registrar-General's estimated population is adopted for all statistical purposes in subsequent years. 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 31st DECEMBER. 1933. DISTRICTS. Estimated Population. 1933. ANNUAL RATE PER 1,000 PERSONS LIVING Inl'a its u der 1 year Death rate per 1,000 Live Birtns. PERCENTAGE TO TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS. DEATHS DURING 1933 FROM Inque.l Cases. Deaths in Public Insti'.u'ions. Uncertified Causes of Death. 1 (cols. 2, 8) 2 3 4 5 6 7 8 9 10 1930. 1931. 1932. 1933. Principal Zynio ic i >iseases. S nallpox Measles. Scaret Fever. Diph heria. Whooping Cough. * Fever. †Diarrhœa Enteritis (under 2 years). Tuberculous Disease. Violence. London 4,298,600 13.2 11.4 12.3 12.3 12.2 0.36 0.00 0.02 0.02 0.08 0.08 0.00 0.15 0.90 0.58 59 6.3 . 0.00 Shoreditch 93,550 16.0 12.2 12.5 12.3 13.0 0.94 ... 0.07 ... 0.16 0.15 ... 0.23 1.05 0.65 74 6.9 68.5 ... Wards. Moorfields 3,906 18.4 15.5 10.6 16.9 14.6 1.28 ... ... ... ... 0.26 ... 0.26 0.26 ... 69 10.5 58.0 ... Church 16,217 16.6 12.3 14.8 13.3 13.9 0.74 ... ... ... 0.12 0.31 ... 0.68 1.05 0.74 107 6.6 68.9 ... Hoxton 15,089 15.6 12.7 12.4 13.7 12.5 0.86 ... 0.13 ... 0.20 0.13 ... 0.13 0.79 0.86 60 8.5 68.1 ... Wenlock 14,885 16.4 130 11.6 11.3 11.4 0.81 ... ... ... 0.07 0.07 ... 0.13 0.94 0.54 49 7.1 67.7 ... Whitmore § 13,987 18.9 131 12.9 12.5 14.5 1.22 ... 0.21 ... 0.07 0.29 ... 0.21 1.14 0.93 102 6.4 69.5 ... Kingsland 9,089 15.3 10.1 12.1 115 13.2 0.77 ... ... ... 0.22 0.11 ... 0.22 1.21 0.66 72 7.5 73.3 ... Haggerston 9,770 14.3 11.1 13.0 11.9 11.0 0.92 ... ... ... 0.41 ... ... ... 1.38 0.41 57 4.7 72.0 ... Acton 10,607 12.2 10.5 10.0 9.4 13.4 1.23 ... 0.19 ... 0.19 ... ... 0.09 1.32 0.47 39 5.6 66.2 ... * Fever includes typhus, typhoid and continued fevers. † Diarrhoea in this table includes enteritis in children under two years. § 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 to few to express as a rate per 1.000 within two places of decimals. 000 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 1933. 5 BIRTH.RATE, DEATH.RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1933. (Non.civilians included). Rate per 1,000 Total Population. Annual Death.rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. All Causes. Typhoid and Paratyphoid Fevers Small.pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under two years). Total Deaths under one year. Certified by Registered Medical Practitioners. Inquest cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still.births Shoreditch 16.0 0.59 13.0 0.00 0.00 0.07 0.00 0.15 0.16 0.48 0.65 14.9 74 89.79 6.93 5.28 0.00 England and Wales 14.4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 90.9 6.3 1.9 0.9 118 County Boroughs and Great Towns, including London 14.4 0.67 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.49 9.4 67 91.0 6.0 2.5 0.5 132 Smaller Towns (Estimated Resident Populations, 25,000 to 50,000 at Census, 1931) 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 91.7 5.8 1.5 1.0 London 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 88.3 6.3 5.4 0.0 6 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 follows :—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 1933, shows a rainfall for the year of 430 millimetres. This figure is 329 millimetres below the average for the thirty-five years, 1881-1915. The daily mean number of hours of sunshine during the year in London was 421. This figure was 0 09 hours less than the average daily mean for the 35 years 1881-1915. SOCIAL CONDITIONS. I have to thank the Director of Statistics of the Ministry of Labour for the following tables which show improvement in the unemployment figures at the end of the year:— 7 Numbers of persons resident in the Metropolitan Borough of Shoreditch, recorded as unemployed, at quarterly dates in the years 1928 to 1933:— Date Men. Women Juveniles Total 1928 11th June 2,237 557 31 2,825 17th September 2,134 453 41 2,628 17th December 1,987 677 37 2,701 1929. 11th March 2,286 719 68 3,073 17th June 2,325 541 29 2,895 16th September 1,929 381 21 2,331 16th December 1,994 680 49 2,723 1930 17 th March 2,687 1,058 67 3,812 16th June 2,767 1,375 141 4,283 15th September 3,221 1,322 59 4,602 15th December 3,509 1,445 49 5,003 1931 16th March 4,320 1,566 104 5,990 15th June 3,882 1,450 79 5,411 14th September 4,101 1,382 88 5,571 14th December 4,294 1,076 99 5,469 1932 21st March 3,985 984 120 5,089 27th June 4,478 1,075 110 5,663 26th September 4,362 918 102 5,382 19th December 4,108 1,131 84 5,323 1933 20th March 4,508 1,216 99 5,823 26th June 3,838 815 44 4,697 25th September 3,507 690 32 4,229 18th December 3,104 599 20 3,723 I have also to thank the Chief Officer of Public Assistance of the London County Council for the following figures relating to persons in receipt of domiciliary relief in Shoreditch:— Week ended Number of persons in receipt of domiciliary relief (excluding medical relief only) Number of persons in receipt of medical relief only. 1931 28th March 2,876 74 27th June 2,492 87 26th September 2,321 94 26th December 2,842 118 1932 26th March 3,366 92 25th June 3,087 105 24th September 2,974 138 31st December 2,982 145 1933 25th March 3,047 126 24th June 2,983 59 30th September 2,918 51 30th December 2,684 45 8 HOSPITALS, ETC. Within the Borough— St. Leonard's Hospital, Hoxton Street, N. 1, General, London County Council, formerly Shoreditch Guardians 572 beds. Royal Chest Hospital, City Road, E.C. 1 85 beds. Shoreditch Model Welfare Centre, 210, Kingsland Rd., 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, 8/14, Laburnum Street, E.2 No beds. Welfare Centres, see page 112, 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, Hollowav Road, N.7 286 beds. German Hospital, Ritson Road, Dalston, E. 8 . . 160 beds. London Hospital, Mile End, E.l 843 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.l 301 beds. Mildmay Mission Hospital, Austin Street, E.2 56 beds. Special Hospitals— Queen's Hospital for Children, Hackney Road, E. 2 204 beds. (Included in these beds are 44 at Branch, Little Folks' Home, Bexhill.) City of London Maternity Hospital, City Road, E.C. 1 71 beds. Royal London Ophthalmic Hospital (late Moorfields), E.C. 1 152 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.2 188 beds. Elizabeth Garrett Anderson Hospital for Women, Euston Road, N.W. 1 107 beds. Hospital for Sick Children, Gt. Ormond Street, W.C. 1 252 beds. (10 private) 9 Hospitals under Public Health Department of London County Council used by Inhabitants of Shoreditch— 9 Fever Hospitals (acute) containing 4,634 beds. 2 Fever Hospitals (Convalescent) containing 1,882 beds. 3 River Hospitals (Fever or Small Pox) containing 1,898 beds. Hospital for Ophthalmia Neonatorum, Marasmus and Congenital Syphilis— St. Margaret's, Leighton Road, Kentish Town, N.W. 5 60 beds. Hospitals for Venereal Disease— Sheffield Street Hospital, Kingsway, W.C.2 (Women) 82 beds. Hospital for Post Encephalitis Lethargica— Northern, Winchmore Hill, N.21 (part of) 274 beds. 10 Sanatoria and Hospitals for Tuberculous Patients containing beds as follows: 739 (Children), 210 (Women), 581 (Men), 632 (Men and Women). In all 2,162 beds. 20 Mental Hospitals containing 32,539 beds. Children's Hospitals and Homes— Queen Mary's Hospital for Children, Carshalton, Surrey 1,274 beds. The Down's Hospital for Children, Sutton, Surrey 360 beds. St. Anne's Home, Herne Bay, Kent (Convalescent Children) 127 beds. Contagious Diseases of the Skin and Scalp— Goldie Leigh Homes, Abbey Wood, S.E. 2 248 beds. Ophthalmia— White Oak, Swanley Junction, Kent 364 beds. Venereal Disease Clinics accessible from Shoreditch— Hospital for Sick Children, Great Ormond Street, W.C. 1 (male and female children). Daily treatment (Sunday excepted) 9 to 10 a.m., Monday, Tuesday, Thursday and Friday 2 to 4 p.m. London Hospital, Whitechapel Road, E.l. Gonorrhœa (Clap)—male and female. Daily treatment between 9.30 a.m. and 7 p.m. Syphilis—male and female: Monday 5 to 7 p.m., Tuesday 8.30 a.m. to 12 noon, Wednesday 10 a.m. to 12 noon. Thursday 8.30 a.m. to 12 noon. Patients can also be seen daily at other times. Metropolitan Hospital, Kingsland Road, E.8 (male and female). Monday and Friday 6 to 7 p.m., Wednesday noon to 1 p.m. 10 Royal Free Hospital, Gray's Inn Road, W.C.I (females and children). Daily treatment between 7 a.m. and 9.30 p.m. Royal London Ophthalmic Hospital (Moorfields), City Road, E.C.I. Male: Monday and Friday 5.30 p.m. Female : Wednesday 1.30 p.m. Royal Northern Hospital, Holloway Road, N.7. Skin—Males and females : Wednesday and Thursday 1 p.m. Syphilis—Males: Monday, Wednesday, Thursday and Friday 6 p.m. to 8 p.m. Females and children: Monday 2.30 to 4.30 p.m., Tuesday and Thursday 6 to 8 p.m. Gonorrhoea—Males and females : Monday, Tuesday, Wednesday, Thursday, Friday 6 to 8 p.m. University College Hospital, Gower Street, W.C.L Special (Venereal)—Male: Monday, Wednesday and Friday 5.30 to 7 p.m., Saturday 1.30 to 3 p.m. Female : Monday and Friday 5.30 to 7 p.m., Daily treatment (Sunday excepted) 9 a.m. to 10 p.m 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 (Hop. 0262) or to the Public Health Department, 8/14, Laburnum Street, E.2 (Bis. 4825/4826). Briefly, the London County Council provides ambulances free of cost for the conveyance of persons meeting with accidents, parturient women if the cases are urgent, persons suffering from illness upon medical certificate, and persons suffering from infectious diseases 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 and mechanically operated vehicles, and is burned at the refuse destructor. 11 ACTS, REGULATIONS AND ORDERS which became operative during 1933. Acts. Children and Young Persons Act, 193-3. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. Slaughter of Animals Act, 1933. Pharmacy and Poisons Act, 1933. Regulations. Regulations under the Agricultural Produce (Grading and Marking) Acts, 1928 and 1931, relating to various articles of food. Local Government (Qualification of Medical Officers and Health Visitors (Amendment)) Regulations, 1933. Orders. Transfer of Powers (London) Order, 1933. The Pharmacy and Poisons Act, 1933 (Date of Commencement) Order (No. 1), 1933. 12 II.—POPULATION, BIRTHS, MARRIAGES AND DEATHS. The Registrar-General's estimate for the mid-year 1933 population was 93,550. This figure will be used for statistical purposes throughout this Report. The population in the various Wards of the Borough is estimated as follows:— Ward. Population. Area in acres* Density per acre. Moorfields 3,906 71 55 Church 16,217 105 154 Hoxton 15,089 79 181 Wenlock 14,885 96 155 Whitmore 13,987 81 173 Kingsland 9,089 72 126 Haggerston 9,770 68 144 Acton 10,607 86 123 * Exclusive of water. The density of the population in the Borough as a whole is 141 per acre. Further information upon the subject of the population, area, number of inhabited houses and rateabie value are contained on pages 2, 3, 4, and 101. BIRTHS. Numbers of live births registered in the above-named area during the calendar year 1933:— Total Live Births (Legitimate and Illegitimate). Live births re gistered (excluding re-registration). Inward Transfers. Outward Transfers. Live births allocated to the Borough. Males 601 151 13 739 Females 632 146 23 755 Totals 1 ,233 297 36 1,494 Illegitimate Live Births. Males 24 9 1 32 Females 21 5 7 19 Totals 45 14 8 51 13 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 30 42 72 18.4 Church 134 136 270 16.6 Hoxton 109 126 235 15.6 Wenlock 112 132 244 16.4 Whitmore 128 137 265 18.9 Kingsland 78 61 139 15.3 Haggerston 75 65 140 14.3 Acton 73 56 129 12.2 Totals 739 755 1,494 16.0 Still Births. Numbers of still births registered in the above-named area during the calendar year 1933:— Total Legitimate and Illegitimate. Stillbirths registered. Inward Transfers. Outward Transfers. Stillbirths allocated to the Borough. Males 23 8 - 31 Females 19 6 1 24 Totals 42 14 1 55 Illegitimate. Males 1 - - 1 Females - 1 - 1 The birth rate for the Borough as a whole was 16.0. For England and Wales the birth rate was 14.4 and for London 13.2. The illegitimate births numbered 51, of which 32 were males and 19 females. Of these 19, of which 11 were males, occurred in St. Leonard's Hospital. The illegitimate births B 14 amounted to 3.4 per cent for all births credited to the Borough during the year. The number of births occurring in St. Leonard's Hospital was 385: 178 males and 207 females. In 37 of these the parents were not Shoreditch residents. This is the lowest birth rate so far recorded in the Borough, the previous low record being that of 1931 when the birth rate was 171. There has been a general decline in the birth rate during recent years' and the rate recorded in Shoreditch for 1933 is the highest of any London Borough. MARRIAGES. The number of marriages during the year was 858, and the persons married were at the rate of 18.34 per 1,000 population. The marriage rate for the Metropolis was 18.94. During recent years the corresponding figures have been as follows:— Year. No. of marriages. Marriage rate. Shoreditch. London. 1929 956 19.3 19.1 1930 969 19.6 19.4 1931 912 18.6 18.8 1932 848 17.7 18.0 1933 858 18.3 18.9 DEATHS. During 1933 the total number of deaths registered in the Borough was 1,153. The transferable deaths were as follows:— Deaths of non-residents registered in Shoreditch 254 Deaths of Shoreditch residents registered elsewhere 313 15 The number of deaths properly belonging to Shoreditch is accordingly 1,212, which figure gives a general death rate per 1,000 population of 13.0. In connection with these deaths 84 inquests were held. The death rate in England and Wales for 1933 was 12.3, and in London 12.2. 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 32 25 57 14.6 69.4 Church 118 107 225 13.9 107.4 Hoxton 102 86 188 12.5 59.6 Wenlock 104 66 170 11.4 49.2 Whitmore 110 93 203 14.5 101.9 Kingsland 66 54 120 13.2 71.9 Haggerston 58 49 107 11.0 57.1 Acton 62 80 142 13.4 38.8 Totals 652 560 1,212 13.0 74.0 In the table on page 18 will be found the numbers of deaths from different causes and at different ages and their ward distribution, together with particulars of deaths in Public Institutions within the Borough. Considering the deaths at all ages the chief causes are seen to be as follows:—Heart disease, 276 (22.9 per cent); Cancer, 135 (10.1 per cent); Tuberculosis, all forms, 98 (8.1 per cent); Pneumonia, all forms, 105 (8.7 per cent). The number of deaths due to accidents in connection with vehicular traffic was 17. In the years 1929 to 1932, inclusive, the corresponding figures were respectively 18, 21, 22 and 18. The particulars regarddeaths from cancer are contained in the table on page 24. It will be noted from the Table on page 18 that the chief causes of death of children between the ages of one and two years were Whooping Cough and Pneumonia—these two causes accounted for 13 out of a total of 30 deaths between these ages. Altogether 161 or 13.3 per cent of the total number of deaths of all ages were of children under the age of 5 years. BB 16 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. Special Hospitals:— No. of Deaths. Cane Hill 2 Cancer 1 Claybury 6 Central London Throat, Nose and Ear 3 Dartford 3 Fountain 2 City of London Maternity 2 Horton 2 Colindale 4 Hundred Acres, Epsom 1 Elizabeth Garrett Anderson 1 Tooting Bec 5 Highwood 1 1, West Park Road, Epsom 5 National 1 Nayland Sanatorium 1 Hospitals for Infectious Diseases:— Queen Mary's, Carshalton 4 St. Mark's 1 Eastern 20 Victoria Park 7 Grove Park 1 Other Institutions:— North-Eastern 12 North-Western 5 Northern 1 Park 1 South-Eastern 2 Archway Hospital 8 South-Western 1 Bancroft Lodge 1 General Hospitals:— 79a, Bishops Road I 2a, Bow Road 2 Children's, Gt. Ormond St. 2 214a, Cambridge Road 7 Charing Cross 1 199, Dartmouth Park Hill 1 Devizes and District 1 Edmonton Colony 1 German 9 Friern Barnet Infirmary 10 Golden Square 1 369, Fulham Road 1 Guy's 1 230, High Street, Homerton 6 Homoeopathic 1 86, High Street, Poplar 1 London 7 77a, Highgate Hill 3 Metropolitan 22 4, Kihg's Road, St. Pancras 2 Middlesex 1 Lambeth Hospital 12 Mildmay 6 29, North Side, Clapham 2 North Middlesex 1 129, St. John's Road, Islington 6 Prince of Wales, Tottenham 2 St. Joseph's Hospice 16 Queen's (Children) 13 St. Luke's Home 1 Royal Free 2 St. Peter's Home 1 Royal Northern 3 2a, South Grove, Stepney 2 St. Bartholomew's 39 93, Sydney Street, Chelsea 1 St. Benedict's, Wandsworth 2 1, Uxbridge Road 1 University College 1 17, Wellhouse Lane, Barmet 1 17 Of 297 persons belonging to Shoreditch dying in public institutions beyond the limits of the Borough, 115 died in general hospitals, 26 in asylums, 43 in fever hospitals, 26 in hospitals for special diseases, and 87 in other institutions. Elsewhere than in public institutions, 16 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 830 or 68.5 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:— 1929 63.9 per cent 1931 66.3 percent 1930 67.5 ,, 1932 69.3 ,, PUBLIC MORTUARY, 1933. Number of bodies deposited from— St. Leonard's Hospital 34 L.C.C. Infectious Disease Hospitals 4 LTndertakers 207 Other sources 98 Total number of bodies deposited 343 Number of post-mortem examinations performed 130 The Shoreditch mortuary is an old building, the structure of which is exposed to danger from subsidence by reason of the fact that the site is honeycombed with old graves. Further, the accommodation that the mortuary affords for post-mortem examinations and general arrangements regarding dead bodies does not in all respects conform to modern standards regarding such matters. In May, 1933, it was understood that the London County Council were interesting themselves in the condition of the mortuaries attached to the Coroners' Courts in London, and a request was made for a report upon the Shoreditch mortuary. This was submitted, and at the end of the year the question of the extent of the work to be undertaken by the Borough Council stood deferred until the policy of the London County Council regarding the future of this mortuary should have been made known. 18 19 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 IN EACH WARD. SEX. Holborn Institution S.Leonards Hospital Roy'l Chest Hospital Home ot Good Convent Hospital Infant Welfare Centre 1. Under 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Moorfields. Church. Hoxton Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. 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 belonging to Shoreditch Belonging to Shoreditch. Not belonging to Shoreditch All Causes. 110 30 21 25 10 22 47 63 70 139 211 241 185 38 32 25 118 107 102 86 104 66 110 s>3 66 154 58 |49 62 80 652 560 8 157 505 49 12 39 6 3 ... ... 2 ... M F M F M F M F M F M F M F M F 1. Typhoid and typhoid fevers ... ... ...... ... ... ... ... ... ... ... ... ... ... ... . . . ... 2 Measles 4 2 ... ... ... ... ... ... ... ... ... ... ... 2 2 1 2 2 b ... ... 3 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Whooping cough 6 6 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 4 1 1 1 4 1 3 11 1 5 Diphtheria ... 2 5 7 1 ... ... ... ... ... ... ... ... ... 1 1 2 1 1 1 1 1 2 2 2 7 8 ... 6 Influenza 1 1 4 ... ... 2 2 1 5 7 9 5 6 2 2 2 3 2 3 2 4 4 3 6 1 2 1 2 3 5 20 25 1 18 4 2 1 ... 7 Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 8 Cerebro-spinal fever 2 1 ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... 2 1 ... 2 4 ... ... ... ... ... ... ... ... ... ... ... ... 9 Tuberculosis of respiratory system ... ... 2 ... 1 6 17 24 10 18 10 2 ... ... ... 1 8 7 6 4 11 3 6 7 5 5 8 5 8 6 52 38 ... ... 29 19 1 6 ... ... ... ... ... ... 10 Other tuberculous diseases 1 2 ... 1 1 1 ... 1 ... 1 ... ... ... ... ... ... 2 ... 1 1 ... ... 3 ... ... 1 ... ... ... ... 6 2 ... ... 5 ... ... 1 1 ... ... ... ... ... 11 Syphilis 1 ... ... ... ... ... ... ... 1 2 ... 2 1 ... ... 1 1 1 ... 1 ... ... 1 1 ... ... 1 ... ... ... 3 4 ... ... 6 1 ... 2 ... ... ... ... ... ... 12 General paralysis of the insane, tabes dorsalis ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... ... 3 1 1 ... ... ... ... ... ... ... ... 13 Cancer, malignant disease 1 ... ... ... ... 1 ... 4 8 25 47 37 10 2 3 3 11 8 10 10 18 4 17 4 3 4 10 4 12 14 84 51 1 6 59 3 2 6 ... ... ... ... ... ... 14 Diabetes ... ... ... ... ... ... ... ... 1 1 4 4 ... ... ... 1 1 ... 1 ... 1 ... 1 1 1 1 ... ... 1 1 6 4 ... ... 5 ... ... ... ... ... ... ... ... ... 15 Cerebral haemorrhage, etc. ... ... ... ... ... ... ... 2 1 4 6 15 10 1 ... 1 2 4 4 ... 3 9 3 1 1 2 3 4 5 2 21 18 1 8 20 1 ... ... ... ... ... ... ... ... 16 Heart disease ... ... ... ... ... 6 7 5 14 24 43 83 76 18 11 8 24 30 23 23 21 15 25 23 9 13 12 10 7 22 132 144 2 50 110 7 3 7 ... ... ... ... ... ... 17 Aneurysm ... ... ... ... ... ... 1 ... 1 ... 1 1 1 ... ... ... 1 1 ... ... 1 ... ... 1 1 ... ... ... 1 ... 4 2 ... ... 4 1 ... 1 ... ... ... ... ... ... 18 Other circulatory diseases 1 ... ... ... ... ... ... ... ... 4 11 20 27 1 ... 9 7 6 5 7 9 ... 4 7 6 4 ... 2 2 3 33 31 3 35 37 2 ... ... ... ... ... ... ... ... 19 Bronchitis 3 ... ... ... ... ... ... ... 3 6 12 11 19 2 5 ... 6 5 4 1 3 8 5 2 2 3 4 2 5 1 34 22 ... 4 19 1 ... 2 ... ... ... ... ... ... 20 Pneumonia (all forms) 21 7 2 ... ... 1 2 5 7 12 17 20 6 5 5 1 16 9 12 5 6 4 10 3 9 4 4 6 6 5 68 37 ... 2 60 1 1 4 2 ... ... ... ... ... 21 Other respiratory diseases 1 ... ... ... ... ... 1 1 1 1 ... 1 ... ... 1 ... ... 2 1 ... ... ... 1 ... ... ... ... ... ... 1 3 3 ... ... 1 1 2 2 ... ... ... ... ... ... 22 Peptic ulcer ... ... ... ... ... ... ... ... 1 4 4 5 ... ... ... ... 2 ... ... 2 ... ... 2 2 4 ... 1 ... ... 1 9 5 ... ... 7 ... ... ... ... ... ... ... ... ... 23 Diarrhœa, &c. 21 1 ... ... ... ... 1 ... ... ... 2 ... ... ... 1 ... 8 5 2 ... ... 2 3 ... 2 1 ... ... ... 1 16 9 ... ... 12 1 ... ... 1 1 ... ... 1 ... 24 Appendicitis ... ... ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... .. ... ... 1 ... ... ... ... 2 ... ... ... ... 1 2 ... ... 2 ... ... ... ... ... ... ... ... ... 25 Cirrhosis of liver ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 1 2 ... 1 1 ... ... ... ... ... ... ... ... ... 26 Other diseases of liver, &c. ... ... ... ... 1 ... ... ... ... ... 4 1 ... ... ... ... 1 9 1 ... ... 1 ... ... ... 1 ... ... ... ... 2 4 ... ... 2 ... ... ... ... ... ... ... ... ... 27 Other digestive diseases 1 1 ... 3 1 1 ... 1 ... 7 3 5 1 ... ... ... 1 9 3 1 ... 4 1 5 2 1 1 ... 1 2 9 15 ... ... 7 ... ... ... ... ... ... ... ... ... 28 Acute and chronic nephritis ... ... ... ... 1 ... 2 1 2 4 8 10 4 2 ... 1 2 4 3 3 4 3 4 3 ... ... 1 2 1 3 15 19 ... 3 17 ... 1 4 ... ... ... ... ... ... 29 Puerperal sepsis ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 1 ... ... ... 4 ... ... 4 ... ... ... ... ... ... ... ... ... 30 Other puerperal causes ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... ... 31 Congenital debility, premature birth, malformations, &c. 39 ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 1 2 3 4 1 3 4 5 3 5 ... 3 2 1 1 25 15 ... 1 18 1 ... 1 1 1 ... ... 1 ... 32 Senility ... ... .. ... ... ... ... ... ... ... 1 ... 12 3 ... ... 1 1 1 3 4 ... 2 1 1 ... 1 1 ... ... 10 6 ... 2 11 ... ... ... ... ... ... ... ... ... 33 buicide ... ... ... ... ... ... ... 1 5 6 2 ... ... ... ... ... 2 ... 2 2 1 ... 3 2 ... ... ... 1 1 ... 9 5 ... ... 3 1 ... ... ... ... ... ... ... ... 34 Oth violence 6 1 1 8 1 1 6 2 2 3 8 4 3 1 ... ... 8 2 6 3 4 3 3 5 3 3 2 1 2 2 28 19 ... 2 16 7 ... ... ... ... ... ... 35 Other defined diseases 4 4 3 4 3 3 5 9 8 9 16 9 9 1 2 2 7 7 6 7 7 7 5 8 9 4 4 2 5 5 45 42 ... 22 40* 1 ... 2 1 1 ... ... ... ... 36 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... .... ... ... ... ... ... ... *Included erysipelas 4. 20 Infantile Mortality. The deaths amongst infants under one year numbered 110, of which (JG were males and 44 females. These deaths amounted to 91 per cent of the total nett Shoreditch deaths from all causes as compared with 114 per cent in 1932. The mortality amongst infants under one year was at the rate of 74 per 1,000 births registered during the year. Amongst male infants this rate was 89 and amongst females 58. The infant mortality rates in the different Wards of the Borough are included in the table on page 20. The number of deaths of illegitimate infants was 10, which figure gives a mortality rate of 196 per 1,000 illegitimate births. The chief causes of deaths amongst infants were pneumonia, diarrhoea and enteritis and prematurity. During the last five 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. 1929 74 70 83 1930 60 59 65 1931 66 65 75 1932 65 67 80 1933 64 59 74 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 20 20 A. Infantile Mortality in the Borough during Year, 1933. CAUSE OF DEATH. *AGES. *DEATHS IN EACH WARD. sex. Under 1 day. 1 day-l 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. M F M F M F M F M F M F M F M F 1 Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Measles ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... 1 4 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping cough ... ... ... ... ... ... ... 3 1 2 6 ... 1 1 1 3 ... ... ... 1 5 6 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Erysipelas ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... ... 1 ... 8 Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 German measles ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... 1 13 (a) with Pulmonary complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 (b) with Non - Pulmonary complications ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... 1 15 (c) without stated complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Meningococcal Meningitis ... ... ... ... ... ... ... 2 ... ... 2 ... ... ... ... ... 1 1 ... ... 2 18 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 Other Tuberculous diseases ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... 1 ... 20 Bronchitis ... ... ... ... ... ... 1 1 1 ... 3 ... 1 1 ... ... 1 ... ... ... 2 1 21 Pneumonia (all forms) ... ... ... ... ... ... 3 7 10 1 21 ... 3 3 5 0 ... 3 1 1 1 ... 2 2 14 7 22 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Empyema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... 24 Other Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 Laringitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Convulsions ... ... 1 ... ... 1 ... 1 ... ... 2 1 ... ... ... 1 ... ... ... 2 ... 28 Diarrhoea and Enteritis ... ... ... ... ... ... 1 12 4 4 21 1 7 5 1 2 3 2 ... ... 14 7 29 Ulcer of stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other diseases of the stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Syphilis ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 32 Congenital malformation 1 1 3 ... ... 5 ... 1 ... ... 6 ... ... 1 1 1 1 1 1 ... 5 1 33 Congenital debility and icterus 2 ... ... ... ... 2 ... 2 2 ... 6 ... ... 1 2 1 ... 1 1 3 3 34 Premature birth 6 8 3 1 ... 18 2 ... ... ... 20 2 1 2 1 1 2 1 2 2 4 1 1 ... 13 7 35 Injury at birth ... 3 ... ... 1 4 ... ... ... ... 4 ... 1 1 ... 1 ... ... 1 2 2 36 Accidental mechanical (suffocation) ... 1 ... ... ... 1 1 ... ... ... 2 ... 1 1 ... ... ... ... ... 2 ... 37 Atelectasis 2 1 ... ... ... 3 ... ... ... ... 3 ... 1 ... 1 1 ... ... ... 1 2 38 Other defined diseases ... ... ... ... ... ... 1 3 ... 1 5 ... 1 1 1 1 ... ... ... 1 3 2 39 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Violence 2 ... ... ... ... 2 ... 1 ... 1 4 ... 1 ... ... 1 2 ... ... ... 2 2 Totals 13 14 7 1 1 36 10 34 21 10 111 4 1 15 14 11 3 6 6 15 13 8 2 3 5 4 1 66 45 * Deaths of persons not belonging to Shoreditch occurring within the Borough are excluded. * Deaths of persons belonging to Shoreditch occurring beyond limits of Borough are included. 21 MATERNAL MORTALITY. The number of Shoreditch women whose deaths were primarily classified to childbirth during the year was 6. This gives a Maternal Mortality rate per 1,000 live births of 402 and per 1,000 total births (i.e., Still births included) of 3.87. The corresponding figures for the County of London were 3.20 and 310. The particulars of these deaths, classified according to age and cause, are given in the table on page 22. For purposes of comparison the maternal mortality rates per 1,000 live births in England and Wales, London and Shoreditch, during the year 1933 and four preceding years are given as follows:— England and Wales. London Shoreditch Year. 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. 1933 1.79 2.63 4.42 1.48 1.72 3.20 2.68 1.34 4.02 1932 1.55 2.49 4.04 1.19 1.47 2.64 *0.60 1.79 2.39 1931 1.59 2.36 3.95 2.02 1.78 3.80 ... 1.78 1.78 1930 1.84 2.38 4.22 1.71 1.45 3.16 2.0 1.5 3.5 1929 1.73 2.43 4.16 1.88 1.73 3.61 1.0 1.0 2.0 * This figure relates to one death from post abortive sepsis. 22 The particulars of these deaths are entered in the following table:— MATERNAL MORTALITY, 1933. AGES. Married. Single. Widowed. WARDS. 15 to 20 yrs. 20 to 25 yrs. 25 to 30 yrs. 30 to 35 yrs. 35 to 40 yrs. 40 to 45 yrs. 45 yrs. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Post abortive Sepsis ... ... 1 1 ... ... ... 2 ... ... ... ... ... 1 ... ... 1 ... Abortion not returned as septic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hæmorrhage following abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Without record of hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal hæmorrhage ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... Placenta prœvia ... ... ... 1 ... ... ... l ... ... ... ... ... ... 1 ... ... ... Other puerperal hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal sepsis ... ... ... 2 ... ... ... 2 ... ... ... ... 2 ... ... ... ... ... Puerperal septicæmia and pyæmia ... ... ... 2 ... ... ... 2 ... ... ... ... 