AC 4363 SHOR 42 REPORT ON THE HEALTH AND SANITARY CONDITION OF THE Metropolitan Borough of Shoreditch IN THE COUNTY OF LONDON FOR THE YEAR 1937 BY E. H. R. SMITHARD, M.D., D.P.H., Medical Officer of Health. LONDON : JAS. TRUSCOTT & SON, LTD. SUFFOLK LANE, E.C. 4 REPORT ON THE HEALTH AND SANITARY CONDITION OF THE Metropolitan Borough of Shoreditch IN THE COUNTY OF LONDON FOR THE YEAR 1937 BY E. H. R. SMITHARD, M.D., D.P.H., Medical Officer of Health. LONDON : JAS. TRUSCOTT & SON, LTD. SUFFOLK LANE, E.C.4 1 CONTENTS section page I.—Statistics and General Information 14 II.—Population, Births, Marriages and Deaths 24 III.—Infectious Disease 42 IV.—Tuberculosis 63 V.—Maternity and Child Welfare 86 VI.—Municipal Dental Hospital 109 VII.—Special Clinics for Women 114 VIII.—Foot Clinic 120 IX.—Sanitary Circumstances 122 X.—Housing 143 XI.—Health Propaganda 149 2 LIST OF PRINCIPAL STATISTICAL TABLES CONTAINED IN THE REPORT Section I.—Statistics and General Information. page Table No. 1 Statistical summary 13 2 Extracts from vital statistics for 1937 14 3 Whole district during 1937 and previous years 15 4 Comparison of Shoreditch and London birth and death rates for 1937 10 5 Birth rate, death rate and analysis of mortality during 1937 17 6 Unemployment in Shoreditch 19 Section II.—Population, Births, Marriages and Deaths. Table No. 8 Ward population and density 24 10 Births and birth rates in the wards 25 12 Birth rates: Comparison between Shoreditch, London, and England & Wales for period of years 27 13 Marriages and marriage rates for period of years 28 14 Death rates: Comparison between Shoreditch, London, and England & Wales for period of years 29 15 Deaths and death rates in the wards 30 17 Deaths in age groups 31 19 Infantile mortality: Comparative table, Shoreditch, London, and England & Wales for period of years 34 20 Infantile mortality in borough during 1937 f 34 22 Maternal mortality : Comparison between Shoreditch, London and England & Wales for period of years 36 24 Cancer: deaths during 1937 37 25 Vital statistics for the metropolitan boroughs 38 26 Deaths, causes of, during 1937 40 Section III.—Infectious and other diseases. Table No. 27 Cases of infectious disease notified during 1937 43 29 Vaccination Officers' return 45 31 Scarlet fever: cases and case rates in the wards 47 34 Diphtheria: cases and case rates in the wards 49 39 Measles : deaths in age groups for period of years 55 Section IV.—Tuberculosis. Table No. 51 Summary of notification received during 1937 64 56 Notification rates : Comparative table for period of years 67 57 Death rates : Comparative table for period of years 67 59 Summary of tuberculosis deaths during 1937 69 62-64 Dispensary returns (Ministry of Health forms) 72-76 67 Care work 83 3 Section V.—Maternity and Child Welfare. page Table No. 70 Infant deaths in age groups for period of years 88 71 Maternal mortality : Comparison between Shoreditch, London, and England & Wales for period of years 89 76 Still births : Comparative table for period of years 94 78 Health visitors : statistical report for year 95 79 Welfare Centres : attendances during year 96 86 Child Life Protection : work for year 104 87 Dining Centres : comparative attendances for period of years 105 89 & 90 Routine medical inspection of elementary school entrants during 1937 107 & 108 Section VI.—Municipal Dental Hospital. Table No. 91 Inspection and treatment of children 110 92 Inspection and treatment of adults 110 93 Analysis of visits 111 96 Proportion of cases attending for treatment: Comparative figures for period of years 113 Section VIII.—Foot Clinic. Table No. 103 Conditions treated 121 Section IX.—Sanitary Circumstances. Table No. 104 Sanitary inspections for 1937 123 105 Work done during 1937 124 108 Workshops on register 129 109 Inspections of workshops 130 121 Food and Drugs—Analysis of samples 140 Section X.—Housing. Table No. 124 Underground rooms—position during year 145 125 Housing Acts—table required by Ministry of Health 147 Section XI.—Health Propaganda. Table No. 126 Health Week attendances 150 4 METROPOLITAN BOROUGH OF SHOREDITCH PUBLIC HEALTH COMMITTEE (Nov., 1936—Oct., 1937.) MATERNITY AND CHILD WELFARE COMMITTEE (Nov., 1936—Oct., 1937.) Ex-officio : Mrs. D. Thurtle, j.p. (Mayor). Chairman : Councillor Charles, A. (resigned 22/2/37). ,, Councillor Higgins, Mrs. M. Vice-Chairman : Councillor Alsford, M. Alderman Kellett, Miss E. „ Lusher-Pentney, Mrs. C. R. ,, Touchard, G. J. Councillor Alsford, Mrs. H. ,, Ceeney, H. S. „ Crathern, Mrs. A. S. „ Hills, A. E. ,, Jeger, Dr. S. W., l.c.c. „ Keeble, A. ,, Macbeth, A. I. Murphy, Mrs. J. M. „ Orgel, S., j.p. „ Pooler, T. Chairman : Alderman Kellett, Miss E. Vice-Chairman : Councillor Alsford, Mrs. H. Alderman Lusher-Pf.ntney, Mrs. C. R. Councillor Charles, A. (resigned 22/2/37). ,, Clemenson, P. D. ,, Crathern, Mrs. A. S. ,, Girling, Mrs. H., o.b.e., j.p., l.c.c. ,, Higgins, Mrs. M. „ Hills, A. E. „ Murphy, Mrs. J. M. ,, Parkinson, G. (Co-opted) Brown, Mrs. E. „ Charles, Mrs. E. M. ,, Colville, Lady Cynthia, j.p. „ Laxton, Mrs. E. J. „ Penn, Mrs. B. PUBLIC HEALTH COMMITTEE (Nov., 1937 to end of year.) MATERNITY AND CHILD WELFARE COMMITTEE (Nov., 1937 to end of year.) Ex-officio : George Jeger, Esq., j.p. (Mayor). Chairman : Councillor Thurtle, Mrs. D. Vice-Chairman : Councillor Higgins, Mrs. M. Alderman Coyne, W. ,, Kellett, Miss E. ,, Touchard, G. J. Councillor Alsford, M. ,, Alsford, Mrs. H. „ Bamford, G. H. J. „ Falk, R. S. ,, Henwood, Mrs. B. A. „ James, F. „ Jeger, Dr. S. W., l.c.c. „ Linale, R. G. ,, Mayhew, A. G. „ Orgel, S., j.p. Chairman : Alderman Kellett, Miss E. Vice-Chairman : Councillor Alsford, Mrs. H. Councillor Bamford, Mrs. E. F. „ Gee, A. E. ,, Girling, Miss B. A. ,, Girling, Mrs. H., o.b.e., j.p., l.c.c Henwood, Mrs. B. A. „ Higgins, Mrs. M. „ Parkinson, G. ,, Smith, Mrs. E. E. (Co-opted) Brown, Mrs. E. ,, Colville, Lady Cynthia, j.p. ,, Falk, Mrs. Ada „ Laxton, Mrs. E. J. Penn, Mrs. B. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health and Chief Tuberculosis Officer. Assistant Medical Officer of Health Clinical Tuberculosis Officer Medical Officers for Maternity and Child W elf are. Dental Surgeons Anesthetist Physician to General Medical Clinic for Women Gynecologist Bacteriologist Public Analyst Obstetric Consultants Public Vaccinators Chief Clerk and Administrative Assistant Senior Sanitary Inspector District Sanitary Inspectors Food and Drugs Inspector Infectious Disease Visitor E. H. R. Smithard, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h. (from 13/12/37) (Dr. Underwood resigned on 18/10/37). Evelyn C. McGregor, m.b., ch.b., d.p.h. Carl Knight Cullen, m.r.c.s., l.r.c.p., d.p.h. Edna M. Goffe, m.b., b.s., d.p.h. Marjorie Kathleen Hall, m.b., b.s., d.p.h. Florence Harvey, m.b., ch.b. Rose Hudson, m.b., cii.b., d.p.h. I.ouise Livingstone, m.d. Lilian Phillips, m.r.c.s., l.r.c.p. The Hon. Noel Olivier Richards, m.d., b.s., m.r.c.p. Alice Rose, m.b., ch.b., m.r:c.p. Fede Mackenzie Shattock, m.b., b.s. Sylvia Smith, m.b., b.s. C. S. Abraham, m.c., l.d.s., r.c.s., (Eng.) H. V. E. Jessop, l.d.s., r.c.s. (Eng.) Maurice Marcus, m.b., b.s., m.r.c.s., l.r.c.p. Janet K. Aitken, m.d., b.s., m.r.c.p. Gladys Hill, m.a., m.d., b.s., m.c.o.g., f.r.c.s. F. H. Teale, m.d., f.r.c.p. H. G. Harrison, m.a., f.i.c. (resigned 31/3/37). H. A. Williams, a.c.g.f.c., f.i.c. (from 31/3/37). Harold Chapple, m.b., m.ch., f.r.c.s. Eardley Holland, m.d., f.r.c.p., f.r.c.s. W. H. McKim McCullagh, d.s.o , m.c., m.b., b.ch., f.r.c.s. F. W. RoQUES, m.d., b.c|,., f.r.c.s. N. H. Clubwala, m.d., b.hy., d.p.m., d.t.m. & h. L. Statnigrosch, m.d., m.r.c.s., l.r.c.p. E. G. Wilsher. C. J. Wright7, 10. R. A. Bishop7, 10. G. C. E. Gibbs9, 10. D. Grant', 11. T. H. Jackson7. J. Marginson9, 10. J. E. Millway7 (appointed 19/10/37). J. B. Molloy7, 8, A. Stratton7, ll. J. H. Thomas7, u. G. Walker7, 8, 10. F. C. Shaw7, Ivy M. Heward1, 2, 3, 7, 8, 14. 6 Health Visitors Tuberculosis Visitors First Assistant Clerks Clerks Tuberculosis Care Committee Secretary Chiropodist Matron Sister Dispenser Vaccination Officers Nursing Staff at Dental Hospital— Sister-in-charge Nurse Municipal Midwives Enquiry Officer Telephone Operator Dental Mechanics, etc. Nursing Staff in Wards at Centre Kitchen Helpers Porters ... Disinfecting Officers Caretakers and Cleaners Mortuary Attendant Additional Temporary Staff D. Bales1, 2, 3, !. A. M. Brotherton1, 2, 3. K. Clements1, 2, 3, 5 (appointed 21/12/37). C. M. G. Glass1, 2, 3, 5. 15. M. Hornby1, 2, 3, 5. D. L. Mackenzie1, 2, 3, 5. M. Morrell2, 5, 8. M. Redcliffe2, 3, 5. M. Williamson1, 2, 5,16. E. F. Dance1, 2, 3 . N. K. Fitzmaurice2 School for Mothers. Mrs. A. A. Grange1, 3. W. I. Hiscoke1, 2, 3, 13 (resigned 30/6/37). E. J. Hayes. G. H. Pratt. W. L. Job (General Assistant). E. R. Banks. V. H. Sewell. H. Fitzgerald. W. F. Leaver. H. M. B. Burge. W. E. D. Smith. W. Harris. Eileen Lehane12. Mrs. Ida M. Rutherford. Mrs. B. Green, b.a. Mrs. H. E. Maber, m.c.c.h.a. Margaret D. Borrow1, 2, 3. Annie J. Wholman1, 2, 3 (appointed 25/5/37). Joyce N. Holmes6. S. W. Dyson. W. H. Williams (resigned 31/12/37). L. Frier1, 2, 3. M. F. Campbell3. A. E. Leaton1, 2, 3. E. M. Ball2 (permanent appointment 20/7/37). C. A. Newson. A. Duck. Four. Six. Two. Four. Three. Ten. One. Three. NOTES 1 State Registered Nurse. 2 Certificate of Central Midwives Board. 3 Certificate of General Training. 4 State Registered Children's Hospital Trained Nurses. 5 Health Visitor's Certificate. 0 Certificate of the Society of London Apothecaries. Certificate in Practical Bacteriology given by London College of Pharmacy, Westbourne Park Road. 7 Certificate of Sanitary Inspectors' Examination Board. 8 Certificate of Royal Sanitary Institute as Inspectors of Nuisances. 9 Certificate of Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. 10 Certificate of Royal Sanitary Institute for Inspection of Meat and other Foods. 11 Certificate of Sanitary Inspectors' Examination Board for Inspection of Meat and other Foods. 12 Certificate of Fever Nursing Training. 13 Certificate for Tuberculosis, Brompton Hospital. 11 Certificate for Tuberculosis, Royal Chest Hospital. 15 Certificate of Seaman's Hospital, Greenwich. 16 Certificate of the Mothercraft Training Society. 7 METROPOLITAN BOROUGH OF SHOREDITCH To the MAYOR, ALDERMEN and COUNCILLORS Sir, Ladies and Gentlemen, I beg to submit the annual report on the progress of the health services of your authority during 1937. Dr. Underwood, under whose supervision most of the work detailed in this report was carried out, was appointed medical officer of health to the County Borough of West Ham in 1937 and left Shoreditch on 18th October. I did not take up my appointment here until the middle of December and therefore so far as this report is concerned I have done little more than arrange and edit it. The vital statistics show that in the middle of 1937 the population of the district, as estimated by the Registrar-General, was 82,240. This is a decrease of 3,160 on the previous year and shows a continuation of the decrease in the population which has been going on in London generally, and in the crowded parts of the East End particularly, for a number of years. So far as Shoreditch is concerned the maximum recorded population was in the first year for which public health statistics have been kept, namely, 1893, when it was 122,420. Since then the decline has been gradual with a few exceptional years in which an increase was estimated. It is impossible to know with any degree of accuracy what the future will be so far as the population is concerned as the tendency to a declining population will to some extent be checked by the building (which started some years ago but has now increased in speed) of large blocks of flats. It is a fact also that the tendency of working people to move into outlying suburbs is probably being checked. This is to some extent because of transport difficulties, the present state of congestion for transport in London wasting a considerable amount of time in travelling and this waste of time being sufficient to offset a large number of the advantages which working people find in being away from the centre of a densely populated area. In 1937 the birth rate was 14.86 per thousand population (against 14.92 in 1936). Thus the rate remains practically unchanged and in fact it has been between 14 and 15 in each of the last three years. Before that time however there had been a gradual decline almost throughout the period during which statistics have been kept. 8 The crude death rate was 12.47 per thousand population (against 12.81 per thousand in 1936) and here again this figure appears to represent a fairly stabilised rate. The crude death rate is of course not a good criterion of the health of a community as it varies with many factors, such, for example, as the average age of the population or the ratio of the sexes—factors which may differ widely in different communities. The infant mortality rate for 1937 was 54 per thousand births. This showed a welcome drop from the previous year when it was 75 per thousand births and which in itself was considerably higher than in 1935 when it was 52 per thousand births. As I have pointed out however in the body of the report, the infant mortality rate will vary considerably from year to year and this is especially due to a group of diseases, the enteritis group, which is always more prevalent and causes far more mortality in a poor, heavily congested district than it does in districts which are economically better off and which are less crowded. Most of the other causes of deaths in infants are due to prematurity or inborn faults, and over these causes there is at present little control. The infectious illnesses (which include the enteritis group) can however to some extent be controlled and when this is done the infant mortality rate should be both lower and more stabilised. The difficulties are great but are being tackled so far as the Department is able. The toddlers' clinic was commenced in May, 1937. This clinic, which was set up to make routine inspections and arrange for the proper treatment of children between the ages of 1 and 5 years, has already met with a fair amount of success. I am hopeful that with some slight alterations of administrative technique, it will continue to advance and fill the very real gap which has heretofore been present in the medical supervision of children at this period of their life. The idea, shortly, is to detect by means of routine inspections at the ages of 18 months and at or near subsequent anniversaries of the toddler's birthday any deviation from the normal. Treatment, if necessary, will then be given, and will be started at a stage when it can be most effective and when it will be relatively painless. The increased call on the services of the municipal midwife, which had previously necessitated the appointment of a temporary part-time additional midwife, continued to increase during the year, and in July the part-time midwife was put on the permanent staff. At the end of the year negotiations had opened and were still being continued with the London County Council with regard to their scheme for a service of midwives under the Midwives Act, 1936. Only two boroughs in London have municipal midwives but as the London County Council scheme includes only 47 whole-time midwives in the service of the County Council it is obvious that nothing approaching a comprehensive domiciliary midwifery service can be provided by the County Council itself. It certainly seems more rational that where a borough has established an extensive maternity and child welfare service this important link between the ante-natal and post-natal branches of the service and the equally important link between the ante-natal life of a child and its individual existence 9 should be provided as part and parcel of the same service. There are undoubtedly administrative difficulties on either side but it is the Borough Council's hope that both the London County Council and the Ministry of Health will incline to the view that where this domiciliary midwifery service has been established and is functioning well it should be left undisturbed. During the year no major statute was passed as regards public health work comparable with the two major Acts of the previous year—The Public Health (London) Act and the Housing Act. There were passed however three acts dealing with subjects on the fringe of public health, namely, The Air Raid Precautions Act, the Factories Act and the Physical Training and Recreation Act. In addition, the Hydrogen Cyanide (Fumigation) Act, which deals with the growing custom of disinfestation by the cyanide method, and enables the Minister of Health to make regulations concerning the use of this highly poisonous material, was passed, but to the end of the year no regulations had been made by the Minister. The report which follows covers the outlines suggested by the Ministry of Health. 11 WARD MAP OF THE BOROUGH OF SHOREDITCH 13 SUMMARY 1937 Area of Borough 662 acres Average height above sea.level 60 feet Population (Registrar.General's mid.year estimate) 82,240 Estimated number of houses 13,983 Number of families (1931 census) 25,156 Rateable value £800,117 Sum represented by a penny rate £3,133 Table No. 1 London. 1937. Average. 1927.1936. 1937. Average. 1927.1936. Birth rate (rate per 1,000 living) 14.86 17.84 13.4 14 62 Still births (rate per 1,000 total births) 32.73 32.06 38.8 32.15* Death rate (deaths per 1,000 living) 12.47 12.98 12.5 12.10 Marriage rate (persons married per 1,000 living) 21.18 19.26 21.9 19.08 Infantile mortality rate— (Deaths under 1 year per 1,000 births) 54 74 60 64 Maternal mortality rate (deaths per 1,000 live births) 3.27 2.22 2.29 2.99 Death rate from pneumonia and bronchitis 1.68 1 86 1.31 1.48 ,, ,, ,, cancer 1.62 1.45 1 .75 1.62 „ „ „ diarrhoea and enteritis (under 2 years) per 1,000 births 9.00 13.80 12.3 11.13 Cases. Case. rate. Deaths. Death. rate. Smallpox 0 0.00 0 0.00 Scarlet fever 168 2.04 0 0.00 Diphtheria 125 1.52 3 0.04 Typhoid fever 8 0.10 0 0.00 Measles (all ages) — — 2 0.02 ,, (notified cases under 5 years) 112‡ — — — Puerperal fever 3 0.04 1 0.01 Pulmonary tuberculosis 113 1.37 73 0.89 Other forms of tuberculosis 27 0.33 13 0.16 * Average rate for 1930.1936 ; Still births were not recorded before 1930. ‡ This figure represents only the first cases under 5 years in each household. 14 I.—STATISTICS AND GENERAL INFORMATION STATISTICS Area—662 acres. Population, Census 1931—97,038 ; Registrar-General's estimate mid-1937—82,240. Number of structurally separate dwellings, 1931 Census—14,115. Number of houses (end of 1937) according to rate books—13,983. Number of families and separate occupiers, 1931 Census—25,156. Rateable value— £800,117. Sum represented by penny rate—£3,133. The length of public streets in the Borough is 43 miles. Briefly, Shoreditch is a densely populated area—average density, 124 persons per acre—containing approximately 14,000 structurally separate dwellings and 3,000 business premises. A great variety of industries is 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, but 500 may be given as a round number. Particulars regarding home work will be found in Section IX of this report, page 132. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR 1937 Table No. 2 Total. M. F. Birth Rate. Live births Legitimate 1,175 604 571 'Illegitimate 47 20 27 1,222 624 598 14.86 Still births Rate per 1,000 total births 32.73 General death rate (crude rate) 12.47 Percentage of total deaths occurring in public institutions 76.6 Number of women dying in, or in consequence of, childbirth— From sepsis 1 ,, other causes 3 Death rate of infants under one year of age per 1,000 live births— Legitimate 53 Illegitimate 85 Total 54 Deaths from measles (all ages) 2 „ whooping cough (all ages) 7 „ diarrhoea (under 2 years of age) 11 15 Deaths from pulmonary tuberculosis 73 „ all forms of tuberculosis 86 Death rate from pulmonary tuberculosis 0.89 ,, ,, all forms of tuberculosis 1.05 For purposes of comparison the vital statistics of the Borough during recent years are given in the following table:— Table No. 3 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 regisyered in the District Under 1 year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 nett. Number. Rate 1 2 3 4 5 6 7 8 9 10 II 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 1935 88400 1121 1290 14.6 1013 11.4 294 282 67 52 1001 11.3 1936 85400 1174 1274 14.9 1224 14.3 442 312 95 75 1094 12.8 1937 82240 1138 1222 14.9 1165 14.2 389 250 66 54 1026 12.5 Note.—This 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 population. 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. 16 Table No. 4 ANALYSIS AND COMPARISON OF LONDON AND SHOREDITCH BIRTH AND DEATH RATES FOR THE YEAR ENDING 31st DECEMBER, 1937 DISTRICTS. Estimated Population 1937. ANNUAL RATE PER 1,000 PERSONS LIVING. Infants under 1 year. Death rate per 1,000 Live Births. PERCENTAGE OF TOTAL DEATHS. BIRTHS. DEATHS DURING THE YEARS DEATHS DURING 1937 FROM Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. 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 yea Tuberculous Disease. Violence. 1934 1935 1936 1937 London 4,094,500 13.4 11.9 11.4 12.3 12.5 0.29 ... 0.01 0.01 0.05 0.06 0.00 0.16 0.76 0.51 60 5.9 0.0 Shoreditch 82,240 14.9 13.1 11.3 12.8 12.5 0.28 ... 0.02 ... 0.04 0.09 ... 0.13 1.05 0.36 54 6.5 76.6 0.09 Wards. Moorfields 3,332 11.7 14.0 12.8 15.3 13.5 ... ... ... ... ... ... ... 0.90 0.30 26 80.0 ... Church 13,899 17.1 14.4 11.4 13.8 14.0 0.29 ... 0.07 ... ... 0.07 ... 0.14 0.86 0.43 59 9.8 75.3 ... Hoxton 13,472 13.4 13.8 10.5 12.9 11.0 ... ... ... ... ... ... ... 1.41 0.29 61 6.1 79.1 ... Wenlock 13,295 14.4 13.0 12.6 12.2 12.0 0.23 ... ... ... ... 0.08 ... 0.15 1.35 0.60 47 8.1 79.4 ... Whitmore 12,685 15.8 13.7 10.8 12.7 13.5 0.47 ... 0.08 ... ... 0.08 ... 0.32 1.03 0.24 55 7.0 82.5 ... Kingsland 8,110 14.8 12.4 10.6 12.5 11.1 0.49 ... ... ... ... 0.25 ... 0.25 0.86 0.62 50 5.6 67.8 ... Haggerston 8,367 17.0 13.0 12.0 14.3 11.7 0.48 ... ... ... 0.36 0.11 ... ... 0.72 0.12 49 4.1 73.5 ... Acton 9,080 12.0 10.7 10.9 10.3 13.2 0.22 ... ... ... ... 0.11 ... 0.11 0.88 0.33 64 4.0 71 7 0.80 * 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 1937. 17 Table No. 5 BIRTH.RATE, DEATH.RATE AND ANALYSIS OF MORTALITY DURING THE YEAR 1937 (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 14.9 0.49 12.5 ... 0.02 0.09 0.04 0.34 0.36 9.0 54 84.2 6.5 9.2 0.09 England and Wales 14.9 0.60 12.4 0.01 0.03 0.01 0.04 0.07 0.45 0.56 5.5 58 90.4 6.1 2.5 1.0 125 County Boroughs and Great Towns, including London 14.9 0.58 12.5 0.01 0.03 0.01 0.05 0.08 0.41 0.54 7.4 62 90.8 5.5 3.2 0.5 148 Smaller Towns (Estimated Resident Populations, 25,000 to 50,000 at Census, 1931) 15.1 0.64 11.8 0.01 0.03 0.01 0.04 0.07 0.44 0.57 4.6 56 92.1 5.1 1.7 1.1 London 13.4 0.46 12.5 0.00 0.01 0.01 0.06 0.05 0.40 0.56 12.3 60 87.5 5.9 6.6 0.0 The maternal mortality rates for Shoreditch, and England and Wales, are as follows:— Puerperal Sepsis. Other Causes. Total. England and Wales, per 1,000 live births 0.97 2.26 3.23 „ ,, per 1,000 total births 0.94 2.17 3.11 Shoreditch, per 1,000 live births 0.82 2.45 3.27 „ per 1,000 total births 0.79 2.38 3.17 18 GENERAL Shoreditch is a district of irregular shape, of which the two longest diameters measure 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 Meteorological Table for London, deduced from observations at Greenwich under the superintendence of the Astronomer Royal, issued by the Registrar-General for 1937, shows a rainfall for the year of 731 millimetres. This figure is 22 per cent. above the average for the thirty-five years, 1881-1915. The daily mean number of hours of sunshine during the year in London was 3.12. The percentage of the average daily mean for the 30 years 1906-1935, was 79. SOCIAL CONDITIONS I have to thank the Director of Statistics of the Ministry of Labour for the following figures of unemployment. The statistics of unemployment among Shoreditch residents for 1937 relate to persons aged 16-64, insured under the Unemployment Insurance Acts (exclusive of persons within the agricultural scheme) who were resident in Shoreditch and who were recorded as unemployed at a date towards the end of each quarter. The figures for September and December, 1937, have been compiled in accordance with the revised procedure for counting the unemployed, introduced in September, under which persons subsequently found to be in employment at the date of the count are excluded from the figures; a full explanation of this change and of its general effects was given in an article on page 379 of the October issue of the Ministry of Labour Gazette. Number of persons resident in the Metropolitan Borough of Shoreditch, recorded as unemployed, at quarterly dates in the years 1928 to 1937:— 19 Table No. 6 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 1935 25th March 2,859 985 45 3,889 24th June 3,172 1,099 43 4,314 23rd September 2,803 687 38 3,528 16th December 2,798 868 21 3,687 1936 23rd March 3,206 869 38 4,113 22nd June 2,761 945 28 3,734 21st September 1,949 613 15 2,577 14th December 2,767 601 16 3,384 Total persons Males Females (16-64 years) 1937 15th March 2,637 638 3,275 21st June 2,782 622 3,404 13th September 2,216 495 2,711 13th December 2,922 768 3,690 20 I also have to thank the Chief Officer of Public Assistance of the London County Council for the following figures relating to persons in receipt of domiciliary relief in Shoreditch:— Table No. 7 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 1935 30th March 3,538 57 29th June 3,447 43 28th September 3,183 55 28th December 3,085 58 1936 28th March 3,079 88 27th June 2,721 49 26th September 2,624 48 26th December 2,684 52 1937 27th March 2,668 52 26th June 2,241 65 25th September 2,137 62 25th December 2,214 55 HOSPITALS, ETC. Within the Borough— St. Matthew's Hospital, Shepherdess Walk, N.l (for chronic sick, London County Council) 627 beds. St. Leonard's Hospital, Nuttall Street, N.1 (general hospital), London County Council 549 beds. Royal Chest Hospital, City Road, E.C.I 85 beds. 21 Shoreditch Model Welfare Centre, 210, Kingsland Road, E.2 10 cots. Shoreditch Tuberculosis Dispensary, 145, Great Cambridge Street, E.2 No beds. Shoreditch Municipal Dental Hospital, 8-14, Laburnum Street, E.2 No beds. Shoreditch Municipal Foot Clinic, Hoxton Library, N.l No beds. Welfare Centres, see page 97, M. & C. W. Section of this report No beds. City of London & East London Dispensary, Wilson Street, E.C.2 No beds. London County Council, Shoreditch Treatment Centre, 80, Nichols Square, E.2 No beds. London County Council, Hoxton Schools Treatment Centre, Sarah Place, Drysdale Street, N.l No beds. Near the Boundary of the Borough— General Hospitals— Metropolitan Hospital, Kingsland Road, E.8 150 beds. Royal Northern Hospital, Holloway Road, N.7 480 beds. German Hospital, Ritson Road, Dalston, E.8 219 beds. London Hospital, Mile End, E.l 849 beds. University College Hospital, Gower Street, W.C.I 540 beds. St. Bartholomew's Hospital, West Smithfield, E.C.I 692 beds. Royal Free Hospital, Gray's Inn Road, W.C.I 327 beds. Mildmay Mission Hospital, Austin Street, E.2 58 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.I 79 beds. Royal London Ophthalmic Hospital (Moorfields), E.C.I 200 beds. St. Mark's Hospital for Cancer, Fistula and other Diseases of Rectum, City Road, E.C.I 72 beds. London Chest Hospital, Victoria Park, E.2 (previously called City of London Hospital for Diseases of the Heart and Lungs) 188 beds. Elizabeth Garrett Anderson Hospital for Women, Euston Road, N.W.I 105 beds. Hospital for Sick Children, Gt. Ormond Street, W.C.I 257 beds. London Fever Hospital, Liverpool Road, N.l 200 beds. Home Hospital for Women, High Street, Stoke Newington, N.16 31 beds. Popham Road Schools Treatment Centre, 26, Popham Road, N.l No beds. Finsbury Schools Treatment Centre, 31, Spencer Street, E.C.I No beds. Hackney Schools Treatment Centre;Goulton Road, E.5 No beds. Kingsland Treatment Centre, Albion Road, E.8 No beds. 22 Hospitals under Public Health Department of London County Council used by Inhabitants of Shoreditch— 9 Fever Hospitals (acute) containing 4,856 beds. 2 Fever Hospitals (Convalescent) containing 1,862 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 81 beds. Hospital for Venereal Disease— Sheffield Street Hospital, Kingsway, W.C.2 (Women) 102 beds. Hospital for Post Encephalitis Lethargica— Northern, Winchmore Hill, N.21 (part of) 298 beds. 10 Sanatoria and Hospitals for Tuberculous Patients containing beds as follows: 614 (children), 210 (women), 581 (men), 632 (men and women). In all 2,037 beds. 21 Mental Hospitals containing 33,862 beds. Children's Hospitals and Homes— Queen Mary's Hospital for Children, Carshalton, Surrey 1,284 beds. The Downs Hospital for Children, Sutton, Surrey 360 beds. St. Anne's Home, Heme Bay, Kent (for convalescent children) 127 beds. Contagious Diseases of the Skin or Scalp— Goldie Leigh Hospital, Abbey Wood, S.E.2 248 beds. Ophthalmia— White Oak Hospital, Swanley Junction, Kent 364 beds. Venereal Disease Clinics accessible from Shoreditch— Hospital for Sick Children, Great Ormond Street, W.C.1 (male and female children). Daily treatment (Sunday excepted) 9 to 10 a.m.; Monday, Tuesday, and Friday 2 to 4 p.m. Whitechapel (L.C.C.) Clinic, Turner Street, Mile End, E.l (males, females and children). Daily treatment between 8 a.m. and 9 p.m. 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.1 (females and children). Monday to Friday, 10 a.m. to 8 p.m., Saturday 10 a.m. to 3.45 p.m. Royal Northern Hospital, Holloway Road, N.7. Males and females: Monday to Friday, 6 p.m. to 8 p.m. Females and children, Monday, 2.30 to 4.30 p.m. University College Hospital, Gower Street, W.C.1. Special (Venereal)—Male: Monday, Wednesday and Friday 5.30 to 7 p.m., Saturday 1.30 to 3 p.m. Female: Monday, Thursday and Friday 5.30 to 7 p.m. Daily treatment (Sunday excepted) 9 a.m. to 10 p.m. 23 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 (Wat. 3311) or to the Public Health Department, 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 12s. 6d. 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. ADOPTIVE ACTS, BYE-LAWS, ETC., IN FORCE IN THE DISTRICT See Appendix A on p. 151. ACTS, REGULATIONS AND ORDERS which became operative during 1937. See Appendix B on p. 153. 24 II.—POPULATION, BIRTHS, MARRIAGES AND DEATHS The Registrar-General's estimate for the mid-year 1937 population was 82,240. This figure is used for statistical purposes throughout this Report. The population in the various wards of the Borough is estimated as follows:— Table No. 8 Ward. Population. Area in acres.