AC 4363 M SHOR 39 REPORT on the Health and Sanitary Condition of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1934, BY E. ASHWORTH UNDERWOOD, M.A., B.Sc., M.B., D.P.H., Medical Officer of Health. london: j as. truscott & son, ltd. suffolk lane, e.c. 4. ' ' ' ■••.'V REPORT on the Health and Sanitary Condition of the Metropolitan Borough of Shoreditch, IN THE COUNTY OF LONDON, FOR THE YEAR 1934, BY E. ASHWORTH UNDERWOOD, M.A., B.Sc., M.B., D.P.H., Medical Officer of Health. london: Jas. truscott & son, ltd. suffolk lane, e.c. 4. iii. CONTENTS. section. page I.—Statistics and General Information 3 II.—Population, Births, Marriages and Deaths 14 III.—Infectious Disease 28 IV.—Tuberculosis 47 V.—Maternity and Child Welfare 63 VI.—Municipal Dental Hospital 87 VII.—Sanitary Circumstances 94 VIII.—Housing 119 IX.—Health Propaganda 125 LIST OF STATISTICAL TABLES CONTAINED IN THE REPORT. page Statistical Summary 2 Whole district during 1934 and previous years 4 Comparison of London and Shoreditch birth and death rates in 1934 5 Birth rate, death rate and analysis of mortality during 1934 6 Unemployment 8 Population, births, marriages and deaths 14 to 18 Infantile mortality during 1934 facing 20 Maternal mortality 22 Cancer 24 Vital statistics for the Metropolitan Boroughs 25 Causes of, and ages at, death during 1934 26 & 27 Cases of infectious disease notified during 1934 29 Vaccination Officers return 31 Nursing list 44 Summary of tuberculosis certificates received 47 to 49 Summary of deaths from tuberculosis during 1934. 51 Return of work carried out at Tuberculosis Dispensary 54 to 56 Return of tuberculosis care work 61 Premature deaths and death rates : Comparison between Shoreditch and England and Wales 64 Infantile mortality : Comparative table for Shoreditch, London and England and Wales 66 Maternal mortality : Comparative table for Shoreditch, London and England and Wales 67 Statistical report upon the work of the Health Visitors 73 Attendances at Welfare Centres during 1934 74 Routine medical inspection of elementary school entrants 84 & 85 Dental "Hospital: Summary of work done during 1934 88 & 89 Summary of work carried out by the Sanitary Inspectors 95 & 96 Summary of work under Factory and Workshop Act 101 to 103 Outworkers, tables relating to 105 & 106 Legal proceedings 116 to 118 iv. METROPOLITAN BOROUGH OF SHOREDITCH. PUBLIC HEALTH COMMITTEE. (Nov., 1933—Oct., 1934.) MATERNITY AND CHILD WELFARE COMMITTEE. (Nov., 1933—Oct., 1934.) 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. (resigned 19-6-34). Brown, W. J. (deceased). ,, Crouch, C. 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. (resgd. 20-2-34). Varnals, G. J. Councillor Abraham, G. (resigned 20-2-34). Ellett, W. T. (deceased). ,, Girling, Mrs. H., j.p., l.c.c. ,, Houseman, J. E., j.p. ,, Jarvis, Mrs. M. J. Mitchell, M. Palmer, R. E. (Co-opted) Baker, Miss D. W. Colville, Lady Cynthia, j.p. Crouch, Mrs. A. N. Furse, Mrs. J. (resigned 17-7-34). ,, Lovejoy, Mrs. ,, Yeoman, Mrs. PUBLIC HEALTH COMMITTEE. (Nov., 1934—Dec., 1934.) MATERNITY AND CHILD WELFARE COMMITTEE. (Nov., 1934—Dec., 1934.) Ex-officio : Wm. Hebden, Esq., j.p. (Mayor). Chairman : Councillor Jeger, Dr. S. W., l.c.c. Vice-Chairman : Councillor Thurtle, Mrs. D. Alderman Kellett, Miss E. Touchard, G. J. Councillor Alsford, M. Bryant, H. Charles, A. „ Clemenson, P. D. ,, Crathern, Mrs. A. Higgins, Mrs. M. ,, Linale, R. ,, Macbeth, A. I. Orgel, S., j.p. ,, Pooler, T. ,, Sherwin, A, H, Chairman : Alderman Kellett, Miss E. Vice-Chairman : Councillor Higgins, Mrs. M. Alderman Lusher-Pentney, Mrs. C. R. ,, Varnals, G. J. Councillor Alsford, Mrs. H. ,, Charles, A. Clemenson, P. D. Crathern, Mrs. A. ,, Girling, Mrs. H., j.p., l.c.c. ,, Murphy, Mrs. J. (Co-opted) Brown, Mrs. E. Charles, Mrs. E. M. Colville, Lady Cynthia, j.p. Penn, Mrs. B. Smith, Mrs. L, V. 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. E. Ashworth Underwood, M.A., B.Sc., M.B., 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 : II. P. Abbott (General Assistant), E. R. Banks, H. Fitzgerald, W. L. Job, V. H. Sewell, W. Wilson, E. Lehane (12), I. M. RUTHERFORDF. (f These 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 Sanitary Inspector, C. J. Wright. District Sanitary Inspectors. I, H. G. Chapman7, 8, 10 ; II, G. C. E. Gibbs9, 10 ; III, D. Grant', 11 ; IV, R. A. Bishop7, 10 V, G. Walker7, 8, 10 ; VI, A. Stratton', 11; VII, C. J. Wright7, 10 ; VIII, J. B. Molloy7, 8, 11 IX, J. H. Thomas7, 11. Inspector with duties under Food and Drugs Acts, etc., F. C. Shaw7, n. Maternity and Child Welfare. Health Visitors : District Numbers I, M. Redcliffe2, 3, 5 ; II, M. Morrell2, 5, 8 ; III, D. Bales1, 2, 3, 5 ; IV, I. M. Heward1, 2, 3, \ 8, 16 ; V, B. C. Hunt1, 2, 3 ; VI, A. M. Brotherton1, 2, 3; IX, M. W. Toogood1, 2, 3, 5, 12, 13 ; X, D. L. Mackenzie, 1, 2, 3, 5. Model Welfare Centre, 210, Kingsland Road. Municipal Midwife, A. E. Leaton1, 2, 3. Nursing Staff:—Matron, M. D. Borrow1, 2, 3 ; Sister, D. A. Kennedy1, 2, 3 ; Staff Nurses, J. E. Gray, l, 2, 3, 5 ; E. Crowley, 1, 2, 3 ; M. Millward, 2, 3 ; G. E. Woods (resigned 5-4-34) ; M. M. Furmidge (resigned 15-12-34). Other Staff:—Cook, E. Riggs (deceased); Waitress, J. McDonnell; Porters, J. E. Perry, H. Peters (resigned 11-9-34), H. Oliver. Laundress and Helper, M. Whittington ; Cleaners, J. Durling, A. Hesketh. Women Cleaners, Public Health Offices : L. Searle, A. Reed. 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. Grange1, 3 ; W. I. Hiscoke1, 2, 3, 15 ; Dispenser, J. N. Holmes' ; Clerk, W. Harris ; Porter, A. Whittard. Tuberculosis Care Committee Secretary, Miss B. Wolsey, B.A. Dental Hospital. Dental Surgeon, C. S. Abraham, M.C., L.D.S., R.C.S.(Eng-). Sister and Clerk, L. Frier1, 2, 3. 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.l. (For Moorfields, Church, Hoxton and Wenlock Wards.) These two officers also act as Registrars of Births and Deaths, and in the case of Mt. Dyson also as Registrar of Marriages. vi. Disinfecting Officers (Town Hall), A. Fawns. G. Kennedy. A. Flack. Mortuary (St. Leonard's Churchyard). Keeper, G. Ball. Health Shelter (Reeves Place). Caretaker, Mrs. Whittard. The following officers who are not members of the permanent staff perform various duties in :onnection 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. McCullagh, 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. Anesthetist 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, 101, Kingsland Road, E.2. (For Whitmore, Haggerston, Kingsland and Acton Wards.) Public Analyst: H. G. Harrison, M.A., F.I.C. Deputy Public Analyst: H. A. Williams, A.C.G.F.C., F.I.C. Health Visitors, Shoreditch School for Mothers, 28, Herbert Street, N.I. Districts Nos. VII and VIII, E. F. Dance1, 2, 3 ; N. K. Fitzmaurice2. Sister in Charge of Artificial Sunlight Clinic : M. Pollard3. Sister in Charge, Diphtheria Immunisation Clinic : M. Pollard3. Dental Hygienist : Miss Mold12 (resigned). Dental Nurse and Assistant Clerk : M. F. Campbell. Probationers, Model Welfare Centre : H. Abbott, B. Hewitt, D. Noakes. Women Cleaners, Model Welfare Centre : E. Williament, C. Gascoigne. Telephone Assistant, Model Welfare Centre : M. Hughes. Assistant Enquiry Officer : G. A. Newson. Temporary Clerk : R. Horn. Pram Minder and Assistant, Model Welfare Centre : E. Sage. Plaster Boy, Dental Hospital : J. H. Cooper. NOTES. 1 State Registered Nurse. 2 Certificate of Central Mid wives 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 ol 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. 11 Certificate of Sanitary Inspectors' Examination Board for Inspection of Meat and other Foods. 12 Certificate of Fever Nursing Training. 13 Certificate for Tuberculosis, Broinpton Hospital. 14 Certificate for Tuberculosis, Royal Chest Hospital. 15 Certificate of six months' training as Dental Hygienist at Dental Department, University College Hospital Medical School. Metropolitan Borough of Shoreditch. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH Public Health Offices, 8-14, Laburnum Street, E.2. August, 1935. 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 1934—the first year during which I have held office under your Authority. My predecessor, Ur. Maitland Radford, relinquished his duties at the end of June, and I took up my position at the beginning of October. It should be mentioned, therefore, that although I am responsible for the presentation of this report, much of the work described was carried out under the supervision of Dr. Radford and Dr. Evelyn McGregor, the Assistant Medical Officer of Health, who acted in the three months' interval after the departure of Dr. Radford. The year 1934 was marked by another low birth rate. This, although only slightly above the lowest which has ever been recorded, was nevertheless higher than in London as a whole. The death rate was considerably above that for England and Wales and for London as a whole. The rate for the deaths of infants under one year, although in excess of that for England and Wales, was fairly satisfactory considering the social conditions of the district. Scarlet fever continued to be of the mild type which has been prevalent in this country during a number of years. Diphtheria, on the other hand, is becoming more and more a grave disease of childhood. The death rate for this Borough for 1934 was slightly above the rates for England and Wales and for London, and there are definite indications that much can still be done in the prevention of this disease by immunization. There was a slight decrease in the notified cases of tuberculosis. The case rate for all forms of tuberculosis for 1934 was only slightly above the rate for 1932, which was the lowest recorded. The death rate continues to be markedly lower than it was even as recently as ten years ago. During the year further arrangements were made by the London County Council to improve the comfort of those Shoreditch patients who avail themselves of the facilities for institutional treatment which are provided by the London County Council. The low maternal mortality rate for the year is very gratifying, but it cannot be anticipated that this will continue at this extremely low level. The next few years will certainly see chance fluctuations, some of which will be in an upward direction. During the latter part of the year under review the housing question in Shoreditch was reconsidered, and steps were adumbrated which are likely to lead to an improvement in the domestic conditions of many of the occupants of houses in the Borough. At the end of the year I proffer my thanks to those who have assisted me in the work of the department, especially to Dr. Evelyn McGregor, Assistant Medical Officer of Health, Dr. C. K. Cullen, Tuberculosis Officer, Mr. Wilsher, the Chief Clerk, and to Mr. Wright, Senior Sanitary Inspector. To the Chairman and Members of the Health and Maternity and Child Welfare Committees I desire to express my appreciation of their courtesy and assistance. I am, Sir, Ladies and Gentlemen, Your obedient Servant, E. ASHWORTH UNDERWOOD, Medical Officer of Health. 2 SUMMARY. 1934. Area of Borough 662 acres Average height above sea-level 60 feet Population (Registrar-General's mid-year estimate) 90,630 Estimated number of houses 14,077 Number of families (1931 census) 25,156 Rateable value £825,378 Sum represented by a penny rate £3.439 Birth rate (rate per 1,000 living) Still births (rate per 1,000 total births) Death rate (deaths per 1,000 living) (adjusted) Marriage rate (persons married per 1,000 living) Infantile Mortality rate— (deaths under 1 year per 1,000 births) Maternal Mortality rate (deaths per 1,000 live births) Death rate from Pneumonia and Bronchitis „ „ Cancer ,, ,, Diarrhoea and Enteritis (under 2 years) per 1,000 births 1934. 16.06 31.27 14.4 20.5 84 0.69 2.07 1.48 21.29 Average. 1924-1933. 20.48 31.05* 13.18 18.62 77 2.74 2.34 1.29 13.39 London. Average. 1934. 1924-33. 13.2 159 31 32.5* 12.14 12.08 16.9 18.30 67 65 2.48 3.25 1.37 1.69 1.72 1.54 12.8 10.43 Smallpox Scarlet Fever Diphtheria Typhoid Fever †Measles Puerperal Fever Pulmonary Tuberculosis Other forms of Tuberculosis Cases. 2 364 288 0 — 6 132 26 Caserate. 0.02 4.02 3.18 — — 0.06 1.45 0.29 Deaths. 0 2 13 0 29 0 84 10 Deathrate. 0.02 0.14 0.32 0.93 0.11 *Average rate for 1930-1933. Still births were not recorded before 1930. †Not notifiable. 3 I.—STATISTICS AND GENERAL INFORMATION. STATISTICS. Area—662 acres. Population, Census 1931—97,038 ; Registrar-General's estimate mid-1934—90,630. Number of structurally separate dwellings, 1931 Census—14,115. Number of houses (end of 1934) according to Rate Books—14,077. Number of families and separate occupiers, 1931 Census—25,156. Rateable value— £825,378. Sum represented by penny rate—£3,439. The length of public streets in the Borough is 4-3 miles. Briefly, Shoreditch is a densely populated (average 137 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 VII of this report, page 103. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1934. Total. M. F. Birth Rate. Live births j Legitimate 1,402 747 655 16.06 Illegitimate 54 34 20 1,456 781 675 Still births Rate per 1,000 total births 31.27 General death rate (Crude rate) 13.11 Percentage of total deaths occurring in Public Institutions 73.1 Number of women dying in, or in consequence of, childbirth— From Sepsis — ,, other causes 1 Death rate of infants under one year of age per 1,000 live births— Legitimate, 85. Illegitimate, 56. Total, 84. 4 Deaths from Measles (all ages) 29 ,, Whooping Cough (all ages) 12 ,, Diarrhoea (under 2 years of age) 31 ,, Pulmonary Tuberculosis 84 ,, all forms of Tuberculosis 94 Death rate from Pulmonary Tuberculosis0.93 Tuberculosis Death Rate 1.04 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. N umber. Rate per 1,000 nett Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1934 90630 1223 1456 16.1 1096 12.1 219 311 122 84 1188 13.1 Note.—The above table is arranged to show the gross births and deaths in the Borough, and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1,000 of the estimated gross population. For columns 5 and 13 the population of the Holborn Institution, estimated at 1,000, has been deducted in calculating the rates for the year 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. ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31st DECEMBER, 1934. DISTRICTS. Estimated Population 1934. BIRTHS. ANNUAL RATE PER 1,000 PERSONS LIVING. Infants under 1 year. Death rate per 1,000 Live Births. PERCENTAGE TO TOTAL DEATHS. DEATHS DURING THE YEARS DEATHS DURING 1934 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. I (cols 2-8) 2 3 4 5 6 7' 8 9 10 Principal Zymotic Diseases. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. *Fever. Diarrhœa Enteritis (under 2 years) Tuberculous Disease, Violence. 1931 1932 1933 1934 London 4,230,200 13.2 12.3 12.3 12.2 11.9 0.57 o.oo 0.20 0.02 0.11 0.07 0.00 0.17 0.83 0.56 67 6.3 – 0.00 Shoreditch 90,630 16.1 12.5 12.3 13.0 13.1 0.96 ... 0.32 0.02 0.14 0.13 ... 0.34 1.04 0.53 84 5.2 73.1 ... Wards. . Moorfields 3,669 14.2 10.6 16.9 14.6 14.0 1.09 ... 0.27 ... ... 0.27 ... 0.54 0.55 0.27 96 2.0 75.5 ... Church 15,320 17.2 14.8 13.3 13.9 14.4 1.24 ... 0.19 ... 0.19 0.19 ... 0.52 1.44 0.20 80 2.7 74.2 ... Hoxton 14,848 14.8 12'4 13.7 12.5 13.8 0.94 ... 0.40 ... 0.14 0.20 ... 0.20 0.67 0.54 87 5.9 70.7 ... Wenlock 14,652 15.7 11.6 113 11.4 13.0 1.43 ... 0.34 0.14 0.27 0.14 ... 0.61 1.02 0.61 117 7.1 79.2 ... Whitmore 13,979 17.2 12.9 12.5 14.5 13.7 0.84 ... 0.29 ... 0.21 0.07 ... 0.29 1.22 0.86 104 7.3 75.5 ... Kingsland 8,939 16.5 12.1 115 132 12.4 0.43 ... 0.11 ... ... ... ... 0.33 1.12 0.56 82 5.4 71.2 ... Haggerston 9,218 16.0 13.0 119 11.0 13.0 0.87 ... 0*76 ... ... ... ... 0.11 1 .08 0.54 41 4.2 67.5 ... Acton 10,005 15.6 10.0 94 13.4 10.7 0.60 ... 0.20 ... 0.10 0.20 ... 0.10 0.80 0.50 45 4.7 67.3 ... 5 * Fever includes typhus, typhoid and continued fevers. † Diarrhoea in this table includes enteritis in children under two years. Note.—Where the deaths under any heading are too few to express as a rate per 1.000 within two places of decimals, 0.00 is inserted : where no deaths have occurred, dots are placed in the space under the heading. The London population is adjusted to the middle of 1934. BIRTH-RATE. DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1934. (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. Live Births. Still-births. ! 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. Shoreditch 161 0.52 13.1 0.00 0.00 0.32 0.02 0.13 0.14 0.07 0.53 21.3 84 87.6 5.2 7.2 0.0 England and Wales 14.8 0.62 11.8 0 00 0.00 0.09 0.02 0.05 0.10 0.14 0.54 5.5 59 90.4 6.5 2.1 1.0 121 County Boroughs and Great Towns, including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 135 Smaller Towns (Estimated Resident Populations, 25,000 to 50,000 at Census, 1931) .. 15.0 0.67 11.3 0.00 – 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 87.7 6.3 6.0 0.0 The maternal mortalitv rates for Shoreditch, and England and Wales, are as follows :— Puerperal Sepsis. Other Causes. Total. England and Wales, per 1,000 live births 2 03 2.57 4.60 ,, ,, per 1,000 total births 1.95 2.46 4.41 Shoreditch, per 1,000 live births 0.00 0.69 0.69 ,, per 1,000 total births 0.00 0.66 0.66 7 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 3 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 5 feet. The Metereological Table for London, deduced from observations at Greenwich under the superintendence of the Astronomer Royal, issued by the Registrar-General for 1934, shows a rainfall for the year of 496 millimetres. This figure is 8 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 3-91. This figure was 0-09 less than the average daily mean for the 30 years 1901-1930. 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 for the year as compared with those for 1933. There was a very significant increase in the numbers of unemployed females in the fourth quarter of the year. On the other hand there was an increase of 1,364 in the number of persons who were in receipt of domiciliary relief, as compared with the figure for 1933. 8 Number of persons resident in the Metropolitan Borough of Shoreditch, recorded as unemployed, at quarterly dates in the years 1928 to 1934:— 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 17th 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 1934 19th March 3,654 604 43 4,301 25th June 3,316 831 37 4,184 24th September 2,993 759 47 3,799 17th December 3,067 897 31 3,995 9 I have also to thank the Chief Officer of Public Assistance of the London Country 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 1934 31st March 2,969 62 30th June 3,255 50 29th September 3,194 44 29th December 3.578 55 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 Road, E. 2 10 cots for babies. Medical Mission of the Good Shepherd, 4-1-49, 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 75, 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. 10 Near the Boundary of the Borough— General Hospitals— Metropolitan Hospital, Kingsland Road, E. 8 150 beds. Royal Northern Hospital, Holloway Road, N. 7 466 beds. German Hospital, Ritson Road, Dalston, E. 8 180 beds. London Hospital, Mile End, E. 1 851 beds. University College Hospital, Gower Street, W.C. 1 540 beds. St. Bartholomew's Hospital, West Smithfield, E.C. 1 692 beds. Royal Free Hospital, Gray's Inn Road, W.C. 1 315 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.I 252 beds. (10 private) London Fever Hospital, Liverpool Road, N.l 200 beds. 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. 11 Hospital for Post Encephalitis Lethargica— Northern, YVinchmore Hill, N. 21 (part of) 271 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, Heme 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.I (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. Gonorrhoea {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. tc 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. 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. 2 12 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. Gonorrhcea.—Males and females : Monday, Tuesday, Wednesday, Thursday and Friday 6 to 8 p.m. University College Hospital, Gower Street, W.C.I. 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, for parturient women if the cases are urgent, for persons suffering from illness (upon production of medical certificate), and for persons suffering from infectious diseases who are to be removed to the Council's fever hospitals. In other cases ambulances are supplied at a charge of 10s. if they are not to be used outside the 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 intervals which are never longer than one week ; in many instances it is collected daily, and from a considerable proportion of the premises in the Borough two or three times per week. Refuse is removed in horse-drawn and mechanically operated vehicles, and is burned at the refuse destructor, 13 ACTS, REGULATIONS AND ORDERS which became operative during 1934. Acts. Local Government Act, 1933. Shops Act, 1934. Regulations. Public Health (Shellfish) Regulations. Regulations under the Agricultural Produce (Grading and Marking) Acts, 1928 and 1931, relating to various articles of food. Orders. The Merchandise Marks (Imported Goods) Orders, Nos. 5, 6, 1. Milk and Dairies, No. 1317. 14 II.—POPULATION, BIRTHS, MARRIAGES AND DEATHS. The Registrar-General's estimate for the mid-year 1934 population was 90,630. This figure is 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 3,669 71 52 Church 15,320 105 146 Hoxton 14,848 79 188 Wenlock 14,652 96 153 Whitmore 13,979 81 173 Kingsland 8,939 72 124 Haggerston 9,218 68 136 Acton 10,005 86 116 * Exclusive of water. The density of the population in the Borough as a whole is 137 persons per acre . Further information upon the subject of the population, area, number of inhabited houses and rateable value are contained on pages 2, 3, 4 and 5. BIRTHS. The numbers of live births registered in the Borough during the calendar year 1934 are given in the following table:— Total Live Births (Legitimate and Illegitimate). Live births registered (excluding re-registration). Inward Transfers. Outward Transfers. Live births allocated to the Borough. Males 639 171 29 781 Females 584 128 37 675 Totals 1,223 299 66 1,456 Illegitimate Live Births. Males 28 10 4 34 Females 26 3 9 20 Totals 54 13 13 54 15 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 28 24 52 14.2 Church 124 140 264 17.2 Hoxton 132 87 219 14.8 Wenlock 120 110 230 15.7 Whitmore 126 115 241 17.2 Kingsland 86 61 147 16.5 Haggerston 77 70 147 16.0 Acton 88 68 156 15.6 Totals 781 675 1,456 16.1 Still Births. The numbers of still births registered in the Borough during the calendar year 934 are given in the following table:— Total Legitimate and Illegitimate. Stillbirths registered. Inward Transfers. Outward Transfers. Stillbirths allocated to the Borough. Males 19 4 — 23 Females 17 7 — 24 Totals 36 11 — 47 Illegitimate. Males 1 — — 1 Females 4 — — 4 The birth rate for the Borough as a whole was 16.1. For England and Wales the birth rate was 14.8 and for London 13.2. The illegitimate births numbered 54, of which 34 were males and 20 females. Of these 14, nine of which were males, occurred in St. Leonard's Hospital. The illegitimate births therefore represented 3.7 per cent. of all the births in the Borough during the year. The number of births which occurred in St. Leonard's Hospital was 435 : 228 males and 207 females. In 65 of these the parents were not Shoreditch residents. The birth rate for 1934 is the second lowest which has so far been recorded in the Borough. Last year the rate was 16.0. Although the increase is very small, it is nevertheless more welcome than would have been a further decline. Examination of the table showing the birth rate in Wards shows that there was no particular " black spot " in the Borough. The lowest rate of 14.2 was recorded in the Moorfields Ward, but this figure is based on a much smaller total population than is the case in the other Wards. 16 In these days when the continued fall in the birth rate affords excellent copy for journalists, eugenists and those who preach racial hygiene, it is comforting to reflect that the Shoreditch birth rate is much above that for England and Wales and for the County of London respectively. In fact, examination of the table on page 25 shows that Shoreditch had the highest birth rate in London. Even more important is the fact that there was a substantial credit balance of 1.7 per 1,000 of births over deaths. In many other Boroughs this balance is in the other direction, but in Shoreditch there is no doubt that the population (apart from emigration and immigration) is increasing. This increase is unlikely, however, to show itself in any tangible manner. One of the chief aims of modern public health measures is to effect a decrease in the density of population, and in a circumscribed borough like Shoreditch this can only be accomplished by reducing the population of the Borough as a whole. MARRIAGES. The number of marriages during the year was 929, and the marriage rate was 20.5 per 1,000 population. The marriage rate for the Metropolis was 16.9. During recent years the corresponding figures were as follows:— Year. No. of marriages. Marriage rate. Shoreditch. London. 1930 969 19.6 19.4 1931 912 18.6 18.8 1932 848 17.7 18.0 1933 858 18.3 18.9 1934 929 20.5 16.9 It is interesting to note a distinct increase in the marriage rate for the Borough, especially in view of the fact that London as a whole showed an equally marked decline. The difference between the rates for Shoreditch and for London was greater in 1934 than it has been for many years. DEATHS. During 1934 the gross number of deaths registered in the Borough was 1,096. The transferable deaths were as follows:— Deaths of non.residents registered in Shoreditch 219 Deaths of Shoreditch residents registered elsewhere 311 17 The number of deaths which must be debited to Shoreditch is accordingly 1,188, which figure gives a nett death rate of 13.1 per 1,000 population. In connection with these deaths 62 inquests were held. The death rate in England and Wales for 1934 was 11-8, and in London 11-9. In the table on page 5, 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 19 30 49 14.0 96.1 Church 135 86 221 14.4 79.5 Hoxton 119 86 205 13.8 86.8 Wenlock 94 89 183 13.0 117.4 Whitmore 105 87 192 13.7 103.7 Kingsland 66 45 111 12.4 81.6 Haggerston 63 57 120 13.0 40.8 Acton 62 45 107 10.7 44.9 Totals 663 525 1,188 13.1 84 In the table on page 26 will be found the numbers of deaths from different causes and at different ages with their distribution by wards, 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, 269 (22.6 per cent.); cancer, 134 (11.3 per cent.); tuberculosis, all forms, 94 (7.92 per cent.); pneumonia, all forms, 121 (10.2 per cent.). The number of deaths due to accidents in connection with vehicular traffic was 19. In the years 1930 to 1933 inclusive, the corresponding figures were respectively 21, 22, 18 and 17. The particulars regarding deaths from cancer are contained in the table on page 24. It will be noted from the table on page 26 that the chief causes of death of children between the ages of one and two years were measles and pneumonia. These two causes accounted for 26 out of a total of 40 deaths between these ages. Altogether 195 or 16.4 per cent. of the total number of deaths of all ages were of children under the age of 5 years. A noteworthy feature of the deaths for the year is the comparatively small rate in Acton Ward. During the last few years the rate for this Ward has often been considerably lower than those for the other Wards. So far as the nett death rate is concerned, the year was uneventful. The rate showed a very slight increase on that for 1933, but no importance can be attached to this observation. From the table on page 25 it will be seen that the mortality in Shoreditch (after adjustment) is very high. This feature is obviously associated with the environmental conditions. 18 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 who died therein during the year Asylums & Mental Hospitals:— No. of Deaths Special Hospitals:— No. of Deaths. 