2 ... ... ... ... ... Puerperal tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal albuminuria and convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other conditions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other toxæmias of pregnancy ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... Puerperal phlegmasia alba dolens, embolism and sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal phlegmasia alba dolens not returned as septic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal embolism and sudden death ... ... ... ... … … … ... … … … … … … … … … … Other accidents of childbirth … … … … … … … … … … … … … … … … … … Other or unspecified conditions of the puerperal state … … … … … … … … … … … … … … … … … … Puerperal insanity … … … … … … … … … … … … … … … … … … Puerperal diseases of the breast … … … … … … … … … … … … … … … … … … Childbirth unqualified … … … … … … … … … … … … … … … … … … Associated with pregnancy and childbearing, but not classed thereto … … … 1 … … … 1 … … … 1 … … … … … … Ruptured ectopic gestation … … … 1 … … … 1 … … … 1 … … … … … … 23 Cancer. The deaths from Cancer in the Borough during the year numbered 135 as compared with 148 in 1932. Particulars concerning these deaths as regards age, situation of disease and Ward are given in the table on page 24. As was the case last year the stomach was the most frequent site of disease among the deaths from Cancer allocated to Shoreditch during the year. The deaths from Cancer during the last five years per million persons living are given in the following comparative table:— England and Wales. London. Shoreditch. 1929 1,437 1,300 1,479 1930 1,454 1,553 1,346 1931 1,555 1,641 1,242 1932 1,581 1,553 1,545 1933 … 1,604 1,443 24 Deaths from Cancer in the Borough during Year 1933. AGES. SEX. WARDS. 0 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and up. Male. Female. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerstou Acton. M F M F M F M F M F M F M F M F All situations 1 1 ... 4 8 25 47 37 10 2 84 51 3 3 11 8 10 10 18 4 17 4 3 4 10 4 12 14 Tongue ... ... ... ... ... 1 3 ... ... ... 4 ... 1 ... ... 1 1 1 ... ... Other buccal cavity ... ... ... ... ... ... 1 3 ... ... 4 ... ... 1 ... 2 ... ... ... 1 Pharynx ... ... ... ... ... 1 2 ... ... ... 3 ... ... ... 1 1 ... ... 1 ... Oesophagus ... ... ... ... ... 2 1 4 1 ... 7 1 ... 1 1 1 3 ... 1 1 Stomach ... ... ... 1 ... 7 8 8 ... ... 15 9 2 1 1 3 1 4 4 ... 3 1 4 Liver ... ... ... ... ... ... 3 ... ... ... 2 1 ... 1 1 ... 1 ... ... ... Gall bladder ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... Intestines ... ... ... ... ... 1 5 2 5 ... 8 5 1 ... 1 2 1 1 1 1 2 1 2 Rectum ... ... ... 1 2 2 4 3 1 ... 8 5 ... 1 1 1 1 2 2 ... 2 1 1 Others ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... Uterus ... ... ... 1 2 5 3 2 ... ... ... 13 ... 1 2 1 1 2 ... 6 Ovary and Fallopian tube ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... Vagina, Vulva ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... Breast ... ... ... ... ... ... 2 2 ... ... ... 5 ... 1 ... 1 ... 1 1 1 Skin ... ... ... ... ... ... 1 ... ... 1 ... 2 ... 1 1 ... ... ... ... ... Larynx ... ... ... ... ... 2 4 3 ... ... 9 ... ... 1 1 2 3 ... ... 2 Lung and Pleura ... ... ... 1 2 4 3 2 ... ... 12 2 1 3 2 1 3 ... ... 1 2 1 Mediastinum ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bladder ... ... ... ... ... ... 1 2 1 ... 3 1 ... ... 1 1 1 ... ... 1 Prostate ... ... ... ... ... ... 1 1 ... ... 2 ... ... 1 ... ... ... ... ... 1 Others 1 1 ... ... 1 ... 2 4 ... ... 6 3 ... 2 1 1 ... 1 1 1 2 25 III.—INFECTIOUS DISEASE. Notifiable Disease. Excluding tuberculosis, the deaths during the year from notifiable infectious diseases numbered 137 (11.3 per cent of the total deaths). The corresponding number for 1932 was 129 (10.9 per cent of total deaths). The following table shows the numbers of cases of infectious disease (tuberculosis excluded) notified in the Borough, together with distribution as to quarter, age and Ward:— NOTIFIABLE DISEASE. NUMBER OF CASES NOTIFIED. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total AGES. WARDS. Cases removed to Hospital Diagnosis evised subsequently Deaths I II III IV V VI VII VIII Under 1 year 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 Moorfields Chur^ h Hoxton Wenlock Whitmore Kingsland Haggerston Acton Enteric fever ... 1 ... 1 2 ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... 1 2 ... ... Small-pox 3 17 6 3 29 1 4 10 6 4 4 ... ... 16 ... 6 4 1 2 ... 29 5 ... Scarlet fever 97 120 191 197 605 5 208 338 39 12 3 ... 18 80 118 87 102 61 85 54 598 38 ... Diphtheria 64 78 88 124 354 5 115 181 31 18 4 ... 14 63 58 49 49 33 67 21 354 68 15 Acute primary pneumonia 11 7 3 7 28 1 4 7 3 7 2 4 2 6 5 5 5 1 3 1 21 ... 105 Acute influenzal pneumonia 28 2 ... 7 37 ... 2 2 10 13 7 3 1 11 6 2 8 1 3 5 9 Erysipelas 12 9 16 23 60 2 ... 10 8 16 19 5 1 13 5 12 13 3 5 8 39 ... 5 Puerperal fever 1 2 ... 1 4 ... ... ... 1 3 ... ... ... 1 ... 1 ... 1 ... 1 4 ... 4 Puerperal pyrexia 7 10 9 5 31 ... ... ... 9 22 ... ... 4 5 5 1 5 7 1 3 24 ... 2 Cerebro-spinal fever 4 7 1 1 13 1 3 5 3 1 ... ... 1 1 2 1 1 2 4 1 13 ... 6 Ophthalmia neonatorum 7 6 4 9 26 26 ... ... ... ... ... ... 2 7 7 1 3 2 3 1 5 ... ... Acute Poliomyelitis 1 ... 1 ... 2 ... 1 1 ... ... ... ... ... ... ... ... 1 1 ... ... 2 ... ... Totals 235 259 319 378 1,191 41 337 554 110 97 40 12 43 203 206 165 192 113 173 96 1,100 111 137 Numbers and percentages of cases moved to hospitals. 200 242 308 350 1,100 85.1% 93.4% 96.2% 92.6% 92.3% 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 fever, 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). 26 The total number of cases of infectious disease occurring in the Borough was more than during 1932, the number for the two years being respectively 1,191 and 931. Smallpox. (Variola minor.) No. of cases notified 29 No. of cases in which diagnosis not confirmed 5 No. of actual cases 24 All cases were of the mild type of the disease (variola minor). The age, Seasonal and Ward distribution are included in the table on page 25. 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 ... ... ... ... ... ... ... ... ... Church 10 6 16 ... ... ... 0.99 ... ... Hoxton ... ... ... ... ... ... ... ... ... Wenlock 2 2 4 ... ... ... 0.27 ... ... Whitmore 1 3 4 ... ... ... 0.29 ... ... Kingsland ... ... ... ... ... ... ... ... ... Haggerston ... ... ... ... ... ... ... ... ... Acton ... ... ... ... ... ... ... ... ... Total 13 11 24 ... ... ... 0.26 ... ... London ... ... 530 ... ... 1 0.1 0.00 0.00 The following table shows the prevalence of smallpox in the country, London and Shoreditch during recent years:— Cases Notified. England & Wales. London. Shoreditch. 1929 10,975 1,905 246 1930 11,855 5,167 788 1931 5,665 1,452 122 1932 2,070 1,133 14 1933 631 530 29 27 The condition as to vaccination of the 24 actual cases was as follows:— Unvaccinated 18 Vaccinated after infection 4 Vaccinated more than 10 years previously 2 Vaccinated less than 10 years previously 0 No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. 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. S. W. 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. L. Statnigrosch, 191, Kingsland Road, E.2 (Shoreditch North-East District). (2) Dr. N. H. Clubwala, 247, Kingsland Road, E.2 (Shoreditch South-West District). 28 The following report upon vaccination is in the form required by the Registrar-General:— VACCINATION OFFICERS' RETURN RESPECTING THE VACCINATION OF CHILDREN WHOSE BIRTHS WERE REGISTERED IN 1932. Date. Registration sub-districts comprised in vaccination officers' district. Number of births returned in birth list sheets. Number of these births duly entered in Columns 1, 2, 4 and 5 of the vaccination register (birth list sheets), viz.:— Number of these births which are not entered in the vaccination register, on account (as shown by report book), of Column 1, successfully vaccinated. Column 2. Column 5, dead, unvaccinated. Postponement by medical certificate. Removed to other districts and notified to vaccination officers of the districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Cases remaining or temporarily unaccounted for. Total number of certificates of successful vaccination received during the calendar year 1933. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1933. Insusceptible of vaccination. Certificate of conscientious objection. 1932. 1 2 3 4 6 7 8 9 10 11 12 13 1st Jan. to 31st Dec. North-East 849 170 — 487 49 23 63 21 36 214 413 South-West 509 119 2 254 28 6 2 88 10 91 218 Other Districts - - - - - - - — - 82 4 Total 1,358 289 2 741 77 29 65 109 46 387 635 29 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 year ended 30th September, 1933:— Name of Poor Law Institution or 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. St. Leonard's Hospital. Dr. T. Kelleher — 15 15 20 — Holborn & Finsbury Institution Dr. R. T. Taylor — 1 1 - - Shoreditch South-West District. Dr. N. H. wala 156 176 332 14 - Shoreditch North-East District. Dr. L. Statnigrosch 187 134 321 6 — 343 326 669 40 Scarlet Fever. The cases certified numbered 605, of which 38 or 6.3 per cent were subsequently not regarded as Scarlet Fever. The actual number of cases was accordingly 567, which gives an attack rate of 6.06 per 1,000 inhabitants. The age, seasonal and Ward distribution of the cases are included in the table on page 25. There were no fatal cases. The number of cases and the attack rates in the Borough and Wards are given in the subjoined table:— (See also table on page 18.) Ward. 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 12 5 17 ... ... ... 4.35 ... ... Church 39 34 73 ... ... ... 4.50 ... ... Hoxton 59 51 110 ... ... ... 7.28 ... ... Wenlock 37 43 80 ... ... ... 5.37 ... ... Whitmore 37 61 98 ... ... ... 7.00 ... ... Kingsland 31 27 58 ... ... ... 6.38 ... ... Haggerston 31 48 79 ... ... ... 8.09 ... ... Acton 23 29 52 ... ... ... 4.90 ... ... Total 269 298 567 ... ... ... 6.06 ... ... London ... 21,998 ... 81 5.12 0.02 0.37 c 80 The number of cases in Shoreditch was more than in 1932, in which year there were 419 cases with an attack rate of 4.37. The measures taken to control the disease are as follows:— Isolation of patient. With the exception of seven 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. It is sometimes found that there is a missed case in the house still in the infectious stage. 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. Diphtheria. The cases certified numbered 354, of which 68 or 15.8 per cent were subsequently not regarded as being diphtheria. The number of cases during the year was thus 286, which gives an attack rate of 3.1 per 1,000. inhabitants. In 1932 the number of cases was 249 and the attack rate 2.6. The age, seasonal and ward distribution of the cases are included in the table on page 25. There were 15 fatal cases—7 males and 8 females. These occurred in the following age groups:— Aged 1-2 years 2 Aged 2-5 years 5 Aged 5-10 years 7 Aged 10-15 years 1 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 5 8 13 ... ... ... 3.33 ... ... Church 24 22 46 1 1 2 2.83 0.12 4.35 Hoxton 21 28 49 2 1 3 3.25 0.20 6.12 Wenlock 18 24 42 1 ... 1 2.81 0.07 2.38 Whitmore 19 19 38 ... 1 1 2.71 0.07 2.63 Kingsland 10 17 27 1 1 2 2.97 0.22 7.41 Haggerston 23 29 52 2 2 4 5.32 0.41 7.69 Acton 7 12 19 ... 2 2 1.79 0.19 10.53 Total 127 159 286 7 8 15 3.06 0.16 5.24 London ... 9,662 358 2.25 0.08 3.71 31 The death rates from diphtheria in Shoreditch and other areas are compared in the table on page 30 of this Report. The number of cases notified per 1,000 population are compared in the following table:— 1925 1926 1927 1928 1929 1930 1931 1932 1933 England and Wales 1.23 1.31 1.33 1.55 1.59 1.86 1.26 London 2.73 2.96 2.71 2.75 2.68 3.1 1.94 1.87 2.25 Shoreditch 4.1 4.0 3.7 3.5 2.8 3.3 2.3 2.6 3.1 During the year the number of bacteriological examinations made for the purpose of detecting the diphtheria bacillus numbered 897. Home enquiries were made in the majority of cases notified and it was possible to trace the source of infection in 24 instances. Much can be done to lower the mortality and to lessen the serious after effects of the disease by securing the prompt removal of patients to hospital and by advising those who have been exposed to infection to seek medical aid if suspicious symptoms develop. It is usually possible for cases to be removed to one of the London County Council Fever Hospitals within an hour of the receipt of a telephone message from the doctor in attendance, so that there is a minimum of delay in the commencement of anti-toxin treatment. All the cases notified during the year were removed to hospital. If for any reason the patient cannot at once be removed to hospital, anti-toxin and syringe can be obtained from the Public Health Department, at 8-14, Laburnum Street, or after office hours from the Town Hall. Diphtheria is sometimes spread by "carriers," that is, by individuals who though not ill themselves carry the diphtheria germ in the nose or throat. These cases are most commonly found amongst children, and the London County Council have made arrangements under which school children can be treated for this condition at special clinics at Guy's, the London, and St. Mary's Hospitals. On one or two occasions it has been possible to arrange for children who were below school age to attend these clinics. Diphtheria Immunization Clinic. This Clinic was commenced on 17th October and is held on Tuesday afternoon in the premises used at other times for the Artificial Sunlight Clinic and situated in the basement of the new offices in Laburnum Street. Dr. McGregor, the Assistant Medical Officer of Health, is in medical charge and nursing and clerical assistance is rendered by Sister Pollard, who is a part-time Officer. cc 32 In addition we have to render thanks for assistance received from Miss Heath, of the Sutton Branch of the Voluntary Aid Detachment. The following are the particulars of the work done at this Clinic during 1933:— Year Schick Tested Commenc'd treatment without Schick Test Naturally Immune No. under treatment at end of year Pre-School Age School Age Adults 1933 Nil 43 2 45 20 73 Enteric Fever. One case of Typhoid and one of Paratyphoid were notified during the year. Upon further investigation the former was found to be a case of paratyphoid B. Both cases made good recoveries. In neither was it possible to trace the source of infection. Dysentery. No cases of dysentery came to the knowledge of the Department during the year. Erysipelas. The cases certified numbered 60, and there were 5 deaths, 4 males and 1 female. The deaths occurred at the following ages:— Under 1 year 1 Between 20 and 25 years 1 ,, 45 and 55 years 1 ,, 55 and 65 ,, 1 ,, 75 and 85 ,, 1 The age, seasonal and ward distribution of the cases are included in the table on page 25. 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 0.65 0.04 6.76 Shoreditch 0.64 0.05 8.33 Thirty-nine cases were moved to Hospital, mostly to St. Leonards, during the course of the year. 33 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. Four cases of puerperal fever were notified during the year, one of which had previously been notified by another doctor as a case of puerperal pyrexia. Of the thirty-one cases of Puerperal Pyrexia notified, four, including the case above referred to, were finally diagnosed as suffering from Puerperal Fever. The total number of cases of which information was received during the year was accordingly seven. All cases were removed to hospital. There were four deaths from Puerperal Fever, one being originally notified as such, and three being notified in the first instance as puerperal pyrexia. Puerperal Fever is a disease associated with child-birth and caused by infection from the generative tract. 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. 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. 34 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 pueperal 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. Consultations were held in one case notified under these regulations. The number of cases of Puerperal Pyrexia notified was thirty-one. It is the practice to follow up these notifications with a request for a final diagnosis of the condition from which the patient is found to be suffering, and from replies received. It appeared that four of the cases were finally diagnosed as Puerperal Fever, two from conditions only fortuitously associated with the puerperal state, and the remaining twenty-five from a variety of conditions all directly related to pregnancy or childbirth. There were three deaths among the cases originally diagnosed as Puerperal Pyrexia. Twenty-six out of the thirty-one cases notified were removed to hospital. 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 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 cases. 35 Cases Vision Unimpaired Vision Impaired Died Notified Treated at home In Hospital 26 21 4 24 Nil Two died in hospital reported before completion of Health Visitors report upon case. The cases per 1,000 births numbered 168. Cases of Inflammation of eyes numbered 39, of which 8 were subsequently notified as Ophthalmia Neonatorum. Cases of Ophthalmia Neonatorum removed:— St. Margaret's Hospital 2 Queen's Hospital for Children 1 Died from other causes. St. Leonard's Hospital 1 Do. Treated as out-patients:— Royal London Ophthalmic Hospital 14 City of London Maternity Hospital 5 Greenwich Hospital 2 Medical Practitioner and District Nurse 1 The cases per 1,000 births numbered 17.4 in Shoreditch, as compared with 8.47 for London as a whole. In addition to the cases notified, 39 cases of inflammation of the eyes in the newly born were reported by the Medical Officer of Health of the London County Council. This figure includes 8 cases subsequently notified as ophthalmia neonatorum and included in the foregoing table. 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. Cerebro-Spinal Fever. Fourteen cases of this disease came to the knowledge of the Health Department during the year. Of these thirteen were notified. 36 There were six deaths. Enquiries were made, though without success, to trace the source of infection and in several instances contacts were examined bacteriologically. None of the contacts, however, proved to be carriers of the meningococcus. The number of deaths from this disease in London and Shoreditch during recent years have been as follows:— 1933 1932 1931 1930 1929 Shoreditch 6 6 6 — 4 London 116 131 131 80 85 Encephalitis Lethargica. Number of cases notified during the year Nil Number of cases Post Encephalitis Lethargica living in the Borough at end of year (approximately) 27 Number of cases Post Encephalitis Lethargica admitted to special Institutions during the year 3 Number of applications for admission made by Medical Officer of Health Nil The after effects of this disease are most serious. Years after the initial illness these patients frequently develop partial paralysis. If this is progressive they can only receive satisfactory treatment and care in special institutions. Acute Poliomyelitis. Two cases of this disease were notified, one a girl aged 8½ years and the other a boy aged 4 years and 9 months. Both were removed to hospital. This disease, which most commonly attacks children, is characterized by acute feverish onset, with pain in one or more limbs, and is followed by more or less extensive paralysis. Frequently it is not diagnosed during the initial stages, and the number of actual cases is no doubt in excess of the notifications. After treatment is most important. If neglected, children readily become badly crippled, who under skilled orthopædic treatment might enjoy normally active lives. Every effort is made by the Health Visitors to secure that children under 5 years of age who are afflicted in this way attend hospital and that the parents carry out the advice given. On reaching school age these children attend the Hoxton House Physically Defective School where all are medically inspected and referred to hospital where necessary. 37 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. A memorandum (Memo. 166/Med.) dealing with this disease was issued by the Ministry of Health at the end of 1932. Among other matters dealt with in this memorandum, two call for mention here. The value of convalescent serum if given before the onset of paralysis receives official recognition. The action to be taken by the Medical Officer of Health on receipt of notification or on learning of suspected cases of Poliomyelitis is indicated in the following terms:— (a) To aid in securing suitable accommodation, including isolation, for the patient in hospital or otherwise. (b) To ensure the precautions required in the light of the information that the disease is apparently capable of transmission by mild cases or by even the apparently healthy, and (c) To make investigation of the associated circumstances including a search for missed cases. In addition to the cases mentioned at the head of this section, information was received in the Department of one case of Acute Encephalo Myelitis in the person of a young woman, 23 years of age. This, however, is not a notifiable disease. Acute Primary Pneumonia. Acute Influenzal Pneumonia. The number of cases notified during the year was as follows:— Acute primary pneumonia 28 Influenzal pneumonia 37 Of the 65 cases thus brought to the notice of the Department, it was found that 27 were receiving treatment in St. Leonard's Hospital. 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 38, fairly satisfactory 11, unsatisfactory 10. In addition to the cases of pneumonia notified, as above, 33 cases of pneumonia not of notifiable type were visited by the District Nursing Association, who paid in all 639 visits to pneumonia cases. 38 Anthrax. There were no cases certified during the year. Infectious Diseases not notifiable in Shoreditch. Measles. The deaths from Measles numbered 7 and occurred in the following age groups:— Under 1 year 1 One to 2 years 4 Two to 5 years 2 7 Measles was responsible for 4.3 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. Deaths Death rate per 1,000 population Year Shoreditch London Shoreditch London 1929 17 194 0.17 0.04 1930 49 1,035 0.50 0.23 1931 26 115 0.26 0.03 1932 60 824 0.63 0.19 1933 7 101 0.07 0.02 The distribution of the deaths in the different wards was as shown on the table on pages 18 and 19. Information regarding cases of measles reaches the Public Health Department in various ways:—From the School Authorities, from the Measles Visitor, from the Health Visitor, and from Medical Practitioners in the Borough. The number of cases thus brought to our knowledge was 526. Upon the recommendation of the Medical Officer of Health, the London County Council will take severe cases, or cases in which home nursing is specially difficult. During the year the number of cases removed to the hospitals of the Council was 263. 39 In accordance with arrangements made by the Borough Council, the District Nursing Association paid 105 visits in connection with 9 cases of measles. The measles epidemic which was expected to commence in the Autumn did not, in fact, do so until after the end of the year. The epidemic and the arrangements carried out in co-operation with the London County Council scheme of control do not, therefore, fall within the scope of this report. Whooping Cough. The number of deaths from this disease in Shoreditch during 1933 and preceding years were as follows:— Year. Deaths. Year. Deaths. 1933 14 1930 3 1932 4 1929 40 1931 11 1928 5 Six of the deaths occurred under one year of age, six between one and two, and two between two and five years of age. The death rate from this disease was 0.15 per 1,000 inhabitants. The deaths in London as a whole numbered 327, the death rate being 0.08. The number of cases removed to the Hospitals of the London County Council during the year was 53. Influenza. Influenza was more prevalent both in Shoreditch and in London as a whole in 1933 than during the immediately preceding year. Comparative figures for recent years are contained in the following table:— Shoreditch. London. Year. Deaths. Deaths per 1,000 population. Deaths. Deaths per 1,000 population. 1933 45 0.48 2,215 0.51 1932 19 0.19 1,188 0.27 1931 23 0.23 1,114 0.25 1930 1 0.01 370 0.08 1929 68 0.68 3,088 0.69 40 Diarrhœa and Enteritis. The death rate per 1,000 live births in Shoreditch and other areas are compared in the table on page 4, and particulars of the age, sex and ward distribution of these deaths will be found in the tables on pages 18 and 19. In the following table the deaths and death rates of children under one year and between one year and two years in Shoreditch and London are compared: 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. 1932 1933 1932 1933 1932 1933 1932 1933 1932 1933 London 776 658 0.18 0.15 732 600 10.86 9.58 17.9 17.8 Shoreditch 26 22 0.27 0.24 22 21 13.1 17.2 16.4 19.1 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 from the Head Teachers 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. 41 The particulars of these exclusions from school are as follows: — Disease from which suffering or to which exposed. Number of exclusions from School. Smallpox 28 Diphtheria 576 Scarlet Fever 903 Measles 628 Chicken Pox 387 Whooping Cough 328 Mumps 159 Cerebro-Spinal Fever 6 Other Infectious Disease 388 3,403 Large number of exclusions clue to prevalence of Influenza. In addition to the exclusions from school referred to above, information was received from the School Medical Officer that five children had been excluded from school on account of the presence of diphtheria bacilli in their noses or throats. The families resident in the houses to which these children belonged were kept under observation. One case of diphtheria, however, was subsequently notified amongst the residents of these houses. Factory and Workshops Act. It was not found necessary to serve any notice under Sections 108 or 110 of the Factory and Workshops Act, 1901. These sections relate to infection in the homes of outworkers. Where it was considered that there was any risk of infection the work was temporarily discontinued and the premises were disinfected. 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 1s. 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. 42 Subjoined is a list of cases nursed under this agreement during the year 1933. Disease Under 5 Visits Disease Over 5 Visits Abdominal 1 3 Abortion 3 30 Adenoids 1 2 Ante-Natal 4 178 Boil on arm 1 9 Breast Abscess 4 61 Bronchitis 5 43 Influenza 17 129 Broncho Pneumonia 7 163 Influenza and Bronchitis 2 57 Chest 3 28 Influenza and Pneumonia 7 81 Cough and Pyrexia 1 12 Influenza and Pleurisy 1 33 Disease of Ear 4 75 Influenzal Pneumonia 1 13 „ Eyes 6 157 Mastitis 2 14 „ Umb 2 18 Miscarriage 8 69 Eczema of Scalp 1 24 Parturition 8 99 Impetigo 7 69 Pleurisy and Pneumonia 1 23 Influenza 3 36 Pneumonia 24 522 Influenza and Bronchitis 1 6 Post-Natal 4 15 Injury to knee 1 15 Post Partum 3 58 Intestinal 4 43 Post Partum Pyrexia 2 14 Mastoid 4 58 Tuberculosis 23 744 Measles 5 34 Uterine 1 23 Measles and Bronchitis 4 39 Measles and Pneumonia 2 32 Meningitis 1 20 Neo. Natal 7 94 Otorrhœa 14 477 Pemphigus 1 2 Pertussis and Bronchitis 1 50 Pertussis and Pneumonia 2 18 Pneumonia 12 222 Prematurity 2 20 Pyrexia 5 37 Pyrexia and Intestinal 1 11 Rickets 1 105 Septic Toe 1 3 Stomatitis 6 48 Thread Worms 43 465 Tonsils and Adenoids 45 199 Totals 205 2637 Totals 115 2163 Bacteriological Examinations. With the exception of those carried out at 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 taken by messenger to the laboratory. The report upon a throat swab sent in this way is telephoned to the doctor the following morning. 43 During the year some 1,112 examinations were made, which included the following:—For suspected diphtheria 897, for suspected tuberculosis 112, in connection with the diagnosis of venereal disease 45. Disinfection. The premises disinfected numbered 1,321. The articles removed to the Borough Council's Disinfecting Station totalled 13,184, and included 1,128 beds, 401 mattresses, 2,334 pillows, 617 bolsters and some 8,704 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. The Shelter. The accommodation provided under Section 60 (4) of the Public Health (London) Act, 1891, was in use on 2 occasions in order to facilitate disinfection after the removal of smallpox cases—2 adults and 2 children. Venereal Diseases. The London County Council is the authority responsible for the provision of facilities for the diagnosis and treatment of these diseases and special clinics are held in various voluntary hospitals and in other institutions. None of these are actually within the boundaries of the Borough, but those of the Metropolitan, the London, the Royal Free and University College Hospitals are readily accessible to the people of Shoreditch. Lists of these centres are displayed in the Public Conveniences in the Borough and can also be seen in the Health Department. The times at which these clinics are open will be found on page 9 of this Report. The London County Council also provides for doctors, laboratory facilities to aid diagnosis, the supply of salvarsan and its substitutes, and courses of instruction in modern methods of diagnosis and treatment. The County Council further co-ordinates the work of hospitals, public health services and practitioners, and undertakes publicity and propaganda work with regard to matters relating to venereal disease. 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: — 1929 69 1932 37 1930 79 1933 45 1931 80 44 IV.