* Density per acre. Moorfields 3,332 71 47 Church 13,899 105 132 Hoxton 13,472 79 170 Wenlock 13,295 96 138 Whitmore 12,685 81 157 Kingsland 8,110 72 113 Haggerston 8,367 68 123 Acton 9,080 86 106 *Exclusive of water, if any. The density of the population in the Borough as a whole is 124 persons per acre. Further information upon the subject of the population, area, number of inhabited houses and rateable value are contained on pages 13 and 14. BIRTHS The numbers of live births registered in the Borough during the calendar year 1937 are given in the following table:— 25 Table No. 9 Total Live Births (legitimate and illegitimate). Live births registered (excluding re-registration). Inward transfers. Outward transfers. Live births allocated to the Borough. Males 576 114 66 624 Females 562 121 85 598 Totals 1,138 235 151 1,222 Illegitimate live births: Males 23 3 6 20 Females 26 5 4 27 Totals 49 8 10 47 The distribution of the corrected births and the birth rates in the eight wards of the Borough are given below:— Table No. 10 Ward. Males. Females. Total. Births per 1,000 population. Moorfields 21 18 39 11.7 Church 128 110 238 17.1 Hoxton 87 94 181 13.4 Wenlock 93 99 192 14.4 Whitmore 102 99 201 15.8 Kingsland 57 63 120 14.8 Haggerston 74 68 142 17.0 Acton 62 47 109 12.0 Totals 624 598 1,222 14.9 26 STILL BIRTHS The numbers of still births registered in the Borough during the calendar year 1937 are given in the following table:— Table No. II Total (legitimate and illegitimate). Still births registered. Inward transfers. Outward transfers. Still births allocated to the Borough. Males 23 3 5 21 Females 18 3 2 19 Totals 41 6 7 40 Illegitimate: Males 2 — — 2 Females 3 — — 3 The birth rate for the Borough as a whole was 14.9. For England and Wales the birth rate was 14.9 and for London 13.4. The illegitimate births numbered 47, of which 20 were males and 27 females. Of these, 25, of which 11 were males, occurred in St. Leonard's Hospital. The illegitimate births therefore represented 3.8 per cent. of all the births in the Borough during the year. The number of births which occurred in St. Leonard's Hospital was 602 : 299 males and 303 females. In 151 of these the parents were not Shoreditch residents. The table on page 27 gives details of the birth rates for Shoreditch, London, and for England and Wales since 1893. The birth rate for 1937 was exactly the same as that for 1936. The birth rates for different wards showed the usual variation, but corresponded roughly to the previous year. Last year the Shoreditch birth rate was again slightly higher than that for London, and equal to that for England and Wales. In 1934 the birth rate for Shoreditch was the highest of the rates for the Metropolitan Boroughs; in 1935 four London Boroughs had higher rates; in 1936 this number was increased to five, while the rate for one other Borough equalled that for Shoreditch; and last year four Boroughs exceeded the rate in Shoreditch, while two others equalled it. The conclusion must be accepted that this highly congested Borough is no longer an area with a high birth rate. Some of the factors which have possibly helped to bring about the reduction in the number of births were briefly discussed in the Report for 1935. 27 BIRTH RATES Table No. 12 Year. Population (Shoreditch). No. of Births (Shoreditch). Birth Rates (Shoreditch). Birth Rates (London). Birth Rates (England & Wales). 1893 122,420 4,366 35.5 31.0 30.7 1894 122,420 4,203 34.5 30.1 29.6 1895 122,090 4,255 34.8 30.5 30.3 1896 121,108 4,275 35.5 30.2 29.6 1897 120,708 4,233 35.0 30.0 29.6 1898 120,370 4,233 35.1 29.5 29.3 1899 120,120 4,052 33.7 29.4 29.1 1900 119,950 3,947 32.9 28.6 28.7 1901 117,162 4,025 34.3 29 0 28.5 1902 116,573 3,890 33.3 28.5 28.5 1903 116,365 3,835 32.9 28.5 28.5 1904 115,985 3,672 31.6 27.9 28.0 1905 115,564 3,953 34.2 27.1 27.3 1906 115,130 3,870 33.6 26.5 27.2 1907 114,700 3,720 32.4 25.8 26.5 1908 114,269 3,678 32.2 25.2 26.7 1909 113,912 3,692 32.4 24.2 25.8 1910 113,653 3,575 31.6 23.9 25.1 1911 109,951 3,497 31.8 25.0 24.4 1912 109,739 3,529 32.1 24.7 24.0 1913 109,082 3,393 31.1 24.8 24.1 1914 108,362 3,470 32.0 24.6 23.8 1915 102,299 3,091 30.2 24.3 21.8 1916 98,614 2,983 30.3 23.4 21.0 1917 88,347 2,225 22.5 17.5 17.8 1918 87,045 1,719 17.5 161 17.7 1919 97,534 2,286 22.3 18.3 18.5 1920 101,000 3,731 36.9 26.5 25.5 1921 104,184 2,975 28.5 22.3 22.4 1922 104,800 2,926 27.9 21.0 20.4 1923 105,200 2,832 26.9 20.2 19.7 1924 105,500 2,528 23.9 18.7 18.8 1925 106,400 2,627 24.6 18.0 18.3 1926 106,400 2,516 23.5 17.1 17.8 1927 104,700 2,188 20.9 16.1 16.6 1928 100,200 2,091 20.9 15.9 16.7 1929 98,710 2,005 20.3 15.7 16.3 1930 98,710 1,988 20.1 15.7 16.3 1931 98,260 1,684 17.1 15.0 15.8 1932 95,800 1,674 17.5 14.3 15.3 1933 93,550 1,494 16.0 13.2 14.4 1934 90,630 1,456 16.1 13.2 14.8 1935 88,400 1,290 14.6 13.3 14.7 1936 85,400 1,274 14.9 13.6 14.8 1937 82,240 1,222 14.9 13.4 14.9 28 MARRIAGES The number of marriages during the year was 871, and the marriage rate was 21.18 per 1,000 population. The marriage rate for the Metropolis was 2109. During recent years the corresponding figures were as follows:— Table No. 13 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 1935 890 20.1 21.1 1936 839 19.6 21.5 1937 871 21 .2 21 .9 It will be seen that the general increase of the marriage rate, which was noted in the report for last year, is being maintained. DEATHS During 1937 the gross number of deaths registered in the Borough was 1,165. The transferable deaths were as follows:— Deaths of non.residents registered in Shoreditch 389 Deaths of Shoreditch residents registered elsewhere 250 The number of deaths which must be debited to Shoreditch is accordingly 1,026, which figure gives a net death rate of 12.47 per 1,000 population. In connection with these deaths 67 inquests were held. The death rate for England and Wales for 1937 was 12.4 and for London 12.5. Table 14 on page 29 gives comparative death rates for a number of years. 29 DEATH RATES Table No. 14 Year. Population (Shoreditch) Nett Deaths (Shoreditch) Death Rate (Shoreditch) Death Rate (London) Death Rate (England & Wales) 1893 122,420 3,146 25.7 22.7 19.2 1894 122,420 2,466 20.1 17.8 16.6 1895 122,090 2,860 23.4 19 8 18.7 1896 121,108 2,622 21.6 18.6 17.1 1897 120,708 2,626 21.8 17.7 17.4 1898 120,370 2,704 22.4 18.3 17.6 1899 120,120 2,911 24.2 19.7 18.3 1900 119,950 2,576 21.4 18.8 19.5 1901 117,162 2,596 22.1 17.6 16.9 1902 116,573 2,441 20.9 17.2 16.3 1903 116,365 2,280 19.6 15.7 15.5 1904 115,985 2,392 20.6 16.1 16.3 1905 115,564 2,296 19.8 15.1 15.3 1906 115,130 2,289 19.8 15.1 15.5 1907 114,700 2,365 20.6 14.6 15.1 1908 114,269 2,006 17.5 13.8 14.8 1909 113,912 2,189 19.2 14.7 14.6 1910 113,653 1,913 16.8 12.7 13.5 1911 109,951 2,227 20.2 15.8 14.6 1912 109,739 2,017 18.3 14.3 13.3 1913 109,082 2,008 18.4 14.2 13.8 1914 108,362 2,101 19.4 14.4 14.0 1915 102,299 2,071 20.2 14.4 15.7 1916 98,614 1,841 18.7 14.3 14.4 1917 88,347 1,990 22.5 15.0 14.4 1918 87,045 2,108 24.2 18.9 17.6 1919 97,534 1,537 15.7 13.4 13.7 1920 101,000 1,583 15.6 12.4 12.4 1921 104,184 1,498 14.4 12.4 12.1 1922 104,800 1,712 16.3 13.4 12.8 1923 105,200 1,370 13.0 11.2 11.6 1924 105,500 1,444 13.7 12.1 12.2 1925 106,400 1,421 13.3 11.7 12.2 1926 106,400 1,298 12.2 11.6 11.6 1927 104,700 1,328 12.7 11.9 12.3 1928 100,200 1,381 13.8 11.6 11.7 1929 98,710 1,593 16.1 13.8 13.4 1930 98,710 1,208 12.2 11.4 11.4 1931 98,260 1,227 12.5 12.3 12.3 1932 95,800 1,180 12.3 12.3 12.0 1933 93,550 1,212 13.0 12.2 12.3 1934 90,653 1,188 13.1 11.9 11.8 1935 88,400 1,001 11.3 11.4 11.7 1936 85,400 1,094 12.8 12.3 12.1 1937 82,240 1,026 12.5 12.5 12.4 30 The distribution of the deaths and the death rates in the different wards is given below:— Table No. 15 Ward. Males. Females. Total. Deaths per 1,000 population. Deaths of infants under 1 year per 1,000 births registered. Moorfields 21 24 45 13.5 25.6 Church 100 94 194 14.0 58.8 Hoxton 70 78 148 11.0 60.8 Wenlock 87 73 160 12.0 46.9 Whitmore 91 80 171 13.5 54.7 Kingsland 48 42 90 11.1 50.0 Haggerston 52 46 98 11.7 49.3 Acton 61 59 120 13.2 64.2 Totals 530 496 1,026 12.5 54.0 In Table No. 26 on page 40 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, 272 (26.5 per cent.) cancer, 133 (13.0 per cent.); tuberculosis, all forms, 86 (8.4 per cent.); bronchitis, 47 (4.6 per cent.); pneumonia, all forms, 91 (8.9 per cent.). The number of deaths due to accidents in connection with vehicular traffic was 10. In the years 1933 to 1936 inclusive, the corresponding figures were respectively 17, 19, 17 and 7. The particulars regarding deaths from cancer are contained in Table No. 24 on page 37 . The death rate for Shoreditch for 1936 was 12.8, so that the rate for 1937 represents a decrease. The crude rate for Shoreditch is still slightly below the average for the last ten years, but it is slightly higher than the rates for London as a whole and for England and Wales respectively. The crude death rate does not give a very accurate conception of the position, but it should be noted (see Table No. 25 on page 38) that there are six other London boroughs whose adjusted death rates are higher than that of Shoreditch. As has been mentioned, the number of deaths upon which the crude death rate is calculated was 1,026, and the corresponding figure for 1936 was 1,094. 31 The main alterations in numbers compared with 1936 were as follows:— Table No. 16 Increase. Decrease. Total deaths for 1937. Measles - 39 2 Influenza 18 - 28 Tuberculosis (respiratory) 23 - 73 Cancer - 9 133 Cerebral haemorrhage - 19 33 Pneumonia - 14 91 Diarrhoea, etc. - 18 13 Senility - 12 14 The ward death rates given in Table No. 15 show no very unusual features. The particulars regarding deaths from tuberculosis are given in the section of this report devoted to that disease. The following table shows the age.grouping of the deaths from all causes:— Table No. 17 Age. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- All ages. No. of deaths 66 11 10 22 36 42 65 102 177 234 261 1,026 Percentage 6.43 1.07 0.97 2.14 3.51 4.09 6.34 9.94 17.25 22.81 25.44 32 In Table No. l8 are set forth the various institutions outside Shoreditch with the number of persons belonging to the Borough who died therein during the year:- Table No. 18 Asylums and Mental Hospitals: No. of deaths. Special Hospitals: No. of deaths. Bexley, Dartford 2 Colindale 1 Coulsdon and Purley 1 Downs, for children 1 Grove, Epsom 1 Elizabeth Garrett Anderson 1 Horton, Epsom 4 Homeopathic 2 Hundred Acres 3 Hospital for sick children 3 Infirmary, Friern Barnet 2 Queen's, for children 15 Leavesden, Herts 3 St. Joseph's Hospice 3 la, Manor Road, llford 5 Tooting Bee 7 Public Assistance Institutions: 1, Uxbridge Road, Norwood 2 1, West Park Road, Epsom 1 Archway Hospital 15 Bancroft Lodge, Stepney 2 Hospitals for Infectious Diseases: Bethnal Green Hospital 10 Hackney Hospital 2 Brook 1 Hackney Institution 2 Eastern 8 Hammersmith Hospital 1 North-Eastern 4 Highgate Hospital 1 North-Western 2 Islington Institution 9 Park 5 Lambeth Hospital 4 South-Eastern 3 Mile End Hospital 1 New End Hospital 1 General Hospitals: North Middlesex Hospital 2 German 6 Poplar Institution 11 London 2 St. Andrew's Hospital 3 London-Jewish 1 St. Clement's Hospital 3 Metropolitan 22 St. George in the East Hospita 3 Middlesex 1 St. John's Hospital 1 Mildmay Mission 3 St. Luke's Hospital 1 Mount Vernon 1 St. Mary Abbots Hospital 1 National 1 St. Peter's Hospital 5 National Temperance 1 St. Pancras Institution 4 Queen Mary's, Carshalton 1 Wandsworth Institution 1 Queen Mary's, West Ham 2 17, Wellhouse Lane, Barnet 1 Royal Free 3 Royal Victoria, Dover 2 Other Institutions: Royal Waterloo 1 Home Office, Ducane Road 2 St. Bartholomew's 16 Firs Home, Bournemouth 1 St. Columba's 1 St. Luke's, Lowestoft 1 Seamen's 1 University College 1 West Kent General 1 Of 235 persons belonging to Shoreditch who died in public institutions beyond the boundary of the Borough, 69 died in general hospitals, 30 in asylums, 23 in fever hospitals, 26 in special hospitals, 84 in public assistance institutions and 3 in other institutions. Elsewhere than in public institutions, l5 persons belonging to Shoreditch died beyond the boundary of the Borough. 33 Altogether 786, or 76.6 per cent., of the people belonging to Shoreditch who died daring the year died in public institutions. The corresponding figures for recent years were as follows:— 1931 66.3 per cent. 1934 73.1 per cent. 1932 69.3 1935 74.8 „ 1933 68.5 1936 73.5 „ INFANTILE MORTALITY The deaths of infants under one year numbered 66, of which 36 were of males and 30 of females. These deaths amounted to 6 43 per cent. of the total net Shoreditch deaths from all causes as compared with 8.68 per cent. in 1936. The infantile mortality rate (death rate of infants under one year) was 54 per 1,000 births registered during the year. For male infants the rate was 58 and for females 50. The infant mortality rates in the different wards of the Borough are included in Table No. 15 on page 30. The number of deaths of illegitimate infants was 4, which gives a death rate of 85 per 1,000 illegitimate births. Table No. 19 on page 34 gives the comparative infant mortality rates for Shoreditch, London and England and Wales respectively. It will be noted that the infant mortality rate for 1937 shows a welcome drop from the figures for 1936, and apart from the year 1935 when it was 52 per thousand births, the present figure of 54 per thousand births is a record low rate for the borough. As mentioned in the last report, however, there are various causes of deaths in infants, such as catarrhal conditions, diarrhoea and enteritis, etc., which vary greatly from year to year, and although a still lower rate is the objective to be aimed at, it must not be expected that fairly wide variations will be prevented from year to year. The causes of the deaths of infants under one year of age, together with age and ward distributions, are given in Table No. 20 facing page 34. 34 INFANTILE MORTALITY Table No. 19 Year. Shoreditch Deaths under one year. Rate per 1,000 Births. Shoreditch. London. England and Wales. 1893 809 186 164 159 1894 704 166 143 137 1895 867 203 166 161 1896 786 183 161 148 1897 789 186 159 156 1898 846 200 167 160 1899 854 210 167 163 1900 741 187 160 154 1901 812 201 149 151 1902 704 181 139 133 1903 676 176 131 132 1904 706 190 146 145 1905 652 165 131 128 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 1935 67 52 58 57 1936 95 75 66 59 193 66 54 60 58 MATERNAL MORTALITY The number of Shoreditch women whose deaths were primarily classified to childbirth during the year was 4. This gives a maternal mortality rate per 1,000 live births of 3.27 and per 1,000 total births (i.e., still births included) of 3.17. The particulars of these deaths, classified according to age and cause, are given in Table No. 21. 35 MATERNAL MORTALITY, 1937 Table No. 21 AGES STATUS WARDS 15 to 20 yrs. 20 to 25 yrs. 25 to 30 yrs. 30 to 35 yrs. 35 to 40 yrs. 40 to 45 yrs. 45 yrs. + Married. Single. Widowed. Moorfields. Church. Hoxton. Wedlock. Whitmore. Kingsland. Haggerston. Acton. Post abortive sepsis 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... Abortion not returned as septic: Haemorrhage following abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Without record of haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ectopic gestation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other accidents of pregnancy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal haemorrhage: Placenta praevia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other puerperal haemorrhage ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... Puerperal sepsis: Puerperal septicaemia and pyaemia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal albuminuria and convulsions: Puerperal convulsions ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... Other conditions ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 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 ... Chronic rheumatic endocarditis, syncope during labour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 For purposes of comparison the maternal mortality rates per 1,000 live births in England and Wales, London and Shoreditch, during the year 1937 and the six preceding years are given as follows:— Table No. 22 Year. Shoreditch. London. England and Wales. 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. 1931 0.00 1.78 1.78 202 1.78 3.80 1.59 2.36 3.95 1932 0.60 1.79 2.39 1.19 1.47 2.64 1.55 2.49 4.04 1933 2.68 1.34 4.02 1.48 1.72 3.20 1.79 2.63 4.42 1934 0.00 0.69 0.69 1.18 1.30 2.48 2.03 2.57 4.60 1935 1.55 1.55 3.10 1.15 1.43 2.58 1.68 2.42 4.10 1936 0.00 0.00 0.00 0.75 1.17 1.92 1.40 2.41 3.81 1937 0.82 2.45 3.27 0.84 1.45 2.29 0.97 2.26 3.23 CANCER The deaths from cancer in the Borough during the year numbered 133 as compared with 142 in 1936. Of these 133 persons, 58 were males and 75 females. Particulars concerning these deaths as regards age, situation of disease, and the ward in which they occurred are given in Table No. 24. The deaths from cancer during the last seven years per 1,000 persons living are given in the following comparative table:— Table No. 23 Year. Shoreditch. London. England and Wales 1931 1.24 1.64 1.48 1932 1.55 1.55 1.51 1933 1.44 1.60 1.53 1934 1.48 1.72 1.56 1935 1.66 1.66 1.59 1936 1.66 1.75 1.63 1937 1.62 1.75 1.63 During the year under review there was again a slight decrease in the total number of deaths from malignant disease. Table No. 24 on page 37 shows that the alimentary tract was again the most frequently affected site, and that the stomach, intestines and rectum, in that order, were the organs most frequently affected. There was a considerable increase in the frequency of deaths due to malignant disease of the lungs and pleura, but the numbers are not sufficiently large for any generalisations to be made. 37 DEATHS FROM CANCER IN THE BOROUGH DURING YEAR 1937 Table No. 24 AGES SEX WARDS Total 0 to IS. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Male. Female. Moorfields. Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. M F M F M F M F M F M F M F M F Tongue ... ... ... ... ... ... 1 1 ... ... 1 1 ... ... ... — 1 1 - ... ... ... 2 Other buccal cavity ... ... ... 1 ... ... ... 3 ... 1 2 3 1 - ... 1 1 ... - 1 ... ... - 1 5 Pharynx ... ... ... ... ... 1 1 ... ... ... 2 - 1 ... ... ... ... ... - 1 ... 2 Oesophagus ... ... ... ... ... ... ... 5 1 ... 6 ... ... 2 - 2 — 1 — 1 - ... ... ... 6 Stomach ... ... ... 2 1 4 3 7 ... ... 10 13 1 1 2 1 1 3 - 3 1 1 2 - 1 1 2 3 23 Liver ... ... ... ... ... ... 1 ... ... ... ... 1 ... - 1 ... ... ... ... ... ... 1 Gall bladder ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... - 1 ... ... ... 1 Bladder ... ... ... ... ... ... ... 3 1 ... 3 1 ... 1 1 ... ... ... ... 2 ... 4 Intestines ... ... ... ... ... 2 3 5 ... ... 5 10 ... - 3 1 1 1 2 1 - - 1 2 2 - 1 15 Rectum ... ... ... ... ... ... 2 8 1 ... 4 7 - 1 — 1 — 1 1 2 - 2 ... 1 - 2 ... Other digestive organs ... ... ... ... ... ... - ... ... ... 1 1 ... ... 1 - ... — 1 ... ... ... 2 Uterus ... ... ... ... 1 4 3 3 ... ... ... 13 - 1 — 2 — 4 - 1 - 2 - 2 - 1 ... 13 Ovary and Fallopian tube ... ... ... ... ... 1 1 - ... ... ... 2 ... - 1 ... ... ... ... - 1 ... 2 Vagina, vulva ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Breast ... ... ... ... 1 4 1 ... ... ... ... 9 ... - 2 — 3 - 1 ... - 2 ... - 1 9 Skin ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... - 1 ... ... ... ... 1 Larynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lung and pleura ... ... ... 2 ... 5 7 ... 1 ... 18 4 ... 5 2 3 — 2 1 4 — 1 - 1 - 2 1 22 Mediastinum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pancreas ... ... ... ... ... 1 2 ... ... 2 2 ... ... ... ... 1 1 1 1 ... ... 4 Prostate ... ... ... ... ... ... ... 2 ... ... 2 ... ... 1 - ... ... ... ... 1 ... 2 Other organs ... 1 ... 1 1 1 1 1 2 ... 4 4 - 1 - 1 ... 2 - ... 1 2 1 - ... 8 All situations ... 1 ... 6 8 23 27 45 22 1 58 75 2 5 11 15 9 13 7 12 9 9 5 8 9 6 6 7 133 38 VITAL STATISTICS OF THE METROPOLITAN BOROUGHS Table No. 25 Metropolitan Boroughs. Estimated Resident Population (mid.1937). Birth rate. Death rate— Infanti le Mortality per 1,000 births. Maternal Mortality. Rate per 1,000 live births. Rate per 1,000 live and still births. Crude Adjusted Puerperal Sepsis. Other causes. Total. Puerperal Sepsis. Other causes. Total. West Districts: Paddington 138,300 13.6 130 12 9 66 1.06 3.17 4.23 1.02 3.06 4.08 Kensington 175,600 12.1 13.3 12.4 83 0.9 2.3 3.3 0.9 2.3 3.2 Hammersmith 126,500 15.1 12.6 13.0 68 0.5 1.6 2.1 0.5 1.5 2.0 Fulham 138,900 13.9 13.1 13.2 56 0.00 3.1 3.1 0.00 2.9 2.9 Chelsea 56,510 10.8 141 12.0 59 0.00 0.00 0.00 0.00 0.00 0.00 Westminster 124,300 8.2 11.5 11.8 59 3.9 4.8 8.8 3.7 4.7 8.4 North Districts: St. Marylebone 92,110 9.4 13.1 13.0 73 2.33 2.33 4.66 2.23 2.23 4.46 Hampstead 90,690 11.2 11.6 10.9 54 0.98 1.97 2.95 0.96 1.91 2.87 St. Pancras 181,900 13.0 12.7 13.0 62 2.1 1.3 3.4 2.0 1.2 3.2 Islington 295,400 15.2 12 9 13.0 66 1.99 l.l1 3.10 1.94 1.07 3.01 Stoke Newington 50,250 14.9 12.5 12.0 38 0.00 4.0 4.0 0.00 3.9 3.9 Hackney 206,700 13.8 1l.l 11.7 43 0.34 1.04 1.39 0.33 1.01 1.34 Central Districts: Holborn 34,600 8.1 11.8 12.7 79 3.57 0.00 3.57 3.4 0.00 3.4 Finsbury 58,700 13.8 14.6 15.9 71 0.00 2.46 2.46 0.00 2.40 2.40 City of London 8,980 6.1 11.2 12.4 36 0.00 0.00 0.00 0.00 0.00 0.00 East Districts: Shoreditch 82,240 14.9 12.5 13.7 54 0.82 2.45 3.27 0.79 2.38 3.17 Bethnal Green 94,560 13.3 12.5 14.1 54 1.59 0.79 2.38 1.53 0.77 2.30 Stepney 203,100 13.5 12.2 14.2 61 0.72 1.8 2.5 0.69 1.74 2.4 Poplar 136,800 15.5 12.6 14.0 61 0.47 0.47 0.94 0.46 0.46 0.92 South Districts: Southwark 147,400 14.7 13.6 14.1 64 0.46 2.77 2.33 0.45 2.68 3.13 Bermondsey 98,790 14.4 12.3 14.0 59 0.00 0.70 0.70 0.00 0.68 0.68 Lambeth 273,800 14.1 13.2 13.0 68 1.29 0.77 2.06 1.24 0.74 1.98 Battersea 143,500 14.9 12.9 12.8 70 0.00 1.87 1.87 0.00 1.81 1 81 Wandsworth 341,700 11.5 12.4 11.4 62 0.76 2.53 3.29 0.73 2.45 3.18 Camberwell 224,800 14.1 12.8 12.8 58 0.95 0.95 1.90 0.92 0.92 1.84 Deptford 96,580 15.1 11.8 12.3 45 0.00 0.7 0.7 0.00 0.6 0.6 Greenwich 95,990 13.9 12.0 12.3 50 0.75 0.00 0.75 0.72 0.00 0.72 Lewisham 226,000 13.9 10.8 10.9 46 0.33 0.99 1.32 0.32 0.96 1.27 Woolwich 149,400 14.2 1 l.l 11.7 40 0.00 1.41 1 .41 0.00 1.35 1 .35 London 4,094,500 13.4 12.5 — 60 0.84 1.45 2.29 0.81 1.41 2.22 39 PUBLIC MORTUARY, 1937 Number of bodies deposited from— St. Leonard's Hospital 30 L.C.C. Infectious Disease Hospitals 2 Undertakers 157 Other sources 2 Total number of bodies deposited 191 Number of post-mortem examinations performed 130 In the report for 1934 reference was made to the condition of the Public Mortuary. No action has so far been taken with a view to the provision of a new mortuary, although I think the time is fast approaching when this will be necessary. 40 41 Table No. 26 The causes of deaths at all ages together with Ward distribution and particulars relating to the deaths in Public Institutions in the Borough are contained in the following table:— CAUSES OF DEATH. (The figures in italics refer to the list numbers in the short list of the International List of Causes of Death.) AGES. DEATHS IN EACH WARD. SEX St. Matthew's Hospital. St. Leonard's Hospital. Royal Chest Hospital. Infant Welfare Centre. Total deaths due to each cause. Cause of death. 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 :o Shoreditch. M F M F M F M F M F M F M F M F 1 Typhoid paratyphoid fevers ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 Measles ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 2 3 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 4 Whooping cough 6 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 2 ... 1 ... ... 1 3 4 ... ... ... ... ... ... ... ... 7 4 5 Diphtheria ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 ... ... ... ... ... ... ... ... 3 5 6 Influenza ... 1 ... ... ... ... 1 1 2 4 6 6 7 ... 1 2 5 2 1 2 3 4 ... 2 ... ... 1 1 2 2 13 15 ... 10 7 ... ... 1 ... ... 28 6 7 Encephalitis lethargica ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... 2 7 8 Cerebro-spinal fever 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 l ... 1 2 ... ... ... ... ... ... ... ... 3 8 9 Tuberculosis of respiratory system ... ... ... ... 1 5 10 17 12 11 14 1 2 ... 3 ... 6 4 6 9 14 2 8 3 4 3 5 1 3 2 49 24 ... 1 32 15 1 13 ... ... 73 9 10 Other tuberculous diseases 1 2 3 2 1 1 1 ... 1 ... 1 ... ... ... ... ... 1 1 2 2 2 ... ... 2 ... ... ... ... 2 1 7 6 ... ... 6 1 ... ... ... ... 13 10 11 Syphilis ... ... ... ... ... ... ... ... 2 1 ... 1 1 ... ... ... ... 1 1 ... ... 1 ... ... ... 1 ... ... 1 ... 2 3 ... ... 1 ... ... 1 ... ... 5 11 12 General paralysis of the insane, tabes dorsalis ... ... ... ... ... ... ... ... 1 1 1 1 ... ... ... ... 1 ... ... ... 1 ... 1 1 ... ... ... ... ... ... 3 1 ... ... 2 1 ... ... ... ... 4 12 13 Cancer, malignant diseases ... ... ... ... ... 1 ... 6 8 23 27 45 22 1 2 5 11 15 9 13 7 12 9 9 5 8 9 6 6 7 58 75 1 5 81 23 ... 11 ... ... 133 13 14 Diabetes ... ... ... ... ... ... ... 1 ... 1 2 3 ... ... ... ... 1 3 ... ... 1 ... 2 ... ... ... ... ... ... ... 4 3 ... ... 6 2 ... ... ... ... 7 14 15 Cerebral haemorrhage, etc. ... ... ... ... ... ... ... ... 1 3 11 11 6 1 1 2 2 5 2 ... 5 2 3 1 1 ... 2 ... 5 2 21 12 ... 17 27 12 ... 1 ... ... 33 15 16 Heart disease ... ... ... ... 1 1 5 6 9 19 38 76 93 24 2 7 25 25 16 23 16 19 23 20 16 12 10 18 20 20 128 144 4 52 135 47 ... 5 ... ... 272 16 17 Aneurysm ... ...... ... ... ... ... ... ... 1 1 7 1 ... 1 ... ... 1 I ... 1 ... ... 1 ... ... ... ... 1 1 ... 3 3 ... ... 3 1 ... 3 ... ... 6 17 18 Other circulatory diseases ... ... ... ... ... ... ... ... ... 3 12 20 19 2 1 ... 3 2 4 6 3 6 6 8 2 1 6 2 ... 6 25 31 3 74 39 16 ... 1 ... ... 56 18 19 Bronchitis 1 ... ... ... ... ... ... ... 1 6 3 16 14 6 ... 3 4 3 4 1 8 1 3 4 3 3 3 4 1 2 26 21 2 6 27 8 ... 4 ... ... 47 19 20 Pneumonia (all forms) 17 3 1 ... ... ... ... 2 8 9 19 17 10 5 6 2 15 8 6 11 4 7 9 7 3 5 3 1 4 47 44 ... ... 51 27 ... 3 ... ... 91 20 21 Other respiratory diseases ... ... ... ... ... ... ... ... 3 ... 3 1 1 2 ... 1 ... ... ... 1 ... 2 4 1 ... ... ... ... ... 1 4 6 ... ... 5 1 5 ... ... 10 21 22 Peptic ulcer ... ... ... ... ... ... ... ... 3 4 1 2 1 1 ... 2 ... ... ... ... ... 2 ... 1 ... 1 ... 3 ... 11 ... ... ... 8 1 ... ... ... ... 11 22 23 Diarrhoea, etc. 11 ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 3 ... 1 1 1 2 2 2 ... ... ... ... 1 5 8 ... ... 1 2 ... ... ... ... 13 23 24 Appendicitis ... ... ... ... 2 ... ... 2 ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 2 ... ... 3 2 ... ... 4 2 ... ... ... ... 5 24 25 Cirrhosis of liver ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 25 26 Other diseases of liver, etc. ... ... ... ... ... ... ... ... 1 ... 2 1 ... ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 4 ... ... 3 ... ... ... ... ... 4 26 27 Other digestive diseases 1 1 ... 1 ... ... ... ... ... ... 6 2 3 ... 1 1 ... 2 ... 2 1 1 3 1 ... ... ... 1 1 ... 6 8 ... ... 6 4 ... ... ... ... 14 27 28 Acute and chronic nephritis ... ... ...... ... ... ... 2 1 2 5 5 1 1 ... ... 1 2 1 1 1 1 ... 1 1 1 ... 3 ... 2 6 11 ... ... 9 7 ... ... ... ... 17 28 29 Puerperal sepsis ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 29 30 Other puerperal causes ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 ... ... 2 ... ... ... ... ... 3 30 31 Congenital debility, premature birth, malformations, etc. 19 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 3 ... 3 2 1 2 ... ... 2 ... 1 1 12 8 ... ... 10 3 ... ... ... ... 20 31 32 Senility ... ... ... ... ... ... ... ... ... ... ... ... 7 7 1 2 2 ... 2 1 1 1 l 1 ... ... ... 1 7 7 ... ... 11 2 ... ... ... ... 14 32 33 Suicide ... ... ... ... ... ... ... 2 1 3 6 3 1 ... ... ... 3 1 1 1 4 ... ... 1 1 1 1 ... 1 1 11 5 ... ... 4 3 ...... ... ... ... 16 33 34 Other violence 2 ... 3 5 2 1 1 ... 5 2 1 5 5 1 ... ... 2 4 4 ... 4 5 2 4 1 2 1 1 3 ... 17 16 ... ... 15 12 ... ... ... ... 33 34 35 Other defined diseases 6 1 1 ... 4 4 3 ... 5 7* 17 15 13 3 2 ... 15 4* 6 2 7 3 8 4 3 2 5 4 9 5 55 24* 1 11 43 16 ... 3 ... ... 79 35 36 Causes, ill defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 36 Total Deaths (all causes) 66 11 10 11 11 14 22 42 65 102 177 234 207 54 21 24 100 94 70 78 87 73 91 80 48 42 52 46 61 59 530 496 11 127 538 200 2 51 ... ... 1026 *Includes 1 death from erysipelas. *Includes 1 death from erysipelas. 42 III.—INFECTIOUS AND OTHER DISEASES During the year 1937 the number of notifications of all infectious diseases (excluding tuberculosis) was 754, as compared with 1,681 for the year 1936. The deaths from notifiable diseases (excluding tuberculosis) during 1937 numbered 104, which figure represents 10.1 per cent. of the total deaths for the Borough. The corresponding number for 1936 was 146 (13.3 per cent. of the total deaths). The decrease in the total number of notifications was almost entirely due to the low incidence of measles. Full particulars of the notified cases, classified according to the time of occurrence, age, and the wards in which they occurred, are given in Table No. 27. Those diseases of importance, in which a moderate incidence was shown, were scarlet fever, diphtheria, and dysentery. During the year under review the cases of both scarlet fever, and diphtheria again showed a considerable decrease on the corresponding figures for 1936, and the diminution was again more marked in the case of diphtheria. Examination of Table 27 will indicate that diphtheria showed no definite seasonal prevalence, but that the number of cases of scarlet fever, as is generally the case, was higher in the two winter quarters. As was the case during both the previous years, the disease continued to be a mild one; no deaths occurred from this cause during the year. Of the 169 notified cases of diphtheria the diagnosis was subsequently revised in respect of 44, so that the total accepted cases for the year was 125—which gives a true attack rate of 1.52 per 1,000 of the population. The number of deaths in these diphtheria cases was 3, which gives a death rate of 0.04 per 1,000 and a case mortality rate of 2.40 per cent., compared with a case mortality of 2.84 per cent. for 1936. Of the 169 patients, 8 (4.7 per cent.) were over the age of 25 years. The reduction of the incidence and mortality of diphtheria is welcome, as the disease is one of the most serious of childhood. In previous reports the necessity for action during interepidemic periods, and the fact that the disease can be very effectively prevented by artificial immunisation, has been explained. A noteworthy feature of the history of infectious diseases in various areas during recent years is the prominence achieved by dysentery bacilli of the Sonne type. Although the organism has long been known it was only in 1926 that the first outbreak of an illness due to this cause was described. Nowadays the disease appears to be almost endemic in certain areas. During the year 1937, 58 cases occurred in Shoreditch. A further discussion of these cases appears on page 50. Attention should be directed to the fact that in 21.9 per cent. of the notified cases of scarlet fever and in 26.0 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. It should be noted that during the year 87 per cent. of all notified cases of infectious disease were removed to hospital. When measles cases are left out of consideration this figure becomes 90 per cent. 43 TABLE SHOWING CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR, 1937 Table No. 27 NOTIFIABLE DISEASE. NUMBER OF CASES NOTIFIED. Cases removed to hospital. Per cent. removed to hospital. Diagnosis revised subsequently. Deaths. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total AGES. WARDS. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 + Moorfields. j Church. Hoxton. Wenlock. Whitmore. Kingsland. Haggerston. Acton. Smallpox ... ... ... ... ... ...... ... ... ... ... ... ...... ... ... ... ... ...... ... ... ... ... ... ... ... Scarlet fever 61 54 39 61 215 3 71 105 18 17 1 ... 15 38 36 32 30 18 26 20 214 99.5 47 ... Diphtheria 49 39 37 44 169 5 51 88 17 8 ... ... 9 30 25 18 26 19 32 10 169 100.0 44 3 Enteric fever (including paratyphoid) 2 1 4 1 8 ... 1 3 2 ... 2 ... 1 ... ... 5 ... 1 1 ... 8 100.0 5 ... Puerperal fever ... 1 1 1 3 ... ... ... ... 3 ... ... ... 1 ... ... ... 1 ... 1 1 33.3 ... 1 Puerperal pyrexia 4 5 6 6 21 ... ... ... 6 15 ... ... 2 2 2 6 3 3 2 1 16 76.2 ... ... Acute primary pneumonia 10 12 9 29 60 3 13 14 4 14 9 3 4 19 7 9 9 6 1 5 39 65.0 ... 91 Acute influenzal pneumonia 25 1 3 1 30 1 2 3 2 3 5 14 2 7 1 15 1 1 ... 3 18 60.0 ... Erysipelas 10 11 13 21 55 5 1 5 6 12 17 9 4 10 6 8 7 5 6 9 45 81.8 ... 1 Cerebro.spinal fever 2 2 ... 1 5 1 ... 2 2 ... ... ... ... I ... 2 ... 1 1 ... 5 100.0 ... 3 Ophthalmia neonatorum 4 4 ... 3 15 15 ... ... ... ... ... ... ... 4 ... 2 5 ... 2 1 6 40.0 ... ... Acute poliomyelitis ... ... ... ... I ... ... I ... ... ... ... ... ... ... ... ... 1 ... ... 1 100.0 ... ... Dysentery 5 7 11 35 58 8 20 17 ... 2 4 ... ... 7 ... 13 8 3 10 5 56 96.6 ... 1 Encephalitis lethargica ... 1 ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 100.0 ... 2 Malaria (induced) ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 100.0 ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles (under 5 years)* 16 46 30 20 112 16 96 ... ... ... ... ... 6 28 13 20 25 4 9 7 78 69.6 ... 2 Totals 188 184 158 224 754 57 255 238 59 75 39 31 45 148 101 131 114 63 90 62 658 87.3 ... 104 Tuberculosis (pulmonary) 32 29 29 23 113 ... 1 9 28 42 28 5 3 22 13 17 26 8 15 9 — — — 73 ,, (other forms) 7 12 4 4 27 1 6 10 7 - 3 - 1 4 8 5 5 3 2 2 - - - 13 Numbers and percentages of cases moved to hospitals (excluding tuberculosis) 159 84.58% 159 86.41% 135 85.44% 205 91.52% 658 87.27% 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 polioencephalitis 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), and measles (under 5 years). *N.B.—The figures for measles refer only to notifications received in respect of the first case under 5 years of age in each household. 44 SMALLPOX No case of smallpox occurred in the Borough during the year 1937. The following table shows the prevalence of smallpox in the country, London and Shoreditch during recent years:— Table No. 28 Year. Cases Notified. Shoreditch. London. England and Wales. 1929 246 1,905 10,975 1930 788 5,167 11,855 1931 122 1,452 5,665 1932 14 1,133 2,070 1933 29 530 631 1934 2 147 179 1935 — - 1 1936 — - 12 1937 — - 4 No vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. VACCINATION ORDER The Public Vaccination Officers for the year were:— (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). (Mr. W. H. Williams retired on 31st December and his duties were transferred to Mr. E. G. Wilsher, Chief Clerk in the Public Health Department.) The Public Vaccinators are:— (1) Dr. L. Statnigrosch, 191, Kingsland Road, E.2 (Shoreditch North-East District). (2) Dr. N. H. Clubwala, 242, Kingsland Road, E.2 (Shoreditch South-West District). The following report upon vaccination is in the form required by the RegistrarGeneral:— 45 VACCINATION OFFICERS' RETURN RESPECTING THE VACCINATION OF CHILDREN WHOSE BIRTHS WERE REGISTERED IN 1936 Table No. 29 Date. 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 Registration sub-districts comprised in vaccination officers' district. Number of births returned in birth list sheets. 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 1937. 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 1937. Insusceptible of vaccination. Certificate of conscientious objection. 1936. 1 2 3 4 6 7 8 9 10 11 12 13 1st Jan. to 31st Dec. North-East 846 162 — 385 24 11 192 31 41 209 416 South-West 326 69 — 178 6 3 — 13 57 54 130 Other Districts — — — — — — — — — 61 15 Total 1,172 231 — 563 30 14 192 44 98 324 561 46 Return showing the number of persons successfully vaccinated and revaccinated at the cost of the rates by Medical Officers of Institutions and Public Vaccinators during the year ended 30th September, 1937:— Table No. 30 Name of the 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. A. D. Morris — — — — — St. Matthew's Hospital. Dr. R. T. Taylor 4 1 5 — — Shoreditch South-West District. Dr. N.H.CIubwala. 112 29 141 12 - Shoreditch North-East District. Dr. L. Statnigrosch. 158 39 197 - - 274 69 343 12 — SCARLET FEVER The cases certified numbered 215, of which 47 or 21.9 per cent. were subsequently not regarded as scarlet fever. The actual number of cases was accordingly 168, which gives an attack rate of 2.04 per 1,000 inhabitants. The age, seasonal and ward distribution of the cases are included in Table No. 27 on page 43. There were no fatal cases. The number of cases and the attack rates in the Borough and wards are given in the subjoined table:— (See also Table No. 4.) 47 Table No. 31 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 7 7 14 ... ... ... 4.20 ... ... Church 13 9 22 ... ... ... 1.58 ... ... Hoxton 16 13 29 ... ... ... 2.15 ... ... Wenlock 12 14 26 ... ... ... 1.95 ... ... Whitmore 10 15 25 ... ... ... 1.98 ... ... Kingsland 3 12 15 ... ... ... 1.85 ... ... Haggerston 14 8 22 ... ... ... 2.63 ... ... Acton 4 11 15 ... ... ... 1.65 ... ... Total 79 89 168 ... ... ... 2.04 ... ... London ... ... 8,554 ... ... 33 2.09 0.01 0.38 The number of cases in Shoreditch was less than in 1936, in which year there were 256 cases with an attack rate of 3.00. The following table gives particulars regarding scarlet fever for Shoreditch, London, and England and Wales for a period of years:— SCARLET FEVER Table No. 32 Year. Shoreditch. London. England & Wales. Cases notified Case rate Deaths Death rate Case rate Death rate Case rate Death rate 1920 513 5.3 5 0.04 5.0 0.05 3.19 0.04 1921 917 8.7 7 0.06 7.3 0.06 3.64 0.03 1922 337 3.2 6 0.07 3.8 0.07 2.85 0.04 1923 391 3.7 6 0.06 2.2 0.02 2.24 0.03 1924 366 3.4 2 0.02 2.5 0.02 2.16 0.02 1925 485 4.5 5 0.04 2.7 0.03 2.36 0.03 1926 432 4.0 4 0.04 2.7 0.02 2.10 0.02 1927 383 3.7 3 0.03 2.9 0.01 2.16 0.02 1928 457 4.6 3 0.03 3.4 0.02 2.61 0.02 1929 314 3.2 3 0.03 3.6 0.02 3.05 0.02 1930 384 3.9 1 0.01 3.8 0.02 2.76 0.02 1931 263 2.7 0 0.00 2.8 0.02 2.05 0.01 1932 419 4.4 6 0.06 3.3 0.02 2.12 0.01 1933 567 6.1 0 0.00 5.1 0.02 3.21 0.02 1934 306 3.5 2 0.02 2.6 0.01 3.76 0.02 1935 364 4.0 2 0.02 4.3 0.02 2.96 0.01 1936 256 3.0 0 0.00 2.6 0.01 2.53 0.01 1937 168 2.0 0 0.00 2.1 0.01 2.33 0.01 48 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. In addition, a new method of drug treatment by one of the sulphanilamide group became more popular during the year and is now used extensively in various fever hospitals. This group of drugs is not only effective in cases of scarlet fever but also in many other diseases due to the streptococcus such as, for example, puerperal sepsis and epidemic sore throat. From the administrative point of view the problem of scarlet fever is now largely one of correct diagnosis and the search for missed cases. The effect of seasonal incidence was not marked during the year. There was a slight increase in the incidence of the disease in both the first and fourth quarters. During the year all the notified cases except one were removed to hospital. This high hospitalization rate seems worthy of special mention. Return cases.— "Return 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 three cases were considered to come in this category. 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 at present 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 169, of which 44, or 26.04 per cent., were subsequently not regarded as being cases of diphtheria. The actual number of cases for the year was thus 125, which gives an attack rate of 1.52 per 1,000 inhabitants. In 1936 the number of cases was 176 and the attack rate was 2.06. The age, seasonal incidence and ward distribution of the cases are given in Table No. 27 on page 43. The number of deaths was 3—of females. This gives a death rate of 0.04 per 1,000 inhabitants and a case mortality of 1.52. The deaths occurred in the following age groups:— 2.5 years, 1; 5.10 years, 2. The following table gives particulars regarding diphtheria for Shoreditch, London, and England and Wales for a period of years:— 49 Table No. 33 Year Shoreditch London England & Wales Cases notified Case rate Deaths Death rate Case rate Death rate Case rate Death rate 1920 401 3.9 26 0.25 30 0.22 1 .86 0.15 1921 584 5.8 40 0.38 3.7 0.25 1.76 0.13 1922 439 4.1 27 0.26 3.4 0.25 1.37 0.11 1923 365 3.4 13 0.12 2.3 0.13 105 0.07 1924 381 3.6 15 0.14 2.3 0.12 1.07 0.06 1925 440 4.1 17 0.16 2.7 0.07 1 .23 0.07 1926 372 3.5 12 0.12 2.9 0.12 1.31 0.08 1927 467 4.5 12 0.11 2.7 0.09 1.33 0.07 1928 354 3.5 13 0.13 2.7 0.09 1 .55 0.08 1929 281 2.8 10 0.10 2.7 0.08 1 .59 0.09 1930 326 3.3 20 0.20 3.1 0.10 1 .84 0.09 1931 288 2.3 7 0.07 1.9 0.06 1.26 0.07 1932 249 2.6 7 0.07 1.9 0.07 108 0.06 1933 286 3.1 15 0.16 2.3 0.08 1.18 0.07 1934 288 3.2 13 0.14 2.8 0.11 1.70 0.10 1935 252 2.9 9 0.10 2.2 0.06 1 .60 0.09 1936 176 2.1 5 0.06 1.7 0.05 1 .39 0.08 1937 125 1.5 3 0.04 1.9 0.05 1.49 0.07 The number of cases, the deaths amongst males and females and the attack, death and case mortality rates in the Borough, its wards and in London are given in the subjoined table:— Table No. 34 Ward. No. of cases. Fatal cases. Rates per 1,000 population. Case mortality. Deaths per 100 cases. M. F. Total. M. F. Total. Attack Death. Moorfields 1 4 5 ... ... ... 1.50 ... ... Church 10 11 21 ... ... ... 1.51 ... ... Hoxton 12 9 21 ... ... ... 1.56 ... ... Wenlock 7 8 15 ... ... ... 1.13 ... ... Whitmore 5 13 18 ... ... ... 1.45 ... ... Kingsland 5 9 14 ... ... ... 1.73 ... ... Haggerston 13 12 25 ... 3 3 2.99 0.36 12.0 Acton 1 5 6 ... ... ... 0.66 ... ... Total 54 71 125 ... 3 3 1.52 0.04 2.40 London — — 7,903 — — 210 1.93 0.05 2.66 50 During the year the number of bacteriological examinations made in connection with diphtheria was 899. In eleven instances the source of infection, as represented by a previous case in the same household, was established. Diphtheria Immunization.—The desirability of an increase in immunization work, and one of the methods adopted to effect it, was mentioned in the introduction to this section (page 42). At the diphtheria immunization clinic the total number of attendances was 870. The number of persons who received the primary Schick test was 148, and of these 72 were naturally immune and were not immunized. During the year 102 of the children completed the course of inoculations and 57 of these were tested and found immune. At the end of the year 64 cases were still under treatment or were awaiting the final Schick test. Diphtheria Carriers.—Five persistent carriers were referred by the County Medical Officer of Health to the Carrier Clinic for treatment of school children at the Hospital for Sick Children, Great Ormond Street. DYSENTERY During the year 1937, notifications were received of 58 cases of dysentery. Thirtyfour of these were removed to hospital, and in twenty-two other cases the patients were in hospital when the disease supervened. Bacteriological confirmation of the presence of the dysentery bacillus in the stools was obtained in 20 cases before the patient went into hospital, and the diagnosis was confirmed in other cases in hospital. Information from the various hospitals to which the patients were sent showed that twelve of the notified cases were discharged as not suffering from dysentery. The monthly distribution of the 58 cases was as follows: February, 4; March, 1; April, 2; May, 2; June, 2; July, 3; August, 1; September, 6; October, 8; November, 14; December, 15. The cases were therefore sufficiently numerous during the last four months of the year to constitute epidemic proportions, especially as it is probable that there are many more missed cases of the disease than the numbers notified. The ages of the patients varied considerably. The youngest notified patient was aged 6 months, and the oldest patient was 85 years. The cases occurred in the following age groups:— Under 1 year 1 to 2 2 to 5 5 to 10 10 to 15 15 to 35 35 to 55 55 up 8 10 10 10 7 3 2 8 Thirty-three of the notified patients were males and 25 were females. 51 In three instances in which the primary cause was notified as dysentery and the organism was isolated from the stools, examination of the house contacts revealed the fact that at least one of the contacts in each household was carrying the organism. Whenever possible, examination of the stools of all or the majority of the contacts was carried out and investigation was extended to any persons who had been closely in contact with the patients. From the clinical notes which are available in respect of certain patients, it would seem that in the majority of cases the attack was mild. A proportion of the patients showed blood in the stools during the early phase of the illness and diarrhoea and vomiting were common features. In every case enquiries were made regarding the diet of the patients, and in certain instances bacteriological examinations were carried out. These investigations elicited nothing of value. From published statistics it appears evident that there has been for the past few years a gradual increase in the number of cases of dysentery in England and Wales. Dysentery used to be regarded as an institutional or an asylum disease but it is now spreading over the population generally. Two or three large outbreaks were reported in provincial towns during the late summer and autumn of 1937 and the number of cases both in Shoreditch and the rest of London rapidly increased during the last few weeks of 1937 and the first few weeks of 1938. The figures of the last quarter of 1937 for Shoreditch, London and England and Wales are shown in the following table. It must be noted that these figures probably only account for a proportion of the total cases actually occurring. Table No. 35 1937. Week ending Shoreditch London England and Wales October 9th 2 22 40 ” 16th 3 17 37 ” 23rd — 30 69 ” 30th 2 21 59 November 6th 2 8 284 ” 13th 2 27 109 ” 20th 5 69 228 ” 27th 5 91 351 December 4th 1 124 454 ” 11th 3 109 441 ” 18th 5 127 411 ” 25th 2 72 270 January 1st 4 77 247 52 ERYSIPELAS The cases certified numbered 55, and there was one death—a female aged 52 years. The disease affected all ages, but it was much more frequent in adults than in children. The maximum incidence was in the last quarter of the year. A comparison between London and Shoreditch is contained in the following table:— Table No. 36 1937. Per 1,000 inhabitants. Deaths per 100 cases. Attack rate. Death rate. London 0.44 0.01 2.83 Shoreditch 0.67 0.01 1.82 Forty-five cases were removed to hospital, mostly to St. Leonard's,during the course of the year. PUERPERAL FEVER AND PUERPERAL PYREXIA Three cases of puerperal fever were notified during the year, giving a case rate of 0.04 per 1,000 population. There was one death due to sepsis. All three cases occurred in hospital. In the Borough provision is made for consultations under the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. No such consultations were held during the year. During the year 21 cases of puerperal pyrexia were notified. Of the 21 cases, 16 were removed to hospital. The final diagnosis in these cases was as follows:— Genital sepsis 6 Urinary infections 5 Influenza, bronchitis, etc. 3 Mastitis 3 Puerperal fever 2 Incomplete abortion 1 Mechanical failure of drainage 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. 53 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. In about 70 per cent. of cases the infection is gonorrhoeal in nature, and in these cases it 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:— Table No. 37 Cases. Vision unimpaired. Vision Impaired. Died. Notified. Treated at home. In hospital. 15 9 6 15 Nil Nil Of the six patients who were removed to hospital, 2 were treated at St. Margaret's Hospital, 1 at Royal Free Hospital, 2 at St. Leonard's Hospital and 1 at City of London Maternity Hospital. Of the nine patients treated at home seven attended other hospitals as out-patients. The case rate per 1,000 births was 12.28 as compared with 8.33 for London as a whole. In addition to these cases of ophthalmia neonatorum 27 cases of inflammation of the eyes were reported by the Medical Officer of Health of the London County Council. Of these three 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. The patients were males aged 7, 9, 22 and 23 years, and one female aged 3 months. These cases were evidently sporadic in nature. The diagnosis was subsequently altered to scarlet fever in respect of the male aged 7 years. The number of deaths from this disease in London and Shoreditch during recent years was as follows:— Table No. 38 1931 1932 1933 1934 1935 1936 1937 Shoreditch 6 6 6 2 2 3 3 London 131 131 116 80 73 72 85 54 The patient aged 3 months succumbed 11 days after notification, the cause of death being certified as meningococcal meningitis and broncho-pneumonia. There were in addition 2 deaths from this disease in persons who were not notified cases during life. ENCEPHALITIS LETHARGICA One case of this disease was notified during the year, a male aged 53 years. It is well known that the after effects of this disease present numerous administrative difficulties. At the end of the year 25 patients who were suffering from post-encephalitic symptoms were living in the Borough. There were two deaths of patients who were suffering from post-encephalitic symptoms. ACUTE POLIOMYELITIS One case of this disease was notified during the year, a male aged 7 years. The patient was discharged from the Queen's Hospital for Children as cured in December, 1937. Children of school age suffering from this disease may 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 90, of which 60 were in respect of the primary and 30 of the influenzal type. The attack rate for the two varieties, based on the notifications received, was 0.73 and 0.36, as compared with 0.36 and 0.20 for 1936. The number of deaths from pneumonia of all types was 91, which gives a death rate of 1.01 per 1,000. It will be apparent that during the year under review influenza contributed very little to the causes of death. Table No. 27 on page 43 shows that the cases of acute primary pneumonia were distributed more or less evenly throughout all the age groups. The highest incidence was in the first quarter, but there was also a high incidence in the fourth quarter. Of the 90 cases of pneumonia brought to the notice of this department, 38 received treatment in St. Leonard's Hospital, 13 in St. Matthew's Hospital, and 11 in other hospitals. 39 cases of pneumonia were visited by members of The District Nursing Association, who paid in all 679 visits to pneumonia cases. ANTHRAX No case of this disease was notified during the year. 55 MEASLES There were two deaths from measles daring 1937, both being males, aged 1 year 9 months and 1 year 4 months, respectively. The following table shows the numbers of deaths from measles in age groups for a period of years:— Table No. 39 Year. Under 1. 1 and under 2. 2 and under 5. 5 and under 10. 10 and under 15. Total deaths. 1927 2 4 1 - - 7 1928 9 28 19 3 - 59 1929 4 6 7 — - 17 1930 13 25 8 3 - 49 1931 8 11 6 1 - 26 1932 13 29 16 2 - 60 1933 1 4 2 — - 7 1934 5 15 8 1 — 29 1935 1936 7 24 8 2 - 41 1937 — 2 - - - 2 A comparison of the death rates from measles for Shoreditch, London, and England and Wales is given below:— Table No. 40 Year. Shoreditch. London Death rate. England & Wales Death rate. Deaths. Death rate. 1920 50 0 49 0.22 0.19 1921 18 0 17 0.05 0.06 1922 84 0 81 0.34 0.15 1923 23 0 21 0.08 0.14 1924 58 0.55 0.29 0.12 1925 34 0.32 0.07 0.14 1926 25 0.23 0.20 0.09 1927 7 0.09 0.04 0.09 1928 59 0.59 0.30 0.1l 1929 17 0.17 0.05 0.09 1930 49 0.59 0.23 0.11 1931 26 0.26 0.03 0.08 1932 60 0.63 0.19 0.09 1933 7 0.07 0.02 0.05 1934 29 0.32 0.20 0 .09 1935 0 0.00 0.00 0.03 1936 41 0.48 0.14 0.07 1937 2 0.02 0.01 0.03 In the report for 1935 the provisions of the Shoreditch (Measles) Regulations, 1935, were given. These regulations provide that every medical practitioner, as soon 56 as he becomes aware that a child under five years of age is suffering from measles, shall, provided that it is the first case in the household, forthwith send a notification to the Medical Officer of Health. The following table shows the number of accepted notifications during the quarters March, June, September and December of 1937, and the number of these cases removed to hospital. CASES NOTIFIED UNDER REGULATIONS Table No. 41 Quarter 1937. Under 1 1 and under 2 2 and under 3 3 and under 4 4 and under 5 Total. Cases removed. March 5 6 - 4 1 16 9 June 3 10 9 16 8 46 33 Sept. 4 13 5 3 5 30 16 Dec. 4 4 2 6 4 20 20 16 33 16 29 18 112 78 The ward distribution of the notified cases is given in the table below:— Table No. 42 Ward. Number of cases. Total. Male. Female. Moorfields 1 5 6 Church 9 19 28 Hoxton 11 2 13 Wenlock 11 9 20 Whitmore 11 14 25 Kingsland — 4 4 Haggerston 2 7 9 Acton 5 2 7 Total 50 62 112 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., 7, that there was no considerable outbreak of the disease in the Borough. The deaths occurred in the following age groups:—Under 1 year, 6; 5-10 years, 1. The death rate from this disease was 0.08. The deaths in London as a whole numbered 245, the death rate being 0.06. The number of cases removed to London County Council hospitals during the year was 97. 57 The following table gives comparative annual figures for mortality from whooping cough. Table No. 43 Year. Shoreditch. London Death rate. England & Wales Death rate. Deaths. Death rate. 1920 12 0.1l 0.17 0.12 1921 19 0.18 012 0.12 1922 27 0.26 0.25 0.17 1923 10 0.09 009 0.1l 1924 28 0.26 Oil 0.10 1925 29 0.27 019 0.16 1926 0 0.00 0.05 0.11 1927 24 0.22 012 0.09 1928 5 0.05 009 0.08 1929 40 0.40 0.26 0.16 1930 3 0.04 003 0.05 1931 11 0.11 007 0.06 1932 4 0.04 0.08 0.07 1933 14 0.15 0 08 0.06 1934 12 0.13 0.07 0.05 1935 4 0.04 0.04 0.04 1936 8 0.09 0.07 0.05 1937 7 0.08 0.06 0.04 Table No. 44 Year. Shoreditch. London Death rate. England & Wales Death rate. Deaths. Death rate. 1920 51 0.50 - 0.28 1921 27 0.26 0.23 0.24 1922 69 0.66 0.57 0.56 1923 14 0.13 0.17 0.22 1924 28 0.26 0.37 0.49 1925 19 0.18 0.24 0.33 1926 25 0.23 0.18 0.23 1927 25 0.24 0.40 0.57 1928 16 0.16 0.13 0.20 1929 68 0.68 0.71 0.73 1930 1 0.01 0.08 0.13 1931 23 0.23 0.25 0.36 1932 19 0.19 0.28 0.33 1933 45 0.48 0.52 0.57 1934 6 0.07 0.12 0.14 1935 14 0.16 0.11 0.18 1936 10 0.12 0.13 0.15 1937 28 0.30 0.40 0.45 INFLUENZA Twenty-eight deaths occurred from this disease, which gives a death rate of 0.30. The following table gives comparative annual figures for mortality from influenza. 58 The following table gives the age distribution of the 28 persons who died from influenza during 1937:— Table No. 45 Under 1 year. 1 — year. 5— years. 15 years. 25— years. 35— years. 45— years. 55— years. 65— years. 75— years. — 1 - 1 1 2 4 6 6 7 DIARRHCEA AND ENTERITIS During the year 11 deaths of children under two years of age from diarrhcea and enteritis, along with associated and other conditions, were reported. This gives a death rate of 0.13 per 1,000 population and 9.00 per 1,000 births. 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:— Table No. 46 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. 1936 1937 1936 1937 1936 1937 1936 1937 1936 1937 1936 1937 1936 1937 London 823 662 0.20 0.16 14.5 12.0 785 626 0.19 0.15 13.95 1 1.44 20.9 19.2 Shoreditch 28 11 0.33 0.13 21.98 9.00 25 11 0.29 0.33 19.60 9.00 25.3 16.7 The following table shows the monthly incidence of the deaths of true enteritis (that is, enteritis not associated with other diseases) in the seven years 1931-1337. 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 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. 59 Table No. 47 True Enteritis. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 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 1935 1 - - - 1 1 - - 1 1 - - 5 1936 2 3 2 — 1 1 1 - 2 - - 2 14 1937 1 2 - - - - - - - - 2 2 7 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. FACTORY AND WORKSHOP ACT It was not found necessary to serve any notice under Sections 108 or 110 of the Factory and Workshop 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. The particulars of these exclusions from school are as follows :— Table No. 48 Disease from which suffering or to which exposed. Number of exclusions from School. Measles and German measles 738 Scarlet fever 270 Diphtheria 246 Chicken pox 397 Whooping cough 160 Mumps 76 Dysentery 7 Scabies and Impetigo 144 Erysipelas 6 Other exclusions 121 2,165 60 NURSING IN THE HOME The Shoreditch and Bethnal Green District Nursing Association undertakes home nursing in the Borough and has 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 the Medical Officer of Health, (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. Below is a list of cases nursed under this agreement during the year 1937:— In addition to the cases referred to in the table, the District Nurses paid a number of visits to otorrhcea cases. These cases are referred to in another section of this Report (see page 99). Table No. 49 Under 5 Over 5 Disease. Cases Visits Disease. Cases Visits Abscess 1 6 Abortion 1 9 Bronchitis 10 115 Ante-natal conditions 7 115 Chicken-pox 1 6 Breast abscess 1 13 Circumcision 1 18 Enlarged breasts 3 26 Congestion of lungs 1 2 Influenza 14 104 Constipation 1 2 Mastitis 8 148 Cut chin 1 6 Miscarriage 8 108 Diarrhoea 1 6 Parturition 5 78 Discharging eye 7 113 Pneumonia 26 464 Gastro enteritis 2 17 Post-natal condition 5 121 Impetigo 13 210 Puerperal pyrexia 1 2 Influenza 1 8 Shingles 1 10 Intestinal 4 41 Threadworms 1 3 Mastoid 1 4 Tuberculosis 13 490 Nasal catarrh 1 6 Wax in ear 1 5 Nasal polypus 1 4 Neo-natal condition 3 32 Pneumonia 13 215 Post-natal condition 3 45 Pyrexia 1 6 Rheumatism 1 4 Septic hand 1 2 Septic spots 1 15 Septic throat 2 19 Spina-bifida 2 63 Stomatitis 2 23 Threadworms 29 259 Tonsils and adenoids 48 230 Ulcer of mouth 3 29 Totals 156 1,506 Totals 95 1,696 Table No. 50 Swabs for B. diphtheriae 883 Swabs for virulence test 9 Sputum for tubercle bacilli 83 Swabs for gonococci 28 Blood for Wasserman reaction 345 Blood counts 75 Blood, for typhoid, etc. 1 Blood, for pertussis 1 Stools for infective organisms 130 Urine for tubercle bacilli 1 Pus for tubercle bacilli 2 Routine examination of milk 91 Milk, for Brucella abortus 42 Milk, re souring, spores, etc. 1 Milks, for phosphatase test 4 Maternity outfits (for sterility) 3 Material in bread 1 Meat pie : complete examination 1 Watercress for infective organisms 2 Ice cream for infective organisms 1 Paste for infective organisms 2 Celery for infective organisms 4 Sausage for infective organisms 3 1,713 61 BACTERIOLOGICAL AND PATHOLOGICAL EXAMINATIONS With the exception of those carried out at the Tuberculosis Dispensary, all the examinations made directly on behalf of the Borough Council were performed by Dr. F. H. Teale at the University College Hospital Medical School, and the following is a summary of the work done by him for the Borough:— Examinations by Bacteriologists other than Dr. Teale:— Swabs for B. diphtheriae 7 FOOD POISONING During the year thirteen notifications of suspected food poisoning were received. These cases appeared to be minor gastric disturbances, possibly due to dietetic indiscretions. 62 DISINFECTION The premises disinfected numbered 989. The articles removed to the Borough Council's Disinfecting Station totalled 9,115 and included 899 beds, 262 mattresses, 1,663 pillows, 475 bolsters and 5,816 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 195, sub-section 4, of the Public Health (London) Act, 1936. 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 is 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 22 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 venereal disease during the past six years is as follows:— 1932 37 1935 22 1933 45 1936 35 1934 36 1937 28 63 IV.