1, Bexley Lane, Dartford 3 Cancer 1 Camberwell House 1 Chest, Bethnal Green 3 Cane Hill 1 City of London, Maternity 3 Friern Barnet 2 Colindale 4 Grove, Horton Lane, Epsom 2 Consumption 1 Hundred Acres 3 East London, Children's 1 Leavesden 4 Elizabeth Garrett Anderson 1 1a, Manor Road, Ilford 5 Grove Park 3 The Forest, Hook Rd., Epsom 3 Hospital for Sick Children 1 Tooting Bee 8 Infants, Westminster 1 1, Uxbridge Road 1 Mount Sanatorium 1 Hospitals for Infectious Diseases:— Mount Vernon (Cancer) 1 National for Diseases of Hear 1 Queen's (for Children) 27 Brook 5 Queen Mary's, Carshalton 2 Royal Ear 1 Eastern 15 Grove 1 Public Assistance Institutions:— North-Eastern 18 ,, Western 1 Park 1 Archway Hospital 8 South-Eastern 1 Bancroft Lodge 2 ,, Western 3 2a, Bow Road 4 Western 2 214a, Cambridge Road 4 2, Clatterbridge 1 General Hospitals:— 199, Dartmouth Park Hill 1 73a, Devons Road 3 Charing Cross 3 72a, East Dulwich Road 1 German 6 32, Elder Road 1 Grove Park, Mottingham 2 230, High Street, Hackney 5 Guy's 2 86 ,, Poplar 2 Italian 1 77a, Highgate Hill 1 King's College 1 Lambeth Hospital 6 London 11 New End Hospital 1 Metropolitan 22 North Middlesex County Hospital 3 Metropolitan Convalescen Home 1 1, Oldchurch Road, Romford 1 Middlesex 1 129, St. John's RcL, Islington 4 Mildmay Mission 3 St. Peter's Hospital 2 National Temperance 2 2, Sidney Road 1 29, North Side, Wandsworth 2 2a, South Grove, Stepney 3 Queen Mary's, Chislehurst 1 Other Institutions ,, ,, Wandsworth 1 Royal Free 3 8, Alexandra Road 1 Royal Sussex 1 Darenth Training Colony 2 St. Bartholomew's 37 5, Highbury Quadrant 1 St. George's 2 Home & Hospital for Jewish Incurables 1 St. Joseph's 8 St. Thomas' 1 24, Underwood Street 1 19 Of 303 persons belonging to Shoreditch, who died in public institutions beyond the limits of the Borough, 112 died in general hospitals, 23 in asylums, 47 in fever hospitals, 51 in special hospitals, 54 in public assistance institutions and 6 in other institutions. Elsewhere than in public institutions, 8 persons belonging to Shoreditch died beyond the limits of the Borough. Altogether 868 or 73.1 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:— 1930 67.5 per cent. 1932 69.3 per cent. 1931 66.3 1933 68.5 PUBLIC MORTUARY, 1934. Number of bodies deposited from— St. Leonard's Hospital 32 L.C.C. Infectious Disease Hospitals 7 Undertakers 101 Other sources 56 Total number of bodies deposited 196 Number of post-mortem examinations performed 120 In the Report for 1933 reference was made to the condition of the public mortuary. Since that Report was written the matter has been discussed but no action has so far been decided upon. It seems obvious that the problem will have to be tackled at no very distant date. 20 Infantile Mortality. The deaths amongst infants under one year numbered 122, of which 61 were males and 61 females. These deaths amounted to 10.27 per cent. of the total nett Shoreditch deaths from all causes as compared with 9.1 per cent. in 1933. The infantile mortality rate (death rate of infants under one year) was at the rate of 84 per 1,000 births registered during the year. Amongst male infants this rate was 78 and amongst females 90. The infant mortality rates in the different Wards of the Borough are included in the table on page 17. The number of deaths of illegitimate infants was 3, which figure gives a death rate of 56 per 1,000 illegitimate births. 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 1930 60 59 65 1931 66 65 75 1932 65 67 80 1933 64 59 74 1934 59 67 84 The causes of deaths of infants under one year together with ages and ward distribution are given in the table on the opposite page. The upward trend of infantile mortality in London as a whole has evidently been reflected in Shoreditch, though the table on page 25 shows that, despite the degree of poverty and overcrowding in the Borough, the infantile mortality rate compares favourably with the rates for other Boroughs of similar nature. The table which faces this page shows that the three chief causes of death were diarrhoea and enteritis (28 deaths), pneumonia (27 deaths), and prematurity (26 deaths). For some years the deaths from these three causes have been more or less equal and of paramount importance. As is to be expected, prematurity took its toll during the first month of life, and the other two diseases in the later months. It should be remembered that these three conditions are all preventable. It should also be pointed out that a substantial reduction in the number of deaths from any one of the three would cause a material decrease in the infantile mortality rate. To face page 20 Infantile Mortality in the Borough during the Year 1934. cause of death. *ages. *deaths in each ward. sex. Under 1 day. I day to 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total under 1 year. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Male. Female. m f m f m f m f m f m f m f m f 1 Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Measles ... ... ... ... ... ... ... 1 2 2 5 ... ... 1 1 2 ... ... 1 ... 2 3 4 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping cough ... ... ... ... ... ... ... ... 1 ... 2 ... 1 ... 1 ... ... ... ... 1 1 6 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ]0 German measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 (a) with pulmonary complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 (b) with non - pulmonary complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 (c) without stated complications ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Meningococcal meningitis ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... 1 18 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 Other tuberculous diseases ... ... ... ... ... ... ... 1 1 1 3 ... ... ... ... 1 1 1 1 2 20 Bronchitis ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... 1 ... 21 Pneumonia (all forms) ... ... ... ... 1 1 8 11 5 2 27 1 3 1 2 3 1 4 4 3 1 3 1 14 13 22 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Empyema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Other pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 Diarrhoea and enteritis ... ... ... ... ... ... 4 7 14 3 28 2 4 4 3 3 5 3 1 2 1 15 13 29 Ulcer of stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other diseases of the stomach ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Syphilis ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 32 Congenital malformation ... 6 ... 1 ... 7 5 ... ... ... 12 ... 2 1 2 2 1 1 "1 1 5 7 33 Congenital debility and icterus ... 4 ... ... ... 4 ... ... ... ... 4 ... 1 ... 1 1 1 ... ... ... 2 2 34 Premature birth 13 7 2 1 ... 23 3 ... ... ... 26 1 2 2 3 3 2 4 5 1 1 1 1 12 14 35 Injury at birth ... ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 36 Accidental mechanical suffocation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Atelectasis 1 1 ... ... ... 2 1 ... ... ... 3 ... 1 1 1 ... ... ... ... ... 1 2 38 Other defined diseases ... ... ... ... ... 1 2 1 ... 8 ... 1 2 1 2 2 ... ... ... 7 1 39 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other violence ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 14 18 3 2 1 38 23 23 24 14 122 5 10 11 11 8 9 18 14 11 7 5 5 1 5 2 61 61 * 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. These notes apply to ages and deaths in each ward. 21 MATERNAL MORTALITY The number of Shoreditch women whose deaths were primarily classified as due to childbirth during the year was 1. This gives a maternal mortality rate per 1,000 live births of 0.69, and per 1,000 total births (i.e., still births included) of 0-66. The corresponding figures for the County of London were 2-48 and 240. In addition to this death three deaths occurred as a result of conditions which were associated with pregnancy and childbearing, but which were not classifiable as maternal deaths. 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 1934 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. 1930 1.84 2.38 4.22 171 1.45 3.16 2.01 1.51 3 52 1931 1.59 2.36 3.95 2.02 1.78 3.80 0.00 1.78 1.78 1932 1.55 2.49 4.04 1.19 1.47 2.64 *0.60 1.79 2.39 1933 1.79 2.63 4.42 1.48 1.72 3.20 2.68 1.34 4.02 1934 2.03 2.57 4.60 1.18 1.30 2.48 0.00 0.69 0.69 * This figure relates to one death from post abortive sepsis. It should be noted that the single death which occurred was due to a primary condition which was unavoidable. The low maternal mortality rate for the year is very satisfactory. 22 The particulars of these deaths are entered in the following table : — MATERNAL MORTALITY, 1934. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abortion not returned as septic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Haemorrhage following abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Without record of haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic gestation ... ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal hemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta prævia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other puerperal haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal septicaemia and pyæmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal albuminuria and convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other conditions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other toxaemias of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes mellitus ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... Chronic rheumatic carditis ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... Chronic nephritis ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 23 Cancer. The deaths from cancer in the Borough during the year numbered 134 as compared with 135 in 1933. Particulars concerning these deaths as regards age, situation of disease and Ward arc given in the table on page 24. 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. 1930 1,454 1,553 1,346 1931 1,484 1,641 1,242 1932 1,510 1,553 1,545 1933 1,526 1,604 1,443 1934 1,563 1,720 1,479 Although there was no marked change of incidence, it is satisfactory to note that there has been no alarming increase in cancer deaths. The rate for 1934 is identical with that for 1929. In the table on page 24 it is seen that the alimentary tract was the most frequently affected site, and that the stomach was the organ which was most liable to show the disease. A somewhat disquieting feature is the fact that 14 of the 134 deaths were due to malignant disease of the lung or pleura. The high incidence of this condition in males is generally recognised. 24 Deaths from Cancer in the Borough during Year 1934. AGES. SEX. WARDS. 0 to 15. 16 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65 65 to 75. 75 to 85. 85 and upwards. Male. Female. Moorfields. Church. Hoxton. Wenlock. , Whitmore. Kingsland. Haggerston. Acton. M F M F M F M F M F M F M F M F All situations 1 ... ... 1 7 23 37 43 22 ... 77 57 3 2 16 9 15 11 11 7 9 6 9 4 6 7 8 11 iongue ... ... ... ... ... ... 2 1 1 ... 4 ... ... ... 2 1 1 ... ... ... Other buccal cavity ... ... ... ... ... ... 1 2 1 ... 4 ... ... 2 2 ... ... ... ... ... Pharynx ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... Oesophagus ... ... ... ... ... 1 4 4 1 ... 10 1 1 3 1 1 2 ... 1 Stomach ... ... ... ... ... 2 7 8 6 ... 12 11 ... 3 2 1 2 1 2 3 1 1 1 3 2 1 Liver ... ... ... ... 1 ... 1 1 1 ... 3 1 ... 1 ... 1 1 ... 1 ... Gallbladder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Intestines ... ... ... ... 1 2 3 7 4 ... 4 13 2 1 1 2 2 1 2 1 2 3 Rectum ... ... ... ... ... ... 3 6 1 ... 8 2 ... 2 1 1 1 1 1 ... 1 9 Others ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterus ... ... ... ... ... 3 1 3 1 ... ... 8 ... ... 1 2 1 1 1 * 2 Ovary and Fallopian tube ... ... ... ... 1 1 ... 3 1 ... ... 6 ... 2 1 1 ... 1 ... 1 Vagina, vulva ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Breast ... ... ... ... 3 1 2 1 ... ... 7 1 3 1 l 1 Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Larynx ... ... ... ... ... 1 1 1 ... ... 3 ... ... ... 2 ... 1 ... ... ... Lung and pleura ... ... ... ... 1 6 6 ... 1 ... 11 3 1 1 2 1 1 1 2 1 2 1 1 Mediastinum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pancreas ... ... ... ... ... 1 2 1 1 ... 2 3 ... 1 1 1 ... ... 1 1 ... ... Bladder ... ... ... ... ... 1 ... 1 ... ... 1 1 ... ... ... ... ... 1 ... 1 Prostate ... ... ... ... ... ... 1 1 2 ... 4 ... ... 3 ... 1 ... ... ... ... Others 1 ... ... 1 ... 4 4 2 ... ... 10 2 1 1 1 4 ... 1 1 2 1 25 The following table shows the actual numbers and the percentage of total deaths in various age groups:— All ages. 0— 1— 2 5— 15— 1,188 122 40 33 35 47 100% 10.27% 3.37% 2.78% 2.94% 3.96% 25— 35— 45— 55— 65— 75— 42 59 132 200 262 216 3.54% 4.97% 11.11% 16.83% 22.05% 18.18% Vital Statistics for the Metropolitan Boroughs. Metropolitan Boroughs. Estimated Resident Population. (mid-1934). Birth rate. Death rate— Infantile Mortality per 1,000 births. Crude. Adjusted. West Districts. Paddington 139,790 13.7 12.4 12.3 95 Kensington 179,080 12.3 13.3 12.5 93 Hammersmith 129,170 13.8 12.9 13.3 77 Fulham 145,400 13.7 12.6 12.7 59 Chelsea 58,160 10.8 13.4 11.4 65 Westminster 124,050 9.4 11.8 12.1 66 North Districts. St. Marylebone 92,320 9.0 12.7 12.6 61 Hampstead 90,000 10.4 11.3 10.6 53 St. Pancras 187,540 13.1 12.8 13.2 65 Islington 314,200 14.7 11.8 11.9 62 Stoke Newington 50,620 13.7 11.5 11.0 61 Hackney 211,120 14.2 11.7 12.2 56 Central Districts. Holborn 36,000 8.6 12.2 13.0 71 Finsbury 64,970 15.1 13.4 14.6 51 City of London 9,660 6.8 10.5 11.6 121 East Districts. Shoreditch 90,630 16.1 13.1 14.4 84 Bethnal Green 102,060 14.3 11.8 13.3 73 Stepney 214,990 15.3 12.3 14.3 87 Poplar 146,370 15.5 12.3 13.7 62 South Districts. Southwark 159,930 14.9 13.5 14.4 77 Bermondsey 105,060 14.8 12.4 14.1 64 Lambeth 283,900 14.2 12.8 12.7 63 Battersea 150,870 14.3 12.5 12.3 61 Wandsworth 345,250 11.0 11.2 10.4 57 Camberwell 238,360 13.2 12.3 12.3 67 Deptford 101,380 15.8 13.1 13.6 68 Greenwich 97,250 13.7 12.2 12.5 87 Lewisham 222,180 12.2 10.0 10.1 43 Woolwich 145,520 13.7 11.3 12.0 63 26 27 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. St. Leonard's Hospital. Royal Chest Hospital. Home of Good Shepherd. Convent Hospital. Infant Welfare Centre. Under 1. 1 to 2. 2 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75 75 to 85 85 and Upwards Moorfields. Church. 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 122 40 33 24 11 19 28 42 59 132 200 262 180 | 36 19 |30 135 ,86 1191 86 94 89 105 87 66! 45 63 57 62 45 663 525 17 116 527 51 16 46 5 2 ... ... ... ... M F M F M F M F M F M F M F M F 1 Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles 5 15 8 1 ... ... ... ... ... ... ... ... ... ... ... 1 2 1 4 2 3 2 i 3 ... 1 3 4 1 1 14 15 ... ... 3 1 ... ... ... ... ... ... ... ... 3 Scarlet fever ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 4 Whooping cough 2 5 4 1 ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 2 1 1 1 ... ... ... ... ... 1 1 7 5 ... ... 1 ... ... ... ... ... ... ... ... ... 5 Diphtheria ... 2 4 7 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 1 1 3 1 2 ... ... ... ... 1 ... 5 8 ... ... ... ... ... ... ... ... ... ... ... ... 6 Influenza ... ... ... ... ... ... 1 1 1 ... 3 ... ... ... ... 1 1 1 ... ... ... 1 ... ... 1 ... ... ... 1 ... 3 3 ... ... 1 ... ... ... ... ... ... ... ... ... 7 Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 8 Cerebro-spinal fever 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 9 Tuberculosis of respiratory system ... ... 1 ... 1 7 9 17 15 15 17 2 ... ... 1 ... 16 5 6 3 7 7 10 5 6 3 7 1 6 1 59 25 ... 1 34 12 1 13 ... ... ... ... ... ... 10 Other tuberculous diseases 3 1 ... ... ... ... 2 1 3 ... ... ... ... ... l 1 ... 1 ... 1 ... 1 1 1 ... ... 2 ... 1 5 5 ... ... 3 ... ... ... ... ... ... ... ... ... 11 Syphilis 1 ... ... ... ... ... ... ... 2 5 2 2 ... ... 1 ... 3 1 ... ... 1 ... 2 1 ... ... 2 1 ... ... 9 3 ... ... 7 1 2 ... ... ... ... ... ... ... 12 General paralysis of the insane, tabes dorsalis ... ... ... ... ... 1 1 ... ... 2 ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 4 ... ... 2 ... ... ... ... ... ... ... ... ... ... 13 Cancer, malignant disease 1 ... ... ... ... ... ... 1 7 23 37 43 22 ... 3 2 16 9 15 11 11 7 9 6 9 4 ... 7 8 11 77 57 1 6 56 4 2 8 ... ... ... ... ... ... 14 Diabetes ... ... ... ... ... ... 1 ... ... 1 5 3 2 ... ... ... ... 2 ... 1 1 3 ... 1 ... 2 ... 1 ... 1 1 11 ... ... 6 ... ... ... ... ... ... ... ... ... 15 Cerebral haemorrhage, &c. ... ... ... ... ... ... ... ... ... 5 8 12 7 ... ... 2 4 2 2 1 2 4 1 3 3 1 2 4 1 14 18 1 11 12 2 ... ... ... ... ... ... ... ... 16 Heart disease ... ... ... 1 2 2 ... 3 8 21 54 95 67 16 7 9 37 20 26 iy 13 25 23 21 13 8 15 13 10 10 144 125 10 44 102 2 4 13 ... ... ... ... ... ... 17 Aneurysm ... ... ... ... ... ... ... 1 1 1 3 ... ... ... ... ... 2 1 ... 1 1 ... 1 ... ... ... ... ... ... ... 4 2 ... ... 3 ... ... ... ... ... ... ... ... ... 18 Other circulatory diseases ... ... ... ... ... ... ... ... ... 5 9 18 11 3 2 2 3 2 5 2 7 1 5 1 5 2 4 2 2 1 33 13 1 32 29 1 ... 1 ... ... ... ... ... ... 19 Bronchitis 1 1 ... ... ... ... 3 2 5 9 19 20 7 ... 1 5 7 6 8 8 3 3 6 4 5 ... 6 2 3 28 39 2 4 30 1 ... 1 ... ... ... ... ... ... 20 Pneumonia (all forms) 27 11 9 2 ... 1 2 3 6 12 16 23 7 2 3 1 17 8 17 14 10 5 14 11 1 3 7 2 5 3 74 47 1 2 64 2 4 3 2 1 ... ... ... ... 21 Other respiratory diseases ... ... ... ... ... 1 ... 1 3 3 1 3 1 ... ... ... ... ... 2 3 1 ... 2 1 1 ... 1 ... 1 1 8 5 ... ... 5 ... 2 1 ... ... ... ... ... ... 22 Peptic ulcer ... ... ... ... ... ... ... 1 ... 5 2 1 ... ... ... ... ... ... 3 ... 1 ... 2 ... 1 ... 1 ... 1 ... 9 ... ... ... 3 ... ... ... ... ... ... ... ... ... 23 Diarrhoea, etc. 28 3 2 ... ... ... ... ... 1 1 ... ... ... ... ... 2 4 5 4 0 5 3 1 2 2 1 ... 1 ... 20 15 ... ... 19 1 ... ... 1 ... ... ... ... ... 24 Appendicitis ... ... 1 2 ... 1 ... ... ... ... 1 1 ... ... ... ... ... 2 ... 1 1 ... 1 ... ... ... 1 ... ... ... 3 3 ... 1 ... ... ... ... ... ... ... ... ... 25 Cirrhosis of liver ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... ... ... 2 ... ... ... ... ... ... ... ... ... 26 Other diseases of liver &c. ... ... ... ... ... ... ... ... ... 1 4 1 1 ... ... ... 1 1 ... 1 ... 1 ... 1 ... 1 ... ... 1 ... 2 5 ... ... ... ... ... ... ... ... ... ... ... ... 27 Other digestive diseases 1 ... ... 1 1 1 2 1 2 4 6 7 5 ... ... ... 2 6 4 1 1 ... 2 1 1 2 4 4 1 2 15 16 ... ... 24 2 ... 2 ... ... ... ... ... ... 28 Acute and chronic nephritis ... ... ... ... ... 1 3 2 1 5 6 9 4 1 ... 3 2 2 3 1 3 3 3 3 2 1 2 1 3 13 19 ... 5 14 ... 1 1 ... 1 ... ... ... ... 29 Puerperal sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other puerperal causes ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 31 Congenital debility, premature birth, malformations, &c. 46 ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... 1 1 5 2 4 3 6 5 8 5 2 1 1 3 2 20 29 ... ... 19 1 ... 1 2 ... ... ... ... ... 32 Senility ... ... ... ... ... ... ... ... ... ... 1 3 9 5 1 ... 4 ... ... 2 1 3 1 2 1 1 2 ... ... 10 8 ... 1 13 1 ... ... ... ... ... ... ... ... 33 Suicide ... ... ... ... ... 1 ... 1 3 4 1 1 ... ... ... ... ... ... ... 2 ... 5 1 1 ... 1 1 ... ... 9 2 ... ... 1 2 ... ... ... ... ... ... ... ... 34 Other violence ... ... ... 5 3 1 1 3 2 3 2 6 10 1 ... 1 1 2 6 2 1 6 ... 4 3 1 ... 3 4 1 17 20 ... 3 24 14 ... ... ... ... ... ... ... ... 35 Other defined diseases 6 2* 1 4 4 2 5 3 2 7 13* l1† 14 1 ... 1 8 1 10 6 10* 1 6† ... 8 2 5 5 6 2 53 22 1 5* 50† 4 ... 2 ... ... ... ... ... ... 36 Causes, ill defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... * Includes 1 death from erysipelas. † Includes 2 deaths from erysipelas. * Includes 2 deaths from erysipelas. † Includes 4 deaths from erysipelas. 3 28 III.—INFECTIOUS AND OTHER DISEASES. During the year 1934 the number of notifications of all infectious diseases (excluding tuberculosis) was 950, as compared with 1,191 for the year 1933. The deaths from notifiable diseases (excluding tuberculosis) during 1934 numbered 142, which figure represents 11-9 per cent. of the total deaths for the Borough. The corresponding number for 1933 was 137 (11.3 per cent. of the total deaths). Full particulars of the notified cases, classified according to the time of occurrence, age, and the wards in which they occurred, are given in the table on page 29. The outstanding feature of this table is the number of cases of scarlet fever (409) and diphtheria (362) which were notified during the year. The table shows that seasonal factors had little effect upon the incidence of these two diseases. Scarlet fever is nowadays of a mild type, but diphtheria is a very dangerous disease of childhood. In the case of diphtheria the diagnosis was altered later in 74 cases, so that the actual incidence of the disease for 1934 was 3.2 per 1,000 of the population. This incidence must be considered fairly high. The number of deaths in these 288 diphtheria cases was 13, which gives a case mortality rate of 4.5 per cent. The disease was therefore not of such a severe type as is found in some parts of the country. Nevertheless the incidence is a matter of some concern. In another part of this report particulars are given regarding the progress of diphtheria immunization. Although the population as a whole has considerable general knowledge of the purpose of immunization, individual parents often lack the will to apply this knowledge in the case of their own children unless they are stimulated to do so by some external influence. Of all such influences there is no doubt that the most potent is the realisation by parents during the course of a diphtheria epidemic that the disease may halt with dire results at their own thresholds. Fear is the greatest of all propagandists. During the early part of the present year (1935) diphtheria was extremely prevalent in many parts of the country, and reports in the press diffused knowledge of the dangers of the disease. The result of this knowledge, which was stimulated by the personal efforts of members of the health department staff, was a very marked increase in the number of children who attended for immunization. It is not generally recognised by individual members of the community that all other measures for the prevention of diphtheria pale into insignificance when compared with specific immunization. Until this dictum receives widespread recognition, there is little chance of effecting a substantia] reduction in the incidence of this disease. Attention should be directed to the fact that in 11 per cent. of the notified cases of scarlet fever and in 20 per cent. of the notified cases of diphtheria the diagnosis was subsequently altered. These percentages may appear to be high, but it should be remembered that the London County Council requires every case to be certified as suffering from one of the notifiable diseases before the Council will remove the patient to one of its infectious hospitals. The result is that the weekly figures of notifications are unduly swollen by the inclusion of patients who obviously require observation in hospital, but who are possibly not suffering from one of the notifiable diseases. 29 TABLE SHOWING CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE CALENDAR YEAR, 1934. NOTIFIABLE DISEASE. NUMBER OF CASES NOTIFIED. Cases removed to Hospital. Diagnosis revised subsequently. Deaths. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total AGES. WARDS. 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 Moorfielda. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerton. Acton Smallpox ... 2 ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... Enteric fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever 100 102 96 111 409 1 148 223 28 9 ... ... 19 54 66 53 78 34 47 58 394 45 2 Diphtheria 74 94 81 113 362 9 131 177 22 21 2 ... 19 59 63 54 59 30 38 40 361 74 13 Acute primary pneumonia 26 8 4 19 57 ... 10 8 10 16 9 ... 2 11 7 13 10 5 5 4 43 1 Acute influenzal pneumonia 3 ... ... ... 3 ... 1 1 1 ... ... ... ... 1 ... ... ... ... 1 1 2 ... 121 Erysipelas 16 16 15 12 59 ... 5 9 5 15 15 10 1 10 11 10 10 5 5 7 41 ... 4 Puerperal fever 2 ... 2 2 6 ... ... ... 2 4 ... ... ... 1 2 ... 1 1 ... 1 4 ... ... Puerperal pyrexia 4 7 7 5 23 ... ... ... 8 15 ... ... ... 7 3 1 4 3 3 2 21 ... ... Cerebro-spinal fever 1 ... 1 1 3 1 1 ... ... ... ... ... ... 1 1 1 ... ... ... ... 3 ... 2 Ophthalmia neonatorum 6 6 2 4 18 18 ... ... ... ... ... ... 4 2 2 3 4 2 ... 12 ... ... Acute anterior poliomyelitis ... ... 2 1 3 ... 2 1 ... ... ... ... ... 2 1 ... ... ... ... ... 3 ... ... Dysentery 5 ... ... ... 5 3 2 ... ... ... ... ... ... 1 1 1 1 1 ... ... 5 1 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus & typhoid fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 237 235 210 268 950 32 300 422 76 80 26 14 41 151 157 135 168 83 101 114 891 120 142 Tuberculosis (pulmonary) 33 47 33 19 132 3 13 42 41 32 1 7 26 16 27 20 11 7 18 ... ... 84 ,, (other forms) 6 9 5 6 26 2 4 10 7 3 ... ... ... 8 4 3 7 2 1 1 ... ... 10 Numbers and percentages of cases moved to hospitals (excluding tuberculosis) 217 91.6% 219 97.0% 205 97.6% 250 93.3% 891 93.8% 3a Note.—The following diseases are notifiable:— Small-pox, cholera, diphtheria, erysipelas, scarlet fever, typhus fever, typhoid fevers, relapsing fever, continued fever, puerperal fever, puerperal pyrexia, plague, cerebro spinal meningitis, acute polio encephalitis and poliomyelitis, encephalitis lethargica, glanders, anthrax, hydrophobia, malaria, dysentery, acute primary pneumonia, acute influenzal pneumonia, ophthalmia neonatorum, tuberculosis, all forms (for which see special section of this report). 30 Apart from scarlet fever and diphtheria there was no undue prevalence of infection during the year. It is gratifying to be able to record that only two cases of smallpox were notified. This presumably represents the trough of the long post-war epidemic wave of this disease. Attention should also be directed to the fact that during the year 94 per cent, of all notified cases of infectious disease were removed to hospital. Smallpox. Only two cases of smallpox were notified during the year, and in both cases the diagnosis was confirmed. Both cases were examples of the mild type of the disease (variola minor) and both patients were unvaccinated and were females. These two cases occurred in the Whitmore ward. They recovered satisfactorily. The attack rate per 1,000 for the Borough was 0.02. 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 1934 179 147 2 No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. Vaccination Order. The Public Vaccination Officers are:— (1) Mr. S. W. Dyson (Mansfield Street Baths), Shoreditch North-East SubDistrict (Acton, Haggerston, Kingsland and Whitmore Wards). (2) Mr. W. H. Williams (94, New North Road), Shoreditch South-West SubDistrict (Church, Hoxton, Moorfields and Wenlock Wards). The Public Vaccinators are:— (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). 31 The following report upon vaccination is in the form required by the Registrars General:— VACCINATION OFFICERS' RETURN RESPECTING THE VACCINATION OF CHILDREN WHOSE BIRTHS WERE REGISTERED IN 1933. 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 1934. 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 1934. Insusceptible of vaccination. Certificate of conscientious objection. 1933. 1 2 3 4 6 7 8 9 10 11 12 13 1st Jan. to 31st Dec. North-East 775 168 — 423 33 19 69 32 31 205 408 South-West 459 99 2 223 21 6 — 68 40 77 200 Other Districts — — — — — — — — — — — Total 1,234 267 2 646 54 25 69 100 71 282 608 32 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, 1934:— 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 — — – — — Holborn& Finsbury Institution Dr. R. T. Taylor — 1 1 — — Shoreditch South-West District. Dr. N. H. Clubwala 160 120 280 11 – Shoreditch North-East District. Dr. L. Statnigrosch 154 77 231 4 – 314 198 512 15 Scarlet Fever. The cases certified numbered 409, of which 45 or 11.0 per cent. were subsequently not regarded as scarlet fever. The actual number of cases was accordingly 364, which gives an attack rate of 4.02 per 1,000 inhabitants. The age, seasonal and ward distribution of the cases are included in the table on page 29. There were two 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 5.) 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 8 11 19 • • • • • • • • • 5.18 • • • • • • Church 17 31 48 • • • • • • • • • 3.13 • • • • • • Hoxton 32 27 59 • • • • • • • • • 3.97 • • • • • • Wenlock 17 30 47 • • • 2 2 3.21 0.14 4.25 Whitmore 39 34 73 • • • • • • • • • 5.22 • • • • • • Kingsland 18 11 29 • • • • • • • • • 3.24 • • • • • • Haggerston 19 20 39 ... • • • • • • 4.23 • • • • • • Acton 27 23 50 • • • • • • • • • 4.01 • • • • • • Total 177 187 364 • • • 2 2 4.02 0.02 0.55 London • • • ••• 18,373 ... ... 