—SANITARY WORK. DISTRICT INSPECTORS. As explained in the last report, the number of Sanitary Inspectors on the staff at the commencement of the year 1933 had fallen to eleven. In February, the Senior Inspector, Mr. J. H. Pearson, who had served the Council for twenty-seven years, retired on grounds of ill-health one year before attaining the normal retiring age. After consideration, it was decided not to make any fresh appointment to the three vacancies on the Sanitary Inspectors' staff, but instead to rearrange the duties of these officers in such a manner as to make it possible for the work to be carried on with a staff of ten. At its meeting in February, the Council adopted the following recommendations of the Health Committee relating to this matter: — (i) That the Borough be divided into nine districts, such districts being allocated to nine of the Sanitary Inspectors. (ii) That the Sampling Officer only in future shall act as Sampling Officer, and that the number of samples to be taken under the Sale of Food and Drugs Acts, be reduced from 950 to 600 per annum. (iii) That the Sampling Officer shall, in addition, exercise duties under the following, viz.: — Merchandise Marks Act Regulations. Sale of Food Order, 1921. Regulations as to Sale of Eggs. Meat Regulations (Stalls), but that he be relieved of the duties of Smoke Observation. (iv) That the Medical Officer of Health be requested to submit, in six month's time, a report on the working of the arrangements as to sampling. At the same meeting, Mr. Wright was appointed to the position of Senior Sanitary Inspector in succession to Mr. Pearson. Mr. Wright's duties, however, differed from those of Mr. Pearson in that he was made responsible for a small district whereas Mr. Pearson was relieved of all district work. 45 Mr. Wright's duties were defined as follows:— (i) To render the Medical Officer of Health such assistance as he may require in connection with the administrative supervision and direction of the work for which the Sanitary Inspectors are responsible under Part. III of the Sanitary Officers' Order, 1926. (ii) To attend the meetings of the Public Health Committee. (iii) To carry out all the duties of a Sanitary Inspector as laid down in Section 19 of the Sanitary Officers' Order in relation to District No. 7. (iv) To make inspections, submit reports and keep records as directed regarding matters dealt with under the Housing Acts. (v) To attend the meetings of the Housing Committee. (vi) To keep under general supervision, and to regularly inspect the Disinfecting Station, the Mortuary and the Shelter in Reeves Place. The total number of Intimations served as to insanitary conditions was 4,470. The number served on each Sanitary District was as follows: — District No. I 405 District No. VI 428 II 483 VII 258 III 544 VIII 463 IV 913 IX 364 V 612 In connection with the Inspectors' Sanitary work, some 1,105 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 542 instances. For non-compliance with the requirements of the Sanitary Authority, proceedings were taken before the Magistrates in 9 instances. A list of Legal Proceedings will be found on pages 70 and 71. The following tables (page 46), prepared by the Senior Sanitary InInspector, summarize the visits and work of the Sanitary Inspectors during 1933. The work done in compliance with the provisions of the Factory and D 46 Workshops Act, 1901, and in connection with the drains and sanitary arrangements of new buildings is included:— Inspections, 1933 DISTRICTS Total 1 2 3 4 5 6 7 8 9 House to house 154 163 174 121 144 150 106 174 116 1,302 Other premises 756 710 1,140 1,114 498 709 368 758 611 6,664 Re-inspections, &c. 1,804 2,687 1,648 3,590 2,799 2,753 1,418 2,337 3,079 22,115 Visits in connection with— Smallpox 10 55 51 12 8 80 3 5 26 250 Other Infectious diseases 65 248 118 157 175 58 9 88 139 1,057 Houses let in lodgings ... 49 31 ... 481 4 8 15 ... 588 Workshops 395 316 37 182 121 187 32 99 104 1,473 Factories 45 145 41 149 14 54 11 47 12 518 Outworkers 46 140 67 195 74 5 16 105 61 709 Bakehouses 5 20 23 33 14 11 14 26 20 166 Milkshops, Cowsheds 43 187 117 241 183 80 95 116 228 1,290 Cookshops 144 73 47 43 96 34 20 39 20 516 Fried Fish Shops 11 30 16 32 26 12 16 16 30 189 Ice Cream Shops 28 45 18 54 68 16 18 34 20 301 Meat and Food 4 23 44 63 40 20 7 49 31 281 Stables ... ... ... 7 9 ... 3 20 18 57 Rag and Bone 2 14 6 2 ... ... ... 1 6 31 Markets 22 35 28 36 28 34 5 30 31 249 Total 37,756 47 Work Done, 1933 DISTRICTS Totals 1 2 3 4 5 6 7 8 9 Premises, throughout 49 12 12 33 8 4 6 3 6 133 „ partially 162 192 209 382 287 201 97 202 218 1,950 „ total rooms 511 500 571 808 757 574 257 460 488 4,926 Verminous rooms 18 14 42 55 38 6 2 1 12 188 „ premises 12 12 25 35 31 5 1 ... 8 129 Premises, generally repaired 142 276 367 479 85 307 141 239 337 2,373 Light and Ventilation 2 3 ... 3 1 ... ... 1 ... 10 Roofs, gutters, rain-water pipes 68 108 139 353 194 123 80 143 276 1,484 Overcrowding 17 7 27 126 11 6 11 2 4 211 Water re-instated 7 1 9 24 13 1 9 2 1 67 Drains, new 6 2 4 2 1 6 1 ... ... 22 „ re-constructed 8 10 8 11 1 11 1 7 18 75 „ improved or repaired 15 31 25 81 25 15 10 37 47 286 „ obstructions removed 14 25 17 26 29 14 5 12 10 152 Soil, vent pipes repaired 7 2 4 15 2 2 3 ... 6 41 W.C.'s— New 58 27 17 7 2 9 27 21 168 Improved or repaired 82 131 129 202 140 121 63 81 130 1,079 Obstructions removed 11 15 20 55 30 18 8 10 42 209 Sinks, improved 22 23 23 21 36 19 8 8 17 177 „ traps provided 7 2 7 9 2 1 4 3 2 37 Outdoor Premises Floors, paving repaired 13 50 35 139 59 42 43 16 53 450 Cleansed or limewashed 152 10 99 244 149 65 39 5 90 853 Improved or repaired ... ... ... 1 ... ... ... ... ... 2 Dustbins provided 29 22 79 113 81 80 29 59 44 536 Ashpits improved or repaired ... 3 1 ... ... ... ... ... 2 6 „ abolished ... 8 ... 2 ... ... ... ... 1 11 Accumulations removed 17 37 18 53 23 9 22 5 8 192 Urinals cleansed or repaired ... 2 2 13 3 1 8 1 3 33 Animals removed 1 4 4 2 3 ... 1 1 ... 16 DD 48 Water Supply. The number of certificates issued as required under the Public Health (London) Act, 1891, Section 48 (2), was 24. The water supply is almost entirely from the Metropolitan Water Board. There are nine artesian wells in the Borough, the water from one of which is used for brewing. In no instance is well water, so far as is known, being used for drinking purposes at the present time. There is a satisfactory supply of drinking water from the mains in the Public Elementary Schools. Rats and Mice Destruction Act, 1919. Summary. Inspectors DISTRICTS Totals 1 2 3 4 5 6 7 8 9 Complaints dealt with 28 12 23 39 23 23 5 10 3 166 Drains tested ... 1 18 8 3 12 1 4 3 50 Found defective ... ... 4 4 2 7 1 2 ... 20 Found satisfactory ... 1 14 4 1 5 ... 2 3 30 Premises where egress of rats was ascertained 12 2 23 35 11 14 3 2 3 105 Premises reported freed from rats 9 10 16 27 21 22 5 9 3 122 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 12. At its meeting in October, after considering a report from the Health Committee on the matter, the Council resolved to discontinue the scheme of voluntary registration of hairdressers. Smoke Nuisances. There was 1 communication from the London County Council referring to the emission of black smoke. This was duly brought to the notice of the person responsible. Some 33 observations were made by the Inspectors. FOOD. Street Markets and Food. The Street Markets were kept under observation in the evenings and on Sunday mornings in accordance with arrangements approved by this Committee. 49 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 46. The following were surrendered or seized and destroyed as unfit for the food of man: 3 cwts. 42 lbs. Apples; 3 cwts. Bananas; 28 lbs. Dog Fish; 500 tins fillets of Anchovy; 14 cwts. Grapes; 32 lbs. tinned Ham; 2 cwts. Pears; 1 cwt. Potatoes and 4 cwts. Tomatoes. Meat. The number of butchers' shops under inspection during the year was 73 and the number of visits of inspection was 115. General observation was kept of all meat stalls where butchers' meat was exposed for sale. Three warning letters were sent in respect of minor infringements of the Public Health (Meat) Regulations, 1924. Slaughter Houses. There are now no slaughter-houses in the Borough. 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. Cowhouses. There are two licensed cowhouses in this Borough, viz.: — 26, Nile Street; David Llewellyn Walters 14 cows. 76, St. John's Road; W. J. G. Harris 14 cows. The sanitary condition of both these cowhouses is satisfactory, but in all the circumstances of the milk trade of to-day, the presence of cowhouses in the midst of a densely crowded city appears to be an anachronism in favour of which there is very little to be said. Twenty visits of inspection were paid to these cowhouses during the year. cookshops and eating houses. Including the kitchens of public houses where food is prepared for customers, the number of these under inspection during the year was 228, and some 516 visits were made in connection with them. Some 54 sanitary notices were served, mainly for cleansing. Fried Fish Shops. Some 57 were under inspection and 179 visits were made to them. 23 sanitary notices were served, mainly for cleansing. 50 Ice-Cream Shops. The number under observation during the year was 137, and 301 visits of inspection were made. In 27 instances sanitary notices were served. Most of these were for general cleansing. The L.C.C. (General Powers) Act, 1932, provides for the registration of ice-cream premises. At the end of the year the number on the register was 137. Bakehouses. The number of bakehouses on the register throughout the year was 48. The number underground was 30, and the number of factory bakehouses was 37. In connection with bakehouses the Sanitary Inspectors paid 1G6 visits of inspection. Intimation notices were served in 30 instances. Sale of Food Order, 1921. The provisions of this Order respecting the marking of imported Meat and Eggs were complied with. No contraventions were noticed or complaints received during the year. Milk and Dairies Order, 1926. General observation was kept on all purveyors of milk by the Sanitary Inspectors. In one case a purveyor of milk was observed " filling bottles in the street." Legal proceedings were instituted and the defendant was fined £2 0s. 0d., and ordered to pay £1 1s. Od. costs. The following summary follows in the main the return made to the Medical Officer of Health of the London County Council for inclusion in his Annual Report for the year 1933 : — Sanitary Area. PREMISES. NUMBER OF PLACES— Number of inspections, 1933 Number of notices, 1933 Number of prosecutions, 1933 On register at end of 1932 Added in 1933 Removed in 1933 On register at end of 1933 Common lodging houses ... ... ... 4 18 ... ... Milk premises 293 21 19 295 1,272 25 ... Cowsheds 2 ... ... 2 18 ... ... Slaughterhouses ... ... ... ... ... ... ... Offensive trade premises 1 ... ... 1 2 3 1 Ice Cream premises 120 17 ... 137 301 27 ... Houses let in lodgings 409 1 ... 410 588 220 ... Restaurants and eating houses 223 13 8 228 516 54 ... 51 Smoke Nuisances. (1) Number of observations 33 (4) Number of Statutory notices (2) Number of intimations served Nil served 6 (5) Number of legal proceedings Nil (3) Number of complaints re- (6) Number of convictions Nil ceived 1 Cleansing and Disinfection. Number of adults cleansed 4 Number of premises cleansed— Number of children cleansed Nil (a) After infectious diseases 1,272 (b) For vermin 49 Water Supply to Tenement Houses. Number of premises supplied 33 Number of prosecutions Nil Sanitary Officers. Number of Sanitary Inspectors (whole-time) : Male—10. Female—Nil. „ „ „ (part-time) : Male—Nil. Female—Nil. Number of Health Visitors (whole-time) : Municipal—6. Voluntary—2. Number of Pupil Health Visitors (part-time)—4. Total number of houses in the Borough 14,102 Number of houses occupied by the Working Classes 13,616 Number of houses inspected : — (a) On account of complaints or illness and otherwise under Public Health Act 7,252 (b) House-to-house (Public Health Act) 1,302 Number of Notices served— (a) Under Public Health Act— (i.) Intimation 4,470 (ii.) Statutory .. 542 (b) Under Housing Act Nil Number of houses repaired or nuisances remedied under Public Health Act, 1891 4,470 Number of houses repaired under Section 17 of Housing Act, 1930— (a) By owners 1 (b) By Local Authority in default of owners Nil Number of houses closed on notice by owner that they could not be made fit Nil 52 Number of houses for the Working Classes— (a) Erected during the year 26 (b) In course of erection 24 Number of representations by Medical Officer or other person (Housing Act, Sec. 17) Nil Number of houses included in such representations Nil Number of Closing Orders made (i.e., Underground Rooms) 5 Number of Closing Orders determined (i.e., houses made fit) Nil Number of Demolition Orders 1 Number of houses demolished— (a) In pursuance of Orders Nil (b) Voluntary 57 Underground Rooms. N.umber illegally occupied 17 (Public Health (London) Act); 2,000 approximately (Housing Act) Number closed or illegal occupation discontinued 12 Overcrowding. Number of cases of overcrowding found 237 Number remedied 201 Number of prosecutions 2 Offensive Trades. The only business carried on within the Borough that falls within this category is that of a Fur Skin Dresser at 110, New North Road. Six visits of inspection were made. Two intimation notices were served in respect of lime washing. Both were duly complied with. Rag and Bone Dealers. Some 16 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 31. Intimations as to the need for cleanliness were written and duly attended to in 3 instances. Verminous Houses. The houses where it was necessary to take measures on account of the presence of vermin numbered 130, and in connection with these some 190 rooms were dealt with during the year, sanitary notices being served where necessary. A number of these premises were found as a result of reports received from the School Authorities concerning children in a verminous condition. 53 During the year the homes of some 16 children, 1 boy and 15 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 1 boy and 11 girls had been given the opportunity of being cleansed at these stations, that in the case of 1 girl a Statutory Notice had been served upon the parents to cleanse the child within 24 hours under Section 122 of the Children's Act, 1908, and that in the case of 3 girls legal proceedings were pending for non-compliance with the requirements of Statutory Notices uhder this Act. In all the cases reported the homes were visited by the Sanitary Inspectors, and the following summarizes the reports received. Fifteen of the rooms were satisfactory, varying from fairly clean to very clean, and one was dirty. In 14 instances the bedding was clean or fairly so, and in 2 verminous. In two of the homes evidence of poverty was marked. No evidence of lice was found in connection with any of the homes. The children reported by the School Authorities as suffering from scabies numbered 66, of whom 39 were females. As a result of the enquiries made 21 other cases came under observation. As far as practicable steps were taken to prevent infection spreading. London County Council (General Powers) Act, 1928, Section 28. Application was made to the Magistrate for the removal of two individuals to St. Leonard's Hospital under this Section. In both cases the order was granted and removal effected without difficulty. Schools. The sanitary condition of the Public Elementary Schools in the Borough, twenty-five in number, is satisfactory. Food Poisoning. By Section 7 of the London County Council (General Powers) Act, 1932, the duty is imposed upon medical practitioners of notifying cases of food poisoning, and of suspected food poisoning. The number of cases notified during the year was 20, and in connection with these the Sanitary Inspectors made 29 visits. Upon investigation none of the cases appeared to amount to anything more serious than slight digestive disturbance. 54 Nutrition. Reference was made in last year's report to the assistance that it would be to those engaged in Public Health and Social Welfare work if an authoritative estimate of the minimum cost of adequate dietries for men, women and children of various ages, were prepared and published for official guidance. In November, 1933, the Committee on Nutrition, appointed by the British Medical Association, issued its report and it appeared at first that such guidance was available. In January, 1934, however, the Ministry of Health issued a Circular (Nutrition 1370) dealing specifically with the report of the British Medical Association Committee and as a result it is not possible to quote the British Medical Association scale as having official sanction. In a Borough such as this where many families are living under economic conditions that make it a nice point whether there is, or is not, enough money available for buying food, an official scale of the kind here considered would be of great value in determining action to be taken or advised regarding a variety of matters affecting health. From the tables on page 7 it will be seen that the number both of the unemployed and of those in receipt of public assistance fell during the year. Unfortunately, however, there is evidence of a downward tendency in the wages of those in work. Possibly for this reason, possibly because of the time lag during which the effect of inadequate diet makes itself apparent, possibly also because of increased interest in this subject, more cases of suspected under nourishment were brought to notice than during the preceeding year. Much has been written upon the difficulty of speaking of under nourishment in the absence of agreed clinical criteria, but the matter is of such fundamental importance to health that while fully recognizing this difficulty, it seems fitting in this report to place on record the impression that there has been a deterioration in the standard of nutrition amongst the families of the poorer members of the population, and that in these families the mothers have been the greatest sufferers. Throughout the year Talks upon diets and wise buying were continued at the Welfare Centre and were listend to with great interest. We have to thank Miss Hall Smith, who has taken a special course of training in Dietetics, for voluntary assistance in connection with this part of our work. Miss Smith commenced working in this Department in April and has since come once, and more recently, twice, weekly, to advise upon the diets of cases specially referred from the Welfare and Ante-Natal Centres. Transfer of Powers (London) Order, 1933. This Order, which became operative on the 1st April, 1933, contains provision among other matters, for the transfer to the Borough Council of certain functions hitherto exercised by the London County Council, 55 Among such functions are: (i) the registration, licensing, inspection, and regulation of Common Lodging Houses, of which there are four in the Borough of Shoreditch, and the enforcement of bye-laws relating to such houses; (ii) the licensing of Dairymen to use premises as a Cowhouse or place for the keeping of cows, of which there are two in the Borough, and (iii) the consideration of, and decision upon, applications for sanction to the establishment anew, or the enlargement of certain offensive businesses. There is one establishment in Shoreditch to which this part of the Order applies, namely, the premises of a fur skin dresser. At its meeting in April, 1933, the Council adopted the following recommendations of the Health Committee relating to duties to be executed by the Sanitary Inspectors in relation to this Order: — (i) That inspections of Common Lodging Houses, Cowhouses, and premises used for offensive businesses, consequent upon the coming into force of the Transfer of Powers (London) Order, 1933, be ordinarily carried out by the Sanitary Inspectors of the districts in which the premises in question are situated. (ii) That the Council do authorize Messrs. C. J. Wright, H. G. Chapman, C. C. E. Gibbs, D. Grant, R. A. Bishop, G. Walker, A. Stratton, J. B. Molloy, J. H. Thomas, and F. C. Shaw, Sanitary Inspectors, to act throughout the Borough as Inspectors of Common Lodging Houses, Cowhouses, and premises used for offensive business, and generally to act as Inspectors in connection with the exercise of the powers transferred to the Council by the Transfer of Powers (London) Order, 1933. Common Lodging Houses. The following is a list of the persons entitled to keep Lodging Houses in the Borough until the 30th June, 1934, together with particulars of accommodation approved : — 277, Kingsland Road. Mrs. Levy, 3, Holland Park Ave., W.ll. 124 beds. 1, Aubert Bldgs., Boot St. Mr. C. Garlev, .104, Malford Road, E.8. 117 beds. 29, Dunloe Street. Mr. J. M. Dowdall, 29, Dunloe Street 46 beds. 2, Dunston Street. Mr. J. Purcigo, 2, Dunston Street. 37 beds. The number of visits of inspection paid was 27. Cowhouses. The following is a list of the persons entitled to keep Cowhouses in the 56 Borough until the 31st October, 1934, together with particulars of accommodation approved. David Llewellyn Walters, 26, Nile Street: 22 cows—1 Cowshed. William Jonathon Wynne Harris, 76, St. John's Road : 14 Cows—2 Cowsheds. The number of visits of inspection paid was 18. Offensive Businesses. The following is entitled to keep premises for offensive business in the Borough : Mr. L. Decent, 110, New North Road, to carry on the business of a Fur Skin Dresser. The number of visits of inspection paid was 2. In one instance a business of Fur Skin Dresser was established anew without permission. Proceedings were instituted and at the time of hearing the business had been discontinued. Dismissed—Costs £3 3s. Od. Registration of Food Premises. The London County Council (General Powers) Act, 1932, Section 5, requires that premises used or proposed to be used (i) for the sale or manufacture or storage of ice cream or other similar commodity, or (ii) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meats, fish or other food intended for sale, shall be registered with the Sanitary Authority. It was agreed to interpret this section so as to require the registration of premises under (ii) above, at which the following are made : — SAUSAGES and allies; large and small, with or without skins. Saveloys. Haggis. Black Puddings. Rissoles. White Puddings. Bladders of Lard. Sausage Skins. MEAT: Potted, Pressed, Pickled, Preserved. Potted meat or head, tongues, ek\ Meat Pastes. Meat Extracts. Faggots. Cooked Meats, Sheep's-head, etc., Pork. Meat Pies, Pork Pies. Dripping. Brawn. Brisket (Pressed). Meat and Pork (pressed). Meat and Pork (pickled). Trotters (pic.kled). j^,icon j boiled, cooked, smoked or cured or otherwise preserved. 57 FISH: Potted, Pressed, Pickled, Preserved. Pastes—various. Pickled or soused. Cured or dried fish. Canned. Eel pies and jellied eels. OTHER FOODS: Potted, Pressed, Pickled, Preserved. Canned soups containing Meat. Hors d'oevres, if containing Meat or Fish. The number of premises on the register at the end of 1933 under this section is : — (i) Ice Cream, etc. 137 (ii) Other Food 83 INSPECTORS WITH SPECIAL DUTIES. In the early part of the year covered by this report consideration was given, as already explained, to the question of the re-arrangement of the duties of the Sanitary Inspectors. At the February meeting of the Council it was resolved that the duties of Sampling Officers should in future be discharged by one Inspector instead of two as previously, and that the number of samples to be taken annually under the Sale of Food & Drugs Acts should be reduced from 950 to 600. It was further resolved that the Sampling Officer should, in addition, exercise duties under the Merchandise Marks Act Regulations, the Sale of Food Order, 1921, and the Meat Regulations (Stalls). The Officer in question was, however, relieved of the duties of smoke observation. When passing this resolution the Council gave instructions that the Medical Officer of Health should report as to the arrangements in connection with Sampling in six months' time. The report was considered in due course and as a result of a recommendation of the Health Committee on the matter, the Council passed the following resolution at its October meeting:— "That the resolution of the Council of the 21st February, 1933, giving the number of samples to be taken at 600 per annum, be varied, to enable the Sampling Officer, at his discretion, to increase the number of samples taken to 650 or 700 per annum." The Food and Drugs (Adulteration) Act, 1928. The reports of the Public Analyst, Mr. H. G. Harrison, M.A., show that 677 samples were submitted to him during the year. This number is at the rate of 7.1 per 1,000 inhabitants. 58 The results of the year's work are summarized in the following Table:— Quarter of 1933. 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 216 7 3.24 2 Nil 2 2 4 14 6 113 8 0 2nd 142 6 4.22 1 Nil 1 1 2 2 0 74 11 0 3rd 143 5 3.49 2 Nil 2 1 3 3 0 75 1 6 4th 176 3 1.70 1 1 Nil Nil 2 2 0 92 8 0 Totals for Year 677 21 3.10 6 1 5 4 12 1 6 355 8 6 The Samples taken during 1933 included:— Milk 450 Sardines 3 Sausages 32 (24 Informal) Non-Alchoholic Wine 3 (Informal) Condensed Milk 16 (Informal) Herrings in Tomato Sauce 12 (Informal) Parrish's Chemical Food 3 (Informal) Butter 11 (1 Informal) Mint Sauce 3 (2 Informal) Whiskey 11 Glycerine and Borax 3 (Informal) Vinegar 15 Gin 8 Borax and Honey B.P. 3 (Informal) Tinned Cream 7 (5 Informal) Fish Paste 3 Tinned Fruit 6 (Informal) Meat Pie 3 Sauce 6 (Informal) Aspirin Tablets 3 (Informal) Castor Oil 6 (Informal) Ground Rice 2 Dried Milk 5 (Informal) Soda Water 2 (Informal) Dried Fruit 5 (Informal) Rum 2 Tinned Peas 5 (Informal) Brislings 2 Jam 4 (Informal) Dried Mint 2 (1 Informal) Dripping 4 (Informal) Pepper 2 Olive Oil 3 (Informal) Ground Ginger 2 Cream 3 Cordials 2 (Informal) Margarine 3 Ground Almonds 1 Boracic Ointment 3 (Informal) Ground Arrowroot 1 Self-raising Flour 3 Soaked Peas 1 (Informal) Ice Cream 3 Ale 1 Bread and Butter 3 (Informal) Stout 1 Porter 1 Tea Dust 3 (Informal) Meat Paste 1 (Informal) 59 Of the three samples of dried mint taken, one was found to contain 30 per cent of leaf other than mint leaf. Legal proceedings were instituted but a warranty was produced and the case was withdrawn on payment of £3 3s. 0d. costs. An informal sample of mint sauce was found to contain 30 per cent of leaf other than mint leaf. A formal sample was obtained from the same source and was certified to contain only 5.8 per cent of foreign leaf. No action was taken. An informal sample of tinned cream which bore a label describing the contents as containing 23 per cent of butter fat was found to be 43 per cent deficient in the amount declared. A formal sample was taken and was certified to be 73 deficient in butter fat. Legal proceedings were taken, and on a warranty being proved, the case was dismissed on payment of £2 2s. Od. costs. Of the samples of milk 11 or 24 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 129 6 4.18 2nd 95 4 4.21 3rd 101 1 0.99 4th 125 — — In six of these samples, water was certified to have been added. In each of these cases the amount of added water was less than 5 per cent. Five of the samples showed deficiency in fat ranging from 1 to 8 per cent below the standard as laid down by the Board of Agriculture. Legal proceedings were instituted in 2, or 18.18 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 the departure from normal was so small that it was not thought advisable to institute legal proceedings was 81.81. 60 Examination of Milk Supplied to L.C.C. Hospitals and Schools, 1933. During 1933, 18 samples of milk were taken in course of delivery to St. Leonard's Hospital and 14 to Holborn Institution, all of which complied with the standard fixed by the Board of Agriculture. Two of the samples did not comply with the standard laid down by the L.C.C. contract, and these were reported upon to the appropriate department of that Authority. In May a sample of Pasteurized milk was taken in course of delivery to the Holborn Institution, which was submitted to the Bacteriologist. The sample conformed to the standard laid down for "Pasteurized" milk. During 1933 samples of milk were taken from 6 dairymen who deliver milk to schools in the Borough as follow:— Dairyman Samples submitted for chemical analysis Result Samples for bacteriological examination Bacteria per c.c. Coliform Bacillus A. 10 All genuine 1 215,000 Present in 1/100 c.c. B. 8 All genuine 2 180,500 Present in 1/100 c.c. 347,200 Present in 1/100 c.c. C. 8 All genuine 1 98,700 Present in 1/100 c.c. D. 7 All genuine 2 20,030 Absent in 1/10 c.c. 68,600 Present in 1/10 c.c. Absent in 1/100 c.c. E. 3 All genuine 1 26,200 Present in 1/10 c.c. Absent in 1/100 c.c. F. 6 All genuine 4 23,500 Absent in 1/10 c.c. 20,650 Absent in 1/10 c.c. 42,600 Absent in 1/10 c.c. 31,060 Absent in 1/10 c.c. 61 The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1908-1933 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. 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 94 26 2.5 16 ... 16 16 42 4 0 660 0 0 1931 1060 91 34 3.2 10 1 9 7 18 17 0 662 10 0 1932 971 98 44 4.5 18 ... 