— TUBERCULOSIS There was during the year an increase in both the number of notifications and in the deaths from tuberculosis. The notification rate, namely, 1.70 per thousand population, was apart from 1933 the highest since 1931. The death rate, namely, 1.05 per thousand population, was equal to the highest since 1929. It is a little difficult to ascribe reasons for these considerable increases. There must of course be variations from year to year and in any year in which there is an increase in catarrhal conditions and respiratory conditions such as influenza, bronchitis, etc., the death rate from tuberculosis rises and the notification rate also tends to rise. It will be seen from Table No. 26 on page 40 that there was a large increase last year in the number of deaths from influenza and there was undoubtedly a large increase in the total incidence of influenza during the year. This therefore is probably one of the factors in the rise in the tuberculosis notification rate and the tuberculosis death rate. Another regrettable feature of the trend of tuberculosis at the present time is the high incidence of the disease among young adults. During the year 1937 the number of cases of tuberculosis between the ages of 15 and 25 years which came to the notice of the medical officer of health was as follows:—males 20, females 10. The total number of new cases for the year was 110 males and 67 females, so that 27.3 per cent. of the new cases occurred in persons between the ages of 15 and 25 years. In the report for 1935 mention was made of the investigation which was being carried out by Dr. F. Ridehalgh, working at the Royal College of Physicians under the auspices of the Prophit Trust. During 1937 Dr. Ridehalgh continued to investigate contacts between the ages of 15 and 25 years. For this work a separate clinic is held every six weeks, and the investigations include the carrying out of tuberculin tests and the radiological investigations of the contacts. The cost of the work is borne by the Prophit Trust. STATISTICS The total number of cases on the tuberculosis register on 31st December, 1937, was 1,456 as compared with 1,476 at the corresponding period of the previous year. This represents a decrease of 20 cases 64 There were added to the register during the year, on account of fresh notifications and inward transfers, 182 names. On account of cancellations, as a result of deith, removal from the area, cure, or change in diagnosis, 202 names were removed from the register (see Table No. 54 on page 66). NOTIFICATIONS During the year there were received notifications of 113 cases of pulmonary and 27 cases of non-pulmonary tuberculosis, making a total of 140 cases, of which 89 were males and 51 females. This represents an increase of 17 in the number of notifications of pulmonary disease, and an increase of 7 in the number of cases of non-pulmonary disease. Compared with the average for the previous five years these figures represent a decrease of 10 in pulmonary and an increase of 1 in nonpulmonary tuberculosis. Of the total cases, 25 were notified by private practitioners and 115 by medical officers of institutions. From the point of view of age grouping it is found that 8.85 per cent. of the total notifications of pulmonary tuberculosis which were received were in respect of children under 15 years and 91.15 per cent. were in respect of persons over 15 years, the corresponding figures for 1936 being 6.3 per cent. and 93.7 per cent. respectively. As regards non-pulmonary tuberculosis 62.96 per cent. were children under 15 years and 37.04 per cent. were individuals over 15 years. The corresponding figures for the previous year were 50.0 per cent. and 50.0 per cent., respectively. The following table gives details regarding the ages of notification of pulmonary and non-pulmonary cases respectively:— Table No. 51 Age periods. FORMAL NOTIFICATIONS Number of Primary Notifications of new cases of Tuberculosis. Total Notifications 0 to 1 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total (all ages) Pulmonary, males — — 3 3 8 4 14 15 10 15 3 75 92 females — 1 1 2 9 7 9 4 3 — 2 38 53 Non-pulmonary, males 1 3 3 2 2 1 — — 1 1 — 14 17 „ females — 3 2 3 3 1 — — 1 — — 13 15 65 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 1937:— Table No. 52 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 — 1 2 4 4 — 2 — 14 ,, females — - 1 — 1 3 3 2 1 1 1 13 Non-pulmonary, males — 1 1 2 — 2 — 1 — — 7 „ females 1 1 - - 1 - - - - - - 3 The source of information in respect of these 37 cases is also given in tabular form:— Table No. 53 SOURCE OF INFORMATION AS TO THE ABOVE-MENTIONED CASES No. of Cases. Pulmonary. Nonpulmonary. Death returns from local registrars 5 - transferable deaths from Registrar-General 1 3 Posthumous notifications 2 — "Transfers" from other areas (other than transferable deaths) 19 7 Other sources (if any) — — Total 27 10 Pulmonary and non-pulmonary 37 66 Further particulars regarding the notifications, with the reason for removal of cases from register, is given in the following table:— NOTIFICATION REGISTER Table No. 54 Number of cases of tuberculosis remaining on the Register at the 31st December, 1937 Pulmonary. Non-pulmonary. Total Cases Males. Females. Total. Males. Females. Total. 557 502 1,059 212 185 397 1,456 Number of cases removed from the Register during the year by reason inter alia of:— 1. Withdrawal of notification 3 1 4 — 1 1 5 2. Recovery from the disease 17 6 23 7 3 10 33 3. Death 52 28 80 9 6 l5 95 4. Otherwise (e.g., removal from district) 31 21 52 10 7 17 69 The distribution of the cases notified (primary notification) in the different wards is as follows:— Table No. 55 Ward. Pulmonary. Nonpulmonary Total. Rate per 1,000 population. Moorfields 3 1 4 1.2 Church 22 4 26 1.9 Hoxton 13 8 21 1.6 Wenlock 17 2 19 1.4 Whitmore 26 5 31 2.4 Kingsland 8 3 11 1.3 Haggerston 15 2 17 2.3 Acton 9 2 11 1.2 Totals 113 27 140 1.7 DEATHS The total deaths from tuberculosis of all types during the year numbered 86 of which 56 were males and 30 females. In the previous year the total number was 61, of which 35 were males and 26 females. Of the total deaths from tuberculosis, the pulmonary form of the disease accounted for 73, or 84.9 per cent., and the nonpulmonary form for 13, or 15.1 per cent. The death rate from pulmonary tuberculosis was 0.89 and from non-pulmonary 0.16, making a total death rate from all forms of the disease of 1.05. The corresponding figures for 1936 were, pulmonary 0.58, non-pulmonary 0.13, a total of 0.71. The average death rates for the five years 1932-1936 in respect of pulmonary tuberculosis, non-pulmonary tuberculosis and all 67 forms of tuberculosis, respectively, were 0.82, 0.12 and 0.94. The figures for 1937, therefore, represent an increase of 0.07 in the pulmonary and an increase of 0.04 in the non.pulmonary rate on the average of the five previous years, making an increase for all forms of the disease of 0.11 compared with the average of those years. The following tables show the incidence of cases of tuberculosis and of deaths from that disease for a number of years for Shoreditch, London and England and Wales respectively:— DEATH RATES PER 1,000 POPULATION Table No. 57 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 0.91 014 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 0.69 013 0.82 1934 0.93 0.11 1.04 0.73 0.10 0.83 0.64 0.13 0.77 1935 0.72 0.14 0.86 0.68 0.09 0.77 0 61 0.11 0.72 1936 0.58 0.13 0.71 0.69 0.09 0.78 0.58 0.11 0.69 1937 0.89 0.16 1.05 0.70 009 0.79 0.58 0.11 0.69 NOTIFICATIONS PER 1,000 POPULATION Table No. 56 Year. Shoreditch. London. England and Wales. Pul. Non. pul. All forms. Pul. Non. pul. All forms. Pul. Non. pul. All forms. 1925 2.28 0.57 2.85 1 .64 0.45 2.09 1 .49 0.49 1.98 1926 2.12 0.58 2.70 1.50 0.45 1.95 1 .43 0.47 1.90 1927 1.77 0.50 2.27 1 .50 0.42 1.92 1 .37 0.45 1.82 1928 2.03 0.53 2.56 1 .51 0.41 1.92 1.34 0.45 1.79 1929 2.18 0.36 2.54 1.60 0.37 1.97 1.32 0.42 1.74 1930 1.79 0.41 2.20 1 .49 0.34 1.83 1 .26 0.42 1.68 1931 1.66 0.38 2.04 1.45 0.32 1.77 1.24 0.40 1.64 1932 1.25 0.27 1.52 1.40 0.31 1.71 1.16 0.38 1.54 1933 1.68 0.32 2.00 1.37 0.29 1.66 1.10 0.35 1.45 1934 1.45 0.29 1.74 1.40 0.21 1.61 1.19 0.40 1.59 1935 1.22 0.31 1.53 1 .27 0.27 1.54 0.97 0.31 1.28 1936 1.12 0.24 1.36 1 .25 0.25 1.50 0.96 0.30 1.26 1937 1.37 0.33 1.70 1.33 0.25 1.58 0.96 0.31 1.27 68 TABLE OF YEAR OF NOTIFICATION OF ALL DEATHS DURING 1937 Table No. 58 Year of notification. Number of deaths in 1937. Total. Percentage of total deaths from tuberculosis. Male. Female. Pul. Non.pul. Pul. Non.pul. Died in Borough. 1914 - - 1 - 1 1.16 1915 1 - - - 1 1.16 1920 1 - - - 1 1.16 1929 - - 1 - 1 1.16 1931 1 — - - 1 1.16 1932 2 — — - 2 2.32 1933 2 - 1 - 3 3.49 1934 1 — 3 — 4 4.65 1935 3 — 4 — 7 8.14 1936 9 — 4 1 14 16.28 1937 8 6 3 - 17 19.76 Died outside Borough. 1923 - - 2 - 2 2.32 1928 - - 1 - 1 1.16 1930 1 — - - 1 1.16 1932 2 — - — 2 2.32 1933 2 — - - 2 2.32 1934 3 — - — 3 3.49 1935 2 — - - 2 2.32 1936 4 — - - 4 4.65 1937 3 — 1 3 7 8.14 1937 45 6 21 4 76 88.32 Not notified 4 1 3 2 10 11.68 Totals 49 7 24 6 86 100.00 69 DEATHS FROM TUBERCULOSIS IN THE BOROUGH DURING 1937. Table No. 59. 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. Whitmore. 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 1 2 3 2 2 6 11 17 13 11 15 1 2 3 — 7 5 8 11 16 2 8 5 4 3 5 1 5 3 56 30 86 18 38 16 1 14 Respiratory system — — — — 1 5 10 17 12 11 14 1 2 3 — 6 4 6 9 14 2 8 3 4 3 5 1 3 2 49 24 73 17 32 15 1 14 Central nervous system 1 1 3 1 — — — — — — — — — — — 1 1 — 1 — — 1 — — 1 1 3 3 6 — 3 1 — — Intestines and peritoneum — — — — 1 — — — — — — — — — — — 1 — — — — 1 — 1 — — — — — Vertebral column — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Other bones and joints — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Skin and subcutaneous tissue — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lymphatic system (abdominal glands excepted) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Genito-urinary system — — — — — — — — — — 1 — — — 1 — — — — — — — 1 — 1 — 1 — — — Other organs— Adrenals — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Other sites — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Disseminated tuberculosis— Acute — 1 — 1 — — 1 — 1 — — — — — — 2 — — 1 — — 1 — 1 3 4 1 — — — — Chronic — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Not distinguished as acute or chronic — — — — — 1 — — — — — — — — — 1 — — — — — — 1 — 1 — 1 — — — 70 Particulars of new cases of tuberculosis and deaths during the year 1937 are given in the following table:— Table No. 60 Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. M F. M. F. M. F. M. F. 0- - - 1 1 — - — 1 1- — 1 4 4 — — 2 3 5- 4 2 4 2 — — 1 1 10- 3 2 4 3 — 1 1 — 15- 9 10 2 4 3 2 1 — 20- 6 10 3 1 3 6 1 — 25- 18 12 — — 12 6 — — 35- 19 6 1 — 9 2 — 1 45- 10 4 1 I 10 1 — — 55- 17 1 1 — 12 3 1 — 65 and upwards 3 3 — — — 3 — — Totals 89 51 21 16 49 24 7 6 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year 1937 was 1 to 8.6. 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. INSTITUTIONAL ACCOMMODATION FOR TUBERCULOSIS Institutional treatment of 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 1937:— 71 Table No. 61 Number of intimations on Form 1 (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 46 60 38 29 Pulmonary, females 29 55 24 33 Non-pulmonary, males 3 4 1 6 Non-pulmonary, females 1 7 1 5 Totals 79 126 64 73 OUT-PATIENT TREATMENT Details of out-patient facilities will be found in the report of the Tuberculosis Officer (pp. 77-80.) PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These Regulations prohibit a person suffering from tuberculosis, and who is in an infectious condition, from following any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk. It was not necessary for these reasons to prohibit any person from following his occupation in a dairy during the year under consideration. SUMMARY OF WORK The work of the Tuberculosis Dispensary is summarised in the following returns to the Ministry of Health:— 72 73 TABLE No. 62. TUBERCULOSIS SCHEME of the SHORE- DITCH METROPOLITAN BOROUGH COUNCIL PULMONARY TUBERCULOSIS Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 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 1927 1927 1928 1929 1930 1931 1932 Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. plus Class T.B. minus 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) I Class T.B. minus 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 L Total (Class T.B. plus) Class T.B. minus Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 7 1 5 - 6 - 1 - - 1 1 - 1 - 1 1 - 1 - 1 2 - - - - 1 1 - - 1 2 2 2 - 4 F. 14 - 4 - - - - - - - - 2 - 2 5 2 1 3 1 - 1 - 1 2 - - ' - - 4 2 3 5 Children 1 - - - - 1 - - - - 1 - - - - 3 - - - - 4 - 1 - 1 4 - - - - 2 - - - Disease not Arrested. Adults M. 2 - 4 3 7 - - 2 - 2 - - 2 - 2 1 - 2 - 2 1 1 5 1 7 1 - 6 1 7 - 1 7 1 9 F. 2 - 5 - 5 - - 1 - 1 - - 2 - 2 - - 2 1 3 - - 2 1 3 1 - 2 1 3 1 1 2 2 5 Children 1 - - - - - - - 1 1 1 - - - - 1 - - - - - - 1 - 1 1 - 1 - 1 - - - - - Condition not ascertained during the year 3 - 2 1 3 1 - 1 - 1 1 - - - - 5 - 1 - 1 1 - - - - 2 - - - - - - - - - Total on Dispensary Register at 31st December 30 1 10 4 25 2 1 4 1 6 4 - 7 - 7 16 2 7 1 10 9 1 10 2 13 12 1 9 2 12 9 6 14 3 23 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered. Adults M. 52 7 6 13 2 1 1 1 - 2 - 2 - 3 - 3 2 2 - 2 1 - 1 - 1 - 1 - - 1 F. 44 3 4 - 7 1 - - _ - 5 - - - - - - 1 - 1 - 2 - - 2 1 - - - - - - - - - Children 20 1 - - 1 3 - - - - 1 1 - - 1 4 Lost sight of, or otherwise removed from Dispensary Register 177 27 58 19 104 15 II 10 5 26 20 2 16 4 22 28 8 15 4 27 26 4 11 2 17 11 5 19 1 25 10 5 20 3 28 Dead Adults M. F. 20 1 19 104 124 3 - 10 31 41 3 1 2 33 36 7 1 9 24 34 6 1 6 31 38 3 - 6 35 41 - - 4 23 27 12 2 11 52 65 2 - 1 14 15 4 - 5 20 25 3 - 6 20 26 1 - 2 17 19 4 - 2 23 25 - - 3 15 18 Chidren 2 - 1 3 4 - - - 2 2 1 - - - - - - - - - 1 - 1 2 3 - - - 2 2 - - - 1 1 Total written off Dispensary Register 327 41 99 178 318 26 12 21 52 85 35 4 25 57 86 42 12 31 48 91 42 7 22 52 81 22 5 28 61 94 10 6 27 42 75 Grand Totals 357 42 119 182 343 28 13 25 53 91 39 4 32 57 93 58 14 38 49 101 51 8 32 54 94 34 6 37 63 106 19 12 41 45 98 1933 1934 1935 1936 1937 (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 5 - 3 - 3 2 2 - - 2 - - - - - - - - - - - - - - - F. 3 3 1 - 4 3 - - - - - - - - - - - - - - - - - - - Children 2 - - - - 4 - - - - - - - - - - - - - - - - - - - Disease not Arrested. Adults M. 1 - 4 3 7 - - 10 2 12 6 3 11 3 17 3 2 14 3 19 15 5 24 1 30 F. - - 4 4 8 - 4 6 1 11 5 - 8 3 11 6 6 6 2 14 6 3 17 1 21 Children 1 - - - - 3 - 1 - 1 6 - 1 - 1 4 - - - - - - - - - Condition not ascertained during the year 1 - 1 - 1 - 1 - - 1 2 - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 13 3 13 7 23 12 7 17 3 27 19 3 20 6 29 13 8 20 5 33 26 8 41 2 51 (b)Notnowon DispensaryRegister and reasonsfor removal therefrom. Discharged as Recovered. Adnlts M. - - - - - - - - - - - - - - - - - - - - - - - - - F- - - - - - - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 16 14 21 5 40 10 3 14 1 18 5 1 9 4 14 2 1 - - 1 4 - 2 1 3 Dead. Adults M. - 1 10 21 32 2 - 6 23 29 - - 1 14 15 1 - 2 18 20 - - - 5 5 F. 2 - 3 16 19 1 - 1 15 16 - - 1 10 11 - - - 10 10 - - - 1 1 Children - - - 1 1 - - 1 2 3 - - - 1 1 - - - - - 1 - - - - Total written off Dispensary Register - 18 15 34 43 92 13 3 22 41 66 5 1 11 29 41 3 1 2 28 31 5 - 2 7 9 Grand Totals - 31 18 47 50 115 25 10 39 44 93 24 4 31 35 70 16 9 22 33 64 31 8 43 9 60 74 75 TABLE No. 63 NON-PULMONARY TUBERCULOSIS Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 of patient; remaining on the Dispensary Register; and (b) tha 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 1927 1927 1928 1929 1930 1931 1932 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary] Register on 31st December Disease Arrested. Adults M. 2 1 — — 3 — — — — — 1 — — — — — — — — 1 — 1 — — 1 — — — — — — — — — — F. — — — — — — — — — — — — — — 1 — — — — — 1 — — — 1 — — 1 — 1 — — — — — Children 6 2 — 5 13 4 — — 1 5 3 — — — 3 1 1 2 — 1 1 3 5 3 1 1 7 12 3 — — 2 5 Disease not Arrested. Adults M. 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 F. — — — — — — — — — — — — 1 — 1 — — — — — — — 1 — 1 — — 1 — 1 — — — 1 1 Children 1 1 — — 2 1 1 1 — — 1 2 — — — — — — — — 1 2 — — — — Condition not ascertained during the year 7 — 1 3 11 — — — — — 1 1 — 1 3 — — — — — 1 1 — 2 — — — 3 3 — — — — — Total on Dispensary Register at 31st December 17 4 1 8 30 5 — — 1 6 6 1 1 1 9 2 — 1 3 3 3 4 3 13 4 1 3 10 18 6 — — 3 9 Transferred to Pulmonary 1 — 1 — 2 1 — — — 1 — — — — — — — — — — — — — 1 1 — — — — — — — — — — b) Not nowon DispensaryRegisterl nd reasons for removaltherefrom.l Discharged as Recovered. Adults M. 4 — — 1 5 — — — — — 1 — — — 1 — — 1 — 1 — — — — — 1 — — — 1 — — — — — F. 3 — 1 4 8 — 1 — — 1 — — — 1 1 — — 1 — 1 — — — — — 1 1 — — 2 — — — — — Children 19 2 1 15 37 3 — 1 1 5 3 2 1 1 7 — — 1 2 3 2 1 — 1 4 2 1 — 1 4 — — — 1 1 Lost sight of, or otherwise removed from 23 6 2 23 54 10 — 4 15 5 3 2 3 13 6 3 2 7 18 10 2 3 3 18 1 1 1 5 8 5 — 1 4 10 Dead. Adults M. 1 — — — 1 — — — — — — — — — — — — 1 — 1 1 — — — 1 - 1 — — 1 — — — — — F. 3 — — — 3 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 2 1 - 2 5 1 — — — 1 — — — — — — 1 — — 1 — 2 — — 2 — 1 — — 1 2 1 — — 3 Total written off Dispensary Register 55 9 4 45 113 15 1 2 5 23 9 5 3 5 22 7 4 6 9 26 13 5 3 4 25 5 5 1 6 17 7 1 1 5 14 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 72 13 5 53 143 20 1 2 6 29 15 6 4 6 31 9 4 6 10 29 16 8 7 7 38 9 6 4 16 35 13 1 ' 8 23 1933 1934 1935 1936 1937 a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 1 — — — 1 — — — — — — — — — — — — — — — — — — — — F. 1 — — — 1 1 — 1 1 3 — — — — — — — — — — Children — 1 — 1 2 — — 1 — 1 — — — 1 1 — — — — — — — — — — Disease not Arrested. Adults M. 1 — — 1 2 2 - 1 - 3 1 - - 1 2 1 — 2 - 3 2 - 2 — 4 F, — — — 1 1 1 — — — 1 — — — — — —— 1 1 1 3 — — 1 3 4 Children — — — 1 1 4 — 1 3 8 2 — — 5 7 3 — — 5 8 2 2 1 1 6 — — 1 2 3 — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st 3 1 1 6 11 8 — 4 4 16 3 — — 7 10 4 3 6 14 4 2 4 4 14 — — — — — — — — — — — 1 — — 1 — — — — — — — — — — b) Not nowon DispensaryRegisterl nd reasons for removal therefrom.] j Discharged as Recovered. Ad u Its M. — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from 4 2 1 1 8 3 — 4 1 8 — 2 2 2 6 1 — — 1 2 — — — — — Dead. Adults M. 1 — — 1 2 1 — — — 1 - — — 1 1 1 - - - 1 1 1 1 — 3 F, — 1 — 3 4 — — — — — I — — — 1 — 1 — — 1 — 1 — — 1 Children — — — — — — — 1 1 2 — — — — 1 1 - - 1 - — 1 1 2 Total written off Dispensary Register 5 3 1 5 14 4 — 5 2 11 1 2 2 3 8 2 2 — 1 5 1 2 2 1 6 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 8 4 2 11 25 12 — 9 6 27 4 2 2 10 18 6 3 3 7 19 5 4 6 5 20 76 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 1937. Table No. 64 Pulmonary. Non-pulmonary. Total. Grand Total. Diagnosis. 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 50 28 5 2 6 5 5 3 56 33 10 5 104 *(b) Diagnosis not completed — — — — — — — 4 6 1 6 17 (c) Non-tuberculous — 101 108 69 53 331 B. Contacts examined during the year:— (a) Definitely tuberculous 2 3 — — — — — —. 2 3 — — 5 *(b) Diagnosis not completed 1 2 — 3 6 (c) Non-tuberculous 44 61 42 42 189 C. Cases written off the sary Register as: (a) Recovered 16 6 1 — 4 3 2 1 20 9 3 1 33 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) ,5, 177 115 97 540 D. Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 215 174 19 12 47 40 36 29 262 214 55 41 572 (b) Diagnosis not completed — — — — — — — — 5 8 1 9 23 1. Number of cases on Dispensary Register on January 1st 610 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 41 3. Number of cases transferred to other areas, cases not desiring further assisttance under the scheme, and cases " lost sight of " 62 4. Cases written off during the year as Dead (all causes) 73 5. Number of attendances at the Dispensary (including Contacts) 3,737 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 215 7. Number of consultations with medical practitioners: 8. Number of visits by the Tuberculosis Officer to homes (including personal consultations) 123 (a) Personal† 2 ‡Plus 33 visits to St. Leonard's Hospital (b) Other 172 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,986 10. Number of: (a) Specimens of sputum, etc., examined 803 (b) X-ray examinations made in connection with Dispensary work ‡378 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 259 *i.e., remaining undiagnosed on 31st Dec. [see Memo. 37/T (Revised), p. 10, Sec. II, Note 4]. ‡AlI 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. ‡Excluding Prophit Trust cases. 77 REPORT BY Dr. C. K. CULLEN, TUBERCULOSIS OFFICER During the year 1937, there was an increase of 20 per cent. in the number of new cases of tuberculosis notified in the borough of Shoreditch and an increase of 25 per cent. in the new cases coming under supervision at the Dispensary. It should be noted however that the figures for the previous year were unusually low. The increase in 1937 was rather higher proportionately in non-pulmonary than in pulmonary cases. The number of contacts attending for examination was slightly smaller, in spite of constant efforts to secure their attendance, but the number of contacts followed up by periodical examination was greater. Three of the five contacts subsequently notified as tuberculous might have been missed but for this following-up. The appointment of Tuberculosis Officers to act as honorary consultants in the County Council's general hospitals has been extended for another year, and I have continued to visit the tuberculosis wards of St. Leonard's Hospital fortnightly during the year. SPECIAL FACILITIES Radiological work : When the opinion of an expert radiologist is desirable, pulmonary cases are referred to the Royal Chest Hospital, and the reports given by Dr. Peter Kerley continue to be of great value and assistance. Considerable use has been made during the year of the facilities for X-ray work provided by the County Council at St. Leonard's Hospital : the films taken there are interpreted by the Tuberculosis Officer and in any case of doubt the patient is referred to Dr. Kerley afterwards. Non-pulmonary cases are usually under the care and supervision of a surgeon at a general hospital but any X-ray examination of these cases that may be required by the Dispensary is usually carried out either at St. Leonard's Hospital or the Royal Northern Hospital and reported on by the Hospital radiologist. Since the introduction of the special facilities for X-ray examination at the County Council's general hospitals I have referred an increasing number of non_ pulmonary cases for radiological investigation of the pulmonary condition. In an appreciable proportion of these cases I have found either an old or an active lesion of the lungs which had previously escaped notice. I am of the opinion that in all so-called " surgical" cases a routine radiological investigation into their pulmonary condition should be carried out. During the past year the following X-ray examinations were made at the request of the Tuberculosis Officer:—199 at the Royal Chest Hospital, 178 at St. Leonard's Hospital, and 1 at the Royal Northern Hospital. In addition, a number of examinations of contacts were carried out under the auspices of the Prophit Trust (see below). 78 Artificial Pneumothorax Treatment: This treatment is almost invariably initiated while the patient is in sanatorium or hospital and the refills are continued when the patient returns home at one or other of the chest hospitals. A few cases who have been under treatment in Colindale or Grove Park Hospitals continue to attend there for refills after discharge. The total number of refills chargeable to the Dispensary in 1937 was 177, of which 104 were carried out at the Royal Chest Hospital, 15 at Colindale Hospital, 35 at the London Chest Hospital (Victoria Park), and 23 at Grove Park Hospital. The charge per refill is 10s. 6d. which includes any necessary X-ray examinations made for the control of the treatment. Finsen Light Treatment: Cases of lupus are usually referred to the London Hospital Skin Department for treatment. Most of them are treated by Finsen Light, occasionally supplemented by general arc-light. Of the three cases mentioned in last year's report, two are still under treatment and progressing favourably and the third has removed to another district. Three new cases have been referred to the Hospital during the year. Two of these are receiving light treatment and the third general treatment without any form of light owing to occasional attacks of epilepsy. The total number of attendances for Finsen Light which were chargeable to the Dispensary during 1937 was 101 and for general arc-light in lupus cases 82. The charge per attendance for Finsen Light is 5s. and for general arc-light 1s. Ear, Nose and Throat Cases : Eight cases were referred for an opinion to Mr. A. M. Zamora, F.R.C.S., Consulting Laryngologist to the Royal Chest Hospital. Apart from the primary examination, some of these cases are kept under supervision with regard to their throat condition by Mr. Zamora, whose advice and assistance continue to be much valued. Dental Treatment: Patients are referred to the Shoreditch Borough Council's Dental Hospital unless they prefer to make arrangements for treatment privately. In the case of tuberculous patients or other members of the patient's family, the assessment for payment is made by the Tuberculosis Care Committee subject to approval by the Public Health Committee. A large proportion necessarily receives treatment free. Diseases of the Eye are rarely met with at the Dispensary as they usually go in the first instance to an Eye Hospital. If they first come under notice at the Dispensary they are usually 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, usually St. Bartholomew's, the London, or the Metropolitan, or to the Queen's Hospital for Children. After-care in surgical cases is supervised by the surgeon who originally recommended sanatorium treatment or by one of the County Council's After-Care Clinics, but the patient is also seen from time to time at the Dispensary. In rare cases, supplementary treatment in the way of 79 artificial sunlight is recommended. One case of Bazin's disease (tuberculous ulceration of the legs) was so recommended during the year and attended the London Hospital for 31 treatments. Residential Treatment for tuberculosis in all forms is ordinarily provided by the London County Council and the treatment is free. A few cases suffering from advanced and incurable disease who are unwilling to go into the County Council's general hospitals are sent through voluntary agencies to Homes for the Dying. Boarding-out of Child Contacts : When for one reason or another pulmonary cases with positive sputum have to remain at or return home, it is sometimes advisable— especially if the home circumstances are poor—to arrange for the boarding out of child contacts in order to minimise the risk of infection, until suitable steps have been taken to improve the home conditions. Such arrangements are made, free of charge to the family, by the County Council, who will also arrange for the care of children if the mother has to go away to sanatorium and there are no relatives in a position to look after them. Convalescence for non-tuberculous but ailing children is usually arranged through the Invalid Children's Aid Association. Nursing for bed-ridden patients is provided by the Shoreditch and Bethnal Green Nursing Association, the Borough Council paying Is. 4d. a visit. 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, the cost being met by the Borough Council. There has been a considerable increase in the number of patients who needed extra nourishment: 113 were helped in this way during the year and 57 were receiving these extras on Dec. 31st, 1937. Patients in receipt of relief from the Public Assistance Committee are recommended to that body for extra nourishment, which is usually granted on the certificate of the Tuberculosis Officer. Similarly patients dependent upon the Unemployment Assistance Board are referred to the Board but there has been some difficulty from time to time in getting the Board to accept responsibility. The number of shelters (lent by the Borough Council) in use during the year was 2, and the number of patients to whom beds and/or bedding were on loan was 25. Prophit Trust Research Scheme : Under this scheme special investigation is being made into the incidence of tuberculosis in contacts between the ages of 15 and 25. Shoreditch contacts belonging to this age-group are examined by Dr. Ridehalgh, the Research Scholar appointed by the Royal College of Physicians under the auspices of the Trust, and a special evening session is held for this purpose approximately every six weeks. The investigation includes radiological and tuberculin tests and the cost is borne by the Prophit Trust. 80 A few comparative figures relating to the work of the Dispensary for the years 1937 and 1936 are given below:— Table No. 65 1937 1936 Total attendances 3,737 3,845 Total examinations 1,586 1,683 New cases of tuberculosis coming under supervision of Dispensary 109 84 Contacts examined 208 209 Sisters' Visits 2,986 3,136 *Tuberculosis Officer's visits 123 152 *ln addition visits were made by the Tuberculosis Officer to St. Leonard's Hospital. Comparative numbers of insured and non-insured persons who attended were:— 1937 1936 Insured 1,872 1,866 Non-insured 1,865 1,979 Special sessions for school children are held weekly and the following table shows their attendances for each month:— Table No. 66 1937 1936 1937 1936 January 36 25 July 17 16 February 42 46 August 14 6 March 36 63 September 29 27 April 35 36 October 31 35 May 31 41 November 34 32 June 62 31 December 23 48 Total attendances 390 406 Total examinations 201 201 Laboratory examinations made at the Dispensary during the year:— 1937 1936 Sputum 773 49 Urines, etc 30 34 X-ray examinations:— 1937 1936 378 268 81 SHOREDITCH TUBERCULOSIS CARE COMMITTEE The following is the annual report of the Tuberculosis Care Committee. During the year 1937 there has been nothing in the work of the Tuberculosis Care Committee which differs materially from that of the previous two years. The number of new patients has increased slightly this year and the number of cases helped is also larger. The Committee have relied, as will be noticed, more than ever upon the Shoreditch Tuberculosis Fund, but it is a natural thing that, wherever this Fund can as well be employed, application is not made elsewhere. Nevertheless, the Committee still have to thank many outside bodies for their help; the Public Assistance Committee, to whom so many of the patients have to apply; the Red Cross Committee who always have ready help for patients who are war pensioners; the East London Workers among the Poor who are particularly helpful in sending for convalescence members of a patient's family who are in need of a rest; the School Care Committee who assist by giving school meals and free milk to the school children ; and the many other societies both in the Borough and outside who have worked with the Committee during the year. It is regretted that repeated difficulty has been experienced with regard to the cases of patients and their families who are dependent on the Unemployment Assistance Board and that so far it has been impossible to establish a basis of friendly co-operation with the particular Area Office which covers the greater part of the Borough of Shoreditch. The assistance given to patients from the Fund has been along the usual lines for the most part—clothing for sanatorium, fares for relatives to visit, pocket-money given, etc., and these, although most important from the patient's point of view, make monotonous reading and can as well be appreciated from the plain statement of the figures appended. With the development of the Fund, however, there has been an increase in the number of cases where " special help " has been given. This includes help formerly outside the Committee's scope and can best be explained by the two following examples. 2516. Patient, husband and four children moved to an L.C.C. house at Dagenham, Husband, the only wage-earner, coming to Shoreditch to work. The journey proved long and expensive and the family was left with insufficient money for food. The Committee provided him with a bicycle. 