66 4.34 0.02 0.36 33 The number of cases in Shoreditch was less than in 1933, in which year there were 567 cases with an attack rate of 6.06. The disease continued to be of the mild type which is now prevalent in this country. This mildness has changed the whole problem of scarlet fever. In past years it was a killing disease, comparable in severity with diphtheria, and treatment in hospital was therefore very desirable. Yet the disease still tends to produce lasting effects as a result of complications—though these, fortunately, have been reduced by the adoption of serum treatment in suitable cases. From the administrative point of view the problem of scarlet fever is now largely one of correct diagnosis and the search for missed cases. A noteworthy feature of scarlet fever during the year was the fact that there was practically no seasonal incidence, the 409 notified cases being distributed almost equally over the four quarters of the year. During the year all the notified cases except 15 were removed to hospital. Return cases.—Returned cases are defined as "cases occurring in the same house or elsewhere within a period of not less than twenty-four hours, or not more than twenty-eight days after return or release from isolation." During the year 26 cases were regarded as return cases, giving a rate of 7.1 per cent. Although a skin test for scarlet fever (the Dick test) is now well established, and although specific immunization can now be effected with considerable success, these procedures are more suitable for hospital experience than for use in the general population. This is due largely to the fact that, although scarlet fever is a specific disease, it is difficult to differentiate it from certain other conditions which are due to closely allied organisms. Consequently specific immunization is not as useful as it is in diphtheria. During the year there was no clinic for this work in the Borough. Diphtheria. The number of cases notified during the year was 362, of which 74, or 20.4 per cent., were subsequently not regarded as being cases of diphtheria. The actual number of cases for the year was thus 288, which gives an attack rate of 3.8 per thousand inhabitants. In 1933 the number of cases was 286 and the attack rate was 2.1. The age, seasonal incidence and ward distribution of the cases are given in the table on page 29. The number of deaths was 13 of which five were males and eight females. This gives a death rate of 0.14 per thousand inhabitants and a case mortality of 4.51. The deaths occurred in the following age groups: Up to 2 years, 2 ; 2-5 years, 4 ; 5-10 years, 7. 34 The following table gives particulars regarding diphtheria for Shoreditch London, and England and Wales for a period of years:— Year. Shoreditch. London. Death Rate. England & Wales. Death Rate. Cases Notified. Case Rate. Deaths Death Rate. 1925 440 4.1 17 0.16 0.07 0.07 1926 372 3.5 12 0.12 0.12 0.08 1927 467 4.5 12 0.11 0.09 0.07 1928 354 3.5 13 0.13 0.09 0.08 1929 281 2.8 10 0.10 0.08 0.09 1930 326 3.3 20 0.20 0.10 0.09 1931 228 2.3 7 0.07 0.06 0.07 1932 249 2.6 7 0.07 0.07 0.06 1933 286 3.1 15 0.16 0.08 0.07 1934 288 3.2 13 0.14 0.11 0.10 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 Popu lation. Case Mortality Deaths per 100 eases. M. F. Total. M. F. Total. Attack Death. Moorfields 8 8 16 ... ... ... 4.36 ... ... Church 26 20 46 1 2 3 3.00 0.19 6.52 Hoxton 24 22 46 1 1 2 3.09 0.14 4.35 Wenlock 24 21 45 1 3 4 3.07 0.27 8.89 Whitmore 21 29 50 1 2 3 3.57 0.21 6.00 Kingsland 21 5 26 ... ... ... 2.91 ... ... Haggerston 16 13 29 ... ... ... 3.15 ... ... Acton 15 15 30 1 ... 1 3.00 0.10 3.33 Total 155 133 288 5 8 13 3.18 0.14 4.51 London ... ... 11,888 ... ... 473 2.81 0.11 3.98 During the year the number of bacteriological examinations made in connection with diphtheria was 1,361. In twenty instances the source of infection, as represented by a previous case in the same household, was established. 35 Diphtheria Immunization.—The desirability of an increase in immunization work was mentioned in the introduction to this section (page 28). At the diphtheria immunization clinic the total number of attendances was 1,494. The number of persons who received the primary Schick test was 188, and of these 40 were naturally immune and were not immunized. During the year 244 of the children completed the course of inoculations and 196 of these were tested and found immune. At the end of the year 60 cases were still under treatment or were awaiting the final Schick test. In connection with this service I have to thank Dr. McGregor, Sister Pollard, and Miss Heath, of the Sutton Branch of the Voluntary Aid Detachment, for the work which they carried out during the year. Diphtheria Carriers.—A number of carrier cases were met with during the year. Most of these were of the convalescent type and the condition rapidly cleared. Twelve were persistent carriers and these were referred to the Carrier Clinics which have been instituted for treatment of school children at Guy's Hospital, the London Hospital and St. Mary's Hospital. Dysentery. Five cases of dysentery came to the knowledge of the department during the year. The patients were all young children and were removed to hospital from an institution in the Borough. The diagnosis in the case of one child was subsequently not confirmed. Enquiries did not elicit any definite facts regarding the source of infection. Erysipelas. The cases certified numbered 59, and there were 4 deaths, 3 males and 1 female. The deaths occurred at the following ages:— Between 1 year and 2 years 1 Between 55 and 65 years 1 Between 65 and 75 years 2 The age, seasonal and ward distribution of the cases are included in the table on page 29. A comparison between London and Shoreditch is contained in the following table :— Per 1,000 inhabitants. Deaths per Attack rate. Death rate. 100 cases. London 0.62 0.04 7.06 Shoreditch 0.65 0.04 6.78 Forty-one cases were moved to hospital, mostly to St. Leonard's, during the course of the year. 36 Puerperal Fever and Puerperal Pyrexia. Six cases of puerperal fever were notified during the year, giving a case rate of 0.69 per 1,000 population. There were no deaths. Of the six cases two occurred in institutions, one in the practice of a private doctor and three in the practice of midwives. Four were removed to hospital, the other two cases being treated at home. In the Borough provision is made for consultations under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, and during the year 1934 one such consultation was held. During the year 23 cases of puerperal pyrexia were notified. 21 out of the 23 cases were removed to hospital, and the final diagnosis was altered to puerperal fever in two cases. The final diagnosis in the remaining 21 cases was as follows:— Pyelitis due to bacillus rommunis 1 Pyelitis 3 Parturition ; idiopathic uterine inertia 1 Capillary bronchitis 1 Infection of uterus 1 Pneumonia and pelvis sepsis (Caeserian Hysterectomy) 1 Infected perineal tear 1 Septic abortion 1 Uterine sepsis 1 Local uterine infection 3 Urinary infection 1 Concealed accidental haemorrhage 1 Vaginal laceration. Placenta praevia 1 Quinsy 1 Acute mastitis 1 Sapraemia (uterine) 1 Broncho pneumonia 1 It will be apparent that a considerable proportion of the cases of puerperal pyrexia although not finally diagnosed as puerperal fever, were due to septic conditions of the generative tract. It is gratifying that the incidence of puerperal fever is low in the Borough. 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. 37 The infection is nearly always gonorrheal in nature and is usually due to infection from the generative tract during birth. The ideal method of treatment is removal of the child and the mother to hospital. The following table gives particulars of the cases which occurred during the year Cases. Vision unimpaired. Vision. Impaired. Died. Notified. Treated at home. In hospital. 18 11 7 18 Nil reported. Nil. The seven patients who were removed were treated at St. Margaret's Hospital. Of the eleven patients treated at home five attended other hospitals as out-patients. The case rate per thousand births was 12.4 as compared with 5.80 for London as a whole. In addition to these cases of ophthalmia neonatorum 29 cases of inflammation of the eyes were reported by the Medical Officer of Health of the London County Council. Of these five were subsequently notified as ophthalmia neonatorum and are included in the above table. Cerebro-spinal Fever. Five cases of this disease occurred in the Borough during the year. Of these three were notified, the other two being reported after the death of the patient. The ages of the patients notified during life were 5 and 4 years and 3 months respectively ; all were females. These cases were evidently sporadic in nature. The number of deaths from this disease in London and Shoreditch during recent years have been as follows:— 1930 1931 1932 1933 1934 Shoreditch 1 6 6 6 2 London 80 131 131 116 80 The fatal cases were aged 3 months and 2 years respectively, one being a male and one a female. Encephalitis Lethargica. No new cases of this disease were notified during the year. It is well known that the after effects of this disease present numerous administrative difficulties. At the end of the year 27 patients who were suffering from post-encephalitic symptoms were living in the Borough and one of these was removed to a special institution. There was one death of a patient who was suffering from post-encephalitic symptoms. 38 Acute Poliomyelitis. Three cases of this disease were notified during the year; two were girls aged 3 years and 4 years respectively and the third was a boy aged 14 years. All were removed to hospital. There were no deaths. It has long been recognised that the acute stage of this disease is often so indefinite in character as to be undiagnosable, and it is only when a short time later paralysis manifests itself that the true nature of the condition is realised. It is therefore essential that treatment should be carried out at the earliest possible stage. If the later stage of the paralysis has become established orthopædic treatment is desirable. Efforts are made to follow up these cases and to ensure that they attend a proper institution for treatment. Children of school age attend Hoxton House Centre for Physical Defectives, where they are kept under observation and referred to hospital where necessary. The Invalid Children's Aid Association also renders valuable assistance in assisting parents with the purchase of appliances which may be necessary for the correction of deformities. Pneumonia. The Ministry of Health Regulations of 1919 made two forms of pneumonia compulsorily notifiable, viz., acute primary pneumonia and acute influenzal pneumonia. During the year under review the number of notifications of pneumonia received was 60, of which 57 were primary and 3 influenzal. The attack rate for the two varieties, based on the notifications received, was 0.63 and 0.03, as compared with 0.30 and 0.39 for 1933. The number of deaths from pneumonia of all types was 121, which gives a death rate of 1.33 per 1,000. It will be apparent that during the year under review influenza contributed very little to the causes of death. The table on page 29 shows that the cases of acute primary pneumonia were distributed more or less evenly throughout all the age groups, and that the incidence was markedly greater in the first and fourth quarters than during the spring and summer. Of the 60 cases of pneumonia brought to the notice of this department, 45 received treatment in St. Leonard's Hospital. In addition to the 60 cases, 21 cases of pneumonia of types which are not notifiable were visited by the District Nursing Association who paid in all 334 visits to pneumonia cases. 39 Anthrax. No case of this disease was notified during the year. Plague. No case of this disease was notified during the year. In connection with this disease it is of interest to note that there has been a recent incursion by the black rat (Rattus alexandrinus) into the central London area. Modern methods of construction have been effective in excluding the brown rat (Rattus norvegicus) from new buildings. The black rat, which was formerly the prevalent variety of the species in this country, died out many years ago and the recent influx is probably due to spread from the ports. The black rat is a host of plague bacilli. A recent circular from the Ministry of Agriculture and Fisheries pointed out the increase in the numbers of the black rat, and steps were taken in the Borough to ascertain whether any of these rodents were harbouring plague bacilli. Ten rats were sent for post-mortem examination, and in every case it was ascertained that the animals were free from this bacillus. Measles. The deaths from measles during 1934 numbered 29 and occurred in the following age groups: under 1 year, 5; between 1 and 2 years, 15; between 2 and 5 years, 8 ; between 5 and 15 years, 1. Measles was responsible for 14.4 per cent. of all deaths of children under five years of age. It will be apparent from these figures that measles was a very important cause of death in children under two years of age, and it is for this reason that efforts have been made in recent years to effect a reduction in this mortality. The following table gives the deaths and death rates from measles for Shoreditch and London respectively during recent years. It will be seen that 1934 was an epidemic year. The actual epidemic commenced in November, 1933, and continued until August, 1934. The disease is not notifiable in Shoreditch and consequently no figures are available regarding the actual incidence of the disease. From information which was received from different sources, however, it would seem that the epidemic was of considerable magnitude. Before the commencement of the epidemic arrangements were made between the London County Council and the Borough authorities whereby all cases of measles or suspected measles discovered by the school authorities would be reported to the Medical Officer of Health of the Borough. Action would then be taken to ensure that suitable cases should be admitted to hospital. A special measles visitor was appointed by the Borough Council and this officer worked in co-operation with the London County Council School Nurse. As a result of these measures the department received information of 1,107 cases of measles during the calendar year 1934. 40 In the case of an epidemic of measles it is obviously undesirable to limit the available information according to the calendar year under discussion. The following table gives the age distribution of cases and deaths for the whole period of the measles epidemic, viz., from 1st November, 1933, to 31st August, 1934. Ages Under 1 1 and under 2 2 and under 3 3 and under 4 4 and under 5 5 and under 6 6 and under 7 7 and under 8 8 and under 14 14 and over Total. No. of cases 64 159 106 237 237 239 199 92 37 6 1,174 No. of deaths 7 18 3 3 1 2 — — — — 34 The epidemic commenced in certain areas of London during November, 1933, but in Shoreditch cases did not occur in epidemic proportions until January, 1934, and it had spent its force by the end of May. The following table gives the number of cases which occurred week by week from January to May. Week ending— Week ending— Week ending— Jan. 5 5 Mar. 2 70 May 4 21 „ 12 22 „ 9 81 „ 11 28 „ 19 35 „ 16 73 „ 18 28 „ 26 35 „ 23 102 „ 25 14 „ 30 81 Feb. 2 45 Apr. 6 26 ,, 9 55 „ 13 63 „ 16 77 „ 20 42 „ 23 63 „ 27 23 Arrangements were made with the District Nursing Association for the visiting of all cases in which nursing was requested by the practitioner who was in attendance. 200 visits were paid to 21 patients, the average number of visits per patient being 9.5. School exclusion was practised to a considerable extent. The total number of children was 252, and about 21 per cent,. of the total measles cases. During 1935 arrangements were made for the notification of measles in the Borough, and at the time of writing the Ministry of Health have sanctioned the notification of all first cases of measles in any household, provided these are under the age of five years. Further particulars regarding these regulations will be given in the next annual report. Whooping Cough. As this disease is not notifiable in Shoreditch the actual number of cases cannot be ascertained. It is apparent, however, from the number of deaths, viz., 12, that there was a considerable outbreak of the disease in the Borough. The deaths occurred between January and November, 1934. 41 The following table gives the deaths from this disease between 1929 and 1934 :— Year. Deaths. Year. Deaths. 1929 40 1932 4 1930 3 1933 14 1931 11 1934 12 The ages of death are given in the following table:— Under 1 year. 1-2 years. 2-3 years. 3-4 years. 4-5 years. 5-10 years. 10-15 years. Total. 2 5 2 1 1 1 — 12 The death rate from this disease was 0.13 per cent. The deaths in London as a whole numbered 283, the death rate being 0.07. The number of cases removed to London County Council hospitals during the year was 91. Influenza. The year 1934 was not an influenza year. Six deaths occurred from this disease, which rives a death rate of 0.07. The following table shows the number of deaths and the death rate during recent years for Shoreditch and for London respectively:— Shoreditch. London. Year. Deaths. Deaths per 1,000 population. Deaths. Deaths per 1,000 population. 1929 68 0.68 3,088 0.69 1930 1 0.01 370 0.08 1931 23 0.23 1,114 0.25 1932 19 0.19 1,188 0.27 1933 45 0.48 2,215 0.51 1934 6 0.07 531 0.12 From general information in the possession of the Health Department it would appear that the prevailing type of influenza was mild. Diarrhœa and Enteritis. During the year 31 deaths of children under two years of age from diarrhoea and enteritis, along with associated and other conditions, were reported. This gives a death rate of 0.34 per thousand population and 2T3 per thousand births. 42 These figures for Shoreditch, and for London respectively, are given along with the corresponding figures for children under one year of age in the following table:— Deaths under two years. Deaths under one year. Total number. Rate per 1,000 population Rate per 1,000 births. Total number. Rate per 1,000 population Rate per 1,000 births. Percentage of deaths under 1 yr. 1933. 1934. 1933. 1934. 1933. 1934. 1933. 1934. 1933. 1934. 1933. 1934. 1933. 1934. London 658 713 0.15 0.17 11.6 10.8 600 669 0.14 0.16 9.58 10.5 17.8 17.7 Shoreditch 22 31 0.24 0.34 14.7 21.3 21 28 0.22 0.31 17.2 19.2 19.1 22.9 The disease "diarrhœa and enteritis" occurring in children under two years of age is often termed "summer diarrhœa." True summer diarrhœa is, however, a disease which occurs towards the latter end of a hot summer and persists during the early autumn. The frequency of this condition bears very little relation to the actual numbers of deaths certified as due to "diarrhœa and enteritis." This statement is borne out by the following table, which shows the actual numbers of deaths which were certified as due to enteritis and other conditions respectively in the four years 1931-1934:— 1931. 1932. 1933. 1934. Enteritis 20 13 11 19 Broncho-pneumonia and enteritis 7 4 2 4 Bronchitis and enteritis 2 1 3 4 Marasmus and enteritis 4 3 2 1 Convulsions and enteritis — 1 — 1 Prematurity or debility from birth and enteritis – – – 1 Skin conditions and enteritis — 1 — — Other conditions and enteritis — 3 4 1 Percentage of true enteritis 33 26 22 31 60.6 50.0 50.0 61.3 The deaths which were certified as due to enteritis alone were possibly not associated with any other condition, but in all the other instances the enteritis was probably a complication of the primary condition which is stated in the table. It is seen that true enteritis cases make up approximately 50 to 60 per cent. of all deaths due to diarrhœa and enteritis which are certified in any one year. The following table shows the monthly incidence of the deaths of true enteritis in the four years 1931-1934. The table shows that the seasonal incidence in these small samples was quite unimportant apart from the fact that a slightly larger number of deaths occurred in July, 1931. The conclusion that must be drawn 43 from these figures is that deaths which are certified as being due to diarrhoea and enteritis are not due to typical epidemic (summer) diarrhoea, which is essentially a disease of the late summer and early autumn. True Enteritis. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec.  1931 — 1 1 1 2 1 5 2 3 2 1 1 20 1932 1 — 3 3 — 1 — 1 — 2 1 1 13 1933 1 — 1 — 1 — — 1 2 2 2 1 11 1934 1 3 4 — 3 1 — 1 2 1 — 3 19 3 4 9 4 6 3 5 5 7 7 4 6 63 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. The particulars of these exclusions from school are as follows:— Disease from which suffering or to which exposed. Number of exclusions from School. Smallpox 2 Diphtheria 591 Scarlet fever 545 Measles 1,016 Chicken-pox 415 Whooping cough 164 Mumps 229 Cerebro-spinal fever 1 Acute anterior poliomyelitis 1 Erysipelas 4 Other infectious disease 190 3,158 Information was also received from the School Medical Officer that fifteen 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. 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. 4 44 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 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. Subjoined is a list of cases nursed under this agreement during the year 1934:— Disease. Under 5 Visits. Disease. Over 5 s./ Abscess of lung 1 26 Abortion 2 17 Adenoids 1 3 Ante-natal conditions 4 66 Boils 1 4 Breast abscess 3 31 Bronchitis 17 244 Enlarged breasts 3 16 Broncho-pneumonia 10 130 Influenza and bronchitis 1 17 Cataract of eye 1 25 Influenza and pleurisy 1 12 Chest 1 15 Influenza 7 53 Constipation 1 2 Mammary abscess 3 26 Conjunctivitis 2 13 Mastitis 7 110 Diarrhœa 2 Miscarriage 5 42 Discharging ear 7 111 Parturition 9 70 Discharging eyes 6 99 Pneumonia 19 314 Impetigo 9 130 Pneumonia and pleurisy 2 20 Intestinal conditions 2 6 Post-natal phlebitis 1 13 Measles 21 220 Post-partum condition 1 21 Neo-natal conditions 6 80 Puerperal phlebitis 1 40 Ophthalmia neonatorum 1 5 Puerperal pyrexia 2 18 Otorrhœa 15 300 Tuberculosis 13 145 Ot. media and intestinal 1 4 Pemphigus 2 63 Pertussis 3 46 Pneumonia 20 377 Post-operative mastoiditis 1 15 Prematurity 1 11 Pyrexia 1 4 Rheumatism 2 23 Scald of head 1 7 Scald of leg 1 23 Septic face 1 4 Septic head 1 49 Septic leg 2 38 Stomatitis 2 18 Swollen glands 1 7 Thread worms 27 296 Tonsils and adenoids 34 148 Totals 205 2553 Totals 84 1,031 45 Bacteriological Examinations. With the exception of those carried out at the Tuberculosis Dispensary, all the examinations made on behalf of the Borough Council are made by Dr. F. H. Teale at the University College Hospital Medical School. The following is a complete summary of the work done for the Borough by Dr. F. H. Teale of University College Hospital Medical School:— Swabs for diphtheria 1,327 Swabs for virulence test 21 Sputum for tuberculosis 165 Swabs for gonococci 36 Bloods for Wasserman reaction 10 Swab for haemolytic streptococci and other organisms 4 Blood counts 4 Sputa for tuberculosis and organisms 7 Stools for infective organisms 19 Feces for occult blood 1 Rats for plague 10 Blood for differential cell count 2 Swab for malarial parasite 1 Urine for complete examination 12 Swab from ulcer of vulva 1 Stool for complete examination 1 Meat pudding 1 Human milk 1 Routine examination of milk 71 Milks for brucella abortus 13 1,707 Examinations by Bacteriologists other than Dr. Teale:— Swabs for diphtheria 13 Food Poisoning. During the year two cases of suspected food poisoning were notified. One case occurred in January and was a woman of 19 years; the suspected food stuff was sausages. Sickness, diarrhoea and shivering was present for two or three days. The other case was a man of 32 years who suffered from suspected food poisoning in August, 1934. He suffered from slight gastric pains. His wife and three other members of the family had similar symptoms. The suspected food was fried fish. Both these cases were investigated without conclusive results and it is probable that the illnesses were not due to food poisoning by specific organisms. 4a 46 Disinfection. The premises disinfected numbered 1,048. The articles removed to the Borough Council's Disinfecting Station totalled 10,650, and included 929 beds, 298 mattresses, 1,907 pillows, 491 bolsters and 7,025 other articles such as sheets, blankets, quilts, curtains, carpets, clothing and the like. Shelter. It was not found necessary to remove any contacts to the Shelter which is provided under Section 60, sub-section 4, of the Public Health (London) Act, 1891. 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 11 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 coordinates the work of hospitals, public health services and practitioners, and undertakes publicity and propaganda work with regard to matters relating to venereal disease. Though the means for treatment are available, much educational work remains to be done. Cases not infrequently come to the notice of the Department in which patients recommended to one of these clinics discontinue treatment before they are cured, thus running the gravest risk of disaster to themselves, of infecting their wife or husband and of transmitting disease to their children. The number of bacteriological examinations carried out on behalf of the Borough Council in connection with the diagnosis of veneral disease during the past five years is as follows:— 1930 79 1931 80 1932 37 1933 45 1934 36 47 IV.—TUBERCULOSIS. Statistics. The total number of cases on the tuberculosis register on 31st December, 1934, was 1,596, as compared with 1,638 at the corresponding period of the previous year ; this represents a decrease of 42 cases. There were added to the register during the year, on account of fresh notifications and inward transfers, 194 names. On account of cancellations, as a result of death, removal from the area, cured, or change in diagnosis, 236 names were removed from the register (see table on page 48). Notifications. During the year there were received notification of 132 cases of pulmonary and 26 cases of non-pulmonary tuberculosis, making a total of 158 cases, of which 97 were males and 61 females. This represents a decrease of 25 in the number of notifications of pulmonary disease, and 4 in the number of cases of non-pulmonary disease. Compared with the average of the previous five years these figures represent a decrease of 35 in pulmonary and a decrease of 8 in non-pulmonary tuberculosis. Of the total cases notified, 34 were by private practitioners and 124 by medical officers of institutions. From the point of view of age grouping it is found that 12.1 per cent. of the total notifications of pulmonary tuberculosis which were received were in respect of children under 15 years and 87.9 per cent. were in respect of persons over 15 years, the corresponding figures for 1933 being 3.8 per cent. and 96.2 per cent., respectively. As regards non-pulmonary tuberculosis 61.5 per cent. were children under 15 years and 38.5 per cent. were individuals over 15 years. The corresponding figures for the previous year were 43.4 per cent. and 56.6 per cent., respectively. The following table gives details regarding the ages of notification of pulmonary and non-pulmonary cases respectively:— Age periods FORMAL NOTIFICATIONS. Number of Primary Notifications of new cases of Tuberculosis. Total Notifications 0 to l 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 — 1 4 3 8 16 11 11 17 9 1 81 130 ,, Females — 2 2 4 8 10 13 6 3 3 — 51 76 Non-pulmonary, Males — 2 3 6 1 2 2 — — — — 16 17 „ Females 2 2 — 1 2 2 1 — — — — 10 12 Column (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) 48 The supplementary table gives the age grouping of cases of tuberculosis which came to the notice of the Medical Officer of Health, otherwise than by formal notifications, during the year 1934:— 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 — — — — 1 4 6 2 2 3 — 18 Females — — — — 1 3 2 2 2 — — 10 Non-pulmonary, Males 1 2 — 3 — — 1 — — — — 7 Females — — — — — — 1 — — — — 1 The source of information in respect of these 36 cases is also given in tabular form. Further particulars regarding the notifications, with the reason for removal of cases from register, is given in the following table:— SOURCE OF INFORMATION AS TO THE ABOVE-MENTIONED CASES. No. of Cases. Pulmonary. Nonpulmonary. Death Returns from local Registrars 3 – transferable deaths from Registrar-General 2 1 Posthumous notifications — – "Transfers" from other areas (other than transferable deaths) 19 6 Other sources, restored to register 4 1 Total 28 8 Pulmonary and non-pulmonary =36 Notification Register. Number of cases of Tuberculosis remaining on the Register at the 31st December, 1934 Pulmonary. Non-pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. 