18 18 40 15 0 535 11 6 1933 677 138 21 3.1 6 l 5 4 12 1 6 355 8 6 E 62 Milk (Special Designations) Order, 1923. The following table shows the results of bacteriological analysis of samples of milk sold under this Order:— No. of Sample Designation of Milk No. of bacteria per c. cm. Presence of coliform bacillus Remarks 99 Pasteurised 17,000 Absent in 1/10 c.c. In every instance these samples conform to the bacteriological status laid down in the order for the relevant grade of milk. 100 Pasteurised 7,120 Absent in 1/10 c.c. 101 Pasteurised 2,980 Absent in 1/10 c.c. 102 Pasteurised 3,250 Absent in 1/10 c.c. 103 Pasteurised 4,030 Absent in 1/10 c.c. 104 Pasteurised 6,810 Absent in 1/10 c.c. 105 Pasteurised 23,500 Absent in 1/10 c.c. 106 Pasteurised 20,650 Absent in 1/10 c.c. 107 Grade "A" (T.T.) 4,810 Absent in 1/100 c.c. 108 Grade "A" (T.T.) 3,480 Absent in 1/100 c.c. 117 Pasteurised 21,580 Absent in 1/10 c.c. 129 Certified 8,720 Absent in 1/10 c.c. 134 Pasteurised 36,100 Absent in 1/10 c.c. 135 Pasteurised 42,600 Absent in 1/10 c.c. 136 Pasteurised 31,060 Absent in 1/10 c.c. 137 Certified 380 Absent in 1/10 c.c. 138 Certified 560 Absent in 1/10 c.c. Tuberculous Milk. The Minutes of the London County Council of the meeting held on 31st October, 1933, contain: page 443, an important report from the Central Public Health Committee on the subject of "Milk supply coming into London —Infection with tubercle bacilli." This report, which is too long to admit of adequate summary, should be read by everyone who is interested in the question of the purity of the milk supply in the Metropolis. Very briefly the present position is that the proportion of milk found upon analysis to contain tubercle bacilli is higher than it was a few years ago, and that two new factors now operate, one of which tends to increase and the other to decrease, though both to an extent not ascertained, the risk of infection to the consumer. The dangers of the tubercle infection of milk are increased by the modern method of transporting milk in bulk in tanks as this facilitates the contamination of large quantities by the addition of small amounts of tuberculous milk. The dangers are lessened by the fact that approximately 90 per cent of London's milk is commercially pasteurized. The report, however, is careful to explain that commercial pasteurization is different from, less efficacious than, and not under administrative supervision, as is pasteurization as defined in the Milk Special Designations Order. Only milk that has been pasteurized as laid down in this Order may be described for purpose of sale as pasteurized milk. 63 The report concludes with a recommendation that propaganda should be directed towards educating the public upon the importance of a pure milk supply and upon the safeguard that lies in the purchase of milk officially designated as Pasteurized. There are two cowsheds in Shoreditch. Six samples from these were examined for the presence of tubercle bacilli, but with negative results in every case. Undesignated Milk. The results of the bacteriological examination of thirty-two samples of ordinary milk are given in the following table:— No. of Sample Date when taken 1933 No. of bacteria per c. cm. Presence of coliform bacillus Remarks 109 25th April 38,500 Absent in 1/10 c.c. The wide variations between reports upon samples taken at the same time of year is an indication that there is room for great improvements in the production and distribution of milk. 110 25th April 3,830 Absent in 1/10 c.c. 111 25th April 85,700 Present in 1/100 c.c. 112 25th April 12,050 Absent in 1/10 c.c. 113 27th April 21,770 Absent in 1/10 c.c. 114 27th April 20,030 Absent in 1/10 c.c. 115 27th April 10,131 Absent in 1/19 c.c. 116 27th April 23,150 Absent in 1/10 c.c. 118 1st Tune 45,900 Absent in 1/10 c.c. 119 1st June 26,200 Present in 1/10 c.c. Absent in 1/100 c.c. 120 1st June 38,600 Present in 1/10 c.c. Absent in 1/100 c.c. 121 13th July 56,200 Present in 1/100 c.c. 122 13th July 215,000 Present in 1/100 c.c. 123 13th July 180,000 Present in 1/100 c.c. 124 13th July 347,200 Present in 1/100 c.c. 125 17th August 24,200 Present in 1/10 c.c. Absent in 1/100 c.c. 126 17th August 40,100 Present in 1/100 c.c. 127 17th August 35,900 Present in 1/100 c.c. 128 17th August 98,700 Present in 1/100 c.c. 130 26th September 82,500 Absent in 1/10 c.c. 131 26th September 68,600 Present in 1/10 c.c. Absent in 1/100 c.c. 132 26th September 96,200 Present in 1/10 c.c. Absent in 1/100 c.c. 133 26th September 273,000 Present in 1/100 c.c. 139 9th November 12,700 Present in 1/10 c.c. 140 9th November 283,000 Present in 1/100 c.c. 141 9th November 10,850 Absent in 1/10 c.c. 142 30th November 210 Absent in 1/10 c.c. 143 30th November 580 Absent in 1/10 c.c. 144 30th November 550 Absent in 1/10 c.c. 145 30th November 920 Absent in 1/10 c.c. 146 30th November 3,340 Absent in 1/10 c.c. 147 30th November 510 Absent in 1/10 c.c. ee 64 For purposes of comparison it may be noted that the bacteriological standard required in the Milk (Special Designations) Order for Certified Milks which is the highest grade of designated milks is as follows:— On a sample being taken at any time before delivery to the consumer the milk shall be found to contain— (a) not more than 30,000 bacteria per cubic centimetre, and (b) no coliform bacillus in one-tenth of a cubic centimetre. These samples were taken with the object of raising the standard of bacteriological purity of the milk sold in the Borough. It will be seen that they were taken in batches. When the reports upon each batch of milks were received, a list was sent to the vendors giving the particulars of the analyses of the milks in that batch, but omitting the names. The report relating to the milk of the vendor to whom each list was sent, was marked so that he might be able to compare his milk with that of other milks sold at the same time. An appropriate covering letter was also sent indicating the principles and emphasizing the importance of clean milk production. Preservatives in Food Regulations. Of the 32 samples of sausages taken, 3 informal samples were certified to contain sulphur dioxide ranging from 170 to 250 parts per million. Formal samples were taken from the same sources and two cases showed the presence of 100 and 150 parts of sulphur dioxide respectively. Legal proceedings were instituted. In one case the defendant was ordered to pay £3 3s. Od. costs and the other case was dismissed. 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. Dried Milk Regulations. Five samples of dried milk were submitted for analysis under the above Regulations, all of which were certified to comply with the standard laid down. Milk and Cream Regulations, 1912. None of the 450 samples of milk submitted for analysis were reported to contain any preservative. Ten samples of cream were submitted for analysis none of which were reported to contain any preservative. Rag Flock Acts, 1911 and 1928. Under the above Act 33 samples were taken for analysis. Two of the samples did not comply with the standard laid down. In one case where the amount of Soluble Chlorine was 50 parts in excess of the legal maximum allowed, proceedings were instituted, but were withdrawn by permission of the Magistrate on payment of £3 3s. 0d. costs. 65 In the other case the amount of Soluble Chlorine was 37 parts in excess of the legal maximum allowed. No action was taken. 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. Seven warning letters were sent in respect of minor infringements. These proved effective and no further action was necessary. 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 1932 was 1,643. The number added to the register during the year under consideration was 95, the number removed was 174, and the number on the register at the end of 1933 was 1,564. A classification of the workshops on the register at the end of the year is contained in the following table:— Registered Workshops—1933. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades. 1,030 (a) Cabinet making 585 (c) Upholstery 138 (b) French polishing 162 (d) Other workers 145 (2) Dress 161 (a) Tailoring 76 (e) Shirt making — (b) Mantles 8 (f) Boot and shoe trades 19 (c) Dress 17 (g) Artificial flowers 3 (d) Millinery 8 (h) Other workers 30 (3) Skin, leather, hair and feather trades 60 (a) Furriers 22 (c) Feathers 4 (b) Saddlery and Harness 9 (d) Other workers 25 (4) Paper, printing, book, stationery and fancy goods trades 47 (a) Box and bag makers 25 (b) Other workers 22 (5) Laundry and washing 4 (6) Food 12 (7) Metals, machines, implements and conveyances 84 (8) Precious metals, jewels, &c. 1 (9) Other trades than those mentioned above 165 Total number of workshops on Register 1,564 Note.—a separate register is kept for bakehouses, the number of which in use at the end of the year was 48, including 37 factory bakehouses. 66 The particulars of inspections made by the Sanitary Inspectors are as follows:— Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 361 101 ... (Including Factory Laundries) Workshops 1,261 205 1 (Including Workshop Laundries) Workplaces (Cookshops, Fried Fish Shops and Ice Cream Shops) (Excluding Outworkers' premises dealt with in Table III.) 883 104 ... Totals 2,505 410 1 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 175 175 ... ... Want of ventilation 1 1 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 305 305 ... ... Sanitary accommodation insufficient ... ... ... ... unsuitable or defective 158 158 ... ... not separate for sexes ... ... ... ... Offences under the Factory and Workshop Act: Illegal occupation of underground bakehouse (Section 101) ... ... ... ... Breach of special sanitary requirements for bakehouses (Sections 97 to 100) ... ... ... ... Other offences (Excluding offences relating to outwork which are included in table on page 68). ... ... ... ... Totals 639 639 ... ... Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Act. 67 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133). 4 Action taken in matters referred by H.M. Inspector as remedial under the Public Health Acts, but not under the Factory and Workshops Act (s. 5). Notified by H.M. Inspector 15( referring to 5 & factories and 10 workshops.) Reports (of action taken) sent to H.M. Inspector. 15 (referring to 5 factories and 10 workshops.) Other 5 Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 30 During the year 205 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 36 Urinals cleansed, etc. 4 Premises cleansed partially 59 Soil and vent pipes dealt with 3 Number of rooms cleansed 155 Water-closets newly constructed 5 Walls, floors, sashes, etc., repaired 37 Water-closets repaired, etc. 80 Water-closets, obstructions removed 10 Light and ventilation improved Nil Sinks, etc., cleansed and repaired 3 Roofs, guttering, etc., repaired 38 Sink taps provided Nil Sculleries, yards, etc., paving repaired 8 Overcrowding abated Nil Water reinstated or improved 2 Sculleries, yards, etc., cleansed or limewashed 40 Drains newly constructed 1 Drains reconstructed 1 Dust receptacles provided 10 Drains repaired, etc. 6 Foul accumulations removed 29 Drains, obstructions removed 4 The number of factories under observation for insanitary conditions during the year was 101, and in connection with these some 101 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 73 instances, the removal of obstructions from drains and water-closets in 15 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 65 lists of out-workers were received from employers in the Borough, 34 in the first and 31 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 of 847 out-workers, of whom 666 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the sanitary authorities of the districts to which they belonged. 68 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. Out work 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. 40 106 516 3 ... 14 ... ... ... ... ... ... 10 ... ... (2) Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers 2 ... 8 ... ... ... ... ... ... ... ... ... 4 ... ... Fur pulling 2 ... 16 ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper bags and boxes 14 ... 144 2 ... 19 ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Xmas Crackers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Leather Goods ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... Carding of Buttons 2 ... 24 ... ... ... ... ... ... ... ... ... 1 ... ... Totals 60 106 708 5 ... 33 ... ... ... ... ... ... 29 ... ... (a) There were no names and addresses of outworkers received in respect to the following' classes of work —Sacks, basket making, mats other than wire nets, racquet and tennis balls, stuffed toys, file making, electro plate, cables and chains, anchors and grapnels, cart gear, locks, latches and keys, pea picking, household linen, lace, lace curtains and nets, curtains and furniture hangings, brass and brass articles, tents, feather sorting, cleaning and washing, furniture and upholstery, umbrellas, brush making, Xmas crackers and leather goods. (b) The figures in columns 2, 3 and 4 are the total number o f 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. (c) See page 70 of this report with regard to infectious disease in the houses of outworkers. 69 Communications were received from various sanitary authorities relating to some 1,026 outworkers for firms outside Shoreditch and as 5 of these were residents in other Boroughs, their addresses were forwarded to the authorities concerned. The following table shows the numbers of addresses of outworkers received from the sanitary authorities referred to during 1933. Showing the Numbers of Outworkers Received from other Districts during 1933. DISTRICTS. Making Wearing Apparel. Toys and Crackers. Artificial Flowers. Furniture and Upholstery. Fur Pulling Lace Curtains Umbrellas. &c. Paper Bags and Boxes Brush Making Fancy Leather Goods. Card Mounting. Stuffed Toys Totals. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Feb. Aug. Bethnal Green 18 23 27 26 ... ... ... ... ... ... ... ... ... 1 13 10 9 8 ... ... ... ... ... ... 135 Camberwell 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 City of London 147 123 4 ... ... ... ... ... 2 1 ... ... 17 11 ... ... ... ... 2 ... ... 1 ... ... 308 Croydon ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Finsbury 54 65 14 11 17 5 5 4 2 1 3 ... 4 1 30 30 ... ... 1 4 7 7 ... 2 267 Fulham 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Hackney 48 48 ... 12 6 1 1 ... ... ... ... ... ... ... 18 16 2 3 ... ... ... ... ... ... 155 Hammersmith 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Hampstead 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Holborn 4 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Hornsey 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Islington 7 14 ... ... ... ... ... ... ... ... ... ... ... ... 11 8 ... ... ... ... ... ... ... ... 40 Kensington 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Kingston 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Lewisham 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Leyton ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 4 Poplar 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Southwark 5 3 ... ... ... ... 1 1 ... ... ... ... ... ... 4 1 ... ... ... ... ... ... ... ... 15 St. Marylebone 6 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Stepney 11 15 1 1 ... ... ... ... ... ... ... ... 1 ... ... 3 ... ... ... ... ... ... ... ... 32 St. Pancras ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Wandsworth ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 West Ham ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Westminster 10 12 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 23 Totals 319 326 47 51 23 6 7 5 4 2 3 ... 22 13 77 70 11 11 3 4 7 8 ... 2 1,021 645 98 29 12 6 3 35 147 22 7 15 2 70 The total number of out-workers reported was 1,873, and of these some 1,203 were residents in Shoreditch. These figures, which are below the average for the past five years, are slightly lower than those for last year. As pointed out in previous reports, in numerous instances names and addresses of out-workers are duplicated owing to lists being sent in twice a year, and in some cases the same out-workers are employed by more than one firm, so that the numbers given above must not be taken as representing the actual numbers of individual out-workers. The tables on pages 68 and 69 show the distribution of out-workers as regards trades in the Borough. Most of them are engaged in work connected with the making of wearing apparel, artificial flowers, paper bags and boxes, umbrellas, toys and crackers. Some 709 visits of inspection were made to places where home-work was being carried on, and in connection with these 98 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 29 and included 18 scarlet fever, 8 diphtheria, 2 erysipelas, and 1 pneumonia. 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. June 29 Fixing a W.C. pan at No. 17 Wimbourne Street without previous notice in writing to the Sanitary Authority. 2 2 0 July 13 Non-compliance with Statutory Notice in respect of No. 267 Old Street. 2 2 0 July 13 Non-compliance with Notice to provide Dustbin at No. 267 Old Street. 1 1 0 July 27 Fixing W.C. pan and trap at No. 29 Forston Street without previous notice in writing to the Sanitary Authority. 1 1 0 Aug. 29 Non-compliance with Statutory Notice in respect of No. 114 Weymouth Terr. 2 2 0 Order made for Notice to be complied with in 28 days. 71 Date Nature of Offence Fine Costs Remarks £ s. d. £ s. d. Aug. 29 Non-compliance with Statutory Notice in respect of No. 116 Weymouth Terr. 2 2 0 Order made for notice to be complied with in 28 days. Aug. 29 Non-compliance with Statutory Notice in respect of No. 118 Weymouth Terr. 2 2 0 Order made for notice to be complied with in 28 days. Nov. 8 Non-compliance with Statutory Notice in respect of No. 93 Shaftesbury Street. 10 0 0 2 2 0 Nov. 8 Non-compliance with Statutory Notice in respect of No. 95 Shaftesbury Street. 5 0 0 2 2 0 Nov. 30 Non-compliance with Statutory Notice in respect of No. 6 Mount Row. 2 0 0 2 2 0 Dec. 6 Non-compliance with Statutory Notice in respect of No. 96 Kingsland Road 1 0 0 2 2 0 Order made for notice to be complied with in 14 days. Dec. 29 Carrying on the business of a Fur Skin Dresser without the sanction of the Bor. Council. 3 3 0 Defendants vacated the premises. 72 Food and Drugs (Adulteration) Act, 1928. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. Milk and Dairies Order, 1926. Date Nature of Offence Fine Costs Remarks £ s. d. £ s. d. Jan. 18 Selling whiskey not of the nature, substance or quality demanded by purchaser 3 3 0 Jan. 18 Selling gin not of the nature, substance or quality demanded by purchaser. 3 3 0 Feb. 24 Selling milk not of the nature, substance or quality demanded by purchaser 3 3 0 Feb. 24 Do. do. 1 11 6 June 29 Selling tinned cream not of nature, substance or quality demanded by purchaser. 2 2 0 Aug. 30 Neglecting, on the sale of certain sausages, to exhibit in a conspicuous place, so as to be easily readable by a customer, a Notice that the same contained a preservative. 3 3 0 Sept. 5 Neglecting on the sale of beef sausages to exhibit a notice that the same contained a preservative. Defendant proved that notice was exhibited, and case was dismissed. Nov. 1 Selling milk from vehicle without having name and address conspicuously inscribed thereon. Dismissed. Dec. 20 Being a person delivering milk in bottles failed to cause milk bottle to be filled and closed on registered premises. l 0 0 1 1 0 73 Rag Flock Acts 1911 and 1928. Date Nature of Offence Fine Costs Remarks April 27 Being in possession of Rag Flock for the purpose of making articles of upholstery which did not conform to prescribed standard of cleanliness. £ s. d. £ 3 s. 3 d. 0 Withdrawn. Merchandise Marks Act, 1926, Orders. Date Nature of Offence Fine Costs Remarks Nov. 1 Exposing imported apples for sale which did not bear an indication of origin. £ s. 5 d. 0 £ 2 s. d. 2 0 74 V.—TUBERCULOSIS. Particulars regarding the Public Health (Tuberculosis) Regulations, 1930, are supplied to the Ministry of Health in the following form:— Form T.137, 1933. Part I.—Summary of Notifications during the period from the 1st January, 1933, to the 31st December, 1933:— Age periods FORMAL NOTIFICATIONS. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications 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) Pulmonary Males ... ... ... 2 8 11 18 14 16 10 1 80 117 ” Females ... 1 1 2 13 22 20 9 6 2 1 77 106 Non-pulmonary Males 1 4 1 3 3 2 2 2 1 1 1 21 25 ” Females 1 2 1 ... 2 ... 2 1 ... ... ... 9 10 Col. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) Supplemental Return. Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification:— 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). Pulmonary Males ... ... ... ... ... 3 4 1 3 2 1 14 ” Females ... ... ... ... 1 3 4 1 1 ... ... 10 Non-pulmonary Males 1 1 2 1 ... 1 1 ... ... ... ... 7 ” Females ... l ... ... ... 1 ... ... ... ... ... 2 Total 33 75 SOURCE OF INFORMATION AS TO THE ABOVE-MENTIONED CASES. No. of Cases Pulmonary NonPulmonary Death Returns from local Registrars 3 1 transferable deaths from Registrar General 3 1 Posthumous notifications "Transfers" from other areas (other than transferable deaths) 17 7 Other sources if any (specify) was removed to address unknown—returned to register 1 ... 24 9 = 33 Part III:— Notification Register. Number of cases of Tuberculosis remaining on the Register at the 31st December, 1933 Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total 645 562 1207 242 189 431 1638 Number of cases removed from the Register during the year by reason inter alia of:— 1. Withdrawal of notification 55 51 106 8 16 24 130 2. Recovery from the disease 9 9 18 7 2 9 27 3. Death 61 46 107 10 3 13 120 4. Totals 125 106 231 25 21 46 277 NOTES. Part I. (a) Formal notifications are notifications which are made in pursuance of Article 5 of the Public Health (Tuberculosis) Regulations, 1930, or by Naval, Military or Air Force Medical Authorities in pursuance of Section 5 (b) of the Local Government (Emergency Provisions) Act, 1916. (b) Primary Notifications for the purpose of columns (2)-(13) relate to patients who have never previously been formally notified in the area to which the Return relates. 76 A patient who changes his residence from one Sanitary District to another in the same County may properly be the subject of Primary Notification in each such District. Only the first of such notifications, however, are recorded in columns (2)-(13) of the Return for the County concerned, the subsequent notification(s) being included in column (14). (c) Column (14). All formal notifications, whether duplicate or not, are included in this column. General.—Patients notified as suffering from combined pulmonary and nonpulmonary tuberculosis are included among the "pulmonary" returns only. If a patient already notified as suffering from one form of tuberculosis is subsequently notified to the Medical Officer of Health of the same Sanitary District as suffering from another form of tuberculosis, the fact is noted in the Notification Register, but such notification is recorded as a duplicate notification. Part II. (a) New cases of tuberculosis first coming to knowledge otherwise than by formal notification may in some instances afterwards be formally notified under the Regulations. Should such formal notification be received within the same year as that in which the case first came to the knowledge of the Medical Officer of Health. it is recorded as a "Primary Notification" and excluded from the Supplemental Return. If the formal notification is received in a subsequent year, such notification is regarded as duplicate, as the case has already been included in the Supplemental Return for a previous year. (b) A formal notification which is not received until after the death of the patient is included in the Supplemental Return as a "posthumous notification." (c) No 'case is included both in the Summary of Notifications and in the Supplemental Return for the same year. 77 The distribution of the cases notified (primary notification) among the different Wards was as follows:— Ward. Pulmonary. NonPulmonary. Total. No. per 1,000 inhabitants. Moorfields 5 1 6 1.5 Church 27 9 36 2.2 Hoxton 20 4 24 1.6 Wenlock 32 6 38 2.6 Whitmore 19 5 24 1.7 Kingsland 10 3 13 1.4 Haggerston 25 2 27 2.8 Acton 19 ... 19 1.8 Totals 157 30 187 2.0 In addition to the notifications summarized on Form T, 137, 1933 on page 74, notifications are received respecting patients admitted to, and discharged from Institutions, the majority of which are now under the control of the London County Council. These notifications are summarized below:— Number of Notifications on Form I (of admission of case to Institution). Number of Notifications on Form II (of discharge of case from Institution). Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. Pulmonary Males 45 97 37 66 Pulmonary Females 35 85 19 56 Non-Pulmonary Males 7 16 2 13 Non-Pulmonary Females 2 4 2 10 Totals 89 202 60 145 f 78 The following comparative figures show the prevalence of tuberculosis in Shoreditch during recent years:— Year. Total Number Primary Notifications. Notifications per 1,000 Inhabitants. Pulmonary. Non-Pulmonary. All forms. 1929 251 2.2 0.4 2.6 1930 217 1.8 0.4 2.2 1931 200 1.7 0.4 2.1 1932 148 1.3 0.3 1.6 1933 187 1.7 0.3 2.0 Particulars of new cases of tuberculosis and of all deaths from the disease in Shoreditch during 1933 are given in the following table:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 0- ... ... 2 1 ... ... 1 1 1- ... 1 5 3 ... ... 3 ... 5- ... 1 3 1 ... ... ... 1 10- 2 2 4 ... ... 1 1 ... 15- 8 14 3 2 1 5 1 ... 20- 14 25 3 1 8 9 ... ... 25- 22 24 3 2 12 12 1 ... 35- 15 10 2 1 7 3 ... ... 45- 19 7 1 ... 14 5 1 ... 55- 12 2 1 ... 6 3 ... ... 65 and upwards 2 1 1 ... 2 ... ... ... Totals 94 87 28 11 50 38 8 2 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year 1933 was 1 to 12.5. No case came to notice in which it was necessary to advise that an individual suffering from tuberculosis should be required to discontinue his employment in the milk trade as provided for in the Public Health (Prevention of Tuberculosis) Regulations, 1925. 79 The interval elapsing between notification and death is an indication of the efficiency of notification. In the following table the deaths from tuberculosis are classified according to this interval:— Male Female Total Pulmonary NonPul monary Pulmonary NonPul monary 1. No. of cases only notified at death ... 1 ... ... 1 2. No. of cases notified within a month of death 7 3 3 1 14 3. No. of cases notified within 3 months of death 2 ... 4 1 7 4. No. of cases notified within 6 months of death 4 ... 1 ... 5 5. No. of cases notified over 6 months from date of death .. 32 2 29 ... 63 6. No. of deaths from tuberculosis of cases not notified under Tuberculosis Regultns. 5 2 1 ... 8 7. No. of tuberculous cases dying from disease other than tuberculosis 11 2 8 1 22 61 10 46 3 120 FF 80 81 DEATHS FROM TUBERCULOSIS IN THE BOROUGH DURING 1933. AGES. DEATHS IN EACH WARD. SEX. TOTAL. DEATHS. Under 1 year. 1 to 2 years. 2 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 25 years. 25 to 35 years. 35 to 45 years. 45 to 55 years. 55 to 65 years. 65 to 75 years. 75 and upwards. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. | Acton. Male. Female. Not in Institutions. St. Leonard's Hospital. Other Institutions Belonging to Shoreditch. Not belonging to Shoreditch. Belonging to Shoreditch. Not belonging to Shoreditch. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. All forms 1 2 2 1 2 7 17 25 10 19 10 2 ... 1 10 7 7 5 11 3 9 7 5 6 8 5 8 6 58 40 98 35 34 19 2 7 Respiratory system ... ... 2 ... 1 6 17 24 10 18 10 2 ... 1 8 7 4 11 3 6 7 5 5 8 5 8 6 52 38 90 35 29 19 1 6 Central nervous system 1 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 3 ... ... ... 3 1 4 ... 2 ... 1 1 Intestines and periteum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Vertebral column ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... Other bones and joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin and subcutaneous tissue ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lymphatic system (abdominal glands excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Genito-urinary system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other organs— Adrenals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other sites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disseminated Tuberculosis— Acute ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 1 2 ... 1 ... ... ... Chronic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not distinguished as acute or chronic ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 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. 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 1931 1.08 1.02 1932 1.05 0.89 1933 1.05 0.90 82 TUBERCULOSIS DISPENSARY, 145, Great Cambridge Street, E.2. (Tel. Bishopsgate 3480). Patients can attend at the Dispensary on the following days and times:— Monday, Tuesday, Wednesday, Thursday, Friday, 2 to 3.30 p.m. Tuesday 4.30 to 6 p.m. For School Children ONLY. A session is held on Monday evenings from 6.30 to 8 p.m., which patients and contacts who are at work during the day are invited to attend. To face page 82. tuberculosis scheme. of the Shoreditch Metropolitan Borough Council. Form T. 145a. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. 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 1931 1932 1933 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 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.p. 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 plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December Disease arrested Adults M. 18 2 9 - 11 2 - - - - 1 - 1 - 1 - - 2 - 2 2 2 - - 2 7 1 2 - 3 - - - - - - - - - - - - - - - F. 17 1 4 - 5 2 2 2 - 4 1 - - - - 2 - - - - 3 1 - - 1 3 - - - - - - - - - - - - - - - - - - - Children 1 - - - - 3 1 - - 1 3 - - - - 2 1 - - 1 8 - - - - 5 - - - - - - - - - - - - - - - - - - - Disease not arrested Adults M. 2 - 7 8 15 - 2 1 - 3 - - 1 1 2 - - 5 3 8 2 1 7 2 10 3 4 5 4 13 6 1 14 8 23 6 8 27 5 40 12 4 27 3 34 F. - - 5 1 6 - - 2 - 2 - - 1 2 3 - 1 6 1 8 4 2 5 1 8 3 1 9 2 12 6 1 13 2 16 8 4 11 1 16 14 8 18 4 30 Children 2 - 1 - 1 - - - - - 2 - 1 - 1 1 - - - - 2 - 2 - 2 7 - 2 - 2 8 - 1 - 1 3 - - - - 5 1 - - 1 Condition not ascertained during the year 17 1 6 - 7 5 - - - - 1 2 1 1 4 - 1 - - 1 7 - 2 - 2 2 - 1 - 1 2 1 2 - 3 - - - - - - - - - - Total on Dispensary Register at 31st December 57 4 32 9 45 12 5 5 - 10 8 2 5 4 11 5 3 13 4 20 28 6 16 3 25 30 6 19 6 31 22 3 30 10 43 17 12 38 6 56 31 13 45 7 65 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 36 2 - - 2 2 1 - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 30 1 1 - 2 6 - - - - 1 - - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 16 - - - - 1 - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight, of, or otherwise removed from Dispensary Register 119 17 38 9 64 38 7 10 9 26 13 11 9 3 23 19 2 10 3 15 21 6 11 2 19 15 2 6 2 10 4 2 9 _ 11 5 1 9 1 11 1 3 4 - 7 Dead Adults M. 9 - 8 54 62 3 1 6 40 47 3 - 9 30 39 3 1 2 31 34 6 1 9 20 30 5 1 4 26 31 2 - 3 22 25 - - 2 7 9 - 1 3 6 10 F. 7 2 5 24 31 2 - 6 25 31 2 - 1 12 13 4 - 5 18 23 3 - 5 19 24 - - 1 15 16 4 - 1 18 19 - - 2 12 14 1 - 1 5 6 Children 1 - - 2 2 1 - 1 1 2 - - - 2 2 1 - - - - - - - - - 1 - - 2 2 - - - 2 2 - - - - - - - - 1 1 *Total written off Dispensary Register 218 22 52 89 163 53 9 23 75 107 21 11 19 47 77 29 3 17 52 72 30 7 25 41 73 21 3 11 45 59 10 2 13 42 57 5 1 13 20 34 2 4 8 12 24 GRAND TOTALS 275 26 84 98 208 65 14 28 75 117 29 13 24 51 88 34 6 30 56 92 58 13 41 44 98 51 9 30 51 90 32 5 43 52 100 22 13 51 26 90 33 17 53 19 89 p.t.o. 82 B. NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. 