82 2565. Patient has been unfit for work for years and the main income was from his wife's earnings. Before the patient was notified his wife had been ill for six months and was unable to work ; as she was uninsured she had no sickness benefit. During this time debts accumulated and on her return to work she was unable to reduce the debts because the interest on them was taking all her spare money. The debts were paid by the Fund and the patient's wife has almost finished repaying the amount loaned to pay this debt. Unfortunately there remain big problems for which the Committee still have no remedy. Those most constantly apparent are unemployment and housing. There are so few light jobs and so few employers who would willingly employ a tuberculous patient that the Committee cannot make any pretence to help patients to find work. The housing problem is hardly less acute. Many families must remain in Central London and, unless they live in a street which is dealt with under a slum clearance scheme, they stand little chance of moving within a reasonable time. There is therefore an increasing tendency to move to one of the London County Council's estates outside the London area if it is at all possible. It was once felt that this tendency should be encouraged because of the obvious advantages of a house in a healthier district, but during the year several families have either returned to Shoreditch or have made application to do so. They find that the price of food is higher, travelling expenses greater and, in certain instances, that the amenities for tuberculous patients are fewer. With these points in mind the Committee feels compelled to urge each applicant to consider whether the family income is large enough to meet these demands whilst maintaining a sufficient standard of food. Whilst the Committee is therefore happy to report its success in being able to help patients and their families in many ways, there are still problems which are at last being dealt with but which will not be overcome for some time. 83 Figures for the year's Care Work:— Table No. 67 1937 1936 New patients 118 96 Re-registrations 27 23 Dental cases 8 8 Visits paid 435 467 Interviews 393 371 Cases reported to Committee: New cases 80 110 Re-registrations 20 24 Dental cases 14 11 Care work 136 111 Admissions 145 160 Discharges 86 103 Deaths 38 41 Referred : Shoreditch Tuberculosis Fund 110 62 Public Assistance Committee 13 17 London County Council 10 11 Red Cross Committee 2 4 Approved Societies 2 — Friends of the Poor 1 — East London Workers among the Poor 1 1 British Legion 1 1 Details of Care Work: Clothing obtained 68 56 Relief obtained 2 11 Relief increased 6 2 Fares paid 27 12 National Health Insurance contributions paid 5 3 Bedding obtained 1 — Rent paid 22 5 Admitted to Homes 3 1 Housing accommodation obtained 2 — Removal expenses paid 9 1 Pocket money paid 4 5 Surgical appliance supplied 2 1 Special help 13 4 84 SHOREDITCH TUBERCULOSIS CARE COMMITTEE, 1937 Councillor Mrs. M. Higgins Public Health Committee. Councillor Mrs. H. Alsford Public Health Committee. Councillor Mrs. H. Girling, O.B.E., J.P., L.C.C. — Mr. Councillor C. J. Smith Mr. Councillor S. Landau — Mr. Councillor H. S. Ceeney — Mr. Councillor A. E. Hills Public Health Committee. Dr. Margaret Hogarth Divisional Medical Officer. Miss G. Murch District Organiser, School Care Committee. Miss Parsell London Insurance Committee. Miss A. Broomfield Invalid Children's Aid Association. Miss D. F. Lee District Nursing Association. Mrs. Salmon — Mrs. Lock — Mrs. Angel Public Assistance Committee. Sister A. A. Grange Tuberculosis Visitor. Sister W. Hiscoke (resigned during year) Tuberculosis Visitor. Dr. C. K. Cullen Tuberculosis Officer. Dr. E. Ashworth Underwood (resigned 18-10-37) Medical Officer of Health. Secretary Mrs. G. B. Green. 85 SHOREDITCH TUBERCULOSIS FUND Committee: Councillor Mrs. M. Higgins (Chairman), Councillor Mrs. H. Alsford, Miss D. F. Lee, Mrs. Salmon, Dr. C. K. Cullen. Hon. Treasurer: R. Jones, Esq. Secretary : Mrs. G. B. Green. The fund is devoted to the following objects:— 1. To cover the expenses of the Handicraft Class. 2. To provide clothing and boots. 3. To assist with the removal expenses when better housing accommodation has been obtained. 4. To pay arrears of National Health Insurance in order to entitle a patient to benefit. 5. To pay fares for relatives to visit patients not more often than once in three weeks. 6. To provide pocket-money in special cases to patients at sanatorium, such pocket-money not to exceed 2s. weekly. 7. To assist, in certain special cases approved by the Tuberculosis Officer, patients and/or their families in ways which are not specifically mentioned in the preceding six clauses provided that the persons assisted are ineligible to obtain such assistance from any other charitable organisation or from the Public Assistance Committee, and provided that the members of the Fund Committee are agreed that such assistance would be legitimately supplied through a Fund of this nature. 86 v.—MATERNITY AND CHILD WELFARE As has been previously pointed out, in a moderately small area like Shoreditch, the annual mortality rates for both mothers and children are apt to show fairly wide variations. This is especially the fact with regard to the maternal mortality rate, where even one death makes a considerable difference in the rate for the borough. An indication of this wide variability is obtained by considering the rates over the last four years. For example, in 1934 there was one maternal death giving a maternal mortality rate of 0.69 per thousand live births, in 1935 there were four deaths, giving a rate of 3.10, in 1936 there were no deaths, giving a rate of 0.0, and last year there were four deaths, giving a rate of 3.27. Similarly with the infant mortality rate. In 1934 there were 122 deaths of infants under one year of age, giving a rate of 84 per thousand live births, in 1935 there were 67 deaths, giving a rate of 52, in 1936 the deaths increased to 95, giving a rate of 75, and last year the deaths fell to 66, making a rate of 54 per thousand live births. It is obvious, therefore, that it is as a rule unsafe to generalise from yearly figures, but nevertheless I think it can be said that on the whole the position in Shoreditch is satisfactory. STATISTICS INFANTILE MORTALITY The number of children under one year of age who died in 1937 was 66, of whom 36 were males and 30 females, as compared with 95 (males 55, females 40) for 1936. The infant mortality rate was 54 as compared with 75 for the previous year, and an average of 73 for the previous five years. The rate for England and Wales was 58, or 7 per cent., and for London 60, or 11 per cent. higher than the rate for Shoreditch. CAUSES OF DEATH The causes of death of the 66 infants who died in 1937 are set out in table No. 20 facing page 34. The main causes of death were diarrhoea and enteritis (11 deaths); pneumonia (17 deaths); prematurity (14 deaths); and whooping cough (6 deaths). The corresponding figures for the year 1936 for the first three of these causes was 25, 22 and 13, respectively. 87 The following table gives the death rate for premature infants over a series of years:— Table No. 68 Shoreditch. England and Wales. Year. Total births. Deaths from prematurity. Death rate (per 1,000 births). Total births. Deaths from prematurity. Death rate (per 1,000 births). 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 1935 1,290 16 12.40 599,167 10,315 17.21 1936 1,274 13 10.20 605,609 10,106 16.69 1937 1,222 14 11.46 610,850 10,374 16.98 The actual age incidence of the Shoreditch infants who died from prematurity is shown in the following table :— Table No. 69 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. 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 — — — 1935 1,290 12 15 1 — — — 1936 1,274 11 11 2 — — — 1937 1,222 11 13 1 — — — 88 The first of these tables shows that there has been no substantial change in the death rate for these premature infants either in Shoreditch or in England and Wales as a whole. The rates for Shoreditch—being calculated from a smaller number of deaths—show more fluctuation than the rates for the country as a whole, but it is obvious that in this short period there has been no substantial decrease in the rate. The second table shows that of the 351 infants who died of prematurity during the fourteen years 1924 to 1937, 252 (or 71.8 per cent.) died within the first week, and 318 (or 90.6 per cent.) died within the first month. The second table shows that there was a slight increase in the number of premature infants who died later than the first week and before the end of the first month. DEATHS IN AGE GROUPS Table No. 20 opposite page 34 gives particulars of the deaths at different ages under one year. Of the total of 66, 7 (10.60 per cent.) occurred on the first day of life 14 (21.21 per cent.) within the first week; 19 (28.79 per cent.) in the first month; 11 (16.67 per cent.) between 1 and 3 months; 19 (28.79 per cent.) between 3 and 6 months; 7 (10.60 per cent.) between 6 and 9 months, and 10 (15.15 per cent.) between nine months and one year. The following table sets out these particulars for the last ten years:— Table No. 70 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. 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 1935 8 23 30 14 8 7 8 1936 14 19 23 11 25 17 19 1937 7 14 19 11 19 7 10 ILLEGITIMATE DEATH RATE Of the 47 illegitimate births, in 4 or 8.51 per cent., death occurred before the child reached the age of one year, which corresponds to an infantile mortality rate of 85 per 1,000 births. This is a decrease as compared with 1936. 89 MATERNAL MORTALITY The following table shows the maternal mortality rates for a period of years:— Table No. 71 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 2.48 4.60 1935 4 3.10 2.58 4.10 1936 0 0.00 1.92 3.65 1937 4 3.27 2.29 3.23 MATERNITY WORK ANTE-NATAL SUPERVISION The ante-atal 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; (b) medical examinations and supervision at ante-atal 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-atal clinics. In addition certain women whose confinement is to be conducted by the municipal midwife are visited by her during their pregnancies. The municipal midwife also visits expectant mothers who are to be confined by students of St. Bartholomew's Hospital under her supervision. The following table 90 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:— Table No. 72 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Number of individuals visited 592 641 631 568 636 456 805 706 842 707 Total number of visits paid 1,045 1,156 1,215 1,011 1,075 998 1,573 1,597 1,958 1,423 Average number of visits per individual 1.8 1.8 1.9 1.8 1.7 2.2 2.0 2.3 2.3 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 576 expectant mothers attended at the ante-natal clinics and 2,054 attendances were made in all. This represents a decrease of 56 individuals and 102 total visits on the figures for 1936. The average attendance per individual works out at 3.57 visits. The following table shows particulars of the ante-natal attendances for a period of ten years:— Table No. 73 Year. First visits by expectant mothers. Total attendances. Average attendance per individual. 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 1935 587 2,066 3.52 1936 632 2,156 3.41 1937 576 2,054 3.57 The number of women who attended the ante-natal clinics during 1937 amounted to approximately 46 per cent. of the confinements of mothers resident in the Borough during the year. 91 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 not required during the year covered by this report. NATAL WORK MIDWIVES The number of midwives practising in Shoreditch at the end of the year was approximately 25. Many of these are attached to organisations outside the borough. The only midwives actually resident in the Borough for domiciliary cases are the two municipal midwives and the midwives under the Salvation Army at 67, Nichol Square. The number of births attended by midwives was 463, which represents 37 per cent. of the total births notified during the year. MUNICIPAL MIDWIVES A 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 has 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. It will be seen from the table below that the expansion of this work necessitated extra assistance. A temporary additional midwife was appointed on March 18th, 1936, and with slight breaks she continued in the Council's employment until October when the Council on the recommendation of the Maternity and Child Welfare Committee appointed her as a second municipal midwife. The following table shows the number of cases attended by students from St. Bartholomew's Hospital and the municipal midwives since the inception of this service:— Table No. 74 1931 1932 1933 1934 1935 1936 1937 Municipal Midwives— Number of cases attended 1 35 55 41 75 136 116 „ „ ante-natal visits — 202 148 169 440 507 664 „ „ ante-natal clinics attended * 60 46 40 46 41 48 „ „ post-natal clinics attended * 6 2 3 8 2 4 St. Bartholomew's Hospital— Number of cases attended 7 91 81 57 38 30 23 „ „ ante-natal visits - 394 350 286 246 185 192 * No figures available. 92 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 1,260 confinements which occurred during 1937, 739, or 59.0 per cent., took place in institutions, and 521, or 41.0 per cent., in the homes of the women concerned. MATERNITY DRESSINGS During the year 486 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. HOME HELPS Home helps are provided from a panel of 12 women who have been approved for this duty by the Maternity and Child Welfare Committee. During the year these women attended, to assist with the housework, etc., 184 cases, of which 154 were conducted by midwives, 14 by students from St. Bartholomew's Hospital, 1 by a student from the London Hospital, 4 where the patient was admitted to St. Leonard's Hospital, in 7 cases of illness on the recommendation of medical practitioners, and 4 where mothers had been sent for convalescence. 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 six years:— 93 Table No. 75 Year. First visits by nursing mothers. Total attendances. Average attendance per individual. 1932 176 290 1.65 1933 152 287 1.89 1934 151 286 1.89 1935 198 327 1.65 1936 193 276 1.43 1937 212 339 1.60 This clinic continues to fulfil a very necessary function, but as yet it does not deal with as many mothers as should normally attend for examination. BREAST-FEEDING CLINIC This clinic is held in the specially designed quarters adjoining the light clinic in the new building at the rear of the model welfare centre. The clinic is open on Mondays from noon to 5 p.m. and Wednesdays and Fridays from 9 a.m. to 5 p.m. each week, and a mother can attend as often as is necessary between these hours or, if advised to do so, she can spend the whole day at the clinic. During the year 263 individual mothers attended the clinic as compared with 296 in 1936. In 24 instances it was possible to establish total restoration of breast feeding, and in another 154 instances a partial restoration was effected. In 24 cases the establishment of breast milk was impossible. Three cases were weaned for medical reasons and 31 cases required regulation only. Of the 263 cases, 17 attended because of over feeding of the children, and in 33 instances the children were not receiving sufficient nourishment. Breasts were treated in 7 instances. Seven babies were admitted to the ward of the model welfare centre for observation. During the year 32 visits were paid to persons who had defaulted. PUERPERAL FEVER Three cases of puerperal fever were notified during the year. The cases occurred in hospital. During the year 21 cases of puerperal pyrexia were notified. Further notes on these conditions will be found on page 52. 94 STILL BIRTHS The following table gives a comparison between live and still births notified for the last ten years:— Table No. 76 Year. Live births notified. Still births notified. Total births notified. Percentage of still births to total births. 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 1935 1,266 44 1,310 3.36 1936 1,246 42 1,288 3.26 1937 1,224 36 1,260 2.86 HOME VISITING The number of visits paid by the health visitors during the year was 18,070. Of these 1,236 were first visits, 3,228 were subsequent visits to infants of under one year, and 8,778 visits to children between one year and five years of age. These figures should be compared with 1,240, 3,802 and 10,220 for 1936. A summary of the work done by the health visitors appears below. Further particulars will be found in table No. 78. Table No. 77 Number of first visits to infants 1,236 Number of first visits to children one to five years 990 Number of re-visits to infants 3,228 Number of re-visits to children one to five years 7,788 Number of visits to still births 33 Number of visits to ophthalmia cases 49 Expectant mothers—first visits 707 Expectant mothers—re-visits 716 Puerperal Fever—first visits and re-visits 2 Puerperal Pyrexia—first visits and re-visits 14 Number of futile visits 3,340 In addition to the above visits the health visitors interviewed mothers on 3,602 occasions. 95 STATISTICAL REPORT FOR 52 WEEKS ENDED 1st JANUARY, 1938, UPON THE WORK OF THE HEALTH VISITORS Table No. 78 Health Visitors' Districts. 1 2 3 4 5 6 7 8 9 10 Total. First visits to infants 168 112 196 146 125 85 94 115 35 160 1,236 Re-visits to infants 395 165 387 359 247 457 398 274 216 330 3,228 Visits to children aged 1-5 years 1,009 569 1,397 707 544 1,116 956 874 851 755 8,778 First visits to expectant mothers 88 36 103 99 82 62 55 87 12 83 707 Re-visits to expectant mothers 104 64 37 115 38 77 87 90 50 54 716 Futile visits 195 69 214 325 420 234 358 906 195 424 3,340 Interviews, etc. 508 139 443 371 591 321 310 186 130 603 3,602 First visits to cases of ophthalmia neonatorum, etc. - 3 7 8 3 2 2 - - - 25 Re-visits to cases of ophthalmia neonatorum, etc. — 1 8 1 5 6 3 — — - 24 First visits to cases of puerperal fever - - - - - - 1 - - 1 2 Re-visits to cases of puerperal fever - - - - - - - - - - - First visits to cases of puerperal pyrexia — — 2 1 — — 3 — — 1 7 Re-visits to cases of puerperal pyrexia — — 1 — — — 5 — — 1 7 Health Visitors' attendances at centres:— (a) Hoxton Market Institute 57 2 5 2 1 91 — — — — 158 (b) Hoxton Hall — — 5 91 — — — — 3 44 143 (c) St. Helen's Club — 3 2 8 88 84 — — — 4 189 (d) Model Welfare Centre 179 365 114 214 53 54 — — 37 63 1,079 (e) Haggerston Hall 4 — 49 — — 1 — — — — 54 (f) Harbour Lights 41 — 47 — — 1 — — — — 89 (g) School for Mothers - - - - - - 200 209 - 409 96 ATTENDANCES AT WELFARE CENTRES DURING THE 52 WEEKS ENDED 1st JANUARY, 1938 Table No. 79 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. Thur. Tue. Thu. a.m. p.m. p.m. p.m. p.m. p.m. p.m. a.m. p.m. p.m. p.m. p.m. p.m. p.m. p.m. a.m. p.m. p.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. M.C. H.H. M.C. First attendances of infants 26 42 71 61 60 42 84 9 39 75 58 33 34 41 120 — 79 24 22 73 993 Total do. do. 695 1,272 791 687 929 846 1,104 202 780 1,230 1,009 717 753 559 1,482 28 1,168 532 416 1,585 16,785 First attendances, children over 1 year 2 8 27 33 9 4 10 4 12 20 12 6 15 16 40 — 23 13 7 21 282 Total do. do. 612 1,035 937 840 760 566 797 290 897 913 1,086 851 916 595 1,265 24 1,180 549 744 1,263 16,120 Attendances—Mothers without children 77 318 232 226 263 216 357 92 252 136 377 309 324 260 — — — 71 307 312 4,129 First exam. by Doctor— Infants 25 41 68 61 60 41 84 10 37 74 60 33 34 43 115 — 78 20 21 69 974 Total infants seen by Dr. 370 705 506 458 546 563 556 91 437 646 487 369 406 314 933 19 704 244 192 625 9,171 First exam. by Doctor— Children 1-5 years 2 6 26 31 10 4 9 4 11 20 10 11 12 11 40 — 23 9 3 14 256 Total children seen by Dr. 324 487 576 494 468 414 472 160 519 546 585 543 524 331 860 16 858 244 441 583 9,445 Suffering from disorders of digestion and nutrition 1,453 462 1454 833 187 158 938 86 639 6,210 Suffering from minor ailments 387 350 1170 774 318 615 1005 90 469 5,178 Referred to hospital 39 155 95 44 58 16 54 11 82 554 First toddlers' attendances 26 61 19 35 32 24 - 21 19 237 Total do. do. 32 83 19 44 38 29 - 27 25 297 First ante-natal do. 66 104 74 54 42 29 110 20 77 576 Total do. do. 181 302 244 190 181 123 449 113 271 2,054 First post-natal do. 38 18 16 21 13 14 46 7 39 212 Total do. do. 44 21 20 25 18 14 135 1 1 51 339 Sewing class do. 130 143 28 131 36 - 413 31 160 1,072 *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. 97 INFANT WELFARE CENTRES In the Borough of Shoreditch there are 19 infant welfare clinics. Eight 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), Harbour Lights (one) and Herbert Street (three). The total first attendances of infants during 1937 was 993 as compared with 964 in 1936. The figure for the total attendances was 16,785 as compared with 15,961 in 1936. The first attendances of children was 282 against 299 in 1936. The total attendances of children between one and five years was 16,120 against 16,197 for 1936. The average number of attendances per infant in 1937 was 16.9 and the corresponding figure for 1936 was 16.6. The number of first examinations of infants was 974 (98.1 per cent. of the total infants who attended on at least one occasion). The corresponding figure for children between one and five years was 256, which represents 90.8 per cent. of the total children at 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 924, and the corresponding number between one and five years was 2,311; hence the total number of children under five years of age who were on the registers at the end of the year was 3,235. Of this total 554 were referred to hospital by clinic doctors during the year. This represents 17.1 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. 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 seven years are shown in the following table:— 98 Table No. 80 1931 1932 1933 1934 1935 1936 1937 Number of children 269 257 214 262 260 427 440 Number of mothers - — - 21 44 45 38 Total attendances of children 4,973 5,552 5,655 5,654 5,813 6,599 6,101 Total attendances of mothers - - - 284 462 498 382 Average number of visits per— child 18.5 21.6 26.4 21.6 22.4 15.5 13.9 mother — — — 13. 10.5 11.1 10.0 Average number of attendances per session— children 24.5 27 27.9 23.9 19.4 21.3 20.3 mothers — — — 5.5 4.7 4.8 2.6* * Up to 26th March, 1937, mothers attended only two sessions weekly, after this date they were allowed to attend any day during the week. This has accordingly reduced the average number of attendances per session. The conditions for which treatment was given during the year are shown in the following table:— Table No. 81 Muscular weakness 39 Anaemia 19 Debility 53 Bronchitis 11 Rickets 68 Malnutrition 58 Late results of rickets 46 For prophylactic purposes 74 Enlarged glands 3 Other minor conditions 16 No diagnosis 53 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 13. Valuable assistance has been given by voluntary workers at this clinic throughout the year. DENTAL CLINIC The dental treatment of cases of mothers and children referred by the clinic doctors is carried out by the dental surgeons in the municipal 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. 99 Table No. 82 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 1935 240 216 1,325 478 1936 245 310 1,365 716 1937 232 248 1,149 607 During the year 232 women were referred from the maternity centres for dental examination; 197 of these attended for a course of treatment. 1,149 visits were paid in all. 248 children were referred from the maternity centres, and 223 attended for a course of treatment. The total number of visits paid was 607. Further particulars regarding this work is given in the section on the dental hospital. OTORRHOEA CASES The arrangements outlined in the last Report continued during 1937. The number of cases visited by the district nurses during the year was 43, and the total visits made was 934. The average number of visits per patient was 21.7. The corresponding figures for last year are 42, 860 and 20.5. TODDLERS' CLINIC The Council at its meeting on 15th December, 1936, adopted a recommendation of the medial officer of health made in a report on the Ministry of Health Circular No. 1550, that a Toddlers' clinic should be established in the Borough. The clinic was first held on 5th May, 1937, and takes place each Wednesday at the Model Welfare Centre, 210, Kingsland Road. The first attendances from the inception of the clinic to the end of the year numbered 237, and the total attendances 297. The number of sessions held was 29, the average attendance per session being 10.3. The numbers for the past year are insufficient for detailed analysis but a full account will be given in the next annual report. 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, sister, 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. 100 At the end of the year 1936 eight patients were in residence, 77 children and one mother were admitted during the year and 79 children and one mother were discharged or transferred to hospitals or convalescent homes. Particulars of the condition for which children were admitted are given in Table No. 83:— Table No. 83 Debility and loss of weight 42 Weaning and general management 16 Vomiting 3 Test feeds 16 Mothers admitted with their infants for the establishment of breast feeding 1 The average duration of stay in the wards of these children was six weeks. Of the 79 children who were discharged during the year, 4 were healthy, 59 were much improved, 1 was improved and 15 were sent to convalescent homes and hospitals. No death occurred 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 199 infants attended at the centre for the first time and 2,678 total attendances were made. The number of first attendances of children between one and five years of age was 63, and the total number of attendances was 2,469. These figures may be compared with the corresponding figures for the year 1936 when 177 infants and 55 children had their first examination by the doctor in charge. The total examinations of infants by the doctor numbered 1,656, and of children from one to five years, 1,734. One hundred and ten expectant mothers attended the clinic on 449 occasions and 46 mothers attended on 135 occasions after their confinements. These figures are recorded in table No. 79, page 96. 101 BRUNSWICK DAY NURSERY This nursery accommodates 40 children. The staff consists of the doctor in charge who visits the nursery weekly; a matron, two staff nurses and six 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 emergencies. During the year 1937 the whole day attendances were 7,417 and half-day, 659, the corresponding figures for 1936 being 7,192 and 690 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. The medical officer-in-charge 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 whose income falls within the half-price scale, the Council pays 4½d. per day to the Nursery and the parent 4½d. Payments under this scheme amounted, during 1937, to £96 17s. 8d. In addition a grant of £5 12s. 6d. was made towards the cost of holidays for 9 children. The numbers of children and attendances since the commencement of this arrangement are shown in the following table:— Table No. 84 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 1935 70 6,775 136 6,911 1936 38 3,475 242 3,717 1937 32 2,539 89 2,628 102 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 1937 was 20,418, and of half-day attendances 987. The corresponding figures for 1936 were: whole-day, 17,532; half-day, 800. The resident staff of the Nursery consists of a matron, two nurses, thirteen probationers, a day nursery teacher and a cook-housekeeper. The cleaning and laundry staff are non-resident. Incidence of infectious disease. The following cases occurred during the year:— diphtheria, 1; measles, 14; pneumonia, 2; whooping cough, 5; german measles, 12. Light treatment. During the year 78 children received this treatment for various conditions. Convalescence. During the year 6 children were sent to convalescent homes for periods varying from six to twelve weeks. Sixty-eight children were also given holidays for periods varying from three to eight weeks. EMERGENCY OPEN-AIR NURSERY By an arrangement entered into between the Borough Council and the Secretary of the Emergency Open-air Nursery School, Trinity Place, Shepherdess Walk, Shoreditch children under the age of five years were sent to this institution. The nursery was closed in July, 1937. This Nursery was situated in the western part of the Borough, and was established expressly for children whose parents were receiving public assistance, and who were 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 was 1s. 8d. per week of 5 days per child, which amount was said to cover the cost of the food supplied. The number of individual children sent to this Nursery to July 21st, 1937, when the nursery closed was 9. The attendances were 559, and the cost £9 6s. 4d. An allowance of £2 10s. was made in respect of summer holidays of children. 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 since 1930:— 103 Table No. 85 Year. 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 1935 50 1,103 206 796 195 698 1936 54 1,029 185 832 184 708 1937 56 1,248 140 678 163 547 CONVALESCENCE In previous reports mention was made of the fact that existing facilities for convalescence were entirely inadequate, and in the report for 1935 details were given of an investigation into the requirements of the borough so far as facilities for convalescence are concerned. Since May, 1936, detailed figures have been kept of all children who are reported by the clinic doctors as requiring convalescence. 97 cases were reported; of these 22 were regarded as very urgent, 50 as moderately urgent and 25 as needing convalescence when convenient. The existing facilities are mainly through the Invalid Children's Aid Association, and the Association of Maternity and Child Welfare Centres. The Council have also a specific arrangement with the last-named association for the reservation of two beds for mothers and babies at the Mayfield Convalescent Home. Details of convalescence arranged for mothers and babies. To Homes under the Association of Maternity and Child Welfare Centres:— Letchworth 21 children. Basing 4 children. Mayfield, 28 mothers with babies, 8 mothers. To Homes under the Invalid Children's Aid Association :— Various Homes, 26 children (12 assisted by grants from the Maternity and Child Welfare Committee and 14 assisted by grants from a voluntary fund.*) In addition to the above, 17 mothers and 15 children were sent to various homes during the year. *Mrs. Gwendolin Choyce very kindly made a further grant towards the cost of convalescence of children belonging to a certain area of the borough, and this fund enabled 14 children to be sent to convalescent homes. The gift was greatly appreciated by the Borough Council. 