632 548 1180 235 181 416 1596 Number of cases removed from the Register during the year by reason inter alia of:— 1. Withdrawal of notification 41 41 82 18 14 32 114 2. Recovery from the disease 7 4 11 5 1 6 17 3. Death 64 30 94 7 4 11 105 4. Totals 112 75 187 29 19 49 236 49 The distribution of the cases notified (primary notification) in the different wards is as follows:— Ward. Pulmonary. Non. pulmonary. Total. No. per 1,000 inhabitants. Moorfields 7 – 7 1.9 Church 26 8 34 2.2 Hoxton 16 4 20 1.3 Wenlock 27 3 30 2.0 Whitmore 20 7 27 1.9 Kingsland 11 2 13 1.4 Haggerston 7 1 8 0.9 Acton 18 1 19 1.9 Totals 132 26 158 1.7 In addition to the notifications summarized on Form T. 137, 1934, on page 47, 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. Deaths. The total deaths from tuberculosis of all types during the year numbered 94, of which 64 were males and 30 females. In the previous year the total number was 98, of which 58 were males and 40 females. Of the total deaths from tuberculosis, pulmonary accounted for 84, or 89.4 per cent., and non.pulmonary for 10, or 10.6 per cent. The death rate from pulmonary tuberculosis was 0.93 and from non.pulmonary 0.11, making a total death rate from all forms of the disease of 1.04. The corresponding figures for 1933 were, pulmonary 0.96, non.pulmonary 0.09, a total of 1.05. The average death rates for the five years 1929.1933 in respect of pulmonary tuberculosis, non.pulmonary tuberculosis and all forms of tuberculosis, respectively, were 0.94, 0.12 and T06. The figures for 1934, therefore, represent a decrease of 0.01 in the pulmonary and 0.01 in the non.pulmonary rate, making a combined total decrease for all forms of the disease of 0.02. The following tables show the incidence of cases of tuberculosis and of deaths from that disease for ten years for Shoreditch, London and England and Wales respectively:— Notifications per 1,000 Population. Year. Shoreditch. London. England and Wales. Pul. Non. pul. All forms. Pul. Non. pul. All forms. Pul. Non. pul. All forms. 1925 2.2 0.7 2.9 1.64 0.45 2.09 1.49 0.49 1.98 1926 2.1 0.6 2.7 1.50 0.45 1.95 1.43 0.47 1.90 1927 1.8 0.5 2.3 1.50 0.42 1.92 1.37 0.45 1.82 1928 2.0 0.6 2.6 1.51 0.41 1.92 1.34 0.45 1.79 1929 2.2 0.4 2.6 1.60 0.37 1.97 1.32 0.42 1.74 1930 1.8 0.4 2.2 1.49 0.34 1.83 1.26 0.42 1.68 1931 1.7 0.4 2.1 1.45 0.32 1.77 1.24 0.40 1.64 1932 1.3 0.3 1.6 1.40 0.31 1.71 1.16 0'38 1.54 1933 1.7 0.3 2.0 1.37 0.29 1.66 1.10 0.35 1.45 1934 1.4 0.3 1.7 1.40 0.21 1.61 1.19 0.40 1.59 50 Death Rates. Year. Shoreditch. London. England and Wales. Pul. Non. pul. All forms. Pul. Non. pul. All forms. Pul. Non. pul. All forms. 1925 1.10 0.30 1.40 0.80 0.20 1.00 0.83 0.21 1.04 1926 1.20 0.20 1.40 0.80 0.10 0.90 0.77 0.19 0.96 1927 0.82 0.25 1.07 0.91 0.14 1.05 0.79 0.18 0.97 1928 1.20 0.16 1.36 0.89 0.14 1.03 0.76 0.17 0.93 1929 0.98 0.18 1.16 0.96 0.13 1.09 0.79 0.17 0.96 1930 0.88 0.13 1.01 0'87 0.12 0.99 0.74 0.16 0.90 1931 0.90 0.10 1.00 0'90 0.13 1.03 0.74 0.15 0.89 1932 0.92 0.13 1.05 0.82 0.12 0.94 0.69 0.15 0.84 1933 0.96 0.09 1.05 0.82 0.11 0.93 0.69 0.13 0.82 1934 0.93 0.11 1.04 0.73 0.10 0.83 0.64 0.13 0.77 Table of year of notification of all deaths during 1934. Year of Notification. Number of deaths in 1934. Total. Percentage of total deaths from Tuberculosis. Male. Female. Pul. Non.Pul. Pul. Non.Pul. Died in Borough 1919 1 — 1 1.1 1921 1 .— — — 1 1.1 1922 1 — — — 1 1.1 1924 — — 2 1 3 3.3 1925 2 — — — 2 2.2 1926 2 — — — 2 2.2 1928 3 — — — 3 3.3 1929 1 — — — 1 1.1 1930 1 — — — 1 1.1 1931 3 — 2 — 5 5.5 1932 5 1 1 1 8 8.8 1933 6 2 5 — 13 14.2 1934 10 1 7 1 19 20.8 Died outside Borough 1927 — — 1 — 1 1.1 1930 — — 1 — 1 11 1931 2 — — — 2 2.2 1932 2 1 1 — 4 4.4 1933 3 — .—. — 3 3.3 1934 8 2 3 1 14 15.3 51 7 23 4 85 93.2 1934 Not notified 3 1 2 — 6 6.8 Totals 54 8 25 4 91 100.0 51 Deaths from Tuberculosis in the Borough During 1934. AGES. DEATHS IN EACH WARD. SEX. TOTAL. DEATHS. Not in Institutions. St. Leonards Hospital Other Institutions. Under 1 year. 1 to 2 years. 2 to 5 ,, 5 to 10 ,, 10 to 15 ,, 15 to 20 20 to 25 ,, 25 to 35 ,, 35 to 45 ,, 45 to 55 55 to 65 „ 65 to 75 „ 75 and upwards. Moorfields. Church. Hoxton. Wenlock. Whit more. Kingsland. Haggerston. Acton. Male. Female. 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 3 1 1 – 1 7 11 18 15 18 17 2 – 1 1 17 5 7 3 8 7 11 6 7 3 7 3 6 2 64 30 94 27 37 12 1 14 Respiratory system — — 1 – 1 7 9 17 15 15 17 2 – 1 – 16 5 6 3 7 7 10 5 6 3 7 1 6 1 59 25 84 25 34 12 1 14 Central nervous system 1 1 – – – – – – – – – – – – 1 – – – – – – 1 – 1 1 2 – – – – – Intestines and peritoneum – – – – – – – – – 1 – – – – – – – – – – – 1 1 1 – – – – – Vertebral column – – – – – – 1 – – – – – – – – – – 1 – – – – – – – – – – – – Other bones and joints – – – – – – – 1 – 1 – – – – – – – – – – – 1 – – 2 2 1 1 – – – Skin and subcutaneous tissue – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Lymphatic system (abdominal glands excepted) – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Genito-urinary system – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Other organs— Adrenals – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Other sites – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Disseminated Tuberculosis— Acute 2 – – – – – – – – – 1 – – – – – 1 – – 1 1 – – – 2 1 3 1 1 – – – Chronic – – – – – – – – – – – – – – – – – – – – – – – – – – – – – Not distinguished as acute or chronic – – – – – – 1 – – – – – – – – 1 – – – – – – – – – – – – – – 52 Particulars of new cases of Tuberculosis and deaths during the year 1934 are giver in the following table:— Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. M. F. M. F. M. F. M. F. 0- — – 1 2 – – 1 2 1- 1 2 4 2 – 1 1 — 5- 4 2 3 – – – – – 10- 3 4 9 1 1 .—. — —. 15- 9 9 1 2 3 4 — — 20- 20 13 2 2 5 4 2 — 25- 17 15 3 2 9 8 — 1 35- 13 8 — — 12 — 3 — 45- 19 5 — — 10 4 1 1 55- 12 3 – — 13 4 — — 65 and upwards 1 — — — 1 — — – Totals 99 61 23 11 54 25 8 4 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year 1934 was 1 to 15.7. The figures for the new cases are the number of formal notifications and of the cases which came to the notice of the Medical Officer of Health otherwise than by formal notification. These figures, therefore, represent the most accurate record of the incidence of the disease during the year. 53 INSTITUTIONAL ACCOMMODATION FOR TUBERCULOSIS. Institutional accommodation for this disease is carried out at sanatoria, the majority of which are now under the control of the London County Council. The following table shows the number of admissions and discharges according to the intimations of admissions and discharges received from these sanatoria and from other institutions during the year 1934. :— Number of Intimations on Form I (of admission of case to Institution). Number of Intimations on Form II (of discharge of case from Institution). L.C.C. Hospitals. Sanatoria. L.C.C. Hospitals. Sanatoria. Pulmonary, males 51 80 48 61 Pulmonary, females 26 59 23 50 Non-pulmonary, males... 2 20 4 15 Non-pulmonary, females 5 8 4 3 Totals 84 167 79 129 Apart from actual in-patient treatment, facilities for specialised out-patient treatment are satisfactory. Radiological work is carried out largely at the Royal Chest Hospital, or in the case of non-pulmonary cases, at St. Leonard's or the Royal Northern Hospitals. Cases for specialised light treatment are usually referred to the London Hospital. Artificial pneumothorax work is carried out at various chest hospitals. Additional cases are treated at the Municipal Dental Hospital and particulars of this important work will be found on page 87. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. 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. The work of the Tuberculosis Dispensary is summarised in the following returns to the Ministry of Health:— TUBERCULOSIS SCHEME of the Shoreditch Metropolitan Borough Council. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus), Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 17 2 7 — 9 2 — — — — 2 1 — — 1 1 — 3 — 3 3 3 1 — 4 F. 15 1 3 — 4 1 2 3 — 5 — — — — — 3 — — — — 4 1 2 — 3 Children — — — — — 2 1 — — 1 2 — — — — 1 1 — — 1 6 — — — — Disease not Arrested. Adults M. 2 — 6 3 9 1 1 2 1 4 — — 3 1 4 — — 3 1 4 1 — 6 1 7 F. 1 — 3 2 5 — — 1 — 1 — — — 2 2 — — 5 2 7 4 1 — 2 3 Children 2 — 1 — 1 — — — — — 1 — 1 — 1 1 — — — — 3 — 1 — 1 Condition not ascertained during the year 14 2 5 1 8 4 — — — — — 1 1 — 2 1 1 — — 1 6 1 1 — 2 Total on Dispensary Register at 31st December 51 5 25 6 36 10 4 6 1 11 5 2 5 3 10 7 2 11 3 16 27 6 11 3 20 (6) Not now on DispensaryRegister and reasons for removal therefrom. Discharged as Recovered Adults M. 38 3 — — 3 2 1 — — 1 2 — — — — — — — — — — — — — — F. 33 1 1 — 2 6 — — — — 1 — — — — — — — — — — — — — — Children 17 — — — — 2 — — — — 1 — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 122 18 44 9 71 40 7 10 9 26 14 11 9 4 24 19 2 12 3 17 23 6 14 2 22 Dead Adults M. F. 13 — 11 58 69 3 1 6 41 48 3 — 9 30 39 3 1 2 33 36 6 1 9 21 31 8 2 5 25 32 2 — 6 25 31 2 — 1 13 14 4 — 5 18 23 3 — 5 19 24 Children 1 — — 2 2 1 — 1 1 2 — — — 2 2 1 — — — — — — — — — Total written off Dispensary Register 232 24 61 94 179 56 9 23 76 108 23 11 19 49 79 30 3 19 54 76 32 7 28 42 77 Grand Totals 283 29 86 100 215 66 13 29 77 119 28 13 24 52 89 37 5 30 57 92 59 13 39 45 97 1930 1931 1932 1933 1934 (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 4 2 1 — 3 1 — — — — 1 — — — — — — — — — — — — — — F. 2 2 — — 2 — 1 — — 1 — — — — — — — — — — — — — — — Children 6 — — — — 1 — — — — — — — — — — — — — — — — — — — Disease not Arrested. Adults M. 2 1 8 3 12 4 1 12 5 18 4 4 24 3 31 8 3 24 5 32 9 6 21 5 32 F. 1 — 6 3 9 6 1 6 2 9 8 4 7 2 13 9 6 14 3 23 9 3 12 1 16 Children 5 — 3 3 5 — 1 — 1 3 — — — — 6 1 — — 1 10 — 2 — 2 Condition not ascertained during the year 2 — — — — 2 — 1 — 1 — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 22 5 18 6 29 19 3 20 7 30 16 8 31 5 44 23 10 38 8 56 28 9 35 6 50 (b) Not now on DispensaryRegister and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — —— — F. — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — —— Lost sight of, or otherwise removed from Dispensary Register 21 3 7 2 12 7 2 13 1 16 5 2 11 1 14 5 8 7 3 18 — — 2 — 2 Dead. Adults M. 5 1 5 26 32 2 — 4 27 31 — — 4 14 18 — 1 9 10 20 1 — 3 12 15 F. — — 1 16 17 4 — 2 20 22 — — 3 13 16 1 — 2 9 11 — — 1 7 8 Children 1 — — 2 2 — — — 2 2 — — — — — — — — 1 1 — — — 1 1 Total written off Dispensary Register 27 4 13 46 63 13 2 19 50 71 5 2 18 28 48 6 9 18 23 50 1 — 6 20 26 Grand Totalss .49 9 31 e2 S3 32 5 39 57 101 21 10 49 33 92 29 19 56 31 106 29 9 41 26 76 54 55 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 of 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 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. 2 — — — 2 1 — — — 1 — — — — — 1 — — — 1 — — — — 2 F. — — — — — 1 — — 1 2 — 1 — 1 1 — — 1 1 — 1 — 1 — 1 Children 8 1 — 2 11 1 — — — — — — — — 5 2 — — — 4 — — 1 3 5 Disease not Arrested Adults M. — — — — — — — 1 — 1 — — — — — — — — — — — — — — — F. 2 — — — 2 — — — — — 1 — — — 1 — — — 1 5 2 — — 2 4 Children 3 1 — 2 6 2 — — — — 3 — — — — 1 — — — 1 — — — — — Condition not ascertained during the year 6 — — 4 10 1 — — — 1 1 — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 21 2 — 8 31 6 — 1 2 9 9 1 — 1 11 6 2 2 2 12 4 — 3 5 12 Transferred to Pulmonary — — 1 2 3 — — — — — — — — — — — — 1 2 — — — — — (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 3 — — 1 4 — — — — — — — — — — — — — — — — — — — — F. 1 — 1 1 3 1 — — 2 3 — — — — — — — — 1 1 — — — — — Children 11 1 — 12 24 4 1 1 2 8 2 — 1 1 4 2 2 — — 4 — — — — — Lost sight of, or otherwise removed from Dispensary Regoster 15 4 2 15 36 2 1 — 6 9 10 — 1 4 15 5 2 2 3 12 5 3 2 5 15 Dead Adults M. 1 — — — 1 — — — — — — — — — — — — — — — — — 1 — 1 F. 2 — — — 2 — — — — — 1 — — — — — — — — — — 1 — — 1 Children 1 — — 2 3 1 1 — — 2 — — — — — — — — — — — — — — — Total written off Dispensary Register 34 5 3 31 73 8 3 1 10 22 13 — 2 5 20 7 4 2 4 17 6 4 3 5 18 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 55 7 3 39 104 14 3 2 12 31 22 1 2 6 31 13 6 4 6 29 10 4 6 10 30 1930 1931 1932 1933 1934 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — 2 — — 2 — — — — — — — — — — — — — — — — — — — — F. — — — — — 1 1 1 — 3 — — — — — — — — — — — — — — — Children 2 1 1 3 7 3 — — 2 5 — — — — — — — — — — — — — — — Disease not Arrested Adults M. — — — — — 1 — — — 1 1 1 — — 2 4 1 1 1 7 2 — 3 1 5 F. 1 1 — — 2 — — 1 — 1 6 — — 1 1 — 1 — 1 1 — — 3 2 3 Children 3 — — 4 7 4 — — — — — — 3 9 — — — 3 4 7 — — — 12 Condition not ascertained during the year — — 1 — 1 — 1 — 2 3 — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 6 4 2 7 19 9 4 3 8 24 7 1 — 5 13 4 2 1 5 12 9 — 8 3 20 Transferred to Pulmonary — — — 1 1 — — — — — — — — — — — — — — — — — — — — (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 8 1 3 1 13 — 1 1 3 5 4 — — 3 7 1 1 2 — 4 1 — 1 1 3 Dead. Adults M. 1 — — — 1 — 1 — — 1 — — — — — 1 — — — — 1 — — — 1 F. — — — — — — — — — — — — — — — 1 — — — 1 — — — — — Children — 2 — — 2 — 1 — — 1 1 1 — — 2 1 — — — 1 — — — — 1 Total written off Dispensary Register 9 3 3 1 16 — 3 1 3 7 5 1 — 3 9 4 1 2 — 7 2 — 1 2 5 Grand Totals of (a) and (b) (excluding those transterred to Pulmonary). 15 7 5 8 35 9 7 4 11 31 12 2 — 8 22 8 3 3 5 19 11 — 9 5 25 56 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 1934. 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 59 31 6 3 6 4 7 6 65 35 13 9 122 *(b) Diagnosis not completed – – – – – – – – – 7 2 2 11 (c) Non-tuberculous – – – – – – – – 101 131 77 84 393 B.—Contacts examined during the year:— (a) Definitely tuberculous — 2 2 1 — — 1 – — 2 3 1 6 *(b) Diagnosis not completed – – – – – – – – – 3 75 8 (c) Non-tuberculous — — — – — — — — 56 88 70 75 289 C.—Cases written off the Dispensary Register as:— (a) Recovered 5 3 1 1 4 2 2 —- 9 5 3 1 18 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) – – – – – – – – 164 226 154 163 707 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 270 191 31 18 45 30 52 36 315 221 83 54 673 (b) Diagnosis not completed – – – – – – – – – 10 2 7 19 1. Number of cases on Dispensary Register on January 1st 712 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 46 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 85 4. Cases written off during the year as Dead (all causes) 85 5. Number of attendances at the Dis pensary (including Contacts) 4298 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 315 7. Number of consultations with medical practitioners:— (a) Personal† 3 8. Number of visits by the Tuberculosis Officer to homes (including personal consultations)† 184 †Plus 27 visits to St. Leonard's Hospital. (b) Other 147 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2891 10. Number of:— (a) Specimens of sputum, etc., examined 953 (b) X-ray examinations made in connection with Dispensary work 198 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 302 *i.e., remaining undiagnosed on 31st Dec. [see Memo. 37/T (Revised), p. 10, Sec. II, Note 4], †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. 57 REPORT BY Dr. C. K. CULLEN, TUBERCULOSIS OFFICER. The heavy increase noted in last year's report with regard to most aspects of the Dispensary work has happily been checked a little during 1934, though the figures have not yet fallen back to the 1932 level. Whilst the economic problems of many of our patients have been eased a little by the somewhat more generous scale of relief allowed by the Public Assistance Committees and by the abolition of assessments towards the cost of treatment, the general picture remains much the same, and the comments made in last year's report call for no substantial modification. In particular, the problem of securing proper housing accommodation for the majority of our patients remains unsolved. For those few families whose employment and financial resources permit them to live outside London applications to the County Council for re-housing have met with more success. Most of our patients however are compelled to remain in surroundings which present a serious barrier to recovery. Though the use of the County Council's General Hospitals for initial treatment of tuberculosis appears to have decreased during the past year, I am of the opinion that too many patients are sent back to London for continuation of their treatment in these hospitals when their condition has become stationary elsewhere. It is a curious fact that many of these patients gain weight and improve in other ways in spite of the environment of a thickly populated district such as Shoreditch and the smoky atmosphere of London. This is possibly due to a change in dietary coupled with a period of complete rest in bed. It suggests, however, that a pessimistic view of the patient's chances of further improvement is too often taken in certain sanatoria and a transfer to some other sanatorium outside London would probably bring greater benefit in such cases. The appointment of Tuberculosis Officers to act as Tuberculosis consultants in the General Hospitals has been extended by the London County Council for a further period and I have continued to visit the Tuberculosis wards of St. Leonard's Hospital fortnightly during the year. Special Facilities. Radiological work.—Pulmonary cases are referred to the Royal Chest Hospital and Dr. Peter Kerley's reports continue to be of very great assistance. Nonpulmonary cases are usually under the care and supervision of a surgeon at a general hospital and any X-ray examination required is usually carried out at the hospital concerned; when this is not the case, the patient is referred either to St. Leonard's Hospital or the Royal Northern Hospital for examination and report. Artificial Pneumothorax Treatment.—Refills are usually carried out, by arrangement through the Dispensary, at one or other of the Chest Hospitals, most of them at the Royal Chest Hospital. When desirable, arrangements can be made for the attendance of patients for this purpose at Grove Park Hospital or Colindale Hospital through the 58 London County Council. This is occasionally done when the treatment has been commenced at these hospitals. The cost is borne by the Borough Council. Finsen Light Treatment for cases of lupus is provided at the London Hospital. Ear, Nose and Throat cases are referred for examination and advice to Mr. Zamora at the Royal Chest Hospital. Dental cases are treated at the Shoreditch Municipal Dental Hospital. Diseases of the Eye are rarely met with at the Dispensary, but such cases are referred to the Royal London Ophthalmic Hospital. Surgical cases requiring the opinion or supervision of a surgeon are referred to one of the general hospitals, such as the London, St. Bartholomew's and the Metropolitan Hospital, or the Queen's Hospital for Children. After-care in surgical cases is supervised by the surgeon originally recommending sanatorium treatment or by one of the County Council's After-care Clinics. Convalescence for non-tuberculous but ailing children is usually arranged through the Invalid Children's Aid Association. Nursing for bed-ridden patients is arranged through the Shoreditch and Bethnal Green District Nursing Association, the Borough Council paying 1s. 4d. a visit. In addition, nursing assistance is often given, on the application of patients themselves, by the Harman Street Medical Mission. Residential treatment for tuberculosis is ordinarily provided by the London County Council. A few patients suffering from advanced and incurable disease who are unwilling to go into General Hospitals are sent through voluntary agencies to Homes for the Dying. Cases of social, economic or domestic difficulty are referred to the Tuberculosis Care Committee (appointed by the Shoreditch Borough Council). Assistance in the way of extra nourishment, and the provision of separate beds or of garden shelters is given to a number of patients on the recommendation of the Tuberculosis Officer and the cost is met by the Borough Council. Further figures relating to the work of the Dispensary are given in the following tables:— 1933 1934 Total attendances 4,514 4,298 Total examinations 2,006 1,785 Contacts examined 292 311 Sisters' visits 3,160 2,891 Tuberculosis Officer's visits 152 184 In addition to the above examinations, 27 visits were made by the Tuberculosis Officer to St. Leonard's Hospital. Comparative numbers of insured and non-insured persons who attended were:— Insured 2,173 Non-insured 2,125 59 Special sessions for school-children are held weekly and the following table shows the attendances for each month:— 1933 1934 1933 1934 January 54 54 July 31 27 February 63 72 August 21 8 March 56 45 September 37 20 April 32 21 October 57 38 May 37 33 November 53 37 June 25 29 December 44 30 Totals. 510 414 Total attendances 510 414 Total examinations 231 201 Laboratory examinations made at the Dispensary during the year:— 1933 1934 Sputum Urine 1,106 36 921 32 The number of patients who received extra nourishment from the Borough Council during the year was 93, of whom 38 were still receiving these extras on 31st December, 1934. The number of shelters (supplied on loan) in use during the year was six. The number of patients who had beds and/or bedding on loan was 28. SHOREDITCH TUBERCULOSIS CARE COMMITTEE. Miss E. Church, Secretary of the Care Committee, resigned in January, 1934, and Miss G. B. Woolsey, B.A., was appointed in her place and took up her duties in March, 1934. The following is the annual report of the Tuberculosis Care Committee:— The year has been an important one for Tuberculosis Care Committees in the London area in that on 10th July, the London County Council decided that "no contributions towards the cost of the residential treatment of tuberculosis ... or towards the cost of the boarding-out of children ... be asked for from patients or persons legally responsible for them." We should like to express our appreciation of this step which has relieved the patient of one of the difficulties which arise as a result of his illness and has thus facilitated the work of the Care Committee in dealing with the other problems. 5 60 The Council's decision necessitates a great deal of readjustment. A draft of the revised scheme for the treatment of tuberculosis in London was issued by the London County Council in the autumn, and we are later, it is understood, to receive new instructions on the aims of Tuberculosis Care Committees. While it is therefore not yet possible to discuss fully the results of the Council's decision, it is certain that the abolition of assessments does involve a complete reconsideration of the function of this Committee. It has been pointed out by the Council that "the relieving of the care committees of their present duties of assessment and collection should enable them to devote more time to their care and after-care work." The need for more time and, in particular, more opportunity for care work has frequently been felt by this Committee during the past year and there have been cases which it has been difficult or impossible to help because we have at present no voluntary fund. Nevertheless, we are glad to be able to record many cases in which help has been secured from other sources through this Committee. Early in the year we became affiliated to the National Association for the Prevention of Tuberculosis and, among many advantages, this gave us the opportunity of participating in the Christmas Seal Sale, by which we were able to raise an encouraging amount of money. We wish especially to thank the Local Public Assistance Committee for their co-operation with this Committee; we have found it of great help in the solving of many problems. Our thanks are also due to the voluntary societies in the Borough and outside for their assistance. The Handicraft Class, never a great success in Shoreditch, has temporarily closed down. We had a very small attendance and it was becoming increasingly difficult to sell the articles which were made. We are to reconsider the position shortly when we hope to find some way of making the class more satisfactory and more useful. 61 Figures for the year's Care Work 1933 1934 New Patients 147 158 Re-registrations 53 49 Dental Cases — 8 Visits paid 678 878 Interviews 410 405 Cases reported to Committee:— New cases — 205 Dental Cases — 10 Care Work .— 157 Admissions — 208 Discharges —- 158 Deaths — 83 Total 762 821 Referred:— Public Assistance Committee 54 74 Charity Organisation Society 61 19 East London Workers among the Poor 13 12 Shoreditch Housing Association — 9 The County Hall 3 2 Royal Naval Benevolent Trust 2 1 British Legion — 1 Friends of the Poor 4 1 Red Cross Society 5 1 Royal Surgical Aid Society — 1 Approved Societies 2 1 Details of Care Work Clothing Supplied 75 53 Relief obtained 25 34 Relief increased 13 15 Fares obtained 18 9 Temporary help obtained 6 13 Admitted to Homes 3 3 Housing accommodation obtained 3 2 Convalescence arranged 6 1 Pocket money obtained 2 1 Surgical appliance obtained 1 5a 62 SHOREDITCH TUBERCULOSIS CARE COMMITTEE, 1934. Mrs. Alsford (from June) St. Leonard's Hospital. Mrs. Barr - Mrs. Bourdon - Miss Broomfield Invalid Children's Aid Association. Mrs. Cox - Dr. Cullen Tuberculosis Officer. Cllr. Mrs. Girling, J.P., L.C.C. Public Health Committee. Sister Grange Tuberculosis Visitor. Mrs. Higgins Local Public Assistance Committee. Sister H. Hiscoke Tuberculosis Visitor. Dr. Hogarth Divisional Medical Officer. Cllr. Mrs. Jarvis (Chairman from May) Public Health Committee. Miss Lee Shoreditch and Bethnal Green Nursing Association. Miss Murch Children's Care Committee. Dr. Radford (resigned June) Medical Officer of Health. Miss Sherman . London Insurance Committee. Miss Thwaites (from June) Maurice Hostel, Women's Settlement. Dr. Underwood (from October) Medical Officer of Health. Miss Wragge (Chairman till resignaMaurice Hostel, Women's Settlement, tion in May). Miss Church (resigned February) Secretary. Miss Woolsey (from May) Secretary. 63 V.