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 1931 1932 1933 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 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 (a) Remaining on Dispensary Register on 31st December. Disease arrested Adults M. 4 - - - 4 1 - - - 1 - - - - - 1 - - 1 1 - 1 - 2 1 1 1 - 3 - - - - - - - - - - - - - - - F. 1 - - 1 2 2 - - 1 3 - 1 - - 1 - - - 1 1 1 - 3 - 4 - - - - - 1 1 2 - 4 - - - - - - - - - - Children 8 1 - 6 15 3 - - 2 5 4 - - 2 6 2 2 1 - 5 - 1 1 2 4 3 - 1 1 5 - - - 1 1 - - - - - - - - - - Disease not arrested Adults M. 1 1 1 1 2 - 1 - - 1 1 1 - - 2 1 - - - 1 4 1 3 1 9 F. 2 - - - 2 - - - - - 1 - - - 1 - - 1 - 1 1 - 1 - 1 1 1 1 - 3 - - 1 - 1 - - - 1 1 - - 1 1 2 Children 5 1 - 2 8 2 - - - 2 5 - - - 5 4 2 - 2 8 2 - 1 - 3 3 1 - 4 8 6 2 1 6 15 6 - - 5 11 - 1 - 3 4 Condition not ascertained during the year 2 - - - 2 1 - - - 1 1 - - - 1 1 - - - 1 - - - - - - 1 - 1 2 - 1 - 2 3 - - - - - - - - - - Total on Dispensary Register at 31st December 22 2 - 9 33 9 - 1 3 13 11 1 - 2 14 8 4 2 3 17 6 1 6 3 16 8 5 3 6 22 8 5 4 9 26 7 - - 6 13 4 2 4 5 15 Transferred to Pulmonary 1 - 1 1 3 2 - - - 2 - - - - - - 1 - 1 2 - - - - - - - - 1 1 - - - - - - - - - - - - - - - (ib) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 3 - - 1 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 1 - 1 1 3 1 - - 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 10 1 - 11 22 4 1 1 1 7 2 - 1 1 4 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Reg. 13 3 2 14 32 - 1 - 6 7 9 - 1 4 14 3 2 2 3 10 3 1 - 5 9 6 - 2 1 9 - 1 - 2 3 3 - - 2 5 1 1 - - 2 Dead Adults M. 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 1 - - - 1 - - - - - 1 - - - 1 - - - 1 - - - - - 1 - - - - - - - - - - - - - - - 1 - - - 1 Children 1 - - 2 3 1 1 - - 2 - - - - - - - - - - - 1 1 - 1 - 2 - - 2 - 1 - - 1 1 1 - - 2 1 - - - 1 Total written off Dispensary Register 30 4 3 29 66 6 3 1 8 18 12 - 2 5 19 4 2 2 3 11 4 2 -J 5 11 7 2 2 1 12 - 3 - 2 5 4 1 - 2 7 3 1 - - 4 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 52 6 3 38 99 15 3 2 11 31 23 1 2 7 33 12 6 4 6 28 10 3 6 8 27 15 7 5 7 34 8 8 4 11 31 11 1 - 8 20 7 3 4 5 19 83 First Schedule. Memo. 37/T (Revised). Form T. 145. Tuberculosis Scheme of the Shoreditch Metropolitan Borough Council. (A) Return showing the work of the Dispensary during the Year 1933. Diagnosis. Pulmonary. Non-pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):- (a) Definitely tuberculous 58 51 2 4 9 3 5 1 67 54 7 5 133 (b) Diagnosis not completed - - - - - - - - 6 4 6 1 17 (c) Non-tuberculous - - - - - - - - 107 166 85 104 462 B.—Contacts examined during the year:— (a) Definitely tuberculous 4 2 1 - - - - 1 4 2 1 1 8 (b) Diagnosis not completed — — — — - — - - 1 3 3 3 10 (c) Non-tuberculous — — — — - — - - 46 84 72 68 270 C.—Cases written off the Dispensary Register as:— (a) Recovered 9 13 2 1 3 4 4 0 12 17 6 1 36 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 156 258 165 183 762 D.—Number of Cases on Dispensary Register on December 31st (a) Definitely tuberculous 266 204 28 18 45 39 51 34 311 243 79 52 685 (b) Diagnosis not completed - — — - — — — — 7 7 9 4 27 1. Number of cases on Dispensary Register on January 1st 698 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 61 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 59 4. Cases written off during the year as Dead (all causes) 90 5. Number of attendances at the Dispensary (including Contacts) 4514 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 293 7. Number of consultations with medical practitioners:— (a) Personal2 (b) Other 4 174 8. Number of visits by Tuberculosis Officers to homes (including personal consultations)2 152 plus 24 visits to St. Leonard's Hospital 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3160 10. Number of:— (a) Specimens of sputum, etc., examined (b) X-ray examinations made in connexion with Dispensary work 1144 182 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 306 1i.e., remaining undiagnosed on 31st Dec. [see Memo. 37/T (Revised), p. 10, Sec. II, Note 4]. 2 All personal consultations, whether held at the homes of patients or elsewhere, are included in Item 7 (a); and all visits by the Tuberculosis Officer to homes, whether or not accompanied by a personal consultation already included in Item 7 (a), are entered in Item 8. 84 Note upon Classification of Patients suffering from Tuberculosis. Memo 37/T (Revised). For the purpose of the Annual Returns required under this Memorandum, and of the case records necessary to enable these returns to be completed, the following system of classification of cases and of recording results should be used:— I.—All patients should be grouped according to their sex and age; patients under 15 years of age should be classed as children, and those of 15 years and upwards as adults. II.—Patients should then be classified according to the organs or parts affected as follows:— (1) Pulmonary tuberculosis (including tuberculosis of the pleura or intrathoracic glands). (2) Non-pulmonary tuberculosis. Patients suffering from both pulmonary and non-pulmonary tuberculosis should be classified as pulmonary cases. III.—Patients suffering from pulmonary tuberculosis should be divided into— Class T.B. minus, viz., cases in which tubercle bacilli have never been demonstrated in the sputum, pleural fluid, faeces, etc., and Class T.B. plus, viz., cases in which tubercle bacilli have at any time been found. It should be noted that a patient originally in Class T.B. minus must be transferred to Class T.B. plus at any stage in the course of treatment if and when tubercle bacilli are found, while on the other hand a patient who is once placed in Class T.B. plus can never be included in Class T.B. minus. Class T.B. plus should be further subdivided into three groups as follows:— Group 1.—Cases with slight constitutional disturbance, if any; e.g., there should not be marked acceleration of pulse nor elevation of temperature except of very transient duration; gastro-intestinal disturbance or emaciation, if present, should not be excessive. The obvious physical signs should be of very limited extent as follows : Either present in one lobe only and, in the case of an apical lesion of one upper lobe, not extending below the second rib in front or not exceeding an equivalent area in any one lobe; or where these physical signs are present in more than one lobe, they should be limited to the apices of the upper lobes, and should not extend below the clavicle and the spine of the scapula. No complication (tuberculous or other) of prognostic gravity should be present. A small area of dry pleurisy should not exclude a case from this group. 85 Group 3.—Cases with profound systemic disturbance or constitutional deterioration, with marked impairment of function, either local or general, and with little or no prospect of recovery. All cases with grave complications (e.g., diabetes, tuberculosis of intestine, etc.), whether those complications are tuberculous or not, should be classified in this group. Group 2.—All cases which cannot be placed in Groups 1 and 3. IV.—Patients suffering from non-pulmonary tuberculosis should be classified according to the site of the lesion as follows:— (1) Tuberculosis of bones and joints. (2) Abdominal tuberculosis (i.e. tuberculosis of peritoneum, intestines or mesenteric glands). (3) Tuberculosis of other organs. (4) Tuberculosis of peripheral glands. Patients suffering from multiple lesions should be classified in one subgroup only, viz., in that applicable to the case which stands highest in the immediately preceding list. Report by Dr. C. K. Cullen, Tuberculosis Officer. As will be seen from the figures given in the statistical section of this report, there has been a marked increase in almost every aspect of the Dispensary work. New patients examined show an increase of 20%, new cases notified in the Borough 26%, total attendances 16%, examinations 16%, contacts examined 27%, and cases receiving extra nourishment 41%. The increase in the number of attendances of non-insured patients, which this year exceeds the number of insured, is an indication that a growing number of patients are lapsing from the benefits of health insurance. These figures suggest that unemployment and its associated poverty are taking an increasingly heavy toll on the lives of the people of Shoreditch. Yet the full extent of the increase in the Dispensary work is not revealed by the figures. As I indicated in my report last year, the attempt—often fruitless—to find some solution of the economic difficulties of the patients in order to enable them to benefit from treatment and supervision involves the expenditure of a considerable amount of time and anxiety in almost every case; and a large proportion of the time of the Tuberculosis Officer, the Care Committee Secretary, the Health Visitors, and the Clerk is spent not in dealing with the medical aspects of tuberculosis but with the social problems affecting the individual. It is a serious reflection on our present social organization that, in an age when the development of industrial science and invention has placed within our reach vast possibilities of wealth production, widespread poverty should largely nullify our efforts in the treatment and prevention of disease. 86 With the fear of hardship for their families while they are away and of unemployment for themselves on their return haunting them, patients are reluctant to give up work until physical incapacity compels them. Their own condition gets worse and their families are exposed to increasing dangers of infection. Bad housing conditions such as overcrowding, dark and badly ventilated rooms, the proximity of high buildings around—factories, warehouses, and big tenement blocks—with a resulting stagnation of air, create an environment favourable to the spread of infection, the deterioration of patients remaining at home, and the relapse of those returning from sanatorium. Rehousing in municipal dwellings is frequently ruled out by the inadequacy of the family income to meet the considerably higher rents which must be paid, particularly when the cost of travelling expenses has to be added in the case of workers rehoused in estates outside London. The monotony of diet enforced by poverty and the lack of opportunities for proper recreation increase the handicaps. Difficulties of this kind have been particularly common during the past year, and though a few of the worst cases have been taken up with the appropriate authorities (the Public Assistance and the Housing Departments of the London County Council) with some resulting amelioration of their conditions, the general problem remains. No standard of relief which is based largely upon the costs of a minimum diet and does not take into account the other factors necessary for a healthy life can protect either the family concerned or the community at large from the spread of the disease. With regard to housing, the Sheffield scheme of assistance for infectious cases of tuberculosis which has been in operation since 1928 has aroused considerable interest among Tuberculosis Officers. Whilst it does not offer a complete solution, its adoption in London would be of great assistance. While these conditions remain, it seems to me desirable that patients should receive a longer period of initial treatment in sanatorium as a routine. This would do much to fortify them more strongly against a recurrence of the disease which happens so frequently at the present time. It is true that bad home conditions are taken into consideration by the County Council now when the length of treatment is being decided, but very few Shoreditch patients come home to good conditions and far too many of them have less than six months' treatment in Sanatorium. There has been a tendency during the past year to make increasing use of the General Hospitals of the County Council for initial treatment. Except in special circumstances, patients are only transferred thence to hospitals or sanatoria outside London when they have progressed sufficiently to be up and about without temperature for the greater part of the day. St. Leonard's Hospital is particularly badly placed as regards environment and, though many cases do fairly well, thanks to the rest and supervision which are the most important features of the treatment, I am convinced that their progress 87 would be more rapid in country air and in better surroundings. I am strongly of the opinion that the Tuberculosis wards of this and other general hospitals should be kept for the treatment of emergencies and of advanced cases who wish to remain near home and that other cases should be sent to institutions specially equipped and staffed for the treatment of this disease. The London County Council has appointed the Tuberculosis Officers of the various Metropolitan Borough Councils to act as Tuberculosis consultants in the General Hospitals and I have continued to pay fortnightly visits to St. Leonard's during the year. This arrangement has proved of great service in helping to secure the consent of patients to hospital treatment when this is desirable. The special facilities mentioned in last year's report remain unchanged, with the addition of the Shoreditch Municipal Dental Hospital, reference to which was inadvertently omitted in my last report. The number of cases referred to the Dental Hospital for treatment is however small. In most newly-notified cases of tuberculosis it is important to get the patient away to sanatorium or other residential treatment as soon as possible and a welcome feature of the past year's work has been the shortening of the waiting period and the earlier offer of vacancies by the County Council. It is thus not always practicable to secure the completion of dental treatment before the patient's admission even if the patient is in a fit physical condition to stand it. Any necessary dental treatment not carried out before admission is provided in the institution to which the patient is sent. Greater use has been made this year of X-ray examinations both for diagnosis and for estimation of the activity of the disease at later stages. The reports of Dr. Kerley, Radiologist to the Royal Chest Hospital, continue to be of great value. I also wish to acknowledge once again the assistance given in cases of laryngitis by Mr. Zamora, the Laryngologist to the same Hospital, to whom such cases are referred for examination. Further figures relating to the work of the Dispensary are given in the following tables:— 1933. 1932. Total attendances 4,514 3,861 Total examinations 2,006 1,729 Contacts examined 292 229 Sisters' visits 3,160 2,849 Tuberculosis Officer's visits 152 156 In addition to the above, twenty-four fortnightly visits were made by the Tuberculosis Officer to St. Leonard's Hospital. 88 Comparative numbers of insured and non-insured attendances were:— Insured 2,246 Non-insured 2,268 Special sessions for school-children are held weekly and the following table shows the attendances for each month:— 1933. 1932. 1933. 1932. January 54 23 July 31 11 February 63 28 August 21 17 March 56 32 September 37 20 April 32 30 October 57 31 May 37 25 November 53 52 June 25 36 December 44 35 1933. 1932. Total attendances 510 340 Total examinations 231 159 " Laboratory examinations made at the Dispensary during the year:— Sputum 1,106 (1932: 1,151) Urine 36 (1932: 41) Pus from abscesses, etc. 2 (1932: 0) The number of patients receiving extra nourishment from the Borough Council during the year was 99, of whom 38 were receiving it on 31st December, 1933. The number of shelters (supplied on loan) in use during the year was 4. The number of patients who had beds and/or bedding on loan was 33. 89 Annual Report of the Shoreditch Tuberculosis Care Committee for the Year 1933. During the year the Committee has continued its work in the Borough, the members being as follows:— Miss Wragge (Maurice Hostel), Chairman, Mrs. Barr, Mrs. Bourdon, Miss Bloomfield (Invalid Childrens' Aid Association), Miss Church (Secretary from April, 1933), Mrs. Cox, Dr. Cullen (Tuberculosis Officer), Councillor Mrs. Girling, Mrs. Grange (Tuberculosis Visitor), Miss Hatton (representing the Public Assistance Committee, resigned February, 1934), Miss Hiscoke (Tuberculosis Visitor), Mrs. Ingham, Councillor Mrs. Jarvis, Dr. Kelleher (resigned as from 21st November, 1933), Miss King (Acting Honorary Secretary, until April, 1933), Miss Lee (Shoreditch and Bethnal Green District Nursing Association), Miss Murch (District Organizer of Childrens' School Care Committees), Mrs. Nicholas (representing London Insurance Committee, resigned as from 21st November, 1933), Dr. Maitland Radford (Medical Officer of Health), Mrs. Yeomans. - Dr. Lewis, Divisional Medical Officer, was a member of Committee until his death at the end of the year. Miss King acted as Honorary Secretary until April, when Miss Church was appointed as the first salaried Secretary to the Committee. The Committee works in close co-operation with the local charitable and official agencies of the district in helping to solve the many problems presented by the family in which tuberculosis has occurred. Some of the larger problems, such as overcrowding and bad housing, are beyond the scope of this Committee, but the opportunities of helping afforded to a Tuberculosis Care Committee are nevertheless legion, and include such varied work as the provision of clothing, especially for patients entering sanatoria, the payment of National Health Insurance arrears, obtaining temporary help from Exservice men's funds or other sources, provision of fares for relatives to visit sanatoria and hospitals, the finding of work for a wife whose husband is ill, arranging for the care of children whose mother is ill, planning for the future of a homeless boy whose health does not allow him to build his future for himself, etc. The Care Committee, by keeping in close touch with a man's family when he goes away for treatment may do much to set his mind at rest, thus helping him to obtain the maximum benefit from his stay in sanatorium, while the Care Committee has endless opportunities of putting his family in touch with the suitable agency which can prevent any economic hardship; when the breadwinner comes home there is the extra mouth to feed and the future to plan with all the difficulty of finding suitable work for a tubercular man or woman who has indifferent health to contend with in addition to the unemployment problem. 90 The following instances give some idea of the care work undertaken during the year:— 2084.—Man admitted sanatorium. Baby of ten months died the same month. Three weeks' holiday arranged for widow (aged 23) and on her return to London permanent work found for her. Now living with her mother. 2030.—Man admitted sanatorium. United Services Fund helped wife and baby for six months and over Christmas. Wife supplied with glasses meantime. On discharge man allowed Extra Nourishment from Borough Council until fit to return to his old job. Now at work again. 1985.—Man admitted Papworth after sanatorium treatment. Earning and allotted cottage. Charity Organization Society paid cost of removal of wife and child to join man at Papworth. 2055.—Man in sanatorium six months. Wife at work. No children. On man's discharge wife on short time. Royal Naval Benevolent Trust helped for eight weeks and gave underclothing. Man then died. R.N.B.T. helping wife pending permanent full-time job which she has been promised where her husband was employed. During the year the Handicraft Centre has continued to pay the teacher as the number attending are not yet sufficient to qualify for a teacher paid by the London County Council. Eleven students are now on the register and are all keenly interested in the work. A most successful sale, held jointly by the Metropolitan Boroughs of Shoreditch, Hackney, Stoke Newington and Islington took place in Shoreditch Town Hall on 1st November, at which Shoreditch cleared over £9 (nine pounds) profits. This helped our finances very materially, in addition to the generous grant of £20 received from the National Association for the Prevention of Tuberculosis. The class can be visited any Friday morning between 11 and 12 and orders for leather or basket work, embroidery, etc., would be gladly received and carefully executed. We should like to take this opportunity of thanking all those who have so kindly sent us clothes during the past year. Clothes of all kinds, especially pyjamas, nightdresses and dressing gowns are always in demand and are most gratefully received by the Committee. 91 The figures for the year's care work are as follows : — New patients 147 Re-registrations 53 General hospital patients 23 Home inquiry forms received 152 Visits paid 678 Interviews 410 Letters received 605 Letters written 1,109 Forms received 729 Form B, received 13 Removals from district 122 Telephones in and out 292 Decisions of Committee 181 Reported to Committee : number of cases 581 Details of Care Work: Beds supplied 23 Bedding 2 Bad housing conditions remedied 3 Clothing supplied 75 Relief obtained 25 Relief increased 13 Fares supplied 18 National Health Insurance arrears paid 5 Temporary help arranged 6 School meals 2 Extra nourishment (exclusive of Borough Council) 9 Work obtained 7 Pocket money obtained 2 Convalescence arranged 6 General help 4 Placed in homes 3 Rent paid 1 Furniture instalments reduced 2 Dental cases including Borough Council cases referred to T.B.C.C. for assessment 4 Cases have been referred to: Public Assistance Committee 54 Charity Organization Society 38 United Services Fund 19 Regiments 4 Royal Naval Benevolent Trust 2 Red Cross 5 Children's School Care Committees 20 East London Workers among the Poor 13 The County Hall 3 Friends of the Poor (Ebury Street) 4 Approved Societies 2 Invalid Children's Aid Association 22 Industrial Law Bureau 1 Central Association for the Protection of Women and Girls 1 Jewish Board of Guardians 2 92 VI.—MUNICIPAL DENTAL HOSPITAL. 8/14, Laburnum Street, E.2. REPORT FOR THE YEAR 1933. The times of the Sessions are as follows — Monday, Tuesday, Thursday and Friday : 2 p.m. to 8 p.m. Wednesday : 10 a.m. to 12 noon. 4 p.m. to 8 p.m. Thursday (Special session for Maternity and Child Welfare cases): 10 a.m. to 12.30 p.m. Saturday: 10 a.m. to 1 p.m. The Dental Surgeon is not in attendance between 5 p.m. and 6 p.m. on Monday to Friday evenings inclusive. The scale of charges is as follows:— Scaling, per individual.—5s., but not chargeable in respect of a jaw in which a denture of eight or more teeth is supplied. Fillings, per filling.—5s., with a maximum charge of 10s. for any one tooth. Root treatment, per tooth.—5s., with a maximum charge of 12s. 6d. for fillings and root treatment in any one tooth. Extractions.—2s. per tooth (with or without local anaesthetic). Maximum 10s. for any single attendance. Extractions with general anaesthetics.—Extraction fee 2s. each tooth. Gas 3s. 6d. Maximum 15s. for any single attendance. 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. for each subsequent tooth. 93 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:— (i) Cracks, fissures, or fractures of dentures. (ii) The replacing of a loosened tooth, or loosened band or wire. (iii) The adding of one new tooth. (iv) An extension of the plate, even when that extension embraces part of a natural tooth. (v) New band or wire, 3s. 6d. 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, £2. 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 charge to be made in special X-ray cases is considered and determined by the Committee. In the case of Approved Society patients, the foregoing scale of charges is applied as follows:— (i) In the case of Approved Society patients the cost of the treatment to the Society is based on the Approved Society Scale of Charges, and (ii) In the case of Approved Society patients the Council's scale of allowances is applied to the portion of the cost of treatment not borne by the Approved Society. The scale of charges for treatment of school children is as follows, viz.:— Extractions 1s., with a maximum of 5s. Fillings 2s. 6d. per filling, maximum of 7s. 6d. Gas 3s. 6d. Orthodontic Treatment—Cost of appliance, plus 50 per cent. g 94 All who live or work in Shoreditch are eligible to receive treatment at this hospital. Persons who have resided in the Borough for six months (but not non-residents working in the Borough) who state that they are unable to afford the foregoing charges are asked to complete a form stating the number of the family and the income. Applicants are further required to sign the following undertaking:— 1, the undersigned, hereby acknowledge that in the event of my application for treatment at the Municipal Dental Hospital without present payment in full being granted, the Shoreditch Borough Council reserve to themselves the right to call upon me for payment of the cost of such treatment if at any time it is found that I am in a position to pay for the same. 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. Income per head after deducting rent, National Health and Unemployment Insurance contributions not more than : s. d. s. d. s. d. s. d. 1 . 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 six months residential qualification to which reference has been made does not apply to Maternity and Child Welfare cases who are entitled to the appropriate remissions by the fact that they are referred to the Hospital from one or other of the Welfare Centres. There were considerable changes in the permanent staff during the year. Mr. H. L. Davies, the Dental Surgeon, resigned his appointment in April, and later in the year the positions held by the junior Nurse and two of the Dental Mechanics became vacant. The temporary arrangements made for carrying on the work of the hospital were still in being at the end of the year here under consideration. At the time of writing, however, steps are being taken to appoint a whole-time Dental Surgeon. Other matters relating to the staffing and administration of the Hospital stand deferred until this appointment has been made. 95 A summary of the work done during the year is contained in the following tables : — Table I.—Inspection and Treatment of Children. No. of primary examinations No. of 1st Attendances for Course of Treatment No. of extractions (teeth) Local Anaesthetics General Anaesthetics No. of Fillings No. of scalings No. of Orthodontic plates fitted Orthodontic visits No. of surgical operations Complete Temporary 1st (a) Subsequent (b) (1) (2) (3) (4) (5) (< 5) (7) (8) (9) (10) Up to 2 yrs. 6 1 1 ... 1 ... ... ... ... ... ... ... Over 2 ,, 37 34 111 ... 33 5 ... ... ... ... ... ... Over 3 ,, 63 50 167 1 46 11 4 ... ... ... ... ... Over 4 ,, 116 104 325 ... 103 66 12 ... ... ... ... ... School children 108 51 118 9 39 56 25 ... 12 6 137 1 Total 330 240 722 10 222 138 41 ... 12 6 137 1 GG 96 Table II.—Inspection and Treatment of Adults. No. of primary examinations No. of 1st Attendances for Course of Treatment No. of extractions (teeth) Local Anaesthetics General Anaesthetics No. of Filling's No. of scalings No. of dentures fitted No. of repairs to dentures No. of surgical operations No. of other operations No. of visits Complete Temporary Women referred from M.C.W. centres (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 293 208 1749 27 273 62 29 37 135 23 l 514 1287 Other Women 338 198 1090 32 159 85 59 14 146 45 2 590 1356 Adolescents (half-rate cases) Female 45 32 53 6 24 53 38 6 1 1 ... 53 204 Male 34 29 53 8 19 17 14 2 2 2 ... 16 93 Men 345 216 1331 80 193 127 61 41 218 84 5 826 1714 Tuberculous 3 4 31 ... 4 10 ... ... 5 1 ... 12 31 Total (including Children, Table I) 1388 927 5029 163 894 492 242 100 509 156 9 2181 5534 97 Table III.—Analysis of Visits. Sessions Morning Afternoon Evening Total No. of M. & C.W. Visits Anaesthetic Sessions Att'nd'ncs Special Anaesthetic Visits Women Children Interviews Examinations and Treatm't Interviews Examinations and Treatm'nt Interviews Examinations and Treatm'nt Interviews Examinations and Treatm'nt 1st Subsequent 1st Subsequent Monday - - 131 634 84 456 215 1,090 76 106 52 17 - 6 Tuesday - - 59 535 65 342 124 877 26 191 22 112 467 2 Wednesday 82 496 33 161 66 399 181 1,056 38 136 41 7 - 11 Thursday 82 579 66 454 48 322 196 1,355 89 310 64 70 - 2 Friday — — 83 562 31 447 114 1,009 38 232 33 37 402 — Saturday 69 147 — — — — 69 147 5 16 5 4 — 5 Total 233 1,222 372 2,346 294 1,966 899 5,534 272 991 217 247 869 26 Note.—Tables I and II. Column—1.—When course of treatment prescribed at primary examination is completed next visit by individual is recorded as another primary examination. Column 2.—Number of patients whose treatment is commenced during the week. Column 3.—Weekly total of teeth extracted. Columns 4/5.—Weekly total of patients to whom anaesthetics have been administered. Column 6.