104 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 195 and the number of visits paid 2,126. The particulars of these cases will be found on page 60 of this report. During 1937, 116 visits were paid, 76 to registered cases, the remainder being to the following:— (1) To children who were returned to their parents from foster mothers living out of the Borough. (2) To people wishing to adopt children. (3) To women who undertake the care of children without registration. The work for the year is shown in Table No. 86. CHILD LIFE PROTECTION Table No. 86 1. Number of foster parents on register:— (a) At the beginning of year 8 (b) At the end of year 8 2. Number of foster parents receiving foster children:— (a) At the beginning of year 8 (b) At the end of the year 8 3. Number of children on the register:— (a) At the beginning of the year 10 (b) At the end of the year 7 4. Number of children received by foster parents during the year 5 5. Number of foster children:— (a) Reached the age of nine during the year 1 (b) Removed during the year to different foster parents or to children's societies 4 (c) Adopted Nil (d) Returned to parents 2 (e) Removed at the request of the Medical Officer of Health Nil (f) Died during the year 1 (g) On whom inquests were held Nil 6. Total number of visits made during the year 116 7. Number of cases in which Court proceedings were taken Nil 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 105 on production of a certificate from one of the assistant medical officers. Liability is determined by the milk scale. 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. In May, 1937, toddlers' dinners were commenced at 31, Herbert Street. The number of mothers and toddlers who attended during 1937 and the preceding five years is shown in Table No. 87. Table No. 87 Model Welfare Centre. 1932. 1933. 1934. 1935. 1936. 1937. Number of individual mothers attending 234 229 169 149 132 105 Total attendances 14,130 13,635 10,312 7,102 6,939 6,451 Number of individual toddlers attending 44 139 116 121 109 92 Total attendances 848 5,443 5,978 6,596 6,753 6,472 31, Herbert Street. 1932. 1933. 1934. 1935. 1936. 1937. Number of individual mothers attending 201 194 149 127 95 79 Total attendances 13,659 12,017 10,406 8,400 6,355 4,711 Number of individual toddlers attending 27 Total attendances — — — — — 1,792 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 780 at the beginning of the year; it rose to 799 in May, but fell to 723 in August, and, by the end of the year, it had again risen to 826. 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 ten years were as follows:— 106 Table No. 88 28, Herbert Street. Model Welfare Centre. 1928 463 549 1929 319 526 1930 416 595 1931 357 593 1932 378 633 1933 560 573 1934 606 637 1935 478 875 1936 459 1,039 1937 413 659 NATIONAL PARENTCRAFT COMPETITIONS There were again many entries for these competitions which are held each year by the Association of Maternity and Child Welfare Centres, and it is pleasing to mention that Shoreditch was awarded the silver medal for the second year in succession, gaining the third highest number of marks for the whole country. The entries and marks were as follows:— Class. Subject. Marks gained, (out of 100) 1. Written paper on Mothercraft 80 2. Medical and Health records 98 3. Educational and Social activities 98 4. Needlework 79 7. Knitting 95 9. Fathers' Handicraft 75 10. Fathers' written paper 75 12. Theoretical Cookery 79 Only six classes count for the higher awards, and Shoreditch obtained 530 marks out of a possible 600. In addition to the silver medal referred to, four Honours Certificates and four first-class certificates were gained. Some of the Shoreditch entries were subsequently viewed by the Queen at Buckingham Palace where they were taken specially for her inspection. It need hardly be said that a result such as mentioned above can only be brought about by the great interest taken in the work by the Health Visiting Staff, and in this connection special praise should be given to Miss Morrell, the senior health visitor. 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. 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 1937. 107 Table No. 89 Routine Medical Inspection of Elementary School Entrants in Shoreditch in 1937. †Defects found. *—Noted for treatment and included in defects found. Disease or Defect. Boys 621. Girls 671. Shoreditch. London Per cent. Shoreditch. London Per cent. No. Per cent. No. Per cent. Skin disease † 5 0.8 1.0 8 1.2 0.9 * 4 0.6 0.7 7 1.0 0.6 Tonsils only † 98 15.8 14.0 90 13.4 14.0 * 32 5.2 5.7 17 2.5 5.4 Adenoids † — — 1.0 4 0.6 0.7 * — — 0.6 4 0.6 0.5 Tonsils and adenoids † 3 0.5 3.8 — — 3.4 * 1 0.2 2.7 — — 2.4 Other nose and throat † 7 11 11 5 0.7 0.9 * 2 0.3 0.4 2 0.3 0.2 Glands of neck † 25 4.0 2.6 21 31 2.2 * — — 0.3 — — 0.2 Eye disease † 14 2.3 2.7 15 2.2 2.9 * 8 1.3 1.7 13 1.9 1.7 Otorrhoea † 4 0.6 0.8 6 0.9 0.9 * — — 0.4 5 0.7 0.5 Other ear defects † — — 0.3 1 0.1 0.4 * — — 0.2 1 0.1 0.2 Hearing † 1 0.2 0.1 4 0.6 0.1 * — — 0.0 2 0.3 0.0 Speech † 3 0.5 0.4 1 0.1 0.1 * — — 0.0 — — 0.0 Heart † 7 11 1.3 4 0.6 1.3 * — — 01 — — 0.1 Anaemia † — — 0.6 1 0.l 0.4 * — — 0.2 1 0.1 0.2 Lungs † 19 3.1 3.1 19 2.8 2.9 * 2 0.3 1.2 4 0.6 11 Epilepsy † 1 0.2 0.0 — — 0.0 * 1 0.2 0.0 — — 0.0 Chorea † — — 0.0 — — 0.0 * — — 0.0 — — 0.0 Paralysis † — — 0.1 — — 0.1 * — — 0.0 — — 0.0 Other nervous diseases † 2 0.3 0.3 — — 0.2 * — — 0.1 — — 0.0 Pulmonary tuberculosis... † — — 0.0 — — 0.0 * — — — — — — Other tuberc. lesions † 2 0.3 0.0 1 0.1 0.0 * — — — — — 0.0 Rickets † 3 0.5 1.0 2 0.3 0.5 * — — 0.1 2 0.3 0.1 Spinal deformities † — — 0.1 1 0.1 0.1 * — — 0.0 — — 0.1 Other deformities † —, — 1.0 3 0.4 0.9 * — — 0.4 3 0.4 0.3 Other defects † 12 1.9 2.3 9 1.3 2.3 * 8 1.3 1.4 5 0.7 1.4 Shoreditch. London. Percentage of boys requiring treatment for all defects 50.9 48.1 Do. do. (excluding nutrition and dental defects) 9.2 14.8 Percentage of girls requiring treatment for all defects 55.5 48.6 Do. do. (excluding nutrition and dental defects) 9.4 13.9 108 ROUTINE MEDICAL INSPECTION OF ELEMENTARY SCHOOL ENTRANTS IN SHOREDITCH IN 1937 Table No. 90 Number examined Clothing and boots. Nutrition. Cleanliness of head. Cleanliness of body. Teeth. Good Fair Poor Excellent Normal Slightly Sub-normal Bad Clean Nits Pediculi Clean Dirty Pediculi All sound Less than 4 decayed 4 or more decayed For treatment Entrants:— Boys 621 115 493 13 53 531 36 1 523 94 4 573 45 3 339 197 85 277 Girls 671 130 526 15 62 569 40 — 575 88 8 623 45 3 324 256 91 334 Total 1,292 245 1,019 28 115 1,100 76 1 1,098 182 12 1,196 90 6 663 453 176 611 Percentage, Shoreditch 19.0 78.8 2.2 8.9 85.1 6.0 85.0 14.1 0.9 92.5 7.0 0.5 51.3 35.1 13.6 47.3 Percentage, London 58.2 41.5 0.3 15.3 78.5 6.3 98.0 1.7 0.3 99.1 0.9 0.0 57.9 33.8 8.3 39.3 109 VI.—MUNICIPAL DENTAL HOSPITAL In view of the continued increase in the attendances at the dental hospital the Council at its meeting on 17th November, 1936, agreed to the holding of another additional session. This extra session commenced on 30th September, 1937. A temporary dental surgeon and a temporary nurse are engaged for the three sessions which are held in addition to the routine sessions. The staff of the dental hospital now consists of two dental surgeons (one temporary, part time), a sister, two nurses (one temporary, part time), two dental mechanics, one improver and a plaster boy. FINANCIAL ASPECT For reference purposes the complete scale of charges is printed herewith:— Scaling, per individual 5s. (not chargeable in respect of a jaw in which a denture of eight or more teeth is supplied). Fillings, per filling 5s. (maximum 10s. for any one tooth). Root treatment, per tooth 5s. (maximum 12s. 6d. for fillings and root treatment in respect of any one tooth). Extractions, per tooth (with or 1s. (maximum 12s. 6d., irrespective of number without local anaesthetic). of attendances). Extractions with general anaesthetics—Extraction fee, 1s. per tooth. Gas, 3s. 6d.' Maximum 15s., irrespective of number of attendances, until all recommended extractions have been performed. Dentures, full upper or lower £2 15s. 0d. Dentures, full upper and lower £5 10s. 0d. Partial dentures £1 1s. for first two teeth; 5s. for each subsequent tooth. Repairs 7s. 6d. for the first item. Additional items graded. Maximum charge for one denture, £1. New band or wire 3s. 6d. Crowns £1 1s., including any necessary root treatment. Other items at Approved Society rates. The scale of charges for treatment of children is as follows:— General treatment—1s. per attendance, with a maximum of 2s. until the course of treatment is completed—for extractions (including gas) and any fillings, but not orthodontic treatment. Orthodontic treatment—Cost of appliance, plus 50 per cent. The scale of income for remission of charges remains unchanged from that printed in the report for 1934. 110 SUMMARY OF THE WORK DONE DURING 1937 Tables 91, 92 and 93 summarise the work which was done at the dental hospital during 1937. INSPECTION AND TREATMENT OF CHILDREN Table No. 91 Examinations. First treatments. Extractions. Conservative Work. Mechanical Work. Anaesthetics. No. of visits. Scalings. Fillings. Silver Nitrate. Other operations. Dentures. Repairs. Orthodontics. Local. General. Special. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) Under 5 yrs. 248 223 530 2 97 383 21 — — 1 — 162 23 607 Over 5 yrs. 284 260 691 13 209 99 112 6 — 54 4 204 58 830 Totals 532 483 1,221 15 306 482 133 6 — 55 4 366 81 1,437 INSPECTION AND TREATMENT OF ADULTS Table No. 92 Examinations. First treatments. Extractions. Conservative Work. Mechanical Work. Anaesthetics. No. of visits. Scalings. Fillings. Silver Nitrate. Other operations. Dentures. Repairs Orthodontics. Local. General. Special. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) Women referred from M. & C.W. 232 197 1,338 42 79 5 442 130 20 — 6 272 22 1,149 Other women 498 373 1,848 60 179 — 1,117 315 75 — 45 363 58 2,452 Half-rate women 83 78 181 10 127 — 75 10 1 22 5 49 8 307 Half-rate men 62 57 118 7 65 — 19 1 — — 9 41 7 185 Other men 385 297 1,707 67 126 5 890 264 83 — 60 292 55 1,979 T.B. patients 12 12 64 1 14 — 30 14 1 — 1 11 1 81 Adults and adolescents 1,272 1,014 5,256 187 590 10 2,573 734 180 22 126 1,028 151 6,153 Totals (including Children, Table 91) 1,804 1,497 6,477 202 896 492 2,706 740 180 77 130 1,394 232 7,590 111 ANALYSIS OF VISITS Table No. 93 Morning. Afternoon. Evening. Total. Monday 543 571 903 2,017 Tuesday — 817 590 1,407 Wednesday 961 586 — 1,547 Thursday 800 564 — 1,364 Friday — 631 624 1,255 Total 2,304 3,169 2,117 7,590 Notes on Tables 91, 92 and 93. Column I.—When the course of treatment prescribed at the primary examination is completed, the next visit by the individual is recorded as another primary examination. Column 4.—Number of patients who have had their teeth scaled. Column 5.—Total number of teeth filled, completely or temporarily. Column 6.—Application of silver nitrate when the fillings are impracticable. Column 7.—Total separate surgical operations performed. Column 8.—Represents the total single denture repairs completed. Column 10.—Represents the total visits made by patients for orthodontic treatment, and includes children who were already attending for orthodontic treatment at the beginning of the year. Columns 11/13.—Number of patients to whom anaesthetics were administered. Column 13.—Number of patients to whom anaesthetics were administered on special emergency visit of anaesthetist. Column 14.—Total number of separate visits for examination or treatment. Table 93.—Total attendances given here include Tables 91 and 92. Note on "Other Operations." (Column 7)—The column for "other operations" includes; the surgical operations given in previous reports. Operations include the following:— (a) Children: dealing with abscesses without extraction ; division of labial frena; (b) Adults: socket syringing after treatment following difficult septic extraction; curetting of sockets; treatment of epulus; division of fibrous bands, treatment of cysts, removal of sequestra. GROWTH OF HOSPITAL The following table shows the work done since the uniform system of classification adopted in 1933. Table No. 94 Visits. Dentures fitted. Fillings. Silver nitrate treatment. Children. Adults.* Maternity cases. 1933 849 4,685 1,287 509 492 1934 857 4,971 1,545 552 566 1935 830 5,183 1,325 622 670 1936 1,252 6,009 1,365 670 965 1937 1,437 6,153 1,149 740 896 492 * Including maternity cases. 112 ANAESTHETICS During the year 130 local anaesthetics and 1,626 general anaesthetics were administered. The number of general anaesthetics has increased from 894 in 1933 to 1,626 in 1937. Actually the ratio which these figures for general anaesthetics bear to the total for all anaesthetics each year was as follows:— 1933 84.5 per cent. 1934 85.7 1935 91.3 1936 94.8 1937 92.6 These figures indicate the reliance which is placed upon a general anaesthetic for the purposes of extractions performed in a district like Shoreditch. In other words, they indicate that most of the mouths upon which extractions have to be carried out show some degree of sepsis. DENTAL INSPECTION AND TREATMENT OF PRE-SCHOOL CHILDREN The procedure in connection with the routine dental inspection and treatment of pre-school children was outlined in the report for 1936. Results of examination.—During the year 142 pre-school children have been recommended to attend for examination and treatment. Of these 41 (28 per cent.) actually attended. In five cases treatment was not necessary, and five children attended but did not carry on with the treatment. Of the remainder all received treatment with the exception of 12 who have not yet completed the prescribed course. The information in respect of the 19 children who received treatment is given in the following table:— Table No. 95 Age (years). 2-3 3-4 4-5 Number 2 10 7 Percentage 10.53 52.63 36.84 PROPORTION OF CASES ATTENDING FOR TREATMENT The proportion of first attendances to primary examinations for various classes of patients is given in Table No. 96. 113 Table No. 96 (a) No. of patients who had primary dental examinations. (b) No. of patients in (a) who attended for treatment. Under 5 years. School children. Women from M.&C.W. Other women. Adolescents. Adult males. 1933: (a) 222 108 293 338 79 345 (b) 189 51 208 198 61 216 Percentage (b) to (a) 85.1 47.2 70.9 58.6 77.2 62.6 1934: (a) 274 88 251 372 81 293 (b) 258 51 205 264 61 224 Percentage (b) to (a) 94.2 58.0 81.6 71.0 75.3 76.5 1935: (a) 222 126 240 410 58 338 (b) 186 III 190 303 47 274 Percentage (b) to (a) 83.8 88.0 79.2 73.9 81.0 81.1 1936: (a) 310 177 245 498 96 399 (b) 262 160 212 375 71 328 Percentage (b) to (a) 84.5 90.4 86.5 75.3 74.0 82.2 1937: (a) 248 284 232 498 145 397 (b) 223 260 197 373 135 309 Percentage (b) to (a) 89.9 91.5 84.9 74.9 93.8 77.8 114 VII—SPECIAL CLINICS FOR WOMEN In view of the increased attendances at these clinics and in view also of the fact that a number of women who are desirous of attending the clinics are unable to attend during the day time, the Committee decided to hold an extra session in the evening. This session is held on Tuesday evenings and both medical and gynaecological clinics are held at the same time, thus enabling patients to be seen by the two specialists if necessary. The evening clinic was commenced on 20th July, 1937. The specialist staff of the clinics remains unchanged. The Council is fortunate to be able to retain the services of Dr. Janet K. Aitken, M.D., M.R.C.P., as physician, and of Dr. Gladys Hill, M.A., M.D., B.S., M.C.O.G., F.R.C.S., as gynaecologist. For reference purposes the scope of the work carried out at the clinics and the method of administration are again described in this section, and any changes which were effected during the year are embodied in the following account. SCOPE OF THE WORK CARRIED OUT AT THE CLINICS General Medical Clinic.—Women suffering from any complaint of a medical nature may attend this clinic, but they are strongly advised to bring with them a report from their private practitioner or from the doctor at some other Clinic. In actual fact the majority of the patients do bring such references. It was thought that this clinic would be specially useful in the difficult work of differentiating between functional and organic conditions, and this expectation has been realised. As a general rule continued treatment is not carried out. Many women do receive courses of a comparatively small number of stock drugs, but in most cases this therapy can be regarded as mainly diagnostic. This clinic is held on Fridays at 10 a.m. and, jointly with the gynaecological clinic, on Tuesdays at 6.30 p.m. Gynœcological Clinic.—At the gynaecological clinic birth regulation cases and gynaecological cases are dealt with at the same session. In the case of all patients who request birth-control information a complete gynaecological examination is performed, and any necessary minor treatment is carried out. Patients who request birth-control information are also recommended to attend at the medical clinic for examination, and a large proportion of them have a general medical examination. Minor conditions which are treated at the clinic include erosions, prolapse, and other displacements. No single method of contraceptive technique is used. In many cases Dutch caps are recommended and fitted, and frequently these are supplemented by solubles or by lactic acid pessaries. The method employed is often dictated by 115 the medical condition of the applicant, i.e., the degree of necessity for prevention of contraception. The clinic is held on Mondays at 2 p.m., and, jointly with the general medical clinic, on Tuesdays at 6.30 p.m. Reference of individual patients to hospital.—In general it may be said that the results of the working of these clinics indicate that many women suffer from minor disorders which can be dealt with efficiently at an outdoor clinic, but which if left untreated would certainly cause considerable trouble or discomfort and which might lead to more grave conditions, requiring in-patient treatment in hospital. Financial aspect.—During 1937 no alterations were made in the fees which the patients are required to pay. Women who receive treatment at either clinic pay the sum of Is. per attendance, and those who receive birth control appliances are required to refund to the Council the cost thereof, but the Medical Officer of Health is empowered to use his discretion in the matter of the collection of the charges for birth control appliances, in cases where the women concerned are unable to afford the cost. The fee is usually collected before the apparatus is supplied. Any female adult who resides or works in the Borough may attend the clinic. RESULTS (a) Medical Clinic. During the year 72 sessions were held, 256 new cases attended the clinic, and the total attendances were 859. Most of these patients were referred by clinic doctors or by health visitors ; ten cases were referred from the ante-natal clinic and 24 cases from the gynaecological clinic. The age distribution of the patients is shown in the following table :— Table No. 97 Age (years) 15— 20— 25— 30— 35— 40— 50— 60— Total. No. of patients 11 40 49 65 46 39 4 2 256 The youngest patient was aged 15 years and the oldest 67 years. The mean age of these 256 patients was 32.8 years. It will be seen that a considerable proportion of the women were at an age when the strain of child-bearing was beginning to assert itself. 116 The obstetric history of the patients is shown in the following table:— Table No. 98 No. of pregnancies 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Total. No. of patients 17 51 49 35 30 14 15 12 11 10 3 4 3 1 1 256 No. of children alive 0 1 2 3 4 5 6 7 8 9 10 13 Total. No. of patients 21 61 48 39 33 13 13 12 7 3 5 1 256 The average number of pregnancies was 3.7 and the average number of children alive per patient was 3.0. The patients who attend this clinic do not on the whole present any exceptional obstetric history in respect of the total number of pregnancies and it would appear that if the children play any part in the causation of ill health in the mothers, they possibly exert their influence not so much through the strain of child bearing but owing to the economic factors which are induced by the presence of several children in a poor household. Medical findings.—In a report of this type a detailed description of the medical findings is unwarranted, but the following brief summary will give some idea of the conditions dealt with during the year:— Heart conditions 26 Debility 17 Anæmia 79 Malnutrition 3 Circulatory conditions 13 Rheumatism 9 Chest conditions 13 Migraine 2 Nervous conditions 12 Other conditions 43 Menopausal or allied conditions 10 No apparent disease 22 Diseases of the liver or ducts 7 Of the patients mentioned above three were referred to Elizabeth Garrett Anderson Hospital, one to St. Bartholomew's Hospital for further examination or for outpatient treatment, and two were referred to the tuberculosis officer. Three patients were referred to their own practitioners. It will be noted that there has been a very definite increase in the number of cases of anaemia. This is further dealt with in a report by Dr. Aitken which is appended hereto. 117 REPORT By Dr. JANET K. AITKEN The most striking feature of the analysis of medical findings is the high proportion of anaemia among the patients. It is probably considerably higher even than the figures indicate, as a patient has not been definitely labelled "Anæmia " unless a full blood count has been done, and this has not been possible in all cases that were suspected. At this clinic almost all the cases sent for a full blood count have proved to be anaemic, but my experience elsewhere has proved that a clinical diagnosis of anaemia can be very misleading—patients in whom the mucous membrane, as well as the skin, appeared to be pale having normal haemoglobin and red blood cell count. There are no cases of pernicious anaemia in this group; they are nearly all microcytic anaemias with a low colour index, and treatment with iron has had an immediate beneficial effect. Very few panel patients attend the clinic, and the expense of the large doses of iron required over a long period makes it very difficult for these patients to be referred back to their general practitioners, as one would wish—it is usually impossible for them to afford the necessary medical attention. There have been many conflicting opinions and statistics published about the incidence of anaemia in women, and my experience in attending hospital out-patients has not led me to suppose that anaemia was a very common complaint; not nearly as common as this clinic's figures indicate. An analysis of the type of patient affected shows, however, that a very large proportion are mothers with young children. I believe that it is these women who usually receive no medical attention, they have not the time or the energy to attend the hospital out-patients, and they have not the means to attend their general practitioner. They will however attend the clinic; it is near at hand, and doesnt take so long as going to hospital. It would seem therefore that the explanation of the different statistics published is due to the different groups of patients examined, and that one indication of the value of the clinic is that a type of patient is attending the clinic which is not getting treatment elsewhere, and this type of patient is in urgent need of attention. (b) Gynæcological clinic. During the year 72 sessions were held, 248 new cases attended the clinic and the total attendances were 769. As in the case of the medical clinic most of the patients were referred by clinic doctors or by health visitors. The age distribution of the patients is shown in the following table :— Table No. 99 Age (years) 15— 20— 25— 30— 35— 40— 50— 60— Total. No. of patients 13 51 59 47 41 34 3 — 248 The youngest patient was aged 15 years, and the oldest 52 years. The mean age of these 248 patients was 30.2 years. 118 The obstetric history of the patients is shown in the following table:— Table No. 100 No. of pregnancies 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Total. No. of patients 26 57 40 39 20 20 12 10 12 4 4 2 1 1 248 No. of children alive 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Total. No. of patients 25 63 43 51 21 16 11 6 3 8 1 — — — 248 The average number of pregnancies per patient for the 248 new patients was 3.2 and the average number of children alive per patient in respect of the 248 patients was 2-8. These averages are definitely lower than the corresponding figures for the patients who attended the medical clinic. Duration of married state.—The following table shows the length of time which had elapsed since marriage in respect of 234 of the patients in which the details are available. Patients who were married during 1937 were counted as having been married one year, those married in 1936 two years, and so on:— Table No. 101 Period since marriage (years) 1 2 3 4 5 6 7 8 9 10 10+ Total. No. of patients 24 12 20 14 16 15 19 7 6 15 86 234 This table brings out the rather important fact—which was also elicited previously—that there was apparently no relationship between attendance at the clinic and the duration of the married state. Opponents of birth control clinics often state that there will be a preponderance of young married women at such clinics, but the figures above—although they refer to both gynaecological and birth regulation cases— indicate broadly that such a supposition is incorrect. Gyncecological work.—Of the 248 new patients who attended the clinic, 184 were gynaecological cases. The conditions found and treated, when treatment was necessary, may be shown broadly as follows:—Cervical erosions, 3; menorrhagia, 27; leucorrhcea, 27; pregnancy, 32; fibroid, 2; uterine displacements, 30; sterility, 8; post-natal debility, 24; other conditions, 31. Birth regulation work.—During the year 43 women had advice regarding birth regulation, and in these instances the necessary appliances were provided. Of the 248 women, two were referred to St. Leonard's Hospital, 1 to Moorfields Eye Hospital, 2 to Mildmay Mission Hospital, and 3 to other hospitals for examination or for admission. 119 SOCIAL AND PHYSICAL CONDITIONS Of the 256 new patients who attended the medical clinic, the husbands of 211 were employed, those of 42 were unemployed, and the husbands of the remaining 3 were in receipt of public assistance relief. In the case of the gynaecological clinic the corresponding figures for husbands are:—Employed 187; unemployed, 45; on relief, 16. These figures show a considerable degree of employment amongst the husbands. Further information was available in respect of 185 of the women who attended the gynaecological clinic. It was found that 24 of these were employed and the remaining 161 did no work apart from their domestic duties. The weights of 238 of the new patients who attended the medical clinic are available. It is not possible to draw any deduction from this sample, but the figures are inserted here for reference purposes:— Table No. 102 Weight (Stones) 5½- 6- 6½- 7- 7½- 8- 8½- 9- 9½- 10- 10½- 11- 11½- 12- 12½- 13- 14- 15- No. of patients 2 1 14 21 33 30 30 27 18 14 12 6 7 4 4 11 3 1 120 VIII.—FOOT CLINIC This clinic was opened on 8th May, 1936, with three weekly sessions, each of two hours. During the latter part of 1936, owing to the success of the clinic, the weekly sessions were increased to six. During 1937 it became necessary to hold an additional session on Monday evenings. This additional session was first held on 12th July, 1937, and is mostly used for cases requiring massage and heat treatment. The clinic is held in a room at the Public Library building, Pitfield Street. The sessions are now held as under:— Monday 2.30—6.30 p.m. Tuesday and Wednesday 2.30—4.30 p.m.; 6 to 8 p.m. Friday 10 a.m.—Noon. The clinic deals with minor abnormalities of the feet such as corns, bunions, ingrowing toenails, etc. Orthopaedic cases are referred either to the patient's own doctor or to hospital. The charge made is 1s. per visit for one foot and 1s. 6d. for two feet, but no charge is made in respect of persons who are unemployed, or in receipt of public assistance, or to members of their families, or Old Age Pensioners. The total attendances of patients during the year was 1,981, of which 485 represented first attendances. The total number of patients who attended during the year was 648. Of these 648 patients, 200 made only one visit during 1937 and had not returned for further treatment up to the time of writing this report (9th May; 1938). The number of sessions held during the year was 325; the average attendance per session being 6.1. The following Table shows the type of cases dealt with and gives some indication of the progress made by the patients:— 121 Table No. 103 Type of ailment. Number treated. Cured or corrected Improved. Remarks. Arthritic and rheumatic conditions of joints 26 — 11 Massage and heat treatment given. Bunions 21 — 10 — Bursitis 25 9 10 — Chilblain 6 1 5 — Cyst 1 — — Condition relieved. Corns 418 24 Majority improved Several kept under observation. Flat foot 35 22 4 — Fissures (heels and between toes) 6 3 1 — Hallux rigidus 2 1 1 — Hallux valgus 10 6 4 — Hammer toes 4 2 1 Kept under observation. Hyperidrosis 30 17 13 — Metatarsalgia 71 — — A large number of these patients are pregnant women. After confinement condition is completely cleared up. Morton's toe 5 3 2 — Onychrogryphosis (Ram's horn nail) 80 Majority cured 7 Visit for periodical observation. Onychocryptosis 30 25 5 — Paronychia 1 1 — — Pes cavus 2 — — Both referred to hospital Psoriasis 1 — — Referred to private doctor. Septic toe 1 — 1 — Swelling of foot 1 — — Sent to hospital. Urticaria 1 — 1 — Various forms of sprains, etc. 3 2 1 — Verruca 8 6 — Two referred to private doctor. 122 IX.—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 1937, summarize the work done by the sanitary inspectors during the year:— The total number of intimations served in respect of insanitary conditions was 4,474. The number served in each sanitary district was as follows :— District No. I 350 District No. VI 635 „ „ II 369 „ „ VII 232 „ III 594 „ „ VIII 431 „ IV 768 „ „ IX 408 „ V 687 In connection with the inspectors' sanitary work, 1,263 letters were written to owners and others. Nuisance notices under the Public Health (London) Act, 1936, were served by order of the Sanitary Authority upon the parties responsible for the abatement of nuisances in 951 instances. For non-compliance with the requirements of the sanitary authority, proceedings were taken before the magistrates in 17 instances. A list of legal proceedings will be found in Appendix D. The following tables (Nos. 104 and 105) summarize the visits and work of the sanitary inspectors during 1937. The work done in compliance with the provisions of the Factory and Workshops Act, 1901, and in connection with the drains and sanitary arrangements of new buildings is included. 