—MATERNITY AND CHILD WELFARE. The principal rates upon which any estimate of the value of maternity and child welfare work is based are the infantile mortality rate and the maternal mortality rate. The infantile mortality rate for 1933 showed a decrease on the rate for 1932 and the maternal mortality for 1933 showed an increase on that for 1932. For the year under review (1934) these tendencies have been reversed, the infantile mortality rate increased from 74 to 84 per 1,000 births and the maternal mortality rate decreased from 4.02 to 0.69 per 1,000 births. Certain aspects of these features were discussed on pages 20 and 21. The increase in the infantile mortality rate was to a certain extent due to an increase in the number of deaths from diarrhoea and enteritis under one year. As has been shown on page 42 this increase was to a large extent due to the comparative prevalence of true enteritis which was observed more or less throughout the year. The remarkable decrease in the maternal mortality rate is worthy of note. This decrease to a figure of 0.69 is probably associated with the preventive work which has been carried on in the Borough for some years. It is, nevertheless, hardly to be expected that the rate will continue at this extremely low level. STATISTICS. INFANTILE MORTALITY. The number of children under one year of age who died in 1934 was 122, of which 61 were males and 61 females, as compared with 110 (males 66, females 44) for 1933. The infant mortality rate was 84 as compared with 74 for the previous year, and an average of 75 for the previous five years. The rate for England and Wales was 59, or 30 per cent., and for London 67, or 20 per cent. lower than the rate for Shoreditch. Causes of Death. The causes of death of the 122 infants who died during 1934 are set out in the table opposite page 20. As has been mentioned previously, the outstanding causes were diarrhcea and enteritis, pneumonia, prematurity and congenital malformations, which claimed 28, 27, 26 and 12 deaths of infants respectively. Measles claimed 5 deaths and whooping cough 2. The other causes of death were relatively unimportant. The figures for 1933 for diarrhoea and enteritis, pneumonia, prematurity and congenital malformations were 21, 21, 20 and 6 respectively. There has, therefore, been an increase in the deaths from these diseases. The figures for measles and whooping cough for 1933 were 1 and 6 respectively. It is scarcely to be hoped that any improvement can be effected in respect of the deaths from congenital malformations. These conditions are due to causes 64 which are possibly outside the immediate control of the individual. The other three important causes of death are, however, all preventable, and in this respect it is advisable to consider the figures in more detail. It will be seen from the table opposite page 20 that prematurity exerted its effects almost wholly under the age of one month, whereas diarrhoea and enteritis and pneumonia claimed their victims almost entirely after the age of one month and mainly between the ages of three and nine months. It is, therefore, in the latter period, which is often in the case of an individual child a period of transition from breast to artificial feeding, that the risks from these two diseases are highest. A death from prematurity under one month is difficult to prevent; in fact the preventive measures which are likely to be successful are probably those which are applied to the mother before the birth of the child. Deaths from infectious disease are to some extent in a different category and they are dealt with in another section of this report. It should further be pointed out that the general nutrition of the individual child has an important bearing upon the prognosis so far as a fatal result is concerned, especially in diseases such as measles and whooping cough. The actual number of deaths from these diseases in any one month will, however, depend very considerably upon epidemic factors. Prematurity, as a cause of death, is interesting in that it reflects the condition not only of the child after birth, but also of its ante-natal life, and, therefore, of the condition of the mother before birth. The incidence of prematurity is, therefore, associated not only with infant welfare but also with maternal welfare. It is interesting to follow the trend of deaths from this condition over a number of years. The following table shows the premature deaths and the death rate from prematurity for twelve years for Shoreditch and for England and Wales respectively:— Year. Shoreditch. England and Wales. Total births. Deaths from prematurity. Death rate (per 1,000 births). Total births. Deaths from prematurity. Death rate (per 1,000 births). 1923 2,832 48 16.94 758,131 13,379 17.65 1924 2,528 35 13.84 729,933 13,738 18.82 1925 2,627 29 12.18 710,582 12,534 17.64 1926 2,516 38 15.10 694,563 12,146 17.49 1927 2,188 26 11.88 654,172 12,132 18.55 1928 2,091 35 16.74 660,267 11,671 17.68 1929 2,005 32 15.96 643,673 11,992 18.63 1930 1,988 26 13.08 648,811 11,360 17.51 1931 1,684 14 8.43 632,081 11,565 18.30 1932 1,674 27 16.13 613,972 11,174 18.20 1933 1,494 20 13.39 580,413 10,885 18.75 1934 1,456 26 17.17 597,642 10,518 17.60 65 The following table gives particulars of the actual age incidence of deaths from prematurity for a period of twelve years:— Year. Births in year. Under 1 week. Under 1 month. 1 and under 3 months. 3 and under 6 months. 6 and under 9 months. Between 9 months and 1 year. 1923 2,832 36 43 5 - - - 1924 2,528 26 33 2 - - - 1925 2,627 19 27 1 1 - - 1926 2,516 27 34 4 - - - 1927 2,188 20 25 - 1 - - 1928 2,091 23 28 7 - - -. 1929 2,005 20 31 1 - - - 1930 1,988 20 24 2 - - - 1931 1,684 11 12 2 - - - 1932 1,674 18 24 2 1 - - 1933 1,494 14 18 2 - - - 1934 1,456 20 23 3 - - - From this table and from the consideration of corresponding rates it must be concluded that the deaths of premature infants are not becoming less numerous, and that there has been little change in the actual period of death. Most of these deaths occurred under the age of one week. Deaths in Age Groups. The table opposite page 20 gives particulars of the deaths at different ages under one year. Of the total of 122, 14 (11.47 per cent.) occurred on the first day of life; 32 (26.23 per cent.) within the first week; 38 (31.15 per cent.) in the first month; 23 (113.85 per cent.) between 1 and 3 months; 23 (18.85 per cent.) between 3 and 6 months; 24 (19.67 per cent.) between 6 and 9 months, and 14 (11.48 per cent.) between nine months and one year. The following table sets out these particulars for a period of 12 years:— Year. 1 day. Under 1 week. Under 1 month. 1 and under 3 months. 3 and under 6 months. 6 and under 9 months. Between 9 months and 1 year. 1923 -* 57 89 46 35 30 32 1924 -* 46 70 32 35 44 40 1925 -* 36 64 45 52 39 33 1926 -* 44 72 24 18 28 25 1927 -* 33 51 24 30 29 29 1928 19 36 55 29 37 20 23 1929 21 35 56 23 35 22 32 1930 14 30 46 18 26 21 18 1931 12 21 30 20 30 25 21 1932 9 28 42 17 30 28 17 1933 13 27 36 10 34 21 10 1934 14 32 38 23 23 24 14 * Not given for these years. 66 Illegitimate Death Rate. Of the 54 illegitimate births, in 3, or 5.55 per cent., death occurred before reaching the age of one year, which corresponds to an infantile mortality rate of 56 per 1,000 births. This is a decrease of 140 as compared with 1933. Infantile Mortality. Year. Shoreditch Deaths under one year. Rate per 1,000 Births. Shoreditch. London. England and Wales. 1900 741 187 160 *138 1901 812 201 149 1902 704 181 139 1903 676 176 131 1904 706 190 146 1905 652 165 131 1906 651 168 131 132 1907 569 153 116 118 1908 510 138 113 120 1909 512 138 107 109 1910 528 147 103 105 1911 598 171 128 130 1912 451 128 91 95 1913 530 157 105 108 1914 496 143 104 105 1915 447 144 111 110 1916 369 124 89 91 1917 352 158 103 96 1918 286 166 107 97 1919 251 110 85 89 1920 340 91 75 80 1921 341 114 80 83 1922 301 102 74 77 1923 232 82 60 69 1924 221 87 69 75 1925 233 88 67 75 1926 167 66 64 70 1927 163 74 59 70 1928 164 78 67 65 1929 168 83 70 74 1930 129 65 59 60 1931 126 75 65 66 1932 134 80 67 65 1933 110 74 59 64 1934 122 84 67 59 *The figure of 138 represents the average for the years 1900-1905. 67 The corresponding table shows the maternal mortality rate:— Year. Shoreditch Total Maternal Deaths. Rate per 1,000 Live Births. Shoreditch. London. England and Wales. 1919 9 3.84 - 4.37 1920 7 1.89 - 4.33 1921 7 2.35 2.98 3.92 1922 6 2.00 2.84 3.81 1923 4 1.41 2.89 3.82 1924 9 3.59 3'08 3.90 1925 8 3.04 3.19 4.08 1926 6 2.40 3.35 4.12 1927 3 1.38 2.91 4.11 1928 7 3.34 3.59 4.42 1929 4 2.00 3.61 4.33 1930 7 3.50 3.33 4.40 1931 3 1.78 3.81 4.11 1932 4 2.39 2.99 4.21 1933 6 4.02 3.66 4.51 1934 1 0.69 2.40 4.60 Maternal Mortality. Particulars of the accepted maternal deaths are given in the table on page 22 together with particulars of three deaths which were due to conditions associated with pregnancy, but which are not considered as maternal deaths. The table on page 67 shows the relative incidence of maternal deaths in Shoreditch, London and England and Wales respectively for a number of years. MATERNITY WORK. Ante.natal Supervision. The ante.natal work which is carried out under the control of the Borough Council may be divided broadly into three groups—(a) home visiting by health visitors ; (6) medical examinations and supervision at ante.natal clinics held at the model welfare centre ; and (c) medical examinations and supervision at the antenatal clinic connected with the Shoreditch School for Mothers. (a) Home visiting.—This is carried out by the health visitors mainly as an adjunct to an examination of pregnant women by a doctor at one of the ante.natal clinics. In addition certain women whose confinement is to be effected by the Municipal Midwife are visited by her during their pregnancies. 68 The Municipal Midwife also visits expectant mothers who are to be confined, by students of St. Bartholomew's hospital under her supervision (see later). The following table shows the number of mothers who were attended by the health visitors for a number of years. The table also gives the total visits made to these patients each year:— 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 No. of individuals visited 564 641 619 592 641 631 568 636 456 805 Total number of visits paid 1,027 1,200 1,109 1,045 1,156 1,215 1,011 1,075 998 1,573 Average No. of visits per individual 1.8 1.8 1.9 1.8 1.8 1.9 1.8 1.7 2.2 2.0 (b) and (c) Medical examinations and supervision at the Ante.Natal Clinics.—At the present time four ante.natal clinics are held—three at the Model Welfare Centre and one at the School for Mothers, 28, Herbert Street. At these clinics the most modern methods of supervision are constantly employed and facilities are available for radiological examination where necessary. During the year 544 expectant mothers attended at the ante.natal clinics and 1,629 attendances were made in all. This represents a decrease of three individuals and seven total visits on the figures for 1933. The following table shows particulars of the ante.natal attendances for a period of ten years Year. First visits by expectant mothers. Total attendances. Average attendance per individual. 1925 380 673 1.77 1926 504 863 1.71 1927 399 750 1.88 1928 412 763 1.85 1929 494 961 1.95 1930 525 984 1.88 1931 543 1,348 2.50 1932 646 1,740 2.69 1933 547 1,636 2.99 1934 544 1,629 3.00 The number of women who attended the ante.natal clinics during 1934 amounted to approximately 37 per cent. of the confinements of mothers resident in the Borough during the year. In two cases X.ray examinations were made at St. Leonard's Hospital. 69 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 one occasion during the year covered by this report. NATAL WORK. Midwives. The total number of midwives on the roll practising in Shoreditch at the end of the year 1933 was 38. During the year 12 were added and 13 were removed. At the end of the year there were 37 midwives practising in the Borough. The number of births attended by midwives was 600 which represents 41 per cent. of the total births notified during the year. Municipal Midwife. The Municipal Midwife was appointed in 1931 for the purpose of attending those expectant mothers in the Borough who apply for her services (municipal cases) she also attends the confinements and acts as maternity nurse in cases conducted in Shoreditch by medical students from St. Bartholomew's Hospital. 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 the municipal midwife acts as maternity nurse in the manner described. Places of Confinement. Of the 1,444 confinements which occurred during 1934, 725, or 50.2 per cent., took place in institutions, and 719, or 49.8 per cent., in the homes of the women concerned. Maternity Dressings. During the year 660 sterilised maternity outfits were supplied to mothers through the ante-natal clinics and the midwives practising in the borough. The use of these outfits undoubtedly tends to make the confinement more hygienic. The patients who received the sets were asked to contribute what they could afford towards the cost. 70 Home Helps. Home helps are provided from a panel of approximately 14 women who have been approved for this duty by the Maternity and Child Welfare Committee. At the end of the year 1933 there were 12 home helps on the panel and at the end of 1934, 14. During the year these women attended, to assist with the housework, etc., 125 cases, of which 83 were conducted by midwives, 3 by private practitioners, 20 by students at the City of London Maternity Hospital, 17 by students at St. Bartholomew's Hospital, 1 by a student from the Royal Free Hospital and one by St. Leonard's Hospital. The women on the panel are specially selected for this duty and they work according to rules which have been drawn up to regulate their duties, and to prevent the possibility of a home help in any circumstances acting as a nurse. A printed copy of these rules is supplied to the home help and also to the woman she will attend. Application for the services of a home help is made by the husband and the charge is based on a scale of income, reference to which is made in the annual report for 1933, page 128. Under the arrangement with St. Bartholomew's Hospital all patients who are to be attended by the hospital students are offered the services of a home help if their income is under scale. POST-NATAL WORK. One post-natal clinic is held at the Model Welfare Centre on the second and fourth Wednesdays in each month. This clinic was established in 1931, and the following table gives particulars of the first attendances and total visits for the year over a period of four years:— Year. First visits by nursing mothers. Total attendances. Average attendance per individual. 1931 36 69 1.92 1932 176 290 1.65 1933 152 287 1.89 1934 151 286 1.89 This clinic continues to fulfil a very, necessary function. During the year of writing (1935) a gynaecological clinic was opened for the diagnosis of gynæcological conditions and treatment of other minor ailments of this type. There is no doubt that this work is of preventive value so far as future pregnancies are concerned. A fuller account of the work of this clinic will appear in the annual report for 1935. 71 Breast-feeding Clinic. This clinic is now in the specially designed quarters adjoining the Light Clinic in the new building. The clinic is open on three days each week from 9 a.m. to 5 p.m. and a mother can attend as often as is necessary between these hours or, if advised to do so, can spend the whole day at the clinic. During the year 264 individual mothers attended the clinic, as compared with 257 in 1933. The total attendances were 792 as compared with 832 in 1933. In six instances it was possible to establish total restoration of breast-feeding and in another twelve instances a partial restoration was effected. In 46 cases the breast feeding was regulated. Of the 264 cases, 31 were for over-feeding the children and in 66 instances the children were not receiving sufficient nourishment. 56 single test feeds were given ; 10 babies were weaned and 10 were admitted to the ward for observation. During the year 55 visits were paid to persons who had defaulted. Puerperal Fever. Six cases of puerperal fever were notified during the year. There were no deaths. Of the six cases, two occurred in institutions, one in the practice of a private doctor and three in the practice of midwives. Four cases were removed to hospital; two others were treated at home. During the year 23 cases of puerperal pyrexia were notified. On enquiry the diagnosis was altered to puerperal fever in two cases and in the other cases the diagnosis is given on page 36. Stillbirths. The following table gives a comparison between live and still-births notified under the Notification of Births Act, 1907, for the last ten years:— Year. Live births notified. Still births notified. Total births notified. Percentage of still births to total births. 1925 2,287 44 2,331 1.88 1926 2,369 59 2,428 2.43 1927 2,083 73 2,156 3.39 1928 1,956 54 2,010 2.68 1929 1,953 53 2,006 2.64 1930 1,891 38 1,929 1.97 1931 1,648 50 1,698 2.94 1932 1,635 54 1,689 3.20 1933 1,448 51 1,499 3.40 1934 1,425 38 1,463 2.59 72 Home Visiting. The number of visits paid by the Health Visitors during the year was 19,765. Of these 1,415 were first visits, 3,219 were subsequent visits to infants of under one year, and 10,294 visits to children between one year and five years of age. These figures should be compared with 1,443, 3,089 and 8,748 for 1933. A summary of the work done by the Health Visitors appears below. Further particulars will be found in the detailed table on page 73. Number of first visits to infants 1,415 Number of first visits to children one to five years 4,198 Number of revisits to infants 3,219 Number of revisits to children one to five years 6,096 Number of visits still-births and deaths, including revisits 34 Number of visits deaths of children from one month to five years 158 Number of visits to Ophthalmia cases 49 Expectant mothers—first visits 805 Expectant mothers—revisits 768 Puerperal Fever—first visits and revisits 16 Puerperal Pyrexia—first visits and revisits 20 Number of futile visits 3,179 In addition to the above visits the Health Visitors interviewed mothers on 3,813 occasions. 73 Statistical Report for 52 Weeks ending 29th December, 1934, upon the Work of the Health Visitors. Health Visitor's Districts. 1 2 3 4 5 6 7 8 9 10 Total. No. 1st visits to infants 180 137 241 147 184 115 154 124 30 103 1,415 No. re-visits to infants 410 234 316 310 496 384 359 184 149 377 3,219 No. visits to children aged 1-5 years 1,313 800 1,372 1,061 1,665 1,375 748 939 408 613 10,294 No. 1st visits to expectant mothers 80 60 99 78 136 72 86 84 34 68 805 No. re-visits to expectant mothers 129 76 34 84 137 55 45 94 28 86 768 No. of futile visits 337 110 294 275 380 239 377 710 145 311 3,179 No. of interviews, etc. 669 143 507 595 116 313 768 387 100 215 3,813 No. 1st visits to cases of ophthalmia neonatorum, etc. 4 — 1 4 1 5 2 4 — — 21 No. re-visits to cases of ophthalmia neonatorum, etc. 2 2 1 4 1 9 3 6 — — 28 No. 1st visits puerperal fever 1 3 1 — — 1 3 — — 9 No. re-visits puerperal fever 3 — — — — — 1 3 — — 7 No. 1st visits puerperal pyrexia 3 2 2 3 2 — — 1 — — 13 No. re-visits puerperal pyrexia — 2 — 2 2 — — 1 — — 7 No. of Health Visitors' attendances at centres: (a) Hoxton Market Institute 33 1 3 1 41 96 — — — — 175 (b) Hoxton Hall — 1 15 86 — 1 — — 1 26 130 (c) St. Helens Club — 1 15 — 73 75 — — — — 164 (d) Model Welfare Centre 178 278 128 143 82 69 — — 56 60 994 (e) Haggerston Hall 3 — 38 — 4 1 — — — — 46 (/) Harbour Lights 41 2 48 — — 3 — — — — 94 (g) School for Mothers — 2 — — — — 213 126 — — 341 74 Report of Attendances at Welfare Centres during the 52 Weeks ended 29th December, 1934. District 1 2 3 4 5 6 7 & 8 9 10 Total Day Tuesday. Mon. Tue. Wed Thu. Fri. Tuesday. Fri. Tue. Fri. Mon. Wed. Tue Thursday. Thursday. Tue. Thursday. a.m. p.m. a.m. p.m. a.m. p.m. a.m. p.m.. a.m. a.m. p.m. Centre *M.C. M.C. M.C. H.R. h.l. H.H. M.C. St. H. H.i. Herbert St. H.H. M.C. H.H. M.C. 1st attendances of infants 36 70 65 49 76 49 75 16 48 58 64 66 45 43 138 — 98 1 22 14 — 54 1,087 Total do. do. 760 1,128 908 905 1,071 550 1,071 373 838 1,007 889 784 770 640 1,456 36 1,168 120 432 156 23 1,078 16,163 1st attendances children over 1 year. 12 10 47 40 7 13 19 33 25 19 10 16 27 16 46 — 27 — 4 6 2 15 394 Total do. do. 1,059 1,150 1,384 1,304 1,303 371 1,211 675 1,078 1,035 1,178 805 1,154 938 1,211 41 1,345 103 408 135 40 1,131 19,059 Attendances—Mothers without children. 126 366 345 361 290 98 474 110 175 135 330 263 374 384 2 — 12 4 43 36 5 203 4,136 Infants seen by Dr. 1st time. 36 69 62 48 73 49 75 16 38 52 65 68 45 40 133 — 100 — 25 14 — 50 1,058 Total infants seen by Dr. 365 630 487 494 501 397 516 215 439 632 396 370 369 317 893 12 734 — 168 85 — 440 8,460 Children, 1-5 yrs. seen by Dr. 1st time. 11 9 43 35 10 11 16 23 14 20 10 16 23 19 46 — 27 — 12 6 — 14 365 Total children seen by Dr. 555 572 742 687 538 263 615 433 619 637 462 361 544 435 894 16 857 — 241 72 — 493 10,036 Suffering from disorders of digestion and nutrition 1,302 556 1,282 1,389 449 216 1,233 128 414 6,969 Suffering from minor ailments. 677 518 990 865 340 591 1,052 168 297 5,498 Referred to hospital 93 252 139 98 87 40 113 16 41 879 1st Ante-natal attendances 62 77 98 53 44 35 123 16 36 544 Total do. do. 191 211 297 197 111 100 333 60 129 1,629 1st Post-natal attendances 24 14 11 9 22 4 48 6 13 151 Total do. do. 36 25 28 17 27 4 115 9 25 286 Sewing Class attendances 127 122 71 183 29 — 606 38 67 1,243 * M.C. = Maternity Centre, Kingsland Road. H.R. = Haggerston Road Mission Hall. H.L. = Harbour Lights, Goldsmith's Row. H.H. = Hoxton Hall, Hoxton Street. H.I. = Hoxton Market Institute, Boot Street. St. H.= St. Helen's Club, St. John's Road. 75 INFANT WELFARE CENTRES. In the Borough of Shoreditch there are 15 infant welfare clinics. Seven clinics are held at the Model Welfare Centre, 210, Kingsland Road, and the others are held at Hoxton Market Mission (two), Hoxton Hall (two), St. Helen's (two), Haggerston Road (one) and Harbour Lights (one). The total first attendances of infants during 1934 was 1,087, as compared with 1,135 in 1933. The figure for the total attendances was 16,163 as compared with 17,812 in 1933. The first attendances of children was 394 against 418 in 1933. The total attendances of children between one and five years was 19,059, against 20,252 for 1933. The average number of attendances per infant in 1934 was 15.0 and the corresponding figure for 1933 was 15.7. Practically all the children were seen by a doctor on at least one occasion. The number of first examinations of infants was 1,058 (97.3 per cent.) of the total infants who attended on at least one occasion. The corresponding figure for children between one and five years was 365, which represents 90.1 per cent. of the total children of these ages who were examined on at least one occasion by one of the assistant Medical Officers for Maternity and Child Welfare. The work of the clinics proceeded as usual during the year and no detailed comments on their functions are called for. The total number of children who attended at the centres during the year, who at the end of the year were under one year of age, was 1,071, and the corresponding number between one and five years was 2,943, hence the total number of children under five years of age who were on the registers at the end of the year was 4,014. Of this total 879 were referred to hospital by clinic doctors during the year. This represents 21.9 per cent. of the total infants and children on the register and is a fairly high figure. SPECIAL CLINICS. Artificial Sunlight Clinic. This clinic is equipped with two mercury vapour lamps and these are continuing to give good service. Additional sessions were commenced in June, 1934, on Tuesday and Thursday mornings, so that sessions are now held on six half.days each week. Particulars of those referred to the clinic during the last five years are shown in the following table:— 1930. 1931. 1932. 1933. 1934. Number of children 244 269 257 214 262 Number of mothers — — — — 21 Total attendances of children 4,095 4,973 5,552 5,655 5,654 „ „ of mothers — — — — 284 Average number of visits per child 17 18.5 21.6 26.4 21.6 „ „ „ mother — — — — 13.7 Average number of attendances per session— Children 20 24.5 27 27.9 23.9 Mothers — — — — 5.5 76 The conditions for which treatment was given during the year is shown in following table:— the Muscular weakness 21 Pneumonia 16 Debility 45 Malnutrition 21 Rickets 58 For prophylactic purposes 48 Late results of rickets 7 Other minor conditions 42 Enlarged glands 4 The diagnosis and progress of all cases referred to this clinic for rickets is confirmed by radiological examination. This work is carried out at St. Leonard's Hospital. The number of X-ray examinations made during the year was 42. The members of the Sutton Branch of the Voluntary Aid Detachment continued, as they have done for so many years, to render invaluable assistance at this clinic. Dental Clinic. The dental treatment of cases of mothers and children referred by the clinic doctors is carried out by the dental surgeon in the dental hospital The following table summarises the work done in connection with this branch of the Maternity and Child Welfare work since the hospital was opened on a full-time basis. Year. First attendances. Total attendances. Mothers. Children. Mothers. Children. 1931 309 217 1,410 401 1932 306 223 1,421 426 1933 272 217 1,263 464 1934 266 263 1,541 680 Note.—The dental hospital was opened in March, 1927. Prior to that date cases refer to individuals treated by a part-time dentist. During the year 256 women were referred from the maternity centres for dental examination; 205 of these attended for a course of treatment. 1,545 visits were paid in all. 263 children were referred from the maternity centres, and of these 258 attended for a course of treatment. The total number of visits paid was 680. Further particulars regarding this work is given in the section on the dental hospital. Otorrhœa Clinic. The Otorrhcea clinic is held at the Model Welfare Centre every morning, Saturday included. The actual treatment is carried out by a nurse attached to the Shoreditch and Bethnal Green District Nursing Association and the work is under the supervision of the Assistant Medical Officer of Health. Children attending the welfare centres who are found to be suffering from Otorrhoea are referred to the 77 Queen's Hospital for advice and the treatment recommended is given at the otorrhoea clinic. Particulars of the attendances at 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 1934 58 432 75 School Entrants. It is interesting to have some estimate of the physical condition of the children in the borough after they pass from the supervision of the child welfare centres to the care of the Education Authority. I have to thank the School Medical Officer of the County of London for the following particulars regarding the children who entered school during 1934. The relevant information is contained on pages 84 and 85. INSTITUTIONS. Babies' Wards—Model Welfare Centre. This institution was opened in December, 1923, when the centre was built. There is accommodation for ten babies or eight babies and two mothers. The nursing staff consists of a Matron, three staff nurses and three probationer nurses. Acutely ill cases are not admitted, but the ward does good work in helping to tide infants and young children over some of the more difficult ailments of childhood. At the end of the year 1933 ten patients were in residence, 51 children and 4 mothers were admitted during the year and 48 were discharged or transferred to convalescent homes. Particulars of the condition from which children were admitted is given in the following table:— Malnutrition and wasting 9 Debilitated and loss of weight 13 Debility following illness 12 Pneumonia 1 Rickets 1 Wasting 3 Test feeds and re-establishment of breast feeding 4 Mothers and babies for re-establishment of breast feeding 4 78 Of the 48 children who were discharged during the year, 8 were healthy, 38 were much improved and 2 were improved. There were no deaths during the year. The Committee of the School for Mothers administers two institutions, viz., 28, Herbert Street and the Brunswick Day Nursery, Brunswick Place. 28, Herbert Street. This is an institution which has for many years worked in close co-operation with the Borough Council, which contributes a grant of £1,205 per annum towards the expenses of the institution. The Committee employs two health visitors and the western portion of the borough, in which this institution is situated, is allocated to them. A note of all births is sent from the Public Health Offices and these two health visitors are responsible for all visits in this district. Two infant welfare centres, one weighing centre, one ante-natal consultation centre, and a sewing class are held weekly. During the year 236 infants attended at the centre for the first time and a total of 2,660 attendances were made. The number of first attendances of children between one and five years of age was 73, and the total number of attendances was 2,597. These figures may be compared with the corresponding figures for the year 1933 when 233 infants and 73 children had their first examination by the doctor in charge. The total examinations of infants by the doctor numbered 1,639, and of children from one to five years, 1,767. One hundred and twenty-three expectant mothers attended the clinic on 333 occasions and 48 mothers attended on 115 occasions after their confinements. These figures are recorded in the table on page 74. Brunswick Day Nursery. This nursery accommodates 40 children. The staff consists of the doctor in charge who visits the nursery weekly; a matron, a staff nurse and five probationer nurses. The domestic staff is made up of a daily cleaner and laundry woman who attends on two days a week. A local practitioner is called in in the event of an emergency. During the year 1934 the attendances were 7,036 and half-day, 586; the corresponding figures for 1933 being 6,373 and 666 respectively. Sun Babies' Nursery, Norris Street. The nursery has accommodation for 100 children. With this number the buildings are rather crowded and the average attendance is usually less. For several years an annual grant was paid by the Borough Council in consideration of the value of the work which was done by this nursery. With the discontinued Ministry grant, this figure makes a total of £1,200, which is the annual contribution of the Borough Council to this institution. 