—Total number of teeth filled, completely or temporarily. Column 7.—Number of patients who have had their teeth scaled. Column 8.—Number of single Orthodontic or Dental Plates fitted. Column 9.—Table I.—(a) Represents the number of patients presenting themselves for first time for Orthodontic treatment; (b) represents the weekly total of visits made by patients for Orthodontic treatment, and includes children who were already attending for Orthodontic treatment at the beginning of the year. Table II.—Represents the weekly total of single Denture repairs completed. Column 10.—Weekly total of separate surgical operations performed. Column 11.—Weekly total of operations not registered in the preceding columns. Column 12.—Total number of separate visits for examination or treatment. Table III. Total attendances given here include Tables I and II. 98 A comparison of the work done each year since the Hospital was opened is contained in the following table : — 1927 From 31stMar. Five Sessions 1928 Five Sessions 1929 Jan.-May Five Sessions TuneDec. Eleven Sessions 1930 Eleven Sessions 1931 Eleven Sessions 1932 Eleven Sessions Jan.-Nov. when new Time Table introduced 1933 Times as stated on page No. of children's visits 499 794 1,081 1,577 1,576 1,978 849 No. of adults' visits* 1,430 3,032 3,505 6,658 6,174 5,064 4,685 No. of maternity cases visits 627 1,021 1,209 1,290 1,407 1,421 1,287 No. of dentures fitted 61 222 329 699 752 663 509 *Including Maternity cases. It will be seen that there has been a marked falling off in the number of children attending the Hospital. This is the most important difference between the figures for the last two years, and is undoubtedly the result of the increased fees for school children introduced in November, 1932. In connection with this matter it is of interest to record that the arrangements under which dental treatment is given at the London County Council school dental clinics are as follows: All children attending school are eligible for treatment. The charges vary from 1s for slight treatment; 2s. for all forms of more extensive treatment other than extraction under gas; 3s. if extraction under gas is included, one payment covers all treatment for six months, in addition to routine examination of teeth, urgent cases are always seen by a Dental Surgeon. Shoreditch school children receive treatment either at Hoxton House Treatment Centre or at the special London County Council Clinic at the Queen's Hospital. 99 Sessions are held at these Clinics at the following times:— Hoxton House Queen's Hospital Monday 1.30 to 4 p.m. 9 a.m.; 1.30 afternoon session on alternate weeks. Tuesday 9.30 a.m.; 1.30 to 4 p.m. afternoon session on alternate weeks. 9 a.m.; every other session is a gas session. Wednesday 9.30 a.m; 1.30 to 4 p.m. 9 a.m.; 1.30 p.m. Thursday 9.30 a.m 9 a.m. gas session; 1.30 p.m. Friday 9.30 a.m.; 1.30 gas session 9 a.m. Saturday Nil Nil. At Hoxton House children requiring gas must wait until the gas session. At the Queen's Hospital gas is available at any session if urgently required. Orthodontic work is not normally undertaken at any London County Council school clinic. During school holidays the London County Council sessions are not held, but children are sent to the ordinary Dental clinics held at the Queen's Hospital on Tuesday and Friday afternoon commencing at 1.30 p.m. A small decrease in the number of attendances both of Maternity and Child Welfare and of other adult cases will also be observed. The former is due to the fact that it became necessary to tighten somewhat the administrative arrangements under which cases were accepted at the hospital as coming within this category. The decrease in the number of attendances of other adults is to be attributed in part to the fact that the hospital moved to new quarters during the year, and partly to the loss of parents who have in previous years followed their children to the hospital. The following table is of interest as affording an indication of the effect of raising the charges for children and lowering those for adults : — Percentage of those previously examined who attended subsequent course of treatment. 1932 1933 Children 88 73 Adults 57 65 Total 69 67 In March this Hospital was transferred from the premises in kingsland Road, occupied since its inception, to its new quarters on the first floor of the new building in Laburnum Street. As already reported this floor is approached by a separate entrance and stairway, and has been designed for 100 its special purpose. The present accommodation is a great improvement upon the old both for patients and for the staff, and it is a matter for satisfaction that this important work is now being carried out under first rate conditions. Miss Mould, the Dental Hygienist, for whose services we have to thank the Hon. Arthur Villiers, continued her work throughout the year. Miss Mould submits the following brief summary of her work: — "During the early part of 1933, under the direction of Dr. McGregor, 1 carried out an inspection of the teeth of 300 children between the ages of 3 and 9 years. This meant visiting the homes in order to see the children. From January—October, 80 mothers had their teeth scaled. Since then I have not done the scalings. "In October, Health Week was held. Dr. McGregor and helper organized a Toddlers' Revue which was performed during Health Week. I assisted in this work by arranging for some children to sing and give a demonstration on how to clean their teeth. "The remainder of my time has been spent in the Dental Hospital, under the direction of the Sister, helping in the general work of the Hospital." Cards for the attention of children leaving school which were first introduced during .1930, continued to be distributed throughout the year. This card is in the following terms:— "Shoreditch Borough Council. "The Care of the Teeth. "To children leaving school. "While you have been at school your teeth have been looked after for you. Now that you are leaving school you must make your own arrangements. Unless you do so, it is likely that your teeth will decay and your general health suffer. "In order that the good work done at school may continue, you should place yourself under the care of a dental surgeon. "Treatment can be obtained from any dental surgeon, of whom there are several in Shoreditch, or at the Municipal Dental Hospital, 8/14, Laburnum Street, E.2." Thanks are due to Mr. S. H. Coplans who has held the post of acting Dental Surgeon from the resignation referred to above until the present time, for his assistance and co-operation in regard to all matters relating to the administration of the hospital. 101 VII.—HOUSING. In the following table particulars are given in the form required by the Ministry of Health : — 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,192 (b) Number of inspections made for the purpose 30,669 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 Nil 2. Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers (Intimation Notice)—Public Health London Act 4,470 3. Action under Statutory Powers during the Year: — A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 1 (b) By local authority in default of owners Nil B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which statutory notices were served requiring defects to be remedied (and see 2 above) 542 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 542 (b) By local authority in default of owners Nil 102 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which Demolition Orders were made: 1 appeal against order granted (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 5 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil E.—Proceedings under section 3 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners (b) By local authority in default of owners (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which Closing Orders became operative Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which Demolition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil Note.—Section 3 and Sections 11 to 15 of the Housing Act, 1925, have been repealed by the Housing Act, 1930, but the proviso to Section 64 of the Act of 1930 continues in force any Closing Orders and Demolition Orders made before the operation of the Act (15th August, 1930), and houses subject to those Orders must continue to be dealt with under the relative provisions of the Act of 1925. 103 Housing Consolidated Regulations. As explained in previous reports, it has been the policy in this Borough to deal with housing defects under the Public Health (London) Act to the exclusion of action under the Housing Acts. Further, the opinion has been expressed that while an immense amount of useful work has been accomplished by this means, this procedure does not make it possible to recondition those houses, of which there are a large number, that are neither ripe for demolition on the one hand, nor to be regarded as in all respects fit for human habitation on the other. This matter has engaged the careful consideration of the Housing Committee, and in November a report was prepared by the writer which was still under consideration at the end of the year. Slum Clearance (Ministry of Health Circular 1331). This important circular, which was issued in April, called upon Local Authorities to prepare and adopt a programme, the components of which should be: — (1) A list of the areas in which clearance is necessary, with information of the number of houses to be demolished in each, and of the number of their inhabitants; (2) A list of the areas in which improvement by way of reconditioning or otherwise is necessary, with information as in (1) above; (3) A time-table for the initiation, progress and completion of action to secure clearance or improvement, as the case may be, of all these areas; and (4) A time-table of re-housing co-ordinated with the displacements contemplated by the time-table of clearance operations; and to make an immediate begihning with the programme by the declaration as clearance or improvement areas of such areas as could be immediately dealt with, and to make the necessary orders. Upon receipt of this circular, authority was given to engage the services of a temporary Sanitary Inspector, and with the guidance obtained from existing records a rapid survey of the Borough was made. As a result, a list comprising some 3,000 houses, included in some 33 areas, and with a population of approximately 20,000 was submitted to the Council at its meeting in June with the recommendation that the houses in question be included in the Slum Clearance Scheme for demolition. This recommendation was approved by the Council and referred to the London County Council as the authority responsible for submitting to the Minister a Slum Clearance Scheme for the whole of London. 104 In the Ministry's circular, special recognition is given to the magnitude of the Slum problem in London and to the fact that greater efforts and a longer period will be required than elsewhere for its solution. Satisfactory as it is to know that a scheme for the abolition of slum property has been inaugurated, it must be remembered that Shoreditch is an area of which it is specially true to say, and the point has very frequently been made in public discussion of the Housing Problem, that the worst housing conditions are by no means always found in the worst houses. There are a large number of tenement houses in the Borough which would be considered perfectly satisfactory if occupied by the single families for which they were designed, but which now harbour a family per floor, and sometimes more, under conditions far worse than those obtaining in many of the small dilapidated cottages scheduled for demolition. At its meeting in June the Council adopted the following recommendations contained in a report upon this Circular placed before them by the Chairman of the Housing Committee—Councillor H. P. Griffiths, viz.:— (1) The Council do approve, in principle, the expenditure of a halfpenny rate annually upon the demolition of certain areas included in this list. This undertaking must, of course, be subject to the London County Council providing the necessary re-housing accommodation, apart from from that which will ultimately be available on the Stonebridge Estate, which may be estimated at not less than sufficient for 400 additional persons. It is suggested that after clearing the areas in question, they should, where practicable, be utilized as open spaces, or to extend existing ones. (2) That certain areas should, under Town Planning arrangements, be definitely secured for re-housing, and the most suitable area, having regard to the properties listed would appear to be that bounded by the Canal, Hyde Road, Hoxton Street and Kingsland Road. (This area includes the London County Council Whitmore Estate, St. Leonard's Hospital, and at its southern end, the Drysdale Street area. There are other possible areas which might usefully be considered both in regard to housing and possible street widening. (3) That the London County Council be urged to approve the Borough Council's suggestion in regard to travelling expenses, with a view to a portion of the subsidy being utilized for the purpose, and to include the recommendation on these lines in the report which they must make to the Ministry of Health next September. (4) That the London County Council be asked to include in their scheme some definite plan regarding zoning and town planning, so as to secure adequate protection for existing or future residential areas in the Borough. 105 Dangerous Structure Notices. The number of these notices served during the last four years has been as follows:— 1930—148; 1931—190; 1932—211; 1933—225. These notices afford some indication of the dilapidation that is so common in the Borough. In considering these figures it must be remembered that they relate only to notices actually served and that a great deal of work is carried out by owners in anticipation of the District Surveyor's Notice. In the early part of this year a scheme of co-operation was suggested by the London County Council the object of which was to prevent the considerable expenditure occasioned by compliance with a dangerous structure notice being incurred in respect of houses that might more suitably be dealt with by demolition order under the Housing Act. Briefly the suggestion, made was that lists of houses of which it was alleged that their condition was dangerous should be sent from County Hall with a request to your Medical Officer of Health to state whether any of the houses in question were in his opinion unfit for habitation and suitable for demolition. The Housing Committee of the Borough Council were then to be asked to consider taking the necessary action to secure the demolition of such of these houses as they were satisfied were unfit. It is understood that the scheme in question has been put into operation in a number of Metropolitan Boroughs, but its adoption was deferred in Shoreditch pending discussion upon certain points, and at the time of writing the matter is still under consideration. Underground Rooms. In last year's report the number of underground rooms in this Borough occupied in such a manner as to contravene the provisions of Section 18 of the Housing Act, 1925, was estimated at 2,000. As a result of the housing campaign inaugurated by the Ministry of Health this estimate and the question of underground rooms generally have both received considerable attention. It must be emphasized that in the absence of a special inspection of the Borough this estimate of 2,000 is only approximate, but the further general consideration given to the problem has not served to indicate that it requires revision. 106 Misunderstanding, however, may easily arise if it is thought that all these 2,000 rooms are basement dwellings of the worst type. The conditions to which an underground room must conform before it can be legally used as an habitual sleeping place are contained in Section 18 of the Housing Act, 1925, and the Regulations in respect of such rooms passed by the Shoreditch Borough Council in November, 1932 and approved by the Ministry of Health in the following February. These conditions are exacting and it may be reasonably assumed that very few indeed of the 4,000 odd rooms in this Borough, the floor of which is more than three feet below the street, are so constructed as to qualify them to be used without alteration as habitual sleeping places. The question to be decided in giving a rough estimate of the number of these rooms that are illegally occupied can accordingly be re-stated in the simple form of "How many underground rooms are used as habitual sleeping places?" It is thought probable that half are so used, making an estimated total of 2,000. Of these rooms a small number are of the worst type, being completely underground and badly lighted and ventilated to a degree that well merits the worst that has been said about dwellings of this kind. Such rooms as these are capable of being dealt with under the Public Health (London) Act only if let as a separate dwelling, and this proviso has the effect of rendering that Act inapplicable in a large number of cases. The majority of the rooms comprising the estimated total of 2,000 illegally occupied cannot be considered to constitute a grave menace to health. Though it is most desirable that the legal provisions relating to such rooms should be strictly enforced, it must be recognized that in all the circumstances of this Borough much time must elapse and the general housing problem assume a very different complexion before it will be possible to report that the illegal ocupation of underground rooms as at present defined has ceased to exist. Apart from such general considerations as the foregoing, the Housing Committee were called upon to decide what action it was proposed to take regarding certain underground rooms the occupants of which had made application to the London County Council for other accommodation. The London County Council have recently adopted the practice of writing to the Borough Council in such cases to ask whether or not the underground room to be vacated is one in which action under Section 20 of the Housing Act, 1930, might properly be taken. As a result the Housing Committee have considered reports upon a number of rooms. In respect of seven of these Closing Orders were made, and in one the Order was determined upon the room having been made fit. 107 The experience gained from these cases has served to show that with comparatively little alteration a considerable proportion of the underground rooms at present illegally occupied could be made to comply with the conditions enabling them to be used for sleeping purposes. The wisdom, however, of confining action regarding underground rooms entirely, or in the main, to those rooms rendered vacant by reason of alternative accommodation being offered by the London County Council has been questioned. In the first place the tenant who is accepted by the County Council is likely to vacate one of the better rather than one of the worse underground rooms, and in the second, the procedure of calling upon owners to affect alterations or to close rooms only when initiative is take by the London County Council in this way, is open to the criticism of being arbitrary and unfair. For these reasons it was decided to refer the whole question of action to be taken regarding underground rooms to a Joint Sub-Committee of the Housing and Health Committees, and at the time of writing the matter awaits the recommendations of this Sub-Committee. County of London (Drysdale Street) Housing Confirmation Order, 1933. The area to which this Order relates is substantially the same as that represented in 1919 by my predecessor, and as that which I myself represented in 1929. It was again represented, this time by an Officer of the London County Council, and at its meeting on 23rd May the London County Council declared the area in question to be a Clearance Area within the meaning of Section I of the Housing Act, 1930. A Ministry of Health enquiry regarding the scheme was held at the Town Hall on 31st October, and the confirming order was made on 21st December. In this Order the following lands are included within the Clearance Area : — Windsor Place. Part of public street and dust shoots; Nos. 4, 8 to 24 inclusive; land and ruins adjoining 25; No. 25. Drysdale Place. Public street (part of), Nos. 1 to 24 inclusive; 26, 28, 30, 32. Sarah Street. Public street (part of) 1 to 26 inclusive, and builders' store between 5 and 6. Crooked Billet Yard. Public and private street (part of) 2 to 8 inclusive. Eliza Place. Public street, Nos. 1 to 12 inclusive. Drysdale Street. Public street (part of) Nos. 4, 6, 8, 10, 12, 14, 16, 18, 18a, 20, 22, 24. 108 The following lands not included in the Clearance Area are incorporated in the Order : — Hoxton Street (part of) Nos. 28, 28a, 30, 32, 32a, 34, 36; disused timber store, saw mill, offices, yard, land and outbuildings, 40, and rear of 28 to 36; 42, 44, 46 and 48. Windsor Place. Land between 4 and 8; part of public street and dust shoots; land rear of 46 and 48, Hoxton Street and adjoining 4, Windsor Place. Sarah Street. Part of public street, No. 13a (workshop). Crooked Billet Yard. Private and public street (part of). Kingsland Road. No. 9a (factory, offices, showrooms and storerooms). Whitmore Estate. Fourteen blocks of dwellings have now been erected by the London County Council upon the Ware Street area represented in 1919. These dwellings contain 435 tenants and 1339 rooms. It is understood that four blocks remain to be built to complete this scheme. Demolition of old houses in Nuttall Street has been commenced in preparation for these. Rent Restrictions Acts. Previous Rent Restrictions Acts were continued and amended by the Amending Act of 1933, which received the Royal Assent on 18th July. Under this Act the control of dwelling houses with annual recoverable rents or rateable values of over £45 was ended as from 29th September, 1933. Rent control has been a factor of the greatest importance in determining the housing situation in this Borough since the war, and the effect of the application of this new limit is accordingly a matter of considerable interest. 1 have to thank Mr. Bean, the Council's Registration and Valuation Officer, for giving me his views. In his opinion the effect of the new £45 limit in this Borough is infinitesimal so far as private dwelling houses are concerned. Shops are the premises mainly affected. Since the passing of this Act, as before, it is estimated that some 90 per cent of the rents in Shoreditch are controlled. The effect is that it is very much cheaper to continue to live in a controlled, and often in a thoroughly unsatisfactory house, than to move into uncontrolled and better accommodation. Controlled tenants are thus unwilling to move. The new Act further requires the registration of houses decontrolled by reason of the fact that the landlord has obtained possession. A large number of premises have been registered under this provision, but as these premises are not newly decontrolled this part of the Act has no bearing upon the general position as just stated. STONEBRIDGE ESTATE IMPROVEMENT SCHEME. Dunston Road Cottages Demolished Jan., 1934. front view. 109 The provision of previous Rent Restrictions Acts under which the Council were empowered to issue a certificate as to the state of repair of a controlled dwelling house has been made compulsory under the new Act and not merely permissive as previously. The number of these certificates issued during the last six years has been as follows : — 1928, 5; 1929, 1; 1930, 3; 1931, 1; 1932, 4; 1933, 3. The Provost Street Site. Throughout the year covered by this report the situation regarding this site remained practically unchanged (Annual Report, 1932, page 110). Demolition, however, was commenced by the London County Council early in 1934 preparatory to developing the area which comprises Provost Street, Moneyer Street, Marsom Street, and Custance Street, and contains 53 houses. At the time of writing one block of 30 flats is in course of erection on the north side of the area and is likely to be ready for occupation by about the end of the year. Overcrowding, 1933. The number of cases dealt with by the Sanitary Inspectors was 201 :—- Accommodated by the L.C.C. in Shoreditch 21 » ,, out of ,, 72 ,, ,, own efforts out of ,, 11 » i > > > m j j 43 ,, ,, ,, address unknown ... 21 ,, ,, ,, in same house 33 201 In addition to the above the following applications were dealt with by the L.C.C. Accommodated by the L.C.C. on grounds of special hardship ... 41 ,, ,, ,, ,, ,, of health ... ... 10 ,, ,, ,, for various reasons ... ... 143 194 h 110 Housing Inspector. As explained in the Section of this report dealing with Sanitary Work, the duties of the Senior Sanitary Inspector were re-defined upon the retirement of Mr. Pearson. Mr. Wright, who was appointed as his successor, and who commenced duty in February, 1933, has assigned to him the following duties under the Housing Acts: To make inspections, submit reports, keep records as directed regarding matters dealt with under the Housing Acts; to attend the meetings of the Housing Committee. In accordance with these duties, Mr. Wright made the following inspections during the year under consideration : — Underground rooms inspected with reference to action being taken under Section 20, Housing Act, 1930 ... ... ... 19 Houses inspected with reference to action being taken under Section 17, Housing Act, 1930 ... ... ... ... 3 Derelict houses inspected upon instructions of Committee ... 28 As a result of action taken by the Committee upon reports arising out of these inspections, one house—48, Whitmore Road—was rendered fit for habitation and a demolition order was made in respect of 2, Northport Street. There was an appeal against this order on the grounds that the building in question although originally a dwelling-house had ceased to be such as a result of certain alterations made soon after the war for the purpose of using the premises as a factory. This appeal was granted in the County Court. Haggerston Road School. This school was not in use throughout the year here considered. Demolition was commenced by the London County Council in January, 1934, and it is understood that a block of flats is to be erected in the near future and that ultimately this block will form the nucleus of a larger scheme. Stonebridge Estate Improvement Scheme. I have to thank Mr. C. T. Fulcher, the Borough Surveyor, for the following memorandum upon this scheme : — Stonebridge Estate comprised 143 properties in Lee Street, Haggerston Road, Acton Street, Stean Street, Dunston Street, Loanda Street, Clarissa Street and Dunston Road, accommodating 940 persons. The area covers 3'51 acres or 152,895 feet super approximately, and was purchased by the Council on 25th June, 1901. back view. 111 The original planning of the estate reveals the desire to obtain the maximum density per acre. The property being over 100 years old, coupled with inferiority of materials and methods of construction originally adopted, has for many years resulted in the expenditure of large sums for general maintenance. Latterly this assumed a serious aspect, and a schedule of dilapidations made in January, 1933, showed an immediate expenditure of £120 per house was necessary to effect a temporary recovery. The scheme for replacing the obsolete property commenced with the demolition of 12 cottages in Dunston Road and the erection on the site of a block of 18 flats and 6 maisonettes on modern lines. The plans were prepared by the Borough Surveyor, and received the Council's approval on 15th May, 1933. The following data will show how the accommodation to be provided is some 50 per cent increase over the old property, while at the same time the tenants will enjoy all the amenities of modern, hygienic, sanitary and fully equipped dwellings, with either 1, 2, 3 or 4 bedrooms. Each dwelling has a kitchen, living-room, and separate bathroom and W.C. hh Comparative Table. Existing Estate New Scheme Remarks Total Area 152,895 ft. sup. 152,895 ft. sup. Unchanged. Approximate built up area 67,925 ft. sup. 61,290 ft. sup.. 6,635 ft. sup. increased open space for ventilation. Population housed 940 1,400 460 increase. Average floor area based on Dunston Road Block 512 ft. sup. (area of each 2-storey cottages now demolished) 560 ft. sup. one bedroom flats Substantial increase 610 ft. sup. two bedroom flats. 787 ft. sup maisonettes Average cube based on Dunston Road Block 4,096 ft. cube 4,760 ft. cube one bedroom flats Substantial increase 5,185 ft. cube two bedroom flats 6,750 ft. cube maisonettes Total habitable space 183,325 ft. cube for entire block. 112 VIII.