123 Table No. 104. Inspections, 1937 DISTRICTS Total 1 2 3 4 5 6 7 8 9 Housing Act, 1936, section 9 ... ... ... ... ... ... 85* ... ... 85* Housing Consolidated Regs., 1925 24 79 49 32 60 49 56 46 30 425 Other premises 570 659 855 1192 581 789 807 1138 853 7444 Re-inspections, etc. 1431 2245 2440 3199 2663 2692 2405 2280 2090 21445 Visits in connection with infectious diseases— (a) By sanitary inspectors 3 65 49 75 66 82 38 29 17 424 (b) By infectious disease visitor ... ... ... ... ... ... ... ... ... 2551 Common lodging houses 4 ... ... ... ... ... 13 16 8 41 Houses-let-in lodgings ... 8 37 ... 674 ... ... ... ... 719 Workshops 362 118 74 251 107 179 92 30 26 1239 Factories 141 289 81 262 17 8 36 15 6 855 Outworkers 93 99 117 151 102 91 65 112 62 892 Bakehouses 14 21 36 41 20 12 15 6 18 183 Milkshops and cowshed 133 95 96 132 124 43 72 63 68 826 Cookshops 74 88 49 91 67 23 40 28 13 473 Fried fish shops 12 22 38 24 29 8 29 7 15 184 Ice cream shops 34 33 57 59 89 7 31 31 22 361 Meat and food 16 21 49 104 114 14 36 17 21 392 Stables ... ... ... 17 13 2 2 7 ... 41 Rag and bone dealers 6 17 7 11 1 ... ... ... 2 44 Markets 20 24 28 23 23 26 22 26 13 205 Total 38829 * The whole of the inspections under this section of the Housing Act, 1936, are carried out by the Inspector for District 7, and do not therefore relate to one district. 124 Table No. 105. Work Done, 1937. DISTRICTS Total 1 2 3 4 5 6 7 8 9 Premises, cleansed throughout 42 10 3 42 3 12 5 1 3 121 Premises, partially ditto 106 138 216 398 365 229 83 176 194 1905 Premises, total rooms 359 398 557 1025 823 513 243 448 456 4822 Verminous rooms 44 20 38 40 51 28 24 4 22 271 Verminous premises 17 18 22 24 40 12 12 2 10 157 Premises, generally repaired 197 235 482 633 524 489 180 294 507 3541 Light and ventilation 1 6 2 34 7 3 ... 1 2 56 Roofs, gutters, rainwater pipes 79 111 393 506 323 279 60 170 229 2150 Overcrowding 7 17 19 136 29 38 6 6 11 269 Water re-instated 1 18 11 40 38 5 10 16 ... 139 Drains, new ... 3 1 1 1 3 6 7 ... 22 Drains, re-constructed 2 10 7 10 9 5 6 3 ... 52 Drains, improved or repaired 18 2 14 66 48 54 19 16 26 263 Drains, obstructions removed 20 21 30 37 25 29 9 4 12 187 Soil, vent pipes repaired 7 12 44 55 19 5 10 31 11 194 W.C.'s— new 13 22 19 11 5 7 53 205 ... 335 improved or repaired 32 48 159 144 78 69 49 98 88 765 obstructions removed 22 15 24 25 35 12 5 11 11 160 Sinks, improved 32 52 103 46 151 118 30 91 15 638 Sinks, traps provided 3 2 7 10 2 33 ... 8 3 68 Outdoor Premises. Floors, paving repaired 12 43 174 98 144 55 20 52 37 635 Cleansed or limewashed 35 44 216 176 190 74 60 2 2 799 Improved or repaired ... ... 15 3 ... 4 2 ... ... 24 Dustbins provided 8 3 58 81 5 42 ... 30 4 231 Ashpits improved or repaired 2 15 54 73 75 42 6 ... 40 307 Ashpits abolished ... ... ... ... ... ... ... ... ... ... Accumulations removed 9 37 53 53 33 8 21 25 8 247 Urinals cleansed or repaired ... 3 ... 3 6 ... ... ... ... 12 Animals improperly kept ... 6 ... 2 3 ... ... 1 ... 12 125 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 1937:— Table No. 106 Premises No. in borough on 31st December 1937 No. of inspections No. of prosecutions Houses let in lodgings 378 719 Nil Common lodging houses 4 29 Nil Seamen's lodging houses Nil Nil Nil Cowsheds (licensed) 1 11 Nil Slaughterhouses (licensed) Nil Nil Nil Other offensive trades 1 7 Nil Milkshops 288 729 Nil Ice cream premises 185 287 Nil Restaurants and eating houses 231 417 Nil Registered foster mothers 8 116 Nil Nurse children kept 10 116 Nil SMOKE NUISANCES (1) Number of observations 58 (5) Number of legal proceedings Nil (2) Number of intimations served 6 (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 44 Number of premises cleansed— Number of children cleansed 13 (a) After infectious diseases 834 (b) For vermin 155 WATER SUPPLY TO TENEMENT HOUSES Number of premises supplied 123 Number of prosecutions Nil HOUSING General Statistics—Table No. 107. Total number of houses in the Borough 13,859 Public Health Act—- Number of houses inspected on account of complaints or illness 12,606 Number of statutory notices served 874 Number of houses repaired or nuisances remedied 4,474 126 Housing Act, 1936— Number of houses inspected—house-to-house (Housing Consolidated Regulations, 1925) 568 (a) Number of houses included in representations by the Borough Medical Officer under Section 25 of the Housing Act, 1936 Nil (b) Number of houses demolished following representation by Borough Medical Officer under Section 25 of the Housing Act, 1936 43 Number of houses repaired under sections 9 and 10 of the Housing Act, 1936 (a) by owners 57 (b) by local authority in default of owners Nil Number of houses demolished:— (a) in pursuance of orders under section 11 of the Housing Act, 1936 3 (b) Voluntarily 140 Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) Nil Number of Closing Orders determined (i.e., houses made fit) Nil UNDERGROUND ROOMS Number occupied but unfit under Housing Act, 1936 221 Number closed or modified occupation approved 106 OVERCROWDING (HOUSING ACT, 1936) Number of families found to be living in overcrowded conditions 279 Number of overcrowded families who have obtained alternative accommodation 269 Number of houses erected by the Borough Council for working classes during year Nil HOUSES LET IN LODGINGS (1) Number in Borough 378 (3) Number of prosecutions Nil (2) Number of inspections 208 (4) Number of complaints remedied under the Bye-laws (not included under any other heading) Nil WATER SUPPLY The number of certificates issued as required under the Public Health (London) Act, 1936, section 95 (2), was 292. The water supply is almost entirely from the Metropolitan Water Board. There are nine artesian wells in the borough. One is used for brewing, drinking and general purposes, one for all purposes, one for general commercial purposes, one has been partly filled in, one rafted over and the other four are not now in use. 127 L.C.C. DRAINAGE BYE-LAWS During the year, 9 contraventions of the above bye-laws were reported to the Public Health Committee. In each instance a warning letter was sent to the builder responsible for the work. ASHPITS It is satisfactory to be able to state that there are now only three ashpits in the Borough. One of these serves 14 houses, one 12 houses and one 11 houses. These are reported to be in satisfactory condition, but total abolition would certainly be desirable. PUBLIC CONVENIENCES FOR WOMEN No alteration was made during the year. This matter was fully discussed in the annual report for 193G. COMMON LODGING HOUSES The work in connection with common lodging houses is carried out under the Public Health (London) Act, 1936. 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 29 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 1937, 378 houses were registered as houses let in lodgings. 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, 1936. During the year 248 visits of inspection were made. There was no appreciable amount of overcrowding above that which generally prevails in the district 128 VERMINOUS HOUSES It was necessary to take measures on account of the presence of vermin in respect of 157 houses, and in connection with these 271 rooms were dealt with during the year, sanitary notices being served where necessary. VERMINOUS PERSONS During the year the homes of 7 children, three boys and four 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. Intimation was received that 3 boys and 3 girls had been given the opportunity of being cleansed at these stations, and that in the case of one girl legal proceedings were pending for non-compliance with the requirements of the statutory notice under Section 87 of the Education Act, 1921. In all the cases reported the homes were visited by the sanitary inspectors. The children reported by the school authorities as suffering from scabies numbered 341, of whom 172 were females. As a result of the enquiries made, 38 other cases came under observation. As far as practicable steps were taken to prevent the spread of infection. OFFENSIVE TRADES The only business carried on in the Borough which falls within this category is that of a fur-skin dresser. Seven visits of inspection were made. RAG AND BONE DEALERS At the end of the year 15 premises to which bye-laws under Section 9 of the London County Council (General Powers) Act, 1908, as amended by Section 146 of the Public Health (London) Act, 1936, apply were on the register. Thirty-one visits were paid to these during the year. Intimation as to the need for cleanliness was sent and duly attended to in seven instances. RAG FLOCK During the year 29 samples of rag flock were submitted to the Public Analyst. Twenty-six complied with the legal standard of not more than 30 parts of chlorine per 100,000 parts. The amount of chlorine in these 26 samples varied from 1 to 29 parts, the average being 8.1 parts per 100,000. One sample contained 33 parts of chlorine per 100,000 parts. No legal proceedings were taken in connection with this sample. The two remaining samples contained 45 and 46 parts of chlorine per 100,000 parts respectively. Legal proceedings were instituted and the manufacturers were ordered to pay £3 3s. Od. costs in each case. 129 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 1936 was 1,575. The number added to the register during the year under consideration was 34, the number removed was 171, and the number on the register at the end of 1937 was 1,438. A classification of the workshops on the register at the end of the year is contained in the following table:— REGISTERED WORKSHOPS 1937 Table No. 108 Workshops on the Register (s. 131) at the end of the year. Number. (1) Furniture, woodwork, fitting and other branches of the furniture trades 975 (a) cabinet making 548 (c) upholstery 117 (b) french polishing 172 (d) other workers 138 (2) Dress 152 (a) tailoring 70 (e) shirt making — (b) mantles 4 (f) boot and shoe trades 22 (c) dress 17 (g) artificial flowers 2 (d) millinery 9 (h) other workers 28 (3) Skin, leather, hair and feather trades 48 (a) furriers 20 (c) feathers 1 (b) saddlery and harness 12 (d) other workers 15 (4) Paper, printing, book, stationery and fancy goods trades 30 (a) box and bag makers 26 (b) other workers 4 (5) Laundry and washing 1 (6) Food 10 (7) Metals, machines, implements and conveyances 72 (8) Precious metals, jewels, etc. 1 (9) Trades other than those mentioned above 149 Total number of workshops on register 1,438 Note.—A separate register is kept for bakehouses, the number of which in use at the end of the year was 42, including 35 factory bakehouses. 130 The particulars of inspections made by the sanitary inspectors are as follows:— Table No. 109 Premises Number of Inspections. Written Notices. Prosecutions. Factories (including factory laundries) 855 93 ... Workshops (including workshop laundries) 1,240 201 ... Workplaces (cookshops, fried fish shops and ice cream shops) (excluding outworkers' premises dealt with in table 110.) 1,018 88 ... Totals 2,113 382 ... The defects found and dealt with were as follows:— Table No. 110 Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts*:— Want of cleanliness 49 49 ... ... Want of ventilation 4 4 ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 365 365 ... ... Sanitary accommo¬dation insufficient 20 20 ... ... unsuitable or defective 145 145 ... ... not separate for sexes 11 11 ... ... Offences under the Factory and Workshop Acts— 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 131) ... ... ... ... Totals 594 594 ... ... * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Act. 131 OTHER MATTERS Table No. III Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix abstract of the Factory and Workshop Act (Section 133) 2 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (Section 5). Notified by H.M. Inspector 16 (9 factories and 7 workshops.) Reports (of action taken) sent to H.M. Inspector. 16 (9 factories and 7 workshops.) Other 1 Underground Bakehouses (Section 101):— Certificates granted during the year Nil. In use at the end of the year 27 During the year 201 sanitary notices were served upon as many workshops. The following is an abstract of the sanitary work carried out in compliance with these notices:— Table No. 112 Premises cleansed throughout 25 Soil and vent pipes dealt with 6 Premises cleansed partially 78 Water-closets newly constructed 35 Number of rooms cleansed 181 Water-closets repaired, etc. 96 Walls, floors, sashes, etc., repaired 86 Water-closets obstructions removed 14 Roofs, guttering, etc., repaired 52 Sinks, etc., cleansed and repaired 14 Water reinstated or improved 2 Sculleries, yards, etc., paving repaired 20 Drains newly constructed 2 Drains reconstructed 4 Sculleries, yards, etc., cleansed or Drains repaired, etc. 11 limewashed 31 Drains, obstructions removed 11 Dust receptacles provided 24 Urinals cleansed, etc. 13 Foul accumulations removed 14 The number of factories under observation for insanitary conditions during the year was 92, and in connection with these 93 sanitary notices were served. The work carried out in compliance with these notices included the cleansing and repairing of water-closets in 139 instances, the removal of obstructions from drains and water-closets in 44 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. 132 HOME WORK During the year 73 lists of out-workers were received from employers in the Borough, 38 in the first and 35 in the second half-year. Those for the first half-year are due in February, for the second in August. These lists contained the names of 1,047 out-workers, of whom 796 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 2,203, and of these 1,398 were resident in Shoreditch. These figures may be compared with the corresponding figures of 1,957 and 1,297 for the year 1936. As was 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. The tables on pages 133 and 134 show the distribution of outworkers as regards trades in the Borough. During the year 892 visits of inspection were made to places where home-work was being carried on, and in connection with these 138 sanitary notices were served. The cases of notifiable infectious disease occurring at out-workers' premises numbered 22 and included 7 of scarlet fever, 12 of diphtheria and 3 of erysipelas. The usual steps were taken in connection with these cases by the officers of the sanitary authority. 133 HOME WORK The following is a summary of the lists received from employers in the Borough:— Table No. 113 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, etc. 32 75 350 5 9 11 ... ... ... 36 36 Nil. 6 ... ... (2) Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers 2 ... 11 ... ... ... ... ... ... 9 9 Nil. Nil. ... ... Upholstery ... ... ... ... ... ... ... ... ... 2 2 Nil. ... ... ... Paper bags and boxes 28 ... 132 ... ... ... ... ... ... 51 51 Nil. 16 ... ... Fancy leather goods 6 ... 23 ... ... ... ... ... ... 21 21 Nil. Nil. ... ... Carding of buttons ... ... ... ... ... ... ... ... ... 2 2 Nil. Nil. ... ... Totals 68 75 516 5 9 11 ... ... ... 121 121 Nil. 22 ... ... (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 132 of this report with regard to infectious disease in the houses of outworkers. 134 Communications were received from various sanitary authorities relating to 1,164 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 1937. Table No. 114 Numbers of Outworkers Received from other Districts during 1937. Districts Making Wearing Apparel. Toys and Crackers. Artificial Flowers. Furniture and Upholstery. Fur Pulling. Umbrellas, Etc. 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. Bethnal Green 22 22 16 11 ... ... ... ... ... ... ... 1 17 17 ... 1 1 4 ... ... ... ... 122 Croydon 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Camberwell ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 City of London 135 125 ... ... 9 8 ... ... 10 10 14 16 ... ... ... 1 3 6 ... ... ... ... 337 Dagenham ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Finsbury 67 89 18 34 13 28 8 5 7 8 7 ... 24 23 ... ... 24 17 6 5 8 ... 391 Hackney 34 30 ... 15 8 4 1 1 ... ... ... ... 12 30 1 1 ... 3 ... 1 ... ... 141 Hampstead 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Holborn ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Hornsey 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Islington 32 12 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 4 ... ... ... ... 51 Kensington 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Lambeth ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Leyton 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 Poplar 2 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 St. Marylebone 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 St. Pancras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 Stepney 16 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 Stoke Newington ... ... 9 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Southwark ... 7 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Tottenham 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 7 West Ham 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Westminster 13 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Totals 337 319 55 67 30 40 10 7 17 18 21 17 55 72 1 3 29 34 8 7 8 1 1,156 656 122 70 17 35 38 127 4 63 15 9 135 REMOVAL TO HOSPITAL OF AGED AND INFIRM PERSONS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1936, S. 224 Five cases which might possibly have been dealt with under the above Act came to the notice of the department during the year. Enquiries were made and it was possible to arrange for the voluntary removal to St. Leonard's Hospital of four persons and the other case was found to be not in all respects suitable for action under the Act. SCHOOLS The sanitary condition of the public elementary schools in the Borough is satisfactory. 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 58 cases, the usual period of observations ranging from five to thirty minutes. In six instances intimation notices were served. RAT SUPPRESSION During November, 1937, 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. Table No. 115 Districts. Totals 1 2 3 4 5 6 7 8 9 Complaints dealt with 27 6 23 50 29 7 10 20 6 178 Drains tested 3 2 18 32 5 6 7 8 6 87 found defective 2 1 5 4 5 2 4 1 — 24 found satisfactory 1 1 13 28 — 4 3 7 6 63 Premises where egress of rats was ascertained 27 2 23 49 14 4 3 14 — 136 Premises reported freed from rats 23 5 23 27 29 6 10 14 6 143 In addition to the above, rat poison was deposited in sewers four times during the year. 136 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. MEAT The number of butchers' premises under inspection during the year was 54 shops and 8 stores and the number of visits of inspection was 171. General observation was kept of all meat stalls where butchers' meat was exposed for sale. No warning letters were sent in respect of minor infringements of the Public Health (Meat) Regulations, 1924. SLAUGHTER HOUSES There are no slaughter houses in the Borough. COW HOUSES There is one licensed cow house in the Borough, in St. John's Road, licensed 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 231, and 417 visits were made in connection with them. Sanitary notices were served on 45 owners mainly for cleansing. FRIED FISH SHOPS At the end of the year 47 fried fish shops were under the supervision of the Health Department, and 184 visits were made to them. ICE CREAM The number of premises under observation during the year was 191, and 287 visits of inspection were made. In 17 instances sanitary notices were served. Most of these were for general cleansing. At the end of the year the number on the register was 185. 137 BAKEHOUSES The number of bakehouses in use during the year was 42. Of these 27 were underground, and 35 were factory bakehouses. The total number of bakehouses in the borough is 51, of which 9 are not at present in use, and 6 of these 9 are in premises which are let for other purposes and at the present time there is apparently no intention of using them again for baking purposes. It should be noted, however, that no further authorisation for this purpose is required from the local authority. Of the 42 bakehouses which are in use 17 manufacture both bread and smalls, 20 bake bread only, and 5 bake cakes and smalls. Of bakehouses where bread is baked, the largest appear to be one which uses 36 sacks of flour per week, two which use 26 sacks, 5 between 20 and 25 sacks, 8 between 10 and 20 sacks, 6 between 5 and 10 sacks; the majority of the remainder have only a small trade. 39 bakehouses have shops attached, and three bakehouses manufacture for the wholesale trade only. In connection with bakehouses the sanitary inspectors paid 183 visits of inspection. Intimation notices were served in 19 instances. REGISTRATION OF FOOD PREMISES The Public Health (London) Act, 1936, section 187, 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 foodstuffs. The number of premises on the register at the end of 1937 under this section was: — (i) Ice cream, etc. 185 (ii) Other food 92 The number of inspections of premises at which food is prepared or sold, made by each inspector during the year, is shown in table 104 on page 123. The following foodstuffs were surrendered and destroyed during the year:— 2 tinned hams, 39 cases strip vermicelli, 15 bags macaroni, 1 crate haddock, 152 cases carrots, 1 case tomatoes, 1 case (2 qrs.) apples, 41 tins pineapple chunks, 8 bars chocolate. 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. PHARMACY AND POISONS ACT, 1933 The number of persons whose names are entered in the list as being entitled to sell those poisons included in Part II of the Poisons List is 39. 138 MILK (SPECIAL DESIGNATIONS) ORDER, 1936 During the year 56 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. 40 Dealers' Licences and 5 supplementary licences were issued in respect of the sale of pasteurised milk and 9 Dealers' and 2 supplementary licences in respect of tuberculin-tested milk. An application was received for a licence to pasteurise milk but on investigation it was found that the pasteurising plant was not satisfactory, and the licence was not issued. Sixty-five samples of milk were taken during 1937, compared with 60 in 1936. Of the 65 samples, 4 did not comply with the standard laid down by the order. The result of the examination of these is given in the following table:— Table No. 116 No. of sample. Designation of milk. No. of bacteria per c.cm. Presence of coliform bacillus. Remarks. 30 Pasteurised 206,900 Absent in 1/10c.c. Unsatisfactory. 31 „ 370,000 „ „ 40 „ 282,600 Present in 1/10c.c. „ 41 „ 416,000 „ „ Of the 4 samples which did not comply with the order, 2 were taken from a dairyman in the Borough, and 2 from wholesalers outside Shoreditch who were delivering milk in this district. A warning was issued to the offending Shoreditch dairyman, and in the other cases details were furnished to the district concerned. Of the remaining 61 samples, four were of tuberculin-tested milk and the remainder were of pasteurised milk. All the samples of tuberculin tested milk complied with the methylene blue test and the b. coli test as laid down in the Order. Of the 57 samples of pasteurised milk which complied with the prescribed standards 6 showed b. coli in 1/10 c.c. The total counts of these 6 samples are shown in the following table:— Table No. 117 Below 1,000. Below 10,000. Below 20,000. Below 50,000. Below 100,000. — — — 1 5 139 In the other samples submitted for count b. coli was absent in 1/10 c.c. The total counts of these 47 samples are shown in the following table:— Table No. 118 Below 1,000. Below 10,000. Below 20,000. Below 50,000. Below 100,000. — 19 11 11 6 The remaining four samples of pasteurised milk were submitted to the phosphatase test. Satisfactory results were obtained in all cases. UNDESIGNATED MILK During the year 31 samples of undesignated milk were submitted for bacteriological examination. Of these 31 samples, 3 were from individual cows in the borough, and b. coli was absent in 1/10 c.c. in all of these samples. The total counts in these 3 samples were all between 1,000 and 26,000. In the other 28 cases samples were taken in course of delivery. In these b. coli was present in 1/1,000 c.c. in eight samples, present in 1/100 c.c. in one sample, present in 1/10 c.c. in three samples and absent in 1/10 c.c. in the remaining sixteen samples. The total counts in these 28 samples are shown in the following table:— Table No. 119 Under 1,000. 1,0005,000. 5,00025,000. 25,000100,000. 100,000200,000. 200,000500,000. Over 500,000. 1 4 5 11 4 2 1 CONDENSED MILK REGULATIONS Twelve samples of condensed milk were submitted for analysis under the above Regulations, all of which were certified to comply with the standard laid down. 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 is one cowshed in Shoreditch. Three samples of milk from this and twentyfour samples of milk in course of delivery were submitted for guinea pig test, but in no instance was the presence of tubercle bacilli reported. 140 EXAMINATION OF MILK SUPPLIED TO L.C.C. HOSPITALS During 1937 thirty-three samples of milk were taken in course of delivery to St. Leonard's Hospital and 17 to St Matthew's Hospital. All except one of the samples complied with the standard laid down by the Ministry of Agriculture. The remaining sample contained not less than 1.0 per cent. of added water. MILK SAMPLES TESTED IN THE DEPARTMENT During 1937, 179 samples of milk were tested in the department by the Gerber process with the following results:— Table No. 120 Genuine. Deficient in fat only. Deficient in solids other than fat. Deficient in fat and non-fatty solids. 169 1 7 2 The average composition of these samples was:— Fat, 3.3% Solids not fat, 8.9% Total solids, 12.2% THE FOOD AND DRUGS (ADULTERATION) ACT, 1928 During the year 700 samples were submitted to the Public Analyst, Mr. H. A. Williams, A.C.G.F.C., F.I.C. This figure gives a rate of 8-5 per 1,000 inhabitants. The results of the year's work are summarized in the following table:— Table No. 121 Quarter of 1937. Number of samples taken. Number of samples adulterated. Percentage adulterated. Number of prosecutions instituted. Prosecutions withdrawn because of warranties, etc. Prosecutions proceeded with Number of successful prosecutions. Fines and costs. £ s. d. 1st 160 24 15.00 4 — 4 4 11 9 0 2nd 194 11 5.67 1 — 1 1 3 3 0 3rd 140 25 17.86 2 — 2 2 8 8 0 4th 206 17 8.25 4 — 4 4 9 17 0 Totals for year 700 77 11.00 11 — 11 11 32 17 0 The samples taken during 1937 included:— 358 milk (5 informal); 5 cream; 13 beer; 13 butter (4 informal); 4 vinegar; 10 bread and butter (8 informal); 4 liquorice powder (2 informal); 3 margarine (1 informal); 4 whisky; 1 cod liver oil; 6 gin. 141 Informal samples were also taken as follows:— 8 aspirin tablets; 6 black pudding; 4 castor oil (B.P.); 8 cocoa; 4 coffee; 8 tinned cream; 12 condensed milk; 4 liquid paraffin (B.P.); 9 sauce; 9 tinned fish; 4 zinc ointment (B.P.); 4 brawn; 4 tinned fruit; 8 ice cream; 4 marmalade; 6 meat pie; 12 chopped meat; 4 mineral water; 8 olive oil; 4 split peas; 4 tinned peas; 4 rice; 4 tinned soup; 10 breakfast sausage; 4 tea dust; 9 dripping; 4 boiled ham; 4 table jelly; 4 lard; 8 lemonade powder; 1 tinned meat; 3 meat paste; 3 minced meat; 4 sulphur ointment (B.P.); 8 sweets; 4 ground almonds; 4 bread; 6 cake; 5 candied peel; 4 coffee and chicory extract; 4 cordial (non-alcoholic); 5 Epsom salts (B.P.); 14 dried fruit; 4 jam; 2 compound liquorice powder; 4 mustard; 4 pepper; 3 saveloys; 4 chopped suet; 4 foot sugar; 4 wine (non alcoholic). The subjoined table gives a comparison of the results of the work under the Sale of Food and Drugs Acts for the years 1932-1937 inclusive:— Table No. 122 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. Prosecution proceeded with. Number of successful prosecutions. Fines and costs. £ s. d. 1932 971 98 44 4.5 18 - 18 18 40 15 0 1933 677 138 21 3.1 6 1 5 4 12 1 6 1934 660 137 22 3.3 8 1 7 1 19 4 6 1935 640 138 34 5.3 7 - 7 5 14 0 6 1936 614 139 39 6.3 3 1 2 2 10 10 0 1937 700 117 77 11.0 11 - 11 11 32 17 0 Two samples of bread and butter were certified to consist of bread and margarine. Legal proceedings were instituted and the defendants were ordered to pay £1 1s. 0d. and £2 2s. 0d. costs respectively. A sample of wood vinegar was found to be deficient in acetic acid and to be infested with vinegar eels. The remainder of the stock was surrendered and destroyed and a suitable warning was given to the vendor. A sample of gin was found to contain 20 per cent, of excessive water. Legal proceedings were instituted and the defendant was fined £2 0s. 0d. and ordered to pay £3 3s. 0d. costs. The majority of the samples taken were of milk, which was represented by 358 samples during the year. Of these 64 or 17.88 per cent, were found to be belowthe standard fixed by the Ministry of Agriculture. The following table shows the result of analysis:— 142 Table No. 123 Quarter of the year. Number of samples. Number not genuine. Percentage adulterated. First 114 24 21.05 Second 92 11 11.96 Third 83 22 26.51 Fourth 69 7 10.14 54 of these samples were certified to contain added water, the highest amount being 42 per cent., but the majority being less than 2 per cent. Six of the samples showed deficiency in fat ranging from less than 1 per cent, to 13 per cent., whilst the remaining 3 samples were deficient both in milk fat and non fatty solids. Legal proceedings were instituted in 8, or 12.5 per cent., of the cases in which samples of milk were below standard. No legal proceedings were considered advisable in the remainder of the milk samples which were below standard. The percentage of adulterated samples of milk in which it was not thought advisable to institute legal proceedings was 87-5. PRESERVATIVES IN FOOD REGULATIONS All articles taken were in accordance with the regulations. SHOPS ACT, 1934 This Act, which came into operation on the 31st December, 1934, requires the Sanitary Authority to enforce various sanitary and hygienic provisions. The Council have appointed each of its sanitary inspectors to enforce the provisions of the Act. SWIMMING BATHS AND POOLS There are two publicly owned swimming baths in the borough namely, Hoxton Baths, Pitfield Street, which consists of a first-class swimming bath and a secondclass swimming bath, both used for mixed bathing, and the Haggerston Bath, Mansfield Street, which is also used for mixed bathing. There are no privately owned swimming baths or pools in the district which are open to the public. The water in the baths is cleansed by a system of continuous filtration, sedimentation, chlorination and subsequent aeration and it is subjected to chemical and bacteriological tests from time to time. The last analyses taken in October and November, 1937, showed the water to be, in the opinion of the public analyst, reasonably satisfactory for swimming baths. LEGAL PROCEEDINGS Legal proceedings taken during the year are shown in Appendix D on page 157. 