79 The medical officer-in-clmrge—Dr. Morton—attends once weekly for the purpose of examining children. The services of a local practitioner are available in an emergency. 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 Annual Report for 1933). 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 1934, to £210 18s. The numbers of children and attendances since the commencement of this arrangement are shown in the following table:— Year. No. of Children. Attendances. Total Attendances. At full cost. At half cost. 1929 (11 weeks) 20 394 36 430 1930 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 1934 62 5,562 124 5,686 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. The total number of whole-day attendances at this nursery during 1934 was 17,896, and of half-day attendances 772. The corresponding figures for 1933 were: whole-day, 10,949; half-day, 574. The resident staff of the Nursery consists of a matron, two nurses, two probationers, a day nursery teacher and a cook. The cleaning and laundry staff are non-resident. Dr. Morton, in her report to the Medical Officer of Health on the medical aspect of the institution for the year 1934, states that the total attendances for the year 1934 were lower than they might have been owing to the fact that the Nursery was closed for two weeks at holiday time. This arrangement was in the nature of an experiment to enable all members of the staff to take their holidays at one time, thus avoiding the Nursery being carried on with a depleted staff. The closing of the building also provided facilities for thorough cleansing. Although the total attendances were possibly reduced as a result of the closure, the average attendance was higher than for 1933. It is interesting to note that there is always a waiting list for babies under nine months. During the year certain structural alterations were carried out. The result was an improvement in the general condition of the building. 80 Incidence of Infection.—During the year under review seven cases of measles, five of mumps and two cases of scarlet fever occurred in children who attended the Nursery. The appointment of an additional qualified nursery teacher added considerably to the efficiency and educational capacity of the school side of the institution. Dr. Morton is of opinion that the high standard of mothercraft efficiency for the baby at home is not maintained for the toddler and she believes that a spell in the Nursery effects a distinct improvement in the mental and physical condition of the toddler. The Nursery is equipped with both mercury vapour and carbon arc lamps and 20 to 30 children are treated weekly. Dr. Morton states that the general standard of health is good. There has been less catarrhal infection and she has been impressed by the low incidence of skin lesions. Efforts are being made to bath the toddlers frequently, and, if possible, daily. The incidence of early dental caries is low and only three toddlers were referred for removal of tonsils and adenoids. Emergency Open-air Nursery. During June an arrangement was entered into between the Borough Council and the Secretary of the Emergency Open Air Nursery School, Trinity Place, Shepherdess Walk, by which ten Shoreditch children under the age of five years could be sent to this institution. This Nursery is situated in the western part of the Borough, and was established expressly for children whose parents are receiving public assistance, and are not therefore in a position to pay the usual nursery fee of one shilling per week. The amount paid for this service by the Council is 1s. 8d. per week of 5 days per child, which amount is said to cover the cost of the food supplied. The number of individual children sent to this Nursery during the year was six. These children attended on 255 occasions and the cost to the Council was £i 5s. Medical Mission of the Good Shepherd, Harman Street. This is an institution of ten beds for the treatment of babies and young children suffering from, acute medical conditions. 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. The cases in the wards are under the care of Dr. E. A. Worley. During the year 41 children were admitted and there were six deaths. 81 Queen's Hospital for Children. An agreement was entered into on the 22nd January, 1930, whereby, in consideration of a payment of £150 per annum (increased since that date to £200 per annum) children might be sent to the hospital for examination and report by a member of the honorary staff; for treatment at the minor ailment centre, or for admission to hospital for examination and treatment. The following are particulars of the cases referred under this agreement during the last five 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 1934 33 517 167 911 169 708 CONVALESCENCE. At the present time children under five years of age can receive convalescent treatment in one of three ways: (a) they may be referred to the Invalid Children's Aid Association, with which organisation the Committee has a working arrangement; such children are sent to the Association's homes; (b) through the Women's Holiday Fund; and (c) to the homes of the Association of Infant Welfare Centres. The number of children whose convalescence was dealt with by the Invalid Children's Aid Association in the last four years is as follows : 1931, 23; 1932, 30; 1933, 16; 1934, 8. The Maternity and Child Welfare Committee made a contribution towards the cost of maintenance of all the cases in 1934. It should be pointed out that of the ten beds in the wards at the Model Welfare Centre, five are reserved for the treatment of children suffering from alimentary troubles and the other five are for toddlers and mothers. Further particulars of the work carried out in the ward will be found on page 77. The adequacy of the arrangements for convalescence has been a matter for serious consideration of the Maternity and Child Welfare Committee since the end of the year under review. At the Centres lists are drawn up of children who are recommended for convalescent treatment, and in preparing these lists it is the practice to include only those children who require such treatment urgently. During the last two years only about 50 who were definitely listed as requiring convalescence were actually sent to one of the convalescent establishments indicated above. There is, unfortunately, no satisfactory arrangement in the Borough for the convalescent treatment of mothers. During the year under review four mothers were sent away at the Council's expense and another three received treatment under voluntary agencies. From the above facts it will be evident that at the present time there is not sufficient accommodation for the convalescence of mothers and children, and daring the present year (1935) steps are being taken to remedy this position. 82 NURSING. The District Nursing Association undertakes the nursing of children under five years and of parturient women referred to them by medical practitioners and by the Maternity and Child Welfare Department. The number of cases visited was 246 and the number of visits paid 3,023. The particulars of these cases will be found on page 44 of this report. 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. On January 1st, 1934, there were twelve foster mothers in the Borough, each being in charge of one foster child. During the year eight new foster mothers were registered. Ten foster mothers were removed from the register during the year. The Infant Life Protection Visitor reports that during 1934, 227 visits were paid in connection with this work. With one exception all foster children under five years of age attended the Welfare Centre, the exception being a delicate child who was under treatment at St. Bartholomew's Hospital for tonsillectomy. He made rapid progress. On the whole, the health of the children was good. Two cases of measles were nursed satisfactorily in the homes under the care of a doctor. One child went to hospital with whooping cough and was away two months. It was found necessary to advise the removal of the children from two homes. In one of these cases the foster mother took a second child and it was left alone in the house for two hours at a time. The baby was given into the charge of another foster mother. In the other case the foster mother who had previously been satisfactory, became untidy and the child suffered. On advice from this department the parents removed the child from the care of the foster mother. Every child 83 under two years of age was visited once a month and those over two years of age were visited once in two months. Daily visits were made where necessary in case of illness. DINING CENTRES. There are two dining centres in the Borough, both of which are under the control of the Maternity and Child Welfare Committee. Necessitous mothers receive dinners on a production of a certificate from the Assistant Medical Officer of Health. Liability is determined by the milk scale. The number of mothers who attended during 1934 and the preceding four years is shown in the following table:— Model Welfare Centre. 31, Herbert Street. 1931. 1932. 1933. 1934. 1931. 1932. 1933. 1934. Number of individual mothers attending 183 234 229 169 148 201 194 149 Total attendances 11,552 14,130 13,635 10,312 10,046 13,659 12,017 10,406 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. The number of individual toddlers who attended dinners during the year was 116, and the total number of attendances was 5,978. MILK ALLOWANCES. Particulars regarding the scale of income and the quantities of milk allowed under this scheme were given in the Annual Report for 1933. The number of individuals in receipt of milk or dinner allowances was 1,307 at the beginning of the year, fell to 998 in June, and by the end of this year had further fallen to 894. The minimum being in early December, when the number was 861. 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 eight 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 1934 606 637 84 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 1934. Routine Medical Inspection of Elementary School Entrants in Shoreditch in 1934. †—Defects found. *—Noted for treatment and included in defects found. Disease or Defect. Boys 765. Girls 766. Shoreditch. London. Shoreditch. London. No. Per cent. Per cent. No. Per cent. Per cent. Skin disease † 6 0.8 1.1 9 1.2 0.8 * 4 0.5 0.7 6 0.8 0.6 Tonsils only † 149 19.5 14.7 132 17.2 14.3 * 43 5.6 5.0 37 4.8 4.7 Adenoids † 1 0.1 1.1 2 0.3 0.8 * — — 0.7 2 0.3 0.5 Tonsils and adenoids † 7 0.9 3.0 6 0.8 2.6 * 5 0.6 2.1 1 0.1 1.8 Other nose and throat † 7 0.9 1.1 7 0.9 1.0 * 3 0.4 0.5 1 0.1 0.4 Glands of neck † 14 1.8 2.9 16 2.1 2.3 * — — 0.3 1 0.1 0.2 Eye disease † 27 3.5 3.3 28 3.7 3.1 * 19 2.5 2.1 16 2.1 2.0 Otorrhœa † 10 1.3 1.2 9 1.2 1.1 * 6 0.8 0.7 9 1.2 0.7 Other ear defects † 2 0.3 0.4 1 0.1 0.5 * 2 0.3 0.2 1 0.1 0.2 Hearing † 1 0.1 0.1 — — 0.2 * 1 0.1 0.1 — — 0.1 Speech † 1 0.1 0.4 1 0.1 0.2 * — — 0.0 — — 0.0 Heart † 12 1.6 1.9 7 0.9 1.7 * 1 0.1 0.1 — — 0.1 Anæmia † 2 0.3 1.2 — — 0.9 * — — 0.4 — — 0.3 Lungs † 31 4.1 3.9 18 2'3 3.4 * 3 0.4 1.2 5 0.7 1.1 Epilepsy † — — 0.0 1 0.1 0.0 * — — 0.0 1 0.1 0.0 Chorea † — — 0.0 — — 0.0 * — — 0.0 — — 0.0 Paralysis † — — 0.1 — — 0.0 * — — 0.0 — — 0.0 Other nervous diseases † — — 0.5 — — 0.4 * — — 0.1 — — 0.1 Pulmonary T.B. † — — 0.0 — — 0.0 * — — 0.0 — — 0.0 Other tuberc. lesions † — — 0.0 — — 0.0 * — — 0.0 — — — Rickets † 4 0.5 1.0 5 0.7 0.5 * — — 0.2 1 0.1 0.1 Spinal deformities † — — 0.1 — — 0.2 * — — 0.1 — — 0.0 Other deformities † 1 0.1 1.0 2 0.3 0.8 * — — 0.3 1 0.1 0.2 Other defects † 12 1.6 2.7 18 2.3 2.8 * 7 0.9 1.5 15 2.0 1.6 85 Routine Medical Inspection of Elementary School Entrants in Shoreditch in 1934. Number examined Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. 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 765 150 585 30 132 599 34 — 656 102 7 702 58 5 368 309 88 377 Girls 766 152 590 24 126 621 19 — 622 128 16 694 64 8 377 293 96 377 Total 1,531 302 1,175 54 258 1,220 53 — 1,278 230 23 1,396 122 13 745 602 184 754 Percentage, Shoreditch 19.7 76.8 3.5 16.8 79.7 3.5 — 83.5 15.0 1.5 91.2 8.0 0.8 48.7 39.3 12.0 49.3 Percentage, London 53.7 45.7 0.6 20.0 75.9 4.1 — 96.9 2.7 0.4 98.6 1.3 0.1 54.4 34.3 11.3 41.8 86 NATIONAL PARENTCRAFT COMPETITION. Shoreditch Centres again entered the National Parentcraft Competition. It is gratifying to be able to state that Shoreditch was placed fifth in all England. The successes included five Honours Certificates, two First-class Certificates and one Second-class Certificate. VOLUNTARY WORKERS. It is fitting to close this section of the report with an expression of appreciation of the services of those ladies who have attended voluntarily for the purpose of assisting with the work of the various centres and clinics. 87 VI.—MUNICIPAL DENTAL HOSPITAL. It is pleasing to be able to record that the work of the dental hospital continues to increase and that all sections of the community are taking advantage of this institution, which is rather unique in the annals of public health work. The dental clinic was opened in 1927 and the institution was transferred to its new premises—the Municipal Dental Hospital—in 1932. A full-time staff consisting of dental surgeon, nurses ajid mechanics is employed and all persons who live or work in Shoreditch are eligible for treatment. Not so many years ago the difficulty of obtaining adequate dental treatment and of providing dentures at small cost frequently militated against the treatment of cases of tuberculosis and other diseases, and was also a distinct blot on the record of achievement in purely preventive methods. Much has been written on all aspects of dental work—the dangers of sepsis, its ultimate effects, often upon a healthy system, the effects of a deficiency of teeth upon health, and the relatively high incidence of minor malformations of the jaws and teeth which may ultimately predispose to general ill-health. While these dangers have been widely recognised in the past in most areas, their removal in individuals of the poorer classes has been possible only in children of school age. Sometimes in quite large authorities provision for the dental treatment of cases of tuberculosis is non-existent, and those who have had to supervise the treatment of such cases in institutions know how hopeless is the task of effecting a satisfactory cure when there are no facilities for proper dental treatment. In Shoreditch the needs of all members of the community, old or young, are catered for, and there is some evidence that the work which has been done is having a good effect upon the general health of the inhabitants. Procedure at the Dental Hospital. As has already been stated, any persons who live or work in Shoreditch are eligible for treatment. Applicants who state that they are unable to afford the prescribed charges are asked to complete a form giving the number in family and income. They are also required to sign an undertaking that they understand that they may be called upon to reimburse the Council if their circumstances improve at a later date. These particulars are verified by the Enquiry Officer and the charge for treatment is assessed according to a scale which was given in the Annual Report for 1933. The remission of charges is, however, limited to persons who have resided in the borough for a period of not less than six months. 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 reason of the fact that they are referred to the hospital from one or other of the welfare centres. 88 Summary of the Work Done. Tables I, II and III summarise the work which was done at the dental hospital during 1934. The corresponding figures for 1933 will be found in the report for that year. Table I.—Inspection and Treatment of Children. No. of primary examinations No. of 1st Attendances for Course of Treatment. No. of extractions (teeth). Local Anæsthetics. General Anæsthetics. No. of Fillings. No. of Scalings. No. of Orthodontic plates fitted. Orthodontic visits. No. of Surgical Operations. No. of other Operations. No. of visits. Complete. Temporary. 1st (a). Subsequent (b). (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Up to 2 yrs. 7 6 10 ... 3 9 ... ... ... ... ... ... ... 13 Over 2 ,, 29 26 91 ... 25 8 ... 1 ... ... ... ... 13 68 Over 3 ,, 108 98 314 ... 83 70 12 ... ... ... ... ... 19 215 Over 4 ,, 130 128 411 1 113 80 5 ... ... ... ... ... 5 269 School children 88 51 169 15 39 60 16 4 13 4 99 1 94 292 Total 362 309 995 16 263 227 33 5 13 4 99 1 131 857 Table II.— Inspection and Treatment of Adults. No. of primary examinations No. of 1st attendances for Course of Treatment. No. of Extractions (teeth) Local Anæsthetics. General Anæsthetics. No. of Fillings. 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. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Women referred from M.C.W. centres 251 205 1949 14 336 85 15 58 158 17 9 733 1545 Other Women 372 264 1393 49 246 109 42 32 184 48 4 810 1717 Adolescents (half-rate cases) Female 46 33 92 10 31 32 5 2 4 ... 1 21 128 Male 35 28 73 13 16 13 2 ... 2 1 ... 6 70 Men 293 224 1135 74 175 91 17 39 181 67 4 629 1450 Tuberculous 12 8 59 4 10 9 ... ... 10 ... ... 26 61 Total (including Children, Table I) 1371 1071 5696 180 1077 566 114 136 552 133 19 2356 5828 89 Table III.—Analysis of Visits. Sessions. Morning. Afternoon. Evening. Total. No. of M. & C.W. Visits. Anaesthetic Sessions. Attendances Special Anaesthetic Visits Women. Children. Interviews Examinations and Treatm't Interviews Examinations and Treatm't Interviews Examinations and Treatm't Interviews Examinations and Treatm't 1st Subsequent 1st Subsequent Monday ... ... 214 695 121 438 335 1,133 59 130 45 12 ... 10 Tuesday ... ... 126 592 116 427 242 1,019 26 249 44 116 545 1 Wednesday 144 603 26 66 108 380 278 1,049 31 188 25 24 ... 19 Thursday 126 593 110 524 84 251 320 1,368 83 405 105 82 8 9 Friday ... ... 139 624 82 526 221 1,150 50 293 41 82 480 ... Saturday 108 109 ... ... ... ... 108 109 2 10 3 1 ... 6 Total 378 1,305 615 2,501 511 2,022 1,504 5,828 251 1,275 263 417 1,033 45 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. 90 It is satisfactory to note that there was a very definite increase in the numbers of pre.school children, 258 first visits having been made to the hospital, compared with 189 in 1933. This increase is to a considerable extent due to propaganda work carried out at the infant welfare centres and elsewhere. In view of the fact that there are several clinics for school children within the borough or within easy reach, it was not to be expected that the year 1934 would show a very marked increase ; in point of fact the numbers were the same, viz., 51 attendances. General Anaesthetics. General anaesthetics were given to children in 263 instances as against 222 in 1933, and to adults in 1,077 instances as against 894 in 1933. Another satisfactory feature was the marked increase in the number of complete fillings, especially in children. During 1934, 227 complete fillings were carried out in children as against 138 for the year 1933. In adults the figure increased from 492 in 1933 to 566 in 1934. The number of orthodontic cases was low, but it should be borne in mind that such cases have to attend for long periods and the amount of work involved is considerable. It is interesting to note the ratio between the number of persons who attended for treatment as a result of a previous primary examination and the number of first examinations. The following tables show the number of primary examinations the number of first attendances for treatment as a result of these examinations and the percentages for different groups of peisons during 1933 and 1934 respectively. 1933. Percentage (b) to (a). 1934. Percentage (b) to (a). (a) Primary examinations. (b) First attendances for treatment {a) Primary examinations. (b) First attendances for treatment Up to 2 years 6 1 16.7 7 6 85.7 Over 2 „ 37 34 91.9 29 26 89.7 „ 3 „ 63 50 79.4 108 98 90.7 „ 4 „ 116 104 89.7 130 128 98.5 School children 108 51 47.2 88 51 58.0 Women referred from M. & C.W. Centres 293 208 70.9 251 205 81.6 Other Women 338 198 58.6 372 264 71.0 Adolescents:— Female 45 32 71.1 46 33 71.7 Male 34 29 85.3 35 28 80.0 Men 345 216 62.6 293 224 76.5 91 It will be seen, that nearly all groups show a higher percentage for 1934, which probably indicates that more persons are having the recommended treatment actually carried out. This is also very satisfactory. Even a cursory dental examination takes some time and it is obviously of advantage not only to the officials concerned, but also to the patients, if as many as possible complete the examination. In the case of school children it will be noted that the percentage is very low. This may mean one of three things: a considerable proportion of the children who attend for examination do not require treatment; or many of those who require treatment have this carried out at school clinics or by private dentists; or thirdly, a proportion of those who are recommended for treatment do not have it at all. It is probable that a considerable number of these children have treatment carried out at the school clinics. In 1930 school dentists found that 69.5 per cent. of the chilldren they inspected required treatment ; of those recommended for treatment 63.4 per cent. actually attended. In the table for Shoreditch cases it will be noticed that the percentages are very much higher than this figure. It is evident, therefore, that the work of the hospital is being appreciated by the public. Growth of the Hospital. The following table gives a comparative statement of the work done since the hospital was opened:— 1927 From 31st Mar. 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 EightSes sions. 1934 Eight Sessions. No. of children's visits 499 794 1,081 1,577 1,576 1,978 849 857 No. of adults' visits* 1,430 3,032 3,505 6,658 6,174 5,064 4,085 4,971 No. of maternity cases visits 627 1,021 1,209 1,290 1,407 1,421 1,287 1,545 No. of dentures fitted 61 222 329 699 752 663 509 552 * Including Maternity cases. It is very satisfactory that the number of visits by women attending the Maternity centres continues to increase. 7 92 Scale of Charges. The following is a statement of the charges which are at piesent in force in connection with the hospital:— 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.—Is. per tooth (with or without local anaesthetic). Maximum 12s. 6d., irrespective of number of attendances. Extractions with general anaesthetics.—Extraction fee Is. each tooth. Gas 3s. 6d. Maximum 15s., irrespective of number of attendances, until course of treatment completed. Dentures, full upper or lower.—£2 15s. Dentures, full upper and lower.—£5 10s. Partial Dentures, extractions not included, £1 Is. for first two teeth; 5s. for each subsequent tooth. 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 moie. Maximum (including any necessary additions at 5s. per tooth) per denture, £2. Remakes within 12 months.—Half original fee. Crowns.—£l 1s., including any necessary root treatment. 93 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.:— General treatment.—Is. per attendance, with a maximum of 2s., until course of treatment completed, for extractions (including gas and any fillings) but not orthodontic treatment. Orthodontic treatment.—Cost of appliance, plus 50 per cent. Young persons under 19 years of age receive treatment at half price. The charges which were in force in 1934 were amended by the Council in 1935 and the statement given is that of the amended charges. Further particulars regarding changes which were effected during the early part of 1935 will be given in the next annual report. Staff. Mr. C. S. Abraham, M.C., L.D.S., was appointed Dental Surgeon on 13th March, 1934. Times of Sessions.—(See Appendix at end of report.) 7a 94 VII.—SANITARY CIRCUMSTANCES. DISTRICT SANITARY INSPECTIONS. The following tables which are based on reports made to the Medical Officer of Health of the London County Council, for inclusion in his Annual Report for 1934, summarizes the work done by the Sanitary Inspectors during the year:— The total number of Intimations served in respect of insanitary conditions was 4,785. The number served on each Sanitary District was as follows:— District No. I 495 District No. VI 478 II 484 VII 232 III 547 VIII 585 IV 822 IX 448 V 694 In connection with the Inspectors' Sanitary work, 1,228 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 668 instances. For non-compliance with the requirements of the sanitary authority, proceedings were taken before the Magistrates in 14 instances. A list of legal proceedings will be found on pages 116 to 118. The following tables (pages 95 and 96), summarize the visits and work of the sanitary inspectors during 1934. The work done in compliance with the provisions 95 of the Factory and Workshops Act, 1901, and in connection with the drains and sanitary arrangements of new buildings is included:— Inspections, 1934 DISTRICTS. Total 1 2 3 4 5 6 7 8 9 House-to-house 173 173 196 132 157 141 106 144 103 1,325 Other premises 909 491 1,634 1,450 570 694 573 854 609 7,784 Re-inspections, &c. 2,076 3,046 1,862 3,573 3,088 3,156 1,236 2,809 2,936 23,782 Visits in connection with infectious diseases 46 190 83 143 125 42 33 89 91 842 Common lodging houses 6 ... ... ... ... ... 14 10 11 41 Houses-let-in lodgings 48 33 8 627 2 9 17 ... 744 Workshops 454 285 69 164 67 56 88 66 175 1,424 Factories 91 215 33 205 17 88 14 23 15 701 Outworkers 46 121 67 190 35 34 26 64 144 727 Bakehouses 2 24 5 25 6 12 13 14 21 122 Milkshops, cowsheds 64 155 144 223 159 66 102 138 231 1,282 Cookshops 231 71 82 71 87 48 20 59 27 696 Fried fish shops 19 25 16 19 14 16 46 25 36 216 Ice cream shops 33 47 37 61 46 20 32 55 38 369 Meat and food 17 55 50 54 74 17 10 50 43 370 Stables ... ... ... 3 ... ... 6 2 11 22 Rag and bone dealers 4 10 10 12 1 ... ... ... 7 44 Markets 33 29 25 27 28 31 ... 32 35 240 Total 40,731 96 Work Done, 1934. DISTRICTS Totals 1 2 3 4 5 6 7 8 9 Premises, complete exam. 75 11 26 52 3 3 5 2 4 181 „ partial exam 192 204 225 421 372 242 103 248 200 2,207 „ total rooms 738 561 743 1,154 1,087 679 222 640 430 6,284 Verminous rooms 17 16 127 80 49 11 12 3 32 347 „ premises 14 56 51 41 9 8 ... 27 206 Premises, generally repaired 140 299 399 541 475 388 140 321 380 3,083 Light and Ventilation ... 5 ... 11 2 1 1 1 ... 21 Roofs, gutters, rain-water pipes 90 172 139 337 285 306 71 200 264 1,864 Overcrowding 6 16 21 120 29 6 2 10 9 219 Water re-instated 7 6 9 28 4 5 1 16 1 77 Drains, new ... ... 5 7 5 1 1 2 2 23 „ re-constructed ... 19 25 16 18 7 ... 3 19 107 „ improved or repaired 9 36 30 89 43 14 9 49 32 311 „ obstructions removed 11 11 18 44 28 28 12 30 19 201 Soil, vent pipes repaired 4 4 5 21 12 3 6 3 3 61 W.C.'s— New 1 26 92 46 20 8 2 26 3 224 Improved or repaired 105 125 91 207 125 67 36 110 103 969 Obstructions removed 11 23 29 43 ... 24 6 12 29 177 Sinks, improved 26 29 23 35 65 46 8 11 10 253 „ traps provided 4 ... 6 11 27 3 ... 4 3 58 Outdoor Premises Floors, paving repaired 6 59 26 147 84 29 30 41 73 495 Cleansed or limewashed 197 17 111 268 199 82 44 7 90 1,015 Improved or repaired ... ... ... 2 1 ... ... ... ... 3 Dustbins provided 27 31 84 118 92 60 22 63 31 528 Ashpits improved or repaired ... 1 1 ... ... ... ... ... ... 2 Ashpits abolished ... 6 1 ... ... ... ... ... ... 7 Accumulations removed 6 53 30 61 27 8 11 13 4 213 Urinals cleansed or repaired ... 4 4 11 6 ... 3 ... ... 28 Animals removed ... 2 5 3 ... 1 ... 1 ... 12 97 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 1934:— PREMISES. NUMBER OF PLACES— Number of inspections, 1934 Number of notices, 1934 Number of prosecutions, 1934 On register at end of 1933 Added in 1934 Removed in 1934 On register at end of 1934 Houses let in Lodgings 410 16 8 418 744 284 Nil Common Lodging Houses 4 ... ... 