—MATERNITY AND CHILD WELFARE. For the purpose of Maternity and Child Welfare work the Borough is divided into seven districts. Six of these are allocated to the six Municipal Health Visitors whose office is at the new Public Health Offices, 8-14, Laburnum Street, and one to the School for Mothers, a voluntary organization employing two Health Visitors, that for many years has done most excellent work in the Borough. The School for Mothers is at 28, Herbert Street, where the Health Visitors have their office, and where Centres are held. Home Visiting. Under the provisions of the Notification of Births Act, 1907, and extending Act, 1915, all births must be notified to the Medical Officer of Health within 36 hours. Acting upon the information thus received the Health Visitors visit all babies born in their district as soon as the Midwife in charge has left, which she ordinarily does when the baby is ten days old. The number of live births notified during the year was 1,448, and the number of still births 51. There were 51 illegitimate births. The number of registered births was 1,494. The number of births notified and registered are not strictly comparable as the time allowed to lapse is different under the two acts, but the fact that the ratio of births notified to births registered was 96 9 to 100 gives an indication that notification is being carried out in a satisfactory manner. Particulars of the visits paid by the Health Visitors will be found in the table at the end of this section of the report. The question of the adequacy of the home visiting engaged the attention of the Committee during the year and soon after its conclusion the Council adopted a recommendation to appoint two additional Health Visitors in the place of certain part-time officers and holiday locum tenentes. These arrangements will fall to be described in detail in the next report. They are mentioned here for the reason that it is intended that they shall be the means of increasing the number of visits paid to the homes. As has often been stated in these reports, home visits are the foundation upon which all other Maternity and Child Welfare work rests. Infant Welfare Centres. At the end of the year the weekly programme of Welfare Centres was as follows (Mornings, 9.30-11.30. Afternoon, 2-4):— MONDAY. Afternoon. Model Welfare Centre, 210, Kingsland Road. District 2. Dr. Olivier Richards. Hoxton Market Mission. District 6. Dr. R. Hudson. TUESDAY. Morning. Model Welfare Centre, 210, Kingsland Road. District 1. Dr. E. C. McGregor. Hoxton Hall, Hoxton Street. District 4. Dr. R. Hudson. 113 TUESDAY. Afternoon. Model Welfare Centre, 210, Kingsland Road. Districts 1 and 2. Dr. E. M. Goffe and Dr. A. Rose. School for Mothers, 28, Herbert Street. District 7. Dr. N. Dancy. Hoxton Hall, Hoxton Street. District 4. Dr. R. Hudson. St. Helen's Club, St. John's Road. District 5. Dr. L. Phillips. WEDNESDAY. Afternoon. Model Welfare Centre, 210, Kingsland Road. District 3. Dr. Olivier Richards. Hoxton Market Mission. District 6. Dr. E. M. Goffe. THURSDAY. Afternoon. Model Welfare Centre, 210, Kingsland Road. District 5. Dr. E. C. McGregor. School for Mothers, 28, Herbert Street. District 7. Dr. L. Livingstone. FRIDAY. Afternoon. Model Welfare Centre, 210, Kingsland Road. District 4. Dr. Sylvia Smith. Harbour Lights, Goldsmith Row. District 3. Dr. E. M. Goffe. At the time of writing arrangements have been made to open a Centre at Haggerston Mission Hall on Thursday afternoon, to serve the needs of District No. 3. Hitherto two doctors have attended Harbour Lights, one seeing the mothers and children from District No. 1, and the other those from District No. 3. Consequent upon the reorganization of the Health Visitors Districts the attendance of mothers from No. 1 District at Harbour Lights was discontinued and only one Doctor now attends this Centre. Particulars of attendances at the Centres are given in the table on page 135. Approximately 80 per cent of all infants under one year of age visited the Centres during the year. The average number of attendances made was 157. Educational work at the Centres continued throughout the year A special feature was made of talks and demonstrations upon dietetics, these being held not only in the Welfare Centre but frequently in the various halls in which Centres are held throughout the Borough. As in previous years Miss Mould, the Dental Hygienist, gave talks and demonstrations upon the need for dental care. National Parentcraft Competition. In the last Report mention was made of the fact that the Shoreditch Centres had entered the National Parentcraft Competition. A further entry made in 1933 met with the highly gratifying result that the Shoreditch Municipal Maternity and Child Welfare Centres won Dr. Eric Pritchard's Special Prize for the best medical and health visiting records. 114 Students. The arrangement referred to in the last report under which five Students from the National Health Society attend the Maternity and Child Welfare Department on Tuesday and Thursday each week, continued during the year. These Students prepare for the examination for the Health Visitor's certificate and receive practical instruction in all branches of the work. In addition to these Students, four probationer Health Visitors were engaged in the Department throughout the year in accordance with the arrangements approved by the Ministry of Health under Circular 978 and fully explained in last year's report. Babies' Wards. Model Welfare Centre. There is accommodation at this Centre for 10 babies, or 8 babies and 2 mothers. Babies suffering from disorders of nutrition are admitted and mothers with their babies for the establishment of breast feeding. The nursing staff comprises a matron (Miss Borrow), sister, three staff nurses and three probationers. Statistical summary relating to children admitted: — Number of cases in the wards on 1st January, 1933 10 Number of cases admitted 54 babies and 1 mother. Average duration of stay 91 weeks. Reason for admission:— Wasting and malnutrition and debility 28 Prematurity 3 Disorders of digestion 3 Mother dead 1 Weaning 5 Establishment of breast feeding 8 Rickets 2 Bronchitis 1 Mismanagement 3 Two cases were transferred to Hospital and two to Convalescent Homes. There were two deaths:— Male.—1 month: Prematurity. ,, 5 months: Acute Enteritis. 115 Artificial Sunlight Clinic. This Clinic is now held in the new building and is reached by a covered passage from the Welfare Centre. As was anticipated the new premises have proved a very great improvement upon the old. The Clinic is held on Monday, Wednesday, Thursday, and Friday afternoons, and is under the medical direction of Dr. McGregor, the Assistant Medical Officer of Health, who holds two medical consultations weekly. A mercury vapour lamp (K.B.B.) is used. Sister M. Pollard gives the treatment and is responsible for the records and the general arrangements of the Clinic. Particulars of attendances during the last four years are shown in the following table : — 1930. 1931. 1932. 1933. Number of children referred to Light Clinic 244 269 257 214 Total attendances 4,095 4,973 5,552 5,655 Average number of visits per child 17 18.5 21.6 26.4 Average number of attendances per session 20 24.5 27 27.9 The diagnosis and progress of all cases referred to this Clinic for treatment of rickets is checked by X-ray examination which is carried out at St. Leonard's Hospital under an agreement with the London County Council. The number of X-ray examinations made during the year was 67. The members of the Sutton Branch of the Voluntary Aid Detachment continued, as they have done for so many years, to render invaluable assistance in the good work of this Clinic. Voluntary Workers. The work of the Maternity and Child Welfare Department is much indebted to many ladies who regularly attend for the purpose of performing voluntary tasks in connection with the various Centres and Clinics. As a result of the help thus given the members of the staff are able to devote themselves more exclusively to duties for which their special training is necessary. Otorrhcea Clinic. The Otorrhcea Clinic is held at the Model Welfare Centre every morning, Saturday included, from 10 to 11. The Assistant Medical Officer of Health supervises generally the work of this Clinic, 116 All children attending the Welfare Centre found to be suffering from Otorrhoea are referred to the Queen's Hospital for medical advice, and they receive at our Clinic, from a Nurse attached to the Shoreditch and Bethnal Green District Nursing Association, treatment recommended by the Consultant at the Hospital. Particulars of the attendances of this Clinic since its inception are contained in the following table:— Year. No. of individuals treated. Total Attendances. Average No. of Attendances made per Patient. 1929 (44 weeks) 90 973 10.75 1930 161 1,812 11.25 1931 137 1,674 12.22 1932 131 1,819 13.89 1933 64 1,082 16.90 Breast Feeding Clinic. This Clinic is now held in the specially designed quarters adjoining the Light Clinic in the new building. As already explained there is a corridor between the new building and the Welfare Centre. In the past the excellent work done by this Clinic was carried on under very unfavourable conditions, and it is a matter for satisfaction that it is now suitably housed and equipped. The Clinic is open from 9 a.m. to 5 p.m. on Monday, Wednesday, and Friday, and a mother can attend as often as necessary between these hours, or if advised to do so, can spend the day at the Clinic. Dr. McGregor is in medical charge, and the routine work is carried out by Sister Christey (S.R.N., C.M.B.) assisted by Miss Grist, who is a Norland trained Nurse. The particulars of the work done during the year are as follows:— Number of individual mothers attending 257 Total attendances 832 Visits to defaulters 75 117 Dental Treatment. 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 1931 527 1,776 1932 463 1,831 1933 483 1,776 In last year's Report mention was made of an enquiry into the state of the teeth of 300 children born in 1929. This enquiry was directed by Dr. McGregor, the Assistant Medical Officer of Health, and the actual inspections, which were visual inspections without the use of mirror or probe, were carried out by Miss Mould, the Dental Hygienist. Of the 300 children so inspected 155 were found to have defective teeth either of slight or severe degree. This high proportion shows that local conditions favour the development of dental defectiveness at an early age. Enquiry was made in all cases as to whether or not the child had been breast fed and as to whether or not cod liver oil had been given, but the results obtained do not suggest any definite correlation between either of these disiderata and freedom from dental decay. A possible explanation is that the diets of the mother and child, bad housing conditions and lack of sunlight have exercised a preponderating influence. Decayed teeth is the commonest of the defects found upon the examination of school entrants and is one that has a far-reaching influence upon future health. In attacking the problem we should begin at the beginning by giving special attention to the diet of the expectant mother and to ante-natal treatment generally. 118 Agreement with Queen's Hospital for Examination and Treatment of Children referred from Welfare Centres. This Agreement came into operation on 22nd January, 1930, and in consideration of a payment of £150 per annum, 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 and treatment. The following are the particulars of the cases referred under this Agreement during the last four years : — in-patients. out-patients. casualty. Number. Days. New Cases. Attendances. New Cases. Attendances. 1930 2 - — 107 — 121 1931 13 235 133 597 155 276 1932 37 624 192 909 189 729 1933 35 616 255 1,191 225 597 At the time of writing the Council have agreed to increase the payment in respect of this agreement to £200 per annum. 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 seven years have been as follows:— 28, Herbert Street. Model Welfare Centre. 1927 484 592 1928 463 549 1929 319 526 1930 416 595 1931 357 593 1932 378 633 1933 560 573 119 Dining Centres. There are two Dining Centres, one at 31, Herbert Street and one at the Model Welfare Centre, both under the direct control of the Maternity and Child Welfare Committee. At these Centres, the Maternity and Child Welfare Committee allow dinners to necessitous mothers upon the certificate of the Assistant Medical Officer of Health and the recommendation of the Health Visitor. Eligibility for these allowances is determined by the application to each case of the approved scale of income set out in the next section of this report dealing with milk allowances. Except in special cases where the need is urgent, all statements as to income are verified before the allowance is made. Great benefit is derived from these dinners both during the later months (5th to 9th inclusive) of pregnancy and the period of lactation. The number of mothers attending for dinners during 1933 and the three preceding years are compared in the following table:— Model Welfare Centre. 31, Herbert Street. 1930. . 1931. 1932. 1933. 1930. 1931. 1932. 1933. Number of individual mothers attending 114 183 234 229 122 148 201 194 Total attendances 6,625 11,552 14,130 13,635 8,749 10,046 13,659 12,017 Fresh fruit and salads are now more freely introduced than was formerly the case. In October, 1932, a scheme was commenced under which selected children under five years of age who were eligible on financial grounds to receive milk allowances should as an alternative be allowed dinners at the Welfare Centre on the recommendation of the doctor at the Welfare Centre and the Health Visitor. The menus for these Toddlers' dinners have received special consideration, and much time has been given by voluntary and other workers to assisting in feeding these babies, many of whom require much coaxing and management. The results, however, have been most gratifying, as these children have been found to make excellent progress and to have gained in weight. One teaspoonful of pure cod liver oil is given to each child after the dinner. The number of individual toddlers who attended these dinners during the year was 139, and the total number of attendances was 5,443. 120 Milk Allowances. An allowance of milk is made to necessitous nursing and expectant mothers and to children under five 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 or 1 lb. Dried Milk weekly. Child under 3 years of age1 pint daily or 1 lb. Dried Milk weekly. Child 3-5 years (upon special medical certificate) 1 pint daily or 1 lb. Dried Milk weekly. Child 3-18 months (upon special medical certificate) 1J pints daily or 1½ lbs. Dried Milk weekly. The number of individuals in receipt of milk or dinner allowances was 1,274 at the beginning of the year, rose to 1,532 in June, and by the end of this year had fallen to 1,307. The minimum being in September, when the number was 1,187. With the approval of the Committee the rule requiring parents to bring children in receipt of milk or dinner allowances regularly to the Centre continued to be strictly enforced. This ensures that mothers receive instruction regarding their children and that the latter are under medical supervision. 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:— 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. 121 Nursing. The District Nursing Association undertake the nursing of children under five years and parturient women referred to them by medical practitioners and by the Maternity and Child Welfare Department. The number of cases visited was 244 and the number of visits paid 3,198. The particulars of these cases will be found on page 42 of this report. Convalescence. Children recommended for convalescent treatment by the doctors at the Welfare Centres can be sent either to one of the homes approved by the Invalid Childrens' Aid Association, with which organization the Committee have a working arrangement, or to the Noel Home at Letchworth, or the John Maddox Home at Basing, the Homes of the Association of Infant Welfare Centres. The number of children whose convalescence was arranged by the Invalid Childrens' Aid Association was 16 and in 15 of these cases the Maternity and Child Welfare Committee made a contribution towards the cost. In March an agreement was entered into with the Association of Infant Welfare Centres under which, in consideration of a payment of £150 per annum, three beds at the Letchworth Convalescent Home, or alternatively, at the John Maddox Home at Basing, were placed at the disposal of the Committee. This former home now takes the place of the one at Arkley, near High Barnet. With the exception of one week these cots were continuously in use throughout the year. Eighteen children were convalesced under this agreement during the year. Owing to an epidemic of infectious disease in the home at Letchworth several children were kept longer than had been advised. The average duration of convalescence of all children above referred to was slightly over 8 weeks. Mention was made in the last Report of the kind gift of Miss Ricketts of a sum of money to assist in making arrangements for convalescence. Altogether, Miss Ricketts' generosity has been the means of sending away 10 children and 9 mothers in addition to those mentioned above. School Entrants. I have to thank the School Medical Officer of the County of London for the following information regarding the routine medical inspection of the Shoreditch children who entered school during 1933. This information is of much interest affording as it does an indication of the physical condition of children at the age at which they pass beyond the scope of our Maternity and Child Welfare schemes. Routine Medical Inspection of Elementary School Entrants in Shoreditch in 1933. Clothing & Boots Nutrition Cleanliness of Head Cleanliness of Body Teeth Number examined Good Fair Poor Good Average Below normal Bad Clean Nits Pediculi Clean Dirty Pediculi All sound Less than 4 decayed 4 or more decayed For treatment Entrants— Boys 821 254 516 51 187 581 53 707 102 12 736 76 9 501 228 92 294 Girls 779 235 485 59 158 573 48 613 138 28 679 91 9 514 189 76 251 Total 1,600 489 1,001 110 345 1,154 101 1,320 240 40 1,415 167 18 1,015 417 168 545 Per centage 30.6 62.5 6.9 21.6 72.1 6.3 82.5 15.0 2.5 88.5 10.4 1.1 63.4 26.1 10.5 34.1 London, percentage 55.0 44.2 0.8 20.5 75.4 4.1 96.6 3.0 0.4 98.2 1.7 0.1 55.7 32.6 11.7 40.4 122 123 Routine Medical Inspection of Entrants in Elementary Schools in Shoreditch in 1933. *—Defects found, †—noted for treatment and included in defects found. Disease or Defect Boys Girls Shoreditch % London % Shoreditch % London % Skin disease * † 15 1.8 1.1 4 0.5 0.9 10 1.2 0.8 3 0.4 0.6 Tonsils only * † 124 15.1 14.2 109 14.0 14.4 47 5.7 5.1 42 5.4 5.0 Adenoids only * † 5 0.6 1.1 2 0.3 0.9 2 0.2 0.6 2 0.3 0.5 Tonsils and Adenoids * † 6 0.7 2.7 8 1.0 2.5 3 0.4 1.9 4 0.5 1.8 Other Nose and Throat * † 5 0.6 1.2 2 0.3 1.1 2 0.2 0.5 —. —. 0.4 Glands of Neck * † 9 1.1 2.4 4 0.5 2.1 1 0.1 0.3 — — 0.2 Eye disease * † 30 3.7 3.2 38 4.9 3.0 24 2.9 2.0 33 4.2 2.0 Otorrhoea. * † 17 2.1 1.1 11 1.4 1.0 15 1.8 0.8 6 0.8 0.7 Other Ear disease * † 1 0.1 0.4 2 0.3 0.5 1 0.1 0.2 1 0.1 0.3 Hearing * † — — 0.2 1 0.1 0.2 — — 0.1 1 0.1 0.1 Speech . * † 1 0.1 0.3 2 0.3 0.2 1 0.1 0.0 — — 0.0 Heart * † 9 1.1 1.7 11 1.4 1.7 — — 0.1 2 0.3 0.1 Anaemia * † 1 0.1 1.1 5 0.6 0.9 — — 0.4 3 0.4 0.3 Lungs * † 33 4.0 3.7 32 4.1 3.4 11 1.3 1.1 12 1.5 1.1 Epilepsy * † - — 0.0 — — 0.0 — — 0.0 — — 0.0 Chorea * † - — 0.0 — - 0.0 — — 0.0 — - 0.0 Paralysis * † — — 0.0 1 0.1 0.0 —- — 0.0 — - 0.0 Other Nervous Disorders * † 1 0.1 0.5 2 0.3 0.4 — — 0.1 — — 0.1 Pulmonary T.B. * † — — 0.0 — - 0.0 — — 0.0 — — 0.0 Other T.B * † — — 0.0 .— — 0.0 - - - - - - Rickets * † 2 0.2 0.7 1 0.1 0.3 2 0.2 0.1 - — 0.0 Spinal Deformity * † — — 0.1 1 0.1 0.1 — — 0.1 1 0.1 0.1 Other Deformities * † - — 0.9 2 0.3 0.7 - — 0.2 1 0.1 0.2 Other Defects * † 12 1.5 2.5 19 2.4 2.6 6 0.7 1.4 15 1.9 1.5 124 Maternal Care. At the end of the year the Council's scheme for the care of women during the periods of pregnancy, parturition and puerperium comprised the following activities:— Home Visiting. Pregnancy is not a notifiable condition, but as a result of the widely spread knowledge concerning, and confidence in, Maternity and Child Welfare work, many women seek the advice of the health visitors in connection with this matter. If schemes for maternal care are to achieve their object of helping and safeguarding women during the critical periods referred to at the beginning of this sub-section it is of the greatest importance that advice should be sought as soon as pregnancy is suspected. Delay increases the difficulty of correcting any abnormality that may be present. The numbers of individual expectant mothers visited and subsequent visits paid to these during recent years are shown in the following table : — 1925 1926 1927 1928 1929 1930 1931 1932 1933 No. of individuals visited 564 641 619 592 641 631 568 636 456 Total number of visits paid 1,027 1,200 1,109 1,045 1,156 1,215 1,011 1,075 998 Ante and Post-Natal Clinics. Particulars of the attendances at the ante-natal clinics will be found in the table at the end of this section. At the time of writing the ante-natal clinics are as follows:— Monday morning. Model Welfare Centre. Districts 1-6. Dr. Gladys Hill. Thursday morning. Model Welfare Centre. Districts 1-6. Dr. Gladys Hili. Thursday morning. School for Mothers, 28, Herbert Street. District 7. Dr. Dancy. Friday morning. Model Welfare Centre. Districts 1-6. Dr. Sylvia Smith. A Post-Natal Clinic is held on Wednesday mornings (2nd and 4th in month only). Model Welfare Centre Districts 1-6. Dr. Gladys Hill. Women attended the ante-natal and post-natal clinics either of their own accord or are referred by doctors or midwives practising in the Borough or by the Health Visitors or by the Municipal Midwife. The number of midwives practising in Shoreditch is 38. 125 Particulars of attendances at these clinics during recent years are contained in the following table:— 1925 1926 1927 1928 1929 1930 1931 1932 1933 ANTE-NATAL— No. of expectant mothers attending 380 504 399 412 494 525 543 646 547 Total attendances 673 863 750 763 961 984 1,348 1,740 1,636 POST-NATAL— No. of mothers attending ... ... ... ... ... ... 36 176 152 Total attendances ... ... ... ... ... ... 69 290 287 The number of women who attended the Ante-Natal Clinics during 1933 amounted to approximately 35 per cent of the confinements in the Borough during the year. In three cases X-ray examinations were made at St. Leonard's Hospital. The decrease to be noticed, both as regards home visits and attendances at ante-natal centres, in the figures for 1933, is associated with the fact that St. Leonard's Hospital and the Salvation Army Nurses at Nichols Square now have ante-natal centres of their own, and that Sister Leaton, the Municipal Midwife, now does a considerable number of ante-natal visits— see her report, page 129. Panel of Consultants. A medical practitioner in attendance upon a woman resident in Shoreditch can upon application to the Medical Officer of Health obtain the advice of a consultant upon any condition arising during pregnancy, parturition or the puerperium. The names of the consultants who are available under this arrangement will be found in the section of this report dealing with Staff. The services of a consultant were engaged on two occasions during the year covered by this report. Maternity Outfits. Packages of sterile dressings for confinement cases have been supplied by the Borough Council since 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. 2d., and the patient is asked to contribute what can be afforded. I 126 During the year 760 packets of dressings were distributed. The contents of these packets are as follows:— 1 Accouchement pad, 36 ins. by 36 ins. 12 Large Maternity Pads. 6 Medium Maternity Pads. 6 Umbilical Pads. 4 ozs. Absorbent Wool. 1 large Waterproof Sheet. Home Helps. Home Helps are provided from a panel of women numbering twelve approved by the Maternity and Child Welfare Committee for this duty. 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. 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 Public Health Offices, 8/14, Laburnum Street, E.2. " 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 Public Health Offices. 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). 127 She is only expected to attend up to a maximum of 48 hours per week for two weeks and should commence duty not later than 8 o'clock in the morning. Any time in excess of this is not paid tor 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 Public Health Offices 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 ther would supply a nurse to doctors' cases if a Home Help is being supplied. It will be noted that under the arrangement regarding St. Bartholomew's Hospital students' cases, page 128, all cases under scale are offered the services of a Home Help. II 128 Home Helps attended in 127 cases, as follows:— Midwives' cases 86 Doctors' cases (nurse also provided) 4 City of London Maternity Hospital 14 St. Bartholomew's Hospital 17 Royal Free Hospital 1 St. Leonard's Hospital 2 Cases approved by Committee under special circumstances 3 127 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 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 Ante-Natal Consultative Centres. Agreements, in force since 1st April, 1930, have been entered into—one with the City of London Maternity Hospital and the other with St. Bartholomew's Hospital, under which cases may 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. The number of cases referred under the agreement during 1933 was: to St. Bartholomew's Hospital 2, to City of London Maternity Hospital 15. 129 Municipal Midwifery. Sister Leaton whose appointment to the position of Municipal Midwife was recorded in the last report submits the following statistical report upon her work during the year:— Municipal Cases St. Bartholomew's Hospital Cases No. of cases attended 55 81 No. of ante-Natal visits 148 350 No. of ante-Natal Clinics attended 46 - No. of post-Natal Clinics attended 2 - To understand this table it is necessary to remember that Sister Leaton takes cases in the Borough who apply for her services (Municipal cases) and also attends the confinements and acts as Maternity Nurse in cases conducted in Shoreditch by Students from St. Bartholomew's Hospital (St. Bartholomew's Hospital cases). The full fee for Municipal cases is 25s. for the first child and 21s. for other children, and the Council have approved a comprehensive scheme under which these charges can be remitted in whole or in part to those whose income falls below a certain scale. The Council receives 15s. from St. Bartholomew's Hospital for every case in which Sister Leaton acts as Maternity Nurse in the manner described. Local Government Act, 1929. The conditions, subject to which the grant formerly payable by the Ministry of Health to the Voluntary Institutions reported upon in this subsection, is now to be paid by the Borough Council out of the Treasury block grant, are set forth in the Ministry of Health scheme prepared under Section 101 of the Act. Subject to these conditions the following voluntary organizations receive the discontinued Ministry grant. Shoreditch School for Mothers. At its meeting in February the Council agreed to increase its contribution to this Association from £955 to £1,205 per annum. In connection with this matter, it is of interest to remember that the smaller sum of £955 was made up as follows: £200 paid to the School for Mothers, Herbert Street, in respect of delegated duties under the Maternity and Child Welfare Act, and £755 payable under the terms of the Local Government Act, 1929, in respect of discontinued grant how included in the Treasury Block grant to the Borough Council, 130 The Committee of the School for Mothers administer the two following institutions:— School for Mothers, 28, Herbert Street. For many years this institution has worked in close co-operation with the Borough Council. A district (No.7) in the Western portion of the Borough in which this Centre is centrally placed has been allocated to the two Health Visitors employed. Notifications of births are sent from the Public Health Offices, and the Health Visitors are responsible for all visiting within this district. Two Infant Welfare, one weighing centre without a doctor, one Ante-Natal Consultation, and a Sewing Class are held weekly. Particulars of the visits made and attendances at the Centres in the School for Mothers district will be found in the tables at the end of this section of the report. Brunswick Day Nursery, Brunswick Place. This Nursery accommodates 40 children. The attendances during the year were as follows: Whole days, 6,373; half-days, 666. The corresponding figures for 1932 were : Whole days, 7,358; half-days, 694. Dr. Dancy is the doctor in charge. She visits the Nursery weekly and in case of emergency a local practitioner is consulted. The staff consists of Matron (Miss Sharpe), Staff Nurse, and five Probationers. The domestic staff, consisting of daily cleaner and laundry woman on two days each week, is non-resident. Sun Babies' Nursery, Norris Street, Hoxton. The amount payable in respect of discontinued Ministry grant is £1,013 4s. 10d. For several years an annual grant of £63 per annum has been paid by the Borough Council in consideration of the value of the work done by this Nursery for the Shoreditch children living in the vicinity. This amount was increased at the end of the financial year 1932-33 to £187 making the total contribution from the Borough Council £1,200. Accommodation for 100 children is available at this Nursery, though with this number the Nursery is somewhat crowded and the average attendance is rather less. The number of whole days attendances during 1933 was 10,949 and of half-day attendances 574. The corresponding figures for 1932 were: whole day, 19,472; half-day, 1,166. 