143 X.—HOUSING OVERCROWDING The special conditions which are found in Shoreditch made it impossible for the Minister of Health to fix the "appointed day" during the year. Overcrowding in this borough was therefore not an offence under the Housing Act, 1936. It has now however been agreed to fix 1st April, 1938, as the appointed day for section 62 of the Housing Act, 1936, and 1st October, 1938, as the appointed day for sections 6 (2), 59, 60 and 64 of the Act in respect of overcrowding provisions. The overcrowding survey which was carried out during 1935 brought to light the fact that 72 families living in properties owned by the Borough Council were overcrowded. At the end of 1937 twenty-nine families were still overcrowded. Of the 8 families dealt with 4 were rehoused by the London County Council and 4 by the Borough Council. Action taken in respect of overcrowding. During the year 1937, 269 cases of overcrowding were abated as a result of enquiry and action by the sanitary staff, and in some cases as a result of reports to the Housing Committee. The London County Council accommodated 78 of these families and in the other 191 instances the accommodation was obtained from other sources. In addition to these cases 89 families were re-housed by the London County Council in connection with their slum clearance programme and 10 cases dealt with as a result of representations made to the London County Council regarding the health of certain members of the family. Whilst a certain amount of relief of overcrowding is being steadily effected by official housing activities, it is apparent that many more families are being accommodated as a result of their own efforts. There are of course other factors which have a bearing on the subject. Any information which is available is therefore incomplete, and does not form a proper basis for an accurate estimate of the number of houses which are overcrowded or of families which are still living under overcrowded conditions. At the time of writing this report a detailed survey of the borough is in progress and full particulars will be available for the next report. CLEARANCE AREAS During the year the London County Council declared the following to be clearance areas under section 25 of the Housing Act, 1936 Foundry Place area. Lyndoch Street area. Wilks Place (Nos. 1 and 2) areas. Britannia Gardens (Nos. 1, 2 and 2a) areas. Long Street (Nos. 1, 1a and 2) areas. 144 The Council at its meeting on 17th January, 1937, decided to purchase compulsorily the following blocks of property under powers given them by section 74 of the Housing Act, 1936:— (1) Property bounded by Loanda Street, Dunston Street, Stean Street and Lee Street; and (2) property bounded by Loanda Street, Dunston Road, Stean Street and Dunston Street. The properties, of which there are 102, have a total area of approximately 2f acres and comprise 91 dwellings, 2 shops, 2 dairies, 1 cafe, 2 licensed premises, and 4 workshops. It was later decided to omit the two licensed premises from the order. On the 21st December, 1937, the Council approved plans for this site. The plans will provide two blocks of flats (one on each side of Duston Street), a garden for the use of residents of the estate, a children's playground, and a site which will be reserved for a hall for social purposes. . The following areas in which clearance orders were made in 1936 were demolished during the year:— Dunston Street, Bateman's Place, Reliance Square, Dereham Place, Socrates Place, Holywell Place. 74 families who were resident in the Bateman's Place, Dereham Place, French Place, Holywell Place, Reliance Square and Socrates Place clearance areas were dealt with as follows:— 33 rehoused by the borough council. 20 „ „ London County Council. 3 „ „ Stepney Housing Association. 18 secured own accommodation. The Housing Committee in October, 1937, adjourned sine die the consideration of the representations made in 1936 in respect of the undermentioned areas !— Lees Buildings (13 houses). Renous Court (9 houses). Bartlett Buildings (10 houses). Market Street (27 houses). Brunswick Street (5 houses). Bevenden Street (11 houses). Teale Street area. Plans for the erection of a block of ten four-roomed flats on land at the rear of Teale Street Dwellings were approved by the Borough Council on 16th February, 1937. This land was required for housing purposes at the time of the erection of the dwellings. The flats, to be named 21-30, Halley House, will have accommodation for a maximum of 75 persons, and are reserved for the accommodation of persons resident in the Loanda Street Compulsory Purchase area. 145 INDIVIDUAL UNFIT HOUSES. S. II, HOUSING ACT, 1936 In 1937, one house, 7, Dereham Place, was represented as not fit for human habitation and not capable at reasonable expense of being rendered fit. The owner gave an undertaking that the premises would not be used for residential purposes, which was accepted by the Council in February. The house was subsequently vacated in June and later in the year demolished. Two houses, Nos. 47 and 55, Appleby Street, represented in 1936 as being not fit for human habitation under section 19 of the Housing Act, 1930, were demolished during the year. UNDERGROUND ROOMS During the year 207 basement rooms were visited and of these 184 were reported to the Housing Committee as being underground rooms within the meaning of the Act. Undertakings were given in respect of 124 of these rooms by the Owner or Agent and of these 72 were in force at the end of the year. Closing orders were made by the Council in respect of 9 rooms, and of these 6 were closed by the end of the year, the remainder being closed early in 1938. In 13 of the underground rooms, the owners carried out the necessary work required and the rooms were made to comply with the regulations. Five underground rooms belonging to the Borough Council were closed during the year. Table No. 124 shows the position during the year in respect to underground rooms. Table No. 124 Rooms reported to Council during 1936 and still outstanding 1937 20 „ „ „ „ 1937 184 204 „ in respect of which undertakings were received 124 „ on which Closing Orders were made 9 „ made to comply with regulations 13 „ belonging to Borough Council which were closed 5 151 Number of rooms still outstanding end 1937 53 204 The total number of underground rooms reported to the Council during 1937 but still not complying with the Regulations at the end of the year was 177. ERADICATION OF BED BUGS The method employed in 1936 to prevent the bug infestation of the Council's flats was continued throughout 1937. All families who are allocated flats have to subject their belongings to fumigation. At about 8 a.m. on the day of removal a specially 146 constructed van takes the furniture and effects, other than bedding and soft goods, to the yard adjoining the Council's disinfecting station. The furniture is disinfested by the hydrogen cyanide method by a firm of private contractors under the supervision of one of the sanitary inspectors who has specialized in this type of work. The bedding and soft goods are disinfested by steam at the disinfecting station. The removal and disinfestation is thus completed on the same day. The number of families moving to or transferring in the Council's flats during the year was 99. During the year the Council also supervised the work of disinfestation by the cyanide method of 15 Shoreditch families who were moved to a block of flats erected in the Borough by the Shoreditch Housing Association. It is the practice for the rooms vacated by persons moving into this Council's flats to be dealt with by sanitary notice when necessary. All other cases of bug infestation are dealt with by sanitary notice. In many instances the bedding, etc., is subjected to steam and the tenants offered the use of a pneumatic hand spray containing D solution. SPECIAL REPAIR WORK Housing Act, 1936. Section 9. The following is a report of the work done under Section 9, Housing Act, 1936, from the 1st January, 1937, to 31st December, 1937:—- Number of premises inspected 84 Number of premises where Intimation Notices have been served 56 Number of premises where Statutory Notices were served 1 Number of premises where work required by notices has been satisfactorily completed 55 Number of premises where progress is not satisfactory 1 The total estimated cost of works required amounts to £2,506 l2s. 0d. The total estimated cost of works completed amounts to £2,486 17s. 0d. 1,170 visits of re-inspection were made to the premises in connection with this work. The premises inspected were confined to districts which are of the better type of working class dwellings, occupied generally by a good type of tenant. Only one inspector was employed on this special work. Dangerous Structure Notices. The number of these notices served during the last seven years was as follows:— 1931—190; 1932—211; 1933—225; 1934—210; 1935—106; 1936—110; 1937—127. REBUILDING During the year the following new blocks of flats were commenced (but not completed), viz.:— L.C.C. Estate, Nile Street 133 flats. Shoreditch Borough Council, Halley House 10 „ 147 The following table gives particulars of the work done under the Housing Acts in the form required by the Ministry of Health:— Table No. 125 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) 7,954 (b) Number of inspections made for the purpose 29,399 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which Were inspected and recorded under the Housing Consolidated Regulations, 1925 425 (b) Number of inspections made for the purpose 699 (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 179 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 4,474 3. Action under Statutory Powers during the Year:- A.—Proceedings under sections 9, 10 and 16 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 57 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 57 (b) By local authority in default of owners Nil B.—Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 874 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 874 (b) By local authority in default of owners Nil 148 C.—Proceedings under sections II and 13 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which Demolition Orders were made or Undertaking accepted 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 D.— Proceedings under section 12 of the Housing Act, 1936— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 9 (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 4. Housing Act, 1936 Part IV.—Overcrowding (a) (i) Number of dwellings overcrowded at the end of the year See page 143 of this Section. (ii) Number of families dwelling therein (iii) Number of persons dwelling therein (b) Number of new cases of overcrowding reported during the year (c) (i) Number of cases of overcrowding relieved during the year (ii) Number of persons concerned in such cases (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report RENT AND MORTGAGE INTEREST (RESTRICTIONS) AMENDMENT ACT, 1933 The number of certificates issued under section 12 of the above Act was 3. A certificate under section 5 (2) was also issued during the year. 149 XI.—HEALTH PROPAGANDA Health Week, which was held from the 11th to 15th October, 1937, did not include an exhibition, but took the form of a series of lectures—illustrated by films— and demonstrations which were given in the afternoons and evenings on health subjects. In the mornings parties of school children attended to hear talks given on matters relating to health; films were also shown at these talks. The programme of lectures was as follows:— Date. Lecturer and Title of Lecture. Chairman. Monday, 11th October, 1937. 7.30 p.m. Opening of Week's proceedings, followed by Health Films. 8.0 p.m. Swimming Gala for School Children at Hoxton Baths, Pitfield Street. (Admission by Special Programme only.) Tuesday, 12th October, 1937. 3.0 p.m. Film Display. Alderman Miss E. Kellett. 7.30 p.m. Dr. E. Ashworth Underwood, Medical Officer of Health. "Health and Self Help." Film: "London Contrast." 8.30 p.m. Dr. J. E. McCartney, Director of Research and Pathological Services, L.C.C. ''Diphtheria and its Prevention." Film: "The Empty Bed." Mr. Councillor A. E. Hills. Wednesday, 13th October, 1937. 3.0 p.m. Lecture Demonstration by the Women's League of Health and Beauty. Councillor Mrs. H. Alsford. 7.30 p.m. Mr. C. S. Abraham, M.C., L.D.S. "The Winning Smile." Film: "A Brush with the Enemy." Mr. Councillor M. Alsford. 8.30 p.m. Dr. C. K. Cullen, Tuberculosis Officer. "The Fight against Tuberculosis." Film: "Stand up and breathe." Councillor Mrs. M. Higgins. Thursday, 14th October, 1937. 3.0 p.m. Film Display. Mr. Councillor George Jeger, J.P. 7.30 p.m. Dr. John McMillan, D.S.O., M.C. "Pests of the Night." Film: "The Terror that walks by night." 8.30 p.m. Demonstration by team from Central Council of Recreative Physical Training. Mr. Councillor T. J. Sillitoe, J.P. Friday, 15th October, 1937. 3.0 p.m. Lecture Demonstration by the Women's League of Health and Beauty. Alderman Mrs. C. R. LusherPentney. 7.30 p.m. Professor S. J. Cowell, F.R.C.P. "Your Daily Diet." Film: "Food and Growth." Mr. Councillor H. S. Ceeney. 8.30 p.m. Dr. James Fenton, President of the Society of Medical Officers of Health. "Health and happiness." Councillor Dr. S. W. Jeger, L.C.C. 150 Two lecture demonstrations by the Women's League of Health and Beauty and a demonstration by a team from the Central Council of Recreative Physical Training were given during the week and were much appreciated. Monday evening was devoted to a swimming gala held at the Pitfield Street Baths. This was primarily intended for school children. The programme included team races by Shoreditch boys and girls; a display of fancy diving by "The Lucratics"; a display of scientific swimming by two members of the Hammersmith Ladies' Swimming Club and a demonstration by another member of the Club; and a water polo match between the "Penguins IV" and "Anlaby." Music was again provided by the Hoxton Excelsior Silver Band. The attendances during Health Week are shown in table No. 126. Table No. 126. Attendances. Morning (School children). Afternoon. Evening. Monday - - 513 Tuesday 108 200 504 Wednesday 66 220 517 Thursday 125 260 404 Friday 60 200 375 Totals 359 880 2,313 Swimming gala (Monday) 1,200. Total attendances 4,752. I am, Sir, Ladies and Gentlemen, Your obedient Servant, E. H. R. SMITHARD, Medical Officer of Health. Public Health Offices, Laburnum Street, 26th June, 1938. 151 APPENDIX A Adoptive Acts, Bye-laws, etc., in foRCE in the District. 1. Shoreditch (Measles) Regulations, 1935. 2. Bye-laws made by the Borough Council:— (a) For the prevention of any nuisances arising from any snow, ice, salt, dust, ashes, rubbish, offal, carrion, fish or filth or other matter or thing in any street. (b) For preventing nuisances arising from any offensive matter running out of any manufactory, brewery, slaughterhouse, knackers' yard, butcher's shop or fishmonger's shop or dunghill into any uncovered place, whether or not surrounded by a fence or wall. (c) For the prevention of the keeping of animals on any premises in such place or manner as to be a nuisance or injurious or dangerous to health. (d) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (e) As to the paving of yards and open spaces in connection with a dwelling- house. (f) Public Mortuary. 3. Regulations concerning underground rooms. 4. Other Bye-laws, Orders, etc., enforced by the Borough Council:— (a) Drainage and deposit of drainage plans. (b)Closing and filling up of cesspools and privies. (c) Removal and disposal of house and other refuse. (d) Removal of faecal or offensive matter by road or water. (e) Waterclosets, urinals, earthclosets, privies and cesspools. (/) Ashpits and receptacles for dung. (g) Conveyance of carcasses of dead horses through streets. (h) Houses divided into separate tenements, etc. 152 (i) Registration, licensing, inspection and regulation of common lodging houses. (j) Licensing of dairymen to use premises as cowhouses. (k) Licensing and inspection of slaughterhouses and knackers' premises. (/) Offensive businesses. (m) Rag and bone dealers. (n) Slaughtering of animals. (o) Slaughtering of poultry. (p) Part 1 of the Children Act, 1908, as amended by part V of the Children and Young Persons Act, 1932. (q) Smoke abatement. (r) Fish curers and vendors of fried fish. (s) Protection of food. 153 APPENDIX B Acts of Parliament, Local Government Orders, Memoranda, and Circular Letters issued by Government Departments with regard to the Public Health and Maternity and Child Welfare Services during the year 1937. Statutes. Air-raid Precautions Act, 1937. Factories Act, 1937. Hydrogen Cyanide (Fumigation) Act, 1937. Physical Training and Recreation Act, 1937. Ministry of Health. Circulars. No. 1519. Expectant mothers. Supply of milk. No. 1522. Public Health (Imported Food) Regulations, 1937. No. 1591. Overcrowding—duties of local authorities. No. 1596. Notification and treatment of ophthalmia neonatorum. No. 1597. Public Health Act, 1936. No. 1598. (i) Annual Reports of Medical Officers of Health. (ii) Special Reports of Medical Officers of Health to Minister of Health. No. 1599. Public Health (Imported Food) Regulations, 1925—Public Health (Imported Food) (Amendment) Regulations, 1933. No. 1600. Public Health Act, 1936—Moveable dwellings. No. 1605. Local Government Act, 1929—Welfare of blind persons—Contributions Scheme. No. 1609. Departmental Committee on the cost of hospitals. No. 1611. Housing Acts, 1935 and 1936—Housing (Rural Workers) Acts, and Small Dwellings Acquisition Acts. Interests on loans, etc. No. 1614. Treatment of tuberculosis. No. 1620. Supervision of midwives. No. 1621. Prevention of blindness. No. 1622. Maternal mortality. No. 1639. Public Health (Imported Food) Regulations, 1937. No. 1640. Building bylaws. No. 1641. Therapeutic Substances Act, 1925. No. 1643. Local Health Services—Information at post offices. No. 1643a. ditto No. 1643b. ditto No. 1646. Midwives Act, 1936. No. 1647. Casual Poor. 154 No. 1648. Physical Training and Recreation Act, 1937. No. 1651. Meat Inspection. No. 1652. Housing Acts, 1935 and 1936. No. 1662. Administration of outdoor relief. No. 1665. Acquisition of land. Assistance of district valuers. No. 1666. Public Health (Imported Food) Regulations, 1937. Memoranda. Local Government Acts, 1929 and 1937. Meat inspection (Supplementary memorandum) (September, 1937). Statutory Rules and Orders. No. 35. Public Health (Ophthalmia Neonatorum) Amendment Regulations, 1937. No. 78. Housing Act (Forms of Orders and Notices) Regulations, 1937. No. 79. Housing Act (Extinguishment of Public Right of Way) Regulations. 1937. No. 80. Housing Act (Overcrowding and Miscellaneous Forms) Regulations, 1937. No. 329. Public Health (Imported Food) Regulations, 1937. No. 398. Midwives (Qualifications of Supervisors) Regulations, 1937. No. 784. Midwives (Certifying Hospitals and Institutions) Order, 1937. No. 885. Certificates of Births, Deaths and Marriages (Requisition) Regulations, 1937. Home Office. Circulars. Air-raid wardens. (23-2-37.) Air-raid precautions. Badges for volunteers. (23-2-37.) Air-raid precautions. (27-2-37.) Air-raid precautions—Contacts. (31-5-37.) Anti-gas training. (10-7-37.) Emergency Fire Brigade Organisation Scheme. (15-12-37.) Orders in Council. Statutory Rules and Orders. No. 327. Dangerous drugs. Order in Council excluding certain preparations containing morphine, cocaine, etc., from Part III of the Dangerous Drugs Act, 1920. Joint Committee. Statutory Rules and Orders. No. 767. Therapeutic Substances (Amendment) Regulations, 1937. 155 APPENDIX C LIST OF CLINICS Day. Clinic. Where held. Time. Officer in charge. Mon Ante Natal 210, Kingsland Road 10.0 —12.0 Dr. Hall. Child Welfare Do. 2.0 — 4.0 Dr. Richards. Do. Hoxton Market Institute 2.0 — 4.0 Dr. Hudson. Artificial Sun Light 210, Kingsland Road 2.0 — 4.0 Dr. McGregor. Breast Feeding Do. 12.0 — 5.0 Do. Foot Hoxton Library, Pitfield St. 2.30— 6.30 Mrs. Maber. Gynaecological 210 Kingsland Road 2.0 — 4.0 Dr. Hill. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 Dr. Cullen. Do. Do. 6.30— 8.0 Do. * Dental Hospital 8-14, Laburnum Street 10.0 —12.30 Mr. Abraham. 2.0 — 4.30 Do. 6.0 — 8.0 Mr. Abraham and Mr. Jessop. Tues. Child Welfare 210, Kingsland Road 10.0 —12.0 Dr. McGregor. 2.0 — 4.0 Drs. Goffe and Rose. Do St. Helen's Club 2.0 — 4.0 Dr. Phillips. Ante Natal 28, Herbert Street 10.0 —12.0 Dr. Hill. Child Welfare Do. 2.0 — 4.0 Dr. Harvey Do. Hoxton Hall 10.0 —12.0 Dr. Hudson. 2.0 — 4.0 Do. Artificial Sun Light 210 Kingsland Road 10.0 —12.0 Dr. McGregor. Gynaecological ... Do. 6.30— 8.30 Dr. Hill. General Medical for Women Do. 6.30— 8.30 Dr. Aitken. Foot Hoxton Library, Pitfield St. 2.30— 4.30 Mrs. Maber. 6 0 — 8.0 Do. Diphtheria Immunization 210, Kingsland Road 2.30— 4.0 Dr. McGregor. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 Dr. Cullen. 4.30— 6.0 Do. f Dental Hospital... 8-14, Laburnum Street 2.0 — 4.30 i Mr. Abraham. 6.0 — 8.0 Mr. Abraham and Mr. Jessop. Wed Post Natal (2nd and 4th Wednesdays only) 210, Kingsland Road 10.0 —12.0 Dr. Hall. Toddlers Do. 2.0 — 4.0 Dr. Richards. Child Welfare Do. 2.0 — 4.0 Dr. McGregor. Do Hoxton Market Institute 2.0 — 4.0 Dr. Goffe. Artificial Sun Light 210, Kingsland Road 2.0 — 4.0 Dr. McGregor. Breast Feeding Do. 9.0 — 5.0 Do. Foot Hoxton Library, Pitfield St. 2.30— 4.30 Mrs. Maber. 6.0 — 8.0 Do. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 Dr. Cullen. Dental Hospital 8-14, Laburnum Street 10.0 —12.30 Mr. Abraham and Mr. Jessop. Mr. Abraham. 2.0 — 4.30 * For patients and contacts at work during the day. † For School children only. ‡ Gas sessions. 156 Day. Clinic. Where held. Time. Officer in charge. Thurs. Ante Natal 210, Kingsland Road 10.0 —12.0 Dr. Hall. Child Welfare Do. 2.0 — 4.0 Two Doctors. Do. Haggerston Hall 2.0 — 4.0 Dr. Rose. Do. 28, Herbert Street 2.0 — 4.0 Dr. Livingstone. Artificial Sun Light 210, Kingsland Road 10.0 —12.0 Dr. McGregor. 2.0 — 4.0 Do. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 Dr. Cullen. Dental Hospital 8-14, Laburnum Street 10.0 —12.30‡ Mr. Abraham. 2.0 — 4.30 and Mr. Jessop. Mr. Abraham. Fri Ante Natal 210, Kingsland Road 10.0 —12.0 Dr. Smith. Child Welfare Do. 2.0 — 4.0 Do. Do. Harbour Lights 2.0 — 4.0 Dr. Goffe. Do. St. Helen's Club 2.0 — 4.0 Dr. Phillips. Artificial Sun Light 210, Kingsland Road 2.0 — 4.0 Dr. McGregor. Breast Feeding Do. 9.0 — 5.0 Do. General Medical for Women 210, Kingsland Road 10.0 —12.0 Dr. Aitken. Foot Hoxton Library, Pitfield St. 10.0 —12.0 Mrs. Maber. Tuberculosis Dispensary 145, Gt. Cambridge Street 2.0 — 3.30 Dr. Cullen. Dental Hospital 8-14, Laburnum Street 2.0 — 4.30 Mr. Abraham 6.0 — 8.0} and Mr. Jessop. Mr. Abraham. ‡ Gas sessions. 157 APPENDIX D LEGAL PROCEEDINGS IN 1937 The following is a full list of legal proceedings instituted during the year under report:— Public Health (London) Act, 1936, and Bye-Laws Date. Nature of Offence. Fine. Costs. Remarks. £ s.d. £ s. d. Jan. 5 Fixing lavatory basins with traps at No. 41, Brunswick Place, without previous notice in writing to the Sanitary Authority. 1 0 0 1 0 0 - Jan. 19 Non-compliance with Nuisance Notice in respect of No. 11, Bristow Street. - 2 2 0 Order made for notice to be complied with in 14 days. Mar. 23 Non-compliance with Nuisance Notice in respect of No. 49, Westmoreland Place. 5 0 0 2 0 0 - Mar. 23 Non-compliance with Nuisance Notice in respect of No. 84, Westmoreland Place. 5 0 0 - - Mar. 31 Non-compliance with Nuisance Notice in respect of No. 68, Nicholas Street. - 2 2 0 Notice complied with. Mar. 31 Non-compliance with Nuisance Notice in respect of No. 33, Mintern Street. - 2 2 0 Notice complied with. Mar. 31 Non-compliance with Nuisance Notice in respect of the provision of a dustbin at No. 33 Mintern Street. - 1 3 0 Notice complied with. July 6 Non-compliance with Nuisance Notice re overcrowding of the ground floor front and back rooms at No. 10, Poole Street. - - Order made for nuisance to be abated in 21 days. Sept. 28 Non-compliance with Nuisance Notice in respect of No. 1, Fairbank Street. - 2 2 0 Order made for notice to be complied with in 14 days. Sept. 28 Non-compliance with Nuisance Notice in respect of No. 5, Fairbank Street. - 1 1 0 Order made for notice to be complied with in 14 days. Sept. 28 Non-compliance with Nuisance Order re overcrowding of ground floor front and back rooms at No. 10, Poole Street. 1 0 0 - - Nov. 30 Non-compliance with Nuisance Notice in respect of No. 27, Mintern Street. - 3 3 0 Notice complied with. 158 Date. Nature of Offence: Fine. Costs. Remarks. £ s. d. £ s. d. Dec. 7 Non-compliance with Nuisance Notice in respect of No. 12, Herbert Street. - 2 2 0 Notice complied with. Dec. 7 Non-compliance with Nuisance Notice in respect of No. 39, Penn Street. - 2 2 0 Notice complied with. Dec. 14 Non-compliance with Nuisance Notice in respect of No. 7, Harvey Street. - 2 2 0 Notice complied with. Dec. 21 Non-compliance with Nuisance Notice in respect of No. 77, Herbert Street. - 2 2 0 Notice complied with. Dec. 21 Non-compliance with Nuisance in respect of No. 61, Rushton Street. - 2 2 0 Notice complied with. Dec. 21 adj. Jan. 18 Non-compliance with Nuisance Notice in respect of No. 65, Rushton Street. - 3 3 0 - London County Council (General Powers) Act, 1908. £ s. d. £ s. d. July 6 Distributing toys in exchange for rags. - 2 0 - 159 Public Health (London) Act, 1936 s. 180. Food and Drugs (Adulteration) Act, 1928. Milk and Dairies (Amendment) Act, 1922. Date. Nature of Offence. Fine. Costs. Remarks. £ s. d. £ s. d. Feb. 9 Selling milk not of the nature, substance and quality demanded by the purchaser. - 2 0 0 - Feb. 10 Selling whiskey not of the nature, substance and quality demanded by the purchaser. - 3 3 0 - Feb. 10 Exposing for sale at 21, Broadway, a turkey which was unfit for food. 5 0 0 2 2 0 — Feb. 10 Depositing for the purpose of sale at 21, Broadway, a goose which was unfit for food. 5 0 0 2 2 0 - Feb. 23 Selling milk not of the nature, substance and quality demanded by the purchaser. - 3 3 0 - Feb. 23 Selling milk not of the nature, substance and quality demanded by the purchaser. - 3 3 0 - Mar. 16 Selling milk to which the addition of water had been made. - 3 3 0 - May 11 Selling milk not of the nature, sub- stance and quality demanded by the purchaser. - 3 3 0 - Sept. 28 Delivering milk not of the nature, substance and quality demanded by the purchaser. - 4 4 0 - Sept. 28 Delivering milk not of the nature, subtance and quality demanded by the purchser. - 4 4 0 - Rag Flock Regulations, 1912. Date. Nature of Offence. Fine. Costs. Remarks. Oct. 26 Being in possession of rag flock at 148, Curtain Road, intended to be used for the purpose of making articles of upholstery which did not conform to the prescribed standard of cleanliness. (Two summonses.) £ s. d . £ s. d. 3 3 0 (in each case.) The defendants having purchased the flock under a warranty, the warrantors were brought before the Court and ordered to pay the Council costs in each case. INDEX SUBJECT. PAGE Acts, Regulations and Orders151 Aged and infirm persons 135 Ambulance facilities 23 Ante-natal supervision 89 Anthrax 54 Area of Borough 14 Artificial sunlight clinic 97 Ashpits 127 Bacteriological examinations 61 Bakehouses 137 Bed bugs 145 Births registered 24 Births in sub-districts 25 Birth rates 27 Breast feeding 93 Brunswick day nursery 101 Byelaws 151 Cancer 36 Cerebro-spinal fever 53 Child life protection 104 Child welfare 86 Cleansing 128 Clearance areas 143 Clinics, list of 155 Committees— Public Health 4 Maternity and Child Welfare 4 Tuberculosis Care 84 Common lodging houses 127 Condensed milk regulations 139 Consultants, panel of obstetrical 91 Convalescence 103 Cookshops and eating houses 136 Cowhouses 136 Dangerous structure notices 146 Deaths, causes of 40 Death rates 29 Density of Borough 24 Dental Hospital 109 Diarrhoea and enteritis 58 Dining centres 104 Diphtheria 48 Diphtheria immunization 50 Disinfection 62 SUBJECT. PAGE Disinfestation 145 Drainage124 Dysentery 50 Emergency open-air nursery 102 Encephalitis lethargica 54 Enteritis 58 Erysipelas 52 Factories and workshops 129 Food and Drugs (Adulteration) Act 140 Food poisoning 61 Food premises 137 Foot clinic 120 Foster children 104 Fried fish shops136 Gynaecological clinic 114 Health propaganda 149 Health visiting statistics 95 Home helps 92 Homework 132 Hospitals 20 House refuse 23 Houses let in lodgings 127 Housing 143 Housing Act, 1936— Repair of defects 146 Individual unfit houses 145 Housing—particulars required by Ministry of Health 147 IceCream 136 Infantile mortality 33 Infant welfare centres 97 Infectious cases 42 Infectious diseases and schools 59 Influenza 57 Inquests 28 Laboratory facilities 61 Legal proceedings 157 index. SUBJECT. PAGE Map, shewing wards 11 Marriages 28 Maternal mortality 34 Maternity dressings 92 Maternity work 89 Measles 55 Meat 136 Medical clinic for women 114 Midwives 91 Milk allowances 105 Milk and Dairies Order, 1926 137 Milk (Special Designations) Order 138 Model welfare centre 99 Mortuary 39 Municipal dental hospital 109 Municipal midwives 91 Notifiable diseases 43 Nursing in the home 60 Offensive trades 128 Official publications 153 Ophthalmia neonatorum 53 Otorrhoea 99 Outworkers 132 Overcrowding 143 Pharmacy and Poisons Act 137 Pneumonia 54 Poliomyelitis 54 Population 24 Post-natal work 92 Prematurity 87 Pre-school medical inspection 106 Preservatives in food regulations 142 Prosecutions 157 Public cleansing 23 Public conveniences for women 127 Public Health (Prevention of Tuberculosis) Regulations 71 Puerperal fever and pyrexia 52 Queen's Hospital for Children 102 Rainfall 18 Rag and bone dealers 128 Rag flock 128 Rateable value 14 Rats 135 Rent Restrictions Acts 148 SUBJECT. PAGE Sanitary circumstances, 122 Scarlet fever 46 School entrants 106 Schools 135 School for mothers 100 Sewing classes 105 Shelter 62 Shops 142 Slaughterhouses 136 Smallpox 44 Smoke nuisances 135 Social conditions 18 Staff 5 Stillbirths 26 Street markets 136 Sun Babies Nursery 101 Swimming baths 142 Tuberculosis— Deaths and death rates 66, 69 Institutional accommodation 70 Notification 64 Out-patient treatment 71 Statistics 72 Tuberculosis Care Committee report 81 Tuberculosis dispensary 71 Tuberculosis Officer's report 77 Tuberculous milk 139 Undesignated milk 139 Underground rooms 145 Unemployment 18 Unsound food 137 Vaccination 44 Venereal diseases 62 Verminous houses 128 Verminous persons 128 Vital statistics 14 Voluntary workers 106 Ward map of borough 11 Water supply 126 Whooping cough 56 Workshops 129 Women, special clinics 114 ii i~5 0cti96;)M % #