4 41 2 „ Seamen's „ ... ... ... ... „ Cowsheds (licensed) 2 ... ... 2 19 1 „ Slaughterhouses „ ... ... ... ... ... ... „ Other offensive trades 1 ... ... 1 6 2 „ Milkshops 295 28 16 307 1,263 24 „ Ice Cream premises 137 42 7 172 369 14 „ Restaurants and Eating Houses 243 29 12 260 696 78 „ Registered Foster mothers ... ... ... 10 184 ... „ Nurse children kept ... ... ... 10 184 ... „ Smoke Nuisances. (1) Number of observations 24 (5) Number of legal proceedings Nil (2) Number of intimations served 5 (6) Number of convictions Nil (3) Number of complaints received 4 (7) Amount of penalty and costs imposed in each case Nil (4) Number of statutory notices served Nil Cleansing and Disinfection. Number of adults cleansed 6 Number of premises cleansed— Number of children cleansed 3 (a) After infectious diseases 974 (b) For vermin 74 Water Supply to Tenement Houses. Number of premises supplied 56 Number of prosecutions Nil Total number of houses in the Borough 14,077 Number of houses occupied by the working classes 13,559 Number of houses inspected:— (a) On account of complaints or illness and otherwise under Public Health Act 7,670 (b) House-to-house (Public Health Act) 1,325 98 Number of Notices served— (a) Under Public Health Act-— (i) Intimation 4,785 (ii) Statutory 668 (b) Under Housing Act Nil Number of houses repaired or nuisances remedied under Public Health Act, 1891 4,785 Number of houses repaired under Section 17 of Housing Act, 1930— (a) By owners Nil (b) By Local Authority in default of owners Nil Number of houses closed on notice by owner that they could not be made fit Nil Number of houses for the working classes— (a) Erected during the year 150 (b) In course of erection 100 Number of representations by Medical Officer or other person (Housing Act, 1930, Sec. 1) 2 Number of houses included in such representations 39 Number of closing orders made (i.e., underground rooms) Nil Number of closing orders determined (i.e., houses made fit) Nil Number of demolition orders Nil Number of houses demolished— (a) In pursuance of orders (made by L.C.C. with support of Borough Council) 190 (b) Voluntarily 17 Underground Rooms. Number illegally occupied 10 (Public Health (London) Act); 2,000 approximately (Housing Act) Number closed or illegal occupation discontinued 9 Overcrowding. Number of cases of overcrowding found 125 Number remedied 195 Number of prosecutions 1 Water Supply. The number of certificates issued as required under the Public Health (London) Act, 1891, section 48 (2), was 90. The water supply is almost entirely from the Metropolitan Water Board. 99 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. Ashpits. It is satisfactory to be able to state that there are now only six ashpits in the Borough. One of these serves 14 houses, two 12 houses and one 11 houses. These are reported to be in satisfactory condition, but total abolition would certainly be desirable. During the year 1934 seven ashpits were abolished. Common Lodging Houses. The work in connection with common lodging houses, which is carried out under the Public Health (London) Act, 1891, was transferred to the Borough Council by the Transfer of Powers (London) Order, 1933. The number of common lodging houses in the borough is four, the number of beds being 123, 87, 46 and 28 respectively. All the lodging houses are for males. During the year 41 visits of inspection were paid. In general it may be said that the common lodging houses are not of modern type, the buildings are old and the houses can only be kept up to the required standard of efficiency by constant supervision. Houses Let in Lodgings. At the end of the year 1933, 410 houses were registered as houses let in lodgings. During the year 1934 sixteen were added and eight were removed, leaving a total of 418 on the register at the end of 1934. The type of house varies but the greater proportion consist of from seven to ten rooms. It need hardly be mentioned that the majority of these houses were originally constructed for a totally different purpose and generally it may be said that they are unsatisfactory for the purpose for which they are used. This is, however, a difficulty which can only be overcome when improvement is effected in the housing of the people as a whole. Many of these houses have basement rooms which are occupied in contravention of the regulations of the Borough Council. The sanitary conveniences are usually in the yard; there is generally a water supply in the yard and most of the houses have a water supply on the upper floors. The sinks are often fitted on the landings of the staircase. The houses are kept in fair repair and action to maintain this is taken under the Public Health (London) Act, 1891. During the year 744 visits of inspection were made. There was no appreciable amount of overcrowding above that which generally prevails in the district. 100 Verminous Houses. It was necessary to take measures on account of the presence of vermin in respect of 206 houses, and in connection with these 347 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. Verminous Persons. During the year the homes of 18 children, three boys and fifteen girls, notified as verminous by the School Medical Officer, were reported with a view to the homes, bedding, etc., being dealt with by the Sanitary Authority, whilst the children were cleansed and their clothing disinfected at the cleansing stations of the London County Council. Intimations were received that three boys and six girls had been given the opportunity of being cleansed at these stations, that in the case of two girls Statutory Notices had been served upon the parents to cleanse the children within 24 hours under Section 87 of the Education Act, 1921, and that in the case of seven girls legal proceedings were pending for non-compliance with the requirements of the statutory notices under this Act. In all the cases reported the homes were visited by the Sanitary Inspectors, and the following summarizes the reports received:— Twelve of the homes were satisfactory, the condition varying from fairly clean to very clean, and two were dirty. In 11 instances the bedding was fairly clean and in two instances it was verminous. The children reported by the school authorities as suffering from scabies numbered 84, of whom 39 were females. As a result of the enquiries made 12 other cases came under observation. As far as practicable steps were taken to prevent the spread of infection. Offensive Trades. The supervision of offensive trades was transferred to the Borough Council by the London County Council under the Transfer of Powers (London) Order. The only business carried on in the Borough which falls within this category is that of a fur skin dresser. Six visits of inspection were made. Two notices were served in respect of limewashing, and these were duly complied with. Rag and Bone Dealers. At the end of the year 14 premises to which bye-laws under Section 9 of the London County Council (General Powers) Act, 1908, apply were on the register. Forty-four visits were paid to these during the year. Intimations as to the need for cleanliness were sent and duly attended to in five instances. 101 Rag Flock Acts, 1911 and 1928. During the year 31 samples of rag flock were submitted to the Analyst and were found to comply with the legal standard of not more than 30 parts of chlorine per 100,000. The amount of chlorine present varied from 4.0 to 28.1, the average being 12.3 per 100,000. 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, occurring in factories are however, only remediable under the Public Health Act, and these are referred by H.M. Inspectors to the Health Department. The number of workshops, exclusive of bakehouses, on the register at the end of 1933 was 1,564. The number added to the register during the year under consideration was 44, the number removed was 63, and the number on the register at the end of 1934 was 1,545. A classification of the workshops on the register at the end of the year is contained in the following table:— Registered Workshops—1934. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) (1) Furniture, woodwork, fitting and other branches of the furniture trades. 1,050 (a) Cabinet making 610 (c) Upholstery 127 (b) French polishing 177 (d) Other workers 136 . . (2) Dress ... ... 167 (a) Tailoring 75 (e) Shirt making (b) Mantles 8 (f) Boot and shoe trades 25 (c) Dress ... 14 (g) Artificial flowers 3 (d) Millinery 7 (h) Other workers 35 (3) Skin, leather, hair and feather trades ... 47 (a) Furriers 18 (c) Feathers 1 (b) Saddlery and Harness 10 (d) Other workers 18 . (4) Paper, printing, book, stationery and fancy goods trades 37 (a) Box and bag makers 31 (b) Other workers 6 (5) Laundry and washing ... ... 3 (6) Food ... ... 10 (7) Metals, machines, implements and conveyances ... 82 (8) Precious metals, jewels, &c. ... 1 (9) Other trades than those mentioned above ... 148 Total number of workshops on Register ... 1,545 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. 102 The particulars of inspections made by the Sanitary Inspectors are as follows Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including factory laundries) 701 90 ... Workshops (Including workshop laundries) 1,424 189 ... Workplaces (cookshops, fried fish shops and ice cream shops) (excluding outworkers' premises dealt with in Table III.) 1,281 117 ... Totals 3,406 396 ... 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 213 213 ... ... Want of ventilation ... ... ... ... Overcrowding 1 1 ... ... Want of drainage of floors ... ... ... ... 0 ther nuisances 522 522 ... ... Sanitary accommodation insufficient ... ... ... ... unsuitable or defective 178 178 ... ... 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 105). ... ... ... ... Totals 914 914 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Act. 103 During the year 189 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 45 Soil and vent pipes dealt with 1 Premises cleansed partially 53 Water-closets newly constructed 10 Number of rooms cleansed 196 Water-closets repaired, etc. 79 Walls, floors, sashes, etc., repaired 54 Water-closets obstructions removed 10 Roofs, guttering, etc., repaired 77 Sinks, etc., cleansed and repaired 7 Water reinstated or improved 1 Sculleries, yards, etc., paving repaired 6 Drains newly constructed 1 Drains reconstructed 1 Sculleries, yards, etc., cleansed or limewashed 63 Drains, repaired, etc. 12 Drains, obstructions removed 7 Dust receptacles provided 3 Urinals cleansed, etc. 4 Foul accumulations removed 33 The number of factories under observation for insanitary conditions during the year was 90, and in connection with these 90 sanitary notices were served. The work carried out to comply with these notices included the cleansing and repairing of water-closets in 79 instances, the removal of obstructions from drains and water-closets in 14 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 56 lists of out-workers were received from employers in the Borough, 29 in the first and 27 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 Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories :— 4 Failure to affix abstract of the Factory and Workshop Act (s. 133). Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5). Notified by H.M. Inspector 22 relerring to 14 factories and 8 workshops. Reports (of action taken) sent to H.M. Inspector. 22 referring to 14 factories and 8 workshops. Other 5 Underground Bakehouses (s. 101):— Certificates granted during the year Nil. In use at the end of the year 30 104 of 953 out-workers, of whom 752 were not residents in Shoreditch. The addresses of those non-resident were forwarded to the sanitary authorities of the districts to which they belonged. The total number of out-workers reported was 1,994, and of these some 1,233 were residents in Shoreditch. These figures are slightly lower than those for last year. As pointed out in previous reports, in numerous instances names and addresses of outworkers are duplicated owing to lists being sent in twice a year, and in some cases the same outworkers are employed by more than one firm, so that the numbers given above must not be taken as representing the actual numbers of individual outworkers and the tables on pages 105 and 106 show the distribution of outworkers as regards trades in the Borough. During the year 727 visits of inspection were made to places where home-work was being carried on, and in connection with these 104 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 14 and included 9 scarlet fever, 4 diphtheria, 1 erysipelas, and 1 case of pneumonia. The usual steps were taken in connection with them by the officers of the sanitary authority. 105 Home Work. The following is a summary of the lists received from employers in the Borough : — NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Outwork in unwholesome premises. Section 108. Outwork in infected premises, Sections 109 and 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made. (S. 109.) Prosecutions. (S. 109, 110.) Twice in the Year. Once in the Year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing apparel:— (1) Making, &c. 32 191 516 2 . . . 22 . . . . . . . . . . . . . . . . . . 6 . . . . . . (2) Cleaning and washing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Artificial flowers 2 . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fur pulling . . . . . . . . . 1 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paper bags and boxes 16 . . . 166 1 . . . 22 . . . . . . . . . . . . . . . . . . 5 . . . . . . Brush making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . Carding of buttons 2 . . . 27 . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . Totals 52 191 711 4 7 44 . . . . . . . . . . . . . . . . . . 14 . . . . . . (a) The figures in columns 2, 3 and 4 are the total number of lists received from employers who sent them both for February and August, and of the entries of names of outworkers in those lists. Therefore these figures constitute 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. (b) See page 104 of this report with regard to infectious disease in the houses of outworkers. 106 Communications were received from various sanitary authorities relating to 1,041 outworkers for firms outside Shoreditch and as 9 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 1934. Showing the Numbers of Outworkers Received from other Districts during 1934. 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 14 21 19 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 9 6 6 . . . . . . . . . . . . . . . . . . 104 City of London 149 157 . . . 1 2 1 . . . . . . 2 5 . . . . . . 17 13 . . . . . . . . . . . . 5 . . . . . . . . . . . . . . . 352 Croydon . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Finsbury 54 56 9 27 10 13 . . . 5 . . . 2 . . . . . . 6 1 23 23 . . . . . . 8 1 8 5 4 . . . 255 Fulham 1 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Hackney 52 30 10 11 1 3 . . . . . . . . . . . . . . . . . . . . . . . . 7 11 2 2 . . . . . . . . . . . . . . . . . . 129 Hammersmith 1 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Hampstead 1 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Holborn . . . 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Hornsey 1 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Islington 15 23 1 . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . 1 10 2 . . . 1 . . . . . . . . . . . . . . . 54 Kensington 1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Leyton 3 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Poplar 2 . . . 1 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 St. Marylebone 3 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 St. Pancras . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Southwark 2 3 . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . 3 2 . . . . . . . . . . . . . . . . . . . . . . . . 11 Stepney 13 17 . . . 2 . . . . . . . . . . . . 2 . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . 35 Stoke Newington . . . . . . 10 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Wandsworth . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 West Ham . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . 3 Westminster 8 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Totals 320 348 50 74 13 17 1 5 4 7 1 . . . 23 14 48 57 10 8 14 1 8 5 4 . . . 1,032 668 124 30 6 11 1 37 105 18 15 13 4 107 London County Council (General Powers) Act, 1928, Section 28. By the provisions of this section power is given to remove aged and infirm persons to a suitable institution. During the year under review no cases of this type came to the notice of the department. This section is rather a cumbersome one and where cases are removed to hospital under its provisions, the attendance of the Medical Officer of Health at court is necessary. It will be readily understood that if the section was operated to any extent the administrative procedures would become very heavy. On the other hand when these cases enter hospital voluntarily they seldom elect to request their discharge and Borough officers are thus spared the expenditure of a considerable amount of time. Schools. The sanitary condition of the public elementary schools in the borough is satisfactory. During the year Haggerston Road school was demolished and a new block for mental defectives was commenced at Christchurch school in the New North Road. Smoke Nuisance. During the year under review the Inspectors continued to pay attention to the possibility of nuisance due to smoke from chimneys of factories and workshops Observations were made in 26 cases, the usual period of observation ranging from five to thirty minutes. In four instances the emission of smoke to such an extent as to create a nuisance was observed. The period of emission of black smoke from the premises under observation was one, thirteen, fifteen and twenty-five minutes respectively. The following particulars will give some information of the type of chimney which is likely to give rise to a nuisance in this Borough:— Type of chimney. Number of observations. Brick shafts 2 Steel shafts from factory boilers 2 Small flues from workshops 10 Although the number of workshops in Shoreditch is large, the factories are few. Consequently, the type of chimney which is most likely to give rise to a smoke nuisance is the small metal flue which emits the smoke either from a baker's oven or from premises used in connection with the manufacture of furniture. Although the smoke emitted from such flues is not so dense as that emitted from large boilers, the flues are lower than brick chimneys and smoke tends to be dispersed at a lower level. A further disadvantage is that these small furnaces are likely to be stoked up or used at indefinite intervals; this procedure makes control of smoke emission more difficult. 8 108 In each instance where a smoke nuisance was observed the factory or workshop was visited by the Inspector who made the observation. In one instance a cabinet maker removed the stove and chimney as a result of the Inspector's representation. In three instances the nuisance was due to faulty stoking, and in another case a furnace box which was defective was repaired. The action taken in these different cases was effective in each instance. Rat Suppression. During November 1934, the annual rat week was held and an effort was made to educate the public concerning the danger to health and the economic wastage which is occasioned by rats. Posters were exhibited throughout the Borough. It is not sufficiently realised by members of the general public that the Rats and Mice (Destruction) Act, 1919, places upon the owner the onus of clearing rat-infested premises. The Sanitary Inspectors offer considerable assistance to owners in the matter of advice regarding the most suitable methods of suppression in connection with any particular type of building. The work done during the year is summarised in the following table, but it should be realised that the items tabulated do not embrace all the work done by the Inspectors in connection with rat suppression. DISTRICTS. Totals. 1 2 3 4 5 6 7 8 9 Complaints dealt with 41 9 48 34 40 23 1 16 10 222 Drains tested — 2 45 16 9 1 1 8 8 90 Found defective — — 11 4 8 — — 1 2 26 Found satisfactory — 2 34 12 1 1 1 7 6 64 Premises where egress of rats was ascertained — 2 31 34 6 6 — — 7 86 Premises reported freed from rats 8 9 48 24 20 20 1 14 9 153 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. PREMISES FOR PREPARATION AND SALE OF FOOD STUFFS. Street Markets. The street markets were kept under observation in the evenings and on Sunday mornings in accordance with arrangements approved by this Committee, 109 Meat. The number of butchers' shops under inspection during the year was 62 and the number of visits of inspection was 154. General observation was kept of all meat stalls where butchers' meat was exposed for sale. One warning letter was sent in respect of a minor infringement of the Public Health (Meat) Regulations, 1924. Slaughter Houses. There are no slaughter houses in the Borough. Cow Houses. There are two licenced cow houses in the Borough, one in Nile Street licensed for 22 cows and one in St. John's Road licenced for 14 cows. 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 260 and 696 visits were made in connection with them. Sanitary notices were served on 78 owners mainly for cleansing. Fried Fish Shops. At the end of the year 51 fried fish shops were under the supervision of the Health Department, and 216 visits were made to them. Twenty-five sanitary notices were served, mainly for cleansing. It must be said here that the condition of the fried fish shops in the Borough is not satisfactory. The premises are mainly of an old type, the rooms from which the fish is sold are generally fairly small, and the ceilings are low. The cleaning rooms are generally very unsatisfactory and in many cases they consist merely of an area of the yard which is roofed over as a protection from the weather. There is, as a rule, no attempt to ensure that the walls and floors of these cleaning rooms shall be impervious to moisture. Ice Cream. The number of premises under observation during the year was 179 and 369 visits of inspection were made. In 14 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 172. 8A 110 Bakehouses. The number of bakehouses on the register during 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 122 visits of inspection. Intimation notices were served in 19 instances. Registration of Food Premises. The London County Council (General Powers) Act, 1932, section 5, requires the registration with the sanitary authority of certain premises which are used or are proposed to be used for the sale or manufacture of certain food stuffs. A list of these was given in the annual report for 1933. The number of premises on the register at the end of 1934 under this section was (i) Ice cream, etc. 172 (ii) Other food 89 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 95. The following were surrendered or seized and destroyed as unfit for the food of man: 1 cwt. 2 qrs. apples; 1 box Cod Chitlings; 1 box Cod Livers; 1 barrel Cucumbers; 1 qr. 14 lbs. Dog Fish; 8 barrels Grapes; 6 cwts. 1 qr. 14 lbs. Kippers and Bloaters; 18 cwts. Meats (various joints); 383 tins Machine Skimmed Milk; 2 cwts. Oranges; 2 cwts. Pork Pies; 26 Rabbits; 3 trucks Savoy Cabbages; 56 lbs. Skate Wings; 4 tins Ham. Milk and Dairies Order, 1926. General observation was kept by the Inspectors on all purveyors of milk in the Borough. No legal proceedings were taken during the year. Milk (Special Designations) Order, 1923. During the year 42 applications were received for the sale of milk under these regulations in the Borough. The applications were investigated and all were found to be satisfactory. Thirty-three samples of milk were taken during 1934, compared with 17 in 1933. This increase is mainly due to the fact that during the year under review the Council decided that all milk which was supplied under the Maternity and Child Welfare Scheme and under the scheme for the provision of extra nourishment to tuberculous cases, should be "pasteurised," and the same decision was arrived at by the London County Council with regard to the supply of milk to schools. 1ll Of the 33 samples, 8 did not comply with the standard laid down by the Order. The result of the examination of these is given in the following table:— No. of sample. Designation of milk. No. of bacteria per c.cm. Presence of coliform bacillus. Remarks. 206 Pasteurised 144,500 Absent in 1/10 cc. Unsatisfactory. 207 „ 185,500 „ „ 208 „ 221,600 „ „ 209 „ 209,400 „ „ 210 „ 149,400 „ „ 212 „ 116,700 Present in 1/10 c.c. „ 213 „ 124,200 „ „ 218 „ 186,100 „ „ Of the eight samples which did not comply with the order, five were taken from dairymen in the Borough, and three from wholesalers outside Shoreditch who were delivering milk in this district. Warnings were issued to the offending Shoreditch dairymen and in the other cases details were furnished to the district concerned. Two of the remaining 25 samples were certified milk and the others were pasteurised milk. Both samples of certified milk showed no B. coli in 1/10 c.c.; in one the total count per c.cm. was 1,260 and in the other 350. In both instances a guinea pig was inoculated and subsequently showed no signs of infection with Brucella abortus. Of the 23 samples of pasteurised milk which complied with the prescribed standards, two showed B. coli in 1/10 c.c., the counts being 83,600 and 93.000 respectively. In all the others B. coli was absent in 1/10 c.c. The total counts in these 21 samples are shown in the following table:— Below 1,000. Below 10,000. Below 20,000. Below 50,000. Below 100,000. 1 8 4 5 3 Undesignated Milk. During the year 38 samples of undesignated milk were submitted for bacteriological examination. Of these 38 samples 11 were from individual cows in the Borough and B. coli was present in 1/10 c.c. in two of these samples. In the other 9 B. coli was absent in 1/10 c.c. The total counts in these 11 samples were as follows:— Under 1,000. Between 1,000-2,000. Between 2,000-4,000. Over 4,000. 3 4 3 1 112 In the other 27 cases the samples were taken in course of delivery. In these B. coli was present in 1/100 c.c. in seven samples and present in 1/10 c.c. in six samples. In the remaining 14, B. coli was absent in 1/10 c.c. The total counts in these 27 samples are shown in the following table:— Under 1,000- 5,000- 25,000- 100,000- 200,000- 1,000 5,000 25,000. 100,000. 200,000. 500,000. 2 1 9 3 5 7 These samples were taken with the object of raising the standard of bacteriological purity of the milk sold in the Borough. The samples 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. Condensed Milk Regulations. Three 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. Two samples of dried milk were submitted for analysis under the above Regulations, both of which were certified to comply with the standard laid down. Milk and Cream Regulations, 1912. None of the 433 samples of milk submitted for analysis was reported to contain any preservative. Eight samples of cream were submitted for analysis ; none of these was reported to contain any preservative. Tuberculous Milk. Samples of milk entering London are taken by the London County Council at railway termini and also from supplies entering by road. There are two cowsheds in Shoreditch. Eleven samples of milk from these were submitted for guinea pig test, but in no instance was the presence of tubercle bacilli reported. 113 Examination of Milk Supplied to L.C.C. Hospitals and Schools, 1934. During 1934, 21 samples of milk were taken in course of delivery to St. Leonard's Hospital and 9 to Holborn Institution, all of which complied with the standard fixed by the Board of Agriculture. Two samples of milk were taken in course of delivery to the above hospitals, both of which complied with the standard laid down for "Pasteurised" milk. Milk Samples tested in the Department. In April, 1934-, permission to acquire an apparatus for testing milk by the Gerber process was passed by the Health Committee. Since May, 1934, 151 samples have been examined in the Department. The following table gives the result of these examinations:— Genuine. Deficient in fat only. Deficient in solids not fat. Deficient in fat and nonfatty solids. 