131 The lower number of attendances than in the previous year can largely be accounted for by the fact that two Nurseries were closed for some time owing to re-building. During the year an Army hut was disposed of, and in its place a buildinghas been erected which will give additional bath and lavatory accommodation. The need for this extra accommodation had been felt for some time. Dr. Margaret Morton, the Medical Officer in charge, attends the Nursery once weekly for the purpose of examining the children. An arrangement has been made under which the services of a local medical practitioner are available in emergency. There are three lamps at the Nursery, two are carbon arc, one a mercury vapour, and Dr. Morton gives artificial sunlight treatment twice a week to the children attending. Dr. Mary Luff, who holds the diploma of Psychological Medicine, attends the Nursery at fortnightly intervals for the purpose of detecting early mental defect or abnormality and of advising as to the course of action most suitable to the case. The Maternity and Child Welfare Committee have an arrangement with the Nursery under which payment (9d. per day) is made for the admission of the children of necessitous parents upon the recommendation of the Health Visitor. Necessitousness under this scheme is determined by the application of the "milk scale" (see page 120). In the case of parents falling within the half price scale, the Council pays 4½d. per day to the Nursery and the parent 4½d. Payments under this scheme amounted, during 1933, to £201 10s. 9d. The numbers of children and attendances since the commencement of this arrangement are shown in the following table : Year No. of Children ATTENDANCES At Full Cost At Half Cost Total Attendances 1929 (11 weeks) 20 394 36 430 1930 (full) 69 4,508 124 4,632 1931 64 5,316 265 5,581 1932 158 5,980 61 6,041 1933 75 5,292 164 5,456 In order to ensure continuity of feeding of the bottle fed babies attending the Nursery, milk (wet or dry) is supplied by the Nursery to the mothers of these babies for feeds at night and during week-ends. 132 The resident staff of the Nursery is as follows : Matron (Miss Faraker), two Nurses, one of whom has had a Children's (S.R.N.), and one Day Nursery Training, twelve Probationers, Day Nursery Teacher, who holds fully trained Froebel Certificate, and Cook. The cleaning and laundry staff are non-resident. Dr. Morton's Report upon the Year's Work at the Nursery is as Follows:— 1933-34 has been a constructive year. Many improvements have taken place, but of immediate Medical interest are:— 1. Building extension to accommodate 20 Toddlers (2-3 years). 2. Improved dieting (Protein ratio increased). 3. Additional heating installation. 4. Increase of permanent staff (a) assistant nursery teacher, (b) fied assistant—Ultra Violet Dept. 5. Installation of Mercury Vapour Lamp. 6. Introduction of standard approved uniform garments for babies and tweenies. Worthy of note is, I think the comparative freedom of the children from Diphtheria. There have been no cases this year and I think only three, of which two were bacteriological, in my previous two years' office. The early incidence of measles prevented the children going to the country throughout the summer and autumn, but needy cases are now being sent in rotation. Dental caries, so much a popular topic, has received some consideration. Out of interest, I chose 12 toddlers at random who had been with us 3-4 years. The teeth were carefully scrutinized and results found as follows:— 1. No child had to date required dental attention. 2. Eight children had sound, evenly spaced teeth with no suggestion of caries. 3. The remaining four only shewed small pin pricks of decay in one or at most two teeth. In one there was a small cavity. This result I considered favourable. It is perhaps well to mention that all these children had been given ultra violet radiation. I think the nursery toddlers compare favourably with those I see at Welfares. I believe that at 5 years they start better equipped—probably 6 months ahead of outside children—mentally and physically. 133 With the babies—I think the nursery should remain as it is—a boon for a limited number of specially needful—possibly difficult cases. My own experience is that mothercraft for the milk period has reached a high standard in the home and the milk supply natural or artificial is now assured. With the toddlers after 18 months, home management, home facilities, and dieting are very variable factors to assess, and I think in many cases inadequate to deal with the rather specialized nurture which the present day child apparently demands. Medical Mission of the Good Shepherd, Harman Street, Hoxton. Amount payable in respect of discontinued Ministry grant is now £300 per annum. 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. During the year 45 children were admitted. The particulars of the conditions from which they were suffering are as follows:— Pneumonia 4 Unhealed Wound 1 Bronchitis 7 Cervical Adenitis 1 Concussion 1 Dermatitis 1 Vomiting 2 Prematurity 1 Impetigo 2 Forceps Injury 1 General Debility 5 Constipation 1 Wasting 9 Circumcision 1 Meningitis and Colitis 1 Stomatitis 1 Diarrhoea and Vomiting 5 Pyrexia of unknown origin 1 There were six deaths. At the 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. The Nursing staff is as follows: Matron (Miss D. Edenborough), Sister, Night Nurse, and two Nurses (partially trained). 134 Statistical Report for 52 Weeks ending 30tii Dec., 1933, upon the work of the Health Visitors. Health Visitor's Districts 1 2 3 4 5 6 7 Total No. 1st visits to infants 157 170 195 193 231 175 322 1,443 No. re-visits to infants 315 261 341 254 430 378 1,150 3,089 No. visits to children aged 1 -5 years 1,111 841 1,730 1,076 1,272 1,329 1,389 8,748 No. 1st visits to expectant mothers 52 44 70 51 63 81 95 456 No. re-visits to expectant mothers 112 55 28 49 91 41 166 542 No. of futile visits 183 72 223 181 245 246 871 2,021 No. of interviews, etc 470 116 210 417 110 455 1,095 2,873 No. 1st visits to cases of opthalmia neonatorum, etc - 1 6 21 - 5 - 33 No. re-visits to cases of opthalmia neonatorum, etc. - - 8 18 1 8 - 35 No. 1st visits puerperal fever - - - 6 - 2 - 8 No. re-visits puerperal fever - - 1 4 - 2 - 7 No. 1st visits puerperal pyrexia - 4 4 3 1 4 - 16 No. re-visits puerperal pyrexia — 3 1 8 2 1 — 15 No. of Health Visitors' Attendances at Centres : (a) Hoxton Market Institute 37 1 2 1 47 99 - 187 (b) Hoxton Hall -— — 24 97 — 1 — 122 (c) St. Helens Club — — 1 — 49 27 — 77 (d) Model Welfare Centre 171 261 133 157 135 78 - 935 (e) Harbour Lights 41 — 48 — 1 13 — 103 (/) School for Mothers - - - - - - 368 368 135 Report of Attendances at Welfare Centres during the 52 Weeks ended 30th December, 1933. Health Visitors' Districts 1 2 3 4 5 6 7 Day Tuesday Fri. Mon. Tues. Wed. Fri. Tues day Fri. Tes. Thur. Mon. Wed. Tues. Wed. Thur. Totals a.m. p.m. a.m. p.m. Centre M.C. M.C. H.L. M.C. M.C. M.C. H.L. H.H. H.H. M.C. St.H. M.C. H.L. H.L. H St. H St. H St. 1st Attendances of infants 38 66 18 77 51 107 67 21 46 78 62 105 72 76 159 18 74 1135 Total attendances of infants ... 682 1,131 265 1,260 1,181 1,746 1,010 463 852 1,362 1,060 1,392 1,087 1,011 1,607 343 1,360 17812 1st attendances children over one 9 18 8 48 33 21 24 15 20 16 22 28 55 38 34 5 24 418 Total attendances do. 976 1,233 349 1,491 1,465 1,588 1,374 841 968 1,178 1,428 1,934 1,348 1,408 1,198 229 1,244 20252 Attendances Mothers, etc. 180 404 181 370 375 353 571 164 215 283 268 461 498 493 25 - - 4946 Infants seen by Dr. 1st time 41 64 18 76 50 105 66 19 41 71 61 99 69 75 151 6 97 1109 Total infants seen by Dr. 329 598 129 630 583 747 500 269 430 793 373 563 487 487 889 164 715 8686 Children 1-5 yrs. seen Dr. 1st time 26 37 8 62 28 21 24 10 14 14 21 30 45 31 33 3 29 436 Total children seen by Dr. 482 618 183 746 674 685 763 492 548 617 454 718 576 542 721 127 736 9682 No. suffering from disorders of digestion and nutrition 1,309 551 1,285 1,429 610 346 1,269 6799 No. suffering from minor ailments 598 404 819 952 540 780 1,007 5,100 No. referred to hospital 85 261 146 91 119 78 121 901 1st Ante-natal attendances 40 128 100 50 62 43 124 547 Total do. 121 311 296 204 170 169 365 1,636 1st Post-Natal Attendances 21 21 20 21 22 10 37 152 Total do. 30 29 38 26 43 17 104 287 Sewing Class Attendances 87 172 38 231 45 560 1,133 136 Infant Life Protection. Under the provisions of the Transfer of Powers Order which became operative on 1st April, 1933, powers under Part I of the Children's Act, 1908, as amended by Part V of the Children's and Young Persons' Act, 1932, were transferred to the Borough Council. Briefly the duties transferred are as follows :— Reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of infants, and the inspection of premises by infant protection visitors or other persons appointed by the Council for that purpose. Fixing the number of infants to be kept in a dwelling in which any infant is received for reward. Applications to a Court of Justice for an order directing the removal of an infant to a place of safety. Miss Heward, who holds the office of Health Visitor under the Shoreditch Borough Council, was appointed Infant Life Protection Visitor and is normally responsible for carrying out the duties above-mentioned. In order that there should be no interruption of this work at holiday times or in an emergency, the other Health Visitors, namely, Mrs. Bales, Miss Brotherton, Miss Hunt, Miss Morrell and Miss Redcliffe were also formally appointed in the same capacity, but ordinarily Miss Heward is the officer responsible for the discharge of these duties. Miss Heward submits the following report upon her work :— Report on Infant Life Protection Work in 1933. The Infant Life Protection work was taken over by the Borough Council on 1st April, 1933. At that time there were 11 Foster Mothers living in tine Borough each having one Foster-child. During the year 7 new Foster Mothers were registered, and one already registered took two children. Six Foster Mothers were removed from the register under the following circumstances : — (a) In two cases, the children reached 9 years of age, and were referred to the School Care Committee. (b) Three parents removed their children. 137 (c) In the sixth case the payments made by the mother were irregular and insufficient, thus causing unpleasantness between the Foster Mother and her husband. This made the mental atmosphere of the home bad for the child. Arrangements were subsequently made for the child to be taken by the Public Assistance Committee. One of the children taken by the Foster Mother, registered for two, had an accident, and as it was considered that this might be due to carelessness, the Foster Mother was instructed to return the child to its parents. Alternative homes were offered. 202 visits in connection with the work were paid in 1933. These visits consist of: — (a) Regulation visits to Foster Mothers. (b) Visits to parents wishing to find Foster Mothers for their children. (c) To inspect the homes of women desirous of taking a Foster-child. (d) To children returned to their parents from Foster Mothers out of the Borough. (e) To parents of children placed with Foster Mothers in this Borough. Each Foster-child under two years of age is visited once a month. Children between 2 and 9 years of age are visited once in two months. In cases of illness and at the request of Foster Mothers the visits are more frequent. Each Foster-child has been visited once between the hours of 7 and 9 p.m., and several have been visited as early as 9 a.m. I. M. Heward, Infant Life Protection Visitor. Report by Dr. Evelyn McGregor, Assistant Medical Officer of Health. Progress in many directions has been made in Maternity and Child Welfare work in the Borough during the year 1933. It is wise to pause periodically to review this progress in the light of past experience, and as an aid to future endeavour. Maternity and Child Welfare work, a service still in its infancy, was commenced with the object of lowering infantile mortality. This purpose is already being achieved, and in its achievement the work is meeting a much greater need—it is educating the parents. 138 The function of education is to prepare individuals for complete living, and yet, in the past, this most important branch of education, the training in the art of parentcraft, lias been entirely neglected. The bringing up of children was left to impulse, joined with suggestion from people who often had no knowledge of the laws of health. It is not surprising that thousands of children died, and that many who survived were enfeebled in body and mind. To fill this need of education is then the primary function of our work, and 1933 has been a year of steadfast endeavour in this direction. The forms of teaching vary—perhaps the most successful method of instructing mothers is group teaching each day during the session at the Welfare Centres. Talks are given, aided by practical demonstrations, and this method is found to be most far reaching in its results, especially among the less educated type of mothers. They frequently remember what they see more than what they hear,'and we know by question and answer, -and by simple written competitions, that the teaching is bearing fruit. This work has been undertaken by Health Visitors and Student Health Visitors under my supervision—most of the talks being written and scrutinized before being given. Great care must be taken that knowledge imparted to mothers is sound, accurate and up-to-date. To achieve this object it is of the utmost importance that the Health Visitor should be acquainted with recent advances in knowledge, by reading widely and by attending Conferences, lectures, and post-graduate courses from time to time. During the year an effort litis been made to cover the whole range of subjects relating to the successful rearing of children. In view of the modern advances in the study of diet, however, we have concentrated somewhat on this factor during the year. For although it is impossible to buy sufficient food with insufficient money, it does not follow that those who have enough money get the right kind of food. We have also concentrated on propaganda on Breast Feeding with successful results. Only 25% of children attending our largest Infant Welfare Centre were artificially fed during the year. The second method of instruction is by individual teaching given at the Centres by the Doctors, Health Visitors, Students and by the Dietitian. The function of the Health Visitor as an advisor has been encouraged during the year—much of the routine work being undertaken by Students and voluntary workers. Here again it is essential that the Health Visitor should keep up to date with recent advances in knowledge, as she may be faced with difficult problems in child management which require thought and study. Students, of whom we had 2(i in Shoreditch during the year, also had practice in this form of teaching, and an attempt was made to train the students to develop a thoughtful attitude to the work, to be enthusiastic and to use initiative. 139 Much good educational work has been undertaken during the year by the Dietitian, who gives valuable detailed advice on diet to individual mothers. In this field of individual teaching there is room for skilled instruction to mothers in dealing with the problems of child management. Few of the mothers have any knowledge of dealing with the unfolding mind of childhood, and many are utterly confused when difficulties arise. During a busy Child Welfare Session, it is only possible, owing to lack of time, to tackle these problems cursorily. There is great need in tine future to concentrate more on this side of the work, and in this connection, doctors undertaking Child Welfare work should be acquainted with recent advances in Psychology. Scientists are agreed that it is in the pre-school years that the whole foundation of the child's character is laid—the Maternity and Child Welfare service has then a glorious opportunity and a great responsibility. We must take full advantage of this opportunity. That some instruction in the laws of health and in infant care could, with advantage, be given to school children is undoubted. At the time of writing, therefore, a class for school girls is being held at the Welfare Centre. The education of the father, too, comes within the scope of the work, and it is hoped that we shall be able to tackle this problem in the near future. In Health Week we had an original piece of Health Propaganda in the form of a Toddlers' Revue. The object was to stimulate interest and enthusiasm in the child and his environment through the artistic senses. A rhythmic exercise class for children between three and five years of age has been held throughout the year, directed by Mrs. Sykes, a trained voluntary worker. These children gave a display of movements and dancing entitled "The Dawn of Health" and "The Dance of the Germs." A series of tableaux of children throughout the ages led up to a scene in which a group of children in model garments displayed the ideals of modern children's clothing—comfortable, hygienic and beautiful, and served to direct the mothers' minds to the importance of correct clothing as an aid to health. Dental drill and a tableaux of silhouettes "Coming to the Welfare Centre" completed the entertainment, and there is no doubt that the Revue produced the desired results. Steady endeavour and constant enthusiasm on the part of the staff is essential in a successful Maternity and Child Welfare service, and I take this opportunity of thanking all those who have helped in the uphill task. 140 IX.—HEALTH WEEK. The general arrangements in connection with Health Week were similar to those of the preceding year. During this Week, commencing Monday, 2nd October, a series of Health Lectures, illustrated by films, were given at the Town Hall. On Wednesday, 4th, a Swimming Gala was held at the Pitfield Street Baths. The programme included fancy diving by members of tne Highgate Diving Club, team races for Shoreditch girls and for Shoreditch boys, a ladies' water polo match, a swimming display by members of the Hammersmith Ladies' Swimming Club, and a water polo match between two men's teams. Music was provided by the Hoxton Excelsior Silver Band, and the evening proved most interesting and enjoyable. A new feature was introduced by Dr. McGregor, the Assistant Medical Officer of Health, who arranged a Toddlers' Revue that was performed before appreciative audiences on Tuesday, Wednesday, Thursday and Friday afternoons. In this Revue simple laws of health were symbolized in a lighthearted and charming manner, and as mothers and children themselves were the principal performers, the educational benefit of this delightful entertainment was enjoyed on both sides of the curtain. The Week concluded with a display of Physical Training by members of the Maurice Hostel Girls' Club, and of Gymnastics by the Hoxton Manor Boys' Club. Both were excellent and both were a strong incentive to other girls and boys to take exercise. In so doing they will both enjoy themselves and promote good health. The programme for the Week was as follows : — Date. Lecturer. Chairman. Monday, 2nd October, 1933. 8 p.m. Dr. Maitland Radford, Medical Officer of Health, entitled "What We Eat." Film : " Our Food Supplies" Mr. Councillor W. Parr. 8.30 p.m. Dr. A. D. Matthews, entitled "Modern Methods of Diagnosis and Treatment." Film : "The Death Mystery" Mr. Councillor T. Baker. Tuesday, 3rd October, 1933. 7.30 p.m. Mr. F. W. Maquire, L.D.S., Dental Board of the U.K., entitled, "Your Teeth : How They Come and Where They Go." Film: "Outposts of Health" Mr. Councillor W. J. Parker. 8.30 p.m. Dr. I. Feldman, entitled: "The Tragedy of Ignorance." Films Mr. Councillor R. E. Palmer. 141 Wednesday, 4th October, 1933. 7.30 p.m. Swimming Gala at Hoxton Baths, Pitfield Street. Thursday, 5th October, 1933. 7.30 p.m. Mr. Councillor W. E. Yarrow, J.P., entitled, "Maternity and Child Welfare Administration." Film: "Rules for Jim" Mr. Councillor E. Lee. 8.30 p.m. Dr. W. E. Cartney, L.C.C., entitled, "Diphtheria Immunization." Film : " Risk of Diphtheria Banished" Mr. Councillor W. Ricketts. Friday, 6th October, 1933. 7.30 p.m. Dr. C. K. Cullen, Tuberculosis Officer, entitled "Tuberculosis." Film: "Consumption" Mr. Councillor D. Rider. 8.30 p.m. Mr. Councillor H. P. Griffiths, entitled, "The Housing Question." The Under Forty Club Housing Film. Mr. Councillor J. S. Baker, J.P. Saturday, 7th October, 1933. 7.30 p.m. Gymnastic Display by Hoxton Manor Boys' Club and Maurice Hostel Girls' Club. Tuesday to Friday. 3 p.m. A "Toddlers' Revue" arranged by Medical Officer of Health. Dr. E. C. McGregor, Assistant The attendances during Health Week were as follows :— Days. School Children. Mornings. Toddlers' Revue (Afternoon). Evenings. Total. Monday _ 1,000 1,000 Tuesday 640 720 1,700 3,060 Wednesday 850 550 1,400 2,800 Thursday 400 700 1,600 2,700 Friday 1,000 1,000 750 2,750 Saturday _ _ 2,400 2,400 2,890 2,970 8,850 14,710 k 142 X.—STAFF OF THE PUBLIC HEALTH DEPARTMENT. The following are in the permanent employment of the Borough Council:— 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 (including special duties in connection with Maternity and Child Welfare). Evelyn C. McGregor, M.B., Ch.B., D.P.H. Chief Clerk and Administrative Assistant, E. G. Wilsher. First Assistant Clerks, E. J. Hayes, G. H. Pratt. Clerks : H. P. Abbott (General Assistant), E. R. Banks. H. Fitzgerald, W. L. Job, V. H. Sewell, W. Wilson, E. lehanet (14), I. M. Rutiierford+. (tThese two ladies also assist at Welfare Centres). Enquiry Officer (Part time in Health Department), W. E. Dale. Telephone Operator, W. F. Leaver. Porter, A. Duck. Senior Inspector, J. H. Pearson (Retired 21-2-33). C. J. Wright (Appointed 21-2-33). District Sanitary Inspectors. I, H. G. Chapman1?, 8, 10; n, G. C. E. Gibbs9, 10; III, D. Grant?, 11; IV, R. A. Bishop?, 10; V. G. Walker?, 8l 10; VI, A. Stratton?, 11; VII, C. J. Wright?, 10; VIII, J. B. Molloy?, 8, 11; IX, J. H. Thomas?, U. Inspector with duties under Food and Drugs Acts, etc., F. C. Shaw?, 11. Maternity and Child Welfare. Health Visitors: District Numbers I, M. Redcliffe2, 3; 5; II, M. Morrell2, 5, 8; III, D. BalesI, 2, 3, 5; IV, I. M. HewardI, 2, 3, 7, 8, 16; v, B. C. HuntI, 2, 3; VI, A. M. BrothertonI 2 3. Model Welfare Centre, 210, Kingsland Road. Municipal Midwife, A. E. LeatonI 2 3. Nursing Staff:—Matron, M. D. Borrow! 2 3; Sister, D. A. KennedyI 2 3; Staff Nurses, G. E. Woods1', J. E. Gray, 1, 2, 3, 5 ; E. Crowley, 1, 2, 3 ; I. Rockingham (resigned 24-7-33), J. Williams (resigned 31-8-33). Other Staff:—Cook, E. Riggs ; Waitress, J. McDonnell; Porters, J. E. Perry, H. Peters, H. Oliver. Laundress and. Helper, M. Whittington; Cleaner, J. Durling. Dining Centre, 31, Herbert Street. Cook Caretaker, M. Zemaitis. General Assistant, W- Miller. Tuberculosis Dispensary, 145, Gt. Cambridge Street. Tuberculosis Officer, Carl Knight Cullen, M.R.C.S., L.R.C.P., D.P.H. Tuberculosis Visitors, A. A. GrangeI, 3; "W. I. HiscokeI 2 3 15; Dispenser, J. N. HolmesG ; Clerk, W. Harris ; Porter, A. Whittard. DENTAL HOSPITAL, Dental Surgeon. H. L. Davies, L.D.S., R.C.S. (England). (Resigned.) Sister and Clerk. Nurse and Assistant Clerk. L. FrierI 2 3. M. F. Campbell (Temporary). Dental Mechanic* T. A. Diss. 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 oi Mr. Dyson also as Registrar of Marriages. 143 Disinfecting Officers (Town Hall). A. Fawns. G. Kennedy. A. Flack. Mortuary (St. Leonard's Churchyard). Keeper, G. Ball. The following officers who are not members of the permanent staff perform various duties in connection with the work of the department:— Physicians to Maternity and Child Welfare Centres: Sylvia Smith, M.B., B.S. ; Noel Olivier Richards, M.D., B.S., M.R.C.P. ; Edna M. Goffe, M.B., B.S., D.P.H. ; Alice Rose, M.B., Ch.B., M.R.C.P.; Gladys Hill, M.D., B.S. ; Rose Hudson, M.B., Ch.B., D.P.H.; Lilian Phillips, M.R.C.S., L.R.C.P. ; Naomi Dancy, M.B., B.S. ; Louise Livingstone, M.D. 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. McC-ullagh, D.S.O., M.C., M.B., Bch., F.R.C.S.; F. W. Roques, M.D., Bch., F.R.C.S. ; Harold Chapple, M.B., M.Ch., F.R.C.S. Bacteriologist: F. H. Teale, M.D., F.R.C.P. Ancesthetist to Dental Hospital: Maurice Marcus, M.B., B.S., M.R.C.S., L.R.C.P. Public Vaccinators : Dr. N. H. Clubwala, 247, Kingsland Road, E. 2. (For Moorfields, Church, Hoxton and Wenlock Wards.) Dr. L. Statnigrosch, 191, Kingsland Road, E. 2. (For Whitmore, Haggerston, Kingsland and Acton Wards.) Public Analyst: H. G. Harrison, M.A., F.I.C. Health Visitors, Shoreditch School for Mothers, 28, Herbert Street, N. 1. No. 7 District: E. F. DanceI 2 3 ; n. K. Fitzmaurice2. Sister in Charge, Artificial Sunlight Clinic : M. Pollard^. Sister in Charge, Breast Feeding Clinic and Relief Midwife : R. ChristeyI 2 3. Dental Hygienist: Miss Mold!?. Secretary, Tuberculosis Care Committee : Miss E. Church. Probationers, Model Welfare Centre : T. Davies, B. Grist, M. McKenzie. Women Cleaners, Model W elf a rd-. Centre : A. Hesketh, E. Williament, C. Gascoigne. Telephone Assistant, Model Welfare Centre: K. Williams. Assistant Enquiry Officer : G. A. Newson. 'Tram Minder and Assistant, Model Welfare Centre : E. Sage. Plaster Boy, Dental Hospital: J. H. Cooper. NOTES. 1 State Registered Nurse. 2 Certificate of Central Midwives Board. 3 Certificate of General Training. 4 State Registered Children's Hospital Trained Nurses. 5 Health Visitor's Certificate. 6 Certificate of the Society of London Apothecaries. Certificate in Practical Bacteriology given by London College of Pharmacy, Westbourne Park Road. 7 Certificate of Sanitary Inspectors' Examination Board.. 8 Certificate of Royal Sanitary Institute as Inspectors of Nuisances. 9 Certificate of Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. 10 Certificate of Royal Sanitary Institute for Inspection of Meat and other Foods. H Certificate of Sanitary Inspectors' Examination Board for Inspection of Meat and other Foods. 14 Certificate of Fever Nursing Training. 15 Certificate for Tuberculosis, Brompton Hospital. 16 Certificate .for Tuberculosis, Royal Chest Hospital. 17 Certificate of six months' training as Dental Hygienist at Dental Department, University College Hospital Medical School. Changes in the staff have been recorded in this report in the sections dealing with the duties of the Officers concerned. Thus it has been explained that Mr. C. J. Wright was promoted to the position of Senior Sanitary Inspector upon the retirement of Mr. J. H. Pearson, who retired in the early part of the year. Mr. Pearson had been in the service of this Council for twenty-seven years, and the best wishes his colleagues go with him in his retirement. The re-arrangements of the staff at the Dental Hospital that have been described in the appropriate section were of a temporary nature, and at the time of writing the re-organization of the staff is engaging the attention of the Health Committee. INDEX. page Acts, Regulations and Orders 11 Acute Influenzal Pneumonia 37 Acute Poliomyelitis 36 Acute Primary Pneumonia 37 Ambulance facilities 10 Ante-natal Clinics 124 Ante-natal Consultative Centres 128 Anthrax 38 Area 2 Artificial Sunlight Clinic 115 Bacteriological Examinations 42 Bakehouses 50 Birth-rates 12 Births in sub-districts 13 Breast Feeding Clinic 116 Brunswick Day Nursery 130 Cancer 23 Cerebro-Spinal Fever 35 Cleansing and Disinfection 51 Common Lodging Houses 55 Condensed Milk Regulations 64 Consultants, Panel of 125 Convalescence 121 Cookshops and Eating-houses 49 Cowhouses 49 Dangerous Structure Notices 105 Death-rate 15 Deaths—ages at 18 Deaths—causes of 18 Deaths in Outlying Institutions 16 Deaths in Public Institutions 17 Deaths in sub-districts 15 Dental Hospital 92 Dental Hospital—Orthodontic 93 Dental Hospital—Scale of Charges (treatment) 92 Diarrhoea 40 Dining Centres 119 Diphtheria 30 Diphtheria Immunization 31 Disinfection 43 District Inspectors 44 Dried Milk Regulations 64 Dy sentry 32 Encephalitis Lethargica 36 Enteric fevers 32 Enteritis 40 Erysipelas 32 page Factory and Workshop Act 65 Food and Drugs Acts 57 Food Poisoning 53 Food premises, registration of 56 Fried Fish Shops 49 Fur Skin Dressers 52 Hairdressers 48 Health Week 140 Home Helps 126 Home Visiting 112 Housing conditions 101 Housing Consolidated Regulations 103 Housing Inspector 110 Hospitals 8 House refuse 10 Houses let in lodgings 50 Ice Cream Shops 50 Infantile Mortality 20 Infant Life Protection 136 Infant Welfare Centres 112 Infectious cases, number certified 25 Infectious cases, number removed to hospitals 25 Infectious diseases, age periods 25 Infectious diseases and schools 40 Infectious diseases, deaths from 25 Influenza 39 Inhabited houses 51 Legal Proceedings 70 Local Government Act, 1929 129 L.C.C. (General Powers) Act, 1928, sec. 28 53 Marriage-rate 14 Marriages 14 Maternal care 124 Maternal mortality 21 Maternity and Child Welfare 112 Maternity Outfits 125 Measles 38 Meat Regulations, 1924 49 Medical Mission of Good Shepherd 133 Merchandise Marks Act, 1926 65 Milk Allowances 120 Milk and Cream Regulations, 1912 64 Milk and Dairies Order, 1926 50 Milk (Special Designations) Order, 1923 62 Mortuary 17 Municipal Midwifery 129 INDEX—continued. page National Parentcraft Competition 113 Nursing in the Home 41 Nutrition 54 Offensive trades 52 Ophthalmia Neonatorum 34 Otorrhoea Clinic 115 Outworkers 67 Overcrowding 52 & 108 Population 12 Post-natal Clinics 124 Preservatives in Food Regulations 64 Public Health (Prevention of Tuberculosis) Regulations, 1925 49 Puerperal Fever 33 Puerperal Pyrexia 34 Rag and Bone Dealers 52 Rag Flock Acts 64 Rateable value 2 Rats and Mice (Destruction) Act 48 Rents Restrictions Acts 108 Sale of Food Order, 1921 50 Sanitary area 50 Sanitary Officers 51 Sanitary Work 44 Scarlet fever 29 Schools 53 School Entrants 121 School for Mothers 129 Sewing Classes 118 page Shelter 43 Slaughterhouses 49 Slum Clearance—Circular 1331 103 Smallpox 26 Smoke Nuisances 51 Social conditions 6 Staff 142 Still Births 13 Stonebridge Estate Improvement Scheme 110 Street Markets and Fond 48 Students 114 Sun Babies Nursery 130 Transfer of Powers Order, 1933 54 Tuberculosis 74 Tuberculosis Care Committeee 89 Tuberculosis, deaths from 80 Tuberculosis Dispensary 82 Tuberculous Milk 62 Underground Rooms 52 & 105 Undesignated Milk 63 Unemployment 7 Vaccination Order 27 Venereal Diseases 43 Verminous Houses 52 Vital Statistics 2 Voluntary Workers 115 Water Supply 48 Water Supply to Tenement Houses 51 Whooping Cough 39