147 2 1 1 The average composition of these samples was:— Fat 3.5% Solids not fat 8.7% Total solids 12.2% The Food and Drugs (Adulteration) Act, 1928. During the year 660 samples were submitted to the Public Analyst, Mr. H. G. Harrison, M.A. This figure gives a rate of 7.3 per 1,000 inhabitants. The results of the year's work are summarized in the following table :— Quarter of 1934. 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 166 7 4.28 2 1 1 1 6 5 0 87 3 0 2nd 137 7 5.11 2 — 2 2 7 5 0 71 18 6 3rd 169 7 4.14 4 — 4 3 5 14 6 88 14 6 4th 183 1 0.53 — — — — — 98 14 0 Totals for Year 660 22 333 8 1 7 6 19 4 6 346 10 0 114 The samples taken during 1934 included:— 433 milk (4 informal); 23 sausages (21 informal); 14 bread and butter (12 informal); 20 whiskey; 17 butter; 10 vinegar; 5 gin; 4 dried mint (3 informal); 4 self raising flour; 2 rum; 2 fish paste; 2 ground ginger; 2 ground arrowroot; 1 chopped meat; 1 dried sage; 1 brandy; 1 margarine. Informal samples were also taken as follows:— 8 dripping; 8 cream; 6 boracic ointment B.P.; 6 chocolate; 6 cheese; 6 tomato puree; 4 herrings in tomato sauce; 4 meat paste; 4 mineral water; 4 ice cream; 4 cider; 4 castor oil B.P.; 4 tomato soup; 4 cocoa; 3 condensed milk; 3 jam; 3 tinned peas; 3 lemonade powder; 3 tea dust; 3 liquid paraffin; 3 pickles; 3 cordials; 3 non-alcoholic wine; 2 sauce; 2 tinned fruit; 2 coffee and chicory; 2 Parrish's chemical food B.P.; 1 Parrish's chemical food (Parrish's formulæ); 1 zinc ointment B.P.; 1 tomato ketchup; 1 tinned salmon; 1 tinned crab; 1 tinned sardines; 1 cod liver oil emulsion B.P.C.; 1 dried milk full cream; 1 dried milk half cream; 1 coffee; 1 chicory and coffee. The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1930-1934 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. 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 31 6 1 5 4 12 1 6 355 8 6 1934 660 137 22 3-3 8 1 7 1 19 4 6 346 10 0 An informal sample of mint sauce was found to contain 35 per cent. of leaf other than mint leaf. A formal sample was obtained from the same source and was certified to also contain 35 per cent. of leaf other than mint leaf. Legal proceedings were instituted and defendant was ordered to pay 10s. 6d. costs. An informal sample of bread and butter was certified to have margarine substituted for butter. A formal sample was taken from the same source and the same substitution was found. Legal proceedings were instituted and defendant was fined £2 0s. 0d. and ordered to pay £2 2s. 0d. costs. The majority of the samples taken were of milk which was represented by 433 samples during the year. Of these 16 or 3.70 per cent. were found to be below the standard fixed by the Board of Agriculture. The following table shows the results of analysis:— 115 Quarter of the year. Number of Samples. Number not genuine. Percentage adulterated. 1st 125 7 5.60 2nd 87 4 4.60 3rd 108 5 4.63 4th 113 — — In seven 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. Nine of the samples showed deficiency in fat ranging from 1 to 31 per cent. below the standard laid down by the Board of Agriculture. Legal proceedings were instituted in 6 or 37.5 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 which were 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 62.5. In the report for 1933 it was mentioned that the Council had resolved on the 22nd February, 1933, that the number of samples taken should be reduced to 600 per annum, but at the Council meeting in October, 1933, it was resolved that the sampling officer, at his discretion, be allowed to increase the samples to 650 or 700 per annum. Since that date there has been no alteration in the number of samples to be taken under the Food & Drugs (Adulteration) Act. Of the 23 samples of sausages taken, one informal sample was certified to contain sulphur dioxide 120 parts per million. A formal sample was taken from the same source, but on this occasion the preservative was disclosed. 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. Preservatives in Food Regulations. It was not necessary for these reasons to prohibit any person from following his occupation in a dairy during the year under consideration. 116 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. Feb. 14 Non - compliance with Statutory Notice in respect of No. 23, Ilva Place. — 2 2 0 — Feb. 21 Non - compliance with Statutory Notice in respect of No. 10, Bracklyn Street. — 2 2 0 — Mar. 21 Fixing a W.C. pan and trap at No. 32, Salisbury Street, without previous notice in writing to the Sanitary Authority. 1 0 0 1 3 0 — Mar. 27 Non - compliance with Statutory Notice in respect of No. 5, Holt Place. — 2 2 0 — May 2 Non - compliance with Statutory Notice in respect of No. 34, Rushton Street. — 1 3 0 — May 2 Non - compliance with Statutory Notice in respect of No. 70, Rushton Street. — 2 2 0 — June 27 Non - compliance with Statutory Notice in respect of No. 45, Cremer Street. — 2 2 0 — July 18 Non - compliance with Statutory Notice in respect of No. 63, Buttesland Street. — — Adjourned sine die. Aug. 8 Non - compliance with Statutory Notice in respect of No. 99, Brunswick Street. — 2 2 0 — July 25 Non - compliance with Statutory Notice in respect of No. 7, Bristow Street. — 2 2 0 — July 25 Non - compliance with Statutory Notice in respect of No. 9, Bristow Street. — 2 2 0 — 117 Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. Oct. 3 Fixing sink waste pipe and traps at No. 153, High Street, without previous notice in writing to the Sanitary Authority. - 0 2 0 - Oct. 3 Fixing a W.C. pan and trap at No. 14, Bookham Street, without previous notice in writing to the Sanitary Authority. l 0 0 - - Oct. 10 Non-compliance with Statutory Notice in respect of No. 60, Newton Street. - 2 2 0 - Oct. 10 Non-compliance with Statutory Notice in respect of No. 24, Newton Street. - 2 2 0 - Oct. 10 Non-compliance with Statutory Notice in respect of No. 17a, North port Street. - 2 2 0 - Oct. 17 Fixing waste pipe and trap at No. 293, Hoxton Street, without previous notice in writing to the . Sanitary Authority. l 0 0 2 2 0 - Oct. 17 Fixing W.C. pan at No. 23, Newton Street, without previous notice in writing to the Sanitary Authority. 0 10 0 1 1 0 - Oct. 24 Fixing sink and bath waste pipes and traps at " Barley Mow " P.H., Hyde Road, without previous notice in writing to the Sanitary Authority. l 0 0 - Oct. 31 Constructing drainage work at premises in Norton Folgate without previous notice in writing to the Sanitary Authority. - 2 2 0 - Nov. 21 Non - compliance with Statutory Notice in respect of No. 11, Harriett Square. - 2 2 0 Order made for Notice to be complied with in 7 days 118 Food and Drugs (Adulteration) Act, 1928. Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. Feb. 7 Selling mint not of the nature, substance or quality demanded by the purchaser. - 2 2 0 Warranty produced. Summons withdrawn on payment of costs. Mar. 28 Selling milk not of the nature, substance or quality demanded by the purchaser. l 0 0 2 2 0 - Apr. 11 Selling milk not of the nature, substance or quality demanded by the purchaser. - 3 3 0 Withdrawn with consent of Court on payment of costs. June 27 Selling milk not of the nature, substance or quality demanded by the purchaser. - 3 3 0 - July 11 Selling bread and butter not of the nature, substance or quality demanded by the purchaser. 2 0 0 2 2 0 - Aug. 22 Selling milk not of the nature, substance or quality demanded by the purchaser. 1 0 0 3 3 0 - Aug. 22 Selling dried mint not of the nature, substance or quality demanded by the purchaser. - 0 10 6 - Oct. 3 Selling milk not of the nature, substance or quality demanded by the purchaser. - - Dismissed on proof of Warranty. Oct. 31 Selling milk not of the nature, substance or quality demanded by the purchaser. - 1 1 0 - Public Health (Meat) Regulations, 1924. Jan. 31 Being a person exposing meat for sale from a stall in Hoxton Street, placed meat within 18 inches of the ground without adequate protection. 2 0 0 1 1 0 - 119 VIII.—HOUSING. The year 1934 marked a transition stage in the housing activity of the Borough Council. It was generally anticipated that a very intensive slum clearance scheme would be necessary in the area, and it was thought that the London County Council would probably be prepared to deal with the largest of these schemes. Consequently, action in respect of individual areas was postponed until the limits of the larger schemes had been settled. It is proposed to give in this report merely a brief outline of the various aspects of the housing question. In the next Annual Report the whole problem will be dealt with in greater detail. Number of Houses. The total number of houses in the Borough on 31st December, 1934, was 14,077. Overcrowding. In an urban area this may be of two types: (a) spacial overcrowding, in which the amount of cubic space for the occupants is insufficient according to recognised standards; (b) overcrowding in which unmarried persons of opposite sex over ten years of age are compelled through lack of space to occupy the same room at night. In the past there has been great difficulty in drawing up standards which would take into account both these aspects of overcrowding. The recognised general standard makes no attempt to allow for moral overcrowding, and there has been no definite concensus of opinion regarding the most suitable standard to be adopted. Many follow the Manchester standard, while others adopt the standard set up by the Merseyside Social Survey. It is satisfactory to note that an official ruling will shortly be given on this important question, since the new Housing Bill contains certain prescribed standards. The first schedule to the Bill sets out the maximum number of persons who may sleep in houses of different sizes without the existence of overcrowding. In addition, the Bill contains a very important clause, Section 2 (I) (a): " A dwelling house shall be deemed for the purposes of this Act to be overcrowded at any time when the number of persons in the house either—(a) is such that any two of those persons being persons ten years old or more of opposite sexes and not being persons living together as husband and wife, must sleep in the same room." It is possible that moral overcrowding is more common than is generally realised. At the present time no satisfactory figures exist regarding the whole question of overcrowding. The new Act will, however, call for a rapid survey of the whole Borough, and it is anticipated that this survey will be completed before the conclusion of the year 1935. It will then be possible to judge the question of overcrowding in the Borough and to apply the necessary steps for its abatement. 120 Since the shortage of new houses in the Borough is acute, relief of overcrowding is a very difficult question. Facilities are, of course, given by the London County Council, to many of these tenants for transfer to one of the Council's estates outside the metropolitan area. Such efforts, however, do not always solve the problem, since many of the inhabitants of the Borough reside there for some particular reason, i.e., proximity to their workplace, and transfer to an estate at some distance from Shoreditch means an increased outlay on travelling expenses. During the year 1934, 210 cases of overcrowding were abated as a result of enquiry and action by the sanitary staff, and in some cases as a result of a report to the Housing Committee. The London County Council accommodated 56 of these families, and in the other 154 instances the accommodation was obtained from other sources. In addition to these cases, 222 other families were accommodated, in 23 cases on the grounds of special hardship and 18 as a result of representations made to the London County Council with regard to the health of certain members of the family. The Shoreditch Housing Association, which opened in November, 1934, a new block of flats—Shakespeare House, in Hackney—accommodated 22 Shoreditch families before the end of the year. Three of these were on account of overcrowding. Verminous Houses. The problem of infestation, mainly with bugs, is undoubtedly bound up with the problem of old houses and overcrowding. Various surveys have been carried out in other parts of the country, and these show that practically all slum houses are to a certain extent infested. During the early winter of 1934-35, the writer carried out a personal investigation to determine to what extent infestation existed in Shoreditch. The results were illuminating. In a number of houses gross infestation was present. More important, however, was the fact that 75 to 80 per cent, of the houses were not altogether free from vermin. In many of these cases the evidence of infestation, although definite, was slight, and it was usually found that the condition was not more marked owing to the continued care and attention of the housewife. In other words, such houses can be freed from bugs, but only by extreme care and attention to detail in cleaning. The number of substances which are reputed to be effective in ridding a house of bed bugs is legion. This number in itself shows that most of the vaunted remedies are quite ineffective. In the writer's experience there is only one substance which is effective in cleansing furniture and houses of this very objectionable pest. This substance is hydrocyanic acid gas, in one or other of its forms. The problem of infestation has been repeatedly considered by the Health Committee recently, and the steps which are being taken to deal with it will be dealt with in the next annual report. 121 Housing Inspection. In the past it has been customary to carry out house-to-house inspections in the Borough under the Public Health (London) Act. Under this system many minor defects have been dealt with. The drawback to the method, however, is that there is no record of the condition of the house at the time of inspection, and consequently, if this house has to come under review at a future date, a reinspection has to be carried out. During the early part of the present year a report made to the Public Health Committee by the Medical Officer of Health was considered, and as a result the Committee agreed that when suitable arrangements had been made, house-to-house inspections under the Public Health (London) Act, should be discontinued, and to substitute for them detailed inspections of houses with the operation of suitable measures carried out under Section 8 of the Housing Act. Repair of Defects. During the year 1934, 1,325 houses were inspected under the scheme of houseto-house inspection which is mentioned above. As a result of these inspections 4,330 defects were remedied during the year. The Housing Act, 1930, Section 17, gives local authorities power to compel owners of dwelling-houses which are not in a reasonable state of repair to carry out such work as will make the houses fit for human habitation. In the past it has not been customary to apply this section in Shoreditch. Admittedly the section is not ideal, but it does give a local authority power to compel the carrying out of extensive alterations which would be impracticable under the Public Health Act. In considering the housing problem in an area like Shoreditch it should be borne in mind that a large part of the property in the area is of such a type or in such a state of disrepair that demolition is the only remedy. There are, nevertheless a considerable number of houses which, though not at present ideal as working class dwellings, are not yet ripe for slum clearance. Such houses tend to be dealt with lightly where slum clearance is being carried out extensively, and as a result the existing defects soon become accentuated, and in a comparatively few years the deterioration has proceeded to such an extent that demolition is the only remedy. It is generally admitted that in dealing broadly with the housing question, the aim of the administrator should be, not only to rid the area of its existing slums, but also to prevent the formation of new slums. This latter object can best be achieved by the judicious application of Section 17 of the Housing Act, 1930. This question was also reviewed by the Health Committee early in 1935, and in the next annual report particulars will be given of the results achieved by application of this section. Dangerous Structure Notices. Notices for the repair of dangerous structures are sent to the owners by the District Surveyor. These notices very often deal with the dangerous nature of 122 walls and chimneys, and the repairs are usually effected by rebuilding either the whole or part of the particular structure which is referred to in the notice. The number of notices which have been served year by year during the last few years is as follows:— 1930—148; 1931—190; 1932—211; 1933—225; 1934—210. This figure gives some indication of the extent of these dangerous structures in the Borough. Underground Rooms. During the year under review the question of dealing with underground rooms illegally occupied has been the subject of a good deal of consideration. In the early part of the year closing orders were made by the Council in six cases, and in some few cases, as a result of representations made to owners, alterations to rooms were effected which rendered them fit for occupation. The question of further action being taken in connection with these rooms was deferred owing to difficulties which arose in finding accommodation for tenants displaced as a result of closing orders being made. Clearance Areas. During the year two areas were represented, viz., Prichards Road and Essex Place. The first comprised 14 houses and was represented in January, and a Public Enquiry was held in February. The second comprised 25 houses in Essex Place, but action was deferred. Much of the first-named area has now been cleared. Representations under Section 1 of the Housing Act were made in August, 1934, by the London County Council in respect of the Nile Street area, comprising 200 houses. Rebuilding. During the year the following new blocks of flats were commenced (but not completed), viz.:— Clarissa House, Clarissa Street 30 lettings Blocks Nos. 1, 2 and 3, L.C.C. estate, Clarissa Street 70 „ The following table gives particulars of the work done under the Housing Act 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) 8,995 (b) Number of inspections made for the purpose 23,032 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 Nil (b) Number of inspections made for the purpose Nil 123 (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 4,330 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 Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (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) 668 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 668 (b) By local authority in default of owners Nil 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 Nil (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 124 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 Nil (b) By local authority in default of owners Nil (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. Rent Restrictions Acts. The number of these certificates issued during the last seven years has been as follows:— 1928—5; 1929—1; 1930—3; 1931—1; 1932—4; 1933—3; 1934—7. 125 IX.— HEALTH PROPAGANDA. The general arrangements in connection with Health Week were similar to those of the preceding year. During this week, commencing Monday, 1st October, a series of Health Lectures, illustrated by films, were given at the Town Hall. On Wednesday, 3rd, a Swimming Gala was held at the Pitfield Street Baths. The programme included fancy diving by members of the 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. E. C. McGregor, Assistant Medical Officer of Health, who arranged a display of rhythmic exercises. These displays were given on Tuesday afternoon, Thursday afternoon and Friday evening. The rhythmic exercises are those which were taught at a class for mothers at the Welfare Centre. The exercises are very beneficial in tightening up the muscles. The programme for the Week was as follows:— Date. Lecturer. Chairman. Monday, 1st October, 1934. 8 p.m. Dr. Maitland Radford, Medical Officer of Health of St. Pancras, entitled " The Growth of the Public Health Service " Mr. Councillor W. Parr. 9 p.m. Dr. J. E. McCartney, Director of Research and Pathological Services, L.C.C., entitled "Protection Against Diphtheria." Film: "Diphtheria Immunization " Mr. Councillor R. E. Palmer. 9 p.m. In Council Chamber. For Adults only. Dr. Gladys Hill, entitled" The Life of the Child Before Birth" Mrs. Yeoman. Tuesday, 2nd October, 1934. 3 p.m. Rhythmic Exercises by Shoreditch Mothers. Films. 7.30 p.m. Professor S. J. Cowell, entitled "The Contribution of Food to Health." Film: "Food, Digestion and Air" Mr. Councillor S. Orgel, J.P, 8.30 p.m. Mr. C. S. Abraham, L.D.S., entitled "Teeth and Health." Film: "Outposts of Health" Mr. Councillor W. J. Parker. 126 Date. Lecturer. Chairman. Wednesday, 3rd October, 1934. 7.30 p.m. Swimming Gala, at Hoxton Baths, Pitfield Street. Thursday, 4th October, 1934. 3 p.m. Rhythmic Exercises. 7.30 p.m. Dr. C. W. Saleeby, entitled "Sunlight and Health." Film: "Sunlight is Life" Mr. Councillor W. Ricketts. 8.30 p.m. Dr. C. K. Cullen, Tuberculosis Officer, entitled "Tuberculosis." Film: "Consumption" Mr. Councillor D. Rider. Friday, 5th October, 1934. 7.30 p.m. Dr. E. C. McGregor, Assistant Medical Officer of Health, entitled "The Maternity and Child Welfare Movement" Mr. Councillor W. E. Yarrow, J.P. 8 p.m. Rhythmic Exercises. The attendances during Health Week were as follows:— Days. School Children. Mornings. Rhythmic Exercises Display. Evening Lectures. Swimming Gala. Total Attendances. Monday - Tuesday & 950 Wednesday - Tuesday 728 Thursday 1,000 Evening, — Wednesday 843 Afternoon, — 1,200 — Thursday 827 1,200 1,200 — Friday 764 - 600 - - 3,162 1,200 3,750 1,200 Total Attendances, 9,312 127 APPENDIX. LIST OF CLINICS. Day. Clinic. Where Held. Time. Doctor. Mon Ante Natal 210, Kingsland Road 9.30—11.30 G. Hill. Child Welfare Do. 2.0 — 4.0 N. O. Richards. Do. Hoxton Market Institute 2.0 — 4.0 R. Hudson. Artificial Sun Light 210, Kingsland Road 2.0 — 4.0 E. C. McGregor. Breast Feeding Do. 9.0 — 5.0 Do. Otorrhcea Do. 10.0 —11.0 D. N. A. Nurse. Gynaecological Do. 2.0 — 4.0 G. Hill. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 C. K. Cullen. Do. Do. 6.30— 8.0 Do. * Dental Hospital 8-14, Laburnum Street .. 9.30— 1.0 Mr. C. S. Abraham. 2.0 — 5.30 Tues Child Welfare 210, Kingsland Road 9.30—11.30 E. C. McGregor. 2.0 — 4.0 Do. St. Helen's Club 2.0 — 4.0 L. Phillips. Ante Natal 28, Herbert Street 9.30—11.30 N. Dancy. Child Welfare Do. 2.0 — 4.0 Do. Do Hoxton Hall 9.30—11.30 R. Hudson. 2.0 — 4.0 Artificial Sun Light 210, Kingsland Road 9.30—11.30 E. C. McGregor. Otorrhoea Do. 10.0 —11.0 D. N. A. Nurse. Diphtheria Immunization Do. 2.30— 4.0 E. C. McGregor. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 C. K. Cullen. 4.30— 6.0 Do. f Dental Hospital 8-14, Laburnum Street .. 1.0 — 5.0 Mr. C. S. Abraham. Wed Post Natal (2nd and 4th Wednesdays only) 210, Kingsland Road 9.30—11.30 G. Hill. Child Welfare Do. 2.0 — 4.0 N. O. Richards. Do. Hoxton Market Institute 2.0 — 4.0 E. Goffe. Artificial Sun Light 210, Kingsland Road 2.0 — 4.0 E. C. McGregor. Breast Feeding Do. 9.0 — 5.0 Do. Otorrhoea Do. 10.0 —11.0 D. N. A. Nurse. Dental Hospital 8-14, Laburnum Street .. 9.30— 1.0 Mr. C. S. Abraham. 2.0 — 5.30 Thurs Ante Natal 210, Kingsland Road 9.30—11.30 G. Hill. Child Welfare Do. 2.0 — 4.0 Two Doctors. Do. Haggerston Hall 2.0 — 4.0 A. Rose. Do. 28, Herbert Street 2.0 — 4.0 L. Livingstone. Artificial Sun Light 210, Kingsland Road 9.30—11.30 E. C. McGregor. 2.0 — 4.0 Otorrhcea 210, Kingsland Road 10.0 —11.0 D. N. A. Nurse. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 C. K. Cullen. Dental Hospital 8-14, Laburnum Street .. 2.0 — 5.30 Mr. C. A. Abraham. fir Ante Natal 210, Kingsland Road 9.30—11.30 S. Smith. Child Welfare Do. 2.0 — 4.0 Do. Do. Harbour Lights 2.0 — 4.0 E. Goffe. Do. St. Helen's Club 2.0 — 4.0 L. Phillips. Artificial Sun Light 210, Kingsland Road 2.0 — 4.0 E. C. McGregor. Breast Feeding Do. 9.0 — 5.0 Do. Otorrhoea Do. 10.0 —11.0 D. N. A. Nurse. General Medical for Women Do. 10.0 —12.0 J. K. Aitken. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 C. K. Cullen. Dental Hospital 8-14, Laburnum Street .. 1.30— 5.30 Mr. C. S. Abraham. Sat Otorrhoea 210, Kingsland Road 10.0 —11.0 D. N. A. Nurse. *For patients and contacts at work during the day. †For School children only. INDEX. page Acts, Regulations and Orders 13 Acute Poliomyelitis 38 Ambulance Facilities 12 Anthrax 39 Appendix 127 Area 3 Artificial Sunlight Clinic 75 Ashpits 99 Bacteriological Examinations 45 Bakehouses 110 Births Registered 14 Births in Sub-districts 15 Birth Rates 15 Breast Feeding Clinic 71 Brunswick Day Nursery 78 Cancer 23 Cerebro-spinal Fever 37 Cleansing and Disinfection 97 Clearance Areas 122 Clinics 127 Committees— Public Health iv. Maternity and Child Welfare iv. Tuberculosis Care 62 Common Lodging Houses 99 Condensed Milk Regulations 112 Consultants, Panel of Obstetrical 69 Convalescence 81 Cook shops and Eating houses 109 Cowhouses 109 Dangerous Structure Notices 121 Dental Hospital— Procedure 87 Summary of Work 88 General Anaesthetics 90 Scale of Charges 92 Maternity and Child Welfare Cases 76 Deaths, causes of 26 Deaths in Age Groups 25 Deaths in Outlying Institutions 18 Deaths in Public Institutions 19 Death Rates 17 Deaths from Street Accidents 17 page Deaths in Wards 16 Density 14 Diarrhoea and Enteritis 41 Dining Centres 83 Diphtheria 33 Diphtheria Immunization 35 Disinfection 46 & 97 Dried Milk Regulations 112 Dysentery 35 Emergency Open- Air Nursery 80 Encephalitis Lethargica 37 Enteritis 41 Erysipelas 35 Factory and Workshop Act 101 Food and Drugs (Adulteration) Act 113 Food Poisoning 45 Food Premises 110 Foreword 1 Fried Fish Shops 109 Fur Skin Dresser 100 Health Propaganda 125 Home Helps 70 Home Visiting 72 Home Work 102 Hospitals 9 House Refuse 12 Houses Let in Lodgings 99 Housing 119 Housing Conditions (Ministry of Health Table) 122 Ice Cream 109 Infant Life Protection 82 Infantile Mortality 20, 63-66 Infant Welfare Centres 75 Infectious Cases, number certified 29 Infectious Cases, number removed 29 Infectious Diseases, deaths from 29 Infectious Diseases and Schools 43 Influenza 41 Legal Proceedings 116 L.C.C. (General Powers) Act, 1928, Section 28 107 INDEX—continued. page Marriages 16 Maternal Mortality 21,67 Maternity and Child Welfare 63 Maternity Dressings 69 Measles 39 Meat 109 Medical Mission of the Good Shepherd 80 Merchandise Marks Act, 1926 108 Midwives 69 Milk Allowances 83 Milk and Cream Regulations, 1912 112 Milk and Dairies Order, 1926 110 Milk (Special Designations) Order, 1923 110 Model Welfare Centre 77 Municipal Dental Hospital 87 Municipal Midwife 69 Natal Work 69 National Parentcraft Competition 86 Nursing in the Home 44,82 Offensive Trades 100 Ophthalmia Neonatorum 76 Otorrhoea Clinic 76 Outworkers 103 Overcrowding 98, 119 Plague 39 Pneumonia 38 Population 14 Post-natal Work 70 Prematurity 64 Preservatives in Food Regulations 115 Public Health (Prevention of Tuberculosis) Regulations 53, 115 Public Mortuary 19 Puerperal Fever 36, 71 Puerperal Pyrexia 36 Queen's Hospital for Children 81 Rag and Bone Dealers 100 Rag Flock Acts 101 Rateable Value 3 PAGE Rat Suppression 108 Rebuilding 122 Rent Restriction Acts 124 Sanitary Circumstances 94 Sanitary Inspections 94 Scarlet Fever 32 School Entrants 77 Schools 107 School for Mothers 78 Sewing Classes 83 Shelter 46 Slaughterhouses 109 Smallpox 30 Smoke Nuisances 97, 107 Social Conditions 7 Staff v. Stillbirths 15, 71 Street Markets 108 Sun Babies Nursery 78 Tuberculosis Statistics 47 Tuberculosis Notifications 47 Tuberculosis Deaths and Death Rates 49, 50 Tuberculosis, institutional accommodation for 53 Tuberculosis Dispensary Scheme 54 Tuberculosis Officer's Report 57 Tuberculosis Care Committee Report 59 Tuberculous Milk 112 Undesignated Milk 1ll Underground Rooms 98, 122 Unemployment 8 Vaccination 30 Venereal Diseases 46 Verminous Houses 100, 120 Verminous Persons 10 Vital Statistics 30 Voluntary Workers 86 Water Supply 98 Water Supply to Tenement Houses 97 Whooping Cough 40 Workshops 101